BACKGROUND Bivalirudin,a direct thrombin inhibitor,is used in anticoagulation therapies as a substitute for heparin,especially during cardiovascular procedures such as percutaneous coronary intervention.AIM To explore...BACKGROUND Bivalirudin,a direct thrombin inhibitor,is used in anticoagulation therapies as a substitute for heparin,especially during cardiovascular procedures such as percutaneous coronary intervention.AIM To explore the effect of bivalirudin on myocardial microcirculation following an intervention and its influence on adverse cardiac events in elderly patients with acute coronary syndrome(ACS).METHODS In total,165 patients diagnosed with acute myocardial at our hospital between June 2020 and June 2022 were enrolled in this study.From June 2020 to June 2022,elderly patients with ACS with complete data were selected and treated with interventional therapy.The study cohort was randomly divided into a study group(n=80,administered bivalirudin)and a control group(n=85,administered unfractionated heparin).Over a 6-mo follow-up period,differences in emergency processing times,including coronary intervention,cardiac function indicators,occurrence of cardiovascular events,and recurrence rates,were analyzed.RESULTS Significant differences were observed between the study cohorts,with the observation group showing shorter emergency process times across all stages:Emergency classification;diagnostic testing;implementation of coronary intervention;and conclusion of emergency treatment(P<0.05).Furthermore,the left ventricular ejection fraction in the observation group was significantly higher(P<0.05),and the creatine kinase-MB and New York Heart Association scores were CONCLUSION In elderly patients receiving interventional therapy for ACS,bivalirudin administration led to increased activated clotting time achievement rates,enhanced myocardial reperfusion,and reduced incidence of bleeding complications and adverse cardiac events.展开更多
BACKGROUND Left ventricular(LV)remodeling and diastolic function in people with heart failure(HF)are correlated with iron status;however,the causality is uncertain.This Mendelian randomization(MR)study investigated th...BACKGROUND Left ventricular(LV)remodeling and diastolic function in people with heart failure(HF)are correlated with iron status;however,the causality is uncertain.This Mendelian randomization(MR)study investigated the bidirectional causal relationship between systemic iron parameters and LV structure and function in a preserved ejection fraction population.METHODS Transferrin saturation(TSAT),total iron binding capacity(TIBC),and serum iron and ferritin levels were extracted as instrumental variables for iron parameters from meta-analyses of public genome-wide association studies.Individuals without myocardial infarction history,HF,or LV ejection fraction(LVEF)<50%(n=16,923)in the UK Biobank Cardiovascular Magnetic Resonance Imaging Study constituted the outcome dataset.The dataset included LV end-diastolic volume,LV endsystolic volume,LV mass(LVM),and LVM-to-end-diastolic volume ratio(LVMVR).We used a two-sample bidirectional MR study with inverse variance weighting(IVW)as the primary analysis method and estimation methods using different algorithms to improve the robustness of the results.RESULTS In the IVW analysis,one standard deviation(SD)increased in TSAT significantly correlated with decreased LVMVR(β=-0.1365;95%confidence interval[CI]:-0.2092 to-0.0638;P=0.0002)after Bonferroni adjustment.Conversely,no significant relationships were observed between other iron and LV parameters.After Bonferroni correction,reverse MR analysis showed that one SD increase in LVEF significantly correlated with decreased TSAT(β=-0.0699;95%CI:-0.1087 to-0.0311;P=0.0004).No heterogeneity or pleiotropic effects evidence was observed in the analysis.CONCLUSIONS We demonstrated a causal relationship between TSAT and LV remodeling and function in a preserved ejection fraction population.展开更多
BACKGROUND Cardioneuroablation(CNA)has shown encouraging results in patients with vasovagal syncope(VVS).However,data on different subtypes was scarce.METHODS This observational study retrospectively enrolled 141 pati...BACKGROUND Cardioneuroablation(CNA)has shown encouraging results in patients with vasovagal syncope(VVS).However,data on different subtypes was scarce.METHODS This observational study retrospectively enrolled 141 patients[mean age:40±18 years,51 males(36.2%)]with the diagnosis of VVS.The characteristics among different types of VVS and the outcomes after CNA were analyzed.RESULTS After a mean follow-up of 4.3±1.5 years,41 patients(29.1%)experienced syncope/pre-syncope events after CNA.Syncope/pre-syncope recurrence significantly differed in each subtype(P=0.04).The cardioinhibitory type of VVS had the lowest recurrence rate after the procedure(n=6,16.7%),followed by mixed(n=26,30.6%)and vasodepressive(n=9,45.0%).Additionally,a significant difference was observed in the analyses of the Kaplan-Meier survival curve(P=0.02).Syncope/pre-syncope burden was significantly reduced after CNA in the vasodepressive type(P<0.01).Vasodepressive types with recurrent syncope/pre-syncope after CNA have a lower baseline deceleration capacity(DC)level than those without(7.4±1.0 ms vs.9.0±1.6 ms,P=0.01).Patients with DC<8.4 ms had an 8.1(HR=8.1,95%CI:2.2-30.0,P=0.02)times risk of syncope/pre-syncope recurrence after CNA compared to patients with DC≥8.4 ms,and this association still existed after adjusting for age and sex(HR=8.1,95%CI:2.2-30.1,P=0.02).CONCLUSIONS Different subtypes exhibit different event-free rates.The vasodepressive type exhibited the lowest event-free rate,but those patients with DC≥8.4 ms might benefit from CNA.展开更多
Traumatic mitral chordae rupture is a rare and known cause of acute mitral valve regurgitation and de novo heart failure.Concomitant pathologies in a trauma patient may mask the findings of de novo heart failure due t...Traumatic mitral chordae rupture is a rare and known cause of acute mitral valve regurgitation and de novo heart failure.Concomitant pathologies in a trauma patient may mask the findings of de novo heart failure due to mitral chordae rupture.Trauma patients may also have other potential pre-diagnoses that could explain symptoms related to heart failure,such as tachycardia,circulatory shock,and acute hypoxemia.The possibility of traumatic chordae tendinea rupture being a preventable cause of mortality should be carefully evaluated.展开更多
Objectives To observe the influence of weight loss induced by orlistat on several cardiovascular diseases risk factors in obese Chinese subjects. Methods Sixty obese Chinese patients participated in a 24 week clinical...Objectives To observe the influence of weight loss induced by orlistat on several cardiovascular diseases risk factors in obese Chinese subjects. Methods Sixty obese Chinese patients participated in a 24 week clinical trial. Participants were prescribed a slightly hypocaloric diet and exercise, then they were randomly assigned double -blind treatment with either orlistat 120 mg three times a day or placebo. Their body weight, blood pressure, fasting glucose, insulin, HbA1c, and serum lipid profile were performed before and after the weight loss intervention. Results After 24 weeks, orlistat -treated group lost more of their body weight than placebo group (6. 66 ± 0. 52 kg, 8. 44±4.08% and 1. 98 ± 0. 44 kg, 2. 44±1. 74 % , respectively, P < 0. 05) . Moreover, after treatment, orlistat - treated patients showed significant decreases in serum levels of total cholesterol, low density lipoprotein - cholesterol and high density lipoprotein - cholesterol ( P < 0.01), but in placebo group we found no change. Both systolic blood pressure and diastolic blood pressure fell significantly in orlistat - treated group. Fasting glucose and HOMA - IR in orlistat - treated group was distinctly reduced if compared with placebo group. Conclusions Weight loss resulting from orlistat treatment and slightly hypocaloric diet has produced favorable effects on several cardiovascular risk factors in obese Chinese subjects.展开更多
Patients with heart failure(HF)often have a poor prognosis,with high morbidity and mortality.In the Chinese adult population,the prevalence of HF increased by 44%in the past 15 years,which was1.3%[1].HF is often assoc...Patients with heart failure(HF)often have a poor prognosis,with high morbidity and mortality.In the Chinese adult population,the prevalence of HF increased by 44%in the past 15 years,which was1.3%[1].HF is often associated with multiple organ disorders[2].展开更多
Objective Current clinical evidence on the effects of home blood pressure telemonitoring(HBPT)on improving blood pressure control comes entirely from developed countries.Thus,we performed this randomized controlled tr...Objective Current clinical evidence on the effects of home blood pressure telemonitoring(HBPT)on improving blood pressure control comes entirely from developed countries.Thus,we performed this randomized controlled trial to evaluate whether HBPT plus support(patient education and clinician remote hypertension management)improves blood pressure control more than usual care(UC)in the Chinese population.Methods This single-center,randomized controlled study was conducted in Beijing,China.Patients aged 30-75 years were eligible for enrolment if they had blood pressure[systolic(SBP)≥140 mmHg and/or diastolic(DBP)≥90 mmHg;or SBP≥130 mmHg and/or DBP≥80 mmHg with diabetes].We recruited 190 patients randomized to either the HBPT or the UC groups for 12 weeks.The primary endpoints were blood pressure reduction and the proportion of patients achieving the target blood pressure.Results Totally,172 patients completed the study,the HBPT plus support group(n=84),and the UC group(n=88).Patients in the plus support group showed a greater reduction in mean ambulatory blood pressure than those in the UC group.The plus support group had a significantly higher proportion of patients who achieved the target blood pressure and maintained a dipper blood pressure pattern at the12th week of follow-up.Additionally,the patients in the plus support group showed lower blood pressure variability and higher drug adherence than those in the UC group.Conclusion HBPT plus additional support results in greater blood pressure reduction,better blood pressure control,a higher proportion of dipper blood pressure patterns,lower blood pressure variability,and higher drug adherence than UC.The development of telemedicine may be the cornerstone of hypertension management in primary care.展开更多
Osimertinib,a third-generation epidermal growth factor receptor tyrosine kinase inhibitor(EGFR-TKIs),is approved globally as the first-line treatment for patients with EGFR mutations(EGFRm:Ex19del/L858R)and T790M resi...Osimertinib,a third-generation epidermal growth factor receptor tyrosine kinase inhibitor(EGFR-TKIs),is approved globally as the first-line treatment for patients with EGFR mutations(EGFRm:Ex19del/L858R)and T790M resistance mutations in advanced non-small cell lung cancer(NSCLC).[1−3]With its widespread use,the cardiotoxicity of osimertinib has been of great concern.According to the U.S.Food and Drug Administration Adverse Events Reporting System(FAERS),the main cardiac-related adverse events with EGFR-TKIs are heart failure,QT prolongation,atrial fibrillation,acute myocardial infarction and pericardial effusion,and osimertinib has a higher incidence of QT prolongation,heart failure and atrial fibrillation than other EGFR-TKIs.展开更多
Background:Pulmonary arterial hypertension(PAH)is a chronic and progressive disease that is strongly associated with dysregulation of glucose metabolism.Alterations in nuclear receptor subfamily 4 group A member 1(NR4...Background:Pulmonary arterial hypertension(PAH)is a chronic and progressive disease that is strongly associated with dysregulation of glucose metabolism.Alterations in nuclear receptor subfamily 4 group A member 1(NR4A1)activity alter the outcome of PAH.This study aimed to investigate the effects of NR4A1 on glycolysis in PAH and its underlying mechanisms.Methods:This study included twenty healthy volunteers and twenty-three PAH patients,and plasma samples were collected from the participants.To mimic the conditions of PAH in vitro,a hypoxia-induced model of pulmonary artery smooth muscle cell(PASMC)model was established.The proliferation of PASMCs was assessed using CCK8 assays.Results:Levels of NR4A1,hypoxia-inducible factor-1α(HIF-1α),and various glycolysis-related enzymes were measured.In addition,extracellular glucose and lactate production were assessed.The interaction between NR4A1 and HIF-1αwas evaluated by co-immunoprecipitation assays.Levels of NR4A1 and HIF-1αwas increased in PAH patients,and exposure to hypoxia resulted in increased levels of NR4A1 and HIF-1αin PASMCs.NR4A1 interacted with HIF-1α.NR4A1 overexpression enhanced hypoxia-induced expression of HIF-1α,GLUT1,PKM2,HK2,and CD36,decreased glucose levels,increased lactate levels and promoted hypoxic PASMC viability.Conversely,silencing NR4A1 decreased hypoxia-induced expression of HIF-1α,GLUT1,PKM2,HK2,and CD36,promoted glucose production,reduced lactate levels and inhibited hypoxic PASMC viability.Furthermore,overexpression of HIF-1αreversed the regulation of glycolysis caused by NR4A1 knockdown.Conclusion:NR4A1 enhances glycolysis in hypoxia-induced PASMCs by upregulating HIF-1α.Our findings indicate that the management of NR4A1 activity may be a promising strategy for PAH therapy.展开更多
In recent years,extended life expectancies and lifestyle changes have markedly contributed to the increased incidence of heart failure(HF)worldwide[1].In China,while the age of patients with chronic HF has increased a...In recent years,extended life expectancies and lifestyle changes have markedly contributed to the increased incidence of heart failure(HF)worldwide[1].In China,while the age of patients with chronic HF has increased annually,the mortality rate has not decreased significantly[1].展开更多
Objective We aimed to assess the feasibility and superiority of machine learning(ML)methods to predict the risk of Major Adverse Cardiovascular Events(MACEs)in chest pain patients with NSTE-ACS.Methods Enrolled chest ...Objective We aimed to assess the feasibility and superiority of machine learning(ML)methods to predict the risk of Major Adverse Cardiovascular Events(MACEs)in chest pain patients with NSTE-ACS.Methods Enrolled chest pain patients were from two centers,Beijing Anzhen Emergency Chest Pain Center Beijing Bo’ai Hospital,China Rehabilitation Research Center.Five classifiers were used to develop ML models.Accuracy,Precision,Recall,F-Measure and AUC were used to assess the model performance and prediction effect compared with HEART risk scoring system.Ultimately,ML model constructed by Naïve Bayes was employed to predict the occurrence of MACEs.Results According to learning metrics,ML models constructed by different classifiers were superior over HEART(History,ECG,Age,Risk factors,&Troponin)scoring system when predicting acute myocardial infarction(AMI)and all-cause death.However,according to ROC curves and AUC,ML model constructed by different classifiers performed better than HEART scoring system only in prediction for AMI.Among the five ML algorithms,Linear support vector machine(SVC),Naïve Bayes and Logistic regression classifiers stood out with all Accuracy,Precision,Recall and F-Measure from 0.8 to 1.0 for predicting any event,AMI,revascularization and all-cause death(vs.HEART≤0.78),with AUC from 0.88 to 0.98 for predicting any event,AMI and revascularization(vs.HEART≤0.85).ML model developed by Naïve Bayes predicted that suspected acute coronary syndrome(ACS),abnormal electrocardiogram(ECG),elevated hs-cTn I,sex and smoking were risk factors of MACEs.Conclusion Compared with HEART risk scoring system,the superiority of ML method was demonstrated when employing Linear SVC classifier,Naïve Bayes and Logistic.ML method could be a promising method to predict MACEs in chest pain patients with NSTE-ACS.展开更多
Introduction-Objectives: Through the presentation of epidemiological, anatomo-clinical and surgical aspects, we report our experience in the management of traumatic axillary lesions. Materials and Methods: A descripti...Introduction-Objectives: Through the presentation of epidemiological, anatomo-clinical and surgical aspects, we report our experience in the management of traumatic axillary lesions. Materials and Methods: A descriptive retrospective study was based on the medical records of patients who suffered vascular axillary and/or brachial plexus trauma and who underwent surgical repair at the Abidjan Cardiology Institute from January 2008 to June 2022. Epidemiological, anatomo-clinical and surgical data were studied. Results: Thirty-four medical files belonging to 33 men and one woman, aged 32 on average, were collected. The circumstances of occurrence were dominated by the stab wound (n = 22). The combinations of injuries were as follows: associated involvement of the axillary artery and vein (n = 4);isolated involvement of axillary artery (n = 3);isolated involvement of the axillary vein (n = 2);associated involvement of the axillary artery and brachial plexus (n = 17);associated involvement of the axillary artery and vein and brachial plexus (n = 08). Anatomic lesions included acute arterial lesions (n = 29) and arteriovenous fistula (n = 1) and false aneurysms (n = 4). All patients were operated on under general anesthesia;vascular repair included direct suturing (n = 16), arterial and venous bypass using a long saphenous graft (n = 9), prosthetic arterial bypass (n = 5) and prosthetic flattening-graft (n = 4). Brachial plexus surgery consisted of an end-to-end anastomosis of each transected bundle in all cases (n = 25). The medium-term postoperative course was marked by success without functional sequelae in 88.24% of cases (n = 30) and by the persistence of distal paralysis of the thoracic limb after 6 months in 05.88% (n = 2) of all patients, i.e., 8% of patients who presented with brachial plexus injury. Conclusion: The concomitant surgical treatment of these axillary vascular and nerve lesions has given good results. However, if paralysis of the thoracic limb persists after 6 to 12 months, the patient should be referred to a specialist in brachial plexus surgery.展开更多
Objective: Through this surgical series, we present the epidemiological and anatomical-clinical aspects and the surgical results concerning patients operated on for a primary cardiac tumor at the Abidjan Heart Institu...Objective: Through this surgical series, we present the epidemiological and anatomical-clinical aspects and the surgical results concerning patients operated on for a primary cardiac tumor at the Abidjan Heart Institute. Materials and Method: This is a retrospective descriptive study covering the period of January 1982 to December 2022, based on the medical records of patients operated on for a primary cardiac tumor at the Abidjan Heart Institute. Results: Twenty-seven (27) patients underwent surgery for a primary cardiac tumor, including 14 women and 13 men with a mean age of 41.5 years (range 19 - 76 years). The main circumstances of discovery were exertional dyspnea, palpitation and syncope or pseudo-syncope. The main site was the septal wall of the left atrium. The diagnosis of myxoma was confirmed by pathological examination of the surgical specimen in 96.3% (n = 24) of the patients and it was a malignant large cell immunoblastic lymphoma of the myocardium in 3.7% (n = 1) of the patients. The mean largest diameter was 46.1 mm. The postoperative course was marked by an ischaemic stroke (n = 1);recurrence of a left atrial myxoma 5 years after the first tumor removal (n = 1). Two cases of death were noted, one due to the evolution of immunoblastic large cell lymphoma and the other due to an extracorporeal circulation accident. Conclusion: Almost all primary cardiac tumors operated on in Abidjan are myxomas. The circumstances of the discovery of these cardiac tumors are multiple and varied but dominated by exertional dyspnea, palpitation and syncope. Whatever their histological type, primary cardiac tumors are serious affections, in view of the haemodynamic and rhythmic disorders they cause.展开更多
In order to approach the effects of Shenmai Injection on SOD activity and MDA level in the senile patients with coronary heart disease, 48 cases, who had stenosis of over 70% in more than one branches of the coronary ...In order to approach the effects of Shenmai Injection on SOD activity and MDA level in the senile patients with coronary heart disease, 48 cases, who had stenosis of over 70% in more than one branches of the coronary arteries, were assigned randomly into a treatment group (given Shenmai Injection plus the routine treatment) and a control group (given the routine treatment only). The superoxide dismutase (SOD) activity and malondialdehyde (MDA) level were determined before treatment and at the end of a 3-week treatment. The results showed that in the treatment group, the SOD activity was significantly increased (P<0.05) and the MDA level markedly decreased (P<0.01) in the treatment group. It can be concluded that Shenmai Injection may enhance the antioxidant ability of the senile patients with coronary heart disease.展开更多
Aim: To investigate the relationship between androgen level and the indexes indicating endothelial function in male patients with coronary heart disease (CHD). Methods: We registered the following data for 106 50-...Aim: To investigate the relationship between androgen level and the indexes indicating endothelial function in male patients with coronary heart disease (CHD). Methods: We registered the following data for 106 50-70-year-old men: age, weight, blood lipid, including total cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol and triglyceride, whether a smoker, sugar levels, blood pressure, free testosterone (FT), vascular cell adhesion molecule- 1 (VCAM- 1) and the intima-media thickness (IMT) of common carotid artery, common carotid diameter, maximum velocity in systolic phase, minimum velocity in diastolic phase and resistent index. Among the 106 men, 51 were patients with CHD. The relationships between FT level, VCAM-1 concentration and IMT were examined, respectively, using a stepwise linear regression technique among all the 106 men. Results: There was no statistical difference in terms of age, blood pressure, whether a smoker, sugar levels, HDL-C, minimum velocity in diastolic phase, resistent index between male CHD patients and controls; whereas results for weight, total cholesterol, low density lipoprotein cholesterol, triglyceride, VCAM- 1 and IMT of male CHD patients were higher than those of controls; FT level and maximum velocity in systolic phase were lower. It was found that among all the objects, FT level was inversely correlated with IMT and VCAM-1 concentration. Condusion: FT level was inversely correlated with VCAM-I concentration and IMT which are indicators of endothelial function. (Asian JAndro12008 Mar; 10: 214-218)展开更多
Coronary artery perforation(CAP)remains an infrequent but potentially lifethreatening complication during percutaneous coronary intervention(PCI).Although the prevalence of CAP is about 0.2%−0.9%in relatively low risk...Coronary artery perforation(CAP)remains an infrequent but potentially lifethreatening complication during percutaneous coronary intervention(PCI).Although the prevalence of CAP is about 0.2%−0.9%in relatively low risk PCI,the incidence could up to 9%in complex clinical scenarios such as severe coronary calcification,chronic total occlusions and rotational atherectomy.[1]Despite the new techniques and equipment had lower morbidity and mortality,up to 17%of acute CAP cases would evolve to tamponade and subsequent death.展开更多
文摘BACKGROUND Bivalirudin,a direct thrombin inhibitor,is used in anticoagulation therapies as a substitute for heparin,especially during cardiovascular procedures such as percutaneous coronary intervention.AIM To explore the effect of bivalirudin on myocardial microcirculation following an intervention and its influence on adverse cardiac events in elderly patients with acute coronary syndrome(ACS).METHODS In total,165 patients diagnosed with acute myocardial at our hospital between June 2020 and June 2022 were enrolled in this study.From June 2020 to June 2022,elderly patients with ACS with complete data were selected and treated with interventional therapy.The study cohort was randomly divided into a study group(n=80,administered bivalirudin)and a control group(n=85,administered unfractionated heparin).Over a 6-mo follow-up period,differences in emergency processing times,including coronary intervention,cardiac function indicators,occurrence of cardiovascular events,and recurrence rates,were analyzed.RESULTS Significant differences were observed between the study cohorts,with the observation group showing shorter emergency process times across all stages:Emergency classification;diagnostic testing;implementation of coronary intervention;and conclusion of emergency treatment(P<0.05).Furthermore,the left ventricular ejection fraction in the observation group was significantly higher(P<0.05),and the creatine kinase-MB and New York Heart Association scores were CONCLUSION In elderly patients receiving interventional therapy for ACS,bivalirudin administration led to increased activated clotting time achievement rates,enhanced myocardial reperfusion,and reduced incidence of bleeding complications and adverse cardiac events.
基金funded by the Key Research and Development of the Gansu Province(No.20YF8FA 079)the Construction Project of the Gansu Clinical Medical Research Center(No.18JR2FA003).
文摘BACKGROUND Left ventricular(LV)remodeling and diastolic function in people with heart failure(HF)are correlated with iron status;however,the causality is uncertain.This Mendelian randomization(MR)study investigated the bidirectional causal relationship between systemic iron parameters and LV structure and function in a preserved ejection fraction population.METHODS Transferrin saturation(TSAT),total iron binding capacity(TIBC),and serum iron and ferritin levels were extracted as instrumental variables for iron parameters from meta-analyses of public genome-wide association studies.Individuals without myocardial infarction history,HF,or LV ejection fraction(LVEF)<50%(n=16,923)in the UK Biobank Cardiovascular Magnetic Resonance Imaging Study constituted the outcome dataset.The dataset included LV end-diastolic volume,LV endsystolic volume,LV mass(LVM),and LVM-to-end-diastolic volume ratio(LVMVR).We used a two-sample bidirectional MR study with inverse variance weighting(IVW)as the primary analysis method and estimation methods using different algorithms to improve the robustness of the results.RESULTS In the IVW analysis,one standard deviation(SD)increased in TSAT significantly correlated with decreased LVMVR(β=-0.1365;95%confidence interval[CI]:-0.2092 to-0.0638;P=0.0002)after Bonferroni adjustment.Conversely,no significant relationships were observed between other iron and LV parameters.After Bonferroni correction,reverse MR analysis showed that one SD increase in LVEF significantly correlated with decreased TSAT(β=-0.0699;95%CI:-0.1087 to-0.0311;P=0.0004).No heterogeneity or pleiotropic effects evidence was observed in the analysis.CONCLUSIONS We demonstrated a causal relationship between TSAT and LV remodeling and function in a preserved ejection fraction population.
基金supported by the CAMS Central Public Welfare Scientific Research Institute Basal Research Expenses (No.2021-XCGC09-1&No.2022-I2M-C&T-B-045)the Beijing Municipal Science&Technology Commission (Z191100006619019)the High-level Hospital Clinical Scientific Research Business Fees (No.2022-GSP-QZ-4)
文摘BACKGROUND Cardioneuroablation(CNA)has shown encouraging results in patients with vasovagal syncope(VVS).However,data on different subtypes was scarce.METHODS This observational study retrospectively enrolled 141 patients[mean age:40±18 years,51 males(36.2%)]with the diagnosis of VVS.The characteristics among different types of VVS and the outcomes after CNA were analyzed.RESULTS After a mean follow-up of 4.3±1.5 years,41 patients(29.1%)experienced syncope/pre-syncope events after CNA.Syncope/pre-syncope recurrence significantly differed in each subtype(P=0.04).The cardioinhibitory type of VVS had the lowest recurrence rate after the procedure(n=6,16.7%),followed by mixed(n=26,30.6%)and vasodepressive(n=9,45.0%).Additionally,a significant difference was observed in the analyses of the Kaplan-Meier survival curve(P=0.02).Syncope/pre-syncope burden was significantly reduced after CNA in the vasodepressive type(P<0.01).Vasodepressive types with recurrent syncope/pre-syncope after CNA have a lower baseline deceleration capacity(DC)level than those without(7.4±1.0 ms vs.9.0±1.6 ms,P=0.01).Patients with DC<8.4 ms had an 8.1(HR=8.1,95%CI:2.2-30.0,P=0.02)times risk of syncope/pre-syncope recurrence after CNA compared to patients with DC≥8.4 ms,and this association still existed after adjusting for age and sex(HR=8.1,95%CI:2.2-30.1,P=0.02).CONCLUSIONS Different subtypes exhibit different event-free rates.The vasodepressive type exhibited the lowest event-free rate,but those patients with DC≥8.4 ms might benefit from CNA.
文摘Traumatic mitral chordae rupture is a rare and known cause of acute mitral valve regurgitation and de novo heart failure.Concomitant pathologies in a trauma patient may mask the findings of de novo heart failure due to mitral chordae rupture.Trauma patients may also have other potential pre-diagnoses that could explain symptoms related to heart failure,such as tachycardia,circulatory shock,and acute hypoxemia.The possibility of traumatic chordae tendinea rupture being a preventable cause of mortality should be carefully evaluated.
文摘Objectives To observe the influence of weight loss induced by orlistat on several cardiovascular diseases risk factors in obese Chinese subjects. Methods Sixty obese Chinese patients participated in a 24 week clinical trial. Participants were prescribed a slightly hypocaloric diet and exercise, then they were randomly assigned double -blind treatment with either orlistat 120 mg three times a day or placebo. Their body weight, blood pressure, fasting glucose, insulin, HbA1c, and serum lipid profile were performed before and after the weight loss intervention. Results After 24 weeks, orlistat -treated group lost more of their body weight than placebo group (6. 66 ± 0. 52 kg, 8. 44±4.08% and 1. 98 ± 0. 44 kg, 2. 44±1. 74 % , respectively, P < 0. 05) . Moreover, after treatment, orlistat - treated patients showed significant decreases in serum levels of total cholesterol, low density lipoprotein - cholesterol and high density lipoprotein - cholesterol ( P < 0.01), but in placebo group we found no change. Both systolic blood pressure and diastolic blood pressure fell significantly in orlistat - treated group. Fasting glucose and HOMA - IR in orlistat - treated group was distinctly reduced if compared with placebo group. Conclusions Weight loss resulting from orlistat treatment and slightly hypocaloric diet has produced favorable effects on several cardiovascular risk factors in obese Chinese subjects.
文摘Patients with heart failure(HF)often have a poor prognosis,with high morbidity and mortality.In the Chinese adult population,the prevalence of HF increased by 44%in the past 15 years,which was1.3%[1].HF is often associated with multiple organ disorders[2].
基金The Project of the National Ministry of Industry and Information Technology[2020-0103-3-1-1]The Project of Beijing Science and technology“capital characteristics”[Z181100001718007]。
文摘Objective Current clinical evidence on the effects of home blood pressure telemonitoring(HBPT)on improving blood pressure control comes entirely from developed countries.Thus,we performed this randomized controlled trial to evaluate whether HBPT plus support(patient education and clinician remote hypertension management)improves blood pressure control more than usual care(UC)in the Chinese population.Methods This single-center,randomized controlled study was conducted in Beijing,China.Patients aged 30-75 years were eligible for enrolment if they had blood pressure[systolic(SBP)≥140 mmHg and/or diastolic(DBP)≥90 mmHg;or SBP≥130 mmHg and/or DBP≥80 mmHg with diabetes].We recruited 190 patients randomized to either the HBPT or the UC groups for 12 weeks.The primary endpoints were blood pressure reduction and the proportion of patients achieving the target blood pressure.Results Totally,172 patients completed the study,the HBPT plus support group(n=84),and the UC group(n=88).Patients in the plus support group showed a greater reduction in mean ambulatory blood pressure than those in the UC group.The plus support group had a significantly higher proportion of patients who achieved the target blood pressure and maintained a dipper blood pressure pattern at the12th week of follow-up.Additionally,the patients in the plus support group showed lower blood pressure variability and higher drug adherence than those in the UC group.Conclusion HBPT plus additional support results in greater blood pressure reduction,better blood pressure control,a higher proportion of dipper blood pressure patterns,lower blood pressure variability,and higher drug adherence than UC.The development of telemedicine may be the cornerstone of hypertension management in primary care.
文摘Osimertinib,a third-generation epidermal growth factor receptor tyrosine kinase inhibitor(EGFR-TKIs),is approved globally as the first-line treatment for patients with EGFR mutations(EGFRm:Ex19del/L858R)and T790M resistance mutations in advanced non-small cell lung cancer(NSCLC).[1−3]With its widespread use,the cardiotoxicity of osimertinib has been of great concern.According to the U.S.Food and Drug Administration Adverse Events Reporting System(FAERS),the main cardiac-related adverse events with EGFR-TKIs are heart failure,QT prolongation,atrial fibrillation,acute myocardial infarction and pericardial effusion,and osimertinib has a higher incidence of QT prolongation,heart failure and atrial fibrillation than other EGFR-TKIs.
基金supported by the National Natural Science Foundation of China(No.82000300).
文摘Background:Pulmonary arterial hypertension(PAH)is a chronic and progressive disease that is strongly associated with dysregulation of glucose metabolism.Alterations in nuclear receptor subfamily 4 group A member 1(NR4A1)activity alter the outcome of PAH.This study aimed to investigate the effects of NR4A1 on glycolysis in PAH and its underlying mechanisms.Methods:This study included twenty healthy volunteers and twenty-three PAH patients,and plasma samples were collected from the participants.To mimic the conditions of PAH in vitro,a hypoxia-induced model of pulmonary artery smooth muscle cell(PASMC)model was established.The proliferation of PASMCs was assessed using CCK8 assays.Results:Levels of NR4A1,hypoxia-inducible factor-1α(HIF-1α),and various glycolysis-related enzymes were measured.In addition,extracellular glucose and lactate production were assessed.The interaction between NR4A1 and HIF-1αwas evaluated by co-immunoprecipitation assays.Levels of NR4A1 and HIF-1αwas increased in PAH patients,and exposure to hypoxia resulted in increased levels of NR4A1 and HIF-1αin PASMCs.NR4A1 interacted with HIF-1α.NR4A1 overexpression enhanced hypoxia-induced expression of HIF-1α,GLUT1,PKM2,HK2,and CD36,decreased glucose levels,increased lactate levels and promoted hypoxic PASMC viability.Conversely,silencing NR4A1 decreased hypoxia-induced expression of HIF-1α,GLUT1,PKM2,HK2,and CD36,promoted glucose production,reduced lactate levels and inhibited hypoxic PASMC viability.Furthermore,overexpression of HIF-1αreversed the regulation of glycolysis caused by NR4A1 knockdown.Conclusion:NR4A1 enhances glycolysis in hypoxia-induced PASMCs by upregulating HIF-1α.Our findings indicate that the management of NR4A1 activity may be a promising strategy for PAH therapy.
文摘In recent years,extended life expectancies and lifestyle changes have markedly contributed to the increased incidence of heart failure(HF)worldwide[1].In China,while the age of patients with chronic HF has increased annually,the mortality rate has not decreased significantly[1].
基金supported by Beijing Nova Program[Z201100006820087]National Key R&D Program of China[2020YFC2004800]+2 种基金National Natural Science Foundation of China[81870322]The Capital Health Research and Development of Special Fund[2018-1-2061]The Natural Science Foundation of Beijing,China[7191002].
文摘Objective We aimed to assess the feasibility and superiority of machine learning(ML)methods to predict the risk of Major Adverse Cardiovascular Events(MACEs)in chest pain patients with NSTE-ACS.Methods Enrolled chest pain patients were from two centers,Beijing Anzhen Emergency Chest Pain Center Beijing Bo’ai Hospital,China Rehabilitation Research Center.Five classifiers were used to develop ML models.Accuracy,Precision,Recall,F-Measure and AUC were used to assess the model performance and prediction effect compared with HEART risk scoring system.Ultimately,ML model constructed by Naïve Bayes was employed to predict the occurrence of MACEs.Results According to learning metrics,ML models constructed by different classifiers were superior over HEART(History,ECG,Age,Risk factors,&Troponin)scoring system when predicting acute myocardial infarction(AMI)and all-cause death.However,according to ROC curves and AUC,ML model constructed by different classifiers performed better than HEART scoring system only in prediction for AMI.Among the five ML algorithms,Linear support vector machine(SVC),Naïve Bayes and Logistic regression classifiers stood out with all Accuracy,Precision,Recall and F-Measure from 0.8 to 1.0 for predicting any event,AMI,revascularization and all-cause death(vs.HEART≤0.78),with AUC from 0.88 to 0.98 for predicting any event,AMI and revascularization(vs.HEART≤0.85).ML model developed by Naïve Bayes predicted that suspected acute coronary syndrome(ACS),abnormal electrocardiogram(ECG),elevated hs-cTn I,sex and smoking were risk factors of MACEs.Conclusion Compared with HEART risk scoring system,the superiority of ML method was demonstrated when employing Linear SVC classifier,Naïve Bayes and Logistic.ML method could be a promising method to predict MACEs in chest pain patients with NSTE-ACS.
文摘Introduction-Objectives: Through the presentation of epidemiological, anatomo-clinical and surgical aspects, we report our experience in the management of traumatic axillary lesions. Materials and Methods: A descriptive retrospective study was based on the medical records of patients who suffered vascular axillary and/or brachial plexus trauma and who underwent surgical repair at the Abidjan Cardiology Institute from January 2008 to June 2022. Epidemiological, anatomo-clinical and surgical data were studied. Results: Thirty-four medical files belonging to 33 men and one woman, aged 32 on average, were collected. The circumstances of occurrence were dominated by the stab wound (n = 22). The combinations of injuries were as follows: associated involvement of the axillary artery and vein (n = 4);isolated involvement of axillary artery (n = 3);isolated involvement of the axillary vein (n = 2);associated involvement of the axillary artery and brachial plexus (n = 17);associated involvement of the axillary artery and vein and brachial plexus (n = 08). Anatomic lesions included acute arterial lesions (n = 29) and arteriovenous fistula (n = 1) and false aneurysms (n = 4). All patients were operated on under general anesthesia;vascular repair included direct suturing (n = 16), arterial and venous bypass using a long saphenous graft (n = 9), prosthetic arterial bypass (n = 5) and prosthetic flattening-graft (n = 4). Brachial plexus surgery consisted of an end-to-end anastomosis of each transected bundle in all cases (n = 25). The medium-term postoperative course was marked by success without functional sequelae in 88.24% of cases (n = 30) and by the persistence of distal paralysis of the thoracic limb after 6 months in 05.88% (n = 2) of all patients, i.e., 8% of patients who presented with brachial plexus injury. Conclusion: The concomitant surgical treatment of these axillary vascular and nerve lesions has given good results. However, if paralysis of the thoracic limb persists after 6 to 12 months, the patient should be referred to a specialist in brachial plexus surgery.
文摘Objective: Through this surgical series, we present the epidemiological and anatomical-clinical aspects and the surgical results concerning patients operated on for a primary cardiac tumor at the Abidjan Heart Institute. Materials and Method: This is a retrospective descriptive study covering the period of January 1982 to December 2022, based on the medical records of patients operated on for a primary cardiac tumor at the Abidjan Heart Institute. Results: Twenty-seven (27) patients underwent surgery for a primary cardiac tumor, including 14 women and 13 men with a mean age of 41.5 years (range 19 - 76 years). The main circumstances of discovery were exertional dyspnea, palpitation and syncope or pseudo-syncope. The main site was the septal wall of the left atrium. The diagnosis of myxoma was confirmed by pathological examination of the surgical specimen in 96.3% (n = 24) of the patients and it was a malignant large cell immunoblastic lymphoma of the myocardium in 3.7% (n = 1) of the patients. The mean largest diameter was 46.1 mm. The postoperative course was marked by an ischaemic stroke (n = 1);recurrence of a left atrial myxoma 5 years after the first tumor removal (n = 1). Two cases of death were noted, one due to the evolution of immunoblastic large cell lymphoma and the other due to an extracorporeal circulation accident. Conclusion: Almost all primary cardiac tumors operated on in Abidjan are myxomas. The circumstances of the discovery of these cardiac tumors are multiple and varied but dominated by exertional dyspnea, palpitation and syncope. Whatever their histological type, primary cardiac tumors are serious affections, in view of the haemodynamic and rhythmic disorders they cause.
文摘In order to approach the effects of Shenmai Injection on SOD activity and MDA level in the senile patients with coronary heart disease, 48 cases, who had stenosis of over 70% in more than one branches of the coronary arteries, were assigned randomly into a treatment group (given Shenmai Injection plus the routine treatment) and a control group (given the routine treatment only). The superoxide dismutase (SOD) activity and malondialdehyde (MDA) level were determined before treatment and at the end of a 3-week treatment. The results showed that in the treatment group, the SOD activity was significantly increased (P<0.05) and the MDA level markedly decreased (P<0.01) in the treatment group. It can be concluded that Shenmai Injection may enhance the antioxidant ability of the senile patients with coronary heart disease.
文摘Aim: To investigate the relationship between androgen level and the indexes indicating endothelial function in male patients with coronary heart disease (CHD). Methods: We registered the following data for 106 50-70-year-old men: age, weight, blood lipid, including total cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol and triglyceride, whether a smoker, sugar levels, blood pressure, free testosterone (FT), vascular cell adhesion molecule- 1 (VCAM- 1) and the intima-media thickness (IMT) of common carotid artery, common carotid diameter, maximum velocity in systolic phase, minimum velocity in diastolic phase and resistent index. Among the 106 men, 51 were patients with CHD. The relationships between FT level, VCAM-1 concentration and IMT were examined, respectively, using a stepwise linear regression technique among all the 106 men. Results: There was no statistical difference in terms of age, blood pressure, whether a smoker, sugar levels, HDL-C, minimum velocity in diastolic phase, resistent index between male CHD patients and controls; whereas results for weight, total cholesterol, low density lipoprotein cholesterol, triglyceride, VCAM- 1 and IMT of male CHD patients were higher than those of controls; FT level and maximum velocity in systolic phase were lower. It was found that among all the objects, FT level was inversely correlated with IMT and VCAM-1 concentration. Condusion: FT level was inversely correlated with VCAM-I concentration and IMT which are indicators of endothelial function. (Asian JAndro12008 Mar; 10: 214-218)
文摘Coronary artery perforation(CAP)remains an infrequent but potentially lifethreatening complication during percutaneous coronary intervention(PCI).Although the prevalence of CAP is about 0.2%−0.9%in relatively low risk PCI,the incidence could up to 9%in complex clinical scenarios such as severe coronary calcification,chronic total occlusions and rotational atherectomy.[1]Despite the new techniques and equipment had lower morbidity and mortality,up to 17%of acute CAP cases would evolve to tamponade and subsequent death.