目的 观察并分析对急性冠脉综合征患者给予阿利西尤单抗联用阿托伐他汀的治疗方案,对其血脂和用药安全性所产生的影响.方法 研究时间范围为2022年1月至2023年4月,收集我院收治的70例急性冠脉综合征患者,按照随机数字表法将其分为观察组和对照组,每组各35例.对照组给予单一阿托伐他汀治疗,观察组给予阿利西尤单抗联用阿托伐他汀治疗,对比两组患者的治疗效果、血脂水平、心功能指标、心血管不良事件以及用药不良反应发生率.结果 治疗后,观察组患者治疗总有效率为97.14％,明显高于对照组治疗总有效率80.00％(P＜0.05);治疗后观察组患者的TC、TG以及LDL-C水平均明显低于对照组,且HDL-C水平明显高于对照组(P＜0.05);治疗后观察组患者的LVESD、LVEDD均明显低于对照组,且LVEF明显高于对照组(P＜0.05);组间心血管不良事件总发生率比较(P＞0.05),但观察组患者的心血管不良事件总发生率为2.86％,稍低于对照组14.29％;用药期间观察组不良反应发生率为2.86％,明显低于对照组20.00％(P＜0.05).结论 对急性冠脉综合征患者给予阿利西尤单抗联用阿托伐他汀的治疗方案,不仅能有效改善患者的血脂水平与心功能指标,还能降低其心血管不良事件和用药不良反应的发生几率,治疗效果良好,具有推广应用价值.

目的:分析老年慢性心力衰竭(CHF)患者血清中miRNA-130a水平变化及其与心功能的相关性.方法:选择本院收治的CHF患者172例,根据NYHA心功能分级分为:Ⅱ级组(50例),Ⅲ级组(80例),Ⅳ级组(42例);纳入同期在本院体检健康者55例为健康对照组.比较各组一般资料、超声心动图各指标及血清B型钠尿肽(BNP)水平、miRNA-130a表达水平,并分析血清miRNA-130a表达与BNP水平、左室射血分数(LVEF)、左室舒张末期内径(LVEDd)、左心房内径(LAD)及NYHA心功能分级的相关性.结果:健康对照组、Ⅱ级组、Ⅲ级组、Ⅳ级组患者血清miRNA-130a、BNP水平及LVEDd、LAD依次显著升高,LVEF依次显著降低(P均=0.001).Pearson相关分析显示,CHF患者血清miRNA-130a表达与LVEF呈显著负相关(r=-0.461,P=0.001),与 BNP 水平、LVEDd、LAD 呈显著正相关(r=0.496～0.562,P 均=0.001);Spearman 相关分析显示,血清miRNA-130a表达与NYHA心功能分级呈显著正相关(r=0.905,P=0.001).结论:miRNA-130a在CHF患者血清中呈高表达,与患者心功能密切相关.

Objective:Takotsubo syndrome(TS)is classed as a kind of acute cardiac syndrome with a high incidence of major cardiac events. TS is easy to be misdiagnosed due to the initial clinical presentation and laboratory examination which are similar to acute coronary syndrome(ACS). This study aimed to explore the relationship between systemic oxidative stress and TS through clinical research.Methods:A total of 12 inpatients with TS as the first diagnosis were collected, while AMI patients and the healthy people examined with matching conditions were both included in the controls. Demographic data were recorded, as well as cardiac function was evaluated by ultrasound.At the same time, we detected the levels of plasma MDA and inflammatory factors in the three groups.Results:It was found out in clinical trials that the production of plasma MDA in TS patients showed a significant increase.In the meantime, the level of inflammatory cells and the inflammatory factors were elevated.Conclusions:The level of system oxidative stress increases and the inflammation is activated in TS patients.

近年来,原发性高血压(essential hypertension,EH)合并心律失常的发病率明显增加,常出现一种心律失常或多种律失常并存,严重威胁患者身体健康.随着动态血压监测诊断技术的发展,研究者更加明确人体血压昼夜节律及其时间生物学特征,正常生理状态下,动态血压波动曲线呈“杓型”,这种昼夜节律对心血管功能及结构有一定保护作用;但高血压患者昼夜节律消失,表现为高血压晨峰和夜间血压下降幅度不足,易致靶器官损害.研究报道,高血压患者血压昼夜节律变化与心血管事发生风险呈正相关关系[1].血管内皮功能作为心血管事件始动因子,在疾病发生、发展中起重要参与作用.

单纯舒张压升高(脉压差小) 单纯舒张压高多发生在中青年男性身上.患者常没有明显症状,即使有轻微的头胀、头晕不适和疲劳感,也会在休息后得到缓解,所以容易被忽视,大多得不到及时治疗.

Goal: To investigate the clinical benefits of partial body weight support for the function of Cardiopulmonary and Cardiac autonomic nerve in the early stage of Heart failure rehabilitation. Materials and Methods: We selected 90 patients with heart failure, divided into observation group (n = 45) and control group (n = 45). Both patients had the conventional drug therapy, while the observation group had the partial body weight support additionally within the 3 months treatment period. Serological examination includes brain natriuretic peptide (BNP) and aldosterone. Echocardiography detects left ventricular morphology, cardiac ejection function (EF) and cardiac autonomic nerve function. Minnesota quality of life scale (MHL) evaluates the life quality of the patients. Results: Before any treatment, there is no significant difference of serum brain natriuretic peptide (BNP), aldosterone, cardiac autonomic nerve function and the Minnesota quality of life scale (MHL) (P > 0.05). After treatment, outcome measures declined, including serum brain natriuretic peptide (BNP) and aldosterone (P < 0.01), LVESD and ESV (P < 0.01), LVEDD and EDV (P > 0.05). Outcome measures raised, including SV, CI, EF%, ΔD%. Among them, EF% had significant difference with P value < 0.05, and ΔD% with P value < 0.01. Both LF and HF raised, but LF/HF declined. The Minnesota quality of life scale (MHL) is significantly lower than before. Conclusion: Partial body weight support obviously reduces serum brain natriuretic peptide (BNP) and aldosterone, as well as improves the function of cardiopulmonary and cardiac autonomic nerve of the patients with heart failure, which at last improves the life quality.

目的:探讨血流储备分数(fractional flow reserve,FFR)在非前降支临界病变介入治疗中的指导意义.方法:回顾2011年9月至2014年9月在南京脑科医院心内科住院的稳定型心绞痛的患者,收集这些患者中行冠脉造影显示为单支冠脉临界病变并且FFR值>0.8的患者83例共85处血管病变,将83例患者分为非前降支组(包括右冠及回旋支)32例34处病变和前降支组51例共51处病变,分析其随访期间(48个月)的主要不良心血管事件(Major Adverse Cardiovascular Events,MACE),包括心绞痛发作、室性心律失常、靶血管血运重建、非致死性心肌梗死和心源性死亡.结果:在FFR值>0.8的稳定型心绞痛的患者中,非前降支组和前降支组的患者在临床基线资料如年龄、吸烟史、高脂血症病史、高血压病史等方面均无统计学差异,但非前降支组男性比例明显高于前降支组;通过定量冠状动脉造影测量,发现非前降支组患者的冠脉狭窄程度明显高于前降支组(P=0.000),但前降支组FFR值却明显低于非前降支组(P=0.000).经过48个月的随访,非前降支组的MACE的发生率明显低于前降支组(P=0.006).结论:在稳定型心绞痛的患者中,非前降支临界病变的患者较前降支临界病变的患者拥有更好的长期预后.

目的 探讨血流储备分数(fractional flow reserve, FFR)在非前降支临界病变介入治疗中的指导意义.方法 回顾2011年9月-2014年9月在南京脑科医院心内科住院的稳定型心绞痛的患者,收集这些患者中行冠脉造影显示为单支冠脉临界病变并且FFR值＞0.8的患者83例共85处血管病变,将83例患者分为非前降支组(包括右冠及回旋支)32例34处病变和前降支组51例共51处病变,分析其随访期间(48个月)的主要不良心血管事件(Major Adverse Cardiovascular Events, MACE),包括心绞痛发作、室性心律失常、靶血管血运重建、非致死性心肌梗死和心源性死亡.结果 在FFR值＞0.8的稳定型心绞痛的患者中,非前降支组和前降支组的患者在临床基线资料如年龄、吸烟史、高脂血症病史、高血压病史等方面均无统计学差异,但非前降支组男性比例明显高于前降支组;通过定量冠状动脉造影测量,发现非前降支组患者的冠脉狭窄程度明显高于前降支组(P=0.000),但前降支组FFR值却明显低于非前降支组(P=0.000).经过48个月的随访,非前降支组的MACE的发生率明显低于前降支组(P=0.006).结论 在稳定型心绞痛的患者中,非前降支临界病变的患者较前降支临界病变的患者拥有更好的长期预后.

Objective The purpose of this study was to evaluate the efficacy of first generation cryoballon ablation therapy in atrial fibrillation.MethodsOne hundred fifty-nine patients were enrolled in succession,received CBA therapy due to atrial fibrillation from May 2014 to March 2015.Patients were divided into PAF and PeAF groups based on the arrhythmia history;and 28 mm groups and 23 mm ballon groups due to cryoballon diameter;initial 50(1-50 th)and subsequent 101(51-159 th)groups in learning curve.The success rates in 3months,6months,12months and beyond 12months were analyzed during follow-ups.Results During 12～22(16.9±2.9)months follow-up,43 cases recurred(atrial fibrillation and atrial tachycardias)after first 3 months blank periods,and 20 patients received repeat RFCA procedures.the success rate of single CBA therapy was 91.2％(145/159),87.4％(139/159),78.5％(117/149)and 72.7％(101/139)in 3 month,6 months,12 months and after 12 months follow-ups;the CBA success rate was difference between 28 mm(n=112)and 23 mm(n=47)ballon group 93.8％vs.85.1％(P=0.052),91.1％vs.78.7％(P=0.03),84.9％vs.65.1％(P=0.006),and 80.0％vs.59.0％(P=0.01)respectively.In the learning curve phase analysis,the initial 50(1-50 th)and subsequent 101(51-159 th)groups,the success rate was 80.0％vs.96.3％(P=0.002),72.0％vs.94.5％(P=0.007)and 66.7％vs.86.5％(P=0.005)respectively in the follow-ups.Conclusion The first generation balloon CBA therapy may be effective,with high middle-term success rates,especially in paraoxymal atrial fibrillation groups,28 mm balloon group and experience could improve the efficacy.

Objective To explore immediate efficacy and safety of pulmonary veins(PV) isolation by cryoablation for the treatment of atrial fibrillation in Fujian Provincial Hospital Arrhythmia Center. Methods We analyzed the operation records and perioperative complications of 200 patients presenting with paroxysmal(n =147)or persistent(n= 53)atrial fibrillation from May 2014 to May 2015,who underwent cryoballoon catheter abla-tion(CBCA). Results Seven-hundred and sixty-nine of 818(94. 0%)PV isolated with a single cryoballoon ap-plication,respectively,Left superior pulmonary vein(LSPV)195(97. 5%)PV,Left inferior pulmonary vein(LIPV) 192(96. 0%)PV、right superior pulmonary vein(RSPV)197(98. 5%)PV、right inferior pulmonary vein(RIPV) 167(83. 5%)PV. In 32 patients(16. 0%)with 49 pulmonary veins,a focal radiofrequency was used to create a supplemental focal lesion. The average duration of operation was(108. 8±30. 9) min,the fluoroscopy time(18. 4± 5. 6) min,and the cryoablation time(41. 9±13. 0) min.Two phrenic nerve palsy occurred during the right superior PVI,and they were recovered completely after four months and three months respectively.One left subclavian vein bled one hour after the operation. There was no cardiac perforation,pericardial tamponade,ischemic stroke or esophageal fistula in all patients.Three hundreds of 303(94. 0%)PV were isolated with a single cryoballoon appli-cation in 23 mm balloon group, and 449 of 495 ( 90. 7%) PV were isolated in 28 mm balloon group. Conclusion PVI which use CBCA is a feasible,safe and effective technique for the treatment of atrial fibrillation.

Objective This study was aimed to evaluate electrophysiological characteristics of earliest activation in ventricular arrythmias originating from right ventricular outflow tract ( RVOT) tachycardia( ventricu-lar tachycardia/premature ventricular contraction, VT/PVC ) by noncontact and contact voltage mapping. Methods Fifty-one patients suffered from RVOT-PVC/VT were enrolled in this study( VT group,23 patients, non-sustained VT;PVC group,28 patients).Ensite Array noncontact mapping(St Jude,USA)was applied to find out the earliest activation( EA) and break out( BO) of PVC/VT,then contact voltage mapping of RVOT was cre-ated during sinus rhythm. The distribution of ablation targets were analyzed accordance with voltage mapping. Results The total success rate was 94.1% in all population(48/51).The success rate in VT group(95.7%, 22/23)compared with that in PVC group(92.9%,26/28).The average target voltage of VT group under sinus rhythm was significantly lower than that in PVC group [(1.0±0.9) mV vs. (1.8±1.6) mV,P=0.045].There was no significant difference in the average target voltage of VT/PVC during clinical arrhythmias[(2.4±2.0) mV vs. (2.7±2.1) mV,P=0. 845],neither was the target duration time advanced to VT/PVC QRS [(40.8± 4. 0) ms vs.(39. 2±3. 6) ms,P=0.180].VT group had more preference originating from low-voltage areas than PVC group(82. 6%vs.50%,P=0.031).The first 10 ms dV/dt in VT group was inferior to PVC group [(0. 9±0. 7)vs. (1. 7±1. 1),P=0.010].The EA-BO time of in VT group was significantly longer than PVC group [(14.3±6.0) ms vs. (10.2±4. 3) ms,P=0.044],and more agressive ablation needed(11/23 vs.6/28,P=0. 034).Conclusions VT group had lower initiate dv/dt and longer EA-BO distance,and needsed more aggressive ablations.The majority originating sites of idiopathic RVOT arrhythmias were located in low-voltage zone.VT group showed preferences.Voltage mapping may play an important role inablation of RVOT-concerned arrhythmias.

Hyperpolarization-activated cyclic nucleotide gated channels have four subtypes,named HCN1-HCN4,respectively.The HCN channels' basic structure are similar,and are expressed in many tissues and organs.The most abundant expression of HCN channels is in the brain and heart tissue.HCN channels participate in the normal physiological function of the tissues,and are closely re-lated with the organization's pathological state.Such as HCN1 mRNA expression is increased in the state of nerve injury-induced neu-ropathic pain,and HCN4 mRNA and HCN2 mRNA expression addition were often detected in pathological conditions of hypertrophic cardiomyopathy and end-stage heart failure ventricular cells.In view of the HCN channels are closely related to many diseases,therefore,it is possible to treat disease based on them.Due to the distribution of HCN channels far-ranging and its blockers non-selective,the side effects is unavoidable from clinical application.Therefore,the development of selective HCN channel subtype inhibitor is imperative.This article mainly reviews the features of HCN channels' inhibitor.

Objective After cardiac valve replacement,patients might have the opportunity of suffering from conduction abnormities.There is now still some controversy about the diagnosis and treatment of this disease.We here retrospectively studied 15 cases of permanent pacemaker implantation after cardiac valve replacement,to explore the experience of cardiac pacing in those patients.Methods Fifteen consecutive patients with atrioventricular block after valve replacement were selected in this study,which accepted permanent pacemaker implantation(PPI) at their post-surgery period.They received VVI or DDD mode cardiac pacing according one′s cardiac rhythm or economic status,and so did the location of electrode,whose demographic data was recorded.After the implantation,one month's follow-up was carried out,their NYHA heart function was classified.What′s more,their pacing reference,their electrocardiograhy indicators,such as EF fraction and LVEDD,were analyzed.Results All operations were successful in 15 patients,10 of which received VVI mode pacing,and the other DDD mode.Compared with non-pacemaker dependent(NP) group,pacemaker dependent(P) group presented a higher incidence of conduction disease(P<0.05) and longer cardiopulmonary bypass time(CPB)(P<0.01).Before,right after,one week and one month after cardiac pacing,no significant difference was found in such indexes as NYHA heart function,LVEDD,EF and pacing threshold and sensing.In all septal-location cases,the prothetic vlave was used as an "image navigation" tool for the accurate and smooth location of the active electrode.Conclusion Permanent pacemaker implantation after valve replacement was safe and effective.Already existing conduction disease(grade II and up),longer CPB time might be risk factors of later pacemaker dependency in valve replacement patients.Take advantage of the good visibility of prosthetic valve may be a novel way for the electrode′s septal location.