Objective To analyze the correlation between septal branch characteristics and the prognosis of alcohol septal ablation ( ASA ) in patients with hypertrophic obstructive cardiomyopathy . Methods The clinical , echocardiographic , angiographic and procedural characteristics were analyzed retrospectively in 55 patients.Good prognosis was defined as left ventricular outflow tract gradient decreased by 50%at long term follow-up.The characteristics of septal branch were analyzed in terms of QCA .Results There were no differences in the length of the ablated septal branch , sizes of the adjacent branches , distances between the septal branch and the ostia of the coronary arteries and the volume of alcoholo consumed ( all P>0.05).Compared with poor prognosis group (n =27), the diameter of the ablated septal branches were significantly larger in the good prognosis group ( n=28 ) [ ( 1.75 ±0.36 ) mm vs.( 1.48 ±0.41 ) mm, P=0.012].The distance between the ablated branch and its adjacent branch was farer in the good prognosis group [(18.80 ±10.20)mm vs.(13.04 ±6.65)mm, P=0.020].In multivariate analysis, the diameter of the ablated branch (OR 9.258,95%CI 1.427-60.069, P=0.020)and the distance between the ablated septal branch and its adjacent septal branch (OR 1.102,95% CI 1.002-1.213, P =0.046) were found to be independent risk factors for good prognosis of ASA .Conclusions The diameter of the ablated septal branch and the distance between its adjacent septal branch are associated with better prognosis of ASA .

Objective: To assess the effect of percutaneous transluminal septal myocardial ablation (PTSMA) on mid- to long-term left ventricular diastolic function in patients with hypertrophic obstructive cardiomyopathy (HOCM) by real-time three-dimensional echocardiography (RT-3DE). Methods: A total of 46 HOCM patients who received 2DE and RT-3DE examination before and after (with the mean of 18.8 months) PTSMA were studied. The ratios of E/A and E/Ea were analyzed, RT-3DE was conducted to collect the images, to obtain 17-segmant volume-time curve and to calculate the parameters of rEDV, rESV, rSV and rPFR respectively. Results: The follow-up echocardiography in all 46 patients indicated that the ratio of E/Ea decreased after the operation (12.04 ± 3.29) vs (15.70 ± 5.68),P<0.001, the rSV of left ventricular anterior wall middle segment and anterior septal middle segment decreased after the operation,P<0.05, while the rPFR of anterior septal middle segment, rear septal middle segment and apical segment increased,P<0.05. Conclusion: PTSMA may improve local left ventricular diastolic function in HOCM patients, RT-3DE provides a new method and viewing angle for HOCM evaluation.

Objective: To explore the changing features of plasma amino-terminal pro-B-type natriuretic peptide (NT-proBNP) level in patients with hypertrophic obstructive cardiomyopathy (HCM) after alcohol septal ablation (ASA). Methods: A total of 82 HCM patients treated by ASA in our hospital were studied. According to plasmalevel of NT-proBNP, the patients were divided into 2 groups: High NT-proBNP group and Low NT-proBNP group,n=41 in each group. Plasma NT-proBNP was examined by ELISA; ventricular septal thickness (VST), left ventricular posterior wall thickness (LVPWT), maximal ventricular wall thickness (MLVWT) and left atrial diameter (LAD) were measured by echocardiography. There were 50 patients ifnished 1 year clinical or in-hospital follow-up, their NT-proBNP level and echocardiography were detected at 2 days and 1 year post-operation.The relationship between echocardiography parameter and NT-proBNP level was assessed; NT-proBNP was compared between pre- and 2 days, 1 year post-operation. Results:①In all 82 patients: compared with Low NT-proBNP group, High NT-proBNP group had increased VST (23.66±6.46) mm vs (20.79±4.56) mm,P=0.035, LVPWT (12.79±2.99) mm vs (11.50±2.35) mm,P=0.048, MLVWT (28.03±5.66) mm vs (25.18±4.81) mm,P=0.027 and LAD (40.73±4.86) mm vs (38.08±6.17) mm,P=0.049.②In 50 patients who ifnished 1 year follow-up study: compared with pre-operation, NT-proBNP level was slightly increased at 2 days post-operation (1841.79±1310.88) fmol/ml vs (1552.15±951.57) fmol/ml,P=0.066, while decreased at 1 year post-operation (1038.46±714.03) fmol/ml vs (1552.15±951.57) fmol/ml,P=0.000. Conclusion: Plasma NT-proBNP level was affected by atrial size and ventricular thickness in HCM patients, it may obviously decrease during long-term follow-up period.

Objective To investigate protective effect of tribulus terrestris L (TTL) on photoreceptor in the model of light-induced retinal degeneration.Methods BALB/c mice were exposed to bright light at the intensity of 10 000 lux for 30 minutes to establish the retinal light damage models.The BALB/c mice were divided into normal control group,model group and treatment group,6 cases in each group.TTL decoction was intraperitoneally administered to mice 30 minutes prior to illumination in the treatment group.Saline vehicle was administered in the normal control group and model group.Photoreceptor protection of TTL was assessed by optical coherence tomography (OCT) at 3 hours and 7 days after illumination.Gross histology and immunohistochemistry approaches were also taken to examine the retinal protection conferred by TTL at 7 days after bright light exposure.Results Compared to normal retinal morphology in the normal control group,prominent photoreceptor loss and diminished rod and cone photoreceptors evidenced by attenuated retinal expression of rhodopsin and M-opsin were observed in the model group.In contrast,TTL treatment resulted in significant protection against bright light-induced photoreceptor degeneration and remarkable preservation of rod and cone photoreceptor cells.The outer retinal nuclear layer in the model group was thinner than that in the normal control group (P ＜ 0.05),but the treatment group was thicker than the model group (P ＜ 0.05).Conclusion Bright light induces obviously degeneration in photoreceptors in BALB/c mice.Moreover,TTL is shown for the first to significantly protect the photoreceptors from bright light-induced degeneration.

Objective:To evaluate the independent prognostic value of minute ventilation/carbon dioxide production slope (VE/Vco 2 slope)on heart failure after acute myocardial infarction. Methods:131 patients with acute myocardial infarction (AMI) treated in the cardiology department of China-Japan Friendship Hospital from September 2018 to September 2019 were collected and followed up 3 months after discharge. They were divided into heart failure (HF) group and non-heart failure (NHF) group. All the patients underwent cardiopulmonary exercise test (CPET) before discharge.Results:Three months after discharge, the VE/Vco 2 slope was higher in HF group than in NHF group (36.7±3.8 vs 29.7±4.0, P=0.014). The best VE/Vco 2 slope cutoff for the prediction of heart failure after 3 month was 33.05 with a sensitivity of 81.4% and a specificity of 80.6% [area under curve (AUC) was 0.844, P<0.001]. VE /Vco 2 slope level was an independent predictor of heart failure in patients with acute myocardial infarction after discharge ( OR=1.245, 95% CI: 1.021-1.366, P=0.019). Other independent indicators related to heart failure included N-terminal pro-B type natriuretic peptid (NT-proBNP) level ( OR=1.283, 95% CI: 1.019-1.399, P=0.033). Conclusions:VE/Vco 2 slope yielded strong, independent predictive value for heart failure at 3 month after discharge to AMI patients.

Objective:To investigate the effect of astragaloside A (AS-A) on the photoreceptor degeneration induced by sodium iodate (NaIO 3) and its related mechanism. Methods:Sixty healthy male C57BL/6J mice, aged 6-8 weeks, were randomly divided into normal control (NC) group, NaIO 3 group, and ASA group, with twenty mice in each group. 30 min before modeling, AS-A group mice were intraperitoneally injected with 100 μl AS-A at a dose of 100 mg/kg body weight. 30 min later, mice in NaIO 3 group and AS-A group were intraperitoneally injected with 100 μl NaIO 3 at a dose of 30 mg/kg body weight. Subsequently, AS-A group mice were administered AS-A twice daily at 12 h intervals until the end of the experiment. On day 1 post-modeling, zonula occludens-1 (ZO-1) immunohistochemistry was performed to observe the structure of retinal pigment epithelium (RPE) cells; real-time quantitative polymerase chain reaction (qPCR) was conducted to detect the mRNA expression of various retinal chemokine ligand-2 ( Ccl2), interleukin-1 beta ( Il-1β), mixed lineage kinase domain-like protein ( Mlkl), receptor-interacting protein kinase 3 ( Ripk3), and tumor necrosis factor ( Tnf). On day 3 post-modeling, immunohistochemistry was performed to observe the expression of ionized calcium binding adaptor molecule 1 (Iba1) and glial fibrillary acid protein (GFAP) in the retina; TdT-mediated dUTP nick-end labeling (TUNEL) assay was used to detect photoreceptor cell death in each group. On day 4 post-modeling, fundus morphology of mice in each group was observed by fundus color photography and optical coherence tomography (OCT). Hematoxylin-eosin staining (HE) was used to observe the morphological structure of the retina in each group. Inter-group comparisons between two groups were conducted using independent samples t-test, while comparisons among three groups were performed using one-way ANOVA. Results:Fundus color photography and OCT examination showed that a large number of scattered yellow-white subretinal nodular structures in the fundus of NaIO 3 group mice, and a large number of strong reflection areas in the RPE layer. The number of strong reflection areas in the RPE layer was reduced in the AS-A group. Immunohistochemical analysis of ZO-1 showed that ZO-1 was largely lost on the RPE cell membrane in that NaIO 3 group; whereas in the AS-A group, ZO-1 was evenly distributed on the RPE cell membrane. HE staining results showed circular black deposits were visible in the RPE layer of the NaIO 3 group, and the inner and outer segments of photoreceptors were severely damaged, with a significant decrease in the number of outer nuclear layer (ONL) cell nuclei; whereas in the AS-A group, the RPE layer pigments were orderly, the inner and outer segments of photoreceptors were intact, and the number of ONL cell nuclei significantly increased. The results of TUNEL staining show that numerous TUNEL-positive cell nuclei were observed in the ONL of the retina in the NaIO 3 group, while the number of TUNEL-positive cell nuclei in the ONL of the retina was significantly reduced in the AS-A group, with statistically significant differences ( t=2.66, P<0.05). The analysis of qPCR data showed that compared with the AS-A group, the relative expression levels of Mlkl, Ripk3, Ccl2, Il-1β and Tnf mRNA in the retina were significantly increased in the NaIO 3 group, with statistically significant differences ( F=39.18, 10.66, 53.51, 41.40, 24.13; P<0.001). Immunohistochemical staining results showed that compared with NC group and AS-A group, the positive expression of GFAP in retina of NaIO 3 group was significantly increased, and the difference was statistically significant ( F=9.62, P<0.05). Conclusion:AS-A antagonizes NaIO 3-induced photoreceptor degeneration in part by inhibiting photoreceptor cell death and neuroinflammation. Meanwhile, AS-A treatment protects against NaIO 3-triggered perturbation of retinal homeostasis.

Objective: To investigate the efficacy of bare metal stent for treating focal coronary artery aneurysm complicating with severe stenosisin single coronary artery. Methods: This retrospective analysis was performed in 7 patients who were diagnosed as local coronary artery aneurysm complicating with severe stenosis(≥70%) in single coronary artery and treated with bare metal stent during the period from December 2012 to June 2015 in Fuwai Hospital. All 7 patients were male with age of (62±11) years old. During the interventional operation, the narrow parts were pre-expanded,and all patients received bare metal stents implantation to cover aneurysms.The clinical and imaging data of patients immediately post procedure and at postoperative follow-up were collected to evaluate the clinical efficacy. Results: There were 5 cases of left anterior descending aneurysms and 2 cases of right coronary artery aneurysms. The diameter of aneurysm was (5.21±1.28)mm, and the length was (13.71±3.88)mm. There was intracranial vortex in coronary arteriography immediately after intervention.Proximalstenosis of coronary artery aneurysm was disappeared,and the distal blood flow was TIMI class 3.There were no signs of aortic dissection and thrombus formation.During 6(6 16) months follow-up, the aneurysms were disappeared,and there were no major adverse cardiovascular events which including myocardial ischemia, acute myocardial infarction, revascularization,bleeding,and death for all patients. Conclusion Initial experience shows that double-layer bare metal stents implantation for patients with localized coronary artery aneurysm complicating with severe stenosis in single vessel is safe and effective.

Objectives:To analyze the efficacy and safety of drug coated balloon for coronary de novo lesions in real world. Methods:We enrolled consecutive patients with coronary de novo lesions treated with drug coated balloons from January 2020 to June 2021 in Fuwai Hospital.The baseline data,procedure data and in-hospital cardiac events were collected through case query.All patients were followed up by clinical visit or telephone call.Major adverse cardiac events(MACE)were defined as the composite of the cardiac death,acute myocardial infarction,target lesion revascularization.According to the diameter of the blood vessels,the patients are divided into the large vessel lesion group(vessel diameter≥2.75 mm,n=337),and the small vessel lesion group(vessel diameter<2.75 mm,n=575). Results:There were 940 coronary de novo lesions in 912 patients.A total of 974 drug balloons were used,average diameter was(2.6±0.8)mm,average length was(21.0±6.0)mm,average pressure was(10.0±3.8)atm.Among the 940 primary coronary artery lesions,343 lesions had a diameter≥2.75 mm,and 597 lesions had a diameter<2.75 mm.During hospitalization,two patients with acute ST-segment elevation myocardial infarction died of cardiac rupture after emergency coronary interventional treatment,acute vessel closure because of coronary hematoma occurred in 1 patient and bailout drug-eluting stent was used in this patient,five patients received salvage stent treatment due to type C dissection immediately after drug coated balloon treatment.During follow-up,Target lesion revascularization(TLR)occurred in 15(1.6%)patients(including coronary artery bypass grafting in 1 patient).Nonfatal acute myocardial infarction occurred in 1 patient,cardiac death occurred in 1 patient,2 patients died of cerebral hemorrhage,1 patient died of cerebral infarction,MACE rate was 1.9%(17/912).MACE rate during follow-up was similar between large vessels group and small vessels group(1.8%vs.1.9%,P>0.05). Conclusions:Our study indicates that drug coated balloon for coronary de novo lesion is safe and effective.There is no difference of MACE rate between large vessel group and small vessel group.

Objectives:To evaluate the efficacy and safety of drug-coated balloon in the treatment of de novo coronary chronic occlusive lesions. Methods:Consecutive patients with de novo coronary chronic occlusive lesions treated with drug-coated balloons only were included in this study.The general information,medical history,and surgical information of the patients were recorded,and major adverse cardiovascular events(MACE,including cardiac death,myocardial infarction,and target vessel revascularization)were recorded by telephone or outpatient follow-up. Results:A total of 160 patients were included.There were 26 ostial lesions(16.3%),42 bifurcated lesions(26.3%),117 diffuse lesions(73.1%),and 87 calcified lesions(54.4%).The reference vessel diameter was(2.3±0.4)mm.During hospitalization,there were no acute myocardial infarction,cardiac death,target lesion revascularization,or acute coronary thrombosis.Cardiac death occurred in 1 case and target vessel revascularization occurred in 6 cases during follow-up.The MACE rate is 4.4%. Conclusions:Drug balloon therapy for de novo coronary chronic occlusive lesions is safe and effective,and the prognosis is satisfactory.

Objective To observe the long-term prognosis and related outcome predictors for hypertrophic obstructive cadiomyopathy (HOCM) patients underwent alcohol septal ablation (ASA).Methods A total of 227 consecutive patients (age:(47.8 ± 11.7) years) treated by ASA from September 2005 to December 2013 in our hospital were included and followed-up for 4.42 years(range:(1.17-9.93) years).Follow up rate is 97.4％ (221/227).General information,medical history,data of ASA and complications during hospitalization were obtained through access to medical records of patients.The patients were followed up by telephone or outpatient visit.Results During hospitalization period,one patient died due to retroperitoneal hemorrhage,two ventricular fibrillation events and two sustained ventricular tachycardia events occurred and all patients were successfully recovered after electrical cardioversion (defibrillation).Four cardiac tamponade events occurred,35.7％ (81/227) patients experienced temporary three degree atrioventricular block.Five delayed three degree atrioventricular block evens occurred.During follow up,the percent of NYHA Ⅲ/Ⅳclass was significantly reduced (10.1％ (23/227) vs.74.9％ (170/227),P =0.000).The incidence of syncope and amaurosis fugax was also reduced(2.6％ (6/227) vs.39.2％ (89/227),P =0.035).A total of six patients died (4 cardiac death),one patient complicating atrial fibrillation died of cerebral embolism,one patient died of rectal cancer.One cerebral hemorrhage occurred.Six patients developed-new onset atrial fibrillation.One patient received permanent pacemaker implantation.Eight patients received surgical myocardial resection.Three patients underwent repeated ASA.Survival free of all-cause mortality at 1,5,9 year was 100％,96％,96％,respectively.Survival free of cardiac death and NYHA Ⅲ/Ⅳclass at 1,5,9 year was 100％,86％,70％,respectively.Cox-regression analysis showed that residual left ventricular outflow tract gradient after ablation(HR =1.027,95 ％ CI 1.006-1.048,P =0.010),less volume of injected ethanol (HR =0.596,95 ％ CI 0.398-0.892,P =0.012),presence of temporary complete atrioventricular block (HR =0.332,95％ CI 0.124-0.886,P =0.028) were independent predictors of cardiac death and NYHA Ⅲ/Ⅳ.Conclusion Our study results suggest that ASA could significantly improve symptoms and outcome in patients with HOCM.Residual left ventricular outflow tract gradient after ablation,less volume of injected ethanol,presence of temporary complete atrioventricular block during ASA are independent predictors of cardiac death and NYHA Ⅲ/Ⅳ.