Background: To study the influence of blood lipid levels on hemorrhagic transformation(HT) and prognosis after acute cerebral infarction(ACI).Methods: Patients with ACI within 72 h of symptoms onset between January 1 ...Background: To study the influence of blood lipid levels on hemorrhagic transformation(HT) and prognosis after acute cerebral infarction(ACI).Methods: Patients with ACI within 72 h of symptoms onset between January 1 st, 2015, and December 31 st, 2016, were retrospectively analyzed. Patients were divided into group A(without HT) and group B(HT). The outcomes were assessed after 3 months of disease onset using the modified Rankin Scale(m RS). An m RS score of 0–2 points indicated excellent prognosis, and an m RS score of 3–6 points indicated poor prognosis.Results: A total of 732 patients conformed to the inclusion criteria, including 628 in group A and 104 in group B. The incidence of HT was 14.2%, and the median onset time was 2 d(interquartile range, 1–7 d). The percentages of patients with large infarct size and cortex involvement in group B were 80.8% and 79.8%, respectively, which were both significantly higher than those in group A(28.7 and 33.4%, respectively). The incidence rate of atrial fibrillation(AF) in group B was significantly higher than that in group A(39.4% vs. 13.9%, P<0.001). The adjusted multivariate analysis results showed that large infarct size, cortex involvement and AF were independent risk factors of HT, while total cholesterol(TC) was a protective factor of HT(OR=0.359, 95% CI 0.136–0.944, P=0.038). With every 1 mmol/L reduction in normal TC levels, the risk of HT increased by 64.1%. The mortality and morbidity at 3 months in group B(21.2% and 76.7%, respectively) were both significantly higher than those in group A(8.0% and 42.8%, respectively). The adjusted multivariate analysis results showed that large infarct size(OR=12.178, 95% CI 5.390–27.516, P<0.001) was an independent risk factor of long-term unfavorable outcomes, whereas low-density lipoprotein cholesterol(LDL-C) was a protective factor(OR=0.538, 95% CI 0.300–0.964, P=0.037). With every 1 mmol/L reduction in normal LDL-C levels, the risk of an unfavorable outcome increased by 46.2%. Major therapies, including int展开更多
Objective To study the prevalence of atrial fibrillation （AF） and the relation with its risk factors in China. Methods A total of 19 363 participants （8635 males and 10 728 females） aged 〉35 years in geographical...Objective To study the prevalence of atrial fibrillation （AF） and the relation with its risk factors in China. Methods A total of 19 363 participants （8635 males and 10 728 females） aged 〉35 years in geographically dispersed urban and rural regions of China were included in this cross-sectional survey. All participants received questionnaire, physical and blood examination. Echocardiography were performed for AF patients found in the survey. Results Of the 19 363 participants, 199 were diagnosed with AF. The estimated age-standardized prevalence of AF was 0.78% in men and 0.76% in women. The prevalence of AF in participants aged 〈60 years was 0.41% in men and 0.43% in women, and was 1.83% in both men and women aged 〉_60 years. About 19.0% of males and 30.9% of females with AF were diagnosed with valve disease. Age- and sex-adjusted multivariable logistic regression analysis revealed that myocardial infarction, left ventricular hypertrophy （LVH）, obesity, and alcohol consumption were associated with a increased risk of AF（P〈0.05）. Conclusion The age standardized prevalence of AF is 0.77% in the participants enrolled in the present study. The number of AF cases aged 〉35 years is 5.26 million according to 2010 Chinese Census. Most risk factors for AF, identified mainly in Western countries, are also detected in China.展开更多
1 Introduction Major and profound changes have taken place in China over the past 30 years. An epidemic of cardiovascular diseases （CVD） in China is emerging as a result of lifestyle changes, urbanization, and the ...1 Introduction Major and profound changes have taken place in China over the past 30 years. An epidemic of cardiovascular diseases （CVD） in China is emerging as a result of lifestyle changes, urbanization, and the accelerated process of aging. The incidence of CVD is continuously increasing and will remain an upward trend in the next decade. Since 2005,展开更多
Timely diagnosis and control of cardiovascular risk factors is a priority objective for adequate primary and secondary prevention of acute stroke. Hypertension, atrial fibrillation and diabetes mellitus are the most c...Timely diagnosis and control of cardiovascular risk factors is a priority objective for adequate primary and secondary prevention of acute stroke. Hypertension, atrial fibrillation and diabetes mellitus are the most common risk factors for acute cerebrovascular events, although novel risk factors, such as sleep-disordered breathing, inflammatory markers or carotid intima-media thickness have been identified. However, the cardiovascular risk factors profile differs according to the different subtypes of ischemic stroke. Atrial fibrillation and ischemic heart disease are more frequent in patients with cardioembolic infarction, hypertension and diabetes in patients with lacunar stroke, and vascular peripheral disease, hypertension, diabetes, previous transient ischemic attack and chronic obstructive pulmonary disease in patients with atherothrombotic infarction. This review aims to present updated data on risk factors for acute ischemic stroke as well as to describe the usefulness of new and emerging vascular risk factors in stroke patients.展开更多
Background Atrial fibrillation (AF) is a common arrhythmia associated with increased cardiovascular morbidity and mortality This study was undertaken to analyze the epidemiological factors and evaluate the current sta...Background Atrial fibrillation (AF) is a common arrhythmia associated with increased cardiovascular morbidity and mortality This study was undertaken to analyze the epidemiological factors and evaluate the current status of treatment in patients with AF in China's Mainland Methods Retrospective analysis of hospital records were taken from patients with primary diagnosis of AF, discharged from January 1999 to December 2001 A total of 9297 cases (mean age 65 5 years) with AF were enrolled from 40 hospitals in major parts of China Results The percentage of hospital admissions with AF was gradually increased comparing to those of total cardiovascular admission during three years, with the average of 7 9% The cases distribution progressively rose with age The causes and associated conditions of AF: advanced age 58 1%, hypertension 40 3%, coronary heart disease 34 8%, heart failure 33 1%, rheumatic valvular disease 23 9%, idiopathic AF 7 4%, cardiomyopathy 5 4%, diabetes 4 1% The most common coexistence among these variables was advanced age with hypertension Permanent AF almost accounted for half of these cases (49 5%), paroxysmal and persistent AF were 33 7% and 16 7%, respectively Paroxysmal AF was mainly treated with rhythm control (56 4%) However, 82 8% of patients with chronic AF had therapeutic strategy of rate control In patients with persistent AF, the cardioversion had been attempted in cases more than 50%, with only 31 1% of these patients who could maintain stabilized sinus rhythm The prevalence of stroke in this group was 17 5% In nonvalvular AF patients the risk factors that significantly associated with stroke included advanced age, history of hypertension, coronary heart disease and type of AF Sixty four point five percent of these patients received antithrombotic therapy with dominated use of antiplatelet agents The long term prevention with anticoagulants only accounted for 6 6% In this investigation patients with antiplatelets as well as patients with anticoagulants showed significant lower stroke ra展开更多
Background Recently there has been a great deal of interest in the role of serum uric acid （SUA） in atrial fibrillation （AF）. The objective of this study was to establish whether there is a relationship between le...Background Recently there has been a great deal of interest in the role of serum uric acid （SUA） in atrial fibrillation （AF）. The objective of this study was to establish whether there is a relationship between levels of SUA and recurrence of paroxysmal AF after catheter ablation. Methods Three hundred and thirty patients diagnosed with paroxysmal AF were analyzed. Patients were categorized into quartiles on the basis of their pre-operative SUA measurement and follow-up, and Kaplan-Meier estimation with a Log-rank test was used for the analysis of the influence of SUA on the recurrence of AF. Pre-procedural clinical variables were correlated with the clinical outcome after ablation using multivariate Logistic analysis. A Cox proportional hazards model was used to estimate the relationship between SUA and the recurrence of AF. Results After a mean follow-up of （9.341＋3.667） （range 3.0-16.3） months, recurrence rates from the lowest SUA quartile to the highest SUA quartile were 16.0%, 26.4%, 28.3%, and 29.3% respectively （P=0.014）. After adjustment for gender, body mass index （BMI）, hypertension, serum levels of high sensitivity C-reactive protein （hsCRP）, triglyceride （TG）, left atrial diameter （LA）, estimated glomerular filtration rate （eGFR）, and SUA, there was an increased risk of recurrence in subjects in the highest SUA quartile compared with those in the lowest quartile （hazard ratio 2.804, 95% confidence interval 1.466-5.362, P=0.002）. Following multivariate Logistical analysis, SUA was found to be an independent predictor of recurrence （hazard ratio 1.613, 95% confidence interval 1.601-1.625, P=0.014）. Conclusion In a retrospective study of patients with paroxysmal AF undergoing catheter ablation, elevated preoperative SUA levels were associated with a hiaher rate of recurrence of AF.展开更多
Background Studies have shown that increased levels of serum uric acid （SUA） are associated with atrial fibrillation （AF）. However, less is known about the prognostic value of SUA levels for AF in patients with ch...Background Studies have shown that increased levels of serum uric acid （SUA） are associated with atrial fibrillation （AF）. However, less is known about the prognostic value of SUA levels for AF in patients with chronic heart failure （CHF）. The aim of the study was to examine the prognostic value of SUA levels for AF in patients with CHF. Methods Sixteen thousand six hundred and eighty-one patients diagnosed with CHF from 12 hospitals were analyzed. Patients were categorized into AF group and non-AF group, death group, and survival group according to the results of the patients＇ medical records and follow-up. Univariate and multivariate Cox proportional hazards analyses were performed to examine the risk of AF. The sensitivity and specificity of SUA level in predicting the prognosis were examined by multivariate Cox models and receiver operating characteristic （ROC） curves. Results The results of univariate predictors in overall patients showed that the higher SUA level was associated with AF. SUA level （HR, 1.084; 95% CI, 1.017-1.144; P 〈0.001）, diuretics （HR, 1.549; 95% CI, 1.246-1.854; P 〈0.001）, and New York Heart Association （NYHA） （HR, 1.237; 95% CI, 1.168-1.306; P 〈0.001） function class were the independent risk factors for AF. The sensitivity and specificity of the models were 29.6% and 83.8% respectively for predicting AF. When SUA level was added to these models, it remained significant （Wald Z2, 1494.88; P 〈0.001 for AF）; 58.8% （95% CI, 57.7%-60.0%） of the observed results were concordant with the separate model. Conclusion Higher SUA level is associated strongly with AF in patients with CHF. SUA level can increase the sensitivity and specificity in predicting AF.展开更多
Background The neutrophil-to-lymphocyte （N/L） ratio has been associated with poor prognosis in patients with heart failure, but it has not been compared with N-terminal pro-brain natriuretic peptide （NT-proBNP） in...Background The neutrophil-to-lymphocyte （N/L） ratio has been associated with poor prognosis in patients with heart failure, but it has not been compared with N-terminal pro-brain natriuretic peptide （NT-proBNP） in elderly patients with chronic heart failure （CHF）. We sought to make this comparison. Methods A total of 1355 elderly patients with CHF were analyzed. A multivariate logistic regression model was used to analyze the variables associated with atrial fibrillation （AF）. Cox regression analysis was used to assess the multivariable rela- tionship between the N/L ratio, NT-proBNP level, and subsequent major cardiovascular events （MCE）. Results In the multiple logistic regression analysis, the N/L ratio was demonstrated as a risk factor for AF in elderly patients with CHF [odds ratio （OR）： 1.079, 95% confi- dence interval （CI）： 1.027-1.134, P = 0.003]. The median follow-up period was 18 months. In a multivariable model using tertiles of both variables, the highest tertile of the N/L ratio was significantly associated with MCE [hazard ratio （HR）： 1.407, 95% CI： 1.098-1.802, P = 0.007] compared with the lowest tertile. Similarly, the highest NT-proBNP tertile was also significantly associated with MCE （HR： 1.461, 95% CI： 1.104-1.934, P- 0.008）. Conclusions In elderly patients with CHF, the N/L ratio is one of the important risk factors for AF and it is an inexpensive and readily available marker with similar independent prognostic power to NT-proBNP. The risk of MCE increases 1.407-fold when the N/L ratio is elevated to the highest tertile.展开更多
Background The effects of anxiety and depression on the recurrence of persistent atrial fibrillation （AF） after circumferential pulmonary vein ablation （CPVA） are not clear. Whether CPVA can alleviate the anxiety ...Background The effects of anxiety and depression on the recurrence of persistent atrial fibrillation （AF） after circumferential pulmonary vein ablation （CPVA） are not clear. Whether CPVA can alleviate the anxiety and depression symptoms of persistent AF patients is unknown. Methods One hundred and sixty-four patients with persistent AF, of which 43 treated with CPVA （CPVA group） and 103 treated with anti-arrhythmics drugs （medicine group）, were enrolled. The Zung Self-Rating Anxiety Scale （SAS）, and Zung Self-Rating Depression Scale （SDS） were assessed before and 12 months after treatment in all patients. Results The scores of SAS （40.33±7.90 vs. 49.76±9.52, P 〈0.01） and SDS （42.33±8.73 vs. 48.17±8.77, P 〈0.01） decreased 12 months after CPVA. Over 12 months follow-up, AF relapsed in 17 patients in CPVA group. Compared with the data in the recurrent group （17 patients）, the scores of SAS and SDS were significantly lower in the non-recurrent group （26 patients） at baseline. The results of multivariate Logistic regression analysis showed normal scores of SAS and SDS were the independent risk factors of AF recurrence after CPVA. Conclusions Anxiety and depression increase the recurrence risk of persistent AF after CPVA. CPVA can ameliorate the anxiety and depression symptoms in patients with persistent AF.展开更多
Background Atrial fibrillation (AF) is the most common supraventriculararrhythmia in clinical practice. Chronic atrial fibrillation (CAF) is associated with ionicremodeling. However, little is known about the activity...Background Atrial fibrillation (AF) is the most common supraventriculararrhythmia in clinical practice. Chronic atrial fibrillation (CAF) is associated with ionicremodeling. However, little is known about the activity of ATP-sensitive potassium current I_(K,ATP) during CAF. So we studied the changes of I_(K, ATP) density and allosteric modulation ofATP-sensitivity by intracellular pH during CAF. Methods Myocardium samples were obtained from theright auricular appendage of patients with rheumatic heart disease complicated with valvular diseasein sinus rhythm (SR) or CAF. There were 14 patients in SR group and 9 patients in CAF group. Singleatrial cells were isolated using an enzyme dispersion technique. IKiATP was recorded using thewhole-cell and inside-out configuration of voltage-clamp techniques. In whole-cell model, myocytesof SR and CAF groups were perfused with simulated ischemic solution to elicit I_(K, ATP). Ininside-out configuration, the internal patch membranes were exposed to different ATP concentrationsin pH 7. 4 and 6. 8. Results Under simulated ischemia, I_(K, ATP) current density of CAF group wassignificantly higher than in SR group [(83.5 ± 10.8) vs. (58.7 ±8.4) pA/pF, P < 0. 01 ] . I_(K,ATP) of the two groups showed ATP concentration-dependent inhibition. The ATP concentration for 50%current inhibition (IC_(50) ) for the SR group was significantly different in pH 7. 4 and pH 6. 8(24 vs. 74 μmol/L, P < 0. 01). The IC_(50) did not change significantly in CAF group when the pHdecreased from 7. 4 to 6. 8. Conclusions During CAF, I_(K, ATP) current density was increased andits allosteric modulation of ATP-sensitivity by intracellular pH was diminished.展开更多
Atrial fibrillation （AF） is the most common ,cardiac arrhythmia with debilitating complications of stroke. Multiple-wavelet re-entry and focal activation from pulmonary vein foci are two dominant electrophysiologica...Atrial fibrillation （AF） is the most common ,cardiac arrhythmia with debilitating complications of stroke. Multiple-wavelet re-entry and focal activation from pulmonary vein foci are two dominant electrophysiological theories of AF. Atrial electrical remodeling plays a role in the maintenance of AF. However, molecular mechanisms of the arrhythmia are still poorly understood.展开更多
Background Based on the hypothesis that pulmonary vein isolation could result in the damage of the epicardial fat pads, this study aimed to investigated the impact of right upper pulmonary vein （RUPV） isolation on v...Background Based on the hypothesis that pulmonary vein isolation could result in the damage of the epicardial fat pads, this study aimed to investigated the impact of right upper pulmonary vein （RUPV） isolation on vagal innervation to atria. Methods Bilateral cervical sympathovagal trunks were decentralized in 6 dogs. Metoprolol was given to block sympathetic effects. Multipolar catheters were placed into the right atrium （R.A） and coronary sinus （CS）. RUPV isolation was performed via transseptal procedure. Atrial effective refractory period （ERP）, vulnerability window （VW） of atrial fibrillation （AF）, and sinus rhythm cycle length （SCL） were measured at RA and distal coronary sinus （CSd） at baseline and vagal stimulation before and after RUPV isolation. Serial sections of underlying tissues before and after ablation were stained with haematoxylin and eosin. Results SCL decreased significantly during vagal stimulation before RUPV isolation （197±21 vs 13±32 beats per minute, P〈0.001）, but remained unchanged after RUPV isolation （162±29 vs 140±39 beats per minute, P〉0.05）. ERP increased significantly before RUPV isolation compared with that during vagal stimulation [（85.00±24.29） ms vs （21.67±9.83） ms at RA, P〈0.001; （90.00± 15.49） ms vs （33.33±25.03） ms at CSd P〈0.005], but ERP at baseline hardly changed after RUPV isolation compared with that during vagal stimulation [（103.33 ± 22.50） vs （95.00± 16.43） ms at RA, P = 0.09; （98.33±24.83） vs （75.00±29.50） ms at CSd, P=0.009]. The ERP shortening during vagal stimulation after RUPV isolation decreased significantly [（63.33 ±22.51） ms vs （8.33 ± 9.83） ms at RA, P〈0.005; （56.67±20.66） ms vs （23.33± 13.66） ms at CSd, P〈0.05]. AF was rarely induced at baseline before and after RUPV isolation （VW close to 0）, while VW of AF to vagal stimulation significantly decreased after RUPV isolation [（40.00± 10.95） vs 0 ms at RA, P〈0.001; （45.00±32.09） v展开更多
Atrial fibrillation is the most common arrhythmia affecting patients today. Disease prevalence is increasing at an alarming rate worldwide, and is associated with often catastrophic and costly consequences, including ...Atrial fibrillation is the most common arrhythmia affecting patients today. Disease prevalence is increasing at an alarming rate worldwide, and is associated with often catastrophic and costly consequences, including heart failure, syncope, dementia, and stroke. Therapies including anticoagulants, anti-arrhythmic medications, devices, and non-pharmacologic procedures in the last 30 years have improved patients＂ functionality with the disease. Nonetheless, it remains imperative that further research into AF epidemiology, genetics, detection, and treatments continues to push forward rapidly as the worldwide population ages dramatically over the next 20 years.展开更多
Early recurrence of atrial arrhythmias(ERAA) after ablation is common and strongly predicts late recurrences and ablation failure. However, since arrhythmia may eventually resolve in up to half of patients with ERAA, ...Early recurrence of atrial arrhythmias(ERAA) after ablation is common and strongly predicts late recurrences and ablation failure. However, since arrhythmia may eventually resolve in up to half of patients with ERAA, guidelines do not recommend immediate reintervention for ERAA episodes occurring during a 3-mo postablation blanking period. Certain clinical demographic, electrophysiologic, procedural, and ERAA-related characteristics may predict a higher likelihood of longterm ablation failure. In this review, we aim to discuss potential mechanisms of ERAA, and to summarize the clinical significance, prognostic implications, and treatment options for ERAA.展开更多
Malignant cardiac arrhythmias which result in sudden cardiac death may be present in individuals apparently healthy or be associated with other medical conditions. The way to predict their appearance represents a chal...Malignant cardiac arrhythmias which result in sudden cardiac death may be present in individuals apparently healthy or be associated with other medical conditions. The way to predict their appearance represents a challenge for the medical community due to the tragic outcomes in most cases. In the last two decades some ventricular repolarization(VR) markers have been found to be useful to predict malignant cardiac arrhythmias in several clinical conditions. The corrected QT, QT dispersion, Tpeak-Tend, Tpeak-Tend dispersion and Tp-e/QT have been studied and implemented in clinical practice for this purpose. These markers are obtained from 12 lead surface electrocardiogram. In this review we discuss how these markers have demonstrated to be effective to predict malignant arrhythmias in medical conditions such as long and short QT syndromes, Brugada syndrome, early repolarization syndrome, acute myocardial ischemia, heart failure, hypertension, diabetes mellitus, obesity and highly trained athletes. Also the main pathophysiological mechanisms that explain the arrhythmogenic predisposition in these diseases and the basis for the VR markers are discussed. However, the same results have not been found in all conditions. Further studies are needed to reach a global consensus in order to incorporate these VR parameters in risk stratification of these patients.展开更多
Background Tumor necrosis factor-alpha （TNF-a） is a pleiotropic proinflammatory cytokine and contributes to many kinds of cardiovascular diseases via its receptors （TNFR1/TNFR2）. We hypothesize that TNF-a plays a ...Background Tumor necrosis factor-alpha （TNF-a） is a pleiotropic proinflammatory cytokine and contributes to many kinds of cardiovascular diseases via its receptors （TNFR1/TNFR2）. We hypothesize that TNF-a plays a role in the pathogenesis of chronic atrial fibrillation （AF）. Methods Sixty-seven consecutive patients who were scheduled to have cardiac surgery were enrolled into the study. Thirty-one patients with rheumatic heart disease （RHD） and AF were enrolled as study group （AF group）. The sinus rhythm （SR） control groups consisted of 20 patients with RHD and 16 patients with coronary artery disease （CAD）. Peripheral blood sample was collected before the operation. About 5 mm3 left atrial tissue was disserted during the operation and was separated into three parts for Western blotting, real time polymerase chain reaction （RT-PCR） and immunohistochemistry （IHC） analysis. Results Compared with the controls （RHD SR and CAD SR）, the levels of TNF-α （（14.40±5.45） pg/ml vs. （4.20±3.19） pg/ml vs. （2.68±2.20） pg/ml, P=0.000） and its soluble receptor 1 （sTNFR1） （（1623.9±558.6） pg/ml vs. （1222.3±175.6） pg/ml vs. （1387.5±362.2） pg/ml, P=0.001） in plasma were higher in patients with AF. TNF-a level had positive correlation with the left atrial diameter （LAD） （r=0.642, P=0.000）. Western blotting analysis showed that the protein levels of TNF-α （0.618±0.236 vs. 0.234±0.178 vs. 0.180±0.103, P=0.000） were higher in patients with AF. The RT-PCR analysis results demonstrated that the mRNA expression of TNF-a （0.103±0.047 vs. 0.031±0.027 vs. 0.023±0.018, P=0.000） increased in patients with AF. IHC analysis displayed that, comparing to the SR, the expression of TNF-α （0.125±0.025 vs. 0.080±0.027 vs. 0.070±0.023, P=0.000） increased in the AF group. The protein level and mRNA expression of TNF-α also had positive correlation with left atrium diameter （LAD） （r=0.415, P=0.000 and r=0.499, P=0.000）. Conclusions The 展开更多
文摘Background: To study the influence of blood lipid levels on hemorrhagic transformation(HT) and prognosis after acute cerebral infarction(ACI).Methods: Patients with ACI within 72 h of symptoms onset between January 1 st, 2015, and December 31 st, 2016, were retrospectively analyzed. Patients were divided into group A(without HT) and group B(HT). The outcomes were assessed after 3 months of disease onset using the modified Rankin Scale(m RS). An m RS score of 0–2 points indicated excellent prognosis, and an m RS score of 3–6 points indicated poor prognosis.Results: A total of 732 patients conformed to the inclusion criteria, including 628 in group A and 104 in group B. The incidence of HT was 14.2%, and the median onset time was 2 d(interquartile range, 1–7 d). The percentages of patients with large infarct size and cortex involvement in group B were 80.8% and 79.8%, respectively, which were both significantly higher than those in group A(28.7 and 33.4%, respectively). The incidence rate of atrial fibrillation(AF) in group B was significantly higher than that in group A(39.4% vs. 13.9%, P<0.001). The adjusted multivariate analysis results showed that large infarct size, cortex involvement and AF were independent risk factors of HT, while total cholesterol(TC) was a protective factor of HT(OR=0.359, 95% CI 0.136–0.944, P=0.038). With every 1 mmol/L reduction in normal TC levels, the risk of HT increased by 64.1%. The mortality and morbidity at 3 months in group B(21.2% and 76.7%, respectively) were both significantly higher than those in group A(8.0% and 42.8%, respectively). The adjusted multivariate analysis results showed that large infarct size(OR=12.178, 95% CI 5.390–27.516, P<0.001) was an independent risk factor of long-term unfavorable outcomes, whereas low-density lipoprotein cholesterol(LDL-C) was a protective factor(OR=0.538, 95% CI 0.300–0.964, P=0.037). With every 1 mmol/L reduction in normal LDL-C levels, the risk of an unfavorable outcome increased by 46.2%. Major therapies, including int
基金supported by the 10th National Five-Year Plan Projects(2001BA703B14,and 2001BA703B01)of Ministry of Science and Technology and Ministry of Health
文摘Objective To study the prevalence of atrial fibrillation （AF） and the relation with its risk factors in China. Methods A total of 19 363 participants （8635 males and 10 728 females） aged 〉35 years in geographically dispersed urban and rural regions of China were included in this cross-sectional survey. All participants received questionnaire, physical and blood examination. Echocardiography were performed for AF patients found in the survey. Results Of the 19 363 participants, 199 were diagnosed with AF. The estimated age-standardized prevalence of AF was 0.78% in men and 0.76% in women. The prevalence of AF in participants aged 〈60 years was 0.41% in men and 0.43% in women, and was 1.83% in both men and women aged 〉_60 years. About 19.0% of males and 30.9% of females with AF were diagnosed with valve disease. Age- and sex-adjusted multivariable logistic regression analysis revealed that myocardial infarction, left ventricular hypertrophy （LVH）, obesity, and alcohol consumption were associated with a increased risk of AF（P〈0.05）. Conclusion The age standardized prevalence of AF is 0.77% in the participants enrolled in the present study. The number of AF cases aged 〉35 years is 5.26 million according to 2010 Chinese Census. Most risk factors for AF, identified mainly in Western countries, are also detected in China.
文摘1 Introduction Major and profound changes have taken place in China over the past 30 years. An epidemic of cardiovascular diseases （CVD） in China is emerging as a result of lifestyle changes, urbanization, and the accelerated process of aging. The incidence of CVD is continuously increasing and will remain an upward trend in the next decade. Since 2005,
文摘Timely diagnosis and control of cardiovascular risk factors is a priority objective for adequate primary and secondary prevention of acute stroke. Hypertension, atrial fibrillation and diabetes mellitus are the most common risk factors for acute cerebrovascular events, although novel risk factors, such as sleep-disordered breathing, inflammatory markers or carotid intima-media thickness have been identified. However, the cardiovascular risk factors profile differs according to the different subtypes of ischemic stroke. Atrial fibrillation and ischemic heart disease are more frequent in patients with cardioembolic infarction, hypertension and diabetes in patients with lacunar stroke, and vascular peripheral disease, hypertension, diabetes, previous transient ischemic attack and chronic obstructive pulmonary disease in patients with atherothrombotic infarction. This review aims to present updated data on risk factors for acute ischemic stroke as well as to describe the usefulness of new and emerging vascular risk factors in stroke patients.
文摘Background Atrial fibrillation (AF) is a common arrhythmia associated with increased cardiovascular morbidity and mortality This study was undertaken to analyze the epidemiological factors and evaluate the current status of treatment in patients with AF in China's Mainland Methods Retrospective analysis of hospital records were taken from patients with primary diagnosis of AF, discharged from January 1999 to December 2001 A total of 9297 cases (mean age 65 5 years) with AF were enrolled from 40 hospitals in major parts of China Results The percentage of hospital admissions with AF was gradually increased comparing to those of total cardiovascular admission during three years, with the average of 7 9% The cases distribution progressively rose with age The causes and associated conditions of AF: advanced age 58 1%, hypertension 40 3%, coronary heart disease 34 8%, heart failure 33 1%, rheumatic valvular disease 23 9%, idiopathic AF 7 4%, cardiomyopathy 5 4%, diabetes 4 1% The most common coexistence among these variables was advanced age with hypertension Permanent AF almost accounted for half of these cases (49 5%), paroxysmal and persistent AF were 33 7% and 16 7%, respectively Paroxysmal AF was mainly treated with rhythm control (56 4%) However, 82 8% of patients with chronic AF had therapeutic strategy of rate control In patients with persistent AF, the cardioversion had been attempted in cases more than 50%, with only 31 1% of these patients who could maintain stabilized sinus rhythm The prevalence of stroke in this group was 17 5% In nonvalvular AF patients the risk factors that significantly associated with stroke included advanced age, history of hypertension, coronary heart disease and type of AF Sixty four point five percent of these patients received antithrombotic therapy with dominated use of antiplatelet agents The long term prevention with anticoagulants only accounted for 6 6% In this investigation patients with antiplatelets as well as patients with anticoagulants showed significant lower stroke ra
基金This study was supported by grants from the Beijing Postdoctoral Work Foundation （No. 2012ZZ-40 and 2011ZZ-04）, National Science Foundation Council of China （No. 30971239 and 81070147）, and the Beijing Natural Science Foundation （No. 7101004）. Beijing Municipal Science ＆ Technology Commission （No. DI 1110700300000）.
文摘Background Recently there has been a great deal of interest in the role of serum uric acid （SUA） in atrial fibrillation （AF）. The objective of this study was to establish whether there is a relationship between levels of SUA and recurrence of paroxysmal AF after catheter ablation. Methods Three hundred and thirty patients diagnosed with paroxysmal AF were analyzed. Patients were categorized into quartiles on the basis of their pre-operative SUA measurement and follow-up, and Kaplan-Meier estimation with a Log-rank test was used for the analysis of the influence of SUA on the recurrence of AF. Pre-procedural clinical variables were correlated with the clinical outcome after ablation using multivariate Logistic analysis. A Cox proportional hazards model was used to estimate the relationship between SUA and the recurrence of AF. Results After a mean follow-up of （9.341＋3.667） （range 3.0-16.3） months, recurrence rates from the lowest SUA quartile to the highest SUA quartile were 16.0%, 26.4%, 28.3%, and 29.3% respectively （P=0.014）. After adjustment for gender, body mass index （BMI）, hypertension, serum levels of high sensitivity C-reactive protein （hsCRP）, triglyceride （TG）, left atrial diameter （LA）, estimated glomerular filtration rate （eGFR）, and SUA, there was an increased risk of recurrence in subjects in the highest SUA quartile compared with those in the lowest quartile （hazard ratio 2.804, 95% confidence interval 1.466-5.362, P=0.002）. Following multivariate Logistical analysis, SUA was found to be an independent predictor of recurrence （hazard ratio 1.613, 95% confidence interval 1.601-1.625, P=0.014）. Conclusion In a retrospective study of patients with paroxysmal AF undergoing catheter ablation, elevated preoperative SUA levels were associated with a hiaher rate of recurrence of AF.
文摘Background Studies have shown that increased levels of serum uric acid （SUA） are associated with atrial fibrillation （AF）. However, less is known about the prognostic value of SUA levels for AF in patients with chronic heart failure （CHF）. The aim of the study was to examine the prognostic value of SUA levels for AF in patients with CHF. Methods Sixteen thousand six hundred and eighty-one patients diagnosed with CHF from 12 hospitals were analyzed. Patients were categorized into AF group and non-AF group, death group, and survival group according to the results of the patients＇ medical records and follow-up. Univariate and multivariate Cox proportional hazards analyses were performed to examine the risk of AF. The sensitivity and specificity of SUA level in predicting the prognosis were examined by multivariate Cox models and receiver operating characteristic （ROC） curves. Results The results of univariate predictors in overall patients showed that the higher SUA level was associated with AF. SUA level （HR, 1.084; 95% CI, 1.017-1.144; P 〈0.001）, diuretics （HR, 1.549; 95% CI, 1.246-1.854; P 〈0.001）, and New York Heart Association （NYHA） （HR, 1.237; 95% CI, 1.168-1.306; P 〈0.001） function class were the independent risk factors for AF. The sensitivity and specificity of the models were 29.6% and 83.8% respectively for predicting AF. When SUA level was added to these models, it remained significant （Wald Z2, 1494.88; P 〈0.001 for AF）; 58.8% （95% CI, 57.7%-60.0%） of the observed results were concordant with the separate model. Conclusion Higher SUA level is associated strongly with AF in patients with CHF. SUA level can increase the sensitivity and specificity in predicting AF.
文摘Background The neutrophil-to-lymphocyte （N/L） ratio has been associated with poor prognosis in patients with heart failure, but it has not been compared with N-terminal pro-brain natriuretic peptide （NT-proBNP） in elderly patients with chronic heart failure （CHF）. We sought to make this comparison. Methods A total of 1355 elderly patients with CHF were analyzed. A multivariate logistic regression model was used to analyze the variables associated with atrial fibrillation （AF）. Cox regression analysis was used to assess the multivariable rela- tionship between the N/L ratio, NT-proBNP level, and subsequent major cardiovascular events （MCE）. Results In the multiple logistic regression analysis, the N/L ratio was demonstrated as a risk factor for AF in elderly patients with CHF [odds ratio （OR）： 1.079, 95% confi- dence interval （CI）： 1.027-1.134, P = 0.003]. The median follow-up period was 18 months. In a multivariable model using tertiles of both variables, the highest tertile of the N/L ratio was significantly associated with MCE [hazard ratio （HR）： 1.407, 95% CI： 1.098-1.802, P = 0.007] compared with the lowest tertile. Similarly, the highest NT-proBNP tertile was also significantly associated with MCE （HR： 1.461, 95% CI： 1.104-1.934, P- 0.008）. Conclusions In elderly patients with CHF, the N/L ratio is one of the important risk factors for AF and it is an inexpensive and readily available marker with similar independent prognostic power to NT-proBNP. The risk of MCE increases 1.407-fold when the N/L ratio is elevated to the highest tertile.
文摘Background The effects of anxiety and depression on the recurrence of persistent atrial fibrillation （AF） after circumferential pulmonary vein ablation （CPVA） are not clear. Whether CPVA can alleviate the anxiety and depression symptoms of persistent AF patients is unknown. Methods One hundred and sixty-four patients with persistent AF, of which 43 treated with CPVA （CPVA group） and 103 treated with anti-arrhythmics drugs （medicine group）, were enrolled. The Zung Self-Rating Anxiety Scale （SAS）, and Zung Self-Rating Depression Scale （SDS） were assessed before and 12 months after treatment in all patients. Results The scores of SAS （40.33±7.90 vs. 49.76±9.52, P 〈0.01） and SDS （42.33±8.73 vs. 48.17±8.77, P 〈0.01） decreased 12 months after CPVA. Over 12 months follow-up, AF relapsed in 17 patients in CPVA group. Compared with the data in the recurrent group （17 patients）, the scores of SAS and SDS were significantly lower in the non-recurrent group （26 patients） at baseline. The results of multivariate Logistic regression analysis showed normal scores of SAS and SDS were the independent risk factors of AF recurrence after CPVA. Conclusions Anxiety and depression increase the recurrence risk of persistent AF after CPVA. CPVA can ameliorate the anxiety and depression symptoms in patients with persistent AF.
文摘Background Atrial fibrillation (AF) is the most common supraventriculararrhythmia in clinical practice. Chronic atrial fibrillation (CAF) is associated with ionicremodeling. However, little is known about the activity of ATP-sensitive potassium current I_(K,ATP) during CAF. So we studied the changes of I_(K, ATP) density and allosteric modulation ofATP-sensitivity by intracellular pH during CAF. Methods Myocardium samples were obtained from theright auricular appendage of patients with rheumatic heart disease complicated with valvular diseasein sinus rhythm (SR) or CAF. There were 14 patients in SR group and 9 patients in CAF group. Singleatrial cells were isolated using an enzyme dispersion technique. IKiATP was recorded using thewhole-cell and inside-out configuration of voltage-clamp techniques. In whole-cell model, myocytesof SR and CAF groups were perfused with simulated ischemic solution to elicit I_(K, ATP). Ininside-out configuration, the internal patch membranes were exposed to different ATP concentrationsin pH 7. 4 and 6. 8. Results Under simulated ischemia, I_(K, ATP) current density of CAF group wassignificantly higher than in SR group [(83.5 ± 10.8) vs. (58.7 ±8.4) pA/pF, P < 0. 01 ] . I_(K,ATP) of the two groups showed ATP concentration-dependent inhibition. The ATP concentration for 50%current inhibition (IC_(50) ) for the SR group was significantly different in pH 7. 4 and pH 6. 8(24 vs. 74 μmol/L, P < 0. 01). The IC_(50) did not change significantly in CAF group when the pHdecreased from 7. 4 to 6. 8. Conclusions During CAF, I_(K, ATP) current density was increased andits allosteric modulation of ATP-sensitivity by intracellular pH was diminished.
文摘Atrial fibrillation （AF） is the most common ,cardiac arrhythmia with debilitating complications of stroke. Multiple-wavelet re-entry and focal activation from pulmonary vein foci are two dominant electrophysiological theories of AF. Atrial electrical remodeling plays a role in the maintenance of AF. However, molecular mechanisms of the arrhythmia are still poorly understood.
文摘Background Based on the hypothesis that pulmonary vein isolation could result in the damage of the epicardial fat pads, this study aimed to investigated the impact of right upper pulmonary vein （RUPV） isolation on vagal innervation to atria. Methods Bilateral cervical sympathovagal trunks were decentralized in 6 dogs. Metoprolol was given to block sympathetic effects. Multipolar catheters were placed into the right atrium （R.A） and coronary sinus （CS）. RUPV isolation was performed via transseptal procedure. Atrial effective refractory period （ERP）, vulnerability window （VW） of atrial fibrillation （AF）, and sinus rhythm cycle length （SCL） were measured at RA and distal coronary sinus （CSd） at baseline and vagal stimulation before and after RUPV isolation. Serial sections of underlying tissues before and after ablation were stained with haematoxylin and eosin. Results SCL decreased significantly during vagal stimulation before RUPV isolation （197±21 vs 13±32 beats per minute, P〈0.001）, but remained unchanged after RUPV isolation （162±29 vs 140±39 beats per minute, P〉0.05）. ERP increased significantly before RUPV isolation compared with that during vagal stimulation [（85.00±24.29） ms vs （21.67±9.83） ms at RA, P〈0.001; （90.00± 15.49） ms vs （33.33±25.03） ms at CSd P〈0.005], but ERP at baseline hardly changed after RUPV isolation compared with that during vagal stimulation [（103.33 ± 22.50） vs （95.00± 16.43） ms at RA, P = 0.09; （98.33±24.83） vs （75.00±29.50） ms at CSd, P=0.009]. The ERP shortening during vagal stimulation after RUPV isolation decreased significantly [（63.33 ±22.51） ms vs （8.33 ± 9.83） ms at RA, P〈0.005; （56.67±20.66） ms vs （23.33± 13.66） ms at CSd, P〈0.05]. AF was rarely induced at baseline before and after RUPV isolation （VW close to 0）, while VW of AF to vagal stimulation significantly decreased after RUPV isolation [（40.00± 10.95） vs 0 ms at RA, P〈0.001; （45.00±32.09） v
文摘Atrial fibrillation is the most common arrhythmia affecting patients today. Disease prevalence is increasing at an alarming rate worldwide, and is associated with often catastrophic and costly consequences, including heart failure, syncope, dementia, and stroke. Therapies including anticoagulants, anti-arrhythmic medications, devices, and non-pharmacologic procedures in the last 30 years have improved patients＂ functionality with the disease. Nonetheless, it remains imperative that further research into AF epidemiology, genetics, detection, and treatments continues to push forward rapidly as the worldwide population ages dramatically over the next 20 years.
文摘Early recurrence of atrial arrhythmias(ERAA) after ablation is common and strongly predicts late recurrences and ablation failure. However, since arrhythmia may eventually resolve in up to half of patients with ERAA, guidelines do not recommend immediate reintervention for ERAA episodes occurring during a 3-mo postablation blanking period. Certain clinical demographic, electrophysiologic, procedural, and ERAA-related characteristics may predict a higher likelihood of longterm ablation failure. In this review, we aim to discuss potential mechanisms of ERAA, and to summarize the clinical significance, prognostic implications, and treatment options for ERAA.
文摘Malignant cardiac arrhythmias which result in sudden cardiac death may be present in individuals apparently healthy or be associated with other medical conditions. The way to predict their appearance represents a challenge for the medical community due to the tragic outcomes in most cases. In the last two decades some ventricular repolarization(VR) markers have been found to be useful to predict malignant cardiac arrhythmias in several clinical conditions. The corrected QT, QT dispersion, Tpeak-Tend, Tpeak-Tend dispersion and Tp-e/QT have been studied and implemented in clinical practice for this purpose. These markers are obtained from 12 lead surface electrocardiogram. In this review we discuss how these markers have demonstrated to be effective to predict malignant arrhythmias in medical conditions such as long and short QT syndromes, Brugada syndrome, early repolarization syndrome, acute myocardial ischemia, heart failure, hypertension, diabetes mellitus, obesity and highly trained athletes. Also the main pathophysiological mechanisms that explain the arrhythmogenic predisposition in these diseases and the basis for the VR markers are discussed. However, the same results have not been found in all conditions. Further studies are needed to reach a global consensus in order to incorporate these VR parameters in risk stratification of these patients.
基金This work was supported by Province Science and Technological Program of Guangdong （No. 2010B060900018） and Province Natural Science Foundation of Guangdong （No. 1015008002000010）.
文摘Background Tumor necrosis factor-alpha （TNF-a） is a pleiotropic proinflammatory cytokine and contributes to many kinds of cardiovascular diseases via its receptors （TNFR1/TNFR2）. We hypothesize that TNF-a plays a role in the pathogenesis of chronic atrial fibrillation （AF）. Methods Sixty-seven consecutive patients who were scheduled to have cardiac surgery were enrolled into the study. Thirty-one patients with rheumatic heart disease （RHD） and AF were enrolled as study group （AF group）. The sinus rhythm （SR） control groups consisted of 20 patients with RHD and 16 patients with coronary artery disease （CAD）. Peripheral blood sample was collected before the operation. About 5 mm3 left atrial tissue was disserted during the operation and was separated into three parts for Western blotting, real time polymerase chain reaction （RT-PCR） and immunohistochemistry （IHC） analysis. Results Compared with the controls （RHD SR and CAD SR）, the levels of TNF-α （（14.40±5.45） pg/ml vs. （4.20±3.19） pg/ml vs. （2.68±2.20） pg/ml, P=0.000） and its soluble receptor 1 （sTNFR1） （（1623.9±558.6） pg/ml vs. （1222.3±175.6） pg/ml vs. （1387.5±362.2） pg/ml, P=0.001） in plasma were higher in patients with AF. TNF-a level had positive correlation with the left atrial diameter （LAD） （r=0.642, P=0.000）. Western blotting analysis showed that the protein levels of TNF-α （0.618±0.236 vs. 0.234±0.178 vs. 0.180±0.103, P=0.000） were higher in patients with AF. The RT-PCR analysis results demonstrated that the mRNA expression of TNF-a （0.103±0.047 vs. 0.031±0.027 vs. 0.023±0.018, P=0.000） increased in patients with AF. IHC analysis displayed that, comparing to the SR, the expression of TNF-α （0.125±0.025 vs. 0.080±0.027 vs. 0.070±0.023, P=0.000） increased in the AF group. The protein level and mRNA expression of TNF-α also had positive correlation with left atrium diameter （LAD） （r=0.415, P=0.000 and r=0.499, P=0.000）. Conclusions The
