Background Heart failure is a cardiovascular complication of acromegaly associated with poor prognosis. Treatment directed solely at acromegaly does not reliably improve cardiac function. Case Summary A 56-year-old man was diagnosed with acromegaly and acromegalic cardiomyopathy. After 6 months of somatostatin analog therapy combined with guideline-directed medical therapy for heart failure, his left ventricular ejection fraction and hormone level improved. Subsequently, the patient developed acute heart failure triggered by sustained ventricular tachycardia. The patient received cardiac resynchronization therapy with defibrillator. During follow-up, the patient had no further heart failure exacerbations; echocardiography showed left ventricular ejection fraction increased to 48%. His left ventricular synchrony improved markedly. Discussion Normalization of growth hormone levels does not fully reverse myocardial involvement in this patient with advanced acromegalic cardiomyopathy. In this patient, cardiac resynchronization therapy significantly improved left ventricular synchrony and outcome. Take-Home Message This case highlights the importance of timely and appropriate cardiac resynchronization therapy with defibrillator implantation in patients with advanced acromegalic cardiomyopathy.

BACKGROUND:The risk of incident atrial fibrillation (AF) increases with accumulating risk factors. Baseline-only risk assessment may not reflect the real risk of incident AF. We aimed to evaluate the performance of the dynamic change of the C2HEST score (C2: coronary artery disease/chronic obstructive pulmonary disease (1 point each); H: hypertension (1 point); E: elderly (age ≥75 years, 2 points); S: systolic/diastolic heart failure (2 points); and T: thyroid disease (hyperthyroidism, 1 point) C2HEST) score to assess the risk of incident AF during follow-up. METHODS:The present study data were retrieved from the Information Management and Big Data Center of Peking University Hospital Group. Patients without AF at baseline were enrolled. New-onset comorbidities were recorded during follow-up. The change in the C2HEST score was analyzed. The baseline and the change in C2HEST scores were compared for the prediction of incident AF. RESULTS:A total of 120 133 patients were included in the final analysis. During 346 400 patient-years of follow-up, 2304 developed incident AF (0.67 per 100 patient-years). The mean C2HEST score increased significantly from 1.62 to 2.96 (P<0.05). A significant proportion of patients had newly diagnosed comorbidities (61.9% with ∆C2HEST ≥1 in AF and 14.6% with C2HEST ≥1 in non-AF). The change in C2HEST scores showed better performance compared with the baseline score, as assessed by area under curve analyses (∆C2HEST 0.821 [0.811-0.830], baseline 0.758 [0.747-0.769]), decision curve analysis, and positive net reclassification index. CONCLUSIONS:The risk for incident AF is not static and increases with the accumulation of new comorbidities. The change in C2HEST score had better prediction in assessing individual risk of incident AF compared with the baseline score.

抗血小板治疗是冠心病二级预防的基石,但有增加出血的潜在风险,围术期抗血小板治疗决策务必要权衡个体血栓与出血风险和推迟非心脏手术潜在后果之间的平衡.围术期抗血小板治疗的管理应个体化,由多学科小组和患者共同决策,将血栓风险和出血风险降至最低.目前指南提供的建议并不一致,优化管理策略仍未确定.

目的 采用CARTO 3 Version 6.0系统指导心房颤动(简称房颤)消融术后房性心动过速(简称房速)标测中的应用经验和技巧.方法 2020年7月至2020年12月因房速行导管消融术的11例患者(以上患者均曾接受房颤导管消融术).术中放置6F十极冠状静脉窦电极导管,在CARTO 3 Version 6.0系统指引下,利用PENT-ARAY高密度标测电极进行三维电解剖标测,在扩展的"早接晚"(EEML)功能中设置高阈值为75％ ～80％,对应的低阈值为25％ ～20％ 精准确认房速的关键部位及消融靶点,消融终止心动过速,验证消融线阻滞且心动过速不再自发及诱发则手术成功.结果 11例术中均为房速心律,EEML能够提供清晰的瘢痕阻滞区,明确其房速机制,经标测后证实其中8例为单源性房速,余3例可经心房刺激诱发或自行转化出2种以上不同机制的房速.房速平均周长为(256.5±37.1)m s.肺静脉相关房速4例,其余包括顶部依赖折返2例、二尖瓣环折返1例,左房瘢痕相关折返性房速3例,右房瘢痕相关折返性房速1例.首次消融中所有患者房速终止并无法再次诱发.中位数随访时间8个月,1例房速复发并接受第二次消融,证实为顶部依赖折返,1例复发房颤.消融术中未出现严重并发症.结论 CARTO 3 Version 6系统提供的EEML功能为识别瘢痕造成的阻滞区提供了更直观的手段.房颤消融术后房速的机制多样,通常与此前房颤消融造成的瘢痕有关.

BACKGROUND:The C2HEST score (C2: coronary artery disease [CAD] / chronic obstructive pulmonary disease [COPD] (1 point each); H: Hypertension; E: Elderly (Age≥75, doubled); S: Systolic heart failure (doubled); T: Thyroid disease (hyperthyroidism)) has been validated to predict incident atrial fibrillation (AF). Its performance in the hospital-based Chinese population has never been evaluated.METHODS:Risk factors for incident AF were investigated in a hospital-based population. Comparison of the C2HEST score and other clinical scores with the capacity of predicting incident AF was conducted using area under the curves (AUC), net reclassification index (NRI), integrated discriminative improvement (IDI), and decision curve analysis (DCA). An age-stratified criterion was used to refine the C2HEST score to form a modified C2HEST score (mC2HEST). The performance of the mC2HEST score was also evaluated.RESULTS:A total of 23,523 patients entered the study with 520 developed AF during 2.84 ± 3.56 years of follow-up. Risk factors for incident AF included age, male sex, hypertension, CAD, COPD, previous ischemic stroke, hyperthyroidism, and heart failure. Age ≥65 years has significantly increased the risk of AF, which was considered as the age cutoff for a modified C2HEST score (mC2HEST). The risk of AF increased by 89% per one-point increase of the mC2HEST score. The mC2HEST score showed better predictive performance (AUC of 0.809) compared with the original C2HEST (AUC of 0.752), CHA2DS2-VASc (0.756), HATCH (0.722), and HAVOC (0.758) scores, also as estimated by IDI, NRI and DCA. Among those enrolled after 2012, the mC2HEST score had numerically higher AUC (0.849) compared with the C2HEST score (0.826) and the other scores.CONCLUSION:In a hospital-based Chinese population, by refining the age strata of the original C2HEST score, the mC2HEST score had significantly increased predictive accuracy and discriminative capability for incident AF. The clinical benefits of the application of novel mC2HEST score needs further validation in multiple settings.

目的 探讨心腔内超声(CartoSound)三维标测指导下射频消融室间隔治疗肥厚型梗阻性心肌病(HOCM)的安全性及疗效.方法 在CartoSound三维标测技术指导下,对5例HOCM患者行经皮室间隔射频消融治疗,以收缩期二尖瓣瓣叶前向运动(SAM)对应的左室室间隔部位作为消融靶点,应用Smartouch盐水灌注消融电极,消融能量35～40 W,冷盐水灌注流速20 m L/m in,温度43℃,贴靠压力5～10 g,每次放电时间60 s.以左室流出道(LVOT)压力阶差下降50％ 或SAM区域心肌活动显著减弱作为消融有效终点.比较术前、术后LVOT压力阶差变化,记录围术期并发症发生情况,评价疗效和安全性.结果 术中累计消融放电15～42次,消融范围占SAM区域比值22.9％ ～76.6％.术后即刻LVOT压力阶差由术前(105±93.6)mmHg下降至(40.6±37.2)mmHg(P<0.001).随访至术后6个月,患者临床症状消失,心功能改善;术后6个月室间隔厚度由术前(16.1±2.9)mm下降至(13.3±2.4)mm(P=0.115);LVOT压力阶差由术前(105±93.6)mmHg逐步下降至(94.7±71.9)mmHg(术后7日,P=0.146)、(30.72±12.9)mmHg(术后1个月,P<0.01)、(19.4±17.8)mmHg(术后6个月,P<0.01).5例患者均未出现手术并发症.结论 经心腔内超声CartoSound指导下室间隔射频消融术治疗HOCM安全、有效.

目的 了解心脑血管疾病住院患者对不同健康传播材料的评价.方法 以584名心脑血管病住院患者作为目标人群,通过"微信公众号"推送心脑血管疾病防治传播材料,并指导患者采用Likert 5级评分法对传播材料的实用性、趣味性和可读性(图文)、易懂性(微视频)进行评价.结果 科普图文类评价总分为(52.58±6.91)分,各维度评价从高到低依次为实用性(13.26±1.82)、趣味性(13.24±1.99)及可读性(13.03±1.93);科普微视频类传播材料评价总分为(44.81±3.60)分,各维度评价从高到低依次为趣味性(13.69±1.83)、易懂性(13.66±1.80)、实用性(4.22±1.71).结论 健康教育传播材料评价较理想,建议医疗机构增加图文传播材料可读性以及微视频材料实用性,制作更适宜的健康传播材料.

绝大多数男性对于健康的关注度要显著低于女性,而一旦身体出现问题,大多数男性的态度是无所谓、忍忍就过去了……但是,忍一忍能过去的却可能不是小问题.这篇文章就是提醒各位男士,请正确看待和重视自己的健康问题.

在中国,已经有超过2.7亿的高血压患者,平均4个成年人中就会有一个人患有高血压,所以高血压的发病率是非常高的.高血压具有诊断率低、治疗率低、控制率低,而致残率和死亡率却很高的特点.造成这样的结果,是因为大家对其不够重视,仍存在很多认识误区.下面我们就一起来看看5个常见的认识误区!

目的 探讨冠心病患者血中成纤维细胞生长因子23(FGF23)水平与炎性反应指标的相关性.方法 157例患者加入本研究并接受冠状动脉造影检查,129例确诊为冠心病的患者纳入冠心病组,其他患者纳入非冠心病组.收集患者的矿物质代谢指标、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)及FGF23水平.结果 研究结果显示,冠心病组的患者TNF-α和IL-6水平的中位数分别为135.12,63.33 pg·mL-1,均显著高于非冠心病组患者的66.54和39.04 pg·mL.相关性分析表明,冠心病患者中炎性反应指标TNF-α,IL-6及UACR与FGF23水平呈正相关(P＜0.05);多因素分析表明,IL-6及UACR是FGF23独立影响因素.结论 冠心病患者中炎性因子如TNF-α、IL-6水平显著升高.进一步分析显示,FGF23水平与炎性反应指标中的TNF-α和IL-6存在显著相关性.

新冠肺炎疫情期间,大家都响应号召,“宅”在家中,减少外出.然而,此时的心血管病患者却处于“进退两难”的地步,心血管病患者多为中老年、多种疾病并存,疫情期间若贸然前往医院,也会有一定风险.那么当心血管病患者,尤其是心律失常患者出现心慌等不适症状时,应该如何应对呢?

高血压作为一种慢性病,用药、调药、监测、副作用是每位患者最关心的问题,本套课程主要针对降压药的用药细节和误区进行全方位讲解,并附赠每人一份生活指导处方,希望可以帮助到每一位高血压患者.

Atrial fibrillation (AF) is a highly prevalent cardiac arrhythmia characterized by atrial remodeling. Complement C1q tumor necrosis factor-related protein 3 (CTRP3) is one of the adipokines associated with obesity, diabetes, and coronary heart disease. The association between plasma CTRP3 levels and AF is uncertain. The aim of this study was to investigate whether plasma CTRP3 concentrations were correlated with AF. Our study included 75 AF patients who underwent catheter ablation at our hospital and 47 sinus rhythm patients to determine the difference in plasma CTRP3 concentrations. Blood samples before the ablation were collected, and ELISA was used to measure the concentrations of CTRP3. Plasma CTRP3 concentrations were significantly lower in AF patients compared with control group (366.9±105.2 ng/ml vs. 429.1±100.1 ng/ml, p=0.002). In subgroup studies, patients with persistent AF had lower plasma CTRP3 concentrations than those with paroxysmal AF (328.3±83.3 ng/ml vs. 380.0±109.2 ng/ml, p=0.037). The concentrations of plasma CTRP3 in the recurrence group after radiofrequency catheter ablation of AF were lower than those in the nonrecurrence group (337.9±77.3 ng/ml vs. 386.6±108.1 ng/ml, p=0.045). Multivariate regression analysis revealed the independent correlation between plasma CTRP3 level and AF. Plasma CTRP3 concentrations were correlated with the presence of AF and AF recurrence.

患者男性,22岁,主因"发作性心悸伴黑矇12年"入院.患者自12年前开始经常发作心动过速,突发突止,7年前确诊为心肌致密化不全并发预激综合征、室上性心动过速,7年来先后出现5个部位的右侧房室旁道,均行射频消融术成功.

每年的秋季,都是体检的高峰期,很多人都会有这样一种感受:每到体检结束,心里忐忑不安,生怕哪个指标不好.尽管有时候,医生强调,体检报告的某个数值虽然高一点,但也没什么问题,只要注意休息/睡眠/运动……就能改善,但还是想把这些数据弄个明白,心里有数,才能不慌不乱.

Objective To investigate the relation of post-exercise heart rate recovery(HRR)with exercise capacity, and the predictive value on long-term prognosis in patients of ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). Methods A total of 260 patients were investigated from July 2011 to December 2014. All the patients were conducted cardiopulmonary exercise testing(CPET)within 30 days after STEMI, and heart rate recovery at 1 minute (HRR1)were calculated. The correlation between HRR with exercise tolerance was analysed. The median followup duration was 55 months(42,72), and the cardiovascular endpoint events were collected. Results The mean HRR1 was 26.0±12.2 beats in the whole study population who completed CPET.(1)HRR1 was positively correlated to peak oxygen uptake(VO2peak)(r=0.129, P<0.001).Multiple linear regression analysis demonstrated that VO2peak was independently positively associated with HRR1. (2) Cardiovascular endpoint events occurred in 60 cases (23.1%). Single factor screening through Cox regression model showed that decreased HRR1 (HRR1 ≤ 12 beats)(P=0.010)significantly correlated with the cardiovascular endpoint events. After adjusted by multiple factors, the risk of cardiovascular endpoint events in the group of decreased HRR(HRR1 ≤ 12 beats)was 2.671 times as the group of HRR1>12 beats. Conclusions Decreased HRR1 is associated with lower exercise tolerance, and it shows signifi cant prognostic values in increasing cardiovascular endpoint events in STEMI patients treated with primary PCI.

1 临床资料 患者 女,68岁.主因"间断性心悸6个月,加重1个月"于2015年12月11日收入北京大学第三医院心内科治疗.患者入院前6个月,反复出现心悸,每周1～2次,每次持续3～5 min后自行缓解.多次检查心电图提示心房颤动,口服美托洛尔治疗无效.既往冠心病、陈旧性心肌梗死病史10年,曾于左前降支(LAD)置入1枚药物洗脱支架,术后规律口服冠心病二级预防药物,无心绞痛复发.高血压病史2年,2型糖尿病病史5年,均规律用药治疗,血压、血糖监测控制良好.1个月前发现双侧颈动脉多发粥样硬化斑块.入院查体:血压137/89 mmHg(1 mmHg=0.133 kPa),心脏不大,心率76次/min,脉搏72次/min,心律绝对不齐,第一心音强弱不等,脉短绌,A2＞P2,各瓣膜听诊区未闻及杂音、附加音,无心包摩擦音,肺、腹未见异常,双下肢无水肿.入院后查血、尿、便常规正常,肝功能、肾功能、血脂、血糖、电解质、心肌酶、凝血功能均正常,B型脑钠肽正常,糖化血红蛋白 7.7 ％.超声心动图示:室壁节段性运动异常(左心室前壁、前间壁中段—心尖段),左心房扩大(前后径38.5 mm,左心房面积23 cm2)、左心室射血分数(LVEF) 55 ％.X线胸片未见异常.平板运动试验阴性.肺静脉CT正常.经食管超声心动图未探及左心耳血栓.入院诊断:心律失常(持续性心房颤动),冠状动脉粥样硬化性心脏病,陈旧性前壁心肌梗死,心脏不大,NYHA心功能Ⅱ级,高血压病1级(极高危),2型糖尿病,外周动脉粥样硬化.完善术前准备后于2015年12月17日在三维电解剖(CARTO)标测下行射频消融治疗.

Aiming at the characteristics of angina pectoris,the task driven teaching,the case-based teaching and multimedia teaching were reasonably used during the teaching process.The complains of the three out-patients were used as the main line to assist the students understanding and mastering the key points and difficult points of the teaching content.

Exercise training in patients with heart failure is well established as a recommended and additional therapeutic strategy that is an integral part of an evidence-based management involving pharmacological and non-pharmacological therapies. Despite the many known benefits of exercise training, referral and participation rates in these programs are paradoxically low. In this article, we gave an overview of challenges and opportunities of exercise training implementation as well as recommendations as the highest priority in advancing exercise training as a therapy for patients with heart failure.

Objective:To evaluate the effects of aerobic exercise on cardiorespiratory fitness and endothelial func-tion in middle aged women and whether these effects are related to the estrogen levels.Methods:In this test,a total of 45 healthy women aged 45-55 years were divided into exercise group (n = 31,including 1 5 postmenopausal women)and control group (20 subjects).The exercise group conducted a 12-weeks aerobic exercise,while the con-trol group had no exercise intervention.Each subject had taken cardiopulmonary exercise testing before and after 12 week with PVO2 reflecting the cardiorespiratory fitness.Plasma ADMA and NOS levels were measured to estimate endothelial function,and changes in plasma estrogen levels were also detected.Results:After 12 weeks,PVO2 and plasma NOS levels were increased,and plasma ADMA levels were decreased in exercise group as compared with the control group (P <0.05).However,there were no significant differences between premenopausal and postmenopa-usal women (P >0.05 ).Pearson correlation analysis showed the degrees of improvement in PVO2 was positively correlated with NOS (r=0.339,P =0.023),and negatively with ADMA (r=0.333,P =0.025).Both PVO2 and NOS had no correlation to baseline estrogen levels.Conclusion:The aerobic exercise training can significantly im-prove cardiorespiratory fitness in healthy middle-aged women and improve endothelial function as well.The increa-ses in the cardiorespiratory fitness may be related to the improvement of endothelial function.The improvement of endothelial function is not dependent on the basic estrogen level,suggesting that premenopausal and postmenopausal women get the same benefit from exercise.