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Objective:To evaluate the diagnostic value of coronary angiography-based fractional flow reserve(caFFR)versus a wire-based fractional flow reserve(FFR)in elderly patients with stable ischemic heart disease.Methods:A total of 168 patients(186 vessels)who underwent a pressure wire(PW)-based FFR measurement from Jan.2015 to Dec.2019 in Beijing hospital were enrolled and analyzed retrospectively.Coronary angiography images and matched steady-state aortic pressure of patients were sent to the core laboratory for caFFR measurement under the blind method.All patients were divided into the non-elderly group(<65 years, n=93)and the elderly group(≥65 years, n=75). The diagnostic value of caFFR was evaluated by using the wire-based FFR cut-off value of ≤0.80 as the reference standard.The correlation and consistency of caFFR and wire-based FFR were analyzed, and compared between the non-elderly and elderly groups.Results:The caFFR had a good correlation and consistency with wire-based FFR in the elderly group( r=0.796, P<0.01). In non-aged versus elderly groups, diagnostic accuracy of caFFR was 91.9% versus 93.1%, diagnostic sensitivity of caFFR was 91.8% vs.93.2%, diagnostic specificity of caFFR was 92.3% vs.93.0%, all P>0.05.The area under the receiver-operating characteristic curve of caFFR had no significant difference between the non-elderly and elderly patients(0.964 vs.0.972, Z=0.00823, 95% CI: -0.037-0.052, P>0.05). Conclusions:The caFFR has a good diagnostic correlation and consistency with wire-based FFR in the elderly group, and caFFR's diagnostic performance in the elderly is similar to that in the non-elderly patients.
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Objective@#To screen for hotspot gene mutations associated with genetic deafness in Chinese pregnant women, and to perform risk assessment and prenatal diagnosis in high-risk families.@*Methods@#Between November 2012 and October 2017, 26 117 pregnant women were screened by molecular hybridization microarray for 9 hot-spot mutations in 4 hereditary deafness related genes (GJB2 c. 35 del G, c. 176_191 del 16 bp, c. 235 del G, c. 299_300 del AT, GJB3 c. 538 C>T, SLC26A4 c. 2168 A>G, IVS 7-2 A>G, mitochondrial DNA 12S rRNA m. 1494 C>T, m. 1555 A>G). Genotype analysis was carried out in husbands of women carrying mutations, and prenatal diagnosis was carried out in the fetuses with high risk of deafness.@*Results@#Among all women tested, 1 208(4.63%) were carriers of genetic deafness mutations, 7 with hearing impairment were affected by homozygous or compound heterozygous mutations, 51 were mitochondrial gene mutation carriers, 103 were carriers of GJB3 c. 538 C>T heterozygous mutation, 1 026 were carriers of GJB2 or SLC26A4 heterozygous mutations, and 21 carried heterozygous mutations in two genes simultaneously. In 394 families, the husbands accepted gene sequence testing, and 27 in which were determined as carriers of mutations in identical genes as their wives. Among which, 18 families received prenatal diagnosis, and 5 fetuses were diagnosed as hereditary deafness. In 9 families who did not receive prenatal diagnosis, 1 neonate was diagnosed as compound heterozygote after delivery.@*Conclusion@#In order to prevent birth defects with congenital hearing problems, it is effective to provide screening for hotspot mutations in pregnant women and to perform prenatal diagnosis on high risk pregnancies.
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Objective To analyze the safety and efficacy of coronary rotational atherectomy in elderly patients with coronary heart disease.Methods A total of 107 consecutive patients with coronary artery disease receiving rotational atherectomy from January 2012 to December 2016 were retrospectively analyzed.Patients were divided into an ≥75 years group(n=44)and a ＜75 years group (n=63).We compared the characteristics of rotational atherectomy,peri-procedural complications,instant procedure success rates and 1-year cardiovascular events,including angina,re-infarction,hospitalization due to heart failure,repeat revascularization and cardiac death.Results There was no significant difference in the target coronary vessel,reference vessel diameter,maximal diameter of the burr and ratio of maximal diameter of the burr to reference vessel diameter between the two groups(all P＞0.05).Compared with ＜75 years patients,more ≥75 years patients used 2 burrs(10 cases or 22.7％ vs.4 cases or 6.3％,P =0.013),while there was no significant difference in terms of burr size,rotational time,maximal rotational speed,pre-and post-dilation pressure between the two groups (all P＞0.05).The incidence of peri-procedural complications had no significant difference between the ≥75 years group and the ＜75 years group(8 cases or 18.2％ vs.13 cases or 20.6％,P =0.753).One case of burr entrapment occurred in each group with successful retrieval.The procedure success rate was 96.8％(61 cases)in the ＜75 years group and 100％ in the ≥75 years group(P=0.640).No acute or sub-acute stent thrombosis or urgent coronary artery bypass graft occurred in the two groups during hospitalization.No cardiac death occurred in either group.Conclusions Coronary rotational atherectomy is effective and safe in elderly patients with coronary disease with a high instant procedure success rate.
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Objective To investigate the prevalence and risk factors for atherosclerotic renal artery stenosis (ARAS) in elderly patients with refractory hypertension.Methods Two hundred and eight elderly patients with a mean age of (68.3±4.9)years (53.8％ in men) diagnosed with refractory hypertension were recruited in this retrospective study from January 2010 to January 2017 in Beijing hospital.Fifty of the 208 patients with ultrasonography-suspected renal artery stenosis received renal arteriography and 39 were confirmed as renal artery stenosis.Renal artery stenosis was defined when stenosis located in at least one of renal arteries and only if the stenosis equal or over 50％.The prevalence of ARAS was calculated.Besides,univariate and final multivariate Logistic regression analyses were conducted to detect independent risk factors for development of ARAS.Results Thirty-nine of 208 patients (18.8％) were confirmatively diagnosed as ARAS.Although univariate Logistic regression showed that diabetes,coronary heart disease,renal insufficiency,and peripheral artery disease (P=0.034,0.040,0.022,and 0.030) might be risk factors for ARAS,a multivariate regression analysis demonstrated that only the peripheral artery disease (OR=3.218,P＜0.01) and renal insufficiency (OR=3.827,P＜0.01) were independent risk factors for ARAS.Conclusions Renal angiography should routinely be performed in refractory hypertension patients with renal insufficiency or peripheral artery disease to identify ARAS in time.
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Objective To evaluate the clinical impact of percutaneous coronary intervention (PCI)on prognosis in elderly patients(≥70 years old)with coronary artery chronic total occlusion (CTO). Methods A total of 445 consecutive patients with a angiography-confirmed CTO lesions registered from January 2011 to December 2013 were divided into the elderly group(≥70 years)and the non-elderly group(< 70 years).The primary endpoints measured were defined as the composite outcomes of hospitalization due to angina,re-infarction,heart failure,repeat re-vascularization,and cardiac death at 36 months follow-up. Results The elderly group included 200 patients(44.9%) and the non-elderly group included 245 patients(55.1%).During the follow-up,the proportions of coronary lesion were significantly higher in the elderly group with left main(LM)disease(45, 22.5%),three-vessel disease(166,83.0%)and J-CTO score≥2(64,32.0%)than in the non-elderly group with diseases of LM,three-vessel,and J-CTO score ≥ 2〔(34,13.9%);(180,73.5%);(57, 23.3%),respectively〕(χ2 =5.607,5.782,4.243;P=0.018,0.016,0.039).T he ratio of the patients undergoing PCI-reperfusion therapy of CTO was higher in non-elderly group(109/275,39.6%)than in elderly group(53/222,23.9%)(χ2 =13.891,P<0.001),while CTO PCI success rate was similar between the two groups(38 patients,71.7% vs.90 patients,82.6%,χ2 = 2.541,P= 0.111).The elderly group versus non-elderly group showed that the 3-year cardiac mortality rate was 12.5%(25 patients)versus 3.3%(8 patients)(χ2 =13.677,P<0.011),and the incidence rate of 3-year primary endpoint was 31.5%(63 patients)versus 22.9%(56 patients)(χ2 =4.199,P=0.040).Among the elderly group,patients without CTOs re-vascularized by PCI had a greater tendency toward higher risk of hospitalization due to angina,re-infarction,heart failure,or repeat re-vascularization than patients with CTOs re-vascularized by PCI(34/149,22.8% vs.3/33,9.1%,χ2 =3.143,P=0.076),while they had comparable incidence of 3-year cardiac death(19/149,12.8% vs.5/33,15.2%,χ2 = 0.007,P=0.933).Multivariate analysis revealed that after adjusting for baseline and procedure differences,LM combined with three vessel disease(OR= 3.804,95% CI:1.274 to 11.356,P= 0.017)remained an independent predictor for 3-year cardiac mortality in elderly patients with CTOs. Conclusions Elderly patients with CTO have mostly a serious coronary artery disease and a poor prognosis.Although CTO is re-vascularized by PCI,long-term clinical outcome seems not more to be improved in elderly patients with CTOs.LM combined with three-vessel disease might be an independent predictor for 3-year cardiac mortality in elderly CTO patients.
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Objective To investigate the accuracy of transthoracic echocardiography (TTE) for diagnosing left cardiac valve calcification in elderly patients.Methods In this retrospective study,410 elderly patients died in Beijing Hospital from 1982 to 2015 were collected.They all had full pathological cardiac valve examination data in the autopsy examination and full mortem TTE data.They were classified into three groups according to the year of death:group 1982-1995,group 1996-2005 and group 2006-2015,as well as into three groups according to the age of death:group 60-75,group76-90 and group 91-106.Results The sensitivity,specificity,diagnostic coincidence rate,positive likelihood ratio (PLR),negative likelihood ratio (NLR),positive predictive value (PPV) and negative predictive value(NPV) of TTE versus autopsy pathological findings as golden standard for diagnosing left cardiac valve calcification were 88.6％,28.2％,43.7％,1.234,0.405,0.298 and 0.878.Compared with group 1982-1995,the group 1996-2005 and group 2006-2015 showed the sensitivity and PPV of TTE versus golden standard autopsy findings for diagnosing left cardiac valve calcification in the elderly were increased while the specificity,PLR,NLR and NPV were decreased.Compared with group 60-75,the group 76-90 and group 91-106 showed that the sensitivity and PPV of TTE versus golden standard autopsy findings for diagnosing left cardiac valve calcification were increased,while the specificity and diagnostic coincidence rate were decreased.The sensitivity,specificity,diagnostic coincidence rate,PLR,NLR,PPV,NPV of TTE versus golden standard autopsy findings for the diagnosis of aortic valve calcification and mitral valve calcification in the elderly were 88.2％ and 44.0％,30.8％ and 75.3％,42.7％ and 71.5％,1.275 and 1.780,0.382 and 0.744,0.250 and 0.198,0.909 and 0.906,respectively.Conclusions TTE provides high sensitivity for diagnosing left cardiac valve calcification in the elderly,especially for diagnosing the aortic valve calcification,but the specificity is not satisfactory.
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Objective: To study the prognostic impact of chronic total occlusion (CTO) on non-infarct-related artery (non-IRA) in patients of acute ST-elevation myocardial infarction (STEMI) with emergent primary percutaneous coronary intervention (PCI). Methods: In this prospective study, a total of 185 consecutive acute STEMI patients received early stage primary PCI in our hospital from 2010-01to 2011-06 were enrolled. The patients were divided into 2 groups:non-CTO group, n=160 and CTO group, n=25. The patients were followed-up for 1 year and the primary endpoint events included the hospitalization for angina, re-MI, heart failure or revascularization and cardiac death. Results: ①There were more patients with diabetes and three vessel disease in CTO group than those in non-CTO group (40.0%vs 20.0%, P=0.049) and (68.0%vs 36.3%, P=0.003);LVEF in CTO group was lower than non-CTO group (40.0 ± 20.1%vs 51.3 ± 15.3%, P Conclusion: Non-IRA combining CTO in STEMI patients with primary PCI are usually having poor prognosis.
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Objective To evaluate the incidence of aortic valve calcification,and the correlation between valve function and commonly encountered disease in the aged patients.Methods Totally 996 patients who underwent ultrasonic cardiography (UCG) in our hospital were included.They were divide into elderly group and non elderly group,and the elderly group was divided into calcification subgroup and non calcification subgroup.The calcification,stenosis and regurgitation of aortic valve were detected by UCG,and risk factors of calcification were evaluated by Logistic regression analysis.Results The incidence of calcification was higher in elderly group than in non elderly group [71.8％ (526/733) vs.14.6％ (34/233),x2＝237.10,P＜0.01].In elderly group,the incidence of aortic valve stenosis was 2.1％ (11/526) in calcification subgroup and 1.9％ (4/207) in non calcification subgroup (x2＝0.81,P＞0.05).In elderly group,the incidence of aortic valve regurgitation was 63.3％ (333/526) in calcification subgroup and 19.3％ (40/207) in non calcification subgroup (x2＝116.10,P＜0.01).The hazard ratio of aortic valve calcification in different diseases were as follows:hypertension (OR＝2.06,95％CI:1.400-3.031),coronary heart disease (OR＝3.46,95％CI:2.217-5.384),diabetes mellitus (OR ＝ 2.66,95％CI:1.652-4.278),renal dysfunction (OR＝ 2.34,95％ CI:1.415-3.869),osteoporosis (OR＝ 2.33,95％CI:1.119-4.838).Conclusions The incidence of calcification,mainly causing aortic valve regurgitation,is high in elderly patients.Patients with hypertension,coronary heart disease,diabetes mellitus,renal dysfunction and osteoporosis are prone to the development of aortic valve calcification.
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ObjectiveTo observe the in-hospital and long-term results in patients with drugeluting stenting age≥70 years with unprotected left main (UML) coronary artery disease.MethodsIn this retrospective study, 100 patients with UML disease were enrolled. Death, myocardial infarction, repeated revascularization and composite end points during follow-up were compared between groups aged ≥70 years and control aged ＜70 years.ResultsThere was no remarkable distinction between the two groups in cardiovascular risk factors, anatomic findings of coronary artery disease and stent variables. No significant differences were found between the two groups in procedure success rate[96.2％ (50 cases) vs. 97.9％ (47 cases) ,x2 = 1.75, P＞0.05] and in-hospital mortality [3.8％ (2 cases) vs. 2.1％ ( 1 case), x2 = 0.27, P ＞0.05]. Patients were clinically followed for an average time of 22.0 months in the elderly group and 23.0 months in the control group (t= -0.78, P＞0.05). There were no significant differences in death[3.9％(2 cases) vs. 2.1％(1 case) ,x2 =2.51,P＞0.05], myocardial infarction[7.7 ％ (4 cases) vs. 4.2 ％ (2 cases), x2 = 0.55, P＞0.05], repeated revascularization [13.5％ (7 cases) vs. 12.5％(6 cases) ,x2 =0.02, P＞0.05]and composite endpoints of death, myocardial infarction and repeated revascularization[30.7％ (16 cases)vs. 18.8％ (9 cases),x2 = 1.92, P＞0.05] between the elderly group and the control group.ConclusionsThe procedure success rate and in-hospital mortality of drug-eluting stent implantation in elderly patients aged≥70 years old with unprotected left main coronary artery are comparable to group aged＜70 years. The main endpoints including death, myocardial infarction and repeated revascularization are favorable at about 2 years clinical follow up. It is safe and efficacious to implant drug-eluting stent in patients aged ≥70 years old with unprotected left main coronary artery.