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Featured researches published by Zhaoliang Shan.


Journal of Cardiovascular Medicine | 2014

Relative efficacy and safety of direct oral anticoagulants in patients with atrial fibrillation by network meta-analysis

Wenbin Fu; Hongyang Guo; Jian-Ping Guo; Kun Lin; Haijun Wang; Yu Zhang; Yutang Wang; Zhaoliang Shan

Background Much direct evidence has proved that the novel oral anticoagulants (NOACs) are noninferior or superior to warfarin for stroke prevention in patients with nonvalvular atrial fibrillation, and lead to a relevant decrease in bleeding profiles. However, no study has compared NOACs with each other head-to-head. The current study is a network meta-analysis aiming to assess the efficacy and safety of NOACs. Methods Cochrane library, Pubmed NCBI, EMBASE and MEDLINE were systematically searched for randomized controlled trials that assessed the efficacy and safety profiles of NOACs compared with warfarin. The primary outcome was the rate of stroke or systemic embolism, and the secondary outcome was the rate of bleeding events. Network meta-analysis was performed using Markov chain Monte Carlo methods. Results A total of four phase III randomized controlled trials (n = 71683) met the inclusion criteria. All NOACs except low dose of edoxaban showed noninferior efficacies to warfarin in stroke prevention. In the field of hemorrhage, apixaban was safer than edoxaban 60 mg in any bleeding events and had fewer major bleeding events compared with dabigatran 150 mg and rivaroxaban. Conclusion NOACs are promising candidates for stroke prevention in patients with nonvalvular atrial fibrillation due to a favorable risk–benefit profile. All NOACs other than edoxaban 30 mg had parallel efficacies with respect to stroke prevention. Apixaban had an advantage over the other NOACs in safety.


PLOS ONE | 2015

Renal Denervation Suppresses Atrial Fibrillation in a Model of Renal Impairment

Zhuo Liang; Xiangmin Shi; Li-feng Liu; Xin-pei Chen; Zhaoliang Shan; Kun Lin; Jian Li; FuKun Chen; YanGuang Li; Hongyang Guo; Yutang Wang

Background A close association exists between renal impairment (RI) and atrial fibrillation (AF) occurrence. Increased activity of the sympathetic nervous system (SNS) may contribute to the development of AF associated with RI. Renal denervation (RDN) decreases central sympathetic activity. Objective The main objective of the study was to explore the effects of RDN on AF occurrence and its possible mechanisms in beagles with RI. Methods Unilateral RI was induced in beagles by embolization of small branches of the renal artery in the right kidney using gelatin sponge granules in Model (n = 6) and RDN group (n = 6). The Sham group (n = 6) underwent the same procedure, except for embolization. Then animals in RDN group underwent radiofrequency ablation of the renal sympathetic nerve. Cardiac electrophysiological parameters, blood pressure, left ventricular end-diastolic pressure, and AF inducibility were investigated. The activity of the SNS, renin-angiotensin-aldosterone system (RAAS), inflammation and atrial interstitial fibrosis were measured. Results Embolization of small branches of the renal artery in the right kidney led to ischemic RI. Heart rate, P wave duration and BP were increased by RI, which were prevented or attenuated by RDN. Atrial effective refractory period was shortened and AF inducibility was increased by RI, which were prevented by RDN. Antegrade Wenckebach point was shortened, atrial and ventricular rates during AF were increased by RI, which were attenuated or prevented by RDN. Levels of norepinephrine, renin and aldosterone in plasma, norepinephrine, angiotensin II, aldosterone, interleukin-6 and high sensitivity C-reactive protein in atrial tissue were elevated, and atrial interstitial fibrosis was enhanced by RI, which were attenuated by RDN. Conclusions RDN significantly reduced AF inducibility, prevented the atrial electrophysiological changes in a model of RI by combined reduction of sympathetic drive and RAAS activity, and inhibition of inflammation activity and fibrotic pathway in atrial tissue.


Scientific Reports | 2016

Assessing bleeding risk in 4824 Asian patients with atrial fibrillation: The Beijing PLA Hospital Atrial Fibrillation Project

Yutao Guo; Ye Zhang; Xiangmin Shi; Zhaoliang Shan; Chunjiang Wang; Yutang Wang; Yundai Chen; Gregory Y.H. Lip

The risks of major bleeding and intracranial hemorrhage (ICH) are higher in Asian patients with atrial fibrillation (AF) compared to non-Asians. We aimed to investigate risk factors for bleeding, and validate the predictive value of available bleeding risk scores (mOBRI, HEMORR2HAGES, Shireman, HAS-BLED, ATRIA and ORBIT) in a large cohort of Chinese inpatients with AF. Using hospital electronic medical databases, we identified 4824 AF patients (mean age 67 years; 34.9% female) from January 1, 1995 to May 30, 2015, with median (interquartile) in-hospital days of 10 (7–16) days. On multivariate analysis, prior bleeds, vascular disease, anemia, prior stroke, and liver dysfunction were independent risk factors of major bleeding (all p < 0.05). C-statistics (95%CI) of the HAS-BLED score were 0.72 (0.65–0.79) for major bleeding events and 0.83 (0.75–0.91) for ICH (all p < 0.001). Compared to other risk scores, the HAS-BLED score was significantly better in predicting major bleeding events (Delong test, all P < 0.05, apart from mOBRI, HEMORR2HAGES) and ICH (all p < 0.05), and additionally, resulted in a net reclassification improvement (NRI) of 17.1–65.5% in predicting major bleeding events and 29.5–67.3% in predicting ICH (all p < 0.05). We conclude that the HAS-BLED score had the best predictive and discriminatory ability for major bleeding and ICH in an Asian/Chinese AF population.


PLOS ONE | 2015

Effects of Body Mass Index on Risks for Ischemic Stroke, Thromboembolism, and Mortality in Chinese Atrial Fibrillation Patients: A Single-Center Experience

Haijun Wang; Quanjin Si; Zhaoliang Shan; Yutao Guo; Kun Lin; Xiaoning Zhao; Yutang Wang

Background Obesity is considered to be related to recurrence of atrial fibrillation (AF), left atrial thrombus formation, and atrial remodeling. However, whether obesity is an independent risk factor for stroke and other thromboembolic events is still controversial. Objective This study aimed to investigate the effects of body mass index (BMI) on the risks of stroke, thromboembolism, and mortality in AF patients. Methods Patients who were diagnosed with nonvalvular AF were included in this observational, retrospective study. The study population was stratified by BMI at baseline. The Cox proportional hazard model was adopted to calculate adjusted hazard ratios of risk factors for adverse clinical events (stroke, thromboembolism, and mortality). Results A total of 1286 AF patients (males, 78.30%; mean age, 74.50 years; 94.48% paroxysmal AF) were followed up for a median of 2.1 years (IQR: 1.5–2.9 years). Overall, 159 patients died. A total of 84 strokes and 35 thromboembolic events occurred. Multivariate analysis showed that overweight (25.0≤BMI<30.0 kg/m2) and age ≥75 years were independent risk factors for ischemic stroke (both P<0.01). Obesity (BMI ≥30.0 kg/m2), age ≥75 years, persistent/permanent AF, and prior thromboembolism were independent risk factors for thromboembolism (all P<0.05). Underweight (BMI <18.5 kg/m2), age ≥75 years, prior ischemic stroke/transient ischemic attack, renal dysfunction, and heart failure were independent risk factors for all-cause deaths (all P<0.05). Conclusions Overweight or obesity may be a risk factor of ischemic stroke and thromboembolism in AF patients. Excessive low weight is significantly associated with increased all-cause mortality.


Life Sciences | 2014

Protective effect of piperine on electrophysiology abnormalities of left atrial myocytes induced by hydrogen peroxide in rabbits

Yan Liu; Yu Zhang; Kun Lin; De-Xian Zhang; Miao Tian; Hongyang Guo; Yutang Wang; Yang Li; Zhaoliang Shan

AIMS Piperine had protective effects on oxidative stress damage of ventricular myocytes by hydrogen peroxide (H2O2). In this study we aimed to explore the protective effect of piperine on abnormalities of the cardiac action potential (AP) and several ion currents induced by hydrogen peroxide (H2O2) in single rabbit left atrial myocyte. MAIN METHODS Conventional microelectrodes were used to record action potential duration (APD), resting membrane potential (RMP) and some ion currents (ICa,L,Ito,IK1 and Ikur,ect.), before and after H2O2 administration with or without piperine. KEY FINDINGS The piperine (7 μmol/L) had no significant effect on APD, ICa,L,Ito,IK1 and Ikur and their channel dynamics. In the presence of 50 μmol/L H2O2, APD50 and APD90 shortened (P<0.01), amplitude of RMP decreased (P<0.05), the peak of ICa,L reduced significantly (P<0.05). Piperine (7 μmol/L) significantly alleviated the inhibiting effect of H2O2 on APD and ICa,L (P<0.01) and protected the changes of ICa,L dynamics induced by H2O2. The peak current of Ito was reduced significantly (P<0.05); Piperine (7 μmol/L) significantly alleviated the inhibiting effect of H2O2 on Ito (P<0.01). In addition, piperine protected the changes of Ito dynamics induced by H2O2. The peak current of IK1 and IKUr was significantly reduced (P<0.05); Piperine (7 μmol/L) alleviated the inhibiting effect of H2O2 on IK1 and IKUr significantly (P<0.01). In addition, piperine protected the changes of IKUr dynamics induced by H2O2. SIGNIFICANCE These results suggest that piperine effectively protects atrial myocytes from oxidative stress injury in atrial electrophysiology.


Chinese Journal of Physiology | 2014

Protective Effects of Apocynin on Atrial Electrical Remodeling and Oxidative Stress in a Rabbit Rapid Atrial Pacing Model

De-Xian Zhang; Kai Ren; Yuan Guan; Yutang Wang; Zhaoliang Shan

It has been proposed that apocynin might be used in the prevention and management of atrial fibrillation (AF). The purpose of this study was to investigate the effects of apocynin on atrial electrical remodeling and oxidative stress promoted by rapid atrial pacing (RAP) in rabbits. New Zealand white rabbits were subjected to RAP with or without apocynin treatment. Serial electrophysiological studies (EPS) were performed at baseline and every half hour after RAP onset. Superoxide dismutase (SOD) and lactate dehydrogenase (LDH) activities and Ca²⁺ content in tissue homogenates of both atria were assayed after EPS. In the RAP group but not in the sham-operated and RAP with apocynin groups, atrial effective refractory periods (AERPs) at cycle length of 200 and 150 ms shortened most clearly by 20.8 ± 10.2 ms at 3 h (P < 0.001) and by 12.8 ± 11.1 ms at 2 h (P < 0.05) respectively, and AERP rate adaptation decreased to minus values. Higher AF inducibility (66.7%) and longer AF duration (an average of 37.8 min) were presented in the RAP group. Compared with the other groups, SOD activity was lower, and LDH activity and Ca²⁺ content were higher in the RAP group. Similar differences were not found between the sham-operated and the RAP with apocynin treatment groups. These data show that apocynin attenuates the development of atrial electrical remodeling in a short period of 3-hour RAP, and reduces RAP-mediated inducibility and duration of AF in this model.


PLOS ONE | 2014

Establishment of a Model of Renal Impairment with Mild Renal Insufficiency Associated with Atrial Fibrillation in Canines

Zhuo Liang; Li-feng Liu; Xinpei Chen; Xiangmin Shi; Hongyang Guo; Kun Lin; Jian-Ping Guo; Zhaoliang Shan; Yutang Wang

Background Chronic kidney disease and occurrence of atrial fibrillation (AF) are closely related. No studies have examined whether renal impairment (RI) without severe renal dysfunction is associated with the occurrence of AF. Methods Unilateral RI with mild renal insufficiency was induced in beagles by embolization of small branches of the renal artery in the left kidney for 2 weeks using gelatin sponge granules in the model group (n = 5). The sham group (n = 5) underwent the same procedure, except for embolization. Parameters associated with RI and renal function were tested, cardiac electrophysiological parameters, blood pressure, left ventricular pressure, and AF vulnerability were investigated. The activity of the sympathetic nervous system, renin-angiotensin-aldosterone system, inflammation, and oxidative stress were measured. Histological studies associated with atrial interstitial fibrosis were performed. Results Embolization of small branches of the renal artery in the left kidney led to ischemic RI with mild renal insufficiency. The following changes occurred after embolization. Heart rate and P wave duration were increased. Blood pressure and left ventricular systolic pressure were elevated. The atrial effective refractory period and antegrade Wenckebach point were shortened. Episodes and duration of AF, as well as atrial and ventricular rate during AF were increased in the model group. Plasma levels of norepinephrine, renin, and aldosterone were increased, angiotensin II and aldosterone levels in atrial tissue were elevated, and atrial interstitial fibrosis was enhanced after 2 weeks of embolization in the model group. Conclusions We successfully established a model of RI with mild renal insufficiency in a large animal. We found that RI with mild renal insufficiency was associated with AF in this model.


Journal of Geriatric Cardiology | 2014

Impact of body mass index on the development of pocket hematoma: A retrospective study in Chinese people

Jian-Ping Guo; Zhaoliang Shan; Hongyang Guo; Hongtao Yuan; Kun Lin; Yue-xiang Zhao; Yu-Tang Wang

Background Pocket hematoma is one of the major complications associated with cardiovascular implantable electronic devices (CIEDs) implantation. The aim of this study is to evaluate the impact of body mass index (BMI) on the occurrence of pocket hematoma after CIEDs implantation. Methods The study is a retrospective review of 972 patients receiving CIEDs implantation between 2008 and 2012 in a tertiary hospital. Results Twenty two patients (2.2%) developed severe pocket hematoma requiring re-intervention. The hematoma rate (4.6%, n = 15) of patients with a BMI of < 23 kg/m2 was significantly higher compared with that of patients with a BMI of ≥ 23 kg/m2 (1.1%, n = 7, P < 0.001). In multivariate regression analysis, a BMI < 23.0 kg/m2 may be associated with the development of severe pocket hematoma. An increase of 1.0 kg/m2 in BMI was associated with lower incidence of hematoma formation (OR: 0.84; 95% CI: 0.74-0.95; P = 0.006). Conclusion BMI < 23 kg/m2 was associated with a higher incidence of pocket hematoma, requiring re-intervention. The data support that great care must be taken when patients were with a lower BMI received CIEDs implantation.


Europace | 2018

Surface electrocardiography characteristics and radiofrequency catheter ablation of idiopathic ventricular arrhythmias originating from the left infero-septal papillary muscles: differences from those originating from the left posterior fascicle.

Shixing Li; Zulu Wang; Zhaoliang Shan; Xiangmin Shi; Ming Liang; Yanchun Liang; Zhiqing Jin; Yaling Han; Yutang Wang

Aims Distinguishing between ventricular arrhythmias originating from the left ventricular infero-septal papillary muscles (PM) and those from the left posterior fascicle (LPF) by surface electrocardiography (ECG) is very difficult. This study aimed to report the ECG characteristics and radiofrequency catheter ablation of PM and LPF ventricular arrhythmias. Methods and results A total of 127 patients underwent catheter ablation of idiopathic ventricular arrhythmias originating from the LPF (n = 106; 85 males; 10-70 years) or PM (n = 21; 14 males; 4-68 years) were studied. A three-dimensional electroanatomic system (3D-EAS) was used to aid ablation. PM ventricular arrhythmias had a longer QRS duration (154.4 ± 18.0 vs. 119.7 ± 12.6 ms, P < 0.001) than LPF ventricular arrhythmias. All 7 ventricular arrhythmias with QRS duration >160 ms originated from the PM, whereas all 87 ventricular arrhythmias with QRS duration <130 ms arose from the LPF. In 33 ventricular arrhythmias with QRS 130-160 ms, all 13 with Vi/Vt ≤ 0.85 originated from the PM, and 19 of 20 with Vi/Vt > 0.85 arose from the LPF. Of the 8 PM ventricular arrhythmias patients whose initial ablation was undertaken using a non-irrigated 4 mm-tip catheter, 1 failed and 6 recurred. However, of the remaining 13 ones using an irrigated catheter and the 3D-EAS, all succeeded and 2 recurred. No complications were noted in any patient. Conclusion PM ventricular arrhythmias could be identified from LPF ventricular arrhythmias by calculation of QRS duration combined with Vi/Vt using ECG.


Heart | 2010

e0007 The effect of omeprazole on the oxidative stress and acute atrial electrical remodelling in rabbits

Yuan Guan; Kai Ren; De-Xian Zhang; Zhaoliang Shan; Yutang Wang; Yunming Li; Hongyang Guo; Ye Zhang

Objective To investigate the effect of omeprazole on the acute atrial electrical remodelling and oxidative stress status in rabbit atrial fibrillation (AF) model. Methods 18 rabbits were randomly divided into atrial tachypacing (ATP) group, sham operating (SM) group, and atrial tachypacing with omeprazole therapy (A+O) group. In the ATP group and A+O group the right atrium was tachypaced at 500–600 bpm to induce and maintain AF for 3 h. The A+O group were given intravenous administration of omeprazole treatment (4 mg/kg) 15 min before tachypacing. The ATP group were given intravenous administration of physiological saline 10 ml 15 min before pacing. The SM group were not paced. The atrial electrophysiological indexes (AERP, Rate adaptive of AERP) were measured at different time point (baseline, 0.5 h, 1 h, 1.5 h, 2 h, 2.5 h and 3 h after pacing). Oxidative stress markers (SOD, MDA, T-NOS) in serum were measured at different time point (baseline and 3 h after pacing). Results 1. Compare to SM group, the atrial effective refractory period (ERP) at a cycle length of 200 ms was decreased from 93.89±5.88 to 72.78±5.37 ms (p<0.01) after pacing in ATP group, and the Rate adaptive of ERP appeared non-performing significantly after tachypacing in ATP group (from 0.10±0.02 to 0.04±0.01, p<0.01); but no change in A+O group, with ERP and Rate adaptive of ERP averaging 100.17±8.93 ms and 0.09±0.02. The level of lipid peroxidation index --MDA increased significantly after tachypacing in ATP group (from 1.99±0.51 to 2.94±0.78 nmol/ml, p<0.05), but no change in A+O group. 2. Compare to the result at the same time in R+O group, the ERP shortened dramatically (p<0.05) after tachypacing in ATP group; The Rate adaptive of ERP appeared non-performing significantly after pacing in ATP group; The level of MDA increased (p<0.05) after tachypacing in ATP group. Conclusion Omeprazole could effectively suppressed tachypacing-induced electrical remodelling in rabbit AF model and greatly attenuated the oxidative stress by downregulating lipid peroxidation.

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Yutang Wang

Chinese PLA General Hospital

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Hongyang Guo

Chinese PLA General Hospital

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Xiangmin Shi

Chinese PLA General Hospital

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Jian-Ping Guo

Chinese PLA General Hospital

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Kun Lin

Chinese PLA General Hospital

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Zhuo Liang

Chinese PLA General Hospital

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De-Xian Zhang

Chinese PLA General Hospital

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Hongtao Yuan

Chinese PLA General Hospital

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Jian Li

Chinese PLA General Hospital

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Yu Zhang

Chinese PLA General Hospital

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