Objective To investigate the effect of large dosage of spironolactone on cardiac function and plasma level of brain natriuretic peptide (BNP) in elderly patients with chronic heart failure (CHF).Methods Totally 68 cases with CHF (NYHA cardiac function class Ⅲ and Ⅳ) were randomly divided into study group (with adding spironolactone 20 mg/d and 60 mg/d to conventional treatment,n =34) and control group (conventional treatment,n =34).The cardiac function and plasma level of BNP were evaluated after 6 months treatment.Results The post-treatment plasma level of BNP dropped from ( 921.4 + 284.5) ng/L to ( 316.4 ± 193.3 ) ng/L in study group (t=14.722,P=0.000) and from (904.3 + 274.0) ng/L to (481.3 ± 202.5) ng/L in control group (t=9.271,P=0.000) with significant difference in posttreatment BNP level between two groups (t=4.280,P=0.011).The values of left ventricular ejection fraction (LVEF) were higher after treatment than before treatment in study group[(32.2 + 4.7) ％ vs.(45.1 + 6.2) ％,t =6.820,P=0.004]and in control group[(31.8±5.1) ％ vs.(38.3+5.7)％,t=5.283,P=0.008],and the post-treatment LVEF was much higher in study group than in control group (t=3.844,P=0.017).The value of left ventricular end diastolic diameter (LVEDD) dropped significantly after treatment as compared to before treatment in study group[(58.6±4.4) mm vs.(45.7±4.4) mm,t =5.822,P=0.006]and in control group[(59.1±5.2) mm vs.(52.4±4.8) mm,t=3.018,P=0.024],and there was remarkable difference in LVEDD value between the two groups after treatment (t=3.393,P=0.020).The cardiac function after treatment was markedly improved as compared to before treatment in study group (x2=5.527,P=0.009) and in control group (x2=4.180,P=0.013),and the study group showed a more satisfactory result than control group (x2 =3.273,P=0.022).The incidence of side effects were 11.76％ in the study group and 8.82％ in control group with no significant difference (P=0.116).Conclusions Large dosage of spironolactone added to the conventional therapy may significantly improve cardiac function and decrease plasma BNP,especially for the elderly patients with severe CHF.

Growth differentiation factor(GDF)-15,a distant member of the transforming growth factor-? cytokine superfamily,is a powerful cardioprotective factor.Many studies have demonstrated that serum GDF-15 level is a novel marker closely associated with the diagnosis,risk stratification,and prognosis of several cardiovascular diseases.This article mainly reviews the characteristics of GDF-15 and its multifunction in cardiovascular diseases.

Objective To investigate the safety and efficacy of Left atrial linear ablation of paroxysmal atrial fibrillation guided by three-dimensional electroanatomical system. Methods 29 patients with paroxysmal atrial fibrillation in this study. A nonfluoroscopic mapping system was used to generate a 3D electroanatomic LA mapping, and all pulmonary vein ostia were marked under the help of pulmonary veins angiography on the 3D map. Radiofrequency (RF) energy was delivered to create continuous linear lesions encircling the pulmonary veins. It was delivered with a target temperature of 43℃, a maximal power limit of 30W and applied for ≥20 seconds until the maximal local electrogram amplitude decreased by ≥50%. The ablation was completed by finishing the circular line. Results The mean procedure duration was 180?18 minutes, with mean fluoroscopy time of 80?20 minutes. The average number of RF pulses was 120?15. After a follow-up of 6.0 months, 24 patients maintained sinus rhythm. 3 patients suffered from less frequent paroxysmal atrial fibrillation during the first 3.0 months after the ablation and remained Af free after 6 months. 1 patient had atrial fibrillation episodes and 1 patient had atrial fibrillation attacks unchanged. No pulmonary vein narrowing was observed. Conclusion Left atrial linear ablation of paroxysmal atrial fibrillation guided by three-dimensional electroanatomical system was safe and effective.

The association between fasting plasma ghrelin levels and insulin resistance and blood pressure (BP) in octogenarians was investigated in this study. A total of 487 unrelated octogenarians (including 203 men and 284 women) were enrolled in this cross-sectional study at the Healthy Care Center of Shanghai East Hospital, Tongji University, China, from October 2008 to April 2009. Plasma ghrelin was determined by using the enzyme linked immunosorbent assay (ELISA). Insulin sensitivity was assessed using the homeostasis model of assessment-insulin resistance (HOMA-IR). The age of the participants ranged from 80 to 89 years (mean=83.9+/-4.8 years) with a body mass index (BMI) of 25.3+/-4.9 kg/m(2). Plasma ghrelin levels were 20.94+/-5.34 mug/L, being 20.89+/-5.53 mug/L in men and 21.38+/-3.73 mug/L in women respectively. Plasma ghrelin was not associated with systolic (P=0.981) or diastolic (P=0.724) BP, waist circumference (P=0.278), fasting insulin (P=0.246), fasting blood glucose (FBG) (P=0.693) and HOMA-IR (P=0.232). In the control cohort, no significant differences in plasma ghrelin were found between genders (P=0.489), and among subjects with hypertension (BP>140/90 mmHg) (P=0.284) and type 2 diabetes (P=0.776). In conclusion, fasting plasma ghrelin levels are not directly correlated with insulin resistance and BP among octogenarians.

A total of 167 coronary heart disease (CHD) patients were divided into metabolic syndrome (MS) group (68 cases) and non-MS group (99 cases). There were significant differences in the disease-related metabolic indicators and coronary angiography (multivessel lesions, diffuse stenosis, occlusive lesions, Ginsini score) between MS group and non-MS group ( all P<0.05 ). When the patients with MS were divided into 3 groups according to the number of componernts of MS, three lesions, diffuse stenosis, and occlusive lesions were more frequent in five components group compared with three components group. Ginsini points rised with the increased risk factors. There existed differences in Ginsini score between three components group and four, five components group (P<0. 05 or P<0.01 ). Multivariable logistic regression analysis showed that obesity, hypertension,diabetes, high low-density lipoprotein-cholesterol, and low high-density lipoprotein-cholesterol were the predictors of CHD in patients with MS (P<0.05 or P<0.01 ).

AIM: To investigate the effects of angiotensin-converting enzyme inhibitors (ACEI), fosinopril, captopril and angiotensin II AT 1 antagonists, valsartan on tissue factor (TF) expression on monocytes induced by lipopolysaccharide (LPS). METHODS: Mononuclear leukocytes from normal delivered female umbilical veins were incubated with bacterial LPS in presence or absence of different ACE inhibitors .At the end of incubation, the cells were disrupted by 3 freeze-thaw cycles. TF procoagulant activity was assessed by a one-stage clotting assay. RT-PCR was used to check TF mRNA expression, and GAPDH mRNA was used for parallel assay. RESULTS and CONCLUSION: The results showed that increased expression of TF mRNA induced by LPS was inhibited by fosinopril, captopril and valsartan, respectively, and the procoagualant activity of monocytes was also reduced. [

The association between fasting plasma ghrelin levels and insulin resistance and blood pressure(BP)in octogenarians was investigated in this study.A total of 487 unrelated octogenarians (including 203 men and 284 women)were enrolled in this cross-sectional study at the Healthy Care Center of Shanghai East Hospital,Tongji University,China,from October 2008 to April 2009.Plasma ghrelin was determined by using the enzyme linked immunosorbent assay(ELISA).Insulin sensitivity was assessed using the homeostasis model of assessment-insulin resistance(HOMA-IR).The age of the participants ranged from 80 to 89 years(mean=83.9±4.8 years)with a body mass index(BMI)of 25.3±4.9 kg/m2.Plasma ghrelin levels were 20.94±5.34 μg/L,being 20.89±5.53 μg/L in men and 21.38±3.73 μg/L in women respectively.Plasma ghrelin was not associated with systolic(P=-0.981)or diastolic(P=0.724)BP,waist circumference(P=0.278),fasting insulin(P=0.246),fasting blood glucose(FBG)(P=0.693)and HOMA-IR(P=0.232).In the control cohort,no significant differences in plasma ghrelin were found between genders(P=0.489),and among subjects with hypertension (BP＞140/90 mmHg)(P=0.284)and type 2 diabetes(P=0.776).In conclusion,fasting plasma ghrelin levels are not directly correlated with insulin resistance and BP among octogenarians.