OBJECTIVE To evaluate the feasibility and tolerability of metoprolol standard dosing pathway(MSDP)in Chinese patients with acute coronary syndrome(ACS).METHODS In this multicenter,prospective,open label,single-arm and...OBJECTIVE To evaluate the feasibility and tolerability of metoprolol standard dosing pathway(MSDP)in Chinese patients with acute coronary syndrome(ACS).METHODS In this multicenter,prospective,open label,single-arm and interventional study that was conducted from February 2018 to April 2019 in fifteen Chinese hospitals.A total of 998 hospitalized patients aged≥18 years and diagnosed with ACS were included.The MSDP was applied to all eligible ACS patients based on the standard treatment recommended by international guidelines.The primary endpoint was the percentage of patients achieving the target dose at discharge(V2).The secondary endpoints included the heart rate and blood pressure at V2 and four weeks after discharge(V4),and percentage of patients experiencing bradycardia(heart rate<50 beats/min),hypotension(blood pressure<90/60 mmHg)and transient cardiac dysfunction at V2 and V4.RESULTS Of the 998 patients,29.46%of patients achieved the target dose(≥95 mg/d)at V2.The total population was divided into two groups:target group(patients achieving the target dose at V2)and non-target group(patients not achieving the target dose at V2).There was significant difference in the reduction of heart rate from baseline to discharge in the two groups(-4.97±11.90beats/min vs.-2.70±9.47 beats/min,P=0.034).There was no significant difference in the proportion of bradycardia that occurred in the two groups at V2(0 vs.0,P=1.000)and V4(0.81%vs.0.33%,P=0.715).There was no significant difference in the proportion of hypotension between the two groups at V2(0.004%vs.0.004%,P=1.000)and V4(0 vs.0.005%,P=0.560).No transient cardiac dysfunction occurred in two groups during the study.A total of five adverse events(1.70%)and one serious adverse event(0.34%)were related to the pathway in target group.CONCLUSIONS In Chinese ACS patients,the feasibility and tolerability of the MSDP have been proved to be acceptable.展开更多
Transcatheter aortic valve replacement(TAVR)has emerged as an effective alternative to surgical aortic valve replacement in symptomatic aortic stenosis(AS).^([1,2])Approximately one in five cases of AS are emergent wi...Transcatheter aortic valve replacement(TAVR)has emerged as an effective alternative to surgical aortic valve replacement in symptomatic aortic stenosis(AS).^([1,2])Approximately one in five cases of AS are emergent with acute decompensation of cardiac function;^([3])therefore,emergent TAVR is an essential approach for severe AS patients with acute condition.展开更多
Background Subclinical hypothyroidism （SCH） has recently been acknowledged as an unconventional risk factor for coronary artery disease （CAD） and characterized by poor prognosis, which may be due to atheroscleroti...Background Subclinical hypothyroidism （SCH） has recently been acknowledged as an unconventional risk factor for coronary artery disease （CAD） and characterized by poor prognosis, which may be due to atherosclerotic plaque characteristics. We conducted this study to observe coronary plaque characteristics in coronary artery disease patients with concomitant SCH. Methods Patients with coronary artery disease were enrolled in the study and divided into an SCH group （patients, n = 26; plaques, n = 35） and a non-SCH group （patients, n = 52; plaques, n = 66）. They were divided 1：2 according to propensity-matched analysis including age, diabetes mellitus, gender, CAD severity and culprit vessel. Optical coherence tomography （OCT） imaging was performed on all patients, and images were analyzed by two inde- pendent investigators. Lipid-rich plaques （LRP）, the precursor of vulnerable plaques, were defined as having more than one quadrant occu- pied with lipid pool. Maximum lipid arcs were simultaneously recorded. Fibrotic plaques and calcific plaques were also identified. The pres- ence of coronary dissection, plaque erosion, thrombus, macrophage, calcific nodule, thin-cap fibroatheroma and micro channel were all noted. Results The ratio of LRP in SCH group was significantly higher than that in non-SCH group （54% vs. 30.3%, P = 0.037）. That was the case as well for the maximum lipid arcs value （181.5°± 61.6° vs. 142.1° 4± 35.9°, p = 0.046）. While thin-cap fibroatheroma （TCFA） was detected, no difference was identified between the two groups in either TCFA ratio （20% vs. 16.7%, P = 0.579） or fibrous cap thickness （57.5 4± 14.0 vs. 63.5 4±10.7 gin, P = 0.319）. Other OCT characteristics such as dissection, plaque erosion, thrombus, macrophage shadow and calcific nodule were also similar. ConcLusion Higher ratio of LRP with greater lipid arc in SCH patients may be related to the plaque instability and poor prognosis in CAD patients with SCH.展开更多
Woven coronary artery (WCA) is a rare and underdiagnosed anomaly characterized by epicardial coronary artery dividing into multiple twisted single channels then anastomosing at distal segment. The malformation is usua...Woven coronary artery (WCA) is a rare and underdiagnosed anomaly characterized by epicardial coronary artery dividing into multiple twisted single channels then anastomosing at distal segment. The malformation is usually believed as a benign condition without traces of thrombosis or dissection flaps, and merely diagnosed incidentally. However, coincidence of WCA with atherosclerosis or tachycardia may incur myocardium ischemia,[1] and even caused acute coronary syndrome (ACS) or sudden cardiac death (SCD) in reported cases.[2–4] Since the absence of evidence, the guideline for management of the coronary malformation is still lacking. Notably, as an intravascular image modality with high resolution,[5] optical coherence tomography (OCT) may shed lights on diagnosis and management of WCA.[2] Herein, we reported three cases of optimizing WCA management through performing OCT.展开更多
The coronary artery calcification score and pericardial fat volume have recently been reported to be strongly associated with the severity and presence of coronary atherosclerosis. However, no studies have explored th...The coronary artery calcification score and pericardial fat volume have recently been reported to be strongly associated with the severity and presence of coronary atherosclerosis. However, no studies have explored the outcome of phased progression of atherosclerosis by non-contrast computed tomography in asymptomatic people in China. The population-based cohort study in outcome of phased progression of atherosclerosis in China （PERSUADE）, an observational, longitudinal and prospective cohort study in a target population of healthy sub- jects based in Jidong Oilfield （China）, prospectively analyzes the outcome of phased progression of atherosclerosis by non-contrast computed tomography in healthy population. The results of this study are expected to be of value for utilizing noninvasive imaging combine with tradi- tional cardiovascular risk factors to create a risk stratification and find pertinent biomarkers associated with the outcome of phased progres- sion of atherosclerosis in healthy people, thereby could help to establish a more personalized treatment of clinical practice.展开更多
BACKGROUND Lipoprotein(a)[Lp(a)]has been closely related to coronary atherosclerosis and might affect perivascular in-flammation due to its proinflammatory properties.However,there are limited data about Lp(a)and rela...BACKGROUND Lipoprotein(a)[Lp(a)]has been closely related to coronary atherosclerosis and might affect perivascular in-flammation due to its proinflammatory properties.However,there are limited data about Lp(a)and related perivascular inflam-mation on coronary atheroma progression.Therefore,this study aimed to investigate the associations between Lp(a)and the peri-vascular fat attenuation index(FAI)with coronary atheroma progression detected by coronary computed tomography angio-graphy(CCTA).METHODS Patients who underwent serial CCTA examinations without a history of revascularization and with available data for Lp(a)within one month before or after baseline and follow-up CCTA imaging scans were considered to be included.CCTA quantitative analyses were performed to obtain the total plaque volume(TPV)and the perivascular FAI.Coronary plaque pro-gression(PP)was defined as a≥10%increase in the change of the TPV at the patient level or the presence of new-onset coronary atheroma lesions.The associations between Lp(a)or the perivascular FAI with PP were examined by multivariate logistic regres-sion.RESULTS A total of 116 patients were ultimately enrolled in the present study with a mean CCTA interscan interval of 30.80±13.50 months.Among the 116 patients(mean age:53.49±10.21 years,males:83.6%),32 patients presented PP during the follow-up interval.Lp(a)levels were significantly higher among PP patients than those among non-PP patients at both baseline[15.80(9.09−33.60)mg/dL vs.10.50(4.75−19.71)mg/dL,P=0.029]and follow-up[20.60(10.45−34.55)mg/dL vs.8.77(5.00−18.78)mg/dL,P=0.004].However,there were no differences in the perivascular FAI between PP group and non-PP group at either baseline or follow-up.Multivariate logistic regression analysis showed that elevated baseline Lp(a)level(OR=1.031,95%CI:1.005−1.058,P=0.019)was an independent risk factor for PP after adjustment for other conventional variables.CONCLUSIONS Lp(a)was independently associated with coronary atheroma progression beyond low-density lipoprotein cholesterol and other conventional risk factors.Further studies are warranted to identify the inflammation effect exhibited as the perivascular FAI on coronary atheroma progression.展开更多
To the Editor:Coronary computed tomographic angiography(CCTA)has been considered as one of the most important noninvasive imaging modalities in diagnosing coronary artery disease(CAD).[1]Modern scanner of CCTA can pro...To the Editor:Coronary computed tomographic angiography(CCTA)has been considered as one of the most important noninvasive imaging modalities in diagnosing coronary artery disease(CAD).[1]Modern scanner of CCTA can provide precise coronary atherosclerotic plaque information,showing improved diagnostic accuracy and sensitivity for identifying obstructive CAD with a preferable temporal and spatial resolution.Several studies have demonstrated the prognosis value of CCTA for the prediction of future adverse CAD events.展开更多
基金supported by the National Key Research and Development Program of China(2016YFC1300300)。
文摘OBJECTIVE To evaluate the feasibility and tolerability of metoprolol standard dosing pathway(MSDP)in Chinese patients with acute coronary syndrome(ACS).METHODS In this multicenter,prospective,open label,single-arm and interventional study that was conducted from February 2018 to April 2019 in fifteen Chinese hospitals.A total of 998 hospitalized patients aged≥18 years and diagnosed with ACS were included.The MSDP was applied to all eligible ACS patients based on the standard treatment recommended by international guidelines.The primary endpoint was the percentage of patients achieving the target dose at discharge(V2).The secondary endpoints included the heart rate and blood pressure at V2 and four weeks after discharge(V4),and percentage of patients experiencing bradycardia(heart rate<50 beats/min),hypotension(blood pressure<90/60 mmHg)and transient cardiac dysfunction at V2 and V4.RESULTS Of the 998 patients,29.46%of patients achieved the target dose(≥95 mg/d)at V2.The total population was divided into two groups:target group(patients achieving the target dose at V2)and non-target group(patients not achieving the target dose at V2).There was significant difference in the reduction of heart rate from baseline to discharge in the two groups(-4.97±11.90beats/min vs.-2.70±9.47 beats/min,P=0.034).There was no significant difference in the proportion of bradycardia that occurred in the two groups at V2(0 vs.0,P=1.000)and V4(0.81%vs.0.33%,P=0.715).There was no significant difference in the proportion of hypotension between the two groups at V2(0.004%vs.0.004%,P=1.000)and V4(0 vs.0.005%,P=0.560).No transient cardiac dysfunction occurred in two groups during the study.A total of five adverse events(1.70%)and one serious adverse event(0.34%)were related to the pathway in target group.CONCLUSIONS In Chinese ACS patients,the feasibility and tolerability of the MSDP have been proved to be acceptable.
基金supported by the National Key Research and Development Program of China(2016YFC1300304)the Logistic Health Care Program(21BJZ33)the Youth Independent Innovation Science Fund of Chinese PLA General Hospital(22QNCZ024).
文摘Transcatheter aortic valve replacement(TAVR)has emerged as an effective alternative to surgical aortic valve replacement in symptomatic aortic stenosis(AS).^([1,2])Approximately one in five cases of AS are emergent with acute decompensation of cardiac function;^([3])therefore,emergent TAVR is an essential approach for severe AS patients with acute condition.
文摘Background Subclinical hypothyroidism （SCH） has recently been acknowledged as an unconventional risk factor for coronary artery disease （CAD） and characterized by poor prognosis, which may be due to atherosclerotic plaque characteristics. We conducted this study to observe coronary plaque characteristics in coronary artery disease patients with concomitant SCH. Methods Patients with coronary artery disease were enrolled in the study and divided into an SCH group （patients, n = 26; plaques, n = 35） and a non-SCH group （patients, n = 52; plaques, n = 66）. They were divided 1：2 according to propensity-matched analysis including age, diabetes mellitus, gender, CAD severity and culprit vessel. Optical coherence tomography （OCT） imaging was performed on all patients, and images were analyzed by two inde- pendent investigators. Lipid-rich plaques （LRP）, the precursor of vulnerable plaques, were defined as having more than one quadrant occu- pied with lipid pool. Maximum lipid arcs were simultaneously recorded. Fibrotic plaques and calcific plaques were also identified. The pres- ence of coronary dissection, plaque erosion, thrombus, macrophage, calcific nodule, thin-cap fibroatheroma and micro channel were all noted. Results The ratio of LRP in SCH group was significantly higher than that in non-SCH group （54% vs. 30.3%, P = 0.037）. That was the case as well for the maximum lipid arcs value （181.5°± 61.6° vs. 142.1° 4± 35.9°, p = 0.046）. While thin-cap fibroatheroma （TCFA） was detected, no difference was identified between the two groups in either TCFA ratio （20% vs. 16.7%, P = 0.579） or fibrous cap thickness （57.5 4± 14.0 vs. 63.5 4±10.7 gin, P = 0.319）. Other OCT characteristics such as dissection, plaque erosion, thrombus, macrophage shadow and calcific nodule were also similar. ConcLusion Higher ratio of LRP with greater lipid arc in SCH patients may be related to the plaque instability and poor prognosis in CAD patients with SCH.
基金supported by grants from National Key R&D Program of China (2016YFC1300304)
文摘Woven coronary artery (WCA) is a rare and underdiagnosed anomaly characterized by epicardial coronary artery dividing into multiple twisted single channels then anastomosing at distal segment. The malformation is usually believed as a benign condition without traces of thrombosis or dissection flaps, and merely diagnosed incidentally. However, coincidence of WCA with atherosclerosis or tachycardia may incur myocardium ischemia,[1] and even caused acute coronary syndrome (ACS) or sudden cardiac death (SCD) in reported cases.[2–4] Since the absence of evidence, the guideline for management of the coronary malformation is still lacking. Notably, as an intravascular image modality with high resolution,[5] optical coherence tomography (OCT) may shed lights on diagnosis and management of WCA.[2] Herein, we reported three cases of optimizing WCA management through performing OCT.
基金We appreciate all the participants and their relatives in the study. And we will thank to the members of the survey teams from the Jidong community. The authors thank the staff of the Recovery Medical Technology Development Co., Ltd for their important efforts. This study was supported by grants from National Key Research and Development program of China （2016YFC1300300）, National Natural Science Foundation of China （Nos.81270186, 81400229）, Scientific Technology Program of Beijing City （Z1411070025 14103）.
文摘The coronary artery calcification score and pericardial fat volume have recently been reported to be strongly associated with the severity and presence of coronary atherosclerosis. However, no studies have explored the outcome of phased progression of atherosclerosis by non-contrast computed tomography in asymptomatic people in China. The population-based cohort study in outcome of phased progression of atherosclerosis in China （PERSUADE）, an observational, longitudinal and prospective cohort study in a target population of healthy sub- jects based in Jidong Oilfield （China）, prospectively analyzes the outcome of phased progression of atherosclerosis by non-contrast computed tomography in healthy population. The results of this study are expected to be of value for utilizing noninvasive imaging combine with tradi- tional cardiovascular risk factors to create a risk stratification and find pertinent biomarkers associated with the outcome of phased progres- sion of atherosclerosis in healthy people, thereby could help to establish a more personalized treatment of clinical practice.
基金supported by the National Key Research and Development Program of China(2016YFC1300304)the Beijing NOVA Program(Z181100006218055).
文摘BACKGROUND Lipoprotein(a)[Lp(a)]has been closely related to coronary atherosclerosis and might affect perivascular in-flammation due to its proinflammatory properties.However,there are limited data about Lp(a)and related perivascular inflam-mation on coronary atheroma progression.Therefore,this study aimed to investigate the associations between Lp(a)and the peri-vascular fat attenuation index(FAI)with coronary atheroma progression detected by coronary computed tomography angio-graphy(CCTA).METHODS Patients who underwent serial CCTA examinations without a history of revascularization and with available data for Lp(a)within one month before or after baseline and follow-up CCTA imaging scans were considered to be included.CCTA quantitative analyses were performed to obtain the total plaque volume(TPV)and the perivascular FAI.Coronary plaque pro-gression(PP)was defined as a≥10%increase in the change of the TPV at the patient level or the presence of new-onset coronary atheroma lesions.The associations between Lp(a)or the perivascular FAI with PP were examined by multivariate logistic regres-sion.RESULTS A total of 116 patients were ultimately enrolled in the present study with a mean CCTA interscan interval of 30.80±13.50 months.Among the 116 patients(mean age:53.49±10.21 years,males:83.6%),32 patients presented PP during the follow-up interval.Lp(a)levels were significantly higher among PP patients than those among non-PP patients at both baseline[15.80(9.09−33.60)mg/dL vs.10.50(4.75−19.71)mg/dL,P=0.029]and follow-up[20.60(10.45−34.55)mg/dL vs.8.77(5.00−18.78)mg/dL,P=0.004].However,there were no differences in the perivascular FAI between PP group and non-PP group at either baseline or follow-up.Multivariate logistic regression analysis showed that elevated baseline Lp(a)level(OR=1.031,95%CI:1.005−1.058,P=0.019)was an independent risk factor for PP after adjustment for other conventional variables.CONCLUSIONS Lp(a)was independently associated with coronary atheroma progression beyond low-density lipoprotein cholesterol and other conventional risk factors.Further studies are warranted to identify the inflammation effect exhibited as the perivascular FAI on coronary atheroma progression.
基金National Key Research and Development Program of China(No.2016YFC1300304)Beijing NOVA Program(No.Z181100006218055)。
文摘To the Editor:Coronary computed tomographic angiography(CCTA)has been considered as one of the most important noninvasive imaging modalities in diagnosing coronary artery disease(CAD).[1]Modern scanner of CCTA can provide precise coronary atherosclerotic plaque information,showing improved diagnostic accuracy and sensitivity for identifying obstructive CAD with a preferable temporal and spatial resolution.Several studies have demonstrated the prognosis value of CCTA for the prediction of future adverse CAD events.
