Objectives:This study aimed to compare the clinical characteristics between light-chain cardiac amyloidosis(AL-CA)and transthyretin cardiac amyloidosis(ATTR-CA). Methods:A retrospective analysis was conducted in patients diagnosed with AL-CA and ATTR-CA at Peking University Third Hospital from January 2011 to October 2023.There were 35 patients diagnosed with AL-CA(AL-CA group)and 21 patients diagnosed with ATTR-CA(ATTR-CA group).Clinical manifestations,ECG,echocardiography and cardiac magnetic resonance(CMR)results were compared between patients with AL-CA and ATTR-CA. Results:Compared to the AL-CA group,the ATTR-CA group has a higher proportion of males(54.3%vs.90.5%,P=0.005),the proportion of patients with hypertension was lower(42.9%vs.9.5%,P=0.009).In terms of clinical manifestations,edema,proteinuria,renal insufficiency and serous effusion were more common in the AL-CA group,while the incidence of limb numbness was higher in the ATTR-CA group(all P＜0.05).There were significant differences in the incidence of limb lead low voltage(57.1%vs.28.6%,P=0.038)and conduction block(14.3%vs.61.9%,P=0.001)between the AL-CA group and ATTR-CA group on ECG.Although the AL-CA group had a shorter time interval from initial symptoms to diagnosis(6.0[2.0,15.0]months vs.35.0[14.0,56.5]months,P=0.002)and less pronounced left ventricular thickening on echocardiography(interventricular septum thickness:[13.3±2.0]mm vs.[15.7±2.2]mm,P=0.001;left ventricular mass:[198.4±67.8]g vs.[246.6±53.5]g,P=0.009)and CMR(interventricular septum thickness:[16.0±2.1]mm vs.[18.9±3.8]mm,P=0.033;left ventricular mass:[132.9±45.3]g vs.[194.7±50.8]g,P=0.011),the proportion of patients with NYHA grades Ⅲ-Ⅳ(48.6%vs.19.0%,P=0.027)was higher,the levels N-terminal B-type natriuretic peptide precursor and cardiac troponin T levels were higher(both P＜0.05),and the 1-year survival rate was lower in the AL-CA group than in the ATTR-CA group(65.7%vs.100%,P=0.001). Conclusions:AL-CA and ATTR-CA had differences in clinical and ECG manifestations.While the severity of left ventricular hypertrophy was less pronounced in AL-CA compared to ATTR-CA,cardiac function and prognosis were worse in AL-CA than in ATTR-CA.

Objective To investigate clinical significance and the correlation between oxygen uptake efficiency slope(OUES) measured by the cardiopulmonary exercise test(CPET) and echocardiographic left ventricular function in elderly patients with coronary heart diseases after the percutaneous coronary intervention.Methods Patients aged 65 years and over after PCI and CPET were enrolled to collect relevant parameters including the peak oxygen consumption(VO2peak),oxygen pulse(VO2/HR),OUES and cardiorespiratory fitness(CRF) index,also mitral annulus systolic peak speed(Sm),early diastolic mitral flow velocity Em and mitral annular early diastolic peak velocity Em ratio(E/Em) using the echocardiography.Patients with systolic velocity of mitral annulus(Sm)≥8 cm/s were assigned to the normal Sm group,while the rest were selected into the lower Sm group.The correlation between the cardiopulmonary fitness and cardiac function was analyzed.Results Four hundred and two patients were enrolled,with an average age of 71 ± 5 years,283 males(70.40％),and 119 females(29.60％).Among them,111 (27.61％) were 75 years of age or older,202(50.25％) ranging from 65 to 69 and 89 (22.14％) between 70 and 74.Totally 227 patients were diagnosed as angina pectoris(56.47％),62 as acute myocardial infarction (15.42％),and 113 patients with old myocardial infarction (28.11％).It was found that the heart systolic function was associated with CRF:Sm and OUES were positively correlated independently(r=29.220,P=0.001);Em was positively related to VO2peak(r=0.176,P＜0.001) andOUES (r=0.151,P=0.003).However,E/Em was negatively correlated with VO2peak (r=-0.199,P＜0.001),VO2/HR (r=-0.118,P=0.018) and OUES (r=-0.201,P＜0.001).The left atrial pressure was negatively correlated with VO2peak (r=-0.187,P＜0.001),VO2/HR (r=-0.108,P=0.030) and OUES (r=-0.185,P＜ 0.001).Left ventricular ejection fraction and left ventricular end diastolic diameter were not found to be related to cardiorespiratory fitness parameters (P＞0.05).Conclusion The cardiopulmonary exercise test can be used as a practical method to evaluate and guide the rehabilitation exercises.The CRF parameters can evaluate the heart function exercise and is significantly correlated to the resting cardiac systolic and diastolic function parameters.

Objective To assess the difference in left atrial properties between elderly and younger control subjects and the role of left atrium remodeling in patients of different ages with atrial fibrillation.Methods A total of 194 patients with non-valvular atrial fibrillation were enrolled from September 2014 to June 2016.Based on age,patients were divided into an elderly group (≥60 years,n=129) and a younger group (＜60 years,n=65).We evaluated remodeling parameters for the left atrium using an Ultrasound Cardiography (UCG) system in 125 elder subjects,together with 64 control subjects.All remodeling parameters were recorded,including left atrial diameter (LAD),left atrial square (LAS),left atrial pressure (LAP) and left ventricular end-diastolic dimension (LVEDD).Results The elderly group had more female patients and more patients with persistent atrial fibrillation.Meanwhile,scores of CHA2DS2Vsc and levels of N-terminal pro-brain natriuretic peptide (NT-ProBNP) were significantly increased in elderly patients (both P＜0.05).Moreover,the elderly group was associated with increased values of LAD and LAS[(39.1±4.4)mm vs.(37.1±5.3)mm,P＜0.01;and(23.3±4.5)cm2 vs.(21.4±4.8)cm2,P＜0.01;respectively],compared with those in the control group.Spearman's correlation analysis showed that LAD,LAS and LAP were all markedly related to age (r=0.213,P＜0.05;r=-0.175,P＜0.05;r=0.170,P＜0.05;respectively),persistent onset of atrial fibrillation (r=0.401,P＜0.05;r=0.446,P＜0.05;r=0.160,P＜0.05;respectively),and impaired heart function,measured by left ventricular ejection fraction (r=-0.4371,P＜0.05;r=-0.403,P＜0.05;r=-0.364,P＜0.05;respectively) and NT-ProBNP (r=0.485,P＜0.01;r=0.483,P＜ 0.01;r =0.293,P＜ 0.01;respectively).Conclusions Left atrial remodeling properties measured by the UCG system in the elderly with non-valvular atrial fibrillation are more serious than those in mid-aged and young subjects.As a convenient and accurate assessment of remodeling parameters,the UCG system is an excellent option for measuring left atrial remodeling in the elderly population.

Objective: To assess the predictive value of coronary lfow reserve (CFR) for diagnosing coronary stenosis by transthoracic Doppler echocardiography (TTDE) in patients with hypertension.
Methods: A total of 132 patients scheduled for elective coronary angiography (CAG) due to chest pain were enrolled. The patients were divided into 2 groups: Hypertension group,n=95 and Non-hypertension group,n=37. The CRF of left anterior descending coronary artery (LAD) was measured by ATP stress TTDE at 2 days before CAG in all patients and the results were compared between 2 groups. ROC curve was conducted to assess CFR value in diagnosing LAD stenosis which was deifned by LAD luminal diameter stenosis ≥ 70% in relevant patients.
Results: The condition of LAD stenosis was similar between 2 groups (42.1% vs. 35.1%),P>0.05. The CFR value in Hypertension group was lower than that in Non-hypertension group (2.39 ± 0.86) vs. (2.87 ± 1.12),P<0.05. The ROC curve for diagnosing LAD stenosis in all patients were at 0.884 (95% CI 0.83-0.94,P<0.0001), in Hypertension group at 0.874 (95% CI 0.81-0.94,P<0.0001) and in Non-hypertension group at 0.915 (95% CI 0.82-0.98,P<0.0001). With the cut-off point of CFR ≤ 2.2, it had the diagnostic sensitivity, speciifcity and accuracy in all patients were at 80.3%, 83.5% and 80.3%; in Hypertension group were at 77.5%, 80.0% and 78.9%, in Non-hypertension group were at 69.2, 91.7% and 83.8% respectively.
Conclusion: The patients of hypertension combining chest pain had decreased CFR which implied the dysfunction of their microcirculation. CFR had the better diagnostic value for predicting the signiifcant LAD stenosis in such patients.

Objective To observe the association between ambulatory blood pressure levels and blood pressure variability (BPV) with myocardial performance index (MPI) in untreated hypertensive patients.Methods From January to September 2013,a total of 81 untreated hypertensive patients were included in this study.All patients received ambulatory blood pressure monitoring and echocardiography measurements.MPI was determined in all patients by the following formula:MPI =(isovolumic contraction time + isovolumic relaxation time)/ejection time.The patients were divided into two groups according to left ventricular MPI:patients with MPI ＞ 0.47 (n =39) and patients with MPI ≤ 0.47 (n =42).The mean levels and standard deviation (SD) of 24 h,daytime and nighttime blood pressures were compared between the two groups.SD was used to express BPV.Determinants of MPI were identified by multivariate regression analysis.Results 24 h and daytime systolic blood pressure,24 h,daytime and nighttime diastolic blood pressure,as well as SD of 24 h and daytime systolic blood pressure ((130.1 ± 8.7),(134.0 ± 8.2),(89.1 ±6.3),(90.9 ±6.4),(83.1 ±9.9),(13.7 ± 3.3) and(14.2 ± 3.5) mmHg(1 mmHg =0.133 kPa),respectively) were significantly higher in patients with MPI ＞ 0.47 than those ((124.8 ± 8.7),(126.7 ±8.8),(84.5 ±7.1),(86.2 ± 7.4),(76.4 ± 7.5),(11.8 ±2.1) and(10.4 ± 1.9) mmHg,respectively) in patients with MPI≤0.47 (all P ＜ 0.05).Multivariate regression analysis showed that 24 h diastolic blood pressure (β =0.239,P =0.007) and SD of 24 h systolic blood pressure (β =0.333,P ＜0.001),left ventricular mass index and early diastolic mitral annular velocity were independently associated with MPI.Conclusion The increase of diastolic blood pressure and systolic BPV are associated with the deterioration of left ventricular function.

Objective To investigate the cerebral haemodynamics change and morbidity of periventricular-intraventricular hemorrhages(PIVH) in premature infants with or without patent ductus ateriosus (PDA).Methods Bedside Echocardiography and transcranial sonography (TCS) were performed on 85 cases of preterm infants in 48 h,48 to 96 h,96 to 120 h,120 to 168 h after birth (gestational age≤34 weeks and birth weight≤2 000 g).PDA,peak systolic velocity (Vs),end-diastolic velocity (Vd),pulsatility index (PI) and resistant index (RI) of anterior and middle cerebral artery(ACA and MCA) and PIVH were monitored simutaneously.Results According to the Echocardiography and clinical symptoms,all the cases were divided into 3 groups:haemodynamic significant PDA group (hsPDA group,n =23),non-hsPDA group(nhsPDA group,n =38) and non-PDA group(nPDA group,n =24).The mean birth weight and gestational age did not differ significantly among the 3 groups.Single and multiple Logistic analysis indicated that invasive mechanical ventilation less than 48 h after birth was related to hsPDA (x2 =11.182,P =0.019; OR =10.06,P =0.039).Repetitive measurement deviation analysis found that:Vd of ACA and MCA were lower in the hsPDA group than those in the nhsPDA group (P =0.000,P =0.001) and the nPDA group (P =0.003,P =0.013),while PI and RI were higher than in the other 2 groups.Compared with non-closed group,at 7 days after birth in hsPDA group,RI and PI of closed group were significantly lower,while Vd was significantly higher.Nevertheless,there was no significant difference in hemodynamic parameters when comparison with nPDA group at 7 days after birth.There was no statistical difference in the grading and severity of PIVH with or without PDA.However,the rate of severe PIVH was found higher in hsPDA group than the other 2 groups(17.39％ vs 8.33％ vs 5.26％,x2 =2.405,P =0.280).Conclusions The invasive mechanical ventilation less than 48 h after birth was probably associated with preterm hsPDA.HsPDA could result in major cerebral haemodynamic changes and increase the morbidity of severe PIVH.

Holistic education is an important philosophy of medical education.Medical graduate students can show their skills of medical specialties,improve their abilities of communication and cooperation,and promote their sense of social responsibility through social practice.Through conducting questionnaire among medical graduate students of Peking University Third Hospital who major in internal medicine,we have got to know the effect of social practice on holistic education philosophy.Meanwhile,social practice is a crucial approach to implementing holistic education.

Objective To assess the differences in carotid artery stiffness properties and endothelium-independent dilation (EID)between elderly and young patients,and evaluate the echotracking (ET)system for vascular stiffness at different ages.Methods A total of 79 outpatients with multiple cardiovascular risks were recruited.Clinical data including medical history,height,weight,blood pressure,fasting blood glucose and blood lipid were collected.We evaluated the arterial stiffness parameters of carotid artery and EID using an ultrasonic ET system in 46 elderly subjects,compared with 33 sex-matched non-elderly subjects.The impaired EID function was defined as brachial artery nitroglycerin mediated dilation (NMD)below 4％.Results All stiffness parameters including pressure-strain elasticity modulus stiffness index β (Ep),pulse wave velocity β (PWVβ)and augmentation index (AI)were significantly increased in elderly group compared with the non-elderly group [(138.9±64.7)kPa vs.(100.6±30.8)kPa,(10.9±4.7)vs.(8.2±2.3),and (6.9±1.4)m/s vs.(6.1±0.9)m/s,P＜0.05 respectively],while the exception of arterial compliance (AC)was reduced (0.9±0.3)mm2/kPa vs.(1.0±0.5)mm2/kPa(P＜0.05).The incidence of impaired EID in elderly group was higher than in non-elderly group [56.5％ (26 cases) vs.33.3％ (11 cases),P＜0.05].ET parameters including Ep,stiffness index β,PWVβ,AC and AI were related to age (r=-0.44,-0.45,-0.40,-0.40,0.34,all P＜0.01)； Ep,stiffness index β,PWVβ and AC were also related to impaired EDI (r=-0.38,-0.40,-0.34,-0.29,all P＜0.01).Conclusions Arterial stiffness properties and EID measured by ET system was more serious in elderly with multiple cardiovascular risks than in non-elderly subjects.As a convenient and accurate assessment of stiffness parameters,ET system is optimal option for measuring arterial stiffness and EID in elderly people.

Objective To investigate the relationship of B-type natriuretic peptide(BNP),Creactive protein(CRP)and left ventricular diastolic function with cardio-and cerebrovascular disease (CVD)in the elderly patients with hemodialysis.Methods 96 elderly patients with hemodialysis were divided into CVD group(n =35)and non CVD control group(n =61).The patients were followed up once a month for 24 to 30 months.The baseline anthropometric and laboratory parameters were measured.The ratio of mitral peak flow velocity(E)and peak velocities at mitral annuluses (Em)during early diastole of left ventricular was recorded by doppler echocardiography.The time and cause of hospitalization and mortality by CVD were documented.Results The levels of CRP and BNP were significantly higher in CVD group than in control group[(3.1 ± 6.7)mg/L vs.(1.8 ± 1.2)mg/L,(1345.2±1427.8)pmol/L vs.(719.8±1073.8)pmol/L](t=2.14 and-2.82,P＜0.05 or P＜0.01).The ratio of E/ Em was increased in CVD group as compared with control group(t=5.23,P＜0.01).Kaplan-Meier survival curves showed that the morbidity of CVD events was enhanced(P＜0.05 or P＜0.01)at BNP≥500 pmol/L,CRP≥1.5 mg/L and E/Em≥17 which were the independent risk factors of CVD events for the elderly patients with hemodialysis by COX regression model.There was positive correlation between LogBNP and E /Em(r =0.23,P ＜ 0.05).Conclusions Higher levels of BNP,CRP and E/Em may predict the increasing risks of CVD in the elderly patients with hemodialysis.

Objective To evaluate Left ventricular(LV) diastolic function in essential hypertension by conventional pulse-wave Doppler echocardiography (cPWD) and Doppler tissue imaging (DTI) and compare the two modalities. Methods Two hundred patients with essential hypertension were classified as NLVH subgroup (n = 160) and LVH subgroup (n =40) based on left ventricular mass index (LVMI) with one hundred and sixty health subjects as control group. The mitral valve flow pattern (MVFP) was obtained.Early diastolic (E) and late velocities (A) were measured and E/A was calculated. DTI was used to obtain the left ventricular lateral wall early diastolic mitral annulus velocity (Em) and E/Em was calculated.Results Essential hypertension patients had LV diastolic dysfunction both by cPWD (higher E and lower E/A ratio) and DTI (lower Em and higher E/Em ratio) compared with healthy subjects [E:(0. 88 ±0. 18)cm/s vs (0. 76 ±0. 19) cm/s;E/A ratio:0. 86 ±0. 28 vs 1.02 ±0. 38;Em: (9. 4 ±2. 8)cm/s vs (11. 9 ±3. 8)cm/s;E/Em ratio;7. 9 ± 2. 7 vs 6. 0 ± 1. 8: with all P value ＜0.01]. Em was significantly reduced and E/Em was significantly elevated in LVH subgroup than NLVH subgroup [Em; (7.7 ±2. 6) cm/s vs (9. 9 ± 2. 8) cm/s, E/Em: 9. 6 ± 3. 6 vs 7. 4 ± 2. 4, P ＜ 0. 05]. No significant difference was found in A and E/A between these two subgroups [(0. 90 ± 0. 22) cm/s vs (0. 87 ± 0. 17) cm/s; 0. 80 ± 0. 34 vs 0.88 ±0.28, P ＞ 0.05]. Conclusions cPWD and DTI both had implications to detect diastolic dysfunction in non-hypertrophic stage hypertension. Em、E/Em could be more sensitive and precise to reflect the impairment of diastolic function in the progress of hypertension.