Combining ezetimibe (EZ) and statins is recommended for the treatment of elevated low-density lipoprotein-cholesterol (LDL-C). This subgroup analysis evaluated the efficacy of fixed-dose combination (FDC) therapy with EZ and atorvastatin (AS) versus AS monotherapy on attaining LDL-C goals in Chinese patients with very high risk of atherosclerotic cardiovascular disease (ASCVD) grouped by ASCVD risk, age, and sex. Data from the phase III, randomized, double-blind study (NCT03768427) compared EZ10/AS10 mg FDC versus AS20 mg (cohort A), and EZ10/AS20 mg FDC versus AS40 mg monotherapy (cohort B) in Chinese patients with uncontrolled hypercholesterolemia. Proportions of patients attaining 2016 Chinese guideline-recommended LDL-C goals (low/medium risk [< 130 mg/dL], high risk [< 100 mg/dL], very high risk [< 70 mg/dL]) were assessed at weeks 6 and 12. Subgroup analyses by ASCVD risk, age (< 65 and ≥ 65 years), and sex were conducted. LDL-C goal attainment was significantly higher with FDCs versus AS monotherapy at week 12 (cohort A: 62.7

BackgroundTo evaluate the safety and efficacy of hybutimibe plus atorvastatin for lipid control in hypercholesterolemia patients with atherosclerotic cardiovascular disease risk equivalent.MethodsIn this double-blind phase III study, we 1:1 randomly assigned 255 hypercholesterolemia patients with atherosclerotic cardiovascular disease to receive hybutimibe plus atorvastatin or placebo plus atorvastatin. The primary endpoint was the rate of change of plasma low-density lipoprotein-cholesterol (LDL-C) level at 12 weeks from baseline. The secondary endpoints were plasma total cholesterol (TC), triglyceride (TG), high-density lipoprotein-cholesterol (HDL-C), non-HDL-C, apoprotein (Apo) B, and 2-, 4-, 8-, and 12-week Apo A1 levels change rate and rates of change of plasma LDL-C levels at 2, 4, and 8 weeks from baseline.ResultsFrom April 2016 to January 2018, 128 in the hybutimibe plus atorvastatin group and 125 in the atorvastatin group were included in modified intention-to-treat (mITT) analysis. After 12 weeks of treatment, LDL-C level changed from 2.61 mmol/L (±0.30) at baseline to 2.18 mmol/L (±0.45) in the hybutimibe plus atorvastatin group and from 2.58 (±0.31) mmol/L to 2.40 (± 0.46) mmol/L in the atorvastatin group (P < 0.0001), in mITT. The change rate in the hybutimibe plus atorvastatin group was significantly higher than that in the atorvastatin group (P < 0.0001); the estimated mean rates of change were −16.39 (95% confidence interval: −19.04, −13.74) and −6.75 (−9.48, −4.02), respectively. Consistently, in per-protocol set (PPS) analysis, the rate of change of LDL-C in the hybutimibe plus atorvastatin group was significantly higher than that in atorvastatin group. Significant decreases in the change rates of non-HDL-C, TC, and Apo B at 2, 4, 8, and 12 weeks (all P < 0.05) were observed for hybutimibe plus atorvastatin, while the differences were not significant for HDL-C, TG, and Apo-A1 (all P > 0.05). During the study period, no additional side effects were reported.ConclusionsHybutimibe combined with atorvastatin resulted in significant improvements in LDL-C, non-HDL-C, TC, and Apo B compared with atorvastatin alone. The safety and tolerability were also acceptable, although additional benefits of hybutimibe plus atorvastatin were not observed compared with atorvastatin alone in HDL-C, TG, and Apo-A1.

Purpose: The 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors ("statins") and the cholesterol-lowering medication ezetimibe are widely used in the treatment of patients with high- and very high-risk atherosclerotic cardiovascular disease. This study compared the efficacy and tolerability of a fixed-dose combination (FDC) of ezetimibe/atorvastatin (EZ/AS) with those of escalating doses of atorvastatin monotherapy in Chinese patients with hypercholesterolemia uncontrolled with statin monotherapy. Methods: This Phase III, 12-week, randomized, double-blind study included patients aged 18 to 80 years with hypercholesterolemia uncontrolled on atorvastatin 10 or 20 mg/d monotherapy. After a 5-week run-in period of treatment with atorvastatin 10 or 20 mg/d (cohorts A and B, respectively), or a bioequivalent dosage of another statin, patients were randomized in a 1:1 ratio within each cohort to receive EZ/AS 10/10 mg FDC (EZ10/AS10) or atorvastatin 20 mg (AS20), once daily (cohort A); or EZ/AS 10/20 mg FDC (EZ10/AS20) or atorvastatin 40 mg (AS40), once daily (cohort B). The primary end point was the percentage change from baseline in low-density lipoprotein cholesterol (LDL-C). Tolerability was also evaluated. Findings: Of the 454 patients enrolled, 412 (90.7%) completed the study. The percentage change from baseline in LDL-C was statistically greater with EZ10/AS10 treatment (n = 88) compared with AS20 monotherapy (n = 89) (treatment difference, -19.5%; 95% CI, -26.7% to -12.3%; P < 0.001). The percentage change from baseline in LDL-C was statistically greater with EZ10/AS20 treatment (n = 137) compared with AS40 monotherapy (n = 140) (treatment difference, -15.9%; 95% CI, -21.0% to -10.7%; P < 0.001). The safety profile was comparable between the EZ/AS and atorvastatin groups in the two cohorts. Implications: The LDL-C level at week 12 was significantly improved with both FDCs compared with escalated doses of atorvastatin (20 or 40 mg/d) in these Chinese patients with hypercholesterolemia uncontrolled on atorvastatin 10 or 20 mg/d. Both FDCs were well tolerated, with no new tolerability-related findings. Chinadrugtrials.org.cn identifier: CTR20190172; ClinicalTrials.gov identifier: NCT03768427 (c) 2022 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

目的:评估海博麦布治疗原发性高胆固醇血症的有效性和安全性.方法:本研究为多中心、随机、双盲、安慰剂平行对照的Ⅲ期临床试验.共纳入分析原发性高胆固醇血症患者373例,按2:1随机接受海博麦布(试验组,n=248)或安慰剂(对照组,n=125)20 mg/d治疗12周(治疗评价期).延伸期持续40周,两组均口服海博麦布20 mg/d.主要疗效终点为第12周低密度脂蛋白胆固醇(LDL-C)较基线的变化率,次要疗效终点为治疗评价期和延伸期其他血脂指标的变化率,同时观察用药安全性.结果:第12周试验组LDL-C较基线的变化率为(-10.23±13.58)％,显著优于对照组(4.34±15.88)％,P<0.05.试验组非高密度脂蛋白胆固醇(non-HDL-C)、总胆固醇(TC)和载脂蛋白B(Apo B)的变化率分别为(-10.81±12.28)％、(-7.92±9.88)％和(-12.06±11.32)％,均显著优于对照组的(3.22±15.90)％、(2.18±11.68)％和(0.51±13.37)％(P均<0.05),而高密度脂蛋白胆固醇、甘油三酯和载脂蛋白AI变化率的差异无统计学意义.试验组与对照组不良反应的发生率在第12周分别为4.55％和8.40％,在延伸期分别为4.43％和7.07％,未发现新的或加重的与海博麦布可能相关的不良事件.结论:海博麦布可以有效降低原发性高胆固醇血症患者的LDL-C、non-HDL-C、TC和Apo B水平,降脂效果可长期持续,不良反应发生率低,耐受性好.

目的 探讨氯吡格雷联合阿司匹林用于冠状动脉粥样硬化性心脏病(CAD)患者经皮冠状动脉介入术(PCI)后抗血小板的疗效与预后相关性.方法 入选2019年1月至2019年8月期间某院心血管内科CAD住院患者408例,行PCI术后予以氯吡格雷联合阿司匹林双联抗血小板治疗,即规律服用阿司匹林100 mg/d联合氯吡格雷75 mg/d.用药前及用药后均采用光学比浊法(LTA)测定血小板聚集率(PA),包括阿司匹林抗血小板反应性(LTAAA)及氯吡格雷抗血小板反应性(LTAADP).并根据PA结果进行分组,将LTAAA≥20％定义为阿司匹林抵抗(AR),LTAADP值≥70％定义为氯吡格雷抵抗(CR).所有患者随访6～12个月,观察心血管事件发生率.结果 根据LTA法测定结果,将入选患者分为CR组和非氯吡格雷抵抗(NCR)组,入选患者中无AR.其中CR组为101例,NCR组307例,CR发生率为24.8％.所有入院患者中共有46例患者发生心血管事件,其中CR组患者中心血管事件发生17例(16.8％),NCR组患者中心血管事件发生率为29例(9.4％),CR组患者发生心血管事件发生风险显著高于NCR组(OR=1.940,95％CI:1.016～3.703,P<0.05).多因素COX回归分析提示,吸烟因素、Grace评分及CR为CAD患者PCI术后发生心血管事件的风险因素.结论 氯吡格雷联合阿司匹林用于CAD患者PCI术后抗血小板治疗安全有效;CR与心血管事件发生风险相关.

目的 探讨建立急救绿道APP管理模式对急性ST段抬高型心肌梗死(ASTEMI)患者救治的影响.方法 选取航天中心医院心脏医学部急救绿道APP管理模式建立之前2017年6月至2018年6月收治的ASTEMI患者87例为对照组,急救绿道APP管理模式成立之后2018年7月至2019年7月收治的ASTEMI患者108例为观察组.比较两组发病至首次医疗救治时间、入院后首份心电图完成时间、入门-球囊(D2B)时间、住院期间心力衰竭发生率、住院时长、住院期间死亡率、住院期间平均花费.结果 两组发病至首次医疗救治时间比较差异无统计学意义(P>0.05);观察组入院后首份心电图完成时间较对照组缩短,有统计学差异(P<0.01);观察组D2B时间较对照组缩短(P<0.01);观察组住院期间心力衰竭发生率较对照组明显降低(P<0.05);住院期间死亡率两组比较无统计学差异(P>0.05);观察组住院时长较对照组降低(P<0.01),观察组住院期间平均花费较对照组明显降低(P<0.05).结论 采用急救绿道APP模式管理ASTEMI患者进一步提高了ASTEMI再灌注治疗的水平,缩短了心肌总缺血时间,减少患者住院时长,降低医疗支出,临床实践中简便,易于推广,实用性强.

目的 观察丹参酮ⅡA对大鼠心肌梗死后心房颤动诱发率及持续时间的影响,并初步探讨其作用机制.方法 将大鼠分为假手术组、心肌梗死组、丹参酮ⅡA组,大鼠心肌梗死后1周开始给予丹参酮ⅡA灌胃4周.采用经食管高频起搏左房技术检测心房颤动诱发率和持续时间,Masson染色和羟脯氨酸检测左房总胶原蛋白含量,蛋白免疫印迹法检测左心房Ⅰ型和Ⅲ型胶原蛋白含量并检测纤维化相关因子基质金属蛋白酶-9(MMP-9)/金属蛋白酶组织抑制剂1(TIMP-1)变化.结果 丹参酮ⅡA组给药4周后,心房颤动诱发率低于心肌梗死组,持续时间显著短于心肌梗死组,差异均有统计学意义(P<0.05).与心肌梗死组比较,丹参酮ⅡA组左心房心肌纤维化面积百分比降低,Ⅰ型和Ⅲ型胶原蛋白含量降低,MMP-9蛋白表达降低,TIMP-1蛋白表达升高,MMP-9/TIMP-1比值降低,差异均有统计学意义(P<0.05).结论 丹参酮ⅡA通过调节MMP-9/TIMP-1平衡抑制左心房纤维化,从而降低心肌梗死大鼠心房颤动发生率和持续时间.

目的 研究早发心肌梗死患者的临床特点和冠状动脉病变特点.方法 收集早发ST段拾高型心肌梗死患者(早发组)1 59例,非早发ST段抬高型心肌梗死患者(非早发组)190例,比较2组一般资料、实验室检查结果、冠状动脉造影结果及院内并发症发生情况.结果 早发组男性比例、BMI水平、吸烟比例、早发冠心病家族史比例、高脂血症比例、入院舒张压水平、心功能Killip分级2级以上比例高于非早发组,高血压、糖尿病、脑卒中、肾脏疾病和贫血比例均低于非早发组;早发组LDL-C、总胆固醇、三酰甘油、非HDL-C水平均高于非早发组;早发组血红蛋白水平高于非早发组,血肌酐、血糖水平均低于非早发组;早发组住院期间接受冠状动脉造影和急诊PCI比例均高于非早发组,早发组梗死相关血管以左前降支最常见,比例高于非早发组;受累冠状动脉单支病变比例高于非早发组,病变部位以左主干和右冠状动脉受累在非早发组中更多见;早发组院内严重并发症发生率和院内病死率低于非早发组.结论 早发心肌梗死患者的男性、吸烟、早发冠心病家族史比例,BMI水平、血脂水平均高于非早发心肌梗死患者;早发心肌梗死患者梗死相关血管以前降支最常见,院内严重并发症及病死率均低于非早发心肌梗死患者.

Objective:To investigate the effects and mechanism of Wushen Decoction (WST) on atrial fibrillation (AF) in rats with heart failure (HF) after myocardial infarction (MI).Methods:Twenty-four HF rats with HF were randomly divided into HF group (HF group) and Wushen Decoction group (WST group) (n=12,each group),Ten sham operation controlrats were grouped into Sham group.The WST group was treated with Wushen Decoction,and the other groups were administrated with the normal saline.After four weeks intervention,echocardiography,AF vulnerability,atrial fibrosis,connexin 43,PI3k,Akt,Nrf2 protein expression were assessed.Results:WST resulted in an attenuation of arrhythmogenic left atrial remodeling,with a significant reduction in left atrial diameter (P＜0.01),AF inducibility and duration,and atrial fibrosis (P＜0.05),and an increase of protein expression of Cx43 and up-regulation of PI3k/Akt/Nrf2 signaling pathway (P＜0.05).Conclusion:WST has the potential to reduce arrhythmogenic atrial remodeling and AF vulnerability via anti-fibrosis,inhibiting gap junction remodeling by upregulating PI3k/Akt/Nrf2 signaling pathway.

Objective The protective isthmus occurred during diastolic period in most macroreentrant atrial tachycardia (MAT) after heart surgery.We set a novel window of interest (WOI) to identify the diastolic conduction zone (IDZ) of the diastolic period to guide ablation of MAT.Methods The patients underwent high-density mapping using the EnSite NavX system.A novel WOI was calculated by identified the peak of the P wave of MATs,and the onset of the WOI was located in the diastolic interval of the circuit.The DCZ was identified by white/violet interface.Results A total of 16 MATs (mean cycle length 259±56 ms) mapping were completed in 15 consecutive patients after heart surgery.The DCZ (mean width 25.38± 12.44 mm) identified by the new setting of the WOI was located in all protective isthmus of the 16 MATs.Local conduction velocity at the sites of DCZ was significantly slower than the systolic area (38.9 ± 13.68 cm/s vs 76.24 ± 15.85 cm/s,P＜0.05).The acute success rate was 100％ with the DCZ ablation.During the (11.5 ± 5) months follow up,two patients had atrial tachyarrhythmia recurrence.Conclusions The DCZ of the MATs after heart surgery patients can be identified by the white /violet interface using a novel window of interest setting in electroanatomic mapping.Moreover,the DCZ is likely to locate in the protective isthmus,and exhibited with fractionated potentials and slow conduction velocity.Ablation of DCZ can terminate the tachycardias effectively.

阻塞性睡眠呼吸暂停(obstructive sleep apnea,OSA)是一类常见的疾病,目前认为该病是多种心血管疾病的危险因素,近年来日益受到重视.OSA可通过气道阻塞改变胸腔负压,或因呼吸暂停造成缺氧,继发神经、体液炎症因子改变等方式直接或间接影响心房,与房性心律失常如房早、房颤的发生密切相关.本文主要从临床研究、病理生理机制和治疗三方面对OSA与房性心律失常的关系进行综述.

患者男,57岁,2年前行二尖瓣置换术和外科迷宫消融术,再发心悸半年,心电图提示心房扑动(房扑),入广东省中医院拟行射频消融治疗。 患者空腹、局部麻醉下接受消融术,穿刺股静脉将10极电极导管( Daig Response CSL,美国圣犹达公司)送至右心房( RA),使其远端( RA1~2)在低位右心房游离壁,近端在高位右心房游离壁( RA9~10)。穿刺左锁骨下静脉放置10极冠状静脉窦电极导管,腔内心电图提示为周长(TCL)240 ms的房扑。穿刺股静脉送入大头电极导管( IBI Therapy Coolpath Duo,美国圣犹达公司),分别以短于周长20~30 ms的刺激频率沿三尖瓣环低位右心房侧、前房间隔、三尖瓣环峡部和高位右心房行拖带刺激,起搏后间期( PPI)分别为240、240、258、248 ms,PPI-TCL均短于30 ms,初步证实折返环围绕三尖瓣环。在 Ensite NavX/Velocity 三维标测系统(美国圣犹达公司)下于右心房进行高密度标测。高密度标测导管( In-quiry AFocus Ⅱ,美国圣犹达公司)为10极肺静脉环状电极导管,每1次移动能同时获得9个双极电图信息,并手工完成校正。该电极导管在Ensite系统下能同时建模并完成高密度标测,在记录到复杂电位的部位以褐色点进行标记,记录到双电位的部位以蓝色点进行标记,双电位提示传导阻滞,其电信息不参与激动标测。

房颤是临床最常见的心律失常，是患者致残或致死的主要原因。心房的结构重构和电重构是房颤的重要发病机制。心房结构重构宏观表现为心肌纤维化，细胞及分子水平则体现在心房缝隙连接蛋白 Cx40的分布和数量的变化；电重构表现为离子通道分布和功能变化，主要为 L 型钙通道下调和内向整流 K+通道的上调。房颤是多种致病因素共同作用的结果，因此需要通过多环节干预治疗。中药复方制剂因其含有多种成分，如稳心颗粒、参松养心胶囊，可以通过多靶点、多作用而有效治疗房颤。抗纤维化药物、选择性心房离子通道阻滞剂等药物有望成为治疗房颤的新型药物，不同靶点药物联合应用有可能成为临床治疗房颤的有效方法。

心房颤动(AF)是目前临床上最常见的心律失常之一.绝大多数患者是在AF晚期已经出现无规则的心脏节律后被发现,治疗效果欠佳.近年,研究者开始关注AF早期无症状阶段的病理生理改变,发现纤维化、炎症和氧化应激等与AF密切相关,相应的生物标记物也被证明可以预示AF的发生和预后.血清生物标志物的变化是AF发生和预后的强预测因子.生物标记物作为一种廉价、安全的检测指标可以帮助临床医生对高危人群进行早期诊断、指导治疗、判断疗效和评估预后,具有较好的临床应用前景.

心肌纤维化是指在心肌的正常组织结构中胶原纤维过量积聚、心脏组织中胶原浓度显著升高或胶原成分发生改变.该病理变化是临床多种心血管疾病发展到终末阶段的必然过程,是心脏结构重构的主要表现.目前认为其与心律失常、心功能障碍甚至心原性猝死密切相关.心肌纤维化以成纤维细胞的增殖和细胞外基质(extracellular matrix,ECM)的沉积为主要特征.ECM的沉积引起心脏硬度增加,顺应性降低,影响心脏的正常舒张和收缩功能.心肌纤维化是决定心血管疾病预后的关键性因素.成纤维细胞是心肌纤维化过程的主要作用细胞,本研究针对成纤维细胞的来源、分化、分泌及与疾病关系进行总结.

大多数老年人在遇到突发事件或劳累的时候会出现心跳加速、胸闷等不适，这就是心悸。中医专家建议，心悸时不妨弹拨腋下的极泉穴。

心脏有节奏地跳动有赖于心肌收缩和心脏内特殊传导系统的正常工作.成人每分钟心率超过100次称心动过速.遇到突发心动过速时,千万不要过分紧张,因为紧张情绪往往会使症状加重.可以试试以下几种急救方法:

To explore the role of heme oxygenase (HO)-1 experimental system in dachengqitang (DD) ameliorating ALI induced by lipopolysaccharide (LPS) in mice. Seventy-five male Kunming mice were randomly divided into control group (normal saline was instilled intratracheally(50 microL/per mouse), LPS group (LPS was instilled intratracheally to replicate ALI model), DD + LPS group, DD + LPS + ZnPP (ZnPP, HO-1 specific inhibitor) group and the DD group. Mice were killed at 6 h after administration. Lung indexes were tested; lung histomorphological changes were observed under microscope, and neutrophils (PMN) number and protein content of bronchoalveolar lavage fluid (BALF) were measured; HO-1 mRNA and protein expression in lung tissue were detected by RT-PCR and Western blot. The results showed that intratracheal instillation of LPS in mice can cause significant morphological changes in lung tissue. Both PMN numbers and protein content in BALF were increased. meanwhile the expressions of HO-1 mRNA and protein in lung tissue were increased. Pretreated with DD and then intratracheally instillated LPS coulde ameliorat lung tissue injury, reduced PMN BALF number and protein content, but increase HO-1 mRNA and protein expression in the lung tissue when compared with LPS. HO-1 inhibitor ZnPP coulde inhibite the ameliorative effect of DD. The results suggest that the ameliorative effect of DD on ALI induced by LPS in mice were related with upregulation HO-1 mRNA and protein.

房性心动过速多起源于右心房,位于右房侧壁终末嵴、冠状窦口附近,而左房房速相对少见,且多靠近肺静脉附近[1].起源于其他部位的房性心动过速相对少见.笔者对射频消融治疗2例起源于特殊部位的房速患者情况报告如下.