目的:探讨左房主动排空分数(LAaEF)在预测阵发性心房颤动(PAF)患者首次导管射频消融术(RFCA)术后心房颤动(AF)复发的机制及再次RFCA的预后中的价值.方法:回顾性分析在我院首次行RFCA术后AF复发并再次行RFCA的PAF患者73例.患者再次RFCA术前行经胸心脏超声测算LAaEF等左房参数.将所有患者依据再次RFCA术中明确的复发机制分为单纯肺静脉(PV)组、上腔静脉(SVC)组和其他部位(non-PV/SVC)组,比较3组患者的LAaEF等参数.另依据LAaEF分为高LAaEF组和低LAaEF组,对比两组患者在再次RFCA术中明确的AF复发机制.所有患者再次RFCA术后随访12个月以上.使用多因素COX回归分析复发组与非复发组临床特征的区别,筛选再次复发的独立预测因素.结果:机制分组中,PV组的LAaEF明显高于SVC组和non-PV/SVC组.LAaEF分组中,高LAaEF组比低LAaEF组单纯PV机制的比例明显较多,non-PV/SVC机制的比例明显较少.随访过程中,总体复发率24.7％;其中,PV组的复发率为10％,SVC组为10％,non-PV/SVC组为42.4％;高LAaEF组的复发率为10.8％,低LAaEF组为38.9％.多因素Cox回归分析发现,单纯PV机制、non-PV/SVC机制和LAaEF是再次RFCA术后AF复发的独立预测因素.其中PV机制和LAaEF是保护性因素,non-PV/SVC机制是危险性因素.结论:LAaEF对于预判首次RFCA术后AF的复发机制及预测再次RFCA术后AF的复发率具有重要的价值.

Background/Objective: Hypertensive spontaneous intracerebral hemorrhages (ICH) cause significant morbidity and mortality. In this study, we aimed to investigate the association between calcium level at admission and outcome in hypertensive ICH patients. Methods: 658 hypertensive ICH patients were enrolled from January 2012 to January 2016 in this retrospective study, and demographic, clinical, laboratory, radiographic, and outcome data were collected. The associations between serum calcium level and initial hematoma volume, hematoma enlargement and functional outcome were assessed. Results: Lower calcium level at admission was associated with larger initial hematoma volumes, baseline NIHSS and mRSscore (p < .05), but not with platelet count, activated partial thromboplastin time and international normalized ratio on admission (p > .05). For outcome assessment, 30 days mortality and 6 months mRS were adjusted for age, gender and time from onset to admission, cigarette smoking, alcohol drinking, history of hypertension, baseline NIHSS score, Baseline mRS score and hematoma position, lower calcium level at admission was associated with worse outcomes. Conclusion: Low calcium level at admission is associated with worse outcome and might be a prognostic factor for acute ICH.

Objective To develop a new artificial intelligence method,based on Genetic Programming(GP)and Genetic Algorithm(GA),denoted by Genetic Programming-Genetic Algorithm(GPGA),and to improve the accuracy of warfarin dose predictive model. Method Clinical data,CYP2C9and VKORC1genotypes and warfarin maintenance dose(actual data)of 100Chinese Han patients undergoing warfarin therapy with stable international normalized ratio(INR)were collected in the First Affiliated Hospital of Soochow University from January 2014to February 2017.Utilizing GPGA,we generated and evolved warfarin dose prediction models,and got the predicted warfarin dose(predicted data).Then we compared our models with a linear regression model developed by our hospital earlier,the internationally acknowledged model developed by the International Warfarin Pharmacogenetics Consortium (IWPC),as well as three existing artificial intelligence algorithm. Results Among all the models with different complexities,GPGA gave the best overall performance in the squared correlation (R2),mean square error (MSE)and the percentage of patients whose predicted dose of warfarin were within ±20％ of the actual dose (20％-p).Besides,GPGA had no reduction on R2 from training set to test set.Height and gender did not improve the performance of the model. Conclusions GPGA developed in this study shows an overall best correlation,accuracy and applicability among all the models mentioned above.Besides,GPGA shows a good extensiveness for new data.Height or gender is not predictive for the maintain dosage of warfarin.

OBJECTIVE:To establish the induced pluripotent stem cells (iPSCs) from patients with arrhythmogenic right ventricular cardiomyopathy (ARVC).METHODS:The fibroblasts were isolated from ARVC patient and DNA mutation sites were confirmed. We reprogrammed the patient fibroblasts to pluripotency by sendaiviral transduction with defined pluripotency factors. Then, we evaluated the pluripotency of ARVC-iPSCs by performing the immunofluorescence analysis, real-time PCR and 3 germ layer formation assay. We also induced the ARVC-iPSCs into cardiac specific differentiation by regulating Wnt signaling pathway.RESULTS:Apart from alkaline phosphatase positive staining, iPSCs derived from ARVC patients expressed pluripotent related genes and embryonic stem cell marker OCT4, SSEA4 and TRA-1-81. Embryonic body formation in vitro and teratoma test in vivo demonstrated that ARVC-iPSCs could differentiate into all three germ layers. After in vitro cardiac differentiation, ARVC-iPSC could be successfully induced to spontaneously beating mass with cTNT staining positive.CONCLUSIONS:Induced pluripotent stem cell was successfully established by integration free sendai virus from dermal fibroblast of patients with ARVC. It would provide the valuable experimental model to study the molecular mechanism of ARVC.

Objective To explore the effect of different intensity of warfarin therapy on the endpoints of Chi-nese and Japanese patients with nonvalvular atrial fibrillation (NVAF). Methods The cohort studies of different inten-sity of warfarin therapy on patients with NVAF were collected in the databases including Pubmed, EMbase, Cochrane, CBM. Data were analyzed by RevMan 5.3 version. Results Five cohort studies were enrolled into this research. The re-sults of meta-analysis indicated that a range of international normalized ratio (INR) 1.5-2.5 did not increase the inci-dence of the thromboembolic events in patients with nonvalvular atrial fibrillation (OR=1.26,95%CI=0.96 to 1.66, Z=1.66, P=0.10), compared with the range of INR 2.0-3.0. Meanwhile, there were no statistically differences on the inci-dences of bleeding events (OR=0.81, 95%CI=0.63 to 1.05, Z=1.81, P=0.11), fatal bleeding events (OR=0.75, 95%CI=0.47 to 1.19, Z=1.22, P=0.22) and death events (OR=1.22, 95%CI=0.86 to 1.73, Z=1.12, P=0.26) in patients with nonval-vular atrial fibrillation between the two groups. Conclusion The range of INR 1.5-2.5 also has effective anticoagulant effect for Chinese and Japanese patients with nonvalvular atrial fibrillation. The INR range can be adjusted for Chinese and Japanese NVAF patients with warfarin therapy.

For patients with nonvalvular atrial fibrillation (NVAF) receiving warfarin therapy, the target international normalized ratio range of 2.0 to 3.0 is recommended by Western countries. However, this treatment carries a higher risk of bleeding which suggests more researches on whether low-intensity warfarin therapy (range <2.0 to 3.0) is suitable for East Asian patients. Three databases were searched from inception to April 21, 2016. Studies that reported thromboembolic and hemorrhagic events in low- and standard-intensity warfarin groups were included. Finally, seven studies were included in the analysis. There was a significantly decreased risk of hemorrhagic events (odds ratio [OR] 0.59, 95% confidence interval [CI] 0.43 to 0.82, p = 0.002) with no statistically increased risk of thromboembolic events (OR 1.14, 95% CI 0.80 to 1.62, p = 0.47) in the 1.5 to 2.0 group compared with that of the 2.0 to 3.0 group. Meanwhile, there was no significant difference of cardiovascular mortality (OR 1.58, 95% CI 0.89 to 2.83, p = 0.12) between the 2 groups. Further analysis showed there was no significance in thromboembolic events (OR 1.15, 95% CI 0.83 to 1.60, p = 0.40), major bleeding events (OR 0.74, 95% CI 0.50 to 1.09, p = 0.13), and cardiovascular mortality (OR 1.45, 95% CI 0.79 to 2.65, p = 0.23) between 1.5 to 2.5 and 2.0 to 3.0 groups. Although no significant difference was found in hemorrhagic events (OR 0.76, 95% CI 0.57 to 1.01, p = 0.06), there was a decreased trend in it. In conclusion, low-intensity warfarin therapy can achieve reduced hemorrhage without increasing thromboembolism for East Asian patients with NVAF receiving warfarin therapy.

Background: The application of digoxin in treating patients with heart failure (HF) has been lasted for more than 200 years, however, controversies remain on the effectiveness and safety of digoxin in prognosis of HF patients. Thus, we performed this meta-analysis of clinical trials that examined the digoxin use to evaluate effectiveness and safety.Methods and Result: We searched for the cohort studies that investigated the effect of the digoxin on prognosis of the patients with HF in MEDLINE, EMBASE, Chinese National Knowledge Infrastructure (CNKI), and which were published between January 1993 and October 2013. The outcomes of interest comprised all-cause mortality, HF hospitalization and all-cause hospitalization. In addition, pooled hazard risks (HRs) and 95% confidence intervals (CIs) were calculated to assess the effectiveness and safety of digoxin for HF. Nine cohort studies were retrieved from 1431 citation for the analysis, and in total, 84,692 patients were included in the analysis. After synthesizing data, the meta-analysis showed significant increasing of all cause mortality (HR=1.15, 95% CI=1.04-1.27, p<0.001) in the patients with digoxin treatment compared to the controls, whereas no significant difference was found on HF hospitalization (HR=1.06, 95%CI=0.784-1.431, p<0.001) and all cause hospitalization (HR=0.988, 95%CI=0.720-1.354). Moreover, no altered overall results were found after sensitivity analysis.Conclusion: Therefore, according to the results of our meta-analysis, the use of digoxin could significantly increase the risk of all cause mortality. However, no effect on the HF hospitalization and all-cause hospitalization was found.

To investigate the relationship between KCNN3 SNP (single-nucleotide polymorphism) rs13376333 and risk of atrial fibrillation (AF) and to provide evidence for prevention and treatment for AF.The PubMed, Embase, OVID, Cochrane library, CNKI, and Wan Fang databases were searched to identify studies on the relationship between KCNN3 SNP rs13376333 polymorphism and atrial fibrillation. Two authors performed independent article reviews and study quality assessment using the Newcastle-Ottawa Scale (NOS) checklist.Seven studies involving 24,339 individuals were included in the meta-analysis. The overall combined OR of rs13376333 polymorphism was observed for both lone AF (OR: 1.58 [95%CI: 1.37 to 1.82]; P < 0.001; I2 = 47.0%) and total AF (OR: 1.33 [95%CI: 1.14 to 1.54]; P < 0.001; I2 = 0). Further, when stratified by ethnicity, control sources, sample sizes, and genotyping method, similar results were observed in both subgroups. Sensitivity analysis revealed that the source of control was the source of the heterogeneity for lone AF. Omission of any single study had little effect on the combined risk estimate. No evidence of publication bias was found.This meta-analysis suggests that KCNN3 SNP rs13376333 polymorphism significantly increases the risk of lone AF and total AF, which suggests the rs13376333 polymorphism of the KCNN3 gene may play an important role in the pathogenesis of AF.

Objective To study the cardioprotective effects of ischemic postconditioning on rabbit heart injuried by ischemia/reperfusion in vivo .Methods Thirty-six New Zealand rabbits were randomly allocated to three groups: ①Control group ( ischemia/reperfusion group ); ②Ischemic postconditioning group ( IPostC group ); ③Sham operation group ( sham group ) . Models were established by the method of left anterior descending artery occlusion .Electrocardiogram ( ECG ) were performed during the experiment .Blood was drawn from femoral vein to evaluate cardiac troponin I ( cTnI ) by enzyme -linked immunosorbent assay ( ELISA ) before operation and 120 min after reperfusion .Myocardial infarct size of each group was determined by staining with triphenyltetrazolium chloride dye.Morphology of cardiac muscle tissues in each group was examined by transmission electron microscope .Bad expressions in the cardiac muscle tissues were detected by Western blot before and after reperfusion .All experiment data were statistically analyzed by the SPSS 17.0 software.Results ①One hundred and twenty minutes after reperfusion sixty -seven percent of rabbits in control group and eighty-three percent of rabbits in IPostC group had ST -segment resolution ≥50%.But there was no significant difference between two groups (P>0.05).The cardiac arrhythmia score of control group increased significantly than that of IPostC group (2.5 ±1.0 vs 1.4 ±1.0, P<0.05).②One hundred and twenty minutes after reperfusion cTnI value of control group was higher than that of IPostC group (6.63 ±2.32 vs 3.04 ±1.10, P<0.05).③Compared to IPostC group the infarct size of control group increased by 54%(P<0.05).④Morphologic examination indicated that the cardiomyocytes of control rabbits had more significant apoptosis characteristics compared with those of IPostC rabbits .Control group was associated with a significant increase in the expression of Bad compared with IPostC group (P<0.05).Conclusion Ischemic postconditioning at onset of reperfusion can obviously reduce myocardial reperfusion injury .

This paper introduces the design and implementation process of a multifunctional recorder for cardiac electrophysiology stimulation based on an embedded system. The front-end circuit which is composed of a deifbrillation voltage protection circuit and an electrostatic protection circuit and high-voltage circuit which is composed of a boosted circuit of transformer-coupled and single-ended lfyback MOS switch and a high voltage regulator circuit are controlled with Darlington optocoupler switch to maintain the stable pulse output waveform. The isochronous and real-time collection, displaying and storage of 12 lead and esophageal lead electrocardiogram can be implemented through the connection between the computer and the recorder with the USB interface. The examination and recording process of cardiac electrophysiology has been optimized effectively with the recorder which has integrated various operation and analysis functions for clinician.

The pacemaker current If conducted by hyperpolarization-activated cyclic nucleotide-gated (HCN) channels plays a critical role in the regulation of cardiac automaticity, with If density increased in hypertrophied ventricular myocytes. Amiodarone, a highly effective anti-arrhythmic agent, blocks human HCN currents and native If under normal conditions. To determine the effects of amiodarone under pathological conditions, we monitored If under after both acute (0.01, 0.1, 1, 10 and 100 μmol/L) and chronic (10 μmol/L) amiodarone treatment in ventricular myocytes from spontaneously hypertensive rats (SHR) with left ventricular hypertrophy using the whole-cell patch-clamp technique. The If current density was significantly greater in SHR ventricular myocytes than in cells from healthy normotensive control Wistar-Kyoto (WKY) rats. Acute application of amiodarone significantly decreased If density in myocytes from both SHR and WKY rats. The inhibition was concentration dependent with an IC50 of 4.9 ± 1.2 and 6.9 ± 1.3 μmol/L in myocytes from SHR and WKY rats, respectively. Amiodarone increased the activation and deactivation times of If in myocytes from SHR, although it did not alter the relationship of voltage-dependent activation and the reversal potential of If in myocytes from SHR. Chronic exposure of myocytes from SHR to amiodarone potently inhibited If and downregulated HCN2 and HCN4, the major channel subtypes underlying native If , at both the mRNA and protein level. These findings indicate that amiodarone inhibits If under hypertrophied conditions through dual mechanisms: (i) direct channel blockade of If currents; and (ii) indirect suppression via negative regulation of HCN channel gene expression. These unique properties of amiodarone may contribute to its anti-arrhythmic properties under pathological conditions.

目的 研究西拉普利对大鼠肥厚心肌瞬间外向钾电流(Ito)的电压门控钾通道α亚基(Kv4.2、Kv4.3)表达的影响.方法 30只大鼠随机均分为假手术(A)组、腹主动脉缩窄+安慰剂(B)组、腹主动脉缩窄+西拉普利(C)组.9周后,测量大鼠体重(BW)、收缩压(SBP)、心率(HR)、心脏重量(HW)、左心室重量(LVW)及左心室重量指数(LVW/BW),采用RT-PCR和Western blot法分别检测心肌Kv4.2、Kv4.3 mRNA和蛋白表达.结果 与A组相比,9周后B组大鼠SBP、HR、HW、LVW、LVW/BW增加(P＜0.05),Kv4.2、Kv4.3 mRNA和蛋白表达减少(P＜0.01);而C组能有效逆转B组上述各指标的变化(P＜0.05).结论 西拉普利能上调Kv4.2、Kv4.3表达,有效改善大鼠心肌肥厚.

Objective:To evaluate the therapeutic effects of intra-aortic balloon pump(IABP)and continuous veno-venous hemofiltration(CVVH)in treating severe acute viral myocarditis(SAVM).Method:We retrospectively analyzed 26cases of SAVM in our department and reviewed our experiences in treating SAVM.The following clinical variables were compared before and after treatment:patient′s vital signs,serum biochemistry,myocardial enzymogram and echocardiography.The patients were divided into IABP group,CVVH group and IABP + CVVH group.Result:The patients′arterial pressure,heart rate,urine output,renal function,heart function and NTBNP were improved more in IABP,CVVH group,and there were significant differents between IABP,CVVH and non-IABP,non-CVVH group(all P0.05).The results also occurred in IABP+CVVH group.Conclusion:Application of IABP and CVVH in acute severe viral myocarditis with pump failure patients will reduce mortality and improve outcomes.

Background: Transplanted mesenchymal stem cells (MSC) can differentiate into cardiac cells that have the potential to contribute to heart repair following ischemic injury. Overexpression of GATA-4 can significantly increase differentiation of MSC into cardiomyocytes (CM). However, the specific impact of GATA-4 overexpression on the electrophysiological properties of MSC-derived CM has not been well documented.Methods: Adult rat bone marrow MSC were retrovirally transduced with GATA-4 (MSCGATA-4) and GFP (MSCNull) and subsequently co-cultured with neonatal rat ventricular cardiomyocytes (CM). Electrophysiological properties and mRNA levels of ion channels were assessed in MSC using patch-clamp technology and real-time PCR.Results: MSCGATA-4 exhibited higher levels of the TTX-sensitive Na+ current (I-Na.TTX), L-type calcium current (6.0, transient outward K+ current (I-to), delayed rectifier K+ current (IKDR) and inwardly rectifying K+ current (I-K1) channel activities reflective of electrophysiological characteristics of CM. Real-time PCR analyses showed that MSCGATA-4 exhibited upregulated mRNA levels of Kv12, Kv2.1, SCN2a1, CCHL2a, KV1 A and Kir1.1 channels versus MSCNull. Interestingly, MSCGATA-4 treated with IGF-1 neutralizing antibodies resulted in a significant decrease in Kir1.1, Kv2.1, KV1.4, CCHL2a and SCN2a1 channel mRNA expression. Similarly, MSCGATA-4 treated with VEGF neutralizing antibodies also resulted in an attenuated expression of Kv2.1, Kv1.2, Kv1.4, Kir1.1, CCHL2a and SCN2a1 channel mRNAs.Conclusions: GATA-4 overexpression increases Ito, IKDR, ha, I-Na.TTX and I-ca.L, currents in MSC. Cytokine (VGEF and IGF-1) release from GATA-4 overexpressing MSC can partially account for the upregulated ion channel mRNA expression.General significance: Our results highlight the ability of GATA4 to boost the cardiac electrophysiological potential of MSC. (c) 2014 Elsevier B.V. All rights reserved.

目的：了解老年女性急性ST段抬高心肌梗死（ STEMI）患者的发病特点及性别差异对近期预后的影响。方法连续收集2012年1月至2013年12月入住该院心内科的老年STEMI患者354例，其中女性99例（28．0％）。观察老年女性STEMI患者的临床特点、治疗情况、死亡及6个月内主要不良心血管事件。结果与老年男性患者比较，老年女性患者平均年龄较大，合并高血压和2型糖尿病比例较高（P＜0．05）。超敏 C反应蛋白、总胆固醇水平和血清总蛋白水平较高，而血红蛋白浓度较低（P＜0．05）。冠状动脉造影结果显示老年女性患者罪犯血管TIMI血流分级较差（P＜0．05），更倾向于术中应用血栓抽吸治疗，但接受血小板糖蛋白Ⅱb／Ⅲa受体拮抗剂治疗的比例低于老年男性组（42．4％ vs 72．5％，P＜0．001）。老年女性患者MACE发生率显著高于老年男性患者组（30．3％ vs 15．7％，P＝0．017）。在所有MACE中，老年女性患者心源性死亡的发生率显著高于男性（P＜0．05）。多因素COX风险比例回归分析发现女性、高龄、低的左室射血分数（LVEF）和冠脉多支血管病变是预后的独立危险因素。结论老年女性STEMI 患者病情危重，死亡率高。女性、高龄、低LVEF 和冠脉多支病变是STEMI 患者预后的独立危险因素。

室性期前收缩(室早):几乎人人有过,有人偶发,有人频发;有人感觉到,有人感觉不到,因此甚难判断某人未有过室早.室早见于健全的心脏,不代表心脏病标志,也见于各种器质性心脏病患者,也不能从室早估测疾病预后.室早也有不同因素激发,心肌缺血、低氧血症、心肌炎症、低血钾、药物因素、麻醉、手术、情绪紧张、吸烟、咖啡、饮酒、心内假腱索等都可能激发室早.

<正>过去30年来对遗传性心律失常认识有了很的进展,不仅仅认识到有的基因表达异常产生有的心律失常,如长QT间期综合征(LQTS)、短间期综合征(SQTS)、Brugada综合征(BrS)、儿茶酚胺依赖多形性室性心动过速(CPVT)、致心失常性右室心肌病(ARVD)等,除这些离子通疾病的表型认识以外,其实更有积极意义的是基因易感性病例。他们平时与常人相同,心电图正常,无心律失常表现,但在药物作用或外界环境改变下表现出心律失常,尤其是IA类IC类和Ⅲ类抗心律失常药物,他们对此

Objectives The discovery of angiotensin-converting enzyme 2 (ACE2) has greatly modified our understanding of renin-angiotensin system (RAS). This study aimed to investigate the cardiac expression of ACE2 and ACE in spontaneously hypertensive rats (SHR) Methods Fifteen SHRs were randomly assigned to two groups: SHR control group (n = 7) which were treated with vehicle, and enalapril group (n = 8) treated with enalapril [15 mg/(kg·d)]. After 4 weeks of treatment, the rats were killed and the left ventricular tissue dissected carefully. Reverse transcription polymerase chain reaction and Western blot protein staining were performed to detect the expression of mRNA and protein of ACE2 and ACE. Ten WKY rats. Results Compared with the normotensive WKY rats, the cardiac expression of both mRNA and protein of ACE in SHR was significantly increased (1.68 ± 0.34 vs 0.33 ± 0.12, P < 0.05;1.21 ± 0.14 vs 0.71 ± 0.11, P < 0.05), where as the cardiac levels of both mRNA and protein of ACE2 were significantly decreased (0.50 ± 0.15 vs 1.16 ± 0.24, P < 0.05; 0.71 ± 0.24 vs 1.22 ± 0.14, P < 0.05). After treatment with enalapril, the levels of both mRNA and protein of ACE were significantly decreased (0.44 ± 0.19 vs 1.68 ± 0.34, P < 0.01; 0.87 ± 0.13 vs 1.21 ± 0.14, P < 0.05) and the expression of ACE2 mRNA significantly elevated (1.77 ± 0.49 vs 0.50 ± 0.15, P < 0.05), but ACE2 protein remained unchanged. Conclusions In SHR, the expression of cardiac ACE was remarkably increased, where as ACE2 was notably decreased. Reduction of ACE and elevation of ACE2 might be one of the mechanisms underlying the antihypertensive function of enalapril.