Shu Maoqin

CRT-P/D治疗射血分数降低的心力衰竭患者超反应发生的相关因素分析

目的 探讨心脏再同步化治疗(cardiac resynchronization therapy with pacemaker function/defibrillation function, CRT-P/D)在射血分数降低的心力衰竭患者中发生超反应的预测因素及不良事件的影响因素。 方法 回顾分析我科2015年1月至2017年1月收治的59例因心力衰竭采用CRT-P/D治疗并随访12个月以上的患者, 采集一般临床资料、心电图、心脏超声、不良事件发生等临床数据。以术后12个月左室射血分数(left ventricular ejection fraction, LVEF)升高幅度分3组:超反应组(幅度≥15%, 14例), 中度反应组(5%≤幅度＜15%, 23例), 轻度/无反应组(幅度＜5%, 22例)。采用方差分析及多因素Logistic回归分析筛选CRT-P/D治疗发生超反应的独立预测因素。采用Kaplan-Meier法进行预后分析, COX回归模型明确影响预后的危险因素。 结果 超反应组术前心房颤动比例、右房内径(right atrial diameter, RA)明显低于中度反应组及轻度/无反应组(P 结论 对于CRT-P/D治疗射血分数降低的心力衰竭患者, 病程＜1.5年、RA＜35 mm, 双心室起搏比率＞96%是发生超反应的重要预测因素, 心房颤动是影响术后不良事件发生的独立因素。

R-V 1 振幅对完全性左束支传导阻滞患者心脏再同步化治疗反应性的影响

目的探讨V 1 导联起始r波振幅(R-V 1 )对真性左束支传导阻滞(t-CLBBB)患者心脏再同步化治疗(cardiac resynchronization therapy，CRT)反应性的影响。 方法从2012年10月至2016年12月在我院接受CRT的108例患者中，遴选出术前心电图为t-CLBBB且资料完整的患者共55例，根据R-V 1 振幅分为研究组(R-V 1 ≥0.1 mV， n =26)和对照组(R-V 1 ＜0.1 mV， n =29)进行回顾性分析。由专人随访并记录心电图与超声心动图，评估CRT患者心功能应用纽约心脏病学会(New York Heart Association，NYHA)分级变化，测量QRS时限，检测各心腔舒张末期内径(左心室、右心室、左心房、右心房)、左心室射血分数(LVEF)、短轴缩短率(FS)等，评估两组患者的CRT反应性及临床获益情况。患者均完成至少6个月随访。 结果CRT前两组间各项资料差异无统计学意义( P >0.05)。CRT后两组患者QRS波时限、LVEF、FS、LVEDD等指标的改善差异均有统计学意义( P P 结论术前R-V 1 ＜0.1 mV的患者CRT反应性明显优于R-V 1 ≥0.1 mV的患者。R-V 1 振幅可作为影响CRT反应性的独立预测因素。

GW24-e0646 The effects of RNA interference targeting geminin gene on the proliferation of vascular smooth muscle cells in rats

Objectives To investigate the effects of geminin gene on the proliferation and phenotype of VSMCs in rats by using the siRNA method, and analyse the mechanism of the Geminin gene regulating cells proliferation. Methods VSMCs were transfected with three paris of Interference sequence to knock down of Geminin gene, and screened out the interference effect of the the most significant sequence which was used to build the model of slow virus packages. The differentiated phenotype of VSMCs was obtained by serum stimulation, the change of Geminin expression was measured by Western blotting and RT-PCR. The phenotypic markers of VSMCs were detected by Western blotting after Geminin gene silencing, the proliferation of VSMCs was observed by [3H]-TdR and EdU incorporation. The changes of Initiation complex—ORC1, Cdt1 protion were analysed after Geminin gene silencing, and their interrelationship was examed by immunofluorescence and co-immunoprecipitation. Results After transfected three pairs of siRNA sequences targeting Geminin gene respectively, a significant decrease of Geminin expression was observed in one of them, which acted as the model of building lentiviral interference. The differentiated phenotype of VSMCs was obtained successfully after serum stimulation, the expression of differentiation phenotypic marker-α-actin significantly decreased, while that of dedifferentiation phenotypic marker-OPN significantly increased, indicating the Geminin gene could be involved in the regulation of cells phenotypic transformation. After Geminin gene silencing, The [3H]-TdR and EdU incorporation of Positive interference group was significantly higher than that of two controls, suggesting that Geminin gene could inhibit the proliferative of VSMCs and maintain the differentiated phenotype. The expression of ORC1 and Cdt1 in positive group significantly increased, compared with that of two controls, the result of immunofluorescence and co-immunoprecipitation showed the direct interaction between Cdt1 and Geminin gene. Conclusions Geminin gene was closely related to the proliferative and the phenotype transformation of VSMCs, speculating that Geminin gene could be involved in regulation of cells proliferation by affecting the formation of initiation complex.

GW24-e2279 Geminin interference facilitate vascular smooth muscle cells proliferation via up-regulation of Cdt1

Objectives Silencing Geminin gene selectively by using RNA interference and investigate the mechanism of the Geminin gene silence regulating VSMCs proliferation. Methods VSMCs proliferation were determined by [3H]-thymidine incorporation, 5-ethynyl-2’-deoxyuridine (EdU) incorporation and flow cytometry; mRNA and Protein expression of Geminin and Cdt1 were determined by real time-PCR, westernblotting, and immunohistochemistry; the interrelationships of Geminin and Cdt1 were examed by immunofluorescence and co-immunoprecipitation (Co-IP). Results After transfected three pairs of siRNA sequences targeting Geminin gene respectively, a significant decrease of Geminin expression was observed in one of them, which acted as a stable model of building lentiviral interference. After Geminin gene silencing, the 3H-thymidine and EdU incorporation of positive interference group was significantly higher than that of two controls. The flow cytometry showed Geminin gene silencing contributed to the proliferation of VSMCs by supporting the G0/G1-S cell-cycle progression, and may be no apoptotic exists in this process. The protein expression and mRNA of Cdt1 in positive group significantly increased, compared with that of two controls. The results of immunofluorescence and Co-IP showed the close interaction between Cdt1 and Geminin gene in the proliferation of the VSMCs. Conclusions Geminin gene silencing contributes to the proliferation of A10 by supporting the G0/G1-S cell-cycle progression has been demonstrated, interestingly, this positive effect is in short term (24-48h) and reversibility. We believed that the results of the study are not caused by our research method, on account of lentivirus-delivered siRNA transfection instead of liposomes. Lentivirus is one kind of reversal viruses that could exhibit the basic feature and structure of reversal. It can integrate into the host genome and demonstrate long-term expression of integrated genes, and causes efficient down-regulation of gene expression, resulting in a functional inactivation of the target genes. In our study, we constructed a lentivirus vector-mediating RNAi targeting of Geminin (RNAi group), and it down-regulated Geminin expression of up to 80-90% efficacy in A10 cells with great specificity. In conclusion, lentivirus-delivered siRNAs are capable of specific, highly stable and functional silencing of Geminin gene expression in our study.

GW24-e2307 Association between C-reactive protein (CRP) and atrial fibrillation recurrence after catheter ablation: A meta-analysis

Objectives A variety of studies have evaluated whether increased CRP levels have association with AF recurrence after catheter ablation. However, the results remain inconsistent. So this meta-analysis was conducted to offer suggestion. Methods Electronic databases were searched until 31st December 2012 for any CRP association studies, including PubMed, Embase, Medline, ISI Web of Knowledge and ScienceDirect. Overall and subgroup analyses were performed. Standardised mean difference (SMD) and 95% confidence interval (CI) were used to evaluate the associations between CRP levels and post-ablation AF recurrence. Statistical analysis was performed with Review Manager 5.2 and STATA11.0. Results Seven available studies were identified, which included 526 patients (179 recurrence versus 347 no recurrence). Overall, increased baseline CRP levels have significant positive association with post-ablation AF recurrence. The SMD in the CRP levels was 0.65 units (95% confidence interval 0.30 to 0.99), and the z-score for overall effect was 3.70 (p = 0.0002). The heterogeneity test showed that there were moderate differences between individual studies (p = 0.006; I2 = 67%). Meta-regression revealed that different sample sizes of studies possibly accounted for the heterogeneity. Positive associations were also found in subgroup analyses based on sample size. When stratifying for ethnicity, similarly significant associations were found in both European (Caucasian) and Asian. Conclusions Inflammation of AF involved in electrophysiological and structural atrial remodelling and facilitated the disease development and perpetuation. Atrial specimens obtained by endomyocardial biopsy showed clusters of lymphomononuclear cells compatible with diagnosis of myocarditis in 66% of patients with lone AF, as well as, activated T lymphocytes were found in left atrial endocardium, supporting the role of local inflammation as a potential trigger of AF. CRP, an acute-phase protein produced in the liver, is a sensitive biomarker of systemic inflammation in several cardiovascular diseases. Elevated CRP levels are associated with increased risk of cardiovascular events. In the study from Narducci ML et al., atrial tissue CRP was significantly more frequent in patients with paroxysmal AF than persistent AF and there was a trend for the association between atrial tissue CRP and late recurrence of AF. The higher proportion of atrial CRP-positive specimens in paroxysmal AF than in persistent AF group may be an initial feature of myocardial damage via activation of the complement system, opsonisation, chemotaxis, and activation of inflammatory cells by this acute phase protein. Furthermore, a rise in CRP was related to left atrial size and dysfunction offered support the association between inflammation and structural remodelling.