2010年 · 第123卷第17期

The value of cardiac resynchronization therapy (CRT)in chronic heart failure has been well recognized around the world. Multi-center clinical trials have confirmed that CRT not only can improve cardiac function and quality of life, but also reduce mortality and improve the prognosis in patients with advanced heart failure and ventricular dyssynchrony。

Abstract：Background Cardiac resynchronization therapy (CRT) could improve heart function, symptom status, quality of life and reduce hospitalization and mortality in patients with severe heart failure (HF) with optimal medical management. However,the possible adverse effects of CRT are often ignored by clinicians.Method A retrospective analysis of CRT over a 6-year period was made in a single cardiac center.Results Fifty-four patients were treated with CRT(D) device, aged (57±11) years, with left ventricular ejection fraction of (32.1±9.8)%, of which 4 (7%) developed ventricular tachycardia/ventricular fibrillation (VT/VF) or junctional tachycardia after operation. Except for one with frequent ventricular premature beat before operation, the others had no previous history of ventricular arrhythmia. Of the 4 patients, 3 had dilated cardiomyopathy and 1 had ischemic cardiomyopathy,and tachycardia occurred within 3 days after operation. Sustained, refractory VT and subsequent VF occurred in one patient, frequent nonsustained VT in two patients and nonparoxysmal atrioventricular junctional tachycardia in one patient. VT was managed by amiodarone in two patients, amiodarone together with beta-blocker in one patient, and junctional tachycardia was terminated by overdrive pacing. During over 12-month follow-up, except for one patient's death due to refractory heart and respiratory failure in hospital, the others remain alive and arrhythmia-free.Conclusions New-onset VT/VF or junctional tachycardia may occur in a minority of patients with or without prior history of tachycardia after biventricular pacing. Arrhythmia can be managed by conventional therapy, but may require temporary discontinuation of pacing. More observational studies should be performed to determine the potential proarrhythmic effect of CRT。

Abstract：Background Imbalance of the sympathetic nervous system was involved in the pathogenesis of idiopathic ventricular outflow-tract tachycardia (IVOT). We aimed to investigate whether the major genetic variants in β1-and β2-adrenoceptors and GNB3 C825T were associated with IVOT and verapamil sensitive idiopathic left ventricular tachycardia (ILVT).Methods Patients with IVOT and ILVT from December 2005 to December 2007 were consecutively enrolled into this study. Controls were randomly selected from the community-based inhabitants. Five genetic variants, Ser49Gly and Gly389Arg in the β1-adrenoceptor, Arg16Gly and Gln27Glu in the β2-adrenoceptor and GNB3 C825T, were genotyped by polymerase chain reaction-restriction fragment length polymorphism analysis.Results A total of 227 patients with IVOT and 110 patients with ILVT were included. Genotyping revealed that the 16Gly allele of Arg16Gly variant of β2-adrenoceptor was associated with a higher risk of IVOT (OR:1.40, 95% CI: 1.12-1.75,P=0.003 in the addictive model and OR:. 1.62, 95% CI: 1.14-2.31, P=0.007 in the dominant model). Patients with Gly16Gln27 haplotype also had a higher risk of IVOT (OR: 1.38, 95% CI: 1.11-1.73, P=0.012). Other four variants,including Ser49Gly and Arg389Gly in β1-adrenoceptor, GIn27Glu in β2-adrenoceptor and GNB3 C825T, did not differ between patients with IVOT and controls. In patients with ILVT, no significant difference was found in these five variants compared with controls.Conclusions Arg16Gly in β2-adrenoceptor is significantly associated with IVOT in Chinese Han population. Major genetic variants in β1- and β2-adrenoceptor and GNB3 C825T may not be associated with ILVT. These data suggest a different arrhythmogenic mechanism in IVOT and ILVT。

Abstract：Background Both early repolarization and altered heart rate profile are associated with sudden death. In this study, we aimed to demonstrate an association between early repolarization and heart rate profile during exercise.Methods A total of 84 subjects were included in the study. Comparable 44 subjects with early repolarization and 40 subjects with normal electrocardiogram underwent exercise stress testing. Resting heart rate, maximum heart rate, heart rate increment and decrement were analyzed.Results Both groups were comparable for baseline characteristics including resting heart rate. Maximum heart rate, heart rate increment and heart rate decrment of the subjects in early repolarization group had significantly decreased maximum heart rate, heart rate increment and heart rate decrement compared to control group (all P＜0.05). The lower heart rate increment (＜106 beats/min) and heart rate decrement (＜95 beats/min) were significantly associated with the presence of early repolarization. After adjustment for age and sex, the multiple-adjusted OR of the risk of presence of early repolarization was 2.98 (95% CI 1.21-7.34) (P=0.018) and 7.73 (95% CI 2.84-21.03) (P ＜0.001) for the lower heart rate increment and heart rate decrement compared to higher levels, respectively.Conclusions Subjects with early repolarization have altered heart rate profile during exercise compared to control subjects. This can be related to sudden death。

Abstract：Background Multiple neonatal characteristics and adult cardiovascular risk factors are associated with the development of atherosclerosis, however little conclusive evidence exists characterizing the relative strength of these factors. In a large retrospective study, we investigated the association between both objective neonatal measurements and comprehensive adult cardiovascular risk factors with the development of atherosclerosis, quantified by carotid intima-media thickness (CIMT). Further, we assessed the impact of gender on the relative impact of these risk factors.Methods CIMT, a measure of atherosclerosis, was determined by carotid ultrasound on 1568 participants (age 50-85)whose birth records were obtained from Peking Union Medical College Hospital. In addition, each participant was given a physical examination, and completed a medical questionnaire to identify a panel of cardiovascular risk factors. Multiple regression analysis was performed on the population and on the male and female cohorts individually, to identify the relative contribution of these risk factors to increased CIMT.Results For the total population the Framingham score, renal function, adult abdominal circumference and mother's gestational age were associated with CIMT, accounting for 14.7%, 1.4%, 0.9%, and 0.2% of total variance, respectively.In the male population the Framingham score, renal function, abdominal circumference and hemoglobin were the most significant risk factors for CIMT. Risk in the female population was associated with Framingham score, renal function,insulin resistance and gestational age. No relationship between birth weight or head circumference and CIMT were observed.Conclusions Adult cardiovascular risk factors were the most significantly associated with the development of atherosclerosis; however mother's age at birth was associated with CIMT, particularly in the female cohort. The relative contribution of the risk factors analyzed varied between the male and female populations。

Abstract：Background Spinal cord injury (SCI) is a complex trauma that consists of multiple pathological mechanisms involving cytotoxic, oxidation stress and immune-endocrine. This study aimed to establish plasma metabonomics fingerprinting atlas for SCI using 1H nuclear magnetic resonance (NMR) based metabonomics methodology and principal component analysis techniques.Methods Nine Sprague-Dawley (SD) male rats were randomly divided into SCI, normal and sham-operation control groups. Plasma samples were collected for 1H NMR spectroscopy 3 days after operation. The NMR data were analyzed using principal component analysis technique with Matlab software.Results Metabonomics analysis was able to distinguish the three groups (SCI, normal control, sham-operation). The fingerprinting atlas indicated that, compared with those without SCI, the SCI group demonstrated the following characteristics with regard to second principal component: it is made up of fatty acids, myc-inositol, arginine, very low-density lipoprotein (VLDL), low-density lipoprotein (LDL), triglyceride (TG), glucose, and 3-methyl-histamine.Conclusions The data indicated that SCI results in several significant changes in plasma metabolism early on and that a metabonomics approach based on 1H NMR spectroscopy can provide a metabolic profile comprising several metabolite classes and allow for relative quantification of such changes. The results also provided support for further development and application of metabonomics technologies for studying SCI and for the utilization of multivariate models for classifying the extent of trauma within an individual。

Abstract：Background Repair of anterior mitral leaflet (AML) prolapse is still a technical challenge for cardiac surgeons. It is an important issue to find a way to repair the AML prolapse with a reliable and reproducible technique.Methods Between January 2002 and June 2009, the operation of chordal transfer based on the "edge-to-edge"technique was performed in 21 patients with serious mitral valve regurgitation because of prolapse of the anterior leaflet.After the operation, echocardiography was performed in each patient before discharge and at the time of follow-up.Results All patients survived the operation. One patient required mitral valve replacement because of anterior leaflet perforation 3 days after the operation. The other patients were free from reoperation. At the time of follow-up, all these patients were in New York Heart Association (NYHA) functional class I. In all these patients, pre-discharge and follow-up echocardiography showed neither stenosis nor significant regurgitation of the mitral valve: the cross-sectional area of the mitral valve was 3.3-4.8 cm2 (mean (3.78:±0.52) cm2), the mean regurgitation area was (0.45:±0.22) cm2. At the same time, both dimension of left atrium and left ventricle reduced significantly (left atrium diameter: pre-operation (48.26±11.12) mm, post-operation (37.57±9.56) mm, P ＜0.05; the end-diastolic diameter of the left ventricle:pre-operation (61.43±8.24) mm, post-operation (42.35±10.79) mm, P＜0.01).Conclusion "Edge-to-edge" chordal transfer technique is a simple, reliable, and reproducible technique that can provide good results for repair of anterior leaflet prolapse of mitral valve。

Abstract：Background As the Shanghai Obstetrical Cardiology Intensive Care Center, our hospital has accumulated a large number of clinical data of pregnant women with heart disease. This paper is a retrospective analysis of 1142 pregnancies in women with heart disease so as to evaluate the maternal and fetal outcomes of these patients.Methods A retrospective analysis was carried out for pregnancies in 1142 women with heart disease who delivered in Shanghai Obstetrical Cardiology Intensive Care Center between 1993 and 2007.Results In this study, main heart diseases in pregnancy were arrhythmia (n=359, 31.4%), congenital heart disease (CHD; n=291,25.5%), and myocarditis and its sequelae (n=284, 24.9%); based on the functional classification criteria of New York Heart Association (NYHA), more than half (n=678, 59.4%) of patients were classified NYHA Class Ⅰ; pregnant women in NHYA Class Ⅰ-Ⅱ (n=951, 83.3%) commonly had arrhythmia, myocarditis and its sequelae, while those in NHYA Class Ⅲ-Ⅳ (n=191, 16.7%) mainly had CHD, rheumatic heart disease (RHD), cardiopathy induced by hypertensive disorders complicating pregnancy, and peripartum cardiomyopathy (PPCM). Cardiac failure occurred in 97 (8.5%)patients, and 8 (0.7%) maternal deaths and 12 (1.1%) perinatal deaths were reported in this study. Compared with those in NHYA Class Ⅰ-Ⅱ, women in NHYA Class Ⅲ-Ⅳ had a significantly lower gestational age at birth (P ＜0.05), lower birth weight (P ＜0.01), and higher incidence of preterm delivery, small for gestational age and perinatal death (P ＜0.01). The incidence of cardiac failure in pregnant women with cardiopathy induced by hypertensive disorders complicating pregnancy and PPCM was relatively high, with a rate of 80% and 52.2%, respectively. After cardiac operation, 131(90.3%) women were in classified NHYA Class Ⅰ-Ⅱ and 14 (9.7%) in NHYA Class Ⅲ-Ⅳ.Conclusions Arrhythmia is the type of heart disease that has a highest incidence in patients with heart disease in pregnancy, while main types of heart disease that impair cardiac function are CHD and RHD; cardiac failure is more frequently caused by cardiopathy induced by hypertensive disorders complicating pregnancy and PPCM; impaired cardiac function increases perinatal morbidity; cardiac surgery before pregnancy could improve the cardiac function。

Abstract：Background Breast cancer is one of the most common cancers in women, and its incidence seems to have gradually increased every year. During the treatment of breast cancer, patients suffer psychological morbidity, and hope is one important factor in maintaining psychological health. Therefore, in this study, we investigated the level of hope in Chinese women with breast cancer during chemotherapy and confirmed the relationships among hope, coping style, and social support.Methods One hundred and fifty-nine inpatients with breast cancer who were undergoing chemotherapy in two affiliated hospitals of Harbin Medical University were recruited and investigated. Each patient completed the Herth Hope Index (HHI), Jalowiec Coping Scale (JCS), and the social support scale made by XIAO Shui-yuan, and provided general demographic data.Results The mean hope level of the 159 patients with breast cancer was 38.62±4.56. There was a statistical difference between the hope level and monthly income. Analysis of results from the Pearson test showed no relationship between the hope level and coping style; however, there were positive relationships between hope and optimism, hope and self-reliance, and hope and palliative coping styles. In contrast, negative relationships were found between hope and the fatalistic and emotional coping styles. The total score of hope and social support had significantly positive relationship for the three scales.Conclusions Patients with breast cancer achieved high levels of hope, with the level of hope being proportional to increase in the income. During chemotherapy, patients with breast cancer had adopted many coping styles。

Abstract：Background Vital capacity induction and tidal breathing induction are currently administered for inhalation induction of anesthesia with sevoflurane. The aim of this study was to compare them using sevoflurane with respect to induction time,complications of inhalation induction, and compound A production in adult patients.Methods Fifty-one women with American Society of Anesthesiologists physical status Ⅰ-Ⅱ undergoing mammary gland tumorectomy were randomly assigned to receive either vital capacity induction or tidal breathing induction with 8% sevoflurane at 6 L/min followed by laryngeal mask airway insertion. Induction times, complications of inhalation induction,and vital signs were recorded. Inspired concentrations of compound A were assayed and sofnolime temperatures were monitored at one-minute intervals after sevoflurane administration.Results The time to loss of eyelash reflex was significantly shorter with the vital capacity induction technique than with the tidal breathing induction technique ((43.8±13.4) seconds vs. (70.8±16.4) seconds, respectively; P ＜0.01).Cardiovascular stability was similar in both groups. The incidence of complications was significantly less with the vital capacity induction technique than with the tidal breathing induction technique (7.7% vs. 32%, respectively; P ＜0.01).However, the mean and maximum concentrations of compound A during induction were significantly higher in the vital capacity group than those in the tidal breathing group (P ＜0.05); compound A concentration at the beginning of anesthesia maintenance was (40.73±10.83) ppm in the vital capacity group and (29.45±7.51) ppm in tidal breathing group (P=0.019).Conclusion For inhalation induction of anesthesia, the vital capacity induction was faster and produced fewer complications than that for tidal breathing induction, but increased compound A production in the circuit system。

Abstract：Background Ossification of the posterior longitudinal ligament (OPLL) is characterized by the replacement of ligamentous tissue with new ectopic bone formation, and has a strong genetic background. Because of the abnormal bone metabolic features and the strong genetic component, osteoporosis is a related disorder with OPLL. Three polymorphisms on chromosome 20p12 were identified associated with the risk of osteoporosis and osteoporotic fracture.The rs996544 (C/T) "TT" and rs965291 (G/A) "AA" genotypes conferred higher risks for vertebral and hip fractures. The osteoporosis haplotype is defined by two polymorphisms, rs1116867 (A) and D35548 (T). However, it remains unknown whether these three polymorphisms predispose to an increased frequency and severity of OPLL in Han Chinese patients.Methods A total of 420 OPLL patients and 506 age- and sex-matched controls were studied. Three single nucleotide polymorphisms (SNPs), rs996544 (C/T), rs965291 (G/A) and rs1116867 (A/G), were analyzed by direct sequencing.Associations between these SNPs with the occurrence and extent of OPLL were statistically evaluated.Results There was no significant association between the rs996544 (C/T) polymorphism and the prevalence of OPLL.The rs1116867 (A/G) polymorphism "AG" genotype was associated with the occurrence of OPLL. The rs1116867 (A/G) polymorphism "G" allele was associated with the occurrence of OPLL, but not with the extent of OPLL. The rs965291 (G/A) polymorphism in female patients was statistically different between cases and controls (P ＜0.05). The rs965291 (G/A) polymorphism "A" allele was associated with the occurrence of OPLL in female patients. For the rs965291 (G/A)polymorphism, patients with the "A" allele (genotype, "AG" or "AA") showed a significantly greater number of ossified cervical vertebrae than those without the "A" allele (genotype, "GG", P ＜0.05), particularly in female patients.Conclusions The rs1116867 (A/G) and rs965291 (G/A) polymorphisms on chromosome 20p12 are associated with the occurrence and the extent of OPLL, at least in Han Chinese subjects. Our data should advance our understanding of the molecular etiology of OPLL and may guide approaches to prevent the onset of OPLL。

Cardiac ablation is an important modality of invasive therapy in modern cardiology, especially in the treatment of arrhythmias, as well as other diseases such as hypertrophic obstructive cardiomyopathy (HOCM). Since Huang et al1 used radiofrequency (RF) to ablate canine atrial ventricular junction, RF has developed into the leading energy source in catheter ablation of arrhythmias。

Abstract：Objective To review the effect of endothelial progenitor cells in neovascularization as well as their application to the therapy of tumors.Data sources The data used in this review were mainly from PubMed for relevant English language articles published from 1997 to 2009. The search term was "endothelial progenitor cells".Study selection Articles regarding the role of endothelial progenitor cells in neovascularization and their application to the therapy of tumors were selected.Results Endothelial progenitor cells isolated from bone marrow, umbilical cord blood and peripheral blood can proliferate, mobilize and differentiate into mature endothelial cells. Experiments suggest endothelial progenitor cells take part in forming the tumor vascular through a variety of mechanisms related to vascular endothelial growth factor, matrix metalloproteinases, chemokine stromal cell-derived factor 1 and its receptor C-X-C receptor-4, erythropoietin, Notchsignal pathway and so on. Evidence demonstrates that the number and function change of endothelial progenitor cells in peripheral blood can be used as a biomarker of the response of cancer patients to anti-tumor therapy and predict the prognosis and recurrence. In addition, irradiation temporarily increased endothelial cells number and decreased the endothelial progenitor cell counts in animal models. Meanwhile, in preclinical experiments, therapeutic gene-modified endothelial progenitor cells have been approved to attenuate tumor growth and offer a novel strategy for cell therapy and gene therapy of cancer.Conclusions Endothelial progenitor cells play a particular role in neovascularization and have attractively potential prognostic and therapeutic applications to malignant tumors. However, a series of problems, such as the definitive biomarkers of endothelial progenitor cells, their interrelationship with radiotherapy and their application in cell therapy and gene therapy of tumors, need further investigation。

Abstract：Objective To reveal the roles of Rho kinase (ROCK) in the mechanisms of complications in diabetes by reviewing the correlations between ROCK and related complications in diabetes.Data sources The data used in the present article were mainly from PubMed with relevant English articles published from 1998 to 2010. The search terms were "ROCK" and "diabetes".Study selection Original articles including the roles of ROCK or its inhibitors in diabetic complications and review articles about the biological character of ROCK were selected.Results The activity and expression of ROCK were up-regulated in the models of type 1 or type 2 diabetes animals and the cultured cells with concentrations of high glucose, ROCK activation was associated with the development or progression of complications in diabetes. Inhibition of RhoA/ROCK pathway prevented or ameliorated the pathologic changes of diabetic complications, and ROCK has been regarded as a key target for treatment of these complications.Conclusion RhoA/ROCK signaling plays important roles in the pathogenesis of long-term complications in diabetes and ROCK inhibitors are becoming a promising solution to treatments of complications in diabetes。

Hepatitis B virus (HBV) infects more than 350 million people worldwide, leading to chronic hepatitis,cirrhosis and hepatocellular carcinoma.1 In recent years,the treatment of chronic hepatitis B (CHB) has been improved by the availability of nucleoside analogues (NAs), such as lamivudine (LAM), adefovir (ADV), and entecavir (ETV)。

Heart failure is currently one of the most common and most cost-intensive of the chronic diseases.1 The main cause of chronic heart failure (CHF) is the abnormalities of both cardiac contractile performance and myocardial energy metabolism. Elevated levels of reactive oxygen species (ROS) have been proposed to contribute to both of them. Xanthine oxidoreductase (XO)is a major source of ROS in the cardiovascular system。

Infection of hepatitis B virus (HBV) is ubiquitous although the prevalence of hepatitis B surface antigen (HBsAg) varies considerably worldwide. Persistent HBV infection may lead to severe sequelae such as cirrhosis and hepatocellular carcinoma. Thus, clarification of the mechanism of susceptibility to persistent HBV infection would be valuable for the prevention and treatment of chronic hepatitis B。

Catheter ablation has been an established strategy for treating paroxysmal atrial fibrillation (AF).Pulmonary vein isolation is the predominant approach of catheter ablation. This procedure is characterized as transseptal catheterization and point-by-point ablation around the ipsilateral pulmonary veins (PVs). Although catheter ablation can be safely performed in a heart with normal structures, it may be challenging to be performed in a dextrocardia。

Pulmonary mucormycosis is an uncommon and often fatal opportunistic fungal infection caused by fungi in the class zygomycetes of the order mucorales. As a rare clinical entity characterized by acute onset, rapid progression and high mortality rate, pulmonary mucormycosis often results in fatal consequences within two years after the onset, and can be easily misdiagnosed.1,2 Here we report a case of pulmonary mucormycosis for which a definite diagnosis had not been established until 6 years after the initial onset。

Detection of a cardiac mass has a direct therapeutic implication because of its potential for pulmonary or systemic embolization. The choice of treatment is dependent upon the time of the embolization, clinical presentation and type of embolic mass. Imaging features in combination with clinical and laboratory findings are usually helpful in the differentiation of various cardiac masses with high probability. The case we are presenting is a 73-year-old man with occlusion of both pulmonary arteries and a right atrial thrombus initially diagnosed as a myxoma。

Aplastic anemia (AA) is an acquired disorder in which bone marrow fails to produce or release sufficient amounts of blood cell. Antiphospholipid syndrome (APS)is an autoimmune disease characterised by recurrent arterial or venous thrombosis, pregnancy morbidity and the persistence of positive antiphospholipid antibodies (aPL), including anticardiolipin antibody (ACL) and lupus anticoagulant (LA)。

In this paper, we describe a patient with a rather severe form of aspirin-induced asthma (AIA) and allergic bronchopulmonary aspergillosis (ABPA). The patient is a man born in 1948, who first presented with rhinorrhea,nasal congestion and chronic urticaria, and had an episode of asthma after ingestion of non-steroidal anti-inflammatory drugs (NSAIDs) for the further eight years。

Primary cardiac neoplasms are exceedingly rare with a reP1orted prevalence of 0.001% to 0.03% in autopsy series. Sarcomas that most frequently encountered are angiosarcoma, undifferentiated sarcoma, osteosarcoma and leiomyosarcoma, being the second most common primary cardiac neoplasm in all age groups.2

To the Editor: We read with great interest the article by Yu et al,1 in which they summarized the recent progress and prospects of patients with kidney disease in China. This is a very interesting paper on kidney disease since the treatment of end-stage renal disease, especially the right time to haemodialysis (HD), has been controversial over the past decades。