Dilated cardiomyopathy (DCM) is a primary myocardial disorder characterized by progressive ventricular dilatation and impaired myocardial systolic contractility, and it represents the most common form of cardiomyopathy globally. DCM drives a substantial worldwide disease burden, thus presenting a formidable and persistent challenge to global public health systems. The pathogenesis of DCM is marked by extreme etiological heterogeneity: 30%-50% of cases have a familial origin, with genetic determinants serving as the core driver of disease onset and progression. With the rapid advancement and widespread application of next-generation sequencing (NGS) technologies, a growing repertoire of DCM-causative genes has been successfully identified. These genes encode key functional proteins that regulate multiple core physiological processes in cardiomyocytes, including sarcomeric structure maintenance, intracellular signal transduction, and myocardial energy homeostasis. DCM-causing genes can be classified into multiple categories according to their functions. Sarcomeric protein genes (such as TTN, MYH7, and TNNT2) disrupt sarcomere assembly and contractile function through mechanisms such as haploinsufficiency and the toxic peptide hypothesis; mutations in nuclear membrane protein genes (such as LMNA and EMD) cause abnormal nuclear structure and disordered mechanotransduction signals; ion channel genes (such as SCN5A, CACNA1C, and RYR2) affect electrophysiological balance and calcium handling; desmosome-related genes (such as DSC2 and DSP) are associated with abnormal cell junctions and dysregulation of the Wnt/β-catenin pathway; KLF13, ETS1, and BMP10 are possible candidate genes for DCM with limited research; loss of function of RBM20 leads to abnormal splicing of TTN, CamkIIδ, RyR2, etc. and causes nuclear import defects as well as cytoplasmic RBM20-RNP granule toxicity, thereby driving ventricular dilation. These genes drive myocardial remodeling through common signaling pathways (such as ERK and TGF-β). Potential treatment strategies include gene-level interventions, targeted pathway inhibitors, and myosin activators. However, genetic heterogeneity results in a narrow applicable population for single-gene therapies. Future research needs to shift from targeting individual genes to improving the common pathological environment to achieve broad-spectrum treatment. Exploring upstream prevention of mutations or activation of endogenous repair mechanisms provides new directions for the treatment of DCM.

BackgroundAmong patients with stable coronary artery disease (SCAD), those with moderate coronary artery stenosis remain at high risk for adverse cardiovascular events despite optimal medical therapy. Reducing residual cardiovascular risk, particularly inflammation-related risk, is a key target for improving long-term outcomes. Evaluation of plaque burden and hemodynamics in patients with SCAD based on coronary computed tomography angiography (CCTA)-derived techniques, along with risk stratification and prediction, has become a hotspot, holding significant importance for standardizing clinical management of SCAD. Shenqi Yangxin Formula (SYF), a traditional Chinese medicine compound, has been widely used in China for SCAD and shown to alleviate symptoms, but its mechanistic benefits remain unclear. Based on this, we proposed that SYF could benefit patients with SCAD (qi deficiency and blood stasis syndrome) by reducing residual cardiovascular risk and improving coronary hemodynamics. This clinical trial was designed to objectively evaluate the efficacy and safety of SYF in SCAD.MethodsThis is a randomized, double-blind, placebo-controlled trial, enrolling 60 SCAD patients meeting criteria for qi deficiency and blood stasis syndrome. Participants are randomized 1:1 to receive SYF or placebo in addition to guideline-directed medical therapy for 12 weeks at a loading dose, followed by 12 weeks at half dose.ResultsAs of July 2024, enrollment is complete, with trial completion expected in the first quarter of 2026. The primary outcomes are changes in CCTA-derived coronary hemodynamic parameters (CT-derived fractional flow reserve, wall shear stress) and fat attenuation index at 24 weeks. Secondary outcomes include imaging characteristics of plaques, traditional chinese medicine syndrome scores, seattle angina questionnaire scores, echocardiography, adverse cardiovascular events, and metabolomic profiles. Participants undergo follow-up at 4, 12 and 24 weeks post-randomization. All data will be collected in case report forms and analyzed according to predefined statistical plans.ConclusionThis study will provide novel evidence on the efficacy and safety of SYF in improving coronary hemodynamics and reducing residual inflammatory risk in patients with SCAD and moderate stenosis, potentially offering a complementary therapeutic strategy.Clinical Trial Registrationhttp://123.57.9.4:8085/zh-CN/Home/ProjectView?pid=dbc777bb-434e-44a4-af75-cfabc32d64db, identifier ITMCTR2024000215.

Heart Failure represents the severe stage of various heart diseases. Its global morbidity and mortality are on the rise, making it a serious public health issue that imposes a heavy burden on patients’ families and society. Currently, there are relatively few systematic studies on the changes in specific metabolites and pathways in different stages of heart failure, such as Stage A, Stage B and Stage C. Using untargeted-targeted metabolomics to explore the metabolic characteristics of Heart Failure, and screen out serum metabolic markers with potential diagnostic and prognostic value. This study is a cross-sectional study. A total of 210 heart failure patients from Xiyuan Hospital of China Academy of Chinese Medical Sciences were enrolled between October 2023 and October 2024. Among them, 60 patients were selected for targeted metabolomics analysis via stratified sampling. Serum samples of the patients were collected and pretreated with methanol, then metabolites were detected using untargeted and targeted LC-MS respectively. After the raw data were processed with MSDIAL, pattern recognition was performed using principal component analysis (PCA) and partial least squares discriminant analysis (PLS-DA). Differential metabolites with variable importance in projection (VIP) > 1 and P < 0.05 were screened, and relevant pathways were analyzed via enrichment analysis using the Kyoto Encyclopedia of Genes and Genomes (KEGG) database. Untargeted metabolomics revealed that, compared with patients in Stages A and B, those with heart failure in Stage C had decreased serum levels of alanine, creatine, and branched-chain amino acids, along with increased levels of citric acid, fumaric acid, and malic acid. The differential metabolites were primarily enriched in pathways including the citric acid cycle, central carbon metabolism, and amino acid metabolism, indicating that energy metabolism plays a crucial role in the occurrence and progression of HF. Targeted metabolomics validated the findings from untargeted metabolomics: compared with Stage A, the level of phosphoenolpyruvate in Stage B was reduced; and in comparison with patients in Stage A or B, patients in Stage C showed decreased serum levels of multiple energy metabolites (e.g., glucose-6-phosphate, fructose-6-phosphate, 3-phosphoglyceric acid, AMP, ADP and ATP) as well as increased levels of malic acid, which is consistent with the characteristics of the “hypermetabolism-energy starvation” paradox. Stage C of heart failure is characterized by energy metabolism collapse (decreased ATP and TCA compensation), and differential metabolites (such as malic acid) may serve as potential candidate biomarkers pending longitudinal validation.

BACKGROUND:Ischaemic heart disease (IHD) is a major cause of heart failure (HF), a condition expected to increasingly affect global health and economics. This study evaluates the global burden, trends, and disparities of HF linked to IHD, aiming to inform health policy development. METHODS AND RESULTS:Data from the Global Burden of Disease Study 2021 (GBD2021) are analysed using joinpoint regression, decomposition analysis, and Bayesian age-period-cohort analysis (BAPC). Health disparities are assessed through the Socio-demographic Index (SDI) via the Slope Index of Inequality and the Concentration Index, with future trends projected from 2022 to 2045. In 2021, global HF cases due to IHD were over 19.16 million, with an age-standardized prevalence rate (ASPR) of 228.31 per 100 000 [95% Uncertainty Interval (UI), 188.18-279.55] and age-standardized years lived with disability (ASYLDs) rate of 20.43 per 100 000 [95% UI, 13.55-28.7]. In 2021, there was a 2.87% increase in ASPR and ASYLDs compared with 1990, primarily driven by population growth and aging. Significant reductions in global ASPR and ASYLDs disparities are observed, though the disease burden has intensified in countries with lower SDI levels. Projections indicate that by 2045, while the prevalence and years lived with disability for HF caused by IHD will increase, the ASPR and ASYLDs are expected to decrease. CONCLUSION:The global burden of HF due to IHD remains a significant concern. Urgent improvements in the allocation of medical resources and the implementation of effective prevention and management strategies are necessary to address this issue.

Diabetic cardiomyopathy (DCM), a main cardiovascular complication of diabetes mellitus, can eventually develop into heart failure and seriously affect the prognosis of diabetic patients. Myocardial fibrosis (MF) is the main factor causing ventricular wall stiffness and heart failure in DCM. Early control of MF in DCM is of great significance to prevent or postpone the progression of DCM to heart failure. In this review, we systematically analyzed the relevant studies on diabetic MF in recent years, explored the formation mechanism of MF in the pathological process of DCM, and summarized and analyzed in detail the current studies with antifibrotic treatment for DCM, so as to provide guidance for the development of prevention and treatment strategies for MF in DCM.

Cardiovascular diseases (CVDs) are currently the leading cause of death worldwide. In 2022, the CVDs contributed to 19.8 million deaths globally, accounting for one-third of all global deaths. With an aging population and changing lifestyles, CVDs pose a major threat to human health. Mitochondria-associated endoplasmic reticulum membranes (MAMs) are communication platforms between cellular organelles and regulate cellular physiological functions, including apoptosis, autophagy, and programmed necrosis. Further research has shown that MAMs play a critical role in the pathogenesis of CVDs, including myocardial ischemia and reperfusion injury, heart failure, pulmonary hypertension, and coronary atherosclerosis. This suggests that MAMs could be an important therapeutic target for managing CVDs. The goal of this study is to summarize the protein complex of MAMs, discuss its role in the pathological mechanisms of CVDs in terms of its functions such as Ca2+ transport, apoptotic signaling, and lipid metabolism, and suggest the possibility of MAMs as a potential therapeutic approach.

To evaluate the effectiveness and safety of Qishen Yiqi Dripping Pill (QSYQ) in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI). This multicentre prospective cohort study was conducted at 40 centers in China. Patients with ACS after PCI entered either the QSYQ or Western medicine (WM) groups naturally based on whether they had received QSYQ before enrollment. QSYQ group received QSYQ (0.52 g, 3 times a day for 12 months) in addition to WM. The primary endpoint included cardiac death, non-fatal myocardial infarction, and urgent revascularization. The secondary endpoint included rehospitalization due to ACS, heart failure, stroke, and other thrombotic events. Quality of life was assessed by the Seattle Angina Questionnaire (SAQ). A total of 936 patients completed follow-up of the primary endpoint from February 2012 to December 2018. Overall, 487 patients received QSYQ and WM. During a median follow-up of 566 days (inter quartile range, IQR, 517–602), the primary endpoint occurred in 46 (9.45

BackgroundDanlou tablets (DLTs) have been widely used to treat coronary heart disease in China. However, the benefits associated with DLT for patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) in routine practice require further investigation.PurposeTo investigate the effectiveness of DLT in patients with ACS undergoing PCI.MethodsThis multicenter prospective cohort study for patients with ACS undergoing PCI was conducted in 40 centers in mainland China from February 2012 to December 2018. This trial is registered under ChiCTR-OOC-14005552. Patients were assigned to either the DLT group or the conventional medicine (CM) group based on whether they used DLT prior to enrollment. The duration of DLT use (1.5 g, three times a day) was 12 months. The primary endpoint comprised of cardiac death, non-fatal myocardial infarction, and urgent revascularization. Secondary endpoint included rehospitalization owing to ACS, heart failure, stroke, and other thrombotic events. The Seattle Angina Questionnaire (SAQ) was used to assess quality of life (QOL). Primary and secondary endpoints were followed up for 36 months, and the SAQ was followed up for 12 months. The Cox proportional hazards regression model was used to analyze the independent effect of DLT on primary and secondary endpoints. Propensity score matching (PSM) analyses were performed to mitigate bias. Survival estimation was performed using Kaplan–Meier survival curves and log-rank tests in the PSM cohort, and landmark analyses were used for further evaluation of primary and secondary endpoints. Subgroup analyses and interactions confirmed the robustness of the findings. Linear mixed effects models were used to assess the QOL.ResultsOverall, 936 patients were enrolled in this cohort study, of whom 875 completed follow-up. The primary and secondary endpoints had no significantly difference between the DLT and CM groups after Cox proportional hazards models. Kaplan–Meier survival curves and log-rank tests performed in the PSM cohort also found no significant differences between the two groups on primary and secondary endpoints. However, landmark analysis showed significant benefit in the primary endpoint for the DLT group after 200 days (hazard ratio [HR] 0.46, 95% confidence interval [CI] 0.22–0.93, P = 0.03). Landmark analysis also showed a significant benefit in the secondary endpoint in the DLT group within 200 days (HR 0.33, 95% CI 0.15–0.73, P = 0.006). Moreover, DLT improves the SAQ summary score, and scores in the physical limitation, treatment satisfaction, and disease perception domains for patients with ACS undergoing PCI.ConclusionsDLT combined with conventional treatment reduced the risk of the primary endpoint after 200 days and the secondary endpoint within 200 days during the 3-year follow-up. Additionally, DLT can improve the QOL without adverse effects.

ObjectiveTo investigate the causal relationship between 233 newly reported metabolites and coronary atherosclerosis through Mendelian randomization analysis.MethodsFive different methods were used to perform Mendelian randomization analysis on the 233 metabolites and coronary atherosclerosis, with inverse variance weighting as the primary result, supplemented by other methods.ResultsThe analysis identified that certain metabolites increase the susceptibility risk of coronary atherosclerosis, including: Total fatty acids (OR = 1.40, 95% CI: 1.28–1.53, P < 0.001), Saturated fatty acids (OR = 1.44, 95% CI: 1.30–1.60, P < 0.001), Serum total triglyceride levels (OR = 1.33, 95% CI: 1.22–1.46, P < 0.001), Conjugated linoleic acid (OR = 1.16, 95% CI: 1.04–1.30, P = 0.007). Conversely, certain metabolites were found to reduce the occurrence of coronary atherosclerosis, such as: Cholesteryl esters to total lipids ratio in medium HDL (OR = 0.73, 95% CI: 0.67–0.78, P < 0.001), Cholesteryl esters to total lipids ratio in large HDL (OR = 0.64, 95% CI: 0.58–0.71, P < 0.001), Total cholesterol to total lipids ratio in medium HDL (OR = 0.71, 95% CI: 0.65–0.77, P < 0.001).ConclusionThere is a close relationship between metabolites and the occurrence of coronary atherosclerosis. This study conducted Mendelian randomization analysis on the causal relationship between 233 metabolites and coronary atherosclerosis, providing potential new insights for the treatment of this disease.

Introduction: Current treatments for coronary microvascular disease (CMVD) have limited efficacy. Kuanxiong Aerosol (KXA), a representative preparation used for aromatic and warming-up management, is a typical Chinese proprietary medicine that relieves the symptoms of angina pectoris and contributes to improving coronary microcirculation disorders, which may provide an option for the treatment of CMVD. Methods: This is a prospective, multicenter, randomized, double-blind, placebo-controlled clinical trial. A total of 120 eligible patients will be randomized 1:1 to KXA or placebo groups and receive 30-day interventions and follow-up. The primary outcome will be the Seattle Angina Scale score. Secondary outcomes will be the TCM (traditional Chinese medicine) syndrome score, self-rated anxiety scale score, self-rated depression scale, microcirculation function, and laboratory index for coronary microvascular. Discussion: This trial will evaluate the clinical efficacy and safety of KXA in the treatment of CMVD. The results of this study may provide clinical evidence for the use of Chinese patent medicine in CMVD. Trial registration: Chinese Clinical Trial Registry ChiCTR2200057494

Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are closely related in clinical practice. This study aimed to investigate the co-genetic characteristics and potential molecular mechanisms of HF and COPD. HF and COPD datasets were downloaded from gene expression omnibus database. After identifying common differentially expressed genes (DEGs), the functional analysis highlighted the critical role of extracellular matrix and ribosomal signaling pathways in both diseases. In addition, GeneMANIA's results suggested that the 2 diseases were related to immune infiltration, and CIBERSORT suggested the role of macrophages. We also discovered 4 TFs and 1408 miRNAs linked to both diseases, and salbutamol may positively affect them.

Heart failure (HF) represents a group of complex clinical syndromes with high morbidity and mortality and has a significant global health burden. Inflammation and metabolic disorders are closely related to the development of HF, which are complex and depend on the severity and type of HF and common metabolic comorbidities such as obesity and diabetes. An increasing body of evidence indicates the importance of short-chain fatty acids (SCFAs) in regulating cardiac function. In addition, SCFAs represent a unique class of metabolites and play a distinct role in shaping systemic immunity and metabolism. In this review, we reveal the role of SCFAs as a link between metabolism and immunity, which regulate cardiac and systemic immune and metabolic systems by acting as energy substrates, inhibiting the expression of histone deacetylase (HDAC) regulated genes and activating G protein-coupled receptors (GPCRs) signaling. Ultimately cardiac efficiency is improved, cardiac inflammation alleviated and cardiac function in failing hearts enhanced. In conclusion, SCFAs represent a new therapeutic approach for HF.

Heart failure (HF) is one of the main public health problems at present. Although some breakthroughs have been made in the treatment of HF, the mortality rate remains very high. However, we should also pay attention to improving the quality of life of patients with HF. Traditional Chinese medicine (TCM) has a long history of being used to treat HF. To demonstrate the clinical effects and mechanisms of TCM, we searched published clinical trial studies and basic studies. The search results showed that adjuvant therapy with TCM might benefit patients with HF, and its mechanism may be related to microvascular circulation, myocardial energy metabolism, oxidative stress, and inflammation.

AbstractAimsHeart failure with preserved ejection fraction (HFpEF) and non‐alcoholic fatty liver disease (NAFLD) are related conditions with an increasing incidence. The mechanism of their relationship remains undefined. Here, we aimed to explore the potential mechanisms, diagnostic markers, and therapeutic options for HFpEF and NAFLD.Methods and resultsHFpEF and NAFLD datasets were downloaded from the Gene Expression Omnibus (GEO) database. Common differentially expressed genes (DEGs) were screened for functional annotation. A protein–protein interaction network was constructed based on the STRING database, and hub genes were analysed using GeneMANIA annotation. ImmuCellAI (Immune Cell Abundance Identifier) was employed for analysis of immune infiltration. We also used validation datasets to validate the expression levels of hub genes and the correlation of immune cells. To screen for diagnostic biomarkers, we employed the least absolute shrinkage and selection operator and support vector machine‐recursive feature elimination. Drug signature database was used to predict potential therapeutic drugs. Our analyses identified a total of 33 DEGs. Inflammation and immune infiltration played important roles in the development of both diseases. The data showed a close relationship between chemokine signalling pathway, cytokine–cytokine receptor interaction, calcium signalling pathway, neuroactive ligand–receptor interaction, osteoclast differentiation, and cyclic guanosine monophosphate‐protein kinase G signalling pathway. We demonstrated that PRF1 (perforin 1) and IL2RB (interleukin‐2 receptor subunit beta) proteins were perturbed by the diseases and may be the hub genes. The analysis showed that miR‐375 may be a potential diagnostic marker for both diseases. Our drug prediction analysis showed that bosentan, eldecalcitol, ramipril, and probucol could be potential therapeutic options for the diseases.ConclusionsOur findings revealed common pathogenesis, diagnostic markers, and therapeutic agents for HFpEF and NAFLD. There is need for further experimental studies to validate our findings.

OBJECTIVE:To assess the efficacy and safety of Guanxin Danshen Dripping Pills (GXDS) in the treatment of depression or anxiety in patients with coronary heart disease (CHD) after percutaneous coronary intervention (PCI).METHODS:From September 2017 to June 2019, 200 CHD patients after PCI with depression and anxiety were included and randomly divided into GXDS (100 cases) and placebo control groups (100 cases) by block randomization and a random number table. Patients in the GXDS and control groups were given GXDS and placebo, respectively, 0.4 g each time, 3 times daily for 12 weeks. The primary outcomes were scores of Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Scale (GAD-7) and the Seattle Angina Pectoris Scale (SAQ). The secondary outcomes included 12 Health Survey Summary Form (SF-12) scores and the first onset time and incidence of major adverse cardiovascular events (MACEs). Other indices including blood pressure, blood lipids, microcirculation and inflammatory-related indices, etc. were monitored at baseline, week 4, and week 12.RESULTS:In the full analysis set (200 cases), after treatment, the PHQ-9 and GAD-7 scores in the GXDS group were considerably lower than those in the control group (P<0.05). Compared with the baseline, the total PHQ-9 scores of the experimental and control groups decreased by 3.97 and 1.18, respectively. The corrected mean difference between the two groups was -2.78 (95% CI: -3.47, -2.10; P<0.001). The total GAD-7 score in the GXDS group decreased by 3.48% compared with the baseline level, while that of the placebo group decreased by 1.13%. The corrected mean difference between the two groups was -2.35 (95% CI: -2.95, -1.76; P<0.001). The degree of improvement in SAQ score, SF-12 score, endothelin and high-sensitive C-reactive protein levels in the GXDS group were substantially superior than those in the placebo group, and the differences between the two groups were statistically significant (P<0.05). Similar results were obtained in the per protocol population analysis of 177 patients. Three cases of MACES were reported in this study (1 in the GXDS group and 2 in the placebo group), and no serious adverse events occurred.CONCLUSIONS:GXDS can significantly alleviate depression and anxiety, relieve symptoms of angina, and improve quality of life in patients with CHD after PCI. (Registration No. ChiCTR1800014291).

PurposeSalvia miltiorrhiza Bge. (Danshen, DS) and Ligusticum chuanxiong Hort. (Chuanxiong, CX) have been widely used in traditional Chinese medicine to prevent and treat myocardial ischemia and renal insufficiency, and their extracts (Guanxinning injection, GXN) have been reported to exhibit antioxidant, anti-inflammatory, and anti-ischemia-reperfusion injury properties. It is well-established that ischemic postconditioning (IPOC) can protect against myocardial ischemia-reperfusion (I/R) injury in rats with chronic renal failure (CRF). However, little is known on whether GXN combined with IPOC may affect myocardial I/R injury in CRF rats. We sought to observe the effect of GXN combined with IPOC on myocardial I/R injury in CRF rats by quantifying changes in the expression of proteins related to mitochondrial dynamics. Materials and MethodsIn a survey, 90 Wistar rats were randomly divided into 6 groups (15 rats per group): CRF group, I/R group, comorbid group (CRF + I/R), IPOC group, IPOC + GXN group and the sham group. Changes in blood myocardial injury markers, urea, and creatinine were analyzed. Heart tissues were harvested for histomorphometry and western blotting when rats were sacrificed. Myocardial infarction area was measured by Evans blue and Triphenyltetrazolium chloride solution staining. The expressions of mitochondrial fission relative proteins (DRP1 and FIS1) and mitochondrial fusion relative proteins (OPA1 and MFN1) were detected by western blotting. ResultsIPOC could significantly decrease myocardial injury markers and myocardial area of necrosis (AN)/area at risk (AAR) of the comorbid model rats. Further results showed that GXN combined with IPOC could significantly reduce CK-MB levels and myocardial AN/AAR in comorbid model rats compared with the IPOC group. Meanwhile, both IPOC and IPOC + GXN significantly reduced DRP1 levels and increased the MFN1 and OPA1 protein levels in the comorbid model rats. However, compared with the IPOC group, MFN1 and OPA1 protein levels increased significantly in the IPOC + GXN group. ConclusionExtracts of DS and CX combined with IPOC exert a protective effect against myocardial I/R injury in rats with CRF, mediated by increased expression of mitochondrial fusion proteins (MFN1 and OPA1).

Heart failure (HF) is one of the main public health problems at present. Although some breakthroughs have been made in the treatment of HF, the mortality rate remains very high. However, we should also pay attention to improving the quality of life of patients with HF. Traditional Chinese medicine (TCM) has a long history of being used to treat HF. To demonstrate the clinical effects and mechanisms of TCM, we searched published clinical trial studies and basic studies. The search results showed that adjuvant therapy with TCM might benefit patients with HF, and its mechanism may be related to microvascular circulation, myocardial energy metabolism, oxidative stress, and inflammation.

Background: The incidence of cardiovascular events remains not unusual in patients following percutaneous coronary intervention (PCI) due to acute coronary syndrome (ACS). Chinese patent medicine (CPM) therapy based on syndrome differentiation in addition to conventional medicine (CM) had been expected to further reduce the risk of cardiovascular events. Purpose: To assess the effectiveness and safety of CPM based on syndrome differentiation in patients following PCI due to ACS. Study design: Nationwide prospective cohort study. Methods: CPM study was conducted in 40 centers in mainland China. Patients following PCI due to ACS entered to syndrome differentiation-based CPM (SDCPM) or CM group according to whether they received CPM or not. The CPM comprised Guanxin Danshen dripping pills, Qishen Yiqi dripping pills, or Danlou tablets, and was used correspondingly with the syndrome differentiation of traditional Chinese medicine. The follow-up time was 36 months. The primary endpoint was composed of cardiac death, non-fatal myocardial infarction and urgent revascularization. The secondary endpoint included rehospitalization due to ACS, heart failure, stroke, other thrombotic events. Seattle Angina Questionnaire (SAQ) was used to evaluate quality of life. Results: Between February 2012 and December 2018, ascertainment of the primary endpoint was completed in 2,724 patients of follow-up. 1,380 patients were in SDCPM group. At a median follow-up of 541 (interquartile range 513 - 564) days, the primary endpoint occurred in 126 (8.61%) patients in SDCPM group and 167 (11.62%) patients in CM group (adjusted hazard ratio [HR] = 0.70; [95% confidence interval [CI] 0.55 - 0.89]; p = 0.003). The secondary endpoint occurred in 144 (9.84%) patients in SDCPM group and 197 (13.71%) patients in CM group (adjusted HR = 0.66; [95% CI 0.53 - 0.82]; p < 0.001). The SAQ score in SDCPM group was higher than CM group (366.78 +/- 70.19 vs 356.43 +/- 73.80, p < 0.001). There were no significant differences of adverse events between two groups. Conclusion: In patients following PCI due to ACS, SDCPM in addition to CM treatment reduced the primary and secondary endpoints, as well as improved the quality of life without adverse events.

目的 系统评价参附强心丸治疗心力衰竭的有效性及安全性.方法 检索万方数据库、中国知网数据库、维普中文科技期刊数据库、中国生物医学文献数据库、EMbase、PubMed、The Cochrane Library、ClinicalTrials.gov共8个数据库,检索时间为建库至2020年11月1日,纳入参附强心丸治疗心力衰竭的随机对照试验(RCT).采用Cochrane协作网提供的风险偏倚评估工具对纳入的文献进行方法学质量评价,对纳入研究进行描述性分析,并应用RevMan 5.3软件进行Meta分析.结果 共纳入10项RCT,共893例病人,其中治疗组448例、对照组445例.Meta分析结果显示:与对照组比较,治疗组可提高总有效率[RR=1.24,95％ CI(1.16,1.33),P＜0.00001]、左室射血分数[MD=5.25,95％ CI (3.96,6.55),P＜0.00001]和6 min步行试验[MD=36.04,95％CI(19.63,52.45),P＜0.0001],缩小左室舒张末期内径[SMD=-1.02,95％CI(--1.19,-0.86),P＜0.00001]和左室收缩末期内径[MD=--4.91,95％CI(-5.51,-4.32),P＜ 0.00001],降低B型脑钠肽[SMD=-2.81,95％CI(-3.15,-2.47),P＜0.00001]和明尼苏达心力衰竭生活质量调查表积分[MD=--6.11,95％CI(-8.05,-4.18),P＜0.00001].两组均未见严重不良反应.结论 现有证据表明:参附强心丸联合西医治疗心力衰竭有一定疗效,未见严重不良反应.

心房颤动是中风的独立危险因素,已造成重大的社会和经济负担.从西医治疗心房颤动进展、中西医病证结合和循证医学证据方面分析当前中西医结合干预心房颤动的现状,并从抗凝、改善症状和预后等方面对中西医结合干预心房颤动的前景提出思考.