Background The Aveir leadless pacemaker employs an active fixation method, enabling real-time monitoring of electrical parameters during implantation. However, comprehensive studies regarding the electrical parameters during this procedure are rare. Objective This study aims to analyze the electrical characteristics to further guide the implantation strategy and improve device stability and safety. Methods This multi-center retrospective study enrolled 119 patients (mean age 70.18 years; 59.58% female) who received the Aveir VR leadless pacemaker from November 2024 to May 2025 across ten centers in China. Intraprocedural variations in commanded electrogram (CEGM), current of injury (COI), impedance, pacing threshold, and sensing parameters were meticulously documented. Results CEGM mapping demonstrated various morphologies (R, RS, QR, QRS, and QS) aiding localization. During fixation, 58.82% of patients exhibited an increased COI from mapping to 0.5 turns, which was associated with reduced short-term pacing thresholds. From 0.5 to 1 turn, 52.94% showed further COI increases. ROC analysis revealed that an impedance increase has predictive value for short-term pacing thresholds, with an AUC of 0.634 and a cut-off value of 230 Ω (sensitivity 0.622, specificity 0.41). Lead stability showed a moderate correlation with impedance increase (ρ=0.44, P<0.001), while the correlation with COI was weak. Conclusion During Aveir implantation, CEGM variations guide site localization. Initial COI increases (0-0.5 turns) are linked to optimal short-term thresholds. Monitoring impedance increase is vital, as a threshold of 230 Ω serves as a key indicator of device stability and fixation quality. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial Not applicable. ### Funding Statement This research was funded by a grant from the Fundamental Research Funds for the Central Universities (Grant No. #3332024039). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: All patients provided written informed consent. The present study was approved by the Ethics Committee of Fuwai hospital I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Datasets used or analyzed during the current study are available from the corresponding author on reasonable request.

BACKGROUND:International studies have shown that use of a subcutaneous implantable cardioverter defibrillator (S-ICD) could reduce lead-related complications while maintaining adequate defibrillation performance; however, data from the Chinese population or other Asian groups are limited. MATERIAL AND METHODS:SCOPE is a prospective, multicenter, observational cohort study. Two hundred patients with primary prevention indication for sudden cardiac death (SCD), who are candidates for S-ICD, will be enrolled. From the same population, another 200 patients who are candidates for transvenous implantable cardioverter defibrillator (TV-ICD) will be enrolled after being matched for age, sex, SCD high-risk etiology (ischemic cardiomyopathy, and non-ischemic cardiomyopathy, ion channel disease, and other) and atrial fibrillation in a 1: 1 ratio with enrolled S-ICD patients. All the patients will be followed for 18 months under standard of care. RESULTS:The primary endpoint is proportion of patients free from inappropriate shock (IAS) at 18 months in the S-ICD group. The lower 95% confidence bound of the proportion will be compared with a performance goal of 90.3%, which was derived from the previous meta-analysis. The comparisons between S-ICD and TV-ICD on IAS, appropriate shock, and complications will be used as secondary endpoints without formal assumptions. CONCLUSIONS:This is the first prospective multicenter study focusing on the long-term performance of S-ICD in a Chinese population. By comparing with the data derived from international historical studies and a matched TV-ICD group, data from SCOPE will allow for the assessment of S-ICD in the Chinese population in a contemporary real-world implantation level and programming techniques, which will help us to further modify the device implantation and programming protocol in this specific population in the future.

Objective To evaluate the application value of new pacing channel techniques in pacing ECG.Methods The ECG of 153 consecutive patients in the artificial pacemaker follow-up center of People’s Hospital of Peking University were collected by using MAC5 electrocardiograph with pacing channel. The accurate detection rates of pacemaker channel and doctor’s recognition of pacemaker pulse were calculated and compared, and the accuracy of automatic description of pacemaker working mode by ECG was analyzed. Results（1）The ECG of 153 patients with pacemaker, 125 patients had pacing pulse, the other 28 patients only had their own rhythm, no pacing pulse.（2）The correct detection rate of pacemaker channel to pacemaker pulse was 89.60%（112 cases）.（3）In 16 CRT patients. 93.75%（15 cases） and 37.50%（6 cases） of ECG doctors correctly identified the pacemaker pulse（P=0.004）.（4）The accuracy of pacemaker working mode automatic description was 86.4%（108 cases）. Conclusions The new technique of ECG pacing channel has shown obvious clinical advantages:（1）It is effective to identify and identify each pacemaker; In particular, CRT duet and triplet pacing Pulse.（2）Can automatically describe various working modes of pacemaker.（3）Has strong anti-interference ability and can accurately identify pacing pulse, which can greatly improve the reading and diagnosis level of pacing ECG, shorten the diagnosis time of pacing ECG. It has important clinical application value.

Objective: To explore the diagnostic value of CT angiography combined with 3-lead dynamic electrocardiogram (DCG-3) in coronary heart disease (CHD) myocardial ischemia. Method The source of the cases is a total of 82 patients with CHD myocardial ischemia admitted from February 2019 to February 2021. The selected patients undergo DCG-3 examination first, and then receive CT angiography. The detection rate of DCG-3 examination and CT angiography combined with DCG-3 examination for CHD myocardial ischemia was counted, and the diagnostic efficiency was evaluated.Result The detection rate of CT angiography combined with DCG-3 was 93.90％, which was no significant difference compared with the detection rate of DCG-3 (89.02％) (P＞0.05). The diagnostic sensitivity of CT angiography combined with DCG-3 for CHD myocardial ischemia was 96.10％, which was equivalent to 89.04％ with DCG-3 alone (P＞0.05);the specificity and accuracy of CT angiography combined with DCG-3 for CHD myocardial ischemia were 80.00％ and 95.12％, respectively. Compared with DCG-3, the detection rate was 66.67％ and 86.59％, which was significantly higher (P＜0.05).Conclusion CT angiography combined with DCG-3 has high diagnostic efficiency in CHDX myocardial ischemia, and can be promoted in clinical practice.

目的 探讨冠状动脉粥样硬化性心脏病(冠心病,CHD)经皮冠状动脉介入治疗(PCI)后患者抑郁状态的发生率及相关影响因素.方法 选取2017年7月至2017年12月于西安交通大学第一附属医院心血管内科接受PCI的438例冠心病患者为研究对象,完成基本人口社会学信息调查及疾病相关状况调查,收集相关资料并由患者本人完成中文版PHQ-9抑郁自评量表以评估患者心理状态.结果 119例(27.2％)患者存在不同程度的抑郁问题(轻度20.5％,中度5.9％,重度0.7％),其中女性患者抑郁发生率明显高于男性(35.5％vs.24.4％,P=0.019);CHD诊断分型中的不稳定型心绞痛(UAP)患者较ST段抬高型心肌梗死(STEMI)患者及非ST段抬高型心肌梗死(NSTEMI)患者抑郁发生率高(31.0％vs.17.1％vs.12.1％,P=0.006);合并短暂性脑缺血发作(TIA)/脑卒中患者较非脑卒中患者抑郁发生率高(39.6％vs.25.6％,P=0.040).术后1月抑郁状态有明显改善,术后6月抑郁状态较1个月随访时加重;急性心肌梗死(AMI)患者术后抑郁状态的改善明显低于UAP患者(9.2％vs.21.3％,P=0.015).结论 冠心病行PCI患者抑郁状态发生与性别、疾病状况有关.术后1月抑郁状态可改善,但随病程延长,抑郁状态又呈恶化趋势.CHD诊断分型中AMI患者术后抑郁状态改善较差,应关注术后远期心理状况.

目的 探讨不同细胞外钾离子浓度环境下氟卡尼对离体兔左室心肌电活动及收缩力的作用情况.方法 建立经冠状动脉灌注兔左室楔形组织块标本,施加基础刺激周长(BC L)为2000、1000、500 ms的电刺激,设立对照组:给予钾离子浓度为3.5 mmol/L的台氏液灌注;实验组:分别给予钾浓度(3.5、5.5、7.0 mmo/L)+氟卡尼浓度(10μmol/L)灌注,观察离体兔左室QRS波时限、QT间期、Tp-e间期、心肌收缩力等受影响情况.结果 氟卡尼可使QRS波时限延长(P<0.05)且该现象呈快频率依赖性(P<0.01);随K+浓度升高,氟卡尼的上述作用被明显放大甚至出现文氏脱漏现象,QT间期、Tp-e间期未受明显影响.在一定刺激频率范围内,心肌收缩力随刺激频率的增加而增强(P<0.001),即收缩力的"正阶梯效应".氟卡尼作用下心肌收缩力及正阶梯效应均减弱(P<0.001);随K+浓度的升高,氟卡尼负性肌力作用增强,正阶梯效应进一步减弱甚至被反转.结论 随细胞外K+浓度增加,氟卡尼对兔左室心肌兴奋性及传导性的阻滞、快频率依赖作用以及负性肌力作用均被放大,高钾时,心肌收缩力正阶梯效应消失甚至可能被反转.

目的 探讨直立倾斜试验(HUTT)在心脏神经官能症患者中鉴别血管迷走性晕厥(VVS)的应用价值,为临床应用提供指导.方法 回顾性分析2019年1月至12月于咸阳市中心医院行直立倾斜试验的1184例心脏神经官能症的患者资料,观察受试者直立倾斜试验阳性结果情况,分析不同性别、年龄组间结果的差异.结果 受试者中直立倾斜试验阳性583例,阳性率49.2％;其中混和型VVS 424例(72.7％),心脏抑制性VVS 8例(1.4％),血管抑制型VVS 151例(26.0％);不同性别患者间阳性率差异有统计学意义(P<0.05),不同性别阳性类型差异亦有统计学意义(P<0.05).将阳性组以65岁为界,按年龄分为两个亚组,小于65岁者阳性率高于65岁及以上者(P<0.05).结论 直立倾斜试验在心脏神经官能症患者中鉴别血管迷走性晕厥具有较好的临床价值,年轻女性患者阳性率显著增高.

目的 观察过氧化氢(H2 O2)对兔离体左室复极相关电生理指标及心律失常的影响.方法 制备经冠状动脉灌注兔左室楔形组织块标本.实验分为对照组(灌注正常台式液)和实验组(灌注正常台式液+1.0 mmol/L H2 O2).两组依次给予基础周长(BCL)为2000、1000、500 ms的刺激,持续时间依次为7、1、0.5 min,观察QT间期、T波峰值至终点的时程(Tp-e间期)、Tp-e/QT、ΔQT、ΔTp-e、ΔTp-e/QT、ΔQT％、ΔTp-e％、ΔTp-e/QT％ 的变化,及是否发生早后除极、晚后除极及室性心律失常.结果 对照组和实验组QT间期、Tp-e间期均随刺激周长的增加而延长,且实验组呈现慢频率依赖性(P<0.01).在2000 ms BCL刺激下,对照组Tp-e/QT随时间无明显变化,但实验组Tp-e/QT随H2 O2作用时间延长呈先增大后减小的变化趋势,其值始终大于对照组(3 min P<0.05,4～9 min P<0.01),而且与对照组相比实验组发生了不同程度的室性心律失常(P<0.001).结论 H2 O2对复极相关电生理指标的影响表现为慢频率依赖性;慢频率条件下,跨壁复极异质性的电生理指标呈先增大后减小的时间依赖性变化,同时也增加复极相关室性心律失常发生风险.

目的 旨在调查和分析非透析性慢性肾病(CKD)患者室性心律失常的发生率及其预测因素,为预防和治疗提供相关依据.方法 连续入选于西安交通大学第一附属医院诊治的CKD患者,并行24 h动态心电图、心脏超声及相关实验室检查,对室性心律失常进行分析.结果 84例CKD患者(男性53例)中34例(40％)发现室性心律失常,其发生与高龄、肾小球滤过率(GFR)降低、左心室质量及左心功能受损密切相关.经logistic多因素分析显示,高龄、GFR水平和左室射血分数下降是此类患者室性心律失常发生的预测因素.结论 非透析CKD患者有较高发生室性心律失常的风险,在临床治疗过程中需要密切监测并进行早期防治,以最大程度地降低其发生率.

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in chronic kidney disease (CKD) patients. QT interval prolongation is a congenital or acquired condition that is associated with an increased risk of torsade de pointes (TdP), sudden cardiac death (SCD), and all-cause mortality in the general population. The prevalence of acquired long QT syndrome (aLQTS) is high, and various acquired conditions contribute to the prolonged QT interval in patients with CKD. More notably, the prolonged QT interval in CKD is an independent risk factor for SCD and all-cause mortality. In this review, we focus on the epidemiological characteristics, risk factors, underlying mechanisms and treatments of aLQTS in CKD, promoting the management of aLQTS in CKD patients.

目的 探讨急性心肌梗死患者心电图有无碎裂QRS波在急诊PCI术后住院期间的预后区别.方法 回顾性分析2017年4月至2018年6月我院收治的AMI并行急诊PCI术的218例患者的临床资料,根据是否存在碎裂QRS(fQRS)波分为有碎裂QRS波组(129例)及无碎裂QRS波组(89例).分析有碎裂QRS波组患者fQRS导联出现的位置.对比两组患者入院72 h的相关临床指标,住院天数、病变数目及支架数量,住院期间不良事件发生情况.结果 有碎裂QRS波组患者fQRS波出现在Ⅱ、Ⅲ、avF导联占89.15％,其余为Ⅲ、avF导联(13.95％),Ⅰ、avF导联(27.13％),V4～V6导联(45.56％).有碎裂QRS波组的BS,TG,BNP,TnT,CK峰值,CKMB峰值明显高于无碎裂QRS波组,差异具有统计学意义(P<0.05),两组的LDL相比,差异无统计学意义(P>0.05).有碎裂QRS波组患者的住院天数与支架数量明显高于无碎裂QRS波组,差异对比显著(P<0.05),但两组患者的单支病变,双支病变,三支病变数目对比差异无显著(P>0.05).有碎裂QRS波组恶性心律失常发生例数明显高于无碎裂QRS波组(P<0.05),而两组的脑血管意外、心源性休克、低血压、心源性猝死发生情况对比无差异(P>0.05).结论 碎裂QRS波作为一种无创心电指标,对患者预后的改善具有重要意义,也可为治疗策略的选择提供参考.

目的 嗜酸性粒细胞增多综合征可以累及几乎全身所有组织器官,心脏是最常受累的器官,也是引起患者死亡的最重要原因.本研究通过总结嗜酸性粒细胞增多综合征患者心脏损害的临床及超声表现,为早期发现、正确诊断以便及时治疗提供准确可行的手段.方法 回顾性分析西安交通大学第一附属医院心内科2004年至2014年诊断的5例嗜酸性粒细胞增多综合征患者的临床及超声心动图表现,探寻其共性及特异性表现.结果 5例患者中有4例为特发性嗜酸性粒细胞增多综合征,另1例为寄生虫感染后的继发性嗜酸性粒细胞增多综合征.超声心动图表现为心房扩大5例,其中4例为双房扩大,2例同时伴有心室扩大;5例患者均出现心内膜增厚伴血栓形成,4例为双心腔心尖部血栓,1例血栓仅出现于左室心尖部.超声心动图同时观察到瓣膜、心包的变化,均可能是本病特征性超声表现.结论 嗜酸性粒细胞增多综合征所致心脏损害是该病患者死亡的主要原因,超声心动图可以准确发现这些特征性改变,为临床早期发现以便及时、正确治疗提供帮助.

Using ECG-gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), we sought to develop and validate a new method to recommend left ventricular (LV) lead positions in order to improve volumetric response and long-term prognosis after cardiac resynchronization therapy (CRT). Seventy-nine patients received gated SPECT MPI at baseline, and echocardiography at baseline and follow-up. The volumetric response referred to a reduction of ≥ 15% in LV end-systolic volume 6 months after CRT. After excluding apical, septal, and scarred segments, there were three levels of recommended segments: (1) the optimal recommendation: the latest contracting viable segment; (2) the 2nd recommendation: the late contracting viable segments whose contraction delays were within 10° of the optimal recommendation; and (3) the 3rd recommendation: the viable segments adjacent to the optimal recommendation when there was no late contracting viable segment. After excluding 11 patients whose LV lead was placed in apical or scarred segments, 75.6% of the patients concordant to recommended LV segments (n = 41) responded to CRT while 51.9% of those with non-recommended LV lead locations (n = 27) were responders (P = .043). Response rates were 76.9%, 76.9% , and 73.3% (P = .967), respectively, when LV lead was implanted in the optimal recommendation (n = 13), the 2nd recommendation (n = 13), and the 3rd recommendation (n = 15). LV leads placed at recommended segments reduced composite events of all-cause mortality or heart failure (HF) rehospitalization compared with pacing at non-recommended segments (log-rank χ2 = 5.623, P = .018). Pacing in the recommended LV lead segments identified on gated SPECT MPI was associated with improved volumetric response to CRT and long-term prognosis.

目的 探讨巴尼地平,氨氯地平和缬沙坦在它们各自血浆游离治疗浓度下对急性心肌缺血与再灌注心律失常发生的作用.方法 用兔左心室冠状动脉灌流楔形标本作为急性心肌缺血与再灌注的模型,记录跨壁心电图和心肌收缩力.并对心肌缺血后再灌注静脉流出液的乳酸浓度进行测量.在进行急性心肌缺血30 min之前,给兔左心室冠状动脉灌流楔形的灌流液中分别加入巴尼地平、氨氯地平和缬沙坦.总缺血时间为40 min,然后再灌注10 min.巴尼地平、氨氯地平和缬沙坦的作用与同一时间匹配的对照组相比.结果 巴尼地平(0.2 nmol/L)、氨氯地平(1.5 nmol/L)和缬沙坦(2μmol/L)对正常灌流兔左心室楔形标本QRS间期,QT间期以及频率依赖性心肌收缩力正阶梯效应无显著影响.巴尼地平组,急性心肌缺血与再灌注的室性早搏,室性心动过速(VT)或心室颤动发生率显著减少.心肌缺血与再灌注时,巴尼地平组的7个标本0例(0/7)发生了VT或心室颤动;对照组10个标本在心肌缺血时5个标本(5/10)以及在再灌注时7个标本(7/10)发生了VT或心室颤动(P＜0.01).巴尼地平减小室性早搏、VT或心室颤动的趋势比氨氯地平和缬沙坦更为明显.巴尼地平也显著减少急性心肌缺血后再灌注乳酸的释放.结论 与氨氯地平和缬沙坦相比,巴尼地平对缺血与再灌注心肌有更加显著的保护作用,其结果减少急性心肌缺血与再灌注心律失常的发生.

compare the predictive value of glomerular filtration rate (eGFR) levels calculated by the two formulas for all-cause mortality in patients with chronic total occlusive disease (CTO) undergoing percutaneous coronary intervention (PCI). Methods 671 patients with CTO who underwent PCI from June 2013 to October 2017. Preoperative baseline eGFR was calculated using the Chinese modified modification of diet in renal disease (cMDRD) equation and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, and patients were grouped (group A eGFR≥90 ml/min·1.73 m2; Group B 90ml/min·1.73 m2＞eGFR≥60 ml/min·1.73 m2; Group C eGFR＜60 ml/min·1.73 m2). Follow-up was conducted by telephone questionnaire, etc. The main study endpoint was all-cause death. The Cox regression risk model was used to estimate the risk ratio of eGFR, including eGFR univariate analysis and multiple-correction model analysis (corrected age, gender, smoking, body mass index, diabetes, low-density lipoprotein and other common risk factors for coronary heart disease). Results Of the 671 CTO patients who underwent PCI, 471 (70.2%) were successful, 200 (29.8%) failed, and 64 (9.5%) died. Univariate analysis of eGFR-cys showed that the difference in HR values between the three groups was statistically significant; the trend test was P<0.001, and the difference was statistically significant. eGFR-cys as a continuous variable (per 10 ml/min·1.73 m2) had HR=0.810, 95%CI: 0.374~0.894, P＜0.01. In combination with the trend test, there was a linear relationship between eGFR-cys level and all-cause mortality risk. For every 10 ml/min·1.73 m2 of eGFR, the risk of all-cause mortality decreased by 19%. The difference was statistically significant (P＜0.05), after the model correction, the above differences are still statistically significant. The difference in HR and trend test between the three groups was statistically significant by eGFR-cMDRD single factor analysis, but the difference was not statistically significant after model correction. Conclusions In patients with CTO undergoing PCI, eGFR-cys may be a stronger predictor of all-cause mortality than eGFR-cMDRD.

Timothy syndrome is a rare disorder caused by CACNA1C gene mutations and characterized by multi-organ system dysfunctions, including ventricular arrhythmias, syndactyly, dysmorphic facial features, intermittent hypoglycemia, immunodeficiency, developmental delay, and autism. Because of the low morbidity and high mortality at a young age, it remains a huge challenge to establish a diagnosis and treatment system to manage Timothy syndrome patients. Here, we aim to provide a detailed review of Timothy syndrome, discuss the mechanisms underlying dysfunctional Cav1.2 due to CACNA1C mutations, and provide some new emerging evidences in treating Timothy syndrome from cell to bedside, promoting the management of this rare disease. Impact statement The knowledge of Timothy syndrome (TS) caused by dysfunctional Cav1.2 channel due to CACNA1C mutations is rapidly evolving as novel technologies of electrophysiology are introduced and our understanding of the mechanisms of TS develops. In this review, we focus on the TS-related dysfunctional Cav1.2 and the underlying mechanisms. We update TS-related CACNA1C mutations in a precise way over the past 20 years and summarize all reported TS patients based on their clinical presentations and molecular mechanisms, respectively. We hope this review will provide a new comprehensive way to better understand the electrophysiological mechanisms underlying TS from cell to bedside, promoting the management of TS in practice.

The placement of left ventricular (LV) pacing lead at the latest activation sites with viable myocardium confers better cardiac resynchronization therapy (CRT) response ([1–3][1]). However, placing LV lead at the appropriate site remains a challenge for achieving an adequate CRT response. This

Background Cardiac resynchronization therapy(CRT)is an effective treatment for chronic heart failure patients.However,approximately 30% of recipients exhibit no response to CRT and the position of left ventricular(LV)lead is thought to be an important factor associated with no response. Majority of the related studies indicated that implantation of LV leads at the sites of the latest activation and away from scar can significantly improve the response to CRT. Single photon emission computed tomography (SPECT)myocardial perfusion imaging(MPI)phase analysis(PA)is a novel method to assess LV mechanical dyssynchrony,the site of the latest activation and scar burden to recommend the suitable position for LV lead. Therefore,randomized,controlled trials using SPECT to guide LV lead implantation to improve CRT response is needed. Rationale GUIDE-CRT study applies pre-operation SPECT MPI AP to evaluate LV mechanical dyssynchrony and distribution of scar and identify the site of the latest activation segment away from scar as optimal pacing site. The feasibility and effectiveness of SPECT MPI PA in guiding LV lead implantation to improve CRT response will be verified. Design Patients with standard CRT indications will be enrolled in 19 centers in China and randomized to two groups(Guided vs.Control). All the patients will undergo baseline echocardiographic assessment,and SPECT imaging to identify the optimal LV lead positions from 13 LV segments. In the Guided group,the implanters will receive SPECT imaging guidance and attempt to place the LV leads to the target positions define as the LV lead is at or close to the latest activation segment away from scar. In the Control group,the patients will undergo routine LV lead implantation. All patients receive 6-month follow-up echocardiographic assessment to evaluate CRT response. The primary endpoint is reduction of LV end-systolic volume(LVESV). The secondary endpoints include reduction of LV end-diastolic volume, changes of LV ejection fraction,and CRT response rate defined as a relative decrease of LVESV by ≥ 15% from baseline to 6-month follow-up. Conclusion SPECT guided LV lead implantation will obviously improve CRT efficacy.

Objective:To investigate the relationship between thyroid functions and platelet test results among acute myocardial infarction patients who received percutaneous coronary intervention therapy.Methods:A total of 122 patients between Dec 2014 and Feb 2016 hospitalized in our hospital of were enrolled in this study and divided into unstable angina (UA) and acute myocardiac infarction (AMI) groups with 45 cases and 77 cases,respectively.The basic clinical indicators were analyzed,HbA1c,blood glucose,LDL-c,HDL-c,TG,LPA,CREA,UA,hsCRP,BNP,CKMB,cTNI,and D-Dimer between the two groups were also compared.Cardiac function was evaluated by EF (％).Quartile group were adopted based on serum FT3 (nmol/L) levels.Test results of platelet such as PLT,MPV,PDW,and P-LCR,hsCRP,D-Dimer among the different FT3 groups were then compared and the relationship of MPV and FT3 in the AMI group were also analyzed.Results:The levels of hsCRP and BNP,CKMB,cTNI,and D-Dimer between UA and AMI groups had a significantly statistical difference(P＜0.01).There were also significant differen in FT3 and FT4 levels(P＜0.01),while TSH,TT3 and TT4 didn't show any statistical differences between these two groups (P＞0.05).In the FT3 quartile groups,the lower of the FT3,the higher of MPV,hsCRP and D-Dimer.Conclusion:FT3 might be negatively related with MPV,hsCRP and D-Dimer,Low FT3 may predict the clinical risks of AMI.

Objective To explore the effectiveness of clinical pathway and team-based learning in the cardiovascular department during resident training.Methods 40 internal medicine residents in First Affiliated Hospital of Xi'an Jiaotong University were applied with two different teaching methods.clinical pathway and team-based learning were used in the intervention group,while the traditional teaching method was applied in the control group.Data were collected by means of a questionnaire and a clinical test.Results Compared with the control group,the intervention group did better in paper test on theories and clinical skills test (t =4.485,P ＜ 0.05).The questionnaire results showed that the intervention group had a strong initiative and independent learning ability,and mastered well of the clinical skills.Conclusions The integrated application of CP and TBL method can be a valuable strategy.