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Oral anti-coagulants use in Chinese hospitalized patients with atrial fibrillation

Chinese Medical Journal 2024年第2期137卷 172-180页

作者： Jing Lin Deyong Long Chenxi Jiang Caihua Sang Ribo Tang Songnan Li Wei Wang Xueyuan Guo Man Ning Zhaoqing Sun Na Yang Yongchen Hao Jun Liu Jing Liu Xin Du Louise Morgan Gregg C.Fonarow Sidney C.Smith Jr Gregory Y.H.Lip dong Zhao jianzeng dong Changsheng Ma On behalf of CCC-AF investigators Department of Cardiology Beijing Anzhen HospitalCapital Medical UniversityBeijing 100029China National Clinical Research Center for Cardiovascular Diseases Beijing 100029 China Department of Epidemiology Beijing Anzhen HospitalCapital Medical UniversityBeijing Institute of HeartLung and Blood Vessel DiseasesBeijing 100029China International Quality Improvement Department American Heart AssociationDallasTX 07076USA Division of Cardiology Geffen School of Medicine at University of CaliforniaLos Angeles CA 90024USA Division of Cardiology University of North CarolinaChapel HillNC 27599USA Department of Cardiology Liverpool Centre for Cardiovascular ScienceUniversity of Liverpool and Liverpool Heart&Chest HospitalLiverpool L143PEUK Department of Clinical Medicine Aalborg UniversityAalborg 9000Denmark 不详

Background:Oral anti-coagulants(OAC)are the intervention for the prevention of stroke,which consistently improve clinical outcomes and survival among patients with atrial fibrillation(AF).The main purpose of this study is to identify problems in OAC utilization among hospitalized patients with AF in China.Methods:Using data from the Improving Care for Cardiovascular Disease in China-Atrial Fibrillation(CCC-AF)registry,guideline-recommended OAC use in eligible patients was assessed.Results:A total of 52,530 patients with non-valvular AF were enrolled from February 2015 to December 2019,of whom 38,203 were at a high risk of stroke,9717 were at a moderate risk,and 4610 were at a low risk.On admission,only 20.0%(6075/30,420)of patients with a diagnosed AF and a high risk of stroke were taking OAC.The use of pre-hospital OAC on admission was associated with a lower risk of new-onset ischemic stroke/transient ischemic attack among the diagnosed AF population(adjusted odds ratio:0.54,95%confidence interval:0.43-0.68;P70%of AF patients were at a high risk of stroke.Although poor performance on guideline-recommended OAC use was found in this study,over time the CCC-AF project has made progress in stroke prevention in the Chinese AF population.Registration:ClinicalTrials.gov,NCT02309398.

关键词： Atrial fibrillation Oral anti-coagulants OAC Stroke prevention Contraindication

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ABC-AF-Stroke score predicts thromboembolism in nonanticoagulated patients following successful atrial fibrillation ablation: a report from the Chinese Atrial Fibrillation Registry

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Chinese Medical Journal 2023年第20期136卷 2451-2458页

作者： Yufeng Wang Chao Jiang Liu He Xin Du Xueyuan Guo Ribo Tang Caihua Sang Deyong Long jianzeng dong Ziad Hijazi Gregory YHLip Changsheng Ma Department of Cardiology Beijing Anzhen HospitalCapital Medical UniversityNational Clinical Research Centre for Cardiovascular DiseasesBeijing 100029China Heart Health Research Center Beijing 100029China The George Institute for Global Health Faculty of MedicineUniversity of New South WalesSydneyNSWAustralia Department of Cardiology The First Affiliated Hospital of Zhengzhou UniversityZhengzhou UniversityZhengzhouHenan 450052China Department of Medical Sciences CardiologyUppsala UniversityUppsalaSweden Uppsala Clinical Research Center Uppsala UniversityUppsalaSweden Liverpool Centre for Cardiovascular Science Liverpool Heart and Chest HospitalUniversity of LiverpoolLiverpoolUK

Background:The age,biomarkers,and clinical history(ABC)-atrial fibrillation(AF)-Stroke score have been proposed to refine stroke risk stratification,beyond what clinical risk scores such as the CHA2DS2-VASc score can offer.This study aimed to identify risk factors associated with thromboembolism and evaluate the performance of the ABC-AF-Stroke score in predicting thromboembolism in non-anticoagulated AF patients following successful ablations.Methods:A total of 2692 patients who underwent successful ablations with discontinued anticoagulation after a 3-month blanking period in the Chinese Atrial Fibrillation Registry(CAFR)between 2013 and 2019 were included.Cox regression analysis was conducted to present the association of risk factors with thromboembolism risk.The ABC-AF-Stroke score was evaluated in terms of discrimination,including concordance index(C-index),net reclassification improvement(NRI)and integrated discrimination improvement(IDI),clinical utilization by decision curve analysis(DCA),and calibration by comparing the predicted risk with the observed annualized event rate.Results:After a median follow-up of 3.5 years,64 patients experienced thromboembolism events.Age,prior history of stroke/transient ischemic attack(TIA),high-sensitivity cardiac troponin T(cTnT-hs),and N-terminal pro-B-type natriuretic peptide(NT-proBNP)were independently associated with thromboembolism risk.The ABC-AF-Stroke score performed statistically significantly better than the CHA2DS2-VASc score in terms of C-index(0.67,95%confidence interval[CI]:0.59-0.74 vs.0.60,95%CI:0.52-0.67,P=0.030)and reclassification capacity.The DCA implied that the ABC-AF-Stroke score could identify more thromboembolism events without increasing the false positive rate compared to the CHA2DS2-VASc score.The calibration curve showed that the ABC-AF-Stroke score was well calibrated in this population.Conclusions:In this real-world study enrolling non-anticoagulated AF patients following successful ablations,age,prior history of stroke/TIA,level of NT-p

关键词： Atrial fibrillation ABC-AF-Stroke score CHAS2DS2-VASc Thromboembolism Catheter ablation

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Comparison of Segmentation Algorithms for Detecting Myocardial Infarction Using Late Gadolinium Enhancement Magnetic Resonance Imaging

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Cardiovascular Innovations and Applications 2020年第4期5卷 89-95页

作者： Yibo Sun dongdong Deng Liping Sun Yi He Hui Wang jianzeng dong Department of Cardiology The First Affi liated Hospital of Zhengzhou UniversityZhengzhouHenanChina School of Biomedical Engineering Dalian University of TechnologyDalianLiaoningChina Department of Cardiology Beijing Anzhen HospitalCapital Medical University and National Clinical Research Center for Cardiovascular DiseasesBeijingChina Department of Cardiology Beijing Friendship HospitalCapital Medical UniversityBeijingChina

Objective:The aim of this study was to validate the accuracy of a new automatic method for scar segmentation and compare its performance with that of two other frequently used segmentation algorithms.Methods:Twenty-six late gadolinium enhancement cardiovascular magnetic resonance images of diseased hearts were segmented by the full width at half maximum(FWHM)method,the n standard deviations(n SD)method,and our new automatic method.The results of the three methods were compared with the consensus ground truth obtained by manual segmentation of the ventricular boundaries.Results:Our automatic method yielded the highest Dice score and the lowest volume difference compared with the consensus ground truth segmentation.The n SD method produced large variations in the Dice score and the volume difference.The FWHM method yielded the lowest Dice score and the greatest volume difference compared with the automatic,6SD,and 8SD methods,but resulted in less variation when different observers segmented the images.Conclusion:The automatic method introduced in this study is highly reproducible and objective.Because it requires no manual intervention,it may be useful for processing large datasets produced in clinical applications.

关键词： magnetic resonance imaging myocardial infarction automatic method

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Dyssynchrony Induced by Ventricular Preexcitation: A Risk Factor for the Development of Dilated Cardiomyopathy

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Cardiovascular Innovations and Applications 2020年第3期5卷 9-18页

作者： Chencheng Dai Baojing Guo Ling Han Caihua Sang jianzeng dong Changsheng Ma Department of Pediatric Cardiology Beijing Anzhen HospitalCapital Medical UniversityNo.2 Anzhen Road100029 BeijingChina Department of Cardiology Beijing Anzhen HospitalCapital Medical UniversityNo.2 Anzhen Road100029 BeijingChina

Background:Signifi cant left ventricular dysfunction may arise in right-sided accessory pathways with ventricular preexcitation in the absence of recurrent or incessant tachycardia.This has just been realized and not enough attention has been paid to it.Methods:In the last 7 years,we identifi ed 12 consecutive children with a diagnosis of ventricular preexcitation–induced dilated cardiomyopathy.This report describes the clinical and echocardiographic characteristics of the patients before and after ablation.Results:Dyssynchronous ventricular contraction was observed by M-mode echocardiography and two-dimensional strain analysis in all patients.The basal and middle segments of the interventricular septum became thin and moved similarly to an aneurysm,with typical bulging during the end of systole.The locations of the accessory pathways were the right-sided septum(n=5)and the free wall(n=7).Left ventricular synchrony was obtained shortly after ablation.The left ventricular function recovered to normal and the left ventricular end-diastolic diameter decreased gradually during follow-up.Conclusions:A causal relationship between ventricular preexcitation and the development of dilated cardiomyopathy is supported by the complete recovery of left ventricular function and reversed left ventricular remodeling after the loss of ventricular preexcitation.Preexcitation-related dyssynchrony was thought to be the crucial mechanism.Ventricular preexcitation–induced dilated cardiomyopathy is an indication for ablation with a good prognosis.

关键词： ventricular preexcitation accessory pathway Wolff-Parkinson-White syndrome dyssynchrony dilated cardiomyopathy

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In Memoriam:C.Richard Conti,MD(1934–2022),Founding Editor-in-Chief of Cardiovascular Innovations and Applications

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Cardiovascular Innovations and Applications 2022年第2期6卷 195-195页

作者： jianzeng dong Dayi Hu Cardiovascular Innovations and Applications

In February 2022,we were deeply shocked and sad-dened to hear of the death of Dr C.Richard Conti,a legendary cardiovascular educator,researcher,and Co-Editor-in-Chief of Cardiovascular Innovations and Applications.Dr Conti was a fi rst-class editor who led CVIA with great commitment.The Editorial Board members wish to express their great sad-ness about the passing of Dr Conti;his enthusias-tic and passionate work for the journal will not be forgotten.

关键词： editor journal passing

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Identifi cation of Novel TTN Mutations in Three Chinese Familial Dilated Cardiomyopathy Pedigrees by Whole Exome Sequencing

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Cardiovascular Innovations and Applications 2020年第2期4卷 229-237页

作者： Ying Peng Jinxin Miao Yafei Zhai Guangming Fang Chuchu Wang Yaohe Wang Xiaoyan Zhao jianzeng dong Department of Cardiology The First Affi liated HospitalZhengzhou UniversityZhengzhouHenan 450052P.R.China Academy of Chinese Medical Sciences Henan University of Chinese MedicineZhengzhouHenan 450046P.R.China College of Life Sciences Zhengzhou UniversityZhengzhouHenan 450000P.R.China Sino-British Research Center for Molecular Oncology National Center for the International Research in Cell and Gene TherapySchool of Basic SciencesAcademy of Medical SciencesZhengzhou UniversityZhengzhouHenan 450052P.R.China Beijing Anzhen Hospital Capital Medical UniversityBeijing 100029China

Familial dilated cardiomyopathy(DCM)is associated with numerous genes,especially those of the sarcomere family.The titin gene(TTN)consists of 365 exons and encodes the largest sarcomere protein(titin)in our bodies.Titin is associated with many diseases,such as hypertrophic cardiomyopathy and DCM.Here we screened three Chinese families affected by DCM,and found that each harbors a stop-gain or splice site mutation in TTN(c.G20137T,c.G52522T,c.44610-2A>C).Assessment of the probands by electrocardiogram,B-mode echocardiography,and cardiac magnetic resonance imaging revealed impaired cardiac function,arrhythmia,or abnormal cardiac structure.In conclusion,using whole exome sequencing,we found three unreported TTN mutations associated with DCM.This has expanded the TTN mutation spectrum of Chinese DCM patients,especially in Henan,the most populous province.These data provide new genetic targets for the diagnosis and treatment of DCM,and will increase our understanding of the relationship between TTN mutation and DCM clinical symptoms.

关键词： TTN mutations DCM heart failure

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Identifi cation of Three FBN1 Mutations in Chinese Patients with Typical or Incomplete Marfan Syndrome by Whole-Exome Sequencing

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Cardiovascular Innovations and Applications 2020年第3期5卷 19-26页

作者： Guangming Fang Jinxin Miao Ying Peng Yafei Zhai Chuchu Wang Xiaoyan Zhao Yaohe Wang jianzeng dong Department of Cardiology The First Affi liated HospitalZhengzhou UniversityZhengzhouHenan 450052P.R.China Academy of Chinese Medical Sciences Henan University of Chinese MedicineZhengzhouHenan 450046P.R.China College of Life Sciences Zhengzhou UniversityZhengzhouHenan 450000P.R.China Sino-British Research Center for Molecular Oncology National Center for the International Research in Cell and Gene TherapySchool of Basic SciencesAcademy of Medical SciencesZhengzhou UniversityZhengzhouHenan 450052P.R.China Beijing Anzhen Hospital Capital Medical UniversityBeijing 100029P.R.China

Objective:The purpose of this work was to obtain the phenotypes and detect potential mutations in three Chinese patients with Marfan syndrome(MFS)or incomplete MFS phenotypes.Methods:Three unrelated patients with a defi nite or suspected clinical diagnosis of MFS and their family members were recruited for research.Genomic DNA was extracted from peripheral blood of these patients and their family members.All the exons were sequenced by next-generation sequencing and the variants were further validated by Sanger sequencing.The functional consequences of the mutations were analyzed with various genomic resources and bioinformatics tools.Results:Three FBN1 mutations were identifi ed in the three patients,including one novel mutation(2125G>A)and two previously reported mutations(4786C>T and 6325C>T).It was interesting to note that the parents of these patients were normal as assessed by clinical features or genetic testing,but all these mutations were detected in their offspring,except for the variant 6325C>T.We also found that a few young members of the family of probands(proband 1 and proband 2)have exhibited no manifestations of MFS so far,although they carry the same disease-causing mutation.Conclusions:We found three FBN1 mutations in three unrelated Chinese families with MFS by genome sequencing,and the relationship between genotypes and phenotypes in MFS patients needs further exploration.

关键词： Marfan syndrome FBN1 Whole-exome sequencing

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Discovery of Digenic Mutation, KCNH2 c.1898A > C and JUP c.916dupA, in a Chinese Family with Long QT Syndrome via Whole-Exome Sequencing

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Cardiovascular Innovations and Applications 2020年第2期4卷 257-267页

作者： Yafei Zhai Jinxin Miao Ying Peng Guangming Fang Chuchu Wang Yaohe Wang Xiaoyan Zhao jianzeng dong Department of Cardiology The First Affi liated HospitalZhengzhou UniversityZhengzhouHenan 450052P.R.China Academy of Chinese Medical Sciences Henan University of Chinese MedicineZhengzhouHenan 450046P.R.China College of Life Sciences Zhengzhou UniversityZhengzhouHenan 450000P.R.China Sino-British Research Center for Molecular Oncology National Center for the International Research in Cell and Gene TherapySchool of Basic SciencesAcademy of Medical SciencesZhengzhou UniversityZhengzhouHenan 450052P.R.China Beijing Anzhen Hospital Capital Medical UniversityBeijingChina

Long QT syndrome(LQTS),which is caused by an ion channel–related gene mutation,is a malignant heart disease with a clinical course of a high incidence of ventricular fi brillation and sudden cardiac death in the young.Mutations in KCNH2(which encodes potassium voltage-gated channel subfamily H member 2)are responsible for LQTS in many patients.Here we report the novel mutation c.1898A>C in KCNH2 in a Chinese family with LQTS through whole-exome sequencing.The c.916dupA mutation in JUP(which encodes junction plakoglobin)is also discovered.Mutations in JUP were found to be associated with arrhythmogenic right ventricular cardiomyopathy.The double mutation in the proband may help explain his severe clinical manifestations,such as sudden cardiac death at an early age.Sequencing for the proband’s family members revealed that the KCNH2 mutation descends from his paternal line,while the mutation in JUP came from his maternal line.The data provided in this study may help expand the spectrum of LQTS-related KCNH2 mutations and add support to the genetic diagnosis and counseling of families affected by malignant arrhythmias.

关键词： Long QT syndrome(LQTS) Digenic mutation KCNH2 JUP

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采用可穿戴设备连续光电容积脉搏波算法检测心房颤动的临床价值

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中华心血管病杂志 2024年第5期52卷 513-518页

作者：李起帆左嵩赖一炜李思彤桑才华杜昕董建增马长生首都医科大学附属北京安贞医院心内科北京100029

目的评估连续光电容积脉搏波算法应用于可穿戴设备时,检出心房颤动(房颤)和评估房颤负荷的准确性。方法本研究是一项自身对照的前瞻性队列研究,连续纳入2022年9至11月于首都医科大学附属北京安贞医院心内科住院治疗的254例房颤患者。所... 详细信息

目的评估连续光电容积脉搏波算法应用于可穿戴设备时,检出心房颤动(房颤)和评估房颤负荷的准确性。方法本研究是一项自身对照的前瞻性队列研究,连续纳入2022年9至11月于首都医科大学附属北京安贞医院心内科住院治疗的254例房颤患者。所有受试者同时佩戴2种设备:(1)心电手表,用于采集光电容积脉搏波(W-PPG)和心电图(W-ECG);(2)心电贴,用于采集心电图(P-ECG)。分别以30 s数据片段和受试者个体为单位,将心电手表得出的测量结果与心电图专家判读心电贴结果相对比,采用受试者工作特征曲线评估其敏感度和特异度。按照房颤负荷比例均分为4个分段,计算由房颤分析软件得出的房颤负荷与心电图专家判别心电贴结果得出的房颤负荷差值。结果254例受试者的年龄为(63.04±11.04)岁,99例(38.98%)为女性,持续性房颤患者97例(38.19%)。以心电图专家判读心电贴的结果为标准,以片段为单位时,P-ECG算法的敏感度为94.86%(95%CI:94.81%~94.91%),特异度为99.30%(95%CI:99.28%~99.31%),W-PPG算法的敏感度为96.07%(95%CI:95.97%~96.18%),特异度为98.62%(95%CI:98.59%~98.65%);以个体为单位时,P-ECG算法的敏感度为92.55%(95%CI:87.57%~95.71%),特异度为96.39%(95%CI:93.45%~98.09%),W-PPG算法的敏感度为93.71%(95%CI:88.75%~96.67%),特异度为89.62%(95%CI:85.61%~92.65%);以单次采集W-ECG记录为单位时,W-ECG算法的敏感度为92.04%(95%CI:88.14%~94.78%),特异度为96.19%(95%CI:94.35%~97.47%)。房颤负荷评估方面,各负荷分布区间内W-PPG分析结果与心电图专家判读心电贴结果相差均小于2%。结论连续PPG算法应用于可穿戴设备检测房颤是一种可行策略。以心电图专家判读心电贴的结果为标准,通过智能手表连续监测PPG对于房颤诊断具有较高的准确性,同时也可有效地完成房颤负荷评估。

关键词：心房颤动心房颤动负荷光电容积脉搏波心电图智能手表可穿戴设备算法连续监测

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The Temporal Relation between Cardiomyopathy and LBBB and Response to Cardiac Resynchronization Therapy:Case Series and Literature Review

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Cardiovascular Innovations and Applications 2020年第1期4卷 163-172页

作者： Sanshuai Chang Yi He Hui Wang Fei Guo Qiang Lv Junping Kang Rong Bai Xiaohui Liu Xin Du Changsheng Ma jianzeng dong Department of Cardiology Beijing AnZhen HospitalCapital Medical UniversityNational Clinical Research Centre for Cardiovascular DiseasesBeijingChina Department of Radiology Beijing AnZhen HospitalCapital Medical UniversityNational Clinical Research Centre for Cardiovascular DiseasesBeijingChina

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.

关键词： left bundle branch block cardiomyopathy heart failure cardiovascular magnetic resonance cardiac resynchronization therapy

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