A 36-year-old male patient was hospitalized due to persistent chest tightness and dyspnea last-ing over 10 days.An echocardiogram revealed significant aortic valve regurgitation,the presence of vegetation on the aortic valve,severe mitral valve regurgitation,and enlargement of both the left atrium and left ventricle.Follow-ing a comprehensive multidisciplinary consultation,the focus was directed towards the aortic valve vegetation as the primary concern,with particular attention given to the potential diagnosis of blood culture-negative infective endocarditis(IE)and non-bacterial thrombotic endocarditis,while differentiating it from rheumatic heart disease.Ultimately,the vegetation was excised during a surgical aortic valve replacement procedure,which facilitated histopathological examination,biological culture,and high-throughput metagenomic sequencing of pathogenic mi-croorganisms.The definitive diagnosis was established as aortic valve infective endocarditis(Q fever IE)leading by infection of Coxiella burnetii.

[Objective]To evaluate the changes in cardiac structure and ventricular function in patients with Ander-son-Fabry Disease(AFD)by two-dimensional speckle tracking echocardiography(2D-STE)and to explore the character-istics of their early cardiac involvement.[Methods]All 45 patients diagnosed with AFD in this observational study under-went routine ultrasonic cardiogram(UCG)examination and 2D-STE.The patients were divided into 2 groups based on UCG measurements:with left ventricular hypertrophy(interventricular septum or posterior left ventricular wall thickness≥12 mm)and without left ventricular hypertrophy.TomTec software was used to analyze the echocardiographic images,then the baseline data,UCG routine parameters and myocardial strain of the two groups were compared.[Results]The study in-cluded 27 males(60.0%)and 18 females(40.0%),with an average age of(32.33±16.11),17 cases(37.78%)with left ventricular hypertrophy and 28 cases(62.22%)without left ventricular hypertrophy.All patients had normal left ventricu-lar ejection fraction(LVEF)(>50%).Compared with those without left ventricular hypertrophy,patients with left ventric-ular hypertrophy had significantly more target organ involvement,significantly higher E/A and average E/E' ratios(P<0.05).No statistical difference was found in global and segmental longitudinal strain(LS),circumferential strain(CS)and radial strain(RS)of the endocardium and myocardium between the two groups(all P>0.05).There were lower abso-lute values of global and segmental LS and CS in the myocardium than in the endocardium(all P<0.05),and higher abso-lute values of LS and RS in the mid segment than in the basal and apical segments(all P<0.05).[Conclusions]There is no significant association between early systolic dysfunction and left ventricular wall thickness.2D-STE strain can be used to detect AFD in the early stage.Ventricular wall myocardium exhibits more serious involvement than endocardium and mid segment was less involved than the apical and basal segments.

Objectives:To explore the prognostic significances of geriatric nutrition risk index (GNRI), controlling nutritional status (CONUT), and prognostic nutritional index (PNI) in patients with heart failure.Methods:This was a retrospective study. Patients with heart failure admitted to the Department of Cardiology, the first affiliated hospital of Sun Yat-sen University from September 16, 2013 to December 28, 2017 were enrolled. Clinical data of patients were collected and patients were followed up. GNRI, CONUT and PNI scores of patients were calculated. Cox proportional risk model was used to evaluate the relationship between the above three nutritional status scores and the risk of all-cause death in patients with heart failure, and restricted cubic spline analysis was used to verify the relationship. Subgroup analysis was performed based on left ventricular ejection fraction, N-terminal pro-B-type natriuretic peptide, number of heart failure comorbidities, systolic blood pressure, creatinine, body mass index, use of angiotensin-converting enzyme inhibitors/angiotensin receptor antagonists, use of β-blockers, and use of spironolactone.Results:A total of 2 016 patients with heart failure aged (67.7±13.0) years old were enrolled, including 1 230 (61.0%) males. All patients were followed up until September 15, 2021. Multivariate Cox proportional hazard models showed that increased GNRI score was significantly associated with reduced risk of all-cause mortality in patients with heart failure ( HR=0.989, 95% CI 0.982-0.996, P=0.001), while CONUT and PNI scores were not associated with all-cause mortality (both P>0.05). Restricted cubic spline analysis showed no U-shaped relationship between the scores and all-cause death. Subgroup analysis suggested that the prognostic value of GNRI score was predominant in patients not using angiotensin-converting enzyme inhibitor/angiotensin receptor blocker ( Pinteraction=0.024), while there was no statistically significant difference between groups in other subgroup analyses ( Pinteraction>0.05). Conclusions:Increased GNRI score is associated with reduced risk of all-cause mortality in patients with heart failure and may serve as an effective tool to assess nutritional status in patients with heart failure.

Objective: To observe the etiology, comorbidities, clinical features and treatment patterns of hospitalized patients with heart failure (HF) in China. Methods: Data were collected prospectively on hospitalized patients with HF who were enrolled in China Heart Failure Center Registry Study from 169 participating hospitals from January 2017 to August 2018. In this cross-sectional study, patients were stratified by left ventricular ejection fraction (LVEF) category: heart failure with reduced ejection fraction (HFrEF, LVEF<40%); heart failure with mid-ranged ejection fraction (HFmrEF, 40%≤LVEF<50%) and heart failure with preserved ejection fraction (HFpEF, LVEF≥50%). The clinical data were collected, including demographic information, diagnosis, signs, electrocardiogram, echocardiography, laboratory tests, and treatment. Results: A total of 31 356 hospitalized patients with HF were included, 19 072 (60.8%) were males and the average age was (67.9±13.6) years old. The common causes of HF were hypertension (57.2%), coronary heart disease (54.6%), dilated cardiomyopathy (14.7%), valvular heart disease (9.2%). The common complications were atrial fibrillation/atrial flutter (34.1%), diabetes (29.2%), and anemia (26.7%). 32.8% of patients had a history of hospitalization for HF within the previous 12 months. There were 11 034 (35.2%) patients with HFrEF, 6 825 (21.8%) patients with HFmrEF and 13 497 (43.0%) patients with HFpEF. Compared with patients with HFpEF, patients with HFrEF had a lower systolic blood pressure ((124.7±21.1)mmHg(1 mmHg=0.133 kPa) vs. (134.9±22.9)mmHg), faster heart rate ((85±19) beats/minutes vs. (81±19)beats/minutes), and higher percentage of New York Heart Association (NYHA) class Ⅳ, smoking, alcohol, left bundle branch block, and QRS time≥130 ms, and higher levels of blood uric acid, BNP, and NT-proBNP (all P<0.05). Compared with patients with HFmrEF and HFrEF, patients with HFpEF were older, more women, and higher comorbidity burden including hypertension, atrial fibrillation/atrial flutter, anemia and chronic obstructive pulmonary disease (all P<0.05). HFmrEF took a mid-position between HFrEF and HFpEF in age, gender, heart rate, systolic blood pressure, hypertension, atrial fibrillation/atrial flutter, anemia, and chronic obstructive pulmonary disease (all P<0.05). Patients with HFmrEF had the highest proportion of coronary heart disease, myocardial infarction and percutaneous coronary intervention (all P<0.05). During hospitalization, loop diuretics were used in 90.2% of patients, and intravenous inotropics were used in 20.4% of patients. The use of ACEI/ARB/ARNI, β blockers and aldosterone receptor antagonists at discharge were 71.8%, 79.1% and 83.6% in HFrEF and 69.9%, 75.5% and 72.4% in HFmrEF, respectively. The use of digoxin at discharge was 25.3% (HFrEF 36.7%, HFmrEF 23.1%, HFpEF 17.0%). The rates of cardiac resynchronization therapy and implantable cardioverter defibrillator in HFrEF were 2.7% and 2.1%. Conclusions Among the hospitalized patients with HF in China, coronary heart disease and hypertension are the mostly prevalent causes. HFpEF accounts for a large proportion of hospitalized patients with HF. HFrEF, HFmrEF and HFpEF have different etiology and clinical features. In real-world, there are still large gaps in the effective application of the guideline recommended therapies to HF patients, especially the non-pharmacological therapy option, which needs to be improved further in China.

Objective To evaluate the development of cerebral anoxia during controlled hypoten-sion with nicardipine or urapidil after carotid endarterectomy in patients. Methods Forty-four patients of either sex, aged 48-64 yr, scheduled for elective carotid endarterectomy under general anesthesia, requi-ring controlled hypotension after operation, were divided into nicardipine group ( group N ) and urapidil group ( group U) using a random number table method, with 22 patients in each group. Nicardipine at 2. 5μg·kg-1 ·min-1 was intravenously infused in group N, and urapidil 2μg·kg-1 ·min-1 was intravenously infused in group U. After systolic blood pressure was decreased to 130-140 mmHg, the consumption of nicardipine was adjusted to 0. 2 - 0. 5 μg·kg-1 ·min-1 and the consumption of urapidil to 1-2μg·kg-1 ·min-1 in group N and group U, respectively, to maintain systolic pressure at 130-140 mmHg. Heart rate ( HR) , cardiac index ( CI) , bispectral index ( BIS) value, regional cerebral oxygen saturation (rSO2) and end-tidal pressure of carbon dioxide (PETCO2) were recorded after entering the operating room ( baseline) , at the beginning of controlled hypotension ( T1 ) , and at 5, 10, 20, 30, 60 and 120 min af-ter systolic blood pressure was decreased to the target hypotension ( T2-7 ) . Development of cerebral anoxia( the relative decrease in rSO2>12％ of the baseline value) was recorded in controlled hypotension period. Results Compared with the value at T1 , the HR at T2,3 and CI at T3-7 were significantly increased ( P<0. 05), and no significant change was found in rSO2, PETCO2 or BIS value at the other time points in group N (P>0. 05), and rSO2 was significantly decreased at T3-7 (P<0. 05), and no significant change was found in HR, CI, PETCO2 or BIS value at the other time points in group U (P>0. 05). Compared with group N, the HR at T2,3, CI at T3-7 and rSO2 at T3-7 were significantly decreased in group U (P<0. 05). The incidence of cerebral anoxia was significantly higher in group U than in group N ( P<0. 05) . Conclu-sion Controlled hypotension with nicardipine is recommended after carotid endarterectomy in order to avoid the development of cerebral anoxia in the patients.

Objective To explore the efficacy of triple therapy and sequential therapy in the eradication of Helicobacter pylori (Hp) in patients receiving long-term non-steroidal antiinflammatory drugs (NSAID) treatment.Methods Patients receiving long-term NSAID treatment were enrolled in this study.Patients diagnosed as Hp infection were divided into triple therapy and sequential therapy groups.The patients in triple therapy group received omeprazole,clarithromycin and amoxicillin theray for 10 days.The patients in sequential group received esomeprazole with amoxicillin for five days,and then esomeprazole with clarithromycin and metronidazole for another five days.All patients were given mucosal protective therapy as maintenance treatment after eradication therapy and followed up for 12 weeks.Patients underwent endoscopy examination and Hp testing before and after follow-up.Hp eradication rates were compared with the intention-to-treat (ITT) and per protocol (PP) analysis.Results According to ITT analysis,the eradication rates of Hp in triple therapy group and sequential therapy group were 78.4 ％ (40/51) and 80.0 ％ (40/50) respectively,there was no significant difference between these two groups (x2 =0.038,P=0.846).According to PP analysis,the eradication rates of Hp in triple therapy group and sequential therapy group were 84.4％ (38/45) and 87.0％ (40/46) respectively,there was no significant difference between these two groups either (x2=0.117,P=0.732).Conclusion There was no significant difference in Hp eradication between triple therapy and sequential therapy in patients receiving long-term NSAID treatment.

[Objective]This study was designed to investigate the effects of 5-aminoimidasole-4-carboxamide ribonucleoside (AICAR)on activity of transcription factor Forkhead O 3a(FOXO3a)and expression of ubiquitin ligase muscle atrophy F-box (MAFbx),and to explore the role of adenosine monophosphate-activated protein kinase(AMPK)on proteolysis pathways in eardiomyocytes.[Methods]The effect of AICAR on activation of AMPK was observed.Cultured neonatal rat cardiomyocytes was treated with AICAR in different concentration.Cultured cardiomyocytes were then divided into three groups:control group,AICAR group,AICAR+Compound C group.Effects of AMPK activation on phosphorylation of FOXO3a and expression of MAFbx in cardiomyocytes were detected using Western blot.[Results]①Compared with control group,activity of AMPK in cultured cardiomyocytes was increased after treatment with 0.25 mmol/L or 0.5 mmol/L AICAR for 6 h(P＜0.05),and the activity of AMPK was further enhanced after treatment with 1.0 mmol/L or 2.0 mmol/L AICAR for 6 h(P＜0.01).②Activation of AMPK by AICAR significantly increased the transcriptional activity of FOXO3a(P＜0.01),and enhanced MAFbx protein expression in cardiomyocytes when comparing with control group(P＜0.01),however,specific AMPK antagonist Compound C markedly reversed these effects induced by AICAR.[Conclusion]AMPK may regulate cardiomyocytes proteolysis by activation of FOXO3a transcription factor,and up-regulation of MAFbx protein expression.

Objective To investigate the prevalence and the risk factors of gastroduodenal damages induced by nonsteroidal anti-inflammatory drugs (NSAIDs). Methods One hundred and eighty-four patients who were prescribed NSA1Ds for long time in rheumatology and cardiovascular clinics were enrolled. Clinical data such as age, sex, medication history and body mass index were recorded. The lesions were estimated by endoscopy and the specimens were tested for Helicobacter pylori (H. pylori) infection. Results Peptic ulcer was found in 63 (34. 24%) patients including gastric ulcer in 22, duodenal ulcer in 34 and compound ulcer in 7. The endoscopic examination showed that 57 out of 121 patients without peptic ulcer had ≥3 erosive lesions. Logistic regression analysis revealed that H. pylori infection was important risk factor that induced the peptic ulcer in those who were taking NSAIDs for long time (OR = 13. 86, 95% CI: 6. 53 ～ 29. 43). The incidence of gastroduodenal damage was similar in patients taking NSAIDs and low dose aspirin (OR =0.45,95CI:0.16～ 1.28). Conclusions NSAIDs may cause gastroduodenal damages in long-term users and H. pylori infection was an important risk factor. The effect of low dose aspirin on gastroduodenal damages is as same as NSAIDs.

AIM: To study the effects of metformin on the pressure overload-induced cardiac hypertrophy in rats. METHODS: Transverse aortic constriction (TAC) model of rat was made through laparotomy. One week after TAC surgery, the rats were randomly divided into 5 groups (n=8 in each group) and were administered with the corresponding drugs orally every day for 8 weeks: sham group (sham surgery, administered with 2 mL distilled water);TAC group (TAC rats, administered with 2 mL distilled water);metformin(MET) group (TAC rats, administered with MET at dose of 300 mg·kg~(-1)·d~(-1));MN group [TAC rats, administered with MET at dose of 300 mg·kg~(-1)·d~(-1) plus NOS inhibitor, NG-nitro-L-arginine methyl ester (L-NAME) 50 mg·kg~(-1)·d~(-1)] and L-NAME group (TAC rats, administered with L-NAME at dose of 50 mg·kg~(-1)·d~(-1)). After treated for 8 weeks, the echocardiography, hemodynamics, the ratio of heart weight to body weight (HW/BW) and histological examination of the heart were performed. The levels of myocardial AMP-activated protein kinase subunit α (AMPKα), p-AMPKα~(Thr172), endothelial nitric oxide synthase (eNOS) and p-eNOS~(Ser1177) were detected by Western blotting. Plasma and myocardial nitric oxide (NO) were detected biochemically. RESULTS: After 8 weeks treatment, the wall thickness of left ventricle, the heart weight/body weight ratio (HW/BW), and the left ventricular myocardial perivascular fibrosis and myocardial interstitial fibrosis of the animals in TAC group were significantly increased as compared to those in sham rats. Treatment with MET for 8 weeks significantly attenuated left ventricular hypertrophy and improved cardiac function in TAC rats. These effects of MET were mostly abolished by L-NAME. Molecular biology and biochemical testing revealed that the levels of left ventricular myocardial p-AMPKα~(Thr172) and p-eNOS~(Ser1177), as well as the levels of myocardial and serum NO were significantly increased in MET group. CONCLUSION: Long-term MET treatment significantly inhibits the cardiac hypertrophy and the myocardial fibrosis and improves the cardiac functions in pressure-overload rats. The anti-hypertrophic effects of MET may be mediated via activation of AMPK-eNOS signaling pathway.

Objective To evaluate the value of the TIMI risk index in predicting 30-day and one-yosr mortality and incidence of heart failure in patients with ST-elevation myocardial infarction (STEMI).Method Data of 229 patients with STEM1 from August 1999 to March 2006 in the First Affiliated Hospital,Sun Yat-sen University,were retrospeclively collected,analyzed and scored with TIMI risk index.When categorized into quintiles(≤12.5,12.5～17.5,17.5～22.5,22.5～30,>30) and modeled as a continuous variable,difference of prediction of 30day and one-year mortality and 30-day incidence of heart failure of patients were compared respectively.Results When categorized into quintilos and modeled as a continuous variable,30-day and one-year mortality and 30-day incidence of heart failure were increasing with increasing score of risk index (P<0.05).The area under the recewer operating characteristic curve were 0.65,0.68,0.67 and 0.70,0.72,0.70,respectively.Conclusions The TIM1 risk index can be used as a simple,rapid and practical tool to risk-stratify patients with STEMI.