Objective To summarize experience in treating patients with native value endocarditis ( NVE) , and discuss the effect of timing of surgery on the infection control , cardiac function recovery and long-term mortality among patients . Methods Eighty NVE cases with antibiotic treatment were recruited between January 2006 and May 2013 .According to the timing of surgery, the subjects were divided into the early surgery group (38 cases) and the late surgery group (42 ca-ses) .The infection-related markers and cardiac function indexes before and after surgery , and 1-year, 3-year and 5-year mortality after surgery were analyzed .Results The infection control and recovery of cardiac function in the early surgery group were better than in the late surgery group (P<0.05).The difference in 3-year and 5-year mortalities between the two groups was significant .Conclusions For NVE patients with routine antibiotics treatment , the surgical effect and long-term survival rate are much better in the early surgery group than in the late surgery group .

AIM:To investigate the effect of nuclear factor kappa B(NF-?B)on proliferation,apoptosis and the expression of TGF-?1 in airway smooth muscle cells(ASMCs).METHODS:Cultured ASMCs were divided into three groups and stimulated with or without TNF-? and pyrrolidine dithiocarbamate(PDTC)in vitro.Reverse transcriptase-polymerase chain reaction(RT-PCR)was used to detect the expression of TGF-?1 mRNA.The location and protein expression of PCNA and Bcl-2 were observed by immunocytochemical staining.The protein expression of TGF-?1 and NF-?B was detected by Western blotting.The proliferation and apoptosis of ASMCs were also observed.RESULTS:The activity of NF-?B in TNF-? group was significantly higher than that in control group and TNF-? plus PDTC group,respectively(P

Objective:To explore the effect of red blood cell distribution width (RDW) on long-term follow-up study in patients with acute pulmonary thromboembolism (APE).
Methods:A total of 214 consecutive patients with the first episode of APE admitted in our hospital from 2009-01 to 2012-12 were enrolled. The patients were divided into 2 groups:RDW≤15%group, n=202 and RDW>15%group, n=12. Baseline RDW was measured at admission, the follow-up study was conducted at 3, 6, 12 months thereafter, and then at once per year. The major primary end point was chronic thromboembolic pulmonary hypertension (CTEPH). The independent predictor for CTEPH occurrence was studied by uni-and multivariate logistic regression analysis and the predictive capability of RDWwas evaluated by ROC curve.
Results: All patients ifnished the follow-up study at the mean of (31±17) months. The overall occurrence rate of CTEPH was 7.5% (16/214), which was higher in RDW>15% group than that in RDW≤15% group (33.3% vs 5.9%, P=0.002). Multivariate logistic regression analysis indicated that with adjusted clinical data and other predictors, RDW>15%was still the strong predictor for CTEPH occurrence (OR=7.916, 95%CI 1.474-42.500, P=0.016). Adding RDW to the evaluating model, the predictive capability could be signiifcantly improved by ROC curve (AUC increased from 0.856 to 0.901, P<0.01).
Conclusion: Elevated RDW is the independent predictor for CTEPH occurrence in APE patients, which is helpful to estimate the prognosis and treatment strategy in APE patients.

Objective: To explore the effect of calcium channel blocker (CCB) treatment in patients of idiopathic pulmonary arterial hypertension (IPAH) with positive acute pulmonary vasodilator test, and to compare the hemodynamic differences between the positive and negative patients.
Methods: A total of 156 consecutive IPAH patients with acute pulmonary vasodilator test were studied. The patients were divided into 2 groups according to the testing result. Positive group, n=23 and Negative group, n=133. The positive patients were followed up by clinical or telephone visit to investigate their CCB dose, WHO PAH cardiac classiifcation and the survival conditions. Kaplan-meier curve was conducted to analyze the living condition and t test was used to compare the hemodynamic differences between the positive and negative patients.
Results: There were 43 male and 113 female patients at the male/female ratio of 1: 2.6, and 14.7% (23/156) positive patients. The average follow-up period for Positive group was (50.9 ± 3.8) months. There were 13 patients using diltiazem with the mean dose of (277 ± 108) mg/d at the range of (90-450) mg/d; 3 patients using amlodipine, 1 with the dose of 15mg/d and 2 with the dose of 7.5mg/d. The 1, 2 and 3 years survival rate for the positive patients were for 91.3%, 86.6% and 79.7% respectively. The mean pulmonary arterial pressure and pulmonary vascular resistance were lower, P=0.000, while the mixed venous oxygen saturation was higher in Positive group than Negative group, P=0.009.The NT-pro BNP level was lower in Positive group, P=0.001.
Conclusion: IPAH patients has lower ratio of positive acute pulmonary vasodilator test. The positive patients has the higher 1, 3 and 5 years survival rate and better hemodynamic parameters as the mean pulmonary arterial pressure, pulmonary vascular resistance and better level of NT-pro BNP.

Objective: To evaluate cardiopulmonary exercise testing (CPET) on sildenaifl effect for treating the patients with pulmonary arterial hypertension (PAH). Methods: A total of 25 PAH patients received sildenaifl treatment in our hospital from 2012-01 to 2014-01 were enrolled as PAH group, in addition, there were a Control group including 24 healthy subjects. The CPET, echocardiography, NYHA function class, 6-mimute walking distance (6MWD) and plasma levels of NT-proBNP at the baseline, (6-12) months and (13-18) months after sildenaifl treatment were assessed and compared between 2 groups. Results: Compared with Control group, PAH group showed decreased aerobic capacity (peakVO?2, Peak O2pulse) and ventilation efifciency (PETCO2@AT, VE?/VC?O2@AT), allP<0.05. At (8±2) months after sildenaifl treatment, aerobic capacity and ventilation efifciency was improved, meanwhile, NYHA function class, 6MWD and plasma levels of NT-proBNP were improved, allP<0.05. At (16±2) months after sildenaifl treatment, 6MWD was similar,P=0.26, while peak VO?2 and peak O2 pulse were decreased than they were at (8±2) months after sildenaifl treatment,P=0.04 and 0.06; the ventilation efifciency was elevated (as presented by increased VE?/VC?O2@AT and decreased PETCO2@AT,P=0.04 and P=0.04); plasma level of NT-proBNP was increased,P=0.05. Conclusion: CPET can effectively evaluate sildenaifl effect for treating PAH patients and therefore and guide the drugs therapy.

OBJECTIVEThis retrospective study is performed to analyze the epidemiological and clinical features of patients with infective endocarditis (IE) hospitalized in Fuwai Cardiovascular Hospital during the latest 7 years.

METHODSThis retrospective study included a cohort of 368 infective endocarditis patients hospitalized in Fuwai Hospital form August 2005 to August 2012. Predisposing cardiac diseases, causative organisms, clinical features and outcomes were analyzed. Risk factors related to outcome including NYHA classes, causative organisms and complications, were evaluated.

RESULTSAmong the IE patients, 6.8% (25/368) patients had rheumatic heart diseases 31.8% (117/368) had congenital heart diseases, 22.8% (84/368) were post-PCI or operative endocarditis and IE developed in 14.1% (52/368) patients without previous cardiac diseases. Blood culture positive rate was 46.2% (170/368). Streptococci viridians [27.6% (47/170) ]were the most common causative organisms, followed by coagulase-negative staphylococci [15.9% (27/170) ]. Fever and cardiac murmur were the most common clinical presentations. Congestive heart failure was the most common complication [87.8% (323/368)]. Systemic and pulmonary embolism occurred in 16.0% patients, 80.9% IE was detected by echocardiography. In-hospital mortality rate was 6.7%, mostly due to refractory congestive heart failure and sepsis. Subgroup analysis showed that incidence of post-PCI or operative endocarditis was significantly higher in IE patients hospitalized after 2009 compared to IE patients hospitalized before 2009 (27.5% vs. 19.2%, P < 0.05) . Higher incidence of staphylococcal infection was evidenced in mechanical valves than in native valves (44.4% vs. 19.8%, P < 0.05).

CONCLUSIONDuring the past decade, there is a significant change on epidemiology and clinical features of IE in China. Incidence of post-surgical and interventional IE increased significantly. Staphylococcal and Gram negative bacilli infection are major pathorganisms of endocarditis of mechanical valves. Due to the lower positive rate of blood culture, echocardiography serves as the most important diagnostic tool for infective endocarditis.

Adult ; Endocarditis ; epidemiology ; microbiology ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Risk Factors

Objectives: To explore weather oxygen uptake efficiency slope (OUES) may predict the prognosis in patients with idiopathic pulmonary arterial hypertension (IPAH). Methods: The consecutive newly diagnosed IPAH patients in our hospital from 2010-11 to 2015-06 were prospectively enrolled and regular follow-up study was conducted to record cardiovascular events (death and lung transplantation). Kaplan–Meier curve, uni- and multivariate Cox regression analysis were performed to assess the survival rate in relevant patients. Results: A total of 210 IPAH patients at the mean age of (32±10) years were finished cardiopulmonary exercise test (CPET) and received regular follow-up study including 159 female. There were 31 patients died and 1 received lung transplantation over 41 months follow-up period. OUES was positively related to peak oxygen uptake (VO2)/body weight (r=0.71, P<0.0001). Multivariate analysis demonstrated that OUESI and NT-proBNP could independently predict the prognosis of IPAH patients. The 5-year survival rate in patients with OUESI≤0.52 L/(min?m2) was lower than those with OUESI>0.52 L/(min?m2) (41.9% vs 89.8%), P<0.0001.Conclusion: OUES as a submaximal CPET parameter may well predict the prognosis in IPAH patients.

Objectives:To evaluate the tricuspid valve(TV)geometric remodeling in patients with idiopathic pulmonary arterial hypertension(IPAH)by three-dimensional transthoracic echocardiography. Methods:Two-dimensional and three-dimensional transthoracic echocardiography were performed in 30 IPAH patients and 15 healthy controls,and the geometry parameters of TV were obtained by four-dimensional auto tricuspid valve quantitative(4D Auto-TVQ)in the right ventricular-focused apical view.Pulmonary arterial hypertension was determined by right heart catheterization within 48 hours of echocardiography. Results:The 4-chamber diameter,tricuspid annular(TA)perimeter,TA area,maximal tenting height,coaptation point height and tenting volume were larger in IPAH patients than those in healthy controls(all P＜0.05),2-chamber diameter was similar between two groups.In IPAH group,maximal tenting height and coaptation point height were moderately correlated with right ventricular end-diastolic volume(r=0.710,r=0.515,both P＜0.05),while TA perimeter,4-chamber diameter and TA area were moderately correlated with right atrial end-systolic volume(r=0.712,r=0.558,r=0.545,all P＜0.05). Conclusions:IPAH patients have larger maximal tenting height,coaptation point height and tenting volume,TA enlargement is mainly visible in 4-chamber diameter.TV tenting height is associated with right ventricular volume,but TA size is associated with right atrial volume in IPAH patients.

BACKGROUND: Coronary artery disease (CAD) is the commonest cause of heart failure (HF), whereas pulmonary hypertension (PH) has not been established or reported in this patient population. Therefore, we assessed the prevalence, risk factors, and survival in CAD-associated HF (CAD-HF) complicated with PH. METHODS: Symptomatic CAD-HF patients were continuously enrolled in this prospective, multicenter registry study. Echocardiography, coronary arteriography, left and right heart catheterization (RHC), and other baseline clinical data were recorded. Patients were followed up and their survival was recorded. RESULTS: One hundred and eighty-two CAD-HF patients were enrolled, including 142 with HF with a preserved ejection fraction (heart failure with preserved ejection fraction [HFpEF]; left ventricular ejection fraction [LVEF] ≥50%) and 40 with a reduced ejection fraction (heart failure with reduced ejection fraction [HFrEF]; LVEF < 50%). PH was diagnosed with RHC in 77.5% of patients. Patients with PH showed worse hemodynamic parameters and higher mortality. HFrEF-PH patients had worse survival than HFpEF-PH patients. CAD-HF patients with an enlarged left ventricular end-diastolic diameter and reduced hemoglobin were at higher risk of PH. Nitrate treatment reduced the risk of PH. Elevated creatinine and mean pulmonary arterial pressure (mPAP), diastolic pressure gradient (DPG) ≥7 mmHg, and previous myocardial infarction (MI) entailed a higher risk of mortality in CAD-HF patients with PH. CONCLUSIONS: PH is common in CAD-HF and worsens the hemodynamics and survival in these patients. Left ventricle enlargement and anemia increase the risk of PH in CAD-HF. Patients may benefit from nitrate medications. Renal impairment, elevated mPAP, DPG ≥7 mmHg, and previous MI are strong predictors of mortality in CAD-HF-PH patients. TRIAL REGISTRATION ClinicalTrials.gov, NCT02164526.
Coronary Artery Disease/epidemiology* ; Creatinine ; Heart Failure/complications* ; Humans ; Hypertension, Pulmonary/complications* ; Nitrates ; Prevalence ; Prognosis ; Prospective Studies ; Registries ; Risk Factors ; Stroke Volume ; Ventricular Function, Left