Zhonghua Xin Xue Guan Bing Za Zhi
· 2025 Nov · PMID 41287296
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To analyze the clinical characteristics, diagnostic and therapeutic strategies, and clinical outcomes of ventricular electrical storm. This study was a descriptive cross-sectional analysis. Patients with ventricular ele...To analyze the clinical characteristics, diagnostic and therapeutic strategies, and clinical outcomes of ventricular electrical storm. This study was a descriptive cross-sectional analysis. Patients with ventricular electrical storm admitted to the Department of cardiology, General Hospital of Northern Theater command between July 1, 2022 and July 31, 2023 were enrolled. A retrospective analysis was conducted on their demographic data, clinical characteristics, etiology, diagnosis, treatment, and outcome. A total of 20 patients with ventricular electrical storm were enrolled, aged (62.4±12.0) years, including 13 males. There were 11 cases of acute myocardial infarction (AMI), 1 case of previous myocardial infarction complicated with ischemic cardiomyopathy, 4 cases of dilated cardiomyopathy, and 4 cases of valvular disease. Electrocardiographic manifestations comprised monomorphic ventricular tachycardia in 3 cases, polymorphic ventricular tachycardia in 6 cases, ventricular fibrillation in 4 cases, and polymorphic ventricular tachycardia combined with ventricular fibrillation in 7 cases. Antiarrhythmic therapy primarily involved amiodarone, combined with β-blockers and adjunctive agents such as lidocaine and nifekalant, along with sedation, hypothermia, and anti-heart failure treatment. Ten out of 11 AMI patients underwent successful revascularization, while 1 received medical therapy due to small vessel size. Ten patients met indications for implantable cardioverter-defibrillator (ICD) therapy, with 9 receiving ICD implantation during hospitalization and 1 refusing. Three patients underwent radiofrequency ablation. Two in-hospital deaths occurred due to refractory malignant arrhythmias. During a follow-up of (7.36±2.74) months, 10 out of 11 AMI patients remained free from recurrent ventricular tachycardia and ICD discharges, while 1 was hospitalized twice for heart failure. Both ICD-treated patients with DCM had appropriate shocks for ventricular tachycardia and ventricular fibrillation confirmed by device interrogation. Two additional deaths occurred during follow-up: 1 AMI patient (who refused ICD implantation) died from arrhythmia, and 1 post-mitral valve replacement patient succumbed to heart failure. Ventricular electrical storm represents a life-threatening emergency with poor prognosis, requiring a comprehensive treatment strategy that includes identification and management of triggers, treatment of the underlying disease, standardized drug therapy, and when necessary, adjunctive interventions such as catheter ablation, ICD implantation, and extracorporeal membrane oxygenation may contribute to reduce mortality and improve prognosis.
Li M, Wang ML, Li YR
… +3 more, Zhang HY, Jia XQ, Huang TT
Zhonghua Xin Xue Guan Bing Za Zhi
· 2025 Nov · PMID 41287295
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Publisher ↗
To establish and validate the diagnostic model of acute pulmonary embolism (APE) based on clinical and laboratory variables. This retrospective analysis was conducted on patients with suspected APE who underwent CT pulm...To establish and validate the diagnostic model of acute pulmonary embolism (APE) based on clinical and laboratory variables. This retrospective analysis was conducted on patients with suspected APE who underwent CT pulmonary angiography at the First Affiliated Hospital of Henan University of Chinese Medicine between February 2015 and December 2023. The patients were randomly divided into a training set and a validation set at a ratio of 7∶3. Clinical and laboratory data of the enrolled patients were collected, and patients were divided into an APE group and a non-APE group according to CT pulmonary angiography results. In the training set, univariate and multivariate logistic regression as well as Lasso regression were used to identify risk factors for APE, and a diagnostic model was developed and validated. Receiver operating characteristic curves were plotted, and calibration and decision curves were used to assess the performance of the diagnostic model. The diagnostic efficacy of the model was compared with that of the Wells score and the revised Geneva score using the DeLong test. A total of 752 patients were enrolled, aged (64±15) years, including 417 (55.5%) males. The training set included 526 patients and the validation set included 226 patients. The incidence of APE in this cohort was 48.7% (366/752), with 366 cases in the APE group and 386 in the non-APE group. Multivariable logistic regression analysis showed that cyanosis (=8.88, 95% 2.04-49.11), elevated neutrophil count (=1.82, 95% 1.06-3.15), elevated creatine kinase isoenzyme (=3.45, 95% 1.76-6.91), decreased partial pressure of carbon dioxide (=12.88, 95% 7.64-22.34), elevated age-adjusted D-dimer (=2.53, 95% 1.10-6.20), prolonged thrombin time (=4.08, 95% 2.06-8.33), and positive lower limb venous ultrasound for thrombus (=4.39, 95% 2.59-7.58) were risk factors associated with APE. The area under the curve () of the diagnostic model was 0.92 (95% 0.90-0.94) in the training set and 0.92 (95% 0.89-0.95) in the validation set. The diagnostic efficacy of this model was superior to that of the Wells score (: 0.92 vs. 0.63, <0.01) and the revised Geneva score (: 0.92 vs. 0.59, <0.01). The diagnostic model for acute pulmonary embolism constructed based on clinical and laboratory parameters demonstrates excellent diagnostic performance and may facilitate rapid and accurate screening in clinical practice.
Sun YJ, Zhang XY, Hu Y
… +38 more, Lin ZW, Xiao J, Li P, Zhao X, Zhang HF, Qin B, Jia DQ, Zhang T, Ma J, Chen HP, Zhang CJ, Geng XW, Zhang KY, Zheng M, Zhang FL, Lang Y, Hou HG, Liu P, Jia HF, Lu JJ, Zhao K, Zhao H, Xu JC, Zhang M, Li XX, Zhang DX, Zhong L, Zhao H, Liu FF, Liu Y, Miao DX, Wang CW, Zhang H, Wang C, Wang F, Zhang XJ, Lyu HX, Ji XP
Zhonghua Xin Xue Guan Bing Za Zhi
· 2025 Nov · PMID 41287294
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Publisher ↗
To explore the impact of the two-way referral model on compliance and prognosis in patients with heart failure. This bidirectional cohort study enrolled chronic heart failure (CHF) patients treated at Qilu Hospital of S...To explore the impact of the two-way referral model on compliance and prognosis in patients with heart failure. This bidirectional cohort study enrolled chronic heart failure (CHF) patients treated at Qilu Hospital of Shandong University or designated primary hospitals between March 2018 and March 2022. Patients were categorized into two groups based on referral status: two-way referral group (participating in the referral model with≥1 follow-up visit at primary hospitals) and the core hospital group (receiving treatment and follow-up exclusively at Qilu Hospital). Baseline clinical characteristics were collected and compared between groups. Patients underwent followed-up, with primary endpoints including follow-up rate, drug (β-blockers, angiotension converting enzyme inhibitor (ACEI)/angiotensin Ⅱ receptor blockers (ARB)/angiotensin receptor-neprilysin inhibitor (ARNI), sodium-glucose cotransporter 2 inhibitors and mineralocorticoid receptor antagonists) utilization rate and target dose achievement rate. Secondary endpoints encompassed changes from baseline in left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDd), and N-terminal pro-brain natriuretic peptide (NT-proBNP), plus cardiovascular mortality and heart failure rehospitalization. Generalized linear mixed models analyzed longitudinal trends in LVEF, LVEDd, and NT-proBNP levels. Kaplan-Meier curves and Cox regression evaluated LVEF recovery rates, supplemented by subgroup analyses. Multivariate logistic regression was used to identify factors influencing target dose achievement rate for β-blockers and ACEI/ARB/ARNI therapies in CHF patients. A total of 357 patients were enrolled, aged 53 (41, 63) years, including 256 males (71.7%). 157 patients were in the two-way referral group and 200 patients in the core hospital-treated group. Compared with the core hospital-treated group, the two-way referral group had lower baseline LVEF (28 (22, 34)% vs. 31 (23, 36)%, =0.021) and systolic blood pressure (116 (104, 125) mmHg vs. 121 (109, 134) mmHg (1 mmHg=0.133 kPa), =0.010). The 12-month follow-up rate of the two-way referral group was higher than the core hospital-treated group (73.8% vs. 56.0%, =0.004). No significant between-group differences were observed in drug utilization rate of β-blockers, ACEI/ARB/ARNI, or sodium-glucose cotransporter 2 inhibitors during follow-up (all >0.05), while mineralocorticoid receptor antagonists use showed a declining trend in both groups. Although the core hospital-treated group had higher target dose achievement rates for β-blockers (65.4% vs. 49.3%, =0.042) and ACEI/ARB/ARNI (79.8% vs. 65.8%, =0.046) than the two-way referral group, multivariate logistic regression indicated that the two-way referral model was not a negative predictor for these outcomes (all >0.05). Both groups showed improved NT-proBNP, LVEDd, and LVEF from baseline (all <0.001) with no significant difference in trends between groups (all >0.05). There was no significant difference in the composite incidence (7.6% vs. 6.5%, =0.674) and cumulative incidence (log-rank =0.684) of cardiovascular death and heart failure rehospitalization at 12 months between two groups. The two-way referral model demonstrates advantages in improving medication adherence, drug utilization rates, and targetdoseachievement rates among CHF patients. This model not only promotes cardiac functional recovery but also reduces risks of cardiovascular mortality and heart failure rehospitalization, achieving comparable therapeutic and management outcomes to those observed in core hospital-treated patients.
Wang W, Wang YM, Cui HW
… +8 more, Yang HZ, Guo SY, Zhang CY, Wang Y, Zhou QP, Tian YF, Yin DC, Tian Y
Zhonghua Xin Xue Guan Bing Za Zhi
· 2025 Nov · PMID 41287293
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To investigate the effect and underlying mechanism of sonodynamic therapy (SDT) on inflammation-related atrial fibrillation (AF) susceptibility. Lipopolysaccharide (LPS)-stimulated mouse and HL-1 mouse atrial myocyte mo...To investigate the effect and underlying mechanism of sonodynamic therapy (SDT) on inflammation-related atrial fibrillation (AF) susceptibility. Lipopolysaccharide (LPS)-stimulated mouse and HL-1 mouse atrial myocyte models were used. (1) In vivo study: experimental groups included control, LPS, LPS+SDT, and SDT groups, with 20 mice in each group. Atrial fibrillation inducibility and duration were assessed by electrical stimulation. Western blot was used to analyze atrial expression of NOD-like receptor family pyrin domain-containing protein 3 (NLRP3), interleukin (IL)-1β, and IL-18. Immunohistochemistry was used to detect calcium voltage-gated channel subunit alpha1 C (CACNA1C) expression. (2) In vitro study: cell counting kit-8 (CCK-8) and Western blot were used to determine the optimal and safe LPS concentration. The safe incubation condition for the sonosensitizer sinoporphyrin sodium was determined by CCK-8 and fluorometry. An LPS-induced inflammatory model in HL-1 atrial myocytes was used, with experimental groups including control, LPS, LPS+SDT, LPS+sinoporphyrin sodium, and LPS+ultrasound groups. NLRP3 was overexpressed using plasmid transfection, with experimental groups including control, NLRP3 plasmid, negative control plasmid, and NLRP3 plasmid+SDT groups. SDT was applied to LPS-stimulated or NLRP3-overexpressing HL-1 cells. Quantitative real-time polymerase chain reaction (qRT-PCR) and Western blot were used to measure mRNA and protein levels of NLRP3, apoptosis-associated speck-like protein containing a CARD (ASC), Cleaved Caspase-1, IL-1β, IL-18, and CACNA1C. The NLRP3 inhibitor MCC950 was used to validate the relationship of NLRP3 and CACNA1C. The experimental groups included control, LPS, LPS+MCC950, and MCC950 groups. Intracellular reactive oxygen species (ROS) levels were detected using the probe DCFH-DA, and the ROS scavenger N-acetyl-L-cysteine (NAC) was used to test if the effects of SDT was ROS-dependent. (1) In vivo: The LPS+SDT group exhibited a lower incidence of atrial fibrillation induction and a shorter duration of atrial fibrillation compared to the LPS group(both <0.05). Protein expression levels of NLRP3 and IL-1β were lower than those in the LPS group (all <0.05), while the expression of CACNA1C subunit tended to increase relative to the LPS group (>0.05). (2) In vitro: The safe concentration of LPS for administration was ≤20 μg/ml, with an optimal pro-inflammatory concentration of 4 μg/ml. The safe concentration of sinoporphyrin sodium for administration was 0.4 μmol/L, with an optimal incubation time of 4 hours. Compared to the LPS group or NLRP3 plasmid group, the LPS+SDT group or NLRP3 plasmid+SDT group exhibited lower expression levels of NLRP3, ASC, Cleaved Caspase-1, IL-1β, and IL-18, and higher mRNA and protein levels of CACNA1C (all <0.05). The LPS+MCC950 group had higher CACNA1C protein expression than the LPS group (<0.05). SDT increased intracellular ROS levels, and NAC blocked the regulatory effects of SDT on NLRP3 and CACNA1C. SDT reduces atrial fibrillation susceptibility in mice by inhibiting NLRP3 inflammasome activation in atrial cardiomyocytes, thereby upregulating the L-type calcium channel subunit CACNA1C.
Qian J, Du Y, Sha W
… +10 more, Rong SK, Yao YQ, Hu R, Deng CM, Liu DC, Du JL, She Q, Yu B, Chen XP, Huang J
Zhonghua Xin Xue Guan Bing Za Zhi
· 2025 Nov · PMID 41287292
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Publisher ↗
To preliminarily evaluate the efficacy and safety of a domestically developed bilateral interventional ultrasound renal denervation (RDN) system in patients with uncontrolled hypertension despite antihypertensive medicat...To preliminarily evaluate the efficacy and safety of a domestically developed bilateral interventional ultrasound renal denervation (RDN) system in patients with uncontrolled hypertension despite antihypertensive medication. A multicenter, single-arm trial was conducted. Patients with uncontrolled hypertension (≥2 antihypertensive drugs) were enrolled from April 2023 to April 2024 at the Second Affiliated Hospital of Chongqing Medical University, West China Hospital of Sichuan University, and the Second Affiliated Hospital of Harbin Medical University. RDN was performed using the UltraCure™ bilateral interventional ultrasound system via femoral or brachial artery access. Multi-segmental "quadrant-based" ablation was performed in bilateral main renal arteries and branches/accessory arteries (diameter≥4 mm). Primary endpoints were changes in office systolic blood pressure (SBP) and 24-hour daytime SBP at 2-and 6-months post-procedure. The primary safety endpoints included the incidence of major adverse events, device-related adverse events, and puncture site complications. Ten patients, mean aged 47.1 years, including 9 male, successfully completed RDN. At 2 and 6 months post-procedure, office SBP decreased by (19.7±15.2) mmHg (=0.002, 1 mmHg=0.133 kPa) and (13.8±13.9) mmHg (=0.013) from baseline, while the 24-hour daytime SBP decreased by (13.4±10.6) mmHg (=0.004) and (11.2±9.2) mmHg (=0.004). Apart from one case of a limited distal renal artery dissection, no other serious device/procedure-related adverse events were observed. At 6-month follow-up, the estimated glomerular filtration rate remained stable ((85.3±18.3) ml·min·1.73 m vs. (82.3±19.2) ml·min·1.73 m, =0.41). No renal artery stenosis was detected. The domestic interventional ultrasound RDN system could effectively reduce office and ambulatory blood pressure in patients with uncontrolled hypertension, demonstrating a favorable safety profile. Long-term efficacy requires confirmation through large-scale randomized controlled trials.
Wang Y, Sun YH, Liu Y
… +9 more, Fan JX, Wang YQ, Jiang YX, Wang H, Yang JM, Wang LY, Guo SY, Wang W, Tian Y
Zhonghua Xin Xue Guan Bing Za Zhi
· 2025 Nov · PMID 41287291
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Publisher ↗
To preliminarily evaluate the lumen gain of sonodynamic therapy (SDT) mediated by sinoporphyrin sodium at carotid and femoral atherosclerotic plaque sites, and to assess whether concomitant statin use, lesion location, p...To preliminarily evaluate the lumen gain of sonodynamic therapy (SDT) mediated by sinoporphyrin sodium at carotid and femoral atherosclerotic plaque sites, and to assess whether concomitant statin use, lesion location, plaque echogenicity/type, and baseline stenosis severity modify the therapeutic response. This single-center, prospective, exploratory pilot clinical study enrolled patients with peripheral artery disease who attended the outpatient cardiology clinic of the First Affiliated Hospital of Harbin Medical University between February and September 2016. All enrolled patients received optimized oral medical therapy in combination with a single session of SDT. Vascular evaluation was performed using color Doppler ultrasound before treatment and 1 and 4 weeks after treatment. The primary efficacy endpoint was the percent change from baseline in luminal diameter stenosis at the site of the atherosclerotic plaque (%Δ) at week 4, while the secondary efficacy endpoint was %Δ at week 1. Subgroup analyses were conducted according to prior statin use, plaque location, plaque characteristics, and baseline degree of luminal stenosis. A total of 24 patients, aged (70.7±2.2) years were enrolled. There were 20 (83%) males. Compared to baseline, luminal diameter stenosis at the plaque site reduced by week 4 ((50.1±1.2)% vs. (57.2±1.1)%,<0.001), %Δ was(12.32±1.05)%; and luminal diameter stenosis also reduced by week 1 ((51.7±1.2)% vs. (57.2±1.1)%,<0.001)), %Δ was(9.61±0.85)%. In subgroup analyses, the treatment effect on diameter stenosis was independent of prior statin use; SDT reduced stenosis in both carotid and femoral plaques; with superior efficacy observed in hypoechoic and mixed-echo plaques; and efficacy was observed across mild, moderate, and severe baseline stenosis categories (all <0.05). In this single-center pilot study, SDT demonstrates therapeutic efficacy across mild, moderate, and severe stenoses, as well as in hypoechoic and mixed-echo plaques, showing potential to rapidly promote luminal gain at carotid and femoral atherosclerotic plaque sites.
Wang YM, Hou L, Feng XF
… +2 more, Quan KY, Chen GX
Zhonghua Xin Xue Guan Bing Za Zhi
· 2025 Oct · PMID 41139651
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To explore an initial target rate for resuscitation attempted by bystanders for patients experiencing out-of-hospital cardiac arrest in China. We searched seven electronic databases, including CNKI, VIP, Wanfang, CBM, P...To explore an initial target rate for resuscitation attempted by bystanders for patients experiencing out-of-hospital cardiac arrest in China. We searched seven electronic databases, including CNKI, VIP, Wanfang, CBM, PubMed, Cochrane, EMBase, for Utstein-style reports of out-of-hospital cardiac arrest, containing data on bystander resuscitation and survival to discharge or 30 days after arrest. All patients with cardiac arrest diagnosed at prehospital emergency medical services were included. Meta-analysis was performed to pool rate ratios (RR) with 95% confidence intervals (CI) of the rate of survival to discharge or 30 days. The population attributable risk percent (PARP) was calculated with RR, and the growth rate curve of PARP following bystander cardiopulmonary resuscitation rate was plotted. We established a multiple linear regression model to show the change in survival to discharge or 30 days with increasing rates of resuscitation attempted by bystanders. We included 24 cohorts with 279 641 patients experiencing out-of-hospital cardiac arrest. The median rates of bystander cardiopulmonary resuscitation and survival to discharge or 30 days after arrest in seven cohorts from China were 2.8% and 0.47%, respectively, both far below the first tertiles in all cohorts worldwide (10.0% and 2.70%, respectively). The meta-analysis showed that resuscitation attempts by bystanders increased the chance of survival to discharge or 30 days (=5.91, 95% 3.28-10.66; =0, =0.990). The growth rate curve on PARP showed a rapid attenuation in the increase of PARP after the bystander resuscitation rate reached 10%. The multiple linear regression showed that resuscitation attempted by bystanders could explain 74.4% of the variation in the rates of survival to discharge or 30 days. By increasing the bystander resuscitation rate to 10%, the rate of survival to discharge or 30 days could increase to 1.40% (95% 0.76%-2.05%), and the PARP could increase from 19.7% to 32.9%. Low rate of resuscitation attempted by bystanders is currently the main reason for the poor survival rate of out-of-hospital cardiac arrest in China. It is recommended to increase the rate of resuscitation attempted by bystanders in stages with an initial target rate of 10%.