Clinical analysis of transcatheter closure of perimembranous ventricular septal defects with occluders made in China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Results of perimembranous ventricular septal defects (pmVSD) transcatheter closure have been reported in the literature mostly using a Amplatzer VSD device. However, the data of percutaneous closure of pmVSD with VSD occluder (VSD-O) made in China are still limited. We sought to analyze safety, efficacy, and follow-up results of percutaneous closure of pmVSD with VSD-O made in China.</p><p><b>METHODS</b>Between February 2005 and June 2009, 78 patients underwent percutaneous closure of pmVSD at our institution. A VSD device made in China was used for all subjects. The safety and the efficacy of the VSD-O were investigated.</p><p><b>RESULTS</b>The average age at closure was 11 years (range 2.5 to 44 years). The attempt to place device was successful in 74 patients (94.9%). The average device size used was 8 mm (range 5 to 16 mm). No deaths occurred. Total occlusion rate was 62.8% at completion of the procedure, rising up to 87.2% at discharge and 99.0% during follow-up. A total of eight early complications occurred (10.3%), but in all subjects these were transient. The average follow-up period was 40.5 months. The most significant complication was complete atrioventricular block (cAVB) in the early phase (five subjects, 6.4%) and during the follow-up (1 subject, 1.3%), which saw no need for pacemaker implantation in six subjects. Cox proportional hazards regression analysis showed that the age was only the variable significantly associated with the occurrence of this complication during the procedure (P = 0.025; relative risk 0.22). The subjects who experienced this complication were less than five years old.</p><p><b>CONCLUSIONS</b>Percutaneous pmVSD closure used VSD-O made in China is associated with excellent success and closure rates, no mortality, and low morbidity. Longer follow-up data and improvements in device characteristics are needed to reduce the risk of cAVB.</p>

Effects of socioeconomic status on the distribution of cardiovascular risk factors and clinical treatments of patients with acute myocardial infarction in Beijing / 中华流行病学杂志

Objective To evaluate the effects of socioeconomic status on the distribution of cardiovascular risk factors and clinical treatments of patients with acute myocardial infarction in Beijing.Methods In Beijing, a prospective, muhi-center, registration study was carried out which including 800 patients who were consecutively hospitalized for ST-segment elevation acute myocardial infarction within 24 hours after event attack in 19 different hospitals in Beijing between November, 2005 and December, 2006.Indicators of socioeconomic status included self-reported personal income (＜500, 500-2000,＞2000 RMB/month), educational attainment (≤ 12 and ＞ 12 years) and status of medical insurance (yes/no).According to categories of education, patients were categorized into two groups of lower socioeconomic status and higher socioeconomic status. Differences of cardiovascular risk factors and clinical treatments were compared across the two groups respectively. Results Proportion of diabetes and hyperlipidemia in patients with higher socioeconomic status was much higher than that of patients with lower socioeconomic status (P＜0.05, P＜0.01 respectively). Patients with lower socioeconomic status were more likely to be smokers (P ＜0.05). The rates of receiving coronary angiography and PTCA were much lower in patients with lower socioeconomic status. Medical insurance and income were the most important two socioeconomic factors determining the use of PTCA. Conclusion Compared to patients with lower socioeconomic status,patients with higher socioeconomic status had higher rates of hyperlipidemia and diabetes but lower smoking rate among cardiovascular risk factors. The rates of receiving interventional therapies were much lower in patients with lower socioeconomic status.

Public knowledge of heart attack symptoms in Beijing residents / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Definitive treatment for heart attack is early reperfusion with either angioplasty or thrombolytic therapy, and the benefit is strictly time-dependent. Patient outcomes are improved with either therapy when initiated as soon as possible. Recognition of heart attack symptoms is logically tied to taking action to receive prompt emergency care. Inadequate knowledge of heart attack symptoms may prolong delay. The purpose of this study was to document knowledge about heart attack symptoms in Beijing residents and to identify the characteristics associated with increased knowledge of heart attack.</p><p><b>METHODS</b>A structured survey was conducted in 18 communities in Beijing from March 1 through June 10 in 2006. Addresses and participants were selected randomly following a stratification. The survey was designed to collect knowledge of heart attack symptoms from sampled adults in each community.</p><p><b>RESULTS</b>A total of 4627 respondents completed the questionnaires correctly, and 50.29% of them were female. Totally 64.15% of the respondents reported chest pain or discomfort (common symptoms) as a symptom of heart attack; 75.38% reported at least one of the following eight symptoms as a symptom of heart attack: back pain, shortness of breath, arm pain or numbness, nausea or vomiting, neck, jaw or shoulder pain, epigastric pain, sweating, weakness (less common symptoms); 20.36% correctly reported four or more heart attack symptoms, only 7.4% knew all the correct heart attack symptoms, and 28.94% knew about reperfusion therapy for heart attack; 31.7% reported to call 120 or 999 while having a heart attack themselves; however 89.6% reported to call 120 or 999 when someone else is suffering from a heart attack. Very old persons and those with health insurance coverage, high education level, high household income, longer living in Beijing and previous experience with heart disease had greater knowledge of heart attack symptoms.</p><p><b>CONCLUSIONS</b>Public knowledge of common heart attack symptoms as well as less common heart attack symptoms is deficient in Beijing residents. But their knowledge of calling emergency medical services when someone is having a heart attack is relatively adequate. Public health efforts are needed to increase the recognition of the major heart attack symptoms in both the general public and groups at high risk for an acute cardiac event, especially in socioeconomically disadvantaged subgroups, including persons with low education level, low household income, and no health insurance coverage.</p>

Prognostic Value of 99mTC-MIBI SPECT Exercise Myocardial Imaging in Patients with Suspected or Diagnosed Coronary Artery Disease / 中国康复理论与实践

@#ObjectiveTo examine the prognostic value of 99mTC-MIBI single-photon emission computed tomography (SPECT) in patients with suspected or diagnosed coronary artery disease (CAD).Methods116 patients with suspected or diagnosed CAD were examined with 99m TC-MIBI SPECT exercise and rest myocardial imagings, and followed by investigation of cardiac events.Results Follow-up information was complete in 106 patients. Over an average follow-up of 25±8 months, cardiac events occurred in 11 patients. Univariate analyses showed that age, old myocardial infarction, exercise peak heart rate, the change in heart rate from rest to exercise peak, exercise peak systolic blood pressure, the change in systolic blood pressure from rest to exercise peak, abnormal myocardial imaging, the number of myocardial perfusion defect and ischemic volume rate (IVR) were the effective predictors of subsequent cardiac events. Multivariate stepwise Logistic regression analyses revealed that the size of IVR was the only variable with independent predictive value for occurrence of subsequent cardiac events. IVR more than 25% was associated with a significantly increased frequency of subsequent cardiac events (relative risk ratio was 5.9, P<0.005). IVR less than 25% or even normal myocardial perfusion imaging was associated with a very low-risk of cardiac event and a very good prognosis.Conclusion 99mTC-MIBI SPECT myocardial imaging is the most effective noninvasive technique that predicted the occurrence of cardiac event in patients with suspected or diagnosed CAD. According to the size of IVR, high-risk and low-risk patients can be effectively identified.

Mutation analysis of a Chinese family with inherited long QT syndrome / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To identify the mutation of a Chinese family with inherited long QT syndrome(LQTS).</p><p><b>METHODS</b>The disease-causing gene was tentatively determined in light of the clinical manifestations and electrophysiological properties, and then polymerase chain reaction and DNA sequencing were used for screening and identifying mutation.</p><p><b>RESULTS</b>A missense mutation G940A(G314S) in the KCNQ1 gene was identified, which was the 'hot spot' of long QT syndrome mutation.</p><p><b>CONCLUSION</b>The mutation that is involved with long QT syndrome in Chinese patients is the same as that in the European, American and Japanese patients.</p>

Relationship between congenital long QT syndrome and Brugada syndrome gene mutation / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the molecular pathology in families with long QT syndrome (LQTS) including Jervell-Longe-Nielsen syndrome (JLNS) and Romano-ward syndrome (RWS) and Brugada syndrome (BS) in Chinese population.</p><p><b>METHODS</b>Polymerase chain reaction and DNA sequencing were used to screen for KCNQ1, KCNH2, KCNE1, and SCN5A mutation.</p><p><b>RESULTS</b>We identified a novel mutation N1774S in the SCN5A gene of the BS family, a novel mutation G314S in a RWS family which had also been found in Europe, North America, and Japan, and a single nucleotide polymorphisms (SNPs) G643S in the KCNQ1 of the JLNS family. In this JLNS family, another heterozygous novel mutation in exon 2a was found in KCNQ1 of the patients.</p><p><b>CONCLUSION</b>New mutations were found in our experiment, which expand the spectrum of KCNQ1 and SCN5A mutations that cause LQTS and BS.</p>