Background To investigate the clinical characteristics, angiographic findings and clinical outcomes (in-hospital) of young adults with acute myocardium infarction in a Chinese population. Methods This was an observational study. Five hundred and forty-nine patients who suffered with ST-segment elevation myocardial infarction (STEMI) firstly between January 2013 and December 2015 were enrolled consecutively. All patients were divided into two groups: “young group” patients were ≤ 50 years old; and “non-young group” patients were > 50 years old. Clinical features were compared, angiographic findings and clinical outcomes were observed between the two groups. Results There were 131 and 418 patients included in the young group and the non-young group, respectively. Twenty-eight patients suffered deaths during the hospital stay and only one death occurred in the young group. Compared with non-young group, the young group was associated with male, smoke, fewer chronic diseases, Killip class I on admission, lower level of N-terminal pro B-type natriuretic peptide (NT-proBNP), higher level of triglyceride and lower level of high-density lipoprotein cholesterol (HDL-C), single-vessel lesion and intracoronary thrombus (p < 0.005). The average length of hospital stay of non-young group was 1.5 days longer than the young group. Compared with the non-young group, the young group inclined not to use or use only one stent (p = 0.026). Multivariable logistic regression analysis showed that older age, shorter hospital stay, advanced Killip class III/IV, increased white blood cell and NT-proBNP were independent risk factors for survival in acute STEMI patients during hospitalization (p < 0.005). Conclusions Compared with non-young group, the young group was associated with male, smoke, higher level of triglyceride and lower level of HDL-C. The condition of patients in young group were relatively mild and the risk of death during hospitalization was lower than the other group.

OBJECTIVES To investigate the diagnostic performance of deep learning (DL) based vascular extraction and stenosis detection technology in assessing coronary artery disease (CAD). METHODS The diagnostic performance of DL technology was evaluated by retrospective analysis of coronary computed tomography angiography (CCTA) in 124 suspected CAD patients, using invasive coronary angiography (ICA) as reference standard. Lumen diameter stenosis ≥50% was considered obstructive, and the diagnostic performances were evaluated at per-patient, per-vessel and per-segment levels. The diagnostic performances between DL model and reader model were compared by the areas under the receiver operating characteristics curves (AUCs). RESULTS In patient-based analysis, AUC of 0.78 was obtained by DL model to detect obstructive CAD [sensitivity of 94%, specificity of 63%, positive predictive value (PPV) of 94%, and negative predictive value (NPV) of 59%], While AUC by reader model was 0.74 (sensitivity of 97%, specificity of 50%, PPV of 93%, NPV of 73%). In vessel-based analysis, the AUCs of DL model and reader model were 0.87 and 0.89 respectively. In segment-based analysis, the AUCs of 0.84 and 0.89 were obtained by DL model and reader model respectively. It took 0.47 min to analyze all segments per patient by DL model, which is significantly less than reader model (29.65 min) (p < 0.001). CONCLUSIONS The DL technology can accurately and effectively identify obstructive CAD, with less time-consuming, and it could be a reliable diagnostic tool to detect CAD. ADVANCES IN KNOWLEDGE The DL technology has valuable prospect with the diagnostic ability to detect CAD.

Background: The SYNTAX score for decision makings or outcome predictions in coronary artery disease does not account for the variations in the coronary anatomy, which is a clear fallacy for patients with less typical anatomy than suggested by the SYNTAX score. The current study aimed to derive a new coronary angiographic scoring system accommodating the variability in the coronary anatomy. Methods: The 17-myocardial segment model and laws of competitive blood supply and flow conservation were utilized to derive this new scoring system. Results: We obtained 6 types of RCA dominance, 3 types of diagonal size and 3 types of left anterior descending artery (LAD) length, which together resulted in a total of 54 patterns of coronary artery circulation to account for the variability in the coronary anatomy among individuals. A Coronary Artery Tree description and Lesion EvaluaTion (CatLet) angiographic scoring system has been designed based on the above-mentioned reclassification scheme (htpp://www.catletscore.com, IE browser is required to run this calculator). Conclusions: This new CatLet angiographic scoring system accommodated the variability in the coronary anatomy and standardized the collection of the coronary angiographic data, which could facilitate the comparison and exchange of these data between different catheter labs. Its utility for predicting the clinical outcomes and standardizing the angiographic data collection will be investigated in a series of clinical trials enrolling "all-comers" with coronary artery disease (CAD).

Objective To explore the effect of remote ischemic postconditioning (RIPostC)on ischemia-reperfusion injury(IRI) in patients with ST-segment elevation myocardial infarction ( STEMI) .Methods 80 consecutive patients with STEMI were randomly to receive primary percutaneous coronary intervention (PPCI) without RIPostC (PPCI group,n=36) or PPCI plus RIPostC (PPCI+RIPostC group,n=44 ) .RIPostC consisted of 4 cycles of 5 min/5 min ischemia/reperfusion by cuff in flation/deflation of the upper limb .Protocol was started in 3 minutes after the first balloon inflation during PPCI operation .Peripheral venous blood sample in all patients were collected before PPCI op-eration and 0.5,8,24,48,72 h after PPCI operation to detect creatine kinase (CK)-MB concentration in serum.The transthoracic echocardio-graphy was performed on all patients 7 days after operation to assess left ventricular ejection fraction ( LVEF) .Results The peak CK-MB se-rum concentration in PPCI+RIPostC was significantly lower compare to that of PPCI group〔(280.60±45.83)vs (352.21±65.42) ng/ml,P<0.01〕.The median CK-MB area under the curve (AUC) over 72 h of PPCI+RIPostC group was significantly less then PPCI group〔717.25 (364.63~921.98) vs 807.00 (693.30~1136.00),P=0.02〕.LVEF assessed by transthoracic echocardiography in PPCI+RIPostC group was significantly higher compare to that of PPCI group〔(54.50±9.73)%vs (48.14±7.04)%,P=0.01〕.Conclusions RIPostC on upper limb could attenuate CK-MB release,improve the LVEF,may protect patients with STEMI from IRI .

Objective To evaluate the prevalence and prognostic implications of hypoxic liver injury(HLI)in acute ST-segment elevation myocardial infarction(STEMI).Methods Patients with STEMI who had undergone primary percutaneous coronary intervention (PCI)were enrolled from January 2013 to August 2015.Patients' medical records were reviewed and their families were interviewed via telephone to assess the outcomes.Results Of the 622 STEMI patients(aged 62(18) years,with 534 males),37 patients (5.9 ％) died during the follow-up (duration:632 (495) days).These patients were older and had higher AST 625(695)U/L vs.247(236)U/L,ALT 123(133)U/L,vs.52 (42) U/L,creatine kinase-myocardial band isoenzyme 248.5 (407.5) ng/ml vs.184.7 (197.0) ng/ml and troponin I 80.0(30.4)ng/ml vs.49.6 (61.6)ng/ml from the initial tests at the hospital.Particularly,AST and ALT independently predicted all-cause mortality.Conclusions The presence of HLI is common and predicts mortality in patients with STEMI who undergo primary PCI.

目的 对急性心肌梗死(AMI)患者行经皮冠状动脉介入术(PCI)后早期左室收缩功能保留的心力衰竭发生情况及其预测因素进行分析,以期探讨其发生的相关因素.方法 回顾2013-01 ～ 2015-04接受急诊PCI术治疗的早期左室收缩功能保留的AMI患者413例,根据冠状动脉再通后是否出现心力衰竭分为心力衰竭组和非心力衰竭组,经多因素Logistic回归分析,筛选出与其相关的危险因素,并绘制ROC曲线来判断预测效果.结果 ①AMI患者PCI术后早期左室收缩功能保留的心力衰竭与左房内径(LA)、女性比例、主干前降支梗死、近段梗死、多支病变、中性粒细胞、高敏C-反应蛋白(hs-CRP)、左室收缩末内径(LVS)、发病至血管再通时间及高血压病史呈正相关,各组比较差异有统计学意义(P＜0.05).②多因素Logistic回归分析显示,女性、主干前降支梗死、近段梗死、多支病变、中性粒细胞、hs-CRP、发病至血管再通时间及高血压病史是早期射血分数(EF)保留患者发生心力衰竭的独立预测因素.ROC曲线下面积为0.783(95％CI0.739～0.828,P＜ 0.001).结论 女性、主干前降支梗死、近段梗死、多支病变、中性粒细胞高、hs-CRP高、发病至血管再通时间长及既往高血压病史增加AMI患者急诊PCI术后早期左室收缩功能保留的心力衰竭发生的危险性.

目的 比较替格瑞洛和氯吡格雷对急性冠状动脉综合征(ACS)患者血小板聚集的影响.方法 81例ACS患者被随机分为替格瑞洛组(A组,41例)和氯吡格雷组(B组,40例),比较两组服药前和服药后1、2、4、8、24 h及治疗第7天的血小板最大聚集率(PMAR)、血小板聚集抑制率(IPA)及出血事件.结果 两组服药前PMAR水平相近(P＞0.05).A组患者服药期间的PMAR均低于B组(P＜0.01),IPA及IPA≥50％的患者比例均高于B组(P＜0.01).B组服药后2h的IPA低于服药后8 h(P＜0.01),而A组两个时间段IPA差异无统计学意义(P＞0.05).两组均只有轻微出血事件.结论 在ACS患者,替格瑞洛较氯吡格雷更能有效地抑制血小板聚集;两药短期的安全性相仿.

目的 探讨在倾斜试验基础阶段相关指标的变化是否对试验结果 有预测作用.方法 2011年7月至2013年6月行直立倾斜试验(HUTT)的335例患者,符合条件并纳入分析共272例.阴性受试者(199例)为对照组;药物激发试验阶段诊断为"血管抑制型晕厥"受试者(73例)为观察组,对其基础试验(BTTT)阶段中五个时间点的心率、收缩压、休克指数与初始卧位状态的基础值比较分析.结果 两组受试者在年龄分布、性别构成、基础心率、基础血压、基础休克指数比较差异均无统计学意义(P>0.05).观察组心率、休克指数与对照组比较差异有统计学意义(P<0.05),两组血压变化差异无统计学意义(P>0.05).结论 在BTTT阶段,若心率明显增快或休克指数明显增加则其在药物激发阶段发生阳性结果 的可能性大.

目的:比较替格瑞洛和氯吡格雷对急性ST段抬高性心肌梗死(ST-elevation myocardial infarction,STEMI)患者的临床预后、安全性、血小板最大聚集率(maximum aggregation rate,MAR)及高敏C反应蛋白(high-sensitivity C-reactive protein,hsCRP)的影响.方法:109例STEMI患者被随机分入替格瑞洛组和氯吡格雷组,替格瑞洛组给予180 mg替格瑞洛顿服、90 mg bid维持,氯吡格雷组给予600 mg氯吡格雷顿服、75 mg qd维持,两组患者均成功接受急诊冠脉介入治疗(percutaneous coronary intervention,PCI).比较两组30 d的主要心脏不良事件及出血事件的发生率.检测服药前、服药后7d及30 d的MAR和hsCRP水平.结果:服药后30 d,两组主要心脏不良事件发生率的差异无统计学意义(7.3％vs1.9％,P=0.363),两组均只发生轻微出血事件,发生率的差异无统计学意义(7.3％vs 14.8％,P=0.208).在以ADP诱导的血小板聚集率检测中,替格瑞洛组服药7d及30 d的MAR均显著低于氯吡格雷组[7d:(22.80±6.37)％vs(30.96±8.90)％,P＜ 0.001;30 d:(22.26±5.85)％vs(30.87±8.54)％,P＜ 0.001].在服药后7d和30 d,氯吡格雷组分别有6例(10.9％)和5例(9.1％)患者的血小板聚集抑制率低于30％,而替格瑞洛组无论在7d还是30 d,均无一例血小板聚集抑制率低于30％.两组患者在服药前、服药7d及服药30 d的hs-CRP水平的差异无统计学意义(P＞0.05).结论:和氯吡格雷比较,替格瑞洛可以更强地抑制血小板聚集,且两者安全性相似.但未发现替格瑞洛可显著改善STEMI患者的短期预后.

Objective To investigate the risk and relative factors for occurrence of hypotension after recanalization of IRA (infarct-related artery) during PCI (percutaneous coronary intervention) for acute myocardial infarction(AMI). Methods Clinical and PCI data of 420 patients in whom the infarct-related artery(IRA) was successfully recanalized by primary PCI for AMI in the first affiliated hospital of Soochow University from January 2011 to November 2013 were retrospectively analyzed. These patients were divided into the hypotension group and non-hypotension group. Multivariate Logistic regression model was used to investigate the relation between hypotension and these data. Results 42.4%of these 420 patients (178 patients) had got hypotension after the recanalization of IRA. After comparing all the clinical and PCI data of the two groups, we found that there were no significant differences in gender, age, percentage of hypertension、diabetes、hyperlipidemia, smoken, onset time, peak value of CK-MB, multivessel lesion. Angina pectoris before infarction, inferior wall or right ventricular infarction, right coronary artery lesion, total occlusion lesion,proxima vessel lesion and TIMI<2 after PCI in hypotension group were higher than those of non-hypotension group (P<0.05). Conclusion Inferior wall or right ventricular infarction, right coronary artery lesion, total occlusion lesion proxima vessel lesion and TIMI<2 after PCI can increase the possibility of hypotension after PCI, and angina pectoris before infarction can reduce the incidence of hypotension after PCI.

BACKGROUND:Although cardiac troponin I gives excellent accuracy in the identification of myocardial necrosis, it can also be elevated in a series of diseases other than acute coronary syndromes.CASE PRESENTATION:We present two cases of Chinese patients with a high serum troponin I level after an acute episode of paroxysmal supraventricular tachycardia with normal coronary arteries via angiography.CONCLUSION:Abnormal troponin elevations can be seen in patients presenting with paroxysmal supraventricular tachycardia and angiographically-normal coronary arteries. Caution is advised with the use of invasive assessments such as coronary angiography in the differential diagnosis of patients with paroxysmal supraventricular tachycardia and elevated troponin levels.

弥漫性巨大冠状动脉瘤样扩张在临床比较罕见。本院于2013年8月17日收治1例弥漫性巨大冠状动脉瘤样扩张并发急性下壁心肌梗死患者，报告如下。

Objective To investigate the dynamic characteristics of the pacemaker current of canine sino-atrial node cells and compare them with the wild type mHCN2 pacemaker current overexpressed in neonatal rat myocardial cells.Methods Fresh canine sino-atrial node cells were enzymatically isolated in a calcium-free solution containing collagenase and elastase,and the funny current was recorded and compared with the mHCN2 current overexpressed in cultured neonatal rat myocardial cells under the same experimental conditions.Results The canine sinus node cells were elongated,spindle-shaped or polygonal,with well-defined boundaries,and showed spontaneous beating.The elicited pacemaker current was an inward current and its rise in amplitude quickened as the hyperpolarization potential increased.At V ＝-75 mV,the canine sinus atrial node pacemaker current was (-2.1±0.3) pA/pF and had the same activation kinetics as those of the mHCN2 channel current overexpressed in neonatal rat myocardial cells [τact:(728±137) ms vs.(530±65) ms,P＞0.05].Conclusions Within the physiological range,the pacemaker current in canine sino-atrial node cells and the wild type mHCN2 pacemaker current over expressed in neonatal rat myocardial cells have similar activation kinetics.

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 changes of target lesions and delayed stent implantation after primary percutaneous coronary intervention ( PCI) in high thrombus burden patients with acute ST elevation myocardial infarction ( STEMI ) . Methods A total of 48 STEMI patients with high thrombus burden underwent primary PCI were enrolled. After treatment of percutaneous transtuminal coronary angioplasty ( PTCA) only and/or catheter aspiration of coronary thrombus, the forward blood flow in infarct-related arteries got thrombolysis in myocardial infarction ( TIMI ) flow grade 3. All patients accepted coronary angiography ( CAG) 7 days after primary PCI and the stenosis of target lesion and delayed stent implantation were evaluated. Data of target lesion changes including degree, length of stenosis, diameter of proximal and distal reference vessel were collected. Stenting proportions were compared between elderly patients (≥60 ys) and young and middle-aged patients ( ﹤60 ys). Results Compared with the data of primary PCI, the stenosis degree alleviated ( 35. 5﹪ ± 14. 1﹪ vs. 48. 8﹪ ± 11. 1﹪, P ﹤0. 01 ) , the length of stenosis shortened [(18. 94 ± 5. 37)mm vs. (15. 69 ± 5. 36)mm, P﹤0. 01], both diameters of proximal [(3. 24 ± 0.32)mmvs. (3.29±0.33) mm,P=0.02] anddistal[(3.08±0.33)mmvs. (3.18±0.33)mm,P﹤0. 01] reference vessel increased when CAG preformed 7 days later. 39. 6﹪(19/48)of the patients received delayed stenting for stenosis>50﹪ in target lesion. 56﹪ (9/16) of the elderly and 31﹪ (10/32) of the young and middle-aged patients (P=0. 04) accepted delayed stent implantation. Conclusions For young and middle-aged STEMI patients with high thrombus burden and unsuitable for primary stenting, the strategy of reperfusing infarct-related artery with primary PTCA and/or catheter aspiration of coronary thrombus, and delayed stenting when necessary is safe and effective.

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.

目的：探讨心肌淀粉样变性的临床诊疗特点以便提高该病的诊断率；

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。

目的探讨观察重组人脑利钠肽(rhBNP)治疗难治性心力衰竭的临床疗效和安全性。方法选择难治性心力衰竭患者65例,随机分为治疗组(rhBNP组,33例)及对照组(常规治疗组,32例),治疗组在常规治疗基础上加用rhBNP(1.5μg/kg静脉推注,再以0.0075~0.0μg/kg·min,静脉微泵注射72 h)。在用药前和一周后评估两组患者心功能的变化,测定血浆脑钠肽(NT-proBNP)、左室射血分数(EF)值,观察患者72 h治疗过程中利尿剂用量及血压的变化。结果 rhBNP组的心功能疗效较常规治疗组更优(P<0.05),两组血BNP均下降,rhBNP组更明显(P<0.05);与对照组相比,rhBNP组EF值改善(P<0.05),利尿剂用量更少(P<0.01)。结论与常规药物治疗相比,rhBNP能更好的改善难治性心力衰竭患者的临床症状,且无明显不良反应。