Objective To investigate the prevalence and modifiable risk factors of degenerative valvular heart disease(DVHD)among elderly population in southern China.Methods A stratified multistage sampling method was used to recruit subjects.The contents of the survey included the questionnaire,laboratory examination,echocardiography,and other auxiliary examinations.The possible risk factors of DVHD were analyzed by logistic regression analysis.Results A total of 3538 subjects≥65 years of age were enrolled.One thousand three hundred and seven subjects(36.9%)were diagnosed with DVHD.Degenerative was the most common etiology of VHD.Prevalence of DVHD increased with advancing age.The prevalence of DVHD differed by living region(χ^(2)=45.594,P<0.001),educational level(χ^(2)=50.557,P<0.001),and occupation(χ^(2)=36.961,P<0.001).Risk factors associated with DVHD included age(two-fold increased risk for each 10-year increase in age),elevated level C-reactive protein(OR=1.346,95%CI:1.100-1.646),elevated level low density lipoprotein(OR=1.243,95%CI:1.064-1.451),coronary artery disease(OR=1.651,95%CI:1.085-2.513),smoking(OR=1.341,95%CI:1.132-1.589),and hypertension(OR=1.414,95%CI:1.221-1.638).Other significant risk factors included reduced or elevated level red blood cell(OR=1.347,95%CI:1.031-1.761;OR=1.599,95%CI:1.097-2.331;respectively),elevated level platelets(OR=1.891,95%CI:1.118-3.198),elevated level uric acid(OR=1.282,95%CI:1.112-1.479),and stroke(OR:1.738,95%CI=1.085-2.513).Conclusions The survey characterized the baseline conditions of DVHD cohort of elderly population in Guangzhou city.The established and emerging risk factors for DVHD may represent challenges and opportunities for therapy.
Objective To evaluate the predictive value of red cell distribution width （RDW） on left atrial thrombus （LAT） or left atrial spontane- ous echo contrast （LASEC） in patients with non-valvular atrial fibrillation （AF）. Methods We reviewed 692 patients who were diagnosed as non-valvular AF and underwent transesophageal echocardiography （TEE） in Guangdong Cardiovascular Institute from April 2014 to December 2015. The baseline clinical characteristics, laboratory test of blood routine, electrocardiograph measurements were analyzed. Results Eighty-four patients were examined with LAT/LASEC under TEE. The mean RDW level was significantly higher in LAT/LASEC patients compared with the non-LAT/LASEC patients （13.59% ± 1.07% ws. 14.34% ± 1.34%; P 〈 0.001）. Receiver-operating characteristic curve analysis was performed and indicated the best RDW cut point was 13.16%. Furthermore, multivariate logistic regression analysis indicated that RDW level 〉 13.16% could be an independent risk factor for LAT/LASEC in patients with AF. Conclusion Elevated RDW level is associated with the presence of LAT/LASEC and could be with moderate predictive value for LAT/LASEC in patients with non-valvular AF.
Background Valvular heart disease （VHD） is defined as a structural or functional abnormality in cardiac valve which encompasses a number of common cardiovascular conditions. This study was aimed to analyze the epidemiological changes of VHD in a single cardiovascular center of Southern China. Methods A total of 13,138 VHD patients of Guangdong general hospital from January 2011 to December 2013 were screened by transthoracic echocardiography （TTE） or transesophageal echocardiography （TEE） and enrolled for this study. The morbidity, etiological spectrum and management of these patients were analyzed. Continuous variables were expressed as mean _＋ standard deviation. Categorical variables were expressed as ratio or percentage. Results Patients in this study were divided into different groups and were analyzed throughout changes in morbidity, etiological spectrum and management. Conclusions The prevalence of VHD remains high in Southern China and RHD is still the leading etiology of VHD. But morbidity rate is reduced and surgery is still the main treatment option.
Background Valvular heart disease(VHD)is expected to become more prevail as the population ages and disproportionately affects older adults.However,direct comparison of clinical characteristics,sonographic diagnosis,and outcomes in VHD patients aged over 65 years is scarce.The objective of this study was to evaluate the differences in clinical characteristics and prognosis in two age-groups of geriatric patients with VHD.Methods We retrospectively enrolled consecutive individuals aged>65 years from Guangdong Provincial Peopled Hospital and screened for VHD using transthoracic echocardiography(TTE)or transesophageal echocardiography(TEE).Finally,260(48.9%)patients were in the 65-74 years group,and 272(51.1%)were in the>75-year group.Factors that affected long-term survival was explored.A multivariable Cox hazards regression was performed to identify the predictors of major adverse cardiac events(MACEs)in each group.Results In our population,the older group were more likely to have chronic obstructive pulmonary disease(COPD),degenerative VHD,but with less rheumatic VHD,aortic stenosis(AS)and mitral stenosis(MS).Compared with those aged 65-74 years,the older group had a higher incidence of all-cause death(10.0%vs.16.5%,P=0.027),ischemic stroke(13.5%vs.20.2%,P=0.038)and MACEs(37.3%vs.48.2%,P=0.011)at long-term follow-up.In multivariable Cox regression analysis,mitral regurgitation,a history of COPD,chronic kidney disease,diabetes,hypertension,atrial fibrillation and New York Heart Association(NYHA)functional class were identified as independent predictors of MACEs in the older group.Conclusion Advanced age profoundly affect prognosis and different predictors were associated with MACEs in geriatric patients with VHD.
A 70-year-old female visited our hospital due to a 5-year history of long-standing persistent atrial fibrillation （LSPsAF） refractory to medical treatment. Chest x-ray and echocardiography were free of abnormalities and did not detect manifest structural heart disease. A hybrid AF pro- cedure （Epicardial thoracoscopic ablation ＋ appendage re- section, and endocardial catheter ablation） was referred to patient.
Backgrounds Whether the contact force(CF)-sensing catheter could improve the efficiency of pace mapping(PM)in right ventricle outflow tract(RVOT)has not been fully studied.The present study was the first investigation of the CF distribution in the right ventricle(RV)by using a CF-sensing catheter and the relationship between CF and capture threshold in RVOT.Methods In total,4543 mapping points with CF were recorded in 15 patients.Operators were blinded to CF data and data were analyzed according to 10 predefined RV segments.PM were performed at 6 different RVOT segments with 3 different intentional CF levels and 3 different pacing setup.The pacing threshold in RVOT and pacing capture level were recorded.The morphology matching score were recorded and analyzed.Results Median CF during RV mapping was 8(5-12)g and coefficient of variation was 71.64%.Median CF ranged from 9.5(5.8-16)g at the posterior-outflow tract freewall(OTFW)to 7(4-10)g at the apex.Distribution of CF≥20 g in RV predefined segments mainly located in the OTFW.Distribution of CF≤2 g in RV predefined segments mainly located in the inflow tract freewall(ITFW),anterior-OTFW,and apex.A total of 810 pacing were performed at RVOT with different CF and output.Stable capture rate could be significantly improved via increasing CF level under 2 mA output(46.7%/2-5 g vs.50%/6-9 g vs.91.1%/≥10 g),and no capture rate could be significantly declined simultaneously(16.7%/2-5 g vs.8.9%/6-9 g vs.2.2%/≥10 g).Conclusions A marked variability in CF was observed among the different predefined segments.CF mapping could improve the safety and efficacy of catheter ablation of premature ventricular contraction(PVC)/ventricular tachycardia(VT)in RV.CF was an essential factor in RVOT pace mapping process,especially under low-pacing output.[S Chin J Cardiol 2021;22(1):21-29]
LIU Hai-yanLIU Fang-zhouLIN Wei-dongLIAO Hong-taoFANG Xian-hongLIAO Zi-liLIU YangZHAN Xian-zhangXUE Yu-mei
