梁拓
中国医学科学院阜外医院 内科
OBJECTIVE:We investigated the current level of knowledge of Chinese heart failure (HF) guidelines among physicians, as a reference for the promotion and transformation of HF knowledge.METHODS AND RESULTS:Physicians from 88 hospitals in 27 provinces of China completed our survey between July and December 2014. The questions covered the main points included in the Chinese HF diagnosis and treatment guidelines (2014). A total of 2146 physicians, aged 20 to 62 years (35.6 ± 7.6 years), completed the survey. The correctness rate of their answers to the 15 multiple-choice questions in the HF questionnaire was generally low (mean 32.6%). The mean correctness rate for 10 blank-filling questions about the target doses of angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists, and β-blockers was 42.5%. On the basis of their responses, physicians whose knowledge of the guidelines was "excellent," "good," "medium," and "bad" accounted for 1.1%, 11.4%, 14.2%, and 73.4%, respectively. Physicians who possessed a higher level of qualifications had significantly greater awareness of HF guidelines than those with relatively low qualifications (P < .001). A statistically significant association was found between hospital level and adherence to treatment guidelines (P < .001). A significant difference was also observed among physicians in different practice scopes (P < .001).CONCLUSIONS:The survey found an obvious deficiency in physicians' mastery of fundamental knowledge about HF. There is a need to improve physicians' education about HF in China.
Quality management in health care 2017
BACKGROUND:There has been no research evaluating the association between human Neuregulin (NRG) 1/ErbB2/ErbB4 gene polymorphisms and heart failure risk.METHODS AND RESULTS:Genotyping of 13 single nucleotide polymorphisms (SNPs) in the NRG-1/ErbB2/ErbB4 genes was performed in 569 unrelated heart failure patients and 682 healthy controls from a Northern Han Chinese population with the use of iPlex SNP Genotyping analysis on a Sequenom Massarray System. In the ErbB4 gene, the variants rs10932374 and rs1595064 were associated with reduced risk of heart failure under allelic, recessive and additive genetic models, and the variants rs13003941 and rs1595065 were associated with increased risk of heart failure under allelic, dominant, and additive models. The G-G-C-C-T haplotype of rs10932374-rs13003941-rs1595064-rs1595065-rs3748960 in the ErbB4 gene increased the risk of heart failure (odd ratio 1.35, 95% confidence interval [CI] 1.06-1.70; P = .014). The T variant of rs13003941 was associated with larger left ventricle (dominant model, P = .014; additive model, P = .048), and increased risk of overall death (relative risk [RR] 1.48, 95% CI 1.01-2.18; P = .045) and cardiovascular death (RR 1.56, 95% CI 1.04-2.33; P = .03) after adjusting for age and sex. NRG-1/ErbB2 gene polymorphisms were not associated with heart failure risk or prognosis.CONCLUSION:ErbB4 gene polymorphisms were associated with the risk, severity, and prognosis of heart failure in a Northern Han Chinese population.
Journal of cardiac failure 2016
BACKGROUND:Osteopontin (OPN) is a pleiotropic cytokine, which has been shown to a close relationship with cardiac fibrosis. Overexpression of OPN in cardiomyocytes induces dilated cardiomyopathy (DCM). This research is to study whether inhibition of OPN could reduce myocardial remodelling in DCM, and if this process is focal adhesion kinase (FAK) dependent, which is recently found an important signal molecule in fibrosis.METHOD:Eight-week-old cTnTR141W transgenic mouse of DCM were injected with OPN-shRNA in left ventricular free wall, which could inhibit the OPN expression. Six weeks later, echocardiographic examinations were performed to test left ventricle function and heart tissues were harvested to test the quality of FAK by western blot and severity of fibrosis by masson staining. Human cardiac fibroblast was administrated with OPN, and FAK inhibition by PP2 was treated 2 h before OPN was given. Expression of α-SMA and collagen-I were tested by western blot and real-time PCR assay.RESULTS:OPN-shRNA group has a relatively high ejection fraction (EF), fractional shortening (FS), LV free wall thickness and a less sever cardiac fibrosis. In vitro, OPN could increase collagen-I and α-SMA expression, and this process can be inhibited by FAK inhibitor.CONCLUSION:Inhibition of OPN could reduce the LV remodeling and dysfunction in DCM mice, which may attribute to the suppression of collagen-I secretion in fibroblast through a FAK/Akt dependent pathway.
American journal of translational research 2016
BACKGROUND:Qiliqiangxin (QL) capsule is a traditional Chinese medicine which has been approved for the treatment of chronic heart failure. Evidences proved that QL capsules further reduced the NT-proBNP levels and improved left ventricular ejection fraction in CHF patients but the evidence supporting its underlying mechanism is still unclear.METHODS AND RESULTS:Myocardial infarction (MI) -Heart failure (HF) Sprague-Dawley ratsmodel and neonatal rat cardiac myocytes (NRCMs) were used. Animals were assigned into 4 groups, normal group (n=6), shame-operation group (n=6), MI rats 4 weeks after left anterior descending coronary artery ligation were randomized into vehicle group (n=8), QL group (n=8). QL significantly attenuated cardiac dysfunction and ventricle remodeling as echocardiography and hemodynamic measurements showed improvement in left ventricular ejection fraction, fractional shortening, ±dp/dt and left ventricular end diastolic and systolic diameters in QL treated group compared with the vehicle group. Improvements ininterstitial fibrosisand mitochondrial structures were also exhibited by Sirius Red staining, RT-PCR and electron microscopy. QL treatment improved apoptosis and VEGF expression in rats marginal infract area. Complementary experiments analyzed the improved apoptosis and up-regulate of VEGF in ischemia-hypoxia cultivated NRCMs is in an Akt dependent manner and can be reversed by Akt inhibitor.CONCLUSION:QL capsule can improve cardiac dysfunction and ventricular remodeling in MI-HF ratsmodel, this cardiac protective efficacy may be concerned with attenuated apoptosis and cardiac fibrosis. Up-regulated VEGF expression and Akt phosphorylation may take part in this availability.
American journal of translational research 2016
OBJECTIVE:This study was designed to investigate the plasma level of soluble ST2 (sST2) and related influencing factors, and establish its reference value in the healthy community-based population in Beijing area of China.METHODS:We measured plasma sST2 level by enzyme-linked immunosorbent assay between March 2012 and August 2012 in 1 334 healthy subjects in communities, including 597 males and 737 females. Empiric and quantile regression methods were used to determine the reference range of plasma sST2. A multiple linear regression model was established to analyze the factors that might affect the level of plasma sST2.RESULTS:Gender is the most important factor affecting the plasma level of sST2 in healthy people. Plasma level of sST2 is significantly higher in men than in women (P < 0.01). Within each age strata, i.e. < 45, 45-54, 55-64, ≥ 65 years old, the plasma levels of sST2 were significantly higher in men than age-matched female (all P < 0.01). Age, body mass index (BMI), systolic blood pressure, diastolic blood pressure, and smoking did not affect plasma sST2 level. Reference range of sST2 was 5.7-53.5 µg/L for men and 4.4-42.4 µg/L for women (95% nonparametric reference interval). The one-side upper 95th percentile value of sST2 to discriminate the cardiovascular disease from healthy state was 47.2 µg/L for men and 37.2 µg/L for women.CONCLUSIONS:This study established the normal reference range of plasma sST2 in healthy community-based population. The major influencing factor of sST2 level in healthy population is gender.
Zhonghua xin xue guan bing za zhi 2015
BACKGROUND:As a novel device-based approach targeting the renal sympathetic nerves, percutaneous renal denervation (RDN) has been shown to be effective and safe for reducing blood pressure. However, while considerable data on RDN have been obtained from Western populations, there is limited findings from East Asian populations. The purpose of this study was to evaluate one-year outcomes of RDN for the treatment of resistant hypertension in Chinese patients.METHODS:Between February and August 2012, 14 patients (mean age 39 ± 8 years, 10 males) with resistant hypertension underwent successful RDN at the Fuwai Hospital. All 14 patients were followed up at 1, 3, 6 and 12 months post-procedure. Blood pressure, use of antihypertensive agents, renal function, and complications were investigated.RESULTS:Baseline values included mean office blood pressure of 164/103 ± 14/10 mmHg, mean 3.9 ± 0.6 anti-hypertensive agents, and an estimated glomerular filtration rate of (79 ± 19) ml × min(-1)×1.73 m(-2). Office blood pressure after the procedure was reduced by -14/-10, -17/-11, -21/-12, and -24/-14 mmHg at 1, 3, 6, and 12 months respectively, and the reduction of the number of antihypertensive agents at the above corresponding time points was -1.3, -1.5, -1.7 and -1.8 respectively (all P < 0.001). The mean reduction of 24-hour ambulatory blood pressure was similar to the reduction of office blood pressure at the four corresponding time points. Renal function did not significantly change at any time point (all P > 0.05). No clinical complications were observed at 12-month follow-up.CONCLUSION:This study showed that RDN seems to be effective in reducing blood pressure of Chinese patients with resistant hypertension, with minimal adverse events at 12-month follow-up.
Chinese medical journal 2014
OBJECTIVE:As a novel device-based approach targeting the renal sympathetic nerves, renal denervation has been shown to be effective and safe in reducing blood pressure. The femoral artery is currently the most common access site for this procedure due to catheter profile and length limitations that restrict the use of radial access. The purpose of this study was to evaluate technical feasibility and short-term outcomes of transradial renal denervation by a longer radiofrequency ablation catheter (155 cm; AngioCare).METHODS:Five patients (mean age, 46 ± 15 years; 3 male) with resistant hypertension underwent successful transradial renal denervation (3 right, 2 left) at our institution from April to June, 2013. In this group, 3 patients were excluded from femoral access due to an acute aorto-renal angle, or severe tortuosity of the abdominal aorta and iliac arteries. All 5 patients were followed at 1 month and 3 months post procedure. Blood pressure, use of antihypertensive agents, renal function, and complications were investigated.RESULTS:The mean reduction of 24-hour ambulatory blood pressure was -13/-8 mm Hg at 1-month and -20/-12 mm Hg at 3-month follow-up exam (P<.05, compared with baseline) with unchanged antihypertensive drugs. There was no significant change of renal function at 3-month follow-up exam (P>.05, compared with baseline). No complications were observed in this patient group.CONCLUSIONS:Our preliminary results revealed that transradial renal denervation is technically feasible, relatively safe, and effective for the treatment of resistant hypertension, especially where a femoral approach may not be possible.
The Journal of invasive cardiology 2014
Renal denervation (RDN) has been shown to be safe and efficacious in reducing blood pressure in patients with resistant hypertension. In the present study, we describe a first-in-man report of the Iberis renal denervation device in a patient who underwent two RDN procedures: one via the femoral artery and one via the transulnar approach. RDN was performed in the patient's right renal artery using an Iberis catheter via the transulnar approach, as the transfemoral or transradial arteries could not be approached due to their anatomic constraints. In summary, RDN via the transulnar approach is feasible and represents a technical alternative solution in certain patients.
EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 2013
OBJECTIVE:Transcatheter renal sympathetic denervation (RDN) is a novel technology/therapy in treating resistant hypertension. The present study aims to evaluate the safety and short-term efficacy of RDN for the treatment of resistant hypertension in a Chinese population.METHODS:This prospective single-center pilot study was the first one conducted in China with Medtronic Ardian Symplicity Catheter System. Eight patients (6 males and 2 females) with resistant hypertension underwent RDN at our hospital from February to April 2012. All patients were followed up at one month and three months post-RDN. Blood pressure, use of antihypertensive medications, renal function and complications were recorded and analyzed.RESULTS:At one month and three months post-RDN, 24-hour ambulatory blood pressure monitoring showed mean systolic blood pressure and diastolic blood pressure decreased 10 (0 - 18) 13 (3 - 19) and 8 (-2 - 15), 9 (2 - 16) mm Hg throughout 24 hours respectively (P < 0.05, vs baseline). The number of drugs decreased from 4.3 ± 0.5 to 2.8 ± 0.9 and 2.5 ± 0.7 post-RSD respectively (P < 0.01). There was no significant change of renal function (P > 0.05). No complications were observed.CONCLUSION:The preliminary results revealed that RDN was safe and effective for the treatment of resistant hypertension in the Chinese population during a 3-month follow-up. Further large and long-term studies are warranted.
Zhonghua yi xue za zhi 2012
