Establishment of a predictive model for inpatient sudden cardiac death in a Chinese cardiac department population: a retrospective study / 中华医学杂志(英文版)

BACKGROUND@#Little is known about the risk factors for sudden cardiac death (SCD) in the overall hospitalized cardiac department population. This study was conducted to investigate the risk factors and develop a predictive model for SCD in a hospitalized cardiac department population.@*METHODS@#We conducted a retrospective study of patients admitted to the cardiac department of the First Affiliated Hospital of Xinjiang Medical University from June 2015 to February 2017. We collected the clinical data from medical records. Multiple stepwise logistic regression analysis was carried out to confirm the risk factors for SCD and develop a predictive risk model. The risk score was assessed by the area under receiver operating characteristic (AUROC) curve and the Hosmer-Lemeshow goodness-of-fit test.@*RESULTS@#A total of 262 patients with SCD and 4485 controls were enrolled in our study. Logistic regression modeling identified eight significant risk factors for in-hospital SCD: age, main admitting diagnosis, diabetes, corrected QT interval, QRS duration, ventricular premature beat burden, left ventricular ejection fraction, and estimated glomerular filtration rate. A predictive risk score including these variables showed an AUROC curve of 0.774 (95% confidence interval: 0.744-0.805). The Hosmer-Lemeshow goodness-of-fit test showed the chi-square value was 2.527 (P = 0.640). The incidence of in-hospital SCD was 1.3%, 4.1%, and 18.6% for scores of 0 to 2, 3 to 5 and ≥6, respectively (P < 0.001).@*CONCLUSIONS@#Age, main admitting diagnosis, diabetes, QTc interval, QRS duration, ventricular premature beat burden, left ventricular ejection fraction, and estimated glomerular filtration rate are factors related to in-hospital SCD in a hospitalized cardiac department population. We developed a predictive risk score including these factors that could identify patients who are predisposed to in-hospital SCD.

Medicine in Future and Advantages of Integrated Chinese and Western Medicine / 中国结合医学杂志

The history of medical development shows that oriental medicine, or traditional medicine, was born through medical practice during the times when science and technology were immature and underdeveloped, whereas with the development of science and technology, Western medicine, or modern medicine, was born through experimental analysis and research. With the development of medicine, the pros and cons of both medical systems become increasingly evident. How to integrate them and learn from each other will be the direction of future development of medicine. The formation and development of integrated medicine will, inevitably, usher in a new era for medicine.

Effect of Chinese herbs for stasis removing and collaterals dredging upon angiotensin-converting enzyme 2-angiotensin-(1-7)-mas axis in the renal cortex of diabetic nephropathy rats / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To observe the effect of Chinese herbs for stasis removing and collaterals dredging (CHSRCD) upon angiotensin-converting enzyme 2-angiotensin-(1-7)-Mas axis in the renal cortex of diabetic nephropathy rats.</p><p><b>METHODS</b>Totally 89 male Sprague-Dawley rats were randomly divided into the blank control group (C group, n=22), the high-glucose high-fat control group (H group, n=10), and the streptozotocin (STZ)-injecting group (n=57). The diabetes rat model (n=50) was induced by feeding high-glucose high-fat diet in combination with intraperitoneal injection of STZ, which were further divided into the model group (M group, n=24), the irbesartan group (I group, n=13), and the CHSRCD (Z group, n=13). Rats in I and Z groups were intragastrically fed with suspension of irbesartan and CHSRCD, once daily for 16 weeks. Equal volume of drinking water was administrated to rats in the rest groups. Blood glucose and 24 h urine protein quantitation were tested at four time points. And the mRNA expression of ACE2 and Mas at various time points was detected by Real-time PCR, immunohistochemical assay, and Western blot. Quantitative analyses of ACE2 and Mas protein expression were performed at the end of week 16.</p><p><b>RESULTS</b>Compared with the C group, blood glucose increased in the H and M groups (P < 0.01). It was higher in the H group (P < 0. 01). 24 h urine protein quantitation at different time points increased in the M group, and it was higher than that in the H group (P < 0.05). Compared with the M group, 24 h urine protein quantitation decreased at the end of week 8 in the I group, and at the end of week 8 and 16 in the Z group (P < 0.05). It was lower in the Z group than in the I group at the end of week 16 (P < 0.05). Compared with the C and H groups, the expression of ACE2 mRNA in the renal cortex was lower in the M group at the end of week 16 (P < 0.01). Compared with the M group, it was higher in the Z group (P < 0. 01). There was no statistical difference in the expressions of Mas mRNA at the end of week 16 between the C group and the M group (P > 0.05). It was lower in the M group than in the H group (P < 0.05). It was higher in the Z group than in the M group (P < 0.05), and higher than in the I group (P < 0.05). The expression of ACE2 and Mas protein in the M group decreased as time went by. The expression quantitation of ACE2 and Mas protein at the end of week 16 was lower in the M group than in the C group (P < 0.05). Compared with the M group, ACE2 expression of the Z group and Mas of the I and Z groups increased more significantly (P < 0. 05).</p><p><b>CONCLUSION</b>CHSRCD could play a role in renal protection for diabetic nephropathy rats by up-regulating the mRNA and protein expression of ACE2 and Mas, promoting the ACE2-Ang-(1-7)-Mas axis, and lowering urinary protein.</p>

Application experience of attain ® select II catheter delivery system for left ventricular lead implantation in cardiac resynchronization therapy / 中华心血管病杂志

<p><b>OBJECTIVE</b>To summarize application experience of attain ® select II catheter delivery system for left ventricular lead implantation in cardiac resynchronization therapy (CRT).</p><p><b>METHODS</b>CRT/CRT-D was applied for 86 patients with congestive heart failure and left bundle-branch block. Left ventricular lead implantation was applied without use of attain ® select II catheter delivery system in 42 patients without coronary vein anatomy variation (group A). Coronary sinus and cardiac vein angiography detected coronary vein anatomy variations in 44 patients and attain ® select II catheter delivery system was not used in 21 patients (group B) and used in 23 patients (group C). Total procedure time, LV lead implantation time, X-ray exposure time and complications were compared among groups. The optimal LV lead location were observed at the end of procedure.</p><p><b>RESULTS</b>Patients were followed up to 245 days (160 - 368 days). Total procedure time [(119 ± 18) min vs. (142 ± 17) min; (119 ± 18) min vs. (143 ± 17) min], LV lead implantation time [(32 ± 7) min vs. (49 ± 8) min;(32 ± 7) min vs. (51 ± 7) min]and X-ray exposure time [(27 ± 6) min vs. (46 ± 84) min;(27 ± 6) min vs. (45 ± 7) min] were significant reduced in group C compared to group A and B. Procedure-related complications were similar among the 3 groups. The rate of optimal LV lead location was significantly higher in group C than in group B (96% vs. 71%).</p><p><b>CONCLUSIONS</b>It is feasible and safe to implant LV lead through coronary sinus with attain ® select II catheter delivery system. Applying Attain ® select II catheter delivery system can improve the rate of optimal LV lead location with coronary venous anatomy variation.</p>

Use of the Attain Select II catheter delivery system to improve / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Despite technical advances in tools used to facilitate implantation of cardiac resynchronization therapy (CRT) devices, there are many hurdles related mainly to the variation in the anatomy of the coronary veins. One such difficulty is the presence of a very sharply-angulated or tortuous of the lateral or posterolateral cardiac vein.</p><p><b>METHODS</b>Totally 44 patients, 28 males and 16 females, with congestive heart failure and intraventricular conduction delay were studied retrospectively. There were 23 patients who had left ventricular (LV) lead implantation using standard techniques and equipment. For the other 21 patients with LV lead implantation we used the Attain Select II catheter delivery system. The patients were seen every 3 - 6 months for 12 months and the efficacy of the primary procedure, LV lead implantation time, procedure and fluoroscopy time and the complications associated with the two techniques were evaluated.</p><p><b>RESULTS</b>There were no significant differences in the age, gender, New York Heart Association (NYHA) functional class, ischemic etiology, QRS duration, left ventricular ejection fraction, left ventricular end-diastolic diameter, left ventricular end-systolic diameter and LV dyssynchrony between the two groups. The LV lead implantation time, procedure time and fluoroscopy time were significantly shorter in the group using the Attain Select II catheter delivery system; LV lead implantation time from (51 ± 7) minutes to (40 ± 7) minutes (P < 0.001), procedure time from (143 ± 17) minutes to (124 ± 18) minutes (P = 0.001), and fluoroscopy time from (45 ± 7) minutes to (35 ± 6) minutes (P < 0.001). A successful procedure of LV lead implantation was significantly improved from 17/23 (74%) patients using the standard techniques and equipment, to 20/21 (95.3%) patients using the Attain Select II catheter delivery system (P = 0.06)</p><p><b>CONCLUSION</b>It is feasible and safe to implant LV leads through the coronary sinus using the Attain Select II catheter delivery system.</p>

Safety and efficacy of intraoperative defibrillation threshold measured by defibrillation safety margin in 52 patients with implantable cardioverter defibrillator / 中华心血管病杂志

<p><b>OBJECTIVE</b>To observe the safety and efficacy of implantable cardioverter defibrillator (ICD) intraoperative defibrillation threshold (DFT) measured by defibrillation safety margin (DSM).</p><p><b>METHODS</b>Fifty-two patients underwent ICD implantation were enrolled in this study (25 single chamber ICD, 23 double chamber ICD, 4 three chamber ICD). DFT was measured by DSM method. All patients were followup regularly.</p><p><b>RESULTS</b>DFT was (13.27 ± 2.95) J and DSM was (17.40 ± 2.89) J in this patient cohort. There were no serious intraoperative complications. Malignant ventricular arrhythmia occurred in 38 patients post ICD, 469 episodes of nonsustained ventricular tachycardia (VT) were spontaneously terminated, 265 episodes were sustained VT and 245 (92.5%) episodes were successfully terminated by 1 antitachycardia pace treatment (ATP), 13 (4.89%) episodes successfully terminated by 2 ATP, and ATP failed to terminate VT in 7 (2.64%) episodes and VTs were terminated by low energy cardioversion. All 141 episodes of ventricular fibrillation (VF) were successfully identified, and 14 episodes spontaneously terminated before discharging, 127 VF episodes (91.34%) were terminated by 1 energy shock, defibrillation energy was (12.84 ± 3.18) J, 11 (12.2%) VF episodes were terminated by 2 energy shocks, defibrillation energy was (16.36 ± 2.34) J.</p><p><b>CONCLUSION</b>It is safe and feasible to use defibrillation threshold measured by DSM for patients receiving ICD implantation.</p>