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Recent studies have shown that acute blood glucose elevation in patients with ST-segment elevation myocardial infarction (STEMI) suggests a poor prognosis. To investigate the effect of fasting blood glucose (FBG) on the risk of heart failure (HF) and left ventricular systolic dysfunction (LVSD) in non-diabetic patients undergoing primary percutaneous coronary intervention (PCI) for acute STEMI, we retrospectively recruited consecutive non-diabetic patients who underwent primary PCI for STEMI in our hospital from February 2003 to March 2015. The patients were divided into two groups according to the FBG level. A total of 623 patients were recruited with an age of 61.3 ± 12.9 years, of whom 514 (82.5%) were male. The HF risk (odds ratio 3.401, 95% confidence interval (CI) 2.144-5.395, P < 0.001) was significantly increased in patients with elevated FBG than those with normal FBG. Elevated FBG was also independently related to LVSD (β 1.513, 95%CI 1.282-1.785, P < 0.001) in a multiple logistics regression analysis. In conclusion, elevated FBG was independently associated with 30-day HF and LVSD risk in non-diabetic patients undergoing primary PCI for STEMI.
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Aged , Female , Humans , Male , Middle Aged , Fasting , Glucose , Heart Failure , Percutaneous Coronary Intervention , Prognosis , Retrospective Studies , Risk Factors , ST Elevation Myocardial Infarction/surgeryABSTRACT
Immunotherapy of malignant tumors has become a hot spot in the field of cancer research and treatment, bringing new hope to patients with advanced cancer. Activation of molecular programmer death protein-1 and T lymphocyte-associated antigen 4-related signaling pathways at the immunological checkpoint can inhibit T lymphocyte activation and thereby block the inflammatory response. Tumor cells achieve immune escape by activating the molecular pathways associated with immune checkpoints. The immune checkpoint inhibitor can wake up T lymphocytes and enhance the body's clearance of tumor cells. However, the role of immune checkpoint inhibitors is not specific to tumor cells, and it can cause side effects of multiple systems including the cardiovascular system while killing tumor cells. We will summarize the relevant cardiac side effects and give advice on how to manage it.
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Objective@#To observe the relationship between impaired myocardial untwisting and left ventricular diastolic dysfunction in patients with autoimmune diseases (AD).@*Methods@#In this retrospective study, 95 AD patients (27 males, (38.6±14.2) years old) were enrolled as AD group and 71 gender and age matched healthy subjects (24 males, (37.6±12.2) years old) were enrolled as control group, all underwent transthoracic echocardiography and two-dimensional speckle-tracking echocardiography (STE) in our hospital between January 2014 and June 2018. Left ventricular untwisting and diastolic function parameters were measured. Multiple logistic regression analysis was used to identify related factors of left ventricular diastolic dysfunction in AD patients. Receiver operating characteristic (ROC) curve was used to identify the diagnosis value of untwisting parameters for left ventricular diastolic dysfunction in AD patients.@*Results@#Compared with control group, left ventricular ejection fraction was lower (58(47, 66)% vs. 67 (62, 71) %, P<0.001), E/e′ was higher (10.78 (7.28, 13.65) vs. 6.30 (5.55, 7.25) , P<0.001), isovolumic relaxation time was longer (73.5 (56.5, 88.0) ms vs. 62.0 (58.0, 68.5) ms, P<0.001),and untwist slope during isovolumic relaxation period (USIR) was lower (31.92 (14.09, 54.92) °/s vs. 59.90 (40.09, 87.18) °/s, P<0.001) in AD group than in control group. Multiple logistic regression analysis showed heart rate (OR=0.885, 95%CI 0.840-0.931, P<0.001), E/e′ (OR=0.655, 95%CI 0.537-0.798, P<0.001) and USIR (OR=0.986, 95%CI 0.974-0.998, P=0.020) were independently related with left ventricular diastolic dysfunction in AD patients. ROC curve showed that area under the curve (AUC) was 0.919 (P<0.001), sensitivity was 87.6%, and specificity was 88.7%, when combining the heart rate, E/e′, and USIR as assessment parameters for the diagnosis of left ventricular diastolic dysfunction in AD patients at a cutoff of 0.51.@*Conclusions@#Impairment of myocardial untwisting indicates the presence of early stage left ventricular diastolic dysfunction in AD patients. USIR may be a sensitive parameter to evaluate early stage left ventricular diastolic dysfunction in AD patients.
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Objective@#To observe the treatment of inflammatory myopathy-associatied cardiomyopathy and its impact on prognosis of disease.@*Methods@#In this single-center retrospective study, 29 cases of inflammatory myopathy-associated cardiomyopathy were collected in Peking Union Medical College Hospital from 1999 to 2016. The clinical data and adverse events during follow up were documented. Among 29 patients there were 11 cases of polymyositis, 8 cases of dermatomyositis, 8 cases of overlap syndrome and 2 cases of nonspecific myositis.All the patients started with sufficiene prednisone (1-2 mg·kg-1·d-1). 7 cases received intravenous immune globulin, while 12 cases were prescribed with steroid pulse therapy, 16 cases with methotrexate, 15 cases with cyclophosphamide, 6 cases with cyclosporine A, while 11 cases with combination of immune suppressors (methotrexate plus cyclophosphamide or cyclosporine A). After a median follow up of 4.8 years (2 month to 15 years), 14 cases died including 9 of cardiac death. Patients with cardiac deaths had lower usage percentages of intravenous gamma globulin (0 vs. 7/20, P=0.05) and steroid pulse therapy (1/9 vs. 11/20, P=0.043) than controls. Comparing with controls, patients in the group of adverse events were more prone to choose methotrexate alone rather than combination of immune suppressors (all-cause death: 1/14 vs. 8/15, P=0.014; cardiac death: 0 vs. 9/20, P=0.027). Kaplan-Meier survival analysis showed significant difference of survival rates between patients with combination of immune suppressors and controls (Log Rank χ2=6.001, HR=7.58, P=0.014), as well as between patients with β receptor blockers and controls (Log Rank χ2=4.589, HR=2.95, P=0.032).@*Conclusions@#We recommend a management strategy that emphasize both primary disease controlling and cardiac remodeling improvement in patients with inflammatory myopathy-associated cardiomyopathy. On the basis of sufficient glucocorticoids, intravenous gamma globulin, steroid pulse therapy, combination of methotrexate plus other immune suppressants, and β receptor blockers were worthy to be considered.
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Objective To observe the treatment of inflammatory myopathy-associatied cardiomyopathy and its impact on prognosis of disease.Methods In this single-center retrospective study,29 cases of inflammatory myopathy-associated cardiomyopathy were collected in Peking Union Medical College Hospital from 1999 to 2016.The clinical data and adverse events during follow up were documented.Among 29 patients there were 11 cases of polymyositis,8 cases of dermatomyositis,8 cases of overlap syndrome and 2 cases of nonspecific myositis.All the patients started with sufficiene prednisone (1-2 mg· kg-1· d-1).7 cases received intravenous immune globulin,while 12 cases were prescribed with steroid pulse therapy,16 cases with methotrexate,15 cases with cyclophosphamide,6 cases with cyclosporine A,while 11 cases with combination of immune suppressors (methotrexate plus cyclophosphamide or cyclosporine A).After a median follow up of 4.8 years (2 month to 15 years),14 cases died including 9 of cardiac death.Patients with cardiac deaths had lower usage percentages of intravenous gamma globulin (0 vs.7/20,P=0.05) and steroid pulse therapy (1/9 vs.11/20,P=0.043) than controls.Comparing with controls,patients in the group of adverse events were more prone to choose methotrexate alone rather than combination of immune suppressors (all-cause death:1/14 vs.8/15,P=0.014;cardiac death:0 vs.9/20,P=0.027).Kaplan-Meier survival analysis showed significant difference of survival rates between patients with combination of immune suppressors and controls (Log Rank x2=6.001,HR=7.58,P=0.014),as well as between patients with β receptor blockers and controls (Log Rank x2=4.589,HR=2.95,P=0.032).Conclusions We recommend a management strategy that emphasize both primary disease controlling and cardiac remodeling improvement in patients with inflammatory myopathy-associated cardiomyopathy.On the basis of sufficient glucocorticoids,intravenous gamma globulin,steroid pulse therapy,combination of methotrexate plus other immune suppressants,and β receptor blockers were worthy to be considered.
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To observe the effect of different R‐R interval on left ventricular systolic function measured by echocardiography in patients with persistent atrial fibrillation ( AF ) ,and assess the clinical feasibility of the use of an index that is based on the RR1/RR2 ratio to accurately estimate left ventricular systolic function during AF . Methods T wenty‐one patients with persistent AF received echocardiographic examination ,left ventricular ejection fraction ( LVEF ) and stroke volume ( SV ) were recorded at least 10－20 consecutive cardiac cycles for each patient . T he effects of different R‐R intervals on LVEF and SV determined by echocardiography were analyzed . Bland‐Altman analysis was used to assess the correlation and agreement between the systolic parameters of a single beat method based on the ratio of preceding R‐R intervals approaching to 1 and the average value of multiple cardiac cycles as the golden standard . Results In the same patient with AF ,LVEF and SV measured in different cardiac cycles were unstable with great variation . LVEF and SV were not only correlated with heart rate ,showing significantly positive correlations with RR interval ( all r ＞ 0 .4 , P ＜ 0 .05 ) ; w hich were also affected by heart rate variability ,w hen the heart rate variability was high ( heart rate standard deviation ≥ 30 beats/min ) ,the measured SV was better correlated with RR 1/RR2 ( r :0 .581 vs 0 .835 , P ＝ 0 .009 ) . Bland‐Altman analysis showed excellent correlation and agreement between the LVEF and SV of a single beat with identical RR1and RR2 intervals and measured average values over all cardiac cycles ( r ＝0 .897 ,0 .918 ; all P ＜ 0 .001 ) . Conclusions LV systolic function is significantly correlated with RR interval and is also affected by heat rate variability . Single beat based on ratio of RR 1/RR2 to assess LV systolic function in patients with AF is as accurate as the time‐consuming method of averaging multiple cardiac cycles .
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Objective To explore the relationship between the body weight and the structure and function of the left ventricle in the elderly inpatients,in order to emphasize the importance of body weight in the health management for elderly patients.Methods A total of 152 elderly inpatients meeting the enrollment criteria and providing informed consent were consecutively recruited.The height,body weight,body mass index (BMI),liver and kidney function,glycosylated hemoglobin,blood lipid,blood uric acid and structure and function of left ventricular were measured by anthropometry,biochemical examination and echocardiography respectively.The clinical characteristics,metabolic parameters,structure and function of left ventricular were compared among the low/normal weight,overweight and obesity groups.The correlation between left ventricular diastolic dysfunction (E/A ≤ 0.7) and the metabolic factors was analyzed.Results The incidences of lower/ normal weight,overweight and obesity in elderly inpatients were 29.6％ (45/152),52.6％ (80/152) and 17.8％ (27/152) respectively.Compared with the lower/normal weight group,the level of systolic blood pressure,glycosylated hemoglobin (P=0.005),left atrial diameter (P =0.000),left ventricular posterior wall dimension (P=0.010),left ventricular diastolic diameter (P=0.010),left ventricular mass (P=0.000),relative wall thickness and septal thickness increased significantly in overweight and obesity groups (all P＜ 0.05).A higher proportion of left ventricular diastolic dysfunction was observed in overweight and obesity groups in the patients aging 60-69 years (P=0.028).There was positive correlation between left ventricular diastolic dysfunction and BMI (P=0.022).Conclusions Overweight/obesity increases the risk of left ventricular diastolic dysfunction among elderly inpatients.The body weight management needs to be strengthened in health management for the elderly patients.
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Objective To evaluate the efficacy and safety of higenamine hydrochloride(HG) stress echocardiography for diagnosis of coronary artery disease (CAD). Methods The study was designed as prospective,randomized,open-labled,positively controlled and crossover phase II multi-center clinical research.Ninety subjects who were suspected to have CAD were enrolled.HG dosage was titrated at 0.5,1, 2,4 μg.kg -1.min-1every 3 min.Adenosine was injected 140 μg.kg -1.min-1for 6 min with total dosage 0.8 mg/kg.Visual assessment of the left ventricle wall motionand 17-segment model were used for analysis of stress echocardiography.CAD was defined as identifying >50% diameter stenosis in at least one major coronary artery by coronary angiogram.All adverse reaction were recorded. Results For HG group,the sensitivity,specificity,accuracy,positive predictive value and negative predictive value were 28.9%,89.7%, 57.1%,76.5% and 47.8%,respectively;for adenosine group,they were 26.7%,94.9%,58.3%,85.7%and 47.1%,respectively. There was no significant difference between the two groups( P > 0.05). The diagnostic sensitivities of HG and adenosine echocardiography for single vessel stenosis were 11.1% and 5.6%,respectively( P >0.05).Both HG and adenosine echocardiography have the same sensitivity with 37.5% for double vessel stenosis and 44.4% for triple vessel stenosis.Advers reaction rate was 84.4% in HG group and 92.2% in adenosine group( P >0.05).Conclusions HG stress echocardiography for CAD diagnosis has high specificity,good safety and low sensitivity,which are similar to adenosine echo.
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Objective@#To evaluate the association between the ratio of early diastolic transmitral velocity to early diastolic mitral annular velocity (E/E') and left atrial pressure (LAP) estimated from invasive catheter measurements in patients with atrial fibrillation (AF).@*Methods@#A total of 46 consecutive patients with non-valvular AF and preserved left ventricular ejection fraction (LVEF) admitted in our department to receive the first radiofrequency ablation from May to July 2017 were included. All patients underwent echocardiography at 24-48 hours before radiofrequency ablation, and LAP was invasively measured during the ablation procedure. According to mean LAP, patients were divided into 2 groups of normal LAP (LAP≤12 mmHg(1 mmHg=0.133 kPa, n=31) and elevated LAP (LAP>12 mmHg, n=15). Linear correlation analysis was used to evaluate the relationship between E/E' and LAP.@*Results@#E/E' correlated well with LAP (septal E/E' (E/E'sep), r= 0.397, P=0.006; lateral E/E' (E/E'lat), r=0.433, P=0.003; mean E/E' (E/E'mean), r=0.431, P=0.003). Using receiver operating characteristic analysis, the optimal cut-off for E/E'sep was 12.5 (sensitivity 73.3%, specificity 67.7%), E/E'lat was 10.8 (sensitivity 80.0%, specificity 77.4%), E/E'mean was 11.0 (sensitivity 86.7%, specificity 64.5%) to predict mean LAP>12 mmHg.@*Conclusion@#E/E', especially the E/E'lat, is positively correlated with LAP in patients with AF and preserved LVEF, and may be used to estimate the diastolic function in AF patients with preserved LVEF.
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Objective To explore the clinical characteristics and risk factors in patients with peripartum cardiomyopathy (PPCM).Methods A total of 35 patients admitted in Peking Union Medical College Hospital and diagnosed with PPCM between January 1995 and December 2014 was included and analyzed in this study.The subjects were divided into two groups:the early recovery and delayed recovery.Early recovery was defined as normalization of left ventricle ejection fraction (LVEF) ≥ 50％ before 6 months post-diagnosis.Delayed recovery was defined if the length of time required for recovery of LVEF was longer than 6 months or death was reported during follow-up.Risk factors for delayed recovery were assessed.Results The incidence of PPCM was 1 per 1 067 deliveries between the study periods.The age of the 35 patients was (28.9±5.6) years old.Among them,20 (57.1％) patients were not in the first pregnancy,13 (37.1％) had delivered before,and 5 (14.3％) patients had twin pregnancies.The LVEF at diagnosis was (34.1 ±8.0) ％.62.9％ (22 cases) of the subjects were in the early recovery,while 37.1％ (13 cases) of the subjects were in the delayed recovery group,2 of whom suffered death.Multivariate logistic regression indicated that LVEF (OR =1.339,95％ CI 1.063-1.688,P =0.013) and left ventricle end-dilated diameter(OR 0.763,95％CI 0.607-0.960,P =0.021)were independent risk factors for delayed recovery.Conclusions PPCM is a rare but life-threatening complication of pregnancy.LVEF and left ventricle end-dilated diameter at diagnosis were two independent factors associated with the prognosis of PPCM.
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Objective To understand the clinical features of Behcet′s Disease( BD) with pulmonary hypertension( PH) .Methods The etiology, clinical features, treatment and prognosis of 25 patients with Bahcet′s disease ( BD) complicated with pulmonary hypertension ( PH) admitted in Peking Union Medical College Hospital from January 2000 to August 2015 were retrospectively reviewed.Results Total 912 BD patients were hospitalized during the same period, among whom 25 cases were complicated with PH accounting for 3%.There were 15 males (60%) and 10 females (40%), with the mean age of (33 ±12) years (range 19 to 66 years).The median interval from the diagnosis of BD to the onset of PH was 1 year (range 0 to 40 years).The most common cause of PH was heart valve disease (n=10, 40%), followed by pulmonary arterial stenosis or occlusion (n=6, 24%), pulmonary arterial aneurysm with thrombus (n=1, 4%), pulmonary thrombosis (n=1, 4%), cardiomyopathy (n=1, 4%);there were no causes identified in 6 cases (24%).Pulmonary arterial pressures estimated by echocardiography were 40 to 117 mmHg (1 mmHg=0.133 kPa) with a mean pressure of (60 ±22) mmHg.When the PH developed, elevated erythrocyte sedimentation rate ( ESR ) and increased hypersensitive C-reactive protein ( hs-CRP ) were founded in 48% ( 11/23 ) and 82% ( 14/17 ) of patients, respectively.After treated with glucocorticoid (96%,24/25), immunosuppressive agents(92%, 23/25), anticoagulation or thrombolysis(36%,9/25) and specific targeted vasodilator(32%,8/25), the levels of ESR and hs-CRP declined in 91% (10/11) and 71%(10/14) of patients, respectively; and pulmonary arterial systolic pressure declined in 50% of cases (8/16).Among 9 patients followed for 2 to 96 months, 4 died, 1 aggravated, 2 kept stable and 1 improved.Conclusion PH is an uncommon complication in disease.Heart valve disease, pulmonary artery involvement are the major causes of PH.The therapeutic effect and prognosis are poor.
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<p><b>OBJECTIVE</b>To explore the clinical implications of left ventricular hypertrophy (LVH) in patients with pheochromocytoma and paraganglioma (PH/PGL).</p><p><b>METHODS</b>Seventy-eight PH/PGL patients receiving medical attention at Peking Union Medical College Hospital from October 2010 to April 2013 were included in the study.Forty-six healthy people who had no hypertension, pathoglycemia, dyslipidemia history, and with normal chest X-ray, electrocardiogram and echocardiography results served as control group. Clinical symptoms and signs, levels of 24-hour urinary catecholamine, electrocardiogram and echocardiography of participants were recorded and analyzed.</p><p><b>RESULTS</b>(1)Left ventricular ejection fraction, cardiac output index, left ventricular mass index (LVMI), left atrial volume index (LAVI) and mitral E/E' were all significantly higher while mitral annulus lateral E' velocity was significantly lower in PH/PGL group than in control group (all P < 0.05). (2) LVH was associated with more prevalent acute left-sided heart failure episodes (12% (3/25) vs. 0, P = 0.030), sustained LVEF depression (12% (3/25) vs. 0, P = 0.030) and ECG ST-T segment alterations (60% (15/25) vs. 21% (11/53) , P = 0.001) in PH/PGL patients. LAVI ((30.2 ± 8.8) ml/m(2) vs. (23.8 ± 4.7) ml/m(2), P = 0.007) and mitral E/E' (11.2 ± 6.0 vs. 7.2 ± 1.4, P = 0.003) were significantly higher in patients with LVH than in patients without LVH. Mitral annulus septal ((7.8 ± 2.6) cm/s vs. (10.4 ± 3.2) cm/s, P = 0.001) and lateral ((9.3 ± 3.3) cm/s vs. (12.9 ± 2.9) cm/s, P < 0.001) E' velocity, averaged S' velocity((7.9 ± 1.6) cm/s vs. (8.8 ± 1.7) cm/s, P = 0.036) were significantly lower in LVH patients comparing to patients without LVH. (3) According to multiple linear regression analysis, age (t = 3.491, P = 0.001), gender (t = 2.899, P = 0.005), heart rate (t = 2.255, P = 0.027), and 24-hour urinary norepinephrine level (t = 3.369, P = 0.001) were independent factors affecting LVMI of PH/PGL patients.</p><p><b>CONCLUSION</b>Left ventricular hypertrophy is associated with acute left-sided heart failure, left ventricular diastolic dysfunction and elevated left ventricular filling pressure in PH/PGL patients.</p>
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Humans , Echocardiography , Electrocardiography , Heart Failure , Heart Rate , Hypertension , Hypertrophy, Left Ventricular , Pathology , Mitral Valve , Paraganglioma , Pheochromocytoma , Ventricular Function, LeftABSTRACT
Objective To prospectively investigate the characteristics and correlative influential factors of pulmonary hypertension (PHT) in patients on long-term maintenance hemodialysis (MHD). Methods Pulmonary artery systolic pressure (PASP) was assessed by echocardiography according to the guideline from the American Society of Echocardiography in 2010 and PASP more than 35 mm Hg was diagnosed as PHT.Echocardiography and pulse wall velocity (baPWV) was performed in the next day after hemodialysis.Arteriovenous fistula (AVF) flow was evaluated by the ultrasound dilution method.Hemodialysis-related informations and laboratorial parameters were detected in the same period. Results One hundred and eleven MHD patients [male 45,female 66,mean age (57.32±12.49) years old] in our hemodialysis center were included in the study.All of the patients received MHD treatment for more than 6 months with AVF as the vascular access.The patients with any possible diseases causing PHT were excluded.The mean MHD period was (70.51±44.98) months.Twenty-eight patients (25.32％) were diagnosed as PHT with mean PASP (45.68±10.83) mm Hg.Left ventricular diastolic dysfunction was severer in patients with PHT than that in patients without PHT.The prevalence of moderate to severe diastolic dysfunction was statistically higher in PHT group compared to non-PHT group (53.60％ vs 6.02％,P＜0.01).Ejection fraction (EF),fractional shortening of left ventricular diameter in PHT group were also significantly lower than those in non-PHT patients (62.06％±14.90％ vs 69.72％±8.60％,36.46％±10.04％ vs 40.20％±7.86％,P＜0.01).The patients with EF less than 50％ were 21.43％and 3.61％ in PHT and non-PHT group respectively.However,there were no significant differences in age,sex,MHD periods,body mass index (BMI),interval dialysis weight growth,blood pressure before dialysis,hemoglobin,albumin,pre-albumin,serum calcium and phosphorus,iPTH,nPCR,Kt/V,baPWV and AVF flow between the two groups. Conclusions PHT is a common complication of patients on long-term MHD.There is close relationship between PHT and left ventricular insufficiency.PHT is not significantly relevant to mineral metabolic disturbance,AVF flow,hemoglobin,dialysis adequacy and nutrition status.
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Objective To report the clinical characteristics of prosthetic valve endocarditis (PVE).Methods All 25 cases of definite PVE (Duke criteria) diagnosed at our hospital between January 1992 to December 2008 were retrospectively analyzed. Among them, 7 cases were pathologically confirmed and the others were clinically confirmed with either 2 major criteria or 1 major and ≥3 minor criteria. Their clinical characteristics, underlying heart diseases, previous heart operations, presenting manifestations, causative microbes, echocardiographic findings and prognosis, were studied. Results (1) Although most cases underwent valve transplantations for underlying heart diseases of rheumatic heart diseases and congenital heart diseases, 10 patients were complicated with infectious endocarditis (IE) prior to the operations, 4 of them were PVE. (2) Eleven of them developed PVE within 2 months postoperatively. Fever (100%),major vessel embolism (48%), and anemia (36%) were the most frequently manifestations. Fourteen cases (56%) had positive culture results with 15 causative pathogens, including 5 coagulase-negative Staphylococcus (CNS, 3 were methicillin-resistant coagulase-negative Staphylococcus, MRSCoN), 4 fungi, 2Enterococcus faecalis, 2 Burkholderia cepacia, 1 Stenotrophomonasmal-tophilia, and 1 Streptococcus.(3)Prosthetic valve vegetations, periannular leakage, regurgitation, were the main echocardiographic findings.Transesophageal echocardiography (TEE) revealed 13 PVE who had no positive findings on previous transthoracic echocardiography (TTE). (4) Eighteen PVE (72%) developed peri-annular complications (12 leakage, 3 dehiscence, 2 abscesses, 1 fistula), major vessel embolism, congestive heart failure (16%) were frequently observed, 9 of the 17 patients died in hospital, in spite of intensive managements.Conclusions PVE has a high mortality and is a severe complication for patients who underwent heart surgery. Its causative pathogen spectrum is quite different from that of native valve endocarditis. TTE is not sensitive for some PVE cases.
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The occurrence of total chronic coronary occlusion is about 10% in patients undertaking coronary angiography.These patients are often asymptomatic,but can have angina pectoris after exercise and in other conditions increasing oxygen assumption,a few have cardiac insufficiency.The most effective therapies are coronary arterial bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA) plus stenting.The clinical manifestation can be alleviated and cardiac function improved after successful intervention.