李晓瑶
中国医学科学院阜外医院 心律失常中心
Objectives:This study aims to investigate the association between waist circumference (WC) and cardiovascular death in patients with permanent pacemakers (PPMs).Methods:This is a retrospective cohort study that enrolled patients who underwent PPM implantation in Fuwai Hospital from May 2010 to April 2014, according to the BIOTRONIK Home Monitoring database. The WC was treated as sex-specific quartiles, and patients were divided into three groups according to body mass index (BMI): normal (≤22.9 kg/m2), overweight (23-24.9 kg/m2), and obese (≥25 kg/m2). Cox proportional hazards models were used to calculate hazard ratios and 95% confidence intervals for cardiovascular death according to WC and BMI in patients.Results:492 patients with PPMs implantation were analyzed (mean age: 71.9 ± 10.8 years; 55.1% men (n = 271)). Data showed that after a mean follow-up 67.2 ± 17.5 months, 24 (4.9%) patients had experienced cardiovascular death and 71 (14.4%) were cases of all-cause mortality. Men in the third quartile of WC had an HR of 10.67 (Model 4, 95% CI: 1.00-115.21, p trend = 0.04) for cardiovascular death. However, the association disappeared in female patients (Model 4, HR = 3.99, 95% CI: 0.37-42.87, p trend = 0.25). There was no association between BMI and cardiovascular death or all-cause mortality in both male and female patients.Conclusions:Abdominal obesity was associated with an increased risk of cardiovascular death in patients with PPMs, and this relationship was only in male patients.
Evidence-based complementary and alternative medicine : eCAM 2023
Aims:To determine the interaction of electrical storm (ES) and impaired left ventircular ejection fraction (LVEF) on the mortality risk of patients with implantable cardioverter defibrillator (ICD).Methods and results:A total of 554 Chinese ICD recipients from 2010 to 2014 were retrospectively included and the mean follow-up was 58 months. The proportions of dilated cardiomyopathy and the hypertrophic cardiomyopathy were 26.0% (144/554) and 5.6% (31/554), respectively. There were 8 cases with long QT syndrome, 6 with arrhythmogenic right ventricular cardiomyopathy and 2 with Brugada syndrome. Patients with prior MI accounted for 15.5% (86/554) and pre-implantation syncope accounted for 23.3% (129/554). A total of 199 (35.9%) patients had primary prevention indications for ICD therapy. Both ES and impaired LVEF (<40%) were independent predictors for all-cause mortality [hazard ratio (HR) 2.40, 95% CI 1.57-3.68, P < 0.001; HR 1.94, 95% CI 1.30-2.90, P = 0.001, respectively] and cardiovascular mortality (HR 4.63, 95% CI 2.68-7.98, P < 0.001; HR 2.56, 95% CI 1.47-4.44, p = 0.001, respectively). Compared with patients with preserved LVEF (≥40%) and without ES, patients with impaired LVEF and ES had highest all-cause and cardiovascular mortality risks (HR 4.17, 95% CI 2.16-8.06, P < 0.001; HR 11.91, 95% CI 5.55-25.56, P < 0.001, respectively). In patients with impaired LVEF, ES increased the all-cause and cardiovascular mortality risks (HR 1.84, 95% CI 1.00-3.37, P = 0.034; HR 4.86, 95% CI 2.39-9.86, P < 0.001, respectively). In patients with ES, the deleterious effects of impaired LVEF seemed confined to cardiovascular mortality (HR 2.54, 95% CI 1.25-5.14, p = 0.038), and the HR for all-cause mortality was not significant statistically (HR 1.14, 95% CI 0.54-2.38, P = 0.735).Conclusion:Both ES and impaired LVEF are independent predictors of mortality risk in this Chinese cohort of ICD recipients. The interaction of ES and impaired LVEF in patients significantly amplifies the deleterious effects of each other as distinct disease.
Frontiers in cardiovascular medicine 2022
BACKGROUND:To study the relationship between objective daily physical activity (PA), as measured by implantable cardioverter defibrillators (ICDs)/cardiac resynchronization therapy defibrillators (CRTDs), and long-term prognoses in patients with age > 75 years at high risk of sudden cardiac death (SCD).METHODS:In total, 133 patients with age > 75 years old (age 79.52 ± 3.68 years) in the SUMMIT study were retrospectively analysed. The major endpoint was all-cause mortality, and the minor endpoint was cardiac death.RESULTS:The mean follow-up time was 57.1 ± 24.2 months (range: from 4 to 96 months). In total, 46 all-cause mortality and 23 cardiac death events occurred. The receiver operating characteristic curve indicated a baseline PA cut-off value of 6.47% (93 min/day) can predict all-cause mortality in patients with age > 75 years, with an area under the curve of 0.670 (95% confidence interval (CI): 0.573-0.767, P = 0.001). The sensitivity was 67.4%, and the specificity was 66.7%. Patients with baseline PA ≤ 6.47% had higher rates of all-cause mortality (51.7% vs 20.5%, P < 0.001) and cardiac death (25.0% vs 11.0%, P = 0.040). The estimated Kaplan-Meier survival curves showed that patients with PA ≤ 6.47% had an increased cumulative incidence of all-cause mortality (Log-rank P < 0.0001) and cardiac death (Log-rank P = 0.0067). Multivariate Cox regression analysis showed that PA ≤ 6.47% was an independent predictor of all-cause mortality (hazard ratio (HR) 3.137, 95% CI: 1.667-5.904, P < 0.001) and cardiac death (HR value 3.345, 95% CI: 1.394-8.028, P = 0.007).CONCLUSIONS:Daily PA of about 1.5 h was associated with lower all-cause mortality and cardiac death risk in patients with age > 75 years and high risk of SCD with ICDs/CRTDs. PA monitoring may aid in long-term management of older patients at high risk of SCD.
BMC geriatrics 2022
Background: Common ostium of inferior pulmonary veins (COIPV) is a kind of pulmonary vein variation. The safety and efficacy of COIPV isolation using the second-generation cryoballoon (CB) ablation remain unknown. Methods: A total of 10 patients with COIPV from a consecutive series of 1,751 patients with atrial fibrillation (AF) were included. Pulmonary vein isolation (PVI) was performed using the second-generation CB. Results: The prevalence of a COIPV was 0.57% in this study. PVI was achieved in all pulmonary veins (PVs) without the need for a touch-up. A segmental freeze strategy was applied for each inferior PV, respectively. The mean number of freeze cycles of inferior PVs was 1.4 ± 0.5 for the left inferior pulmonary vein (LIPV), and 2.0 ± 0.9 for the right inferior pulmonary vein (RIPV). Pulmonary vein potential (PVP) of RIPV could not be monitored in real-time in three cases. Eight of 10 patients (80%) were free from atrial arrhythmias without the use of antiarrhythmic drugs during a follow-up period of 23.6 ± 12.9 months. No procedure-related complications occurred in any of the 10 patients. Conclusions: Common ostium of inferior pulmonary veins is a rare but challenging PV variant. PVI with this unusual anatomic variation using the second-generation 28-mm CB is effective and safe.
Frontiers in cardiovascular medicine 2021
OBJECTIVE:To investigate whether plasma big endothelin-1 (ET-1) predicts ventricular arrythmias (VAs) and end-stage events in primary prevention implantable cardioverter-defibrillator (ICD) indication patigents.METHODS:In total, 207 patients fulfilling the inclusion criteria from Fuwai Hospital between January 2013 and December 2015 were retrospectively analyzed. The cohort was divided into three groups according to baseline plasma big ET-1 tertiles: tertile 1 (< 0.38 pmol/L, n = 68), tertile 2 (0.38-0.7 pmol/L, n = 69), and tertile 3 (> 0.7 pmol/L, n = 70). The primary endpoints were VAs. The secondary endpoints were end-stage events comprising all-cause mortality and heart transplantation.RESULTS:During a mean follow-up period of 25.6 ± 13.9 months, 38 (18.4%) VAs and 78 (37.7%) end-stage events occurred. Big ET-1 was positively correlated with NYHA class (r = 0.165, P = 0.018), serum creatinine concentration (Scr; r = 0.147, P = 0.034), high-sensitivity C-reactive protein (hs-CRP; r = 0.217, P = 0.002), Lg NT-pro BNP (r = 0.463, P < 0.001), left ventricular end diastolic diameter (LVEDD; r = 0.234, P = 0.039) and negatively correlated with left ventricular ejection fraction (LVEF; r = -0.181, P = 0.032). Kaplan-Meier analysis showed that elevated big ET-1 was associated with increased risk of VAs and end-stage events (P < 0.05). In multivariate Cox regression models, big ET-1 was an independent risk factor for VAs (hazard ratio (HR) = 3.477, 95% confidence interval (CI): 1.352-8.940, P = 0.010, tertile 2 vs. tertile 1; HR = 4.112, 95% CI: 1.604-10.540, P = 0.003, tertile 3 vs. tertile 1) and end-stage events (HR = 2.804, 95% CI: 1.354-5.806, P = 0.005, tertile 2 vs. tertile 1; HR = 4.652, 95% CI: 2.288-9.459, P < 0.001, tertile 3 vs. tertile 1).CONCLUSIONS:In primary prevention ICD indication patients, plasma big ET-1 levels can predict VAs and end-stage events and may facilitate ICD-implantation risk stratification.
Journal of geriatric cardiology : JGC 2020
OBJECTIVE:To investigate the obesity paradox and its interrelationship with objective physical activity (PA) in patients at high risk of sudden cardiac death.METHODS:A total of 782 patients with implantable cardioverter-defibrillators/cardiac resynchronization therapy defibrillators in the Study of Home Monitoring System Safety and Efficacy in Cardiac Implantable Electronic Device-Implantable Patients registry were retrospectively analyzed and grouped by body mass index (BMI) (kg/m2): normal weight (18.5 ≤ BMI < 25) and overweight or class I obesity (25 ≤ BMI < 35). PA was measured with home monitoring and categorized into 4 groups (Q1-Q4) by the baseline quartiles. The main endpoint was all-cause mortality.RESULTS:During a mean follow-up period of 59.9 ± 21.9 months, 182 all-cause mortality events occurred. Mortality tended to be lower in overweight and obesity patients (18.9% vs 25.1%, P = 0.061) and decreased by PA quartiles (44.1% vs 22.6% vs 15.3% vs 11.2%, Q1-Q4, P < 0.001). Multivariate Cox analysis indicated BMI (hazard ratio, 0.918; 95% confidence interval, 0.866-0.974; P = 0.004) and PA (0.436, 0.301-0.631, Q2 vs Q1; 0.280, 0.181-0.431, Q3 vs Q1; 0.257, 0.158-0.419, Q4 vs Q1; P < 0.001 for all) were associated with reduced risk. The obesity paradox was significant in the total cohort (log rank P = 0.049) and low PA group (log rank P = 0.010), but disappeared in the high PA group (log rank P = 0.692). Dose-response curves showed a significant reduction in risk with low-moderate PA, and the pattern varied between different BMI groups.CONCLUSIONS:The obesity paradox only persisted in physically inactive patients. PA might be related to the development of the obesity paradox.
The Journal of clinical endocrinology and metabolism 2020
Objective: To clarify the impact of sex on physical activity (PA) levels among patients with implantable cardioverter-defibrillators/cardiac resynchronization therapy defibrillators (ICD/CRT-D) and its association with cardiac death and all-cause mortality. Methods: Overall, data of 820 patients with ICD/CRT-D from the SUMMIT registry were retrospectively analyzed. Baseline PA from 30 to 60 days after device implantation was measured using Biotronik accelerometer sensors. The primary and secondary endpoints were cardiac death and all-cause mortality, respectively. Results: Baseline PA levels were significantly higher in male patients than in female patients (11.40 ± 5.83% vs. 9.93 ± 5.49%, P = 0.001). Males had higher predictive PA cut-off values for cardiac death (11.16 vs. 7.15%) and all-cause mortality (11.33 vs. 7.17%). During the median follow-up time of 75.7 ± 29.1 months, patients with baseline PA Frontiers in cardiovascular medicine 2020
BACKGROUND:Cardiovascular implantable electronic devices (CIEDs) with physical activity (PA) recording function can continuously and automatically collect patients' long-term PA data. The dose-response association of implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy defibrillator (CRTD)-measured PA with cardiovascular outcomes in patients at high risk of sudden cardiac death (SCD) was investigated.METHODS:In total, 822 patients fulfilling the inclusion criteria were included and divided into three groups according to baseline PA tertiles: tertile 1 (< 8.04%, n = 274), tertile 2 (8.04-13.24%, n = 274), and tertile 3 (> 13.24%, n = 274). The primary endpoint was cardiac death, the secondary endpoint was all-cause mortality.RESULTS:During a mean follow-up of 59.7 ± 22.4 months, cardiac death (18.6% vs 8.8% vs 5.5%, tertiles 1-3, P < 0.001) and all-cause mortality (39.4% vs 20.4% vs 9.9%, tertiles 1-3, P < 0.001) events decreased according to PA tertiles. Compared with patients younger than 60 years old, older patients had a lower average PA level (9.6% vs 12.8%, P < 0.001) but higher rates of cardiac death (13.2% vs 8.1%, P = 0.024) and all-cause mortality (28.4% vs 16.7%, P < 0.001) events. Adjusted multivariate Cox regression analyses showed that a higher tertile of PA was associated with a lower risk of cardiac death (hazard ratio (HR) 0.41, 95% confidence interval (CI): 0.25-0.68, tertile 2 vs tertile 1; HR 0.28, 95% CI: 0.15-0.51, tertile 3 vs tertile 1, P trend < 0.001). Similar results were observed for all-cause mortality. The dose-response curve showed an inverse non-linear pattern, and a significant reduction in endpoint risk was observed at the low-moderate PA level. The HR for cardiac death was reduced by half with 12.32% PA (177 min), and the HR for all-cause mortality was reduced by half with 11.92% PA (172 min). Subgroup analysis results indicated that older adults could benefit from PA and the range for achieving optimal benefits might be lower.CONCLUSIONS:PA monitoring may aid in long-term management of patients at high risk of SCD. More PA will generate better survival benefits, but even low-moderate PA is already good especially for older adults, which is relatively easy to achieve.
The international journal of behavioral nutrition and physical activity 2020
BACKGROUND:Previous studies have reported inconsistent results on the relationship between body mass index (BMI) and clinical outcomes in implantable cardioverter defibrillator (ICD) patients. Additionally, research on ICD patients with nonischemic cardiomyopathy (NICM) is lacking.HYPOTHESIS:This study aimed to investigate the impact of BMI on mortality and ventricular arrhythmias (VAs) in NICM patients with an ICD.METHODS:This study retrospectively analyzed the data from the Study of Home Monitoring System Safety and Efficacy in Cardiac Implantable Electronic Device-implanted patients (SUMMIT) in China. Four hundred and eighty NICM patients with an ICD having BMI data were enrolled. Patients were divided into two groups: underweight and normal range group (BMI < 24 kg/m2 ), overweight and obese group (BMI≥24 kg/m2 ). The primary endpoint was all-cause mortality. The secondary endpoint was the first occurrence of VAs requiring appropriate ICD therapy or shock.RESULTS:During a median follow-up of 61 (1-95) months, 70 patients (14.6%) died, 173 patients (36%) experienced VAs requiring appropriate ICD therapy, and 112 patients (23.3%) were treated with ICD shock. Multivariate Cox regression modeling indicated a decreased mortality risk in the overweight and obese group compared with the underweight and normal range group (hazard ratio = 0.44, 95% confidence interval 0.26-0.77, P = .003). However, the risk of VAs was similar in both groups in univariate and multivariate Cox models.CONCLUSIONS:Compared with underweight and normal weight, overweight and obesity are protective against mortality but have only a neutral impact on VAs risk in NICM patients with an ICD.
Clinical cardiology 2020
Our report detailes an eldly woman with multiple liver space-occupying lesions (SOLs). Abdominal ultrasonography revealed multiple hypoechoic masses of different sizes, and enhanced computed tomography showed multiple nodules and masses in the liver parenchyma. Ultrasound-guided liver biopsy was performed because the radiological and endoscopic examinations could not determine the diagnosis. Pathological diagnosis indicated poorly differentiated adenocarcinoma. Immunohistochemical staining showed that the expression of CK7, CK8/18, CK19, mammaglobin, ER/SP1, PR/1E2 and GS were positive whereas the expression of Hepatocyte, AFP, GPC-3, WT-1, CK20, CD34, Syn, CgA, CD56, TTF-1, NapsinA, CDX-2, GCDFP 15 and CA125 were negative. Combined with pathological and immunohistochemical results, the diagnosis was determined as the primary intrahepatic bile duct adenocarcinoma. However, no definite risk factor had been found for this patient, and we found that the patient had a medical history of fatty liver for 20 years. She was obese, with a body weight of 92 kilograms (BMI, 32.86 Kg/m2), and radiological examinations showed the typical imaging characteristics for fatty liver. According to our current knowledge, we deduce that nonalcoholic fatty liver disease may be the possible risk factor for this patient with intrahepatic bile duct adenocarcinoma, but a mere coincidence cannot be ruled out. In this report, we detail the case and discuss the relationship between nonalcoholic fatty liver disease and primary intrahepatic bile duct adenocarcinoma.
International journal of clinical and experimental pathology 2018
