Objective: To investigate the acute effect of carotid artery stenting (CAS) on hemodynamics. Methods: We retrospectively analyzed 170 consecutive patients who received CAS in our hospital from 2014-09 to 2015-09. The acute effects of proximal internal CAS on blood pressure (BP) and heart rate (HR) were studied, the patients were followed-up for a month to observe the relationship between CAS and peri-operative adverse events occurrence. Results: ① Compared with pre-operative condition, the all day mean systolic blood pressure (SBP) from (126.6±15.1, 93-175) mmHg decreased to (117.7±13.7, 87-158) mmHg, P<0.01, all day mean DBP from (72.8±11.5, 49-100) mmHg decreased to (67.3±10.3, 48-90) mmHg, P<0.01, and all day HR from (66.3±6.8, 49-84) bpm decreased to (62.6±7.2, 49-88) bpm, P<0.01. ② The incidence of hemodynamic instability (HI) was 51.8％ (88/170) and the occurrence rates of thypertension, hypotension and bradycardia were 3.5％ (6/170), 39.4 ％ (67/170) and 22.4％ (38/170) respectively. Multivariate regression analysis showed that HI was closely related to gender, history of hypertension, bilateral CAS and carotid bifurcation lesions. Upon HI onset, BP and HR could be restored to normal via intravenous infusion of vasoactive drugs and 6 (3.5％) patients having the medication time more than 24 hours. ③ Peri-operative adverse events happened in 8 (4.7％) patients including 4 transient ischemic attack, 2 minor stroke and 2 major stroke (1 patient died). The ratio of adverse events was 2.4％ (2/82) in Non-HI group and 6.8％ (6/88) in HI group, P=0.32. In HI group, the incidences of hypertension, hypotension, bradycardia and hypotension combining bradycardia were 16.7％ (1/6), 6.8％ (3/44), 0％ (0/15) and 8.7％ (2/23) respectively, compared with the overall patients' group, P=0.669, P=0.723, P=0.793 and P=0.658 respectively. Conclusion: HI incidence was relatively high in peri-operative period of CAS; gender, history of hypertension, bilateral CAS and carotid bifurcation lesions were the independent predictors for CAS occurrence. It is important to reasonably use vasoactive drugs in time for preventing and reducing HI related adverse events.

Objective: To explore the incidence and risk factors of vascular cognitive impairment (VCI) for in-hospital atrial fibrillation (AF) patients. Methods: A total of 303 in-hospital AF patients were studied. Based on MMSE score evaluation, the patients were divided into 2 groups: Non-VCI group, n=216 and VCI group, n=87. The incidence of VCI was assessed and different cognitive functions were studied by uni- and multivariate regression analysis. Results: Compared with Non-VCI group, the patients in VCI group had the elder age, higher proportion of CHA2DS2-VASC score ≥ 2, more with persistent/permanent AF, more combining diabetes and heart failure (HF), more had increased systolic blood pressure, mean arterial pressure, pulse pressure, left atrial (LA) diameter and serum creatinine; less male and decreased left ventricular end-diastolic diameter, P<0.05 and P<0.001. The occurrence rate of VCI for in-hospital patients was 40.3％, with age and CHA2DS2-VASC score increasing, the incidence of VCI was elevating and the occurrence rates in female was higher than male, the patients with persistent/permanent AF was higher than paroxysmal AF, P<0.05 and P<0.001. Multiple linear regression analysis showed that age (OR=-0.1135, 95％ CI -0.1708 to -0.0562, P=0.0001), female (OR=-1.2528, 95％ CI -2.2056 to -0.3000, P=0.0105), education [primary school level (OR=3.2193, 95％ CI 1.844-4.5940, P<0.0001),middle school and above level (OR=5.9104, 95％ CI 4.6055-7.2154, P<0.0001)], HF (OR=-1.9357, 95％ CI -3.5522 to-0.3192, P=0.0196), stroke (OR=-1.6349, 95％ CI -2.7517 to -0.5181, P=0.0044) and LA diameter (OR=-0.1252, 95％ CI-0.1962 to -0.0541, P=0.0006) were related to VCI occurrence in hospitalized AF patients. Conclusion: The incidence of VCI was high in hospitalized AF patients; elder age, female, lower education, HF, stroke and enlarged LA diameter were the risk factors for VCI occurrence in AF patients.

Objective: To explore the prevalence and risk factors of orthostatic hypotension (OH) in elderly hypertension patients. Methods: A total of 532 retired hypertension patients elder than 65 years in Guangzhou military region were enrolled. The patients were divided into 2 groups: Hypertension group, n=414 and Hypertension combining OH (H+OH) group, n=118. The patient's age (65-79、≥ 80), hypertension grade (Grade 1-3) and complication status were studied. The risk factors for H+OH prevalence were analyzed by multivariate Logistic regression analysis. Results: The incidence rate of H+OH was 22.2％ (118/532). In H+OH group, the ratios of elderly and very elderly patients were 6.7％ and 23.1％, P<0.05 and the ratios of OH occurrence for hypertension grade 1, 2 and 3 were 12.6％, 23.3％ and 25.2％ respectively, P<0.05. Multivariate Logistic regression analysis presented that systolic blood pressure (BP) in supine position, BP at immediate standing, heart rate in supine position, heart rate after 2 minutes standing and chronic cardiac insufficiency were the impact factors for H+OH occurrence, P<0.05. Conclusion: In elderly hypertension patients, incidence of OH was increasing with age elevating; H+OH has been related to age, severity of hypertension and chronic cardiac insufficiency.

Objective: To explore the effect of β-blocker in hypertension patients with different basic heart rate (HR). Methods: A total of 191 hypertension patients without using β-blocker were enrolled. Based on different basic HR, the patients were divided into 3 groups: Group A: HR (70-79) beats/min, n=58, Group B: HR (80-89) beats/min, n=90 and Group C: HR≥90 beats/min, n=43. All patients received metoprolol extended release at 47.5 mg/d for 2 weeks, for those didn't reach the target HR, 23.75 mg/d was added as 71.25 mg/d for 4 weeks, for those still didn't reach target HR, the dose was added to 95 mg/d, total length of medication was 8 weeks. Blood pressure (BP) and HR were measured every 2 weeks in all patients. Results: 62％ patients had basic HR>80 beats/min, 36％ had basic HR>85 beats/min and 20％ had basic HR>90 beats/min. The average dose of metoprolol was (59.7±17.0) mg/d. HR decreased in 3 groups after medication, all P<0.05. The reducing level in Group C was (29.3±7.8) beats/min, in Group B was (18.7±4.9) beats/min and in Group A was (11.0±4.0) beats/min, P<0.05; upon HR elevating 10 beats/minute, metoprolol caused HR reducing may increase 7.9％. BP was similar among 3 groups before and after medication, P>0.05. The average HR decreasing levels in patients with metoprolol 47.5 mg/d, 71.25 mg/d and 95 mg/d were (17.6±8.1) beats/min, (19.5±8.7) beats/min and (22.5±9.2) beats/min respectively; upon dose elevated to 71.25 mg/d and 95 mg/d, metoprolol caused HR reducing may increase10.8％ and 27.8％. 1 patient had sinus bradycardia and 1 had dizziness during medication, the symptoms improved by dose reducing or drug withdrawal.Conclusion: About 2/3 hypertension patients had basic HR>80 beats/min, metoprolol could cause more HR reducing in patients with the faster basic HR. Metoprolol (47.5-95) mg/d was safe and effective in hypertension patients.

Objective: To systematically evaluate the efficacy and safety of ticagrelor and clopidogrel in acute coronary syndrome (ACS) patients after percutaneous coronary intervention (PCI) in China. Methods: We searched the databases of CNKI, Wanfang, VIP, CBM, PubMed and Web of Science to collect RCTs for the efficacy and safety of ticagrelor and clopidogrel in ACS patients after PCI; R software was used to perform Meta-analysis. Results: A total of 31 RCTs with 4342 patients were enrolled. Meta-analysis presented that compared with clopidogrel, during follow-up period, ticagrelor had the reduced incidences of major adverse cardiac events (MACE) (RR=0.37, 95％ CI 0.31-0.45, P<0.05), myocardial infarction (MI) (RR=0.37, 95％ CI 0.23-0.57, P<0.05), stent thrombosis (RR=0.28; 95％ CI 0.16-0.49, P<0.05) and stroke (RR=0.44, 95％ CI 0.23-0.81, P<0.05); while elevated incidences of hemorrhagic events (RR=1.47; 95％ CI 1.19-1.81, P<0.05) and dyspnea (RR=2.05; 95％ CI 1.47-2.84, P<0.05) . Conclusion: Ticagrelor treatment may decrease the risk of MACE, MI, stent thrombosis and stroke in Chinese ACS patients after PCI; while the incidences of hemorrhagic events and dyspnea should be alert.

Objective: To explore the relationship between plasma level of soluble urokinase plasminogen activator receptor (suPAR) and the severity of acute coronary syndrome (ACS) with its influence factors. Methods: A total of 321 consecutive patients with chest pain admitted in our hospital from 2015-03 to 2016-09 were studied. According to clinical presentation, laboratory test and coronary angiography (CAG), the patients were divided into 2 groups: ACS group, n=228 and Control group, the patients with normal coronary artery, n=93. Plasma levels of suPAR and high sensitive C reaction protein (hs-CRP) were measured by ELISA and compared between 2 groups. Results: The levels of plasma suPAR in ACS patients were significantly higher than those in the control group (OR= 0.104, 95％ CI: 0.048-0.223, P<0.01). In ACS group, the plasma suPAR level gradually increased with the increase of Gensini score, The sensitivity and specificity of the levels of suPAR were determined by ROC curve. The values of ACS were predicted to be 1.8 μg / L, the sensitivity was 0.732 and the specificity was 0.710. Multiple linear regression analysis showed that smoking, Gensini score and uric acid were the main factors affecting plasma suPAR levels. Conclusion: Elevated plasma suPAR level has been related to the severity of coronary stenosis in ACS patients, such relationship is superior to hs-CRP; suPAR might be worked as a new biomarker for predicting coronary stenosis and risk stratification in ACS patients.

Objective: To explore the application status of trans-femoral route (TFR) and trans-radial route (TRR) percutaneous coronary intervention (PCI) via a single center large sample 2-year follow-up study and to evaluate their impact on long-term prognosis in relevant patients. Methods: A total of 10577 patients received PCI by TFR or TRR in our hospital during 2013 were analyzed. The patients were divided into two groups: TRR group, n=9745 (90.9％) and the TFR group, n=812 (7.6％). Clinical features were compared between 2 groups and their impacts on prognosis were studied. Results: Compared with TRR group, TFR group had more patients with elder age, more female, diabetes, more with the histories of myocardial infarction (MI), PCI or CABG, all P<0.001; more patients with left main disease or 3-vessel lesions, all P<0.001. Logistic regression analysis indicated that female, age, histories of MI, PCI or CABG and left main disease were the predictors for choosing TFR. With propensity score matching, TFR group had the higher in-hospital mortality than TRR group, P<0.05. 2-year follow-up Kaplan-Meier survival analysis showed that the end point events were similar between 2 groups. Cox multivariate analysis found that TFR was an independent risk factor of BARC ≥ 2 bleeding (HR=2.210, P=0.013), while not an independent risk factor for main cardiac end point events. Conclusion: ① Female, elder age, histories of MI, PCI or CABG and left main disease were the predictors for choosing TFR. ② The in-hospital mortality was higher in TFR PCI. ③ TFR was an independent risk factor of BARC≥2 bleeding, while it had no impact on long-term prognosis in PCI patients.

Objective: To analyze the incidences of anxiety, depression in patients with chronic heart failure (CHF) and their correlations to quality of life and cognitive emotion regulation. Methods: The forms of short health survey item (SF-36), self-rating depression scale (SDS), self-rating anxiety scale (SAS) and cognitive emotion regulation questionnaire (CERQ) were used to conduct a survey in 200 CHF patients admitted in our hospital. Results: The incidences of anxiety and depression were 71.0％ and 64.5％ in CHF patients. NYHA grading, rational analysis, self-blame in cognitive emotion regulation and physical role, general health, emotional role in quality of life were the impact factors for anxiety. NYHA grading, rational analysis and catastrophizing, positive reappraisal in cognitive emotion regulation and general health, social functional role, physical role in quality of life were the impact factors for depression. Conclusion: The incidences of anxiety and depression were high in CHF patients; NYHA grading, quality of life and the cognitive emotion regulation were the impact factors for anxiety and depression occurrence in CHF patients.

Objective: To conduct a knowledge survey on heart failure (HF) guidelines for HF diagnosis and treatment in physicians in China. Methods: A questionnaire including15 multiple-choice and 10 blank-filling questions was developed based on Chinese HF diagnosis and treatment guidelines 2014. The survey was conducted in physicians who registered at Chinese HF study from 88 hospitals in China and the knowledge level was presented by the correction rate of questionnaire survey. Results: A total of 2146 physicians finished the survey including 56.2％ female and 43.8％ male with the mean age of (35.6±7.6) years. The ratios of resident, attending physician, associate chief physician and chief physician were 28.2％, 43.6％, 20.3％ and 7.9％ respectively; the ratios of cardiovascular specialists, physician and general practitioners were 62.1％, 28.8％and 9.1％ respectively. Physicians from community hospital, 2nd grade hospital and 3rd grade hospital were 5.4％, 26.5％, and 68.2％ respectively. The correct answer for 15 multiple-choice questions was only 32.6％ and for 10 blank-filling questions regarding the target doses of anti-HF drugs was 42.5％. Physicians with the higher professional title had greater awareness of HF guidelines than those with the lower title, P<0.001. The compliance and command to HF guidelines were different among hospital levels, P<0.001; the command to HF prevention and treatment were different among physicians in different practice scopes, P<0.001. Conclusion: The knowledge for HF diagnosis and treatment had deficiency in physicians in China, further systemically study should be enforced.

Objective: To analyze gender differences for the long-term prognosis in patients with chronic heart failure (CHF). Methods: A total of 925 consecutive CHF patients admitted in our hospital were enrolled those including 460 (49.7％) female. The mean follow-up time was 3.4 years and the end point event was all-cause mortality. Gender differences for the long-term prognosis in CHF patients were studied by Cox proportional-hazards regression analysis. Results: The overall all-cause mortality was 27.9％ during follow-up period, mortality in female was 25.2％ and in male was 30.5％. Multivariate Cox regression analysis presented that the long-term death risk in male patients was higher than female (HR=1.309, 95％ CI 1.002-1.708, P=0.048). Subgroup analysis showed that for patients age≥65 years, LVEF<45％and with NYHA grade III/IV, the long-term prognosis in female was much better than male. Conclusion: Long-term prognosis of CHF in female patients was better than male; female at age≥65 years, LVEF<45％and NYHA grade III/IV had the better prognosis.