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To explore the correlation between incidence of atrial fibrillation (AF) and thyroid dysfunction.Patients with stable angina pectoris with thyroid function test results hospitalized at Fuwai Hospital from 2011 Jan to 2011 Dec were included in this analysis (n = 2 541). General clinical data and related biochemical parameters were analyzed. We divided patients into 5 subgroups according to TSH levels:0.55 mIU/L (n = 105), 0.55-2.49 mIU/L (n = 1599), 2.50-4.77 mIU/L (n = 621), 4.78-9.99 mIU/L (n = 180),10.00 mIU/L (n = 36).A total of 157 patients were diagnosed with AF (6.8%). (1) Compare to stable angina pectoris patients without AF, stable angina pectoris patients with AF have older age (P0.001), higher proportion of female (P = 0.04), uric acid (P0.001), NT-proBNP (P = 0.001), larger left atrial diameter (P0.001), left ventricular end diastolic diameter (P0.001) and lower LVEF (P = 0.038), FT3(P = 0.002), TT3 (P0.001). (2) When TSH levels were less than 0.55,0.55-2.49, 2.50-4.77, 4.78-9.99 mIU/L and greater than 10.00 mIU/L, the incidence of AF were 7.6% (8/105) , 5.7% (91/1 599), 7.9% (49/621), 9.4% (17/180) and 22.2% (8/36), respectively. Both a high and a low TSH level were associated with an increased incidence of AF. After adjustment for common risk factor (age, gender and so on) , stepwise multiple logistic regression analysis revealed that TSH levels were significantly related with the incidence of AF. Compared to patients with TSH 0.55-2.49 mIU/L, the adjusted odds ratio of AF for TSH0.55, 2.50-4.77, 4.78-9.99,10.00 mIU/L were 1.37 (95%CI 0.65-2.90, P = 0.415), 1.42 (95CI 0.99-2.04, P = 0.057), 1.73 (95%CI 1.01-2.97, P = 0.048), 4.74 (95%CI 2.10-10.69, P0.001), respectively.Our results show that incidence of AF increases in proportion to TSH level in patients with stable angina pectoris.

To evaluate the gender differences on the short-term outcomes of patients with acute myocardial infarction in the real world.A total of 471 consecutive patients [male 368(78.1%) and female 103(21.9%)] with acute myocardial infarction72 hours in cardiac care unit were included. The clinical data, death and major adverse cardiac and cerebrovascular events at 30 days post hospitalization were analyzed.Female patients were older (66.8 ± 10.1 vs. 56.9 ± 12.0, P0.001), TIMI score (5.1 ± 2.3 vs. 3.9 ± 2.1, P0.001) and GRACE score (162 ± 39 vs. 142 ± 35, P0.001) in female patients were higher than in male patients. Female patients had lower proportion of stent implantation (P = 0.038) while higher percentage of complex lesions and contraindications to PCI (P = 0.015) compared to male patients. Proportion of cardiac rupture, mitral regurgitation, malignant arrhythmia, post-infarction angina pectoris, contrast-induced nephropathy and minor gastrointestinal bleeding were also higher in female patients tan in male patients (P0.05). Thirty-day mortality was significantly higher in female patients than in male patients [5.8% (6/103) vs. 1.9% (7/368), P = 0.032], MACCE [10.7% (11/103) vs. 5.4% (20/368), P = 0.058] also tended to be higher in female patients than in male patients. Multi-logistic regression analysis showed that female gender was not an independent predictor for thirty-day mortality (P = 0.141) or MACCE (P = 0.426) while systolic blood pressure (OR = 1.072, 95%CI:1.016-1.130, P = 0.010) and pericardial effusion after myocardial infarction (OR = 40.518, 95%CI:1.098-1495.702, P = 0.044) were independent predictors for thirty-day mortality while systolic blood pressure (OR = 1.027, 95%CI:1.002-1.052, P = 0.036) and left ventricular ejection fraction (OR = 1.108, 95%CI:1.032-1.190, P = 0.005) were independent predictors for MACCE.Female gender itself is not an independent predictor for thirty-day mortality and MACCE despite poorer clinical characteristics, higher incidence of complications, and worse prognosis in female patients.

To evaluate the safety and feasibility of carotid artery stenting (CAS) for treating patients with coexisting carotid and coronary artery disease.The clinical data of 237 consecutive patients [(66.1 ± 7.7) years old, 79.7% male] with coexisting carotid and coronary artery disease undergoing CAS in Fuwai hospital from January 2005 to June 2010. The patients were analyzed retrospectively.Indication for CAS was defined as carotid artery diameter reduction of60% (symptomatic) or80% (asymptomatic) with suitable carotid artery anatomy for stenting. Thirty-day rates of stroke, death and myocardial infarction after CAS were assessed.All patients suffered from coronary artery disease, of whom 87(36.7%) had unstable angina pectoris and 82(34.6%) had recent myocardial infarction (30 days). The procedural success rate of CAS was 99.2 % (235/237). Cerebral protection devices were used in 234 patients (99.6%). Among them, 36(15.2%) patients received simultaneous bilateral CAS and 79(33.3%) patients underwent simultaneous percutaneous intervention of other non-coronary arteries.Within 30 days after CAS, 127(53.6%) patients underwent coronary revascularization, including 118(49.6%) coronary artery bypass grafting and 9 (3.8%) percutaneous coronary intervention. The rate of major stroke, minor stroke, death and myocardial infarction from time of CAS to 30 days was 2.1% (5/237), 3.0% (7/237),0.4% (1/237) and 0.4% (1/237) respectively.Data from this study indicate that CAS is safe and feasible for treating patients with coexisting carotid and coronary artery disease with a low incidence of periprocedural complication rate.

To assess the clinical outcomes of rotational atherectomy followed by drug-eluting stenting via the transradial approach for the treatment of heavily calcified coronary lesions.From January 2009 to October 2012, 114 consecutive patients with heavily calcified coronary lesions underwent rotational atherectomy and drug-eluting stents via transradial approach in our hospital were enrolled in this retrospective study. Characteristics of heavily calcified coronary lesions, the success rates of rotational atherectomy and stenting, rates of complication during perioperative treatments, and adverse cardiovascular events during hospitalization and follow up were analyzed.All 114 patients were successfully treated with rotational atherectomy and drug-eluting stent placement, and totally 120 target lesions of type B or C were treated including 8 left main lesions, 93 left anterior descending and 2 circumflex, 17 right coronary lesions. No-reflow was observed in 7 patients during the procedure, there was one case of entrapped rotablator burr which was successfully retrieved together with guiding catheter without serious complication. During the 6 months (median) follow-up, angina was reported in 11 patients and revascularization was performed in 8 patients due to stent restenosis and intensified medical therapy was applied in 3 patients. There was no acute myocardial infarction and death during follow-up.Rotational atherectomy followed by drug-eluting stenting via transradial approach is feasible, effective and safe and the short-term outcome is satisfactory for patients with heavily calcified coronary lesions.

To analyze the short-term prognosis and risk factors of ventricular septal rupture (VSR) following acute myocardial infarction (AMI).A total of 70 consecutive VSR patients following AMI hospitalized in our hospital from January 2002 to October 2010 were enrolled in this study. We compared the clinical characteristics of patients with VSR who survived ≤ 30 days (n = 39) and survived30 days (n = 31) post AMI. A short-term prognosis index of VSR (SPIV) was established based on the logistic regression analysis.The single factor analysis showed that the risk factors of death within 30 days of VSR patients were female, anterior AMI, Killip class 3 or 4, apical VSR and non-aneurysm (all P0.05). Logistic regression analysis revealed that female (P = 0.013), anterior AMI (P = 0.023), non-aneurysm (P = 0.023), non-diabetes (P = 0.009), Killip class 3 or 4 (P = 0.022) and time from AMI to VSR less than 4 days (P = 0.027) were independent risk determinants for death within 30 days post VSR. Patients with SPIV ≥ 9 were associated with high risk [77.4% (24/31)] of dying within 30 days post AMI. SPIV ≤ 8 were associated with low risk as the 30 days mortality is 28.6% (8/28).Female gender, anterior AMI, non-aneurysm, non-diabetes, Killip class 3 or 4 and time from AMI to VSR less than 4 days are independent risk factors of short-term mortality of VSR.

To detect the single nucleotide polymorphisms of clopidogrel metabolism related genes (CYP2C19, ABCB1 and PON1) in Chinese patients with acute coronary syndrome (ACS) by genotype analysis.Genetic analysis was performed in patients admitted to Fuwai Hospital from 2005 to 2008 with ACS within 4 weeks. The detection of polymorphisms was performed by TaqMan real-time PCR method. The alleles genotyped were CYP2C19 *2-*8, *17, ABCB1 C3435T, PON1 Q192R and PON1 L55M. Minor allele frequency (MAF) was calculated. Patients were classified as one of the 5 categories by clopidogrel metabolizer phenotypes as extensive [without any "loss-of-function" (LOF) allele *2-*8 or "gain-of-function" (GOF) allele *17], intermediate (with only one LOF allele), Poor (with two or more LOF alleles), ultra (with one or two GOF alleles) or unknown (with one LOF allele and one GOF allele).A total of 2800 ACS patients were enrolled [mean age (59.0 ± 12.3) years and 2236 males (79.9%)]. There were 74% patients with ST-segment elevation myocardial infarction (STEMI, n = 2072), 22.0% patients with non-ST-segment elevation myocardial infarction (NSTEMI, n = 617) and 4.0% patients with unstable angina (UA, n = 111). The minor allele frequency (MAF) for each genotype of CYP2C19 *2, *3, *4, *17 was 28.7%, 4.6%, 0.1% and 1.2%, respectively. There was no LOF allele *5-*8 in the study population. The MAF for ABCB1 C3435T, PON1 Q192R and PON1 L55M was 39.4%, 37.8% and 4.4%, respectively. Clopidogrel metabolizer groups were defined as extensive in 41.7%, intermediate in 45.6%, poor in 10.3%, ultra in 1.9% and unknown in 0.6% patients, respectively. There were no significant differences for all genotypes between males and females. Total LOF carriers of CYP2C19 were 56.4% and GOF carriers were 2.5%.Our study demonstrated a high distribution of the LOF allele of CYP2C19 in China ACS population.

Myocardial edema plays an important role in the development of myocardial no-reflow and reperfusion injury after the revascularization of acute myocardial infarction (AMI). The present study investigated whether the effect of ischemic preconditioning (IPC) against myocardial no-reflow and reperfusion injury was related to the reduction of myocardial edema through the protein kinase A (PKA) pathway.Twenty-four minipigs were randomized into sham, AMI, IPC, and IPC + H-89 (PKA inhibitor, 1.0 µg · kg(-1) · min(-1)) groups. The area of no-reflow (ANR), area of necrosis (AN), and water content in left ventricle and ischemic-myocardium and non-ischemic area were determined by pathological studies. Microvascular permeability was determined by FITC-labeled dextran staining. Cardiomyocyte cross-sectional area (CSA) and mitochondria cross-sectional area (MSA) were evaluated by histological analysis. Myocardial expression of aquaporins (AQPs) was detected by Western blot.Compared with the MI group, the sizes of no-reflow and infarct were reduced by 31.9% and 46.6% in the IPC group (all P0.01), water content was decreased by 5.7% and 4.6% in the reflow and no-reflow myocardium of the IPC group (all P0.05), microvascular permeability and cardiomyocytes swelling in the reflow area were inhibited by 29.8% and 21.3% in the IPC group (all P0.01), mitochondrial water accumulation in the reflow and no-reflow areas of the IPC group were suppressed by 45.5% and 34.8% respectively (all P0.01), and the expression of aquaporin-4, -8, and -9 in the reflow and no-reflow myocardium were blocked in the IPC group. However, these beneficial effects of IPC were partially abolished in the IPC + H-89 group.The cardioprotective effects of IPC against no-reflow and reperfusion injury is partly related to the reduction of myocardial edema by inhibition of microvascular permeability and aquaporins up-regulation via PKA pathway.

To investigate the neointimal coverage at the very early phase after drug-eluting stent (DES) implantation using optical coherence tomography (OCT).OCT examination was performed immediately after stent deployment and about one week post stenting in 12 patients with coronary artery disease to detect neointimal coverage and stent thrombus. Sirolimus eluting stent implantation was also performed in 5 healthy Chinese minipigs, OCT and histopathology examination were made one week later in these minipigs.(1) Twenty-nine DES were implanted in 12 patients. There was no major cardiovascular event post stenting. The mean time of follow-up was (7.7 ± 2.6) d, the mean percentage of stent coverage was (21.8 ± 17.7)%, and neointimal hyperplasia thickness was (42.9 ± 32.2) µm and the percentage of malapposition struts was (1.5 ± 3.0)%, respectively. Mural stent thrombus was found in 2 of the 12 patients (the percentage is 16.7%). (2) In the minipigs model, OCT evidenced that (43.2 ± 11.5)% struts were covered by neointima with a mean neointimal hyperplasia thickness of (24.0 ± 8.5) µm at one week. Histopathology examination illustrated that the neointima was mainly consisted of proteoglycan, inflammation cells, fibrin and organized thrombus at the very early phase after DES implantation, while endothelial cells were barely found on the neointima.Neointimal coverage is found as early as one week after DES implantation by OCT. The covered struts rate is very low and the main components of neointima are proteoglycan, inflammation cells, fibrin and organized thrombus. Re-endothelialization is rather poor at the very early phase post DES implantation.

To analyze the cause of in-hospital death among acute myocardial infarction patients undergoing primary percutaneous coronary intervention (PPCI) in Beijing area to evoke better individualized preventive approach.In-hospital mortality and causes were analyzed based on database from Beijing percutaneous coronary intervention registry study (BJPCI Registry) in 2010.A total of 4660 PPCI patients from 48 hospitals were included. In-hospital mortality was 2.4% (n = 110). Cardiogenic shock (39.1%, 43/110), mechanical complications (28.2%, 31/110) and intervention-related complications [28.2%, 31/110: procedure related (n = 28), drug related (n = 3)] were the leading causes of in-hospital death. Five deaths was attributed to comorbidity related reason (4.5%, 5/110). The in-hospital mortality had no significant difference among hospitals of different grade or total annual PCI (all P0.05). In-hospital mortality was slightly higher in hospital with annual PPCI300 than in hospitals with annual PPCI ≥ 300 (2.9% vs. 1.8%, P0.05).Cardiogenic shock, mechanical complications and intervention-related complications are the main causes of in-hospital death among acute myocardial infarction patients receiving PPCI.

To evaluate the safety and feasibility of simultaneous bilateral carotid stenting for treating patients with bilateral atherosclerotic carotid stenosis.The clinical data of 39 consecutive patients with bilateral atherosclerotic carotid stenosis undergoing simultaneous bilateral carotid artery stenting in Fuwai hospital from January 2005 to December 2009 were collected and analyzed retrospectively. The reduction of the angiographic diameter stenosis after stenting and clinical outcomes of 30 days after stenting including hyperperfusion syndrome, hemodynamic depression, stroke, myocardial infarction and death were assessed.The patients were 43 - 78 (65.9 ± 8.5) years old, and there were 25 (64.1%) male. Carotid stenting procedure success rate was 100%. Distal embolic protection devices were used in all patients, and 20 (51.3%) out of 39 patients underwent coronary artery bypass surgery after carotid stenting. The angiographic diameter stenosis reduced from (87.0 ± 5.8)% to (10.2 ± 5.6)% after stenting (P0.01). Up to 30 days after carotid artery stenting, the incidence of hyperperfusion syndrome, hemodynamic depression, minor stroke, major stroke, myocardial infarction and death was 2.6% (1/39), 28.2% (11/39), 5.1% (2/29), 0, 2.6% (1/39), 2.6% (1/39), respectively.The data show that simultaneous bilateral carotid stenting is a technically feasible and safe alternative for patients with severe bilateral atherosclerotic carotid stenosis.

To explore clinical outcomes of patients undergoing emergent coronary artery bypass grafting (CABG) following failed percutaneous coronary intervention (PCI) in the stent era.Eleven patients who underwent emergent CABG following failed PCI from January, 2002 to December 2010 were enrolled. The in-hospital follow-up included cardiac deaths, Q-wave myocardial infarction, kidney failure, and cerebrovascular events. The clinical end-point of out-hospital follow-up was the major adverse cardiac events including death, myocardial infarction, and target lesion revascularization.The patients were (61 ± 5) years old. Coronary angiography showed 5 patients had triple vessel lesions. There were 9 target lesions on left anterior descending artery. There were 3 (27.3%) severe calcified, 4 (36.4%) chronic total occlusion, and 4 (36.4%) diffused long lesions. Reasons for emergent CABG were dissection (n = 5, 45.5%), perforation (n = 3, 27.3%), failure to sufficient predilation (n = 1, 9.1%), acute closure (n = 1, 9.1%) and stent loss (n = 1, 9.1%). The average duration of follow-up was (47 ± 33) months. During in-hospital follow-up, there were 1 (9.1%) cardiac death and 2 (18.2%) Q wave myocardial infarction. During follow-up after hospital discharge, 1 patient (9.1%) died of kidney failure, and there was no rehospitalization due to cardiac events.Emergent CABG after failed PCI often happened in patients with complex coronary lesions. The long term outcome of patients requiring emergent CABG after failed PCI was favorable in this cohort.

The study aimed to evaluate the value of plasma NT-proBNP in diagnosing heart failure in patients with previous myocardial infarction.Plasma concentration of NT-proBNP was measured in patients with previous myocardial infarction by ELISA method at admission. Patients were divided into non heart failure group (NYHA class I) and heart failure group (NYHA class II-IV). The NT-proBNP levels were compared between NYHA class I, II, III and IV, and between heart failure group and non heart failure group. ROC analyses were performed to evaluate the diagnosing value of plasma NT-proBNP for heart failure and to identify the optimal cut-off point for diagnosing heart failure patients.Total 586 patients [aged from 25 - 83 (58 ± 11) years, 80% male] with previous myocardial infarction were enrolled in his study (n = 374 of NYHA class I, n = 99 of NYHA classes II, n = 82 of NYHA class III, n = 31 of NYHA class IV). Plasma NT-proBNP levels in these four NYHA classes were 484.7 (381.6, 647.8) pmol/L, 907.6 (516.6, 1290.3) pmol/L, 1420.2 (879.5, 2336.2) pmol/L, 2442.6 (1695.4, 3670.7) pmol/L, respectively (P0.01). The plasma NT-proBNP level in heart failure group was significantly higher than in non heart failure group [1148.2 (707.9, 2145.3) pmol/L vs. 484.7 (381.6, 647.8) pmol/L, P0.01]. Plasma NT-proBNP level in patients with age ≥ 60 years was significantly higher than patients with age60 years [702.3 (472.4, 1208.5) pmol/L vs. 526.6 (392.1, 855.6) pmol/L, P0.01]. ROC analysis showed that the area under the curve (AUC) for diagnosing heart failure was 0.844 (95%CI: 0.809 - 0.880, P0.01), the optimal plasma NT-proBNP cut-off point for diagnosing heart failure was 700 pmol/L with a sensitivity of 75.9%, a specificity of 79.9%, an accuracy of 78.3%, a positive predictive value of 67.9% and a negative predictive value of 85.3%. The optimal plasma NT-proBNP cut-off point was 600 pmol/L for patients ≥ 60 years old and 800 pmol/L for patients60 years old.Plasma NT-proBNP level is a valuable parameter for diagnosing heart failure in patients with previous myocardial infarction.

The effect of mesenchymal stem cells (MSCs) transplantation is poor because of the harsh environment post infarction. Our previous studies have proven that Statins could enhance the implanted bone marrow MSCs survival, but the exact mechanism remained to be clarified. We hypothesized that atorvastatin (Ator) could protect MSCs from hypoxia and serum-free (H/SF) induced apoptosis and investigated the potential mechanisms.Chinese mini-swine's bone marrow derived MSCs were cultured in vitro and exposed to hypoxia and H/SF, Ator of various concentrations (0.001 - 10 µmol/L), AMPK inhibitor-compound C (CC), PI3K inhibitor-LY294002 (LY), Ator + CC and Ator + LY. Cell apoptosis was assessed using Annexin V/Prospidine Iodine kit by flow cytometry. Phosphorylation of AMPK, Akt, endothelial nitric oxide synthase (eNOS) level and phosphorylation were tested with Western blot. Real Time-PCR was performed to analyze the gene expression of AMPK, Akt and eNOS.MSCs apoptosis in Ator (0.01 - 10 µmol/L) treated H/SF groups was significantly reduced compared with H/SF group (1.94% - 6.10% vs. 10.94%, P0.01 or 0.05). Apoptosis was higher in Ator + CC group than in 1 µmol/L Ator group (4.94% ± 0.98% vs. 2.59% ± 0.84%, P0.01) and similar between Ator + LY and 1 µmol/L Ator group (2.02% ± 0.45% vs. 2.59% ± 0.84%, P0.05). The gene expressions of AMPK, Akt and eNOS were significantly upregulated in atorvastatin treated groups. Meanwhile, phosphorylation of AMPK and eNOS increased in MSCs treated with atorvastatin (P0.01 or 0.05). Phosphorylation of eNOS significantly correlated with AMPK phosphorylation (r = 0.599, P = 0.004), but not with Akt phosphorylation (P = 0.263).Atorvastatin can protect MSCs from H/SF induced apoptosis through AMPK pathway, which resulting in activation of eNOS.

To analyze the incidence of coronary artery disease (CAD) and outcome of patients with left ventricular noncompaction (LVNC).Fifty-one patients with LVNC evaluated by echocardiography and/or cardiac magnetic resonance (CMR) from January 2006 to August 2010 were retrospectively reviewed. Coronary angiography or MDCT was performed for detecting coronary artery disease. Predictors of the cardiac events were analyzed by Cox regression analysis.There were 31 LVNC patients without CAD and 20 LVNC patients with CAD including single vessel coronary disease in 9 cases, double vessel coronary disease in 3 cases, three vessel coronary disease in 5 cases and left main coronary disease in 3 cases. Coronary artery bypass graft and percutaneous coronary intervention (PCI) were performed in 4 patients. Compared to LVNC patients without CAD, mean age (P = 0.008), incidence of hypertension (65.0% vs. 19.4%, P = 0.001), diabetes mellitus (40.0% vs. 12.9%, P = 0.026) and hyperlipidemia (55.0% vs. 25.8%, P = 0.035) were significantly higher while NT-proBNP level was significantly lower (P = 0.049) in LVNC patients with CAD. Incidence of major cardiac events was similar in LVNC patients with or without CAD. LogNT-proBNP is the independent prognostic factor for adverse cardiac events in patients with LVNC (HR 3.993, 95%CI 1.140 - 13.988, P = 0.030).Coronary artery disease is common in patients with LVNC and associated with traditional risk factors for CAD. Poor prognosis is associated with increased NT-proBNP but not with CAD in this patient cohort.

To investigate the impact of cytochrome P450 (CYP) 2C19 681GA polymorphism on long-term prognosis of clopidogrel-treated Chinese patients after percutaneous coronary intervention (PCI).Between January 1, 2009 and August 31,2009, 267 patients with coronary heart disease who received PCI and treated with clopidogrel for 12 months were enrolled. CYP2C19 * 2 was detected by MALDI-TOF MS and patients were grouped into CYP2C19 * 1/ * 1 (n = 130) and CYP2C19 * 2 carriers group (n = 137). Follow-up was 12 months. The primary endpoint was angina recurrence, urgent coronary revascularization, acute myocardial infarction, stent thrombosis, death and the combined end points.Baseline data were similar between two groups (P0.05). Urgent coronary revascularization and the combined end points occurred more frequently in CYP2C19 * 2 carriers than in CYP2C19 * 1/* 1 patients (7.3% vs. 1.5% and 8.0% vs. 2.3% respectively, all P0.05). But incidence of angina recurrence, acute myocardial infarction, stent thrombosis and death was similar between two groups (all P0.05). Hazard risk of 1 year cumulative survival of CYP2C19 * 2 carriers group was significantly higher than CYP2C19 * 1/ * 1 group after PCI ( HR = 3.59, 95% CI: 1.02 - 12.87, P0.05).CYP2C19 681GA polymorphism is a determinant of prognosis in coronary heart disease patients receiving chronic clopidogrel treatment after PCI.

To evaluate the diagnostic value of NT-proBNP in aortic stenosis (AS) patients with heart failure.We measured the whole venous blood of NT-proBNP with enzyme linked immuno sorbent assay (Biomedica, Vienna, Austria) in 40 AS patients with heart failure and 76 normal subjects and assessed the diagnostic value of NT-proBNP for heart failure.NT-proBNP levels were significantly higher in AS patients with heart failure compared to controls (P0.01). The level of NT-proBNP increased in proportion to the increase of NYHA functional classes (all P0.01). The level of NT-proBNP was similar between compensated heart failure group and control group (P0.05) and significantly (8 times) increased in decompensated heart failure group (P0.01 vs. control group). NT-proBNP level was also significantly higher in LVEDD50 mm group than that in LVEDD ≤ 50 mm group (P0.05) and in LVEF ≤ 60% group than that in LVEF60% group (P0.01). Patients with atrial fibrillation also had higher NT-proBNP levels compared to those with sinus rhythm (P0.05). The NT-proBNP value of 1360 ng/L was determined as the best cutoff value for the diagnosis of AS patients with heart failure (AUC = 0.762, P0.01) and decompensated heart failure (AUC = 0.997, P0.01), the sensitivity, specificity and accuracy were 67.50% and 100.00%, 96.05% and 96.05% and 86.21% and 95.83%, respectively. Log (NT-proBNP) was positively related with NYHA functional class and negatively related with LVEF in univariate analysis and multiple regression analyses (P0.05). NT-proBNP was independent correlative with NYHA functional class and LVEF.NT-proBNP has a fairly good diagnostic potential for the identification of AS patients with heart failure. The accuracy is 86.21% for the diagnosis of AS patients with heart failure and 95.83% for decompensated heart failure with the diagnostic cutoff value of 1360 ng/L.

To compare the clinical characteristics and clinical outcomes in young (/ = 45 years) female and male coronary artery disease (CAD) patients undergoing percutaneous coronary intervention (PCI).Angiographic and clinical data from 124 premenopausal female patients who underwent elective PCI from April 2004 to February 2008 were compared to age-matched 430 male patients who underwent elective PCI between 2006 and 2007 in our department. All patients were treated according to guidelines and coronary angiography was repeated after 6 months. One year clinical follow-up were performed in all patients.Incidences of dyslipidemia, the history of myocardial infarction and smoking were significantly lower in female patients than in male patients (all P0.01). Left main, left anterior descending and bifurcation lesions were more common while type C lesion and right coronary lesion were less common in young female CAD group compared to young male CAD group (P0.01-0.05). The average lesion length in female patients was significantly longer than that in male patients [(20.36 +/- 13.37) mm vs. (23.04 +/- 13.86) mm, P0.05]. The in-hospital and follow-up incidences of major adverse cardiac events, stent thrombosis and in-stent restenosis were similar between young female and male CAD patients.CAD risk factors were less and vessel lesions were more likely to be found at left main, left anterior descending and bifurcation in young female CAD patients compared to young male CAD patients. The clinical outcomes were similar between young female and male CAD patients.

To evaluate the efficacy of one-stop hybrid coronary revascularization [simultaneous minimally invasive direct coronary artery bypass surgery (MIDCAB) and percutaneous coronary intervention (PCI) procedures performed in an enhanced (or called "hybrid") operative unit] for the treatment of unprotected left main coronary artery (ULMCA) disease.From June 2007 to April 2009, 14 patients [13 male, mean age: (60.4 +/- 15.4) years] underwent the one-stop hybrid approach in the "hybrid" operating room. Proximal lesions were evidenced in 5 patients and distal or bifurcation lesions in 11 patients. MIDCAB procedure for grafting of the left intramammary artery (LIMA) with the left anterior descending (LAD) artery was first performed via lower partial ministernotomy on the beating heart, followed by PCI on the LMCA disease and non-LAD coronary lesions.Operation was successful in all patients underwent the one-stop hybrid procedure. LIMA grafts were used in all 14 patients and confirmed to be patent by angiography. A total of 25 non-LAD coronary lesions were treated by PCI and 29 stents (27 drug-eluting stents and 2 bare-mental stents) were implanted to 23 lesions and coronary angioplasty was performed in the remaining lesions. There was no death, perioperative myocardial infarction, stroke or repeat revascularization during the procedure and the follow-up period. All the patients remained free from angina during the 7.9 months (range 1 - 15 months) follow-up period. LIMA grafts and stents were patent in 5 patients at 1-year follow-up.Our initial experience demonstrates that one-stop hybrid coronary revascularization provides a reasonable, feasible and safe alternative for selected patients with LMCA diseases.

Primary indications for endomyocardial biopsy (EMB) include heart transplant rejection surveillance and identifying cardiomyopathy or myocarditis. EMB procedures have not yet gained widespread acceptance because of concerns about possible complications associated with EMB procedures. In this single-center retrospective study, we analyzed the incidence of major and minor EMB procedure-related complications of 439 EMBs during the past 4.5 years.From May 2004 to November 2008, 15 patients with cardiomyopathy and 1 patient with suspected cardiac tumor underwent 16 EMB procedures and 131 heart transplant recipients underwent 423 EMB procedures with the use of a modified Cordis bioptome. All EMB procedures were made via the right internal jugular vein approach and RV septum EMBs were performed under fluoroscopic guidance without additional echocardiographic monitoring. Operators were allowed to perform EMB procedure alone if a minimum of 50 EMB procedures had been previously supervised by a senior operator and all EMBs were performed by 4 operators. All patients underwent a 12-lead electrocardiogram (ECG), 12-hour continuous ambulatory ECG monitoring, chest X-ray and transthoracic echocardiography before and after EMB procedures to obtain a detailed evaluation of the incidence of conduction abnormalities, arrhythmias, pericardial effusions and worsening valve insufficiency.There was no major complications like cardiac tamponade, hemothorax and pneumothorax. Minor complications such as conduction abnormalities including temporary RBBB (lasting24 h after EMB procedures) were found in 2 cases (0.47%) and sustained RBBB (24 h) was evidenced in 1 case (0.23%). There were no A-V block, complex ventricular arrhythmias or episodes of atrial fibrillation during and post procedure. In addition, 4 cases (0.91%)of EMB induced mild-moderate tricuspid regurgitation during the procedure were diagnosed by echocardiography.The EMB procedure via the right internal jugular vein approach under fluoroscopic guidance is safe and associated with a very low complication rate when performed by experienced operators.

The aim of this study was to assess the long-term clinical outcome of patients with diabetes mellitus and chronic total occlusion (CTO) underwent drug-eluting stents (DES) implantation.Data of 143 consecutive eligible patients from January, 2006 to May, 2007 were retrospectively analyzed. The endpoint of the study was the major adverse cardiac events (MACE), including death, myocardial infarction, target lesion revascularization. The patients were divided into two groups, event group and non-event group, according to the result of follow-up.Long-term follow-up was finished in 139 (97.2%) patients. Mean follow-up duration was (19.8 + or - 5.1) months. MACE rate was 10.5% during follow-up: 3 deaths, 1 myocardial infarction and 11 repeated target lesion revascularization with PCI. Compared with the non-event group, the percentage of residual lesion [(17.7 + or - 1.8)% vs. (15.4 + or - 5.0)%, P = 0.001] was significantly higher in the event group, however, the final minimal luminal diameter [(2.14 + or - 0.22)% vs. (2.89 + or - 0.37)%, P = 0.004] was lower. Cox regression analysis showed that final luminal diameter (OR: 0.097, 95%CI: 0.013 - 0.694, P = 0.020) was the only dependent predictor at follow-up.Final minimal luminal diameter is an independent predictor of MACE during follow-up for patients with diabetes and CTO underwent DES implantation.

In individuals without cardiovascular disease, elevated body mass index (BMI) is associated with an increased risk of death. However, in patients with certain chronic diseases, including heart failure, low BMI has been associated with increased mortality. We investigated the association between BMI and prognosis in patients with systolic HF.Follow-up was made on 540 patients (mean age 58.53 years, 84.2% men) with systolic HF (LVEFor = 45%) and association between BMI and adverse cardiac events was analyzed.During a median follow-up of 24 months, 92 patients died including 87 cases of cardiac death and 92 patients were rehospitalized. Compared with patients with BMI higher than 28.0 kg/m(2), patients in lower BMI categories (BMIor = 18.5 kg/m(2) andor = 18.5 kg/m(2)24.0 kg/m(2)) had a graded increase in the all cause death rate [5.44 (1.78 - 16.66), 4.30 (1.71 - 10.82)], cardiac death rate [OR(95%CI): 5.42 (1.77 - 16.59), 4.00 (1.59 - 10.10)], HF death rate [8.94 (2.37 - 33.74), 4.97 (1.52 - 16.20)] and MACE rate [2.10 (1.09 - 4.07), 1.79 (1.14 - 2.82)]. After adjustment for age, gender, LVEF and NYHA grade using cox regression analysis, BMI categories still significantly associated with all cause death rate (OR = 0.77, P0.05), cardiac death rate (OR = 0.78, P0.05) and HF death rate (OR = 0.79, P0.05).In patients with systolic heart failure, lower BMI was an independent predictor of increased all cause death rate, cardiac death rate and HF death rate.

To determine the reference value of plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) in subjects without heart diseases.The plasma concentration of NT-proBNP was measured with ELISA method in 300 adults excluded heart disease through various examinations including electrocardiography, echocardiography, X-ray and coronary artery angiography. The plasma NT-proBNP concentration was compared between age-groups 30-39, 40-49, 50-59, 60-69 andor = 70 years old, between male and female in the same age-group and between subjects with and without hypertension, diabetes and obesity. A multiple linear regression analysis was used to detect factors influencing NT-proBNP among age, sex, body mass index, blood pressure, heart rate, serum creatinine, hypertension, diabetes mellitus, use of angiotensin-converting-enzyme inhibitors, Ca(2+)-antagonist, and beta-blocker.The plasma NT-proBNP concentration increased in proportion to aging in male subjects more than 60 years old (P0.05), remained unchanged in males less than 60 years old and females (P0.05). Plasma NT-proBNP concentration was significantly higher in female (170-660 pmol/L) than in male (160-470 pmol/L) in subjects less than 60 years old (P0.05) and significantly lower in female (180-560 pmol/L) than in male (180-760 pmol/L) in subjects more than 60 years old (P0.05). Multiple linear regression analysis demonstrated that age was the only independent predictor for plasma NT-proBNP in these subjects (P0.01).The plasma concentration of NT-proBNP in subjects without heart diseases was different between male and female, and was increasing with age in male subjects more than 60 years old.

To observe the correlation of plasma amino-terminal pro-A-, B- and C-type natriuretic peptide (NT-proANP, NT-proBNP and NT-proCNP) levels with New York Heart Association (NYHA) functional class and echocardiographic derived parameters of cardiac function in heart failure patients.Data of NYHA grade, echocardiographic derived parameters of cardiac function, plasma levels of NT-proANP, NT-proBNP and NT-proCNP (measured by enzyme immunoassay method) were obtained in 112 heart failure patients and 44 normal control subjects. The correlation analysis was made between NT-proANP, NT-proBNP, NT-proCNP and NYHA functional class, left atrium diameter (LAD), left ventricular end-diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF), respectively.The plasma concentrations of NT-proANP, NT-proBNP and NT-proCNP in heart failure patients were significantly higher than in control group (all P0.05). Correlation analysis revealed a strong correlation between NT-proANP and NT-proBNP (r = 0.790, P = 0.000) and a weak correlation between NT-proCNP and NT-proBNP (r = 0.278, P = 0.003) as well as between NT-proCNP and NT-proANP (r = 0.236, P = 0.012) in heart failure patients. Univariant analysis showed that NT-proANP and NT-proBNP were positively correlated to LAD, LVEDD and negatively correlated to LVEF (all P0.05) while there was no significant correlation between NT-proCNP and echocardiographic derived parameters of cardiac function in heart failure patients. Multivariate stepwise regression analysis including age, gender, NYHA classification, LAD, LVEDD and LVEF revealed that NYHA classification, LVEF, LAD and age were independent predictors of NT-proANP; while NYHA classification, LVEF and age were independent predictors of NT-proBNP while there was no association among these factors and NT-proCNP.In heart failure patients, the plasma concentration of NT-proANP, NT-proBNP and NT-proCNP were significantly increased and NT-proANP, NT-proBNP but not NT-proCNP were significantly correlated to NYHA classification and echocardiographic derived parameters of cardiac function.

To evaluate the predictive value of admission plasma amino-terminal pro-B-type natriuretic peptide (NT-proBNP) on in-hospital mortality in patients with decompensated heart failure.Plasma NT-proBNP levels were measured in patients with decompensated heart failure within 24 hours after admission with ELISA method. The NT-proBNP levels were compared between survivals and dying patients in hospital. ROC analyses were performed to evaluate the predictive value of admission plasma NT-proBNP on in-hospital mortality and to identify the optimal NT-proBNP cut-point for predicting in-hospital mortality. A binary logistic regress analyses was used to evaluate if NT-proBNP was an independent predictor for in-hospital mortality.A total of 804 patients with decompensated heart failure were enrolled in his study (293 valvular heart diseases, 219 ischemic cardiomyopathy, 141 dilated cardiomyopathy, 14 hypertrophic cardiomyopathy, 21 restrictive cardiomyopathy, 39 hypertensive heart disease, 41 chronic pulmonary heart disease and 36 adult congenital heart disease) and 96 patients were in class II, 450 in class III and 258 in cases IV according to NYHA Classification. During hospitalization, 64 deaths were recorded and the on admission plasma NT-proBNP levels of patients died during hospitalization were significantly higher than those of survivals [4321.1 (3063.8, 6606.5) pmol/L vs. 1921.6 (873.9, 3739.2) pmol/L, P0.01]. Area under receiver operating characteristic curve (AUC) of NT-proBNP to predict in-hospital death was 0.772 (95% CI: 0.718 - 0.825, P0.01), the optimal plasma NT-proBNP cut-point for predicting in-hospital mortality was 3500 pmol/L, with a sensitivity of 70.3%, a specificity of 72.0%, an accuracy of 71.9%, a positive predictive value of 17. 8% and a negative predictive value of 96.6%. Patients whose NT-proBNP levels were equal or more than 3500 pmol/L had a much higher in-hospital mortality (17.8%) compared with those with NT-proBNP levels of less than 3500 pmol/L (3.4%), P0.01. Binary logistic regress analyses demonstrated that admission plasma NT-proBNP, pneumonia, heart rate and NYHA class were independent predictors for in-hospital mortality in patients with decompensated heart failure (P0.05 or 0.01) and admission plasma NT-proBNP was the strongest predictor for in-hospital mortality.Admission plasma NT-proBNP level was an independent predictor for in-hospital mortality in patients with decompensated heart failure. The optimal NT-proBNP cut-point for predicting in-hospital mortality was 3500 pmol/L in this patient cohort.

To explore the correlation between plasma BNP level and left ventricular dysfunction parameters in patients with acute myocardial infarction (AMI).Plasma BNP level was determined in 230 consecutive inpatients with AMI and 111 normal controls. Patients were grouped according Killip grades, LVEF and LVEDd, respectively. BNP was transformed into lnBNP for the normal distribution. The receiver operator characteristic curve (ROC curve) was drawn to determine the best threshold and criteria for diagnosing heart failure.After AMI, lnBNP levels increased significantly in proportion with increasing Killip grades (I-III), and decreasing LVEF (all P0.05). lnBNP level was significantly higher in LVEDd55 mm group than in the LVEDd55 mm group (P0.01). lnBNP, LVEDd and LVEF all linearly correlated with Killip grades (P0.05) and the best correlation was shown between lnBNP and Killip grades (r = 0.53, P0.05). lnBNP also positively correlated with LVEDd (r = 0.17, P0.05) and negatively correlated with LVEF (r = -0.41, P0.01). Among the parameters, lnBNP level presented the largest AUC in their ROC curves (P0.01) for diagnosing decompensated heart failure and cardiogenic shock. The sensitivity, specifiticity and accuracy rates for diagnosing decompensated heart failure were 84.9%, 45.0% and 70.0% respectively by lnBNP at the cut point of 140 ng/L. The sensitivity, negative predicting value and accuracy rate for diagnosing cardiac shock were 82.8%, 66.7% and 67.4% respectively by BNP at the cut point of 400 ng/L.lnBNP level in hospitalized patients with AMI was positively correlated with Killip grades and LVEDd, negatively correlated with LVEF and could serve as a parameter for diagnosing the decompensated heart failure and excluding the cardiac shock.

To compare the outcome of patients with coronary artery disease implanted with bioabsorbable polymer sirolimus-eluting stent (Excel) and the durable polymer sirolimus-eluting stent (Cypher).One year clinical and 7 months angiographic follow-up data were analyzed in 591 consecutive patients implanted with Excel (E group: n = 350, 58.1 +/- 10.9 years old) or Cypher (C group: n = 241, 56.4 +/- 10.7 years old) during May 2006 to November 2006 in our center.There were more patients with old myocardial infarction and triple vessel diseases while there were less left main stem disease in E group compared to those of C group at baseline. Reference vessel diameter [(2.76 +/- 0.45) mm vs. (2.87 +/- 0.38) mm, P = 0.043], stent diameter [(3.11 +/- 0.48) mm vs. (3.25 +/- 0.34) mm, P = 0.045] and minimal stent diameter [(2.67 +/- 0.43) mm vs. (2.78 +/- 0.35) mm, P = 0.046] and rate of post-dilation (15.9% vs. 46.7%, P0.001) were all significantly smaller in E group compared to those in C group. Procedure was successful in all patients. One year clinical follow-up results showed similar results on major adverse cardiac events (MACE) rate (8.3% vs. 7.1%, P = 0.641), rate of cardiac death (0.9% vs.0.0%, P = 0.274), non-fatal myocardial infarction (2.0% vs. 1.2%, P = 0.747) and target vessel revascularization (5.4% vs. 5.8%, P = 0.857) between E and C groups. Total (0.9% vs. 0.4%, P = 0.649), early (0.6% vs. 0.0%, P = 0.516) and late (0.3% vs. 0.4%, P = 1.000) stent thrombosis rates according to Academic Research Consortium (ARC) standard definitions (definite + probable) were also similar between the E and C groups. Seven months angiographic follow-up results indicated that there were no differences of in-stent and in-segment restenosis rate between E and C groups (4.7% vs. 3.2%, P = 0.725; 5.6% vs. 3.2%, P = 0.505) but in-stent and in-segment late loss were significantly smaller in E group than those in C group [(0.18 +/- 0.07) mm vs. (0.21 +/- 0.08) mm, P0.001; (0.21 +/- 0.09) mm vs. (0.23 +/- 0.11) mm, P = 0.003].One year clinical and 7 months angiographic outcome were comparable in patients implanted with Excel and Cypher sirolimus-eluting stents.

To evaluate the safety and efficacy of carotid artery stenting before open heart surgery.Patients with heart disease and severe carotid artery stenosis received carotid stenting before open heart surgery were included in this prospective cohort study. The incidence of stroke, myocardial infarction and death from carotid stenting to 30 days after cardiac surgery was assessed.A total of 42 patients were enrolled. The carotid stenting procedural success rate was 100%. Distal embolic protection devices were used in 97.6% patients (41/42). Thirty-six (85.7%) patients received bypass surgery, 5 patients received bypass and valve replacement surgery (11.9%) and 1 patient received valve replacement surgery (2.4%) post carotid stenting. The incidence of stroke, myocardial infarction and death from carotid stenting to 30 days after cardiac surgery was 2.4% (1/42), 0% and 0% respectively.Our data from this small cohort study showed that carotid artery stenting before open heart surgery was safe and effective for patients with heart disease and severe carotid artery stenosis.

To evaluate the safety and efficiency of the dobutamine stress echocardiography in patients with hypertrophic cardiomyopathy and estimate the difference between provokable obstruction and resting obstruction in these patients.Echocardiography was performed in 22 patients with HCM (LVOTPG50 mm Hg at rest, 1 mm Hg = 0.133 kPa) at rest and at the end point of dobutamine stress. Dobutamine was administered via an infusion pump, starting at a dose of 5 microg x min(-1) x kg(-1) and increasing every 5 minutes by 5 microg x min(-1) x kg(-1) till the maximum dose of 20 microg x min(-1) x kg(-1). Fifty-seven patients with HCM (LVOTPG50 mm Hg at rest) were also studied at rest.In these 22 patients, the mean maximum velocity of LVOT was 5.39 +/- 1.60 m/s, the mean maximum LVOTPG was 125.7 +/- 62.4 mm Hg at the end point of dobutamine stress and the mean dose of dobutamine was 13.90 +/- 6.85 microg x min(-1)xkg(-1). Sixteen patients evidenced positive stress results at the end point of dobutamine stress. The main difference between the provokable obstruction and resting obstruction was that in provokable obstruction patients, the SAM positive patients were fewer and the proportion of Maron II patients was higher (50%).Dobutamine stress echocardiography was a safe and sensitive way for detecting patients with hypertrophic cardiomyopathy. Provokable obstruction patients had fewer SAM and higher proportion of Maron II.

To compare the effect of treating ostial left anterior descending artery (LAD) stenosis using drug-eluting stents (DES) by precisely positioning versus crossing over into left main (LM) technique.From April 2004 to May 2006, DES implantations in 224 consecutive patients with ostial LAD lesions were performed by precisely positioning in 161 patients (P group) and crossing over into LM in 63 patients (C group). Clinical and angiographic follow-up was performed at 7 months post DES implantations.Relevant vessel diameter (RVD) was significantly larger (3.44 +/- 0.52 mm vs. 3.17 +/- 0.40 mm, P = 0.039) and LM/LAD diameter ratio was significantly lower (1.16 +/- 0.07 vs. 1.28 +/- 0.05, P = 0.000) in C group compared that in P group. Stent (3.53 +/- 0.31 mm vs. 3.16 +/- 0.29 mm, P = 0.035) and postdilatation balloon (3.59 +/- 0.65 mm vs. 3.24 +/- 0.32 mm, P = 0.035) diameter were significantly larger and postdilatation (94.1% vs. 29.5%, P = 0.000) and kissing balloon (47.1% vs. 15.2%, P = 0.000) rates were significantly higher in P group than that in C group. Both groups achieved 100% procedure success rate. Major adverse cardiac events (MACE) rate (4.3% vs. 1.6%, P = 0.447), death (0 vs. 0, P = 1.000), AMI (1, 2% vs. 1.6%, P = 1.000) and target vessel revascularization (TVR) rate (3.1% vs. 0%, P = 0.325) were similar between the 2 groups. One patient in P group developed subacute in-stent thrombosis. Follow-up angiography at 7 months showed that in-stent (0 vs.7.7%, P = 0.316) and in-segment restenosis rate (3.8%vs. 10.8%, P = 0.431) tended to be lower while in-stent (0.12 +/- 0.08 mm vs. 0.59 +/- 0.37 mm, P = 0.000) and in-segment (0.17 +/- 0.09 mm vs. 0.64 +/- 0.49 mm, P = 0.000) late loss were significantly lower in C group compared with P group.Compared with precisely positioning technique, crossing over into LM technique was more feasible and tended to reduce restenosis rate for ostial LAD lesions treated with DES.

To compare the short and long-term clinical and angiographic outcomes of drug-eluting stents (DES) versus cutting balloon angioplasty followed by bare metal stents (CBA + BMS) for the treatment of ostial lesions of the left anterior descending coronary artery (LAD).A total of 51 consecutive patients with LAD ostial lesions were treated by DES and all patients had completed 2-year clinical follow-up, 50 consecutive patients with LAD ostial lesions treated by CBA + BMS and followed up for 2 years prior to the DES era (May 2000 to November 2003) served as control group.In DES group, one patient experienced acute myocardial infarction (AMI) during hospitalization, the in-hospital major adverse cardiac event (MACE) was 1.96% (1/51), angiography follow-up data at 6-8 months were available in 29 patients and the in-DES restenosis was 10.3% (3/29), at 2-year clinical follow-up, 1 patient died, 4 patients received target lesion revascularization. Total MACE rate was 9.8% (5/51). In CBA + BMS group, there was no in-hospital death and AMI. Angiographic follow-up at 6-8 months was completed in 28 cases and in-stent restenosis rate was 17.9% (5/28). During 2-year follow-up, there was no death and AMI and 6 patients underwent target lesion revascularization. MACE rate was 12% (6/50) in this group.This study showed that both clinical and angiographic outcomes were comparable between DES and CBA + BMS treated patients with LAD ostial lesions during the 2-year follow up period.

To explore the disease-causing gene mutation in Chinese families with hypertrophic cardiomyopathy (HCM) and to analyze the correlation between the genotype and phenotype.Samples of peripheral blood were collected from three Chinese families with HCM (at least two HCM patients existed/family). The exons in the functional regions of the beta myosin heavy chain gene (MYH7) were amplified with PCR and the products were sequenced.A Val606Met missen mutation was identified in the exon 16 of MYH7 gene in a Chinese family and this mutation was identified in all HCM patients (n = 4) and there was also a 15-years-old young mutation carrier who was not HCM patient now (penetrance of 80%). This mutation was not identified in other healthy family members in this family, in other 2 Chinese familiar HCM families and in 120 non-HCM control patients.The Val606Met missen mutation is closely associated with familiar HCM in a Chinese family which is associated with clinical phenotype with a penetrance of 80%.

The purpose of this study was to analyze the electrocardiographic features of the people living in the area with high incidence of unexplained sudden deaths in Yunnan province.The electrocardiograms of 338 residents from three villages (Dayao, Ninglang, Heqing) with high incidence of unexplained sudden deaths and one control village (Dali) were analyzed [averaged age was (33.4 +/- 11.7) years, 175 men and 163 women].The incidence of cardiac arrhythmias was similar low in all groups. The left ventricular hypertrophy was observed in 34.6% of residents from Dayao. QTc significantly prolonged in the residents from all 3 high incidence areas compare the control area of Dali [control (386.8 +/- 27.22) ms, Ninglang (428.92 +/- 25.71) ms, Heqing (440.67 +/- 28.03) ms, Dayao (417.7 +/- 24.00) ms, P0.05 vs. control]. Incidence of U wave was significantly higher in Heqing village than that in control village (P0.05). The QUc of these 3 villages was: (613.67 +/- 37.34) ms, (597.19 +/- 46.47) ms, (608.59 +/- 39.59) ms respectively, and also significantly longer than the control village of Dali (589.33 +/- 41.27) ms (P0.05). The typical pattern of U wave presents as enlarged U wave and apparent T-U complex. In the 7 residents who have the family history of unexplained sudden death, 6 residents have U wave, and 4 of them present typical U wave pattern.The significant ECG changes in villages with high incidence of unexplained sudden death in Yunnan province were prolonged QTc, enlarged U wave and apparent T-U complex and these ECG features suggested the repolarization abnormalities of the heart in these subjects.

To observe the incidence rate of stent thrombosis after implantation of drug-eluting stents (DES) in patients with coronary artery disease (CAD) in the real world.A total of 8190 consecutive CAD patients underwent implantation with Cypher or Cypher Select stents (Cordis, USA, n = 2986), TAXUS stents (Boston Scientific Corp., USA, n = 1587) and Chinese Rapamycin eluting stents (Firebird, Microport Medical Company, China, n = 3617) for enrolled in this single center registry study from Dec.2001 to April 2007. One-year follow-up was completed in 5412 patients (2210 Cypher or Cypher select stents, 1238 TAXUS stents and 1964 Firebird stents). Two-year follow-up was finished in 2176 patients (1245 Cypher or Cypher Select stents, 558 TAXUS stents and 373 Firebird stents). 80.1% of all the lesions were the type B2 and type C lesions. All patients were treated with aspirin plus clopidogrel for at least 9 months post DES.Among 8190 patients, 17 patients had acute stent thrombosis (0.21%): 7 in the Cypher group, 4 in the TAXUS group, 6 in the Firebird group; 23 patients had subacute stent thrombosis (0.28%): 8 in Cypher group, 6 in TAXUS group and 9 in Firebird group. The incidence rate of acute and subacute thrombosis was 0.49% (40/8190) and incidence of thrombosis was similar among the three groups (0.50% in Cypher group, 0.63% in TAXUS group and 0.41% in Firebird group, P0.05). One-year follow-up showed that late thrombosis rate was 0.63 % (34/5412) and similar among the groups (0.63% in Cypher group, 0.89% in TAXUS group and 0.46% in Firebird group, P0.05). Two-year follow-up showed that late thrombosis rate was 0.74 % (16/2176) and was similar among the 3 groups (0.72% in Cypher group, 0.90% in TAXUS group and 0.54% in Firebird group, P0.05).This study indicates that using the first-generation DES to treat complex coronary lesions is safe and effective and the incidence of late thrombosis remains low (1%) under double antiplatelet treatment.

To compare the effects of intracoronary transplantation of autologous bone marrow mononuclear cells (BM-MNC) or peripheral endothelial progenitor cells (EPC) in mini-swine model of myocardial ischemia-reperfusion.The Mini-swine acute myocardial infarction and reperfusion model was created with 90 min occlusion of the left anterior descending coronary artery followed by reperfusion and the animals were then divided into BM-MNC group (3.54 x 10(8) +/- 0.90 x 10(8), n = 9), EPC group (1.16 x 10(7) +/- 1.07 x 10(7), n = 7) and control group (saline, n = 7). Echocardiography, hemodynamic measurements and myocardium infarction size were evaluated before and 4 weeks after intracoronary cell transplantations.The net decrease from baseline to 4 weeks after transplantation of left ventricular ejection fraction (LVEF), left ventricular end systolic pressure, cardiac output and +dp/dt(max) were significantly attenuated post BM-MNC and EPC therapy compared to control group (all P0.05) and were similar between BM-MNC and EPC groups. Transplantation of BM-MNC and EPC also significantly decreased myocardial infarction size compared to control group.Autologous intracoronary transplantation of BM-MNC or EPC in this model equally improved cardiac systolic function and reduced infarction area.

To compare the procedural success and 10-month outcome between sirolimus-eluting stent (Cypher stent) and paclitaxel-eluting stent (TAXUS stent) for the treatment of in-stent restenosis lesions.Patients with in-stent restenosis treated with drug-eluting stents (DES) from December 2002 to March 2005 were included in this study and 10 months post stenting follow-up data were reported.A total of 253 patients with 262 in-stent restenosis lesions were treated with 176 Cypher and 132 TAXUS stents. There were 29 total occlusion, 143or = 90% stenosis and 9090% stenosis lesions. Target lesion type distributions were as follows: 9 type A, 45 type B1, 73 type B2 and 135 type C lesions. The mean diameter in Cypher group (2.96 +/- 0.27) mm was smaller than that of TAXUS (3.05 +/- 0.35 mm, P = 0.041) and mean DES length was similar between the two groups (23.31 +/- 6.68 mm vs. 23.56 +/- 6.54 mm, P = 0.745). Procedural success rate of DES implantation was 100% for both Cypher and TAXUS groups. MACE rate during hospitalization was similar between the two groups. At 10-month follow up, MACE rate was significantly higher in TAXUS group than that in Cypher group (16.0% vs. 6.7% P = 0.031) and angiographic in-stent restenosis rate tended also higher in TAXUS group than that in Cypher group (29.4% vs. 14.0%, P = 0.075).Procedural success rate was similar between Cypher and TAXUS groups and the angiographic and clinical outcome at 10 months was better in Cypher DES group than in TAXUS DES group.

To compare the clinical and angiographic outcome in patients with type-II diabetes mellitus undergoing drug-eluting stent (DES) or bare-metal stent (BMS).A total of 139 consecutive diabetic patients (114 males) with coronary disease who underwent successful elective percutaneous coronary intervention with DES (n = 83 with 151 lesions) or BMS (n = 56 with 70 lesions) on native coronary arteries from April 2004 to August 2005 at our institution were included in this study. All patients were treated according to guidelines and coronary angiography was repeated at 6 months post procedure in all patients. Aspirin (300 mg/d) and clopidogrel (75 mg/d) were administered till 6 months after the procedure.There were 42.5% C type by ACC/AHA and 19.0% total occlusion lesions. The average stent length of each lesion was 26.53 +/- 14.72 mm, and mean reference diameter was 2.80 +/- 0.43 mm. Baseline characteristics were similar between DES and BMS groups except lower mean reference vessel diameter in DES than that of BMS group (2.71 +/- 0.41 mm vs. 2.98 +/- 0.53 mm, P0.001). The in stent restenosis rate at 6 months (10.6% vs. 38.6%, P0.001) and in-segment late loss (0.24 +/- 0.56 mm vs. 0.91 +/- 0.77 mm, P0.001) were significantly lower in DES group than those of BMS group. The target lesion revascularization (TLR) incidence was also significantly lower in DES group compared to BMS group (8.6% vs. 30.0%, P0.001). However, 4 late in-stent thrombosis were seen in DES group and none in BMS group of DES (P = 0.148).DES implantation in patients with diabetes mellitus is associated with lower in-stent restenosis and TLR rates compared to BMS implantation 6 months after procedure and attention should be paid on late in-stent thrombosis after DES implantation.

To investigate the differentiation status of autologous bone marrow mononuclear cells (BM-MNC) and peripheral endothelial progenitor cells (EPC) transplanted into myocardial ischemia reperfusion injury region in swine.BM-MNC marked with PKH26 (n = 9), EPC marked with CM-DiI (n = 7), phosphate buffer saline (control, n = 7) were transplanted into myocardial ischemia reperfusion injury region of swine by intracoronary artery injection. Specimens were harvested 4 weeks after injection for histological analysis (HE, immunochemical stain for vWF, alpha-sarcomeric-actin and fibronectin antibody). Cell differentiation was observed under transmission electronmicroscope.The number of small blood vessels was similar between BM-MNC group and EPC group (13.39 +/- 6.96/HP vs.12.39 +/- 4.72/HP, P0.05), but was significantly higher than that of control group (P0.05). Responsive intensity of immunochemical stain for fibronectin antibody was significantly lower in BM-MNC and EPC groups than that in control group. Responsive intensity of immunochemical stain for alpha-sarcomeric-actin antibody was similar among the three groups. Cluster cells were observed in one swine from BM-MNC group which might relate to the proliferation of stem cells in situ. Immature endothelial cells and myocytes were also detected by transmission electronmicroscope in BM-MNC and EPC group.BM-MNC and EPC transplanted into myocardial ischemia reperfusion injury region in swine stimulated the formation of blood vessels and inhibited fibrogenesis.

To compare the clinical and angiographic outcome in patients with total occlusion lesion treated with drug-eluting stent (DES) or bare-metal stent (BMS).A total of 155 (138 males) consecutive patients with total occlusion lesion underwent successful revascularization with DES (n = 74) or BMS (n = 81) in our hospital were included in this study. All patients received aspirin 300 mg and clopidogrel 75 mg once daily for at least 3 months after the procedure. Clinical and angiographic follow-up were completed in all patients at 6 months post stenting.Demographic data between the two groups were similar except there was more diabetic patients in DES group (33.8% vs. 18.5%, P0.05). A total of 232 stents for 159 target lesions (77 treated with DES, 82 treated with BMS) were implanted. There were 85.4% C ACC/AHA type lesions and 17.0% lesions were treated with overlapping stents. Six months post stenting, the incidence of restenosis (15.6% vs. 41.5%, P0.001), the cumulative rate of major adverse cardiac events (MACE) (1.4% vs. 11.1%, P = 0.032) and TLR (5.8% vs. 19.9%, P = 0.001) were significantly lower in DES group than that of BMS group. The incidence of local restenosis in DES group is higher in DES group than that in BMS group (58.3%, 17.6%, P0.001). Two DES treated patients developed late in-stent thrombosis.For patients with total occlusion lesion, the clinical and angiographic outcome 6 months post DES stenting is clearly superior to that of BMS stenting.

To evaluate the discrepancy between pre- and post-transplant diagnosis of end-stage dilated cardiomyopathy, a pre-transplantation diagnosis was compared with the diagnosis made after macroscopic and microscopic examination of the explanted hearts in 40 cardiac transplant recipients who had undergone cardiac transplantation at our institute.Pre-operation echocardiograms were obtained in all patients and coronary angiogram was obtained in 9 patients who had significant risk factors for coronary heart disease (CHD). CHD was considered present when there was a 75% reduction in cross-sectional luminal area ofor= 1 major coronary artery. Idiopathic dilated cardiomyopathy (IDC) was diagnosed when ventricular dilation and global reduction in ventricular systolic function were present in the absence of any identifiable cause. IDC patients with an alcohol consumption of100 g/day during the last 12 months before the onset of congestive heart failure were classified as having alcoholic cardiomyopathy. The pathological diagnosis of arrhythmogenic right ventricular cardiomyopathy was formulated in the presence of gross/or histological evidence of regional or diffuse transmural fatty or fibrofatty infiltration of the right ventricular free wall.Before transplantation, 45.0%, 17.5%, 17.5% and 7.5% of patients were classified as IDC, CHD, alcoholic cardiomyopathy and hypertrophic cardiomyopathy. Post-transplant CHD diagnosis was made in all patients with a pre-transplant diagnosis of CHD. Post-transplant CHD diagnosis was also established in 4 patients with a pre-transplant diagnosis of IDC, in 4 patients with presumptive alcoholic cardiomyopathy, in 1 patient with hypertensive cardiomyopathy and in 1 patient with a pre-transplant diagnosis of aortic valve disease. Post-transplant arrhythmogenic right ventricular cardiomyopathy diagnosis was made in 6 patients with a pre-transplant diagnosis of IDC or KaShan disease. Post-transplant giant cell myocarditis diagnosis was made in 1 patient with a pre-transplant diagnosis of IDC.Post-transplant CHD diagnosis is significantly higher than that of pre-transplant (42.5% vs. 17.5%, P0.05). Part of these patients might benefit from bypass surgery or PCI. Therefore, "in-depth" search for a heart failure cause, especially the coronary angiography examination, should be conducted in all heart transplantation candidates due to heart failure, regardless of their clinical presentation.

To investigate the safety and efficacy of basiliximab as induction agent in preventing early acute rejection post heart transplantation.Basiliximab (20 mg, iv) was administered one hour before and 4 days post operation to patients (n = 47) underwent heart transplantation between June 2004 and Feb 2005 in our department. Intravenous methylprednisolone (500 mg at operation beginning and repeated immediately post operation, followed by 125 mg every 8 hours for the first day). Prednisone was then initiated at 1 mg.kg(-1).d(-1) tapered 10 mg every 3 days to 10 mg/d. Mycophenolate mofetil (MMF, 0.5 - 1.0 g twice daily) was also administered post intubation, oral Cyclosporine A (CsA, 3 to 6 mg.kg(-1).d(-1)) was prescribed after transplantation if serum creatinine was150 micromol/L. The dose of CsA was individually adjusted to achieve a target serum concentration of 180 - 300 ng/ml. Endomyocardial biopsies were performed 3 weeks (19.7 +/- 9.6) d post heart transplantation. Biopsy specimens were graded according to the standardized criteria of the International Society for Heart and Lung Transplantation (ISHLT). Echocardiograms were routinely performed weekly within the first 3 weeks post-operation.All 47 consecutive patients [mean age (44.9 +/- 13.4) years, range 13 - 63 years, 38 men] survived the operation and the underlying diseases was idiopathic cardiomyopathy (42.5%), ischemic heart disease (25.5%), arrhythmogenic right ventricular cardiomyopathy (17.0%), hypertrophic cardiomyopathy (4.2%), heart tumor (4.25%), valve heart disease (2.1%), hypertensive cardiomyopathy (2.1%) and giant cell myocarditis (2.1%). There were 4 patients with pre-operation PRA10% and CDC was less than 5% in all patients. The grades of the acute rejection in biopsy specimens were as follow: Grade (G) 0 in 30 (63.8%), G IA in 11 (23.4%), G IB in 3 (6.3%) and GII in 3 (6.3%) patients. The average dose of MMF was (1.2 +/- 0.3) g/d. The initial time of receiving CsA was (3.4 +/- 2.1) day post operation. The average cumulative dose of CsA was (4.1 +/- 1.2) mg.kg(-1).d(-1) before endomyocardial biopsy. The average serum concentration of CsA was (237.0 +/- 76.2) ng/ml. Left ventricular ejection fraction assessed by echocardiogram was normal in all patients within the first 3 weeks. Five patients suffered from respiratory infections and recovered post antibiotic and symptomatic therapies.Basiliximab as induction agent in combination with conventional triple immunosuppressive therapy is safe and effective in preventing acute rejection in Chinese cardiac transplantation receipts.

To evaluate the clinical outcomes of treating bifurcation lesions with two drug-eluting stent (DES) techniques.From October 2003 to June 2005, 112 patients with 113 bifurcation lesions with severe stenosis at the ostium of side branch and the diameteror = 2.50 mm were treated by two DES. Sixty-two of the bifurcation lesions were located in LAD/diagonal (54.9%), 32 in distal left main coronary arteries (28.3%), 18 in LCX/OM (15.9%) and 1 distal RCA (0.9%). Sixty-four lesions were treated with Crush technique, 27 with "T-form" stent implanting technique, 11 with modified "Y-form" stent implanting technique, 5 with kissing technique, 3 with "V-form" stent implanting technique and 3 with Culotta technique. Ninety-one Cypher or Cypher select DES stents, 74 TAXUS DES stents, 67 Firebird stents were used for 226 lesions. Final kissing balloon inflation was performed in 60 bifurcation lesions (93.7%) after 64 Crush stenting procedure.Success rate of PCI procedure for the bifurcation lesions was 100%. One patient developed subacute stent thrombosis and underwent successful urgent revascularization. In-hospital major adverse cardiac events (death, AMI, revascularization, MACE) rate was 0.89% (1/112). Nine months follow-up was made in all 112 patients and all patients were alive and MACE rate was 8.04% (9/112) with 1 AMI occurred during the follow-up period in 1 patient due to late thrombosis. Follow-up coronary angiography at 9 months was performed in 48 patients (42.9%) and evidenced 8 in-stent restenosis (16.7%) and 1 patient received CABG, re-PCI was performed in 5 patients.Two DES technique for the treatment of bifurcation lesions is safe and effective and short- and long-term outcomes is satisfactory.

Compare drug-eluting stent (DES) to bare-metal stent (BMS) in prognosis on treating diffuse coronary lesions and analysis risk factor of treating complex and diffuse lesions in PCI.205 consecutive patients with complex and diffuse coronary lesions enrolled our hospital, who were treated with more than 25 mm long DES or BMS. We exclude unsuccessful operation and location. All patients received medical treatment by guideline, and aspirin 300 mg and clopidogrel 75 mg once daily were continued at 6 months after the procedure. The patients were followed up after 6 months.The study population were consisted of 205 patients that there were 181 man, and 24 women, who got 382 stents for 227 target lesions in coronary. There were 93.8% C and 6.2% B2 ACC/AHA type lesion. There were 86.8% patients with binary or above vessel treated. The average reference vessel diameter was 2.88 +/- 0.43 mm. The average stent length of per lesion was 40.09 +/- 12.94 mm. There were 54.2% lesions treated with overlapping stent. There were not different between DES and BMS in patients baseline characteristics, but RVD of group DES less than of group BMS (2.80 +/- 0.37 mm, 3.10 +/- 0.48 mm, P = 0.005) in lesion baseline characteristics. After 6 months, restenosis rate in group DES was less than in group BMS (15.4%, 48.4%, P0.001). There were obvious superiority TVR of DES than of BMS (11.6%, 38.5%, P0.001). The rate of local restenosis in group of DES was higher than that in group of BMS (33.3%, 18.2%, P = 0.029). We analyzed the risk factors for diffuse lesion by a logistic regression model, the significant univariate clinical and angiographic predictors of restenosis were treating with overlapping stent (OR = 2.82, P = 0.017) and drug-eluting stent (OR = 5.71, P0.001).We find that implantation of DES in patients with diffuse lesions in coronary is relatively more safe and associated with more good clinical outcomes, than of BMS.

To observe the serum B-type natriuretic peptide (BNP) changes post acute myocardial infarction (AMI).The serum BNP level was determined in 230 consecutive patients with AMI admitted to CCU and in 111 normal cases from October 2002 to October 2003 in Fuwai Hospital. The 230 AMI patients were further divided into various subgroups according to first or recurrent AMI, ST elevations myocardial infarction (STEMI) or non-ST elevations myocardial infarction (NSTEMI) group, infarction location, coronary arteries involved, infarction related arteries (IRA), TIMI blood flow of IRA and primary PCI or not. Serum BNP, CK-MB, TnT and heart function were analyzed.The serum BNP level was significantly increased in patients with AMI (553.7 +/- 735.1) ng/L than that in normal subjects [(26.4 +/- 27.4) ng/L, P0.05]. LVEF was significantly lower, and LVEDd, BNP and LnBNP were all significantly higher in the first time AMI group compared to recurrent AMI group (all P0.001). The BNP level were significantly higher in AMI patients with single or triple coronary arteries stenosis than those without coronary stenosis (P0.05), in TIMI blood flow 0 - 1 and 2 groups than in TIMI 3 group (all P0.001). The CK-MB and TnT were significantly increased while BNP significantly decreased in the patients underwent primary PCI group compared with patients did not receive PCI therapy (all P0.05 - 0.001).Serum BNP was significantly elevated in patients after AMI but decreased after successful primary PCI in patients with AMI.

To evaluate the efficacy and safety of using Enoxaparin instead of UFH for patients with coronary heart disease (CHD) underwent coronary angiogram with or without percutaneous coronary intervention (PCI).From Oct. 2003 to Feb. 2005, 966 patients with CHD underwent coronary angiogram (CAG) were randomized to receive enoxaparin (1 mg/kg subcutaneously, Q12 h, at least twice before CAG and the sheath was withdrawn immediately after the procedure, n = 484) or UFH (25 mg, iv, before CAG with additional 65 mg iv if PCI indicated and the sheath was withdrawn 4 hours after the procedure, n = 482).(1) PCI was not performed in 511 patients due to mild lesions or patients were suitable for CABG. In 455 patients underwent PCI (227 in enoxaparin and 228 in UFH group), 1 patient in enoxaparin group developed acute thrombosis and resulted in AMI during PCI and underwent successful urgent revascularization. The incidence of in-hospital major adverse cardiac events were 0.44% in the enoxaparin group and 0 in the UFH group. (2) Hematoma at the puncture site happened in 8 patients (3.5%) in enoxaparin group and in 20 patients (8.8%, P0.05) in UFH group. (3) One patient had AMI caused by subacute thrombosis in UFH group during 1 month follow-up.Our results suggest that the effects and safety are comparable for enoxaparin and UFH, it is also safe and efficient to give enoxaparin at least twice before CAG/PCI and the sheath can be withdrawn immediately after PCI. For ACS patients received more than twice enoxaparin and the last dose was given within 8 hours before PCI, PCI could be performed directly without additional UFH.