Background The long-term prognostic influence of left atrial diameter （LAD） remodeling on the status of post-radiofrequency catheter ablation （RI CA） atrial fibrillation （AF） is unclear. This study employed a tw...Background The long-term prognostic influence of left atrial diameter （LAD） remodeling on the status of post-radiofrequency catheter ablation （RI CA） atrial fibrillation （AF） is unclear. This study employed a two-stage model from 3-year echocardiographic data to ascertain whether the two-stage model predicts RFCA outcome more favorably than models using the baseline LAD. Methods Data were retrospectively collected from 263 consecutive patients with drug-refractory AF undergoing RFCA. Regular echocardiographic measurements of LAD were performed at baseline, 1, 3, 6, and 12 months and then every 6 months after RFCA. Sex, age, type of AF, number of RFCA, and AF status were recorded. We obtain the actual （predicted） 3-year LAD using a longitudinal linear mixed model （1st stage）. Logistic regression models based on the baseline LAD （Model 1）, actual （predicted） 3-year LAD （Model 2） （2nd stage）, and observed 3-year LAD （Model 3） were constructed to predict RFCA outcome. The area under the receiver operating characteristic curve （AUC） were used to assess the performance of models. Results The lowess smoothed curve indicated that the LAD declined over the first three months and remained stable up to 36 months after RFCA. The degree of LAD reduction was significantly influenced by the baseline LAD. Non-paroxysmal AF, large LAD and female gender were significant predictors of AF recurrence. Model 2 had the largest AUC among the three models. Conclusions This longitudinal study-based two-stage model outperforms the original logistic model using the baseline LAD. Non-paroxysmal AF, larger LAD and female gender are significant predictors of RFCA failure.展开更多
Background The determinants of pulmonary hypertension(PH)due to heart failure with preserved ejection fraction(HFpEF)have been poorly investigated in patients with cardiovascular diseases(CVD).Methods From July 12017 ...Background The determinants of pulmonary hypertension(PH)due to heart failure with preserved ejection fraction(HFpEF)have been poorly investigated in patients with cardiovascular diseases(CVD).Methods From July 12017 to March 312019,a total of 149 consecutive HFp EF patients hospitalized with CVD were enrolled in this prospective cross-sectional study.A systolic pulmonary artery pressure(PASP)>35 mm Hg estimated by echocardiography was defined as PH-HFp EF.Logistic regression was performed to establish predictors of PH in HFpEF patients.Results Overall,the mean age of participants was 72±11 years,and 74(49.7%)patients were females.A total of 59(39.6%)patients were diagnosed with PH-HFpEF by echocardiography.The left atrial diameter(LAD)was related to the ratio of the transmitral flow velocities/mitral annulus tissue velocities in early diastole(E/E’)and the left ventricular diameter in systole(LVDs).N-Terminal pro B-type natriuretic peptide(NT-proBNP)was not found to be associated with LAD and impaired diastolic or systolic function of the left ventricle.Multivariable logistic regression showed that atrial fibrillation(AF)increased the risk of PH-HFpEF incidence 3.46-fold with a 95%confidence interval(CI)of 1.44–8.32,P=0.005.Meanwhile,LAD≥45 mm resulted in a 3.43-fold increased risk,95%CI:1.51–7.75,P=0.003.However,the significance levels of NT-proBNP,age and LVEF were underpowered in the regression model.Two variables,AF and LAD≥45 mm,predicted the PH-HFpEF incidence(C-statistic=0.773,95%CI:0.695–0.852,P<0.001).Conclusions Two parameters associated with electrical and anatomical remodelling of the left atrium were related to the incidence of PH in HFpEF patients with CVD.展开更多
Background： The CHA2DS2-VASc score is used clinically for stroke risk stratification in patients with atrial fibrillation （AF）. We sought to investigate whether the CHA2DS2-VASc score predicts stroke and death in C...Background： The CHA2DS2-VASc score is used clinically for stroke risk stratification in patients with atrial fibrillation （AF）. We sought to investigate whether the CHA2DS2-VASc score predicts stroke and death in Chinese patients with sick sinus syndrome （SSS） after pacemaker implantation and to evaluate whether the predictive power of the CHA2DS2-VASc score could be improved by combining it with left atrial diameter （LAD） and amino-terminal pro-brain natriuretic peptide （NT-proBNP）. Methods： A total of 481 consecutive patients with SSS who underwent pacemaker implantation from January 2004 to December 2014 in our department were included. The CHA2DS2-VASc scores were retrospectively calculated according to the hospital medical records before pacemaker implantation. The outcome data （stroke and death） were collected by pacemaker follow-up visits and telephonic follow-up until December 3 l, 2015. Results： During 2151 person-years of follow-up, 46 patients （9.6%） suffered stroke and 52 （10.8%） died. The CHA2DS2-VASc score showed a significant association with the development of stroke （hazard ratio [HR] 1.45, 95% confidence interval [CI] 1.20-1.75, P 〈 0.00 1） and death （HR 1.45, 95% CI 1.22-1.71, P 〈 0.001）. The combination of increased LAD and the CHA2DS2-VASc score improved the predictive power for stroke （C-stat 0.69, 95% CI 0.61-4）.77 vs. C-stat 0.66, 95% CI 0.57-0.74, P = 0.013）, and the combination of increased NT-proBNP and the CHA2DS2-VASc score improved the predictive power for death （C-stat 0.70, 95% CI 0.64-0.77 vs. C-stat 0.67, 95% CI 0.60--0.75, P= 0.023）. Conclusions： CHA2DS2-VASc score is valuable for predicting stroke and death risk in patients with SSS after pacemaker implantation. The addition of LAD and NT-proBNP to the CHA2DS2-VASc score improved its predictive power for stroke and death, respectively, in this patient cohort. Future prospective studies are warranted to validate the benefit of adding LAD and NT-proBNP to the CHA2DS2-VASc score for predicting stroke and death risk in non-AF populations.展开更多
BACKGROUND Coronary heart disease(CHD)causes many adverse cardiovascular events and poses a threat to the patient’s health and quality of life.AIM To evaluate ultrasonography for evaluation of cardiac function and le...BACKGROUND Coronary heart disease(CHD)causes many adverse cardiovascular events and poses a threat to the patient’s health and quality of life.AIM To evaluate ultrasonography for evaluation of cardiac function and lesion degree in patients with CHD.METHODS A total of 106 patients with CHD(study group)and 106 healthy individuals(control group)in our hospital from March 2019 to September 2020 were selected for this study.All subjects were examined by ultrasound,and the mitral orifice’s early-to-late diastolic blood flow velocity ratio(E/A),left ventricular end-diastolic volume(LVDd),and left atrial diameter(LAD)were measured.Values were compared between the study group and healthy group,and the correlation between the ultrasonic parameters of patients with different cardiac function grades and the degree of CHD were assessed.In addition,the ultrasonic parameters of patients with different prognoses were compared after a follow-up for 6 mo.RESULTS E/A(1.46±0.34)of the study group was smaller than that of the control group(1.88±0.44),while LVDd(58.24±5.05 mm)and LAD(43.31±4.38 mm)were larger(48.15±3.93 and 34.94±2.81,respectively;P<0.05).E/A for patients with grade III disease(1.41±0.43)was smaller and their LVDd(60.04±4.21 mm)and LA(44.16±2.79 mm)were larger than those in patients with grade II disease(1.71±0.48,52.18±3.67 mm,and 39.68±2.37,respectively;P<0.05).Patients with grade IV disease had smaller E/A(1.08±0.39)and larger LVDd(66.81±5.39 mm)and LAD(48.81±3.95 mm)than patients with grade II and III disease(P<0.05).In patients with moderate disease,E/A(1.44±0.41)was smaller and LVDd(59.95±4.14 mm)and LAD(45.15±2.97 mm)were larger than in patients with mild disease(1.69±0.50,51.97±3.88 and 38.81±2.56 mm,respectively;P<0.05).In patients with severe disease,E/A(1.13±0.36)was smaller and LVDd(67.70±6.11 mm)and LAD(49.09±4.05 mm)were larger than in patients with moderate disease(P<0.05).E/A was negatively correlated with cardiac function classi-fication and disease severity,while LVDd and LAD were positively correlated with cardiac function classification and disease severity(P<0.05).E/A(1.83±0.51)for patients with good prognosis was higher than that for those with poor prognosis(1.39±0.32),while LVDd(49.60±4.39 mm)and LAD(36.13±3.05 mm)were lower(P<0.05).CONCLUSION The ultrasonic parameters of patients with CHD are abnormal,and differ significantly in patients with different cardiac function grades,lesion degree,and prognosis.展开更多
Background Tumor necrosis factor-alpha （TNF-a） is a pleiotropic proinflammatory cytokine and contributes to many kinds of cardiovascular diseases via its receptors （TNFR1/TNFR2）. We hypothesize that TNF-a plays a ...Background Tumor necrosis factor-alpha （TNF-a） is a pleiotropic proinflammatory cytokine and contributes to many kinds of cardiovascular diseases via its receptors （TNFR1/TNFR2）. We hypothesize that TNF-a plays a role in the pathogenesis of chronic atrial fibrillation （AF）. Methods Sixty-seven consecutive patients who were scheduled to have cardiac surgery were enrolled into the study. Thirty-one patients with rheumatic heart disease （RHD） and AF were enrolled as study group （AF group）. The sinus rhythm （SR） control groups consisted of 20 patients with RHD and 16 patients with coronary artery disease （CAD）. Peripheral blood sample was collected before the operation. About 5 mm3 left atrial tissue was disserted during the operation and was separated into three parts for Western blotting, real time polymerase chain reaction （RT-PCR） and immunohistochemistry （IHC） analysis. Results Compared with the controls （RHD SR and CAD SR）, the levels of TNF-α （（14.40±5.45） pg/ml vs. （4.20±3.19） pg/ml vs. （2.68±2.20） pg/ml, P=0.000） and its soluble receptor 1 （sTNFR1） （（1623.9±558.6） pg/ml vs. （1222.3±175.6） pg/ml vs. （1387.5±362.2） pg/ml, P=0.001） in plasma were higher in patients with AF. TNF-a level had positive correlation with the left atrial diameter （LAD） （r=0.642, P=0.000）. Western blotting analysis showed that the protein levels of TNF-α （0.618±0.236 vs. 0.234±0.178 vs. 0.180±0.103, P=0.000） were higher in patients with AF. The RT-PCR analysis results demonstrated that the mRNA expression of TNF-a （0.103±0.047 vs. 0.031±0.027 vs. 0.023±0.018, P=0.000） increased in patients with AF. IHC analysis displayed that, comparing to the SR, the expression of TNF-α （0.125±0.025 vs. 0.080±0.027 vs. 0.070±0.023, P=0.000） increased in the AF group. The protein level and mRNA expression of TNF-α also had positive correlation with left atrium diameter （LAD） （r=0.415, P=0.000 and r=0.499, P=0.000）. Conclusions The results revealed that TNF-α elevated in the plasma and left atrial tissue and had positive correlation with LAD in patients of chronic AF. TNF-α miaht involve in the pathogenesis of chronic AF.展开更多
文摘Background The long-term prognostic influence of left atrial diameter （LAD） remodeling on the status of post-radiofrequency catheter ablation （RI CA） atrial fibrillation （AF） is unclear. This study employed a two-stage model from 3-year echocardiographic data to ascertain whether the two-stage model predicts RFCA outcome more favorably than models using the baseline LAD. Methods Data were retrospectively collected from 263 consecutive patients with drug-refractory AF undergoing RFCA. Regular echocardiographic measurements of LAD were performed at baseline, 1, 3, 6, and 12 months and then every 6 months after RFCA. Sex, age, type of AF, number of RFCA, and AF status were recorded. We obtain the actual （predicted） 3-year LAD using a longitudinal linear mixed model （1st stage）. Logistic regression models based on the baseline LAD （Model 1）, actual （predicted） 3-year LAD （Model 2） （2nd stage）, and observed 3-year LAD （Model 3） were constructed to predict RFCA outcome. The area under the receiver operating characteristic curve （AUC） were used to assess the performance of models. Results The lowess smoothed curve indicated that the LAD declined over the first three months and remained stable up to 36 months after RFCA. The degree of LAD reduction was significantly influenced by the baseline LAD. Non-paroxysmal AF, large LAD and female gender were significant predictors of AF recurrence. Model 2 had the largest AUC among the three models. Conclusions This longitudinal study-based two-stage model outperforms the original logistic model using the baseline LAD. Non-paroxysmal AF, larger LAD and female gender are significant predictors of RFCA failure.
基金funded by the National Natural Science Foundation of China (Grant No. 81700398No. 81970309 and No. 81770441)+1 种基金the Natural Science Foundation of Guangdong Province No. 2016A030 313430Nanjing Municipal Healthcare Grant YKK16127。
文摘Background The determinants of pulmonary hypertension(PH)due to heart failure with preserved ejection fraction(HFpEF)have been poorly investigated in patients with cardiovascular diseases(CVD).Methods From July 12017 to March 312019,a total of 149 consecutive HFp EF patients hospitalized with CVD were enrolled in this prospective cross-sectional study.A systolic pulmonary artery pressure(PASP)>35 mm Hg estimated by echocardiography was defined as PH-HFp EF.Logistic regression was performed to establish predictors of PH in HFpEF patients.Results Overall,the mean age of participants was 72±11 years,and 74(49.7%)patients were females.A total of 59(39.6%)patients were diagnosed with PH-HFpEF by echocardiography.The left atrial diameter(LAD)was related to the ratio of the transmitral flow velocities/mitral annulus tissue velocities in early diastole(E/E’)and the left ventricular diameter in systole(LVDs).N-Terminal pro B-type natriuretic peptide(NT-proBNP)was not found to be associated with LAD and impaired diastolic or systolic function of the left ventricle.Multivariable logistic regression showed that atrial fibrillation(AF)increased the risk of PH-HFpEF incidence 3.46-fold with a 95%confidence interval(CI)of 1.44–8.32,P=0.005.Meanwhile,LAD≥45 mm resulted in a 3.43-fold increased risk,95%CI:1.51–7.75,P=0.003.However,the significance levels of NT-proBNP,age and LVEF were underpowered in the regression model.Two variables,AF and LAD≥45 mm,predicted the PH-HFpEF incidence(C-statistic=0.773,95%CI:0.695–0.852,P<0.001).Conclusions Two parameters associated with electrical and anatomical remodelling of the left atrium were related to the incidence of PH in HFpEF patients with CVD.
基金This work was supported by grants from the State Key Program of National Natural Science Foundation of China （No. 81530015）, National Natural Science Foundation of China grant （No. 81270258）, and Shanghai City Committee of Science and Technology Research Projects （Nos. 12411951900, 13140903801, and 14441902502）.
文摘Background： The CHA2DS2-VASc score is used clinically for stroke risk stratification in patients with atrial fibrillation （AF）. We sought to investigate whether the CHA2DS2-VASc score predicts stroke and death in Chinese patients with sick sinus syndrome （SSS） after pacemaker implantation and to evaluate whether the predictive power of the CHA2DS2-VASc score could be improved by combining it with left atrial diameter （LAD） and amino-terminal pro-brain natriuretic peptide （NT-proBNP）. Methods： A total of 481 consecutive patients with SSS who underwent pacemaker implantation from January 2004 to December 2014 in our department were included. The CHA2DS2-VASc scores were retrospectively calculated according to the hospital medical records before pacemaker implantation. The outcome data （stroke and death） were collected by pacemaker follow-up visits and telephonic follow-up until December 3 l, 2015. Results： During 2151 person-years of follow-up, 46 patients （9.6%） suffered stroke and 52 （10.8%） died. The CHA2DS2-VASc score showed a significant association with the development of stroke （hazard ratio [HR] 1.45, 95% confidence interval [CI] 1.20-1.75, P 〈 0.00 1） and death （HR 1.45, 95% CI 1.22-1.71, P 〈 0.001）. The combination of increased LAD and the CHA2DS2-VASc score improved the predictive power for stroke （C-stat 0.69, 95% CI 0.61-4）.77 vs. C-stat 0.66, 95% CI 0.57-0.74, P = 0.013）, and the combination of increased NT-proBNP and the CHA2DS2-VASc score improved the predictive power for death （C-stat 0.70, 95% CI 0.64-0.77 vs. C-stat 0.67, 95% CI 0.60--0.75, P= 0.023）. Conclusions： CHA2DS2-VASc score is valuable for predicting stroke and death risk in patients with SSS after pacemaker implantation. The addition of LAD and NT-proBNP to the CHA2DS2-VASc score improved its predictive power for stroke and death, respectively, in this patient cohort. Future prospective studies are warranted to validate the benefit of adding LAD and NT-proBNP to the CHA2DS2-VASc score for predicting stroke and death risk in non-AF populations.
文摘BACKGROUND Coronary heart disease(CHD)causes many adverse cardiovascular events and poses a threat to the patient’s health and quality of life.AIM To evaluate ultrasonography for evaluation of cardiac function and lesion degree in patients with CHD.METHODS A total of 106 patients with CHD(study group)and 106 healthy individuals(control group)in our hospital from March 2019 to September 2020 were selected for this study.All subjects were examined by ultrasound,and the mitral orifice’s early-to-late diastolic blood flow velocity ratio(E/A),left ventricular end-diastolic volume(LVDd),and left atrial diameter(LAD)were measured.Values were compared between the study group and healthy group,and the correlation between the ultrasonic parameters of patients with different cardiac function grades and the degree of CHD were assessed.In addition,the ultrasonic parameters of patients with different prognoses were compared after a follow-up for 6 mo.RESULTS E/A(1.46±0.34)of the study group was smaller than that of the control group(1.88±0.44),while LVDd(58.24±5.05 mm)and LAD(43.31±4.38 mm)were larger(48.15±3.93 and 34.94±2.81,respectively;P<0.05).E/A for patients with grade III disease(1.41±0.43)was smaller and their LVDd(60.04±4.21 mm)and LA(44.16±2.79 mm)were larger than those in patients with grade II disease(1.71±0.48,52.18±3.67 mm,and 39.68±2.37,respectively;P<0.05).Patients with grade IV disease had smaller E/A(1.08±0.39)and larger LVDd(66.81±5.39 mm)and LAD(48.81±3.95 mm)than patients with grade II and III disease(P<0.05).In patients with moderate disease,E/A(1.44±0.41)was smaller and LVDd(59.95±4.14 mm)and LAD(45.15±2.97 mm)were larger than in patients with mild disease(1.69±0.50,51.97±3.88 and 38.81±2.56 mm,respectively;P<0.05).In patients with severe disease,E/A(1.13±0.36)was smaller and LVDd(67.70±6.11 mm)and LAD(49.09±4.05 mm)were larger than in patients with moderate disease(P<0.05).E/A was negatively correlated with cardiac function classi-fication and disease severity,while LVDd and LAD were positively correlated with cardiac function classification and disease severity(P<0.05).E/A(1.83±0.51)for patients with good prognosis was higher than that for those with poor prognosis(1.39±0.32),while LVDd(49.60±4.39 mm)and LAD(36.13±3.05 mm)were lower(P<0.05).CONCLUSION The ultrasonic parameters of patients with CHD are abnormal,and differ significantly in patients with different cardiac function grades,lesion degree,and prognosis.
基金This work was supported by Province Science and Technological Program of Guangdong （No. 2010B060900018） and Province Natural Science Foundation of Guangdong （No. 1015008002000010）.
文摘Background Tumor necrosis factor-alpha （TNF-a） is a pleiotropic proinflammatory cytokine and contributes to many kinds of cardiovascular diseases via its receptors （TNFR1/TNFR2）. We hypothesize that TNF-a plays a role in the pathogenesis of chronic atrial fibrillation （AF）. Methods Sixty-seven consecutive patients who were scheduled to have cardiac surgery were enrolled into the study. Thirty-one patients with rheumatic heart disease （RHD） and AF were enrolled as study group （AF group）. The sinus rhythm （SR） control groups consisted of 20 patients with RHD and 16 patients with coronary artery disease （CAD）. Peripheral blood sample was collected before the operation. About 5 mm3 left atrial tissue was disserted during the operation and was separated into three parts for Western blotting, real time polymerase chain reaction （RT-PCR） and immunohistochemistry （IHC） analysis. Results Compared with the controls （RHD SR and CAD SR）, the levels of TNF-α （（14.40±5.45） pg/ml vs. （4.20±3.19） pg/ml vs. （2.68±2.20） pg/ml, P=0.000） and its soluble receptor 1 （sTNFR1） （（1623.9±558.6） pg/ml vs. （1222.3±175.6） pg/ml vs. （1387.5±362.2） pg/ml, P=0.001） in plasma were higher in patients with AF. TNF-a level had positive correlation with the left atrial diameter （LAD） （r=0.642, P=0.000）. Western blotting analysis showed that the protein levels of TNF-α （0.618±0.236 vs. 0.234±0.178 vs. 0.180±0.103, P=0.000） were higher in patients with AF. The RT-PCR analysis results demonstrated that the mRNA expression of TNF-a （0.103±0.047 vs. 0.031±0.027 vs. 0.023±0.018, P=0.000） increased in patients with AF. IHC analysis displayed that, comparing to the SR, the expression of TNF-α （0.125±0.025 vs. 0.080±0.027 vs. 0.070±0.023, P=0.000） increased in the AF group. The protein level and mRNA expression of TNF-α also had positive correlation with left atrium diameter （LAD） （r=0.415, P=0.000 and r=0.499, P=0.000）. Conclusions The results revealed that TNF-α elevated in the plasma and left atrial tissue and had positive correlation with LAD in patients of chronic AF. TNF-α miaht involve in the pathogenesis of chronic AF.
