Objective To make an initial assessment of safety, efficacy and clinical significance of the application of transradial left ventricular endomyocardial biopsy(EMB)in the diagnosis of cardiomyopathy. Methods We performed a prospective observational study of 5 patients from December 2017 to February 2018 in Beijing Hospital.Full baseline data, and data of safety and efficacy of all the patients were obtained. Results This study included 3 males and 2 females.Mean age was 42 years(range 28-62 years), and the mean BMI of 28.8 kg/m2.According to the clinical indication, the operations encompassed the left ventricular angiography, coronary artery angiography(CAG)and EMB etc.The operation success rate was 100 %(5 of 5).3 patients were performed operations including left ventricular angiography, CAG and EMB consequently by the same transradial approach, and 2 patients received CAG first and EMB several days later.The The operation time was 34-68 min and the median duration of the invasive evaluation was 54 min.The mean amount of contrast media used was 123.4 ml per patient, ranging from 95.4 to 150.2 ml.The number of biopsy samples harvested ranged from 4 to 6, and 4.4 samples were obtained per patient in average.All biopsy samples harvested where graded as good quality by the pathologists involved.Biopsy sample diagnostic success rate was 100%.Overall mean fluoroscopy time was 15.3 min ranging from 10 to 22 min.The median dose area product was 26 433 cGy·cm2(range 17 323-30 574 cGy·cm2), with a median skin dose of 2 495 mGy(range 1 392-3 088 mGy). Immediate post-procedural ambulation could be achieved and no complications were observed in all patients. Conclusions The present article demonstrates an initial result of safety and efficacy of transradial left ventricular endomyocardial biopsy, which provides a potentially safer and effective novel technique for diagnosis of cardiomyopathy, improving patient comfort and making surgery easier and economical. Key words: Biopsy, needle; Endocardium; Myocardium; Radial artery; Cardiomyopathies

Objective: To evaluate the efficacy of paclitaxel-coated balloon for de novo coronary lesions with diameters ≥ 2.8 mm. Methods: This prospective study included 215 consecutive patients with 238 de novo lesions, who received paclitaxel-coated balloon angioplasty in Beijing Hospital from May 2014 to June 2016. According to the reference vessel diameter, the patients were divided into large vessel disease (LVD) group (reference vessel diameter≥2.8 mm, 85 patients and 90 lesions) and small vessel disease (SVD) group (reference vessel diameter<2.8 mm, 130 patients and 148 lesions). Clinical characteristics, interventional procedures and major adverse cardiovascular events (includingall-cause mortality, non-fatal myocardial infarction and target lesion revascularization) after procedure were compared between the 2 groups. Results: (1)Patients in LVD group were younger than SVD group ((60.1±11.1) years old vs. (65.0±10.6) years old, P<0.01), and less patients had diabetes (24.7% (21/85) vs. 43.1%(56/130), P<0.01).(2)Prevalence of three-vessel disease (35.5%(30/85) vs. 53.6%(67/130), P<0.05) and complex lesions (type B2/C,34.4% (31/90) vs. 50.0%(74/148), P<0.05) were significantly lower in LVD group than in SVD group.(3) During pre-dilation, the rate with plain balloons use was significantly higher in SVD group than in LVD group(76.4%(113/148) vs. 58.9%(53/90), P<0.01), while the proportion of additional use of non-compliant balloons was significantly higher in LVD groupthan in SVD group(20.0% (18/90) vs. 3.4% (5/148) , P<0.01). The ratio of paclitaxel-coated balloon diameter/RVD was significantly lower (0.87±0.12 vs. 0.96±0.15, P<0.01) and the duration of dilationwas significantly shorter ((41.5±9.5) seconds vs. (45.1±9.1) seconds, P<0.01) in LVD group than those in SVD group. Each group had 1 failure case that was bailout stented with drug-eluting stents. The success rate of paclitaxel-coated balloon treatment was similar in LVD group and SVD group (98.9% (89/90) vs. 99.3%(147/148), P>0.05).(4) At the fourth day of procedure, there was 1 acute myocardial infarction requiring emergent target lesion revascularization in SVD group. No major adverse cardiovascular event was observed in LVD group during hospitalization. Forty-two patients with 53 lesions, including 27 LVD lesions and 26 SVD lesions,underwent coronary angiography at (9.4±4.6) months after paclitaxel-coated balloon intervention. The quantitative coronary angiography analysis showed that minimal lumen diameter significantlyincreased during follow-up than that of post-procedurein SVD group ((1.71±0.36)mm vs. (1.52±0.30)mm, P<0.05) , while in LVD group the minimal lumen diameter was similar between during follow-up and post-procedure ((2.35±0.48)mm vs. (2.19±0.34)mm, P>0.05). Major adverse cardiovascular event rate was 0 in LVD group and 2.3%(3/130) in SVD group (P>0.05) during follow up. No death was observed in this patient cohort. Conclusion: Treatment with paclitaxel-coated balloon for de novo coronary lesions with diameters≥2.8 mm is safe and effective.

目的:评价单用紫杉醇药物涂层球囊(DCB)治疗直径大于 2.8 mm 冠状动脉(冠脉)原发(de novo)病变的临床效果. 方法:采用前瞻性研究方法,连续入选 2014-05 至 2016-06 在北京医院心导管室单用紫杉醇 DCB 行冠脉 de novo 病变介入手术的住院患者共 215 例,病变 238 例.根据参考血管直径(RVD),将≥ 2.8 mm 定为大血管病变(LVD)组,共90 例,<2.8 mm 为小血管病变(SVD)组,共 148 例,对其临床资料和冠脉造影结果进行比较.

Objective To assess the clinical efficacy of renal artery stent treatment for severe atherosclerotic renalarterystenosis(ARAS).Methods 106patientswithatherosclerosisunderwentpercutaneoustransluminalrenal angioplasty and stenting( PTRAS) were rolled in,which included 60 male and 47 female patients with renal artery ste-nosis >50%in diameter.The followed-up time was 12 months.The level of patient's blood pressure,serum creatinine and estimated—glomerular filtration rate( eGFR) were detected.Results During 12 months of follow up,both systol-ic and diastolic blood pressure level were significantly decreased(P<0.05),and less antihypertensive medication was taken(P<0.05).EGFR remained stable in the process of follow-up.(P<0.05).Conclusion PTRAS is effective for the treatment of hypertension and keep the renal function stabilize in ARAS patients.

大部分患者在心肌梗死发生前一周会有前兆症状,如出现不稳定性心绞痛,包括新发的心绞痛,有规律的心绞痛变为进展性的心绞痛,即诱发心绞痛的活动量变小,甚至出现安静或睡觉时心绞痛,一旦出现这样的情况,应及时就医,以免发生急性心肌梗死时被动就医.老年人急性心肌梗死的特点是很少表现为典型的胸痛症状,而以胸闷为主.部分人会出现恶心、呕吐、出汗等,也提示急性心肌梗死.急性心肌梗死和心绞痛的胸痛有所区别的,首先,心肌梗死疼痛持续时间长,30分钟以上不缓解.心绞痛疼痛一般持续时间为5～15分钟.其次,心肌梗死的胸痛程度较重.第三,急性心肌梗死发生时,含硝酸甘油或速效救心丸以及休息后疼痛不能缓解.

慢性稳定性冠心病在冠心病中占绝大多数,如何管控这一患者群体,减少他们的心血管事件发生,已成为医务工作者的重要工作。为此,中华医学会于2007年发布了关于慢性稳定性冠心病的诊疗指南[1],2010年又发表了慢性稳定性冠心病管理中国共识[2],2013年欧洲心脏病学会也发表了关于稳定性冠心病的指南[3],以指导临床实践。1慢性稳定性冠心病的诊断慢性稳定性冠心病的诊断有两个要求:第一,有

<正>难治性高血压是高血压领域中最难攻克的堡垒之一,发生率约为10%～30%,其心肌梗死、心力衰竭、卒中、终末期肾病等严重并发症的发生率明显升高。难治性高血压定义为在应用足量的3种以上降压药(其中包括利尿剂)后,血压仍高于140/90mm Hg。诊断时须除外服药依从性不良、相关疾病(如肥胖、睡眠呼吸暂停综合征及其他继发性高血

<正>自1977年瑞士Gruentzig医师首次在苏黎世使用经皮冠状动脉球囊扩张成形术(PTCA)治疗冠心病以来,人类相继研发了众多的经皮冠状动脉介入技术用以攻克冠心病。这些治疗技术的最大好处是能够立刻开通狭窄或闭塞的血管,恢复已减少或中断的冠状动脉血流,使冠心病得以控制,减低病死率,提高生活质量。并且以其创伤小、恢复快而为患

Objective:The treatment experience of group of oral pesticide acute poisoning was investigated.Method: The clinical data of 17 cases in three groups of acute pesticides poisoning were retrospective analyzed in this study.Result:Eleven of 17 cases were poisoned from organophosphorous insecticides,in which 8 cases were very serious.All cases were arranged in rescued room timely and cured by at least one physician and one nurse.Sixteen cases were cured,but one died from respiratory and circulatory failure.Conclusion:Rapid and effective starting of the predicting program for sudden emergency events,diagnosis and evaluation of the conditions accurately,reasonable personal and space arrangement,and standardization of the treatment scientifically were the key for successfully treatment of grouping acute pesticides poisoning.

P>Background A mutation in MEF2A (myocyte enhancer factor-2A) had been reported to be the first gene linked directly to coronary artery disease (CAD). However, an opposing opinion was proposed recently that MEF2A mutations are not a common cause of sporadic CAD. In this study, we screened exon 11 of the MEF2A gene in people of the Han nationality in China and finished some functional analysis of found variations. Materials and methods A gene structural investigation of MEF2A in 257 CAD patients and 154 control individuals were developed in this study. Subsequently, typical MEF2A variations were cloned and expressed in HeLa or 293T cell line to illustrate whether found structure changes could influence the main biological functions of these proteins. At last, another set of gene structural screen was initialized to get more reliable conclusions. Results Totally 16 different variations were detected in exon 11 of this gene in the first set of gene structural screen. By cloning and expressing typical MEF2A proteins in cultured cells, all the acquired MEF2A variations had transcriptional activation capabilities and subcellular localization patterns similar to those of the wild-type protein. Further larger scale genetic screening also revealed that the reported genetic variations of MEF2A did not differ significantly between CAD patients and healthy controls. Conclusions Our results reveal that structural changes of exon 11 in MEF2A are not involved in sporadic CAD in the Han population of China.

Objective To summarize the clinical characteristics and results of different treatment strategies in patients with artery pseudoaneurysm after coronary angiography or percutaneous coronary intervention(PCI).Methods The clinical characteristics and different treatment strategies were summarized among patients who suffered artery pseudoaneurysm after coronary angiography or PCI from November 2004 to July 2008.Results We had 14 cases of arterial pseudoaneurysm.Two patients had diagnostic coronary angiography and 12 patients had percutaneous coronary intervention.Twelve patients had history of hypertension(92.9%) and 6 patients had diabetes(42.9%).One patient had radial artery pseudoaneurysm,2 cases with artery pseudoaneurysm were right brachial artery and 11 cases were femoral artery.One patient had bilateral femoral artery pseudoaneurysm.The average diameter of pseudoaneurysm cavity was 3.46±1.85cm(1.2~8.1cm).Eight cases had a large pseudoaneurysm(defined as diameter≥3cm).The average diameter of neck of artery pseudoaneurysm was(4.09±1.94)mm.One femoral artery pseudoaneurysm was spontaneously closed one day later.Nine of ten patients with pseudoaneurysms(69.2%) were successfully treated by ultrasound-guided manual compression.Three artery pseudoaneurysms were successfully closed by duplex-guided injection of Reptilase.One patient with right brachial pseudoaneurysm had surgery repair of pseudoaneurysm after failure of manual compression with duplex guiding and surgical repair needed local skin ulcer.Conclusion Most patients with arterial pseudoaneurysm could be successfully treated by ultrasound-guided manual compression.Patients who are failure by manual compression may need local injection of Reptilase by ultrasound guiding and manual compression.Direct surgery repair is occasionally needed.

<正>急性主动脉夹层是极为凶险的心血管急症,发达国家发病率约每年1～2/万,未经治疗,发病后48 h内半数左右死亡,约2/3的病例死于发病后1周内。主动脉夹层是指在内因和(或)外力作用下造成主动脉内膜破裂,血液经内膜破口渗入主动脉中

目的分析高龄急性心肌梗死(AMI)的临床特点。方法选择1994年1月至2004年12月确诊的高龄老年(≥80岁)AMI患者,分析患者的临床特点、治疗情况及发病3年后的预后等。结果共有102例患者纳入分析,年龄范围80~102岁,中位年龄85岁。ST段抬高心肌梗死(STEMI)患者为51%;合并高血压、糖尿病、慢性肾功能不全、心力衰竭、肺部感染、消化道出血、中风及肿瘤患者的比例分别为64.7%、32.4%、45.1%、70.6%、50.0%、38.2%、42.2%和36.3%;接受阿司匹林、噻吩吡啶类药物、肝素(包括低分子肝素)、血管紧张素转换酶抑制剂(ACEI)或血管紧张素Ⅱ受体阻滞剂(ARB)、β-受体阻滞剂(β-B)、他汀类药物治疗及介入治疗患者的比例分别为75.5%、23.5%、41.2%、53.9%、58.8%、32.4%和4.9%。发病3年内心血管病死亡率达62.7%,对比AMI发病后3年内存活的患者,心力衰竭、肺部感染的比例明显高于后者(均为P<0.05),而接受抗血小板药物、肝素、ACEI或ARB和他汀类药物的比例均显著低于后者(均为P<0.05)。多元Logistic回归分析显示,高龄老年AMI患者发病3年心血管病死亡的独立危险因素为心力衰竭。结论高龄老年AMI患者中,合并心力衰竭和(或)肺部感染及较少接受AMI后标准治疗的患者3年心血管病死亡率明显升高,心力衰竭与3年心血管病死亡独立相关。

Objective To observe angiographic characteristics and clinical events of post coronary bare metal stent(BMS) implantation in the elderly patients.Methods The patients with coronary bare metal stent implantation were followed up clinically and by angiography.The patients were divided into two groups of age≥60 years as elderly group and age60 years of non-elderly group and the their clinical events and angiographic characteristics were retrospectively analyzed.Results 121 bare metal stents were implanted in 89 elderly patients and 71 stents implanted in 53 non-elderly patients.There was no significantly difference in coronary lesion types,degree of stenosis,stent length,stent diameter and residual stenosis between the two groups.There were more patients with heart failure in elderly group than that in non-elderly group(11.2% vs 1.9%,P0.05).The in-stent restenosis rate defined by coronary angiography were 38.8% in elderly group and 33.8% in non-elderly group,the difference was not statistically significant(P0.05).The types of in-stent restenosis were not significantly different between the groups.There were significantly less patients with new lesion or lesion progression in the elderly group than that in non-elderly group(24.3% vs 43.4%,P0.05).Conclusion The in-stent restenosis rate in the elderly is comparable to the non-elderly patients,but the elderly patients have more frequency occurrence of heart failure.

目的分析冠心病合并糖代谢异常患者的冠状动脉病变特点和糖代谢异常对经皮冠状动脉介入治疗（PCI）操作及住院期不良事件的影响。方法对184例糖代谢异常及147例糖代谢正常的冠心病患者进行回顾性分析。分析患者的冠状动脉病变特点,计算血管造影成功率、操作成功率以及临床成功率,分析糖代谢异常对住院期临床事件的影响。结果糖代谢异常组患者多支病变检出率明显高于糖代谢正常组患者,冠状动脉病变范围更广泛、程度更重、病变更复杂,更易累及小血管（P＜0.05）。糖代谢异常组与糖代谢正常组之间的血管造影成功率、操作成功率和临床成功率差异无统计学意义（分别为91.8%vs.93.9%,88.0%vs.91.8%及85.3%vs.90.5%,P均＞0.05）。Logistic多元回归分析显示糖代谢异常不是PCI术住院期发生不良事件的独立危险因素（OR=0.999,95%IC:0.242~9.172,P＞0.05）。结论糖代谢异常患者冠状动脉病变比糖代谢正常患者更复杂、严重;糖代谢异常不是PCI术住院期发生不良事件的独立危险因素。

目的 评估卡托普利肾动态显像诊断老年人动脉粥样硬化性肾动脉狭窄(ARAS)的价值.方法 经肾动脉造影证实的肾动脉正常者22例(对照组)和28例老年ARAS患者(ARAS组)行卡托普利肾动态显像检查,评价卡托普利肾动态显像诊断ARAS的敏感性、特异性,并对其影响因素进行分析. 结果 卡托普利肾动态显像诊断ARAS的敏感性和特异性分别为71.4%和72.7%,卡托普利肾动态显像的4项诊断指标中,肾小球滤过率下降≥10%诊断的敏感性是46.4%,高于其他3项单项指标(P＜0.05);特异性为86.4%,与其他3项单项指标比较,差异无统计学意义.卡托普利肾动态显像诊断单侧ARAS的敏感性高于双侧,但差异无统计学意义(分别为85.7%与57.1%,P＞0.05).肾小球滤过率中度以上降低(60～90 ml·min-1·1.73 m-2)的患者中,卡托普利肾动态显像诊断ARAS的敏感性高于肾小球滤过率轻度降低(＜60 ml·min-1·1.73 m-2)患者(分别为78.9%与55.6%,P＞0.05).接受卡托普利肾动态显像检查的患者中未发生低血压等不良反应.结论 卡托普利肾动态显像是一项较为安全、有效的诊断老年人ARAS的方法;应用二乙三胺五醋酸为显像剂,卡托普利肾动态显像时肾小球滤过率下降≥10%效果较好.

Objectives To observe the changes of renal function and blood pressure in the patients with atherosclerotic renal artery stenosis(ARAS) undergoing percutaneous transluminal renal artery stenting(PTRAS),and to explore the prognostic result of baseline renal function.Methods Twenty-three patients were divided into two groups:group A(14 case) and group B(9 case),according to an initial GFR≥50 ml·min-1·1.73 mm-2 or 50 ml·min-1·1.73 mm-2 respectively.The changes of blood pressure and renal function were compared between before and after PTRAS and between the two groups after PTRAS.Results For the entire group,SBP and DBP decreased by 19 mm Hg and 6 mm Hg(1 mm Hg =0.133 kPa,P=0.000,P=0.051) respectively,while serum Cr increased by 4.4%(P=0.594) and GFR decreased by 4.4%(P=0.462) after PTRAS.In group A,BP decreased by 26/8 mm Hg(P=0.000,P=0.033),Cr increased by 21.8%(P=0.137) and GFR decreased by 12.9%(P=0.066);while in group B,BP decreased by 8/1 mm Hg(P=0.292,P=0.773),Cr decreased by 12.6%(P=0.126)and GFR increased by 16.8%(P=0.090).Conclusions PTRAS could obviously improve blood pressure in ARAS patients.There seems to be no significance in renal function improvement.

Objective To investigate the clinical and angiographic characteristics and follow-up in patients with variant angina pectoris.Methods The general clinical and angiographic and follow-up data in 7 patients with variant angina pectoris were analyzed.Results All 7 patients had the symptom of angina pectoris.Of which 3 patients had transient ST segment elevation during onset of angina,2mm elevation in V1-3 in one case and 2mm elevation in II,Ⅲ and AVF in another two.The right coronary spasm occurred in 3 cases,left anterior descending artery spasm in another 3 cases,and left anterior descending artery and left circumflex artery spasm in 1 case.The narrow severity of spasm ranged from 50% to 99%.Four patients had normal coronary artery.Two patients presented coronary spasm bed on the mild or medium stenosis.One patient with left anterior descending artery and left circumflex artery spasm had stent implantation.The clinical follow-up was completed for all 7 patients,and during which no acute myocardial infarction or death occurred.Conclusion The coronary spasm in variant angina pectoris may occur in patients with normal coronary artery or on the basis of coronary lesion.The follow-up shows some patients have recurrent angina even though they continue the use of anti-angina agent.

Objective To evaluate the protection effect of atorvastatin treatment to myocardium during percutaneous transluminal coronary intervention(PCI) in patients with unstable angina pectoris.Methods One hundred patients with unstable angina were randomized to atorvastatin group,who received atorvastatin 40 mg per day for 3 to 7 days,and control group,who did not receive statin therapy before PCI.All patients were given conventional treatment for coronary artery disease.Serum TnT,CK-MB,and Hs-CRP were checked before and 24 hours after PCI in both groups.All the patients were followed 1 month for major adverse cardiac events.Results The rates of TnT and CK-MB elevation were lower in atorvastatin group than in control group,but no statistical significance(17.6% vs.24.5%,P>0.05 and 17.6%vs.32.7%,P>0.05,respectively) was found.Seven patients in atorvastatin group and eight patients in control group(13.7% vs.16.3%,P>0.05) had ALT elevation,there is no severe adverse reaction in both group.The change of Hs-CRP after PCI in atorvastatin group was similar to that in control group(0.81±3.14 vs.-0.12±1.53,P>0.05).During 1 month follow-up,there is no death,myocardial infarction or revascularization in both groups.Conclusion Atorvastatin therapy before PCI has good safety and tolerance,it may lead to potential reduction of myocardial damage during PCI.

Aim To investigate the association of platelet endothelial cell adhesion molecule 1 gene polymorphisms with acute coronary syndrome.Methods We analyzed two single nucleotide polymorphisms of platelet endothelial cell adhesion molecule 1 gene Leu125Val and Ser563Asn in 117 angiographically documented patients with acute coronary syndrome and 117 age-and sex-matched controls in the Chinese population,using a polymerase chain reaction-restriction fragment length polymorphism strategy.Some samples were verified by direct sequencing.Results we found that two polymorphisms were in linkage disequilibrium with each other(D'=0.896)and that frequencies of 125Leu1 and 563Ser alleles were significantly increased in patients compared with controls(51.7% vs 39.7%,P<0.05;54.3% vs 42.3%,P<0.05,respectively).The frequencies of genotypes for 125Leu/Leu+ 125Leu/Val and 563Ser/Ser+ 563Ser/Asn were also significantly increased in the patients(P<0.05).In addition,there were no significant difference in patients among different vessel disease and between acute myocardial infarction and unstable angina.Conclusion platelet endothelial cell adhesion molecule 1 gene polymorphism may be a genetic risk factor for acute coronary syndrome.