摘要：In 2019,cardiovascular disease(CVD)accounted for 46.74％and 44.26％of all deaths in rural and urban areas,re-spectively.Two out of every five deaths were attributed to CVD.It is estimated that approximately 330 million individuals in China are affected by CVD.Among them,there are 13 million cases of stroke,11.4 million cases of coronary heart disease,5 mil-lion cases of pulmonary heart disease,8.9 million cases of heart failure,4.9 million cases of atrial fibrillation,2.5 million cases of rheumatic heart disease,2 million cases of congenital heart disease,45.3 million cases of lower extremity artery disease,and 245 million cases of hypertension.With the dual challenges of population aging and a steady increase in the prevalence of metabolic risk factors,the burden of CVD in China is expected to continue rising.Consequently,new demands arise for CVD prevention,treatment,and the allocation of medical resources.Emphasizing primary prevention to reduce disease prevalence,increasing the allocation of medical resources for CVD emergency and critical care,and providing rehabilitation services and secondary preven-tion to reduce the risk of recurrence,rehospitalization,and disability among CVD survivors are of paramount importance.Hy-pertension,dyslipidemia,and diabetes affect millions of individuals in China.Since blood pressure,blood lipids,and blood sug-ar levels often rise insidiously,vascular disease and serious events such as myocardial infarction and stroke occur by the time they are detected in this population.Therefore,it is crucial to implement strategies and measures to prevent risk factors such as hypertension,dyslipidemia,diabetes,obesity,and smoking.Furthermore,greater efforts should be directed towards assessing cardiovascular health status and conducting research on early pathological changes to enhance prevention,treatment,and under-standing of CVD.

摘要：Chronic heart failure (CHF) is the leading cause of hospitalization for those over the age of 65 and represents a significant clinical and economic burden. About half of hospital re-admissions are related to co-morbidities, polypharmacy and disabilities associated with CHF. Moreover, CHF also has an enormous cost in terms of poor prognosis with an average one year mortality of 33%–35%. While more than half of patients with CHF are over 75 years, most clinical trials have included younger patients with a mean age of 61 years. Inadequate data makes treatment decisions challenging for the providers. Older CHF patients are more often female, have less cardiovascular diseases and associated risk factors, but higher rates of non-cardiovascular conditions and diastolic dysfunction. The prevalence of CHF with reduced ejection fraction, ischemic heart disease, and its risk factors declines with age, whereas the prevalence of non-cardiac co-morbidities, such as chronic renal failure, dementia, anemia and malignancy increases with age. Diabetes and hypertension are among the strongest risk factors as predictors of CHF particularly among women with coronary heart disease. This review paper will focus on the specific consideration for CHF assessment in the older population. Management strategies will be reviewed, including non-pharmacologic, pharmacologic, quality care indicators, quality improvement in care transition and lastly, end-of-life issues. Palliative care should be an integral part of an interdiscipli-nary team approach for a comprehensive care plan over the whole disease trajectory. In addition, frailty contributes valuable prognostic in-sight incremental to existing risk models and assists clinicians in defining optimal care pathways for their patients.

摘要：Objective To determine the association between the irregularity of carotid plaque surface using multidimensional magnetic resonance imaging (MRI) of ipsilateral acute cerebral infarction (ACI) cases.Methods Patients with recent cerebrovascular symptoms (stroke or transient ischemic attack ＜ 2 weeks) and atherosclerotic plaque in at least one carotid artery were diagnosed by B-mode ultrasound imaging (intima-media thickness ≥ 1.5 mm) and recruited for the present study.Irregular surface was defined when plaque surface was uneven with high and low fluctuation or plaque with surface ulceration.The irregularity of carotid plaque surface was determined on axial or oblique images alone (single-dimension) and on both axial images and oblique images (multidimensions),separately.Univariate and multivariate logistic regression analyses were performed to calculate the odds ratio (OR) and the corresponding 95％ CI of the irregular plaque surface in discriminating the presence of ipsilateral ACI.Results A total of 217 included subjects (mean age:60.7 ± 10.2 years,149 men) were recruited and 89 (41.0％),88 (40.6％) and 118 (54.4％) of them exhibited irregular plaque surface on axial,oblique and multidimensional MR images,respectively.The OR of irregularity of the plaque surface was determined by multidimensional MRI to be 5.88 (95％ CI:3.16-1 0.96,P ＜ 0.001) in discriminating the presence of ipsilateral ACI.Following adjustment for clinical confounding factors,this association remained statistically significant (OR =5.65,95％ CI:2.53-12.60,P ＜ 0.001).The analysis included further adjustment for the presence of lipid-rich necrotic core,intraplaque hemorrhage and stenosis and the results included that this association also remained statistically significant (OR =6.08,95％ CI:2.52-14.68,P ＜ 0.001).Conclusions The irregular plaque surface was determined by multidimensional MRI as an independent indicator for ipsilateral acute cerebral infarction.

摘要：Background Electroacupuncture pretreatment plays a protective role in myocardial ischemia/reperfusion (I/R) injury and microRNAs (miRNAs) could act on various facets of cardiac function. However, the role of miRNAs in the cardioprotection by electroacupuncture pre-treatment on myocardial I/R injury remains unknown. The purpose of the study was to examine whether miR-214 was involved in cardio-protection by electroacupuncture. Methods Using rat myocardial I/R model, we examined the role of electroacupuncture pretreatment in myocardial I/R injury and analyzed the changes in the expression of miR-214. In addition, I/R was simulated in vitro by performing oxy-gen-glucose deprivation (OGD) on H9c2 cell cultures, and the effect of electroacupuncture pretreatment on I/R injury as well as expressional level of miR-214 were examined in vitro. Furthermore, the miR-214 mimic was transfected into OGD-treated H9c2 cells, we analyzed the cell apoptosis, lactate dehydrogenase (LDH) and creatine kinase (CK) activities, intracellular free Ca2+concentration ([Ca2+]i) as well as the relative protein levels of sodium/calcium exchanger 1(NCX1), BCL2-like 11 (BIM), calmodulin-dependent protein kinase IIδ(CaMKIIδ) and Cyclophilin D (CypD). Results The in vivo results revealed that compared with the I/R group, the electroacupuncture pretreatment group showed significant decreased myocardial infarct size, as well as the increased indices of the cardiac function, including heart rate, mean arterial pressure, left ventricular systolic pressure and maximal rate for left ventricular pressure rising and declining (±dp/dt max). In addition, electroacupuncture pretreatment could inhibit the elevation of LDH and CK activities induced by I/R injury. The quantitative PCR (qPCR) results demonstrated electroacupuncture pretreatment could provide cardioprotection against myocardial I/R injury in rats with miR-214 up-regulation. In the meanwhile, in vitro, electroacupuncture pretreatment protected H9c2 cells from OGD-induced injury. Trans-fection of miR-214 mimic showed protective effects on OGD-induced injury to H9c2 cells by reducing apoptosis, decreasing LDH and CK activities, rescuing the OGD-induced Ca2+and down-regulating elevated protein levels of NCX1, BIM, CaMKIIδand CypD. Conclusions Our findings firstly demonstrated that electroacupuncture pretreatment promotes the expression of miR-214 in myocardial I/R injury and miR-214 contributes to the protective effect of electroacupuncture on myocardial I/R injury.

摘要：Background The neutrophil-to-lymphocyte (N/L) ratio has been associated with poor prognosis in patients with heart failure,but it has not been compared with N-terminal pro-brain natriuretic peptide (NT-proBNP) in elderly patients with chronic heart failure (CHF).We sought to make this comparison.Methods A total of 1355 elderly patients with CHF were analyzed.A multivariate logistic regression model was used to analyze the variables associated with atrial fibrillation (AF).Cox regression analysis was used to assess the multivariable relationship between the N/L ratio,NT-proBNP level,and subsequent major cardiovascular events (MCE).Results In the multiple logistic regression analysis,the N/L ratio was demonstrated as a risk factor for AF in elderly patients with CHF [odds ratio (OR):1.079,95％ confidence interval (CI):1.027-1.134,P =0.003].The median follow-up period was 18 months.In a multivariable model using tertiles of both variables,the highest tertile of the N/L ratio was significantly associated with MCE [hazard ratio (HR):1.407,95％ CI:1.098-1.802,P =0.007] compared with the lowest tertile.Similarly,the highest NT-proBNP tertile was also significantly associated with MCE (HR:1.461,95％ CI:1.104-1.934,P =0.008).Conclusions In eldedy patients with CHF,the N/L ratio is one of the important risk factors for AF and it is an inexpensive and readily available marker with similar independent prognostic power to NT-proBNP.The risk of MCE increases 1.407-fold when the N/L ratio is elevated to the highest tertile.

摘要：Background Increasing research suggests that mitochondrial defect plays a major role in pulmonary hypertension (PH) pathogenesis.Mitochondrial dynamics and quality control have a central role in the maintenance of the cell proliferation and apoptosis balance.However,the molecular mechanism underlying of this balance is still unknown.Methods To clarify the biological effects of hypoxic air exposure and hypoxia-inducible factor-1α (HIF-1α) on pulmonary arterial smooth muscle cell (PASMC) and pulmonary arterial hypertension rats,the cells were cultured in a hypoxic chamber under oxygen concentrations.Cell viability,reactive oxygen species level,cell death,mitochondrial morphology,mitochondrial membrane potential,mitochondrial function and mitochondrial biosynthesis,as well as fission-and fusion-related proteins,were measured under hypoxic conditions.In addition,rats were maintained under hypoxic conditions,and the right ventricular systolic pressure,right ventricular hypertrophy index and right ventricular weight/body weight ratio were examined and recorded.Further,we assessed the role of HIF-1α in the development and progression of PH using HIF-1α gene knockdown using small interfering RNA transfection.Mdivi-1 treatment was performed before hypoxia to inhibit dynamin-related protein 1 (Drp1).Results We found that HIF-1α expression was increased during hypoxia,which was crucial for hypoxia-induced mitochondrial dysfunction and hypoxia-stimulated PASMCs proliferation and apoptosis.We also found that targeting mitochondrial fission Drpl by mitochondrial division inhibitor Mdivi-1 was effective in PH model rats.The results showed that mitochondrial dynamics were involved in the pulmonary vascular remodeling under hypoxia in vivo and in vitro.Furthermore,HIF-1α also modulated mitochondrial dynamics in pulmonary vascular remodeling under hypoxia through directly regulating the expression of Drp 1.Conclusions In conclusion,our data suggests that abnormal mitochondrial dynamics could be a marker for the early diagnosis of PH and monitoring disease progression.Further research is needed to study the signaling pathways that govern mitochondrial fission/fusion in PH.

摘要：Chronic heart failure and depressive disorders have a high prevalence and incidence in the elderly.Several studies have shown how depression tends to exacerbate coexisting chronic heart failure and its clinical outcomes and vice versa,especially in the elderly.The negative synergism between chronic heart failure and depression in the elderly may be approached only taking into account the multifaceted pathophysiological characteristics underlying both these conditions,such as behavioural factors,neurohormonal activation,inflammatory mediators,hypercoagulability and vascular damage.Nevertheless,the pathophysiological link between these two conditions is not well established yet.Despite the high prevalence of depression in chronic heart failure elderly patients and its negative prognostic value,it is often unrecognized especially because of shared symptoms.So the screening of mood disorders,using reliable questionnaires,is recommended in elderly patients with chronic heart failure,even if cannot substitute a diagnostic interview by mental health professionals.In this setting,treatment of depression requires a multidisciplinary approach including:psychotherapy,antidepressants,exercise training and electroconvulsive therapy.Pharmacological therapy with selective serotonin reuptake inhibitors,despite conflicting results,improves quality of life but does not guarantee better outcomes.Exercise training is effective in improving quality of life and prognosis but at the same time cardiac rehabilitation services are vastly underutilized.

摘要：Background Growth-differentiation factor-15 (GDF-15) is a promising prognostic biomarker in patients with chronic heart failure (CHF).Comparatively little is known about the value of repeated measurement of GDF-15 with CHF in Chinese Han population.This study sought to identify the clinical value of repeated measurement of GDF-15 in Chinese Han patients with post-myocardial infarction CHF.Methods In total,232 consecutive Chinese Han patients with post-myocardial infarction CHF were enrolled prospectively from January 2014 to June 2016.The plasma concentration of GDF-15 was determined on admission and over 12 months.Patients were followed up for all-cause death and a composite outcome of major adverse cardiac events (MACE) included all-cause death,myocardial infarction and first heart failure (HF) re-hospitalization.Association with other clinical variables and adverse outcomes of repeated measurement of GDF-15 was explored.Results The median baseline GDF-15 level was 2025 ng/L.Baseline GDF-15 was moderately associated with baseline N-terminal pro-B type natriuretic peptide (NT-proBNP) (coefficient 0.561,P ＜ 0.001).During a median follow-up of 20 months,there were 53 deaths and 100MACE.GDF-15 remained an independent predictor of all-cause death (adjusted hazard ratio 1.826 per 1 Ln U,95％ CI:1.037-8.360;P =0.037) and MACE (adjusted hazard ratio 2.243 per 1 Ln U,95％ CI:1.181-1.775;P ＜ 0.001) adjusted for established risk factors.Repeated measurement of GDF-15 was performed in 173 survivals over 12months.Increase of GDF-15 over 12 months was associated with dilatation of left ventricle and acted as an independent predictor of subsequent all-cause death (adjusted HR =3.164,95％ CI:1.245-0.041;P =0.015).In the joint model,GDF-15 was also shown to be a risk factor for all-cause death (HR =2.749,95％ CI:1.667-3.831;P ＜ 0.001) and MACE (HR =2.434,95％ CI:1.425-3.443;P ＜ 0.001).Conclusions Repeated measurements of GDF-15 have promising prognostic value of the risk of all-cause death in Chinese Han patients with CHF post-myocardial infarction.GDF-15 may influence the post-myocardial infarction CHF through the path physiological pathway of myocardial remodeling.

摘要：BackgroundGrowth differentiation factor (GDF)-15, a divergent member of the transforming growth factor beta super-family does appear to be up-regulated in response to experimental pressure overload and progression of heart failure (HF). HF frequently develops after myocardial infarction (MI), contributing to worse outcome. The aim of this study is to assess the correlation between GDF-15 levels and markers related to collagen turnover in different stages of HF.MethodsThe study consists of a cohort of 179 patients, including stable angina pectoris patients (AP group,n= 50), old MI patients without HF (OMI group,n = 56), old MI patients with HF (OMI-HF group,n= 38) and normal Control group (n = 35). Both indicators reflecting the synthesis and degradation rates of collagen including precollagen I N-terminal peptide (PINP), type I collagen carboxy-terminal peptide (ICTP), precollagen III N-terminal peptide (PIIINP) and GDF-15 were measured using an enzyme-linked inmunosorbent assay.ResultsThe plasma GDF-15 level was higher in OMI-HF group (1373.4 ± 275.4 ng/L) than OMI group (1036.1 ± 248.6 ng/L), AP group (784.6 ± 222.4 ng/L) and Control group (483.8 ± 186.4 ng/L) (P< 0.001). The indi-cators of collagen turnover (ICTP, PINP, PIIINP) all increased in the OMI-HF group compared with Control group (3.03 ± 1.02μg/Lvs. 2.08 ± 0.95μg/L, 22.2 ± 6.6μg/Lvs. 16.7 ± 5.1μg/L and 13.2 ± 7.9μg/Lvs. 6.4 ± 2.1μg/L, respectively;P< 0.01). GDF-15 positively cor-related with ICTP and PIIINP (r = 0.302,P< 0.001 andr= 0.206,P= 0.006, respectively). GDF-15 positively correlated to the echocardio-graphic diastolic indicators E/Em and left atrial pressure (r= 0.349 and r= 0.358, respectively;P< 0.01), and inversely correlated to the systolic indicators left ventricular ejection fraction and the average of peak systolic myocardial velocities (Sm) (r=-0.623 and r=-0.365, respectively;P< 0.01).ConclusionPlasma GDF-15 is associated with the indicators of type I and III collagen turnover.