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OptiVol fluid index predicts acute decompensation of heart failure with a high rate of unexplained events

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Journal of Geriatric Cardiology 2013年第3期10卷 253-257页

作者： Xin-Wei Yang Wei Hua li-gang ding Jing Wang li-Hui Zheng Chong-Qiang li Zhi-Min liu Ke-Ping Chen Shu Zhang Center of Arrhythmia Diagnosis and Treatment Fuwai Cardiovascular Hospital Chinese Academy of Medical Sciences Peking Union Medical College No.167 Beilishi Road Xicheng District Beijing 100037 China

Background Intrathoracic impedance monitoring has emerged as a promising new technique for the detection of impending heart failure (HF). Although false positive episodes have been reported in case reports and clinical trials, the efficacy and false positive rate in real-world practice remain unclear. Objective The aim of this study is to investigate the utility and reliability of the OptiVol alert feature in clinical practice. Methods We continuously recruited patients who underwent implantable cardioverter-defibrillator (ICD) or cardiac re-synchronization therapy with defibrillator (CRT-D) implantation with feature of intrathoracic impedance monitoring system in our center from Sep. 2010 to Oct. 2012. Regular in-office follow-up were required of all patients and the following information was collected at each visit: medical history, device interrogation, N-terminal pro-brain natriuretic peptide (NT-proBNP) measurement and an echocardiogram. Worsening HF was defined as hospitalization or the presentation of signs or symptoms of HF. Results Forty three patients (male:76.7%, mean age:57 ± 15 years, left ventricular ejection fraction (LVEF):33%± 14%) were included in this observational study. Fifty four alert events and 14 adjudicated worsening HF were detected within 288 ±163 days follow-up. Eleven (20.4%) alert episodes were associated with acute cardiac decompensation in 9 patients with a positive predictive value of 78.6%. Forty three audible alerts showed no connection to worsening HF. The unexplained alerts rate was 79.6%and 1.27 per person-year. Thirty seven alarm alerts were detected in patients with EFlic function also exhibited considerable alert events. The OptiVol fluid index predicted worsenin

关键词： Heart failure Intrathoracic impedance measurement Left ventricular ejection fraction OptiVol fluid index

High sensitivity C-reactive protein and cardfiac resynchronization therapy in patients with advanced heart failure

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Journal of Geriatric Cardiology 2014年第4期11卷 296-302页

作者： Chi CAI Wei HUA li-gang ding Jing WANG Ke-Ping CHEN Xin-Wei YANG Zhi-Min liU Shu ZHANG Cardiac Arrhythmia Center Fuwai Hospital Beilishi road No. 167 Xicheng district Beijing 100037 China

Background The data on the prognostic values of high sensitivity C-reactive protein （hsCRP） levels in patients with advanced symp-tomatic heart failure （HF） receiving cardiac resynchronization therapy （CRT） are scarce. The aim of present study was to investigate the association of serum hsCRP levels with left ventricle reverse remodeling after six months of CRT as well as long-term outcome. Methods A total of 232 CRT patients were included. The assessment of hsCRP values, clinical status and echocardiographic data were performed at baseline and after six months of CRT. Long-term follow-up included all-cause mortality and hospitalizations for HF. Results During the mean follow-up periods of 31.3 ± 31.5 months, elevated hsCRP （〉3 mg/L） prior to CRT was associated with a significant 2.39-fold increase （P=0.006） in the risk of death or HF hospitalizations. At 6-month follow-up, patients who responded to CRT showed significant reductions or maintained low in hsCRP levels （–0.5 ± 4.1 mg/L reduction） compared with non-responders （1.7 ± 6.1 mg/L increase, P=0.018）. Com-pared with patients in whom 6-month hsCRP levels were reduced or remained low, patients in whom 6-month hsCRP levels were increased or maintained high experienced a significantly higher risk of subsequent death or HF hospitalizations （Log-rank P〈0.001）. The echocardio-graphic improvement was also better among patients in whom 6-month hsCRP levels were reduced or remained low compared to those in whom 6-month hsCRP levels were raised or maintained high. Conclusions Our findings demonstrated that measurement of baseline and follow-up hsCRP levels may be useful as prognostic markers for timely potential risk stratification and subsequent appropriate treatment strategies in patients with advanced HF undergoing CRT.

关键词： Cardiac resynchronization therapy Clinical outcome Heart failure High sensitivity C-reactive protein

Predictors of super-response to cardiac resynchronization therapy： the significance of heart failure medication, pre-implant left ventricular geometry and high percentage of biventricular pacing

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Journal of Geriatric Cardiology 2017年第12期14卷 737-742页

作者： Han JIN Min GU Wei HUA Xiao-Han FAN Hong-Xia NIU li-gang ding Jing WANG Cong XUE Shu ZHANG The Cardiac Arrhythmia Center State Key Laboratory of Cardiovascular Disease Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China

Background Super-responders （SRs） are defined as patients who show crucial cardiac function improvement after cardiac resynchro- nization therapy （CRT）. The purpose of this study is to identify and validate predictors of SRs after CRT. Methods This study enrolled 201 patients who underwent CRT during the period from 2010 to 2014. Clinical and echocardiographic evaluations were conducted before CRT and 6 months after. Patients with a decrease in New York Heart Association （NYHA） fimctional class 〉 1, a decrease in left ventricular end-systolic volume （LVESV） ≥ 15%, and a final left ventricular ejection fraction （LVEF） ≥ 45% were classified as SRs. Results 29% of the 201 patients who underwent CRT were identified as SRs. At baseline, SRs had significantly smaller left atrial diameter （LAD）, LVESV, left ventricular end-diastolic volume （LVEDV） and higher LVEF than the non-super-responders （non-SRs）. The percentage of patients using angiotensin-converting enzyme inhibitors or angiotensin receptor blockers （ACEI/ARB） was higher in SRs than non-SRs. Most SRs had Biventricular （BiV） pacing percentage greater than 98% six months after CRT. In the multivariate logistic regression analysis, the independ- ent predictors of SRs were lower LVEDV [odd ratios （OR）： 0.93; confidence intervals （CI）： 0.90-0.97], use of ACEI/ARB （OR： 0.33; CI： 0.13~3.82） and BiV pacing percentage greater than 98% （OR： 0.29; CI： 0.16~.87）. Conclusion Patients with a better compliance of ACEI/ARB and a less ectatic ventricular geometry before CRT tends to have a greater probability of becoming SRs. Higher percentage of BiV pacing is essential for becoming SRs.

关键词： Biventricular pacing Cardiac resynchronization therapy Heart failure Super-responders

Does ‘super-responder’ patients to cardiac resynchronization therapy still have indications for neuro-hormonal antagonists? Evidence from long-term follow-up in a single center

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Journal of Geriatric Cardiology 2019年第3期16卷 251-258页

作者： Yi-Ran HU Wei HUA Han JIN Min GU Xiao-Han FAN Hong-Xia NIU li-gang ding Jing WANG Shu ZHANG Cardiac Arrhythmia Center State Key Laboratory of Cardiovascular Disease Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College

Background Whether cardiac resynchronization therapy super-responders (CRT-SRs) still have indications for neuro-hormonal antagonists or not remains *** We reviewed clinical data from 376 patients who underwent CRT implantation in Fuwai Hospital from 2009 to 2015 and followed up to ***-SRs were defined by an improvement of the New York Heart Association functional class and left ventricular ejection fraction to ≥ 50% in absolute values at 6-month *** CRT-SRs were assigned into two groups on the basis of whether persistently receiving neuro-hormonal antagonists (NHA)(defined as angiotensin-converting enzyme inhibitors/ angiotensin receptor blockers and β-blockers) after 6-month follow-up and then we compared long-term *** A total of 60 patients met criteria for *** of thirteen (7.7%) CRT-SRs without NHA had all-cause death,which also occurred in 2 of 47 (4.3%) in CRT-SRs with NHA (P = 0.526).However,3 of 13 (23.1%) CRT-SRs without NHA had heart failure (HF) hospitalization,1 of 47 (2.1%) CRT-SRs with NHA had this endpoint (P = 0.040).Besides,subgroup analysis indicated that,for ischemic etiology group,CRT-SRs receiving NHA had considerably lower incidence of HF hospitalization than those without NHA (0 vs.75%,P = 0.014),which was not observed in non-ischemic etiology group (2.6% vs.0,P = 1.000) during long-term *** Our study found that for ischemic etiology,compared with CRT-SRs with NHA,CRT-SRs without NHA were associated with a higher risk of HF ***,for non-ischemic etiology,we found that CRT-SRs with NHA or without NHA at follow-up were associated with similar outcomes,which needed further investigation by prospective trials.

关键词： Cardiac resynchronization therapy Heart failure Super-responder Optimal medical therapy

Cardiac resynchronization therapy improved the clinical outcomes in pacemaker patients upgraded to biventricular device

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Journal of Geriatric Cardiology 2017年第10期14卷 649-651页

作者： Han JIN Wei HUA li-gang ding Jing WANG Hong-Xia NIU Min GU Cong XUE Shu ZHANG The Cardiac Arrhythmia Center Fuwai Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China

The right ventricular pacing （RVP） is the standard treat- ment for patients with severe bradyarrhythmias; however, it may cause and exacerbate heart failure symptoms in a long run under some circumstances.{1] In fact, significant left ventricular （LV） systolic dysfimction and symptomatic heart failure （HF） is commonly found in patient population with pacemaker implantations.

关键词： Cardiac resynchronization therapy Chronic right ventricular pacing Heart failure Upgrade

Machine Learning for Signal Demodulation in Underwater Wireless Optical Communications

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China Communications 2024年第5期21卷 297-313页

作者： Ma Shuai Yang Lei ding Wanying li Hang Zhang Zhongdan Xu Jing li Zongyan Xu gang li Shiyin Department of Strategic and Advanced Interdisciplinary Research Peng Cheng LaboratoryShenzhen 518055China School of Information and Control Engineering China University of Mining and TechnologyXuzhou 221116China Data-driven Intelligent Information System Laboratory Shenzhen Research Institute of Big DataShenzhen 518172China Ocean College Zhejiang UniversityZhoushan 316021China State Key Laboratory of Millimeter Waves Southeast UniversityNanjing 210096China

The underwater wireless optical communication(UWOC)system has gradually become essential to underwater wireless communication *** other existing works on UWOC systems,this paper evaluates the proposed machine learningbased signal demodulation methods through the selfbuilt experimental *** on such a platform,we first construct a real signal dataset with ten modulation ***,we propose a deep belief network(DBN)-based demodulator for feature extraction and multi-class feature *** also design an adaptive boosting(Ada Boost)demodulator as an alternative scheme without feature filtering for multiple modulated ***,it is demonstrated by extensive experimental results that the Ada Boost demodulator significantly outperforms the other *** also reveals that the demodulator accuracy decreases as the modulation order increases for a fixed received optical power.A higher-order modulation may achieve a higher effective transmission rate when the signal-to-noise ratio(SNR)is higher.

关键词： AdaBoost DBN machine learning signal demodulation

Ultrafast Response and Threshold Adjustable Intelligent Thermoelectric Systems for Next‑Generation Self‑Powered Remote IoT Fire Warning

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Nano-Micro Letters 2024年第11期16卷 413-428页

作者： Zhaofu ding gang li Yejun Wang Chunyu Du Zhenqiang Ye lirong liang Long‑Cheng Tang Guangming Chen College of Materials Science and Engineering&College of Civil and Transportation Engineering Shenzhen UniversityShenzhen 518055People’s Republic of China College of Material Chemistry and Chemical EngineeringKey Laboratory of Organosilicon Chemistry and Material Technology of MoEHangzhou Normal UniversityHangzhou 311121People’s Republic of China

Fire warning is vital to human life,economy and ***,the development of effective warning systems faces great challenges of fast response,adjustable threshold and remote ***,we propose an intelligent self-powered remote IoT fire warning system,by employing single-walled carbon nanotube/titanium carbide thermoelectric composite *** flexible films,prepared by a convenient solution mixing,display p-type characteristic with excellent high-temperature stability,flame retardancy and TE(power factor of 239.7±15.8μW m^(-1) K^(-2))*** comprehensive morphology and structural analyses shed light on the underlying *** the assembled TE devices(TEDs)exhibit fast fire warning with adjustable warning threshold voltages(1–10 mV).Excitingly,an ultrafast fire warning response time of~0.1 s at 1 mV threshold voltage is achieved,rivaling many state-of-the-art ***,TE fire warning systems reveal outstanding stability after 50 repeated cycles and desired durability even undergoing 180 days of air ***,a TED-based wireless intelligent fire warning system has been developed by coupling an amplifier,analogto-digital converter and Bluetooth *** combining TE characteristics,high-temperature stability and flame retardancy with wireless IoT signal transmission,TE-based hybrid system developed here is promising for next-generation self-powered remote IoT fire warning applications.

关键词： Thermoelectric Self-powered IoT fire warning Ultrafast response Threshold adjustable

Clinical outcome of cardiac resynchronization therapy in dilated-phase hypertrophic cardiomyopathy

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Journal of Geriatric Cardiology 2017年第4期14卷 238-244页

作者： Min GU Han JIN Wei HUA Xiao-Han FAN Hong-Xia NIU Tao TIAN li-gang ding Jing WANG Cong XUE Shu ZHANG Cardiac Arrhythmia Center State Key Laboratory of Cardiovascular Disease Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China

Backgrounds Clinical trials have demonstrated that cardiac resynchronization therapy （CRT） is effective in patients with ＂non-is- chemic cardiomyopathy＂. However, patients with dilated-phase hypertrophic cardiomyopathy （DHCM） have been generally excluded from such trials. We aimed to compare the clinical outcome of CRT in patients with DHCM, idiopathic dilated cardiomyopathy （IDCM）, or ischemic cardiomyopathy （ICM）. Methods A total of 312 consecutive patients （DHCM： n = 16; IDCM： n = 231; ICM： n = 65） undergoing CRT in Fuwai hospital were studied respectively. Response to CRT was defmed as reduction in left ventricular end-systolic volume （LVESV） _〉 15% at 6-month follow-up. Results Compared with DHCM, IDCM was associated with a lower total mortality （HR： 0.35, 95% CI： 0.13-0.90）, cardiac mortality （HR： 0.29; 95% CI： 0.11-0.77）, and total mortality or heart failure （HF） hospitalizations （HR： 0.34, 95% CI： 0.17-0.69）, independent of known confounders. Compared with DHCM, the total mortality, cardiac mortality and total mortality or HF hospitalizations favored ICM but were not statistically significant （HR： 0.59, 95% CI： 0.22-1.61; HR： 0.59, 95% CI： 0.21-1.63; HR： 0.54, 95% CI： 0.26-1.15; respectively）. Response rate to CRT was lower in the DHCM group than the other two groups although the differences didn＇t reach statistical significance. Conclusions Compared with IDCM, DHCM was associated with a worse outcome after CRT. The clinical outcome of DHCM patients receiving CRT was similar to or even worse than that of ICM patients. These indicate that DHCM behaves very differently after CRT.

关键词： Cardiac resynchronization therapy Dilated-phase hypertrophic cardiomyopathy Idiopathic dilated cardiomyopathy Ischemic cardiomyopathy

nitial Experience with MultiPoint Pacing Cardiac Resynchronization Therapy in China

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Chinese Medical Journal 2016年第10期129卷 1241-1243页

作者： Wei Hua li-gang ding Xiao-Han Fan Zhi-Min liu Chun-Lan Jiang Fu-Jian Qu Shu Zhang Arrhythmia Center Fuwai Hospital Beijing 100037 China Research St. Jude Medical Inc. Sylmar 91342 CA USA

Recently, cardiac resynchronization therapy （CRT） with multipoint left ventricular （LV） pacing in a single coronary sinus branch （MultiPointTM Pacing [MPP], St. Jude Medical, Inc., Sylmar, CA, USA） has been introduced commercially. The CRT system with MPP feature offers a new strategy for physicians to further enhance CRT in patients with heart failure. Early clinical studies have shown that MPP, compared with conventional biventricular （BiV） pacing, provides acute benefits to LV dP/dtmax, LV dyssynchrony, LV peak radial strain, and LV electrical activation, and improves CRT response at 12 months. In this report, we presented two MPP CRT cases in China with acute hemodynamic assessment under various MPP and conventional BiV pacing configurations, demonstrating that MPP can offer further benefits to patients.

关键词： Cardiac Resynchronization Therapy Cardiac Resynchronization Therapy Optimization Heart Failure MultiPoint Pacing Hemodynamic Benefit