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Objective:To investigate the effects of Sacubitril/Valsartan on the recurrence of atrial fibrillation(AF), cardiac structure and function after catheter ablation(CA)of persistent AF.Methods:A total of 180 patients with persistent AF were randomly divided into the treatment group(n=90)and the control group(n=90)before undergoing CA.The control group was given routine perioperative medication according to the guidelines for AF management, and the treatment group was additionally given Sacubitril/Valsartan.Blood pressure, N-terminal pro-B-type natriuretic peptide(NT-proBNP), P-wave dispersion, left atrial dimension, left atrial volume index, mitral regurgitation area, left ventricular end-systolic volume index, end-diastolic volume index and left ventricular ejection fraction(LVEF)were measured at 3, 6 and 12 months after the procedure.Results:Blood pressure was lower in the treatment group than in the control group( P<0.05), but no hypotension or related symptoms occurred.The sinus rhythm maintenance rate was higher in the treatment group than in the control group at 3, 6 and 12 months during the follow-up(80.0%, 72.2%, 78.9% vs.70.0%, 75.6%, 68.9%, χ2=4.866, 6.667 and 4.091, P=0.027, 0.010 and 0.043, respectively). At 6 and 12 months during the follow-up, NT-proBNP, P-wave dispersion, left atrial diameter, left atrial volume index, mitral regurgitation area, left ventricular end-systolic volume index and end-diastolic volume index were lower(all P<0.05)and LVEF was higher( P<0.05)in the treatment group than in the control group. Conclusions:In patients with persistent AF after CA, Sacubitril/Valsartan has favorable effects in maintaining sinus rhythm, reversing cardiac remodeling and improving cardiac function.
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Objective:To determine the correlations of single nucleotide polymorphisms (SNPs) with atrial fibrillation (AF) in the Chinese Han population from the central plains.Methods:A total of 168 hospitalized patients,including 56 AF and 112 controls,were recruited in this case-control study.The clinical data were obtained from the medical records.All 5 SNPs,rs337711 in KCNN2,rs11264280 near KCNN3,rs17042171 near PITX2,rs6771157 and rs6795970 in SCN10A,were genotyped using amplification refractory mutation system-polymerase chain reaction or direct sequencing.The x2 test was used to compare categorical variables and preliminarily examine correlations between the genotype frequencies and AF.Subsequently,a logistic regression model was constructed to determine the associations between the SNPs and AF based on the above screened results.Odds ratios (ORs) and 95％ confidence interval (CI) were calculated to assess the strength of the correlations.Moreover,we downloaded the genotype data from the HapMap Project for linkage disequilibrium analysis ofrs17042171.Results:AF patients were likely to be of older age and longer left atrial diameter and had more coronary artery disease and higher hypertension compared with the control group (P＜0.05).Among the 5 SNPs,the frequency distribution of genotype AA for rs17042171 was significantly different between the AF and control groups (P＜0.05).After adjusting for several covariates,there was still a high risk ratio in patients with the AA genotype compared with the AC+CC genotype (OR:5.591,95％CI 2.176 to 14.365,P-B＜0.008).Similarly,stratification analysis on the AA genotype demonstrated significant differences between rs17042171 and persistent AF.However,there were not significant correlations between AF and the control groups for the other 4 SNPs (P＜0.05).Conclusion:Rs17042171,near PITX2 on chromosome 4q25,is associated with AF susceptibility in the Chinese Han population from the central plains,suggesting that this SNP can provide a new strategy for clinical diagnosis in AF patients.
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Objective To study the effect of combined atorvastatin and ezetimibe pretreatment on perioperative hs-CRP after elective PCI.Methods One hundred and fifty-six patients with typical chronic stable angina pectoris were randomly divided into atorvastatin treatment group (n=78) and combined atorvastatin and ezetimibe treatment group (n=78).Their serum hs-CRP,TC and LDL-C level was measured before PCI,at hours 8,24,48 and on day 7 after PCI.Results In comparision with pre-operation,the serum TC and LDL-C levels were significantly lower in two groups (P＜0.01) and in combined atorvastatin and ezetimibe treatment group than in atorvastatin treatment group on day 7 after PCI (P＜0.05).The serum hs-CRP level was significantly higher in two groups at 8 h after PCI than before PCI,reached its peak at 24 h after PCI,continued to increase at 48 h after PCI (P＜0.01),no significant difference was found between the two groups on day 7 after PCI (P＞0.05).The average serum hs-CRP level was lower in combined atorvastatin and ezetimibe treatment group than in atorvastatin treatment group at hours 8,24 and 48 after PCI (P＜0.05) with no significant change found between the two groups on day 7 after PCI (P＞0.05).Conclusion The effect of combined atorvastatin and ezetimibe pretreatment is better than that of atorvastatin alone on perioperative acute inflammatory reactions after PCI.
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Objective To analyze and investigate the correlation between the CYP2C19 gene polymorphism and clopidogrel cura-tive effect in the patients with coronary heart disease (CHD) to provide valuable reference information for the future clinical work. Methods A total of 128 cases of CHD undergoing PCI in our hospital from January 2015 to January 2016 were selected as the re-search subjects.All of them were treated with clopidogrel ,the loading dose was 300mg ,and the maintenance dose was 75mg.The subjects were divided into the clopidogrel resistance group and response group.The drug-metabolizing CYP2C19 genotype was com-pared between the two groups and the effect of CYP2C19 genotype on the clopidogrel response was observed.Results Among the subjects ,27 cases were clopidogrel resistance.A total of 16 cases of CYP2C19 slow metabolic gene carriers were detected.There was statistically significant difference between the patients with chronic metabolic genotype VASP-PRI with fast metabolic geno-type and intermediate metabolic genotype(P<0.05).The incidence rate of adverse end point events had statistical difference be-tween the clopidogrel resistance group and clopidogrel response group(P<0.05).Conclusion In the risk factors of clopidogrel re-sistance ,slow metabolism CYP2C19 genotype and clopidogrel resistance will increase the risk of clinical adverse endpoint events oc-currence ,clinic should give adequate attention.
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Objective: To explore the clinical response on cardiac resynchronization therapy (CRT) in patients of chronic heart failure (CHF) with different QRS wave morphology. Methods: A total of 52 CHF patients received CRT in our hospital and the Seventh People's Hospital of Zhengzhou City from 2010-03 to 2013-07 were retrospectively studied. The patients were divided into 3 groups: True-complete left bundle branch block (t-CLBBB) group,n=20, Classic LBBB (CLBBB) group,n=15 and IVCD group,n=17. The general clinical condition, the indexes of echocardiography at 6 months of follow-up study including left ventricular end diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), NYHA classiifcation and 6-MWT were examined and compared among different groups. Results: In general clinical condition, the ratio of non-ischemic heart disease patients in t-CLBBB group was higher than those in CLBBB group and IVCD group, allP<0.05. By 6 months follow-up study, LVEDD in t-CLBBB group (62.6 ± 8.9) mm was lower than those in CLBBB group (70.0 ± 8.9) mm and IVCD group (72.8 ± 8.0) mm, LVEF was higher in t-CLBBB group (38.5 ± 6.2) % than those in CLBBB group (31.7 ± 6.7) % and IVCD group (30.1 ± 6.7) %. NYHA classiifcation in t-CLBBB group (2.00 ± 0.45) grade was lower than those in CLBBB group (2.73 ± 0.80) grade and IVCD group (3.12 ± 0.78) grade . 6-MWT in t-CLBBB group (302.0 ± 57.9) m was longer than those in CLBBB group (257.3 ± 59.0) m and IVCD group (220.2 ± 57.9) m, allP<0.05. Conclusion: CRT is an effective method for treating CHD patients, different QRS morphology may have different response, the patients with t-CLBBB would make better response.
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<p><b>BACKGROUND</b>Radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) has developed rapidly, and is a commonly performed ablation in many major hospitals throughout the world, due to its satisfactory results. The aim of this study was to detect the effect of RFCA on C-reactive protein (CRP), brain natriuretic peptide (BNP), and echocardiograph in patients with persistent and permanent AF.</p><p><b>METHODS</b>A total of 120 patients (71 males, mean age (50.8 ± 12.0) years) with persistent and permanent AF undergoing RFCA under guidance of the Carto merge technique were studied. Left atrial diameter (LAD), right atrial diameter (RAD), left ventricular ejection fraction (LVEF), CRP, and BNP were observed 3, 6 and 12 months after RFCA and compared with results before RFCA. The recurrence of atrial arrhythmias was observed 3 and 12 months after the procedure.</p><p><b>RESULTS</b>Compared with that before RFCA, LAD and RAD decreased and LVEF increased significantly after RFCA. Meanwhile, the levels of CRP and BNP were reduced significantly at 3, 6, and 12 months after RFCA (P < 0.05). In the non-recurrent patients, LVEF was increased significantly compared with the recurrent patients at 3, 6, and 12 months after RFCA (P < 0.05). CRP and BNP levels were decreased significantly in the non-recurrent patients compared with the recurrent patients at 3, 6, and 12 months after RFCA (P < 0.05). After one or two applications of RFCA, during a follow-up of 12 months, 12 patients (10.0%) had AF, 10 patients (8.3%) had atrial flutter, and 5 patients had atrial tachycardia (4.2%).</p><p><b>CONCLUSIONS</b>Conversion of AF to sinus rhythm by RFCA, has been shown to reduce LA size and improve LVEF. It can also significantly decrease the levels of CRP and BNP in patients with persistent and permanent AF and reduce the risk of inflammation and developing heart failure.</p>
Subject(s)
Female , Humans , Male , Middle Aged , Atrial Fibrillation , Blood , Diagnostic Imaging , General Surgery , C-Reactive Protein , Catheter Ablation , Echocardiography , Natriuretic Peptide, Brain , BloodABSTRACT
Objective To compare the clinical outcomes of Chinese rapamycin-eluting stents (Firebird stents) and imported paclitaxel-eluting stents ( Taxus stents ) in the treatment of acute myocardial infarction. Methods Ninety-seven patients with ST segment elevated acute myocardial infarction were treated with Firebird stents (in 51 patients) and Taxus stents (in 46 patients). The death rate, re-acute myocardial infarction, target lesion revascularization (TLR) ,and major adverse cardiac event (MACE) within 9 months after percutaneous coronary intervention ( PCI) were observed between the two groups. Results The rate of successful stent-implantation, angina,death, re-acute myocardial infarction, TLR and MACE was 100% ,9. 8% ,0% ,2. 0% ,0% , 11. 8% in the Firebird stent group and 100% ,8. 7% ,0% ,2. 2% ,0% ,0% and 10.9% in the Taxus stents group within 9 months after PCI. There was no significant difference between the two groups. Conclusions There is no significant difference in the clinical effect between the Firebird stent group and Taxus stent group within 9 months after PCI. However, the effect-cost ratio is better in the Firebird stent than the Taxus stent.
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ObjectiveTo evaluate the efficacy and safety of tirofiban in treatment of ST segment elevation acute myocardial infarction(STEAMI) no-reflow and acute thrombosis after emergency percutaneous coronary intervention(PCI). MethodsForty patients which were made definite diagnosis of STEAMI were intra-coronary artary injection fortirofiban after emergency PCI stenting occured no-reflow and acute thrombosis. First,the dose of 0.4μg·kg-1·min-1 was given from intra--coronary artary injection of tirofiban within three minutes, after 30min the dose were given 0.1μg·kg-1·min-1 for 48 hours. ResultsThe no re-flow and acute thrombosis was completely disappeared within five minutes,at the time,side effect with in one week was not observed. ConclusionsTirofiban treatment by direct injection in coronary arteries combined with emergency PCI, can increase the repeffusion rate of infarction related vessel in AMI patients,and improve TIMI reflow. This reperfusion method was effective and safe.