Editor's Note: On October 12, 2017, the 28th Great Wall International Cardiology Conference (GW-ICC 2017) kicked off at the China National Convention Center in Beijing. The conference set up a special metabolic cardiovascular disease forum, which was co-hosted by Beijing Anzhen Hospital of Capital Medical University and Beijing Institute of Cardiovascular and Vascular Diseases. The executive chairman of the forum, Professor Yang Shiwei of Beijing Anzhen Hospital affiliated to Capital Medical University and other participating experts made detailed reports on the topic of metabolic cardiovascular disease, and the wonderful contents are as follows.
Chairmen of the Metabolic Cardiovascular Forum: Professor Dong Zhao, Professor Yongfen Qi, Professor Yingxin Zhao (from left to right)
Executive Chairman of the Metabolic Cardiovascular Forum: Professor Yang Shiwei
Energy metabolism for ischemic heart disease
Professor Yang Shiwei of Beijing Anzhen Hospital affiliated to Capital Medical University
According to statistics, from 2002 to 2030, the global mortality rate of cardiovascular disease ranked first. Cardiovascular disease is a combination of risk factors, and its residual risk cannot be ignored: there are still patients with cardiovascular events "residual cardiovascular events" after the application of statin; there is still residual cardiovascular risk after simple blood pressure reduction in hypertension; and the risk of coronary heart disease is still higher than that of normal people even if blood pressure drops to normal. There is still a long way to go in conquering the dangers of cardiovascular disease.
Figure 1. Myocardial metabolic processes
Ischemic heart disease has abnormal myocardial metabolism, and under normal myocardial conditions, the use of oxygen is mainly based on the aerobic oxidation of glucose and fatty acids. Abnormal glucose metabolism and lipid metabolism of the myocardium in the state of ischemia and hypoxia, followed by aerobic oxidation restriction and free fatty acid accumulation. Myocardial energy metabolism disorders and ischemic heart disease can lead to myocardial cell death and ischemia-reperfusion injury, while myocardial energy metabolism therapy can promote the body's own production of more energy, eliminate the adverse effects of metabolites, and improve the prognosis of cardiovascular disease. The 2014 China Heart Failure Guidelines clarify the beneficial effects of energy metabolism drugs in the treatment of heart failure. In the multi-target therapy of acute coronary syndrome (ACS), myocardial metabolism therapy for myocardial targets should be emphasized. Energy metabolism therapy for ischemic heart disease stabilizes ATP concentrations, improves microcirculation, and changes cardiac outcomes. Therefore, maintaining levels of high-energy phosphate compounds within cells is a basic principle for correcting myocardial damage.
The role and mechanism of Lp(a) in the occurrence and development of coronary heart disease
Professor Wang Luya, Beijing Anzhen Hospital, Capital Medical University
The main reason for the current active research in the field of blood lipids is the clinical demand. Coronary heart disease is the number one cause of death worldwide, and the effect of low-density lipoprotein cholesterol (LDL-C) in atherosclerotic (As) exceeds any risk factor, and there is still a risk of cardiovascular residue even with statin intensive therapy. Serum lipoprotein a [LP(a)] is a residual risk of coronary heart disease, and the results of a 10-year follow-up of 9330 people by the Copenhagen Cardiological Epidemiology Study (CCHS) show that Lp(a) is positively correlated with myocardial infarction (MI) risk and multiple lesions; Lp(a) is an independent risk factor with STRONG MI; LDL-C < 70 mg/dl, but Lp(a) is significantly elevated, and coronary heart disease is still progressive; Lp(a) predicts post-healing and thrombolytic therapy. Epidemiology supports Lp(a) as an indicator of risk reassessment, and multiple studies support Lp(a) as a strong predictor of coronary heart disease (Figure 2). In addition, the newly reported Lp(a) is a new risk factor for familial hypercholesterolemia (FH), Lancet (2016) Copenhagen prospective cohort study found that 1/4 Lp(a) was elevated in patients with FH; the risk genotype was a risk factor for FH; patients with FH were greater than 50 mg/dl; and Lp(a) was recommended in patients with FH to identify the risk of myocardial infarction. Elevated FH+Lp(a) predicts early OND and CAD severity.
Figure 2. Multiple studies have supported Lp(a) as a strong predictor of coronary heart disease
ESC/EAS "2011 Lipid Guidelines" recommend: cardiovascular high risk and early onset Of As family history, Lp(a) as a test index for initial screening and pretreatment; NHLBI recommends "nmol/L" to express Lp(a) particle concentration, instead of mg/dl mass concentration, clinical cutoff value > 75 nmol/L, that is, cardiovascular disease (CVD) risk increased; 2012 EAS "Lp(a) Screening Management Clinical Manual" Recommendation: With LDL-C reduced as much as possible, niacin can be used as a primary drug to reduce Lp(a), with a reduction of 20% to 35%.
Diagnosis and treatment of arrhythmias
Beijing Anzhen Hospital-Professor Fang Zhe, Beijing Daxing District People's Hospital
Common arrhythmias mainly include: (1) sinus arrhythmias, normal population, 28% of the visible transient sinus arrest and sinus atrial block, related to changes in respiratory and autonomic tone. The duration of sinus arrest is generally 1.2 to 2.0 s, and in rare cases (e.g., athletes), >2 s stops may occur. If a stop of > 3 s occurs in the general adult or elderly, it should be considered abnormal. (2) Atrial arrhythmia, in normal people, 50% to 70% can be monitored to atrial premature beats, and increase with age. Isolated, asymptomatic, with fewer episodes, supraventricular premature beats occur in 64% of healthy young people. However, with age, the number and incidence of premature beats gradually increase, and 90% of the elderly have atrial premature beats. In 98% of patients with atrial premature beats, the number of premature beats was less than 100 times/24 h. Premature beats are less common in newborns and children. (3) Short-burst atrial tachycardia: the incidence of short-burst atrial tachycardia in young people is 2% to 5%, and the incidence of elderly people is about 30%. Most examiners have a short duration of atrial tachycardia, usually 1 to a few seconds, a frequency of 100 to 150 bpm, and may be asymptomatic at the time of attack. Normal atrial flutter and atrial fibrillation are rare. (4) Atrial flutter and atrial fibrillation: rare in normal people.
Pathogenesis of abnormal impulse origin, abnormal triggering activity, and relapse into supraventricular tachycardia (SVT). In the short-term management of SVT, if SVT with abnormal aberrations or SVT with pre-excitation cannot be confirmed, the wide QRS wave tachycardia must be considered as having an unknown mechanism and treated according to the mechanism of unknown tachycardia. SVT with pre-excitation can be the result of a reverse AV relapse, or occasionally another SVT (e.g., atrial tachycardia) in which bypass does not play a major role in maintaining arrhythmias (quoted from Bloomstrom-Lundqvist et al.).
General clinical features of AV nodal re-entrant tachycardia (AVNRT): the most common type of paroxysmal supraventricular tachycardia (about 60% of the total paroxysmal supraventricular tachycardia); ECG (85% specificity) P waves are retrograde (II., III., aVF lead inversion) are often buried in or located in the terminal part of the QRS wave group; palpitations, chest tightness, dizziness, anxiety are the main symptoms; more likely to occur in people aged 40 to 60 years, more women than men, sudden abrupt stop, no warm wake. During the ablation treatment of AVNRT under the guidance of three dimensions, Professor Fang pointed out that multiple His sites (called His bundle clouds) should be recorded when labeling his positions, especially the lowest His sites. Combined with the anatomical position and the potential of the large head, the discharge line is slowly improved, and the position of the large head and the change of the electroluminal map in the cavity are paid attention to when discharging to prevent complications. In addition, Professor Fang also introduced the treatment of left bypass catheter ablation and right bypass catheter ablation.
Figure 3. AVNRT: Ablation under 3D guidance
Group photo of participating experts
(Source: Editorial Board of International Circulation)
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