Objective To determine the risk factors for thromboembolism in lower risk patients with non-valvular atrial fibrillation(AF)and low CHA2DS2-VASc scores,which remain undefined.Methods We retrospectively analyzed the ba...Objective To determine the risk factors for thromboembolism in lower risk patients with non-valvular atrial fibrillation(AF)and low CHA2DS2-VASc scores,which remain undefined.Methods We retrospectively analyzed the baseline clinical characteristics,routine laboratory parameters,and echocardiographic measurements of 705 patients(71.1%male;mean age:52.10±9.64 years)with low CHA2DS2-VASc score(0 or 1;1 point for female sex)out of 1346 consecutive patients with non-valvular AF who underwent transesophageal echocardiography(TEE)at Guangdong Cardiovascular Institute between January 2013 and December 2015.Results Patients with left atrial thrombus(LAT)or spontaneous echo contrast(SEC)on TEE(24/705,4%)showed a higher incidence rate of vascular disease(54.2%vs.32.9%,P=0.045)and non-paroxysmal AF(79.2%vs.29.4%,P<0.001),larger left atrial diameter(43.08±4.59 vs.36.02±5.53 mm,P<0.001),and lower left ventricular ejection fraction(58.23±8.82%vs.64.15±7.14%,P<0.001)than those without.Multivariate logistic regression analysis identified left atrial diameter[odds ratio(OR)=1.171,95%confidence interval(CI):1.084–1.265,P<0.001]and non-paroxysmal AF(OR=3.766,95%CI:1.282–11.061,P=0.016)as independent risk factors for LAT/SEC.In ROC curve analysis,a left atrial dimeter cutoff of 37.5 mm yielded 95.0%sensitivity and 62.7%specificity(AUC:0.847,P<0.0001,95%CI:0.793–0.914).Conclusion In patients with non-valvular AF with low CHA2DS2-VASc score,the presence of LAT or SEC was associated with left atrial enlargement,which had moderate predictive value,and non-paroxysmal AF.展开更多
Atrial fibrillation(AF)is the most common sustained cardiac arrhythmia,significantly impacting patients’quality of life and increasing the risk of death,stroke,heart failure,and dementia.Over the past two decades,the...Atrial fibrillation(AF)is the most common sustained cardiac arrhythmia,significantly impacting patients’quality of life and increasing the risk of death,stroke,heart failure,and dementia.Over the past two decades,there have been significant breakthroughs in AF risk prediction and screening,stroke prevention,rhythm control,catheter ablation,and integrated management.During this period,the scale,quality,and experience of AF management in China have greatly improved,providing a solid foundation for the development of guidelines for the diagnosis and management of AF.To further promote standardized AF management,and apply new technologies and concepts to clinical practice in a timely and comprehensive manner,the Chinese Society of Cardiology of the Chinese Medical Association and the Heart Rhythm Committee of the Chinese Society of Biomedical Engineering have jointly developed the Chinese Guidelines for the Diagnosis and Management of Atrial Fibrillation.The guidelines have comprehensively elaborated on various aspects of AF management and proposed the CHA2DS2-VASc-60 stroke risk score based on the characteristics of AF in the Asian population.The guidelines have also reevaluated the clinical application of AF screening,emphasized the significance of early rhythm control,and highlighted the central role of catheter ablation in rhythm control.展开更多
Objective To evaluate the predictive value of red cell distribution width （RDW） on left atrial thrombus （LAT） or left atrial spontane- ous echo contrast （LASEC） in patients with non-valvular atrial fibrillation ...Objective To evaluate the predictive value of red cell distribution width （RDW） on left atrial thrombus （LAT） or left atrial spontane- ous echo contrast （LASEC） in patients with non-valvular atrial fibrillation （AF）. Methods We reviewed 692 patients who were diagnosed as non-valvular AF and underwent transesophageal echocardiography （TEE） in Guangdong Cardiovascular Institute from April 2014 to December 2015. The baseline clinical characteristics, laboratory test of blood routine, electrocardiograph measurements were analyzed. Results Eighty-four patients were examined with LAT/LASEC under TEE. The mean RDW level was significantly higher in LAT/LASEC patients compared with the non-LAT/LASEC patients （13.59% ± 1.07% ws. 14.34% ± 1.34%; P 〈 0.001）. Receiver-operating characteristic curve analysis was performed and indicated the best RDW cut point was 13.16%. Furthermore, multivariate logistic regression analysis indicated that RDW level 〉 13.16% could be an independent risk factor for LAT/LASEC in patients with AF. Conclusion Elevated RDW level is associated with the presence of LAT/LASEC and could be with moderate predictive value for LAT/LASEC in patients with non-valvular AF.展开更多
Objectives To investigate the relationship between serum uric acid （SUA） and left atrial spontaneous echo contrast （LA-SEC） in non-valvular atrial fibrillation （AF） patients. Methods We retrospectively screened ...Objectives To investigate the relationship between serum uric acid （SUA） and left atrial spontaneous echo contrast （LA-SEC） in non-valvular atrial fibrillation （AF） patients. Methods We retrospectively screened 1,476 consecutive hospitalized patients with AF who underwent transesophageal echocardiography prior to radiofrequency catheter ablation, left atrial appendage closure and electric cardiover- sion at Guangdong General Hospital. Data on the clinical baseline characteristics of all patients were collected from electronic medical re- cords and analyzed. Results After exclusion of patients with left atrial thrombus, 1,354 patients entered into present study and 57 were LA-SEC. The mean female SUA level （380.88 ± 94.35 μmol/L vs. 323.37 ± 72.19μmol/L, P 〈 0.001） and male SUA level （416.97 ± 98.87 μmol/L vs. 367.88 ＋ 68.50 μmol/L, P = 0.008） were both significantly higher in patients with LA-SEC than in the controls. The mean left atrial dimension （41.32 ± 5.12 mm vs. 36.12 ± 5.66 mm, P 〈 0.001） was markedly larger in patients with LA-SEC. In multivariate regression analysis, SUA level was an independent risk factor for LA-SEC （OR： 1.008, P 〈 0.001）. In receiver operating characteristic curve analysis, the corresponding area under the curve for SUA predicting LA-SEC in female and male were 0.670 and 0.657, respectively. SUA level is significantly higher in non-valvular AF patients with LA-SEC. Conclusion SUA level is an independent risk factor and has a moderate predictive value for LA-SEC among non-valvular AF patients in Southern China.展开更多
Objective To investigate the prevalence and modifiable risk factors of degenerative valvular heart disease(DVHD)among elderly population in southern China.Methods A stratified multistage sampling method was used to re...Objective To investigate the prevalence and modifiable risk factors of degenerative valvular heart disease(DVHD)among elderly population in southern China.Methods A stratified multistage sampling method was used to recruit subjects.The contents of the survey included the questionnaire,laboratory examination,echocardiography,and other auxiliary examinations.The possible risk factors of DVHD were analyzed by logistic regression analysis.Results A total of 3538 subjects≥65 years of age were enrolled.One thousand three hundred and seven subjects(36.9%)were diagnosed with DVHD.Degenerative was the most common etiology of VHD.Prevalence of DVHD increased with advancing age.The prevalence of DVHD differed by living region(χ^(2)=45.594,P<0.001),educational level(χ^(2)=50.557,P<0.001),and occupation(χ^(2)=36.961,P<0.001).Risk factors associated with DVHD included age(two-fold increased risk for each 10-year increase in age),elevated level C-reactive protein(OR=1.346,95%CI:1.100-1.646),elevated level low density lipoprotein(OR=1.243,95%CI:1.064-1.451),coronary artery disease(OR=1.651,95%CI:1.085-2.513),smoking(OR=1.341,95%CI:1.132-1.589),and hypertension(OR=1.414,95%CI:1.221-1.638).Other significant risk factors included reduced or elevated level red blood cell(OR=1.347,95%CI:1.031-1.761;OR=1.599,95%CI:1.097-2.331;respectively),elevated level platelets(OR=1.891,95%CI:1.118-3.198),elevated level uric acid(OR=1.282,95%CI:1.112-1.479),and stroke(OR:1.738,95%CI=1.085-2.513).Conclusions The survey characterized the baseline conditions of DVHD cohort of elderly population in Guangzhou city.The established and emerging risk factors for DVHD may represent challenges and opportunities for therapy.展开更多
BACKGROUND Epidemiological surveys on heart failure(HF)in Chinese community are relatively lacking.This study aimed to estimate the prevalence and incidence of HF among community residents in southern China.METHODS Ba...BACKGROUND Epidemiological surveys on heart failure(HF)in Chinese community are relatively lacking.This study aimed to estimate the prevalence and incidence of HF among community residents in southern China.METHODS Baseline data of this prospective study was collected from 2015 to 2017 among 12,013 permanent residents aged≥35years in Guangzhou,China.The same survey process was carried out for individuals aged≥65 years after a three-year follow-up.RESULTS The overall prevalence of HF in community residents aged≥35 years was 1.06%.Male had significantly higher risk of HF prevalence[odds ratio(OR)=1.50,P=0.027].The gender-adjusted risk of HF was 1.48 times higher per 10 years aging.HF prevalence was statistically associated with atrial fibrillation,valvular heart disease,hypertension and chronic obstructive pulmonary disease after adjusting for age and gender(OR=8.30,5.17,1.11,2.28,respectively;all P<0.05).HF incidence in individuals aged≥65 years were 847 per 100,000 person-years.Baseline atrial fibrillation,valvular heart disease,and diabetes mellitus were risk factors for HF incidence for individuals aged≥65 years adjusting for age and gender(OR=5.05,3.99,2.11,respectively;all P<0.05).Besides,residents with new-onset atrial fibrillation and myocardial infarction were at significantly higher risk of progression to HF(OR=14.41,8.54,respectively;all P<0.05).CONCLUSIONS Both pre-existing and new-onset cardiovascular diseases were associated with HF incidence in southern China.Management of related cardiovascular diseases may be helpful to reduce the incidence of HF.展开更多
A 70-year-old female visited our hospital due to a 5-year history of long-standing persistent atrial fibrillation （LSPsAF） refractory to medical treatment. Chest x-ray and echocardiography were free of abnormalities...A 70-year-old female visited our hospital due to a 5-year history of long-standing persistent atrial fibrillation （LSPsAF） refractory to medical treatment. Chest x-ray and echocardiography were free of abnormalities and did not detect manifest structural heart disease. A hybrid AF pro- cedure （Epicardial thoracoscopic ablation ＋ appendage re- section, and endocardial catheter ablation） was referred to patient.展开更多
Schwarzwaveformrelaxation(SWR)algorithmhas been investigated deeply and widely for regular time dependent problems.But for time delay problems,complete analysis of the algorithm is rare.In this paper,by using the reac...Schwarzwaveformrelaxation(SWR)algorithmhas been investigated deeply and widely for regular time dependent problems.But for time delay problems,complete analysis of the algorithm is rare.In this paper,by using the reaction diffusion equations with a constant discrete delay as the underlying model problem,we investigate the convergence behavior of the overlapping SWR algorithm with Robin transmission condition.The key point of using this transmission condition is to determine a free parameter as better as possible and it is shown that the best choice of the parameter is determined by the solution of a min-max problem,which is more complex than the one arising for regular problems without delay.We propose new notion to solve the min-max problem and obtain a quasi-optimized choice of the parameter,which is shown efficient to accelerate the convergence of the SWR algorithm.Numerical results are provided to validate the theoretical conclusions.展开更多
基金This work was supported by National Key R&D Program of China(No.2018YFC1312501 and No.2018YFC1312502)Key R&D Program of Guangdong Province,China(No.2019B020230004).
文摘Objective To determine the risk factors for thromboembolism in lower risk patients with non-valvular atrial fibrillation(AF)and low CHA2DS2-VASc scores,which remain undefined.Methods We retrospectively analyzed the baseline clinical characteristics,routine laboratory parameters,and echocardiographic measurements of 705 patients(71.1%male;mean age:52.10±9.64 years)with low CHA2DS2-VASc score(0 or 1;1 point for female sex)out of 1346 consecutive patients with non-valvular AF who underwent transesophageal echocardiography(TEE)at Guangdong Cardiovascular Institute between January 2013 and December 2015.Results Patients with left atrial thrombus(LAT)or spontaneous echo contrast(SEC)on TEE(24/705,4%)showed a higher incidence rate of vascular disease(54.2%vs.32.9%,P=0.045)and non-paroxysmal AF(79.2%vs.29.4%,P<0.001),larger left atrial diameter(43.08±4.59 vs.36.02±5.53 mm,P<0.001),and lower left ventricular ejection fraction(58.23±8.82%vs.64.15±7.14%,P<0.001)than those without.Multivariate logistic regression analysis identified left atrial diameter[odds ratio(OR)=1.171,95%confidence interval(CI):1.084–1.265,P<0.001]and non-paroxysmal AF(OR=3.766,95%CI:1.282–11.061,P=0.016)as independent risk factors for LAT/SEC.In ROC curve analysis,a left atrial dimeter cutoff of 37.5 mm yielded 95.0%sensitivity and 62.7%specificity(AUC:0.847,P<0.0001,95%CI:0.793–0.914).Conclusion In patients with non-valvular AF with low CHA2DS2-VASc score,the presence of LAT or SEC was associated with left atrial enlargement,which had moderate predictive value,and non-paroxysmal AF.
文摘Atrial fibrillation(AF)is the most common sustained cardiac arrhythmia,significantly impacting patients’quality of life and increasing the risk of death,stroke,heart failure,and dementia.Over the past two decades,there have been significant breakthroughs in AF risk prediction and screening,stroke prevention,rhythm control,catheter ablation,and integrated management.During this period,the scale,quality,and experience of AF management in China have greatly improved,providing a solid foundation for the development of guidelines for the diagnosis and management of AF.To further promote standardized AF management,and apply new technologies and concepts to clinical practice in a timely and comprehensive manner,the Chinese Society of Cardiology of the Chinese Medical Association and the Heart Rhythm Committee of the Chinese Society of Biomedical Engineering have jointly developed the Chinese Guidelines for the Diagnosis and Management of Atrial Fibrillation.The guidelines have comprehensively elaborated on various aspects of AF management and proposed the CHA2DS2-VASc-60 stroke risk score based on the characteristics of AF in the Asian population.The guidelines have also reevaluated the clinical application of AF screening,emphasized the significance of early rhythm control,and highlighted the central role of catheter ablation in rhythm control.
基金We appreciated Xuan Jiang for the statistical analysis. This work was supported by National Nature Science Foundation of China （No.81370295）, Science and Technology Program of Guangdong Province, China （No. 2017A02 0215054）, Science and Technology Planning of Guangzhou City, China （No.2014B070705005）. The authors declared no potential conflicts of interest with respect to the research, authorship or publication of this article.
文摘Objective To evaluate the predictive value of red cell distribution width （RDW） on left atrial thrombus （LAT） or left atrial spontane- ous echo contrast （LASEC） in patients with non-valvular atrial fibrillation （AF）. Methods We reviewed 692 patients who were diagnosed as non-valvular AF and underwent transesophageal echocardiography （TEE） in Guangdong Cardiovascular Institute from April 2014 to December 2015. The baseline clinical characteristics, laboratory test of blood routine, electrocardiograph measurements were analyzed. Results Eighty-four patients were examined with LAT/LASEC under TEE. The mean RDW level was significantly higher in LAT/LASEC patients compared with the non-LAT/LASEC patients （13.59% ± 1.07% ws. 14.34% ± 1.34%; P 〈 0.001）. Receiver-operating characteristic curve analysis was performed and indicated the best RDW cut point was 13.16%. Furthermore, multivariate logistic regression analysis indicated that RDW level 〉 13.16% could be an independent risk factor for LAT/LASEC in patients with AF. Conclusion Elevated RDW level is associated with the presence of LAT/LASEC and could be with moderate predictive value for LAT/LASEC in patients with non-valvular AF.
文摘Objectives To investigate the relationship between serum uric acid （SUA） and left atrial spontaneous echo contrast （LA-SEC） in non-valvular atrial fibrillation （AF） patients. Methods We retrospectively screened 1,476 consecutive hospitalized patients with AF who underwent transesophageal echocardiography prior to radiofrequency catheter ablation, left atrial appendage closure and electric cardiover- sion at Guangdong General Hospital. Data on the clinical baseline characteristics of all patients were collected from electronic medical re- cords and analyzed. Results After exclusion of patients with left atrial thrombus, 1,354 patients entered into present study and 57 were LA-SEC. The mean female SUA level （380.88 ± 94.35 μmol/L vs. 323.37 ± 72.19μmol/L, P 〈 0.001） and male SUA level （416.97 ± 98.87 μmol/L vs. 367.88 ＋ 68.50 μmol/L, P = 0.008） were both significantly higher in patients with LA-SEC than in the controls. The mean left atrial dimension （41.32 ± 5.12 mm vs. 36.12 ± 5.66 mm, P 〈 0.001） was markedly larger in patients with LA-SEC. In multivariate regression analysis, SUA level was an independent risk factor for LA-SEC （OR： 1.008, P 〈 0.001）. In receiver operating characteristic curve analysis, the corresponding area under the curve for SUA predicting LA-SEC in female and male were 0.670 and 0.657, respectively. SUA level is significantly higher in non-valvular AF patients with LA-SEC. Conclusion SUA level is an independent risk factor and has a moderate predictive value for LA-SEC among non-valvular AF patients in Southern China.
基金supported by National Natural Science Foundation of China(No.81370295)Guangzhou Science and Technology Project(No.201508020261)。
文摘Objective To investigate the prevalence and modifiable risk factors of degenerative valvular heart disease(DVHD)among elderly population in southern China.Methods A stratified multistage sampling method was used to recruit subjects.The contents of the survey included the questionnaire,laboratory examination,echocardiography,and other auxiliary examinations.The possible risk factors of DVHD were analyzed by logistic regression analysis.Results A total of 3538 subjects≥65 years of age were enrolled.One thousand three hundred and seven subjects(36.9%)were diagnosed with DVHD.Degenerative was the most common etiology of VHD.Prevalence of DVHD increased with advancing age.The prevalence of DVHD differed by living region(χ^(2)=45.594,P<0.001),educational level(χ^(2)=50.557,P<0.001),and occupation(χ^(2)=36.961,P<0.001).Risk factors associated with DVHD included age(two-fold increased risk for each 10-year increase in age),elevated level C-reactive protein(OR=1.346,95%CI:1.100-1.646),elevated level low density lipoprotein(OR=1.243,95%CI:1.064-1.451),coronary artery disease(OR=1.651,95%CI:1.085-2.513),smoking(OR=1.341,95%CI:1.132-1.589),and hypertension(OR=1.414,95%CI:1.221-1.638).Other significant risk factors included reduced or elevated level red blood cell(OR=1.347,95%CI:1.031-1.761;OR=1.599,95%CI:1.097-2.331;respectively),elevated level platelets(OR=1.891,95%CI:1.118-3.198),elevated level uric acid(OR=1.282,95%CI:1.112-1.479),and stroke(OR:1.738,95%CI=1.085-2.513).Conclusions The survey characterized the baseline conditions of DVHD cohort of elderly population in Guangzhou city.The established and emerging risk factors for DVHD may represent challenges and opportunities for therapy.
基金supported by the National Natural Science Foundation of China(No.81870254)the Guangdong Provincial Clinical Research Center for Cardiovascular Disease Foundation(No.2020B1111170011)the Science and Technology Programs of Guangdong Province(No.2019B020230004)。
文摘BACKGROUND Epidemiological surveys on heart failure(HF)in Chinese community are relatively lacking.This study aimed to estimate the prevalence and incidence of HF among community residents in southern China.METHODS Baseline data of this prospective study was collected from 2015 to 2017 among 12,013 permanent residents aged≥35years in Guangzhou,China.The same survey process was carried out for individuals aged≥65 years after a three-year follow-up.RESULTS The overall prevalence of HF in community residents aged≥35 years was 1.06%.Male had significantly higher risk of HF prevalence[odds ratio(OR)=1.50,P=0.027].The gender-adjusted risk of HF was 1.48 times higher per 10 years aging.HF prevalence was statistically associated with atrial fibrillation,valvular heart disease,hypertension and chronic obstructive pulmonary disease after adjusting for age and gender(OR=8.30,5.17,1.11,2.28,respectively;all P<0.05).HF incidence in individuals aged≥65 years were 847 per 100,000 person-years.Baseline atrial fibrillation,valvular heart disease,and diabetes mellitus were risk factors for HF incidence for individuals aged≥65 years adjusting for age and gender(OR=5.05,3.99,2.11,respectively;all P<0.05).Besides,residents with new-onset atrial fibrillation and myocardial infarction were at significantly higher risk of progression to HF(OR=14.41,8.54,respectively;all P<0.05).CONCLUSIONS Both pre-existing and new-onset cardiovascular diseases were associated with HF incidence in southern China.Management of related cardiovascular diseases may be helpful to reduce the incidence of HF.
基金This work was supported by National Nature Science Foundation of China （No. 81370295）, Science and Tech- nology Program of Guangdong Province, China （No. 2017A020215054）, Science and Technology Planning of Guangzhou City, China （No. 2014B070705005）.
文摘A 70-year-old female visited our hospital due to a 5-year history of long-standing persistent atrial fibrillation （LSPsAF） refractory to medical treatment. Chest x-ray and echocardiography were free of abnormalities and did not detect manifest structural heart disease. A hybrid AF pro- cedure （Epicardial thoracoscopic ablation ＋ appendage re- section, and endocardial catheter ablation） was referred to patient.
基金supported by the NSF of China(11226312,91130003)the NSF of Sichuan University of Science and Engineering(2012XJKRL005)+1 种基金the Opening Fund of Artificial Intelligence Key Laboratory of Sichuan Province(2011RZY04)the Chinese Universities Specialized Research Fund for the Doctoral Program(20110185110020).
文摘Schwarzwaveformrelaxation(SWR)algorithmhas been investigated deeply and widely for regular time dependent problems.But for time delay problems,complete analysis of the algorithm is rare.In this paper,by using the reaction diffusion equations with a constant discrete delay as the underlying model problem,we investigate the convergence behavior of the overlapping SWR algorithm with Robin transmission condition.The key point of using this transmission condition is to determine a free parameter as better as possible and it is shown that the best choice of the parameter is determined by the solution of a min-max problem,which is more complex than the one arising for regular problems without delay.We propose new notion to solve the min-max problem and obtain a quasi-optimized choice of the parameter,which is shown efficient to accelerate the convergence of the SWR algorithm.Numerical results are provided to validate the theoretical conclusions.
