Background:The narrow therapeutic range of warfarin, alongside the response of numerous influencing factors and significant inter-individual variability, presents major challenges for personalized medication. This study aimed to combine clinical and genetic characteristics with machine learning (ML) algorithms to develop and validate a model for predicting stable warfarin doses in patients from Northern China after mechanical heart valve replacement surgery. Methods:This study included patients who underwent mechanical heart valve replacement surgery at the Beijing Anzhen Hospital between January 2021 and January 2024 and achieved a stable warfarin maintenance dose. Comprehensive clinical and genetic data were collected, and patients were divided into training and validation cohorts at an 8:2 ratio through random division. The variables were selected using analysis of covariance (ANCOVA). Algorithms for predicting the stable warfarin dose were constructed using a traditional linear model, general linear model (GLM), and 10 ML algorithms. The performance of these algorithms was evaluated and compared using R-squared (R2), mean absolute error (MAE), and ideal prediction percentage to identify the optimal algorithm for predicting the stable warfarin dose and verify its clinical significance. Results:A total of 413 patients were included in this study for model training and validation, and 13 important features were selected for model development. The support vector machine radial basis function (SVM Radial) algorithm showed the best performance of all models, with the highest R2 value of 0.98 and the lowest MAE of 0.14 mg/day (95% confidence interval (CI): 0.11-0.17). This model successfully predicted the ideal warfarin dose in 93.83% of patients, with the highest ideal prediction percentage found in the medium-dose group (95.92%). In addition, the model demonstrated high predictive accuracy in both the low-dose and high-dose groups, with ideal prediction percentages of 85.71% and 92.00%, respectively. Conclusions:Compared to previous methods, SVM Radial demonstrates significantly higher accuracy for predicting the warfarin maintenance dose following heart valve replacement surgery, suggesting it has potential for widespread application. However, this study was based on a relatively small sample size and conducted at a single center. Future research should involve larger sample sizes and multicenter data to validate the predictive accuracy of the SVM Radial model further.

BACKGROUND:Frontonasal dysplasia (FND) is a rare congenital anomaly resulting from the underdevelopment of the frontonasal process, and it can be syndromic or nonsyndromic. The typical features of FND include a deformed nose and ocular hypertelorism, which are sometimes associated with cleft lip and/or palate. Only approximately 10 cases of prenatally diagnosed nonsyndromic FND have been reported in the past 30 years.CASE PRESENTATION:A 33-year-old woman (G2P1) was referred to our center at 20 gestational weeks for bilateral hydrocephaly. We detected typical features of FND, including severe hypertelorism, median nasal bifidity, a minor cleft lip, and multiple limb anomalies using three-dimensional (3D) ultrasound. A hypoplastic corpus callosum, unilateral microtia, and a ventricular septal defect were also detected. Genetic testing, including karyotype analysis, copy number variation (CNV) analysis, trio-whole exome sequencing (trio-WES), and trio-whole-gene sequencing (trio-WGS), was performed; however, we did not find any de novo gene variants in the fetus as compared to the parents. Postmortem examination confirmed the prenatal diagnosis of FND.CONCLUSION:The present case expands the wide phenotypic spectrum of prenatal FND patients. 3D ultrasound is a useful tool for detecting facial and limb deformities.

A total of 25 patients with right cardiac system tumors in the Department of Cardiac Surgery, Beijing Anzhen Hospital from January 2012 to October 2022 were retrospectively included in the study. The preoperative data, and information of surgical treatment and perioperative management on these patients were analyzed and summarized. One patient developed pulmonary embolism and died before surgery, and the other 24 patients (16 males and 8 females) received surgical treatment, with an average age of (44.7±10.2) years (24-74 years). Nine patients were diagnosed with malignant tumors. Among the 24 patients who received surgical treatment, two patients died during the perioperative period, in-situ tumor recurrence was seen in three patients within about 1 year after surgery (two patients died without surgery, and one patient died 3 months after surgery), two patients had distant metastasis, and 17 patients had a good prognosis. Right cardiac system tumors are rare, with a high malignant rate, and the clinical manifestations vary greatly. Active surgical intervention is found to be effective, and the prognosis is closely related to the pathological type and extent of tumor invasion.

Objectives: There are many available pharmaceutical and surgical management for Coronary artery disease (CAD) patients. However, coronary artery bypass grafting (CABG) is the preferred treatment modality for CAD patients with low ejection fraction (EF) in view of the more favorable outcomes. This study aimed to determine the associated factors of poor outcomes post-CABG for heart failure patients with reduced left ventricular ejection fraction who underwent on-pump and off-pump CABG. Methods: A retrospective review of CAD patients who underwent isolated on-pump CABG (ONCAB) or off-pump CABG (OPCAB) in Beijing Anzhen Hospital Affiliated with Capital Medical University from January 2013 to March 2021. Only those with confirmed reduced left ventricular ejection fraction (LVEF) ≤40% on preoperative echocardiography were included. By analyzing the clinical and surgical data, postoperative mortality and morbidity, as well as major cardiovascular and cerebrovascular adverse events (MACCE) as endpoints, certain risk factors of the postoperative complications were identified. Results: Out of the 500 patients, 64 developed MACCE, of which 14 (13.6%) occurred in the ONCAB group and 50 (14.0%) in the OPCAB group. Univariate COX regression analysis showed that age ≥65 years, history of diabetes, and preoperative renal insufficiency were independent risk factors for postoperative primary endpoint events in CAD patients with heart failure with reduced ejection fraction (HFrEF). Following the multivariate COX regression analysis, in addition to the above three risk factors, a history of previous percutaneous coronary angiography (PCI) intervention was also a risk factor for the occurrence of the primary endpoints post-CABG. Conclusion: Based on the analysis, significant predictors of post-CABG MACCE in patients with HFrEF included being older than 65 years old, having diabetes, preoperative renal insufficiency, and having previous PCI.

OBJECTIVE:To compare the efficacy of isolated off-pump coronary artery bypass grafting (OPCABG) and of coronary artery bypass grafting (CABG) plus mitral valve plasty (MVP) in treating coronary heart disease with moderate ischemic mitral regurgitation to find a better surgical method. METHODS:Clinical data of 822 patients diagnosed with coronary heart disease and moderate ischemic mitral regurgitation were analyzed retrospectively. Patients were divided into the OPCABG and CABG+MVP groups according to surgical methods. Baseline data of both groups were corrected, and clinical efficacy of the two surgical methods was analyzed and compared using the propensity score inverse probability of treatment weighting (IPTW) method. RESULTS:There were no significant differences in the use of mammary artery grafts, number of grafts, and blood product consumption between the two groups (P>0.05) after IPTW. However, the CABG+MVP group had a significantly longer operation time than the OPCABG group (4.13 ± 0.85 hours vs. 5.65 ± 1.02 hours, P<0.001). No statistically significant differences in postoperative major adverse cardiac and cerebrovascular events were observed between the two groups. However, the intra-aortic balloon pump rate was higher in the CABG+MVP group than in the OPCABG group (12.3% vs. 25.0%, P=0.012). Although CABG+MVP can improve ischemic mitral regurgitation significantly (95.4% vs. 81.2%, P<0.001), there were no significant differences in the cumulative survival rate and the incidence of major adverse cardiac and cerebrovascular events between the groups (P>0.05) after IPTW. CONCLUSION:CABG+MVP may not provide more advantage in patients with coronary heart disease and moderate ischemic mitral regurgitation.

Background: To investigate the risk factors of left ventricular ejection fraction (LVEF) improvement in patients with ischemic cardiomyopathy (ICM) after coronary artery bypass grafting (CABG), and to construct a model that predicts LVEF improvement.Methods: A retrospective analysis was performed on 106 ICM patients who received CABG and underwent cardiac magnetic resonance (CMR) at Beijing Anzhen Hospital, Capital Medical University from January 2017 to June 2022. Patients were divided into two groups with improved LVEF and no improved LVEF based on the results of postoperative 6-month transthoracic echocardiography. To analyze the risk factors affecting the LVEF non-improvement after CABG and establish a prediction model.Results: There was LVEF non-improvement in 30.2% (32/106) of patients. Multivariate analysis showed that the number of transmural scar segments and left ventricular end-systolic volume index (LVESVI) were independent risk factors in LVEF non-improvement after CABG [odds ratio (OR) =2.398, 95% CI: 1.607- 3.579, P<0.001; OR =1.036, 95% CI: 1.009-1.063, P=0.008]. The model is built and internally verified. ROC showed that the area under the curve (AUC) was 0.866 (95% CI: 0.792-0.940), calibration curve showed that the probability predicted by the model matched well with the clinical results, and decision curve analysis (DCA) showed that the model had good clinical applicability. During the mean follow-up time of 1.5 years, the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) in the LVEF non improvement group was higher (5.4% vs. 25.0%, P=0.009), and the NYHA grading was higher (P=0.016), when compared to the LVEF improvement group.Conclusions: The prediction model based on the number of transmural scar segments and LVESVI has good diagnostic efficacy. Our findings help to identify patients with improved LVEF and thus guide the selection of clinical treatment strategies.

目的:研究两种不同乳内动脉(internal mammary artery,IMA)获取方式下患者术中以及术后早期治疗效果的差异.方法:回顾性分析从2021年1月至9月,单纯行不停跳冠状动脉旁路移植术(off-pump coronary artery bypass grafting,OPCABG)的患者 97 例,其中男性75例,女性22例,平均年龄(59.4±8.4)岁.根据患者术中IMA获取方式分为骨骼化左乳内动脉组(47例)及带蒂LIMA组(50例).均采用胸部正中切口 OPCABG术式,两组IMA取材均为左侧IMA,行LIMA与前降支(LAD)或LIMA与对角支(D)吻合.通过收集对比患者术中、术后住院时基本情况以及出院后1年情况评估两种方式获取乳内动脉的安全性和有效性.结果:骨骼化组术中LIMA桥血管流量高于带蒂组[71(46,97)vs.53.5(41.75,80.75)mL/min,P=0.044],骨骼化 IMA 组获取 LIMA 时间长于带蒂 IMA 组[(30.4+7.6)vs.(23.1±8.2)min,P＜0.001],但骨骼化IMA组整体手术时间与带蒂IMA组,差异无统计学意义[(4.8±0.6)vs.(4.8±0.7)h,P＞0.05].骨骼化IMA组患者术后引流量少于带蒂IMA组[420(330,700)vs.560(397.5,797.5)mL,P=0.028].1年后两组随访患者无心绞痛复发,随访率86.6％(40/44).结论:骨骼化获取乳内动脉可减少术后患者失血,患者术后早期预后较好,疗效满意,骨骼化乳内动脉的中远期疗效还需要进一步的研究验证.

目的:通过分析双房粘液瘤(BM)的临床特点,总结围术期治疗经验及中短期预后效果.方法:回顾性分析2004年12至2021年5月,北京安贞医院心外科6例双房粘液瘤患者的临床资料,结合国内外相关文献与本组患者术前资料,手术治疗及围术期处理进行分析总结.结果:6例患者均行粘液瘤切除术,术后6例患者心功能均有不同程度改善,无围术期死亡病例,中短期预后良好.结论:双房粘液瘤患者早期明确诊断,尽早行手术治疗可降低并发症发生,降低围术期风险,提高预后效果.

目的:探索冠心病合并中度缺血性二尖瓣反流(ischemic mitral regurgitation,IMR)患者外科治疗围术期危险因素并构建模型,以预测此类患者外科围术期死亡和主要并发症的风险.方法:回顾性分析2009年9月至2021年10月,北京安贞医院诊断为冠心病合并中度IMR并接受外科手术治疗患者的临床资料.以围术期死亡和主要并发症为终点,随机将这些患者的70％划分为训练集,剩余30％的患者划分为验证集.在训练集中应用二元多因素Logistic回归探寻危险因素,并构建模型,绘制列线图,并在验证集中验证模型的区分度和校准度.结果:本研究共纳入的949例患者,179例(18.9％)患者发生终点事件(围术期死亡或出现主要并发症),训练集(n=664)和验证集(n=285)分别有120例(18.1％)和59例(20.7％)患者发生终点事件.多因素Logistic回归分析表明中枢神经系统病史、术前放置主动脉内球囊内反搏、使用体外循环、体表面积＜1.75m2、TnI＞0.7μg/mL、LVEF ≤ 40％、肌酐清除率＜70 mL/min以及LVEDD ≥ 55mm是冠心病合并中度IMR患者外科术后发生围术期死亡及主要终点事件的危险因素.根据以上8个预测因子构建出的模型在训练集中区分度良好,一致性指数(concordance index,C-index)为0.715(95％CI:0.665～0.766),且模型的准确度较高.模型在验证集中的C-index为0.722(95％CI:0.645～0.798).在预测的主要终点事件发生风险低于50％的患者中,校准曲线表明预测风险和观测风险基本一致.结论:建立冠心病合并中度IMR患者外科手术围术期风险预测模型,可有效预测此类患者围术期全因死亡及主要并发症的发生率,有助于在此类人群中识别出高危手术患者.

目的 探讨术前血清N末端B型脑钠肽前体(NT-proBNP)和心肌肌钙蛋白Ⅰ(cTnⅠ)水平对老年重症心脏瓣膜病患者术后发生低心排血量综合征(LCOS)的预测价值.方法 选取2018年2月至2020年1月于首都医科大学附属北京安贞医院行手术治疗的老年重症心脏瓣膜病患者202例.收集患者一般临床资料、心脏生化指标.出院后对患者进行3年随访,按照是否发生LCOS,将患者分为发病组(47例)和对照组(155例).采用Logistic多因素回归方法分析患者术后发生LCOS的独立危险因素,通过受试者工作特征(ROC)曲线确定术前NT-proBNP和cTnⅠ水平的最佳截断点,依据患者术后的独立危险因素建立列线图预测模型并进行验证.结果 多因素Logistic回归分析结果显示,术前心律失常、既往心肌梗死、术前NT-proBNP水平高、术前cTnⅠ水平高、体外循环时间长、重症监护时间长、术后NT-proBNP水平高、术后cTnⅠ水平高为老年重症心脏瓣膜病患者术后发生LCOS的独立危险因素(均P＜0.05).术前NT-proBNP水平预测老年重症心脏瓣膜病患者术后发生LCOS的ROC曲线下面积为0.742,截断点为7117.80 ng/L,敏感度为72.60％,特异度为74.30％;术前cTnⅠ水平预测老年重症心脏瓣膜病患者术后发生LCOS的ROC曲线下面积为0.808,截断点为0.73 μg/L,敏感度为81.00％,特异度为78.40％.列线图模型调查显示,术前心律失常、既往心肌梗死、术前NT-proBNP水平高、术前cTnⅠ水平高、体外循环时间长、重症监护时间长、术后NT-proBNP水平高、术后cTnⅠ水平高是术后发生LCOS的独立危险因素,评分分别为31、25、21、11、18、16、30、16分,总评分为168分,对应LCOS术后发生概率为33.6％.该模型一致性指数为0.773,ROC曲线下面积为0.851,具有较好的区分度;校准曲线评价结果显示该模型具有较高的一致性.结论 术前血清NT-proBNP和cTnⅠ水平高是老年重症心脏瓣膜病患者术后发生LCOS的独立危险因素.

Objective:To explore the feasibility of applying quantitative flow ratio(QFR) to assess the degree of coronary artery functional stenosis before surgery, and to guide coronary artery bypass grafting(CABG) revascularization strategy.Methods:The study prospectively included a total of 154 patients who were electively treated with CABG in the 11th ward of the Department of Cardiac Surgery of Beijing Anzhen Hospital from January 2019 to September 2020, and their coronary angiography visually showed stenosis of the coronary artery to perform QFR analysis to know the diseased blood vessels. For functional stenosis, the surgeon was blinded to the results of QFR analysis before surgery. Collect its baseline data, perioperative data and recent clinical outcomes for summary analysis.Results:One year later, the coronary artery CTA showed that the occlusion rate of functionally significant disease(QFR<0.8) was 5.5%, and that of non-functionally significant disease(QFR≥0.8) was 15.6%. There was no difference in angina class or repeat interventions between patients with or without occluded bypass grafts.Conclusion:According to QFR analysis, coronary arteries with functional non-significant disease have a higher risk of grafts failure than those with functionally significant disease. For coronary arteries with negative QFR lesions, the risk of occlusion of arterial grafts is higher than that of venous. However, this finding is not significantly related to clinical prognosis, because patients with patency or occlusion of the grafts in non-significant lesions have not found excessive angina pectoris or repeated coronary interventions. QFR-guided selection of coronary surgery strategies is safe and feasible.

Background Quantitative flow ratio (QFR) is a new functional index to assess the functional significance of coronary stenosis. While whether there is an association between QFR and transit-time flow measurement (TTFM) parameters of the target coronary artery has not been well addressed. Methods A total of 89 patients receiving the in situ left internal thoracic artery (LITA) grafts to the left anterior descending artery (LAD), and 19 patients undergoing the saphenous vein grafts (SVG) were enrolled in this retrospective study. The QFR value of the LAD was evaluated preoperatively. According to the QFR values, patients with the LITA to the LAD bypass grafts were divided into two groups (group A1: QFR < 0.75, group A2: QFR ≥ 0.75), and SVG patients were divided into two groups (V1 group: QFR < 0.75, V2 group: QFR ≥ 0.75). Results In groups A1 and A2, respectively, median graft flow (Qm) was 44 (34) mL/minute and 26.5 (30.0) ml/minute; median pulsatility index (PI) was 2.00 (1.00) and 2.65 (0.90). Significant differences were observed in Qm (P = 0.034) and PI (P = 0.030). And the correlation coefficients of the TTFM variables with QFR were Qm: r = r = −0.226, (P = 0.036), PI: r = 0.265 (P = 0.012) among the LITA to LAD population. Conclusion TTFM variables, especially the PI, of the LITA in situ graft to the LAD during Coronary artery bypass grafting (CABG) are strongly affected by preoperative QFR values. Moreover, in functionally mild coronary stenosis, the chance of competitive flow increases.

Objective:To investigate the relationship between the expression of mammalian Ste20-like kinase 1 (MST1) and cardiac hypertrophy in hypertrophic cardiomyopathy (HCM) and to determine the associated signaling pathway.Methods:Hypertrophied inter-ventricular septal tissues from 20 patients with HCM and normal myocardial tissues from 4 healthy control group were collected. Firstly, clinical specimens including HCM patients and normal control group, animal models including MST1 gene knockout (KO) mouse model and transverse aortic constriction (TAC) mouse model, and in vitro cell culture models were used to confirm the correlation between MST1 gene expression and cardiac hypertrophy. Then, the role of MST1 signaling pathway including MST1, YAP2, Survivin and AKT in the pathogenesis and development of HCM was verified by cell (H9C2) level, animal model level and clinical specimen level.Results:(1) Compared with normal myocardium, the levels of protein expression and RNA transcription of MST1 gene were significantly decreased in patients with HCM. Moreover, the level of protein expression of MST1 gene was negatively correlated with inter-ventricular septal thickness detected by echocardiograpy in patients with HCM. (2) The ventricular wall thickness and heart weight ratio of MST1 gene KO mice were higher than those of control mice (MST1 gene wild-type). The ventricular wall thickness and heart weight ratio in TAC group were also higher than those in sham group. Furthermore, the ventricular wall thickness and heart weight ratio of mice with MST1 gene KO and TAC were significantly higher than those of control group. (3) In vitro cell culture results showed that lower expression of MST1 gene could promote cardiac hypertrophy. (4) In addition, down-regulation of MST1 gene expression can lead to up-regulation of downstream related genes (YAP2 and Survivin) and active expression of related specific gene (AKT) and subsequently to promote cardiac hypertrophy, which is verified by cell (H9C2) level, animal model and clinical specimen level.Conclusions:The abnormal expression of MST1 is related to the occurrence of HCM. Decrease in the expression of MST1 gene may regulate the up-regulation of downstream genes including YAP2 and Survivin, and then affect the activity of AKT gene, which promoting cardiac hypertrophy and leading to the occurrence of HCM.

Background and Aims: Patients with heart failure with reduced ejection fraction (HFrEF) are among the most challenging patients undergoing coronary artery bypass grafting surgery (CABG). Several surgical risk scores are commonly used to predict the risk in patients undergoing CABG. However, these risk scores do not specifically target HFrEF patients. We aim to develop and validate a new nomogram score to predict the risk of in-hospital mortality among HFrEF patients after CABG.Methods: The study retrospectively enrolled 489 patients who had HFrEF and underwent CABG. The outcome was postoperative in-hospital death. About 70% (n = 342) of the patients were randomly constituted a training cohort and the rest (n = 147) made a validation cohort. A multivariable logistic regression model was derived from the training cohort and presented as a nomogram to predict postoperative mortality in patients with HFrEF. The model performance was assessed in terms of discrimination and calibration. Besides, we compared the model with EuroSCORE-2 in terms of discrimination and calibration.Results: Postoperative death occurred in 26 (7.6%) out of 342 patients in the training cohort, and in 10 (6.8%) out of 147 patients in the validation cohort. Eight preoperative factors were associated with postoperative death, including age, critical state, recent myocardial infarction, stroke, left ventricular ejection fraction (LVEF) ≤35%, LV dilatation, increased serum creatinine, and combined surgery. The nomogram achieved good discrimination with C-indexes of 0.889 (95%CI, 0.839–0.938) and 0.899 (95%CI, 0.835–0.963) in predicting the risk of mortality after CABG in the training and validation cohorts, respectively, and showed well-fitted calibration curves in the patients whose predicted mortality probabilities were below 40%. Compared with EuroSCORE-2, the nomogram had significantly higher C-indexes in the training cohort (0.889 vs. 0.762, p = 0.005) as well as the validation cohort (0.899 vs. 0.816, p = 0.039). Besides, the nomogram had better calibration and reclassification than EuroSCORE-2 both in the training and validation cohort. The EuroSCORE-2 underestimated postoperative mortality risk, especially in high-risk patients.Conclusions: The nomogram provides an optimal preoperative estimation of mortality risk after CABG in patients with HFrEF and has the potential to facilitate identifying HFrEF patients at high risk of in-hospital mortality.

Objectives To summarise the surgical outcomes in patients with cardiogenic shock supported by preoperative extracorporeal membrane oxygenation (ECMO). Methods Between May 2012 and August 2017, eight patients with cardiogenic shock, who were supported by ECMO, underwent emergency surgery; four of them had isolated coronary artery bypass grafting, three had coronary artery bypass grafting with mitral replacement, and one had mitral valve replacement with left ventricular posterior wall repair. Results All eight patients were successfully weaned off from ECMO after their surgeries. Postoperative ECMO time ranged from 6.8 to 228.0 h, with a median of 68.4 h. Two patients died postoperatively while another six survived. The follow up time for the six patients ranged from three to 66 months, whereby one of them died in the third month due to septicaemia. The remaining five patients survived with good cardiac function based on the NYHA classification. Conclusion ECMO is a vital bridge in the preparation of critically-ill patients for cardiac surgery. It is associated with acceptable outcomes among most of the patients.

目的:通过观察射血分数降低型心力衰竭(HFrEF)患者行冠状动脉旁路移植术(CABG)的围术期风险及远期生存率,比较单纯药物治疗与CABG术对这类患者临床结果的差异,探讨HFrEF患者的最优治疗策略.方法:连续收集2014年1月至2018年12月入院,LVEF＜40％合并心力衰竭的症状和体征行CABG术的患者118例及单纯药物治疗的患者45例.住院期间行经胸超声心动图检查测定LVEF和左心室收缩末期容积指数(LVESVI),采用正电子发射断层显像技术(PET)行静息心肌灌注显像及心肌代谢断层显像测定存活心肌占左心室心肌比例.手术组患者除接受指南指导下的药物治疗外均由同一主刀医师行CABG术,单纯药物治疗组患者接受指南指导下的规范化药物治疗.术后平均随访时间(37±12)个月,观察手术组患者手术死亡率,围术期并发症,远期无主要不良心血管事件(MACE)生存率并对比单纯药物治疗组患者与CABG术治疗组患者的远期无MACE事件生存率.结果:全组118例患者围术期死亡8例,死亡率6.8％.死亡原因包括:术后心排4例,感染中毒性休克3例,IABP腿部并发症导致全身代谢紊乱1例.围术期应用主动脉内球囊反搏(IABP)或体外膜式氧合(ECMO)等机械辅助措施的患者分别达到56.8％和8.5％.术中71.2％的患者采用不停跳CABG,全静脉桥血管比例占39.8％.术后平均机械通气时间和ICU时间分别为60 h和84 h.术后对两组患者进行随访,CABG组参与随访103例,药物治疗组参与随访40例,平均随访时间为(37±12)个月.随访期间药物治疗组患者脑卒中,心肌梗死及再次血运重建发生率显著高于CABG组患者(12.5％ vs.6.8％,P=0.000, 27.5％ vs.12.6％,P=0.005,22.5％ vs.4.9％,P=0.000).CABG组患者24个月,36个月,48个月免MACE事件存活率明显高于药物治疗组组患者(96.9％ vs.75.6％,86.4％ vs.45.5％,44.4％vs7.2％,P＜0.01).结论:HFrEF患者行CABG术围术期风险较高,需根据患者左心室存活心肌比例及左心室重构情况制定个性化治疗策略.手术治疗与药物治疗相比,手术治疗中远期获益显著,能够有效改善患者预后.

Objective: To explore the impact of left ventricle remodeling on perioperative risk and short-term survival in patients with heart failure and reduced ejection fraction (HFrEF) undergoing coronary artery bypass grafting (CABG). Methods: A total of 78 coronary artery disease (CAD) patients (54 males, 24 females) with symptoms and signs of heart failure and a left ventricular ejection fraction (LVEF)<40% were consecutively enrolled from January 2014 to December 2018 in Beijing Anzhen Hospital. The average age was (59±8) years old. Transthoracic echocardiography was performed to measure LVEF and left ventricle end-systolic volume index (LVESVI) during hospitalization, and the average LVESVI was (92±18) ml/m(2). According to the mean value of LVESVI, the patients were divided into 2 groups: mild left ventricle remodeling group (group M, n=46, LVESVI<92 ml/m(2)) and severe left ventricle remodeling group (group S, n=32, LVESVI≥92 ml/m(2)). The follow-up period was (30±12) months. Operative mortality, perioperative complications and long-term survival were compared between the two groups. Results: Perioperative mortality was 5.1% (4/78), which was significantly higher in group S than that of group M (9.4% vs 2.2%, P=0.03). The proportion of patients with intra-aortic balloon pump (IABP) was higher in group S than that of group M during the perioperative period (62.5% vs 36.9%, P<0.01). Compared with patients in group M, those with severe left ventricle remodeling were more susceptible to atrial fibrillation after surgery (25.0% vs 6.5%, P=0.02). The mean follow-up time was (30±12) months. There was no difference in major adverse cardiac event (MACE)-free survival in 12 month, 24 month and 36 month between the two groups (100% vs 100%, 87.9% vs 92.1%, 80.3% vs 78.3%, P=0.68). Conclusion: Left ventricular remodeling increases the perioperative mortality and complications of patients with ischemic HFrEF undergoing CABG, but it has no impact on short-term survival.

Objective:To assess the clinical characteristics and grafts status by coronary angiography(CAG) in symptomatic patients with prior coronary artery bypass graft(CABG).Methods:A retrospective descriptive study of symptomatic patients with prior CABG who underwent CAG was performed, 1 136 patients were included and analyzed. The mean age was(62.5±8.7) years, 76.4% were male. There was a high prevalence of risk factors like hypertension(75.0%), dyslipidemia(48.2%), diabetes(46.1%) and smoking history(62.8%).Results:The mean duration after CABG was (4.65±3.39) years. 94.5% of patients had chest pain. 12.9% of patients had all diseased grafts and 28.7% had all patent grafts. The proportion of diseased SVG was higher than that of diseased arterial grafts. The proportion of diseased grafts anastomosed to RCA territory was higher than that of grafts anastomosed to LCX territory or LAD territory. 52.5% of patients received percutaneous coronary intervention(PCI) revascularization, and 88.3% of PCI was performed in native vessels.Conclusion:The most common symptom recurring to patients with prior CABG was chest pain. Graft status in symptomatic patients with prior CABG was worse than we expected. Patients received repeated revascularization mostly by PCI and PCI was mainly performed in native vessels.

Objective:To explore the perioperative effect of coronary artery bypass grafting(CABG) or CABG+ mitral valve repair(MVP) in patients with coronary heart disease(CAD) and moderate ischemic mitral regurgitation(IMR).Methods:The clinical data and perioperative complications of 210 patients with CAD and moderate IMR, who underwent CABG from January 2018 to December 2019, were included into this study, with 155 males and mean age of(62.3±8.5) years old. According to the operation mode, patients were divided into CABG group(138 cases) and CABG+ MVP group(72 cases).Results:There were no significant differences in age, gender, comorbidities(diabetes, hypertension, hyperlipidemia, peripheral vascular disease, cerebrovascular events, previous history of myocardial infarction and PCI), LVEF and of coronary artery lesions between the two groups(all P>0.05). Sequential anastomosis was the main method, and most patients underwent internal mammary artery graft in both groups, there was no significant difference between the two groups( P>0.05). CABG group was higher than CABG+ MVP group in all-cause death, heart failure, cerebrovascular events, secondary thoracotomy, CRRT and IABP support events, but there were no significant differences between the two groups( P>0.05). Echocardiographic reexamination showed that the indexes of cardiac function in CABG+ MVP group were higher than those in CABG group, but there was no significant difference between the two groups( P>0.05). The mean area of mitral regurgitation in CABG + MVP group was 1.3 cm 2, significantly lower than that in CABG group(2.5 cm 2), P<0.05. Conclusion:CABG+ MVP has low perioperative risk in patients with CAD and moderate IMR, and the area of mitral regurgitation is lower.

Objective: To explore the role of pulmonary arterial pressure in chronic obstructive pulmonary disease (COPD) phenotypes based on cluster analysis and its prognostic value. Methods: Three hundred and nineteen patients admitted to Beijing Chaoyang Hospital and Xuanwu Hospital from April 2013 to April 2016 were recruited in the study. All the patients were older than 40 years old and in stable COPD. One-year follow-up was performed and the endpoint was acute exacerbation of COPD or all-cause mortality. Age, body mass index (BMI), smoking index, history of exacerbation, modified British medical research council (mMRC), forced expiratory volume in first second (FEV(1)), pulmonary arterial pressure and right ventricular transverse diameter measured by echocardiography were selected as cluster indicators to classify patients, survival analysis was performed. Results: Eight cluster indexes were converted into four independent principal components by principal component analysis (PCA), with a cumulative contribution rate of 70.1%. The extracted principal components were used for cluster analysis. Patients were divided into four categories, each contained different GOLD grades and had statistically significant differences in age, symptoms, degree of pulmonary function impairment and pulmonary arterial pressure (all P<0.001). The four categories were: class 1: young, pulmonary function damage was medium, lower pulmonary arterial pressure, good prognosis; class 2: elderly, pulmonary function damage was mild, higher pulmonary arterial pressure, poor prognosis; class 3: young, pulmonary function damage was serious, normal pulmonary arterial pressure, the best prognosis; class 4: elderly, pulmonary function damage was medium, pulmonary arterial pressure increased significantly, the worst prognosis. Conclusion: Cluster analysis based on pulmonary artery pressure can be used to identify COPD patients with different risk of acute exacerbation or death, suggesting that pulmonary hypertension as a COPD phenotype plays a role in prognostic assessment.