2017年 · 第45卷第04期

The activity of running a good stent life club initiated by the Professional Committee of Cardiac Prevention and Rehabilitation of Chinese Association of Rehabilitation Medicine and China Heart Alliance was enthusiastically responded by the majority of doctors and patients, and it was quickly promoted nationwide, forming a service network covering the whole country.

With the progression of population aging, the incidence of vascular calcification is increasing. Calcification of coronary arteries can lead to reduced coronary compliance and impaired myocardial perfusion^[1]。 Clinical studies have shown that the degree of coronary artery calcification can predict the risk of myocardial infarction and death from sudden coronary events^[2]。 The presence of coronary artery calcification indicates a poor prognosis in both the general population and patients with coronary artery disease undergoing revascularization^[3]。 Current studies have shown that many factors are involved in the pathogenesis of vascular calcification, but the pathogenesis of vascular calcification is still not fully elucidated. Up to now, there is still a lack of completely effective treatment for coronary artery calcification. The existing methods can only play a relief role, and it is difficult to intervene from the etiology. Vascular calcification has become the bottleneck of cardiovascular disease treatment.

At present, cardiovascular diseases have become the main economic burden of developed countries. In developing countries, with the increasing cardiovascular risk factors such as hypertension, diabetes and obesity, the impact of cardiovascular diseases is also increasing year by year^[1]。 Ischemic heart disease is a myocardial damage caused by the imbalance of coronary blood flow and myocardial demand caused by the changes of coronary artery circulation. It is a critical disease with high mortality rate among cardiovascular diseases. Coronary atherosclerotic lesions are the main cause of ischemic heart disease, and also the main cause of death of patients in China and even around the world.

Most of the investment of health resources in China is used after the occurrence, recurrence and terminal stage of disease. primordial prevention, also known as zero-level prevention, is a new concept of disease prevention that gradually formed and developed in the 1990s. Its theoretical basis is to prevent the prevalence of risk factors in the whole society through crowd intervention, with the ultimate goal of promoting crowd health^[1,2]。

The patient, a 40-year-old female, 28 weeks pregnant, was admitted to the hospital on 24 October 2016 due to "palpitations, chest tightness and dyspnea for 2 months, aggravated by 1 week". At 20 weeks of pregnancy, the patient found moderate mitral stenosis with pulmonary hypertension, sinus rhythm, and cardiac function NYHA grade II. Admission examination: heart rate 90 beats/min, blood pressure 100/70 mmHg (1 mmHg =0.133 kPa), blood oxygen saturation 92% (no oxygen inhalation), clear mind, harmonic heart rhythm, diastolic murmur at the apex of the heart, wet rales in both lungs, abdominal swelling, and mild edema in both lower limbs. Transthoracic echocardiography showed a mitral valve orifice area of 0.7 cm²(Estimated by area method), the mean transvalvular pressure difference of the mitral valve was 20 mmHg, the mitral valve was soft, without calcification, with minor mitral regurgitation, and no left atrial thrombosis was found. Percutaneous balloon mitral valvuloplasty was recommended for pregnancy complicated with severe mitral stenosis (percutaeous balloon mitral valvuloplasty, PBMV). Due to concerns about the effects of radiation on the fetus, the patient refused to receive traditional interventional therapy, so it was proposed to undergo PBMV guided by simple echocardiography.

Example 1The patient, a 30-year-old man, was admitted to the hospital on February 20, 2016 due to general numbness, weakness and palpitations for 3 h. Three hours before admission, he took 100 ml of traditional Chinese medicine wine containing Chuanwu Caowu due to low back pain. Soon, he felt skin numbness, which gradually worsened and developed numbness of mouth and tongue, general weakness and palpitations, and was admitted to the hospital in the emergency department. The pulse was 135 beats/min and the blood pressure was 137/102 mmHg (1 mmHg =0.133 kPa) on admission. Electrocardiogram showed sinus rhythm, frequent multi-source ventricular premature beats (ventricular premature beats) (Figure 1)。 Preliminary diagnosis: acute aconitine poisoning. Oxygen inhalation, ECG, blood pressure monitoring, venous access opening, and atropine 0.5 mg intravenous push were immediately given. ECG monitoring showed a rapid increase in ventricular ectopic rhythm, frequent paired ventricular premature, ventricular premature R on T, paroxysmal ventricular tachycardia (ventricular tachycardia), etc. (Figure 2), the heart rate increased rapidly from 130 beats/min to 200 beats/min, the patient was sweating profusely, irritable, and the blood pressure dropped to 50/30 mmHg. Immediately, dopamine was given to boost pressure, and amiodarone hydrochloride 150 mg was pushed intravenously for 3 consecutive times. The heart rate did not change significantly, and then it was maintained at 1 mg/min. About 30 minutes after admission, he suddenly screamed when vomiting stomach contents, convulsed and lost consciousness. ECG monitoring showed torsade de pointes ventricular tachycardia and then ventricular fibrillation. Immediately, he was given one biphasic electric defibrillation (150 J) and continued cardiac compression. After 3 minutes, he recovered consciousness. ECG monitoring showed that he changed to sinus rhythm, frequent multi-source ventricular premature disease, heart rate 170 beats/min, blood pressure 170/110 mmHg, rapid reduction of dopamine, three bolus injections of lidocaine totaling 250 mg, ventricular ectopic rhythm decreased, followed by maintenance at 3 mg/min; After 10 ml of 25% magnesium sulfate injection was given intravenously, the ectopic heart rhythm was significantly reduced, followed by 2 g/h intravenous infusion. About 1 h after admission, the patient was conscious and had no obvious discomfort, but his blood pressure was low, 90~95/60~65 mmHg. When magnesium sulfate was reduced to 0.5 g/h, the blood pressure was stable at 115/70 mmHg. ECG monitoring showed a significant reduction in multi-source ventricular prematurity. Amiodarone was stopped, supplementary blood volume was given, furosemide was used to promote poison excretion, mannitol was used to prevent cerebral edema, and gastric mucosa was protected. The blood pressure and heart rate were stable 3 h after admission. Monitoring showed sinus rhythm and occasional ventricular prematurity. Twelve hours after admission, the myocardial troponin I was 0.061 ng/L, and he was hospitalized for 1 week, and he was cured and discharged.

The first working meeting of the 9th editorial board (editorial board) of Chinese Journal of Cardiovascular Diseases was held in Beijing on February 16th, 2017. Vice President Liu Yanfei of Chinese Medical Association, President Jiang Yongmao, Editor-in-Chief Wei Junmin, Vice President Liu Bing of Chinese Medical Association Magazine, all staff of the editorial department, as well as the editor-in-chief, deputy editor-in-chief, editorial board and correspondence editorial board of this journal, a total of more than 140 people attended this meeting. The meeting re-elected the 8th editorial board of Chinese Journal of Cardiovascular Diseases and established the 9th editorial board. Academician Han Yaling was appointed as the editor-in-chief of the new editorial board, and 10 professors, namely Dong Erdan, Ge Junbo, Huang Lan, Huo Yong, Jing Zhicheng, Ma Changsheng, Wang Jiguang, Wang Jianan, Wu Shulin and Zhang Yun, were appointed as deputy editors-in-chief. The meeting was chaired by Professor Jing Zhicheng. Liu Yanfei, Vice President of Chinese Medical Association, delivered a speech, thanking the eighth editorial board for its contribution and congratulating the establishment of the ninth editorial board. Vice President Liu Yanfei pointed out that the establishment of the new editorial board is crucial to the magazine's work, and a high-quality editorial board team is the guarantee to improve the magazine's level. He believes that the ninth editorial board has the ability to run the magazine well.

Percutaneous coronary intervention is an important treatment for coronary heart disease^[1]The use of drug-eluting stents (DES) effectively inhibits the excessive proliferation of neonatal endothelium at the stent placement site^[2]。 However, the use of anti-intimal proliferation drugs, while inhibiting intimal proliferation, can lead to delayed healing of damaged endothelium^[3]。 Many factors can lead to late stent failure, including in-stent neoatherosclerosis (ISNA), delayed endothelial healing, local allergic reaction, poor stent adhesion, incomplete stent expansion and stent fracture^[4,5,6]。 In this paper, the latest progress of ISNA is reviewed based on the related research in recent years.

coronary artery bypass grafting (CABG) has been considered the gold standard in the treatment of complex coronary artery disease. In recent years, with the improvement of percutaneous coronary intervention (PCI) technology and the application of new drug-eluting stents, the efficacy of PCI in patients with complex coronary artery disease has been significantly improved. The choice of the best revascularization method for patients with complex coronary artery disease has become the focus of debate among physicians and surgeons. The SYNTAX study emerged as a milestone to guide the selection of PCI or CABG in patients with complex coronary artery disease^[1]。 This article will review the application of SYNTAX score and its derived scores in patients with complex coronary artery disease.

Epidemiological surveys show that mitral regurgitation is the first in the incidence of all types of valvular diseases in the elderly over 65 years old^[1]。 China has a large population base and serious aging, and there is no doubt that the number of patients with mitral regurgitation in China is huge. However, there is no authoritative epidemiological investigation of valvular disease in the elderly in China. To date, surgical valve replacement or repair is the best option for treating severe mitral regurgitation, however, about 50% of patients with severe mitral regurgitation are elderly or suffer from multisystem disease and abandon surgery due to excessive risk^[2]。 Inspired by surgical valve repair surgery, a series of transcatheter mitral valve repair techniques have been developed and gradually applied to clinical practice. According to its different action sites and mechanisms, it can be roughly divided into transcatheter mitral leaflet repair, artificial chordae tendineae placement, direct or indirect transcatheter mitral annularoplasty. This article reviews recent advances in transcatheter mitral valve repair.

ubiqutin proteasome system (UPS) refers to the process in which ubiquitin binds to substrate protein under the catalysis of related enzymes, and then degrades ubiquitin-labeled substrate protein through 26S proteasome. This process is one of the non-lysosome-dependent protein degradation pathways in eukaryotic cells. Studies have shown that UPS is also widely involved in cell cycle, immunity, apoptosis and signal transduction. CD137 is a costimulatory molecule on the surface of immune cells. Studies suggest that the CD137-CD137L signaling pathway is involved in the formation of atherosclerosis (AS). UPS plays an important role in signal transduction. In this paper, the role of UPS in CD137 signaling-mediated AS will be reviewed in combination with the research progress at home and abroad.