Objectives:The aim of this study was to investigate the value of assessing Selvester QRS score in evaluating myocardial fibrosis in hypertrophic cardiomyopathy(HCM)patients.Methods:A total of consecutive 149 patients with HCM,who were admitted in Fuwai Hospital from October 2008 to September 2013,were enrolled in this study.Qualitative and quantitative analyses of myocardial fibrosis were conducted based on late gadolinium enhancement(LGE)derived from enhanced cardiac magnetic resonance imaging(CMR).According to the qualitative analysis of myocardial fibrosis by CMR-LGE,the patients were divided into the LGE-negative group(n=46)and the LGE-positive group(n=103).Standard 12-lead electrocardiogram examination was performed and the Selvester QRS score was calculated.Multivariate binary Logistic regression analysis was used to analyze the predictive factors of positive LGE,and the correlation analysis between the Selvester QRS score and the LGE score was also performed.Results:Compared with the LGE-negative group,the proportion of patients with a family history of HCM(12.8%vs.28.2%),the proportion of patients with a positive Selvester QRS score(65.2%vs.83.5%)and the Selvester QRS score([1.65±1.81]points vs.[5.71±3.80]points)were higher,the maximum thickness of the left ventricular wall([20.5±3.2]mm vs.[24.5±5.0]mm)and the percentage of left ventricular myocardial scar area([5.0±5.5]%vs.[17.1±11.4]%)were larger in the LGE-positive group(all P<0.05).Multivariate binary logistic regression analysis showed that the Selvester QRS score(OR=1.429,95%CI:1.128-1.802,P=0.003)and the maximum left ventricular wall thickness(OR=1.257,95%CI:1.029-1.537,P=0.025)were independent predictors of positive LGE.Pearson correlation analysis showed that in all HCM patients,the Selvester QRS score was positively correlated with the LGE score(r=0.682,P<0.001),and the percentage of left ventricular myocardial scar area was positively correlated with the percentage of enhanced area to the total mass of left ventricular myocardium(LGE%)(r=0.682,P<0.001);In the LGE positive group,the Selvester QRS score was positively correlated with the LGE score(r=0.569,P<0.001).Receiver operating characteristic(ROC)curve analysis showed that the optimal cut-off values of Selvester QRS score and maximum left ventricular wall thickness for predicting positive LGE were≥3.5 points and≥21 mm,respectively.Conclusions:In HCM patients,the Selvester QRS score is significantly associated with myocardial fibrosis,and the total score≥3.5 serves as a good predictive cutoffvalue for identifying the presence of LGE.

Objectives:The aim of this study was to investigate the value of assessing Selvester QRS score in evaluating myocardial fibrosis in hypertrophic cardiomyopathy(HCM)patients.Methods:A total of consecutive 149 patients with HCM,who were admitted in Fuwai Hospital from October 2008 to September 2013,were enrolled in this study.Qualitative and quantitative analyses of myocardial fibrosis were conducted based on late gadolinium enhancement(LGE)derived from enhanced cardiac magnetic resonance imaging(CMR).According to the qualitative analysis of myocardial fibrosis by CMR-LGE,the patients were divided into the LGE-negative group(n=46)and the LGE-positive group(n=103).Standard 12-lead electrocardiogram examination was performed and the Selvester QRS score was calculated.Multivariate binary Logistic regression analysis was used to analyze the predictive factors of positive LGE,and the correlation analysis between the Selvester QRS score and the LGE score was also performed.Results:Compared with the LGE-negative group,the proportion of patients with a family history of HCM(12.8%vs.28.2%),the proportion of patients with a positive Selvester QRS score(65.2%vs.83.5%)and the Selvester QRS score([1.65±1.81]points vs.[5.71±3.80]points)were higher,the maximum thickness of the left ventricular wall([20.5±3.2]mm vs.[24.5±5.0]mm)and the percentage of left ventricular myocardial scar area([5.0±5.5]%vs.[17.1±11.4]%)were larger in the LGE-positive group(all P<0.05).Multivariate binary logistic regression analysis showed that the Selvester QRS score(OR=1.429,95%CI:1.128-1.802,P=0.003)and the maximum left ventricular wall thickness(OR=1.257,95%CI:1.029-1.537,P=0.025)were independent predictors of positive LGE.Pearson correlation analysis showed that in all HCM patients,the Selvester QRS score was positively correlated with the LGE score(r=0.682,P<0.001),and the percentage of left ventricular myocardial scar area was positively correlated with the percentage of enhanced area to the total mass of left ventricular myocardium(LGE%)(r=0.682,P<0.001);In the LGE positive group,the Selvester QRS score was positively correlated with the LGE score(r=0.569,P<0.001).Receiver operating characteristic(ROC)curve analysis showed that the optimal cut-off values of Selvester QRS score and maximum left ventricular wall thickness for predicting positive LGE were≥3.5 points and≥21 mm,respectively.Conclusions:In HCM patients,the Selvester QRS score is significantly associated with myocardial fibrosis,and the total score≥3.5 serves as a good predictive cutoffvalue for identifying the presence of LGE.

Objective To analyze the predictive value of cone beam computed tomography(CBCT)in styloid process syndrome(SPS)via logistic regression combined with receiver operating characteristic(ROC)curve.Methods A retrospective analysis was conducted on imaging data of 186 patients who underwent styloid CBCT.Among them,65 patients were clinically diagnosed with SPS(patient group),while 121 constituted the healthy controls(control group).The styloid length,inclination angle,and anteversion angle were measured,respectively.Logistic regression analysis was employed,and ROC curves were plotted to calculate sensitivity,specificity,and Youden index,the diagnostic cut-off values for SPS was obtained.Results In the control group,the styloid length was(29.66±7.22)mm,inclination angle was(22.34±3.05)°,and anteversion angle was(31.01±4.13)°.In the patient group,the styloid length was(40.30±8.65)mm,inclination angle was(21.86±3.74)°,and anteversion angle was(35.88±6.37)°.Logistic regression analysis revealed that styloid length and anteversion angle were risk factors for diagnosing SPS(P＜0.05),while inclination angle was not a risk factor for diagno-sing SPS(P＞0.05).ROC curve analysis demonstrated that diagnosing SPS,the area under the curve(AUC),sensitivity,specificity,and optimal cut-off value for styloid length were 0.868,92.3％,69.7％,and 31.23 mm,respectively;and for anteversion angle were 0.765,63.1％,89.3％,and 35.15°,respectively.Conclusion CBCT measurements of styloid length,inclination angle,and antever-sion angle suggest that a styloid length exceeding 31.23 mm and an styloid anteversion angle greater than 35.15° may indicate a higher likelihood of SPS.CBCT is a convenient,cost-effective,and safe diagnostic tool with positive clinical implications.

Objective: To investigate the short-term outcome of patients with acute myocardial infarction complicating cardiogenic shock due to left main disease. Methods: A total of 24 patients with acute myocardial infarction complicating cardiogenic shock due to left main artery disease hospitalized in Fuwai hospital from June 2012 to May 2018 were included. The clinical data were analyzed,and the patients were divided into survivor group (11 cases) and death group (13 cases) according to survival status at 28 days post the diagnosis of shock. The patients were further divided into thrombolysis in myocardial infarction(TIMI) flow grade 0-2 group (11 cases) and TIMI flow grade 3 group (13 cases) according to TIMI flow grade after the procedure. The patients were then divided into non-three-vessel lesions group (14 cases) and three-vessel lesions group (10 cases) according to coronary angiography results. Results: Compared with survivor group, patients in death group presented with lower worst systolic blood pressure within 24 hours after admission (50(48, 70) mmHg (1 mmHg=0.133 kPa) vs. 73(70, 80) mmHg, P<0.01), lower worst diastolic blood pressure with in 24 hours after admission ((33.5±12.4) mmHg vs. (48.9±9.4) mmHg, P<0.01), higher respiratory rates ((27.3±2.5) times/min vs. (21.5±4.0) times/min, P<0.01), less 24 hours urine output ((422±266) ml vs. (1 680±863) ml, P<0.01), lower platelet counts ((161.9±81.9)×10⁹/L vs. (241.6±94.0)×10⁹/L, P=0.03), higher serum creatinine ((250.0±36.8) μmol/L vs. (132.7±34.2) μmol/L, P<0.01), higher alanine aminotransferase (288(76,846) IU/ml vs. 81(42, 109) IU/ml, P=0.04), lower artery pH (7.11±0.17 vs. 7.39±0.09, P<0.01), higher lactic acid ((10.29±3.62) mmol/L vs. (4.21±2.85) mmol/L, P<0.01), higher incidence of invasive ventilation (7/13 vs. 2/11, P=0.02), higher scores of acute physiology and chronic health evaluation (APACHE) Ⅱ (35.4±6.8 vs. 18.7±1.7, P<0.01) and simplified acute physiology score (SAPS) Ⅱ (73.5±17.4 vs. 47.0±4.3, P<0.01), and higher incidence of target vessel TIMI flow grade 0-2 (10/13 vs. 1/11, P<0.01). Kaplan-Meier survival curve analysis showed that survival rate at 28 days post the diagnosis of shock in TIMI flow grade 3 group was higher than that in TIMI flow grade 0-2 group (76.9% vs. 9.1%, log-rank test, P<0.01), and mortality rate was similar at 28 days post the diagnosis of shock between non-three-vessel lesions group and three-vessel lesions group (35.7% vs. 60.0%, log-rank test, P=0.14). Multivariate logistic regression analysis showed that compared with TIMI flow grade 0-2 group, the OR value of death at 28 days post the diagnosis of shock in TIMI flow grade 3 patients with acute myocardial infarction complicating cardiogenic shock due to left main disease was 0.030(95%CI 0.003-0.340, P<0.01). Conclusion Short-term outcomeof patients with acute myocardial infarction complicating cardiogenic shock due to left main disease remains poor, and final flow of TIMI grade 3 is confirmed as independent protective factor of death at 28 days post the diagnosis of shock in these patients.

Objective: To compare predictive value of the current 7 scoring systems and CADILLAC-plus scoring system for risk of short-term deathin patients with acute myocardial infarction complicating cardiogenic shock. Methods: A total of 126 acute myocardial infarction patients complicating cardiogenic shock hospitalized in Fuwai hospital from June 2014 to January 2018 were enrolled in this study, the clinical data were retrospectively analyzed. The patients were divided into survival group(49 cases) and death group(77 cases) according to survival or not at 28 days after diagnosis of cardiogenic shock.The scores of APACHE Ⅱ,APACHE Ⅲ,SAPS Ⅱ,PAMI, TIMI-STEMI,TIMI-NSTEMI,and CADILLAC were calculated within 24 hours in coronary care unit (CCU),and scores of CADILLAC-plus, which is an improved score derived from CADILLAC, was also calculated. The predictive value of the different scoring systems for 28 day smortality of acute myocardial infarction patients complicating cardiogenic shock were compared in this patient cohort. Results: Scores of APACHEⅡ,APACHEⅢ,SAPSⅡ,PAMI,TIMI-STEMI, TIMI-NSTEMI,CADILLAC,and CADILLAC-plus were all significantly higher in death group than in survival group: (28.9±10.2 vs. 21.8±8.3,94.0 (57.0,114.0) vs. 57.0 (45.4,81.5) ,62.0 (46.0,81.0) vs. 47.0 (41.5,60.5) ,7.0 (6.0,9.0) vs. 6.0 (6.0,7.5) ,10.0 (9.0,11.0) vs. 9.0 (8.0,10.0) ,4.0 (3.0,5.0) vs. 3.0 (3.0,4.0) ,10.0 (7.0,12.0) vs. 7.0 (5.0,9.0) ,and 10.0 (8.0,14.0) vs. 7.0 (5.0,10.0) , respectively, all P<0.01).The area under the curve(AUC) of receiver operating characteristic(ROC) curve for predicting 28 days death of APACHE Ⅱ,APACHE Ⅲ,SAPS Ⅱ,PAMI, TIMI-STEMI,TIMI-NSTEMI,and CADILLAC scoring systems were 0.820,0.797,0.785,0.667,0.657,0.711,and 0.821,respectively and cut-off value was 27.5,79.5,66.0,8.5,10.5,3.5,and 8.5, respectively and the sensitivity was 0.766,0.844,0.649,0.494,0.494,0.740,and 0.753, respectively and specificity was 0.816,0.755,0.837,0.204,0.796,0.571,and 0.755,respectively.The AUC of ROC of CADILLAC-plus scoring system was 0.885,cut-off value was 9.5, sensitivity was 0.896,and specificity was 0.735. The predicting efficacy of CADILLAC-plus scoring system was superior to other scoring systems. Conclusion The 7 current scoring systems are all suitable for predicting theshort-term death in acute myocardial infarction patients complicating cardiogenic shock, and the predicting efficacy of the improved CADILLAC-plus score is superior to other scoring systems in this patient cohort.

To explore the relationship between blood level of big endothelin and contrast-induced acute kidney injury (CI-AKI) in patients with emergent percutaneous coronary intervention (PCI). Methods: A total of 1061 consecutive patients received emergent PCI in our hospital from 2013-01 to 2015-06 were enrolled. According to blood levels of big endothelin, the patients were divided into 2 groups: Normal big endothelin group, n=236 and Elevated big endothelin group, n=825. The baseline condition, procedural features, occurrence rate of CI-AKI and composite endpoint events at 6 and 12 months post-operation were studied which including nonfatal myocardial infarction, revascularization, stroke and all-cause death. The risk factors for CI-AKI occurrence were identified by Logistic analysis. Results: The overall occurrence rate of CI-AKI was 22.7% (241/1061). Compared with Normal big endothelin group, Elevated big endothelin group had the higher incidence of CI-AKI, increased composite endpoint events at 6 and 12 months post-operation with P=0.041, P=0.040 and P=0.021, respectively. With adjusted covariates, elevated blood level of big endothelin, no matter as a continuous variable or categorical variable had the enhanced risk of CI-AKI incidence in patients after emergent PCI. Conclusion: Elevated blood level of big endothelin may significantly increase the risk of CI-AKI in patients with emergent PCI.

Objective: To investigate the safety and feasibility of sheathless transfemoral aortic valve replacement (TAVR). Methods: In this prospective study, we enrolled 23 patients with severe aortic stenosis (AS) who were inoperable or at high-risk for surgical aortic valve replacement operation in Fuwai hospital From September 2012 to June 2015. Multislice spiral CT and angiography of femoral artery showed that all patients had minimal femoral artery diameters (<6.5 mm) and severe calcification which was not suitable for transfemoral TAVR through sheath. We attempted to apply the sheathless transfemoral TAVR using Venus-A prosthesis without sheath insertion, and procedure related complication during the procedure and hospital stay were observed. Results: The 6 mm×30 mm balloon was used for femoral artery predilation in 1 patient with iliofemoral artery stenosis before delivery system was transported. In the other 22 patients, the delivery system was transported directly. A total of 21 patients finished TAVR with transfemoral sheathless technique. In 2 patients, prosthesis was unable to fully expand after release due to severe valve calcification, and patients received urgent surgical aortic valve replacement. One patient had valve dislocation into the ascending aorta that was not related to the sheathless replacement technique, and delivery system and Venus-A valve were removed after femoral artery was opened surgically, and repeated sheathless TAVR implantation was performed and was successful. Moderate aortic regurgitation occurred in 2 patients immediately after procedure, and trace or mild aortic regurgitation was detected in rest of the patients. One patient had puncture site rupture and bleeding after procedure, and was successfully treated by balloon compression without blood transfusion. Complete atrioventricular block occurred in 3 patients within 24 hours after procedure and lasted after 48-72 hours, permanent pacemakers were implanted in these patients. Conclusion The sheathless transfemoral technique in TAVR is safe and feasible in severe aortic stenosis patients with small access vessel diameter.

Objective: To summarize the characteristics of arrhythmia with the relevant factors affecting its prognosis in patients of apical hypertrophic cardiomyopathy (AHCM). Methods: A total 283 AHCM patients with echocardiography or cardiac magnetic resonance (CMR) conifrmed diagnosis in our hospital from 2005-01 to 2012-08 were summarized. The patients were divided into 2 groups: With arrhythmia group, n=103 and Without arrhythmia group,n=180. The endpoint event was followed-up by clinical and telephone visits in both groups and the relevant risk factors affecting AHCM prognosis were investigated by Cox regression analysis. Results: There were 269 patients ifnished the follow-up investigation, 98 in With arrhythmia group, 171 in Without arrhythmia group, and the death rate was 4.08% vs 1.17%, the occurrence of endpoint event was 18.37% vs 5.58%respectively. Cox regression analysis indicated that age (HR=23.051, 95% CI 1.08-1.068,P<0.005), left atrial diameter (HR=4.113, 95%CI 1.002-1.119,P=0.043) and NT-proBNP (HR= 18.653, 95% CI 3.433-26.650,P<0.005) were the independent risk factors affecting prognosis in AHCM patients. Conclusion: Arrhythmia is one of the common presentations of AHCM, it does not have much impact on survival, while it may cause ventricular ifbrillation and increase the occurrence of cardiovascular events.

The purpose of this study is to prepare 99mTc-HEDTMP [N-(2-hydroxyethyl) ethlenediamine-1,1,2-tri (methylene phosphonic acid), a new kind of bone seeking compound; to investigate its biological properties; and to explore the possibility of using it as a potential radiopharmaceutical for skeleton scintigraphy. HEDTMP was labeled with 99mTc by "pretinning" method, the radiochemical purity was 97.00% +/- 0.34%. 99mTc-HEDTMP was found to be stable in 5 hours in vitro with the radiochemical purity over 95% even after being diluted by physiological saline with the factor of dilution 100. The plane bone scanning of rabbits showed that 99mTc-HEDTMP was principally absorbed by skeletal system. Skull, spine and legs could be observed clearly, and were more legible than the images of 99mTc-MDP. Mice trial also indicated the high bone seeking of 99mTc-HEDTMP. The skeletal uptake was 11.92% ID/g, 13.19% ID/g, 10.14% ID/g, 10.04% ID/g, 7.71% ID/g separately at 30 minutes, 1 hour, 3 hours, 6 hours and 24 hours after the injection. Kidney seemed to be the major excretory organ. The clearance of blood was quick and the retaining amount in non-target organs was small. These results indicate that 99mTc-HEDTMP can be prepared easily, and its biological properties can be compared favorably with the commonly used bone imaging agent, and it is well worth further researching as a promising potential radiopharmaceutical in nuclide diagnosis for skeleton diseases.
Animals ; Bone and Bones ; diagnostic imaging ; metabolism ; Female ; Male ; Mice ; Organotechnetium Compounds ; chemical synthesis ; pharmacokinetics ; Rabbits ; Radiopharmaceuticals ; chemical synthesis ; pharmacokinetics ; Random Allocation ; Technetium Tc 99m Medronate ; pharmacokinetics ; Tissue Distribution ; Tomography, Emission-Computed, Single-Photon

Objective To construct a human phage single chain-antibody library, and to sieve out the antibody ScFv against lung cancer from the library. Methods Total RNA was abstracted from lymph node tissue of the lung cancer, and was used to amplify V_H and V_L gene by RT-PCR. V_H and V_L were joined by a DNA linker by SOE-PCR to form the single chain variable fragment ( ScFv) gene. ScFv gene was coloned into the phage vector pCANT-AB5E. Panning against lung cancer cell line A549 was performed and positive clones were chosen for soluble expression. Results A recombination phage single chain-antibody library was constructed. After 4 rounds panning, the number of eluted phages increased by 115 times. Positive reactions to A549 were detected in 7 of 10 random clones. The human ScFvs against lung cancer were produced and confirmed by SDS-PAGE and ELISA analysis. Conclusion ScFvs against lung cancer were acquired by the construction of phage single chain-antibody library. The soluble ScFvs has specificall avidity to human lung cancer cells.