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请各位翻译一下tertiles在这里应该怎样表达？
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the time between the start of mechanical ven- tilation and ECMO was categorized according to tertiles.
en, the associations between ventilator settings during ECMO and outcome were analyzed.
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tertile直译过来应该叫三分位数 概念上类似中位数median 即把一组数据按照大小的顺序排列 那么两个tertiles可以将整组数据等分成三份类似的概念有：median(2), tercile/tertile (3), quartile (4), quintile (5), sextile (6), septile (7), octile (8), decile (10), hexadecile (16), ventile/vigintile (20), centile/percentile (100)
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学医难救中国人 tertile直译过来应该叫三分位数 概念上类似中位数median 即把一组数据按照大小的顺序排列 那么两个tertiles可以将整组数据等分成三份类似的概念有：median(2), tercile/tertile (3), quartile (4), quintile (5), sextile (6), septile (7), octile (8), decile (10), hexadecile (16), ventile/vigintile (20), centile/percentile (100)the time between the start of mechanical ven- tilation and ECMO was categorized according to tertiles.
then, the associations between ventilator settings during ECMO and outcome were analyzed.谢谢回复。那是不是说应该这样翻译：机械通气以及体外膜肺氧合（ECMO）之间开始的时间根据三分位数分类。（但是不明白的是什么叫作三分位数？怎样来理解呢？）
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看来我没说明白 还是用例子说话吧：对于数列1,1,1,2,3,4,4,5,5,6,7,8中位数为4三分位数为2.5和5四分位数为1.5、4和5.5
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《Circulation》进展翻译
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这个帖子发布于11年零278天前，其中的信息可能已发生改变或有所发展。
希望各位战友踊跃参与，将《Circulation》杂志中自己认为对心血管领域有突破进展或极为重要的文献摘要翻译后和大家共同分享，如果附上自己对所选择文献的见解则更佳。为方便大家查阅，我们将每2月进行汇总。IF(2005):
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2006年4月－6月《Cardiovascular Research》翻译文献汇总(按时间先后顺序）：1. Circulation. 2006 Mar 14;113(10):1287-94Title：Intracoronary Bone Marrow Cell Transfer After Myocardial Infarction Eighteen Months’ Follow-Up Data From the Randomized, Controlled BOOST (BOne marrOw transfer to enhance ST-elevation infarct regeneration) Trial The First Three Authors：Gerd P. M Kai C. W Joachim L Corresponding Author and Address： Helmut Drexler, Abt. Kardiologie und Angiologie, Medizinische Hochschule Hannover, Germany. Received July 14, 2005; revision received December 15, 2005; accepted January 9, 2006. AbstractBackground— Intracoronary transfer of autologous bone marrow cells (BMCs) may enhance recovery of left ventricular (LV) function in patients after acute myocardial infarction (AMI). However, clinical studies addressing the effects of BMCs after AMI have covered only limited time frames ranging from 3 to 6 months. The critical question of whether BMC transfer can have a sustained impact on LV function remains unanswered. Methods and Results– After percutaneous coronary intervention with stent implantation (PCI) of the infarct-related artery, 60 patients were randomized 1:1 to a control group with optimal postinfarction therapy and a BMC transfer group that also received an intracoronary BMC infusion 4.8±1.3 days after PCI. Cardiac MRI was performed 3.5±1.5 days, 6±1 months, and 18±6 months after PCI. BMC transfer was not associated with adverse clinical events. In the control group, mean global LV ejection fraction increased by 0.7 and 3.1 percentage points after 6 and 18 months, respectively. LV ejection fraction in the BMC transfer group increased by 6.7 and 5.9 percentage points. The difference in LVEF improvement between groups was significant after 6 months but not after 18 months (P=0.27). The speed of LV ejection fraction recovery over the course of 18 months was significantly higher in the BMC transfer group (P=0.001). Conclusions– In this study, a single dose of intracoronary BMCs did not provide long-term benefit on LV systolic function after AMI compared with a rand however, the study suggests an acceleration of LV ejection fraction recovery after AMI by BMC therapy. 题目：心肌梗塞后冠状动脉内骨髓干细胞移植－来至于随机受控制追加试验（骨髓移植促进ST段抬高型心梗血管再生）的18个月监测数据背景：冠脉内移植自体骨髓细胞（BMCs）可以促进急性心梗（AMI）患者左室功能的恢复。但是临床研究表明AMI后BMCs的效果只能维持3-6个月。BMC移植能否对左室功能产生稳定的影响还没有定论。方法和结果：60名心梗患者接受经皮穿刺冠状动脉导管介入支架植入术（PCI）后，1：1随机分为常规治疗组和BMC移植组（PCI术后4.8±1.3天接受BMC移植）。PCI术后3.5±1.5 天, 6±1 月, 18±6月分别行心脏MRI检查。BMC移植组没有出现临床副反应。对照组平均左室射血分数在6个月和18个月时各自增加了0.7和3.1个百分点，BMC移植组相应增加了6.7和5.9个百分点，两者有显著差别（P=0.27）。在18个月里BMC移植组的左室射血分数提高速度明显增快（P=0.001）。讨论：在这项研究中，与对照组相比较，AMI患者接受单剂量冠脉内移植BMC不能长期提高左室功能，但加快了左室射血分数的恢复速度。2. Circulation. 5-1392Title:Epinephrine QT Stress Testing in the Evaluation of Congenital Long-QT Syndrome. Diagnostic Accuracy of the Paradoxical QT ResponseThe First There Authors: Himeshkumar Vyas, Joseph Hejlik, Michael J. AckermanCorresponding Author and Address: Michael J. Ackerman, Long QT Syndrome Clinic and Sudden Death Genomics Laboratory, Rochester Abstract：Background—A paradoxical increase in the uncorrected QT interval during infusion of low-dose epinephrine appears pathognomonic for type 1 long-QT syndrome (LQT1). We sought to determine the diagnostic accuracy of this response among patients referred for clinical evaluation of congenital long-QT syndrome (LQTS).Methods and Results—From 1999 to
genotyped patients (125 untreated and 22 undergoing β-blocker therapy)had an epinephrine QT stress test that involved a 25-minute infusion protocol (0.025 to 0.3μg•kg-1•min-1). A 12-lead ECG was monitored continuously, and repolarization parameters were measured. The sensitivity, specificity, and positive and negative predictive values for the paradoxical QT response (defined as a ≥30-ms increase in QT during infusion of ≤0.1μg•kg-1 •min-1 epinephrine) was determined. The 125 untreated patients (44 genotype negative, 40 LQT1, 30 LQT2, and 11 LQT3) constituted the primary analysis. The median baseline corrected QT intervals (QTc) were 444 ms (gene negative), 456 ms (LQT1), 486 ms (LQT2), and 473 ms (LQT3). The median change in QT interval during low-dose epinephrine infusion was -23 ms in the gene-negative group, 78 ms in LQT1,-4 ms in LQT2, and -58 ms in LQT3. The paradoxical QT response was observed in 37 (92%) of 40 patients with LQT1 compared with 18% (gene-negative), 13% (LQT2), and 0% (LQT3; p＜0.0001) of the remaining patients. Overall, the paradoxical QT response had a sensitivity of 92.5%, specificity of 86%, positive predictive value of 76%, and negative predictive value of 96% for LQT1 status. Secondary analysis of the subset undergoingβ-blocker therapy indicated inferior diagnostic utility in this setting.Conclusions—The epinephrine QT stress test can unmask concealed type 1 LQTS with a high level of accuracy.文题：肾上腺素QT应激试验在诊断先天性长QT综合征中的应用－一种更准确检出异常QT变化的方法摘要：研究背景 1型长QT综合征的患者静脉输入小剂量肾上腺素时能够观察到QT间期反常延长的现象。找到准确检测这种现象的方法将有助于临床诊断先天性长QT综合征。方法和结果 从1999年到2002年入选147例患者（其中22例患者已接收β受体阻滞剂治疗），均接受肾上腺素ＱＴ应激试验（静脉应用小剂量肾上腺素25分钟，输入速度为0.025-0.3μg/kg-1•min-1）。随后用12导联心电图持续检测心电变化，并记录复极参数，计算出该方法检测到反常QT延长现象（规定为输入≤0.1μg/kg-1•min-1肾上腺素时QT间期延长≥30ms）的敏感度，特异度，阳性预告值及阴性预告值。125例未接受β受体阻滞剂治疗的患者（44例基因型阴性，40例携带有LQT1，30例携带有LQT2，11例携带有LQT3）行初步分析。已校正基线的QT间期分别是444ms（基因型阴性），456ms（LQT1）,486(LQT2)，473ms(LQT3)，在输入小剂量肾上腺素时QT间期的变化分别是-23ms(基因型阴性)，78ms(LQT1)，-4ms(LQT2)，-58ms(LQT3)。4组患者均观察到QT间期反常延长的现象，在基因型阴性组发生率为18%，LQT2组发生率为13%，LQT3组发生率为0%(p&0.0001)，对比于以上3组LQT1组发生率高达92%。综上所述，LQT1组应用肾上腺素ＱＴ应激试验检测到QT间期反常延长现象的敏感度为92.5%，特异度为86%，阳性预告值为76%，阴性预告值为96%。随后的研究表明在接受β受体阻滞剂治疗长QT综合征患者中，用肾上腺素ＱＴ应激试验检测QT间期反常延长的现象效果差。结论 应用肾上腺素QT应激试验诊断1型长QT综合征是可行的。3. Circulation. 5-1423Title:Contribution of Clinical Correlates and 13 C-Reactive Protein Gene Polymorphisms to Interindividual Variability in Serum C-Reactive Protein LevelThe First Three Authors：Sekar K Martin G. L Ramachandran S. VasanCorresponding Author and Address：Emelia J. Benjamin, MD, ScM, Professor of Medicine,Boston University School of Medicine, Framingham Heart Study, 73 Mt Wayte Ave, Suite 2, Framingham, MA .Background—Serum C-reactive protein (CRP) level is a heritable complex trait that predicts incident cardiovascular disease. We investigated the clinical and genetic sources of interindividual variability in serum CRP.Methods and Results—We studied serum CRP in 3301 Framingham Heart Study (FHS) participants (mean age 61 years, 53% women). Twelve clinical covariates explained 26% of the variability in CRP level, with body mass index alone explaining 15% (P_0.0001) of the variance.To investigate the influence of genetic variation at the CRP gene on CRP levels, we first constructed a dense linkage disequilibrium map for common single-nucleotide polymorphisms (SNPs) spanning the CRP locus (1 SNP every 850 bases, 26 kilobase [kb] genomic region). Thirteen CRP SNPs were genotyped in 1640 unrelated FHS participants with measured CRP levels. After adjustment for clinical covariates, 9 of 13 SNPs were associated with CRP level (P_0.05). To account for correlation among SNPs, we conducted forward stepwise selection among all 13 SNPs; a triallelic SNP (rs3091244) remained associated with CRP level (stepwise P&0.0001). The triallelic SNP (C3T3A; allele frequencies 62%, 31%, and 7%), located in the promoter sequence, explained 1.4% of total serum CRP haplotypes harboring the minor T and A alleles of this SNP were associated with higher CRP level (haplotype P_0.0002 and 0.004).Conclusions—In our community-based sample, clinical variables explained 26% of the interitividual variation in CRP, whereas a common triallelic CRP SNP contributed modestly. Studies of larger samples are warranted to assess the association of genetic variation in CRP and risk of cardiovascular disease. 题目：探讨临床相关指标和13个C－反应蛋白基因多态性在个体差异引起的C-反应蛋白不同水平中的意义摘要背景:血清C-反应蛋白水平是一类可遗传的复杂性状,它可以用来预测偶然发生的心血管疾病事件。我们探讨临床指标和基因指标在由个体差异引起的C-反应蛋白不同水平中的意义。方法和结果：我们调查了Framingham心脏研究中心提供的3301名参与者（平均年龄61岁，其中53％为女性）的血清C－反应蛋白水平。12个临床相关指标解释了在血清C－反应蛋白水平的26％的差异，而体重指数单独解释了上述变量的15％（P&0.0001）。为了调查基因指标对C－反应蛋白基因变量的影响，我们先为单核苷酸多态性组合了一种密集的连续平衡不稳定图谱，以此来生成CRP的基因定位（每850B，26KB基因组区域形成一个单核苷酸多态性）。对Framingham心脏研究中心提供的1640名不相关的参与者进行了CRP测定，同时对他们的13个CRP单核酸多态性进行基因测定。在对临床相关指标进行调整后，13个基因多态性中有9个和CRP水平相关（P&0.05）。为了解释单核苷酸多态性中的相互关联性，我们对全部13个单核苷酸多态性进行分级选择性比较；结果我们发现一个三等位基因的单核苷酸多态性(rs3091244)最终保持和CRP水平的相关性（分级，P&0.0001）。此三等位基因（C－T－A，等位基因频率分别为62％，31％，7％）被定位于启动序列上，解释了全部血清CRP水平变异的1.4％，此等位基因中隐匿了微小的T和A的单倍体型被认为与CRP水平相关性更高（单倍体型，P＝0.）。结论：在以社区为基础的样本中，我们发现对于血清CRP引起的个体差异的26％可以用临床相关指标来解释，而我们研究的三等位基因在基因水平则可以比较好的解释此差异，还有进一步研究的价值。采用更大规模的样本可以确保更好的评估血清CRP基因水平相互之间的关联性及心血管疾病的危险性。4. Circulation. 4-1441Title: Safety of Coronary Sirolimus-Eluting Stents in DailyClinical PracticePhilip U Anthony H. G Giulio GCorresponding author: Philip UrbanBackground—The expanding indications for sirolimus-eluting stents (SES) include increasingly complex coronary lesionsand populations with clinical profiles markedly different from those of early pivotal controlled studies. The e-Cypher registry monitored the safety and efficacy of SES currently implanted worldwide in daily practice.Methods and Results—Between April 2002 and September 2005, data were collected on 15 157 patients who underwent implantation of _1 SES at 279 medical centers from 41 countries. An independent endpoint review committee adjudicated all reported major adverse cardiovascular events, stent thromboses, and target-vessel revascularizations. Data were managed and analyzed by independent organizations. Predictors of adverse clinical events were identified by regression analysis. The mean age of the sample was 61.7_11.4 77.7% were men, and 28.6% were diabetics. A total of 18 295 lesions were treated (20 503 SES) during the index procedure. The cumulative rates of major adverse cardiovascular events were 1.36% at 30 days, 3.38% at 6 months, and 5.80% at 1 year. The rates of acute, subacute, and late stent thrombosis were 0.13%, 0.56%, and 0.19% of patients, respectively, representing a 12-month actuarial incidence of 0.87%. Insulin-dependent diabetes, acute coronary syndrome at presentation, and advanced age were clinical predictors, whereas TIMI flow grade _3 after the index procedure, treatment of multiple lesions, a prominently calcified or totally occluded target lesion, and multivessel disease were the angiographic or procedural predictors of stent thrombosis at 12 months.Conclusions—This analysis of 1-year data collected by the e-Cypher registry suggests a high degree of safety of SES, with a rate of stent thrombosis similar to that observed in randomized trials. 题目：冠状西罗莫司洗脱支架在临床应用的安全性评价背景：西罗莫司洗脱支架（SES)的临床适应征逐渐扩大，包括较前更复杂的冠脉损伤病变和一些在之前的对照研究中未涉及的患者。e-Cypher 注册机构监测了目前已植入SES的安全性和有效性。方法和结果：选取来自于41个国家279个医学研究中心2002年4月至2005年9月的15157名曾植入1枚及其以上SES支架的患者。患者所发生的主要恶性心血管事件、支架内血栓形成和靶血管的血管形成术等状况由专门的委员会最终判定。实验数据交由另一专门机构负责处理和分析。采用回归方法确定恶性临床事件预测因素。样本的平均年龄为61.7加.减11.4岁，其中77.7%是男性，28.6%为糖尿病患者。程序索引中显示共有18295个病变采用20503枚支架治疗。主要恶性心血管事件在30天、6个月和1年的累计发生率分别为1.36%、3.38%和5.80%。急性、亚急性和慢性支架内血栓形成分别为0.13%、0.56%、0.19%，显示1年的发生率为0.87% 。胰导素依赖性糖尿病、急性冠脉综合征和高龄可以作为临床预测因素，同时TIMI血流小于3、复杂多发病变、明显钙化闭塞病变和多支病变是1年内支架血栓形成的预测因素。结论：本研究数据来自于e-Cypher注册器，这些数据表明支架内血栓形成的发生率与对照组相似，显示了SES的高度安全性。5. Circulation. 2-1577Title：Relationship Between Homocysteine and Mortality in Chronic Kidney DiseaseThe First Three Authors：Vandana Menon, Mark J. Sarnak, Tom GreeneCorresponding Author and Address: Mark J. Sarnak, 750 Washington Street, #391, Boston, MA 02111.AbstractBackground—The relationship between total homocysteine (tHcy) and outcomes has not been investigated in patients with chronic kidney disease stages 3 to 4.Methods and Results—The Modification of Diet in Renal Disease Study was a randomized, controlled trial of 840 patients.Serum tHcy was measured in frozen samples collected at baseline (n=804). Survival status and cause of death were obtained from the National Death Index. To evaluate its association with all-cause and cardiovascular disease (CVD)mortality, tHcy was evaluated both as tertiles &14.7, 14.7 to 19.5, ≥19.6 umol/L) and as a continuous variable (per10/umol/L). Participants had a mean age of 52±12 years and glomerular filtration rate (GFR) of 33±12 mL/min per 1.73 m2; 60% were male, and 85% were white. During a median follow-up of 10 years, 195 (24%) died from any cause, and 118 (15%) from CVD. The level of GFR was lower and proteinuria higher in the highest tHcy tertile. There was no association between the highest tertile of tHcy and all-cause (hazard ratio [HR]; 95% confidence interval [CI[, 1.32, 0.94 to 1.85) or CVD (HR; 95% CI, 1.50, 0.96 to 2.34) mortality in this association was further attenuated by adjustment for GFR (HR; 95% CI all-cause, 1.04, 0.72 to 1.51; CVD, 1.20, 0.73 to 1.95). There was no association between tHcy as a continuous variable and all-cause (0.98, 0.83 to 1.16) or CVD (1.04, 0.85 to 1.27) mortality.Conclusions—Hyperhomocystinemia does not appear to be a risk factor for all-cause or CVD mortality in the Modification of Diet in Renal Disease Study. Prior studies demonstrating an association between tHcy and CVD risk may have inadequately adjusted for the confounding effects of kidney function.题目：探讨同型半胱氨酸水平和慢性肾脏疾病发病率之间的关系背景：慢性肾衰竭第三、第四期的病人中总的同型半胱氨酸水平和其效应之间的关系尚未调查。方法和结果：在患有肾脏疾病的840名病人中，采取一项饮食调节的随机对照实验。以基线水平（n＝804）收集的冰冻样本中测量血清总的同型半胱氨酸水平。从国际死亡指数来观察生存状况和死亡原因。为了评估它和所有其他原因引起的疾病及心血管疾病之间的关系，血清总的同型半胱氨酸水平被同时按间隔变量(&14.7, 14.7 to 19.5, ≥19.6 umol/L)和连续变量(每10/umol/L)评估。参与实验者的平均年龄为52±12岁，肾小球滤过率为每1.73m233±12ml/min，其中65%为男性，85%为白种人。在平均10年的随访发现，195名参与者（24%）死于其他疾病，而118名参与者（15%）死于心血管疾病。在最高的血清总的同型半胱氨酸水平组中肾小球滤过率更低，蛋白尿更高。从单变量角度分析，血清总的同型半胱氨酸水平与所有其他原因引起的疾病（危害比〔HR〕，95%的可信区间〔CI〕，1.32，0.94-1.85），或心血管疾病（危害比〔HR〕，95%的可信区间〔CI〕，1.50，0.96-2.34）相互之间并没有多少联系；如果按肾小球滤过率调整评估水平（HR；95%CI，所有其他原因引起的疾病，1.04，0.72-1.51；心血管疾病，1.20，0.73-1.95）的话，上述联系还将更加减弱。按连续变量进行评估，血清总的同型半胱氨酸水平同所有其他原因引起的疾病（0.98，0.83-1.16），或心血管疾病（1.04，0.85-1.27）之间并无太多的联系。结论：在进行饮食调节的慢性肾功能疾病的病人调查研究中，高同型半胱氨酸血症并不能成为所有其他原因引起的疾病或心血管疾病的独立危险因素。先前的研究之所以验证高同型半胱氨酸血症可以作为心血管疾病的独立的危险因子，是因为没有对肾功能不全产生的混淆效应进行充分的考虑。6. Circulation. 78-1587Title：Nonsteroidal Antiinflammatory Drugs, Acetaminophen, and the Risk of Cardiovascular EventsThe First Three Authors：Andrew T. C JoAnn E. M Christine M. ACorresponding Author and Address: Andrew T. Chan, Gastrointestinal Unit, Massachusetts General Hospital, Boston. Background—Although randomized trials of cyclooxygenase-(COX-2) inhibitors have shown increased cardiovascular risk, studies of nonselective, nonsteroidal antiinflammatory drugs (NSAIDs) and acetaminophen have been inconsistent.Methods and Results—We examined the influence of NSAIDs and acetaminophen on the risk of major cardiovascular events (nonfatal myocardial infarction, fatal coronary heart disease, nonfatal and fatal stroke) in prospective cohort of 70 971 women, aged 44 to 69 years at baseline, free of known cardiovascular disease or cancer, who provided medication data biennially since 1990. During 12 years of follow-up, we confirmed 2041 major cardiovascular events. Women who reported occasional (1to 21 d/mo) use of NSAIDs or acetaminophen did not experience significant increase in the risk of cardiovascular events. However, after adjustment for cardiovascular risk factors, women who frequently (&22 d/mo) used NSAIDs had relative risk (RR) for cardiovascular event of 1.44 (95% CI, 1.27 to 1.65) compared with nonusers, whereas those who frequently consumed acetaminophen had RR of 1.35 (95% CI, 1.14 to 1.59)The elevated risk associated with frequent NSAID use was particularly evident among current smokers (RR_1.82; 95% CI, 1.38 to 2.42) and was absent among never smokers (Pinteraction_0.02)Moreover, we observed significant dose-response relations: Compared with nonusers, the RRs for cardiovascular event among women who used _15 tablets per week were 1.86 (95% CI, 1.27 to 2.73) for NSAIDs and 1.68 (95% CI, 1.10 to 2.58) for acetaminophen.Conclusions—Use of NSAIDs or acetaminophen at high frequency or dose is associated with significantly increased risk for major cardiovascular events, although more moderate use did not confer substantial risk.Key Words: acetaminophen aspirin cardiovascular diseases cyclooxygenase-inhibitors
nonsteroidal antiinflammatory drugs文题：非甾体抗炎药，对乙酰氨基酚和心血管事件危险性摘要：背景：尽管环氧合酶—2抑制剂的随机试验已经证实其能增加心血管事件的危险性，然而研究证明非选择性非甾体抗炎药和对乙酰氨基酚的作用却不一致。方法和结果：我们做了70971位年龄从44-69岁的妇女群体的前瞻性观察试验研究，这些妇女知道自己的心脏或癌症疾患，从1990年开始每两年提供一次医学数据，通过这些，我们检查了非甾体类抗炎药和对乙酰氨基酚对主要心血管危险事件（包括：非致死性心肌梗塞，严重的冠状动脉疾病，非致死性和致死性的卒中）的影响。通过12年的跟踪随访，我们证实2041例发生严重的心血管事件。报道证实：偶然（每月有1-21天）使用非甾体类抗炎药或对乙酰氨基酚并没有显现心血管事件危险的明显增加，然而，调整心血管危险因子后，同没有使用此类药物的妇女患者相比，经常（每月&22天）使用非甾体类抗炎药的妇女心血管事件的相对危险度为1.44（可信区间95%，1.27-1.65），然而那些使用对乙酰氨基酚的妇女心血管事件的相对危险度为1.35（可信区间95%，1.14-1.59）。经常使用非甾体类抗炎药且现在吸烟的妇女患者，危险性升高更明显（相对危险度为1.82，可信区间95%，1.38-2.42）。而不吸烟者却没有此类现象（P=0.02）。此外，我们发现明显的剂量依赖关系：同没有使用者相比每周使用15片非甾体类抗炎药的相对危险度为1.86（可信区间95%，1.27-2.73），每周使用15片对乙酰氨基酚的相对危险度为1.68（可信区间95%，1.10-2.58）。结论：经常或大剂量使用非甾体类抗炎药或对乙酰氨基酚，能显著增加发生心血管事件的危险。关键词：对乙酰氨基酚 阿斯匹林 心血管病 环氧化酶抑制剂7. Circulation. 8-1596Title：Impact of Diabetes Mellitus on Regression of Electrocardiographic Left Ventricular Hypertrophy and the Prediction of Outcome During Antihypertensive Therapy The Losartan Intervention For Endpoint (LIFE) Reduction in Hypertension StudyThe First There Authors：Peter M. O Richard B. D Eva G Abstract:Background—Diabetes mellitus is associated with increased cardiovascular (CV) morbidity and mortality and with greater ECG left ventricular hypertrophy (LVH); however, it is unclear whether diabetes attenuates regression of hypertensive LVH and whether regression of ECG LVH has similar prognostic value in diabetic and nondiabetic hypertensive individuals.Methods and Results—A total of 9193 hypertensive patients (1195 with diabetes) in the Losartan Intervention For Endpoint (LIFE) Reduction in Hypertension Study were treated with losartan- or atenolol-based regimens and followed up with serial ECG and blood pressure determinations at baseline and 6 months and then yearly until death or study end. ECG LVH was defined with gender-adjusted Cornell voltage-duration product (CP) criteria 〉2440 mm • ms. After a mean follow-up of 4.8_0.9 years, patients with diabetes had less regression of CP LVH (－138±866 和－204±854 mm • ms, P&0.001), remained more likely to have LVH by CP (56.0% versus 48.1%, P&0.001), and had higher rates of CV death, myocardial infarction, stroke, and all-cause mortality and of the LIFE composite end point of CV death, myocardial infarction, or stroke. In multivariable Cox proportional hazards models, in-treatment regression or absence of ECG LVH by CP was associated with between 17% and 35% reductions in event rates in patients without diabetes but did not significantly predict outcome in patients with diabetes.Conclusions—Hypertensive patients with diabetes have less regression of CP LVH in response to antihypertensive therapy than patients without diabetes, and regression of ECG LVH is less useful as a surrogate marker of outcomes in hypertensive patients with diabetes. These findings may in part explain the higher CV morbidity and mortality in hypertensive patients with diabetes, and the absence of a demonstrable improvement in prognosis in diabetic patients in response to regression of ECG LVH suggests a more complex interrelation between underlying LV structural and functional abnormalities and outcome in these patients. Key Words: diabetes mellitus _ electrocardiography _ hypertension _ hypertrophy _文题：糖尿病影响心电图所示左室肥厚的扭转，和抗高血压治疗的预期效果－高血压研究中的The Losartan Intervention For Endpoint (LIFE) Reduction实验摘要：背景：糖尿病能增加心血管病的发病率和死亡率及ECG LVH的发生，然而，糖尿病是否降低高血压所致左室肥厚的扭转和是否在糖尿病和非糖尿病高血压的个体中ECG LVH扭转有预测价值，这些还是不清楚的。 方法和结果：在高血压研究的LIFE试验中，共9193例高血压患者（1195例患糖尿病）接受氯沙坦或阿替洛尔为基点的药物治疗，从开始到6个月，然后每年直到死亡或研究结束进行一系列的心电图和血压监测随访。心电图所示的左室肥厚定义依据性别调整的Cornell电势电位乘积（CP），标准〉2440 mm • ms。平均随访4.8到9年后，糖尿病患者CP LVH的扭转率较低(－138±866 和－204±854 mm • ms, P&0.001)， 却有较高的CP LVH发生率(56.0% 和 48.1%, P&0.001),，且有更高的心血管死亡率，心肌梗塞发生率，卒中发生率，和各种原因所致的死亡率和由上诉原因引起的高的复合生命终点。在多变量环化酶相称的危害模型中，无糖尿病患者扭转治疗或无CP LVH的患者事件发生率减少17% 到 35% ，但是并不比患糖尿病的患者有显著的预期效果。结论：同没有患糖尿病的高血压患者相比，患糖尿病的高血压患者通过降压治疗较少能扭转CP LVH，且作为一项标志性结局，患高血压的糖尿病患者ECG LVH的扭转是很难奏效的。这些发现可能部分解释了合并糖尿病的高血压病患者有较高的心血管的发病率和死亡率，在糖尿病患者对ECG LVH扭转的反应缺少可证实的预见性提高，这也暗示着在这些患者中潜在的左室结构和功能的异常和所致结局的更复杂的相互关系。8. Circulation. 7-1604Title：Women Have Higher Left Ventricular Ejection Fractions Than Men Independent of Differences in Left Ventricular VolumeThe First Three Authors：Anne K. Chung, Sandeep R. Das, David LeonardCorresponding Author and Address: Mark Drazner, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas.AbstractBackground—Although gender-specific criteria are common for defining cardiac traits such as left ventricular hypertrophy, left ventricular ejection fraction (LVEF) thresholds widely used in clinical practice have traditionally been the same for women and men, perhaps because it remains uncertain whether there is a systematic difference in LVEF between genders.Methods and Results—Using cardiac magnetic resonance imaging in a probability-based sample of Dallas County residents aged 30 to 65 years (1435 women and 1183 men), we compared LVEF in women and men. The association of gender with stroke volume independent of end-diastolic volume (EDV) or other potential confounders was assessed by multivariable analysis. Gender-specific thresholds for a low LVEF were defined at the 2.5th percentile in women and men from a healthy reference subpopulation. The median (25th, 75th percentile) LVEF was higher in women than in men (75% [70%, 79%] in women versus 70% [65%, 75%] in men, P_0.001). Left ventricular EDV and end-systolic volume indexed to body surface area were smaller in women than in men (P_0.001 for both). Gender remained significantly associated with stroke volume, independent of EDV and other potential confounders in multivariable analysis. A low LVEF was defined as below 61% in women and below 55% in men.Conclusions—Women have a higher LVEF than men in the general population, secondary to a higher stroke volume for a given EDV independent of known potential confounders. 题目：女性比男性的左心室射血分数高不依赖于左心室容积的差别背景：尽管以性别特性为标准来定义心脏特征很普遍，如左心室肥厚，但是被广泛用于临床实践的左室射血分数阈值依照传统观点来看，对于男性和女性是一样的，这样评定的标准可能是因为性别之间左室射血分数是否有系统性差异尚无定论。方法和结果：在以概率为基础的样本分析中，达拉斯州随机抽取年龄30-65岁的常住居民（女性1435名，男性1183名）进行心脏核磁共振成像检查，以此来比较男性和女性之间的左室射血分数的差异。在心脏搏出量不依赖于舒张末期容积或其他潜在的混淆因素的基础上，我们采用多变量分析的方法评估性别之间的关联性。我们定义以性别特征为标准的低左室射血分数的阈值在百分位数为2.5的有参考价值的健康亚居民中的男性和女性。在人群第25百分位数和第75百分位数上左室射血分数在女性高于男性（女性75%〔70%，79%〕对比男性70%〔65%，75%〕，P&0.001）。在女性左室舒张末期容积和收缩末期容积占用体表面积的比率比男性要小的多（对于两者均有P&0.001）。在多变量分析中，性别差异保持和心搏出量显著性的关联，不依赖于舒张末期容积和其他潜在的混淆因素。在女性，低的左室射血分数规定为61%，而男性为55%。结论：不依赖于任何潜在的混淆因素，在普通的人群中，女性的射血分数要高于男性，在舒张末期容积不变的情况下会有更多的心搏出量。9. Circulation. 5-1621Title:VKORC1 Haplotypes Are Associated With Arterial Vascular Diseases (Stroke, Coronary Heart Disease, and Aortic Dissection)The First Three Authors：Yibo W Weili Z Yuhui Zhang Corresponding Author and Address：Rutai Hui, Cardiovascular Institute & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, People’s Republic of China. Abstract: Background—The haplotypes in the gene vitamin K epoxide reductase complex subunit 1 (VKORC1) have been found to affect warfarin dose response through effects on the formation of reduced-form vitamin K, a cofactor for γ-carboxylation of vitamin K–dependent proteins, which is involved in the coagulation cascade and has a potential impact on atherosclerosis. We hypothesized that VKORC1-dependent effects on the coagulation cascade and atherosclerosis would contribute to susceptibility for vascular diseases. Methods and Results—To test the hypothesis, we studied the association of polymorphisms of VKORC1 with stroke (1811 patients), coronary heart disease (740 patients), and aortic dissection (253 patients) compared with matched controls (n=, and 416, respectively). Five common noncoding single-nucleotide polymorphisms of VKORC1 were identified in a natural haplotype block with strong linkage disequilibrium (D’&0.9, r2&0.9), then single-nucleotide polymorphism (SNP) +2255 in the block was selected for the association study. We found that the presence of the C allele of the +2255 locus conferred almost twice the risk of vascular disease (odds ratio [OR] 1.95, 95% confidence interval [CI] .58 to 2.41, P&0.001 OR 1.72, 95% CI 1.24 to 2.38, P&0.01 for co and OR 1.90, 95% CI 1.04 to 3.48, P&0.05 for aortic dissection). We also observed that subjects with the CC and CT genotypes had lower levels of undercarboxylated osteocalcin (a regulator for the bone), probably vascular calcification, and lower levels of protein induced in vitamin K absence or antagonism II (PIVKA-II, a des-γ-carboxy prothrombin) than those with TT genotypes. Conclusions—The haplotype of VKORC1 may serve as a novel genetic marker for the risk of stroke, coronary heart disease, and aortic dissection.文题：VKORC1基因单体型与动脉血管疾病（中风、冠心病、主动脉壁夹层形成）的相关性摘要：背景—现已发现维生素K环氧化物还原酶复合体1(VKORC1)基因的单体型可以通过促进还原态的维生素K的生成影响华法林的剂量响应，而还原态维生素K是维生素K依赖蛋白γ-羧基化的一个辅助因子，它存在于凝血连锁反应中，对动脉粥样硬化具有潜在的影响。我们假设在凝血连锁反应和动脉粥样硬化中的VKORC1依赖效应可以促成脉管疾病的易感性。方法和结果—为了验证这一假说，我们研究了VKORC1基因多态现象与中风（1811例病人）、冠心病（740例病人）、主动脉壁夹层形成（253例病人）之间的联系，并与配对的对照组（例数分别为，416）进行了比较，在天然的VKORC1单体型基因共有的非编码区中鉴定出了五个具有极度连锁不平衡性的单核苷酸多态现象(D’&0.9, r2&0.9),然后选取了其中第+2255位的单核苷酸多态现象进行相关性研究，我们发现第+2255基因座中C等位基因的存在将使血管疾病发生的风险加倍(对于中风：优势比 [OR] 为1.95, 95%置信区间 [CI]为0 .58 － 2.41, P&0.001;对于冠心病： OR 为1.72, 95% CI 为1.24 － 2.38, P&0.01; 对于主动脉壁夹层形成：OR 为1.90, 95% CI为 1.04 － 3.48, P&0.05)，我们还观察到CC 和 CT基因型的受试者较之TT基因型的受试者具有更低水平的亚羧基化维生素K依赖蛋白（一种骨调节剂），更可能发生血管钙化、维生素K缺乏或抵抗诱蛋白II（PIVKA-II,一种脱γ-羧基的凝血酶原）的浓度更低。结论—VKORC1基因单体型可以作为预测中风、冠心病、主动脉壁夹层形成风险的新型基因标志物。10. Circulation. 1-1649Title：Clinical Features of Arrhythmogenic Right Ventrticular Dysplasia/Cardiomyopathy Associated With Mutations in Plakophilin-2The First Three Authors：Darshan Dalal, Lorraine H. Molin, Jonathan PicciniCorresponding Author and Address：Daniel Judge, MD, Johns Hopkins University School of Medicine, Baltimore.AbstractBackground—Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is an inherited cardiomyopathy characterized by right ventricular dysfunction and ventricular arrhythmias. A recent study reported mutations in PKP2, encoding the desmosomal protein plakophilin-2, associated with ARVD/C. The purpose of our study was to validate the frequency of PKP2 mutations in another large series of ARVD/C patients and to examine the phenotypic characteristics associated with PKP2 mutations.Methods and Results—DNA from 58 ARVD/C patients was sequenced to determine the presence of mutations in PKP2. Clinical features of ARVD/C were compared between 2 groups of patients: those with a PKP2 mutation and those with no detectable PKP2 mutation. Thirteen different PKP2 mutations were identified in 25 (43%) of the patients. Six of these mutations have not been 4 occurred in multiple, apparently unrelated, families. The mean age at presentation was lower among those with a PKP2 mutation (28_11 years) than in those without (36_16 years) (P_0.05). The age at median cumulative symptom-free survival (32 versus 42 years) and at the median cumulative arrhythmia-free survival (34 versus 46 years) was lower among patients with a PKP2 mutation than among those without a PKP2 mutation (P_0.05). Inducibility of ventricular arrhythmias on an electrophysiology study, diffuse nature of right ventricular disease, and presence of prior spontaneous ventricular tachycardia were identified as predictors of implanted cardioverter/defibrillator (ICD) intervention only among patients without a PKP2 mutation (P_0.05).Conclusions—Our study highlights the clinical relevance of PKP2 mutations in ARVD/C. Presence of a PKP2 mutation in ARVD/C correlates with earlier onset of symptoms and arrhythmia. Patients with a PKP2 mutation experience ICD interventions irrespective of the classic risk factors determining ICD intervention in ARVD/C patients. 题目：致心律失常性右室发育不良型心肌病的临床特征和PKP-2基因变异之间的关系摘要背景：致心律失常性右室发育不良型心肌病是一种遗传性的心肌病，它以右室功能不全和室性心律失常为特征。近来的研究报道PKP-2基因（PKP-2基因编码桥粒斑菲素蛋白-2）的变异同致心律失常性右室发育不良型心肌病密切相关。我们研究的目的是为了在另外一大组患有致心律失常性右室发育不良型心肌病的人群中确认PKP-2基因频率的有效性，以此来检测PKP-2基因变异所引起的相关表型特征。方法和结果：从58例患有致心律失常性右室发育不良型心肌病的病人中取出DNA进行排序，以此来观察PKP-2基因的变异。对两组患有致心律失常性右室发育不良型心肌病的病人（一组为存在PKP-2基因变异，另一组为未检测到PKP-2基因变异）进行比较，观察他们各自的临床特征有何差异。在25个病人中发现有13个病人的PKP-2基因发生变异，并且彼此之间的变异各不相同，这个比例为43%。这些变异中有6种在以前的研究中从来没有报道过；4种变异与多重因素而非家族性相关。那些带有PKP-2基因变异的病人的平均年龄（28±11岁）明显低于那些没有PKP-2基因变异的病人（36±16岁）（P&0.05）。累积的无症状期生存期限从两个组观察比较（32岁组和42岁组），累积的无心律失常期生存期限从两个组观察比较（36岁组和46岁组），得出的结论为那些带有PKP-2基因变异的病人的生存年龄低于无PKP-2基因变异的病人。在无PKP-2基因变异的病人中，电生理刺激诱发的室性心律失常，右室心肌病变的弥散性，先前自发的室性心动过速，所有这些都可以作为植入心脏复律除颤器的可预测因子（P&0.05）。结论：我们的研究结果高度验证了PKP-2基因变异同致心律失常性右室发育不良型心肌病临床特征之间的相关性。在患有致心律失常性右室发育不良型心肌病的病人中，PKP-2基因的变异同早期发生的临床症状及心律失常相关。因此，我们建议在患有致心律失常性右室发育不良型心肌病的病人中，无论是否存在典型的植入心脏复律除颤器的危险因素，都应该在存在PKP-2基因变异的病人中进行ICD的干预治疗。11. Circulation. 9-1666Title：Idiopathic Epicardial Left Ventricular Tachycardia Originating Remote From the Sinus of Valsalva Electrophysiological Characteristics, Catheter Ablation, and IdentificationFrom the 12-Lead ElectrocardiogramThe First Three Authors：David V. Daniels, MD; Yen-Yu Lu, MD; Joseph B. Morton, MD;Corresponding Author and Address：David J. Wilber, MD, Cardiovascular Institute, Loyola University Medical Center, 2160 S. First Ave,Maywood, IL 60153.AbstractdanBackground espite the success of catheter ablation for treatment of idiopathic ventricular tachycardia (VT), occasional patients have been reported in whom VT could not be ablated from the right or left ventricular endocardium or from the aortic sinus of Valsalva (ASOV).Methods and Resultsn 12 of 138 patients (9%) with idiopathic VT referred for ablation, an picardial left ventricular site of origin was identified&10 mm from the ASOV. Coronary venous mapping demonstrated epicardial preceding endocardial activation by&10 ms (41±7 versus 15±11 ms before QRS P&0.001). VT induction was facilitated by catecholamines and terminated by adenosine. Ablation through the coronary veins or via percutaneous trans　pericardial catheterization was successful in 9 2 required direct surgical ablation as a result of anatomic constraints.No ECG pattern was specific for epicardial VT. However, slowed initial precordial QRS activation, as quantified by a novel metric, the maximum deflection index, was more useful. A delayed precordial maximum deflection index ≥0.55 identified epicardial VT remote from the ASOV with a sensitivity of 100% and a specificity of 98.7% relative to all othersites of origin (P&0.001).Conclusions:Although clinically underrecognized, idiopathic VT may originate from the perivascular sites on the left ventricular epicardium. The mechanism is consistent with triggered activity. It is amenable to ablation by transvenous or transpericardial approaches, although technical challenges remain. Recognition of a prolonged precordial maximum deflection index and early use of transvenous epicardial mapping are critical to avoid protracted and unsuccessful ablation elsewhere in the ventricles. 题目：起源于心外膜主动脉窦的特发性室性心动过速：射频消融和用12导心电图鉴别摘要背景：尽管射频消融可以成功的治疗室性心动过速（VT）,但仍有部分患者不能从左侧或右侧心室内膜及主动脉窦（ASOV）成功消融。 方法和结果：138名特发性室速患者中12人行射频消融，起源点大于10mm在左室ASOV。冠状静脉电标测显示心外膜早于心内膜活化&10ms(41±7 versus 15±11 ms before QRS P&0.001)。儿茶酚胺使室速诱导容易而腺苷终止室速。9名患者经冠状静脉或经皮心包导管消融成功，2人因心脏解剖结构原因行外科切除。特发性室速无特殊的心电图表现，然而延迟的心前区QRS激活，通过一种新的方法测量，最大偏移指数更加有用。延迟的心前区最大偏移指数≥0.55提示VT来源于心外膜ASOV，与其它起源点相比敏感度100％，特异度98.7％。结论：虽然临床上尚不能识别，但是特发性室速的确可以起源于左室心外膜血管周围。发生机理与触发机制一致。虽然技术上有一定难度，但可以通过静脉或经心包途径行消融治疗。识别延迟的最大偏移指数和早期应用经静脉电标测可以缩短手术时间及避免心室内错误的消融。12. Circulation.7-1674Title：Effect of Clopidogrel Premedication in Off-Pump Cardiac SurgeryAre We Forfeiting the Benefits of Reduced Hemorrhagic Sequelae?The First Three Authors：Emmanouil I. Kapetanakis, MD; Diego A. Medlam, MD; Kathleen R. Petro, MD;Corresponding Author and Address：Emmanouil I. Kapetanakis, MD, Section of Cardiac Surgery, Department of Surgery, Washington Hospital Center, Washington, DC 2AbstractBackground—Premedication with clopidogrel has reduced thrombotic complications after ercutaneous coronary revascularization procedures. However, because of the enhanced and irreversible platelet inhibition by clopidogrel, patients requiring surgical revascularization have a higher risk of bleeding complications and transfusion requirements. A principal benefit of surgical coronary revascularization without cardiopulmonary bypass is its lower hemorrhagic sequelae. The purpose of this study was to evaluate the effect of preoperative clopidogrel administration in the incidence of hemostatic reexploration, blood product transfusion rates, morbidity, and mortality in patients undergoing off-pump coronary artery bypass graft surgery using a large patient sample and a risk-adjusted approach.Methods and Results—Two hundred eighty-one patients (17.9%) did and %) did not receive clopidogrel before their surgery, for a total of 1572 patients undergoing isolated off-pump coronary artery bypass graft surgery between January 2000 and June 2002. Risk-adjusted logistic regression analyses and a matched pair analyses by propensity scores were used to assess the association between clopidogrel administration and reoperation as a result of bleeding, intraoperative and postoperative blood transfusions received, and the need for multiple transfusions. Hemorrhage-related preoperative risk factors identified in the literature and those found significant in a univariate model were used. Theclopidogrel group had a higher likelihood of hemostatic reoperations (odds ratio [OR], 5.1; 95% confidence interval [CI], 2.47 to 10.47; P&0.01) and an increased need in overall packed red blood cell (OR, 2.6; 95% CI, 1.94 to 3.60; P&0.01), multiple unit (OR, 1.6; 95% CI, 1.07 to 2.48; P&0.02), and platelet (OR, 2.5; 95% CI, 1.77 to 3.66; P&0.01) transfusions. Surgical outcomes and operative mortality (1.4% versus 1.4%; P&1.00) were not statistically different. Conclusions—Clopidogrel administration in the cardiology suite increases the risk for hemostatic reoperation and the requirements for blood product transfusions during and after off-pump coronary artery bypass graft surgery.题目：心脏外科体外循环术前给予氯吡格雷　　　－增加出血并发症的风险？摘要背景：心脏外科冠脉搭桥术前给予氯吡格雷降低了血栓形成的并发症。然而，由于氯吡格雷较强的不可逆性抑制血小板活性，患者在接受冠状动脉再成形术时出血的风险和输血的需求相应增高。外科冠状动脉搭桥不行心肺分流的主要优点是出血并发症低。本研究的目的是用大样本量，修正风险因素的方法评价行体外循环冠脉旁路移植术患者术前给予氯吡格雷在止血再探查术，输血率，发病率和死亡率等方面效果。方法和结果：自2000年1月至2002年6月共1572名患者行冠脉搭桥术，281名患者术前服用氯吡格雷(17.9%)，%)人不服药。利用Logistic回归法和配对检验方法评价给予氯吡格雷和出血再手术、术中、术后输血及多成分输液的相关性。术前鉴定出血危险因素，采用有意义的单变量模型。氯吡格雷组止血再手术的可能性更大一些（优势比[OR], 5.1; 95%，置信区间[CI], 2.47 to 10.47; P&0.01），浓集红细胞需求 (OR, 2.6; 95% CI, 1.94 to 3.60; P&0.01)，多成分输液(OR, 1.6; 95% CI, 1.07 to 2.48; P&0.02)和输血小板(OR, 2.5; 95% CI, 1.77 to 3.66; P&0.01) 增多。外科手术结果和手术死亡率(1.4% versus 1.4%; P&1.00)无统计学意义。结论：心脏外科术前给予氯吡格雷增加体外循环冠脉搭桥术中和术后再止血手术和需要输注血产品的风险。13. Circulation. 5-1682Title: Magnesium Intake and Incidence of Metabolic Syndrome Among Young AdultsThe First There Authors：Ka He,; Kiang Liu；Martha L. Daviglus Corresponding Author and Address：Ka He, , Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University,AbstractBackground—Studies suggest that magnesium intake may be inversely related to risk of hypertension and type 2 diabetes mellitus and that higher intake of magnesium may decrease blood triglycerides and increase high-density lipoprotein(HDL) cholesterol levels. However, the longitudinal association of magnesium intake and incidence of metabolic syndrome has not been investigated.Methods and Results—We prospectively examined the relations between magnesium intake and incident metabolic syndrome and its components among 4637 Americans, aged 18 to 30 years, who were free from metabolic syndrome and diabetes at baseline. Metabolic syndrome was diagnosed according to the National Cholesterol Education Program/Adult Treatment Panel III definition. Diet was assessed by an interviewer-administered quantitative food frequency questionnaire, and magnesium intake was derived from the nutrient database developed by the Minnesota Nutrition Coordinating Center. During the 15 years of follow-up, 608 incident cases of the metabolic syndrome were identified. Magnesium intake was inversely associated with incidence of metabolic syndrome after adjustment for major lifestyle and dietary variables and baseline status of each component of the metabolic syndrome. Compared with those in the lowest quartile of magnesium intake, multivariable-adjusted hazard ratio of metabolic syndrome for participants in the highest quartile was 0.69 (95% confidence interval [CI], 0.52 to 0.91; P for trend &0.01). The inverse associations were not materially modified by gender and race. Magnesium intake was also inversely related to individual component of the metabolic syndrome and fasting insulin levels.Conclusions—Our findings suggest that young adults with higher magnesium intake have lower risk of development of metabolic syndrome. 题目：青年人中镁摄入和代谢综合征发生率摘要：背景：研究表明镁摄入和高血压及2型糖尿病的危险因素成反比，并且高的镁摄入可能降低血甘油三脂和增加高密度脂蛋白水平。然而，还没有关于镁摄入和代谢综合征发病率之间的纵向联系的研究。方法和结果：我们抽取4637例美国人，进行了镁摄入和代谢综合征及其各组成部分间的联系的前瞻性研究。这些人年龄在18-30岁间，在基线水平无代谢综合征和糖尿病。根据国际胆固醇教育计划/成人治疗小组III的定义诊断代谢综合征。通过掌握受试者的定量食物频次表评估饮食，依据明尼苏达营养搭配中心营养数据库规定界定镁摄入。在15年的随访里，发生了608例代谢综合征。调整了主要生活习惯和饮食变量及代谢综合征各组份的基线状态后，镁摄入和代谢综合征的发生率成反比。同位于最低四分位数的镁摄入者相比，位于最高四分位数的受试者,经校正多变量后,代谢综合征危险发生率是0.65（95% 可信区间 [CI], 0.52 - 0.91; P& 0.01）。这些相反的联系实质上并没有经过性别和种族调整。镁摄入同样和代谢综合征的单个组成成分及胰岛素抵抗呈反比。结论：我们的研究表明，青年人中，镁摄入越多，发生代谢综合征的危险就越低。14. Circulation. 3-1729Title: Effects of Gap Geometry on Conduction Through Discontinuous Radiofrequency LesionsThe First Three Authors：Francisco J. Pérez, Mark A. Wood, Christine M. SchubertCorresponding Author and Address：Mark Wood, Virginia Commonwealth University Medical CenterAbstractBackground—Gaps of sufficient cross-sectional dimensions within linear radiofrequency (RF) lesions may allow conduction through the lesion. The purpose of this study was to examine the effects of different gap geometries on conduction through discontinuous RF lesions.Methods and Results—Radiofrequency lesions were created in isolated, perfused rabbit right ventricular (RV) free wall preparations to produce gaps with 3 different lesion geometries: straight, bifurcated, and angled (n=10 each group). Angled preparations contained 2 right angles within the conduction path. Optical mapping was used to assess bidirectional conduction through the myocardium before and after gap formation during pacing at 1000-, 400-, and 200-ms cycle lengths. Histological analysis was performed on each preparation after optical mapping. After lesion formation, 9 of 10 straight gap preparations and 1 of 10 angled gap preparations demonstrated bidirectional conduction (P&0.001) at all cycle lengths. Nine of 10 bifurcated gap preparations demonstrated bidirectional conduction and 1 demonstrated unidirectional conduction at all cycle lengths. Two bifurcated gap preparations showed rate-dependent unidirectional 2:1 conduction. All unidirectional and rate-dependent block occurred during impulse propagation in the direction of diverging arms of the bifurcation. The occurrence of bidirectional conduction in the gaps was associated with the gap geometry (P&0.0001). Histological analysis confirmed the continuity of viable myocardium transmurally throughout the length of the gap in each preparation. The sites of conduction block were demonstrated to be just after the first angle in the conduction path for angled gaps and at the branch point of a bifurcated gap. The predominant myofiber orientation was changed relative to the conduction path at angulations of the gaps. Flecainide (0.1 umol/L) produced bidirectional conduction block in straight and bifurcated gap preparations with bidirectional conduction at baseline.Conclusions—Conduction through discontinuities in RF lesions is associated with gap geometry. Complex gap geometry may allow for unidirectional and/or rate-dependent block. Gaps within RF lesions are susceptible to pharmacological blockade. 题目：不连续的射频损伤后通道的几何形状对传导的影响背景：经过线性射频损伤足够多交叉横断面的通道可能允许传导通过损伤部位。本研究旨在探讨射频损伤后不同几何形状的通道对传导的影响。方法和结果：在离体灌流的兔右心室游离壁标本中进行射频损伤，以此来产生三种不同几何形状的损伤通道：直线、分叉、成角（每组n＝10）。成角通道在传导路径中包括两个直角。利用光谱分析来评估心肌离子通道形成之前和形成之后的双向电传导，频率定为1000-，400-，循环周期为200ms。在光谱分析完成后，对每一个标本均进行组织学分析。在损伤形成后，10个直线通道中的9个及10个成角通道中的1个在所有循环周期内均为双向传导（P&0.001）。在所有循环周期内，10个分叉通道中的9个为双向传导，1个为单向传导。2个分叉通道显示频率依赖性的单向2：1传导。所有的单向的且频率依赖性的阻滞均出现在脉冲传播路径分叉后的分支上。通道中双向传导的出现与通道的几何形状有关（P&0.0001）。经过组织学分析验证了每一个标本中活性心肌通道长度的连续性。成角通道中传导阻滞的部位在第一次成角后，而在分叉通道中位于分叉点。优势肌纤维定位的改变和成角通道传导路径有关。氟卡尼(0.1umol/L)作用于直线和分叉通道产生双向传导阻滞，使双向传导维持在基线水平。结果：不连续的射频损伤造成的传导改变和通道的几何形状有关。复杂几何形状的通道可以造成单向的和/或频率依赖性的阻滞。射频损伤后的通道对药理学封闭敏感。15. Circulation. 0-1737Title：Kir3-Based Inward Rectifier Potassium Current Potential Role in Atrial Tachycardia Remodeling Effects on Atrial Repolarization and ArrhythmiasThe First Three Authors：Tae-Joon Cha, Joachim R. Ehrlich, Denis ChartierCorresponding Author and Address：Dr Stanley Nattel, 5000 Belanger St E, Montréal, QuébecAbstractBackground—We previously characterized a novel K＋current (IKH) with properties of constitutively active acetylcholine related current in dog atrium. IKH is sensitive to tertiapin-Q (IC50 ≈10 nmol/L), a highly selective Kir3 current blocker. This study assessed the role of IKH in atrial tachycardia (AT)–remodeled canine left atrium (LA) with the use of tertiapin-Q as a probe.Methods and Results—Dogs were subjected to 7 to 13 days of AT (400 bpm). Coronary-perfused LA preparations were studied intact or subjected to cardiomyocyte isolation. IKH was recorded with patch-clamp methods. AT pacing increased time-dependent hyperpolarization-activated current (IKH) at-110 mV from -1.8±0.3 (control) to -3.4±0.5 pA/pF (AT) and the 100-nmol/L tertiapin-sensitive component from -1.5±0.4 (control) to-3.3±0.6 pA/pF (AT). Prolonged atrial tachyarrhythmias could be induced with single extrastimuli in AT-remodeled, but not control, preparations, reflecting the atrial fibrillation–promoting effects of AT remodeling. In AT-remodeled preparations, tachyarrhythmia duration averaged 11.0±5.2 seconds, with a cycle length of 108±6 ms. Tertiapin-Q decreased tachyarrhythmia duration (to 0.6±0.1 P&0.001) and increased tachyarrhythmia cycle length (to 175±10 P&0.001). Atrial actionpotential duration (APD) was increased 65±6% by tertiapin in AT-remodeled hearts versus 19±2% (P&0.001) in control. In 2 AT-remodeled preparations, tachyarrhythmia lasted uninterrupted for &20 tertiapin-Q slowed and then terminated arrhythmia in both. Tertiapin had no effect on left ventricular cardiomyocyte currents or APD.Conclusions—AT remodeling increases IKH, and a highly selective Kir3 current antagonist, tertiapin-Q, increases APD and suppresses atrial tachyarrhythmias in AT-remodeled preparations without affecting ventricular electrophysiology. Constitutive acetylcholine-related K＋current contributes to AT-remodeling effects in dogs and is a potentially interesting antiarrhythmic targe题目：Kir3介导的内相整流钾电流：在心动过速型心房重构过程中对心房除极和心律失常的潜在作用背景：研究者先前认为一种新型钾电流IKH具有乙酰胆碱（Ach）激活的电流特性。IKH对一种高选择性的Kir3电流阻滞剂托肽品－Q敏感（半抑制浓度≈10nmol/L）。本研究旨在利用托肽品－Q进行干预，评估犬的左心房模型心动过速型心房重构中IKH的作用。方法和结果：试验用狗的房性心动过速（AT）持续7到13天（每分钟心跳次数400）。完整研究左房冠状动脉灌流模型或将其心肌分离。IKH通过膜片钳的方法进行记录。起搏诱发的房性心动过速将时间依赖性的超极化（－110v）激活电流从－1.8±0.3pA/pF（对照组）升高到－3.4±0.5 pA/pF（AT组），把对托肽品100nmol/L敏感的电流从－1.5±0.4 pA/pF（对照组）升高到－3.3±0.6 pA/pF（AT组）。心动过速型心房重构模型中经单独的额外刺激可以引起房性快速性心律失常延长进而导致房颤，但是在对照组模型中则不然，反映出房颤-房性心动过速的加重效应。在心动过速型心房重构模型中，心律失常的时程平均为11.0±5.2s，快速心律失常反复发作周期为108±6ms。托肽品-Q减少心律失常的时程（0.6±0.1s，P&0.001），增加快速心律失常反复发作的循环周期（175±10ms，P&0.001）。在心动过速型心房重构模型中，给予托肽品组心房动作电位时程（APD）增加65±6%，与之相比较，在对照组APD则增加19±2%（P&0.001）。在两组心动过速型心房重构模型中，对快速性房性心律失常持续20分钟不加干预，托肽品-Q可以减慢进而终止上述两组模型的快速性房性心律失常。托肽品对左心室心肌细胞的电流和APD并无明显影响。结论：心动过速型心房重构模型可以使IKH增加，一种高选择性Kir3电流阻断剂托肽品-Q能够增加心房的动作电位时程并抑制快速性心律失常，而对心室的电生理活动并无明显影响。在狗体内，具有乙酰胆碱（Ach）激活的电流特性的IKH对快速心律失常的形成有影响，它可以作为抗心律失常药物潜在的治疗靶点。16. Circulation. 8-1744Title：Influence of Preoperative Left Ventricular Contractile Reserve on Postoperative Ejection Fraction in Low-Gradient Aortic StenosisThe First Three Authors：Jean-Paul Quere, MD; Jean-Luc Monin, MD; Franck Levy, MD;Corresponding Author and Address：Dr C. Tribouilloy, INSERM, ERI-12, Groupe ospitalier Sud, France.AbstractBackground—Dobutamine stress hemodynamics (DSH) has the potential to stratify operative risk in low-gradient aortic stenosis (AS), but little is known about the relation between left ventricle contractile reserve and postoperative left ventricular ejection fraction (LVEF). We sought to assess the value of DSH to predict postoperative improvement in LVEF.Methods and Results—Sixty-six consecutive patients with symptomatic severe AS (aortic valve area ≤1 cm2), LVEF ≤40%, and mean pressure gradient≤40 mm Hg prospectively enrolled in the French multicenter study on low-gradient AS and who survived to aortic valvular replacement (AVR) were included. Preoperative contractile reserve was present in 46 patients (group I; 70%) and absent in 20 patients (group II; 30%). In the overall sample, 58% of patients improvedby 2 New York Heart Association (NYHA) classes after AVR. Mean LVEF improved from 29±6% to 47±11% (P&0.0001). LVEF improved by ≥10 EF units in 38 patients (83%) in group I and in 13 patients (65%) in group II. Mean LVEF improvement was similar in the 2 groups (19±10% versus 17±11%; P=0.54). On multivariable analysis, multivessel coronary artery disease (P=0.05) and baseline mean transaortic pressure gradient (P=0.01) were related to LVEF improvement, whereas contractile reserve was not.Conclusions—LVEF increases in the majority of patients with low-gradient AS who survive after AVR. Although the absence of contractile reserve on DSH is related to high operative mortality, it does not predict the absence of LVEF recovery in patients surviving to AVR. These data further support the concept that surgery should not be contraindicated on the basis of absence of contractile reserve alone.
题目：低压力阶差主动脉瓣狭窄患者术前左室收缩功能储备对术后射血分数的影响摘要背景：多巴酚丁胺加压试验（DSH）可对低压力阶差的主动脉缩窄（AS）病人手术风险进行分层，但术前左室收缩功能储备对术后左室射血分数（LVEF）的影响的关系所知甚少。我们想评价DSH在预测术后提高的LVEF方面作用。方法和结果：66名严重主动脉瓣狭窄患者（主动脉面积≤1cm2）,LVEF≤40％，平均压力阶差≤40 mm Hg，入选法国低压力阶差主动脉瓣狭窄多中心研究，且行主动脉瓣置换术（AVR）者也入选。46人测量术前收缩功能储备，（I组；70％），20人未做（II组；30％）。所有样本中，58％患者在行AVR后心功能NYHA分级提高2级。平均LVEF提高29±6% to 47±11% (P&0.0001)。I组38名患者（83％）LVEF提高≥10 EF单位，II组有13人（65％）。平均提高LVEF在2组相似(19±10% versus 17±11%; P=0.54)。经多变量分析，多血管冠状动脉病变(P=0.05)和基线平均经主动脉压力阶差(P=0.01)与LVEF提高相关，而收缩储备则无相关性。结论：低压力阶差的AS患者经AVR后大部分患者LVEF提高。虽然在DSH缺乏收缩储备与高的手术死亡率相关，但并不提示AVR术后存活患者不能恢复LVEF。这些数据更加支持这样的观点：单纯收缩储备功能缺乏不是手术的禁忌症。 17. Circulation. : Title:Lipoprotein-Associated Phospholipase A2 and Its Association With Cardiovascular Outcomes in Patients With Acute Coronary Syndromes in the PROVE IT-TIMI 22 (PRavastatin Or atorVastatin Evaluation and Infection Therapy–Thrombolysis In Myocardial Infarction) TrialMichelle O’Donoghue, David A. Morrow, Marc S. Sabatine Corresponding author: David A. Morrow, Brigham and Women’s Hospital, TIMI Study Group, Boston Background—Lipoprotein-associated phospholipase A2 (Lp-PLA2) is associated with the risk of cardiovascular (CV) events in population-based studies. The prognostic value of Lp-PLA2 in patients with acute coronary syndromes (ACS) has not been established.Methods and Results—Plasma levels of Lp-PLA2 activity were measured at baseline (n＝3648) and 30 days (n＝3265) in patients randomized to atorvastatin 80 mg/d or pravastatin 40 mg/d after ACS in the PROVE IT-TIMI 22 (Pravastatin Or atorVastatin Evaluation and Infection Therapy–Thrombolysis In Myocardial Infarction) trial. The primary end point was death, myocardial infarction, unstable angina, revascularization, or stroke (mean follow-up 24 months). At baseline after ACS, the risk of recurrent CV events was similar across all quintiles of Lp-PLA2 activity (Ptrend＝0.88). Overall, mean levels of Lp-PLA2 were lower at 30 days of follow-up than at baseline (35.7 versus 40.9 nmol • min-1• mL-1, P&0.001). In particular, treatment with atorvastatin 80 mg/d was associated with a 20% reduction in Lp-PLA2 activity (P&0.001), whereas Lp-PLA2 rose 3.6% with pravastatin 40 mg/d (P&0.001). Patients with 30-day Lp-PLA2 activity in the highest quintile were at significantly increased risk of recurrent CV events compared with those in the lowest quintile (26.4% versus 17.6%, P trend＝0.002). After adjustment for cardiac risk factors, treatments, achieved low-density lipoprotein (LDL), and C-reactive protein, Lp-PLA2 activity in the highest quintile remained independently associated with a higher risk of recurrent CV events (adjusted hazard ratio 1.33, 95% confidence interval [CI] 1.01 to 1.74).Conclusions—Lp-PLA2 is not useful for risk stratification when measured early after ACS. At 30 days, Lp-PLA2 activity is significantly lowered with high-dose statin therapy and is associated with an increased risk of CV events independent of C-reactive protein and LDL cholesterol levels. 文题: PROVE IT-TIMI 22(普伐他丁或阿托伐他汀的评估和感染治疗――心肌梗死溶栓治疗)试验中急性冠状动脉综合征患者的脂蛋白相关磷脂酶A2水平及其与心血管疾病预后的关系摘要：背景：在以总体人群为基础的研究中，脂蛋白相关磷脂酶A2（Lp-PLA2）与心血管(CV)事件的危险性相关联。而Lp-PLA2对急性冠状动脉综合征(ACS)患者预后的判断价值尚不明确。方法和结果：将PROVE IT-TIMI 22 (普伐他丁或阿托伐他汀的评估和感染治疗――心肌梗死溶栓治疗)试验中的ACS患者随机分为阿托伐他汀80 mg/d或普伐他丁40 mg/d治疗组，并分别测量基线状态(n＝3648)和30天后(n＝3265)Lp-PLA2活性的血浆水平。主要的终点是死亡、心梗、不稳定性心绞痛、血管成形术或中风（平均随访24个月）。在ACS发生后的基线状态，任何Lp-PLA2水平的患者再发心血管事件的风险性都是相同的(Ptrend＝0.88)。总的说来，30天后Lp-PLA2的平均水平较基线状态是降低的(35.7 vs 40.9 nmol •min-1•mL-1, P&0.001)，尤其是阿托伐他汀80 mg/d治疗组，其Lp-PLA2活性降低了20％（P&0.001)。然而，普伐他丁40 mg/d治疗组的Lp-PLA2水平则升高了3.6％(P&0.001)。30天后Lp-PLA2活性高的病人较Lp-PLA2活性低的病人再发心血管事件的风险性显著升高(26.4% vs 17.6%, P trend＝0.002).在经过了对心血管危险因素的校正（经治疗使CRP与LDL达标）后，Lp-PLA2的高活性仍然与再发心血管事件的高风险性呈独立的正相关(校正后的危害比：1.33,95%置信区间[CI]：1.01－1.74)。结论：ACS 后早期测量Lp-PLA2水平无助于危险度分层。而第三十天时，Lp-PLA2活性经大剂量他汀类药物治疗后可显著降低，并与心血管事件的危险性呈独立于CRP和LDL-C水平的正相关。18. Circulation. 4-1831Title：A Tailored Approach to Catheter Ablation of Paroxysmal Atrial FibrillationThe First Three Authors：Hakan Oral, Aman Chugh, Eric GoodCorresponding Author and Address：Hakan Oral, Cardiovascular Medicine, 1500 R. Medical Center Dr, Ann ArborAbstractBackground—Because the genesis of atrial fibrillation (AF) is multifactorial and variable, an ablation strategy that involves pulmonary vein isolation and/or a particular set of ablation lines may not be equally effective or efficient in all patients with AF. A tailored strategy that targets initiators and drivers of AF is a possible alternative to a standardized lesion set.Methods and Results—Catheter ablation was performed in 153 consecutive patients (mean age, 56±11 years) with symptomatic paroxysmal AF with the use of an 8-mm tip radiofrequency ablation catheter. The esophagus was visualized with barium. The pulmonary veins and left atrium were mapped during spontaneous or induced AF. Arrhythmogenic pulmonary veins were isolated or encircled. If AF was still present or inducible, complex electrograms in the left atrium, coronary sinus, and superior vena cava were targeted for ablation. The end point of ablation was absence of frequent atrial ectopy and spontaneous AF during isoproterenol infusion and noninducibility of AF. Routine energy applications near the esophagus were avoided. During follow-up, left atrial flutter developed in 19% of patients and was still present in 10% at &12 weeks of follow-up. A repeat ablation procedure was performed in 18% of patients. During a mean follow-up of 11±4 months, 77% of patients were free from AF and/or atrial flutter without antiarrhythmic drug therapy. Pericardial tamponade or transient neurological events occurred in 2% of procedures.Conclusions—A tailored ablation strategy that only targets triggers and drivers of AF is feasible and eliminates paroxysmal AF in≈80% of patients.Recently updated Impact Factor:12.563
题目：阵发性房颤导管消融一种特定的方法
背景：房颤的产生是多因素、多变异的，所以涉及到肺静脉隔离的消融策略和或特殊类型的消融对所有房颤病人的治疗效果可能并不一样。对于标准损害组，一种定位于房颤触发因子和启动因子的特定策略可作为另外的选择。
方法和结果： 在153个患有典型阵发性房颤的系列病人（平均年龄为56±11岁）中进行导管消融治疗，所用的射频消融导管尖端为8mm。钡餐使食道清晰可见。在自发的、诱发的房颤中，肺静脉和左房被标记定位。把致心律失常性的肺静脉隔绝或环绕。如果房颤持续存在或被诱发，消融靶点将会以左房、冠状窦、上腔静脉中复杂的电记录图标记。在输注异丙肾上腺素和非诱导型房颤病人中因频繁的心房异位及自发性房颤而缺乏消融终点。可以避免食道旁常规射频能量应用。在随访中发现，19%的病人出现左房扑动，并在10%的病人中持续存在超过12周。在18%的病人中重复进行消融操作。在平均随访11±4月中发现77%的病人房颤和或房扑消失，而没有进行心律失常药物治疗。在消融操作过程中出现心包填塞或短暂性神经紊乱的发生率为2%。
结论：仅仅定位于房颤触发因子和启动因子的特定消融策略是可行的，可以终止大约80%病人的阵发性房颤。 19. Circulation. 2-1841Title：Proarrhythmic Potential of Mesenchymal Stem Cell Transplantation Revealed in an In Vitro Coculture ModelThe First Three Authors：Marvin G. Chang, Leslie Tung, Rajesh B. SekarCorresponding Author and Address：M. Roselle Abraham, MD, Department of Cardiology, Johns Hopkins HospitalAbstractBackground—Mesenchymal stem cells (MSCs) are bone marrow stromal cells that are in phase 1 clinical studies of cellular cardiomyoplasty. However, the electrophysiological effects of MSC transplantation have not been studied. Although improvement of ventricular function would represent a positive outcome of MSC transplantation, focal application of stem cells has the potential downside of creating inhomogeneities that may predispose the heart to reentrant arrhythmias. In the present study we use an MSC and neonatal rat ventricular myocyte (NRVM) coculture system to investigate potential proarrhythmic consequences of MSC transplantation into the heart. Methods and Results—Human MSCs were cocultured with NRVMs in ratios of 1:99, 1:9, and 1:4 and optically mapped. We found that conduction velocity was decreased in cocultures compared with controls, but action potential duration (APD80) was not affecte