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Objective To evaluate the feasibility of plasma NT-pro brain natriuretic peptide guided therapy of β1-blocker to patients with moderate and severe heart failure.Methods A total of 1 95 patients with moderate and severe heart failure were ran-domized to the clinical group and the BNP group.The use of β1-blocker was guided by monitoring clinical representation and the changes of BNP values respectively.The duration of initiative use ofβ1-blocker,the recurrence of heart failure,the mortality due to heart failure and the mean dosage ofβ1-blocker were observed and analysed.Results Compared with the clinical group,the time of initiative use ofβ1-blocker was significantly shorter in NT-proBNP group[(5.89±1.76)d vs .(7.03±2.08)d,P <0.01].The mean dosage ofβ1-blocker is significantly higher in BNP group than that in clinical group[(47.65 ± 13.09 )mg/d vs .(35.08 ± 1 1.08) mg/d,P <0.01].The recurrence and mortality of heart failure were similar in two groups(P >0.05).Conclusion NT-proBNP-guided therapy ofβ1-blocker might contribute to early use and tolerance of higher dosage ofβ1-blocker in patients with NYHA Ⅲ-Ⅳ class heart function,with no extra adverse event.

Objective To investigate the correlation of plasma N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) level with echocardiographic indicators and P wave terminal force of lead V 1 (PtfV1) in the patients with hypertension and paroxysmal atrial fibrillation(PAF) .Methods Fifty‐six outpatients and inpatients with hypertension were divided into the PAF group (n=26) and the sinusrhythm group (n=30) .Thirty age‐matched and gender‐matched healthy volunteers were taken as the control group . The plasma NT‐proBNP level was determined .Left ventricular enddiastolic diameter (LVEDD) ,left atrial diameter(LAD) and left ventricular ejection fraction(LVEF) were examined by echocardiography .the 12‐lead electrocardiogram was routinely performed Pt‐fV1 was calculated .Results The plasma NT‐proBNP level in the PAF group was higher than that in the sinusrhythm group and the control group ,the difference was statistically significant (P<0 .05) .The plasma NT‐proBNP level in the PAF group was de‐creased significantly after successful cardioversion .The plasma NT‐proBNP level in the PAF group was positively correlated with LVEDD(r=0 .543 ,P<0 .05) and LAD (r=0 .606 ,P<0 .01) .The plasma NT‐proBNP level was negatively correlated with LVEF (r= -0 .750 ,P<0 .01) and positively correlated with the PtfV 1 absolute value (r= 0 .513 ,P< 0 .01) .Conclusion The plasma NT‐proBNP level can better reflect the heart structure and function in the patients with atrial fibrillation .Detecting the plasma NT‐proBNP level combined with echocardiographic indicators and PtfV 1 is conducive to comprehensively assess the heart function in the patients with hypertension and PAF .

objective To evaluate the vulnerability of coronary artery plaque with coronary angiography(CAG),intravascular ultrasound(IVUS)and the levels of plasma inflammatory markers.Methods 58 consecutive patients with lesion of a single blood vessel demonstrated successfully by CAG were randomly divided into 3 groups based on the angiographic morphology of the the lesions:type Ⅰ lesion group(n=16),type Ⅱ lesion group(n=25),type Ⅲ lesion group(n=17).Meantime,a control group of stable angina(n=17)was established.A subgroup of 28 patients(including 18 acute coonary sysdrome (ACS)patients and 10 stable angina control patients)who underwent IVUS study were analyzed.Then the plasma levels of high sensitivity CRP(hs-CRP),matrix metalloproteinase(MMP,including MMP-2 and MMP-9),CD40 ligand(CD40 L)and pregnancy associated plasma protein-A(PAPP-A)were measured with ELISA.Analyses were performed by statistical package SPSS 11.0.Results The plasma levels of MMP-2,MMP-9 and PAPP-A in typeⅡ lesion group were significantly higher than the other groups(P＜0.05,0.05,0.001,respectively).In type Ⅱ lesion group,linear correlation analysis manifested significantly positive correlation between levels of hs-CRP and MMP-2(r=0.508);MMP-2 and MMP-9,CD40 L,PAPP-A(r=0.647,0.704,0.751,respectively);MMP-9 and CD40L,PAPP-A(r=0.491,0.639,respectively);CD40L and PAPP-A(r=0.896).IVUS subgroup analysis showed that the area of plaques and plaques burden in culprit lesion,the incidence of high-risk plaques,remodeling index(RI)and positive remodeling percentage in ACS patients were significantly greater than those in the control group(P=0.000,0.037,0.028,0.015,0.040,respectively).Compared with the control group,the plasma levels of hs-CRP,MMP-2,MMP-9 and PAPP-A were markedly elevated(P=0.033,0.000,0.000,0.027,respectively).Conclusions CAG and IVUS combined with the study on plasma levels of inflammation mediators were helpful in judging the vulnerability of coronary artery plaques.

Objective Gene linkage would be processed in order to make sure if an autosomal dominant congenital hyperthyroidism family has genetic linking relationship with the known hyperthyroidism disease genes,TSHR or THRB.Methods Microsatellite marked gene linkage was done with the use of three microsatellite markers,D14S74,D3S2338 and D3S1266,whose chromosomal locations were very close to TSHR or THRB gene,and the results were analyzed by Genemapper 3.5 Software.Results LOD scores of the three markers were all less than 1,revealing that there were no linking relationships between TSHR or THRB gene and this hyperthyroidism family,further reflecting this family might have a new disease gene other than TSHR and THRB.Conclusion There might be new disease genes responsible for autosomal dominant congenital hyperthyroidism.

The atherosclerotic plaque vulnerability may be related to inflammation,immunity,metabolism and blood clotting.One of the key factors affecting plaque stability is inflammatory reaction.This study was to investigate the relationship between vulnerability of coronary artery plaque evaluated with coronary angiography (CAG),intravascular ultrasound (IVUS) and the levels of plasma inflammatory markers.Methods Fifty-eight consecutive patients with acute coronary syndrome who had coronary lesion of a single vessel were divided into 3 groups based on angiographic morphology of the lesions:type Ⅰ lesion group (n =16),type Ⅱ lesion group (n =25) and type Ⅲ lesion group (n =17).The control group consisted of 17 patients with stable angina.Plasma levels of high sensitivity C reaction protein (hs-CRP),matrix metalloproteinase (MMP,including MMP-2 and MMP-9),CD40 ligand (CD40L) and pregnancy associated plasma protein-A (PAPP-A) were measured by ELISA.A subgroup of 28 patients (including 18 ACS patients and 10 stable angina control patients) who underwent IVUS study,were analyzed.Results The plasma levels of MMP-2,MMP-9 and PAPP-A in type Ⅱ lesion group were significantly higher than those in other groups (all P＜0.05).In type Ⅱ lesion group,linear correlation analyses showed significant positive correlation between levels of hs-CRP and MMP-2 (r=0.508);MMP-2 and MMP-9,CD40L,PAPP-A (r=0.647,0.704 and 0.751,respectively);MMP-9 and CD40L,PAPP-A (r=0.491 and 0.639,respectively);CD40L and PAPP-A (r=0.896).IVUS subgroup analysis showed that the area of plaques and plaque burden in culprit lesion,the incidence of high-risk plaques,remodeling index (RI) and positive remodeling percentage in ACS patients were significantly greater than those in control subgroup (P=0.000,0.037,0.028,0.015 and 0.040,respectively).Compared with control subgroup,the plasma levels of hs-CRP,MMP-2,MMP-9 and PAPP-A were markedly elevated (P=0.033,0.000,0.000 and 0.027,respectively).Conclusions CAG and IVUS combined with study on plasma levels of inflammation mediators are helpful in judging the vulnerability of coronary artery plaques.(J Geriatr Cardiol 2008;5:207-211)

ObjectiveTo examine the relationship between ankle brachial index (ABI) and the extent of coronary stenosis and evaluate the usefulness of ABI to predict the extent of coronary stenosis in old patients.Methods118 patients with coronary angiography were examined by ABI and hemostatic factors evaluation in addition to history collection.ResultsABI was inversely and significantly associated with Gensini score. ABI reduced significantly (P<0.001) in the patients with 3-vessel or left main coronary artery disease (CAD). But there were no significant differences in ABI among the patients with no CAD, 1-vessel or 2-vessel CAD. The corresponding area under the ROC curve was 0.75±0.045, with 95% CI=0.67～0.84 (P<0.001) in ABI in 3-vessel or left main CAD. When ABI≤0.9, it had a relatively high specificity (89.1%) and sensitivity (55.6%) for predicting the presence of 3-vessel disease or left main CAD.ConclusionIn the old patients, ABI is inversely and significantly associated with the extent of coronary stenosis, and ABI≤0.9 has a relatively high specificity and sensitivity for predicting the presence of 3-vessel or left main CAD.