Objective Telomere length, as an emerging marker of biological age,isrelatedwithhypertension.Ouraimistoinvestigatethe relationship between telomere trajectory and blood pressure change as well as the incident cardiova...Objective Telomere length, as an emerging marker of biological age,isrelatedwithhypertension.Ouraimistoinvestigatethe relationship between telomere trajectory and blood pressure change as well as the incident cardiovascular events in a longitudinal hypertensive cohort in China.展开更多
Fulminant myocarditis is an acute diffuse inflammatory disease of myocardium.It is characterized by acute onset,rapid progress and high risk of death.Its pathogenesis involves excessive immune activation of the innate...Fulminant myocarditis is an acute diffuse inflammatory disease of myocardium.It is characterized by acute onset,rapid progress and high risk of death.Its pathogenesis involves excessive immune activation of the innate immune system and formation of inflammatory storm.According to China’s practical experience,the adoption of the“life support-based comprehensive treatment regimen”(with mechanical circulation support and immunomodulation therapy as the core)can significantly improve the survival rate and long-term prognosis.Special emphasis is placed on very early identification,very early diagnosis,very early prediction and very early treatment.展开更多
Background:Risk assessment and treatment stratification for three-vessel coronary disease(TVD)remain challenging.This study aimed to investigate the prognostic value of left atrial volume index(LAVI)with the Synergy B...Background:Risk assessment and treatment stratification for three-vessel coronary disease(TVD)remain challenging.This study aimed to investigate the prognostic value of left atrial volume index(LAVI)with the Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery(SYNTAX)score II,and its association with the long-term prognosis after three strategies(percutaneous coronary intervention[PCI],coronary artery bypass grafting[CABG],and medical therapy[MT])in patients with TVD.Methods:This study was a post hoc analysis of a large,prospective cohort of patients with TVD in China,that aimed to determine the long-term outcomes after PCI,CABG,or optimal MT alone.A total of 8943 patients with TVD were consecutively enrolled between 2004 and 2011 at Fuwai Hospital.A total of 7818 patients with available baseline LAVI data were included in the study.Baseline,procedural,and follow-up data were collected.The primary endpoint was major adverse cardiac and cerebrovascular events(MACCE),which was a composite of all-cause death,myocardial infarction(MI),and stroke.Secondary endpoints included all-cause death,cardiac death,MI,revascularization,and stroke.Long-term outcomes were evaluated among LAVI quartile groups.Results:During a median follow-up of 6.6 years,a higher LAVI was strongly associated with increased risk of MACCE(Q3:hazard ratio[HR]1.20,95%confidence interval[CI]1.06-1.37,P=0.005;Q4:HR 1.85,95%CI 1.64-2.09,P<0.001),all-cause death(Q3:HR 1.41,95%CI 1.17-1.69,P<0.001;Q4:HR 2.54,95%CI 2.16-3.00,P<0.001),and cardiac death(Q3:HR 1.81,95%CI 1.39-2.37,P<0.001;Q4:HR 3.47,95%CI 2.71-4.43,P<0.001).Moreover,LAVI significantly improved discrimination and reclassification of the SYNTAX score II.Notably,there was a significant interaction between LAVI quartiles and treatment strategies for MACCE.CABG was associated with lower risk of MACCE than MT alone,regardless of LAVI quartiles.Among patients in the fourth quartile,PCI was associated with significantly increased risk of cardiac death compared with CABG(HR:5.25,95%CI:1.97-14.03,P=0.001).Conclusions:LAVI is a potential index for risk stratification and therapeutic decision-making in patients with three-vessel coronary disease.CABG is associated with improved long-term outcomes compared with MT alone,regardless of LAVI quartiles.When LAVI is severely elevated,PCI is associated with higher risk of cardiac death than CABG.展开更多
Fulminant myocarditis(FM) has unacceptable high mortality. This study aimed to evaluate the therapeutic efficacy of a life support-based comprehensive treatment regimen(LSBCTR), a completely novel treatment regimen, f...Fulminant myocarditis(FM) has unacceptable high mortality. This study aimed to evaluate the therapeutic efficacy of a life support-based comprehensive treatment regimen(LSBCTR), a completely novel treatment regimen, for FM. A total of 169 FM patients recruited from January 2008 to December 2018 were divided into two groups: patients receiving LSBCTR(81 cases),which includes(i) mechanical life support(positive pressure respiration, intra-aortic balloon pump with or without extracorporeal membrane oxygenation),(ii) immunomodulation therapy using sufficient doses of glucocorticoids and immunoglobulins, and(iii) application of neuraminidase inhibitors, and those receiving conventional treatment(88 cases). The endpoints were in-hospital death and heart-transplantation. Of all the population, 44 patients(26.0%) died in hospitals. Inhospital mortality was 3.7%(3/81) for LSBCTR group and 46.6%(41/88) for traditional treatment(P<0.001). Early application of LSBCTR, mechanical life support, neuraminidase inhibitors, and immunomodulation therapy significantly contributed to reduction in in-hospital mortality. This study describes a novel treatment regimen for FM patients that dramatically reduces inhospital mortality. Its generalization and clinical application will efficiently save lives although further optimization is needed.This study offers an insight that virus infection induced inflammatory waterfall results in cardiac injury and cardiogenic shock and is the therapeutic target.展开更多
Fulminant myocarditis is characterized by acute and severe inflammation with injury of myocardium globally. It has a fulminant course and high in-hospital mortality rate of up to50%-70%. It onsets rapidly after viral ...Fulminant myocarditis is characterized by acute and severe inflammation with injury of myocardium globally. It has a fulminant course and high in-hospital mortality rate of up to50%-70%. It onsets rapidly after viral infection and progresses to hypotension.展开更多
The role of high sensitivity C-reactive protein(hsCRP)in predicting prognosis after stroke in the Asian population has not been investigated.We hypothesized that elevated levels of hsCRP were associated with worsening...The role of high sensitivity C-reactive protein(hsCRP)in predicting prognosis after stroke in the Asian population has not been investigated.We hypothesized that elevated levels of hsCRP were associated with worsening prognosis after stroke in Chinese patients.Two hundred and ninety consecutive patients withfirst-onset stroke and 290 age-and gender-matched control subjects without any cerebrovascular disease were enrolled for study.Plasma hsCRP level was detected and subsequent vascular events and death were recorded in both groups over a 5-year period.Compared to control group,patients presenting with stroke had higher plasma hsCRP level(3.3±3.8 vs 1.3±2.2 mg/L,P<0.01).Furthermore,in the group of patients with stroke,the mean plasma hsCRP level was higher in patients who developed subsequent vascular diseases or died as compared with the patients without further complications(4.4±4.3 vs 2.7±3.3 mg/L,P<0.01).Compared to the lowest tertile of hsCRP level,the relative risk for vascular events or death in stroke patients was 2.91 in the highest tertile of hsCRP(95%CI,1.54–5.50,P=0.001).This increase in relative risk for vascular events or death in stroke patients continued after adjustment for age,sex and other cardiovascular risk factors such as hypertension and diabetes(OR:2.771,95%CI:1.367–5.617,P=0.005).Thesefindings indicate that increased hsCRP level is associated with worsening prognosis after stroke in Chinese patients and suggests that inflammation is correlated with stroke outcome.展开更多
Epidemiological studies show that increased plasma total homocysteine(tHcy)level was an independ-ent risk factor of cardiovascular diseases.This study was aimed to investigate the relationship between tHcy level and p...Epidemiological studies show that increased plasma total homocysteine(tHcy)level was an independ-ent risk factor of cardiovascular diseases.This study was aimed to investigate the relationship between tHcy level and prognosis of first-onset stroke in Chinese people.One hundred ninety six patients with first-onset ischemic stroke and ninety-five patients with first-onset hemorrha-gic stroke were enrolled in this study.The patients were divided into two groups in terms of tHcy level(,18 mmol/L and>18 mmol/L).The plasma tHcy level was detected by a high performance liquid chromatography method with fluorescence detection.All the patients underwent a 5-year follow-up.Survival analysis shows that the probability of death or new vascular events in the ischemic stroke patients with high tHcy level(>18 mmol/L)was significantly higher than that in the counter-parts with lower tHcy level(,18 mmol/L)(50.9%and 28.7%,respectively,P 50.004).The relative risk of death or new vascular events was 2.363(95%CI,1.209 to 4.617,P 50.012)in ischemic stroke patients with high tHcy levels(>18 mmol/L)compared to those with a lower tHcy level(,18 mmol/L).The increased tHcy level was significantly associated with the risk of death or new vascular events(OR,2.492,95%CI,1.148 to 5.407,P 50.021)in patients with ischemic stroke in the exclusion of the influence of other risk factors such as gender,age,body mass index,plasma cholesterol level,the history of hypertension,diabetes or smoking.However,in the patients with hemorrhagic stroke,there was no significant difference in the probability of death or new vascular events between patients with a high tHcy level and those with a lower tHcy level(33.3%and 28.2%,respectively,P 50.546).Increased tHcy level was an independent risk factor for a worse outcome in patients with first-onset ischemic stroke,but not in hemorrhagic stroke patients.展开更多
文摘Objective Telomere length, as an emerging marker of biological age,isrelatedwithhypertension.Ouraimistoinvestigatethe relationship between telomere trajectory and blood pressure change as well as the incident cardiovascular events in a longitudinal hypertensive cohort in China.
基金supported in part by the National Natural Science Foundation of China(81790624,81630010)Top-Notch Talent Program of Hubei Province and Tongji Hospital(2021YBJRC005)。
文摘Fulminant myocarditis is an acute diffuse inflammatory disease of myocardium.It is characterized by acute onset,rapid progress and high risk of death.Its pathogenesis involves excessive immune activation of the innate immune system and formation of inflammatory storm.According to China’s practical experience,the adoption of the“life support-based comprehensive treatment regimen”(with mechanical circulation support and immunomodulation therapy as the core)can significantly improve the survival rate and long-term prognosis.Special emphasis is placed on very early identification,very early diagnosis,very early prediction and very early treatment.
基金supported by National Program on Key Basic Research Project(973 Program,No.2010CB732601)National High-Tech Research and Development Program of China(863 Program,No.2015AA020407)+5 种基金Beijing Municipal Science&Technology Commission(No.Z191100006619106)National Natural Science Foundation of China(Nos.81470380 and 81770365)National Key Research and Development Program of the Ministry of Science and Technology of China during the"13^(th)Five-Year Plan"(No.2016YFC1301301)National Clinical Research Center for Cardiovascular Diseases,Fuwai Hospital,Chinese Academy of Medical Sciences(No.NCRC2020013)Key Project of Yunnan National Regional Medical Center for Cardiovascular Diseases(No.202002AA310100-14)Beijing United Heart Foundation(No.BJUHFCSOARF201901-19)
文摘Background:Risk assessment and treatment stratification for three-vessel coronary disease(TVD)remain challenging.This study aimed to investigate the prognostic value of left atrial volume index(LAVI)with the Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery(SYNTAX)score II,and its association with the long-term prognosis after three strategies(percutaneous coronary intervention[PCI],coronary artery bypass grafting[CABG],and medical therapy[MT])in patients with TVD.Methods:This study was a post hoc analysis of a large,prospective cohort of patients with TVD in China,that aimed to determine the long-term outcomes after PCI,CABG,or optimal MT alone.A total of 8943 patients with TVD were consecutively enrolled between 2004 and 2011 at Fuwai Hospital.A total of 7818 patients with available baseline LAVI data were included in the study.Baseline,procedural,and follow-up data were collected.The primary endpoint was major adverse cardiac and cerebrovascular events(MACCE),which was a composite of all-cause death,myocardial infarction(MI),and stroke.Secondary endpoints included all-cause death,cardiac death,MI,revascularization,and stroke.Long-term outcomes were evaluated among LAVI quartile groups.Results:During a median follow-up of 6.6 years,a higher LAVI was strongly associated with increased risk of MACCE(Q3:hazard ratio[HR]1.20,95%confidence interval[CI]1.06-1.37,P=0.005;Q4:HR 1.85,95%CI 1.64-2.09,P<0.001),all-cause death(Q3:HR 1.41,95%CI 1.17-1.69,P<0.001;Q4:HR 2.54,95%CI 2.16-3.00,P<0.001),and cardiac death(Q3:HR 1.81,95%CI 1.39-2.37,P<0.001;Q4:HR 3.47,95%CI 2.71-4.43,P<0.001).Moreover,LAVI significantly improved discrimination and reclassification of the SYNTAX score II.Notably,there was a significant interaction between LAVI quartiles and treatment strategies for MACCE.CABG was associated with lower risk of MACCE than MT alone,regardless of LAVI quartiles.Among patients in the fourth quartile,PCI was associated with significantly increased risk of cardiac death compared with CABG(HR:5.25,95%CI:1.97-14.03,P=0.001).Conclusions:LAVI is a potential index for risk stratification and therapeutic decision-making in patients with three-vessel coronary disease.CABG is associated with improved long-term outcomes compared with MT alone,regardless of LAVI quartiles.When LAVI is severely elevated,PCI is associated with higher risk of cardiac death than CABG.
基金supported by the National Basic Research Program of China (2012CB518004)the key project of the National Natural Science Foundation of China (81630010, 81790624)National Key Research and Development Program of China (SQ2017YFSF090157)
文摘Fulminant myocarditis(FM) has unacceptable high mortality. This study aimed to evaluate the therapeutic efficacy of a life support-based comprehensive treatment regimen(LSBCTR), a completely novel treatment regimen, for FM. A total of 169 FM patients recruited from January 2008 to December 2018 were divided into two groups: patients receiving LSBCTR(81 cases),which includes(i) mechanical life support(positive pressure respiration, intra-aortic balloon pump with or without extracorporeal membrane oxygenation),(ii) immunomodulation therapy using sufficient doses of glucocorticoids and immunoglobulins, and(iii) application of neuraminidase inhibitors, and those receiving conventional treatment(88 cases). The endpoints were in-hospital death and heart-transplantation. Of all the population, 44 patients(26.0%) died in hospitals. Inhospital mortality was 3.7%(3/81) for LSBCTR group and 46.6%(41/88) for traditional treatment(P<0.001). Early application of LSBCTR, mechanical life support, neuraminidase inhibitors, and immunomodulation therapy significantly contributed to reduction in in-hospital mortality. This study describes a novel treatment regimen for FM patients that dramatically reduces inhospital mortality. Its generalization and clinical application will efficiently save lives although further optimization is needed.This study offers an insight that virus infection induced inflammatory waterfall results in cardiac injury and cardiogenic shock and is the therapeutic target.
文摘Fulminant myocarditis is characterized by acute and severe inflammation with injury of myocardium globally. It has a fulminant course and high in-hospital mortality rate of up to50%-70%. It onsets rapidly after viral infection and progresses to hypotension.
基金supported by the Special Funds for Major State Basic Research Program of China(973 Program)(No.G2000056901).
文摘The role of high sensitivity C-reactive protein(hsCRP)in predicting prognosis after stroke in the Asian population has not been investigated.We hypothesized that elevated levels of hsCRP were associated with worsening prognosis after stroke in Chinese patients.Two hundred and ninety consecutive patients withfirst-onset stroke and 290 age-and gender-matched control subjects without any cerebrovascular disease were enrolled for study.Plasma hsCRP level was detected and subsequent vascular events and death were recorded in both groups over a 5-year period.Compared to control group,patients presenting with stroke had higher plasma hsCRP level(3.3±3.8 vs 1.3±2.2 mg/L,P<0.01).Furthermore,in the group of patients with stroke,the mean plasma hsCRP level was higher in patients who developed subsequent vascular diseases or died as compared with the patients without further complications(4.4±4.3 vs 2.7±3.3 mg/L,P<0.01).Compared to the lowest tertile of hsCRP level,the relative risk for vascular events or death in stroke patients was 2.91 in the highest tertile of hsCRP(95%CI,1.54–5.50,P=0.001).This increase in relative risk for vascular events or death in stroke patients continued after adjustment for age,sex and other cardiovascular risk factors such as hypertension and diabetes(OR:2.771,95%CI:1.367–5.617,P=0.005).Thesefindings indicate that increased hsCRP level is associated with worsening prognosis after stroke in Chinese patients and suggests that inflammation is correlated with stroke outcome.
基金supported by the Special Funds for Major State Basic Research Program of China(973 Program)(No.G200056901).
文摘Epidemiological studies show that increased plasma total homocysteine(tHcy)level was an independ-ent risk factor of cardiovascular diseases.This study was aimed to investigate the relationship between tHcy level and prognosis of first-onset stroke in Chinese people.One hundred ninety six patients with first-onset ischemic stroke and ninety-five patients with first-onset hemorrha-gic stroke were enrolled in this study.The patients were divided into two groups in terms of tHcy level(,18 mmol/L and>18 mmol/L).The plasma tHcy level was detected by a high performance liquid chromatography method with fluorescence detection.All the patients underwent a 5-year follow-up.Survival analysis shows that the probability of death or new vascular events in the ischemic stroke patients with high tHcy level(>18 mmol/L)was significantly higher than that in the counter-parts with lower tHcy level(,18 mmol/L)(50.9%and 28.7%,respectively,P 50.004).The relative risk of death or new vascular events was 2.363(95%CI,1.209 to 4.617,P 50.012)in ischemic stroke patients with high tHcy levels(>18 mmol/L)compared to those with a lower tHcy level(,18 mmol/L).The increased tHcy level was significantly associated with the risk of death or new vascular events(OR,2.492,95%CI,1.148 to 5.407,P 50.021)in patients with ischemic stroke in the exclusion of the influence of other risk factors such as gender,age,body mass index,plasma cholesterol level,the history of hypertension,diabetes or smoking.However,in the patients with hemorrhagic stroke,there was no significant difference in the probability of death or new vascular events between patients with a high tHcy level and those with a lower tHcy level(33.3%and 28.2%,respectively,P 50.546).Increased tHcy level was an independent risk factor for a worse outcome in patients with first-onset ischemic stroke,but not in hemorrhagic stroke patients.
