2017年 · 第45卷第08期

Forty years ago, shortly after China's "Cultural Revolution" ended, like all walks of life, China's cardiovascular specialty was gradually rebuilt after a catastrophe. With the gradual resumption of various cardiovascular academic activities and scientific research work, in August 1978, a new specialty branch-Cardiovascular Disease Branch of Chinese Medical Association, with experts in cardiovascular medicine, cardiothoracic vascular surgery, cardiovascular epidemiology and other related specialties as the backbone, was established, and became an important new member of the huge academic organization lineup of Chinese Medical Association. From 1978 to 2017, the Cardiovascular Branch of Chinese Medical Association has become a professional academic organization with the largest number of members, the greatest academic influence and the most dynamic in China's cardiovascular community. It shoulders the important tasks of formulating and revising China's cardiovascular disease diagnosis and treatment guidelines and consensus, international academic exchanges, grassroots physician training and continuing education, physician grading assessment and specialist access training, and works together with other brother academic organizations to play an extremely important role in promoting the prevention and control of cardiovascular diseases and the rapid and steady development of cardiovascular specialty in China.

I am an octogenarian. Fortunately, my brain memory function is good. I was appointed to the Cardiovascular Branch of Chinese Medical Association, with the proposition "Review of the Establishment Process of Cardiovascular Branch". After accepting this task, I immediately immersed myself in memories of the past. The past 40 years ago appeared in my mind like smoke and fog. History is precious and should also be recorded and referred to by current physicians.

On November 12th, 1988, the Cardiovascular Disease Branch of Chinese Medical Association held the third national academic conference on cardiovascular diseases in Wuhan, and the third committee of the Cardiovascular Disease Branch of Chinese Medical Association was produced. Tao Shouqi was the honorary chairman, Liu Lisheng was the chairman, Fang Qi, Gu Fusheng, Chen Haozhu and Wang Lihui were the standing committee members and secretary. There are 13 Standing Committees and 39 members. Gu Fusheng serves as the editor-in-chief of the third editorial board of Chinese Journal of Cardiovascular Diseases.

In October, 1998, the fifth committee of Cardiovascular Disease Branch of Chinese Medical Association was held in Beijing. Wu Ning was elected as the chairman, Liu Lisheng as the honorary chairman, Gao Runlin, Hu Dayi, Qi Wenhang and Feng Jianzhang were elected as the vice chairmen, and Liu Guoshu was the academic secretary. With the continuous development of cardiovascular research, the need for academic communication is increasing.

In June 2009, the 8th Committee of Cardiovascular Disease Branch of Chinese Medical Association was established. Hu Dayi was elected as the chairman, and Huo Yong, the chairman-designate, Han Yaling, Ma Changsheng, Ge Junbo, Zhang Yun, Lin Shuguang, Yang Yuejin, the vice chairmen, and Ma Changsheng served as the secretary-general. The eighth committee insisted on holding high the four banners of "public welfare, prevention, standardization and innovation", and promoted the return of cardiovascular medicine to humanities, clinical practice and basic skills.

After 40 years of development, the Cardiovascular Branch of Chinese Medical Association has become a professional academic organization with the largest number of members, the greatest academic influence and the most dynamic in China's cardiovascular community.

On September 16, 1977, in Zurich, Switzerland, German physician Grüentzig used a catheter with an inflatable balloon at the tip to dilate the proximal left anterior descending coronary artery stenosis in a 38-year-old male with angina pectoris for the first time^[1]Thus alleviating the patient's angina symptoms. This is the first percutaneous balloon catheter transluminal coronary angioplasty in the history of world medicine (percutaneous transluminal coronary angioplasty, PTCA). As a result, a new era of coronary heart disease treatment has arrived, ushering in a new era of interventional cardiology.

As one of the most rapidly developing fields of cardiology, cardiovascular imaging technology is an indispensable foundation and basis in the diagnosis and treatment of cardiovascular diseases, and it can guide and optimize the diagnosis and treatment of cardiovascular diseases^[1,2]。 China's cardiovascular imaging technology has grown from scratch, from the early introduction of foreign advanced technology to clinical application, to the current continuous innovation and representing the world's advanced level. The continuous progress of cardiovascular imaging technology has promoted the continuous improvement of cardiovascular diagnosis and treatment in China.

The research on atherosclerosis (AS) has a history of 92 years in China. Using "atherosclerosis, China" AS the keyword to search the literature published on PubMed website in the United States, AS of the time of drafting this article, there are 7,063 articles, of which only one was published in 1962, and the rest were published from 1977 to the present, which indicates that the research on AS in China with international influence basically appeared after the reform and opening up. This paper will briefly review the history of AS research in China, show the major research highlights and look forward to the future development path.

Valvular heart disease is a common heart disease, mainly manifested by structural or functional changes in the aortic valve, mitral valve, tricuspid valve and pulmonary valve due to various reasons, resulting in abnormal cardiac hemodynamics and eventually heart failure. With the aging of the population, the incidence of valvular heart disease increases significantly. Studies have shown that its incidence is as high as 13.3% in the elderly ≥75 years old^[1]。 Although traditional drug treatments such as beta blockers, angiotensin converting enzyme inhibitors and angiotensin II receptor antagonists can delay cardiac remodeling, they cannot prevent the mechanical dysfunction caused by the diseased valve itself, and cannot fundamentally improve the long-term prognosis of the disease. Surgical valve replacement or repair surgery is a classic method for the treatment of valvular heart disease, and it is also the first choice recommended by the current guidelines. However, it requires thoracotomy, cardiopulmonary bypass and cardiac arrest. Some elderly patients with a history of thoracotomy and severe cardiopulmonary function have too high a risk of surgery, and even lose the opportunity of surgery. Moreover, although the surgical technique is mature, the mortality rate of some patients with severe valvular heart disease has not decreased. Take aortic stenosis as an example. Studies have shown that the mortality rate of aortic stenosis in the United States increased by an average of 1.6% per year from 1978 to 2009^[2]。 Therefore, the rapid development of cardiac catheterization-based interventional therapy has brought a major breakthrough for the treatment of heart valve disease. As early as the 1980s, Japanese scholars Inoue et al.^[3]Percutaneous balloon mitral valvuloplasty was carried out, which is of great significance in the treatment of rheumatic mitral stenosis. In recent years, with the continuous progress of transcatheter aortic valve replacement and interventional therapy of mitral valve insufficiency, as well as many large-scale clinical studies, interventional therapy of valvular disease is gradually maturing.

Since the 1970s, with the development of theory, advancement of technology and equipment, and accumulation of experience, great progress has been made in the research of arrhythmia, and the understanding of the pathogenesis and treatment of arrhythmia has reached an unprecedented height. With the development of a large number of clinical trials and the accumulation of research evidence, the treatment of arrhythmia has entered the era of evidence-based medicine from simple empirical treatment. The treatment of arrhythmia is not only limited to improving the symptoms of patients, but also pays more attention to the prognosis of patients to maximize the benefits of patients.

Congenital heart disease (CAD) is one of the most common birth defects in newborns and one of the main causes of infant death, which seriously affects the quality of birth population and survival status in China^[1]。 The distribution of congenital heart disease is different in various regions in China. Every year, 150,000~200,000 children with congenital heart disease are born. According to the report on birth defect prevention in China released by the National Health and Family Planning Commission in 2012, the incidence of perinatal congenital heart disease was on the rise from 2000 to 2011. In 2011, the incidence of congenital heart disease in China was 3.56 times that in 2000, including 4.41 times in urban areas and 2.97 times in rural areas. Due to the poor medical and health conditions in some remote and rural areas, the detection rate and medical treatment rate of children are low. According to incomplete statistics, about 1/3 of children with congenital heart disease are not treated in time due to various reasons, resulting in serious adverse consequences. Therefore, we must attach great importance to the prevention and management of congenital heart disease and carry out early and timely treatment. In addition, with the advent of the second-child era, the incidence of congenital heart disease may continue to rise, and the prevention, control, diagnosis and treatment of congenital heart disease will face more severe challenges, which will become a common concern of prevention, obstetrics, neonatology, pediatrics and cardiovascular medicine and surgery. It is important to pay attention to the prevention, management and treatment of congenital heart disease for the occurrence and prognosis of congenital heart disease.

Heart failure (HF) is one of the main cardiovascular diseases in the 21st century, which is a serious manifestation or late stage of various heart diseases. The morbidity is increasing, the mortality rate and rehospitalization rate remain high. China's understanding and description of heart failure can be traced back to the relevant records in Yellow Emperor's Neijing more than 2,000 years ago. "Su Wen Ni Tiao Lun" said: "People can't lie down and panting when they have anti-qi...". According to data from developed countries, the prevalence of heart failure is 1.5% ~2.0%, and people aged 70 and over are ≥10%. The epidemiological survey in 2000 showed that the prevalence of adult heart failure in China was 0.9%^[1]。 With the aging of China's population, the incidence of chronic diseases such as coronary heart disease, hypertension, diabetes and obesity is on the rise. The improvement of medical level has prolonged the survival of patients with heart diseases, and finally developed into heart failure, which has made the prevalence of heart failure in China continue to rise.

With the great progress of cardiovascular disease diagnosis and treatment technology and its clinical application in China, the prognosis of patients with cardiovascular diseases has improved significantly. However, on the whole, the prevalence and mortality of cardiovascular diseases in China are still on the rise, and the epidemic trend of cardiovascular disease risk factors is obvious^[1]。 The continued rise in the prevalence of hypertension, diabetes, and hyperlipidemia, as well as smoking, poor eating habits, occupational stress, and low exercise participation, are important contributors to the high incidence of ischemic heart disease. Improving and promoting healthy lifestyle, forming a complete intervention chain for cardiovascular disease prevention, treatment and rehabilitation, improving quality of life and reducing the burden of disease have become the top tasks of governments and professional associations of various countries, and it is also the unshirkable mission of Chinese cardiovascular physicians.

In 1896, Scipione Riva Rocci, an Italian pediatrician, invented the method of measuring blood pressure in the upper arm. This method was improved by Russian physician Nicolai Korotkoff in 1905. It has proven to be a simple and relatively reliable method of blood pressure measurement, which is still used today. But at the end of World War II, President Roosevelt of the United States died of untreated hypertension, and Marshal Stalin of the Soviet Union also died of complications of hypertension. At that time, it was not known that hypertension was a risk factor for cardiovascular disease, and it was believed that elevated blood pressure may be a manifestation of aging.

The change of lifestyle in modern society and the intake of high-fat diet are the important reasons leading to the surge in the number of people with metabolic syndrome (MS) worldwide. At the same time, intestinal flora has an important influence on host metabolism, and the combination of environment and host factors significantly affects the proportion and diversity of intestinal flora^[1]。 In recent years, more and more evidence shows that intestinal flora, as an important tandem factor, regulates the influence of environmental and host changes on the occurrence and development of MS. The most direct evidence is that the composition of intestinal flora changes with the change of patient's weight in obese people. At the same time, host genes are also involved in regulating the composition of intestinal flora and affecting its function. The relationship between intestinal flora and MS has become a hot research topic in recent years.

The "R on T" phenomenon is considered to be a reliable marker of high-risk ventricular arrhythmia, which is prone to polymorphic ventricular tachycardia and even ventricular fibrillation^[1]。 However, this phenomenon only stems from the understanding of electrocardiogram, and its electrophysiological basis of arrhythmia is rarely reported. How does "R on T" occur, and how does it relate to cardiac heterogeneity? Can premature ventricular beats really occur in the vulnerable phase of adjacent cardiomyocytes and trigger arrhythmias? How to recognize this electrocardiogram phenomenon and effectively prevent and treat it, and expound the mechanism behind it, this paper will discuss from the perspective of myocardial electrophysiology.