简介：Wolff-Parkinson-White(WPW)syndromeisacongenitaldisorderofcardiacconductionsystemcharacterizedbyelectrocardiographicpreexcitationandepisodesofparoxysmalsupraventriculartachycardia.Itiscausedbyacardiacdevelopmentaldefectintheelectricalinsulationbetweentheatriaandtheventriclesduetothepresenceofanaccessorypathway.WPWsyndromeisacommoncauseofsupraventriculartachycardiawithbenignprognosis.However,thisclinicalentityalsopredisposespatientstoanincreasedriskofsuddencardiacdeath,especiallyinthesettingofpreexcitedatrialfibrillation.WPWsyndromeisusuallysporadicandofunknownetiologyinmostcases.Duringthepast10years,asignificantheritablefactorisincreasinglyrecognized.IdentificationofthegeneticbasisamongpatientswithWPWsyndromehasimportantimplicationsforunderstandingthemolecularmechanismofventricularpreexcitationandthedevelopmentoftherapeuticstrategiesforriskstratificationandmanagement.Thegoalofthisreviewistoexaminethepreviousstudiesonhereditaryvariants,aswellastooutlinepotentialfutureavenuestowarddefiningtheheritabilityofWPWsyndrome.

简介：Takotsubosyndrome(TTS)isarecentlyidentifiedacuteheartsyndrome,characterizedbyregionalwallmotionabnormalitiesnotjustifiedbythepresenceofsignificantcoronaryarteryobstruction.Clinically,TTScloselyresemblesacutecoronarysyndromes(ACS)andthereforedifferentialdiagnosismaybeanimportantobstacleforitscorrectclinicalmanagement.TheprevalenceofTTSisestimatedtobearound2%ofacutemyocardialinfarctions,andthenumberofdiagnoseshasincreasedinrecentyears,possiblyreflectingourgrowingunderstandingofthiscondition.GiventhesimilaritiesbetweenTTSandACS,clinicalpresentationinthesepatientsisequivocal.However,numerouspeculiartraitshavebeenobserved,suchasthegreaterprevalenceinpostmenopausalwomenandthepresenceofstressfultriggers.ManypathogenetichypothesesforTTS,suchascatecholamineoverloadandmicrovasculardysfunction,havebeenproposed.Noneofthesehavebeencapableofindependentlyexplainingtheunderlyingmechanisms.ThediagnosticcriteriaproposedbytheHeartFailureAssociationoftheEuropeanSocietyofCardiologyrepresentanovelattempttointroducesemiquantitativeparameters,yetfurtherscientificvalidationisneeded.Contrarytopreviousopinions,TTSisnotalwaysbenign,consideringtherelativelyhighprevalenceofacutecomplications,anestimatedin-hospitalmortalitysimilartothatofacutemyocardialinfarction(1-8%),andasignificantrateofrecurrencesandpersistenceofsymptoms.ClinicalmanagementofTTShasbeenlargelybasedonempiricalexperiencerelatedtoACS,andthereforepharmacologicalstrategiesarepartiallyoverlapping.Anissueoftheutmostimportanceisthelackofrandomizedprospectivedatavalidatingdiagnosticcriteria,riskstratification,andspecifictherapeuticapproaches.

简介：PatientswithAcuteCoronarySyndrome(ACS)areaclinicalcontinuum-withpatientspresentingwithunstableanginaononeend,withpatientswithSTelevationmyocardialinfarction(STEMI)attheotherendofthespectrum.Inbetweenarethosewithnon-ST

简介：Theetiologyofvasoplegicsyndrome(VS)isnotcompletelyelucidatedandtheclinicalimportanceremainsspeculative.MethodsTwenty-fourpatientswhounderwentcoronaryarterybypassgraftinganddevelopedVSwerecomparedwith48controlpatientswithoutVSina2:1casecontrolstudy.Casesandcontrolswerematchedbygender,age(±5yearsold)andoperationdate(±1week).ResultsTheindependentpredictorsofVSwerelowerejectionfraction(OR10.75,95%CI2.93-39.44,whenLVEF<0.45)anddiureticuse(OR8.98,95%CI2.59-31.10)inlogisticregressionanalysis.Conclusionlowerejectionfraction(<0.45)anddiureticuseareindependentriskfactorsforVSoccurrence.

简介：Toevaluatetheeffectofatrovastatintherapyonborderlinevulnerablelesionsinpatientswithacutecoronarysyndrome(ACS).MethodsPatientswithACSunderwentcoronaryangiography(CAG)andintravascularultrasound(IVUS)investigation.Patientswithculpritvulnerableborderlinelesionswereenrolled.Nocoronaryinter-ventionwasperformedontheselesions.Allthepatientsreceivedatrovastatintherapyfor12monthsandunderwentclin-icalfollow-upalongwithIVUSfollow-up.Crosssectionarea(CSA)ofthetargetedlesion,CSAofthereferencearter-ies(extraelasticmembrane),minimallumenCSA,andplaqueareaweremeasuredatbaselineandfollow-ups.Ad-verseeventsincludedrecurrentangina,recurrentmyocardialinfarction,revascularizationanddeath.ResultsNoad-verseeventswasreportedduringfollow-upperiod.Comparedwithbaselinedata,thelevelofApoBdecreasedsignifi-cantlyattheendofthestudy(0.589±0.136g/Lvs0.681±0.132g/L,P=0.03).Boththepercentdiametersteno-sisandthepercentareastenosisdetectedbyCAGdisplayedminimalchange((62.50±10.21)%vs(54.79±12.35)%,P=0.48and(58.61±8.36)%vs(48.18+10.56)%,P=0.78).DetectedbyIVUS,theminimallu-minalCSAofthetargetedlesionincreasedsignificantly(6.32±2.42mm2vs5.63±2.51mm2,P<0.01),theplaqueareaandCSAstenosisdecreased(7.70±2.19mm2vs8.17±2.55mm2,P<0.05and56.94±8.47%vs61.4±110.34%,P<0.01).Atotalof25softplaques(50%)transformedintofibrousplaque.ConclusionsAtro-vastatintherapystabilizesborderlinevulnerableplaqueandreversesatherosclerosisprogressioninpatientswithACS.

简介：Furtherunderstandingofthepathphophisyology,advanceofthediagnosisinstrumentandrenovationoftheriskdelaminationstandardcanofferbettertherapyevidenceforthenon-ST-segmentelevationacutecoronarysyndrome(NSTE-ACS).Drugs,suchastrigeminyantiplateletdrug,prasugrel,fondaparinuxandbivalirudin,havebroughtgreatclinicaleffecttothehighriskpatients.SincetheresultoftheICTUStestannouncedandthedrugelutingballoondeveloped,wehavereachedthenewestrecognitionofhowtoselectachanceforinterventionandhowtopreventandcuretherestenosisofin-stent.

简介：Acutecoronarysyndrome(ACS)isthemaincauseofdeathworldwideandtheleadingcauseofdiseaseburdeninhigh-incomecountries.ACSreferstoaconstellationofclinicalsymptomsthatarecompatiblewithacutemyocardialischemia.Itdescribesaspectrumofclinicalmanifestationsthatresultfromacommonpathophysiologicalprocess.ThemostcommoncauseofACSareruptureofanatheroscleroticlesioncontainingalargenecroticcoreandathinfibrouscapfollowedbyacuteluminalthrombosis.Itwasthoughtthatahigh-resolutionimagingmodalitywouldbeidealtodetecthigh-riskplaquesbeforetheirdisruptionandtheformationofanocclusivethrombus.Opticalcoherencetomographyhasproventobeaninvaluabletoolinearlydetectionofhigh-riskplaquesandparticularlyintheunderstandingofACS.ThisreviewfocusesonthecurrentevidencefortheroleofopticalcoherencetomographyinthediagnosisandtreatmentofpatientswithACS.

简介：Objective:Toevaluatetheeffectofmultidisciplinarycollaborativecare(MCC)inpatientswithbothacutecoronarysyndrome(ACS)anddepressionand/oranxietydisorderscomparedwithusualphysiciancare(UPC).Methods:Depressionand/oranxietywerescreenedbyusingSDSandSAS,ACSpatientswithdepressionand/oranxietydisorderswererandomizedintoMCCandUPCgroups.Thecardiacoutcomesandthelifequalitywereevaluatedat1yearfollow-up.Results:Overall,30.19%(96/318)patientshadpositivescreenresults.At1year,CardiacoutcomemeasuresforpatientsinMCCgroupweresignificantlybetterforcompositeeventsofcardiacdeathandnon-fatalMI(6.12%vs23.40%,p=0.016),cardiacfunction(NYHAfunctionalclassificationIIIorIV,0%vs25%,p=0.05),andanginapectoris(21.28%vs85%,p<0.0005),thanpatientsinUPCgroup;thelifequalitywereimprovedinpatientsinMCCgroup.Conclusion:AfterACS,30.19%ofpatientshaddepressionand/oranxietydisorders,MCChadbettereffectsoncardiacoutcomesandqualityoflifeinACSpatientswithPsychiatricdisorders.

简介：

简介：BackgroundThrombocytopeniaisacommoncomplicationofIABP.Untilnow,thereisnounifiedconclusionsabouttheincidence,characteristics,riskfactorsandtheprognosisofIABPrelatedthrombocytopenia.MethodsInthisstudy,thedataofpatientswithACSundergoingPCIandIABPwereretrospectivelyanalyzed.Allenrolledpatientsweredividedintothrombocytopeniagroupandnon-thrombocytopeniagroupaccordingtotheoccurrenceofthrombocytopeniaafterinsertionofIABP.Thebaselinedataofthetwogroupswerecompared,andthepossibleriskfactorsofthrombocytopeniaandtheirimpactonprognosiswereanalyzedbychi-squaretestandlogisticregressionanalysis.ResultsSixty-twopatientswereenrolledinthisstudy.TherateofIABPassociatedthrombocytopeniawas25.8%(16/62)ofallpatients.OlderagewasanindependentriskfactorofIABPassociatedthrombocytopenia(OR:3.625;95%confidenceinterval:1.016-12.935;P=0.047).TheincidenceofTIMIbleedingeventswashigherinthrombocytopeniagroup[75.0%(12/16)vs.43.5%(20/46),P=0.042].Therateofin-hospitaldeathwassimilarbetweenthetwogroups[18.8%(3/16)vs.17.4%(8/46),P=1.0].ConclusionIABPassociatedthrombocytopeniaoccursin25.8%ofpatientswithACSundergoingPCIandcorrelateswithincreasedTIMIbleedingevents.OlderagemaypredictIABPassociatedthrombocytopenia.

简介：ObjectiveToobservetheeffectofaccessorypathway(AP)conductiononPJintervalinpatientswithWolff-Parkinson-Whitesyndrome.Methods129patientswithasinglemanifestationofAPwhounderwentsuccessfulradiofrequencyablation(RFCA)wereincluded.Patientsweredividedinto10groupsaccordingtoAPlocation.ThePRintervals,QRSdurationsandthePJintervalsweremeasuredusingsimultaneous12-leadECGbeforeandafterablation.ThePJintervalsbeforeablationwerecomparedwiththatafterablation.Theatrioventricular(AV)conductiontimeviaatrioventricularnode-HisconductionsystembeforeablationwerecomparedwiththePRintervalsafterablation.Theventriculardepolarizationtimeviaatrioventricularnode-HisconductionsystembeforeablationwerecomparedwiththeQRSdurationsafterablation.Deltawaveswerecomparedbetweeneachtwogroups.Results(1)ThePJintervalsofrightposterior(RP)groupandrightposteroseptal(RPS)groupbeforeablationwereshorterthanthatafterablation(RPgroup226±18msvs236±19ms,P<0.01,RPSgroup221±18msvs238±31ms,P<0.05,respectively).(2)Therewerenosignificantdifferencesbetweentheatrioventricular(AV)conductiontimeviaatrioventricularnode-HisconductionsystembeforeablationandthePRintervalsafterablation.(3)Theventriculardepolarizationtimeviaatrioventricularnode-HisconductionsystemofRPgroupandRPSgroupbeforeablationwereshorterthanthePRintervalsafterablation(RPgroup79±12msvs87±9ms,P=0.01;RPSgroup70±13msvs86±9ms,P<0.05,respectively).(4)ThedeltawavesofRPgroupandRPSgroupwerelongerthanthatofleftposteriorgroupandleftposteroseptalgroup(P<0.05).ConclusionPJintervalisshortenedbyAPconductionwhichpre-excitesthegenerallastexcitedpartofleftventricle.ItisdeterminedbyAPlocationandtheextentofpreexcitation.

简介：BackgroundSeveralstudieshavereportedanassociationofhyperglycemiawithincreasedmortalityandcomplicationsinhospitalpatientswithacutecoronarysyndrome(ACS).However,theinfluenceofstresshyperglycemia(SH)onthemedium-andlong-termprognosesinACSpatientshasnotyetbeendetermined.MethodsRandomvenousbloodglucoselevelsweredeterminedin433ACSpatientsandthepatientsweredividedintotwogroupsbasedonbloodglucoseresultsanddiseasehistories.The171patientsincludedintheexperimentalgrouphadnohistoryofdiabetes,hadnodiabetesand/orglucosemetabolismdisordersduringhospitalizationandfollow-upandhadfastingbloodglucoselevelsof≥7.0mmol/Landrandombloodglucoselevels≥11.1mmol/L.The262patientsincludedinthecontrolgrouphadnohistoryofdiabetes,hadnodiabetesand/orglucosemetabolismdisordersduringhospitalizationandfollow-up,andhadfastingbloodglucoselevels<6.1mmol/Landrandombloodglucoselevels<7.8mmol/L.Basicclinicalinformation,coronaryangiographiclesioncharacteristics,PCIsuccessrate,complicationrate,incidenceandmorbidityrateofcardiovasculareventsduringthehospitalizationperiodand6yearsoffollow-upwerecomparedbetweenthetwogroups.ResultsTherewasnosignificantdifferenceinage,genderordiseasehistorybetweenthetwogroups.Thetriglyceridelevelsandtheleftventricularejectionfractionsweresignificantlyhigher(P=0.00)andsignificantlylower(P=0.03)intheexperimentalgroupthaninthecontrolgroup,respectively.BothgroupsweresubjectedtocoronaryangiographyandPCI.ThePCIsuccessratesofthetwogroupsdidnotdiffersignificantly(P=0.63).TheexperimentalgrouphadmoretypeB2lesions,butfewertypeAlesionscomparedwiththecontrolgroup.Theexperimentalgrouphadsignificantlymorestentsimplantedcomparedwiththecontrolgroup(P<0.05).Thecardiovasculareventsweresignificantlyincreased(P=0.01)intheexperimentalgroupcomparedwiththecontrolgroup1yearafterdischarge.Thein

简介：BackgroundPreviousstudieshaveimplicatedastronglinkbetweencirculatingplasmaresistinandcoronaryarterydisease(CAD).Theaimofthisstudywastoinvestigatewhetherresistinelevationpredictsworseoutcomeofstent-placementinacutecoronarysyndrome(ACS)patients.MethodsTotally126ACSparticipantswhowereeligibleforstent-placementwereenrolledfor2years'follow-upbymonitoringclinicalendpointsoccurringviaoutpatientvisitsor/andtelephonecall.Baselinecharacteristicswerecollected.Allparticipantsweredividedintolowresistingroup(<3.464μg/mL)andhighresistingroup(>3.464μg/mL).Clinicalendpointsintermsofmajoradversecardiovascularevents(MACE),cardiovasculardeath,non-fatalmyocardialinfarction,ischemicstroke,andcoronaryrevascularization(CR)werecompared.ResultsPatientswithstenosisinthreevesselspresentedmorefrequentlyinhighresistingroupthaninlowresistingroup(35.6%vs.48.3%,P=0.001).IncidencesofMACEandCRweresignificantlyhigherinhighresistingroupthanthoseinlowresistingroup(31.6%vs.18.8%,P=0.018);15%vs.7.58%,P=0.006).ConclusionsInpatientswithbaselineresistinelevation,theincidenceofMACEissignificantlyincreasedafterstent-placement.

简介：ObjectivesTostudythephenotypeofaChinaLQTfamilyandinvestigatetherelationshipofphenotypeandgene.MethodsTheclinicalmaterialswereanalyzedandgenemutationswerescreenedbysequencing.ResultsAdistinctivebiphasicTwavepatternwasshownintheleftprecordialleadsofallpatients.TheLQT2relatedHERGgeneAla561Valmutationwasfound.ConclusionsAprolongedQTintervalaccompaniedbiphasicTwaveindicatesHERGmutation.

简介：Acuteaorticsyndromeincludesclassicaorticdissection,aorticintramuralhematoma,andpenetratingatheroscleroticulcer–agroupofconditionsthataredefinedbytheirdynamicevolutionandsimilarclinicalmanifestation.Accuratediagnosisandprompttreatmentareessentialasalltheaforementionedconditionsareasignificantthreattoapatient’slife.However,acuteaorticsyndromeandespeciallyaorticintramuralhematomamaybechallengingdiagnosticproblems.Intravascularultrasoundimagingisadiagnosticmethodthatcanbeusefulformorethoroughevaluationoftheaorticlesionandcanparticularlyaidindiscerningthedifferentformsofacuteaorticsyndrome.Wepresentacaseofapatientwithaorticintramuralhematomathatwasmissedbyconventionalimagingstudiesbutwassuccessfullyvisualizedwithintravascularultrasoundimaging.

简介：ObjectivesTostudythestatusoffibrinolyticinhibitioninpatientsofacutecoronarysyndrome(ACS)complicatedwithtypeⅡdiabetesmellitus(NIDDM)andtoevaluatetheeffectoffibrinolyticinhibitiontotheclinicalprognosis.MethodsTypeⅡdiabetesmellituswasdefinedbyADA1997/WH01998criteria.Thesubjectsweredividedintotreatmentgroupsthatincluded39patientsofACSwith20casesofacutemyocardiacinfarction(AMI),36patientsofACS+NIDOMwith20casesofAMI.Twentycasesofhealthypeoplewererandomizedtocontrolgroup.Theplasmaleveloftissuetypeplasminogenactivator(t-PA),plasminogenactivatorin-hibitortype-1(PAI-1)andplasmaD-dimerweredetectedbyusingelisatechnique.TheindexofstatueinfibrinolysiswasdetectedwiththeplasmalevelofD-dimerandtherateofPAI-1/D-dimerinpercentage.ThisindexwasusedtoevaluatethefibrinolyticinhibitionandtheclinicaloutcomeinallthepatientswithAMIintreatmentgroups.TheclinicaloutcomeinpatientswithAMIconsistedoftherateofreperfusion,theincidencesofreinfarction,severi-ousarrhythmia,pumpfailureanddeathintheearlyperiodofAMI.ResultsTheplasmalevelofPAI-1andD-dimerwashigherinthetwotreatmentgroupsthanthatinthecontrolgroup(P<0.01).TheplasmalevelofPAI-1significantlyhigherinACS+NIDDMpatientsthanthatinACS(P<0.05),buttheplasmalevelofD-dimerraisedfrombasiclevelwassignificanflylowerinACS+NIDDMthanthatinACS(P<0.05).TherateofPAI-1/D-dimerinpercentagewassignificantlyhigherinACS+NIDDMthanthatinACSorincontrolgroup(P<0.01).ForAMIpatientsintwotreatmentgroups,therateofreperfusionafterthethrorabolytictherapywassignifi-candylowerinACS+NIDDMthanthatinACS(P<0.01).TherateofincidencesinpumpfailurewassignificantlyhigherinACS+NIDDMthanthatinACStoo(P<0.05).Themorbidityofseveriousarrhythmia,re-infarctionandthemortalitywerealsohigherinACS+NI

简介：Aim:Toinvestigatetheeffectofhome-basedcardiacrehabilitationonfunctionalcapacity,healthbehavior,andriskfactorsinpatientswithacutecoronarysyndromeinChina.Methods:Eightypatientswithacutecoronarysyndromewereenrolledinthisprospectiverandomizedcontrolledstudy.Patientsinthecardiacrehabilitationgroup(n=52)receivedhome-basedcardiacrehabilitationwithaheartmanualandahomeexercisevideofor3monthsandpatientsinthecontrolgroup(n=28)receivedonlyroutinesecondaryprevention.The6-minwalkdistance,laboratorytestresults,healthybehavior(questionnaire),qualityoflife(12-itemShortFormHealthSurvey),anxiety(7-itemGeneralizedAnxietyDisorderQuestionnaire),anddepression(9-itemPatientHealthQuestionnaire)wereevaluatedatthebeginningandaftertreatmentfor3months.Results:Comparedwithbaselinedata,52patientswhoparticipatedincardiacrehabilitationhadlonger6-minwalkdistance(515.26±113.74mvs0.445.30±97.92m,P<0.0002),higherproportionsof“alwaysexercise”(78.26%vs.28%,P<0.05),“alwayslimitfoodwithsugar”(65.22%vs12%,P<0.05),“alwayseatfruits200–400geveryday”(82.61%vs.4%,P<0.05).and“alwayseatvegetables300–500geveryday”(21.74%vs.12%,P<0.06)aftertreatmentfor3months.Thelow-densitylipoproteincholesterolcontrolrate(52.17%vs.28%,P<0.05)andthesystolicbloodpressurecontrolrate(100%vs.68%,P<0.05)werealsosignificantlyincreasedaftertreatmentfor3monthsinthecardiacrehabilitationgroup.Nosignificantincreasewasfoundinthecontrolgroupaftertreatmentfor3months.Nocardiac-eventrelatedtohomeexercisewasreportedinbothgroups.Conclusion:Home-basedcardiacrehabilitationisafeasibleandavailablecardiacrehabilitationmodeinChina.

简介：BackgroundInpatientswithacutecoronarysyndrome(ACS),loweradmissionsystolicbloodpressure(SBP)levelsinferaworseprognosis.However,thepredictivepotentialofadmissionSBPon1-yearmortalityhasnotfullyelucidatedinpatientswithnon-ST-segmentelevationACS(NSTEACS).MethodsWeenrolled1325patientstoinvestigatetheassociationbetweenadmissionSBPinpatientshospitalizedforNSTEACS.WeanalyzedtheassociationbetweenadmissionSBPand1-yearmortality.AdmissionSBPwascategorizedaslow(<110mmHg),normal(110-140mmHg),high(141-160mmHg),andveryhigh(>160mmHg).ResultsComparedwithpatientswithnormaladmissionSBP,thosewithlowSBPhadasignificantlyincreasedhazardratios(HRs)for1-yearmortalityof3.03(P<0.05),whilepatientswithhighandveryhighadmissionSBPhadnosignificantlyincreasedHRsfor1-yearmortality.ConclusionLowadmissionSBP,butnotelevatedadmissionSBP,isastrongindependentpredictorof1-yearmortalityinpatientswithNSTEACS.

简介：BackgroundNon-ST-segmentelevationacutecoronarysyndrome(NSTE-ACS)isanacuteheartdiseasecausedbyincompleteocclusionofrelatedcoronaryarterieswithunstableatheroscleroticplaques.LeadaVRSTsegmentelevationandcTnIpositivearecloselycorrelatedtotheprognosisofNSTE-ACSpatients.However,therearefewstudiesapplyingthetwopredictorstoearlyriskstratificationinNSTE-ACSpatients.MethodTwohundredandfivecasesofNSTE-ACSpatientsfollowedupfor6monthsafterdischargewerereviewed.Allpatientsweredividedintofourgroups:GroupA-cTnInegativecombinedwithaVR-non-ST-segmentelevationgroup(100cases);GroupB-cTnInegativecombinedwithaVR-ST-segmentelevationgroup(31cases);GroupC-cTnIpositivecombinedwithaVR-non-ST-segmentelevationgroup(43cases);GroupD-cTnIpositivecombinedwithaVR-ST-segmentelevationgroup(31cases).Therewasnosignificantdifferenceingender,age,oldmyocardialinfarction,previousPCIhistory,hypertension,anddiabetesbetweenaVR-STelevationgroupandnoaVR-STelevationgroup.Themorbidityofleftmainorthree-vesselcoronaryarterydiseaseaswellasadversecardiovasculareventsinthefourgroupswereobservedandanalyzed.Results(i)Themorbidityofleftmainorthree-vesselcoronaryarterydiseasewashighestinGroupD(87.1%),andwasmarkedlyhigherinGroupB(41.9%)thanthatinGroupA(7%)orGroupC(9.3%);(ii)TheincidenceofadversecardiovasculareventswashighestinGroupD(77.4%),andwasmuchhigherinB(35.5%)ascomparedwiththattinGroupA(1%)orgroupC(7%).ConclusionElectrocardiographicleadaVRST-segmentelevationcombinedwithcTnIpositivehasanimportantclinicalvalueinpredictingtheprognosisofthepatientswithNSTE-ACS.