简介：Introduction,Chronicpericarditisisinflammationthatbeginsgradually,islonglastingandresultsinfluidaccumulationinthepericardialspaceorthickeningofthepericardium.Therearetwomaintypesofchronicpericarditisa)chroniceffusivepericarditis,fluidslowlyaccumulatesinthepericardialspacebetweenthetwolayersofthepericardium.

简介：Coronaryarterychronictotalocclusion(CTO)isdefinedasanoccludedcoronaryarterysegmentwithoutanterogradeflowforatleastthreemonths.Itcanbeclassifiedasa“true”or“functional”CTObasedonflowcharacteristics.In“true”CTO,thereisnoanterogradeflow.In“functional”CTO,thereisminimalanterogradeflowthroughtheoccludedsegmentofthecoronaryartery.CTOisacommonfindingduringcoronaryangiographyanditsprevalencemayvarydependingonthereportedliterature.Amongpatientswithoutpreviouscoronaryarterybypassgrafting(CABG),CTOisfoundinabout20–30%ofthepatients.CTOmaydevelopinsidiouslyoveraperiodoftimeandinvolveacomplexinterplaybetweenintracellularandextracellularfactors,smoothmuscleandfoamcells,calcification,andneovascularization.ThereisagrowingbodyofevidencetosupportthatCTOrevascularizationmayimproveclinicaloutcomewhencomparedtomedicalmanagement.BoththeEuropeanandAmericancardiovascularsocietiessupportCTOrevascularizationwithaclass2arecommendation(levelofevidenceB).Historically,duetolowproceduralsuccessrate,apparentinefficientresourceutilization,potentialincreaseincomplicationratesanduncertainclinicalbenefits,onlyabout10–20%ofpatientswithCTOaretreatedwithpercutaneouscoronaryintervention(PCI).RecentadvancesusingnovelandinnovativetechniqueswithdedicatedequipmenthavesignificantlyimprovedtheproceduralsuccessrateforCTOPCItoabout90%inthehandsofexperiencedoperators.WithincreasinginterestinCTOPCIcoupledwithincreasededucationaleffort,CTOPCIlikelywillbecomemoreaccessibletopatientsinneedofCTOrevascularization.OngoingadvancementininnovativetechniquesandequipmentwillcontinuetoimproveproceduralsuccessratesandreduceproceduralcomplicationrateforCTOPCI.Furthermore,thereareanumberofprospectiveclinicaltrialsonthehorizonwhichshouldhelpdefinetheclinicalbenefitsandlimitationsofCTOPCIinthenear

简介：objectivesTodemonstratethephenomenaandexplorethecausesofanemiainpatientswithchronicheartfailure(CHF).MethodsToobservethephenomenaofanemiainpatientswithCHF,atotalof276patientswithCHFwereincludedinthisretrospectivestudy.Theclinicalcharacteristicsofthepatientsare;meanage69.2±11.0years;male151,female125;NYHAⅢandⅣ115(41.7%).Results①Amongthe276patientswithCHF,81(29.4%)hadanemia(Meanhemoglobulinconcentration101.5±13.0g/L).②PatientswithAnemiaweremorelikelytobefemaleandtohavegreaterNYHA(ⅢorⅣ)(P<0.05),higherserumcreatinine,aswellaslowerserumalbuminandlow-densitylipoproteinlevels(P<0.01).③AweaknegativecorrelationwasalsonotedbetweenthelevelofNYHAandhemoglobulin.④Therewasnosignificantdifferenceinage,theprimarycardiacetiologyoftheCHF,thehistoryofdiabetes,leftventricularenddiastolicdiameter,andleftventricularejectionfractionbetweenCHFpatientwithandwithoutanemia.ConclusionsTheprevalenceofanemiaishighamongpatientswithCHF.TheanemiapatientswithCHFtendtobefemale,havegreatercardiacandrenalfunctionalimpairment,butwithlowerserumalbuminandLDLthatsuggestssomedegreeofmalnutrition.

简介：Chronicheartfailureisincreasinglyprevalentworldwideandisassociatedwithsignificantmorbidityandmortality.TheCochranereviewdemonstratedthatcardiacrehabilitation(CR)resultedinimprovementsinQOLandareductioninlong-termmortality.Chronickidneydisease(CKD)isanotherworldwidepublichealthproblem.ThisreviewfocusesontheimportanceandefficacyofrehabilitationforCKDpatientsasanewtargetofCR.PatientswithCKDonhemodialysis(HD)haveahighmortalityrate,withcardiovasculardiseases,suchaschronicheartfailure.Anewsystematicreviewandmeta-analysisofrandomizedcontrolledtrialsreportedthatexercise-basedrenalrehabilitationimprovedaerobiccapacity,muscularfunctioning,cardiovascularfunction,walkingcapacity,andQOLinCKDpatientswithHD.Moreover,exercisetrainingmayhaverenalprotectiveeffects,notonlyinsomeanimalmodelsofpre-HDCKD,butalsoinpre-HDCKDpatients.Exercisetherapycouldbeaneffectiveclinicalstrategyinimprovingrenalfunction,loweringtheneedforrenalreplacementtherapy,suchasHD,andreducingrenaltransplantriskinpre-HDCKDpatients.ThisledtheMinistryofHealth,LaborandWelfareofJapantoextendrenalrehabilitationpartialcoveragetostage4pre-HDCKDpatientsforthefirsttimeintheworldin2016.

简介：ObjectivesToexploretheeffectoflosartanoncardiacandrenalfunctioninpatientswithchronicheartfailure(CHF).MethodsSixty-fivepatientswithCHFweredividedintotwogroupsusingarandomized,controlandsingleblindmethod:losartangroup(n=30)andconventiongroup(n=35),withatreatmentcourseof8weeksforbothgroups.TheconcentrationsofcystatinC(cysC)inserum,microamountalbumin(MA)inurineweremeasuredbyimmunoturbidimetry.Theconcentrationofaquaporin-2(AQP-2)wasdeterminedbyenzyme-linked-immunosorbentassay(ELISA)andtheheartcontractilefunctionwasmeasuredbyechocardiographybeforeandaftertreatmentrespectively.ResultsComparingwithroutinetreatmentgroup,leftventricularend-diastolicdimension(LVEDd)decreasedsignificantly,whileleftventricularejectionfraction(LVEF)andleftventricularfractionalshortening(LVFS)increasedsignificantlyinlosartangroup.ThelevelsofcysCinserumandMA,AQP-2inurineweresignificantlylowerinlosartangroupthaninroutinetreatmentgroup.ConclusionLosartancanimprovecardiacandrenalfunctioninpatientswithCHF.

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简介：ObjectivesToinvestigatethechangesofβ3-adrenoceptor(β3-AR)mRNAexpressionintheratswithchronicheartfailure(CHF),andtoexploretheeffectofβblockers(βBs)onβ3mRNAexpression.MethodsThirty-fourratswererandomlydividedintoShamgroup(n=10)andheartfailuregroup(n=24).Ratmodelwasestablishedbyaorticconstriction.Thesurvivalratsinheartfailuregroupweredividedintoheartfailurecontrolgroup(HFgroup,n=6),metoprololgroup(METgroup,n=8)andcarvedilolgroup(CARgroup,n=8)threemonthsafteroperation.Metoprololtartartewasstartedorallywith12mg·kg-1·d-1,carvedilolwith6mg·kg-1·d-1,isometricsalinewasstartedinHFgroup.Afterthreemonthsofdrugtherapy,measurementofhemodynamics,indexofventricularmass,thelevelofβ3-ARmRNAexpressionwereperformed.ResultsComparedwithShamgroup,leftventricularendsystolicpressure(LVESP),andtheabsolutevaluesofmaximalrateofriseandfall(±dp/dtmax)ofleftventricularpressurewereallsignificantlydecreased(P<0.01),leftventricularenddiastolicpressure(LVEDP)wassignificantlyincreasedinHFgroup(P<0.01).ThehemodynamicparameterswereimprovedbyβBs,andcarvedilolwasmoreeffectivethanmetoprolol(P<0.01).TheindexofventricularmasswashigherinHFgroupthanMETgroup,CARgroupandShamgroup(P<0.01).βBssignificantlydecreasedtheindexofleftventricularmass(LVMI),andCarvedilolwasmoreeffectivethanmetoprolol(P<0.01).Theindexofrightventricularmass(RVMI)didnotchangeinMETgroup(P>0.05),butsignificantdecreasecouldbeseeninCARgroup(P<0.01).Thelevelofβ3-ARexpressioninleftventriclewasgreaterthanthatinrightventriclewhetherinthefailingheartorinthenon-failingheart.ComparedwithShamgroup,thelevelofβ3-ARmRNAexpressionwassignificantlyincreasedinHFgroup(P<0.01).Thelevelsofβ3-ARmRNAexpressionshowedaremarkabledecreaseinCARgroup(P<

简介：ObjectivesTostudywhetherchangeofBNPlevelsreflectthechangeofcardiacfunctionandtoinvestigatetheshort-termprognosticpotentialofBNPandQOLinpatientswithCHF.Methods96consecutivepatientsadmittedwithCHFbetweenSeptember2002andJanuary2003werestudied,uponentrythestudy,BNPlevelsweremeasured,Patientsadministeredthedisease-specificqualityoflifequestionnaireMinnesotalivingwithheartfailurequestionnaire(LiHFe)within1day.BNPlevelsandadministeringLiHFewererepeatedthreemonthslater.ResultsBNPlevelswereincreasedproportionaltotheseverityofcardiacfunction.PhysicaldomainandtotalscoreofLiHFeweresignificantlycorrelatedtotheseverityofCHF(p＜0.05).BNPlevelsweredecreasedinimprovinggroup(p=0.032).IndeterioratinggroupBNPlevelsincreased(P=0.043).Kaplan-meieranalysisaccordingtoBNPlevelcutoffpoint150ng/l,thelifecurveofhigherBNPlevelgroupwassignificantlylowerthanthelowergroup(p=0.001).Inunivariatelogisticregression,NYHAclass,BNP,LVEF,LVEDD,heartsize,totalscoreofLiHFe,physicaldomainofLiHFeandtheemotionaldomainofLiHFewereallsignificantprognosticfactorsofCHF(p＜0.05forall).Whileinmultipleregression,onlyBNPlevel(p=0.036)andtheemotionaldomainofLiHFe(p=0.025)wereindependentprognosticfactors.ConclusionsChangeofBNPreflectsthetreatmentefficacyofCHF.BNPandQOLarethetwomajorshort-timeprognosticfactorsofthechronicheartfailurepatients.

简介：ObjectivesToinvestigatetheassociationofsolubleFasligand(sFasL)andsolubleFasreceptor(sFas)withhumanchroniccongestiveheartfailure(CHF).MethodsTheserumlevelofsFasLandsFasin33patientswithCHF(13incardiacfunctionclassⅡ,17inclassⅢ,3inclassⅣ,NYHA)wasassessedwithenzyme-linkedimmunosorbentassay,andwascomparedwiththatof18age-,bloodpressure-matchedpatientswithcardiacfunctionclassⅠ(NYHA).ResultsTherewasnodifferenceinthelevelofsFasLbetweenthetwogroups[CHFgroup:231.50+/-84.50(cardiacfunctionclassⅡ216.50+/-96.00,classⅢ226.80+/-85.70,classⅣ244.00+/-73.00)vs.cardiacfunctionclassIgroup:217.50+/-89.00pg/mL,P>0.05].However,thelevelofsFaswassignificantlyhigherinthepatientswithCHFthanthoseofcardiacfunctionclassIgroup[CHFgroup:1353.30+/-507.71(cardiacfunctionclassⅡ1154.85+/-371.20,classⅢ1412.88+/-493.62,classⅣ1875.67+/-806.

简介：BackgroundDataarelimitedregardingtheriskofcontrast-inducednephropathy(CIN)forpatientsafterthesecondcontrastexposure.ObjectiveToexaminetheriskofCINafterthesecondcontrastexposureinpatientsofacutecoronarysyndrome(ACS)withchronickidneydisease(CKD).MethodsPatientsofACSscheduledforasecondelectivePCI.Patientswererequiredtohaveanestimatedcreatinineclearance(CrCl)between15and60ml/min.Thevalueofserumcreatinin(sCr)priortothesecondcontrastexposuremustnotbe≥25%or≥88.4μmol/Lcomparedtobaseline.CINwasdefinedasanincreaseofsCr≥25%frombaselinewithin48-72hafterthesecondcontrastexposure.Theprimaryend-pointwasriskofdevelopingCIN.ResultsThirty-ninepatientscompletedthestudy.Theaverageofintervalbetweencontrastexposureswas116±64h,contrastvolumewas266±100mLandlengthofhospitalizationwas8.3±4.7days.TheincidenceofCINintheoverallstudypopulationwas10.3%.TherewasnotchangesignificantlyinaveragesCrandCrClafterthesecondcontrastexposure(sCr1.52±0.62vs.1.54±0.60mg/dLbaseline,P=0.75;CrCl(40.68±14.46vs.39.16±12.10mL/minbaseline,P=0.26).Noneofthepatientwasdeathin30days.One(2.6%)ofthepatientswhodevelopedCINrequireddialysisin-hospital.ConclusionOurfindingssuggestthatpatientswithpriorrenaldysfunctionarenotincreasedriskofdevelopingCINafterthesecondcontrastexposure.Thiscohortmaybebenefitfromsufficientprophylaxis.

简介：ObjectivesToinvestigatetherelationshipofserumleptinconcentrationwiththelipidsandbodymassindex(BMI)inpatientswithchroniccongestiveheartfailure(CHF).MethodsTheserumconcentrationofleptinin39patientswithCHF(14incardiacfunctionclassⅡ,21inclassⅢ,4inclassⅣ,NYHA)andin46patientswithcardiacfunctionclassⅠ(NYHA)wereassessedbyradioimmunoassay.ResultsTheserumconcentrationofleptinwere9.018±4.519μg/linCHFgroup(cardiacfunctionclassⅡ11.492±5.649μg/l,classⅢ7.763±3.321μg/l,classⅣ6.100±2.657μg/l);11.674±6.911μg/linclassⅠgroup.TheserumconcentrationsofleptinweresignificantlylowerinCHFgroup,ascomparedwithclassⅠgroup(P<0.05).Moreover,thedecreaseofserumleptinconcentrationwassignificantlycorrelatedwiththedecreasedserumconcentrationsoftotalcholesterol,triglyceride,bodymassindexandleftventricularejectionfractioninCHFgroup,respectively(P<0.05).ConclusionsThesignificanceofthedecreaseinserumleptininCHFpatientsneedsfurtherstudy.

简介：ObjectivesTocomparethedifferentpatternsofcoronaryarterycalcification(CAC)inacuteandchroniccoronarysyndromesutilizingelectronbeamcomputedtomography.BackgroundPathologic,angiographic,andintracoronaryultrasoundstudiesrevealedsharpdifferencesintheplaquemorphologybetweenpatientswithacuteversuschroniccoronarysyndromes.Whethertherearedifferentpatternsofcoronaryarterycalcificationinpatientswithstableanginapectoris(SAP)andinthosewithunstableanginapectoris(UAP)oracutemyocardialinfarction(AMI),however,remainsunclear.MethodsTwohundredandsixty-fourpatients,including67withSAP,94withUAPand103withAMIwerestudiedwithelectronbeamcomputedtomographyforanalysisofcoronaryarterycalcificationandwithselectivecoronaryangiographyfordeterminationofatheroscleroticlesions.CACprevalenceandcalciumscorewerecomparedamongthreegroups,andrelationofCACtotheseverityofatheroscleroticdiseaseintheSAPandUAP

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简介：BackgroundChronickidneydisease(CKD)patientsareathighriskofatherosclerosis.Structuralandelasticchangesofcarotidarterywallreflecttherangeanddegreeofatherosclerosisinperipheralarteries,whichcanbeacquiredbyultrasoundradiofrequency-datatechniqueautomaticallyandprecisely.MethodsAtotalof66CKDpatientswithnegativeresultsonroutinecarotidarteryultrasoundexaminationwereenrolled,and30healthyphysicalexamineeswereselectedascontrols.Patientsweredividedinto3groupsaccordingtoCKDstage:stage1-2,stage3-4andstage5.Clinicalcharacteristicsandthelaboratoryresultswereacquired.Intima-mediathickness(IMT)andcompliancecoefficient(CC)ofcommoncarotidarteryweremeasuredbyultrasoundradiofrequencydatatechnique(QIMTandQAS).PredictorsofIMTandCCwereanalyzedrespectively.ResultsAmongthe66patients,15wereonstage1-2,15onstage3-4and36onstage5accordingtoeGFR.ThecommoncarotidarteryIMT(CCIMT)ofalltheCKDgroupsexceptpatientsonstage1-2wassignificantlyincreasedwhencomparedwithcontrols.TheCCofcarotidarterysignificantlywasdecreasedineveryCKDgroupcomparedwithcontrols.AgeandCKDstageweresignificantpredictorsofCCIMTandCCinCKDpatients(P<0.05).AgingandadvancedCKDstagewereassociatedwithincreasedCCIMT(OR=4.855and4.969)anddecreasedCC(OR=32.178and14.068).ConclusionsRadiofrequency-datatechniquecandetectthesmallchangesofstructureandelasticityofcarotidarterywallinCKDpatients.CKDpatientshaveincreasedIMTanddecreasedelasticityofcarotidarterycomparedwithhealthysubjects.AgingandadvancedCKDstageareassociatedwithincreasedCCIMTanddecreasedCC.

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简介：BackgroundThepresenceofachronictotalocclusion(CTO)inanon-infarct-relatedarterymightbeassociatedwithaworseprognosisinlongtermbenefitforST-segmentelevationmyocardialinfarction(STEIMI)patients.Butitstillremaincontroversial.MethodsAll383STEMIpatientsunderwentpercutaneousintervention(PCI)fromJan2015toJan2017inourcenterwereenrolledinthisprospectivestudy.Baselinecharacteristics,medicalhistory,biochemicalfindings,echocardiographicandangiographicparameters,proceduresperformedandcomplicationswererecorded.FactorsrelatedtoworseoutcomeCTOinSTEMIpatientswereanalyzedbythecoxlogisticregressionanalysisforthehazardrate(HR).ResultsInatotalof383patientsenrolledinthisstudy,85caseshadCTOinatleast1coronaryartery.Themeanfollow-upwas352days.1-yearmortalityandMACEratesinpatientswithCTOwere18.8%and11.8%,respectively.Majoradversecardiacevents(MACE)duringfollow-upweresignificantlyhigherinpatientswithCTO(HR=2.88;95%CI,1.82-4.77;P<0.001).ThemultivariateanalysisshowedasignificantassociationbetweenCTOandMACE(HR=2.1195%CI,1.27-3.88;P=0.014).ConclusionChronictotalocclusionisassociatedwithhigherriskofcomorbiditiesandhighermortality,andservesasanindependentpredictorofMACE.

简介：BackgroundItiswellknownthattherewasasignificantlinkbetweenpreproceduralbloodglucoselevelsandshort-termandlong-termadverseoutcomesinpatientsundergoingelectivePCI.However,theroleofpre-proceduralbloodglucoselevelsasapredictorofadverseeventsinCKDpatientswhounderwentPCIoutofestablisheddiabeteshasyettobeidentified.MethodsInourstudy,weconductedaprospectivestudyof331acutecoronarysyndrome(ACS)patientswithCKDwhounderwentPCIoutofestablisheddiabetes.Patientsweredividedintotwogroupsbasedonpre-proceduralglucoselevels(hypoglycemia<7.0mmol/L;hyperglycemia≥7.0mmol/L).Allpatientswerefollowedupprospectivelyformajoradversecardiovascularevents(MACEs)andmortalityfor6months.ResultsInourcohort,hyperglycemiapatientsreportedahigherincidenceofin-hospitalmortalitythanhypoglycemiapatients(7.5%vs.0%,P<0.001).Hyperglycemiapatientsreportedasignificantlyhigherrateof6-monthMACEs(10%vs.2.4%,P=0.007),allcausemortality(7.5%vs.1.6%,P=0.015),andcardiovascularmortality(6.2%vs1.6%,P=0.041)comparedwithhypoglycemiapatientswithpre-proceduralglucoselevels<7.0mmol/L.Multivariateanalysisdisclosedthatapre-proceduralglucoselevel≥7.0mmol/LwasasignificantindependentpredictorofMACEs(OR=2.53,95%CI1.68-17.15,P=0.004),allcausemortality(OR=4.6,95%CI1.10-18.84,P=0.036),andcardiovascularmortality(OR=6.2,95%CI1.53-24.94,P=0.011)at6monthsinpatientsafterPCI.ConclusionThestudysuggestedthatpre-proceduralglucoselevelsareassociatedwithshort-termcardiovascularoutcomeCKDpatientswhounderwentPCIwithoutestablisheddiabetesinthesettingofACS.