To explore the relation of angiotensin-converting enzyme (ACE) and angiotensin II type 1 receptor (AT1R) gene polymorphism with coronary heart disease (CHD) and the severity of coronary artery stenosis, 130 CHD patients who underwent coronary angiography were examined for the number of affected coronary vessels (> or = 75% stenosis) and coronary Jeopardy score. The insertion/deletion of ACE gene polymorphism and AT1R gene polymorphism (an A-->C transversion at nucleotide position 1166) were detected by using polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) in CHD patients and 90 healthy serving as controls. The results showed that DD genotype and of ACE were more frequent in CHD patients than that in control group (38.5% vs 14.4%, P<0.001). The frequency of the AT1R A/C genotypes did not differ between the patients and the controls (10% vs 13.1%, P>0.05). The relative risk associated with the ACE-DD was increased by AT1R-AC genotype. Neither the number of affected coronary vessels nor the coronary score differed among the ACE I/D genotypes (P>0.05). But the number of affected coronary vessels and the coronary score were significantly greater in the patients with the AT1R-AC genotype than in those with the AA genotype (P<0.05). In conclusion, DD genotype may be risk factor for CHD and MI in Chinese people, and is not responsible for the development of the coronary artery stenosis. The AT1R-C allele may increase the relative risk associated with the ACE-DD genotype, and may be involved in the development of the stenosis of coronary artery.
Coronary Disease/genetics ; Coronary Disease/pathology ; Coronary Stenosis/*genetics ; Coronary Stenosis/*pathology ; Peptidyl-Dipeptidase A/*genetics ; Polymorphism, Genetic ; Receptor, Angiotensin, Type 1/*genetics

Objective To investigate indications,pacing modes,pacing parameters and postoperative complications of pacemaker implantation for patients aged 80 years or over.Methods Patients were recruited on a continuous basis and were assigned into two groups,with 112 patients in the very elderly (80-90 years old) group and 484 patients in the elderly (60-79 years old) group,which served as the control.Follow-up observations with the two groups were conducted concerning indications,mode selection,pacing parameters and postoperative complications.Results Compared with the control group,the very elderly group showed:1) a higher rate of coronary heart disease (58cases vs.163 cases or 51.8％ vs.33.7％ ; x2 =12.78,P＜0.01) ; 2) more single-chamber pacemaker implantations (63 cases vs.217 cases or 56.3％ vs.44.8％; x2=4.76,P＜0.05) and fewer dual-or multi-chamber pacemaker implantations (49 cases vs.267 cases or 43.8％ vs.55.2％ ; x2 =4.76,P＜0.05) ; 3) a higher rate of double bundles branch block (19 cases vs.31 cases or 17.0％ vs.6.4％ ; x2=13.20,P＜0.01); 4) a higher rate of postoperative acute cerebral infarction (x2 =8.34,P＜0.01) ; and 5) increased ventricular [(0.78±0.24)V vs.(0.55±0.16)V,P＜0.05]and atrial [(1.07±0.22)V vs.(0.84±0.28)V,P＜0.05]pacing thresholds.Conclusions Special considerations should be made when pacemaker implantation is planned for patients aged 80 or over.Pacemaker selection decisions ought to be based on a comprehensive evaluation of relevant clinical situations so that clinical benefits can be maximized.

Objective Brain natriuretic peptide(BNP) is released from the cardiac ventricles in response to increased wall tension. The prognostic significance of blood brain natriuretic peptide in Chinese patients with cardiovascular disease has not been established. The purpose of this study was to investigate the value of brain natriuretic peptide for predictin g cardiac death within 1 month in Chinese patients with cardiovascular disease. Methods One hundred and seven inpatients with cardiovascular disease, whose blood brain natriuretic peptide concentration were measured within 1 - 3 days of admission, using triage BNP test, were divided into 2 groups: the survival and the non-survival, according to the results of 1was positively correlated with heart rate, left ventricular end-diastolic dimension, history of heart failure and old myocardial infarction (r=0.28, P=0. 000 4; r=0.49, P＜0. 000 5; r=0.39, P＜0. 000 5; r=Area under the curve of the receiver-operating-characteristic(ROC) of brain natriuretic peptide to predict cardiac death at 1 month in patients with cardiovascular disease was 0.89%, 95% confidence interval 0.79-0. 98, P＜0. 000 5; stepwise logistic regression analysis indicated that brain natriuretic peptide (≥755pg/mL) was the only independent predictor of cardiac death at 1 month in patients with cardiovascular disease (OR= 17.6, 95 % confidence interval, 8.7- 66.5, P＜0. 000 5 ). Conclusion Brain natriuretic peptide might predict cardiac death at 1 month in patients with cardiovascular disease.

Objective To explore the effects of walking exercise on glycometabolism,dynamic blood pressure and the quality of life of patients with both hypertension and type 2 diabetes on the basis of conventional drug treatment.Methods Sixty-two patients with both hypertension and diabetes who could support taking walking exercise of more than 5,000 steps/d were randomly divided into a walking exercise group (32 cases) and a control group (30 cases).Both groups were given conventional drug treatment (including valsartan,acarbose and metformin).Those in the walking exercise group took more than 10,000 steps/d of aerobic exercise while the patients in the control group were just given normal community care.This continued for a period of 3 months.Fasting plasma glucose (FPG),glycated hemoglobin-A1C (HbA1c),fasting insulin (FINS),the homeostasis model of assessment for insulin resistence index (HOMA-IR),the homeostasis model of assessment for insulin sensitivity (HOMA-IS),dynamic blood pressure parameters and quality of life were observed.Results In the walking exercise group,the FPG,HbA1c,FINS,HOMA-IR,HOMA-IS,dynamic blood pressure and quality of life indicators were all significantly different after 3 months of daily walking exercise compared with either baseline or the control group.Conclusion Accompanied by conventional drug therapy,10,000 steps/d of walking exercise can improve the glucose metabolism,dynamic blood pressure and quality of life of patients suffering from mild hypertension and type 2 diabetes.

Objective: To study the relationship between insulin resistance (IR) and coronary collateral circulation in patients with impaired glucose tolerance (IGT). Methods: A total of 227 patients with coronary angiography (CAG) were studied. There were 131 patients with male gender and the average patient’s age was (53.2 ± 11.0) years. IR (HOMA2-IR) index was measured by HOMA2 method, the severity level of coronary stenosis was assessed by Gensini scoring system, collateral circulation condition was determined by Rentrop classiifcation. 187 IGT patients were divided into 4 groups: Rentrop 0 group,n=55, Rentrop 1 group,n=42, Rentrop 2 group,n=39 and Rentrop 3 group,n=51; in addition, Control group,n=40 patients with normal glucose tolerance and coronary stenosis<50%. Results: Compared with Control group, all patients in 4 Rentrop groups had increased 2h-PBG, HbA1c, HOMA2-IR and Gensini score, while decreased fasting insulin (FINS), allP<0.05. Compared with Rentrop 3 group and Rentrop 2 group, the patients in Rentrop 1 group and Rentrop 0 group had elevated 2h-PBG, HbA1c, HOMA2-IR and Gensini score, while Rentrop 0 group had reduced FINS, allP<0.05. Multivariable regression analysis showed that HOMA2-IR index (R=0.518,P<0.05), HbA1c (R=1.916, P<0.05), 2h-PBG (R=2.130,P<0.05) and FINS (R=1.547,P<0.05) might be related to the severity of coronary stenosis. Binary regression analysis indicated that poor collateral circulation (the patients in Rentrop 0 group and Rentrop 1 group) was related to HOMA2-IR index (OR=1.679, 95% CI 1.101-2.558,P=0.016). Conclusion: HOMA2-IR index could be signiifcantly higher in patients with IGT combining chronic coronary occlusion. IR was the independent risk factor for the severity of coronary stenosis and coronary collateral formation.

Objective To investigate the differences of pre-hospital delay time in acute ST-elevation myocardial infarction (STEMI)between the advanced age group(>75 years old)and control group(≤75 years old).Methods Four hundreds patients with STEMI in the cardiology and emergency departments of the First Affiliated Hospital and Affiliated Luoyang Central Hospital of Zhengzhou University from January 2013 to March 2015 were selected and divided into two groups according to the age,the ad-vanced age group (>75 years old)and control group(≤75 years old).The patients′data were inquired and recorded for conducting the statistical analysis.Results The proportion of pre-hospital delay time < 6 h in the advanced age group was significantly lower than that in the control group and the time for conducting coronary angiography was longer than that in the control group,the differences were statistically significant(P <0.05).The mortality rates of intra-hospital,on 30 d and half a year after discharge in the advanced age group were higher than those in the control group,the differences between the two groups were statistically signif-icant (P <0.05).Conclusion The advanced age patients receiving active therapy are relatively less,which is mainly due to the wor-ry on the age related adverse reactions.

Objective To investigate the effect of thyroxine replacement therapy with residual subclinical hypothyroidism on the success rate of catheter ablation in elderly patients with atrial fibrillation(AF).Methods Among the consecutive patients with AF who underwent a first AF ablation in our center between 2009 and 2012,we identified 56 patients(41 paroxysmal AF,15 persistent AF)with subclinical clinical hypothyroidism after receiving thyroid hormone replacement therapy as study group.The control group consisted of 56 patients with euthyroidism and no history of thyroid dysfunction.All patients underwent catheter ablation.Results At the end of follow up,37.5%(21/56)patients were AF free after the first procedure in the study group,in comparison to 64.3%(36/56)in control group(χ2=8.655,P=0.003).Last procedure was performed in 27 patients of study group and in 15 patients of control group.After the last performed ablation,62.5%(35/56)study group patients and 80.4%(45/56)controls group patients had no recurrence(χ2=4.653,P=0.031).The major complications rate did not differ between two groups(P=0.642).Conclusions Thyroid hormone replacement therapy with residual subclinical hypothyroidism reduces catheter ablation success rate in elderly patients with atrial fibrillation.

Objective: To evaluate the efficacy and safety of three-dimensional electroanatomical mapping system for catheter ablation of paroxysmal supraventricular tachycardiain (PSVT) children. Methods: Clinical data from 187 children with paroxysmal supraventricular tachycardia undergoing radiofrequency catheter ablation in our department between January 2012 and April 2016 were analyzed. Among the patients, 91 cases were treated with traditional two-dimensional X-ray radiofrequency ablation, 96 cases were treated with radiofrequency ablation guided by three-dimensional electroanatomical mapping system. Postoperative electrocardiogram and echocardiography follow-up was performed at 1, 3, 6, 12, and 24 months. The success rate, recurrence rate, complication rate, operation time and amount of X-ray exposure were compared between the two groups. Kaplan-Meier survival curve was used to analyze the PSVT-free survival rate of the patients between the 2 groups. Results: The mean follow-up time was (739±92) days. The success rate (95.8%(92/96) vs. 94.5%(86/91), P=0.912), recurrence rate (5.4%(5/92) vs. 4.7%(4/86), P=0.807), complication rate (4.2%(4/96) vs. 5.5%(5/91), P=0.379), operation time ((73±31)min vs. (79±36)min, P=0.124) were similar between the two groups. However, X-ray exposure time ((8.1±2.9)min vs. (21.3±8.4)min, P=0.026), amount of X-ray ((23±11)mGy vs. (58±23)mGy, P=0.013) were significantly lower in the three-dimensional electroanatomical mapping system group than in the traditional two-dimensional X-ray radio frequency ablation group. PSVT-free survival rate was similar between the two groups (χ²=0.060, P=0.807) . Conclusion Three-dimensional electroanatomical mapping system is safe and effective for radiofrequency ablation of paroxysmal supraventricular tachycardia in children, and can significantly reduce the amount of radiation as compared to the traditional two-dimensional X-ray radiofrequency ablation.

Objective To ohserve the effect of individualized exercise programs on the activity tolerance and life quality of heart failure patients with a preserved ejection fraction.Methods Heart failure patients with a preserved left ventricular ejection fraction (LVEF) were randomized to an exercise training group (n=55) or a control group (n =53).Both groups were given optimized heart failure drug therapy,while the exercise training group was additionally provided with individualized exercise training.The LVEFs,6-minute walking distances (6MWDs),Minnesota living with heart failure questionnaire (MLHFQ) scores and adverse events were noted before the experiment and after 12 months of the intervention.Results After one year,no significant differences were found in the groups' average LVEFs or in the ineidence of adverse events,while the average 6MWD and the average MLHFQ score of the exercise training group were significantly better than those of the control group.The average MLHFQ seore decrease (7.8 points) was statistically and practically significant.Conclusion Individualized exercise training can significantly improve the activity tolerance and quality of life of patients with a preserved ejection fraction.It is safe,but the impacts on the ejection fraction are small.

To explore the relation of angiotensin-converting enzyme (ACE) and angiotensin Ⅱ type 1 receptor (AT1R) gene polymorphism with coronary heart disease (CHD) and the severity of coronary artery stenosis, 130 CHD patients who underwent coronary angiography were examined for the number of affected coronary vessels (≥75% stenosis) and coronary Jeopardy score. The inser- tion/deletion of ACE gone polymorphism and ATIR gene polymorphism (an A→C transversion at nucleotide position 1166) were detected by using polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) in CHD patients and 90 healthy serving as controls. The re- sults showed that DD genotype and of ACE were more frequent in CHD patients than that in control group (38.5% vs 14.4%, P<0.001). The frequency of the AT1R A/C genotypes did not differ between the patients and the controls (10% vs 13.1%, P0.05). The relative risk associated with the ACE-DD was increased by ATIR-AC genotype. Neither the number of affected coronary vessels nor the coro-nary score differed among the ACE I/D genotypes (P0.05). But the number of affected coronary vessels and the coronary score were significantly greater in the patients with the AT1R-AC genotype than in those with the AA genotype (P<0.05). In conclusion, DD genotype may he risk factor for CHD and MI in Chinese people, and is not responsible for the development of the coronary artery stenosis. The AT1R-C allele may increase the relative risk associated with the ACE-DD genotype, and may be involved in the development of the stenosis of coronary artery.