Imaging for Transcatheter Mitral Valve Edge-to-Edge Repair for an Unusual Cause of Cardiogenic Shock.

Does environmental pollution inhibit urbanization in China? A new perspective through residents' medical and health costs.

Health problems caused by environmental pollution may affect the process of urbanization in China. Therefore, this study, against the backdrop of promoting new-type urbanization, evaluates the level of China's urbanization comprehensively using the fully arranged polygon graphical index method. It uses a dynamic threshold panel model to study the potential non-linear relationship between environmental pollution (wastewater, sulfur dioxide, and solid wastes) and urbanization under different health costs of residents. Our findings show that environmental pollution has inhibited the improvement of comprehensive urbanization, population urbanization, economic urbanization, and living conditions urbanization, but promoted living environment urbanization, in China. It is worth noting that with the rise in residents' health costs, the inhibiting effect of environmental pollution on comprehensive urbanization, population urbanization, economic urbanization, and living conditions urbanization in China has gradually increased, but on living environment urbanization, it has decreased.

Does sanitation infrastructure in rural areas affect migrant workers' health? Empirical evidence from China.

Health is considered the most important factor for individual well-being and a country's sustainable development. Among the influential factors of population health, sanitary infrastructure, particularly sanitary toilets and innocuous-sanitary toilets, have already attracted attention. In recent years, to improve the overall health status of rural residents, the Chinese government has promoted the "toilet revolution" in rural areas to update and modernize the facilities of toilets. Given that migrant workers contribute significantly to China's economic growth, and that the migrant workers generally lived in rural areas before they moved to urban areas to find jobs, it is of great interest and importance to investigate the impacts of sanitary infrastructure in rural areas on the migrant workers. This study analyzes the spatial characteristic of rural sanitation facilities' implementation and looks for possible correlation between the health status of migrant workers and the implementation of sanitation facilities in their hometowns. Micro-survey data of migrant workers' health status from China Household Income Projects (CHIP) 2013 and macro-data of provincial economic factors are matched to provide a quality analysis. The analysis of the spatial distribution shows that there were significantly large gaps between the prevalence rates of sanitary toilets in provinces. Furthermore, the regression analysis indicates that the implementation of sanitary toilets and innocuous-sanitary toilets exhibits a positive effect on the overall health status of migrant workers, although the effects of the innocuous-sanitary toilets are greater. Moreover, the positive influences of both types of toilets on population health are higher in the provinces with relatively greater annual precipitation and higher average temperature.

The aging burden of hospitalization for heart failure in Chinese populations: evidence from the Macao Heart Failure Study.

OBJECTIVE:To assess the aging burden of hospitalization for heart failure in Chinese populations in Macao.METHODS:The Macao Heart Failure Study consists of patients hospitalized with a diagnosis of acute heart failure (AHF) at Centro Hospitalar Conde de São Januário (the only public hospital that provides medical care for the approximately 600, 000 residents of Macao) from January 2014 to December 2016. First, we investigated the relationship between socioeconomic development and epidemiological characteristics of HF in Macao. Then we assessed the patientso clinical features and outcomes according to the age groups.RESULTS:A total of 967 patients were included in the final analysis. The median age at admission was 82 years old. The advanced age at the admission of HF in Macao was significantly associated with a high-income level and the aging population structure. Marked heterogeneity existed in the epidemiological characteristics, clinical features, utilization of evidence-based therapies, short- and long-term outcomes, and prognostic utility of clinical variables among the different age groups.CONCLUSION:Rapid economic development and significantly aging populations have produced a profound impact on the epidemiological characteristics of HF in Chinese populations. Acute decompensated heart failure (ADHF) is predominantly a disease of the elderly in Macao, and a significant heterogeneity exists in the clinical features, managements, and outcomes among different age groups. Age-based risk stratification models and multidisciplinary HF teams are urgently needed to improve the management and outcomes of hospitalized heart failure (HHF) patients.

What is the health cost of haze pollution? Evidence from China.

INTRODUCTION:Haze pollution has become a serious threat to the health of residents and has brought about considerable economic costs. The objectives of this study are to examine the relationship between haze pollution and residents' health and to estimate the health cost of haze pollution.METHODS:Using macro data on 74 major Chinese cities, this study employs a static panel data model and a dynamic panel generalized method of moments model to investigate the impact of haze pollution on the mortality of residents. On the basis of the estimation results, the value of a statistical life (VOSL) method is used to evaluate the economic cost of haze pollution on residents' health.RESULTS:In 74 major cities of China, an increase in concentration of PM2.5 pollutants by 1 μg/m3 may cause the mortality rate to rise by 25 per million people. The VOSL of haze pollution in China is about 1.53 million yuan. The health cost of residents from haze in 74 major cities of China in 2016 was about 888 billion yuan, equivalent to about 2% of the these cities' GDP.CONCLUSIONS:Haze pollution has serious damage to the health of urban residents and therefore brings about considerable economic losses.

The impact of environmental pollution on public health expenditure: dynamic panel analysis based on Chinese provincial data.

In recent years, along with rapid economic growth, China's environmental problems have become increasingly prominent. At the same time, the level of China's pollution has been growing rapidly, which has caused huge damages to the residents' health. In this regard, the public health expenditure ballooned as the environmental quality deteriorated in China. In this study, the effect of environmental pollution on residents' health expenditure is empirically investigated by employing the first-order difference generalized method of moments (GMM) method to control for potential endogeneity. Using a panel data of Chinese provinces for the period of 1998-2015, this study found that the environmental pollution (represented by SO2 and soot emissions) would indeed lead to the increase in the medical expenses of Chinese residents. At the current stage of economic development, an increase in SO2 and soot emissions per capita would push up the public health expenditure per capita significantly. The estimation results are quite robust for different types of regression specifications and different combinations of control variables. Some social and economic variables such as public services and education may also have remarkable influences on residential medical expenses through different channels.

Onset seasons and clinical outcomes in patients with Stanford type A acute aortic dissection: an observational retrospective study.

OBJECTIVES:To evaluate the association of onset season with clinical outcome in type A acute aortic dissection (AAD).DESIGN:A single-centre, observational retrospective study.SETTING:The study was conducted in Fuwai Hospital, the National Centre for Cardiovascular Disease, Beijing, China.PARTICIPANTS:From 2008 to 2010, a set of consecutive patients with type A AAD, confirmed by CT scanning, were enrolled and divided into four groups according to onset season: winter (December, January and February), spring (March, April and May), summer (June, July and August) and autumn (September, October and November). The primary end points were in-hospital death and all-cause mortality during follow-up.RESULTS:Of the 492 cases in this study, 129 occurred in winter (26.2%), 147 in spring (29.9%), 92 in summer (18.7%), and 124 in autumn (25.2%). After a median follow-up of 20.4 months (IQR 9.7-38.9), the in-hospital mortality in cases occurring in autumn was higher than in the other three seasons (23.4% vs 8.4%, p<0.01). Long-term mortality was comparable among the four seasonal groups (p=0.63). After adjustment for age, gender and other risk factors, onset in autumn was still an independent factor associated with increased risk of in-hospital mortality (HR 2.05; 95% CI 1.15 to 3.64, p=0.02) in addition to surgical treatment. Further analysis showed that the seasonal effect on in-hospital mortality (autumn vs other seasons: 57.4% vs 27.3%, p<0.01) was only significant in patients who did not receive surgical treatment. No seasonal effect on long-term clinical outcomes was found in this cohort.CONCLUSIONS:Onset in autumn may be a factor that increases the risk of in-hospital death from type A AAD, especially in patients who receive conservative treatment. Immediate surgery improves the short-term and long-term outcomes regardless of onset season.

[Clinical value of cardiopulmonary exercise testing derived oxygen uptake efficiency parameters in patients with end-stage chronic heart failure].

OBJECTIVE:To assess the cardiopulmonary exercise testing (CPET) derived performance of oxygen uptake and ventilation efficiency parameters, including oxygen uptake efficiency plateau (OUEP) , oxygen uptake efficiency slope (OUES), V·E/V·CO2 slope and lowest V·E/V·CO2, in patients with end-stage chronic heart failure (CHF) and evaluate their clinical value on monitoring cardiac function and hemodynamic status.METHODS:A total of 26 end-stage CHF patients considered for heart transplantation were enrolled in this study. CPET, echocardiography and invasive hemodynamic examinations with Swan-Ganz flowing balloon catheter were performed. Correlation analysis was made between oxygen uptake and ventilation efficiency parameters from CPET and echocardiographic and hemodynamic parameters.RESULTS:OUEP and OUES showed good correlation with peak oxygen consumption (peak V·O2) (r = 0.535, P < 0.01;r = 0.840, P < 0.001). In end-stage CHF patients, the slope of OUEP with respect to peak V·O2 is about 32, but the slope of OUES with respect to peak V·O2 is only about 2. The difference was 16 times. The change of OUEP was more sensitive and significant than those of OUES and peak V·O2 (P < 0.05). OUEP, peak V·O2 (%pred), V·E/V·CO2 slope and lowest V·E/V·CO2 were all correlated well with non-invasive hemodynamic parameters peak cardiac output (r = 0.535, P < 0.01; r = 0.652, P < 0.001; r = -0.640, P < 0.001; r = -0.606, P = 0.001 respectively) and peak cardiac index (r = 0.556, P < 0.01;r = 0.772, P < 0.001; r = -0.641, P < 0.001; r = -0.620, P < 0.001 respectively) derived from CPET, but not correlated with invasive hemodynamic parameters cardiac output and cardiac index at rest (P > 0.05). Both peak V·O2 (%pred) and V·E/V·CO2 slope were significantly correlated with invasive hemodynamic parameters systolic pulmonary arterial pressure (r = -0.424, P < 0.05; r = 0.509, P < 0.01) and mean pulmonary arterial pressure (r = -0.479, P < 0.05; r = 0.405, P < 0.05). Peak V·O2 (%pred) was also significantly correlated with pulmonary capillary wedge pressure (r = -0.415, P < 0.05), and V·E/V·CO2 slope was significantly correlated with pulmonary vascular resistance (r = 0.429, P < 0.05).CONCLUSIONS:The oxygen uptake and ventilation efficiency parameters derived from CPET, including peak V·O2, OUEP, lowest V·E/V·CO2 and V·E/V·CO2 slope etc, are objectively monitoring and evaluating cardiac function and hemodynamic status. And they are useful for optimizing clinical management of patients with end-stage CHF.

[Peak oxygen consumption, NT-proBNP and echocardiographic changes in patients with chronic heart failure].

OBJECTIVE:To assess peak oxygen consumption (peak VO₂) derived from cardiopulmonary exercise testing (CPET), concentrations of NT-proBNP and echocardiographic changes in patients with chronic heart failure (CHF) and reduced left ventricular ejection fraction (LVEF, <40%).METHODS:Seventy patients were included and divided into two groups according to the New York Heart Association (NYHA) classification: NYHA II group (17 cases) and NYHA III-IV group (53 cases). The basic clinical information, plasma concentration of NT-proBNP at rest, echocardiographic parameters and peak VO₂from CPET were compared between two groups. Correlation among peak VO₂, NT-proBNP and echocardiographic parameters in this patient cohort was assessed and their abilities to discriminate the NYHA III-IV grade were analyzed through c-Statistic.RESULTS:Left atrial diameter ((51.3 ± 7.2) mm vs. (44.0±7.4) mm, P<0.001) was larger, plasma concentration of NT-proBNP (1 379-4 399 pmol/L vs. 1 109-2 356 pmol/L, P<0.01) was higher and peak VO₂((13.4 ± 3.5) ml·kg⁻¹·min⁻¹ vs. (18.2 ± 3.7) ml·kg⁻¹·min⁻¹, P<0.001) were significantly lower in NYHA III-IV group than those in NYHA II group. However, left ventricular end-diastolic diameter (LVEDD) and LVEF were similar between two groups. Peak VO₂correlated significantly with NT-proBNP (r=-0.311, P<0.01), but neither peak VO₂nor NT-proBNP correlated with echocardiographic parameters (LA, LVEDD and LVEF). ROC analysis showed that peak VO₂had the strongest discriminatory power for detecting NYHA III-IV grade patients (AUC=0.835, P<0.001), followed by the NT-proBNP (AUC=0.723, P<0.01).CONCLUSION:Peak VO₂is a more sensitive parameter to detect the disease aggravation (NYHA III-IV grade) of the CHF patients with reduced LVEF compared to plasma NT-proBNP and echocardiographic parameters (LA, LVEDD, LVEF).

Imaging for Transcatheter Mitral Valve Edge-to-Edge Repair for an Unusual Cause of Cardiogenic Shock.

Does environmental pollution inhibit urbanization in China? A new perspective through residents' medical and health costs.

Health problems caused by environmental pollution may affect the process of urbanization in China. Therefore, this study, against the backdrop of promoting new-type urbanization, evaluates the level of China's urbanization comprehensively using the fully arranged polygon graphical index method. It uses a dynamic threshold panel model to study the potential non-linear relationship between environmental pollution (wastewater, sulfur dioxide, and solid wastes) and urbanization under different health costs of residents. Our findings show that environmental pollution has inhibited the improvement of comprehensive urbanization, population urbanization, economic urbanization, and living conditions urbanization, but promoted living environment urbanization, in China. It is worth noting that with the rise in residents' health costs, the inhibiting effect of environmental pollution on comprehensive urbanization, population urbanization, economic urbanization, and living conditions urbanization in China has gradually increased, but on living environment urbanization, it has decreased.

Does sanitation infrastructure in rural areas affect migrant workers' health? Empirical evidence from China.

Health is considered the most important factor for individual well-being and a country's sustainable development. Among the influential factors of population health, sanitary infrastructure, particularly sanitary toilets and innocuous-sanitary toilets, have already attracted attention. In recent years, to improve the overall health status of rural residents, the Chinese government has promoted the "toilet revolution" in rural areas to update and modernize the facilities of toilets. Given that migrant workers contribute significantly to China's economic growth, and that the migrant workers generally lived in rural areas before they moved to urban areas to find jobs, it is of great interest and importance to investigate the impacts of sanitary infrastructure in rural areas on the migrant workers. This study analyzes the spatial characteristic of rural sanitation facilities' implementation and looks for possible correlation between the health status of migrant workers and the implementation of sanitation facilities in their hometowns. Micro-survey data of migrant workers' health status from China Household Income Projects (CHIP) 2013 and macro-data of provincial economic factors are matched to provide a quality analysis. The analysis of the spatial distribution shows that there were significantly large gaps between the prevalence rates of sanitary toilets in provinces. Furthermore, the regression analysis indicates that the implementation of sanitary toilets and innocuous-sanitary toilets exhibits a positive effect on the overall health status of migrant workers, although the effects of the innocuous-sanitary toilets are greater. Moreover, the positive influences of both types of toilets on population health are higher in the provinces with relatively greater annual precipitation and higher average temperature.

The aging burden of hospitalization for heart failure in Chinese populations: evidence from the Macao Heart Failure Study.

OBJECTIVE:To assess the aging burden of hospitalization for heart failure in Chinese populations in Macao.METHODS:The Macao Heart Failure Study consists of patients hospitalized with a diagnosis of acute heart failure (AHF) at Centro Hospitalar Conde de São Januário (the only public hospital that provides medical care for the approximately 600, 000 residents of Macao) from January 2014 to December 2016. First, we investigated the relationship between socioeconomic development and epidemiological characteristics of HF in Macao. Then we assessed the patientso clinical features and outcomes according to the age groups.RESULTS:A total of 967 patients were included in the final analysis. The median age at admission was 82 years old. The advanced age at the admission of HF in Macao was significantly associated with a high-income level and the aging population structure. Marked heterogeneity existed in the epidemiological characteristics, clinical features, utilization of evidence-based therapies, short- and long-term outcomes, and prognostic utility of clinical variables among the different age groups.CONCLUSION:Rapid economic development and significantly aging populations have produced a profound impact on the epidemiological characteristics of HF in Chinese populations. Acute decompensated heart failure (ADHF) is predominantly a disease of the elderly in Macao, and a significant heterogeneity exists in the clinical features, managements, and outcomes among different age groups. Age-based risk stratification models and multidisciplinary HF teams are urgently needed to improve the management and outcomes of hospitalized heart failure (HHF) patients.

What is the health cost of haze pollution? Evidence from China.

INTRODUCTION:Haze pollution has become a serious threat to the health of residents and has brought about considerable economic costs. The objectives of this study are to examine the relationship between haze pollution and residents' health and to estimate the health cost of haze pollution.METHODS:Using macro data on 74 major Chinese cities, this study employs a static panel data model and a dynamic panel generalized method of moments model to investigate the impact of haze pollution on the mortality of residents. On the basis of the estimation results, the value of a statistical life (VOSL) method is used to evaluate the economic cost of haze pollution on residents' health.RESULTS:In 74 major cities of China, an increase in concentration of PM2.5 pollutants by 1 μg/m3 may cause the mortality rate to rise by 25 per million people. The VOSL of haze pollution in China is about 1.53 million yuan. The health cost of residents from haze in 74 major cities of China in 2016 was about 888 billion yuan, equivalent to about 2% of the these cities' GDP.CONCLUSIONS:Haze pollution has serious damage to the health of urban residents and therefore brings about considerable economic losses.

The impact of environmental pollution on public health expenditure: dynamic panel analysis based on Chinese provincial data.

In recent years, along with rapid economic growth, China's environmental problems have become increasingly prominent. At the same time, the level of China's pollution has been growing rapidly, which has caused huge damages to the residents' health. In this regard, the public health expenditure ballooned as the environmental quality deteriorated in China. In this study, the effect of environmental pollution on residents' health expenditure is empirically investigated by employing the first-order difference generalized method of moments (GMM) method to control for potential endogeneity. Using a panel data of Chinese provinces for the period of 1998-2015, this study found that the environmental pollution (represented by SO2 and soot emissions) would indeed lead to the increase in the medical expenses of Chinese residents. At the current stage of economic development, an increase in SO2 and soot emissions per capita would push up the public health expenditure per capita significantly. The estimation results are quite robust for different types of regression specifications and different combinations of control variables. Some social and economic variables such as public services and education may also have remarkable influences on residential medical expenses through different channels.

Onset seasons and clinical outcomes in patients with Stanford type A acute aortic dissection: an observational retrospective study.

OBJECTIVES:To evaluate the association of onset season with clinical outcome in type A acute aortic dissection (AAD).DESIGN:A single-centre, observational retrospective study.SETTING:The study was conducted in Fuwai Hospital, the National Centre for Cardiovascular Disease, Beijing, China.PARTICIPANTS:From 2008 to 2010, a set of consecutive patients with type A AAD, confirmed by CT scanning, were enrolled and divided into four groups according to onset season: winter (December, January and February), spring (March, April and May), summer (June, July and August) and autumn (September, October and November). The primary end points were in-hospital death and all-cause mortality during follow-up.RESULTS:Of the 492 cases in this study, 129 occurred in winter (26.2%), 147 in spring (29.9%), 92 in summer (18.7%), and 124 in autumn (25.2%). After a median follow-up of 20.4 months (IQR 9.7-38.9), the in-hospital mortality in cases occurring in autumn was higher than in the other three seasons (23.4% vs 8.4%, p<0.01). Long-term mortality was comparable among the four seasonal groups (p=0.63). After adjustment for age, gender and other risk factors, onset in autumn was still an independent factor associated with increased risk of in-hospital mortality (HR 2.05; 95% CI 1.15 to 3.64, p=0.02) in addition to surgical treatment. Further analysis showed that the seasonal effect on in-hospital mortality (autumn vs other seasons: 57.4% vs 27.3%, p<0.01) was only significant in patients who did not receive surgical treatment. No seasonal effect on long-term clinical outcomes was found in this cohort.CONCLUSIONS:Onset in autumn may be a factor that increases the risk of in-hospital death from type A AAD, especially in patients who receive conservative treatment. Immediate surgery improves the short-term and long-term outcomes regardless of onset season.

[Clinical value of cardiopulmonary exercise testing derived oxygen uptake efficiency parameters in patients with end-stage chronic heart failure].

OBJECTIVE:To assess the cardiopulmonary exercise testing (CPET) derived performance of oxygen uptake and ventilation efficiency parameters, including oxygen uptake efficiency plateau (OUEP) , oxygen uptake efficiency slope (OUES), V·E/V·CO2 slope and lowest V·E/V·CO2, in patients with end-stage chronic heart failure (CHF) and evaluate their clinical value on monitoring cardiac function and hemodynamic status.METHODS:A total of 26 end-stage CHF patients considered for heart transplantation were enrolled in this study. CPET, echocardiography and invasive hemodynamic examinations with Swan-Ganz flowing balloon catheter were performed. Correlation analysis was made between oxygen uptake and ventilation efficiency parameters from CPET and echocardiographic and hemodynamic parameters.RESULTS:OUEP and OUES showed good correlation with peak oxygen consumption (peak V·O2) (r = 0.535, P < 0.01;r = 0.840, P < 0.001). In end-stage CHF patients, the slope of OUEP with respect to peak V·O2 is about 32, but the slope of OUES with respect to peak V·O2 is only about 2. The difference was 16 times. The change of OUEP was more sensitive and significant than those of OUES and peak V·O2 (P < 0.05). OUEP, peak V·O2 (%pred), V·E/V·CO2 slope and lowest V·E/V·CO2 were all correlated well with non-invasive hemodynamic parameters peak cardiac output (r = 0.535, P < 0.01; r = 0.652, P < 0.001; r = -0.640, P < 0.001; r = -0.606, P = 0.001 respectively) and peak cardiac index (r = 0.556, P < 0.01;r = 0.772, P < 0.001; r = -0.641, P < 0.001; r = -0.620, P < 0.001 respectively) derived from CPET, but not correlated with invasive hemodynamic parameters cardiac output and cardiac index at rest (P > 0.05). Both peak V·O2 (%pred) and V·E/V·CO2 slope were significantly correlated with invasive hemodynamic parameters systolic pulmonary arterial pressure (r = -0.424, P < 0.05; r = 0.509, P < 0.01) and mean pulmonary arterial pressure (r = -0.479, P < 0.05; r = 0.405, P < 0.05). Peak V·O2 (%pred) was also significantly correlated with pulmonary capillary wedge pressure (r = -0.415, P < 0.05), and V·E/V·CO2 slope was significantly correlated with pulmonary vascular resistance (r = 0.429, P < 0.05).CONCLUSIONS:The oxygen uptake and ventilation efficiency parameters derived from CPET, including peak V·O2, OUEP, lowest V·E/V·CO2 and V·E/V·CO2 slope etc, are objectively monitoring and evaluating cardiac function and hemodynamic status. And they are useful for optimizing clinical management of patients with end-stage CHF.

[Peak oxygen consumption, NT-proBNP and echocardiographic changes in patients with chronic heart failure].

OBJECTIVE:To assess peak oxygen consumption (peak VO₂) derived from cardiopulmonary exercise testing (CPET), concentrations of NT-proBNP and echocardiographic changes in patients with chronic heart failure (CHF) and reduced left ventricular ejection fraction (LVEF, <40%).METHODS:Seventy patients were included and divided into two groups according to the New York Heart Association (NYHA) classification: NYHA II group (17 cases) and NYHA III-IV group (53 cases). The basic clinical information, plasma concentration of NT-proBNP at rest, echocardiographic parameters and peak VO₂from CPET were compared between two groups. Correlation among peak VO₂, NT-proBNP and echocardiographic parameters in this patient cohort was assessed and their abilities to discriminate the NYHA III-IV grade were analyzed through c-Statistic.RESULTS:Left atrial diameter ((51.3 ± 7.2) mm vs. (44.0±7.4) mm, P<0.001) was larger, plasma concentration of NT-proBNP (1 379-4 399 pmol/L vs. 1 109-2 356 pmol/L, P<0.01) was higher and peak VO₂((13.4 ± 3.5) ml·kg⁻¹·min⁻¹ vs. (18.2 ± 3.7) ml·kg⁻¹·min⁻¹, P<0.001) were significantly lower in NYHA III-IV group than those in NYHA II group. However, left ventricular end-diastolic diameter (LVEDD) and LVEF were similar between two groups. Peak VO₂correlated significantly with NT-proBNP (r=-0.311, P<0.01), but neither peak VO₂nor NT-proBNP correlated with echocardiographic parameters (LA, LVEDD and LVEF). ROC analysis showed that peak VO₂had the strongest discriminatory power for detecting NYHA III-IV grade patients (AUC=0.835, P<0.001), followed by the NT-proBNP (AUC=0.723, P<0.01).CONCLUSION:Peak VO₂is a more sensitive parameter to detect the disease aggravation (NYHA III-IV grade) of the CHF patients with reduced LVEF compared to plasma NT-proBNP and echocardiographic parameters (LA, LVEDD, LVEF).