简介：ObjectivesToinvestigatethegeneexpressionofcalcium-handlingproteinsinpatientswithrheumaticheartdisease(RHD)andatrialfibrillation(AF).MethodsAtotalof50patientswithrheumaticmitralvalvediseasewereincluded.AccordingtocardiacrhythmanddurationofepisodeofAF,patientsweredividedintofourgroups:sinusrhythmgroup,oaroxvsmalAFre'our,persistentAFforlessthan6monthsgroupandpersistentAFformorethan6monthsgroup.Atrialtissuewasobtainedfromtherightatrialappendage,therightatrialfreewallandtheleftatrialappendagerespectivelyduringopenheartsurgery.TotalRNAwasisolatedandreverslytran-scribedintocDNA.Inasemi-quantitativepolymerasechainreactionthecDNAofinterestandofglyceralde-hyde3-phosphatedehydrogenase(GAPDH)weream-plifiedandseparatedbyethidiumbromide-stainedgelelectrophoresis.MultiplelinerregresswasusedforcorrelationbetweenthemRNAamountandage,sex,rightatrialdiameter(RAd)andleftatrialdiameter(LAd)ResultsThemRNAofL-typecalciumchannelα1osubunit,ofCa^2+-ATPaseandofryanodinereceptorinpatientswithpersistentAFformorethan6monthsweresignificantlydecreased(Pall<0.01)ButnoalterationsofthemRNAlevelsforSRphos-pholambanandcalsequestrinwereobservedinpatientswithpersistentAFformorethan6monthscomparedwithpatientswithsinusrhythm,paroxysmalAFandpersistentAFforlessthan6months(Pall>0.05)Therewasnodifferenceofthegeneexpressionamongthethreeatrialtissuesamplingsites(Pall>0.05).Age,gender,RAdandLAdhadnosignificanteffectsonthegeneexpressionofcalcium-handlingproteins(Pall>0.05).ConclusionsThemRNAexpressionofcalcium-handlingproteinsisdown-regulatedonlyinpatientswithRHDandlong-termpersistentAF.Suchabnormalitiesmayberelatedtotheinitiationand/orperpetuationofAFinthepatientswithRHD.

简介：Atrialarrhythmias,includingatrialfibrillation,inthesettingofcongenitalheartdisease(CHD)areepidemiologicallyandmechanisticallydifferentfromthoseencounteredinthegeneralpopulation.ThesearrhythmiasoccuratyoungeragesinpatientswithCHD,andarefrequentlydegenerativeandprogressive.Theepidemiology,incidence,andprevalenceofthespectrumofatrialarrhythmias,includingatrialfibrillation,varyaccordingtothespecificCHDtype,priortreatment,andresidualandongoingstructuralandfunctionalsequelae.Thecombinedimpactofincisionalscars,abnormalhemodynamics,atrialchamberdilatation,andincreasesinatrialwallthicknessanddistributionoffibrosisresultsinahighlydynamicandcontinuouslychangingatrialsubstratethatishighlypredisposedtoarrhythmias.Giventhemultiplesubstrates,individualizedtherapeuticplanscanincludepharmacologictherapy,catheter-basedablation,andsurgicaltherapiesperformedconcomitantlywithprimarysurgicalinterventionforhemodynamicallysignificantsequelaeofCHD.AdvancedimagingwithCTorMRIcanprovidevaluableinformationfordecisionmakingandproceduralplanning.ApplicationofnoveltherapeutictechnologiesandpharmacologicagentsnecessitatesspecialconsiderationswhenappliedtotheCHDpopulationandrequiresgreaterstudyinspecificsubsetsofCHDpatients.

简介：BackgroundChronickidneydisease(CKD)patientsareathighriskofatherosclerosis.Structuralandelasticchangesofcarotidarterywallreflecttherangeanddegreeofatherosclerosisinperipheralarteries,whichcanbeacquiredbyultrasoundradiofrequency-datatechniqueautomaticallyandprecisely.MethodsAtotalof66CKDpatientswithnegativeresultsonroutinecarotidarteryultrasoundexaminationwereenrolled,and30healthyphysicalexamineeswereselectedascontrols.Patientsweredividedinto3groupsaccordingtoCKDstage:stage1-2,stage3-4andstage5.Clinicalcharacteristicsandthelaboratoryresultswereacquired.Intima-mediathickness(IMT)andcompliancecoefficient(CC)ofcommoncarotidarteryweremeasuredbyultrasoundradiofrequencydatatechnique(QIMTandQAS).PredictorsofIMTandCCwereanalyzedrespectively.ResultsAmongthe66patients,15wereonstage1-2,15onstage3-4and36onstage5accordingtoeGFR.ThecommoncarotidarteryIMT(CCIMT)ofalltheCKDgroupsexceptpatientsonstage1-2wassignificantlyincreasedwhencomparedwithcontrols.TheCCofcarotidarterysignificantlywasdecreasedineveryCKDgroupcomparedwithcontrols.AgeandCKDstageweresignificantpredictorsofCCIMTandCCinCKDpatients(P<0.05).AgingandadvancedCKDstagewereassociatedwithincreasedCCIMT(OR=4.855and4.969)anddecreasedCC(OR=32.178and14.068).ConclusionsRadiofrequency-datatechniquecandetectthesmallchangesofstructureandelasticityofcarotidarterywallinCKDpatients.CKDpatientshaveincreasedIMTanddecreasedelasticityofcarotidarterycomparedwithhealthysubjects.AgingandadvancedCKDstageareassociatedwithincreasedCCIMTanddecreasedCC.

简介：BackgroundThisstudytestedthehypothesisthatmoderatealcoholintakeexertsitscardioprotectiveeffectmainlythroughanincreaseintheserumlevelofhigh-densitylipoproteincholesterol.MethodsandResultsIntheCohortofNorway(CONOR)study,149729adultparticipants,recruitedfrom1994to2003,werefollowedbylinkagetotheCauseofDeathRegistryuntil2006.Atrecruitment,questionnairedataonalcoholintakewerecollected,andtheconcentrationofhigh-densitylipoproteincholesterolinserumwasmeasured.UsingCoxregression,wefoundthattheadjustedhazardratioformenfordyingfromcoronaryheartdiseasewas0.52(95%confidenceinterval,0.39-0.69)whenconsumingalcoholmorethanonceaweekcomparedwithneverorrarely.Theratiochangedonlyslightly,to0.55(0.41-0.73),aftertheregressionmodelincludedtheserumlevelofhigh-densitycholesterol.Forwomen,thecorrespondinghazardratioswere0.62(0.32-1.23)and0.68(0.34-1.34),respectively.ConclusionsAlcoholintakeisrelatedtoareducedriskofdeathfromcoronaryheartdiseaseinthefollow-upofalarge,population-basedNorwegiancohortstudywithextensivecontrolforconfoundingfactors.Ourfindingssuggestthattheserumlevelofhigh-densitycholesterolisnotanimportantintermediatevariableinthepossiblecausalpathwaybetweenmoderatealcoholintakeandcoronaryheartdisease.

简介：Background:Ketamineisappliedwidelyforsedationduringcardiaccatheterizationinspontaneouslybreathingchildrenwithcongenitalheartdisease(CHD).However,arareandunreportedrespiratorycomplication,transientandreversibleatelectasisoflungs(TRAL),wasidentified.Purpose:ThestudywasperformedtoinvestigateretrospectivelytheprevalenceandclinicalcharacteristicsofTRALafterketaminesedationinpediatriccardiaccatheterization.Methods:Fourthousandfourhundredandseventy-foursickchildrenweresedatedwithketamine,andpediatriccardiaccatheterizationwascarriedoutunderspontaneousbreathing.TRALwasdetectedin33children(17M/16F,agewas2.1±1.7years)byretrospectiveanalysis.Theclinicalandradiographiccharacteristicswererecordedbefore,duringandafterTRAL.Results:Inpediatriccardiaccatheterization,theprevalenceofTRALwas0.74%afterketaminesedation.TRALoccurredin23childrenwithcyanoticCHD,and10withacyanoticCHD.AllTRALshadcommonclinicalandradiographicfeatures:thediffuseopacityofbilaterallungsdevelopedrapidly(identifiedunderX-rayfluoroscopy),associatedwithdecreaseinlungvolume,andthenthedecreaseinSpO2(94.2±9.2%vs.59.4±2.2%,P<0.05),andheartrates(143.5±14.3bpmvs.58.3±9.7bpm,P<0.05)followedquickly.TRALwasrelievedbysupportiveoxygenin32children(23withfacemask,and9withendotrachealintubation),andthedurationofTRALwas1.6±0.5minutes.However,TRALcausedthedeathofonechild.Conclusions:TRALisarareandurgentrespiratorycomplicationafterketaminesedation,andthemechanismisunclear.RapidanddiffuseopacityofbilaterallungsistheearliestsignofTRALinpediatriccardiaccatheterization,andtheimmediatesupportiveoxygeniscrucial.

简介：Complicationsaremorefrequentinelderlypatientswithcoronaryheartdisease(CHD),suchasimpairedglucosetoleranceandconstipations.Itisalwaysdifficulttocurethesecomplicationsinclinicalpractice.Inthiscasewehadsuccessfullycuredaneighty-threeyearsoldmanwithCHDcomplicatingimpairedglucosetoleranceandconstipationbyintegratedChinese-Westernmedicine.

简介：backgroundStudieshavebeeninconsistentregardingwhetherhyperuricemia,eitherdiuretic-ornondiuretic-induced,isanindependentriskfactorforcardiovascularevents.Thestudyinvestigatedtheassociationofcardiovasculardiseasewithdiuretic-andnondiuretic-inducedelevatedserumuricacid.MethodsAcommunity-basedcross-sectionstudywasconductedin5,235treatedanduntreatedhypertensivepatientsaged40-75years.Conventionalriskfactors,serumuricacidandthepresenceofcardiovasculardiseaseweredetermined.Hyperuricemiawasdefinedasserumuricacidlevels≥420μmol/Linmenor≥360μmol/Linwomen.ResultsHyperuricemiawasmorecommoninmenthaninwomen(21.5%vs.10.2%,P<0.001).Afteradjustmentforageandotherconventionalriskfactors,hyperuricemiawasassociatedwithmetabolicsyndrome,decreasedcreatinineclearance,anduseofdiureticsinbothgenders,aswellasageinwomenandalcoholconsumptioninmen.Thepresenceofcoronaryarterydiseaseorstrokeincreasedsignificantlywiththeincreaseofquartilesofserumuricacid(8.0%,11.0%,13.4%,and16.8%,respectively,P<0.01),andthehighestserumuricacidquartilewasassociatedwitha1.8-foldriskforcardiovasculardisease(OR:1.83,95%CI:1.24-2.71)inuntreatedwomen.Butthisassociationwasnotobservedinuntreatedmenaswellasintreatedpatientsusingdiureticsinbothgenders.ConclusionsHyperuricemiaismarkedlyassociatedwithmetabolicsyndrome,decreasedcreatinineclearance,useofdiureticsbesidesalcoholconsumptioninmenandageinwomen.Elevatedserumuricacid,butnotthatdiuretic-induced,maybeassociatedwithincreasedtheriskofcardiovasculardiseaseinuntreatedhypertensivewomen.

简介：ObjectivesToinvestigatethechangeandclinicalsignificanceofclopidogrelonplateletmembraneCD40Lincoronaryarterydiseasepatientsbeforeandafterpercutaneouscoronaryintervention(PCI).Methods30caseswhowerediagnosiscoronaryarterydiseases(CAD)bycoronaryangiography,meanage56±9yearsold.Allthepatientswhohadnoantiplateletaggregationcontraindication,weretreatedwithstandardantianginapectorisdrugs.BeforePCI,allthepatientstookclopidogrel75mgperday.ActivatedplateletmembraneCD40LexpressratewasmeasuredbyflowcytometrybeforeandafterPCI6hours.ResultsActivatedplateletmembraneCD40Lexpressratewere3.73±2.15and2.46±0.90,respectivelyin30patientsbeforeandafterPCI6hours.ActivatedplateletmembraneCD40LexpressratewassignificantlydecreaseafterPCI6hoursthanthatbeforePCI(P<0.01).ConclusionsClopidogrelhassignificanceeffectonplateletmembraneCD40LincoronaryarterydiseasepatientsundergoingPCI.Clopidogrelcansuppressionplateletactivationandpreventthromboembolismeventoccurrence.

简介：BackgroundValvularheartdisease(VHD)isdefinedasastructuralorfunctionalabnormalityincardiacvalvewhichencompassesanumberofcommoncardiovascularconditions.ThisstudywasaimedtoanalyzetheepidemiologicalchangesofVHDinasinglecardiovascularcenterofSouthernChina.MethodsAtotalof13,138VHDpatientsofGuangdonggeneralhospitalfromJanuary2011toDecember2013werescreenedbytransthoracicechocardiography(TTE)ortransesophagealechocardiography(TEE)andenrolledforthisstudy.Themorbidity,etiologicalspectrumandmanagementofthesepatientswereanalyzed.Continuousvariableswereexpressedasmean±standarddeviation.Categoricalvariableswereexpressedasratioorpercentage.ResultsPatientsinthisstudyweredividedintodifferentgroupsandwereanalyzedthroughoutchangesinmorbidity,etiologicalspectrumandmanagement.ConclusionsTheprevalenceofVHDremainshighinSouthernChinaandRHDisstilltheleadingetiologyofVHD.Butmorbidityrateisreducedandsurgeryisstillthemaintreatmentoption.

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简介：BackgroundTotheeffectofpercutaneouscoronaryintervention(PCI)onplasmalevelofN-terminalpro-Btypenatriureticpeptide(NT-proBNP)inpatientswithcoronaryheartdisease(CHD)andnormalleftventricularfunction.MethodsOnehundredandfivepatientswithCHDandnormalventricularfunctionwereenrolled.BloodsamplesforassessmentofNT-proBNPandcTn-TwerecollectedbeforeandafterPCI.ResultsThemeanleftventricularejectionfractionwas60.3±5.3%.Afterrevascularization,theleveloflgNT-proBNPwassignificantlyreduced(2.40±0.44vs2.23±0.43,P<0.001).SubgroupanalysisshowedthattheleveloflgNT-proBNPwasconsistentlydecreasedindifferentclinicalclassifications(stableangina45,unstableangina31andacutemyocardialinfarction29)andtarget-vesselrevascularization(leftanteriordescendingartery30,leftcircumflexartery26andrightcoronaryartery49),andin99patientswithoutelevationofpost-proceduralcTnT,butitshowedatrendofnon-significantincreasein6patientswithelevatedcTn-T.ConclusionsOurstudydemonstratesthatsuccessfulPCIreducesplasmaNT-proBNPconcentrationinpatientswithCHDandnormalventricularfunction.ThisimplicatesthattheimpactofPCIshouldbeconsideredintheinterpretationofNT-proBNPchangeinclinicalpractice,andfurtherstudiesarenecessarytoinvestigatethedirectand/orindirecteffectofmyocardialischemiaonBNP/NT-proBNP.

简介：BackgroundSepticshockcausedbybacteremiaisalife-threateninginfectionwhoseprognosisishighlydependentonearlyrecognitionandappropriatetreatment.Procalcitonin(PCT)hasbeenshowntoaccuratelyandquicklydistinguishbacteremiafromnoninfectiousinflammatorystatesincriticallyseverepatients.However,theextentofPCTmagnitudeelevationaccordingtotheGramstainresultinelderlypatientswithcoronaryheartdisease(CHD)attheonsetofsepticshockcausedbybacteremiavaries,andhasnotbeenclearlyelucidated.MethodsThemedicalrecordsofadvancedage(non-neutropenic)patientwithCHDandsepticshockbetweenMar2013andJun2015whohadbacteremiacausedbyeitherGram-positive(GP)bacteriaorGram-negative(GN)bacteriawerereviewed,andthelevelsofPCT,C-reactive(CRP)proteinandwhitebloodcellscount(WBC)inbothgroupswereanalyzed.Results75episodesofeitherGNbacteremia(n=40)orGPbacteremia(n=35)wereenrolled.PCTlevelswerefoundtobemarkedlyhigherinpatientswithGNbacteremiathaninthosewithGPbacteremia[(8.93±17.58)vs.(64.42±58.56)ng/L(P<0.001)],whereastherewasnosignificantdifferenceinCRPandWBC(P>0.05).Moreover,ahighPCTlevelwasfoundtobeindependentlyassociatedwithGNbacteremiainthisstudypopulation.APCTlevelof19.69ng/mLyieldeda72.5%sensitivity,a91.4%specificity,an8.43positivelikelihoodratioanda0.30negativelikelihoodratioforGN-relatedbacteremiainthestudycohort[AUROCC=0.870(0.041),95%CI(0.790-0.949)].ConclusionInanelderlypatient(non-neutropenic)withCHDandsepticshock,GNbacteremiacouldbeassociatedwithhigherPCTvaluesthanthosefoundinGPbacteremia(PCT>19.69ng/mL).

简介：Background:Thesafetyandefficacyofcoronaryarterybypassgrafting(CABG)andsecond-generationdrug-elutingstents(DESs)inpatientswithcoronaryarterydisease(CAD)remaincontroversial.ThereforeweaimedtocomparetheoutcomesofCADpatientstreatedwithCABGandsecond-generationDESs.Methods:WesystematicallysearchedthePubMed,CochraneLibrary,Ovid,andElsevierdatabases.Studiescomparingsecond-generationDESswithCABGinCADpatientswereincluded.RevMan5.3wasusedtoextractandpoolthedatafromtheapplicablestudies.Results:Sixtrials(N=6604participants)wereincludedinthismeta-analysis.AmongalloftheCADpatients,second-generationDESswereassociatedwithnodifferencesintherisksofall-causedeath[riskratio(RR)1.18,95%confidenceinterval(CI)0.98–1.43,P=0.09],cardiovasculardeath(RR1.14,95%CI0.81–1.59,P=0.45),myocardialinfarction(RR1.22,95%CI0.98–1.54,P=0.08),andstroke(RR0.83,95%CI0.59–1.17,P=0.29),butincreasedtherisksofrevascularization(RR1.95,95%CI1.66–2.30,P<0.001)andmajoradversecardiacandcerebrovascularevents(RR1.72,95%CI:1.31–2.26,P<0.001)whencomparedwithCABG.Conclusions:InthetreatmentofCADpatients,second-generationDESswasnotassociatedwithincreasedrisksofall-causedeath,cardiovasculardeath,myocardialinfarction,andstroke,butincreasedtherisksofrevascularizationandmajoradversecardiacandcerebrovasculareventswhencomparedwithCABG.

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简介：BackgroundItiswellknownthattherewasasignificantlinkbetweenpreproceduralbloodglucoselevelsandshort-termandlong-termadverseoutcomesinpatientsundergoingelectivePCI.However,theroleofpre-proceduralbloodglucoselevelsasapredictorofadverseeventsinCKDpatientswhounderwentPCIoutofestablisheddiabeteshasyettobeidentified.MethodsInourstudy,weconductedaprospectivestudyof331acutecoronarysyndrome(ACS)patientswithCKDwhounderwentPCIoutofestablisheddiabetes.Patientsweredividedintotwogroupsbasedonpre-proceduralglucoselevels(hypoglycemia<7.0mmol/L;hyperglycemia≥7.0mmol/L).Allpatientswerefollowedupprospectivelyformajoradversecardiovascularevents(MACEs)andmortalityfor6months.ResultsInourcohort,hyperglycemiapatientsreportedahigherincidenceofin-hospitalmortalitythanhypoglycemiapatients(7.5%vs.0%,P<0.001).Hyperglycemiapatientsreportedasignificantlyhigherrateof6-monthMACEs(10%vs.2.4%,P=0.007),allcausemortality(7.5%vs.1.6%,P=0.015),andcardiovascularmortality(6.2%vs1.6%,P=0.041)comparedwithhypoglycemiapatientswithpre-proceduralglucoselevels<7.0mmol/L.Multivariateanalysisdisclosedthatapre-proceduralglucoselevel≥7.0mmol/LwasasignificantindependentpredictorofMACEs(OR=2.53,95%CI1.68-17.15,P=0.004),allcausemortality(OR=4.6,95%CI1.10-18.84,P=0.036),andcardiovascularmortality(OR=6.2,95%CI1.53-24.94,P=0.011)at6monthsinpatientsafterPCI.ConclusionThestudysuggestedthatpre-proceduralglucoselevelsareassociatedwithshort-termcardiovascularoutcomeCKDpatientswhounderwentPCIwithoutestablisheddiabetesinthesettingofACS.