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Development and validation of a model integrating clinical and coronary lesion-based functional assessment for longterm risk prediction in PCI patients

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Journal of Geriatric Cardiology 2024年第1期21卷 44-63页

作者： Shao-Yu WU Rui ZHANG Sheng YUAN Zhong-Xing CAI Chang-Dong GUAN Tong-Qiang ZOU Li-Hua XIE Ke-Fei DOU State Key Laboratory of Cardiovascular Disease BeijingChina Cardiometabolic Medicine Center Fu Wai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina Catheterization Laboratories Fu Wai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina Department of Cardiology Fu Wai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina

OBJECTIVES To establish a scoring system combining the ACEF score and the quantitative blood flow ratio(QFR) to improve the long-term risk prediction of patients undergoing percutaneous coronary intervention(PCI).METHODS In this population-based cohort study, a total of 46 features, including patient clinical and coronary lesion characteristics, were assessed for analysis through machine learning models. The ACEF-QFR scoring system was developed using 1263consecutive cases of CAD patients after PCI in PANDA Ⅲ trial database. The newly developed score was then validated on the other remaining 542 patients in the cohort.RESULTS In both the Random Forest Model and the Deep Surv Model, age, renal function(creatinine), cardiac function(LVEF)and post-PCI coronary physiological index(QFR) were identified and confirmed to be significant predictive factors for 2-year adverse cardiac events. The ACEF-QFR score was constructed based on the developmental dataset and computed as age(years)/EF(%) + 1(if creatinine ≥ 2.0 mg/d L) + 1(if post-PCI QFR ≤ 0.92). The performance of the ACEF-QFR scoring system was preliminarily evaluated in the developmental dataset, and then further explored in the validation dataset. The ACEF-QFR score showed superior discrimination(C-statistic = 0.651;95% CI: 0.611-0.691, P further validated by multivariable Cox regression and Kaplan–Meier analysis(adjusted HR = 1.89;95% CI: 1.18–3.04;log-rank P functional variables(ACEF-QFR)was developed, and its ability for prognostic prediction in patients with PCI was further validated to be significantly better than the post-PCI physiological

关键词： patients coronary prediction

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Adult endothelial progenitor cells from human peripheral blood maintain monocyte/macrophage function throughout in vitro culture

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Cell Research 2006年第6期16卷 577-584页

作者： Shi Ju Zhang~1 Hao Zhang~1 Ying Jie Wei~1 Wen Jun Su~1 Zhong Kai Liao~1 Mai Hou~1 Jian Ye Zhou~1 Sheng Shou Hu~1 Research Center for Cardiovascular Regenerative Medicine,Ministry of Health,and Department of Cardiovascular Surgery,Cardiovascular Institute and fu-wai hospital,PUMC and CAMS,167 Beilishi Road.West District,Beijing 10003 7 China and Department of Cardiovascular Surgery Research Center for Cardiovascular Regenerative Medicine Ministry of Health Cardiovascular Institute and Fu-Wai Hospital PUMC and CAMS 167 Beilishi Road West District Beijing China

Mononuclear cells(MNCs)isolated from peripheral blood by density gradient centrifugation were plated on humanfibronectin-coated culture plates and cultured in EGM-2 medium.Attached spindle-shaped cells,reported as endothelialprogenitor cells(EPCs)by some investigators,had elongated from adherent round cells,but had not proliferated froma small number of cells as supposed previously.The growth curve of the primary EPCs showed that the cells had littleproliferative capacity.Flow cytometry analysis showed that the cells could express some of the endothelial lineage mark-ers,while they could also express CD14,which is considered a marker of monocyte/macrophage lineages throughoutculture.In endothelial function assays,the cells demonstrated a lower level of expression of eNOS than mature endothelialcells in the reverse transcription-polymerase chain reaction and did not show an ability to develop tube-like structuresin angiogenesis assay in vitro.In this study,we identified the monocytoid function of EPCs by the combined Dil-labeledacetylated low-density lipoprotein(Dil-Ac-LDL)and Indian ink uptake tests.All the cells were double positive for Dil-Ac-LDL and Indian ink uptake at days 4,14 and 28 of culture,which means the EPCs maintained monocytoid functionthroughout the culture,Therefore,although adult EPCs from peripheral MNCs have some endothelial lineage properties,they maintain typical monocytic function and have little proliferative capacity.

关键词： mononuclear ceils endothelial progenitor cells endothelial cells monocyte/macrophages

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function of chymase in the heart angiotensin Ⅱ formation in transgenic mice

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Chinese Science Bulletin 2001年第11期46卷 922-925页

作者： LI Peng & CHEN LanyingCardiovascular Institute & fu wai hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China Cardiovascular Institute & fu wai hospital Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China

The myosin light chain 2 promoter-human heart chymase (MLC2-hChymase) transgenic mice founded by our laboratory were used as the model to study the function of chymase in the heart angiotension Ⅱ (Ang Ⅱ) formation and heart remodeling. Tissue-specific expression of human heart chymase gene and transcriptional expression of type Ⅰ and type Ⅲ collagens genes were analyzed by RT-PCR. Activities of chymase, ACE and the levels of Ang Ⅱ in heart and plasma were determined with radioimmunoas-say (RIA) kit. Activity of heart matrix metalloproteinase-9 (MMP-9) was detected using gelatin zymography. The cardiac hypertrophic phenotypes were also observed with the physiological and morphological methods. The results in the MLC2-hChymase transgenic mice indicated: ( i ) human heart chymase gene was expressed specially in the heart; (u) heart chymase activity increased markedly in the transgenic mice vs non-transgenic mice (control) (0.27±0.07 U/mg vs. 0.15±0.02 U/mg, P<0.05) with no significant difference in

关键词： chymase transgenic mice angiotensin Ⅱ heart remod- eling collagen.

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Determination of the optimal atrioventricular and interventricular delays in cardiac resynchronization therapy

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Journal of Geriatric Cardiology 2005年第4期2卷 207-210页

作者： Hongxia NIU Wei HUA Shu ZHANG Fangzheng WANG Keping CHEN Xin CHEN Division of Clinical Electrophysiology Fu Wai Hospital and Cardiovascular Institute CAMS and PUMC Beijing 100037 China Division of Clinical Electrophysiology Fu Wai Hospital and Cardiovascular Institute CAMS and PUMC Beijing 100037 China Division of Clinical Electrophysiology Fu Wai Hospital and Cardiovascular Institute CAMS and PUMC Beijing 100037 China Division of Clinical Electrophysiology Fu Wai Hospital and Cardiovascular Institute CAMS and PUMC Beijing 100037 China Division of Clinical Electrophysiology Fu Wai Hospital and Cardiovascular Institute CAMS and PUMC Beijing 100037 China Division of Clinical Electrophysiology Fu Wai Hospital and Cardiovascular Institute CAMS and PUMC Beijing 100037 China

In order to provide the maximum benefit of cardiac resynchronization therapy (CRT), we tried to use an echocardiography method to optimize the atrioventricular and interventricular delay. Methods The study included 6 patients who underwent implantation of biventricular pacemakers for drug-resistant heart failure. Two-dimensional echocardiography and tissue Doppler imaging were carried out before and after the pacemaker implantation. The optimal AV delay was defined as the AV delay resulting in maximum timevelocity integral (TVI) of transmitral filling flow, the longest left ventricular filling time (LVFT) and the minimum mitral regurgitation(MR). The optimal VV delay was defined as the VV delay producing the maximum LV synchrony and the largest aortic TVI. Results CRT was successfully performed in all patients. After pacemaker implantation, an acute improvement in left ventricular ejection fraction (LVEF) was observed from 26.5% to 35%. Meanwhile, the QRS duration decreased from 170ms to 150ms. The optimal AV delay was programmed at 130, 120, 120, 120, 150 and 110ms respectively with heart rate corrected, LVFT significantly lengthened and TVI of MR decreased (non-optimal vs optimal AV delay: LVFT: 469ms vs 523ms; TVI of MR: 16.43cm vs 13.06cm, P＜0.05). The optimal VV delay was programmed at 4, 4, 4, 8, 12 and 8ms with LV preactivation respectively. Programming the optimal VV delay increased the aortic TVI from 17.33cm up to 21.42cm (P＜0.05). In the septal and lateral wall, peak systolic velocities improved from2.70cm/s to 3.02cm/s (P＞0.05) and froml.31cm/s to 2.50cm/s (P＜0.05) respectively. The septal-to-lateral delay in peak velocity improved from 56.4ms to 13.3ms after CRT (P＜0.01). Conclusions Optimization of AV and VV delays may further enhance the efficacy of CRT. However, there was interindividual variability of optimal values, warranting individual patient examination.

关键词： cardiac resynchronization therapy optimal atrioventricular delay optimal interventricular delay tissue Doppler imaging

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functional remodeling of Ca^(2+)-activated Cl^-channel in pacing induced canine failing heart

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Journal of Geriatric Cardiology 2008年第3期5卷 169-174页

作者： Ning Li,~1 Kejuan Ma,~2 Siyong Teng,~2 Jonathan C.Makielski,~3 Jielin Pu~(1,2) 1. Research Center for Pathology and Physiology, fu wai Cardiovascular hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China 2. Center for Arrhythmia Diagnosis and Treatment, fu wai Cardiovascular hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China 3. Department of Cardiology, University of wisconsin, Madison 53706, USA Research Center for Pathology and Physiology Fu Wai Cardiovascular Hospital Chinese Academy of Medical Sciences Beijing 100037 China Center for Arrhythmia Diagnosis and Treatment Fu Wai Cardiovascular Hospital Chinese Academy of Medical Sciences Beijing 100037 China Department of Cardiology University of Wisconsin Madison WI 53706 United States

To determine whether Ca2+ activated Cl-current (ICl（Ca）) contributes to the functional remodeling of the failing heart. Methods Whole cell patch-clamp recording technique was employed to record the ICl（Ca） in cardiac myocytes enzymatically isolated from rapidly pacing induced canine failing hearts at room temperature and compared that of the normal hearts （Nor）.Results The current density of DIDS （200M） sensitive ICl（Ca） induced by intracellular Ca2+ release trigged by L-type Ca2+ current (ICa,L) was significantly decreased in heart failare （HF） cells compared to Nor cells.At membrane voltage of 20mV,the ICl（Ca） density was 3.02±0. 54 pA/pF in Nor （n=6） vs.1.31±0.25 pA/pF in HF （n=8） cells,（PCa,L density did not show difference between two groups.The time constant of current decay of ICl（Ca） was similar in both types of cells.On the other hand,in intra cellular Ca2+ clamped mode,where the [Ca2+]i was maintained at 100nmol/L,ICl（Ca） density be increased significantly in HF cells when the membrane voltage at +30mV or higher.Conclusions Our results suggest that ICl（Ca） density was decreased in pacing induced failing heart but the channel function be enhanced.Impaired Ca2+ handing in HF cells rather than reduced ICl（Ca） channel function itself may have caused this abnormality.The ICl（Ca） density reduction might contribute to the prolongation of action potential in failing heart.The ICl（Ca） channel function up-regulation is likely to cause cardiac arrhythmia by inducing a delayed after depolarization,when Ca2+ overload occurred in diastolic failing heart cells.

关键词： heart failure cardiac arrhythmia Ca2+-activated Cl-channel

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Mechanical stretch induces mitochondria-dependent apoptosis in neonatal rat cardiomyocytes and G2/M accumulation in cardiac fibroblasts

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Cell Research 2004年第1期14卷 16-26页

作者： Xu Dong LIAO~(1,2), Xiao Hui WANG~1, Hai Jing JIN~1, Lan Ying CHEN~(2,*), Quan CHEN~(1,*) ~1Laboratory of Apoptosis and Cancer Biology, State Key Laboratory of Biomembrane and Membrane Biotechnology, Chinese Academy of Sciences, Beijing 100080, China. ~2Cardiovascular Institute and fu wai hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100037, China. Laboratory of Apoptosis and Cancer Biology State Key Laboratory of Biomembrane and Membrane Biotechnology Chinese Academy of Sciences Beijing China Cardiovascular Institute and fu wai hospital Peking Union Medical College and Chinese Academy of Medical Sciences Beijing China

Heart remodeling is associated with the loss of cardiomyocytes and increase of fibrous tissue owing to abnormal mechanical load in a number of heart disease conditions. In present study, a well-described in vitro sustained stretch model was employed to study mechanical stretch-induced responses in both neonatal cardiomyocytes and cardiac fibroblasts. Cardiomyocytes, but not cardiac fibroblasts, underwent mitochondria-dependent apoptosis as evidenced by cytochrome c (cyto c) and Smac/DIABLO release from mitochondria into cytosol accompanied by mitochondrial membrane potential (△ψ_m) reduction, indicative of mitochondrial permeability transition pore (PTP) opening. Cyclosporin A, an inhibitor of PTP, inhibited stretch-induced cyto c release, △ψ_m reduction and apoptosis, suggesting an important role of mitochondrial PTP in stretch-induced apoptosis. The stretch also resulted in increased expression of the pro-apoptotic Bcl-2 family proteins, including Bax and Bad, in cardiomyocytes, but not in fibrobl

关键词： apoptosis mechanical stretch Bcl-2 and its family proteins mitochondria cardiomyocyte.

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Effect of cytochrome P4502C19(CYP2C19)gene polymorphism and clopidogrel reactivity on long term prognosis of patients with coronary heart disease after PCI

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Journal of Geriatric Cardiology 2024年第1期21卷 90-103页

作者： Cheng-Yan HU Yan-Ling WANG Zhen-Xing FAN Xi-Peng SUN Shuai WANG Zhi LIU Department of Geriatrics Fu Xing HospitalCapital Medical UniversityBeijingChina Department of Cardiology Xuanwu Hospital Capital Medical UniversityBeijingChina Emergency Department of Xuanwu hospital Capital Medical UniversityBeijingChina

Objective To investigate the impact of CYP2C19 gene polymorphism on clopidogrel reactivity and its association with longterm clinical outcome in patients with coronary heart disease(CHD)undergoing percutaneous coronary intervention(PCI).Methods In total,675 patients were enrolled.Based on the platelet inhibition rate,patients were categorized into two groups:clopidogrel low responsiveness(CLR)and normal clopidogrel responsiveness(NCR).The CLR group was divided into ticagrelor and clopidogrel group based on the antiplatelet drugs used in the follow-up treatment.Patients were classified into three groups(normal metabolizer,intermediate metabolizer,and poor metabolizer)based on the CYP2C19 genotype.We aimed to evaluate the impact of CYP2C19 gene polymorphism on clopidogrel reactivity.The cumulative rates of 12-month all-cause deaths,major adverse cardiovascular events(MACCEs),and bleeding events were calculated.Results CLR was observed in 44.4%of the overall population.Significant differences were observed in the platelet inhibition rate of clopidogrel among the three metabolic genotypes(P0.05).Conclusions Low response to clopidogrel in CHD patients is correlated with CYP2C19 gene polymorphism.CYP2C19 genotyping combined with platelet reactivity is an independent predictor of 12-months MACCEs in patients with clopidogrel treatment after PCI,which is better than either test alone.

关键词： CYP2C19 drugs PCI

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Post-fontan circulation hepatocellular carcinoma:Open and laparoscopic hepatectomy

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Hepatobiliary & Pancreatic Diseases International 2024年第1期23卷 90-93页

作者： Karin KY Ho Wong Hoi She Simon HY Tsang Kevin S Lo Tan To Cheung Department of Surgery The University of Hong Kong102 Pok Fu Lam RoadHong KongChina Department of Anaesthesiology Queen Mary Hospital102 Pok Fu Lam RoadHong KongChina

To the Editor:Fontan-associated liver disease shows increasing incidence as advances in pediatric cardiology have prolonged life expectancy in patients with single ventricle congenital heart defects[1].Their unique physiology and procedure-related sequelae present an increasingly relevant challenge in hepatic surgery.We hereby reported a series of patients suffering from hepatocellular carcinoma(HCC)who successfully underwent open and laparoscopic hepatectomy.

关键词： hepatocellular hepatectomy surgery

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Hemodynamic improvement by right ventricular septal pacing in elderly patients with chronic atrial fibrillation and slow ventricular response

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Journal of Geriatric Cardiology 2005年第2期2卷 103-106页

作者： Wei HUA Shidong GUO Shu ZHANG Fangzheng WANG Lida ZHI Hongxia NIU Xin CHEN Division of Clinical Electrophysiology Fu Wai Hospital and Cardiovascular Institute Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100037 China Division of Clinical Electrophysiology Fu Wai Hospital and Cardiovascular Institute Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100037 China Division of Clinical Electrophysiology Fu Wai Hospital and Cardiovascular Institute Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100037 China Division of Clinical Electrophysiology Fu Wai Hospital and Cardiovascular Institute Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100037 China Division of Clinical Electrophysiology Fu Wai Hospital and Cardiovascular Institute Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100037 China Division of Clinical Electrophysiology Fu Wai Hospital and Cardiovascular Institute Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100037 China Division of Clinical Electrophysiology Fu Wai Hospital and Cardiovascular Institute Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100037 China

Background and objectives Right ventricular apical (RVA) pacing has been reported impairing left ventricular (LV)performance. Alternative pacing sites in right ventricle (RV) has been explored to obtain better cardiac function. Our study was designed to compare the hemodynamic effects of right ventricular septal (RVS) pacing with RVA pacing. Methods Ten elderly patients with chronic atrial fibrillation (AF) and long RR interval or slow ventricular response (VR) received VVI pacing. The hemodynamic difference between RVS and RVA pacing were examined by transthoracic echocardiography (TTE). Results Pacing leads were implanted successfully at the RVA and then RVS in all patients without complication. The left ventricular (LV) parameters,measured during RVA pacing including left ventricular ejection fraction (LVEF), FS, stroke volume (SV) and peak E wave velocity (EV) were decreased significantly compared to baseline data, while during RVS pacing, they were significantly better than those during RVA pacing. However, after 3-6 weeks there was no statistical significant difference between pre- and post- RVS pacing.Conclusions The LV hemodynamic parameters during RVA pacing were significantly worse than baseline data. The short term LV hemodynamic parameters of RVS pacing were significantly better than those of RVA pacing; RVS pacing could improve the hemodynamic effect through maintaining normal ventricular activation sequence and biventricular contraction synchrony in patients with chronic AF and slow ventricular response.

关键词： cardiac pacing, right ventricular septal, hemodynamics, echocardiography

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Cardiac resynchronization therapy in China

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Journal of Geriatric Cardiology 2006年第4期3卷 248-249页

作者： Wei HUA Department of Cardiac Electrophysiology Fu Wai Hospital Chinese Academy of Medical Sciences Beijing 100037 China

　　Congestive heart failure (HF) is a major and growing public health problem. The therapeutic approach includes non-pharmacological measures, pharmacological therapy,mechanical devices, and surgery. Despite the benefits of optimal pharmacologic therapy, the prognosis is still not ideal. At this time, cardiac resynchronization therapy (CRT)has gained wide acceptance as an alternative treatment for HF patients with conduction delay.1……

关键词： CRT AHA ACC CHF Cardiac resynchronization therapy in China

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