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简介：Toinvestigatetherelationshipbetweenthechronotropicincompetenceandangiographicseverityofcoronaryarterydisease,andtheclinicalvalueofinappropriatechronotropicresponsesinexercise.MethodsCoronaryangiographywasperformedin130patientssuspectedordiagnosedascoronaryheartdisease(CHD),andangiographicseverityofcoronaryarterydiseasewasquantitatedbyDukescoreandGensiniscore.Thepatientsweredividedinto4groups:non-CHDgroup(39cases),CHDgroupwithonlyonecoronaryarteryinvolved(CHD1,30cases),CHDgroupwithtwocoronaryarteriesinvolved(CHD2,31cases)andCHDgroupwiththreecoronaryarteriesinvolved(CHD3group,30cases).Amonthbeforecoronaryangiography,symptom-limitedbicycleergometorexercisehadbeenaccomplished,thechronotropicresponsehadbeenmeasuredandexpressedasratioofheartratereserve(HRR)andthemaximalage-predictedheartrateachieved(rHR).ResultsAnalysisofvarianceshowedthatrHRandHRRweremuchsignificantlylower(allP<0.01)inCHD2group(rHR0.793±0.078,HRR0.626±0.110)andCHD3group(rHR0.775±0.065,HRR0.586±0.125)thanthatinnon-CHDgroup(rHR0.888±0.062,HRR0.798±0.105)andCHD1group(rHR0.857±0.084,HRR0.735±0.146).rHRwassimilarbothbetweennon-CHDgroupandCHD1group(P>0.05)andbetweenCHD2groupandCHD3group(P>0.05).HRRhasnodifferencebetweenCHD2groupandCHD3group(P>0.05),butwassignificantlydifferentbetweennon-CHDgroupandCHD1group(P<0.05).TherewasasignificantlynegativecorrelationbetweenrHR,HRRandDukescore(r=-0.554,-0.578,respectively,allP<0.01),Gensiniscore(r=-0.453,-0.467,respectively,allP<0.01).CHDproportionreached75%inpatientswhohadpositiverHR(orHRR)andnon-STdepression.Diagnosticvalue[sensitivity0.868(P<0.01),0.846(P<0.01),specificity0.462,0.462,accuracy0.746(P<0.05),0.731,positivepredictivevalue0.790,0.786,negativepredictivevalue0.600,0.563,respectively]ofrHR<85%orHRR<72%whichwereusedasan

简介：BackgroundIncreasedserumleveloflipoprotein(a)(Lp(a))isassociatedwithatherosclerosis.WhetherincreasedLp(a)levelisindependentlyassociatedwiththeseverityofcoronaryarterydisease(CAD)isunclear.MethodsSubjectswereenrolledandreceivedcoronaryangiographytoassessthenumberofstenosedcoronaryartery.ThesubjectswithCADweredividedintonon-significant(<50%stenosis),singleandmultivesselstenosis(≥50%stenosis)groups.Parametersofinterestatbaselinewerecollected.StatisticalanalyseswereperformedtoevaluatetherelationshipbetweenLp(a)levelandCADseverity.ResultsTotally745populationswereenrolledanddiagnosedasCAD(n=605)orwithoutCAD(n=140)onthebasisofangiographyexamination.AscomparedtothesubjectswithoutCAD,serumlevelsofLp(a)andCRP,andthepercentagesofsubjectswithsmokingordiabetesweresignificantlyhigherinsubjectswithCAD.Incontrast,serumlevelsofHDL-CandApo-AweresignificantlylowerinsubjectswithCADascomparedtosubjectswithoutCAD.Incomparisonofsubjectswithnon-significantstenosis(serumLp(a)level,170.0±19.7mg/dL),serumLp(a)levelwassignificantlyhigherinsubjectswithsingle(245.5±22.3mg/dL)ormultiplevesselstenoses(265.8±14.0mg/dL).Withmultivariateregressionanalyses,afteradjustedforage,gender,smoking,familyhistoryandhypertension,therewasstillsignificantassociationbetweenserumLp(a)levelandthenumberofcoronaryarterystenosis.Afteradditionaladjustmentfordiabetes,HbA1c,totalcholesterol,LDL-C,Apo-A,uricacidandCRP,Lp(a)remainedstronglyassociatedwithCADseverity.ConclusionSerumLp(a)levelwassignificantlyassociatedwiththeseverityofcoronaryarterystenosis,whichmayaddthevalueoncardiovascularriskevaluation.

简介：Withimprovementsintheirsurgicalandmedicalmanagement,thenumberofpatientswithcongenitalheartdisease(CHD)reachingadulthoodhasincreasedoverthelastdecade.AsthepopulationofadultCHDpatientscontinuestorise,anincreasingnumberofthesepatientswillrequireevaluationforhearttransplantation.ItisimportanttorecognizeadvancedheartfailureandotherassociatedcomplicationsearlyinthiscohortofcomplexpatientsforearlyreferraltoanadultCHDspecialist.Asthesepatientspresentwithuniquechallengesbecauseoftheirmultiplecomorbiditiesandcomplexanatomy,thereneedstobeacarefulselectionprocessfortransplantationtooptimizetheutilizationofdonororgans.

简介：Therecognitionthatpsychosocialriskfactorscontributetothepathogenesisofcardiovasculardiseasehasledtothedevelopmentofanewfieldofbehavioralcardiology.Theinitialimpetusforthisfieldwasstudiesperformedinthe1980sand1990sthatprovidedepidemiologicalevidenceandapathophysiologicalbasisforastronglinkbetweenanumberofpsychosocialriskfactorsandcardiovasculardisease,includingdepression,anxiety,hostility,jobstress,andpoorsocialsupport.Inrecentyears,additionalpsychosocialriskfactorshavebeenidentified,includingpessimism;otherformsofchronicstress,suchaschildhoodabuseandtrauma,andthepsychologicalstressthatmaybeassociatedwithchronicmedicalillness;lackoflifepurpose;andthesyndromeof“vitalexhaustion,”whichconsistsofatriadofexhaustion,demoralization,andirritability.Newresearchinthelastdecadehasalsoestablishedthatpositivepsychosocialfactors,suchasoptimism,positiveemotions,avibrantsociallife,andastrongsenseoflifepurpose,canhaveanimportanthealth-bufferingeffectthroughtheirfavorableinfluenceonhealthbehaviorsandpromotionofpositivephysiologicalfunctioning.Patientscanbescreenedforpsychosocialriskfactorsinclinicalpracticethrougheithertheuseofopen-endedquestions,whichcanbeintegratedintoaphysician’sstandardreviewofsystems,ortheuseofshortquestionnaires.Physicianscanassistinthetreatmentofpsychosocialriskfactorsinvariousways,suchasscreeningpatientsforpsychologicaldistressandmakingappropriatereferralswhenindicated,providingpatientswithpracticallifestylesuggestions,andemployingofficepersonneltoteachpatientsbehavioralorpsychosocialinterventionsthatcanpromoteasenseofwell-beingand/orreducestress.

简介：Conventionalrecommendationsfordiagnostictestingfortheevaluationofstableischemicheartdiseaseinwomenhavelargelyparalleledthoseinmen.Althoughtheyaredesignedprimarilyfortheidentificationofobstructivecoronaryarterydisease(CAD),traditionalapproachescanleadtoovertestinginwomenwithoutdifferentiatingwhoistrulyatrisk.Severaluniquefactorsrelatedtothepresentation,diagnosis,andunderlyingpathophysiologyofstableischemicheartdiseaseinwomennecessitateamorespecificapproachtotheassessmentoftheirrisk,completewithseparateguidelineswhenappropriate.Thisoverviewhighlightshowadvancednoninvasiveimagingtools,includingcardiaccomputedtomographyangiography,positronemissiontomography,andcardiacmagneticresonanceimaging,areenablingverysensitiveassessmentsofanatomicatheroscleroticplaqueburden,macrovessel-andmicrovessel-relatedischemia,andmyocardialfibrosis,respectively.Movingforward,effectivediagnostictestingwillneedtoidentifywomenathighriskofadversecardiovascularevents(notanatomicallyobstructiveCADperse)withoutovertestingthoseatlowrisk.JudiciousapplicationofnovelimagingapproacheswillbecriticaltobroadeningthedefinitionsofCADandischemiatobetterreflectthewholespectrumofpathologicalphenotypesinwomen,includingnonobstructiveCADandcoronarymicrovasculardysfunction,andaidinthedevelopmentofneededevidence-basedstrategiesfortheirmanagement.

简介：Sex-specificdifferencesintheepidemiologyandpathophysiologyofcoronaryarterydiseaseandischemicheartdiseasearenowwellrecognized.Womenwithanginamoreoftenhavenonobstructivecoronaryarterydisease(NOCAD)comparedwithmen.Thispatientpopulationcarriesasignificantriskoffuturecardiovasculareventsthatisnotcommonlyappreciated,oftenleadingtodelayeddiagnosisandtreatment.WhilecoronarymicrovasculardysfunctionplaysacentralroleinthepathophysiologyofNOCADinwomen,othermechanismsofmyocardialischemiaarenowrecognized.RiskfactorssuchashypertensionandobesitydisparatelyaffectwomenandarelikelytoaccountforasignificantproportionofNOCADinthecomingyears.VascularinflammationisanimportantpathophysiologicpathwayinNOCADandisapotentialtherapeutictarget.CoronaryCTangiographyprovidesacomprehensiveassessmentofcoronaryanatomyandplaquemorphologyandisareasonablescreeningtestofchoiceforNOCAD.

简介：Congenitalheartdisease(CHD)-associatedpulmonaryarterialhypertension(PAH)includesaheterogeneouspatientpopulationthatcanbecharacterizedbytheunderlyingcardiacmalformation.CHD-associatedPAHhasanestimatedprevalenceof5–10%inadultpatients,withanincreasingnumberofpatientssurvivingtoadulthoodbecauseofadvancesinthesurgicalmanagementandthedevelopmentofpulmonaryarterialhypertension(PAH)-targetedpharmacotherapy.Althoughlimiteddataexist,targetedPAHpharmacotherapyhasproventobebeneficialinpatientswithCHD-associatedPAH,withobservedimprovementinfunctionalclass,increaseinexercisecapacity,andimprovementinqualityoflifeandcardiopulmonaryhemodynamics.Additionally,therehasbeenincreasinginterestinthe“treat-to-close”strategy.PAH-targetedpharmacotherapymaybeusedtooptimizecardiopulmonaryhemodynamicssoastoimprovepatients’operabilityinrepairingthecardiacdefect.Althoughtherehavebeensignificantadvancesinthemanagementofthisdiseasestateinthepast2decades,mortalityremainshigh,andongoingclinicaltrialsareneededtobetterunderstandthetreat-to-closestrategy.

简介：ObjectivesToevaluatetheeffectsofn-3fattyacidsonthecoronaryheartdiseasepatients.MethodsFromSeptember2007toMarch2008,60patientswithcoronaryheartdiseasewererandomlyassignedton-3fattyacidsgroup(groupN)andcontrolgroup(groupC).BothgroupsreceivedstandardcoronaryarterydiseasesecondarypreventiontreatmentandgroupNalsoreceivedeicosapentaenoicacid(EPA)1.8gplusdocosahexaenoicacid(DHA)1.2gperdayfor12weeks.Plasmatriacylglycerols,totalcholesterol,low-densitylipoproteincholesterol(LDL-C),high-densitylipoproteincholesterol(HDL-C)andbloodpressureweremeasuredbeforeandafterthestudy.ResultsPlasmatriacylglycerols,bloodpressureandLDL-ClevelwereloweringroupNaftern-3fattyacidstreatmentwhilenochangewasfoundingroupC(P<0.05).HDL-Clevelslightlyincreasedandtotalcholesterollevelslightlydecreasedaftern-3fattyacidsbutbothchangewerenotsignificant(P>0.05).ConclusionsN-3fattyacidshavebeneficialeffectsonthecoronaryarterydiseasepatients.

简介：BackgroundPreviousstudieshavesuggestedthatpatientswithlowendothelialprogenitorcell(EPC)countsandimpairedendothelialcolonyformingactivityhaveahigherincidenceforcardiovasculareventscomparedtopatientswithhighEPCcountsandfavorablecolonyformingactivity.ThepathophysiologicalbasisforthisfindingmaybeaninsufficientendothelialcellrepairbyEPC.TheobjectiveofthisstudywastodeterminewhetherthenumberofEPCsinperipheralbloodwasassociatedwiththepresenceandseverityofangiographicstenosisinpatientsofthelatephaseafteracutemyocardialinfarction(AMI).MethodsOnehundredandonepatientsundergoingcardiaccatheterizationinourhospitalwereenrolledinthestudy.ThenumberofcirculatingEPCswasmeasuredbyafluorescent-activatedcellsorter(FACS).Patientswithacutecoronarysyndromeswereexcluded.ResultsComparedwithpatientswithnormalcoronaryartery,thenumberofcirculatingEPCswassignificantlyreducedamongpatientsinthelatephaseafterAMI(P<0.01).Wealsofoundthatcomparedwiththecontrolgroup,thenumberofEPCsofsingle-vesselstenosisgroupandmulti-vesselstenosisgroupweresignificantlyreduced(P=0.005;P=0.001).ConclusionsThenumberofEPCsintheperipheralbloodisdecreasedinpatientsofthelatephaseafterAMI.TheEPCsnumbercorrelatedwithangiographicstenosisseverity,whichsuggeststhatendothelialinjuryinthedeficientcirculatingEPCsmayaffecttheseverityoftheheartdisorderandtheclinicalpresentations.

简介：Tostudytherelationshipbetweenmyeloperoxidase(MPO)-463G/Apolymorphismsandsusceptibilitytocoronaryarterydisease(CAD)inHanpeopleofnorthAnhuiprovince.MethodsThecasegroupconsistedof79patientswhohadallangiographicallyprovenCADwereretrospectivelystudied.Usedpolymerasechainreaction-restrictionfragmentlengthpolymorphism(PCR-RFLP)methodstodecidethegenotypeofallthepatients.ResultsThefrequencyofAAhomozygotictypeinHanpeopleofAnhuiprovincewas1.4%.TheriskofCADforpersoncarryingatleastoneAallelegenotype(GAandAA)was0.37timesofGGgenotype.TheseverityofcoronaryarterystenosisinCADpatientscarryingatleastoneAallelegenotypewas0.197timesofGGgenotype(P<0.05).ConclusionsThefrequencyofAAhomozygotictypeandMPO-463G/ApolymorphisminHanpeopleofAnhuiprovinceinfluencedtheriskofCAD.AallelehadprotectivefunctioninCAD.

简介：ObjectivesToassesswhetherstatinsreduceall-causemortalityandCVeventsinelderlypeoplewithoutestablishedCVdisease.BackgroundSinceageingofthepopulationissteadilyraising,preventionofcardiovascular(CV)diseaseintheelderlyisrelevant.InelderlypatientswithpreviousCVevents,useofstatinsisrecommendedbyguidelines,whereasbenefitsofthesedrugsinelderlysubjectswithoutpreviousCVeventsarestilldebated.MethodsRandomizedtrialscomparingstatinsversusplaceboandreportingall-causeandCVmortality,myocardialinfarction(MI),stroke,andnewcanceronsetinelderly(>65yearsold)subjectswithoutestablishedCVdiseasewereincluded.ResultsEighttrialsenrolling24,674subjects(42.7%females;meanage73.0+2.9;meanfollow-up3.5+1.5years)wereincludedinanalyses.Statins,comparedtoplacebo,significantlyreducedtheriskofMIby39.4%(relativerisk[RR]:0.606[95%confidenceinterval(CI):0.434to0.847];P=0.003),aswellastheriskofstrokeby23.8%(RR:0.762[CI:0.626to0.926];P=0.006).Incontrast,theriskofall-causedeath(RR:0.941[CI:0.856to1.035];P=0.210)andofCVdeath(RR:0.907[CI:0.686to1.199];P=0.493)werenotsignificantlyreduced.Newcanceronsetdidnotdifferbetweenstatin-comparedtoplacebotreatedsubjects(RR:0.989[CI:0.851to1.151];P=0.890).ConclusionsPInelderlysubjectsathighCVriskwithoutestablishedCVdisease,statinssignificantlyreducetheincidenceofMIandstroke,butdonotsignificantlyprolongsurvivalintheshort-term.

简介：ObjectivesTodetectionofchlamydiapneumoniae(Cpn)DNAinthecirculatingmononuclearcellfractionsofcoronaryheartdiseaseandtoinvestigatetheassociationbetweeninfectionwithchlamydiapneumoniaeandcoronaryheartdisease(CHD)andprospectivelywhetherblood-basednestedpolymerasechainreaction(nPCR)isusefulinidentifyingCpninfection.MethodsTheperipheralbloodmononuclearcell(PBMC)CpnDNAwasexaminedusingnPCRtechniqueandconfirmedbyelectrophoresisin150patientswithCHD.Select55patientswithclinicalsuspectedCHDbutangiographyresultarenormalascontrolgroup(CG).Thenweconductedaprospective,randomized,double-blind,placebo-controlledstudyof6monthsofazithromycinandplacebotreatmentinCHDgroup.PatientswithCpnDNApositivewerethenrandomizedtoreceiveazithromycinorplacebo.Aftertreatmentbloodsamplewerecollectedforrepeatedmeasurement.ResultsChlamydiapneumoniaeDNAwasdetectedin49(32.7%)of150personswithCHDandin1(1.8%)of55personswithcontrolgroup,oddsratio26.2,95%confidenceinterva13.52-194.98.ThepositivityratesofnPCRinCHDgroupswerehigherthanthoseincontrolgroup.16cases(29.1%)inlatentcoronaryheartdiseases(LCHD)group,19cases(39.6%)inunstableangina(UAP)group,and14cases(29.9%)inacutemyocardialinfarction(AMI)groupwereCpnpositivebynPCR.TherewerenosignificantdifferenceamonginAMIUAPandLCHDgroup.ThereweresignificiantdifferenceinCpnDNAnegativeratesaftertheazithromycinandtheplacebotreatment.ConclusionsChlamydiapneumoniaeispresentinPBMCofasignificantproportionofpersonswithCHD.Thepotentialroleofchlamydiapneumoniaeincoronaryatherosclerosismaythereforebemorerelatedtoaccelerationofdiseaseorsystemiceffectsbypersistentinfectionthantosuddeninitiationofprogressivecoronaryarterydiseasebyacuteinfection.ThedetectionofCpnDNAinPBMCwithnPCRmaybeofgreatvalueforidentifyingCpncarriersandfo

简介：ObjectivesToevaluatetheeffectofdifferentstylesofcoronaryheartdisease(CHD),differentregionsofacutemyocardialinfarction(AMI),itsriskfactorsandbranchesofcoronarystenosisonleftventricularremodelinganddysfunctionbyapplyingechocardiography.Methods251patientswithCHDand96patientswithoutCHD(NoCHD)wereverifiedbyselectivecoronaryangiography.CHDpatientsweredividedintostableanginapectoris(SAP)26,unstableanginapectoris(UAP)53,acutemyocardialinfarction(AMI)140andoldmyocardialinfarction(OMI)30basedonclinicalsituation,cTnT,cardiacenzymeandEGG.AMIpatientswerefurtherdividedintosubgroupsincludingacuteanteriormyocardialinfarct(Aa,n=53),acuteinferiormyocardialinfarction(Ai,n,=54)andAa+Ai(n=33)basedonECG.Cardiacparameters:end-diastolicinterventricularseptumthickness(IVSd),end-diastolicleftventricularinternaldiameter(LVd),leftventricularmass(LM),end-diastolicleftventricularvolume(EDV),end-systolicleftventricularvolume(ESV)andleftventricularejectionfraction(LVEF)weremeasuredbyACUSON128XP/10echocardiography.MultipleslinearregressionanalyseswereperformedtoteststatisticalassociationsbetweenLVEFandtheinvolvedbranchesofcoronarystenosis,bloodpressure,lipids,glucoseandetcafteronsetofmyocardialinfarction.ResultsEDVandESVwereincreasedandLVEFdecreasedonpatientswithAMI,OMIandUAP(P<0.05-0.0001).LMwasmainlyincreasedinpatientswithOMI(P<0.01)andLVdwasmainlyenlargedinpatientswithAMI.EFwassignificantlydecreasedandEDV,ESV,LMandLVdwereremarkablyincreasedinAMIpatientswithAaandAa+Ai.WiththemultiplelinearregressionanalysesbySPSSsoftware,wefoundthatLVEFwasnegativelycorrelatedtotheinvolvedbranchesofcoronarystenosisaswellastosystolicbloodpressureafteronsetofmyocardialinfarctionwhiletherewasnosignificantcorrelationbetweenLVEFandotherfactors.LVEFwassignificantlydecreased,and

简介：In2014theAmericanCollegeofCardiology/AmericanHeartAssociationissuedfournewguidelinesforcardiovasculardiseasepreventionthatfocusedoncardiovascularriskassessment,lifestylemanagement,obesitymanagement,andbloodcholesterolmanagement.Thedevelopmentofanatheroscleroticcardiovasculardiseaseriskcalculatorformedthebasisoftheriskassessmentguideline,andthelifestylemanagementguidelinefocusedonrecommendinganevidence-baseddietarypattern.Thebloodcholesterolmanagementguidelinespecificallyidentifiedfourgroupsofpatientsshowntobenefitfrommoderate-intensityorhigh-intensitystatintherapyfrompreviousclinicaltrialsandabandonedtheuseofspecificlow-densitylipoprotein(LDL)cholesterol(LDL-C)goallevelsonthebasisofthelackofclinicaltrialevidence.Therecommendationsfortreatmentwithmoderate-intensityorhigh-intensitystatintherapyarebasedonrigorousevidencefromrandomizedclinicaltrials.Guidancehassincebeenprovidedfortheuseofnonstatintherapies,includingcholesterolabsorptioninhibitorandproproteinconvertasesubtilisin/kexintype9monoclonalantibodytherapywhenadequatereductionofLDL-Clevelsisnotachievedwithmaximallytoleratedstatintherapy.TherecentdevelopmentandapplicationofthesetherapieshaveresultedinremarkablereductionsinLDL-Clevelsthatarewelltolerated,andpreliminaryoutcomedataarepromisinginshowingsubstantialatheroscleroticcardiovasculardiseaseeventreductionsbeyondstatintherapy.

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简介：ObjectivesToelucidatethepotentialroleofcytokinesinthepathogenesisofcoronaryheartdisease(CHD).MethodsTNF-αandIFN-γactivity,IL-8levelsofplasmaandsupernatantsweremeasuredin62patientswithCHDand30healthcontrolsbymethodsofdirectcytotoxicityassay,cytopathiceffectinhibitiontestandELISArespectively.ResultsBothTNF-αactivityandIL-8levelsofplasmainCHDpatientswerehigherandIFN-γactivityofsupernatantsinCHDpatientswerelowerthanthoseofhealthycontrols(P＜0.001),TherehavesignificantdifferencesbetweenhealthycontrolsandthesubgroupsofCHD(P＜0.01).IL-8levelsofplasmaincreasedwiththeadvancingofthediseaseandtherehaveobviousdifferencesamongsubgroupsoftheillness(P＜0.05).TNF-αactivityofplasmainstableanginapectoris(SAP)subgroupwaslowerthanthoseofunstableanginapectoris(UAP)andacutemyocardialinfarction(AMI)subgroups,thedifferencesbetweenSAPandUAPorAMIweresignificant(P＜0.05),ButtherehavenosignificantdifferencesbetweenUAPandAMI(P＞0.05).However,IFN-γactivityofsupernatantsshowednodifferenceamonganysubgroups.ConclusionstherehavecloserelationsbetweenTNF-α,IFN-γ,IL-8andCHD.

简介：ObjectivesTostudyclinicalandcoronaryangiographicfindingsinpatientswithbothcoronaryheartdiseases(CHD)andtype2diabetesmellitus(T2DM).Methods215patientswithCHDconfirmedbycoronaryangiographywereinvolvedinthisstudy.Thepatientsweredividedintotwogroups:74CHDpatientswithT2DM(meanage64.7±8.2years,male/female47/27),and141CHDpatientswithoutT2DM(meanage66.2±9.2years,male/female100/41).Theclinicalfeaturesandthedatafromselectivecoronaryangiographieswerecomparedbetweentype2diabeticandnon-diabeticCHDpatients.ResultsComparedtonon-diabeticCHDpatients,thepatientswithbothCHDandT2DMsufferedmorefromacutemyocardialinfarction,silentischemiaandseverearrhythmias(P＜0.01,P＜0.05),andhadhigherserumtriglyceridesandapo-lipoproteinB,alongwithincreasedserumuricacid(P＜0.01,P＜0.05),increasedleftventricularenddiastolicdiameter(P＜0.01),anddecreasedleftventricularejectionfraction(P＜0.001).Comparedtonon-diabeticCHDpatients,thepatientswithbothCHDandT2DMsufferedmorefromtriplevesseldisease(P＜0.01),severecoronaryarterystenosis,completeocclusionsanddiffuselesions(P＜0.001).ConclusionsSevereclinicalmanifestation,leftventriculardysfunction,diffuseorcomplicatedlesionsofcoronaryarteriesweremorecommoninpatientswithbothCHDandT2DM,itsuggeststhatthetype2diabeticCHDpatientshavepoorprognosis.

简介：Inspiteofrecentadvancesintreatmentandcontrol,theprevalenceofCVDandpulmonaryhypertension(PH)aroundtheworldhasincreasedsignificantly.Webelievethataconceptualbreakthroughisneededandnoveldrugtargetsmustbediscoveredinanattempttocontrolandtreatthem.ACE2,thenewestmemberoftherenin-angiotensinsystem(RAS),appearstoholdthispotential.Ourstudieshaveestablishedanovelconcept:abalancebetweenthevasodeleteriousaxis(ACE/AngⅡ/ATlR)andthevasoprotectiveaxis(ACE2/Ang-1-7/Mas)oftheRASiscriticalinmaintainingnormalCVfunctionsandanyimbalanceinitiatesvasculardysfunctionsleadingtocardiopulmonarydiseases.ThuswehypothesizethatACE2,whichisakeyenzymeindecreasingAngⅡandincreasingAng-1-7,wouldbeanidealforconsiderationasatherapeutictarget.Theobjectiveofmypresentationwillbetopresentevidenceinsupportofthisconcept.ThedatapresentedwilldemonstratethatoverexpressionofACE2bygeneticmeansoritsactivationbenovelACE2activatorsproteststheheartfromhypertension-andMi-inducedcardiacdamage.Also,thisstrategyisextremelyeffectiveinpreventionandreversalofPHandpulmonaryfibrosis.Astructure-baseddrugdiscoveryapproachwillbepresentedtoidentifysmallmoleculeACE2acti-vatorsandtheirpotentialinproducingbeneficialoutcomesonCVDandpulmonaryhypertensionwillbediscussed.

简介：BackgroundDataarelimitedregardingtheriskofcontrast-inducednephropathy(CIN)forpatientsafterthesecondcontrastexposure.ObjectiveToexaminetheriskofCINafterthesecondcontrastexposureinpatientsofacutecoronarysyndrome(ACS)withchronickidneydisease(CKD).MethodsPatientsofACSscheduledforasecondelectivePCI.Patientswererequiredtohaveanestimatedcreatinineclearance(CrCl)between15and60ml/min.Thevalueofserumcreatinin(sCr)priortothesecondcontrastexposuremustnotbe≥25%or≥88.4μmol/Lcomparedtobaseline.CINwasdefinedasanincreaseofsCr≥25%frombaselinewithin48-72hafterthesecondcontrastexposure.Theprimaryend-pointwasriskofdevelopingCIN.ResultsThirty-ninepatientscompletedthestudy.Theaverageofintervalbetweencontrastexposureswas116±64h,contrastvolumewas266±100mLandlengthofhospitalizationwas8.3±4.7days.TheincidenceofCINintheoverallstudypopulationwas10.3%.TherewasnotchangesignificantlyinaveragesCrandCrClafterthesecondcontrastexposure(sCr1.52±0.62vs.1.54±0.60mg/dLbaseline,P=0.75;CrCl(40.68±14.46vs.39.16±12.10mL/minbaseline,P=0.26).Noneofthepatientwasdeathin30days.One(2.6%)ofthepatientswhodevelopedCINrequireddialysisin-hospital.ConclusionOurfindingssuggestthatpatientswithpriorrenaldysfunctionarenotincreasedriskofdevelopingCINafterthesecondcontrastexposure.Thiscohortmaybebenefitfromsufficientprophylaxis.