Aims: Insufficient data exists regarding predictors of electrical storms(ES) and clinical outcome in patients treated with an implantable cardioverter defibrillator(ICD). The purpose of this study was to delineate a s...Aims: Insufficient data exists regarding predictors of electrical storms(ES) and clinical outcome in patients treated with an implantable cardioverter defibrillator(ICD). The purpose of this study was to delineate a subgroup of patients likely to experience ES and to determine the impact of ES on mortality in ICD recipients. Methods and results: Baseline characteristics of 307 ICD-treated patients were retrospectively analysed. ES was defined as two or more ventricular tachyarrhythmias within 24 h leading to an immediate electrical therapy(antitachycardia pacing and/or shock), separated by a period of sinus rhythm. Clinical characteristics and survival of 123 patients experiencing a total of 294 episodes of ES(median 2 ES/ patient, range 1-9), were compared with those of 184 ES-free patients during a median follow-up of 826 days(inter-quartile 1141 days). Median actuarial duration for the first ES occurrence after ICD implant was 1417 days [95% confidence interval(CI) 1061-2363] with a median follow-up of 816 days(7-4642 days) in ES-free patients. Univariate analysis identified older age, depressed left ventricular ejection fraction(LVEF), ventricular tachycardia(VT) as index arrhythmia, chronic renal failure and absence of lipid-lowering drugs as variables significantly associated with an increased risk of ES. Multivariable Cox analysis confirmed an independent predictive value for chronic renal failure [hazard ratio(HR) 1.54, 95% CI 0.95-2.51, P=0.052], VT(HR 2.20, 95% CI 1.44-3.37, P=0.0003), and LVEF(HR 0.98, 95% CI 0.97-0.99, P=0.027). In contrast, diabetics(HR 0.49, 95% CI 0.27-0.90, P=0.022) were less affected by ES. There was no difference in survival between both groups. Conclusion: ES is frequent but does not increase mortality in ICD s recipients. Patients with severe systolic dysfunction, chronic renal failure and VT as initial arrhythmia are likely to experience ES. Diabetics are less affected by ES.展开更多
Aims: To determine the prevalence and clinical predictors of subclinical atherosclerosis and myocardial ischaemia in uncomplicated type 2 diabetes and assess their relationship to short-term outcome. Methods and resul...Aims: To determine the prevalence and clinical predictors of subclinical atherosclerosis and myocardial ischaemia in uncomplicated type 2 diabetes and assess their relationship to short-term outcome. Methods and results: Established risk factors and coronaryartery calcium(CAC) scores were prospectively measured in 510 asymptomatic type 2 diabetic subjects(mean age 53± 8 years,61% males) without prior cardiovascular disease. Myocardial perfusion scintigraphy(MPS) was performed in all subjects with CAC >100 Agatston units(AU)(n=127), and a random sample of the remaining patients with CAC ≤ 100 AU(n=53). Significant CAC(>10 AU) was found in 46.3% . Twenty events occurred(two coronary deaths, nine non-fatal myocardial infarctions, three acute coronary syndromes, three non-haemorrhagic strokes, and three late revascularisations) during a median follow-up of 2.2 years(25th-75th percentile=1.9-2.5 years). The age, systolic blood pressure, the duration of diabetes, United Kingdom Prospective Diabetes Study risk score, CAC score, and extent of myocardial perfusion abnormality were significant predictors of time to cardiovascular events in a univariable Cox proportional hazard model. No cardiac events or perfusion abnormalities occurred in subjects with CAC ≤ 10 AU up until 2 years of follow-up. CAC and MPS findings were synergistic for the prediction of short-term cardiovascular events. Conclusion: Subclinical atherosclerosis, measured by CAC imaging, is superior to the established cardiovascular risk factors for predicting silent myocardial ischaemia and short-term outcome. Further studies evaluating the impact of CAC imaging on clinical outcomes and its cost effectiveness are warranted.展开更多
Aims: The goal of this study is to assess the association between the metabolic syndrome(MS) and parental history of cardiovascular disease(CVD). Methods and results: Participants were recruited in a population survey...Aims: The goal of this study is to assess the association between the metabolic syndrome(MS) and parental history of cardiovascular disease(CVD). Methods and results: Participants were recruited in a population survey of 3441 men and women, aged 35-64. MS was defined with NCEP-III guidelines. Familial history of myocardial infarction(MI), angina, and stroke was assessed with a standardized questionnaire. Parental premature CVD was defined if CVD occurred before 55/65 years in the father/mother. A total of 390 men and 281 women had MS. Positive parental CVD was associated with MS in women(43.0 vs. 36.8% , P< 0.001) but not in men(36.9 vs. 31.8% , P=0.06). Similarly, parental premature CVD was associated with MS in women(19.2 vs. 11.8% , P< 0.0007) but not in men(11.1 vs. 11.1% , ns). In women with MS, the age, centre, and educational level adjusted odds ratios [OR(95% CI)] of having a positive parental premature stroke was 1.84(1.0-3.38), P=0.049. This OR was 1.76(1.23-2.76), P=0.007 for combined parental premature MI and stroke and 1.67(1.17-2.38), P=0.004 for combined premature MI, stroke, and angina. After further adjustment on personal coronary heart disease and CVD risk factors, the ORs of having a positive parental history of combined premature MI and stroke [1.75(1.11-2.76), P=0.016] or MI, stroke, and angina [1.79(1.21-2.63), P=0.003], remained statistically significant, in women with MS. Conclusion: The MS is associated with parental premature CVD independently of classical CV risk factors, suggesting that MS is a contributor to the familial aggregation of premature CVD.展开更多
来自华为、Verizon、中国电信和Inside Products公司的专家近日在IETF的V6OPS提交了关于IPv6部署状态的草案报告,旨在提供一份I P v6过渡技术的调研,并发掘在过渡技术出现中的难点。本刊将逐期刊载该报告,本期将介绍报告的最后一部分,...来自华为、Verizon、中国电信和Inside Products公司的专家近日在IETF的V6OPS提交了关于IPv6部署状态的草案报告,旨在提供一份I P v6过渡技术的调研,并发掘在过渡技术出现中的难点。本刊将逐期刊载该报告,本期将介绍报告的最后一部分,内容包括IPv6网络运营、性能及安全性。展开更多
文摘Aims: Insufficient data exists regarding predictors of electrical storms(ES) and clinical outcome in patients treated with an implantable cardioverter defibrillator(ICD). The purpose of this study was to delineate a subgroup of patients likely to experience ES and to determine the impact of ES on mortality in ICD recipients. Methods and results: Baseline characteristics of 307 ICD-treated patients were retrospectively analysed. ES was defined as two or more ventricular tachyarrhythmias within 24 h leading to an immediate electrical therapy(antitachycardia pacing and/or shock), separated by a period of sinus rhythm. Clinical characteristics and survival of 123 patients experiencing a total of 294 episodes of ES(median 2 ES/ patient, range 1-9), were compared with those of 184 ES-free patients during a median follow-up of 826 days(inter-quartile 1141 days). Median actuarial duration for the first ES occurrence after ICD implant was 1417 days [95% confidence interval(CI) 1061-2363] with a median follow-up of 816 days(7-4642 days) in ES-free patients. Univariate analysis identified older age, depressed left ventricular ejection fraction(LVEF), ventricular tachycardia(VT) as index arrhythmia, chronic renal failure and absence of lipid-lowering drugs as variables significantly associated with an increased risk of ES. Multivariable Cox analysis confirmed an independent predictive value for chronic renal failure [hazard ratio(HR) 1.54, 95% CI 0.95-2.51, P=0.052], VT(HR 2.20, 95% CI 1.44-3.37, P=0.0003), and LVEF(HR 0.98, 95% CI 0.97-0.99, P=0.027). In contrast, diabetics(HR 0.49, 95% CI 0.27-0.90, P=0.022) were less affected by ES. There was no difference in survival between both groups. Conclusion: ES is frequent but does not increase mortality in ICD s recipients. Patients with severe systolic dysfunction, chronic renal failure and VT as initial arrhythmia are likely to experience ES. Diabetics are less affected by ES.
文摘Aims: To determine the prevalence and clinical predictors of subclinical atherosclerosis and myocardial ischaemia in uncomplicated type 2 diabetes and assess their relationship to short-term outcome. Methods and results: Established risk factors and coronaryartery calcium(CAC) scores were prospectively measured in 510 asymptomatic type 2 diabetic subjects(mean age 53± 8 years,61% males) without prior cardiovascular disease. Myocardial perfusion scintigraphy(MPS) was performed in all subjects with CAC >100 Agatston units(AU)(n=127), and a random sample of the remaining patients with CAC ≤ 100 AU(n=53). Significant CAC(>10 AU) was found in 46.3% . Twenty events occurred(two coronary deaths, nine non-fatal myocardial infarctions, three acute coronary syndromes, three non-haemorrhagic strokes, and three late revascularisations) during a median follow-up of 2.2 years(25th-75th percentile=1.9-2.5 years). The age, systolic blood pressure, the duration of diabetes, United Kingdom Prospective Diabetes Study risk score, CAC score, and extent of myocardial perfusion abnormality were significant predictors of time to cardiovascular events in a univariable Cox proportional hazard model. No cardiac events or perfusion abnormalities occurred in subjects with CAC ≤ 10 AU up until 2 years of follow-up. CAC and MPS findings were synergistic for the prediction of short-term cardiovascular events. Conclusion: Subclinical atherosclerosis, measured by CAC imaging, is superior to the established cardiovascular risk factors for predicting silent myocardial ischaemia and short-term outcome. Further studies evaluating the impact of CAC imaging on clinical outcomes and its cost effectiveness are warranted.
文摘Aims: The goal of this study is to assess the association between the metabolic syndrome(MS) and parental history of cardiovascular disease(CVD). Methods and results: Participants were recruited in a population survey of 3441 men and women, aged 35-64. MS was defined with NCEP-III guidelines. Familial history of myocardial infarction(MI), angina, and stroke was assessed with a standardized questionnaire. Parental premature CVD was defined if CVD occurred before 55/65 years in the father/mother. A total of 390 men and 281 women had MS. Positive parental CVD was associated with MS in women(43.0 vs. 36.8% , P< 0.001) but not in men(36.9 vs. 31.8% , P=0.06). Similarly, parental premature CVD was associated with MS in women(19.2 vs. 11.8% , P< 0.0007) but not in men(11.1 vs. 11.1% , ns). In women with MS, the age, centre, and educational level adjusted odds ratios [OR(95% CI)] of having a positive parental premature stroke was 1.84(1.0-3.38), P=0.049. This OR was 1.76(1.23-2.76), P=0.007 for combined parental premature MI and stroke and 1.67(1.17-2.38), P=0.004 for combined premature MI, stroke, and angina. After further adjustment on personal coronary heart disease and CVD risk factors, the ORs of having a positive parental history of combined premature MI and stroke [1.75(1.11-2.76), P=0.016] or MI, stroke, and angina [1.79(1.21-2.63), P=0.003], remained statistically significant, in women with MS. Conclusion: The MS is associated with parental premature CVD independently of classical CV risk factors, suggesting that MS is a contributor to the familial aggregation of premature CVD.
文摘来自华为、Verizon、中国电信和Inside Products公司的专家近日在IETF的V6OPS提交了关于IPv6部署状态的草案报告,旨在提供一份I P v6过渡技术的调研,并发掘在过渡技术出现中的难点。本刊将逐期刊载该报告,本期将介绍报告的最后一部分,内容包括IPv6网络运营、性能及安全性。
