BACKGROUND:Post-infarct left ventricular free wall rupture(LVFWR)is not always an immediately catastrophic complication.The rupture can be subacute,allowing time for diagnosis and intervention.Accordingly,early recogn...BACKGROUND:Post-infarct left ventricular free wall rupture(LVFWR)is not always an immediately catastrophic complication.The rupture can be subacute,allowing time for diagnosis and intervention.Accordingly,early recognition of the entity may be lifesaving.METHODS:We present an electrocardiogram(ECG)change pattern in two cases,which was erroneously attributed to ischemia.Two women in their 80s were admitted to our institute after experiencing the sudden onset of chest pain.They were managed as anterior ST-segment elevation myocardial infarction without reperfusion treatment.Unfortunately,they experienced a recurrence of severe chest pain with cardiogenic shock during hospitalisation.The ECG recorded at that time showed a ST-segment re-elevation in infract-related leads.RESULTS:The two cases were regrettably received a misjudgement of reinfarction at first,and one of the patients even was administrated with tirofi ban.Afterwards the diagnosis of subacute LVFWR was made through antemortem echocardiography.CONCLUSION:New ST-segment elevation(STE)in infarct-associated leads,coupled with recurrence of chest pain and new-onset hypotension,may constitute the premonitory signs of a subacute LVFWR.展开更多
1 Introduction Early detection and diagnosis of stable coronary artery disease （SCAD） is essential for proactive secondary prevention of myocardial infarction （MI）, control of disease progress, and reduction of mo...1 Introduction Early detection and diagnosis of stable coronary artery disease （SCAD） is essential for proactive secondary prevention of myocardial infarction （MI）, control of disease progress, and reduction of mortality. Clinical decision-making in modem medicine is increasingly dependent on cardiovascular imaging techniques. 2012 ACCF/AHA/ACP/AATS/ PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease has been issued by American Heart Association （AHA）. European Society of Cardiology （ESC） has issued 2013 ESC guidelines on the management of stable coronary artery disease.展开更多
The incidence of significant left main(LM)coronary artery stenosis identified by coronary angiography was 5%−17.5%in various clinical presentations;about 80%of stenosis involved the LM bifurcation(LMB).[1]Although per...The incidence of significant left main(LM)coronary artery stenosis identified by coronary angiography was 5%−17.5%in various clinical presentations;about 80%of stenosis involved the LM bifurcation(LMB).[1]Although per-cutaneous coronary intervention(PCI)is an appro-priate alternative to coronary artery bypass graft in LM disease with low-to-intermediate anatomical complexity,[2]PCI for LMB lesions remains the most technically challenging for interventional cardiolo-gists with higher rates of acute periprocedural com-plications and higher risk of long-term major ad-verse cardiac events in the era of drug-eluting stent(DES).展开更多
Background:Despite great reduction of in-stent restenosis,first-generation drug-eluting stents (DESs) have increased the risk of late stent thrombosis due to delayed endothelialization.Arsenic trioxide,a natural subst...Background:Despite great reduction of in-stent restenosis,first-generation drug-eluting stents (DESs) have increased the risk of late stent thrombosis due to delayed endothelialization.Arsenic trioxide,a natural substance that could inhibit cell proliferation and induce cell apoptosis,seems to be a promising surrogate of sirolimus to improve DES performance.This randomized controlled trial was to evaluate the efficacy and safety of a novel arsenic trioxide-eluting stent (AES),compared with traditional sirolimus-eluting stent (SES).Methods:Patients with symptoms of angina pectoris were enrolled and randomized to AES or SES group.The primary endpoint was target vessel failure (TVF),and the second endpoint includes rates of all-cause death,cardiac death or myocardial infarction,target lesion revascularization (TLR) by telephone visit and late luminal loss (LLL) at 9-month by angiographic follow-up.Results:From July 2007 to 2009,212 patients were enrolled and randomized 1 ∶1 to receive either AES or SES.At 2 years of follow-up,TVF rate was similar between AES and SES group (6.67％ vs.5.83％,P =0.980).Frequency of all-cause death was significantly lower in AES group (0 vs.4.85％,P =0.028).There was no significant difference between AES and SES in frequency of TLR and in-stent restenosis,but greater in-stent LLL was observed for AES group (0.29 ± 0.52 mm vs.0.1 0 ± 0.25 mm,P =0.008).Conclusions:After 2 years of follow-up,AES demonstrated comparable efficacy and safety to SES for the treatment of de novo coronary artery lesions.展开更多
There is a paucity of data regarding trends in the incidence of heart disease in China during recent years. Using a large echocardiography database in our center, we analyzed trends in the prevalence of several common...There is a paucity of data regarding trends in the incidence of heart disease in China during recent years. Using a large echocardiography database in our center, we analyzed trends in the prevalence of several common heart diseases from Dec. 2003. This study retrospectively analyzed the echocardiographic database in our Department from 2003 to 2012. A total of 385 682 cases were included in the study. The prevalence of rheumatic heart disease decreased over the 10-year period, from 4.04% in 2003 to 3.06% in 2012 （P〈0.01）. Infective endocarditis also decreased, from a mean prevalence of 0.37% in July 2003 to 0.27% in Dec. 2008 （P〈0.001）. The prevalence of hy- pertrophic cardiomyopathy, which includes 20% apical hypertrophic cardiomyopathy and 20% hypertrophic obstructive cardiomyopathy, was about 1.8%. The prevalence of the three most common adult congenital heart diseases （CHDs） decreased by about 10% from July 2003 to Dec. 2008 （all P〈0.001）. The prevalence of moderate pulmonary arterial hypertension （PAH） or left ventricular systolic dysfunction （LVSD） decreased during the 10-year period （P〈0.001）, but there was no change in the prevalence of severe PAH or LVSD （P〉0.05）. The present study indirectly demonstrates that the prevalence of several common heart diseases in China has declined in recent years.展开更多
To the Editor：A 35-year-old man who smoked for 15 years suffered from chest pain 12 days ago before admission.He was diagnosed as myocardial infarction.Thrombolytic therapy was given consequently.The electrocardiogra...To the Editor：A 35-year-old man who smoked for 15 years suffered from chest pain 12 days ago before admission.He was diagnosed as myocardial infarction.Thrombolytic therapy was given consequently.The electrocardiogram showed sub-acute inferior wall myocardial infarction.Echocardiogram showed attenuated constriction of the inferior wall with an ejection fraction of 59％.On September 5,2013,he was treated with a XINSORB scaffold in right coronary artery （RCA）.展开更多
Background： Coronary microembolization （CME） has been frequently seen in acute coronary syndromes and percutaneous coronary intervention. Small animal models are required for further studies of CME related to sever...Background： Coronary microembolization （CME） has been frequently seen in acute coronary syndromes and percutaneous coronary intervention. Small animal models are required for further studies of CME related to severe prognosis. This study aimed to explore a new mouse model of CME. Methods： The mouse model of CME was established by injecting polystyrene microspheres into the left ventricular chamber during 15-s occlusion of the ascending aorta. Based on the average diameter and dosage used, 30 C57BL/6 male mice were randomly divided into five groups （n = 6 in each）： 9 μm/500,000, 9 μm/800,000, 17 μm/200,000, 17 μm/500,000, and sham groups. The postoperative survival and performance of the mice were recorded. The mice were sacrificed 3 or 10 days after the surgery. The heart tissues were harvested for hematoxylin and eosin staining and Masson trichrome staining to compare the extent of inflammatory cellular infiltration and fibrin deposition among groups and for scanning transmission electron microscopic examinations to see the ultrastructural changes after CME. Results： Survival analysis demonstrated that the cumulative survival rate of the 17 μm/500,000 group was significantly lower than that of the sham group （0/6 vs. 6/6, P = 0.001）. The cumulative survival rate of the 17 μm/200,000 group was lower than those of the sham and 9 μm groups with no statistical difference （cumulative survival rate of the 17 μm/200,000, 9 μm/800,000, 9 μm/500,000, and sham groups was 4/6, 5/6, 6/6, and 6/6, respectively）. The pathological alterations were similar between the 9 μm/500,000 and 9 μm/800,000 groups. The extent of inflammatory cellular infiltration and fibrin deposition was more severe in the 17 μm/200,000 group than in the 9 μm/500,000 and 9 μm/800,000 groups 3 and 10 days after the surgery. Scanning transmission electron microscopic examinations revealed platelet aggregation and adhesion, microthrombi formation, and changes in cardiomyocytes. Conclusion： The injection of 500,000 polystyrene microspheres at an average diameter of 9 μm is proved to be appropriate for the mouse model of CME based on the general conditions, postoperative survival rates, and pathological changes.展开更多
To the Editor:The sinus node artery(SNA)can be occluded during the percutaneous coronary intervention(PCI),which produces bradycardia.Previous studies showed a high incidence of SNA occlusion(SNO).Improvements in sten...To the Editor:The sinus node artery(SNA)can be occluded during the percutaneous coronary intervention(PCI),which produces bradycardia.Previous studies showed a high incidence of SNA occlusion(SNO).Improvements in stent design and anti-thrombotic strategies have decreased branch occlusion.Here,we investigated the results of this procedure in our center.The incidence of SNO was 7.0%.The percentage of diameter stenosis of the SNA,SNA originating at a diseased right coronary artery(RCA),and larger RCA/SNA diameter ratio were independent predictors of SNO.Bradycardia occurred in SNO,but only one temporary pacemaker was implanted.SNO and the consequent bradycardia were not rare during PCI for severe RCA in current practice,yet they led to a benign clinical course with few temporary pacemakers.展开更多
Dear Editor,Aging results in higher susceptibility to age-related disease,especially cardiovascular disease,which has become a public health priority.1,2 Recent studies have progressively unraveled the critical role o...Dear Editor,Aging results in higher susceptibility to age-related disease,especially cardiovascular disease,which has become a public health priority.1,2 Recent studies have progressively unraveled the critical role of vasculature as a gatekeeper of life-span and health-span.3 In this light,vascular rejuvenation is geroprotective.The circulating proteomic signature is tightly related to aging and aging-induced vascular diseases,4 but drugs targeting circulating proteins are not available.展开更多
基金supported by National Natural Science Foundation of China General Program(81970298)the National Key R&D Project(2016YFC1301300,2016YFC1301303)
文摘BACKGROUND:Post-infarct left ventricular free wall rupture(LVFWR)is not always an immediately catastrophic complication.The rupture can be subacute,allowing time for diagnosis and intervention.Accordingly,early recognition of the entity may be lifesaving.METHODS:We present an electrocardiogram(ECG)change pattern in two cases,which was erroneously attributed to ischemia.Two women in their 80s were admitted to our institute after experiencing the sudden onset of chest pain.They were managed as anterior ST-segment elevation myocardial infarction without reperfusion treatment.Unfortunately,they experienced a recurrence of severe chest pain with cardiogenic shock during hospitalisation.The ECG recorded at that time showed a ST-segment re-elevation in infract-related leads.RESULTS:The two cases were regrettably received a misjudgement of reinfarction at first,and one of the patients even was administrated with tirofi ban.Afterwards the diagnosis of subacute LVFWR was made through antemortem echocardiography.CONCLUSION:New ST-segment elevation(STE)in infarct-associated leads,coupled with recurrence of chest pain and new-onset hypotension,may constitute the premonitory signs of a subacute LVFWR.
文摘1 Introduction Early detection and diagnosis of stable coronary artery disease （SCAD） is essential for proactive secondary prevention of myocardial infarction （MI）, control of disease progress, and reduction of mortality. Clinical decision-making in modem medicine is increasingly dependent on cardiovascular imaging techniques. 2012 ACCF/AHA/ACP/AATS/ PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease has been issued by American Heart Association （AHA）. European Society of Cardiology （ESC） has issued 2013 ESC guidelines on the management of stable coronary artery disease.
基金This study was supported by the National Key Research and Development Program of China(2016 YFC1301200)the National Natural Science Foundation of China(No.81300095&No.81900217)+1 种基金the Animal Model Project of Shanghai Scientific Committee(No.19140900901)the Youth Backbone Foundation of Zhongshan Hospital and Shanghai Sailing Program(19YF1406200).
文摘The incidence of significant left main(LM)coronary artery stenosis identified by coronary angiography was 5%−17.5%in various clinical presentations;about 80%of stenosis involved the LM bifurcation(LMB).[1]Although per-cutaneous coronary intervention(PCI)is an appro-priate alternative to coronary artery bypass graft in LM disease with low-to-intermediate anatomical complexity,[2]PCI for LMB lesions remains the most technically challenging for interventional cardiolo-gists with higher rates of acute periprocedural com-plications and higher risk of long-term major ad-verse cardiac events in the era of drug-eluting stent(DES).
基金grants from the National Natural Science Foundation，the National Basic Research Program of China
文摘Background:Despite great reduction of in-stent restenosis,first-generation drug-eluting stents (DESs) have increased the risk of late stent thrombosis due to delayed endothelialization.Arsenic trioxide,a natural substance that could inhibit cell proliferation and induce cell apoptosis,seems to be a promising surrogate of sirolimus to improve DES performance.This randomized controlled trial was to evaluate the efficacy and safety of a novel arsenic trioxide-eluting stent (AES),compared with traditional sirolimus-eluting stent (SES).Methods:Patients with symptoms of angina pectoris were enrolled and randomized to AES or SES group.The primary endpoint was target vessel failure (TVF),and the second endpoint includes rates of all-cause death,cardiac death or myocardial infarction,target lesion revascularization (TLR) by telephone visit and late luminal loss (LLL) at 9-month by angiographic follow-up.Results:From July 2007 to 2009,212 patients were enrolled and randomized 1 ∶1 to receive either AES or SES.At 2 years of follow-up,TVF rate was similar between AES and SES group (6.67％ vs.5.83％,P =0.980).Frequency of all-cause death was significantly lower in AES group (0 vs.4.85％,P =0.028).There was no significant difference between AES and SES in frequency of TLR and in-stent restenosis,but greater in-stent LLL was observed for AES group (0.29 ± 0.52 mm vs.0.1 0 ± 0.25 mm,P =0.008).Conclusions:After 2 years of follow-up,AES demonstrated comparable efficacy and safety to SES for the treatment of de novo coronary artery lesions.
基金Project supported by the National Natural Science Foundation of China(Nos.81400318 and 81300209)
文摘There is a paucity of data regarding trends in the incidence of heart disease in China during recent years. Using a large echocardiography database in our center, we analyzed trends in the prevalence of several common heart diseases from Dec. 2003. This study retrospectively analyzed the echocardiographic database in our Department from 2003 to 2012. A total of 385 682 cases were included in the study. The prevalence of rheumatic heart disease decreased over the 10-year period, from 4.04% in 2003 to 3.06% in 2012 （P〈0.01）. Infective endocarditis also decreased, from a mean prevalence of 0.37% in July 2003 to 0.27% in Dec. 2008 （P〈0.001）. The prevalence of hy- pertrophic cardiomyopathy, which includes 20% apical hypertrophic cardiomyopathy and 20% hypertrophic obstructive cardiomyopathy, was about 1.8%. The prevalence of the three most common adult congenital heart diseases （CHDs） decreased by about 10% from July 2003 to Dec. 2008 （all P〈0.001）. The prevalence of moderate pulmonary arterial hypertension （PAH） or left ventricular systolic dysfunction （LVSD） decreased during the 10-year period （P〈0.001）, but there was no change in the prevalence of severe PAH or LVSD （P〉0.05）. The present study indirectly demonstrates that the prevalence of several common heart diseases in China has declined in recent years.
基金a grant from National Natural Science Foundation of China，the National Basic Research Program of China （No.2011CB503905） from the Ministry of Science and Technology of China,the Specialized Research Fund for the Doctoral Program of Higher Education of China，the Science and Technology Commission of Shanghai,China （No.12DZ1940604）.Conflict of Interest：None
文摘To the Editor：A 35-year-old man who smoked for 15 years suffered from chest pain 12 days ago before admission.He was diagnosed as myocardial infarction.Thrombolytic therapy was given consequently.The electrocardiogram showed sub-acute inferior wall myocardial infarction.Echocardiogram showed attenuated constriction of the inferior wall with an ejection fraction of 59％.On September 5,2013,he was treated with a XINSORB scaffold in right coronary artery （RCA）.
文摘Background： Coronary microembolization （CME） has been frequently seen in acute coronary syndromes and percutaneous coronary intervention. Small animal models are required for further studies of CME related to severe prognosis. This study aimed to explore a new mouse model of CME. Methods： The mouse model of CME was established by injecting polystyrene microspheres into the left ventricular chamber during 15-s occlusion of the ascending aorta. Based on the average diameter and dosage used, 30 C57BL/6 male mice were randomly divided into five groups （n = 6 in each）： 9 μm/500,000, 9 μm/800,000, 17 μm/200,000, 17 μm/500,000, and sham groups. The postoperative survival and performance of the mice were recorded. The mice were sacrificed 3 or 10 days after the surgery. The heart tissues were harvested for hematoxylin and eosin staining and Masson trichrome staining to compare the extent of inflammatory cellular infiltration and fibrin deposition among groups and for scanning transmission electron microscopic examinations to see the ultrastructural changes after CME. Results： Survival analysis demonstrated that the cumulative survival rate of the 17 μm/500,000 group was significantly lower than that of the sham group （0/6 vs. 6/6, P = 0.001）. The cumulative survival rate of the 17 μm/200,000 group was lower than those of the sham and 9 μm groups with no statistical difference （cumulative survival rate of the 17 μm/200,000, 9 μm/800,000, 9 μm/500,000, and sham groups was 4/6, 5/6, 6/6, and 6/6, respectively）. The pathological alterations were similar between the 9 μm/500,000 and 9 μm/800,000 groups. The extent of inflammatory cellular infiltration and fibrin deposition was more severe in the 17 μm/200,000 group than in the 9 μm/500,000 and 9 μm/800,000 groups 3 and 10 days after the surgery. Scanning transmission electron microscopic examinations revealed platelet aggregation and adhesion, microthrombi formation, and changes in cardiomyocytes. Conclusion： The injection of 500,000 polystyrene microspheres at an average diameter of 9 μm is proved to be appropriate for the mouse model of CME based on the general conditions, postoperative survival rates, and pathological changes.
基金the National Natural Science Foundation of China(81801374,81870269)the National Key Research and Development Program of China(2018YFC0116303).
文摘To the Editor:The sinus node artery(SNA)can be occluded during the percutaneous coronary intervention(PCI),which produces bradycardia.Previous studies showed a high incidence of SNA occlusion(SNO).Improvements in stent design and anti-thrombotic strategies have decreased branch occlusion.Here,we investigated the results of this procedure in our center.The incidence of SNO was 7.0%.The percentage of diameter stenosis of the SNA,SNA originating at a diseased right coronary artery(RCA),and larger RCA/SNA diameter ratio were independent predictors of SNO.Bradycardia occurred in SNO,but only one temporary pacemaker was implanted.SNO and the consequent bradycardia were not rare during PCI for severe RCA in current practice,yet they led to a benign clinical course with few temporary pacemakers.
基金supported by the National Natural Science Foundation of China (82200437,81970426)CAMS Innovation Fund for Medical Sciences (CIFMS) (2021-I2M-1-003)+2 种基金National Key Research and Development Program of China (2022YFC2703100)Shanghai Clinical Research Center for Interventional Medicine (19MC1910300)National High Level Hospital Clinical Research Funding 2022-PUMCH-B-098.
文摘Dear Editor,Aging results in higher susceptibility to age-related disease,especially cardiovascular disease,which has become a public health priority.1,2 Recent studies have progressively unraveled the critical role of vasculature as a gatekeeper of life-span and health-span.3 In this light,vascular rejuvenation is geroprotective.The circulating proteomic signature is tightly related to aging and aging-induced vascular diseases,4 but drugs targeting circulating proteins are not available.
