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Objective To investigate the relationship between the volume of left atrial appendage and recurrence of atrial fibrillation(AF)after radiofrequency ablation. Methods In this retrospective cohort study, 66 cases of first atrial fibrillation radiofrequency catheter ablation in the Department of cardiovascular medicine of the First Affiliated Hospital of Zhengzhou University were enrolled from June 2014 to June 2016 and divided into the recurrence group(n=18)and the non recurrent group(n=48)based on the 1 year follow-up results ,Collecting the patient's clinical data and following up.64 layers of spiral CT scans were performed for all patients before operation,and the volume of left atrium( LAV)and left atrial appendage volume(LAAV)were measured. The general data ,laboratory examinationresults ,echocardiographic parameters and left atrial CT parameters of two groups were compared. The relationship between patient parameters and recurrence of atrial fibrillation after radio-frequency ablation were analyzed by multivariate logistic regression analysis. Results There was no significant difference in blood lipid and left ventricular ejection fraction(LVEF%)between the two groups in terms of sex, age ,hypertension ,coronary heart disease and other common diseases (P > 0.05).The volume of left atrial appendage and left atrial volume in the recurrent group were larger than those in the non recurrence group (P <0.05). The left atrial appendage volume(OR=1.518,95%CI:1.151-2.000,P = 0.003)can be used as an independent risk factor for postoperative recurrence of atrial fibrillation. The area under the ROC curve of left atrial appendage volume in predicting the recurrence of atrial fibrillation after radiofrequency ablation is 0.806(95%CI:0.689-0.922 ,P < 0.001). Conclusion Greater left ventricular volume is an independent risk factor for recurrence of atrial fibrillation after radiofrequency catheter ablation ,whether in paroxysmal atrial fibrillation or persistent atrial fibrillation.
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Objeetive To investigate the relationships of CYP2C19 genotype polymorphism with platelet inhibition rate and clopidogrel low responsiveness in patients taking percutaneous coronary intervention (PCI) during perioperative administration of clopidogrel.Methods 404 patients taking clopidogrel after PCI were included from February 2016 to February 2017.They were divided into three groups:fast metaboliszer,moderate metaboliszer and slow metabolizer,according to the CYP2C19 genotype.Platelet inhibition rate induced by adenosine diphosphate (ADP) was detected by thrombelastogram,platelet inhibition rate ＜ 30％ was defined as clopidogrel low responsiveness (CLR) group and the relationships between the three groups were analyzed in view of CYP2C19 genotype and the platelet inhibition rate and the clopidogrel low responsiveness.Results (1) The proportions of the three groups was 45.5％,45.3％ and 9.2％ in the 404 patients,no statistically significant difference among the three groups in general data (age,sex,platelet,hypertension,diabetes mellitus,hyperlipidemia) (P ＞ 0.05).(2) There was no statistically significant difference in the platelet inhibition rate between the three groups (P =0.312).(3) There was no significant difference in the clopidogrel low responsiveness between the three groups (P =0.295),with the fast metabolizer group vs.intermediate metabolizer (P =0.522),the fast metabolizer group vs.the slow metabolizer (P =0.117) and the intermediate metabolizer group vs.slow metabolizer (P =0.255).Conclusion There is no correlation of CYP2C19 genotype with platelet inhibition rate and clopidogrel low responsiveness in patients taking clopidogrel after PCI.Only the detection of CYP2C19 genotype may not accurately predict the antiplatelet aggregative activity of clopidogrel.
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Objective To determine the trend of emergency department (ED)mortality of a tertiary general hospital from 2004 to 2014 in order to find the factors that may impact on ED mortality.Methods Mortality in ED was estimated according to the ratio of ED visiting patients to ED deaths.And the data of all ED deaths in 2004,2009 and 2014 were collected.Variance analysis and chi-square test were used for data analysis.Results During the past decade,ED visiting patients was increased significantly by 38.0% in 2014,compared with those in 2004,and the mortality was also increased accordingly from 0.7% in 2004, to 0.9% in 2009,to 1.2% in 2014 (P <0.01).Finally,a total of 1,091 deaths occurred in these three years were included for further evaluation.There were no significant changes in average age and gender distribution,and the average age was 61.9 and the male /female ratio was 1.36∶1 during past decade.The number of adults under 40 years old (18 -39)increased from 7.5% in 2004,to 10.6% in 2009,to 14.4% in 2014 (P <0.05).Both the facilities were upgraded and the number of staffs in ED increased markedly.The cardiovascular illness,cerebrovascular diseases,and sudden death were the leading causes of ED death during past decade.The incidences of trauma and tumor remained unchanged.Average time consumed from onset of illness to arrival to ED didn’t vary significantly during past decade.The study showed no changes in use of ambulance,but remarkable increases in number of non-compliant patients or their family from 18.3% in 2004,to 25.6% in 2009,to 38.3% in 2014 (P <0.01).The percentage of patients in the night time was higher,but there were no significant changes in number of emergency patients in the night time and during holidays in the past decade,but the mean ED stay time increased obviously from 22.4 h in 2004 to 53.3 h in 2014 (P <0.05 ).Conclusions During the past decade,although ED facilities and number of staffs have been improved apparently,ED mortality rate still keeps on escalating. The increase in ED mortality rate may be related to the severely ill patients presenting to ED,the obvious decrease in compliance of patients and the prolonged ED stay time.
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Objective To assess the effects of fenofibrate on myocardial remodeling in obese rats by echocardiography.Methods Twenty-six SD rats were fed with high fat chow to establish twenty obese rats models,which were randomly divided into two groups:obesity group (OB group,n =10) and fenofibrate group(F group,n =10).The same week-old SD rats group (n =10) was also randomly selected as normal control group.F group was given fenofibrate 60 mg · kg-1 · d-1 for 8 weeks,the other groups were given normal saline.Echocardiographic scan was performed in each group at the beginning and ending of the experiment.Twenty-four weeks later,all rats were executed and the cardiac muscle was used to histological inspect.Results After the experiment,compared with the control group,the body weight,the ventricular thickness,interventricular septal thickness and the left ventricular mass in OB group were significantly increased than those of control group(P ＜0.01),the E/A ratio was significantly decreased(P ＜0.01).Histological detection showed that myocardial structure was disordered,and that interstitial collagen was deposited in the myocardium.Compared with OB group,the parameters all above in F group were significantly improved (P ＜0.01).Left ventricular mass from echocardiography correlated well with the results from pathologic specimen (r =0.98,P ＜0.01).Conclusions Fenofibrate has beneficial effects on preventing myocardial remodeling.By general echocardiography,the effects can be assessed comprehensively and accurately.