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Aims: Valvular heart disease (VHD) is one of the leading causes of heart failure. Clinically significant VHD can induce different patterns of cardiac remodelling, and risk stratification is challenging in patients with various degrees of cardiac dysfunction. The study aimed to investigate the prognostic implications of Meta‐Analysis Global Group in Chronic Heart Failure (MAGGIC) score in patients with VHD. Methods and results: This study used data from the China Valvular Heart Disease (China‐VHD) registry, which was a multicentre, prospective, observational cohort study for patients with significant (at least moderate) VHD. In total, 10 446 patients with moderate or greater VHD from the China‐VHD study were included in the present analysis. The primary outcome of interest was all‐cause mortality within 2 years. Among 10 446 patients with VHD, the mean age was 61.98 ± 13.47 years, and 5819 (55.7%) were male. During 2 years of follow‐up, 895 (8.6%) patients died. The MAGGIC score was monotonically and independently associated with mortality in both total cohort [adjusted hazard ratio: 1.095, 95% confidence interval (CI): 1.084–1.107, P < 0.001] and most types of VHD (aortic regurgitation, mitral stenosis, mitral regurgitation, tricuspid regurgitation, mixed aortic stenosis and aortic regurgitation, and multiple VHD). The score was also an independent prognostic factor in patients with or without symptoms or preserved left ventricular ejection fraction (LVEF) and exhibited both satisfactory discrimination and calibration properties in predicting mortality. The prognostic value of MAGGIC score was robust in most quartiles of N‐terminal pro‐brain natriuretic peptide level, with no significant interaction observed (Pinteraction = 0.498). Compared with the EuroSCORE II, the MAGGIC score achieved significantly better predictive performance in overall population [C index: 0.769 vs. 0.727; net reclassification improvement index (95% CI): 0.354 (0.313–0.396), P < 0.001; integrated discrimination improvement index (95% CI): 0.069 (0.052–0.085), P < 0.001] and in subgroups of patients divided by therapeutic strategy, LVEF, symptomatic status, stage of VHD, and aetiology of VHD. Conclusions: The MAGGIC score is a reliable prognostic factor across the range of cardiac dysfunction in VHD and may assist in risk stratification and guide clinical decision‐making. [ABSTRACT FROM AUTHOR]

Aims: This study aims to provide representative information on heart failure (HF) patients in China, especially older adults aged ≥75 years. We aim to clarify the age‐related discrepancies in performance measures and the modifying effect of age on the impact of HF patients' characteristics on clinical outcomes. Methods and results: All HF patients admitted into five tertiary and four secondary hospitals of the Capital Medical University were divided into two groups according to age: 1419 (53.3%) were <75 years, and 1244 (46.7%) were ≥75 years. Older HF patients were more likely to be women, with higher left ventricular ejection fraction, with co‐morbidities including chronic obstructive pulmonary disease/asthma, anaemia, chronic kidney disease, stroke/transient ischemic attack (TIA), atrial fibrillation/atrial flutter, hypertension, and coronary artery disease, while obesity, diabetes mellitus, hypercholesterolaemia and valvular heart disease were more prevalent among younger HF patients. Left ventricular ejection fraction assessment was performed in a similar proportion of patients in the younger and older groups (81.7% vs. 80.5%, P = 0.426), while B‐type natriuretic peptide/N terminal pro brain natriuretic peptide was tested in a lower proportion in the younger group (84.8% vs. 89%, P = 0.001). At discharge, HF with reduced ejection fraction patients were less likely to receive beta‐blockers, angiotensin‐converting enzyme inhibitors/angiotensin II receptor blockers, or combined beta‐blockers and angiotensin‐converting enzyme inhibitors/angiotensin II receptor blockers therapy in the older group (49.74% vs. 63.2%, P = 0.002; 52.9% vs. 64.7%, P = 0.006; and 28.57% vs. 45.5%, P < 0.001, respectively) but were equally likely to receive mineralocorticoid receptor antagonists in the two age groups (80.8% vs. 84.1%, P = 0.322). Older patients with HF had higher risk of in‐hospital and 1 year mortality (2.7% vs. 1.3%, P = 0.011; 21.7% vs. 12.5%; P < 0.001, respectively). Higher body mass index was associated with better outcomes in both age groups. New York Heart Association functional class IV and estimated glomerular filtration rate < 60 mL/min/1.73 m2 were independent predictors of 1 year mortality. The associations between patients' characteristics and risk of mortality were not modified by age. Conclusions: HF patients aged ≥75 years had distinct clinical profiles, received worse in‐hospital therapies and experienced higher in‐hospital and 1 year mortality. [ABSTRACT FROM AUTHOR]

The article discusses recent advancements in transcatheter interventions for structural heart disease in China. It highlights the challenges in treating these disorders due to their diversity and the need for specialized knowledge to select appropriate treatment strategies. The article presents two studies published in The Chinese Journal of Cardiology, one on the efficacy of a novel-designed transcatheter edge-to-edge repair system for mitral regurgitation and another on the preliminary experience of transcatheter pulmonary valve replacement using a domestic balloon-expandable valve. Both studies found the devices to be safe and feasible for treating patients. However, the article also acknowledges the need for further research and clinical trials to ensure the safety and efficacy of these devices. [Extracted from the article]

Objectives. Psoriasis is a skin disease thought to be related to immune system dysfunction. Our study is aimed at analyzing the prevalence of psoriasis in China in multiple different categories and compared the prevalence at the global level, in order to bring insights to policymakers for treating this disease. Methods. We analyzed psoriasis trends from 1990 to 2019 in China as well as around the globe with data from the Global Burden of Disease 2019 study. Multiple metrics such as age-standardized prevalence rates, percent change in age-standardized prevalence rates, disability-adjusted life years (DALYs), and age and sex patterns were included. We also predicted the trends of psoriasis prevalence and DALYs in the following 30 years. Results. In China, the age-specific prevalence cases showed a right shift in 2019 compared to 1990 with a peak between the ages of 50 and 54 years and an obvious surpass in males between 40 and 69. Though China still had the largest number of psoriasis cases in 2019, the increase rate was below global level. A positive linear relationship between psoriasis prevalence and comorbidities was seen with rheumatoid arthritis, diabetes mellitus, multiple sclerosis, nonrheumatic valvular heart disease, cardiomyopathy and myocarditis, nonmelanoma skin cancer, non-Hodgkin lymphoma, and multiple myeloma in China within the male group in 2019. Discussion. The burden of psoriasis, as measured by the absolute number of DALYs, continues to increase around the world. The scarcity of modifiable risks for most psoriasis burdens suggests that new knowledge is needed to develop effective prevention and treatment strategies. [ABSTRACT FROM AUTHOR]

Background: Clinical phenotype and prognosis of heart failure (HF) may be variable among different racial populations. Therefore, a patient-level comparison of hospitalized HF patients in two university hospitals from China and Sweden was performed.Methods and Results: This study was a pooled data analysis of the patients prospectively enrolled in two single-center studies in China (n = 949) and Sweden (n = 1639) from 2011 to 2015. Clinical characteristics and 6-month all-cause mortality were collected. Higher systolic blood pressure (126.1 ± 20.3 vs. 114.2 ± 15.4 mmHg, p < 0.001) and NT-proBNP level (4540 vs. 3251 pg/mL, p = 0.013) were found in the Swedish cohort, also more patients with ischemic heart disease (32.0% vs. 19.2%), hypertension (64.2% vs. 36.8%), valvular heart disease (40.9% vs.31.6%) and atrial fibrillation (55.3% vs. 39.6%) (all p < 0.001). The use of ACEIs/ARBs (48.8% vs. 80.8%) or beta-blockers (58.8% vs. 86.5%) (both p < 0.001) was lower in Chinese cohort. Given younger age in Chinese cohort (61.6 vs. 76.4 years, p < 0.001), age-stratified analyses were conducted, as there were similar patient numbers in 50-74 years in Chinese (n = 550) and Swedish (n = 554) cohorts, therefore baseline characteristics and prognosis were further compared. The age- and sex-adjusted outcome (HR 0.80 [95% CI 0.55-1.19], p = 0.273) was comparable between the two populations. The NT-proBNP and eGFR independently predicted 6-month mortality in both Chinese (HR [95% CI] 1.006 [1.003-1.008], 0.986 [0.976-0.999]) and Swedish cohort (1.003 [1.000-1.007], 0.988 [0.976-0.999]).Conclusions: Patient-level comparison of real-world HF populations from China and Sweden demonstrated different clinical phenotypes and therapy but similar prognosis and their predictors. [ABSTRACT FROM AUTHOR]

Background. Diabetes mellitus (DM) is a prognostic marker in elderly patients with cardiovascular diseases, but its predictive value in elderly valvular heart disease (VHD) patients is unclear. This study aimed to investigate the effect of DM on the long-term outcome of elderly VHD patients. Methods. This single-center, observational study enrolled patients aged 65 and older consecutively with confirmed VHD using echocardiography. Patients, divided into the DM group and non-DM group, were followed up for major adverse cardiac and cerebrovascular events (MACCEs), including all-cause death, ischemic stroke, and heart failure rehospitalization. Results. Our study consisted of 532 patients over a median follow-up of 52.9 months. Compared with the non-DM group (n = 377), the DM group (n = 155) had higher incidences of ischemic stroke (25.2% vs. 13.5%, P = 0.001), heart failure rehospitalization (37.4% vs. 20.7%, P < 0.001), and MACCEs (60.0% vs. 35.8%, P < 0.001). After adjustment of confounders by the multivariable cox regression, DM appeared as an independent predictor for MACCEs (adjusted hazard ratio, aHR: 1.88; 95% confidence interval 1.42–2.48; P < 0.001). In the subgroup analysis of VHD etiology and functional style, conversely, DM was a protective factor for MACCEs in the patients with rheumatic VHD compared with those without rheumatic VHD (aHR: 0.43 vs. 2.27, P = 0.004). Conclusions. DM was an independent predictor for ischemic stroke and heart failure rehospitalization in elderly VHD patients undergoing conservative treatment. [ABSTRACT FROM AUTHOR]

Background: The association between anxiety and atrial fibrillation (AF) remains unclear. Moreover, this association has rarely been studied in Chinese individuals aged 60 years or older. This study investigated the association between anxiety and AF in a community-based case-control study of older adult residents in urban China.Methods: The cases and controls were from a community-based study conducted in the Jingansi community in Shanghai, China, between January 2010 and December 2012. A total of 3622 residents aged 60 years or older without severe vision, hearing, or speaking impairments were eligible to participate in the physical examinations and questionnaire survey. AF was assessed based on a previous physician's diagnosis, electrocardiogram, ambulatory electrocardiogram, or echocardiogram. Anxiety was evaluated using the Zung Self-Rating Anxiety Scale (ZSAS). Using the AF group as a reference, the control group consisted of randomly selected age- and sex-matched individuals in a 1:5 ratio (case:control = 1:5). The association between anxiety and AF in the AF group and the multifactor-matched control group was explored using logistic regression.Results: In the AF and control groups, after adjusting for a history of coronary heart disease, valvular heart disease, hypertension, stroke, hyperlipidemia, and diabetes, as well as depression score, ZSAS scores (odds ratio 1.07; 95% confidence interval 1.02-1.12; p = 0.003), and anxiety symptoms (odds ratio 3.94; 95% confidence interval 1.06-14.70; p = 0.041) were associated with AF.Conclusions: Anxiety symptoms were associated with AF in a Chinese older population. This suggests that older adults who have anxiety symptoms may need psychological intervention or treatment in daily life and care. [ABSTRACT FROM AUTHOR]

Background: The epidemiology of valvular heart disease (VHD) has changed markedly over the last 50 years worldwide, and the prevalence and features of VHD in China are unknown. The objective of this study was to investigate the current status and etiology of VHD in China.Methods: We used a cross-sectional national survey with stratified multistage random sampling from the general Chinese population to estimate the VHD burden. Data on demographic characteristics, medical history, physical examination, blood tests, and potential etiology were collected. Echocardiography was used to detect VHD.Results: The national survey enrolled 34,994 people aged 35 years or older across China. Overall, 31,499 people were included in the final analysis, and 1309 participants were diagnosed with VHD. The weighted prevalence was 3.8%, with an estimated 25 million patients in China. The prevalence of VHD increased with age and was higher in participants with hypertension or chronic kidney disease than in their counterparts. Among participants with VHD, 55.1% were rheumatic and 21.3% were degenerative. The proportion of rheumatic decreased with age, and the proportion of degenerative rose with age. However, the prevalence of rheumatic disease was still higher in the elderly population than in the younger population. Logistic regression revealed that age and hypertension were correlated with VHD.Conclusions: In China, rheumatic heart disease was still the major cause of the VHD, with a significant increase in degenerative heart disease. Age and hypertension are important and easily identifiable markers of VHD. [ABSTRACT FROM AUTHOR]

Aim. The present study was aimed at investigating the prevalence, incidence, progression, and prognosis of degenerative valvular heart disease (DVHD) in permanent residents aged ≥65 years from Guangzhou, China. Methods. This was a prospective study based on community population. Over a 3-year span, we conducted repeated questionnaires, blood tests, and echocardiographic and electrocardiogram examinations (2018) of a random sample of initially 3538 subjects. Results. The prevalence of DVHD increased with age, average values being 30.6%, 49.2%, and 62.9% in 65-74, 75-84, and ≥85 years of age, respectively. The incidence rate was 1.7%/year. Aortic stenosis was the result of DVHD, and the mean transvalvular pressure gradient increased by 5.6 mmHg/year. The increase of mild aortic stenosis was lower than that of more severe disease, showing a nonlinear development of gradient, but with great individual variations. Mortality was significantly increased in the DVHD group (HR = 2.49). Risk factors for higher mortality included age ( χ 2 = 1.9 , P < 0.05), renal insufficiency ( χ 2 = 12.5 , P < 0.01), atrial fibrillation ( χ 2 = 12.2 , P < 0.01), mitral regurgitation ( χ 2 = 1.8 , P < 0.05), and tricuspid regurgitation ( χ 2 = 6.7 , P < 0.05) in a DVHD population. Conclusions. DVHD was highly prevalent among residents in southern China. With the progression of the disease, the mean transvalvular pressure gradient accelerated. DVHD was an independent predictor of death, and the mortality was higher in those with older age, renal insufficiency, atrial fibrillation, mitral regurgitation, and tricuspid regurgitation. [ABSTRACT FROM AUTHOR]

Background: The risk factors contributing to embolism in cardiac myxoma (CM) are yet controversial. This systematic review and meta-analysis aimed to clarify the risk factors of embolism for the CM patients.Methods: PubMed, Embase, Cochrane library, Web of Science, China National Knowledge Infrastructure, Wan Fang, and Wei Pu databases were searched from inception to June 2019. Statistical analysis was conducted using Stata version 14.0. The pooled odds ratio or mean difference with 95% confidence interval was estimated for each risk factor.Results: Herein, 12 studies, encompassing 1814 patients, were included. The pooled results suggested that New York Heart Association (NYHA) class I/II (P < 0.01), hypertension (P = 0.03), irregular tumor surface (P < 0.01), tumor in atypical location (P = 0.01), narrow base of tumor (P < 0.01), and increased fibrinogen (FIB) (P < 0.01) are significant risk factors of embolism in CM patients. However, sex, age, body mass index, smoking, left ventricular ejection fraction, diabetes, hyperlipidemia, atrial fibrillation, valvular heart disease, coronary heart disease, tumor size, platelet count, white blood cells, and hemoglobin were not associated with embolism (all P > 0.05).Conclusions: NYHA class (I/II), hypertension, irregular tumor surface, atypical tumor location, the narrow base of tumor, and increased FIB were significant risk factors of embolism in CM patients. For CM patients with these factors, early surgery might be beneficial to prevent embolism. [ABSTRACT FROM AUTHOR]

Introduction: More than 42 million people are estimated to suffer from valvular heart disease (VHD) worldwide with a prevalence of 5.3% to 7.7% in the Chinese adult population. The purpose of this study was to examine the associations between symptoms, hope, self-management behaviors, and quality of life (QOL) for preoperative patients with symptomatic VHD in a rural area of China. Method: This was a descriptive comparative study that took place in Nanning, China, between January 2015 and March 2016. The sample was 128 preoperative patients with symptomatic VHD. Data were collected using the Symptom Distress Questionnaire, Herth Hope Index, Self-Management Scale, and Minnesota Living with Heart Failure Questionnaire. Results: Data from 122 patients were included in the final analysis. Mean scores of hope, self-management, and QOL were 36.71, 55.27, and 55.56. Worse total scores of symptom severity (r = 0.57 to 0.69, p <.001) and self-management behaviors (r = −0.22 to −0.25, p <.05) were associated with poorer QOL. Fatigue, loss of appetite, and self-management behaviors explained 49.90% variance of QOL (p <.001). Discussion: Fatigue, loss of appetite, and self-management influenced QOL of patients with symptomatic VHD. Interventions aimed at strengthening self-management and relieving symptoms should be tailored for patients with symptomatic VHD base on their traditional animist belief and food culture in rural areas of China such as the Zhuang Autonomous Region. [ABSTRACT FROM AUTHOR]

The anatomy of the aortic valves plays an important role in the progression of aortic valve disease (AVD) and determination of the appropriate treatment strategy. We described and compared AVD phenotypes according to detailed anatomical classifications and assessed the accuracy of imaging diagnostics using surgical diagnosis as the gold standard. The study enrolled 602 patients (mean age 55.5±12.9 years; 74.1% male) who underwent their first aortic valve replacement surgery between June 2017 and March 2018 at Fuwai Hospital in Beijing, China. Clinical characteristics, histopathological diagnoses, preoperative transthoracic echocardiography (TTE), and other available imaging data were collected retrospectively from medical records. During surgery, 370 patients were diagnosed with a tricuspid aortic valve (TAV), 228 with a bicuspid aortic valve (BAV), and 4 with a quadricuspid aortic valve (QAV). The primary histopathological finding was myxomatous degeneration (48.4%) for those with TAV and fibrocalcification (57.9%) for those with BAV. Nearly all TAV patients (96.2%) had aortic regurgitation, while the majority of BAV patients had aortic stenosis (73.7%); the severity of stenosis and regurgitation varied across the subtypes of BAV. The overall diagnostic accuracy of preoperative TTE for aortic valve anatomy was 85.5%; accuracy was higher for TAV versus BAV (96.8% vs. 68.0%, P <.001). We identified different phenotypes of AVD among patients with different detailed anatomical classifications. In addition, the diagnostic accuracy of preoperative TTE for BAV was suboptimal, and more attention is needed to ensure an accurate anatomic diagnosis prior to surgical intervention. Different phenotypes of patients with aortic valve disease. Patients with aortic valve disease can be classified according to the anatomy of aortic valves. For patients with different aortic valve structures, differences remained in clinical characteristics, preoperative transthoracic echocardiography, and histopathology. AVD = aortic valve disease; BAV = bicuspid aortic valve; QAV = quadricuspid aortic valve; T0-ap = Type 0 anterior–posterior; T0-lat = Type 0 lateral; T1-LN = Type 1 left coronary-noncoronary cusp fusion; T1-LR = Type 1 left coronary-right coronary cusp fusion; T1-RN = Type 1 right coronary-noncoronary cusp fusion; T2-LR/RN = Type 2 left coronary-right coronary cusp fusion combined with right coronary-noncoronary fusion; TAV = tricuspid aortic valve; TTE = transthoracic echocardiography. Unlabelled Image • Aortic valve disease is the most common form of heart valve disease. • Bicuspid aortic valves (BAV) is the most common congenital heart disease with different anatomical structures. • BAV has always been treated as a single disease without taking the differences among subtypes into consideration. • Phenotypic variations are shown between tricuspid aortic valves and BAV, as well as among subtypes of BAV in terms of clinical, hemodynamic and histopathological characteristics. • Preoperative imaging tests suffered suboptimal diagnostic accuracy in BAV, and more extensive examination and careful interpretation are needed in the evaluation of aortic valve disease. • Differences among subtypes of BAVs should be considered in future investigations on etiology, histopathology, risk prediction and treatment decision for BAV. [ABSTRACT FROM AUTHOR]

Background: The aim of this study is to investigate the prevalence and outcome of tricuspid regurgitation (TR) in the Chinese population. Methods: The echocardiography database, including 134,874 patients at our heart center from 2010 to 2012, was retrospectively analyzed. Results: The rates of mild, moderate, and severe TR were 2.96, 2.22, and 1.39%, respectively. Of these patients, 4.86% had primary TR, 91.41% had functional TR, and 3.73% had unexplained TR. The rate of TR was increased in elders (odds ratio: 1.038 for 1 year's increment; 95% confidence interval: 1.037–1.040; p < 0.001) and females (odds ratio: 1.386; 95% confidence interval: 1.327–1.448, p < 0.001). The major etiologies of TR were left-sided valve heart disease (VHD) and dilated cardiomyopathy. The survival rate of severe TR patients with pulmonary artery hypertension (PAH) was lower than in those without PAH (p < 0.0001). There was a positive association between the prevalence of TR and impaired left ventricular ejection fraction. Compared to the non-left-sided VHD group, the left-sided VHD group had a better prognosis among severe TR patients. The 5-year survival rates were 79.69, 71.12, and 77.01% in the groups of left-sided VHD, non-left-sided VHD, and all patients. Conclusions: Patients with severe TR have a bad prognosis, especially those with non-left-sided VHD and those with PAH. [ABSTRACT FROM AUTHOR]

Background: Reoperative cardiac valve surgery via sternotomy is associated with a substantial morbidity and mortality. This study evaluated the right anterolateral thoracotomy for high-risk patients undergoing mitral and tricuspid valve redo procedures.Methods: Out of a series of 173 patients undergoing redo cardiac valve surgery, 24 patients were reoperative via the right anterolateral thoracotomy as the high-risk group on the basis of the proximity of the heart and great vessels to the sternum and the presence and location of patent bypass grafts.Results: In all cases, sternotomy was avoided. The mitral valve and tricuspid valve were replaced in 4 and 19 patients and repaired in 1 and 2 patients, respectively. Moreover, left atrial folding was performed in 5 patients. Mortality was 8.3%. All other patients had uneventful outcomes and normal valve function at follow-up.Conclusions: Reoperative cardiac valve surgery can be performed safely using the right anterolateral thoracotomy in high-risk patients. It offers enough exposure. It minimizes the need for cardiac dissection, and thus, the risk for injury. Avoiding a high-risk resternotomy increases patients comfort and safety of redo mitral and tricuspid valve surgery. [ABSTRACT FROM AUTHOR]

Background: Atrial fibrillation (AF) adversely affects surgical outcomes of cardiac valve surgery. Surgical ablation is an effective way to treat valvular AF. The aim of this study was to evaluate the late outcome of surgical radiofrequency ablation and explore the risk factors of AF recurrence in Chinese patients undergoing cardiac valve surgery.Methods: Three hundred ninety six consecutive patients with persistent valvular AF were enrolled in this study. They underwent concomitant modified Maze IV and were completed follow-ups. Cox survival regression model was used to screen independent risk factors for predicting late recurrence of AF.Results: During the follow-up period of 28 (6 ~ 61) months, AF recurred in 151 patients (38.1%). In multivariate survival regression, factors predictive of AF late recurrence were AF duration, pre-operative serum B-type natriuretic peptide (BNP), pre-operative heart rate and left atrial diameter (LAD), post-operative atrial tachyarrhythmias and AF at discharge. According to receiver operating characteristic curve analysis, the best cutoff values for AF duration, BNP, heart rate and LAD were 66.5 months, 251 pg/ml, 82 beats/min and 67.9 mm, respectively.Conclusions: Longer AF duration, larger LAD, higher BNP level and lower heart rate indicated a poor late outcome of surgical radiofrequency ablation in persistent AF patients undergoing cardiac valve surgery. Therefore, indication to radiofrequency ablation should be carefully considered in these patients. [ABSTRACT FROM AUTHOR]

Background: Valvular heart diseases (VHD) is very common in clinical practice and has became the subject of growing attention in the field of cardiovascular medicine. Our aim was to assess the prevalence and correlates of VHD in the general population in Xinjiang, China. Methods: Using a 4-stage stratified cluster random sampling method, a total of 14618 participants were recruited in the Cardiovascular Risk Survey (CRS) study. The participants’ personal information, medical history were assessed by questionnaire. VHD was diagnosed by transthoracic echocardiography. We carried out the statistical analysis utilizing SPSS Statistics version 19.0. Results: In the total study group, VHD was observed in 1397 (9.65%) individuals. The prevalence rates of VHD in Han, Uygur and Kazak group are 13.51%, 2.71% and 12.29% respectively. The prevalence rates of VHD increased strikingly with age (all P < 0.001). The results of multinomial regression analysis indicated that VHD were related to age in Han group, to age smoking and hypertension in Uygur group, to age and hypertension in Kazak group. Conclusion: Our research provides a unique prevalence rate of VHD in Xinjiang natural population. The result suggests that VHD are notably common in this population (9.65%) and increase with age. There exists significant difference of prevalence rate between ethnics. The main risk factors of VHD are age, hypertension and smoking. Valvular heart diseases should be regarded as a serious and growing public-health problem. [ABSTRACT FROM AUTHOR]

Objective: To investigate the morbidity of complications and pregnancy outcomes in women with mechanical heart valve replacement who received low-dose oral anticoagulation treatment with warfarin throughout the pregnancy, compare the prognosis and complications of patients who were treated with single oral warfarin treatment or the "bridging" therapy treatment, investigate the influence of using vitamin K1 before emergency cesarean section delivery on postoperative warfarin anticoagulant effect and to explore an appropriate anticoagulant regimen during perioperative period for pregnant women with mechanical heart valve replacement.Method: 46 pregnant women with mechanical heart valve replacement who received low-dose oral anticoagulation treatment from October 2008 to October 2014 treated at West China Women's and Children's Hospital were retrospectively reviewed. Eight patients received emergency cesarean section (CS), while 38 patients received selective CS, in which 17 patients received single oral warfarin and 21 patients received "bridging" anticoagulation treatment during postoperative period. Morbidity of complications and the time to achieve the target INR after operation were compared.Results: The mechanical valves were at the mitral position in 35 (76.09 %) patients, at the aortic position in 2 (4.35 %) patient and at both the mitral and aortic position in 9 (19.57 %) patients. 46 full-term healthy babies were delivered and no maternal thromboembolic was observed during pregnancy. There was no significant difference of the amount of uterine bleeding between single oral warfarin group and "bridging" treatment group during postpartum period. In single oral warfarin group, one valve thrombosis was observed and led to sudden death. No periphery thrombosis, hematoma, general hemorrhage or other sign of over-anticoagulation was observed. The INR increased more slowly in the group who received emergency CS with preoperative application of vitamin K1 than other two groups.Conclusion: The use of vitamin K1 preoperatively might result in warfarin resistance and discontinuation of warfarin therapy before selective CS might be more appropriate than application of vitamin K1. The "bridging" anticoagulation treatment which combines oral warfarin and subcutaneous LMWH might be more effective and safer than single oral warfarin therapy for patients with mechanical heart valve replacement during postoperative period, no matter selective or emergency CS. The safety of low-dose oral warfarin therapy throughout pregnancy is still under controversy. [ABSTRACT FROM AUTHOR]

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Background and Aim To identify the underlying heart disease and microbiological pathogen associated with infective endocarditis ( IE) in Chinese patients in one university hospital over a 10-year period. Methods We recruited 115 adult patients admitted to Peking University First Hospital from 2002 to 2011 who were diagnosed with definite IE. Statistical analysis was performed to analyse data on demographics, clinical and laboratory findings, as well as microbiological pathogens. Results The most common underlying heart diseases for IE were congenital heart disease (24.3%) followed by degenerative valvular disease (17.4%). Aortic (44.3%) and mitral (43.5%) valves were most frequently affected. The right-sided IE cases were all found in patients with congenital heart disease. The age of patients was younger in right-sided cases than that in left-sided ones ( P = 0.001). There was no difference in the mortality among groups with different underlying heart disease ( P = 0.841). Forty-four (38.3%) patients were infected with viridans group streptococci. The isolation rate of staphylococci in right-sided IE was higher than that in the left-sided IE group ( P = 0.021). More than 85% of streptococci were susceptible to β-lactams. Conclusions Congenital heart disease and degenerative valvular disease have overtaken rheumatic heart disease as the major underlying heart diseases associated with IE. Viridans group streptococci are the most common microbial cause of IE. [ABSTRACT FROM AUTHOR]

Background: To compare six risk scores with regard to their validity to predict in-hospital mortality after heart valve surgery in a single-centre patient population of China. Methods: From January 2006 to December 2011, 3479 consecutive patients who underwent heart valve surgery at our centre were collected and scored according to the EuroSCORE II, VA risk score, NNE risk score, Ambler risk score, NYC risk score, and STS risk score. Calibration of the six risk scores was assessed by the Hosmer–Lemeshow (H–L) test. Discrimination was tested by calculating the area under the receiver operating characteristic (ROC) curve. Results: Observed mortality was 3.32% overall. The STS score showed good calibration in predicting in-hospital mortality (H–L: P =0.126). The EuroSCORE II, VA score, NNE score, and NYC score underpredicted observed mortality (H–L: P <0.0001, P <0.0001, P =0.001, and P <0.0001, respectively) and the Ambler score overpredicted observed mortality (H–L: P =0.005). The discriminative power (i.e. the area under the ROC curve) for in-hospital mortality was highest for the STS score (0.706), followed by the EuroSCORE II model (0.693), NNE score (0.684), NYC score (0.682), Ambler score (0.677) and VA score (0.643). Conclusion: Compared with the EuroSCORE II, VA score, NNE score, NYC score, and the Ambler score, the STS score gives an accurate prediction for individual operative risk in patients undergoing heart valve surgery at our centre. Therefore, the use of the STS score for risk evaluation maybe suitable in patients undergoing heart valve surgery at our centre in the future. [Copyright &y& Elsevier]

Background: To assess the performance of the The European System for Cardiac Operative. Risk Evaluation II (EuroSCORE II) in Chinese patients undergoing heart valve surgery at our centre. Methods: From January 2006 to December 2011, 3479 consecutive patients who underwent heart valve surgery at our centre were collected and scored according to the original EuroSCORE and EuroSCORE II models. All patients were divided into single valve surgery and multiple valve surgery subgroups. The entire cohort and each subgroup were analysed. Calibration of the original EuroSCORE and EuroSCORE II models was assessed by the Hosmer–Lemeshow (H–L) test. Discrimination was tested by calculating the area under the receiver operating characteristic (ROC) curve. Results: Observed mortality was 3.32% overall, compared to expected mortality 3.84% for the original additive EuroSCORE (H–L: P =0.013), 3.33% for the original logistic EuroSCORE (H–L: P =0.08), and 2.52% for the EuroSCORE II (H–L: P <0.0001). The EuroSCORE II model showed good calibration in predicting in-hospital mortality for patients undergoing single valve surgery (H–L: P =0.103) and poor calibration for patients undergoing multiple valve surgery (H–L: P <0.0001). The discriminative power of the original EuroSCORE model (area under the ROC curve of 0.684 and 0.673 for the additive and logistic model, respectively) and EuroSCORE II model (area under the ROC curve of 0.685) for the entire cohort was poor. The discriminative power of the EuroSCORE II model was good for the single valve surgery group (area under the ROC curve of 0.792) and was poor for the multiple valve surgery group (area under the ROC curve of 0.605). Conclusion: The EuroSCORE II model gives an accurate prediction for individual operative risk in patients undergoing single valve surgery but an imprecise prediction in patients undergoing multiple valve surgery at our centre. Therefore, the use of the EuroSCORE II model for risk evaluation may be suitable in patients undergoing single valve surgery, and the creation of a new model which accurately predicts outcomes in patients undergoing multiple valve surgery is possibly required at our centre in the future. [Copyright &y& Elsevier]

Background: There is controversy regarding the choice of prosthetic valves in patients with cardiac valve disease and dialysis-dependent patients. This review assesses a 12-year experience and outcomes after valve replacement in patients on chronic preoperative renal dialysis, comparing survival and valve-related outcomes following valve replacement with bioprostheses versus mechanical prostheses in this population in china. Methods: From January 1999 and October 2011, 73 consecutive dialysis patients underwent cardiac valve replacement. The patients were divided into two groups: (Group B) bioprosthesis valves were implanted in 38 (52.1%) patients and (Group M) mechanical valves were implanted in 35 (47.9%) patients. Outcome measures included perioperative data, hospital mortality, major postoperative complications, follow-up outcomes, valve related morbidity and late survival. Results: There were no significant differences in terms of patient characteristics in the 2 groups. Thirty-three were isolated aortic valve replacements (45.2%); 28 were isolated mitral valve replacements (38.4%); 10 were combined aortic and mitral replacements (13.7%); 2 were combined tricuspid and mitral replacements (2.7%). The overall hospital mortality was 5.5% (n = 4) and was not different between Group B (5.3%) and Group M (5.7%). Low ejection fraction was the only independent predictors of hospital mortality. There was no significant difference between the groups in the overall rate of complications. The overall mean follow-up was 47 ± 23 months. According to the Kaplan-Meier analysis, late mortality, perivalvular leak and freedom from reoperation were similar in patients with mechanical and bioprosthesis valves. The bioprosthesis valve group had significantly higher freedom from thromboembelism-bleeding events (100% versus 77.6 ± 11.0%, p = 0.012), and valve-related morbidity (73.2 ± 10.1% versus 58.1 ± 10.9%, p = 0.035) in 5 years. Kaplan-Meier survival estimates at 1, 3, and 5 years were 0.971, 0.832, and 0.530 in group B, and 0.967, 0.848, and 0.568 in group M. Conclusions: There is no significant difference in the perioperative morbidity and mortality, late survival of dialysis patients after cardiac valve replacement with bioprostheses versus mechanical valves. In spite of the limited sample size analyzed, its outcome and consistency to several previous reports supports a conclusion that bioprostheses rather than mechanical ones could be a favorable choice for valve replacement needs of renal failure patients. [ABSTRACT FROM AUTHOR]

Background: Mucopolysaccharidosis type I (MPS I) is a rare autosomal storage disorder resulting from the defective alpha‐L‐iduronidase (encoded by IDUA) enzyme activity and accumulation of glycosaminoglycans (GAGs) in lysosomes. So far, more than 100 IDUA causative mutations have been identified leading to three MPS I phenotypic subtypes: Hurler syndrome (severe form), Hurler/Scheie syndrome (intermediate form), and Scheie syndrome (mild form). Methods: Whole‐exome sequencing (WES) was performed to identify the underlying genetic mutations. To verify the identified variations, Sanger sequencing was performed for all available family members following PCR amplification. The impact on IDUA protein was analyzed by sequential analysis and homology modeling. Results: A novel IDUA heterozygous single base insertion (c.1815dupT, p.V606Cfs51*) and a known missence mutation (c.T1037G, p.L346R) were detected in our patient diagnosed as congenital heart disease with heart valve abnormalities. The novel frameshift mutation results in a complete loss of 48 amino acids in the Ig‐like domain and causes the formation of a putative protein product which might affect the IDUA enzyme activity. Conclusions: A novel compound heterozygous IDUA mutation (c.1815dupT, p.V606Cfs51*) was found in a Chinese MPS I family. The identification of the mutation facilitated accurate genetic counseling and precise medical intervention for MPS I in China. [ABSTRACT FROM AUTHOR]

Objective: To explore the risk factors of low cardiac output syndrome (LCOS) after cardiac valvular surgery in elderly patients with valvular disease complicated with giant left ventricle. Methods: This was a retrospective study. The clinical data of patients over 60 years old with giant left ventricle who underwent cardiac valvular surgery in Henan Provincial People's Hospital (Fuwai Central China Cardiovascular Hospital) from January 2016 to January 2020 were collected in this study. Patients were divided into LCOS group and non-LCOS group. The clinical data, preoperative echocardiographic results and surgical data of all patients were collected. Taking LCOS as dependent variable and statistically significant variables in univariate analysis as independent variable, multivariate logistic regression equation was constructed to identify the risk factors of LCOS after cardiac valvular surgery in elderly patients with valvular disease complicated with giant left ventricle. On the basis of logistic regression, the risk factors of continuous variables were put into the regression model for trend test. Results: A total of 112 patients were included, among whom 76 patients were male, the mean age was (65.3±3.8) years. There were 21 cases in LCOS group and 91 cases in non LCOS group. Univariate analysis showed that age≥70 years, preoperative NYHA cardiac function class Ⅳ, preoperative renal dysfunction, preoperative cerebrovascular disease, preoperative LVEF<40%, blood loss/total blood volume>20%, cardiopulmonary bypass (CPB) time>130 minutes and aortic cross-clamp time>90 minutes all had statistically significant differences between the two groups (all P <0.05). Multivariate logistic regression analysis showed that age≥70 years ( OR =5.067, 95% CI 1.320-19.456, P =0.018), preoperative NYHA cardiac function class Ⅳ ( OR =3.100, 95% CI 1.026-9.368, P =0.045), renal dysfunction ( OR =3.627, 95% CI 1.018-12.926, P =0.047), CPB time>130 minutes ( OR =4.539, 95% CI 1.483-13.887, P =0.008) were the independent risk factors of LCOS after cardiac valvular surgery in elderly patients with giant left ventricle. Risk of LCOS was significantly higher in patients aged from 65 to 70 years ( OR =1.784, 95% CI 0.581-5.476) and aged 70 years and above ( OR =4.400, 95% CI 1.171-16.531) than in patients aged from 60 to 65 years. The trend test results showed that the risk of LCOS increased significantly in proportion with the increase of age ( P for trend=0.024). Risk of LCOS was significantly higher in patients with CPB time between 90 and 110 minutes ( OR =1.917, 95% CI 0.356-10.322), 110 and 130 minutes ( OR =1.437, 95% CI 0.114-18.076) and 130 minutes and above ( OR =5.750, 95% CI 1.158-28.551) than in patients with CPB time ≤ 90 minutes ( P for trend=0.009). Conclusions: The risk factors of LCOS after cardiac valvular surgery are age≥70 years, preoperative NYHA cardiac function class Ⅳ, renal dysfunction, CPB time>130 minutes in elderly patients with giant left ventricle.

Examines the efficacy of radionuclide imaging in the detection of coronary artery disease in patients with valvular disease pre-operation in China. Number of patients with results of radionuclide imaging similar to coronary angiography; Rate of concordance; Percent of negative predictability.

Background: In the West, the safety and efficacy of the Lotus valve have been demonstrated; however, data in the Chinese population are still lacking. Few studies have compared the clinical outcomes of transcatheter aortic valve replacement (TAVR) with the Lotus valve in patients with bicuspid or tricuspid aortic valve stenosis. Our aim was to assess TAVR outcomes with the Lotus aortic valve in a Chinese patient cohort., Methods: In total, 23 symptomatic, high-surgical risk patients with severe aortic valve stenosis were enrolled. Among them, nine patients (39%) had bicuspid aortic valves, and three patients had a large annulus dimension. The Lotus valve was successfully implanted in all patients. To facilitate accurate positioning, partial re-sheathing was attempted in ten patients (43.5%), while one patient had a full retrieval. One-year clinical follow-up was completed in all patients., Results: There were no deaths, strokes, or major adverse cardiac and cerebrovascular events in 22 of the 23 patients at 30 days; the all-cause mortality rate at 1 year was 4.4% (1 of 23 patients). The mean aortic valve gradient decreased from 51.5 ± 8.8 mm Hg at baseline to 13.4 ± 4.9 mm Hg (p < 0.001) and the valve area increased from 0.6 ± 0.2 cm 2 to 1.5 ± 0.4 cm 2 (p < 0.001) at 30 days. Paravalvular leakage was absent or mild (22%), and no patient had severe paravalvular leakage. Six patients (26.1%) required a postprocedural pacemaker. There was no difference regarding the procedural and the 1‑year outcomes between patients with bicuspid and tricuspid aortic valve stenosis., Conclusion: Our single-center experience demonstrated that the Lotus valve is feasible and effective for Chinese patients with aortic valve stenosis, including atypical cases with bicuspid aortic valves or large aortic annulus size.

Background: Contemporary nationwide data from mainland China on trends in mitral valve surgery are scarce. The purpose of the present study was to review a single-center experience with mitral valve surgery over a 10-year period in East China., Methods: Between July 2009 and June 2019, 3238 consecutive patients who underwent mitral valve surgery in our center were retrospectively reviewed. The patients were evenly divided into three periods: July 2009 to October 2012 (period I), November 2012 to February 2016 (period II), March 2016 to June 2019 (period III)., Results: The 3238 patients included 536 (16.6%) who had mitral valve repair and 2702 (83.4%) who had mitral valve replacement. Early mortalities for mitral valve repair and mitral valve replacement were 0.2% and 0.9%, respectively. There were trends towards a higher proportion of degenerative valve lesions (24.6%, 35.8%, 54.7% in periods I, II, and III, respectively) and a lower proportion of rheumatic valve lesions (71.0%, 62.6%, 38.0%) in more recent years. The proportions of minimally invasive surgery (0.7%, 2.1%, 30.2%), mitral valve repair (8.3%, 15.4%, 27.5%), use of a bioprosthesis (10.1%, 17.0%, 23.1%), and concomitant tricuspid valve procedures (13.2%, 28.5%, 46.0%) increased dramatically, while early mortality remained constant during the 10-year period (1.0%, 0.3%, 0.9%)., Conclusions: In the past 10 years, the spectrum of mitral valve disease experienced a trend towards more degenerative valve lesions and less rheumatic valve lesions in East China. Mitral valve repair, bioprostheses, tricuspid valve repair, and minimally invasive surgery have been more often applied in recent years.

We have defined a standard surgical procedure for rheumatic mitral valve repair (the Score procedure) including four steps: shaving, checking, commissurotomy, and relaxing. Here, we summarize the clinical pathological classification for making a decision on repair or replacement. Given the large number of patients in China, we consider it the responsibility of Chinese cardiac surgeons to adopt a therapeutic schedule for rheumatic mitral valve disease, which includes a simple operation with reliable effects and easy to promote. This schedule would ensure that millions of patients get the best treatment to extend survival and improve their quality of life.

Objective: To investigate the effect of valve noise on the quality of life (QOL) in Chinese patients who underwent mechanical mitral valve replacement., Methods: We enrolled a total of 103 patients who underwent mechanical mitral valve replacement (MVR, CM valve in 52 patients, SJM valve in 51 patients) from January 2016 to December 2016 in our institution and used the SF-36 as an instrument to assess patients' QOL., Results: Patients' QOL improved over time. Patients who experienced disturbances due to valve noise had lower SF-36 scores in each scale, especially in general health, vitality, and mental health. Only 8.74% (n = 9) of patients complained of valve noise 1 year after the operation compared to 19.42% (n = 20) in the first month after the operation. The number of patients who experienced disturbances due to valve noise decreased over time, with a P value of 0.58. Logistic regression analysis showed that female patients those aged < 60 years old had a higher risk of experiencing disturbances due to valve noise. The valve type (CM vs SJM), body mass index (BMI) and valve size showed no significant differences in patients who experienced disturbances due to continuous valve noise. The SF-36 results were similar in the CM group and SJM group 1 year after the operation., Conclusions: QOL evaluated by the SF-36 improved over time in Chinese patients who underwent mechanical MVR. Age less than 60 years and female sex were high risk factors for experiencing disturbances due to valve noise. CM and SJM mechanical valves demonstrated similar valve noise levels and impact on QOL in patients who experienced mechanical MVR.

Introduction: Evidence for the gender gap in valvular heart disease (VHD) has been mixed. This study aimed to investigate the potential gender differences concerning distribution patterns, clinical characteristics, management and in-hospital outcomes of noteworthy VHD in the elderly Chinese population. Hypothesis: Gender disparities exist across the spectrum and management of valvular heart disease in elderly Chinese patients. Methods: The China Degenerative Valve Disease (China DVD) Cohort Study was conducted from October 2016 to December 2017 in 72 centers from China. It included prospectively 8923 patients aged ≥60 years with moderate to severe native VHD, infective endocarditis, or previous valve intervention. In-hospital outcomes after invasive treatments were evaluated by composite endpoint consisting of death, major bleeding and nonfatal stroke. Results: Of all the 8923 VHD patients, men accounted for 52.48%, with aortic regurgitation (AR; 13.2% vs. 6.5%) and aortic stenosis (AS; 5.8% vs. 3.8%) contributing more of the VHD diagnosis than women. By contrast, the proportion of women with mitral stenosis (MS; 4.8% vs. 1.8%) was much higher than men. While the rheumatic causes stayed significant in MS, a growing predominance of degenerative causes was detected regardless of gender in patients with aortic VHD and MR. Body mass index, history of smoking, hypertension, CHD, cardiomyopathy, aortic diseases and previous intervention were significantly higher in men whereas women were more frequently complicated with atrial fibrillation or atrial flutter. Concerning medical intervention, coronary angiography was used in 51.5% of male patients compared to 47.3% of female patients (p=0.01). Among the 2188 patients received invasive treatments, the prosthetic replacement was performed in 61% of women with AS in comparison to 47.2% of men with AS (p=0.006). Conversely, men with AR were more likely to receive prosthetic replacement than women (29.8% vs. 21.3%, p=0.008). No significant differences were found in patients with mitral VHD. Operative mortality was < 5% for single VHD. Multivariate regression analysis revealed an association between in-hospital outcomes and higher BMI as well as concomitant aortic disease regardless of gender. Conclusions: This study provides sex-specific data on characteristics and management of elderly Chinese patients with VHD. Pronounced sex-specific patterns were observed for aortic VHD and MS. [ABSTRACT FROM AUTHOR]

Background: Prevalence of aortic stenosis (AS) steadily increases with age. There is a consensus that intervention should be advised in patients with severe, symptomatic AS. Decision to operate raises specific problems in the elderly because of the increasing operative comorbidity and mortality. However, little is known regarding the proportion of Chinese patients who denied to receive intervention and the reasons leading to the denial. Hypothesis: Some uncertain clinical factors may be associated with the decision-making and prognosis of severe AS patients in China, which are worth exploring. Methods: Among 8923 patients aged ≥60 years with moderate to severe VHD registered in China Elderly Valve Heart Disease Survey from September to December 2016, 546 patients were diagnosed with severe (valve area ≤ 1 cm2 or peak velocity ≥4.0 m/s or mean gradient ≥40 mmHg), symptomatic (angina or NYHA III/IV or syncope) AS. The association between patient characteristics and denied-intervention decision were evaluated by multivariate logistic regression analysis. Cox model was used in multivariate analysis of the predictive factors for 6-month mortality. Results: Among 546 patients with severe symptomatic AS, the denied-intervention decision was taken in 208 patients (38.1%). In multivariable analysis, age [OR=1.098, 95% CI (1.037-1.163)] was significantly associated with the denied-intervention decision, while angina [OR=0.367, 95% CI (0.148-0.909)] and left ventricular ejection fraction (LVEF) <50% [OR=0.967, 95% CI (0.936-0.998)] showed significant associations with the decision to intervene. Further, multivalvular lesion [HR=3.436, 95% CI (1.33-8.85)] was significantly linked with higher 6-month mortality, whereas decision to intervene [HR=0.057, 95% CI (0.017-0.189)] and female [HR=0.37, 95% CI (0.142-0.960)] were related to lower mortality. Conclusions: Intervention was denied in about forty percent of elderly Chinese patients with severe, symptomatic AS. Age was the most striking factor of patients who were denied intervention, whereas patients with angina and low LVEF were more likely to receive interventional treatment. Multivalvular lesion was the predictive factor of 6-month mortality. Overall, elderly patients with severe, symptomatic AS could benefit from intervention. [ABSTRACT FROM AUTHOR]