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Objective:To investigate the efficacy and safety of percutaneous left atrial appendage occlusion in the treatment of nonvalvular atrial fibrillation.Methods:Eighty-eight patients with percutaneous left nonvalvular atrial fibrillation who received treatment in The Second Hospital of Anhui Medical University from January 2019 to January 2021 were included in this study. These patients were divided into three groups according to different anticoagulant methods: group A (percutaneous left atrial appendage occlusion), group B (livaraban), and group C (warfarin). The incidence of stroke, the incidence of bleeding events, the incidence of adverse cardiovascular events, and live and kidney function and coagulation function after 3 months of treatment were compared among the three groups.Results:There were no significant differences in the incidence of stroke and adverse cardiovascular events among the three groups ( P > 0.05). The incidence of bleeding events in groups A, B, and C was 9.3% (3/32), 15.0% (6/40), and 31.2% (5/16), respectively. There was a significant difference in the incidence of bleeding events among the three groups ( χ2 = 8.07, P = 0.001). After 3 months of treatment, there were no significant differences in prothrombin time, fibrinogen, prothrombin time-international normalized ratio, alanine aminotransferase, aspartate transaminase, and creatinine clearance among the three groups (all P > 0.05). Conclusion:Percutaneous left atrial appendage occlusion, warfarin, and rivaroxaban can prevent stroke in patients with nonvalvular atrial fibrillation. Percutaneous left atrial appendage occlusion is safer and more feasible than warfarin and rivaroxaban alone in the treatment of nonvalvular atrial fibrillation.
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Objective:To investigate the value of CHA2DS2-VASc score for predicting percutaneous coronary intervention (PCI) prognosis in patients with coronary chronic total occlusion.Methods:The clinical data of 139 patients with coronary chronic total occlusion who underwent PCI at the Second Hospital of Anhui Medical University from January 2019 to December 2020 were retrospectively analyzed. These patients were divided into good prognosis and poor prognosis groups according to prognosis outcomes. Univariate and multivariate Cox regression analysis was performed to evaluate the influential factors of adverse events after PCI in patients with coronary chronic total occlusion. The receiver operating characteristic curves were plotted to evaluate the value of the CHA2DS2-VASc score for predicting the occurrence of adverse events in patients with coronary chronic total occlusion undergoing PCI.Results:Among the 139 patients with coronary chronic total occlusion, the average follow-up time was (19.88 ± 7.90) months, 19 (13.7%) patients had a poor prognosis, and 120 (86.3%) patients had a good prognosis. The age, uric acid, and CHA2DS2-VASc score in the poor prognosis group were 73 (65.0, 77.0) years, (383.26 ± 120.60) μmol/L, and 4 (3, 5) points, respectively, which were significantly higher than 66 (57.0, 71.8) years, (322.68 ± 91.88) μmol/L, and 3 (2, 4) points in the good prognosis group ( U = -2.74, t = 2.24, U = -3.09, all P < 0.05). However, the proportion of patients with the successful opening of the occluded coronary artery and albumin, hemoglobin, and triacylglycerol levels in the poor prognosis group were 11 (57.9%), 36.7 (34.4, 38.3) g/L, (120.26±19.74) g/L, and 1.03 (0.85, 1.49) mmol/L, respectively, which were significantly lower than 98 (81.7%)( χ2 = 4.16, P = 0.041), 39.3 (36.78, 42.1) g/L ( U = -2.85, P = 0.004), (133.62 ± 16.84) g/L ( t = 1.52, P = 0.002), and 1.52 (1.09, 2.25) mmol/L ( U =-2.13, P = 0.033) in the good prognosis group. Multivariate Cox regression analysis showed that CHA2DS2-VASc score was a risk factor for poor prognosis of patients with coronary chronic total occlusion undergoing PCI (95% CI: 1.137-2.274, P = 0.007). The receiver operating characteristic curve analysis results showed that the area under the receiver operating characteristic curve plotted for CHA2DS2-VASc score predicting poor prognosis in patients with coronary chronic total occlusion undergoing PCI was 0.716 (95% CI: 0.588-0.844, P = 0.003), with the cut-off point of 3.5, the sensitivity of 68.4%, and specificity of 66.7%, respectively. Conclusion:Compared with those with a good prognosis, patients with a poor prognosis have a higher CHA2DS2-VASc score. The CHA2DS2-VASc score has a certain application value for predicting mid- and long-term prognosis in patients with coronary chronic total occlusion who undergo PCI.
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Objective:To evaluate the diagnostic value of Essen stroke risk score(ESRS) combined with neutrophil lymphocyte ratio(NLR) in coronary heart disease(CHD).Methods:From July 1, 2015 to June 30, 2019, patients who were hospitalized in the Second Affiliated Hospital of Anhui Medical University for suspected CHD and underwent coronary angiography were selected as the study objects.According to the results of coronary angiography, these patients were divided into CHD group (stenosis rate ≥ 50%) and control group(stenosis rate<50%). The clinical, laboratory and angiographic data of the two groups were collected, including NLR, ESRS and coronary narrow degree integral(Gensini integral method). Logistic regression model and receiver operator characteristic(ROC) were used to evaluate the diagnostic value of ESRS combined with NLR in CHD.Results:During the study period, 325 patients were enrolled, including 219 CHD patients and 106 controls.The age, hypertension, diabetes mellitus, peripheral artery disease, ESRS, NLR and fasting blood glucose levels in the CHD group were significantly higher than those in the control group(all P<0.05). Spearman correlation analysis showed that ESRS( r=0.515, P<0.001) and NLR( r=0.250, P<0.001) were positively correlated with coronary Gensini score.Two logistic regression models were established, where model 1 was logit(P1)=-2.072+ 0.566×ESRS+ 0.299×NLR+ 0.173×fasting blood glucose(the diagnostic accuracy rate was 71.7%) and model 2 was logit(P2)=-1.169+ 0.594×ESRS+ 0.302×NLR(the diagnostic accuracy rate was 70.8%). There was no significant difference in the diagnostic accuracy between the two models( P=0.499). Finally, logistic regression model 2 was selected as the joint diagnostic model.The area under curve of ESRS, NLR and logistic regression model 2 was 0.713, 0.634 and 0.736, respectively, and the difference was statistically significant(all P<0.05). The diagnostic threshold of ESRS was 2, and the diagnostic threshold of NLR was 2.74.The 95% CI of the joint diagnostic model 2 was (0.684, 0.783), which showed a sensitivity of 60.27% and a specificity of 78.30%.This model was superior to the diagnostic efficacy of ESRS( P=0.047) and NLR( P<0.001). Conclusion:The joint diagnostic model of ESRS combined with NLR is superior to the single index in the diagnosis of CHD, which may thus be used to predict the occurrence of CHD.
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Objective:To investigate the correlation between serum 25-hydroxyvitamin D [25(OH)D], Essen Stroke Risk Scale (ESRS) and the incidence of coronary atherosclerotic heart disease.Methods:From July 2016 to January 2019, 186 patients who underwent coronary angiography (CAG) in the Department of Geriatric Cardiology at the Second Affiliated Hospital of Anhui Medical University were included.Among them, 117 patients were diagnosed with coronary heart disease, 69 cases without coronary heart disease.The serum 25(OH)D values and ESRS scores of the two groups were collected to analyze the relationship between 25(OH)D, and ESRS scores, coronary heart disease.At the same time, multivariate logistic regression was used to analyze the correlation between serum 25(OH)D and ESRS scores.Results:The serum level of 25(OH)D in the coronary heart disease group was (38.19±16.35)nmol/L, which in the non-coronary heart disease group was (45.37±19.01)nmol/L, the difference was statistically significant difference ( t=2.722, P<0.05). The ESRS scores in the coronary heart disease group was (2.32±1.38)points, which of the non-coronary heart disease group was (1.42±1.32)points, the difference was statistically significant ( t=-4.394, P<0.05). Multivariate logistic regression analysis showed that 25(OH)D was independently associated with coronary heart disease ( OR=0.944, 95% CI: 0.902-0.989, P=0.015), ESRS score was independently associated with coronary heart disease ( OR=1.716, 95% CI: 1.314-2.240, P<0.001). Conclusion:25(OH)D is a protective factor for coronary heart disease, ESRS score is an independent risk factor for coronary heart disease.
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Atrial fibrillation is one of the important risk factors for ischemic stroke, which can lead to the cardioembolic stroke. On the contrary, ischemic stroke can also result in atrial fibrillation, namely, atrial fibrillation detected after stroke (AFDAS). Studies have shown that the pathophysiological mechanism and prognosis of AFDAS may be different from those of atrial fibrillation known before stroke. The monitoring of AFDAS and its effect on prognosis has become a hot research topic. This article reviews the definition, pathophysiological mechanism, monitoring methods and prognosis of AFDAS.
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Objective To investigate the protective effects of alpha-lipoic (α-LA) on H9c2 cardiomyocytes under-going hypoxia or hypoxia/reoxygenation(H/R) injury and explore its possible mechanisms. Methods H9c2 car-diomyocytes in hypoxia or H/R injury researches were respectively divided into normal control group, hypoxia or H/R group, hypoxia or H/R + α-LA group (LA group), hypoxia or H/R+α-LA + Daidzin group (Daidzin group) and hypoxia or H/R+α-LA +DMSO group ( DMSO group) . The myocardial cell survival was detected by MTT,the activity of LDH and ALDH2 were respectively analyzed by microtitration and ELISA,the MDA level was measured by TBA. Results Compared to the normal control group, the cell survival rates of hypoxia and H/R group were decreased ( P0. 05 ) . Conclusion α-LA can protect H9 c2 cardiomyocytes from hypoxia or H/R injury by means of upregulating activities of ALDH2 and decreasing hypoxia or H/R induced lipid peroxidation.