The change in plasma apelin level in heart failure (HF) patients is controversial. We investigated the change in plasma apelin level in HF patients versus control and non-HF patients. The plasma level of apelin was measured by ELISA and plasma level of B-type natriuretic peptide (BNP) by fluorescence immunoassay. We included 101 patients with HF, 32 patients without HF and 20 controls. The three groups did not differ in general and clinical characteristics. Plasma levels of apelin and BNP were both higher in HF patients than non-HF patients and controls. Plasma levels of apelin and BNP were not correlated. Plasma level of BNP was increased with increasing New York Heart Association grade and apelin level was decreased. Apelin level was lower in HF patients with NYHA grade IV than in controls and non-HF patients. Apelin level had 75% diagnostic value for HF, and BNP level had 96.8% diagnostic value. At a cutoff of 6.44 ng/mL apelin level, sensitivity was 69.3%, and specificity 97.1%. However, the diagnostic of apelin for NYHA II patients was higher than that of BNP (99.6% vs. 96.1%). These results suggested that apelin might be particularly useful in association with BNP in mild HF patients.

OBJECTIVE:To explore the risk factors to predict mortality among acute myocardial infarction (AMI) patients aged ≥ 80 years during their hospitalization.METHODS:A cohort of AMI patients aged ≥ 80 years hospitalized in our hospital were recruited from 2005 to 2014. Variables, including demographics, medical history, hemodynamic condition and laboratory results, were collected and analyzed to find risk factors predicting mortality during hospitalization.RESULTS:Amonga total of 384 patients enrolled in this study, the hospital mortality rate was 23.4%. By multivariable stepwise regression analysis, nine independent significant predictors associated with mortality during hospitalization were identified: history of stoke, cardiac shock, Killip class III to IV, ventricular tachycardia, pulse rate ≥ 100 bpm and EF ≤ 40% at presentation, in-hospital bleeding, initial serum creatinine concentration ≥ 177 umol/L and elevated initial WBC level. Prior angina was identified as a protective factor. Hosmer-Lemeshow test indicated good fitness of the predicting variables.CONCLUSION:Patients aged 80 and over have high mortality during hospitalization, and the risk prediction factors are clinically useful for predicting mortality in old patients with AMI.

目的 探究高龄冠心病合并心房颤动(房颤)患者不同抗栓方案的临床效果.方法 90例高龄冠心病合并房颤患者,随机分为对照组及观察组,每组45例.对照组给予阿司匹林治疗,观察组给予华法林联合阿司匹林治疗.比较两组患者的血栓事件发生情况和出血事件发生情况.结果 治疗后,观察组患者发生1例下肢动脉栓塞,血栓事件发生率为2.22％.对照组患者发生5例下肢动脉栓塞,2例急性心肌梗死,3例新发脑梗死,血栓事件发生率为22.22％.观察组患者的血栓事件发生率低于对照组,差异有统计学意义(χ2=8.389,P<0.05).观察组患者的出血事件发生率为35.56％,对照组患者的出血事件发生率为24.44％,两组患者的出血事件发生率比较,差异无统计学意义(P>0.05).结论 高龄冠心病合并房颤患者采用华法林联合阿司匹林的方式进行抗栓治疗,能够减少血栓事件的发生,提高治疗效果.

To investigate the status of percutaneous coronary intervention (PCI) in elderly patients with acute myocardial infarction (AMI) and analyze the reasons for not receiving PCI. A cohort of 387 consecutive hospitalized AMI patients aged >= 80 years were recruited from 2005 to 2014. Their clinical data were collected and analyzed. Among 387 elderly patients with AMI (190 men and 197 women, mean age 84.1 +/- 3.9 years), there were 171 patients with ST-elevation myocardial infarction (STEMI) and 216 patients with non-ST-elevation myocardial infarction (NSTEMI). The emergency and elective PCI treatment rate was 40.6% and 12.1%, respectively, in patients with STEMI; and 1% and 18%, respectively, in patients with NSTEMI. PCI treatment rate of elderly AMI patients enrolled after 2009 showed no significant difference compared to that before 2009 (P>.05). The in-hospital mortality decreased significantly in PCI treatment group. After adjustment for age, sex, and other factors, PCI treatment was identified as the independent protective factors for in-hospital mortality (odds ratio=0.323, 95% confidence interval 0.147-0.710, P=.005). The main influence factors for not receiving PCI treatment were hemorrhage, severe renal dysfunction, infection, or severe anemia-associated complications, whereas delayed treatment was the important reason for patients not undergoing emergency PCI. PCI treatment is the independent protective factor for in-hospital mortality of elderly patients with AMI. Due to various complications, PCI treatment rate is still low in elderly patients with AMI and has not been improved recently. Paying attention to performing PCI treatment for elderly patients with AMI has positive significance.

目的 探究老年非瓣膜性心房颤动(房颤)合并血栓栓塞并发症的抗凝治疗效果.方法 67例采用抗凝治疗的老年非瓣膜性房颤合并血栓栓塞并发症患者作为研究对象,采用华法林或新型口服抗凝药物进行抗凝治疗,并定期进行随访记录.分析其住院期间的抗凝治疗情况及效果,记录抗凝治疗后再次因血栓栓塞并发症或出血事件住院情况.结果 67例患者中,66例使用华法林进行抗凝治疗,1例使用新型口服抗凝药物进行抗凝治疗.进行抗凝治疗的过程中,平均国际标准化比值(INR)为(1.62±0.74),INR达标患者为11例,达标率为16.42％.以再次因血栓栓塞并发症或出血事件住院为终点,进行1年的随访,有3例患者抗凝治疗后再次因血栓栓塞并发症或出血事件住院.结论 在老年非瓣膜性房颤合并血栓栓塞并发症患者的临床治疗中,抗凝治疗的效果不是十分理想,经抗凝治疗患者的INR达标率相对比较低.

Objective To analyze the correlation of the short-term prognosis of acute non-ST-elevated myocardial infarction (NSTEMI) in elderly patients with the levels of serial high sensitivity cardiac troponin (hs-cTnT),whole blood type B natriuretic peptide (BNP) and estimated glomerular filtration rate (eGFR).Methods The patients aged over 65 years with acute NSTEMI in Department of Cardiology in our hospital were selected.Clinical data of the maximum levels of serial hs-cTnT and BNP and the minimum level of eGFR during hospitalization were analyzed retrospectively.Cardiocerebrovascular adverse events (CCVAE) including death,relapse of myocardial infarction,acute left heart failure,cardiac shock,target lesion revascularization (TLR),severe angina pectoris demanding hospitalization and acute cerebral apoplexy were documented if they occurred in hospital or within 90 days after discharge.The patients were divided into Nonadverse-event Group (Group A) and Adverse-event Group (Group B),and the levels of hs-cTnT,BNP and eGFR between two groups were compared.Results There were 310 eligible NSTEMI patients included,which including 158 (51.0％) males,at the mean age of (81.32±6.72) years and with the average hospital stay of (14.95±7.05) days.The overall adverse event incidence (AEI) was 47.7％ during short-term.There was no significant difference between Group A and Group B in the hs-cTnT level (P =0.391).The BNP,eGFR level were significantly different between Group A and Group B (P =0.001,P =0.001).It was revealed by logistic regression analysis that high BNP level was independent risk factor for CCVAE in elderly patients with NSTEMI.Conclusion The hs-cTnT level is not significantly correlated with the incidence of CCVAE.And BNP,eGFR levels show acceptable accuracy in the prediction of CCVAE in the elderly patients with NSTEMI.High BNP level is independent risk factor for CCVAE in the elderly patients with NSTEMI.

Introduction:The acute coronary syndrome (ACS) patients who are not ready to quit smoking immediately have an extremely low rate of cessation. This study aims to investigate the efficacy of intensive personalized '5As+5Rs'intervention (IPANR intervention) on smoking cessation in this population.Methods:A parallel-group randomized controlled trial was carried out, which compared IPANR intervention with routine 5Rs (control) at Fu Xing Hospital, Capital Medical University, Bei Jing, China. Three hundred and twenty hospitalized ACS smokers who were not ready to quit were randomly distributed to IPANR intervention group comprising three individual counseling during hospitalization and 15 intensive follow-up sessions (weekly during months 1, 2, 3, and monthly thereafter until month 6) or 5Rs group in a 1:1 fashion by 8 cardiologists who were blinded to the allocation sequence. Primary end point was carbon monoxide-confirmed continuous abstinence rate (CAR) through week 9 to week 12. Secondary outcome included abstinence rate at 24 weeks.Results:Overall, 97.5% (312/320) participants completed the trial. An intention-to-treat analysis showed statistically significant advantage of IPANR compared with control group at 4 weeks CAR (27.5% vs. 17.5%, RR = 1.571, 95% CI = 1.032-2.392, p = 0.032, number needed to treat (NNT) = 10), and abstinence rate at 24 weeks (23.8% vs.15.0%, RR 1.583, 95% CI = 0.998-2.512, p = 0.048, NNT: 11.36). At 24 weeks, cigarettes smoked per day by the patients who failed to quit were significant lower in IPANR group than 5Rs group (13.21 ± 8.23 vs. 17.45 ± 10.71; p < 0.001).Conclusions:The IPANR initiated during hospitalization, is a feasible and effective approach for smoking cessation in ACS patients not ready to quit immediately.Implications:Smoking has a major impact on acute stages of ACS for recurrent ischemic events and long-term outcomes. However, there are few evidence-based treatments for smokers who are not ready to quit. This study described a cessation intervention initiated during hospitalization and included 15 intensive follow-up aimed at enabling ACS smokers who were not ready to quit immediately to deliver adequate motivational and behavior change counseling. Given its effectiveness demonstrated in this prospective study, this intervention in hospitalized ACS smokers might have the potential to substantially improve the cessation rate of ACS patients who are not ready to quit smoking immediately.

目的 观察苯磺酸氨氯地平与氯沙坦钾对原发性高血压合并高尿酸血症患者的尿酸水平的影响.方法 280例1～2级原发性高血压合并高尿酸血症患者,随机分成苯磺酸氨氯地平组和氯沙坦钾组,各140例.苯磺酸氨氯地平组患者给予苯磺酸氨氯地平治疗,氯沙坦钾组患者给予氯沙坦钾治疗,比较两组患者治疗前后血压及尿酸水平变化情况等.结果 治疗8周后,两组患者收缩压、舒张压及尿酸水平均明显下降,苯磺酸氨氯地平组收缩压、舒张压及尿酸水平治疗后与治疗前差值为(-10.3±0.6)mm Hg(1 mm Hg=0.133 kPa)、(-9.9±0.6)mm Hg、(-15.6±7.2)μmol/L,氯沙坦钾组收缩压、舒张压及尿酸水平治疗后与治疗前差值为(-11.4±1.1)mm Hg、(-10.1±0.7)mm Hg、(-10.2±5.5)μmol/L,上述指标差值组间比较差异无统计学意义(P>0.05).结论 苯磺酸氨氯地平和氯沙坦钾在降压同时均有降低尿酸的作用.

BACKGROUND:To improve the poor prognosis of congestive heart failure (CHF), early and accurate diagnosis is necessary. Relaxin is an endogenous cardiovascular peptide, and its plasma level is usually increased in patients with CHF. In this pilot study, we aimed to determine the diagnostic value of relaxin and B-type natriuretic peptide (BNP) in patients with and without CHF.MATERIALS AND METHODS:The plasma level of relaxin was measured by enzyme-linked immunosorbent assay and plasma level of BNP by fluorescence immunoassay. The area under the receiver operating characteristic curve was used to assess the diagnostic value of relaxin and BNP.RESULTS:We included 81 patients with decompenstated CHF and 36 controls. Plasma levels of relaxin and BNP were both higher in CHF patients than in controls. The correlation between plasma levels of relaxin and BNP and between relaxin or BNP and cardiac function was nonlinear. Relaxin had medium diagnostic value, and BNP had higher value for cardiac function and CHF. At a cutoff of 39.76pg/mL relaxin, sensitivity was 82.7%, specificity 55.6%, sum of the highest positive predictive value 80.5% and negative predictive value 58.8%. Although the diagnostic value was not better for relaxin than BNP, their combined assessment improved the sensitivity and specificity of diagnosis for CHF as compared with BNP alone.CONCLUSIONS:Combined assessment of relaxin and BNP may improve the diagnosis of decompensated CHF, which may have potential application in the clinic.

目的 探讨原发性高血压患者血压变异性(BPV)和肱踝脉搏波传导速度(baPWV)之间的关系.方法 397例原发性高血压患者,均行24 h动态血压监测(ABPM)及baPWV测定,依据baPWV的数值将患者分为baPWV正常组(baPWV≤14 m/s,99例)和baPWV升高组(baPWV>14 m/s,298例).比较两组患者的一般资料及24 h收缩压标准差(24 h SBP-SD)、24 h舒张压标准差(24 h DBP-SD)、日间收缩压标准差(DSBP-SD)、日间舒张压标准差(DDBP-SD)水平.结果 baPWV升高组患者的年龄高于baPWV正常组,差异具有统计学意义(t=2.472,P<0.05);两组的体质量指数(BMI)、空腹血糖(FBG)、甘油三酯(TG)比较,差异均无统计学意义(t=0.822、0.382、1.459,P>0.05).baPWV升高组患者的24 h SBP-SD及DSBP-SD高于baPWV正常组,差异均具有统计学意义(t=2.233、2.064,P<0.05);两组的24 h DBP-SD、DDBP-SD比较,差异均无统计学意义(t=0.382、0.110,P>0.05).结论 原发性高血压患者的年龄是baPWV的影响因素之一,同时DSBP-SD、24 h SBP-SD也是baPWV的影响因素.

目的 探讨吸烟后即刻呼出气CO检测基础上强化5A治疗对无戒烟意愿ACS患者烟草戒断效果.方法 2014年3月至2014年10月,连续入选心脏中心住院的不愿意戒烟的吸烟ACS患者99例,将患者随机分为吸烟后即刻呼出气CO检测基础上充分告知吸烟危害联合强化5A治疗组(试验组)和常规5R组(对照组).均随访24周,以第9～12周持续戒断率及第24周戒断率为主要终点.结果 试验组患者9至12周持续戒断率较对照组明显升高,为26.5％比8.0％,pearson卡方检验示x2 =5.975,P＜0.05 (0.015).24周时试验组患者戒断率较对照组仍显著升高,为20.4％:6％,x2=4.504,P＜0.05(0.034).结论 吸烟后即刻呼出气CO检测后在异常CO值基础上,充分告知吸烟患者吸烟危害及强化戒烟心理行为指导可显著提高烟草戒断率.

Objective To explore the application of Problem-Based Learning (PBL) and the teaching method of Case-Based Learning (CBL) in electrocardiogram (ECG) teaching.Methods Seventy-eight students in our hospital were divided into group A (38 students) and group B (38 students). Lecture-Based Learning (LBL) teaching method was used in group A, and PBL combined CBL were used in group B. Achievements of ECG and satisfaction rate of survey were compared between the two groups. ResultsNot only achievements of theory examination, but also reading and analysis of ECG in group B were higher than those in group A (P<0.01). and the satisfaction survey in ECG teaching, the satisfaction rate in group B obviously higher than that in group A (P<0.01).Conclusion PBL combined CBL teaching method is better than the LBL in ECG teaching.

Objective To investigate the clinical application value of intensive lipid—lowering therapy.Methods 194 patients with borderline stenosis divided into control group and treatment group,the two groups were given 20 mg/d or 40 mg/d. The changes of serum hs-CRP levels after medical treatment in two groups were observed and recorded, and the cardiovascular adverse occurrence rates during the medical treatment were compared as wel1.Results After six months’medical treatment, serum hs-CRP levels of patients in two groups were obviously declined than before (P<0.05),and the declining rate in observation group was much higher than that in control group(P<0.05). The cardiovascular adverse occuence rate of patients observation group was much lower in control group (P<0.05). Conclusion The application of atorvastatin as intensive lipid-lowering treatment can obviously reduce the cardiovascular adverse occurrence rate&nbsp;in borderline stenosis pentiens and whose mechansm of action has close effect on reducing serum hs-CRP level.

Objective To explore the effect of adequate harm inform based on COHb measurement on tobacco cessation in ACS patients without intention to quit smoking. Methods From 2013- 10 to 2014- 02,40 ACS patients without intention to quit smoking aged 18 to 80 were randomly divided into COHb group and control group. The control group received 5R smoking cessation measurement. The COHb levels were measured in the COHb group,in addition to 5R. The smoking cessation rate was evaluated after24 weeks. Two independent sample t test and Pearson squared test were used to compare the difference between the two groups.Results The nicotine dependence score in the COHb group and control group were 7. 5 ± 1. 5 and 7. 7 ± 1. 5 respectively,no significant difference was found in both groups,t = 0. 433,P 0. 05. The COHb level in COHb group was( 6. 2 ± 2. 5) %,significantly higher than the normal range. The tobacco cessation rate in COHb group( 25. 00%) at 24 weeks was higher than the control group( 15. 00%),but not yet reached statistical difference,χ2= 0. 625,P 0. 05. The smoking index in the COHb group was significantly reduced than in the control group,as 560 ± 270 vs 870. 5 ± 480,t = 2. 146,P 0. 05. Conclusion Measurement of the level of arterial blood COHb,and fully informed of the dangers of smoking could significantly reduce the smoking index of ACS patients without intention to quit smoking,and to a certain extent,could increase the smoking cessation rate.

Objective To observe effects of amlodipine besylate and levamlodipine besylate on short time blood pressure variability ( BPV)in hypertensive patients and determine the optimal calcium channel blocker( CCB)therapeutic regimen for hypertensive patients. Meth-ods Two hundred sixty consecutive grade two hypertension patients at first visit were enrolled from Cardiac Clinic of our hospital. Patients were randomly divided into amlodipine besylate group(130 cases)and levamlodipine besylate group(130 cases)and underwent 6 months treatment. Systolic and diastolic blood pressure standard deviation,coefficient of variation and morning blood pressure surge( MBPS)were measured by 24-h ambulatory blood pressure monitoring to assess BPV. Two independent sample t tests were performed to compare BPV difference of hypertensive patients in amlodipine besylate group and levamlodipine besylate group. Results Compared with amlodipine besylate group,in levamlodipine be-sylate group,MBPS(33. 2 ± 2. 0 mmHg vs. 31. 8 ± 2. 1 mmHg,P ﹤0. 001),systolic blood pressure standard deviation(8. 35 ± 1. 30 mmHg vs. 8. 01 ± 0. 82 mmHg,P ﹤0. 05)and systolic coefficient of variation(0. 083 ± 0. 011 vs. 0. 079 ± 0. 012,P ﹤0. 05)were obviously higher. Con-clusion Amlodipine besylate can significantly reduce short time BPV,especially systolic BPV and MBPS in hypertensive patients.

OBJECTIVES:Overwhelming evidence shows that dietary supplementation with n-3 polyunsaturated fatty acids (PUFAs) elicits protective effects on patients with cardiovascular disease. However, the detailed mechanisms underlying n-3 PUFA-mediated cardioprotection are unknown, and examined in the present study.METHODS:We evaluated heart performances with Langendorff perfusion apparatus. Meanwhile, whole mitochondria were purified from non-perfused hearts for functional assessment, and lipid peroxidation level was measured as well.RESULTS:Compared with control groups, hearts from n-3 PUFA-supplemented rats showed improved functional recovery and reduced tissue injury following ischemia/reperfusion (I/R). Furthermore, the mitochondrial function of PUFA-treated hearts was significantly enhanced, as demonstrated by biochemical analysis of respiratory chain activity. In addition, thiobarbituric acid-reactive substance or TBARS assay revealed that lipid peroxidation product, malondialdehyde or MDA, in the mitochondria was significantly reduced by PUFA treatment.CONCLUSION:Taken together, our data indicate that marine n-3 PUFA could improve cardiac performance after I/R injury by restoring mitochondrial respiratory activities and attenuating lipid peroxidation.

目的 探讨对氯吡格雷低反应的急性ST段抬高心肌梗死(ST segment elevation myocardial infarction,STEMI)患者应用替格瑞洛后腺苷二磷酸(adenosine diphosphate,ADP)诱导的血小板抑制率的变化.方法 连续入选2013年2月至2014年3月在复兴医院心脏中心住院,诊断为STEMI同时存在对氯吡格雷低反应性的18岁～80岁的患者共38例.将患者(在SAS软件下)随机分为替格瑞洛治疗组和常规治疗组.两组均于1周后复查ADP诱导的血小板抑制率.比较两组ADP诱导的血小板抑制率和ADP达标率.结果 与常规治疗组相比,替格瑞洛组ADP诱导的血小板抑制率明显升高,差异有统计学意义(78.32％±12.95％ vs.31.89％±11.28％,t=1 1.779,P＜0.001].替格瑞洛组较常规治疗组ADP达标率明显提高,差异有统计学意义[89.5％(12/19) vs.10.5％(2/19),x2=23.684,P＜0.001).结论 对氯吡格雷低反应的STEMI患者应用替格瑞洛后ADP诱导的血小板抑制率明显升高.

Objective To explore the relationship of Helicobacter pylori (Hp) infection and carotid plaques in patients with coronary heart disease and analyze the related factors of carotid plaques.Methods This study enrolled 209 patients.13C-urea breath test (13C-UBT) was used to assess Hp infection.Based on the results of 13C-UBT,patients were divided into infection-positive group (101 patients) and infection-negative group (108 patients).The incidence of carotid plaques was detected by color Doppler,and plasma homocysteine (Hcy),total cholesterol (TC),low density lipoprotein cholesterol (LDL-C),fibrinogen (Fbg),high sensitivity C reactive protein (hs-CRP) were measured and compared.Results The incidence of carotid plaques in infection-positive group(69.31％,70/101) was higher than that in infection-negative group (55.56％,60/108),and there was significant difference (P =0.040).There was significant difference in hs-CRP between infection-positive group and infection-negative group [(3.91 ± 1.91) mg/L vs.(2.65 ± 1.15)mg/L] (P =0.041).There were no significant difference in Hcy,TC,LDL-C,Fbg between infection-positive group and infection-negative group (P ＞ 0.05).Logistic regression analysis showed that Hp infection was correlated with carotid plaques in patients with coronary heart disease.The severity of Hp infection had no significant effect on the incidence of carotid plaques.Conclusions Hp infection-positive patients with coronary heart disease may have a higher incidence of carotid plaque,regardless of Hcy,LDL-C,Fbg and TC level.This study shows that Hp is correlated with carotid plaque.The severity of Hp infection has no significant effect on the incidence of carotid plaque.

Introduction and objectiveThe Global Registry of Acute Coronary Events (GRACE) risk score provides a prediction of the probability of death and myocardial infarction within 6 months after acute coronary syndrome. Our aim was to detect the validity of the GRACE risk score in predicting 6-month death or reinfarction in Chinese acute myocardial infarction (AMI) inpatients 80 years of age and older between 2003 and 2012.MethodsUsing the GRACE risk score to predict the combined endpoints of all-cause death or reinfarction within 6 months of AMI, we evaluated its discrimination and calibration by the C-statistic and the Hosmer-Lemeshow test, respectively.ResultsIn total, 370 patients presenting with ST segment elevation myocardial infarction (STEMI) and non-STEMI were included. The GRACE risk score ranged between 181 and 325; death or reinfarction within 6 months of AMI was 49.2%. The GRACE model showed good discrimination overall (C-statistic 0.708, 95% confidence interval: 0.655-0.760, P<0.001) and in patients with non-STEMI (C-statistic 0.756, 95% confidence interval: 0.690-0.823, P<0.001). However, the discriminatory capacity was lower in patients with STEMI (C-statistic 0.645, P=0.001). The calibration was optimal overall (Hosmer-Lemeshow, P=0.398) and in the subgroups (STEMI, P=0.098; non-STEMI, P=0.822). There was a high correlation (R-2=0.926) between the predicted and the observed 6-month death or reinfarction after AMI.ConclusionThe GRACE score is accurate for determination of 6-month death or reinfarction in Chinese AMI inpatients 80 years of age and older; however, the discrimination and calibration performs less well in patients with STEMI.