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Science Bulletin 2019年第13期64卷 877-878页

作者： Yiran Hu Wei Hua The cardiac Arrhythmia center State Key Laboratory of Cardiovascular Disease National Clinical Research Center of Cardiovascular Diseases Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College

The first permanent implanted pacemaker was successfully used in clinical practice in 1958. In the past 60 years, the development of pacemakers has been witnessed in clinical application [1]. Early pacemakers were large and cumbersome, and had a short battery life, providing only a single-chamber asynchronous pacing (VOO) pacing mode. In 1967, on-demand pacemakers with synchronous pacing (WI) mode just came out. The emergence of the first dual chamber pacemaker in 1977 symbolized the entry into the physiologic pacing era. In 1982, pacemakers began to provide rate adaptive functions. In this age of accelerating development in scientific technologies and clinical researches, pacemakers have evolved into implantable cardioverter-defibrillators for the treatment of sudden cardiac death and cardiac resynchronization therapy for chronic heart failure, instead of simply being an electronic device that treats bradycardia by pulsing the heart (Fig. 1)[2,3].

关键词： symbiotic pacemaker self-powered cardiac implanted electronic device

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

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

The influence of metabolic syndrome on atrial fibrillation recurrence: five-year outcomes after a single cryoballoon ablation procedure

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Journal of Geriatric Cardiology 2021年第12期18卷 1019-1028页

作者： Yu XIA Xiao-Feng LI Jun LIU Miao YU Pi-Hua FANG Shu ZHANG State Key Laboratory of cardiovascular Disease Cardiac Arrhythmia CenterFuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina

BACKGROUND Metabolic syndrome(MetS)has been reported as a risk factor of atrial fibrillation(AF)recurrence after radi-ofrequency catheter *** study aimed to investigate the long-term influence of MetS on paroxysmal AF recurrence after a single cryoballoon ablation procedure,which was scarcely investigated yet in Chinese *** In total,137 paroxysmal AF patients who had successfully completed a single cryoballoon ablation procedure at Fuwai Hospital,Beijing,China from December 2013 to October 2015 were *** for patients with AF recurrence,all patients were followed up for no less than five *** predictors of AF recurrence were determined by Cox propor-tional hazards regression *** Among 137 paroxysmal AF patients,91 patients(66.4%)had successfully achieved overall five-year follow-up after a single cryoballoon ablation procedure,and 44 patients(32.1%)had *** with MetS had a significant lower incidence of freedom from AF recurrence than those without MetS(50.0%vs.74.2%,log-rank P<0.01)during the five-year ***(HR=1.95,95%CI:1.069−3.551,P=0.030)was an independent predictor of AF recurrence after adjusting for multiple *** the second year post cryoballoon ablation procedure,the recurrence rate of AF gradually increased in patients with MetS,in con-trast,decreased recurrence rate of AF in patients without *** MetS is an independent predictor for five-year AF recurrence after a single cryoballoon ablation procedure in paroxysmal AF *** therapy of AF and MetS may improve the long-term outcomes of AF patients.

关键词： balloon fibrillation atrial

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

Contemporary Patterns of Management of Tetralogy of Fallot:Data from a Single center in China

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Congenital Heart Disease 2021年第1期16卷 53-64页

作者： Xianchao Jiang Jinyang Liu Bo Peng Heng Zhang Shoujun Li Jun Yan Qiang Wang center for Pediatric cardiac Surgery Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina Department of cardiac Surgery Yunnan Fuwai Cardiovascular HospitalKunmingChina

Background:There is scarce research on large cohorts with tetralogy of Fallot(TOF)from *** database in Fuwai Hospital was reviewed to ascertain current trends in the management of TOF and to determine the prevalence of various surgical techniques and the optimal early ***:This cross-sectional study included 1861 patients who underwent surgery between 2012 and 2017 and were aged 0-18 years old with a primary diagnosis of TOF.A total of 1760 eligible patients were included in the ***:A total of 1683 patients underwent repair of TOF as a one-stage operation(primary repair).Sixty-one patients underwent repair of TOF after prior *** patients who underwent one-stage repair(n=1683):858 were 6 months to 1 year old,421 were 1 to 2 years old,251 were 2-18 years old,and 145 were 3 to 6 months *** patients who underwent repair following prior palliation(n=61),58(95.1%)were older than 1 year of *** 1744 complete repairs,986(56.0%)had annulus-sparing(AS)*** in-hospital mortality was 15 of 1744(0.9%)for complete repair(including one-stage and staged repairs).The total incidence of the optimal early outcome was 78.2%in terms of a composite of the absence of death in the first year,significant right ventricular outflow tract obstruction,significant pulmonary valve insufficiency,or catheter or surgical ***:Surgical correction in patients with TOF can achieve an acceptable outcome in terms of death and *** repair at 6 months to 1 year of age is the most prevalent strategy in our ***,the relatively high incidence of early undesirable surgical adequacy of the pulmonary valve(PV)represents a wake-up call.

关键词： Tetralogy of Fallot chinese contemporary patterns of management cross-sectional study

The value of serum metabolomics analysis in predicting the response to cardiac resynchronization therapy

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Journal of Geriatric Cardiology 2019年第7期16卷 529-539,I0001-I0004页

作者： Meng-Ruo ZHU Zibire Fulati Yang LIU Wen-Shuo WANG Qian WU Yan-Gang SU Hai-Yan CHEN Xian-Hong SHU Department of Echocardiography Zhongshan HospitalFudan UniversityShanghai Institute of Cardiovascular DiseasesShanghaiChina Department of Cardiology Zhongshan HospitalFudan UniversityShanghai Institute of Cardiovascular DiseasesShanghaiChina Department of cardiac Surgery Zhongshan HospitalFudan UniversityShanghai Institute of Cardiovascular DiseasesShanghaiChina Shanghai center for Bioinformation Technology ShanghaiChina

Objective To construct a prediction model based on metabolic profiling for predicting the response to cardiac resynchronization therapy(CRT).Methods Peripheral venous(PV)and coronary sinus(CS)blood samples were collected from 25 patients with heart failure(HF)at the time of CRT implantation,and PV blood samples were obtained from ten healthy *** serum samples were analyzed by liquid chromatography-mass spectrometry(LC-MS).As per the clinical and echocardiographic assessment at the 6-month follow-up,the HF patients were categorized as CRT responders and *** HF patients had altered serum metabolomic profiles that were significantly different from those of the healthy *** metabolites were also observed between CRT responders and non-responders.A prediction model for CRT response(CRT-Re)was constructed using the concentration levels of the differential metabolites,L-arginine and *** optimal cutoff value of the CRT-Re model was found to be 0.343 by ROC analysis(sensitivity,88.2%;specificity,87.5%;Area under curve(AUC)=0.897,P=0.002).The concentration levels of the differential metabolites,L-arginine and lysyl-gamma-glutamate,in PV serum were significantly correlated with that in CS serum(r=0.945 and 0.680,respectively,all P<0.001).Conclusions Our results suggest that serum-based metabolic profiling may be a potential complementary screening tool for predicting the outcome of CRT.

关键词： Biomarker cardiac resynchronization therapy Heart failure Metabolomics Serum

Impact of Smoking Status on Lipoprotein Subfractions： Data from an Untreated Chinese Cohort

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Biomedical and Environmental Sciences 2017年第4期30卷 235-243页

作者： ZHAO Xi ZHANG Hui Wen ZHANG Yan LI Sha XU Rui Xia SUN Jing ZHU Cheng Gang WU Na Qiong GAO Ying GUO Yuan Lin LIU Geng DONG Qian LI Jian Jun division of Dyslipidemia State Key Laboratory of Cardiovascular DiseaseFu Wai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical SciencesPeking Union Medical College

Objective Cigarette smoking is one of the established risk factors of atherosclerotic cardiovascular disease, however, its impact on lipids is not completely understood, especially in the Chinese population. Therefore, this study evaluated the impact of smoking status （non, former, and current smoking） on the distribution of lipoprotein subfractions in untreated patients with angina-like chest pain. Methods A total of 877 patients were consecutively enrolled and divided into nonsmoking （n = 528）, former smoking （n = 103）, and current smoking （n = 256） groups. Both low- and high-density lipoprotein cholesterol （LDL-C and HDL-C） subfractions were measured using the Quantimetrix Lipoprint System. The distributions of lipoprotein subfractions were evaluated among the groups. Results Compared with nonsmoking subjects, the current smoking group had significantly lower large/medium HDL-C （both P 〈 0.001） concentration and large HDL subfraction percentage but higher small HDL-C and medium LDL-C concentrations as well as medium LDL subfraction percentage. Importantly, former smoking subjects showed elevated levels of large HDL-C concentration, large HDL particle percentage, and mean LDL particle size and attenuation in small HDL/LDL percentages and small LDL-C concentration, but these levels did not reach the optimal status compared with those of the non-smoking group （data not shown）. Conclusion Smoking has an adverse impact on the lipoprotein subfractions, presented as lower large HDL particles besides higher small HDL and medium LDL particles, whereas smoking cessation could reverse these change to a certain degree.

关键词： Smoking Smoking cessation Lipoprotein subfractions Chinese

Long-term outcome of percutaneous or surgical revascularization with and without prior stroke in patients with threevessel disease

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Journal of Geriatric Cardiology 2022年第8期19卷 583-593页

作者： Na XU Ce ZHANG Lin JIANG Jing-Jing XU Ru LIU Ying SONG Xue-Yan ZHAO Lian-Jun XU Run-Lin GAO Bo XU Jin-Qing YUAN Lei SONG center for Coronary Heart Disease National Clinical Research Center for Cardiovascular DiseasesNational Center for Cardiovascular DiseasesState Key Laboratory of Cardiovascular DiseaseFuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina

OBJECTIVE To determine whether high-risk patients with three-vessel disease(TVD)with and without prior stroke preferen-tially benefit from three strategies[percutaneous coronary intervention(PCI),coronary artery bypass grafting(CABG)and medical therapy(MT)].METHODS A total of 8943 patients with TVD were included in the *** enrolled were stratified into two categories according to the presence or absence of prior stroke *** primary endpoint was all-cause *** endpoints in-cluded stroke and major adverse cardiac and cerebrovascular event(MACCE),a composite of death,myocardial infarction(MI),unplanned revascularization and *** Prior stroke was present in 888 patients(9.9%).These patients were older and had higher rates of ***-ring a median follow-up of 7.5 years,patients with prior stroke were strongly associated with increased risks of all-cause death,cardiac death,stroke and MACCE,even after adjusting for confounding variables and results been consistent across either treat-ment subgroup(PCI,CABG and MT)(all adjusted P<0.01).Notably,there was a significant interaction between prior stroke his-tory and treatment *** strategy(PCI or CABG)was associated with a lower incidence of all-cause death and MACCE compared with MT alone,and favorable rates of MACCE,MI and unplanned revascularization in the CABG group compared with the PCI group,but with similar rate of all-cause death regardless of prior stroke *** prevalence of stroke was significantly higher after CABG when compared with PCI or MT in no prior stroke patients[hazard ratio(HR)=1.429,95%CI:1.132-1.805 for CABG ***;HR=1.703,95%CI:1.371-2.116 for CABG ***].CONCLUSIONS Patients with TVD and prior stroke have poor clinical *** is essential to balance benefit and risk when determining the optimal treatment strategy for TVD with and without prior stroke.

关键词： patients prior founding

Association of invasive treatment and lower mortality of patients ≥ 80 years with acute myocardial infarction: a propensity-matched analysis

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Journal of Geriatric Cardiology 2018年第11期15卷 666-674页

作者： Shuo-Lin LIU Na-Qiong WU Meng ZHANG Jing-Lu JIN Bing-Yang ZHOU Qian DONG Jian-Jun LI division of Dyslipidemia 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

Objective To investigate whether invasive strategy was associated with lower mortality in Chinese patients ≥ 80 years with acute myocardial infarction (AMI). Methods We used retrospective data from our center between 2013 and 2017. During a median of 17.4 (interquartile range: 7.3–32.3) months follow-up, 120 deaths were recorded among 514 consecutive patients ≥ 80 years with AMI. The patients were divided into two groups: invasive treatment group (IT group, n = 269) and conservative treatment group (CT group, n = 245), which were also then compared with propensity score matching. Results High mortality was found in CT group compared with that in the IT one. Cox proportional hazard regression analysis showed that invasive treatment was associated with lower mortality of patients ≥ 80 years. Moreover, the results revealed that the patients in IT group had lower in-hospital mortality (3.35% vs. 9.39%, P = 0.005). Besides, the Kaplan-Meier analysis revealed that the mortality was significantly lower in IT group compared with that in CT group using entire and propensity-matched cohort analysis (P < 0.001, respectively). Conclusions Our data suggested that IT appeared to be associated with lower mortality in Chinese patients ≥ 80 years with AMI, which consists with previous studies in spite of either ST elevated myocardial infarction (STEMI) or non-STEMI (NSTEMI) patients.

关键词： Mortality Myocardial infarction Percutaneous coronary intervention The elderly