Objective To investigate whether C-reactive protein (CRP) is a biomarker of malignant ventricular arrhythmias (MVA) occurring in non-ST elevation myocardial infarction (NSTEMI) patients with Global Registry of Acute C...Objective To investigate whether C-reactive protein (CRP) is a biomarker of malignant ventricular arrhythmias (MVA) occurring in non-ST elevation myocardial infarction (NSTEMI) patients with Global Registry of Acute Coronary events (GRACE) scores < 140. Methods A total of 1450 NSTEMI patients were included in this study. Hs-CRP blood levels were measured via a turbidimetric immunoassay after confirming the diagnosis of NSTEMI with GRACE scores < 140. Results Consistent with prior studies, the MVA occurrence rate in our cohort was 6.7%, and patients with MVA exhibited a reduced left ventricular ejection fraction (46.1%± 6.9% vs. 61.5%± 8.7%, P = 0.032), a higher incidence of Killip classification > 1 (34.1% vs. 24.2%, P < 0.001), an increased surgical revascularization rate (34.1% vs. 9.7%, P < 0.001), and increased mortality (16.5% vs. 5.8%, P < 0.001). Serum hs-CRP levels were higher (P = 0.003) in NSTEMI patients with MVA, and this increase appeared unrelated to other clinical parameters. The C-statistic to discriminate MVA was 0.82 (95% CI: 0.74–0.89). Using receiver operating characteristics analysis, we optimized a cutoff point of 16 mL/L, and the sensitivity and specificity were 95% and 61%, respectively;the positive predictive value was 20% and the negative predictive value was 99%. Conclusions An hs-CRP assay is a potential MVA biomarker in low-risk NSTEMI patients with GRACE scores < 140. If validated in prospective studies, hs-CRP may offer a low-cost supplementary strategy for risk stratification for NSTEMI patients.展开更多
Objective To evaluate the PR to RR interval ratio (PR/RR,heart rate-adjusted PR) as a prognostic marker for long-term ventricular arrhythmias and cardiac death in patients with implantable cardioverter defibrillator (...Objective To evaluate the PR to RR interval ratio (PR/RR,heart rate-adjusted PR) as a prognostic marker for long-term ventricular arrhythmias and cardiac death in patients with implantable cardioverter defibrillator (ICDs) and cardiac resynchronization therapy with defibrillators (CRT-D).Methods We retrospectively analyzed data from 428 patients who had an ICD/CRT-D equipped with home monitoring.Baseline PR and RR interval data prior to ICD/CRT-D implantation were collected from standard 12-lead electrocardiograph,and the PR/RR was calculated.The primary endpoint was appropriate ICD/CRT-D treatment of ventricular arrhythmias (VAs),and the secondary endpoint was cardiac death.Results During a mean follow-up period of 38.8 ± 10.6 months,197 patients (46%) experienced VAs,and 47 patients (11%) experienced cardiac death.The overall PR interval was 160 ± 40 ms,and the RR interval was 866 ± 124 ms.Based on the receiver operating characteristic curve,a cut-off value of 18.5% for the PR/RR was identified to predict VAs.A PR/RR ≥ 18.5% was associated with an increased risk of VAs [hazard ratio (HR)= 2.243,95% confidence interval (CI)= 1.665–3.022,P < 0.001) and cardiac death (HR = 2.358,95%CI = 1.240–4.483,P = 0.009) in an unadjusted analysis.After adjustment in a multivariate Cox model,the relationship remained significant among PR/RR ≥ 18.5%,VAs (HR = 2.230,95%CI = 1.555–2.825,P < 0.001) and cardiac death (HR = 2.105,95%CI = 1.101–4.025,P = 0.024.Conclusions A PR/RR ≥ 18.5% at baseline can serve as a predictor of future VAs and cardiac death in ICD/CRT-D recipients.展开更多
In March 2020,the WHO defined the diffusion of novel coronavirus,Severe Acute Respiratory Syndrome-Coronavirus-2(SARS-CoV-2)as pandemic.[1-3]As a consequence,the Italian Government among others has enforced quarantine...In March 2020,the WHO defined the diffusion of novel coronavirus,Severe Acute Respiratory Syndrome-Coronavirus-2(SARS-CoV-2)as pandemic.[1-3]As a consequence,the Italian Government among others has enforced quarantine on the population to contain the diffusion of the infection.Quarantine refers to the separation of communities who have been exposed to an infectious disease.[1-3]Elderly people's lives have been drastically affected by the lockdown and the fear related to the disease’s potential effects and transmission.Fear of contracting COVID-19 is on the rise due to the death toll and alarming news reports in the media.[2,3].展开更多
Prophylactic effect of magnesium sulfate on reperfusion arrhythmias was studiedusing a left anterior descending coronary artery occlusion followed by reperfusion in theisolated rat heart.In the first studies,we have o...Prophylactic effect of magnesium sulfate on reperfusion arrhythmias was studiedusing a left anterior descending coronary artery occlusion followed by reperfusion in theisolated rat heart.In the first studies,we have observed a bell-shaped relationship be-tween the incidence of reperfusion-induced ventricular fibrillation（VF）and the durationof preceding ischemia.With 5,10,15,20 and 25 min of ischemia,10,70,60,50 and 20per cent of the hearts exhibited irreversible VF,respectively.In the second studies（10 minischemia）,perfusate magnesium sulfate was increased to 3.6,4.8 and 6.0 mmol/L 1 min be-fore coronary ligation,VF fell in a dose-dependent manner from its control total inci-dence of 100%（1.2mmol/L MgSO<sub>4</sub>）to 82%,73% and 18%（P【0.01）,respectively.Heartrate was also reduced in a dose-dependent manner,falling from its control value of326±11 to 227±22 beats/min with the highest concentration of magnesium sulfate.Asperfusate magnesium sulfate was increased to 6.0 mmol/L just before reperfusion,no an-ti-arrhythmic effects were observed.With an anti-arrhythmic concentration of magnesiumsulfate（6.0 mmol/L,increased 1 min before ligation）,calcium concentration was increasedby 1.5 mmol/L at the same time,under these conditions the anti-arrhythmic effect of mag-nesium sulfate was lost and its negative chronotropic effect was also partially abolished.We conclude that magnesium sulfate has a certain prophylactic effect againstreperfusion induced arrhythmias and this could be due to a direct or indirect calci-um-antagonist action.展开更多
Effect of berberine on reperfusion arrhythmias was studied using a10min left anterior descending coronary artery occlusion followed by reperfusionin the isolated rat heart.Berberine when given 10min before coronary li...Effect of berberine on reperfusion arrhythmias was studied using a10min left anterior descending coronary artery occlusion followed by reperfusionin the isolated rat heart.Berberine when given 10min before coronary ligation re-duced the incidence of reperfusion arrhythmias in a dose-dependent manner.With10<sup>-5</sup>,3.16×10<sup>-5</sup> and 10<sup>-4</sup>mol/L of berberine,ventricular fibrillation was reducedfrom its control incidence of 100% to 90%,70% and 40% （P【0.05） respectively.Heart rate was also reduced in a dose-dependent manner,falling from its controlvalue of 282±11 to 180±11 beats/min with the highest concentration of berberine.Coronary flow was increased in all berberine treated groups.With anantiarrhythmic dose of berberine (10<sup>-4</sup>mol/L),hearts were paced （5 Hz） duringischemia period;under these conditions the anti-arrhythmic effect of berberinewas lost.When berberine (3.16×10<sup>-5</sup> and 10<sup>-4</sup>mol/L) was administered just beforereperfusion,no anti-arrhythmic effects were observed.The α-adrenoceptor antago-nist phentolamine (2.6×10<sup>-5</sup>mol/L) prevented reperfusion arrhythmias and ismuch more effective than berberine.These results suggest that the prophylatic ef-fects of berberine on reperfusion arrhythmias in the isolated rat heart are due toits negative chronotropic properties.展开更多
Crdiovascular diseases (CVD) incur a heavy burden of morbidity and mortality among patients with chronic kidney disease (CKD),particularly among the elderly.It is estimated that about 22-25% of all adults beyond the a...Crdiovascular diseases (CVD) incur a heavy burden of morbidity and mortality among patients with chronic kidney disease (CKD),particularly among the elderly.It is estimated that about 22-25% of all adults beyond the age of 65 years have moderate or severe renal dysfunction.1。展开更多
Action potentials generated in the sinoatrial node （SAN） dominate the rhythm and rate of a healthy human heart. Subsequently, these action potentials propagate to the whole heart via its conduction system. Abnormali...Action potentials generated in the sinoatrial node （SAN） dominate the rhythm and rate of a healthy human heart. Subsequently, these action potentials propagate to the whole heart via its conduction system. Abnormalities of impulse generation and/or propagation in a heart can cause arrhythmias. For example, SAN dysfunction or conduction block of the atrioventricular node can lead to serious bradycardia which is currently treated with an implanted electronic pacemaker. On the other hand, conduction damage may cause reentrant tachyarrhythmias which are primarily treated pharmacologically or by medical device-based therapies, including defibrillation and tissue ablation. However, drug therapies sometimes may not be effective or are associated with serious side effects. Device-based therapies for cardiac arrhythmias, even with well developed technology, still face inadequacies, limitations, hardware complications, and other challenges. Therefore, scientists are actively seeking other alternatives for antiarrhythmic therapy. In particular, cells and genes used for repairing cardiac conduction damage/defect have been investigated in various studies both in vitro and in vivo. Despite the complexities of the excitation and conduction systems of the heart, cell and gene-based strategies provide novel alternatives for treatment or cure of cardiac arrhythmias. This review summarizes some highlights of recent research progress in this field.展开更多
Acute myocardial infarction （AMI） is an acute cardiovascular emergency. This study was undertaken to assess the effect of tumor necrosis factor-a （TNF-a） on ventricular arrhythmias induced byAMI in rats in vivo. ...Acute myocardial infarction （AMI） is an acute cardiovascular emergency. This study was undertaken to assess the effect of tumor necrosis factor-a （TNF-a） on ventricular arrhythmias induced byAMI in rats in vivo. Two hundred and forty male Wistar rats were randomized into a sham- operation group, an AMI group, and a recombinant human tumor necrosis factor receptor：Fc fusion protein（rhTNFR：Fc） group. Acute anterior wall myocardial infarction was produced in the AMI group by ligating the left anterior descending coronary artery （LAD）, and there was no ligation but operation in the sham-operation group. The rhTNFR：Fc group was treated with rhTNFR：Fc（10 mg/kg）, a TNF-a antagonist, 24 hours before LAD ligation. The spontaneous and induced programmed electrical stimulation ventricular arrhythmias were recorded at baseline and 10 minutes, 20 minutes, 30 minutes, 60 minutes, 3 hours, 6 hours and 12 hours after ligation. At the same time the protein and mRNA expression levels of TNF-a among different groups were detected by histochemistry and real-time fluorescent quantitative PCR. Expression of TNF-a increased markedly from 10 minutes after infarction, peaked at 20-30 minutes, and returned to baseline gradually in the AMI group and rhTNFR：Fc group. The time- windows of spontaneous and induced ventricular arrhythmias were similar. Compared with the AMI group, the rhTNFR：Fc group showed a lesser expression of TNF-a protein and a lower incidence of ventricular arrhythmias （P〈0.05）. There was no obvious change in the sham-operation group. The expression of TNF-a induced by AMI could contribute to the onset of ventricular arrhythmias.展开更多
Brugada syndrome （BrS） is primary electrical disorder characterized by ST segment elevation with right bundle branch block morphology in patients with apparent structurally normal hearts, It predisposes affected in...Brugada syndrome （BrS） is primary electrical disorder characterized by ST segment elevation with right bundle branch block morphology in patients with apparent structurally normal hearts, It predisposes affected individuals to ventricular tachycardia/fibrillation （VT/VF） and sudden cardiac death （SCD）.A number of studies have identified risk factors that are associated with a more malignant course of disease. These include male gender, syncope, a spontaneous type 1 ECG pattern, family history of SCD, family history of Brugada syndrome,展开更多
Objective To explore fetal arrhythmia clinical significance and its correlation with fetal prognosis. Methods Twenty-six cases of fetal arrhythmia detected among 12 799 pregnant women recorded over a ten-year period i...Objective To explore fetal arrhythmia clinical significance and its correlation with fetal prognosis. Methods Twenty-six cases of fetal arrhythmia detected among 12 799 pregnant women recorded over a ten-year period in Peking Uinon Medical College (PUMC) Hospital were reviewed retrospectively. Fetal arrhythmia was diagnosed by fetal auscultation, ultrasonography, electric fetal heart monitoring, and fetal echocardiography. Results Twenty-six fetuses were documented with fetal arrhythmia (3 tachycardia, 4 bradycardia, 19 normal heart rate with irregular fetal cardiac rhythm). The incidence of fetal arrhythmia in our hospital was 0.2%. They were diagnosed at the average of 35 weeks’ gestation (15 to 41 weeks). Twenty-two cases were diagnosed by antenatal fetal auscultation, 1 case was diagnosed by ultrasonography, and 3 cases were diagnosed by electric fetal heart monitoring. Fetal echocardiograms were per-formed on 17 fetuses, 6 cases (35.3%) of which showed that ventricular premature beats with normal structure of fetal heart. All neonates survived postnatally and 24 of them (92.3%) were followed up. Echocardiograms were performed for 16 neonates and 2 of them were identified as atrial septal defects with normal heart rhythms. The results of follow-up showed that the two patients had no apparent clinical manifestation. The echocardiogram showed that atrial septal defect obliterated already. Conclusion The prognosis is well for most of the fetuses with arrhythmias, with low incidence of heart deformation.展开更多
Background:Abnormal myocardial voltage-gated sodium channel 1.5(Nav1.5)expression and function cause lethal ventricular arrhythmias during myocardial ischemia–reperfusion(I/R).Protein inhibitor of activated STAT Y(PI...Background:Abnormal myocardial voltage-gated sodium channel 1.5(Nav1.5)expression and function cause lethal ventricular arrhythmias during myocardial ischemia–reperfusion(I/R).Protein inhibitor of activated STAT Y(PIASy)-mediated caveolin-3(Cav-3)small ubiquitin-related modifier(SUMO)modification affects Cav-3 binding to the Nav1.5.PIASy activity is increased after myocardial I/R,but it is unclear whether this is attributable to plasma membrane Nav1.5 downregulation and ventricular arrhythmias.Methods:Using recombinant adeno-associated virus subtype 9(AAV9),rat cardiac PIASy was silenced using intraventricular injection of PIASy short hairpin RNA(shRNA).After two weeks,rat hearts were subjected to I/R and electrocardiography was performed to assess malignant arrhythmias.Tissues from peri-infarct areas of the left ventricle were collected for molecular biological measurements.Results:PIASy was upregulated by I/R(P<0.01),with increased SUMO2/3 modification of Cav-3 and reduced membrane Nav1.5 density(P<0.01).AAV9-PIASy shRNA intraventricular injection into the rat heart down-regulated PIASy after I/R,at both mRNA and protein levels(P<0.05 vs.Scramble-shRNA+I/R group),decreased SUMO-modified Cav-3 levels,enhanced Cav-3 binding to Nav1.5,and prevented I/R-induced decrease of Nav1.5 and Cav-3co-localization in the intercalated disc and lateral membrane.PIASy silencing in rat hearts reduced I/R-induced fatal arrhythmias,which was reflected by a modest decrease in the duration of ventricular fibrillation(VF;P<0.05 vs.Scramble-shRNA+I/R group)and a significantly reduced arrhythmia score(P<0.01 vs.Scramble-shRNA+I/R group).The anti-arrhythmic effects of PIASy silencing were also evidenced by decreased episodes of ventricular tachycardia(VT),sustained VT and VF,especially at the time 5–10 min after ischemia(P<0.05 vs.Scramble-shRNA+IR group).Using in vitro human embryonic kidney 293 T(HEK293T)cells and isolated adult rat cardiomyocyte models exposed to hypoxia/reoxygenation(H/R),we confirmed that increased PIASy promoted Cav-3 modification by SUMO2/3 and Nav1.5/Cav-3 dissociation after H/R.Mutation of SUMO consensus lysine sites in Cav-3(K38R or K144R)altered the membrane expression levels of Nav1.5 and Cav-3 before and after H/R in HEK293T cells.Conclusions:I/R-induced cardiac PIASy activation increased Cav-3 SUMOylation by SUMO2/3 and dysregulated Nav1.5-related ventricular arrhythmias.Cardiac-targeted PIASy silencing mediated Cav-3 deSUMOylation and partially prevented I/R-induced Nav1.5 downregulation in the plasma membrane of cardiomyocytes,and subsequent ventricular arrhythmias in rats.PIASy was identified as a potential therapeutic target for life-threatening arrhythmias in patients with ischemic heart diseases.展开更多
This study introduces a new classifier tailored to address the limitations inherent in conventional classifiers such as K-nearest neighbor(KNN),random forest(RF),decision tree(DT),and support vector machine(SVM)for ar...This study introduces a new classifier tailored to address the limitations inherent in conventional classifiers such as K-nearest neighbor(KNN),random forest(RF),decision tree(DT),and support vector machine(SVM)for arrhythmia detection.The proposed classifier leverages the Chi-square distance as a primary metric,providing a specialized and original approach for precise arrhythmia detection.To optimize feature selection and refine the classifier’s performance,particle swarm optimization(PSO)is integrated with the Chi-square distance as a fitness function.This synergistic integration enhances the classifier’s capabilities,resulting in a substantial improvement in accuracy for arrhythmia detection.Experimental results demonstrate the efficacy of the proposed method,achieving a noteworthy accuracy rate of 98% with PSO,higher than 89% achieved without any previous optimization.The classifier outperforms machine learning(ML)and deep learning(DL)techniques,underscoring its reliability and superiority in the realm of arrhythmia classification.The promising results render it an effective method to support both academic and medical communities,offering an advanced and precise solution for arrhythmia detection in electrocardiogram(ECG)data.展开更多
Objectives To assess and synthesize the prospective cohort studies published so far on the association between atrial fibrillation (AF) and dementia incidence.Methods We searched PubMed,Web of Science,and the Cochrane...Objectives To assess and synthesize the prospective cohort studies published so far on the association between atrial fibrillation (AF) and dementia incidence.Methods We searched PubMed,Web of Science,and the Cochrane Library for potential studies published in English previous to April 2018.Two independent reviewers screened the search results for prospective cohort studies reporting the association between AF and dementia incidence in patients with normal cognitive function at baseline and not suffering from an acute stroke.The Newcastle-Ottawa Scale was adopted to evaluate the quality of the included studies.The pooled hazard ratio (HR) of AF for dementia was calculated with the Comprehensive Meta-Analysis software,version 2.Heterogeneity and publication bias were assessed with the I2 test and funnel plot,respectively.Results We finally identified 11 prospective cohort studies covering 112,876 patients.All the included studies reported an adjusted HR obtained in multiple Cox regression models.The qualities of the included studies ranged from moderate to high.In pooled analysis with a fixed-effects model,AF was independently associated with dementia incidence (HR = 1.34,95% CI: 1.24–1.44).Subgroup analysis of studies considering anticoagulation as an important confounding factor achieved a similar result.Based on the I2 test and funnel plot,we did not detect obvious heterogeneity and publication bias in our study.Meta-regression on age did not find significant results.Conclusions The results of our meta-analysis further confirmed that AF was an independent risk factor for dementia in patients with normal baseline cognitive function not suffering from acute stroke.Screening for dementia in AF patients and including dementia as an independent outcome in large AF treatment trials is warranted.展开更多
Differential diagnosis of supraventricular tachycardia (SVT) and ventricular tachycardia (VT) is of paramount importance for appropriate patient management. Several diagnostic algorithms for discrimination of VT and S...Differential diagnosis of supraventricular tachycardia (SVT) and ventricular tachycardia (VT) is of paramount importance for appropriate patient management. Several diagnostic algorithms for discrimination of VT and SVT based on surface electrocardiogram (ECG) analysis have been proposed. Following established diagnosis of VT,a specific origination tachycardia site can be supposed according to QRS complex characteristics. This review aims to cover comprehensive and comparative description of the main VT diagnostic algorithms and to present ECG characteristics which permit to suggest the most common VT origination sites.展开更多
An 81-year-old woman was admitted to our cardiology clinic with episodes of atypical chest pain.She had a personal history of hypertension and had undergone implantation of a VVIR pacemaker(in a subcutaneous pocket at...An 81-year-old woman was admitted to our cardiology clinic with episodes of atypical chest pain.She had a personal history of hypertension and had undergone implantation of a VVIR pacemaker(in a subcutaneous pocket at the right upper side of her thorax)fifteen years before at another institution,because of atrioventricular conduction disturbances(Figure 1DI).展开更多
1 Introduction Virtually all cardiovascular diseases including arrhythmias,valve disease,coronary artery disease and heart failure(HF)are increasingly common with advancing age.^([1])Age and disease-related changes in...1 Introduction Virtually all cardiovascular diseases including arrhythmias,valve disease,coronary artery disease and heart failure(HF)are increasingly common with advancing age.^([1])Age and disease-related changes in the heart including fibrosis in the atrial and ventricular myocardium and conduction system,scar tissue from myocardial infarction or other cardiomyopathic processes,increased inflammatory cytokines and changes to ion channels are just some of the factors that predispose older adults to arrhythmias.^([2]).展开更多
Thanks to the development of new medical technologies and improvement in medical care the last decades are characterized by the growth of elderly＇s number. The median age of the world＇s population is increasing beca...Thanks to the development of new medical technologies and improvement in medical care the last decades are characterized by the growth of elderly＇s number. The median age of the world＇s population is increasing because of a decline in birth rates and a 20-year increase in the average life span during the second half of the 20th century.展开更多
Background Cardiac arrhythmias are common conditions in older people.Unfortunately,there is limited literature on associations between cardiac arrhythmias and physical performance or disability.We therefore aimed to p...Background Cardiac arrhythmias are common conditions in older people.Unfortunately,there is limited literature on associations between cardiac arrhythmias and physical performance or disability.We therefore aimed to prospectively investigate associations between cardiac arrhythmias and changes in disability and physical performance during 8 years of follow-up,using data from the Italian Longitudinal Study on Aging(ILSA).Methods Cardiac arrhythmias diagnosis was posed through a screening phase,confirmed by a physician.The onset of disability in activities of daily living(ADL)and the changes in several physical performance tests during follow-up were considered as outcomes.Fully-adjusted and propensity-score Cox Proportional Hazard models and mixed models were used for exploring associations between cardiac arrhythmia and the outcomes of interest.Results The prevalence of cardiac arrhythmia at baseline was 23.3%.People reporting cardiac arrhythmia at the baseline were significantly older,more frequently male,smokers and reported a higher presence of all medical conditions investigated(hypertension,heart failure,angina,myocardial infarction,diabetes,stroke),but no difference in dementia,Parkinsonism,cognitive or mood disorder.Cardiac arrhythmia at baseline was significantly associated with the incidence of disability in ADL(HR=1.23;95%:CI:1.01–1.50;P=0.0478 in propensity score analyses;HR=1.28;95%CI:1.01–1.61;P=0.0401 in fully adjusted models).Cardiac arrhythmia at baseline was also associated with a significant worsening in balance test(P=0.0436).Conclusions The presence of cardiac arrhythmia at baseline was associated with a significant higher risk of disability and of worsening in some physical performance tests,particularly those relating to balance.Screening and frequently assessing physical performance in older people affected by cardiac arrhythmia can be important to prevent a loss of physical performance,with further,potential,complications of medical management.展开更多
The automatic detection of cardiac arrhythmias through remote monitoring is still a challenging task since electrocardiograms(ECGs)are easily contaminated by physiological artifacts and external noises,and these morph...The automatic detection of cardiac arrhythmias through remote monitoring is still a challenging task since electrocardiograms(ECGs)are easily contaminated by physiological artifacts and external noises,and these morphological characteristics show significant variations for different patients.A fast patient-specific arrhythmia diagnosis classifier scheme is proposed,in which a wavelet adaptive threshold denoising is combined with quantum genetic algorithm(QAG)based on least squares twin support vector machine(LSTSVM).The wavelet adaptive threshold denoising is employed for noise reduction,and then morphological features combined with the timing interval features are extracted to evaluate the classifier.For each patient,an individual and fast classifier will be trained by common and patient-specific training data.Following the recommendations of the Association for the Advancements of Medical Instrumentation(AAMI),experimental results over the MIT-BIH arrhythmia benchmark database demonstrated that our proposed method achieved the average detection accuracy of 98.22%,99.65%and 99.41%for the abnormal,ventricular ectopic beats(VEBs)and supra-VEBs(SVEBs),respectively.Besides the detection accuracy,sensitivity and specificity,our proposed method consumes the less CPU running time compared with the other representative state of the art methods.It can be ported to Android based embedded system,henceforth suitable for a wearable device.展开更多
基金supported by the Capital Health Research and Development of Special Foundation (2018-1-2061)
文摘Objective To investigate whether C-reactive protein (CRP) is a biomarker of malignant ventricular arrhythmias (MVA) occurring in non-ST elevation myocardial infarction (NSTEMI) patients with Global Registry of Acute Coronary events (GRACE) scores < 140. Methods A total of 1450 NSTEMI patients were included in this study. Hs-CRP blood levels were measured via a turbidimetric immunoassay after confirming the diagnosis of NSTEMI with GRACE scores < 140. Results Consistent with prior studies, the MVA occurrence rate in our cohort was 6.7%, and patients with MVA exhibited a reduced left ventricular ejection fraction (46.1%± 6.9% vs. 61.5%± 8.7%, P = 0.032), a higher incidence of Killip classification > 1 (34.1% vs. 24.2%, P < 0.001), an increased surgical revascularization rate (34.1% vs. 9.7%, P < 0.001), and increased mortality (16.5% vs. 5.8%, P < 0.001). Serum hs-CRP levels were higher (P = 0.003) in NSTEMI patients with MVA, and this increase appeared unrelated to other clinical parameters. The C-statistic to discriminate MVA was 0.82 (95% CI: 0.74–0.89). Using receiver operating characteristics analysis, we optimized a cutoff point of 16 mL/L, and the sensitivity and specificity were 95% and 61%, respectively;the positive predictive value was 20% and the negative predictive value was 99%. Conclusions An hs-CRP assay is a potential MVA biomarker in low-risk NSTEMI patients with GRACE scores < 140. If validated in prospective studies, hs-CRP may offer a low-cost supplementary strategy for risk stratification for NSTEMI patients.
文摘Objective To evaluate the PR to RR interval ratio (PR/RR,heart rate-adjusted PR) as a prognostic marker for long-term ventricular arrhythmias and cardiac death in patients with implantable cardioverter defibrillator (ICDs) and cardiac resynchronization therapy with defibrillators (CRT-D).Methods We retrospectively analyzed data from 428 patients who had an ICD/CRT-D equipped with home monitoring.Baseline PR and RR interval data prior to ICD/CRT-D implantation were collected from standard 12-lead electrocardiograph,and the PR/RR was calculated.The primary endpoint was appropriate ICD/CRT-D treatment of ventricular arrhythmias (VAs),and the secondary endpoint was cardiac death.Results During a mean follow-up period of 38.8 ± 10.6 months,197 patients (46%) experienced VAs,and 47 patients (11%) experienced cardiac death.The overall PR interval was 160 ± 40 ms,and the RR interval was 866 ± 124 ms.Based on the receiver operating characteristic curve,a cut-off value of 18.5% for the PR/RR was identified to predict VAs.A PR/RR ≥ 18.5% was associated with an increased risk of VAs [hazard ratio (HR)= 2.243,95% confidence interval (CI)= 1.665–3.022,P < 0.001) and cardiac death (HR = 2.358,95%CI = 1.240–4.483,P = 0.009) in an unadjusted analysis.After adjustment in a multivariate Cox model,the relationship remained significant among PR/RR ≥ 18.5%,VAs (HR = 2.230,95%CI = 1.555–2.825,P < 0.001) and cardiac death (HR = 2.105,95%CI = 1.101–4.025,P = 0.024.Conclusions A PR/RR ≥ 18.5% at baseline can serve as a predictor of future VAs and cardiac death in ICD/CRT-D recipients.
文摘In March 2020,the WHO defined the diffusion of novel coronavirus,Severe Acute Respiratory Syndrome-Coronavirus-2(SARS-CoV-2)as pandemic.[1-3]As a consequence,the Italian Government among others has enforced quarantine on the population to contain the diffusion of the infection.Quarantine refers to the separation of communities who have been exposed to an infectious disease.[1-3]Elderly people's lives have been drastically affected by the lockdown and the fear related to the disease’s potential effects and transmission.Fear of contracting COVID-19 is on the rise due to the death toll and alarming news reports in the media.[2,3].
文摘Prophylactic effect of magnesium sulfate on reperfusion arrhythmias was studiedusing a left anterior descending coronary artery occlusion followed by reperfusion in theisolated rat heart.In the first studies,we have observed a bell-shaped relationship be-tween the incidence of reperfusion-induced ventricular fibrillation（VF）and the durationof preceding ischemia.With 5,10,15,20 and 25 min of ischemia,10,70,60,50 and 20per cent of the hearts exhibited irreversible VF,respectively.In the second studies（10 minischemia）,perfusate magnesium sulfate was increased to 3.6,4.8 and 6.0 mmol/L 1 min be-fore coronary ligation,VF fell in a dose-dependent manner from its control total inci-dence of 100%（1.2mmol/L MgSO<sub>4</sub>）to 82%,73% and 18%（P【0.01）,respectively.Heartrate was also reduced in a dose-dependent manner,falling from its control value of326±11 to 227±22 beats/min with the highest concentration of magnesium sulfate.Asperfusate magnesium sulfate was increased to 6.0 mmol/L just before reperfusion,no an-ti-arrhythmic effects were observed.With an anti-arrhythmic concentration of magnesiumsulfate（6.0 mmol/L,increased 1 min before ligation）,calcium concentration was increasedby 1.5 mmol/L at the same time,under these conditions the anti-arrhythmic effect of mag-nesium sulfate was lost and its negative chronotropic effect was also partially abolished.We conclude that magnesium sulfate has a certain prophylactic effect againstreperfusion induced arrhythmias and this could be due to a direct or indirect calci-um-antagonist action.
文摘Effect of berberine on reperfusion arrhythmias was studied using a10min left anterior descending coronary artery occlusion followed by reperfusionin the isolated rat heart.Berberine when given 10min before coronary ligation re-duced the incidence of reperfusion arrhythmias in a dose-dependent manner.With10<sup>-5</sup>,3.16×10<sup>-5</sup> and 10<sup>-4</sup>mol/L of berberine,ventricular fibrillation was reducedfrom its control incidence of 100% to 90%,70% and 40% （P【0.05） respectively.Heart rate was also reduced in a dose-dependent manner,falling from its controlvalue of 282±11 to 180±11 beats/min with the highest concentration of berberine.Coronary flow was increased in all berberine treated groups.With anantiarrhythmic dose of berberine (10<sup>-4</sup>mol/L),hearts were paced （5 Hz） duringischemia period;under these conditions the anti-arrhythmic effect of berberinewas lost.When berberine (3.16×10<sup>-5</sup> and 10<sup>-4</sup>mol/L) was administered just beforereperfusion,no anti-arrhythmic effects were observed.The α-adrenoceptor antago-nist phentolamine (2.6×10<sup>-5</sup>mol/L) prevented reperfusion arrhythmias and ismuch more effective than berberine.These results suggest that the prophylatic ef-fects of berberine on reperfusion arrhythmias in the isolated rat heart are due toits negative chronotropic properties.
文摘Crdiovascular diseases (CVD) incur a heavy burden of morbidity and mortality among patients with chronic kidney disease (CKD),particularly among the elderly.It is estimated that about 22-25% of all adults beyond the age of 65 years have moderate or severe renal dysfunction.1。
文摘Action potentials generated in the sinoatrial node （SAN） dominate the rhythm and rate of a healthy human heart. Subsequently, these action potentials propagate to the whole heart via its conduction system. Abnormalities of impulse generation and/or propagation in a heart can cause arrhythmias. For example, SAN dysfunction or conduction block of the atrioventricular node can lead to serious bradycardia which is currently treated with an implanted electronic pacemaker. On the other hand, conduction damage may cause reentrant tachyarrhythmias which are primarily treated pharmacologically or by medical device-based therapies, including defibrillation and tissue ablation. However, drug therapies sometimes may not be effective or are associated with serious side effects. Device-based therapies for cardiac arrhythmias, even with well developed technology, still face inadequacies, limitations, hardware complications, and other challenges. Therefore, scientists are actively seeking other alternatives for antiarrhythmic therapy. In particular, cells and genes used for repairing cardiac conduction damage/defect have been investigated in various studies both in vitro and in vivo. Despite the complexities of the excitation and conduction systems of the heart, cell and gene-based strategies provide novel alternatives for treatment or cure of cardiac arrhythmias. This review summarizes some highlights of recent research progress in this field.
文摘Acute myocardial infarction （AMI） is an acute cardiovascular emergency. This study was undertaken to assess the effect of tumor necrosis factor-a （TNF-a） on ventricular arrhythmias induced byAMI in rats in vivo. Two hundred and forty male Wistar rats were randomized into a sham- operation group, an AMI group, and a recombinant human tumor necrosis factor receptor：Fc fusion protein（rhTNFR：Fc） group. Acute anterior wall myocardial infarction was produced in the AMI group by ligating the left anterior descending coronary artery （LAD）, and there was no ligation but operation in the sham-operation group. The rhTNFR：Fc group was treated with rhTNFR：Fc（10 mg/kg）, a TNF-a antagonist, 24 hours before LAD ligation. The spontaneous and induced programmed electrical stimulation ventricular arrhythmias were recorded at baseline and 10 minutes, 20 minutes, 30 minutes, 60 minutes, 3 hours, 6 hours and 12 hours after ligation. At the same time the protein and mRNA expression levels of TNF-a among different groups were detected by histochemistry and real-time fluorescent quantitative PCR. Expression of TNF-a increased markedly from 10 minutes after infarction, peaked at 20-30 minutes, and returned to baseline gradually in the AMI group and rhTNFR：Fc group. The time- windows of spontaneous and induced ventricular arrhythmias were similar. Compared with the AMI group, the rhTNFR：Fc group showed a lesser expression of TNF-a protein and a lower incidence of ventricular arrhythmias （P〈0.05）. There was no obvious change in the sham-operation group. The expression of TNF-a induced by AMI could contribute to the onset of ventricular arrhythmias.
文摘Brugada syndrome （BrS） is primary electrical disorder characterized by ST segment elevation with right bundle branch block morphology in patients with apparent structurally normal hearts, It predisposes affected individuals to ventricular tachycardia/fibrillation （VT/VF） and sudden cardiac death （SCD）.A number of studies have identified risk factors that are associated with a more malignant course of disease. These include male gender, syncope, a spontaneous type 1 ECG pattern, family history of SCD, family history of Brugada syndrome,
文摘Objective To explore fetal arrhythmia clinical significance and its correlation with fetal prognosis. Methods Twenty-six cases of fetal arrhythmia detected among 12 799 pregnant women recorded over a ten-year period in Peking Uinon Medical College (PUMC) Hospital were reviewed retrospectively. Fetal arrhythmia was diagnosed by fetal auscultation, ultrasonography, electric fetal heart monitoring, and fetal echocardiography. Results Twenty-six fetuses were documented with fetal arrhythmia (3 tachycardia, 4 bradycardia, 19 normal heart rate with irregular fetal cardiac rhythm). The incidence of fetal arrhythmia in our hospital was 0.2%. They were diagnosed at the average of 35 weeks’ gestation (15 to 41 weeks). Twenty-two cases were diagnosed by antenatal fetal auscultation, 1 case was diagnosed by ultrasonography, and 3 cases were diagnosed by electric fetal heart monitoring. Fetal echocardiograms were per-formed on 17 fetuses, 6 cases (35.3%) of which showed that ventricular premature beats with normal structure of fetal heart. All neonates survived postnatally and 24 of them (92.3%) were followed up. Echocardiograms were performed for 16 neonates and 2 of them were identified as atrial septal defects with normal heart rhythms. The results of follow-up showed that the two patients had no apparent clinical manifestation. The echocardiogram showed that atrial septal defect obliterated already. Conclusion The prognosis is well for most of the fetuses with arrhythmias, with low incidence of heart deformation.
基金supported by grants from the National Natural Science Foundation of China(81770824,81270239)。
文摘Background:Abnormal myocardial voltage-gated sodium channel 1.5(Nav1.5)expression and function cause lethal ventricular arrhythmias during myocardial ischemia–reperfusion(I/R).Protein inhibitor of activated STAT Y(PIASy)-mediated caveolin-3(Cav-3)small ubiquitin-related modifier(SUMO)modification affects Cav-3 binding to the Nav1.5.PIASy activity is increased after myocardial I/R,but it is unclear whether this is attributable to plasma membrane Nav1.5 downregulation and ventricular arrhythmias.Methods:Using recombinant adeno-associated virus subtype 9(AAV9),rat cardiac PIASy was silenced using intraventricular injection of PIASy short hairpin RNA(shRNA).After two weeks,rat hearts were subjected to I/R and electrocardiography was performed to assess malignant arrhythmias.Tissues from peri-infarct areas of the left ventricle were collected for molecular biological measurements.Results:PIASy was upregulated by I/R(P<0.01),with increased SUMO2/3 modification of Cav-3 and reduced membrane Nav1.5 density(P<0.01).AAV9-PIASy shRNA intraventricular injection into the rat heart down-regulated PIASy after I/R,at both mRNA and protein levels(P<0.05 vs.Scramble-shRNA+I/R group),decreased SUMO-modified Cav-3 levels,enhanced Cav-3 binding to Nav1.5,and prevented I/R-induced decrease of Nav1.5 and Cav-3co-localization in the intercalated disc and lateral membrane.PIASy silencing in rat hearts reduced I/R-induced fatal arrhythmias,which was reflected by a modest decrease in the duration of ventricular fibrillation(VF;P<0.05 vs.Scramble-shRNA+I/R group)and a significantly reduced arrhythmia score(P<0.01 vs.Scramble-shRNA+I/R group).The anti-arrhythmic effects of PIASy silencing were also evidenced by decreased episodes of ventricular tachycardia(VT),sustained VT and VF,especially at the time 5–10 min after ischemia(P<0.05 vs.Scramble-shRNA+IR group).Using in vitro human embryonic kidney 293 T(HEK293T)cells and isolated adult rat cardiomyocyte models exposed to hypoxia/reoxygenation(H/R),we confirmed that increased PIASy promoted Cav-3 modification by SUMO2/3 and Nav1.5/Cav-3 dissociation after H/R.Mutation of SUMO consensus lysine sites in Cav-3(K38R or K144R)altered the membrane expression levels of Nav1.5 and Cav-3 before and after H/R in HEK293T cells.Conclusions:I/R-induced cardiac PIASy activation increased Cav-3 SUMOylation by SUMO2/3 and dysregulated Nav1.5-related ventricular arrhythmias.Cardiac-targeted PIASy silencing mediated Cav-3 deSUMOylation and partially prevented I/R-induced Nav1.5 downregulation in the plasma membrane of cardiomyocytes,and subsequent ventricular arrhythmias in rats.PIASy was identified as a potential therapeutic target for life-threatening arrhythmias in patients with ischemic heart diseases.
文摘This study introduces a new classifier tailored to address the limitations inherent in conventional classifiers such as K-nearest neighbor(KNN),random forest(RF),decision tree(DT),and support vector machine(SVM)for arrhythmia detection.The proposed classifier leverages the Chi-square distance as a primary metric,providing a specialized and original approach for precise arrhythmia detection.To optimize feature selection and refine the classifier’s performance,particle swarm optimization(PSO)is integrated with the Chi-square distance as a fitness function.This synergistic integration enhances the classifier’s capabilities,resulting in a substantial improvement in accuracy for arrhythmia detection.Experimental results demonstrate the efficacy of the proposed method,achieving a noteworthy accuracy rate of 98% with PSO,higher than 89% achieved without any previous optimization.The classifier outperforms machine learning(ML)and deep learning(DL)techniques,underscoring its reliability and superiority in the realm of arrhythmia classification.The promising results render it an effective method to support both academic and medical communities,offering an advanced and precise solution for arrhythmia detection in electrocardiogram(ECG)data.
基金supported by a grant from the National Natural Science Foundation of China(Grant No.81471197)the National Key Research and Development Program of China(2017YFC0907703)
文摘Objectives To assess and synthesize the prospective cohort studies published so far on the association between atrial fibrillation (AF) and dementia incidence.Methods We searched PubMed,Web of Science,and the Cochrane Library for potential studies published in English previous to April 2018.Two independent reviewers screened the search results for prospective cohort studies reporting the association between AF and dementia incidence in patients with normal cognitive function at baseline and not suffering from an acute stroke.The Newcastle-Ottawa Scale was adopted to evaluate the quality of the included studies.The pooled hazard ratio (HR) of AF for dementia was calculated with the Comprehensive Meta-Analysis software,version 2.Heterogeneity and publication bias were assessed with the I2 test and funnel plot,respectively.Results We finally identified 11 prospective cohort studies covering 112,876 patients.All the included studies reported an adjusted HR obtained in multiple Cox regression models.The qualities of the included studies ranged from moderate to high.In pooled analysis with a fixed-effects model,AF was independently associated with dementia incidence (HR = 1.34,95% CI: 1.24–1.44).Subgroup analysis of studies considering anticoagulation as an important confounding factor achieved a similar result.Based on the I2 test and funnel plot,we did not detect obvious heterogeneity and publication bias in our study.Meta-regression on age did not find significant results.Conclusions The results of our meta-analysis further confirmed that AF was an independent risk factor for dementia in patients with normal baseline cognitive function not suffering from acute stroke.Screening for dementia in AF patients and including dementia as an independent outcome in large AF treatment trials is warranted.
文摘Differential diagnosis of supraventricular tachycardia (SVT) and ventricular tachycardia (VT) is of paramount importance for appropriate patient management. Several diagnostic algorithms for discrimination of VT and SVT based on surface electrocardiogram (ECG) analysis have been proposed. Following established diagnosis of VT,a specific origination tachycardia site can be supposed according to QRS complex characteristics. This review aims to cover comprehensive and comparative description of the main VT diagnostic algorithms and to present ECG characteristics which permit to suggest the most common VT origination sites.
文摘An 81-year-old woman was admitted to our cardiology clinic with episodes of atypical chest pain.She had a personal history of hypertension and had undergone implantation of a VVIR pacemaker(in a subcutaneous pocket at the right upper side of her thorax)fifteen years before at another institution,because of atrioventricular conduction disturbances(Figure 1DI).
文摘1 Introduction Virtually all cardiovascular diseases including arrhythmias,valve disease,coronary artery disease and heart failure(HF)are increasingly common with advancing age.^([1])Age and disease-related changes in the heart including fibrosis in the atrial and ventricular myocardium and conduction system,scar tissue from myocardial infarction or other cardiomyopathic processes,increased inflammatory cytokines and changes to ion channels are just some of the factors that predispose older adults to arrhythmias.^([2]).
文摘Thanks to the development of new medical technologies and improvement in medical care the last decades are characterized by the growth of elderly＇s number. The median age of the world＇s population is increasing because of a decline in birth rates and a 20-year increase in the average life span during the second half of the 20th century.
基金The Italian National Research Council(CNR)supported the ILSA project from 1991 to 1998 as part of the“Progetto Finalizzato Invecchiamento”Since 1999,the Italian CNR,the“Biology of Aging”Strategic Project and the Ministero della Sanità,through the program“Epidemiology of the Elderly”of the Istituto Superiore di Sanitàand the“Estimates of Health Needs of the Elderly”Special Programme of the Tuscany Region have been supporting the ILSA project.
文摘Background Cardiac arrhythmias are common conditions in older people.Unfortunately,there is limited literature on associations between cardiac arrhythmias and physical performance or disability.We therefore aimed to prospectively investigate associations between cardiac arrhythmias and changes in disability and physical performance during 8 years of follow-up,using data from the Italian Longitudinal Study on Aging(ILSA).Methods Cardiac arrhythmias diagnosis was posed through a screening phase,confirmed by a physician.The onset of disability in activities of daily living(ADL)and the changes in several physical performance tests during follow-up were considered as outcomes.Fully-adjusted and propensity-score Cox Proportional Hazard models and mixed models were used for exploring associations between cardiac arrhythmia and the outcomes of interest.Results The prevalence of cardiac arrhythmia at baseline was 23.3%.People reporting cardiac arrhythmia at the baseline were significantly older,more frequently male,smokers and reported a higher presence of all medical conditions investigated(hypertension,heart failure,angina,myocardial infarction,diabetes,stroke),but no difference in dementia,Parkinsonism,cognitive or mood disorder.Cardiac arrhythmia at baseline was significantly associated with the incidence of disability in ADL(HR=1.23;95%:CI:1.01–1.50;P=0.0478 in propensity score analyses;HR=1.28;95%CI:1.01–1.61;P=0.0401 in fully adjusted models).Cardiac arrhythmia at baseline was also associated with a significant worsening in balance test(P=0.0436).Conclusions The presence of cardiac arrhythmia at baseline was associated with a significant higher risk of disability and of worsening in some physical performance tests,particularly those relating to balance.Screening and frequently assessing physical performance in older people affected by cardiac arrhythmia can be important to prevent a loss of physical performance,with further,potential,complications of medical management.
基金Supported by the National Natural Science Foundation of China(61571063)Key Scientific Research Projects of Colleges and Universities in Henan Province(20A510014)Key Scientific and Technological Projects in Henan Province。
文摘The automatic detection of cardiac arrhythmias through remote monitoring is still a challenging task since electrocardiograms(ECGs)are easily contaminated by physiological artifacts and external noises,and these morphological characteristics show significant variations for different patients.A fast patient-specific arrhythmia diagnosis classifier scheme is proposed,in which a wavelet adaptive threshold denoising is combined with quantum genetic algorithm(QAG)based on least squares twin support vector machine(LSTSVM).The wavelet adaptive threshold denoising is employed for noise reduction,and then morphological features combined with the timing interval features are extracted to evaluate the classifier.For each patient,an individual and fast classifier will be trained by common and patient-specific training data.Following the recommendations of the Association for the Advancements of Medical Instrumentation(AAMI),experimental results over the MIT-BIH arrhythmia benchmark database demonstrated that our proposed method achieved the average detection accuracy of 98.22%,99.65%and 99.41%for the abnormal,ventricular ectopic beats(VEBs)and supra-VEBs(SVEBs),respectively.Besides the detection accuracy,sensitivity and specificity,our proposed method consumes the less CPU running time compared with the other representative state of the art methods.It can be ported to Android based embedded system,henceforth suitable for a wearable device.
