Hemodynamic changes and oxygen metabolism daring off-pump coronary artery bypass grafting

Objective To examine the hemodynamic changes and oxygen metabolism during off-pump coronary artery bypass grafting (OPCABG). Methods Twenty patients (18 male,2 female) aged (60 ±8)yr, weighing (71 ± 9) kg undergoing OPCABG were studied. The patients were premedicated with diazepam 10 mg PO 2h before operation and morphine 10 mg and scopolamine 0. 3 mg im 30 min before operation. Anesthesia were induced with midazolam 0.1 -0.2 mg·kg-1,fentanyl 5 - 10 μg·kg-1 and vecuronium 0. 12 - 0. 15 mg · kg-1 and maintained with 0. 5% - 2% isoflurane inhalation, fentanyl 10 - 20 μg·kg-1 and intermittent iv boluses of vecuronium and in some patients propofol infusion. Radial artery was cannulated. Swan-Ganz catheter was placed via internal jugular vein into pulmonary artery. Hemodynamic parameters including MAP, HR, cardiac index ( CI), stroke volume (SV), MPAP, PCWP, SVR, left ventricle stroke work index (LVSWI) and PVSWI; oxygen metabolism including oxygen delivery (DO2 ), oxygen consumption (VO2) and

Cardioprotective effects of selective Na^＋/H^＋ exchanger inhibitor HOE642 against ischemia/reperfusion injury in immature hearts

Objective To compare the cardioprotective effect of HOE642, a highly selective Na^＋/H^＋ exchanger isoform-1 （NHE1） inhibitor, administered at different phase of ischemia/reperfusion in immature hearts： pre-ischemia, during ischemia and reperfusion.

Hybrid procedure for pulmonary atresia with intact ventricular septum

Objective In patients with pulmonary atresia and intact ventricular septum (PAIVS) without right ventricular-dependent coronaries,catheter techniques including the use of a sniff wire,lasers,and radiofrequency have been the most widely used as initial therapy. However,percutaneous perforation and balloon valvuloplasty were associated with higher rate of procedural failure and

Clinical features and prognosis of patient shospitalized with heart failure and low T_(3) syndrome

Objective To investigate the association between triiodothyronine(T_(3))and inflammatory factors,and its potential effect on long-term outcomes in hospitalized patients with heart failure(HF).Methods A total of 2475 patients with HF admitted in Heart Failure Care Unit were consecutively enrolled in this retrospective cohort study from December 2006 to June 2018.Patients were divided into low T_(3)syndrome group(n=610,24.6%)and normal thyroid function group(n=1865,75.4%).The median follow-up time was 2.9(1.0,5.0)years.A total of 1048 all-cause deaths were recorded at the final follow-up.

A multicenter study on the prognostic value of SPECT myocardial blood flow quantitative technique in patients with intermediate stenoses of coronary arteries

Objective To investigate the prognostic value of myocardial flow reserve(MFR)measured by SPECT myocardial blood flow(MBF)quantitative technique in patients with intermediate stenoses of coronary arteries.Methods From September 2019 to May 2021,patients with intermediate stenoses(50%to 80%)identified by invasive coronary angiography in Fuwai Hospital,Chinese Academy of Medical Sciences,Fuwai Center China Cardiovascular Hospital,and TEDA International Cardiovascular Hospital were prospectively included.All patients underwentaone-dayrest/stress SPECT myocardial perfusion imaging(MPI)and SPECT MBF quantification.The radioactivity distribution of each segment of the MPI bullseye polar maps were obtained according to the standard 5-point method to obtain the summed stress score(SSS)and the summed difference score(SDS)to determine the existence of abnormality.ROC curve analysis was used to obtain the optimal prognostic cut-off value for MFR.

Incidence and case fatality rates of cardiovascular diseases in urban and rural community-dwelling populations in eastern, central and western regions of China

Objective To evaluate the incidence and case fatality rate of cardiovascular disease(CVD)among populations in urban and rural communities in eastern,central and western regions of China.Methods The present study was based on the data of the Prospective Urban and Rural Epidemiology(PURE)-China cohort,which enrolled participants who had at least one followup visit and complete information on age and sex.Information on baseline demographics,cardiovascular risk factors,and prevention and treatment for CVD were collected.CVD and mortality events were documented using the standardized case report form of the PURE Global Study to assess the incidence and case fatality rate ofCVD among populations in urban and rural communities in eastern,central and western China.Results This study included a total of 47262 communitydwelling participants(age:(51.1±9.6)years;female,n=27529,58.2%)from 115 urban and rural communities in 12 provinces across the eastern,central,and western regions of China.Over a follow-up period of 11.9(9.5,12.6)years,2686 deaths and 5873 cardiovascular events were documented.The incidence of CVD was 11.90(95%CI:11.60-12.21)/1000 person-years.A significant difference in CVD incidence was observed across regions(Prend<0.001).

Association between the composite measures of hospital performance and in-hospital mortality for patients with acute ST-segment elevation myocardial: infarction in China

Objective To investigate the association between hospital-specific opportunity-based composite score(OBCS)and in-hospital mortality in patients with acute ST-segment elevation myocardial infarction(STEMI)in China.Methods 80 hospitals with PCI capacities and with more than 50 STEMI patients registered in China Acute Myocardial Infarction(CAMI)Registry were entered in this study.The OBCS was calculated in combination with the Chinese myocardial infarction guidelines and the American quality control criteria for myocardial infarction.The association between OBCS and in-hospital mortality was explored by multivariate generalized estimating equations.Results A total of 29581 STEMI patients were admitted to these 80 hospitals,and 1875(6.3%)patients died during hospitalization,the median OBCS was 74.0%(39.5%,85.8%).The in-hospital mortality rates in hospitals with low OBCS ( < 71. 1%) ( n =26,7 556 patients) ,median OBCS ( 71. 1% - 76. 5%)hospitals ( n = 27,12 751 patients) and high OBCS( > 76. 5%) hospitals ( n = 27,9 274 patients) were7. 2%( 95% CI: 6. 6% - 7. 8%) ,6. 6% ( 95% CI:6. 1% - 7. 0%) ,and 5. 4% ( 95% CI: 4. 9% -5. 8%) ,respectively. After adjusting for confoundingfactors,the in-hospital mortality rate in hospitals withlow OBCS ( OR = 1. 30,95% CI: 1. 11 - 1. 52,P =0. 001 4) and median OBCS ( OR = 1. 11,95% CI:1. 03 - 1. 20,P = 0. 008 6) was significantly higher thanin hospitals with high OBCS. Conclusion The highermedical quality of STEMI patients is associated withlower in-hospital mortality in China.

Risk factors for in-hospital mortality in patients with acute myocardial infarction in China

Objective To explore the risk factors for in-hospital mortality among contemporary patients with acute myocardial infarction (AMI) in China.Methods The information of 23 417 AMI patients (including 5 795 NSTEMI and 17 622 STEMI) from 2013-01 to 2014-09,derived from China Acute Myocardial Infarction (CAMI)registry,was extracted.Our research included 2 groups:In-hospital death group (n=1 504) and In-hospital survival group (n=21 913).

Long-term outcome of EVAHEART Ⅰ implantable ventricular assist device for the treatment of end stage heart failure:clinical 3-year follow-up results of 15 cases

Objective To evaluate the long-term efficacy and safety of the implantable ventricular assist system EVAHEART I in clinical use.Methods Fifteen consecutive patients with end-stage heart failure who received left ventricular assist device therapy in Fuwai Hospital from January 2018 to December 2021 were enrolled in this study.

The impact of LDL-C/HDL-C ratio on severity of coronary artery disease and 2-year outcome in patients with premature coronary heart disease:results of a prospective,multicenter,observational cohort study

Objective To explore the relationship between low density lipoprotein cholesterol(LDL-C)/high density lipoprotein cholesterol(HDL-C)ratio with the severity of coronary artery disease and 2-yeat outcome in patients with premature coronary heart disease.Methods This prospective,multicenter,observational cohort study was originated from the PROMISE study.

Free triiodothyronine level indicates the degree of myocardial injury in patients with acute ST-elevation myocardial infarction

Background Previous studies have suggested that hypothyroidism correlated with coronary heart diseases （CHD） mortality in long-term cohort, but whether the thyroid function status is associated with myocardial injury in acute ST- elevation myocardial infarction （STEMI） has not been investigated sufficiently.

Comparison of loading with maintenance dose of clopidogrel on platelet reactivity in Chinese with different CYP2C19 genotypes prior to percutaneous coronary intervention

Background Whether two clopidogrel pretreatment strategies prior to elective percutaneous coronary intervention （PCI）： a 300 mg loading dose （LD） in clopidogrel naive patients and a 75 mg maintenance dose （MD） once daily in patients on chronic clopidogrel therapy play the same role in the platelet inhibition in Chinese with different CYP2C19 genotypes remains unknown. We aim to evaluate the impact on platelet inhibition by clopidogrel pretreatment strategy and its interaction effect with CYP2C19 genotype. Methods Chinese patients undergoing PCI （n=840） were assigned to 2x2 groups in the trial according to different clopidogrel pretreatment strategies （470 patients in LD, 370 patients in MD） and CYP2C19 genotypes （494 carriers of any CYP2C19 ＊2 or ＊3 loss-of-function allele, 346 non-carriers）. The primary outcome was platelet aggregation （PA） as measured by the 10 umol/L adenosine diphosphate induced light transmission aggregation. Results Compared with MD group, LD strategy showed a significantly higher PA-（（59.22＋11.67）% vs. （52.83±12.17）%, P 〈0.01）, similar PA difference was observed in CYP2C19 loss-of-function carriers compared with non-carriers （（59.41±10.91）% vs. （52.10±12.90）%, P 〈0.01）. LD patients in either the CYP2C19 loss-of-function allele carrier or non- carrier group showed a significantly higher PA compared with MD group （（61.50±10.61）% vs. （56.84±10.74）%, P 〈0.01; （56.06±12.34）% vs. （46.88±11.78）%, P 〈0.01, respectively）. A quantitative interaction effect was observed between clopidogrel pretreatment strategy and CYP2C19 genotype （P=0.001）. Conclusion The 300 mg LD strategy results in a decreased effect on platelet inhibition compared with the 75 mg MD in Chinese patients receiving clopidogrel prior to PCI, especially in the CYP2C19 ＊2 or ＊3 loss-of-function allele non-carriers. （ClinicalTrials.gov number NCT01710436） Chin tided J 2014;127 （14）： 2571-2577

Screening of pathogenic genes in Chinese patients with arrhythmogenic right ventricular cardiomyopathy

Background Arrhythmogenic right ventricular cardiomyopathy （ARVC） is a heritable cardiac disease predominantly caused by mutations in desmosomal protein genes. Previous genetic analyses of the Chinese ARVC population are limited to small size and restriction to a single gene. This study was aimed to investigate the genotype in a large series of Chinese patients with ARVC through comprehensively screening nine ARVC-causing genes. Methods A total of 100 unrelated ARVC patients and 300 age, gender and ethnicity matched healthy controls were genetically tested with multiplexing targeted resequencing for nine previously reported ARVC-causing genes, including plakophilin-2, desmoplakin, desmoglein-2, desmocollin-2, plakoglobin, transforming growth factor beta-3, transmembrane protein 43, desmin and Lamin A/C. Results Fifty-nine mutations were identified in 64% of the patients, among which, 93% were located in desmosomal protein genes. Plakophilin-2 mutations accounted for 54% of the total and 58% of the desmosomal mutations, with a truncating mutation type making up about 2/3 of the plakophilin-2 mutations. Only four mutations were found in nondesmosomal genes; two in transmembrane protein 43 and two in transforming growth factor beta-3. Two of them （one of each gene） appeared as single missense mutations. No mutation was identified in desmin or Lamin A/C. Multiple mutations were found in 23% of the patients, with plakophilin-2 being found in 57% of the multi-mutation carriers. Conclusions Plakophilin-2 was the most common gene mutation that was identified in Chinese ARVC patients. Nondesmosomal genes should be added to desmosomal protein genes when performing molecular genetic screening in patients with suspected ARVC.

Reduction of atrial fibrillation in remotely monitored pacemaker patients： results from a Chinese multicentre registry

Background Many recipients of implantable cardiac electronic devices have atrial fibrillation （AF） occurrences after device implantation, even if there is no previous history of AF, and some of the episodes are asymptomatic. The purpose of this study was to evaluate trends in AF burden following early AF detection in patients treated with pacemakers equipped with automatic, daily Home Monitoring function. Methods Between February 2009 and December 2010, the registry recruited 701 pacemaker patients （628 dual-chamber, 73 biventricular devices） at 97 clinical centers in China. Daily Home Monitoring data transmissions were analyzed to screen for the AF burden. In-office follow-ups were scheduled for 3 and 6 months after implantation. Upon first AF （i.e., mode-switch） detection in a patient, screening olAF burden by Home Monitoring was extended for the next 180 days. Results At least one episode of AF was observed in 22.9% of patients with dual-chamber pacemakers and in 28.8% of patients with biventricular pacemakers. The first AF detection in a patient occurred, on average, about 2 months before scheduled follow-up visits. In both pacemaker groups, mean AF burden decreased significantly （P〈0.05） over 180 days following first AF detection： from 12.0% to 2.5% in dual-chamber and from 12.2% to 0.5% in biventricular pacemaker recipients. The number of patients with an AF burden 〉10% per month was significantly reduced over 6 months of implantation in both dual chamber （38 patients in the first month vs. 21 patients in month 6, P〈0.05） and biventricular （7 patients in the first month vs. 0 patient in months 4-6, P〈0.05） pacemaker recipients. Conclusions Automatic, daily Home Monitoring of patients treated with cardiac pacemakers allows early detection of AF, and there is a gradual and significant decrease in AF burden.

Postoperative diaphragmatic paralysis after cardiac surgery in children： incidence, diagnosis and surgical management

Background Cardiac surgery for congenital heart disease covers a wide spectrum from simple to complex cardiac and extracardiac malformations. Innovations in pediatric cardiac surgery and perioperative care over the past decades have allowed surgical correction or at least palliation in almost all complex congenital heart defects in the first years of life. Diaphragmatic paralysis （DP） due to phrenic nerve injury after congenital cardiac surgery is an important respiratory complication resulting with respiratory insufficiency, lung infections, prolonged hospital stay time and even death.

Association between plasma HDL-C levels and coronary artery severity and impact on outcomes of patients underwent percutaneous coronary intervention

Objective To analyze the association between plasma high-density lipoprotein cholesterol (HDL-C) levels and the severity of coronary artery disease,and to evaluate the impact of HDL-C levels on long-term outcomes in patients underwent percutaneous coronary intervention(PCI).Methods A total of 10 458 consecutive patients underwent PCI from January 2013 to December 2013 at Fuwai hospital were enrolled in this study.

Predictive value of postoperative cardiac troponinⅠelevation for new onset myocardial infarction and thirty-day mortality after coronary artery bypass grafting

Objective To evaluate the predictive value of postoperative cardiac troponin Ⅰ(cTnI) level on new onset myocardial infarction(MI) and thirty-day mortality after coronary artery bypass grafting(CABG).

Correction of RNA aberrant splice increases foreign gene expression in transgenic mice

Transgenic mice with mammary gland secreting human granulocyte colony stimulating factor (G-CSF) were produced using mice whey acid protein gene promoter. It was found that there was very low expression level in mammary gland. Human G-CSF cDNA was obtained by RT-PCR from transgenic mice mammary gland. Sequence analysis showed that this G-CSF gene deleted the 4th exon, and compared with human G-CSF genomic DNA, there were donor and acceptor splice sites in the deletion fragment. It was considered that the 3rd and 4th introns also delete in G-CSF fragment. The transgenic construct was corrected by deleting the 3rd and 4th introns to construct the minigene, which was used to produce transgenic mice by microinjection. Northern blot showed that G-CSF expression using the new construct increased 5.4 times as that before in transgenic mice. The results suggested that it was possible that RNA aberrant splice result in low expression in transgenic mice.

A prospective study to evaluate the efficacy of an intracardiac electrogram-based atrioventricular and interventricular intervals optimization method in cardiac resynchronization therapy

Background Cardiac resynchronization therapy （CRT） with biventricular pacing improves cardiac function,functional capacity and quality of life in selected patients with heart failure.The current study aimed to evaluate the efficacy of the intracardiac electrogram （IEGM）-based optimization method,QuickOptTM,in Chinese patients treated with CRT.Methods Aortic time velocity integrals （AVTI） achieved at the sensed atrioventricular （AV）,paced AV and interventricular （VV） interval settings recommended by both QuickOptTM and standard echocardiographic optimization were measured in 101 patients.Consistency and the strength of the relationship between the two timing cycle optimization methods were assessed by intra-class correlation coefficient （ICC）.Results The ICC showed good agreement and correlation with what the AVTI achieved at the optimal sensed AV （ICC=0.9683 （0.9535-0.9785））,paced AV （ICC=0.9642 （0.9475-0.9757）） and VV （ICC=0.9730 （0.9602-0.9817）） interval settings determined by the two optimization methods.The average time required by echocardiographic optimization and by QuickOptTM were （78.32±32.40） minutes and （1.98±1.64） minutes respectively （P 〈0.0001）.Conclusion The QuickOptTM algorithm provides a quicker,simpler and reliable alternative to the standard method for timing cycle optimization.（ClinicaITrial.gov Reference Number：NCT00918294）

Novel completed biodegradable polymer sirolimus-eluting stent versus durable polymer sirolimus-eluting stent in de novo lesions： nine-month angiographic and three-year clinical outcomes of HOPE trial

Background Drug-eluting stents（DES） with durable polymer have significantly reduced restenosis and target vessel revascularization compared with bare metal stents. Durable polymer has been linked with persistent inflammation of vessel wall and delayed endothelial healing that may increase the risk of late and very late stent thrombosis. This study sought to evaluate the efficacy and safety of HELLOS completed biodegradable polymer sirolimus-eluting stent （SES） in de novo coronary lesions.Methods Totally, 287 patients with one or two de novo coronary lesions （lesion length ≤38 mm and reference vessel diameter 2.5-4.0 mm） were enrolled in the HOPE study, a prospective, multicenter, randomized, non-inferiority trial. Patients were randomized to treatment either with HELIOS completed biodegradable polymer SES （n=142） or PARTNER durable polymer SES （n=145）. The primary endpoint was angiographic in-stent late lumen loss （LLL） at 9-month follow-up. The secondary endpoint included stent thrombosis and major adverse cardiac events including cardiac death, myocardial infarction （MI） and target lesion revascularization （TLR）.Results The 9-month in-stent LLL in the HELIOS group was similar to the PARTNER group, （0.16±0.22） mm vs. （0.19±0.30） mm （P=0.28）. The difference and 95% confidence interval were -0.03 （-0.09, 0.04）, and the P value for non-inferiority 〈0.01. Major adverse cardiovascular event （MACE） occurred in 7.9% vs. 8.2%, MI in 2.4% vs. 3.0%, TLR in 5.5% vs. 3.0%, and stent thrombosis in 0 vs. 1.5%; and events were comparable between the HELIOS group and PARTNER aroup at three-year follow-up （all P 〉0.05）. The three-year cardiac death was lower in the HELIOS group, butwith no significant difference, 0 vs. 3.0% （P=0.12）. Conclusions In the HOPE trial, the novel completed biodegradable polymer SES HELIOS was non-inferior to the durable polymer SES PARTNER with respect to nine-month in-stent LLL in de novo coronary lesions. The incidence of other clinical endpoints was low for both of the stents in three-year follow-up.