Volume 85  ·   Issue 40  ·  2005

evidence-based cardiovascular medicine (EBM) is the most active, fastest developing and rich part of evidence-based medicine. Aiming at the key problems in cardiovascular prevention and treatment, many clinical trials have been advanced sequentially, constantly providing new evidence for updating guidelines and guiding clinical practice.

A large number of studies have shown that inflammation plays an important role in the occurrence, development and evolution of atherosclerosis [1]. Inflammation is the initiating factor of atherosclerosis. Inflammation leads to the local infiltration of neutrophils and monocytes in blood vessels, promotes lipid deposition, and leads to the occurrence of early lesions such as lipid streaks in atherosclerosis.

Although percutaneous coronary intervention (PCI) has become an important method in the treatment of coronary heart disease, it must be closely combined with related drugs to further improve its short-term and long-term efficacy. Besides the routine application of antiplatelet and anticoagulant drugs, the application of anti-myocardial ischemia drugs, angiotensin converting enzyme inhibitors and statins lipid-lowering drugs before and after PCI is also of great value.

Coronary heart disease is a chronic disease caused by many risk factors, and dyslipidemia is one of its important risk factors. Large-scale clinical trials have proved that statins are effective in lowering lipid, which can significantly reduce the morbidity and mortality of coronary heart disease. More and more clinical data show that statins play an important role in the overall prevention and treatment of coronary heart disease.

Objective to evaluate the long-term effect of asymmetric Amplatzer ventricular septal defect occlusion umbrella in the treatment of perimembranous ventricular septal defect. Methods A follow-up study was conducted on patients with perimembranous ventricular septal defect treated with eccentric Amplatzer ventricular septal defect occlusion umbrella. Results 65 cases (95.6%) of 68 patients were successfully occluded. The diameter of the defect measured by left ventricular angiography was 6.7 mm ± 2.3 mm, the distance between the upper edge of the ventricular septal defect and the aortic valve was 2.7 mm ± 1.1 mm, the diameter of the occlusion umbrella was 8.4 mm ± 2.1 mm, and the apical markers of the occlusion umbrella were located between 5: 30 and 6: 00. The average follow-up was 221 days ± 130 days (90~750 days). One case each had transient nodal rhythm and one case had accelerated ventricular autonomic rhythm within 24 hours after operation. 28 patients achieved the disappearance of residual shunt at ventricular septal level immediately after operation, 53 cases also achieved the same effect on the second day, and the defect was completely occluded at 6 months; Three patients had mild aortic regurgitation before operation, but there was no change in regurgitation during follow-up; One patient with mild mitral regurgitation before operation, no change after operation; Among the 4 patients with tricuspid valve insufficiency before operation, regurgitation disappeared in 1 case on the second day after operation, and echocardiography found that regurgitation disappeared in the other 3 cases at 3 months follow-up, and 1 patient developed deep vein thrombosis of lower limbs after operation; During the follow-up period, there were no death, no endocarditis, no shift of the occluding umbrella, no fracture of the occluding umbrella wire, no thrombosis on the surface of the occluding umbrella, no new complications such as aortic valve and tricuspid valve insufficiency, etc. Conclusion The asymmetric Amplatzer occluding umbrella for the treatment of perimembranous ventricular septal defect is effective in the medium and long term, safe and feasible.

Objective to observe the anti-inflammatory effect of atorvastatin in acute stage of cerebral infarction. Methods 131 patients with acute stage of cerebral infarction were randomly divided into 3 groups. Group A was the common treatment group (47 cases), group B was given atorvastatin 10 mg every night (42 cases), and group C was given atorvastatin 20 mg every night (42 cases), all of which were treated for 14 days. The changes of high-sensitivity C-reactive protein (hsCRP) and interleukin-6 (IL-6) were observed before, 7 days after and 14 days after treatment. The changes of blood lipid, neurological deficit score and biochemical indexes before and 14 days after treatment were compared, and the survival status of 6 months after onset of the disease was investigated. Results (1) The hsCRP decreased in all groups after treatment. The hsCRP decreased by 9.1%, 33.9% and 33.5% in groups A, B and C at 7 days and 34.3%, 56.0% and 56.8% at 14 days after treatment, respectively. The percentage of hsCRP decreased in groups B and C was more significant than that in group A, and the differences were statistically significant (all P<(2) After 7 days of treatment, IL-6 decreased by 44.2%, 50.8% and 49.2% in groups A, B and C, respectively, and decreased by 48.0%, 51.6% and 51.4% after 14 days, respectively. There was no significant difference in the percentage of decrease (all P>0.05). (3) There was no correlation between the decrease of hsCRP in group B and the percentage of decrease of total cholesterol (r =0.141, P =0.373), nor the percentage of decrease of low density lipoprotein cholesterol (LDL-C) (r =0.027, P =0.866). There was no correlation between the decrease of hsCRP in group C and the percentage of decrease of total cholesterol and LDL-C (r =0.126, P =0.427; r =0.069, P =0.662, respectively). (4) There was no significant effect on neurological deficit score and 6-month prognosis. Conclusion Atorvastatin has anti-inflammatory effect independent of lipid lowering in the acute stage of cerebral infarction, which is beneficial to alleviate the inflammatory damage secondary to the acute stage of cerebral infarction.

Objective to investigate the value of multi-slice spiral CT (MSCT) in the diagnosis of abnormal coronary artery origin. Methods From 2001 to 2005, 5000 patients with clinically suspected or diagnosed coronary artery disease underwent coronary artery MSCT (0.5 s spiral scan, retrospective ECG gating technique, single or double sector reconstruction algorithm, 0.625 mm or 1.25 mm slice thickness, 250 mm display field, 512×512 matrix, injection of contrast agent through elbow vein), and the CT images of left and right coronary arteries were reconstructed. Results MSCT detected abnormal coronary artery origin in 39 cases (0.78%), including 20 cases with high opening of right coronary artery, 16 cases with coronary artery originating from contralateral coronary sinus or coronary artery (11 cases with right coronary artery originating from left coronary sinus, 3 cases with left circumflex artery originating from right coronary artery or right coronary sinus, 1 case with right coronary artery originating from posterior coronary sinus, 1 case with left main coronary artery originating from posterior coronary sinus), 2 cases with single coronary artery (1 case with single left coronary artery and 1 case with single right coronary artery), One case of left anterior descending artery and left circumflex artery originated from left coronary sinus alone. Conclusion MSCT can be used for the diagnosis of abnormal origin of coronary artery.

Objective to evaluate the degree of myocardial perfusion after emergency percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) by combining TIMI myocardial perfusion classification (TMP) and percentage of total ST segment elevation (sumSTR). Methods 77 consecutive patients with AMI were evaluated by combining TMP and sumSTR to evaluate the degree of myocardial perfusion after emergency PCI. The events of death, reinfarction, revascularization, angina pectoris and heart failure within 2 years after follow-up; Left ventricular end-diastolic diameter (LVEDD) and ejection fraction (LVEF) were measured by echocardiography at 72 hours and 2 years after operation. Results Cox multivariate analysis showed that TMP grade was 0~1 with sumSTR<30% was an independent risk factor for cardiac events at 2 years after PCI (RR =13.186, 95% CI 2.149-80.917, P =0.005); The enlargement of LVEDD at 2 years after operation (7.1mm±1.9mm) in the poor myocardial perfusion group was greater than that in the good myocardial perfusion group (1.5 mm±1.2mm) (t =15.777, P<0.01); Chi-square test showed that the evaluation results of TMP combined with sumSTR were closely correlated with the cardiac function level 2 years after PCI (χ 2=50.58, P<Conclusion the combination of TMP and sumSTR has certain predictive value for cardiac events and cardiac function in patients with AMI 2 years after emergency PCI.

Objective to investigate the epidemic characteristics of obesity and overweight among middle-aged and elderly people in China and its relationship with common chronic diseases, so as to provide scientific basis for community prevention and treatment of obesity. Methods Using the epidemiological data of atrial fibrillation in 14 provinces and cities in China, 14 natural populations were selected for cluster sampling survey. According to the diagnostic criteria of overweight and obesity in Chinese adults recommended by China Obesity Working Group, the prevalence of obesity and overweight was statistically analyzed. Results The total prevalence of overweight in 14 provinces and cities was 38.93%, and the standardized rate was 37.17%; The overall prevalence of obesity was 13.94% and the standardized rate was 12.63%. The prevalence of obesity in women was significantly higher than that in men, and the prevalence of overweight in men was significantly higher than that in women (all P<0.001); The prevalence of overweight and obesity showed a certain regularity with the increase of age; The prevalence of hypertension increases significantly with the increase of body mass index (BMI). Conclusion the situation of overweight and obesity in China is severe, and it is urgent to strengthen the prevention and treatment of people. Weight control is of great significance to the prevention and treatment of chronic diseases such as hypertension.

Objective to compare the clinical efficacy of rapamycin-eluting stent and coronary artery bypass grafting (CABG) in the treatment of multi-vessel coronary artery disease. Methods the clinical data of 512 patients with multi-vessel coronary artery disease who underwent complete revascularization from January 2002 to December 2004 were analyzed. Among them, 262 patients underwent CABG and 250 patients underwent rapamycin-eluting stent. The clinical efficacy during perioperative period and follow-up period were compared. Results the success rate of rapamycin-eluting stent group was higher than that of CABG group (100% vs 96.6%, P<The total mortality rate and the incidence of major adverse cardiac events (MACE) during hospitalization were significantly lower than those in the CABG group (1.2% vs 5.3% and 1.6% vs 5.3%, both P<After discharge, the average follow-up time of the two groups was 19 months ± 14 months, and there were no significant differences in follow-up rate, MACE incidence, angina pectoris recurrence rate and event-free survival rate. However, the mortality rate of heart failure in CABG group was significantly higher than that in rapamycin-eluting stent group (10.9% vs 4.8%, P<0.05). Conclusion the long-term efficacy of rapamycin-eluting stent in the treatment of patients with multi-vessel coronary artery disease is comparable to that of CABG, and it is a better method for the treatment of patients with multi-vessel coronary artery disease.

Objective to investigate the influence of the first department of coronary angiography (CAG) on the mode of revascularization. Methods 2156 patients who underwent CAG and revascularization in our hospital from October 2003 to June 2004 were enrolled. The basic clinical and CAG characteristics, revascularization and inpatient clinical results of the patients were recorded, and the influence of the first department of CAG on the mode of revascularization of patients with coronary artery disease with different lesions and clinical characteristics was analyzed. Results Among 2156 patients, 1667 patients underwent CAG and revascularization in our hospital from October 2003 to June 2004, 1336 patients (80.1%) received percutaneous coronary intervention (PCI), 326 patients (19.6%) received coronary artery bypass grafting (CABG), and 5 patients (0.3%) received PCI + CABG; Among 489 patients with CAG, 52 (10.6%) underwent PCI and 437 (89.4%) underwent CABG. The rate of complete revascularization was 63.3% and 75.5%, respectively (P<0.01). The subgroup analysis revealed that the patients with left ventricular ejection fraction (LVEF) included 1 vessel lesion, 2 vessel lesions, 2 vessel lesions with proximal anterior descending artery, 3 vessel lesions, and 3 vessel lesions with LVEF<0.50. In all subgroups, the rate of CABG after the first diagnosis of surgical CAG was higher than that of the first diagnosis of internal medicine CAG (P<Multivariate Logistic regression analysis showed that CAG (OR 59.074, 95% CI: 39.319-88.753, P<In-hospital mortality (3.9%) and incidence of new myocardial infarction (1.8%) were higher in CAG patients with first surgical department than in CAG patients with first medical department (1.2% and 0.5%, respectively<Conclusion There are obvious differences in the choice of revascularization methods between cardiac surgeons and surgeons. It is necessary to accumulate more evidence-based medical data and formulate clear revascularization guidelines to guide cardiac surgeons and surgeons to choose more reasonable revascularization methods.

A 41-year-old male developed dull pain in the right lower chest and back without obvious trigger 2 months ago, sometimes dull pain, intermittently radiating to the right shoulder scapula, which had little relationship with breathing and movement; Accompanied by a small amount of cough and sputum, the sputum was white mucus-like and thick, and it required deep cough to cough up. The above symptoms were aggravated 3 days ago. He had chronic gastritis and cholecystitis in the past, and denied the history of hepatitis, tuberculosis and diabetes.

A 62-year-old female was admitted to the hospital on November 26, 2001 due to "fatigue, shortness of breath for 4 months, fever and joint pain for more than 1 month". The patient developed fatigue after traveling 4 months ago, shortness of breath after activity, which could be relieved after rest, but was not treated. One month ago, she developed fever without obvious trigger, with body temperature ranging from 37.5 to 38.5℃, aggravated by fatigue and shortness of breath, accompanied by pain in proximal interphalangeal joint and metacarpophalangeal joint of both hands.

In 2000, the World Health Organization declared that obesity has become an epidemic in most developed countries and developing countries with rapid economic growth [1]. 4.7% of adults in the United States suffer from obesity [2]. In 2002, an epidemiological survey found that the prevalence of obesity among people over 15 years old in Beijing was as high as 4.77% [3]. Obesity has been listed as the four major medical and social problems in the world along with AIDS, drug addiction and alcoholism.

After myocardial infarction, myocardial cells are permanently lost, and mature myocardium can not regenerate, so it is impossible to compensate for the pathological reduction of cell numbers through division and proliferation. Although recent studies have confirmed that a small number of myocardial cells undergo mitosis at the edge of infarction area after myocardial infarction, this division is very weak, and it is not enough to compensate for clinically significant necrotic myocardium.

Antiplatelet therapy is the conventional treatment of acute coronary syndrome and coronary heart disease after PCI. Studies have shown that the addition of clopidogrel in patients with acute coronary syndrome on the basis of aspirin therapy can further reduce the incidence of cardiovascular events [1, 2]. Clopidogrel itself has no antiplatelet activity, and it needs to be oxidized by liver cytochrome P450 (CYP) to become an active antiplatelet substance [3-5].

pulmonary thromboembolism (PTE) is a fatal cardiopulmonary disease, and its occurrence is mostly related to the thrombus shedding of deep vein thrombosis (DVT). Generally speaking, DVT is the source and PTE is the fruit. Without DVT, PTE rarely occurs. Therefore, the prevention of PTE lies in the prevention and treatment of DVT.

A 60-year-old female was found to be hypertensive for 2 years, with a maximum of 200/120 mm Hg (1 mm Hg =0.133 kPa), repeated chest tightness and nocturnal paroxysmal dyspnea. Coronary angiography was performed in another hospital, no abnormalities were found, and the diagnosis was "hypertension, acute left heart failure". She took digoxin 0.125 mg, once/d; Betaloc 25 mg, twice/d; Intermittently taking diuretics, blood pressure control was poor, but the symptoms were relieved.

A 25-year-old female was admitted to the hospital on June 7, 2005 due to sudden inmobility of the left limb and unclear speech for 3 days. The patient developed inmobility of the left limb, unclear speech, no headache and no vomiting for 3 days before admission. Her mother, grandmother and uncle all suffered from "congenital heart disease" and died of heart failure. Her aunt, 44 years old, also suffered from "congenital heart disease".

A 49-year-old male was admitted to the hospital on May 20, 2005 because of "25 years after aortic coarctation". At the age of 16, the patient had a blood pressure increase of 160/100 mm Hg (1 mm Hg =0.133 kPa) and was diagnosed as "aortic coarctation". In 1980, he underwent "descending aortic artificial blood vessel transplantation" in Changhai Hospital. After that, his blood pressure was still high for a long time, and he was treated with antihypertensive drugs. He could usually engage in daily activities without dizziness, chest pain and intermittent claudication.

whole-lung lavage (WLL) can remove dust and dust-swallowing macrophage (PAM) and inflammatory and fibrogenic factors in alveolar cavity and bronchioles in the treatment of pneumoconiosis, and has the effects of removing the etiology, improving respiratory function and relieving symptoms.

Myocardial injury caused by acute myocardial infarction (AMI) mainly includes myocardial apoptosis and necrosis. It has been confirmed that apoptosis plays an important role in early myocardial apoptosis compared with necrosis in AMI [1]. The mechanism of apoptosis is still unclear. One of the possible mechanisms is the induction of neurohumoral factors. AMI can induce an increase in the secretion of cytokines in vivo, such as interleukin (IL) 10 and tumor necrosis factor (TNF) α, which can specifically break the nuclear chromatin of myocardial cells and lead to myocardial apoptosis [2].

The characteristics of optical interference tomography (OCT) are similar to intravascular ultrasound (IVUS), but it has higher resolution and contrast, with a resolution of up to 10 μ m. It has been reported that intravascular OCT can obtain high-quality images and clearly show the anatomical structure of blood vessels [1-4].

Aspirin has been widely used as a conventional drug in the prevention and treatment of thromboembolic diseases.However, patients can not obtain uniform antiplatelet effect after taking aspirin, and there are obvious individual differences.Clinical observations have found that some patients who have been treated with aspirin still have cardiovascular thrombotic events [1].

On the eve of "World Heart Day" on September 25, the World Health Organization issued a warning in Geneva on September 22 that more than one billion people worldwide are overweight and obese, and if this situation continues uncontrolled, 1.5 billion people will be obese by 2015.

Smoking is harmful to health, and there is growing evidence that passive smoking at an early age can also have lifetime health effects. According to a survey of 35,000 non-smoking adults in Singapore, David et al., scholar of the National Institute of Environmental Health Sciences of the United States, and Koh et al., scholar of the National University of Singapore, found that living with smokers in early childhood will increase the probability of chronic cough and other respiratory problems in the future. Eating more fruit and bean fiber in adulthood has a protective effect, which can reduce the negative effects of passive smoking on health.