Background It is important to estimate the sodium intake of primary hypertension patients through 24-hour urine sodium excretion,but the collection and testing processes are complicated.It is not clear whether the existing equation for estimating 24-hour urinary sodium excretion from spot urine sample is valid in Chinese primary hypertension patients.Objective To evaluate the validity of the Kawasaki,INTERSALT,and Tanaka equations using spot urine samples to estimate 24-hour urinary sodium excretion among Chinese primary hypertension patients.Methods This study retrospectively selected hospitalized primary hypertension patients from Department of Cardiology Peking University International Hospital from March 2018 to March 2021.General data were collected.The 24-hour urinary sodium extraction in the 24-hour urine sample was measured.The 24-hour urinary sodium extraction from spot urine sample was estimated.Paired t-test was used to measure the significance of difference between the 24-hour urine sodium excretion from spot urine samples predicted using Kawasaki,INTERSALT or Tanaka equation and measured 24-hour urinary sodium excretion from 24-hour urine collections,and the correlation and agreement between them were analyzed using the Spearman correlation coefficient and Bland-Altman plots,respectively.Relative deviation was calculated.The accuracy of the three equations were also evaluated in patients with different levels of salt intake,diabetes or proteinuria.Results One hundred and ninety-six patients were finally included for analysis.The average 24-hour urinary sodium excretion level was(165.04±78.53)mmol/d,which was equivalent to daily NaCl intake of(9.65±4.59)g/d.Female patients were older,had higher ratios of microalbuminuria and proteinuria,while lower BMI,diastolic blood pressure on admission,24-hour average diastolic blood pressure compared with male patients(P<0.05).Moreover,female patients were less likely to be smokers,and had lower spot urine sodium,as while as lower 24-hour urinary sodium excretion(P<0.05).The 24-hour urinary sodium excretion estimated by Kawasaki equation was significantly higher than the measured value(tpaired=-8.008,P<0.001),and the Bland-Altman plots showed that 94.90%spots were in 95%CI.The 24-hour urinary sodium excretion estimated by INTERSALT equation was significantly lower than the measured value(tpaired=4.167,P<0.001).The Bland-Altman plots showed that 94.39%spots were in 95%CI.The 24-hour urinary sodium excretion estimated by Tanaka equation was higher than the measured value(tpaired=-0.547,P>0.05)without significant difference,and the Bland-Altman plots showed that 96.43%spots were in 95%CI.The relative deviation of Kawasaki,INTERSALT and Tanaka equations was-31.82%,12.94%and-1.90%,respectively.After dividing patients according to salt intake,the moderate correlation between predicted and actual values of each equation was no longer significant.There was no significant difference in the predictive accuracy of the equations between patients with and without diabetes or proteinuria.Conclusion The accuracy and consistency of the Kawasaki,INTERSALT and Tanaka equations in estimating 24-hour urinary sodium levels by spot urine in primary hypertension patients were poor.Tanaka's overall estimated value is the closest to the measured mean value.No comorbidity(such as diabetes,proteinuria)that might affect urinary sodium excretion was found to have a significant effect on the accuracy of the estimation equation.

Background: Left bundle branch block (LBBB)-induced cardiomyopathy has been proposed, but the association between LBBB and cardiac resynchronization therapy (CRT) response remains unclear and practical criteria for selecting CRT candidates are needed. Methods: One hundred and seventeen consecutive heart failure patients were reviewed, 24 of whom received CRT. Only two patients had a clear temporal relation between cardiomyopathy and LBBB. Results: Compared with the patient with “cardiomyopathy-induced LBBB,” the patient with “LBBB-induced cardiomyopathy” had higher left ventricular (LV) wall thickness, higher LV wall thickening rate, higher peak circumferential strain, and longer peak circumferential strain delay. The LV deformation patterns in the two patients were obviously distinct on cardiovascular magnetic resonance tissue tracking. During follow-up, the patient with LBBB-induced cardiomyopathy had a good response to CRT (LV ejection fraction 23 before CRT vs. 30% at 6 months vs. 29 at 12 months vs. 32% at 18 months; LV end-diastolic diameter 77 mm before CRT vs. 66 mm at 6 months vs. 62 mm at 12 months vs. 63 mm at 18 months), and the other patient had no response to CRT (LV ejection fraction 29 before CRT vs. 29% at 6 months vs. 26 at 12 months vs. 22% at 24 months; LV end-diastolic diameter 85 mm before CRT vs. 88 mm at 6 months vs. 85 mm at 12 months vs. 84 mm at 24 months). Conclusion: The temporal relation between cardiomyopathy and LBBB could be a determinant for CRT response. Cardiovascular magnetic resonance tissue tracking may be a useful tool to identify the chronological order and a principal consideration for selecting candidates for CRT. Larger prospective clinical trials are needed to study the prevalence of, time course of, and risk factors for LBBB-induced cardiomyopathy.

Objective To investigate the influence of body mass index(BMI) on the prognosis of patients who had received elective PCI.Methods The study population consisted of 2964 consecutive patients with electivePCIs performed between July 2009 and September 2011. The patients were divided into three groups based on their preoperative BMI levels:the normal group( BMI<24.0 kg/m2,n=810); the overweight group( 24.0 kg/m2≤BMI<28.0 kg/m2,n=1454) and the obese group(BMI≥28.0 kg/m2,n=700). We examined the association between baseline BMI levels and postoperative mortality through a mean(571.5±130.8)days of follow up.Results Patients with high BMI had a higher percentage of comorbidities compared with the normal BMI group. The results of multivariate Cox regression analysis revealed that preoperative BMI was inversely associated with mortality after adjustment for other factors (HR 0.896,95％ CI 0.821-0.977,P=0.031). Compared with the obese group, the hazard ratios for risk of mortality in the overweight and the normal groups were 1.908(95％CI 0.689-5.291,P=0.213) and 2.241(95％CI 1.154-4.350,P=0.017).Conclusions For patients undergoing elective PCI, individuals with obesity and overweight had the better prognosis than those with normal BMI.

Objective This study was performed to assess the prevalence of nonalcoholic fatty liver (NAFL) in patients with symptomatic congestive heart failure (CHF) and compare the clinical features with those of patients without NAFL. Methods In total, 102 patients with CHF were divided into NAFL and non-NAFL groups according to their hepatic ultrasonography findings. All patients underwent transthoracic echocardiography and cardiac magnetic resonance examination. Follow-up was performed for major cardiovascular events (MACE) and readmission due to heart failure at 1, 3, 6, and 12 months after the index hospitalization. Results NAFL was detected in 37 of 102 patients (36.27%). Compared with the non-NAFL group, patients with NAFL were younger, had a higher body mass index and left ventricular (LV) mass index, and had more severe fibrosis. MACE and readmission occurred in 15 patients in the NAFL group and 29 patients in the non-NAFL group, without a significant difference. Linear regression analysis revealed that after adjusting for confounders, NAFL was independently associated with the LV fibrosis size and the ratio of the LV fibrosis size to the LV mass index. Conclusions NAFL is present in more than one-third of patients with CHF and is associated with the severity of LV fibrosis.

Objective To investigate the relation among soluble growth stimulation express gene 2 protein (sST2),N-terminal pro-brain natriuretic peptide(NT-proBNP),high sensitivity cardiac troponin Ⅰ(hs-cTnⅠ) and prognosis of patients with heart failure.Methods A total of 173 patients with heart failure were enrolled from May 2015 to November 2015 in the Beijing Anzhen Hospital,Capital Medical University.Levels of sST2,NT-proBNP and hs-cTnⅠ were tested on admission.The relation among sST2,NT-proBNP and hs-cTnⅠ with 1 year incidence of major adverse cardiovascular events (MACE) was analyzed.Results During 1 year follow-up,MACE occurred in 52 cases.Levels of sST2,NT-proBNP and hs-cTnⅠ on admission in MACE group(n =52) were significantly higher than those in non-MACE group(n =121) [41.2 (25.5,62.8) μg/L vs 29.1 (21.6,38.8) μg/L,4 758 (1 978,9 000) ng/L vs 2 799 (1 446,6 073) ng/L,0.05 (0.02,0.09) μg/L vs 0.03 (0.01,0.06) μg/L] (P ＜ 0.05).Cox regression analysis showed that the level of sST2 on admission was an independent predictor of MACE(hazard ratio =2.133,confidence interval:1.011-4.502,P =0.047).Receiver operating characteristic curve analysis showed that sST2,NT-proBNP and hs-cTnⅠ were predictive factors of cardiovascular events [area under curve (AUC) =0.660,0.644,0.659];the predictive value of combination of 3 indicators (AUC =0.705) was higher than that of sST2,NT-proBNP and hs-cTnⅠ alone(P =0.013,0.008,0.031).Kaplan-Meier survival analysis showed that the cumulative survival rate in patients with sST2 ≥39.393 μg/L was significandy lower than that in patients with sST2 ＜ 39.393 μg/L(P ＜ 0.05).Conclusion The concentration of sST2 on admission can be an independent predictive factor of prognosis of heart failure;combined detection of sST2,NT-proBNP and hs-cTnⅠ can improve the prediction.

Objective To investigate the role of CHA2DS2-VASc score in assessing risk of left atrial thrombus in patients with nonvalvular atrial fibrillation(NVAF);to analyze risk factors of left atrial thrombosis.Methods A prospective case-control study was conducted on NVAF patients who were detected left atrial thrombus by transesophageal echocardiography from January 1st,2016 to January 1st,2017 in Beijing Anzhen Hospital,Capital Medical University;56 patients were enrolled in thrombus group and 228 patients were enrolled in non-thrombus group.Clinical data,ultrasonic parameters and CHA2DS2-VASc score were recorded.The relation between CHA2DS2-VASc score and left atrial thrombosis was analyzed.Risk factors of left atrial thrombosis were analyzed.Results Age,CHA2 DS2-VASc score,left atrial diameter(LAD),degrees of mitral regurgitation and tricuspid regurgitation,ratios of permanent atrial fibrillation,heart failure,left ventricular ejection fraction (LVEF) ＜ 50％ and CHA2DS2-VASc score ≥2 points in thrombus group were significantly higher than those in non-thrombus group(P ＜ 0.05).The CHA2 DS2-VASc score of NVAF patients was related to left atrial thrombosis (odds ratio =1.312,95％ confidence interval:1.093-1.577,P =0.004),but multivariate logistic analysis showed that the relation between CHA2 DS2-VASc score and left atrial thrombosis was not significant after adjustment of types of atrial fibrillation(odds ratio =1.077,95 ％ confidence interval:0.850-1.363,P =0.540).With adjustments of atrial fibrillation types and tricuspid regurgitation,multivariate logistic analysis showed that age (65-74 years old,odds ratio =2.323,95％ confidence interval:1.112-4.852,P =0.025;≥75 years old,odds ratio =4.486,95 ％ confidence interval:1.503-11.012,P =0.006),LAD (odds ratio =1.105,95 ％ confidence interval:1.043-1.171,P =0.001) and LVEF ＜ 50％ (odds ratio =3.305,95％ confidence interval:1.045-10.451,P =0.042) were independent risk factors of left atrial thrombosis.Conclusions CHA2DS2-VASc scoring system to assessing risk of thrombus formation in left atrium/auricle is not accurate.Advanced age,left atrial enlargement and decreasing LVEF are independent risk factors of left atrial thrombosis in NVAF patients.

Background Myocardial fibrosis (MF) is a risk factor for poor prognosis in dilated cardiomyopathy (DCM). Late gadolinium enhancement (LGE) of the myocardium on cardiac magnetic resonance (CMR) represents MF. We examined whether the LGE amount increases the incidence of adverse cardiovascular events in patients with stage C or D heart failure (HF). Methods Eighty-four consecutive patients with stage C or D HF, either ischemic or non-ischemic, were enrolled. Comprehensive clinical and CMR evaluations were performed. All patients were followed up for a composite endpoint of cardiovascular death, heart transplantation, and cardiac resynchronization therapy with defibrillator (CRT-D).Results LGE was present in 79.7% of the end-stage HF patients. LGE distribution patterns were mid-wall, epi-myocardial, endo-myocardial, and the morphological patterns were patchy, transmural, and diffuse. During the average follow-up of 544 days, 13 (15.5%) patients had endpoint events: 7 patients cardiac death, 2 patients heart transplantation, and 4 patients underwent CRT-D implantation. On univariate analysis, LGE quantification on cardiac magnetic resonance, blood urine nitrogen, QRS duration on electrocardiogram, left ventricular end-diastolic diameter (LVEDD) and left ventricular end-diastolic volume (LVEDV) on CMR had the strongest associations with the composite endpoint events. However, on multivariate analysis for both Model I (after adjusting for age, sex, and body mass index) and Model II (after adjusting for age, sex, BMI, renal function, QRS duration and atrial fibrillation on electrocardiogram, the etiology of HF, LVEF, CMR-LVEDD and CMR-LVEDV), LGE amount was a significant risk factor for composite endpoint events (Model I 6SD HR 1.037, 95%CI 1.005-1.071, p=0.022; Model II 6SD HR 1.045, 95%CI 1.001-1.084, p=0.022). Conclusion LGE amount from high-scale threshold on CMR increased the incidence of adverse cardiovascular events for patients in either stage C or D HF.

Background Large-scale clinical research on the relationship between red blood cell distribution width (RDW) and intermediate-term prognosis in elderly patients with coronary artery disease (CAD) is lacking. Thus, this study investigated the effects of RDW on the intermediate-term mortality of elderly patients who underwent elective percutaneous coronary intervention (PCI). Methods Data from 1891 patients >= 65 years old underwent elective PCI from July 2009 to September 2011 were collected. Based on preoperative median RDW (12.3%), the patients were divided into two groups. The low RDW group (RDW < 12.3%) had 899 cases; the high RDW group (RDW >= 12.3%) had 992 cases. The all-cause mortality rates of the two groups were compared. Results Patients in the high RDW group were more likely to be female and accompanied with diabetes, had lower hemoglobin level. The mean follow-up period was 527 days. During follow-up, 61 patients died (3.2%). The postoperative mortality of the high RDW group was significantly higher than that of the low RDW group (4.3% vs. 2.0%, P = 0.004). After adjusting other factors, multivariate Cox regression analysis revealed that preoperative high RDW was significantly associated with postoperative all-cause mortality (hazard ratio: 2.301, 95% confidence interval: 1.106-4.785, P = 0.026). Conclusions Increased RDW was an independent predictor of the increased intermediate-term all-cause mortality in elderly CAD patients after elective PCI.

OBJECTIVEThis study examined the hypothesis that correction of AF with catheter ablation can improve FTR.METHODSTwo groups who underwent catheter ablation of atrial fibrillation were compared (From March 2012 to April 2013): 44 patients with FTR; and 44 patients with no or less FTR. To find the predictors of functional tricuspid regurgitation (FTR) in atrial fibrillation patients and assess the effect of catheter ablation on FTR.RESULTSIn multivariable regression analysis, RA size (OR: 1.377, 95% CI 1.150-1.649, P=0.001) and age (OR: 1.093, 95% CI 1.007-1.185, P=0.03) were associated with FTR. The primary end point was achieved in 54.5% (24/44) of patients with FTR, and 59.1% (26/44) in norml ones (P>0.05). Recurrence (OR: 0.53, 95% CI 0.008-0.331, P=0.002) was the only factor related to unimproved FTR after ablation.CONCLUSIONSFTR is associated with advancing age and RA dimension; catheter ablation of AF in FTR patients is effective and safe; FTR will be significantly improved in patients maintaining sinus rhythm after catheter ablation of AF.

Background Rheumatoid arthritis (RA) is associated with an increased incidence of atrial fibrillation (AF). This study evaluated the safety and efficacy of catheter ablation (CA) in the treatment of AF in patients with RA, which has not been previously reported. Methods A total of 15 RA patients with AF who underwent CA were enrolled. For each RA patient, we selected 4 individuals (control group, 60 patients in total) who presented for AF ablation in the absence of structural heart or systemic disease and matched the RA patients with same gender, age (±2 years), type of AF, and procedure date. Results Patients with RA had a significantly higher C-reactive protein level (1.81±2.35mg/dl vs. 4.14±2.30mg/dl, p=0.0320), white blood cell count (5632±1200mm3 vs. 6361±1567mm3, p=0.0482), and neutrophil count (3308±973mm3 vs. 3949±1461mm3, p=0.0441). At 2-year follow-up, atrial tachyarrhythmia (ATa) recurrence rate in the RA group (33.3%, 5/15) was similar to that in the control group (31.7%, 19/60; p=0.579) after single procedure. In all the five patients from the RA group who developed recurrence, ATa relapsed within 90 days following index procedure (median recurrence time 18 days vs. 92 days in control group; p=0.0373). Multivariate Cox regression analysis showed that hypertension and left atrial diameter but not RA, C-reactive protein, white blood cell count, and neutrophil count were independent predictors of ATa recurrence. Conclusions Catheter ablation of AF can be safely performed in patients with RA, with a success rate comparable to that of patients without RA. RA patients tend to develop early ATa recurrence after AF ablation.

OBJECTIVE:To evaluate the efficacy of catheter ablation in Chinese hypertrophic cardiomyopathy (HCM) patients with atrial fibrillation (AF), and to determine the risk factors of AF recurrence.METHODS:This study enrolled 40 HCM patients with AF who underwent primary AF ablation at Beijing Anzhen Hospital from June 2005 to June 2013. Ablation strategy included bilateral pulmonary vein isolation (PVI) for paroxysmal AF (n = 27) and PVI plus left atrial roof, mitral isthmus and tricuspid isthmus linear ablations for persistent AF (n = 13). AF recurrence was followed-up by means of electrocardiography or Holter monitoring. Risk factors associated with AF recurrence were determined by a Cox regression model and the predictive power was evaluated by receiver operating characteristic (ROC) curve.RESULTS:After (34 ± 18) months follow-up, 30% (12/40) cases remained in sinus rhythm off antiarrhythmic drug, most AF recurrence (18/28, 64.3%) occurred within 1 year post ablation. Multivariate Cox regression demonstrated that left atrial dimension (LAD, HR = 1.124, 95% CI 1.051-1.202, P = 0.001) and female gender (HR = 3.304, 95% CI 1.397-7.817, P = 0.007) were independent risk factors of AF recurrence. The cut-off value of LAD at 43.5 mm predicted AF recurrence with sensitivity of 93.5% and specificity of 60.0%. Every 1 mm enlargement in LAD was associated with an increased risk of arrhythmia recurrence (HR = 1.095, 95% CI 1.031-1.163, P = 0.003).CONCLUSIONS:AF ablation in Chinese HCM patients is safe and feasible. However, sinus rhythm maintenance rate is low at long-time follow-up. Most of the recurrent AF occurs within 1 year post AF ablation procedure. Left atrial diameter and female gender are independent risk factors of AF recurrence.

OBJECTIVE:This study sought to explore the impact of metabolic syndrome (MS) on the risk of recurrence after catheter ablation of long-standing persistent atrial fibrillation (AF). METHODS:Totally 248 patients [197 male, (56±12)years] with persistent AF and catheter ablation were included. Long-standing persistent AF was defined based on the duration (more than one year). RESULTS:Among the 248 patients, 96 (38.7%) patients had MS, 130 (52.4%) patients had long-standing persistent AF. After 91-1222 (404±303) days follow-up, 119 (47.9%) had recurrence. The recurrence rate was significantly higher in the MS group than that in the non-MS group (58.3% vs 41.4%, P = 0.017). The proportion of MS was similar between the long-standing persistent AF group and the non-long-standing persistent AF group (36.9% vs 40.7%, P = 0.544). Subjects with MS had higher recurrence rate than those without MS in non-long-standing AF group (56.3% vs 32.9%, P = 0.033), but not in long-standing AF group (60.4% vs 48.8%, P = 0.177). In multivariate analysis, MS (hazard ratio 1.98, 95% CI 1.04-3.76, P = 0.036) and AF history duration (hazard ratio 1.04, 95% CI 1.01-1.07, P = 0.004) were independent risk factors for recurrence after catheter ablation of AF. Long-standing persistent AF was not an independent risk factor of recurrence. CONCLUSION:MS was natively associated with the success rate of catheter ablation of AF in patients with non-long-standing persistent AF, but not in patients with long-standing persistent AF.

目的:分析老年(≥65岁)冠心病合并高血压患者接受血运重建后影响其预后的因素.方法:3 457例接受了血运重建,包括经皮冠状动脉介入治疗(PCI)和冠状动脉移植术(CABG)的老年冠心病患者血压情况分为两组,高血压组[BP≥140/90mmHg(1 mmHg=0.133 kPa),n=2 002]和对照组(即血压正常组,BP＜ 140/90mmHg,n=1 455),对患者进行电话或门诊随访,随访的中位数为555d,比较两组间临床情况和预后的差异.结果:两组间总病死率和主要不良心血管事件(MACCE)发生率差异有统计学意义,其中总病死率高血压组与血压正常组为(3.5％vs.1.2％,P ＜0.001),MACCE为(14.2％ vs.10.5％,P=0.001).高血压组与对照组相比,两组间在如下方面存在显著差异:吸烟史(35.6％ vs.55.4％,P＜0.001),脑血管病史(13.2％ vs.8.8％,P＜0.001),周围血管病史(2.9％vs.1.6％,P =0.012);ST段抬高心肌梗死(STEMI)为(15.3％ vs.11.1％,P=0.004),不稳定性心绞痛(66.1％ vs.61.2％,P=0.004);多支病变(43.8％ vs.35.5％,P＜0.001),左主干病变(9.4％vs.6.4％,P=0.001),支架内再狭窄(ISR)为(3.5％vs.2.2％,P=0.028);完全血运重建率(70.9％ vs.77.7％,P＜0.001).Cox多因素回归分析发现,多支病变(HR=2.077,95％ CI:1.129～3.819,P=0.019)是影响老年冠心病合并高血压患者总病死率的独立危险因素,而脑血管病史(HR=1.550,95％CI:1.092 ～2.200,P=0.014)、左主干病变(HR=1.890,95％ CI:1.198 ～2.982,P=0.006)、多支病变(HR=1.505,95％ CI:1.248～1.814,P＜0.001)是影响其MACCE的危险因素.结论:与对照组相比,老年高血压合并冠心病患者的总病死率和MACCE发生率高.多支血管病变是老年高血压并冠心病患者血运重建后总病死率增加的独立危险因素,而脑血管病史、左主干病变、多支血管病变是其MACCE发生率增加的独立危险因素.

Objective:To explore if CHADS2 score could predict complications in catheter ablation of atrial fibrillation(Af).Method:All 251 patients undergoing catheter ablation of Af were enrolled.CHADS2 score was calculated as follows:two points were assigned for history of stroke or transient ischemic attack and 1point each was assigned for age≥75,history of hypertension,diabetes,recent cardiac failure.Result:Of the 251 patients,109patients had CHADS2=0,75 patients had CHADS2=1,67 patients had CHADS2≥ 2.There were no differences of Af duration,Af type,left atrial diameter,left ventricular end-diastolic diameter,left ventricular end-systolic diameter and ejection fraction among the three groups.There were 27 patients suffered complications(10.7%).CHADS2 score was significantly higher in the patients with complications[(1.4±1.3)vs(0.9±1.0),P0.05]than those without.The incidence rate were 8.3%,8.0%,17.9% among the groups with CHADS2=0,1,≥2,respectively(P=0.087).The thrombotic and bleeding complications was significantly increased with CHADS2 score with the complication rate 2.8%,6.7%,14.9%among the three groups(P0.05).The complication rate was significantly higher in the patients with diabetes(32.1% VS.8.1%,P0.001)and previous stroke(29.4% VS 9.4%%,P=0.010)than those without.Conclusion:CHADS2score have an important role in the prediction of complication in catheter ablation of Af.

目的 探讨阵发性心房颤动(简称房颤)患者房颤发作前后、发作时体表心电图QT间期的变化.方法 收集35例阵发性房颤患者的24 h动态心电图.测量房颤发作前窦性心律(SRbline)、房颤发作、房颤自行转为窦性心律即刻(SRpostAF)时的QT间期.测量连续3个心动周期QT间期.测量每阵房颤的持续时间.分别采用Ba-zetts、Fridericia和Framingham公式校正QT间期(QTc),分析房颤发作时间与SRpostAF的QTc之间的关系.结果 SRpostAF的QTc显著短于SRbaseline的QTc[(407±38)ms vs (435±34)ms; (397±31) ms vs (423±31) ms;(393±35) msvs (422±30) ms,P均＜0.001],而房颤发作时QTc较SRbaseline、SRpostAF的QTc显著性延长[采用三种QT校正公式的QTc分别是(503±69),(454±53),(449±44) ms].SRpostAF的QTc缩短与房颤短阵发作持续时间无显著相关,与房颤发作前的QT间期相关(相关系数分别是:0.500,0.547,0.507;P均＜0.01).结论 房颤发作时QTc显著延长,而房颤发作自行转复窦性心律后QTc显著缩短.

BACKGROUND:Serum uric acid (SUA) is a simple and independent marker of morbidity and mortality in a variety of cardiovascular diseases. In this study we aimed to investigate SUA and the risk of left atrial (LA) thrombus in patients with nonvalvular atrial fibrillation (AF). METHODS:In this retrospective study, 1359 consecutive patients undergoing transesophageal echocardiography before catheter ablation of AF were enrolled. Sixty-one of the 1359 patients (4.5%) had LA thrombus. RESULTS:SUA levels in patients with LA thrombus were significantly greater (413.5 ± 98.8 μmol/L vs 366.7 ± 94.3 μmol/L; P < 0.001). Hyperuricemia was defined as SUA ≥ 359.8 μmol/L in women and ≥ 445.6 μmol/L in men determined according to receiver operating characteristic curve. The incidence of LA thrombus was significantly greater in patients with hyperuricemia than in those with a normal SUA level in women (12.1% vs 1.9%; P < 0.001) and in men (8.5% vs 2.8%; P < 0.001). Hyperuricemia had a negative predictive value of 98.1% in women and 97.1% in men for identifying LA thrombus. Hyperuricemia was associated with significantly greater risk of LA thrombus among Congestive Heart Failure, Hypertension, Age ≥ 75 Years, Diabetes Mellitus, Stroke, Vascular Disease, Age 65 to 74 Years, Sex Category (CHA2DS2-VASc) score = 0, 1, and ≥ 2 groups with odds ratios of 7.19, 4.05, and 3.25, respectively. In multivariable analysis, SUA was an independent risk factor of LA thrombus (odds ratio, 1.004; 95% confidence interval, 1.000-1.008; P = 0.028). CONCLUSIONS:Hyperuricemia was a modest risk factor for LA thrombus, which might refine stratification of LA thrombus in patients with nonvalvular AF.

PURPOSE Cerebrovascular accidents (CVAs) frequently coexist with coronary artery disease (CAD) and adversely affect prognosis in patients with CAD; however, fewer studies have investigated the role of prior ischemic stroke on the outcomes of percutaneous coronary intervention (PCI). The aim of this study was to determine the safety and effectiveness of PCI in patients with a prior ischemic stroke. METHODS A review of patients who underwent PCI between June 2003 and September 2005 (n=3893) at the Beijing Anzhen Hospital of Capital University of Medical Science, identified 295 PCI patients with a prior ischemic stroke (≥ 3 months) and 3598 patients without a prior stroke. To investigate whether prior history of an ischemic stroke was independently associated with increased risk of adverse PCI outcomes, prognostic parameters were analyzed using univariate analysis and Cox multivariate regression analysis. Propensity score analysis was then used to match the two subgroups of patients based on multiple factors known to impact cardiac outcome. RESULTS Patients with a prior ischemic stroke had more frequent high-risk baseline characteristics (diabetes, hypertension, hyperlipidemia and prior myocardial infarction). No significant differences were found in the major adverse cardiac and cerebrovascular event (MACCEs) rates between the two groups (1.7% in the stroke group vs. 1.4% in the non-stroke group; p=0.06). Diabetes mellitus, triple vessel CAD, number of diseased vessels, chronic total occlusion and previous myocardial infarction were independent predictors of MACCE in patients with prior stroke undergoing PCI. CONCLUSIONS This study demonstrates that, in daily clinical practice, PCI can be provided safely and with good results to patients with a prior ischemic stroke (≥ 3 months).

Objective To investigate the impact of aging on complex fractionated atiral electrograms( CFAEs) in patients with non-valvular chronic atrial fibrillation( AF). Methods In this prospective study,116 patients with chronic AF were enrolled( n = 48 in the elderly group,n = 68 in the non elderly group). The elderly was defined as age ≥ 60 years old. The 2. 5-second bipolar electrogram recordings at each endocardial location were analyzed with a custom software embedded in the CARTO mapping system. Interval confidence level( ICL) was used to characterize CFAEs. As the default setting of the software,ICL more than or equal to 7 was considered sites with a highly repetitive CFAEs complex. CFAEs index was defined as the fraction of area of ICL more than or equal to 7 to the left atrial surface. The spatial distribution of CFAEs evaluated in six left atrial( LA) regions: anterior wall,posterior wall,roof,inferior wall,lateral wall and septum.Results The elderly group had higher prevalence of male,hypertension and stroke( all P0. 05). ICL max [( 16. 7±2.0) vs( 15. 7±2. 2),P = 0. 014]and CFAEs index [( 60. 4% ±22. 9%) vs( 48. 6% ±22. 3%),P = 0. 007]in the elderly group was significantly higher than that in the non-elderly group. The regional distribution of CFAEs was frequently found in Conclusion LA anterior wall and LA septum in the elderly. Age had positive relation with CFAEs( r = 0. 244,P = 0. 008). The elderly have extensive substrate for chronic AF.

Objective This study sought to explore the mechanism of recurrence and outcome of cath-eter ablation in patients with paroxysmal atrial fibrillation ( AF) and metabolic syndrome ( MetS) in redo proce-dure. Methods Five hundred and twenty-two patients with paroxysmal AF underwent index catheter ablation were screened. Of these patients, 175 patients had recurrence. Ninety-eight of the 175 patients underwent redo procedure, 3 patients dropped off in the follow-up. Totally, 95 patients were enrolled in this study. The patients were divided into MetS group and non-MetS group. The recurrence mechanism was classed as pulmonary vein ( PV) related and non-PV related according to 3-D mapping and the result of termination and induction of AF after PV isolation. Results Among the 95 patients, 53 (55. 8%) patients had MetS. The type of recurrent ar-rhythmias did not differ between the MetS group and the non-MetS group (P=0. 244). There were 24 cases of&nbsp;AF (45. 3%), 14 cases of atrial flutter or atrial tachycardia (26. 4%) and 15 cases of AF combined with atri-al flutter or atrial tachycardia ( 28. 3%) in MetS group. In non-MetS group, there were 18 cases of AF (42. 9%), 17 cases of atrial flutter or atrial tachycardia (40. 5%), 7 cases of AF combined with atrial flutter or atrial tachycardia (16. 7%). There was no difference of PV-left atrium reconnection rate between the MetS group and the non-MetS group (83. 3% vs. 87. 7%, P=0. 451). The proportion of non-PV related mechanism of recurrent arrhythmias did not differ between the two groups ( 47. 2% vs 47. 6%, P=0. 965 ) . During 3-73 (29. 6±20. 5) months follow-up, the recurrence were 34. 0% and 35. 7% in the MetS group and non-MetS-group respectively (P=0. 955). Conclusion Mets had no significant impact on the recurrent mechanism and outcome of catheter ablation of paroxysmal AF in redo procedure.

BACKGROUND In hypertrophic cardiomyopathy (HCM) patients complicated with atrial fibrillation (AF), catheter ablation has been recommended as a treatment option. Meanwhile, prolongation of QTc interval has been linked to an increased AF incidence in the general population and to poor outcomes in HCM patients. However, whether QTc prolongation predicts arrhythmia recurrence after AF ablation in the HCM population remains unknown. METHODS AND RESULTS Thirty-nine HCM patients undergoing primary AF ablation were enrolled. The ablation strategy included bilateral pulmonary vein isolation (PVI) for paroxysmal AF (n=27) and PVI plus left atrial roof, mitral isthmus and tricuspid isthmus linear ablations for persistent AF (n=12). Pre-procedural QTc was corrected by using the Bazett's formula. At a 14.8-month follow up, 23 patients experienced atrial tachyarrhythmia recurrence. Recurrent patients had longer QTc than non-recurrent patients (461.0±28.8 ms vs. 434.3±18.2 ms, P=0.002). QTc and left atrial diameter (LAD) were independent predictors of recurrence. The cut-off value of QTc 448 ms predicted arrhythmia recurrence with a sensitivity of 73.9% and a specificity of 81.2%. A combination of LAD and QTc (global chi-squared=13.209) was better than LAD alone (global chi-squared=6.888) or QTc alone (global chi-squared=8.977) in predicting arrhythmia recurrence after AF ablation in HCM patients. CONCLUSIONS QTc prolongation is an independent predictor of arrhythmia recurrence in HCM patients undergoing AF ablation, and might be useful for identifying those patients likely to have a better outcome following the procedure.