Prognostic value of free triiodothyronine in patients with dilated cardiomyopathy / 中华医学杂志(英文版)

BACKGROUND@#The association between free triiodothyronine (FT3) and long-term prognosis in dilated cardiomyopathy (DCM) patients has not been evaluated. The purpose of this study was to determine whether the level of FT3 could provide prognostic value in patients with DCM.@*METHODS@#Data of consecutive patients diagnosed with DCM were collected from October 2009 to December 2014. FT3 was measured by fluoroimmunoassay. Other biochemical markers, such as free thyroxin (FT4), thyroid-stimulating hormone, red blood cell, hemoglobin, blood urea nitrogen, and serum creatinine, were tested at the same time. Follow-up was performed every 3 months. The primary endpoint was all-cause mortality. Pearson analysis was used to evaluate the correlation of FT3 and other lab metrics with DCM patients' prognosis. The association of long-term mortality in DCM and FT3 was compared using Cox hazards model.@*RESULTS@#Data of 176 patients diagnosed with DCM were collected. Of them, 24 patients missed FT3 values and six patients were lost to follow-up. Altogether, data of 146 patients were analyzed. During the median follow-up time of 79.9 (53.5-159.6) months, nine patients lost, 61 patients died (non-survival group), and 85 patients survived (survival group). FT3 was significantly lower in non-survival group than that in survival group (3.65 ± 0.83 pmol/L vs. 4.36 ± 1.91 pmol/L; P = 0.003). FT3 also showed a significantly positive correlation with red blood cell and hemoglobin, negatively correlated with age, blood urea nitrogen and serum creatinine (P < 0.05), respectively. Patients in the group of lower FT3 levels (FT3 ≤3.49 pmol/L) suffered from a higher risk of all-cause mortality (P for log-rank = 0.001). In multivariate Cox regression analysis, FT3 level was significantly associated with all-cause mortality (hazard ratio: 0.70, 95% confidence interval 0.52-0.95, P for trend = 0.021).@*CONCLUSION@#Low levels of FT3 were associated with increased all-cause mortality in patients with DCM.

Efficacy of catheter radiofrequency ablation for the treatment of ventricular arrhythmia storm post cardioverter-defibrillators implantation / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the acute and long-term effects of catheter radiofrequency ablation for the treatment of ventricular arrhythmia storm (VAS) post implantable cardioverter-defibrillators (ICD) implantation.</p><p><b>METHODS</b>Acute and long-term effects of catheter radiofrequency ablation for the treatment of VAS post ICD implantation were retrospectively assessed in 11 patients from September 2008 to August 2011.</p><p><b>RESULTS</b>A total of 15 ablation procedures were performed in 11 patients. Six ablation procedures were performed through epicardial approach. In 9 patients, 20 types of ventricular tachycardia (VT) (including 20% hemodynamically unstable VT) were induced during the procedures [mean cycle length (384 ± 141) ms] and polymorphic ventricular tachycardia were induced in 7 patients. The average X-ray fluoroscopy time and procedural time were (26 ± 17) min and (189 ± 60) min, respectively. Complete success, partial success, and failure rates immediately post catheter radiofrequency ablation were 46.7% (7/15), 26.7% (4/15) and 26.7% (4/15), respectively. All patients are alive at follow-up[(2.45 ± 9.6) months after the last catheter ablation] and the complete success, partial success, and failure rates during follow-up were 72.7% (8/11), 9.1% (1/11) and 18.2% (2/11), respectively.</p><p><b>CONCLUSION</b>VAS can be effectively treated by catheter radiofrequency ablation in patients post ICD implantation.</p>

Catheter ablation of epicardial accessory pathway associated with coronary sinus musculature / 中华心血管病杂志

<p><b>OBJECTIVE</b>To report the single-center clinical experience of catheter ablation of epicardial accessory pathway associated with coronary sinus musculature.</p><p><b>METHODS</b>The data of 721 cases of left sided accessory pathway ablation were retrospectively analyzed. Ablation in the coronary sinus was performed in 17 (2.4 %) cases [11 males, mean age (37 ± 11) years].</p><p><b>RESULTS</b>Among the 17 cases, the accessory pathway was successfully ablated in middle cardiac vein and posterior lateral coronary sinus in 11 and 6 cases, respectively. Deverticulum of middle cardiac vein was seen in 2 cases. Mean time required to block the accessory pathway was (4.7 ± 2.7) s. An accessory pathway potential could be recorded at the target site in 10 out of 17 patients (59%). During a mean (21 ± 16) months follow up, only one patient experienced recurrence who was successfully cured by a second ablation session. No procedure related complication was reported.</p><p><b>CONCLUSION</b>About 2.4% of left accessory pathway may have epicardial connection locating at middle cardiac vein or lateral part of the coronary sinus and require epicardial ablation. The epicardial ablation is safe and effective, warrants an excellent long-term results.</p>

Clinical characteristics and long-term outcome of non-pulmonary vein foci ablation in patients with paroxysmal atrial fibrillation / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the clinical characteristics and long-term results of non-pulmonary veins (PV) trigger ablation in patients with paroxysmal atrial fibrillation (AF).</p><p><b>METHODS</b>Eighty-six patients [48 men, mean age (52.3 ± 10.2) years] were included in the study. Circumferential pulmonary vein antrum isolation guided by a 3-D mapping system was performed. Aggressive high right atrium programmed stimulation and burst pacing were made before and after isoproterenol infusion. Additional ablation was performed if other trigger foci were found or other sustained tachycardias could be induced.</p><p><b>RESULTS</b>PV triggers were observed in 59 patients (group I), and non-PV triggers were observed in 27 patients (group II), 12 non-PV triggers were identified during the first procedure. Among them, one was located in the roof of left atrium, 11 were originated from superior vena cava. After a mean follow-up of [37.1 ± 10.4 (range 15-60)] months, the AF recurrence rate was significantly higher in the Group II than in the Group I (55.5% vs. 20.3%, P = 0.001). The number of performed ablation was also significantly in group II than in group I higher difference (1.7 ± 0.8 vs. 1.1 ± 0.4, P < 0.001). In the group II, 15/15 (100%) patients had a repeated ablation procedure for AF recurrence, and 15 patients had new non-PV foci after isoproterenol infusion which were originated from the superior vena cava (n = 11) and coronary sinus (n = 2), respectively. After the second ablation procedure, AF recurrence was observed in three patients, two patients accepted third procedure, the non-PV triggers were located in left atrial septum and coronary sinus, and one patient accepted fourth procedure, the non-PV foci was located in left posterior wall.</p><p><b>CONCLUSIONS</b>Non-PV foci may occur at any age and the main area is located in the super vena cava, Non-PV serves as a major cause of AF recurrence after successful PVAI.</p>

Catheter ablation of focal atrial tachycardia:the topographic distribution and long-term outcome / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the topographic distribution and long-term outcome of catheter ablation for focal atrial tachycardia (AT).</p><p><b>METHOD</b>The data of 207 patients who underwent electrophysiologic study for AT were retrospectively analyzed.</p><p><b>RESULTS</b>A total of 200 AT were identified in 185 patients. The most common site for AT was ostium of the coronary sinus (23.8%), followed by crista terminalis (20.5%), perinodal area (20.0%), cava vena (17.8%), annulus (13.0%), and appendage (10.3%). Eighty percent AT originated from the right atrium, 17.8% originated from the left atrium. AT originated from the left atrium was more common in male than in female (25.0% vs. 13.3%, P = 0.042), while AT originated from the right atrium was more common in female than in male (69.4% vs. 86.7%, P = 0.004). Among the 185 patients, acute success ablation rate was 93.5% (n = 173). The acute success rate in the conventional mapping group was lower than that in the three-dimensional mapping group (79.3% vs. 96.5%, P < 0.01). During a median of 36 months follow up, the AT recurred in 20 patients (success ablation rate 88.4%). Success ablation rate was similar between the conventional mapping group and the three-dimensional mapping group (P > 0.05).</p><p><b>CONCLUSIONS</b>Focal AT commonly originates from ostium of coronary sinus, crystal terminalis, perinodal area, and cava veins. There is a gender related difference in the distribution of focal AT. The radiofrequency catheter ablation yields a satisfying success rate and very low complication rate and could be the first line choice for treating ATs in experienced electrophysiological center.</p>

Myocardial injury resulting from radiofrequency catheter ablation: comparison of circumferential pulmonary vein isolation and complex fractionated atrial electrograms ablation / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Radiofrequency catheter ablation (RFCA) necessarily produces an area of myocardial necrosis. However, the difference of the extent of myocardial injury between circumferential pulmonary vein isolation (CPVI) and complex fractionated atrial electrograms (CFAE) ablation in patients with atrial fibrillation (AF) has not been investigated before.</p><p><b>METHODS</b>Twenty-nine consecutive male patients (n = 29) with either paroxysmal or persistent AF were selected for CPVI or CFAE ablation. The CPVI or CFAE ablation was performed with a three-dimensional electroanatomical mapping system (CARTO). Serum cardiac biomarkers, for example, cardiac troponin T (cTnT), aspartate transaminase (AST), lactate dehydrogenase (LDH), creatine kinase (CK), and creatine kinase myocardial bound (CKMB) were determined by the Elecsys STATE immunoassay. Cardiac structure and function were measured with echocardiography.</p><p><b>RESULTS</b>Echocardiography showed that there was no significant difference of atrioventricular structure or function parameters between the CPVI group and the CFAE ablation group. Serum cTnT showed a significant increase in the CFAE ablation group over the CPVI group at 12 and 24 hours after the procedure (P < 0.05, respectively), and then it was reduced to a normal level after 48 hours. Serum AST showed a significant increase in the CFAE ablation group over the CPVI group at post-procedure, 4 and 12 hours after the procedure (P < 0.05, respectively), and then it reached to a normal level after 24 hours. There was no significant difference in LDH, CK, or CKMB levels between the CFAE ablation group and the CPVI group at any time point (P > 0.05).</p><p><b>CONCLUSIONS</b>cTnT and AST other than LDH, total CK or CKMB activity significantly increased more in the CFAE ablation group than the CPVI group. However, the difference of the serum levels of cTnT, AST between two groups was temporary.</p>

Impact of metoprolol use in the treatment of patients with electrical-storm after cardioverter defibrillators implantation / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the effectiveness of the metoprolol dosage adjustment on reducing the incidence of electrical-storm (ES) in patients with Implantable Cardioverter Defibrillators (ICDs).</p><p><b>METHODS</b>Data from patients with ICD implantation between Jan, 2003 and Jun, 2006 in our hospital were retrospectively analyzed. ES was defined as either ≥ 3 times of ventricular tachyarrhythmias (VTAs) resulting in ICD therapy or VTAs lasting more than 30 s detected by ICD without any therapy within 24 hours.</p><p><b>RESULTS</b>During a follow-up period of (27.5 ± 21.2) months, ES was recorded in 39 cases [34 males, average age (52.0 ± 13.1) years] out of 119 patients (32.8%) and 9 patients died after ES. During the period of storm attack, ES was successfully controlled in 25/30 patients by various interventions, including predisposing factors corrected in 5 cases, ICD reprogramming and antiarrhythmic drugs therapy optimized in 16 cases (one received intravenous injection of metoprolol), and VTAs eliminated by catheter ablation in 4 cases. ES was spontaneously resolved in the remaining 5 cases. In the chronic phase, 2 patients with Brugada syndrome were treated with Quinidine mono-therapy while the dosage of metoprolol was adjusted in the remaining 23 patients and the dosage of metoprolol was increased gradually from (26.8 ± 13.9) mg/d to (88.9 ± 53.5) mg/d without any adverse effects (9 patients received also oral amiodarone 200 mg/d). Post dosage adjustment, the total VTA episodes [(1.9 ± 1.7) times/month vs. (0.8 ± 0.6) times/month, P = 0.004], incidence of antitachycardia pacing therapies [(4.2 ± 3.8) runs/month vs. (2.3 ± 2.0) runs/month, P = 0.003], as well as electrical cardioversion or defibrillation [(1.1 ± 0.9) times/month vs. (0.4 ± 0.2) times/month, P = 0.001] were significantly decreased. ES was not controlled until a extremely high dosage [225 - 300 (255.3 ± 41.7) mg/d] of metoprolol was reached in the remaining 5 patients.</p><p><b>CONCLUSIONS</b>Metoprolol use is essential and its dosage should be individualized in the majority of ICD recipients with ES. In approximately 1/6 patients, the dosage of metoprolol should be higher than 200 mg/d.</p>

Clinical characteristics of congenital ventricular aneurysm and diverticula in inland China / 中华心血管病杂志

<p><b>OBJECTIVE</b>To summarize the clinical characteristics of congenital ventricular aneurysm and diverticula in inland China.</p><p><b>METHODS</b>To identify the literature of congenital aneurysm and diverticula from Wanfang, China National Knowledge Infrastructure (CNKI) and PubMed databases, and to analyze the clinical characteristics of congenital aneurysm and diverticula from January of 2001 to December of 2009.</p><p><b>RESULTS</b>A total of 116 patients [78 men, 1 - 80 (33.5 ± 21.3) years old] with congenital aneurysm or diverticula were included in 109 articles. Twenty-five patients (13 men) were congenital ventricular aneurysm, including a family of 4 patients. Ninety-one patients (65 men) were congenital ventricular diverticula. One hundred patients were detected by echocardiography during medical examination, 34 patients combined with other cardiac anomalies, 4 of which with extracardiac structures. There were 8 patients with ventricular arrhythmia, 8 patients with thrombosis, 2 patients died of cardiac rupture, 4 patients died of sudden death, surgical operation was performed in 46 patients and 3 patients received ablation procedure. All patient did not receive implantable cardioverter defibrillator (ICD) implantation.</p><p><b>CONCLUSIONS</b>Congenital ventricular aneurysm or diverticulum is a rare cardiac malformation. Most congenital left ventricular aneurysms and diverticula are asymptomatic and detected by echocardiography. Congenital ventricular aneurysm or diverticulum may cause ventricular tachycardia, ventricular wall rupture, systemic embolization or sudden death, which had to be treated individually.</p>

The anti-apoptotic effects of N-acetylcysteine in neonatal rat cardiomyocytes underwent hypoxia-reoxygenation injury / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the effects of N-acetylcysteine (NAC) on hypoxia-reoxygenation (H/R) injury induced apoptosis in neonatal rat cardiomyocytes.</p><p><b>METHODS</b>Neonatal rat cardiomyocytes were cultured for 48 h and then randomized into control group, H/R group and H/R + NAC group. Cardiomyocytes underwent hypoxia for 6 h, reoxygenation for 72 h in the absence (H/R group) or presence (H/R + NAC group) of NAC (100 micromol/L). Cell viability was assayed with trypan blue staining. Early stage of apoptosis was detected by flow cytometry with Annexin V, late stage of apoptosis was assessed by TUNEL staining. ROS in culture medium was assayed by Image-iT(TM) LIVE green reactive oxygen species detection kit.bcl2 and bax mRNA levels were determined by real-time quantitative PCR (RT-PCR). bcl2, bax, p38 and pp38 protein levels were measured by Western blot.</p><p><b>RESULTS</b>The percentage of viable cardiomyocytes (93.5%, 74.9%, 89.9%) was significantly reduced while percentage of early stage of apoptotic cardiomyocytes (6.5%, 25.2% and 11.1%) and late stage of apoptotic cardiomyocytes (3.5%, 33.5% and 13.5%) were significantly increased in H/R group compared to control group and these changes could be largely reversed by NAC (all P < 0.01). Significantly increased ROS generation in H/R group could also be attenuated by NAC (P < 0.01). The band density ratio of pp38 and p38 was significantly upregulated in H/R group (13.4 vs. 3.89), the mRNA and protein expressions of bcl2 were significantly lower and bax expressions were significantly higher in H/R group than those in control group and these changes could also be attenuated by NAC.</p><p><b>CONCLUSION</b>NAC significantly reduced apoptosis through inhibiting the phosphorylation of p38 signal pathway.</p>

Prevalence of Epsilon wave in patients with arrhythmogenic right ventricular cardiomyopathy / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the prevalence of Epsilon wave in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC).</p><p><b>METHODS</b>The epsilon wave was detected in 32 patients [24 men, mean age (42.3 +/- 13.3) years] with ARVC using three different electrocardiography (ECG) recording methods: standard twelve leads ECG (S-ECG), right precordial leads ECG (R-ECG) and Fontaine bipolar precordial leads ECG (F-ECG). The Epsilon wave was defined as wiggler, small spike wave and smooth potential between the end of the QRS complex and the beginning of the ST segment.</p><p><b>RESULTS</b>Epsilon wave was detected in 37.5%, 37.5% and 50.0% patients with ARVC by S-ECG, R-ECG and F-ECG respectively. The detection rates derived from the three recording methods were similar (P > 0.05). The Epsilon wave was only detectable by S-ECG in one case, by R-ECG in three cases, and by F-ECG in five cases. The detection rate of Epsilon wave was 50.0% by combined use of S-ECG and R-ECG (SR-ECG), 56.3% by combined use of S-ECG and F-ECG (SF-ECG), and 65.6% by combined use of the three recording methods (SRF-ECG). The detection rate was significantly higher by SF-ECG (56.3%) and SRF-ECG (65.6%) than by S-ECG alone (37.5%, all P < 0.05). Most Epsilon waves detected by the S-ECG, R-ECG and F-ECG were small spiked waves.</p><p><b>CONCLUSION</b>Combined use of S-ECG, F-ECG and R-ECG could increase the detection rate of Epsilon wave in patients with ARVC.</p>

N-acetylcysteine promoted aging through adjusting expression of cell cycle related protein in neonatal SD rat cardiomyocytes / 中华心血管病杂志

<p><b>OBJECTIVE</b>To observe the effects of N-acetylcysteine (NAC) on aging in neonatal SD rat cardiomyocytes and explore related mechanisms.</p><p><b>METHODS</b>Cultured cardiomyocytes were randomized assigned to 6 groups: 1-day, 5-day, 10-day, 1-day + NAC (1 mmol/L), 5-day + NAC (1 mmol/L) and 10-day + NAC (1 mmol/L). Flow cytometry was used to examine cell cycle. Real-time quantitative PCR and Western blot were used to determine mRNA and protein expression of p16INK4a, p21WAF1 and Rb gene. beta-galactosidase staining kit was used to investigate beta-galactosidase activity.</p><p><b>RESULTS</b>Numbers of cardiomyocytes resided in G(0)/G(1) phase were significantly higher in the group of 5-day + NAC and 10-day + NAC compared with 5-day, 10-day, respectively (P < 0.05). The mRNA and protein expression of p16INK4a and p21WAF1 were also significantly higher in the group of 5-day + NAC and 10-day + NAC compared with 5-day, 10-day, respectively (P < 0.05 or P < 0.01). The mRNA and protein expression of Rb was significantly lower in the group of 5-day + NAC and 10-day + NAC compared with 5-day, 10-day, respectively (P < 0.01). beta-galactosidase activity was not affected by NAC in the 1-day + NAC group but was significantly higher in 5-day + NAC and 10-day + NAC groups compared with the 5-day, 10-day groups (all P < 0.05).</p><p><b>CONCLUSION</b>NAC could promote aging through upregulating the expression of p16INK4a and p21WAF1 and inhibiting Rb phosphorylation in neonatal SD rat cardiomyocytes.</p>

The application of tunica vaginalis flap in urethral repair / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the application of tunica vaginalis flap in repairing the deformity of urethra and urethral fistulas.</p><p><b>METHODS</b>Tunica vaginalis flap from the scrotum were used to wrap the reconstructed urethra in the 38 cases of hypospadias urethroplasty and urethral fistulas repair from 2002.</p><p><b>RESULTS</b>All of cases were followed up for six months to one year. There was a fistula reoccurred after epispadias fistula repair, the repair was successful in other patients. There was no recurrent fistulas or urethral strictures. Penile cosmesis was excellent and erected well.</p><p><b>CONCLUSIONS</b>The application of tunica vaginalis flap in urethral repair can raise achievement ratio and reduce the incidence of urethral fistulas. The flap is ease to mobilize with no harmful effects on the testicles.</p>

Correction of pediatric concealed penis by using a modified Devine' s technique / 中华整形外科杂志

<p><b>OBJECTIVE</b>To discuss the diagnosis of pediatric concealed penis and evaluate the results after the correction of the pediatric concealed penis.</p><p><b>METHODS</b>Twenty patients with pediatric concealed penis were treated by using a modified Devine's technique.</p><p><b>RESULTS</b>The appearance with a straightening penile was achieved in all of the patients. All of the patients recovered well after the operation without any complications.</p><p><b>CONCLUSIONS</b>The modified Devine' s technique could be a safe and effective method for the correction of the pediatric concealed penis with satisfactory outcome.</p>