2016年 · 第44卷第04期

The 2015 World Heart Federation (WHF) theme is "Healthy Heart Choice: Everyone, Everywhere!". How to express its meaning accurately in Chinese, I have read a variety of translation methods, all feel too much pursuit of gorgeous words, but the words do not convey the meaning. I think the best translation of the speech by the president of Nestle China is Healthy Heart Choice: Everyone, Every Corner. That is, everyone is healthy, everywhere.

Drug antithrombotic and interventional therapy have important preventive effects on recurrent ischemic cardiovascular events in patients with acute coronary syndrome, but at the same time, they also increase the risk of major bleeding events in hospitalized patients. Severe bleeding events significantly increase mortality, so necessary measures should be taken to balance the risk of bleeding and ischemia in clinical work. What is the value of bleeding risk scoring tools, such as ACUITY score and CRUSADE scoring system, in clinical applications? Does this scoring system significantly reduce the incidence of bleeding events in patients? Combined with the recent literature, this paper reviews its clinical application value.

dilated cardiomyopathy (DCM) is a type of cardiomyopathy characterized by left ventricular enlargement with systolic dysfunction^[1], is a common cause of heart failure with reduced ejection fraction. Traditionally, DCM patients have a poor prognosis, which is characterized by persistent left ventricular enlargement with progressive deterioration of systolic dysfunction, ultimately leading to death or the need for heart transplantation^[1]。 Recent studies have found that DCM is also the most common cause of heart transplantation in China^[2]。 However, in recent years, more and more studies have shown that some patients with DCM can develop "left ventricular reverse remodeling (LVRR)", which is manifested by a significant improvement in left ventricular systolic function with left ventricular structure, especially in patients receiving standard anti-heart failure (heart failure) drugs. This article discusses the LVRR of adult patients with DCM (first visit age ≥18 years) after treatment with anti-heart failure drugs.

The incidence of coronary heart disease in China is increasing year by year, and percutaneous coronary intervention (PCI) is the main measure to treat coronary heart disease^[1]。 At present, the indications for PCI are mostly based on the results of coronary angiography or endovascular imaging (endovascular ultrasound or optical coherence tomography, etc.). Studies have shown that myocardial ischemia is an important determinant in developing treatment strategies for coronary heart disease. However, coronary angiography or endovascular imaging can only evaluate the anatomy of the lesion, but cannot objectively and accurately evaluate the relationship between the lesion and myocardial ischemia^[2]。 In recent 20 years, fractional flow reserve (FFR) has gradually become a well-recognized functional evaluation index of invasive lesions. FFR-guided treatment strategies have been proven to be safe, economical and improve the prognosis of patients^[3]。 Guidelines formulated in China, Europe and America all recommend the application of FFR to guide vascular reconstruction in patients with coronary heart disease. However, the application of FFR has not been widespread in China. In order to promote the standardized application of FFR detection technology and rationally screen patients with coronary heart disease who need vascular remodeling, the Interventional Cardiology Group of Cardiovascular Disease Branch of Chinese Medical Association organized relevant experts to review the relevant materials and research progress in this field, combined with clinical practice in China, repeatedly discussed and reached the following consensus.

The 82-year-old female was admitted to the hospital on November 2, 2015 due to "chest tightness and shortness of breath for 1 year after repeated activities". In the past 1 year, the patient repeatedly experienced chest tightness and shortness of breath after activity, without chest pain, syncope and other symptoms. Has a history of hypertension for more than 20 years and chronic obstructive pulmonary disease for more than 10 years. Physical examination: pulse 70 beats/min, blood pressure 130/70 mmHg (1 mmHg =0.133 kPa), breathing 18 beats/min; The breathing sounds of both lungs were clear, and no dry and wet rales were heard; Critical size of heart turbidity boundary, heart rate 70 beats/min, homogeneous rhythm, systolic jet-like murmur of grade 3/6 can be heard in the auscultation area of aortic valve; The abdomen is soft, and the liver and spleen are untouched under the costs; There was no edema in both lower limbs. Transthoracic echocardiography showed significant thickening and calcification of the aortic valve, mean transvalvular pressure difference of 70 mmHg, mild aortic regurgitation, and no abnormalities in the rest of the valves; Mild hypertrophy of left ventricular wall, left ventricular end-diastolic diameter 44 mm; Left ventricular ejection fraction 69%. CT angiography (CTA) showed that the aortic valve had multiple calcified plaques, the leaflets were three-leafed, the long diameter of the aortic annulus was 22.9 mm, the short diameter was 17.4 mm, the circumference was 66.0 mm, the left coronary artery opening was 10.9 mm away from the annulus, and the right coronary artery opening was 13.2 mm away from the annulus; Multiple mixed plaques of right coronary artery, left anterior descending artery and left circumflex artery, degree of luminal stenosis<50%； The left and right common femoral arteries are thin, with the narrowest internal diameters of 5.6 and 5.5 mm, respectively; There was no stenosis in the inner diameter of the left and right common carotid arteries, and the inner diameter of the left common carotid artery was 9.2 mm; No obvious stenosis of intracranial arteries was observed. Admission diagnosis: severe calcified aortic stenosis, cardiac function grade 3 (NYHA grade), hypertension.

The patient was a 36-year-old male. He was admitted to the hospital on 29 September 2013 due to "shortness of breath with general edema for 7 days, aggravated for 1 day". A 2-year history of hypertension with a maximum blood pressure of 160/110 mmHg (1 mmHg =0.133 kPa) and a 1-year history of diabetes without medical treatment. Has a history of smoking and denies a history of alcohol abuse. History of previous episodes of similar symptoms, history of emotional agitation, history of viral myocarditis, family history of heart disease, unexplained syncope and sudden death are denied. The patient denied a history of drug exposure and drug abuse at admission, but admitted a history of methamphetamine abuse for 5 years on the 3rd day after admission, and discontinued after onset 1 week ago.

A 53-year-old female was hospitalized in the Department of Cardiology of Jiangxi Provincial People's Hospital on May 25, 2015 due to "edema of both lower limbs for 4 months, chest tightness for 2 weeks, fever, sore throat and cough for 1 week". The patient developed edema of both lower limbs without obvious trigger 4 months ago. Two weeks ago, chest tightness occurred when climbing stairs and walking quickly, which was not paid attention to and treated. Fever, sore throat and cough occurred 1 week ago, and went to an outside hospital 4 days ago, suggesting that alanine aminotransferase and aspartate aminotransferase were elevated, and chest CT showed pulmonary infection. After anti-inflammatory treatment (details unknown), the fever subsided and the cough improved, but chest tightness and edema of both lower limbs remained during activity. Past history: Surgical operation for lumbar disc herniation 4 months ago, no history of hypertension, diabetes and heart disease. No bad habits such as smoking, alcohol and drug use.

The patient was a 44-year-old male who went to the local hospital 2 months ago for "recurrent dull pain in the precordial area". The patient complained of chest pain without obvious trigger, mainly under the xiphoid process, which was aggravated after activity, lasting for several minutes each time, and two times were acute attacks when going to the toilet, which could be relieved after rest, but was not paid attention to. Color echocardiography showed pericardial effusion at the time of the patient's recurrence 1 month ago. About 330 ml of hemorrhagic fluid was drained by pericardial puncture, which was coagulated after standing. No obvious abnormalities were found in the effusion examination, that is, drugs to promote blood circulation and remove blood stasis and diuretic drugs were given, and the symptoms were relieved, but the diagnosis was unknown. Recently, the patient was transferred to our hospital because of the aggravation of chest tightness and shortness of breath, which lasted for several hours. There were no chills, cough and sputum, and edema of both lower limbs during the course of the disease. Past physical health, denying history of hypertension, coronary heart disease and tuberculosis. The initial diagnosis was pericardial effusion to be examined.

Coronary heart disease is a common and frequently occurring disease in the world, which seriously endangers human health and quality of life. Although the diagnosis and treatment of cardiovascular diseases have advanced by leaps and bounds in recent years, their mortality rate still accounts for 30% of the world's total disease mortality rate, far exceeding that of other diseases such as cancer, and the cost of cardiovascular diseases is expected to reach $1,044 billion by 2030^[1]。 As we all know, coronary heart disease plays an extremely important role in cardiovascular diseases, and it is urgent to find new and effective methods to treat coronary heart disease. Monocytes (Mon) are involved in many pathophysiological pathways of coronary heart disease, such as lipid metabolism, coagulation, apoptosis, hypoxia, angiogenesis and immune response. They play an important role in various stages of coronary heart disease, and have become the research hotspot in cardiovascular field in recent years. Different subtypes of Mon have different effects, such as pro-inflammatory, anti-inflammatory, promoting collagen deposition and promoting angiogenesis, respectively. Its subpopulation ratio transformation is of great significance for the stabilization of atherosclerotic plaques and the repair and regeneration of ischemic myocardium^[2]。 This paper reviews the research progress on the role of Mon in the occurrence and development of coronary heart disease.

intra aortic balloon pump (IABP) was developed in 1968 by Kantrowitz et al.^[1]It was first used in clinic, and initially mainly used for left ventricular failure after coronary artery bypass grafting (CABG). In the past few decades, the treatment of acute myocardial infarction, including drug therapy, percutaneous coronary intervention (PCI) and CABG, has made significant progress. Especially for some patients with acute myocardial infarction complicated by cardiogenic shock, IABP can effectively improve the treatment effect when performing PCI or CABG^[2,3]。 At present, in clinical practice, IABP has become the main means to promote cardiac function recovery, circulatory support in surgical or interventional treatment and transitional treatment before heart transplantation in patients with coronary heart disease.

Only 20% of the DNA of the human genome is used to encode proteins, and the rest is transcribed into RNA but not translated into proteins, called non-coding RNA. Some non-coding RNAs are involved in post-transcriptional regulation, cleavage and modification of genes, and play an important regulatory role in life activities. In recent years, many advances have been made in the study of small non-coding RNAs, especially microRNAs^[1], it is widely involved in cell differentiation, development, aging and tumorigenesis, development and other life activities and disease processes. Long-chain non-coding RNAs, ranging from 200 to 10 000 nt in length, have also received much attention. Long-chain non-coding RNAs are of great significance in the fields of development, neurological diseases, tumors, etc. Circular RNA is not well understood as compared to these non-coding RNAs, but it has been found to be involved in many important life processes^[2,3]。 Because of its special structure, circular RNA has advantages as a specific marker for disease diagnosis and a target for disease therapy. In this paper, the morphological characteristics, potential functions, mechanisms of action and the role of circular RNA in the occurrence and development of cardiovascular diseases are reviewed.

On January 6, 2016, I bid farewell to my mentor, Professor Xu Yuyun, with great reverence.