2018年 · 第46卷第06期

According to the records of "Zuo Zhuan", in the Spring and Autumn Period, Jin Jinggong got seriously ill, and the famous doctor of Qin State diagnosed that "the disease is under the ointment, above the ointment, it is impossible to attack, it is not reachable, and the medicine is not reachable, so it is impossible to do it". Within a few days, he "went to the toilet, got stuck and died". The ancients called the apical fat "cream", and the relationship between the heart and the diaphragm was called "cream". The ancients thought that the heart was in the middle, so the position of this "cream" is equivalent to the rear of the lower sternum. Seeing this, many people may think of acute myocardial infarction at the first time like me. Although history cannot be reproduced and the truth cannot be restored, the cause of Jin Jinggong's death is still a mystery, but I lament the progress of knowledge and the power of scientific and technological innovation. In the past, even the diseases that the whole country could not save themselves are still dangerous today, but the mortality rate has been greatly reduced, and most patients can survive. As a cardiovascular person who has been involved in the vigorous development of cardiovascular diseases in China for a long time, I have a lot of feelings while thinking! These seemingly inevitable progress contain how many generations of scientific and technological innovation have bravely broken through and persisted.

percutaneous coronary intervention (PCI), as one of the main methods for treating coronary heart disease, is developing rapidly in China and has been widely used. Anticoagulation therapy during perioperative PCI is of great significance to prevent thrombotic events before, during and after PCI. At present, there are many irregularities in the use of perioperative anticoagulants in PCI in China, including indications, types, dosages, initiation timing and treatment course. Although the existing guidelines at home and abroad recommend perioperative anticoagulation therapy for PCI, each guideline only targets one type of coronary heart disease, and it is published in different ages, which is not conducive to the comprehensive and systematic study and combing of perioperative anticoagulation therapy for PCI by doctors. As new research and evidence about perioperative anticoagulant therapy for PCI continue to emerge, the recommendations of existing guidelines need to be updated, supplemented and improved in time. Therefore, the Interventional Cardiology Group of Cardiovascular Disease Branch of Chinese Medical Association and the Thrombosis Prevention Committee of Cardiovascular Physicians Branch of Chinese Medical Physicians Association combined the existing domestic and foreign relevant guidelines, evidence-based evidence and clinical application status^[1,2,3,4,5]Specially compiled the "Chinese Expert Consensus on the Clinical Application of Non-oral Anticoagulants in the Perioperative Period of PCI" (referred to as the Consensus)^[6]In order to promote the standardization and rational use of non-oral anticoagulants during perioperative PCI in China. This consensus deserves attention in the following aspects.

"Analysis of myocardial amyloid deposition in patients with heart failure aged 85 years and older with preserved ejection fraction" published in this issue by Li Yingying et al.^[1]This article is the first study of myocardial amyloidosis in elderly patients with heart failure with preserved ejection fraction (HFpEF) through autopsy pathology in China. The data is precious and worth reading. In recent years, elderly HFpEF has received increasing attention because of its higher incidence in the elderly population compared with heart failure with reduced ejection fraction (HFrEF), more unknown pathogenesis, and worse treatment efficacy and final prognosis due to the coexistence of multiple diseases. Recently, reports of high detection rate of cardiac amyloidoses (CA) in elderly patients with HFpEF have made people pay more attention to elderly HFpEF. Understanding the pathophysiology, clinical characteristics and diagnostic methods of CA is very important for formulating the correct treatment methods and improving the curative effect of elderly patients with HFpEF. This article briefly introduces this.

alcoholic heart disease (AHD) is a diagnostic term sometimes used in clinical research in recent years, which generally refers to cardiovascular damage caused by alcohol abuse. Compared with the traditional diagnosis of alcoholic cardiomyopathy (ACM), AHD is more beneficial to the early diagnosis and treatment of patients with alcoholic cardiovascular injury^[1,2,3]。

percutaneous coronary intervention (PCI) is one of the main methods for the treatment of coronary heart disease^[1]。 Especially in patients with acute coronary syndrome (ACS), there is activation of coagulation system, increased thrombin activity, dysbalance of coagulation and fibrinolysis system, and blood is in hypercoagulable state^[2]The invasive operation of PCI and the contact of the catheter with the vascular endothelial surface can induce the activation of the endogenous/exogenous coagulation system, activate thrombin, promote the conversion of fibrinogen into fibrin and eventually form thrombosis. Therefore, the pre-, middle and post-perioperative stages of PCI are the high incidence of thrombotic events. In summary, ACS should start anticoagulant therapy as soon as possible, and the rational and standardized application of anticoagulant drugs is the key link to ensure the efficacy and safety of interventional surgery^[3,4,5]。

Case 1, a 76-year-old male, was admitted to the hospital due to "repeated chest tightness and shortness of breath for more than 20 years, with recurrent aggravation for 1 month". Post-admission echocardiography (UCG) showed left ventricular end-diastolic diameter (LVEDD) 72 mm, left ventricular ejection fraction (LVEF) 30%, mitral valve thickening with moderate regurgitation, and aortic valve degeneration with moderate regurgitation. Electrocardiogram (ECG) showed sinus rhythm, complete left bundle branch block, and QRS wave time limit of 0.18 s. Admission diagnosis: dilated cardiomyopathy, mitral regurgitation (moderate), aortic regurgitation (moderate), enlarged heart, complete left bundle branch block, New York Heart Association (NYHA) cardiac function class II to III. The patient had indications for the placement of a cardiac resynchronization therapy defibrillator (CRT-D) and decided upon discussion to undergo CRT-D placement.

Currently, the rate of mortality and rehospitalization in heart failure (HF) remains high. In the past 10 years, people have been continuously exploring the mechanism of the occurrence and development of heart failure, and it is proposed that the treatment of heart failure should change from "nerve-humoral inhibition" to "nerve-humoral-immune multi-target regulation"^[1]。 Intestinal flora plays an important role in extracting energy from food and controlling local and systemic immunity. Studies have shown that intestinal flora is related to a variety of diseases, such as obesity, diabetes, gastrointestinal diseases, cancer and cardiovascular diseases^[2,3,4]。 Among them, the study of intestinal flora and heart failure is particularly interesting^[5,6]。 Understanding the role of intestinal flora in the development of heart failure will help us better understand the pathogenesis of heart failure and provide new ideas for its treatment. In this paper, the research progress of intestinal flora and heart failure is reviewed.

dilated cardiomyopathy (DCM) is a type of cardiomyopathy with progressive enlargement of the left ventricle or biventricle, accompanied by obvious reduction of systolic function. It is the third leading cause of progressive heart failure and sudden cardiac death in clinic besides coronary heart disease and hypertension. The patients mainly presented with enlarged cardiac chamber, cardiac insufficiency and malignant arrhythmia, and the prognosis was often poor. Early ultrasound data suggest a DCM prevalence of approximately 1:2 500, while epidemiological data suggest that the actual DCM prevalence may be as high as 1:250^[1]And thus the prevalence of DCM is underestimated. According to the 2016 European Society of Cardiology (ESC) and American Heart Association (AHA) recommendations, echocardiography or cardiac magnetic resonance imaging techniques are recommended for the diagnosis of DCM with reduced left ventricular systolic function (left ventricular ejection fraction<45% or shortened score<25%) and left ventricular end-diastolic volume or diameter>2-fold standard deviation of adjusted normal as the reference criteria, and other diseases leading to cardiomyopathy were excluded^[2,3]。 If the patient exhibits only reduced left ventricular systolic function (left ventricular ejection fraction<45%), not associated with ventricular dilatation and not explained by abnormally increased ventricular load or coronary heart disease, as defined in the ESC Position Statement as a subtype of hypokinetic non-dilated cardiomyopathy (HNDC)^[2]。

hypertrophic cardiomyopathy (HCM) is the most common heart disease with chromosomal abnormalities, with an incidence rate of about 1:500. It is the most common cause of sudden cardiac death in adolescents and athletes, as well as heart failure (heart failure) and stroke^[1,2]。 The pathophysiological mechanism of HCM is complex, and the genotype, clinical phenotype and prognosis are highly heterogeneous. The clinical features mainly include asymmetric left ventricular hypertrophy, abnormal energy metabolism of cardiomyocytes, microcirculatory ischemia, myocardial fibrosis, diastolic dysfunction and multi-source arrhythmia, etc. Drug therapy is very important for alleviating left ventricular outflow tract obstruction, improving diastolic function, controlling clinical symptoms, arrhythmia and heart failure^[3]。 However, at present, there are few clinical trials of drugs and small sample size. The drugs for clinical treatment of HCM are mostly based on small sample size clinical research or expert experience, and the level of evidence is not high.

After entering the era of molecular biology, Jacob and Monod published "Genetic regulatory mechanisms in the synthesis of proteins" in 1961 This paper introduces the concept of messenger RNA for the first time, which lays the foundation for the development of molecular biology. With the development of new generation sequencing technology and the completion of the Human Genome Project, we have gradually realized that 90% of human gene sequences produce transcripts, but only 2% of them encode proteins^[1]This means that the non-coding RNA may have other biological functions. Since then, research on non-coding RNAs with regulatory functions has become increasingly abundant, such as ribonuclease (RNaseP), small nuclear RNA (snRNA), long non-coding RNA (lncRNA), and microRNA (miRNA)^[2]。