2017年 · 第45卷第01期

2016 is an extraordinary year for China's health, medicine and health undertakings. For the first time in the 30 years since reform and opening up, the Central Committee of the Communist Party of China and the State Council convened a national conference on health and wellness. The important speech delivered by * at the meeting sounded the trumpet for the whole party, the whole government and the whole people to work together to realize the dream of a healthy China. Immediately afterwards, the Central Committee of the Communist Party of China and the State Council announced the Healthy China 2030 Plan, which clearly put forward a series of indicators such as a three-year increase in life expectancy and specific measures to achieve the indicators in order to realize the healthy China dream.

The incidence of cardiovascular and cerebrovascular diseases in China continues to increase, and stroke (mainly ischemic) and ischemic heart disease [collectively referred to as atherosclerotic cardiovascular disease (ASCVD)] have become the leading causes of death in China. ASCVD should be more closely related to high cholesterol, with sufficient and conclusive evidence that high cholesterol is a pathogenic risk factor for atherosclerosis. However, data from two global burden of disease studies in 2002 and 2010 by the World Health Organization show that hypertension is the leading risk factor for death from vascular diseases in both developed and underdeveloped regions, and high cholesterol is the second^[1]。

optical coherence tomography (OCT) is a new coronary artery imaging technique after intravascular ultrasound (IVUS). Compared with IVUS, OCT has an extremely high resolution, and it has attracted increasing attention in evaluating vulnerable plaque and guiding stent placement, especially in the diagnosis and treatment of coronary heart disease such as acute coronary syndrome (ACS). In the European Society of Cardiology (ESC) 2013 guidelines for the management of stable coronary artery disease, OCT is recommended as Class IIB (level of evidence B) for assessing lesion characteristics and optimizing the stent placement process, and the overall level of evidence is equivalent to IVUS^[1]。 In the ESC/European Association of Cardiothoracic Surgery (EACTS) 2014 guidelines for myocardial revascularization, the recommendation grade of OCT for optimizing percutaneous coronary intervention (PCI) was upgraded to Class IIA equivalent to IVUS^[2]。 The ILUMIEN I study published in 2015 showed that OCT examination before and/or after PCI can affect the interventional therapy strategy of surgeons^[3]。 Recent ILUMIEN II study results suggest that OCT is not inferior to IVUS in guiding stent expansion^[4]。 Therefore, domestic cardiovascular experts who have been engaged in coronary interventional diagnosis and treatment and imaging research for a long time and have rich clinical experience in coronary heart disease interventional diagnosis and treatment jointly formulate OCT imaging methods, image analysis and application indications through evidence-based medicine review and combined with clinical practical experience. Chinese expert suggestions aim to standardize and guide the application of OCT in the field of coronary heart disease diagnosis and treatment.

A 47-year-old male was admitted to the hospital on 9 December 2015 due to "episodic chest pain of 8 h with aggravation of 1.5 h". Physical examination: blood pressure 80/50 mmHg (1 mmHg =0.133 kPa); The breathing sounds of both lungs were clear, and no dry and wet rales were heard; Heart rate 44 beats/min, low and dull heart sound, no murmur; Soft abdomen, no tenderness, unpalpable liver and spleen. Electrocardiogram at admission: sinus rhythm, P wave was not related to QRS wave, ventricular rate 44 beats/min, ST segment depression in Ⅰ, aVL leads 0.1 mV, ST segment elevation in Ⅱ, Ⅲ, aVF leads 0.3 mV (Figure 1)。 Troponin I<0.05 μ g/L. He was in good health and smoked for more than 30 years, 30 cigarettes/d. Admission diagnosis: acute inferior myocardial infarction, arrhythmia, third degree atrioventricular block. After emergency treatment such as aspirin 300 mg and clopidogrel 300 mg anti-platelet, isoproterenol anti-arrhythmia, dopamine boost and fluid rehydration, percutaneous coronary intervention (PCI) was planned to be performed in an emergency department. The electrocardiogram was re-examined 1 h after admission, and Lambda waves appeared in leads Ⅱ, Ⅲ and aVF (Figure 2)。 Electrocardiogram was re-examined 3 min later, showing sinus rhythm, third-degree atrioventricular block and intraventricular block (Figure 3)。 The patient had sudden loss of consciousness, convulsions, and ECG monitoring suggested ventricular tachycardia and ventricular fibrillation (Figure 4)。 The two-way wave direct current 200 J electric defibrillation was immediately administered, and ventricular fibrillation appeared again after cardioversion. The electric defibrillation was repeated 8 times, and amiodarone and dopamine were administered at the same time. After 30 min, the patient's consciousness recovered, and the ST segment of leads Ⅱ, Ⅲ and aVF dropped>50%. The electrocardiogram was re-examined 1 h after recovery of consciousness, showing sinus rhythm, and ST segment of leads Ⅱ, Ⅲ and aVF dropped back to the isopotential line. Emergency coronary angiography was performed through radial artery, and the results showed that left main trunk was normal; A muscle bridge can be seen in the middle of the left anterior descending artery, and the systolic compression is 70%; No stenosis was seen in the left circumflex artery; No stenosis of the right coronary artery and no thrombosis were observed (Figure 5)。 The patient did not have PCI and returned to the ward. Myocardial necrosis markers were examined with troponin I>25 μ g/L, creatine kinase (CK) 5,407 U/L, creatine kinase isoenzyme (CK-MB) 283 U/L, aspartate aminotransferase (AST) 388 U/L, and lactate dehydrogenase (LDH) 677 U/L. Administration of aspirin, clopidogrel, diltiazemAfter treatment with statins and other drugs, the patient did not have symptoms such as chest pain again. The electrocardiogram before discharge showed sinus rhythm, lead Ⅱ showed qR type, lead Ⅲ and aVF showed qR type, and T wave was low and flat (Figure 6)。 The patient refused to implant an implantable cardioverter defibrillator (ICD) and was discharged after 10 days of hospitalization.

A 43-year-old female who complained of "chest tightness" for 3 months and had no symptoms of chest pain was admitted to the hospital on 6 November 2015. Electrocardiogram showed premature ventricular contractions, abnormal Q wave and T wave changes. Echocardiography showed that the ventricular septum was thickened, about 20 mm thick at most; The apex of the left ventricle was obviously thinned and bulged outward, showing tumor-like changes, about 30 mm ×44 mm in size. Coronary CT angiography (CTA) showed that the coronary artery was normal. The cardiac magnetic resonance film sequence showed (Figure 1): systolic occlusion near the apex of the left ventricle, with obvious cystic bulge outward at the apex of the left ventricle, thin cystic wall and no systolic movement; The ventricular septum is thickened in the proximal middle segment, and the thickest middle segment is about 30 mm; The whole systolic function of left ventricle was basically normal, and the left ventricular ejection fraction was 58.7%. Contrast agent delayed enhancement scanning showed (Figure 1): Enhancement of the proximal middle segment of the interventricular septum and the anterior and posterior transition of the interventricular septum and the right ventricle; The apical ventricular wall showed transmural reinforcement. The patient subsequently underwent ventricular aneurysm resection and no adverse cardiovascular events occurred during a short-term follow-up of 7 months.

coronary bifurcation lesions account for 15% to 20% of percutaneous coronary intervention (PCI). Following the principles of simple, safe and prompt treatment and based on the results of multicentre randomized clinical trials, the European Bifurcation Club expert consensus recommends that single stent surgery should be the preferred strategy for the treatment of bifurcation lesions^[1]。 The consensus also mentioned that for true bifurcation lesions, due to the risks of branch vessel occlusion in single stent surgery, double stent surgery is still an indispensable choice, so there is no unified conclusion on the best treatment strategy^[1]。 The DKCRUSH II study showed that compared with impromptu stenting, double-kiss extrusion technology can bring more clinical benefits to patients in the treatment of true bifurcation lesions^[2]。 In the course of interventional treatment of bifurcation lesions, whether single stent or double stent, various bifurcation therapy techniques (such as U-bend technique, proximal optimization technique and balloon-to-kiss dilation, etc.) are often needed to promote complete stent expansion, branch opening stent wire coverage and stent wire adhesion, so as to reduce the occurrence of clinical adverse cardiovascular events^[3]。 Therefore, PCI operation of bifurcation lesions has many difficulties and complicated steps. Compared with simple coronary artery disease, the interventional treatment of bifurcation lesions has no unified management strategy, many difficulties in operation technology, and the incidence of clinical events such as acute branch occlusion, in-stent restenosis and in-stent thrombosis is high.

drug-eluting balloon (DEB) can transport drugs to the site of coronary artery disease, so that the drugs can be released quickly and adhere uniformly to the blood vessel wall, and inhibit neointimal hyperplasia. in recent years, drug-eluting balloons have emerged in the treatment of in-stent restenosis (ISR). The 2014 European Society of Cardiology (ESC) guidelines recommend DEB for the treatment of ISR (recommended category I, level of evidence A)^[1]。 At the same time, DEB also plays an important role in the treatment of small vessel lesions, bifurcation lesions, primary lesions and other complex coronary artery lesions.

Drug cardiotoxicity refers to patients receiving drug treatment, due to the toxic side effects of drugs, causing myocardial damage, resulting in arrhythmia, abnormal systolic or diastolic function of the heart, and even heart diseases such as myocardial hypertrophy or heart enlargement, which can be manifested as decreased left ventricular ejection fraction and symptoms of chronic heart failure. In recent years, because the cardiotoxicity caused by drugs is becoming more and more common, the cardiotoxicity caused by drugs used in cardiovascular diseases, such as antiarrhythmic drugs and cardiac glycosides, has been widely paid attention to. However, the cardiotoxicity caused by non-cardiovascular drugs, such as antibiotics and oral hypoglycemic drugs, may cause serious adverse drug events and is often ignored. Therefore, this article reviews the cardiotoxicity caused by various non-cardiovascular drugs and the common symptoms of cardiotoxicity.

At present, the prevalence of coronary heart disease, diabetes and chronic kidney disease in China is increasing, and the late complication derived from it-vascular calcification has become an unavoidable medical hot issue^[1,2,3]。 In order to explore the regulatory mechanism of vascular calcification, especially in view of the newly proposed theory that vascular calcification is a programmed osteogenic process initiated by intravascular inflammatory factors, it is of great significance to study the corresponding mediators on the bone-vascular axis^[1,2,3]。 In view of this, this paper briefly expounds the proposal of nuclear factor of activated T-cells cytoplasmic 1 (NFATc1), the molecular switch of vascular calcification and bone remodeling, inflammation associated with bone remodeling, inflammation costimulatory molecule CD137-NFATC1-vascular calcification regulatory axis, etc., hoping to bring new perspectives for basic research on vascular calcification.

Ischemic heart disease has high incidence and poor prognosis, and the 5-year natural survival rate is only 59%^[1]。 Revascularization is a milestone in the treatment of coronary heart disease, and the efficacy after revascularization is related to the survival of myocardium. Hibernating myocardium is an adaptive change in order to avoid myocardial necrosis under ischemic conditions caused by long-term insufficient blood perfusion. Increasing blood flow can partially or fully restore its function^[2]。 After acute, severe and transient ischemic remission (usually ischemic time is less than 20 min), myocardial cells are not necrotic, but there are subtle structural changes and systolic dysfunction. After reperfusion, recovery needs to be delayed for several days or even weeks. This phenomenon is myocardial depression, which is characterized by mismatch between blood supply and systolic function^[3]。 Both hibernating myocardium and stunning myocardium are pathological conditions after myocardial ischemia. After coronary perfusion is improved, its function can be partially or completely restored, which belongs to viable myocardium^[2]。 Compared with drug therapy, the survival rate of early myocardial revascularization in hibernation was higher, and the benefit of revascularization was more obvious in patients with myocardial survival rate greater than 10%^[4]。 Patients with revascularization without viable myocardial segments had no obvious benefit and higher postoperative complication and mortality rates^[1,4]。 Therefore, routine evaluation of myocardial activity before operation is extremely important for treatment plan decision and prognosis judgment^[5]。