宁小晖
中国医学科学院阜外医院 心血管内科
BACKGROUND:The evidence on the association between the triglyceride glucose (TyG) index and the risk of death in the general population remains controversial. This study aims to investigate the relationship between the TyG index and all-cause and cardiovascular mortality in the general population, with a focus on sex differences.METHODS:This prospective cohort study analyzed data from the National Health and Nutrition Examination Survey (1999-2002), comprising 7,851 US adults. The study employed multivariate Cox proportional hazards regression and two-segment Cox hazard regression models to evaluate the sex-specific differences in the relationship between the TyG index and all-cause and cardiovascular mortality.RESULTS:After 11,623 person-years of follow-up, there were 539 deaths, with 10.56% due to all-cause mortality and 2.87% due to cardiovascular mortality. After adjusting for multiple variables, our study found a U-shaped association of the TyG index with all-cause and cardiovascular mortality, with inflection points at 9.36 and 9.52. A significant sex difference was observed in the association between the TyG index and mortality. Below the inflection point, the relationship between the TyG index and mortality was consistent in males and females. However, above the inflection point, only males exhibited a positive association between the TyG index and all-cause mortality (adjusted hazard risk [HR], 1.62, 95% confidence interval [CI], 1.24-2.12) and cardiovascular mortality (adjusted HR, 2.28, 95% CI, 1.32-3.92).CONCLUSIONS:Our study showed a U-shaped association between the TyG index and all-cause and cardiovascular mortality in the general population. Furthermore, sex differences were observed in the association between the TyG index and mortality once it exceeded a certain threshold.
Diabetology & metabolic syndrome 2023
Background:A substantial reduction in the number of cardiac implantable electronic device (CIED) implantation was reported in the early stages of the COVID-19 pandemic. None of the studies have yet explored changes in CIED implantation during the following pandemic.Objective:To explore changes in CIED implantation during the COVID-19 pandemic from 2020 to 2021.Methods:From 2019 to 2021, 177,263 patients undergone CIED implantation from 1,227 hospitals in China were included in the analysis. Generalized linear models measured the differences in CIED implantation in different periods. The relationship between changes in CIED implantation and COVID-19 cases was assessed by simple linear regression models.Results:Compared with the pre-COVID-19 period, the monthly CIED implantation decreased by 17.67% (95% CI: 16.62-18.72%, p < 0.001) in 2020. In 2021, the monthly number of CIED implantation increased by 15.60% (95% CI: 14.34-16.85%, p < 0.001) compared with 2020. For every 10-fold increase in the number of COVID-19 cases, the monthly number of pacemaker implantation decreased by 429 in 2021, while it decreased by 676 in 2020. The proportion of CIED implantation in secondary medical centers increased from 52.84% in 2019 to 56.77% in 2021 (p < 0.001). For every 10-fold increase in regional accumulated COVID-19 cases, the proportion of CIED implantation in secondary centers increased by 6.43% (95% CI: 0.47-12.39%, p = 0.036).Conclusion:The impact of the COVID-19 pandemic on the number of CIED implantation is diminishing in China. Improving the ability of secondary medical centers to undertake more operations may be a critical way to relieve the strain on healthcare resources during the epidemic.
Frontiers in public health 2022
Background:The COVID-19 pandemic has significantly impacted routine cardiovascular health assessments and services. We aim to depict the temporal trend of catheter ablation (CA) and provide experience in dealing with the negative impact of the COVID-19 pandemic.Methods:Data on CA between January 2019, and December 2021, were extracted from the National Center for Cardiovascular Quality Improvement platform. CA alterations from 2019 to 2021 were assessed with a generalized estimation equation.Results:A total of 347,924 patients undergoing CA were included in the final analysis. The CA decreased remarkably from 122,839 in 2019 to 100,019 (-18.58%, 95% CI: -33.40% to -3.75%, p = 0.02) in 2020, and increased slightly to 125,006 (1.81%, 95% CI: -7.01% to 3.38%, p = 0.49) in 2021. The CA experienced the maximal reduction in February 2020 (-88.78%) corresponding with the peak of monthly new COVID-19 cases and decreased by 54.32% (95%CI: -71.27% to -37.37%, p < 0.001) during the 3-month lockdown and increased firstly in June 2020 relative to 2019. Since then, the CA in 2020 remained unchanged relative to 2019 (-0.06%, 95% CI: -7.01% to 3.38%, p = 0.98). Notably, the recovery of CA in 2021 to pre-COVID-19 levels was mainly driven by the growth of CA in secondary hospitals. Although there is a slight increase (2167) in CA in 2021 relative to 2019, both the absolute number and proportion of CA in the top 50 hospitals nationwide [53,887 (43.09%) vs. 63,811 (51.95%), p < 0.001] and top three hospitals in each province [66,152 (52.73%) vs. 72,392 (59.28%), p < 0.001] still declined significantly.Conclusions:The CA experienced a substantial decline during the early phase of the COVID-19 pandemic, and then gradually returned to pre-COVID-19 levels. Notably, the growth of CA in secondary hospitals plays an important role in the overall resumption, which implies that systematic guidance of secondary hospitals with CA experience may aid in mitigating the negative impact of the COVID-19 pandemic.
Frontiers in public health 2022
Background:The joint association of atrial fibrillation (AF) and statin therapy with adverse outcomes in heart failure (HF) patients with cardiac resynchronization therapy (CRT) has not been fully investigated so far. The purpose of this study was to explore the independent and joint association of AF and statin therapy with adverse outcomes.Methods:Study patients were divided into four groups according to AF status and statin use: Non-AF/Statin, Non-AF/Non-Statin, AF/Statin, and AF/Non-Statin. Multivariate Cox proportional hazards regression models were used to evaluate the independent and joint association of AF and statin therapy with poor prognosis.Results:Among 685 CRT patients, there were 180 deaths (26.5%) and 198 HF hospitalization (29.6%) during the 14 years of follow-up. AF was associated with a 46% increased risk of all-cause mortality (HR, 1.46; 95% CI, 1.03-2.07) and a 59% increased risk of HF hospitalization (HR, 1.59; 95% CI, 1.16-2.20) than those without AF. However, statin therapy failed to improve the prognosis. In the joint analysis, compared with the Non-AF/Statin group, the AF/Non-Statin group suffered a higher risk of all-cause mortality (HR, 1.75; 95% CI, 1.04-2.93) and HF hospitalization (HR, 1.76; 95% CI, 1.08-2.86). Furthermore, adding AF to the traditional risk factor model significantly improved the predictive value for death (C-statistic from 0.654 to 0.691) and HF (C-statistic from 0.613 to 0.675).Conclusion:AF was associated with poor prognosis, and statin use failed to improve the prognosis. Further analysis showed that statin therapy is ineffective in improving prognosis and fails to attenuate the adverse effects of AF.
Journal of inflammation research 2022
BACKGROUND:The combined association of triglyceride-glucose (TyG) index and different systolic blood pressure (SBP) levels with all-cause and cardiovascular mortality among the general population remains unclear.METHODS:In this study, 6245 individuals were from the National Health and Nutrition Examination Survey (1999-2002). The study endpoints were all-cause and cardiovascular mortality. Multivariate Cox proportional hazards regression models were used to explore the combined association of TyG index and different SBP levels with all-cause and cardiovascular mortality.RESULTS:During a mean follow-up period of 66.8 months, a total of 284 all-cause deaths (331/100000 person-years) and 61 cardiovascular deaths (66/100000 person-years) were recorded. Multivariate Cox regression analysis revealed that the combination of low TyG index and low SBP (< 120 mmHg and < 130 mmHg) was associated with a reduced risk of all-cause and cardiovascular mortality than others. However, survival benefit was not observed in the combined group with the low TyG index and SBP < 140 mmHg. Furthermore, the mortality rate in the combined group of low TyG index and low SBP gradually increased with the elevation of SBP level.CONCLUSION:The combination of low TyG index and low SBP (< 120 mmHg and < 130 mmHg) was associated with a lower risk of all-cause and cardiovascular mortality. However, no survival benefit was observed in the combined group of low TyG index and SBP < 140 mmHg.
Journal of translational medicine 2022
BACKGROUND:Ventricular arrhythmia is a leading cause of cardiac death among patients with post-infarction left ventricular aneurysm (PI-LVA). The effect of coronary revascularization in PI-LVA patients with ventricular tachyarrhythmia remains unknown. This study aims to investigate the impact of revascularization therapy on clinical outcomes in these patients.METHODS:A total of 238 PI-LVA patients were enrolled, and 59 patients were presented with sustained ventricular tachycardia (VT) or ventricular fibrillation (VF). Patients were classified into 4 groups by treatment strategies (medical or revascularization) and the presence of VT/VF: group 1 (n = 57): VT/VF- and revascularization-; group 2 (n = 122): VT/VF- and revascularization+; group 3 (n = 34): VT/VF+ and revascularization+; and group 4 (n = 25): VT/VF+ and revascularization-. The clinical outcomes were compared, and the primary endpoint was cardiac death or heart transplantation.RESULTS:Patients were followed up for 45 ± 16 months, and 41 patients (17.2%) reached the primary endpoint. Kaplan-Meier analysis showed that in VT/VF- patients, revascularization associated with higher cardiac survival compared with medical therapy (log-rank p = .002), but in VT/VF+ patients, revascularization did not predict better cardiac outcome (log-rank p = .901). Cox regression analysis revealed PET-EF (HR 4.41, 95% CI: 1.72-11.36, p = .002) and moderate/severe mitral regurgitation (HR 2.32, 95% CI: 1.02-5.30, p = .046) as independent predictors of adverse cardiac outcome in patients with VT/VF.CONCLUSION:PI-LVA patients with VT/VF are at high risk of adverse cardiac outcome, and coronary revascularization does not mitigate this risk, although revascularization was associated with higher cardiac survival in PI-LVA patients without VT/VF.
Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc 2021
PURPOSE:Magnetic resonance imaging (MRI) at 3.0 T is becoming more common, but there is a lack of sufficient evidence on the safety of a 3.0 T scan in patients with pacemakers. This study aimed to investigate the safety and practical concerns of 3.0 T scans for patients with MR-conditional pacemakers.METHODS:Twenty consecutive patients were enrolled. A standardized protocol was developed by cardiologists, pacemaker engineers, and radiologists. Pacemaker interrogation was performed immediately before and after the scan. Scan-related adverse events were documented, and imaging quality was graded as level 1 to 4 by radiologists.RESULTS:Twenty-three MRI scans of different body regions (brain = 13, lumbar spine = 4, cervical spine = 2, and heart = 4) were performed, and the average time of a scan was 25 ± 11 min. No significant changes in sensing amplitude (atrial 3.1 ± 1.1 mV vs. 2.9 ± 1.2 mV, P = 0.71; ventricular 9.3 ± 3.5 mV vs. 10.2 ± 3.4 mV, P = 0.46), lead impedances (atrial 647 ± 146 Ω vs. 627 ± 151 Ω, P = 0.7; ventricular: 780 ± 247 Ω vs.711 ± 226 Ω, P = 0.36), or pacing threshold (atrial 0.6 ± 0.2 V/0.4 ms vs. 0.6 ± 0.2 V/0.4 ms, P = 0.71; ventricular 0.7 ± 0.3 V/0.4 ms vs. 0.7 ± 0.2 V/0.4 ms, P = 0.85) were observed pre- and postscan. No adverse events were detected. Image quality review showed grade 1 quality in 16 patients and grade 2 quality in 4 patients with artifacts of pulse generators and leads in cardiac MRI scan and no impact on diagnostic value.CONCLUSION:Our initial data indicated that 3.0 T scanning might be feasible under a standardized protocol with good diagnostic imaging quality irrespective of body region in patients with MR-conditional pacemakers.
Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing 2021
Aims: To evaluate whether low level left vagus nerve stimulation (LLVNS) in early stage of myocardial infarction (MI) could effectively prevent ventricular arrhythmias (VAs) and protect cardiac function, and explore the underlying mechanisms. Methods and Results: After undergoing implantable cardioverter defibrillators (ICD) and left cervical vagal stimulators implantation and MI creation, 16 dogs were randomly divided into three groups: the MI (n = 6), MI+LLVNS (n = 5), and sham operation (n = 5) groups. LLVNS was performed for 3 weeks. VAs, the left ventricular function, the density of the nerve fibers in the infarction area and gene expression profiles were analyzed. Compared with the MI group, dogs in the MI+LLVNS group had a lower VAs incidence (p < 0.05) and better left ventricular function. LLVNS significantly inhibited excessive sympathetic nerve sprouting with the evidences of decreased density of TH, GAP43 and NF positive nerves (p < 0.05). The gene expression profiling found a total of 206 genes differentially expressed between MI+LLVNS and MI dogs, mainly involved in cardiac tissue remodeling, cardiac neural remodeling, immune response and apoptosis. These genes, including 55 up-regulated genes and 151 down-regulated genes, showed more protective expressions under LLVNS. Conclusions: This study suggests that LLVNS was delivered without altering heart rate, contributing to reduced incidences of VAs and improved left ventricular function. The potential mechanisms included suppressing cardiac neuronal sprouting, inhibiting excessive sympathetic nerve sprouting and subduing pro-inflammatory responses by regulating gene expressions from a canine experimental study.
Frontiers in cardiovascular medicine 2021
AIM:To assess the electrocardiogram patterns of paced QRS narrowing after successful left bundle branch area pacing (LBBAP) and echocardiographic measurements in patients with bradycardia and bundle branch block (BBB).METHODS:We prospectively enrolled 55 consecutive bradycardia patients with BBB and left ventricular ejection fraction ≥40% who had attempted LBBAP. Successful LBBAP was defined as paced QRS morphology of a right BBB (RBBB) pattern in lead V1 and a recording of abruptly shortened and then constant stimulus to peak left ventricular activation time with high and low output. Pacing characteristics and echocardiographic measurements were evaluated perioperatively and at 6-month follow-up.RESULTS:The success rate of LBBAP was 83.6% in patients with BBB, and median cumulative X-ray dose-area product was 100.5 µGym2 (60.0, 179.3). LBBAP was successful in 19 of 26 patients with left BBB (LBBB) (73.1%) and in 27 of 29 patients with RBBB (93.1%). The QRS duration (QRSd) was significantly shortened in patients with LBBB (QRSd 169.4 ± 22.6 to 119.6 ± 9.5 ms), and five forms of QRSd narrowing were observed in patients with RBBB with the mean QRSd shortened from 143.1 ± 16.6 ms to 119.5 ± 11.7 ms. The thresholds for narrowing of QRSd were higher in RBBB than LBBB (1.74 ± 0.36 V/0.4 ms vs 0.79 ± 0.17 V/0.4 ms, P < .001). During the 6-month follow-up, both left and right ventricular synchronies were improved, and narrow QRSd persisted in patients with BBB.CONCLUSION:In most bradycardia patients, RBBB could be completely or partially narrowed by LBBAP at different pacing models in addition to the correction of LBBB with LBBAP.
Pacing and clinical electrophysiology : PACE 2020
OBJECTIVE:The aim of this study was to assess pacing and electrophysiological parameters, as well as short-term outcomes, among patients undergoing left bundle branch pacing (LBBP) or His bundle pacing (HBP).BACKGROUND:There are limited data directly comparing different conduction system pacing modalities.METHODS:Consecutive patients undergoing de novo conduction system pacing for bradycardia indications were evaluated. Procedural and fluoroscopic times and pacing characteristics were compared between groups at implantation and at 3-month follow-up.RESULTS:This study included 251 subjects. HBP was successful in 109 (87.2%) of 125 patients, compared with 115 (91.3%) of 126 for LBBP. The mean procedure time (78 ± 36 min vs. 54 ± 24 min, p < 0.001) and fluoroscopy duration (12 ± 5 min vs. 5 ± 2.8 min, p < 0.001) were significantly longer for HBP compared with LBBP. The paced QRS duration (113.7 ± 24.4 ms vs. 114.1 ± 11.2 ms) were similar between groups (p = 0.87). Capture threshold was significantly lower (1.3 ± 0.6 V/1.0 ms vs. 0.6 ± 0.2 V/0.4 ms, p < 0.001), whereas R-wave amplitude was significantly higher (2.8 ± 3.0 mV vs. 12.5 ± 9.0 mV, p < 0.001) with LBBP compared with HBP at implantation. During follow-up, a capture threshold >3.0 V occurred in 8 HBP patients versus 0 LBBP patients (p = 0.003).CONCLUSIONS:LBBP has similar paced QRS durations and success rates, but shorter procedure and fluoroscopy durations, as well as better pacing parameters compared with HBP. Further prospective study is needed to compare long-term outcomes, safety, and pacing stability with these 2 conduction system pacing modalities.
JACC. Clinical electrophysiology 2020
