可溶性ST2联合NT-proBNP评估射血分数保留性心力衰竭患者的短期预后价值

目的评估可溶性ST2(soluble ST2,sST2)联合血浆氨基末端脑钠肽前体(N-terminal pro-brain natriureticpeptide,NT-proBNP)对射血分数保留性心力衰竭(heart failure with preserved ejection fraction,HFPEF)患者短期预后的临床预测价值。方法选择128例深圳市光明新区人民医院住院的HFPEF患者,依据随访1年预后结局差异分为:研究组,共65例,随访1年发生主要心血管事件(major adverse cardiovascular events,MACE);对照组,共63例,随访1年未发生MACE。检测并比较两组的sST2、NT-proBNP、总胆固醇(total cholesterol,TC),低密度脂蛋白胆固醇(low density lipoprotein-cholesterol,LDL-C)以及糖化血红蛋白(glycosylated hemoglobin,HbA_1c)浓度;应用超声心动图检测并比较两组左心室射血分数(left ventricular ejection fraction,LVEF)、左心室舒张末期内径(left ventricular end diastolic diameter,LVEDd)、E/A比值差异。应用单因素直线分析及多元Logistic回归分析对患者MACE发生率相关的危险因素进行分析,应用受试者工作特征(receiver operator char-acteristic,ROC)曲线分析sST2联合NT-proBNP的最佳预测值。结果与对照组相比,研究组的sST2、NT-proBNP、LVEDd显著较高,E/A比值明显降低,差异有统计学意义(P0.05);而两组LVEF及HbA_1c、TC、LDL-C浓度比较,差异无统计学意义(均P0.05)。单因素直线分析显示sST2、NT-proBNP、LVEDd、E/A比值与MACE发生率相关,多元Logistic回归分析显示sST2、NT-proBNP为MACE的独立预测因子。ROC曲线分析显示,血浆sST2≤1 505pg/m L与NT-proBNP≤3010pg/mL为预测MACE发生的最佳预测切点(曲线下面积分别为0.823、0.789,P值分别为0.026、0.017)。结论 sST2联合NT-proBNP能较好预测HFPEF患者的短期预后。     

补益宗气方对冠心病慢性心力衰竭患者中医证候积分、心功能的影响

目的 探究补益宗气方治疗冠心病慢性心力衰竭(CHD-CHF,气虚血瘀)的疗效及对中医证候积分、心功能指标及主要心血管不良事件(MACE)发生率的影响。方法 通过随机数字表法将90例CHD-CHF(气虚血瘀)患者分为两组,每组45例。对照组采用常规西药治疗,研究组于对照组基础上采用补益宗气方治疗。比较两组临床效果、中医证候积分、心功能指标[左心室舒张末期内径(LVEDD)、左室射血分数(LVEF)、左心室收缩末期内径(LVESD)]、心衰症状(Lee氏心力衰竭评分)、生活质量[明尼苏达心力衰竭生活质量量表(MLHFQ)评分]、血清氨基末端脑钠肽前体(NT-proBNP)、可溶性(s)CD146、可溶性生长刺激表达基因蛋白(sST)2水平、不良反应及MACE发生率。结果 与对照组对比,研究组总有效率明显提高(P<0.05);研究组治疗4、8 w后自汗、疲倦乏力、心悸、气短评分明显低,LVEF明显高,LVEDD、LVESD及血清NT-proBNP、sCD146、sST2水平、Lee氏心力衰竭评分、MLHFQ评分、MACE发生率显著低(均P<0.05)。结论 补益宗气方治疗CHD-...     

sST2、NT-proBNP、hs-cTnI水平评估心力衰竭预后及转归的临床价值

目的探讨可溶性生长刺激表达基因2蛋白(sST2)、N末端B型脑钠肽原(NT-proBNP)、超敏心肌肌钙蛋白I(hs-cTnI)水平评估心力衰竭预后及转归的敏感性、特异性及临床应用意义。方法选取我院心血管内科收治的143例心力衰竭病人作为心力衰竭组,同时选择健康体检者50名作为对照组,检测入院时sST2、NT-proBNP、hs-cTnI水平,出院后随访1年,分析sST2、NT-proBNP、hs-cTnI水平与病人预后的关系。结果心力衰竭组Ⅱ级、Ⅲ级和Ⅳ级血浆sST2、NT-proBNP、hs-cTnI水平显著高于对照组(P0.05);心力衰竭组Ⅳ级血浆sST2、NT-proBNP、hs-cTnI水平高于心力衰竭组Ⅱ级、Ⅲ级;心力衰竭组Ⅲ级血浆sST2、NT-proBNP、hs-cTnI水平高于心力衰竭组Ⅱ级,差异均有统计学意义(P0.05)。心力衰竭病人住院期间死亡34例,死亡组血浆sST2、NT-proBNP、hs-cTnI水平较生存组显著升高,差异均有统计学意义(P0.01)。结论 sST2、NT-proBNP、hs-cTnI水平均可预测心血管事件的发生,三者联合评估心力衰竭预后能力明显高于单用sST2、NT-proBNP、hs-cTnI。     

可溶性生长刺激表达基因2联合N末端B型利钠肽原对沙库巴曲缬沙坦干预老年射血分数轻度减低心力衰竭患者的预后评估价值

目的 探讨可溶性生长刺激表达基因2(sST2)与N末端B型利钠肽原(NT-proBNP)对沙库巴曲缬沙坦(SV)干预老年射血分数轻度减低心力衰竭(HFmrEF)患者预后的评估价值。方法 选取2018年4月至2020年4月于承德市中心医院住院治疗的81例HFmrEF患者为研究对象,均使用SV治疗。分析HFmrEF患者应用SV治疗后影响复合终点事件发生的危险因素,并评估sST2联合NT-proBNP对SV干预HFmrEF患者预后的价值。采用SPSS 26.0统计软件进行数据分析。根据数据类型,分别采用t检验、秩和检验、χ²检验或Fisher精确检验进行组间比较。应用Cox风险评估模型分析复合终点事件与变量间的关系。结果 随访6个月后,19例患者出现复合终点事件(复合终点事件组),62例患者未出现复合终点事件(非复合终点事件组)。与非复合终点事件组比较,复合终点事件组心率较快,血肌酐水平较低,sST2、NT-proBNP水平较高,左房内径较大,有吸烟史、PCI或溶栓史、急性心肌梗死史比例更高,差异均有统计学意义(P＜0.05)。单变量与多变量Cox回归分析显示,sST2与NT-proBNP水平是HFmrEF患者应用SV治疗后影响复合终点事件发生的独立危险因素(P＜0.05)。受试者工作特征(ROC)曲线分析显示,sST2联合NT-proBNP预测复合终点事件的诊断价值均高于单一指标。结论 sST2联合NT-proBNP对SV干预老年HFmrEF患者的预后具有较好的评估价值。     

急性心力衰竭患者sST2、NT-proBNP的水平变化及临床意义

目的分析急性心力衰竭患者血清可溶性ST2受体(sST2)、N-末端脑利钠肽前体(NT-proBNP)水平及其临床意义。方法连续入选2016年9月至2017年3月于河南中医药大学第三附属医院收治的急性心力衰竭患者93例,根据纽约心脏学会(NYHA)分级将其分为NYHAⅡ级(n=41)、NYHAⅢ级(n=28)、NYHAⅣ级(n=24),并于同期随机选取40例健康体检者为对照组。采用酶联免疫吸附法测定各组入院时血清sST2、NT-proBNP水平;采用受试者工作曲线(ROC)曲线下面积(AUC)评估sST2、NT-proBNP对急性心力衰竭诊断价值;记录心力衰竭患者出院后1年时间内心血管不良事件的发生情况。结果急性心力衰竭患者血清sST2、NT-proBNP水平高于对照组,并随着NYHA分级越高,血清sST2、NT-proBNP水平越高,差异有统计学意义(P0.05)。血清NT-proBNP的AUC为0.807(95%CI:0.723～0.891,P0.05),血清sST2的AUC为0.781(95%CI:0.694～0.869,P0.05)。将NT-proBNP、sST2水平分别以中位数分组,比较两组的心血管不良事件发生率,NT-proBNP水平高于中位数组的心血管不良事件发生率高于低水平组(36.54%vs. 14.63%,P0.05),sST2水平高于中位数组的心血管不良事件发生率高于低水平组(28.57%vs. 11.36%,P0.05)。结论血清sST2、NT-proBNP参与急性心力衰竭发生、发展过程,早期检测可作为预测急性心力衰竭预后的生物学标志物。     

血清同型半胱氨酸、可溶性基质裂解素2和胱抑素C对慢性心力衰竭的诊断价值研究

目的:探讨血清同型半胱氨酸(Hcy)、可溶性基质裂解素2(sST2)和胱抑素C(CysC)对慢性心力衰竭(CHF)的诊断价值。方法:选择本院收治的86例CHF患者作为CHF组,选择同期体检健康者86例作为健康对照组。检测两组血清Hcy、sST2、CysC水平、血浆氨基末端脑钠肽前体(NT-proBNP)和心功能指标[左房内径(LAD)、左室舒张末期内径(LVEDd)、左室射血分数(LVEF)]并进行比较,采用Pearson相关分析血清Hcy、sST2和CysC与NT-proBNP、心功能指标的相关性,并绘制受试者工作特征(ROC)曲线评估血清Hcy、sST2和CysC联合检测对CHF的诊断价值。结果:与健康对照组比较,CHF组血清Hcy、sST2、CysC水平,血浆NT-proBNP水平和LAD、LVEDd均显著增加,LVEF显著降低(P均=0.001)。血清Hcy、sST2和CysC水平与血浆NT-proBNP水平、LAD、LVEDd均呈显著正相关性(r=0.385～0.511,P<0.05或<0.01),与LVEF呈显著负相关(r=-0.424～-0.402,P均<...     

急性心肌梗死患者经皮冠状动脉介入治疗后血清sST2、NT-proBNP浓度预测心力衰竭的价值

目的探讨急性心肌梗死患者经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗后血清可溶性致癌抑制因子2(solube suppression tumorigenicity 2,sST2)、氨基末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)浓度对心力衰竭的预测价值。方法选取2015年6月至2018年10月六安市人民医院收治的120例急性心肌梗死患者,均行PCI治疗。对比入院时、术后即刻、术后24 h及术后72 h的血清sST2、NT-proBNP浓度;另随访6个月,根据患者是否发生心力衰竭情况将其分为心力衰竭组与未心力衰竭组,比较2组血清sST2、NT-proBNP浓度,且采用Logistic回归分析法分析其对急性心肌梗死PCI治疗后发生心力衰竭的预测价值。结果患者术后即刻及术后24 h的血清sST2及NT-proBNP浓度均明显高于入院时,差异有统计学意义(P<0.05);术后24 h及术后72 h的血清sST2及NT-proBNP浓度均明显低于术后即刻,差异有统计学意义(P<0.05);术后72 h的血清sST2及NT-proBNP浓度均明显低于术后24 h及入院时,差异有统计学意义(P<0.05)。120例患者随访期间共有23例出现心力衰竭,发生率为19.17%;心力衰竭组术后即刻血清sST2及NT-proBNP浓度均明显高于未心力衰竭组,差异有统计学意义(P<0.05)。经Logistic回归分析发现,年龄≥60岁、多个部位梗死、病变支数≥2支、左心室射血分数(LVEF)<50%、并发原发性高血压(高血压)、并发糖尿病、并发高脂血症、有吸烟史、发病至行PCI治疗时间≥12 h、术后即刻sST2浓度>56.68 ng/mL、术后即刻NT-proBNP浓度≥2853.14 pg/mL、PCI治疗后慢或无复流均是急性心肌梗死患者行PCI治疗后发生心力衰竭的危险因素(OR=2.085、2.568、2.375、3.056、2.740、2.241、2.188、2.314、3.374、3.031、4.035,P<0.05)。结论急性心肌梗死患者PCI治疗后短期内血清sST2、NT-proBNP浓度呈现不同程度的升高,但随着时间的推移呈逐渐降低趋势,另术后发生心力衰竭患者血清sST2、NT-proBNP浓度明显高于未发生者,且术后即刻sST2浓度>56.68 ng/mL、术后即刻NT-proBNP浓度≥2853.14 pg/mL、PCI治疗后慢或无复流以及年龄≥60岁等均可增加心力衰竭发生风险。     

血清sST2水平与急性ST段抬高型心肌梗死患者预后的关系

目的探讨血清可溶性致癌抑制因子2(sST2)水平与急性ST段抬高型心肌梗死(STEMI)患者预后的关系。方法选取2016年6月～2017年6月于郑州市第七人民医院就诊并确诊的102例STEMI患者,采取酶联免疫吸附法(ELISA)测定患者血清sST2水平,根据基线sST2中位数水平分为高值组(n=54,血清sST2水平56.68 ng/ml)和低值组(n=48,血清sST2水平≤56.68 ng/ml),分析两组患者的一般资料,随访30 d,观察两组心力衰竭和死亡事件发生情况,经Logistic回归分析,分析STEMI患者预后的相关因素。结果两组在收缩压、舒张压、Killip心功能分级≥Ⅱ级所占比例、高敏C反应蛋白(hs-CRP)、N末端脑钠肽原(NT-proBNP)、肌钙蛋白I、左室射血分数(LVEF)水平方面比较差异显著,组间比较差异存在统计学意义(P0.05);两组在性别、年龄、吸烟史、既往史、心率、血清总胆固醇、肌酐、尿酸、冠状动脉病变方面比较差异无统计学意义(P0.05);经Pearson相关性分析,血清sST2水平与收缩压、舒张压、LVEF呈负相关(P0.05),与Killip心功能分级≥Ⅱ级、hs-CRP、NT-proBNP、肌钙蛋白I水平呈正相关(P0.05);随访30 d,高值组不良事件发生率高于低值组(P0.05);经Logistic回归分析,血清sST2(OR=1.806,95%CI:0.674～13.965,P0.05)是STEMI患者不良预后的危险因素。结论 STEMI患者血清sST2水平升高,则提示不良预后的风险增加。     

血清半乳糖凝集素3和可溶性ST2预测心肺复苏后急性心力衰竭患者近期预后的价值

目的:探讨血清可溶性ST2(soluble ST2,sST2)、半乳糖凝集素3(Galectin-3)对心脏骤停心肺复苏(cardiopulmonary resuscitation,CPR)成功后发生急性心力衰竭的患者近期预后的评估价值。方法:ELISA法检测160例CPR后发生急性心力衰竭的患者CPR后24h的血清sST2、半乳糖凝集素3水平,依据随访出院后6个月的终点事件(出院后6个月内患者因出现急性心力衰竭再次入院或死亡)分为发生事件组(A组,58例)和未发生事件组(B组,102例),同时检测患者左室舒张末期内径(LVEDD)、左室射血分数(LVEF)。采用ROC曲线分析其评估急性心力衰竭患者近期预后的价值。结果:A组血清sST2、半乳糖凝集素3水平均高于B组(均P0.01)。两者联合分析能提高对患者短期预后的预测价值(P0.01)。LVEDD与LVEF随着sST2和半乳糖凝集素3水平的变化而变化。sST2高表达组(200ng/L)、半乳糖凝集素3高表达组(20ng/ml)患者病死率均高于sST2、半乳糖凝集素3低表达组(均P0.05)。结论:血清sST2、半乳糖凝集素3联合分析能提高对CPR后发生急性心力衰竭患者近期预后的预测价值。     

慢性心力衰竭患者血清可溶性ST2、基质金属蛋白酶2、基质金属蛋白酶9水平变化及其与心血管事件的关系研究

背景慢性心力衰竭(CHF)是多种心血管疾病的终末期表现,寻找可靠的生物学标志物以快速、准确地预测心力衰竭患者心血管事件发生风险具有重要临床意义。目的分析CHF患者血清可溶性ST2(sST2)、基质金属蛋白酶2(MMP-2)、基质金属蛋白酶9(MMP-9)水平变化及其与心血管事件的关系。方法选取2016年2月—2018年6月四川大学华西广安医院收治的CHF患者96例作为CHF组,另选取30例同期体检的健康志愿者作为对照组;根据随访期间心血管事件发生情况将CHF患者分为A组(发生心血管事件,n=36)和B组(未发生心血管事件,n=60)。比较对照组与CHF组受试者、不同纽约心脏病协会(NYHA)分级CHF患者血清sST2、MMP-2及MMP-9水平,并比较A组及B组患者一般资料、血红蛋白、血钠、肾小球滤过率、左心室射血分数(LVEF)及血清N末端脑钠肽前体(NT-proBNP)、sST2、MMP-2、MMP-9水平;CHF患者心血管事件的影响因素分析采用多因素Logistic回归分析;绘制ROC曲线以评价LVEF及血清NT-proBNP、sST2、MMP-2、MMP-9水平对CHF患者心血管事件的预测价值。结果(1)CHF组患者血清sST2、MMP-2及MMP-9水平高于对照组(P0.05)。(2)NYHA分级Ⅲ、Ⅳ级CHF患者血清sST2、MMP-2及MMP-9水平高于NYHA分级Ⅱ级,NYHA分级Ⅳ级CHF患者血清sST2、MMP-2及MMP-9水平高于NYHA分级Ⅲ级(P0.05)。(3)随访期间CHF组患者心血管事件发生率为37.5%(36/96);A组与B组患者性别,年龄,高血压、糖尿病、冠心病发生率,心率,收缩压,使用β-受体阻滞剂、血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂(ACEI/ARB)者所占比例,血红蛋白,血钠比较,差异无统计学意义(P0.05);A组患者肾小球滤过率及LVEF低于B组,血清NT-proBNP、sST2、MMP-2及MMP-9水平高于B组(P0.05)。(4)多因素Logistic回归分析结果显示,LVEF〔OR=1.208,95%CI(1.043,1.399)〕及血清NT-proBNP〔OR=1.332,95%CI(1.087,1.634)〕、sST2〔OR=1.560,95%CI(1.059,2.300)〕、MMP-2〔OR=1.385,95%CI(1.037,1.852)〕及MMP-9〔OR=1.461,95%CI(1.208,1.767)〕水平是CHF患者心血管事件的影响因素(P0.05)。(5)ROC曲线显示,LVEF及血清NT-proBNP、sST2、MMP-2、MMP-9水平预测CHF患者心血管事件的曲线下面积分别为0.668、0.671、0.819、0.760、0.782。结论 CHF患者血清sST2、MMP-2及MMP-9水平明显升高且与心功能有关,三者均是CHF患者心血管事件的影响因素且对心血管事件的预测价值较高。     

Satisfaction with ambulatory care of persons with AIDS

OBJECTIVE: To examine the relation of patient characteristics and site of care to the perception of ambulatory care quality by persons with AIDS (PWAs). DESIGN: Patient surveys and medical record review were used to determine PWAs’ perceptions of their ambulatory care, self-perceived health status, primary care relationships, sociodemographic characteristics, and severity of illness. SETTING: A public-hospital HIV clinic, an academic group practice, and a staff-model health maintenance organization (HMO) that together care for 20% of all Massachusetts PWAs. PATIENTS: All active patients as of February 12, 1990, and all new AIDS patients at each of the three sites during the subsequent 13 months. MEASUREMENTS AND MAIN BESULTS: The primary outcome measure was a six-item scale of patient-rated quality of care (PRQC), a newly developed measure that combined patients’ ratings of their physician care, nursing care, involvement in medical decisions, and overall quality of care. Multiple logistic regression was carried out with low PRQC (lowest quart He) as the dependent variable, to identify correlates of patient perceptions of poor quality. Patients who had a primary nurse were significantly less likely to have low PRQC scores (OR=0.50, 95% CI=0.26 to 0.97). Black patients and patients who used injection drugs were significantly more likely to rate their care in the lowest quartile (OR=2.22, 95% CI=1.04 to 4.78; and OR=2.43, 95% CI=1.13 to 5.23, respectively), as were those who had lower self-perceived health status, after controlling for confounders; no association was found by site or severity. CONCLUSIONS: These results show that primary nursing may be an important determinant of how PWAs rate the quality of their ambulatory care. Furthermore, PWAs who are black or who are injection drug users are less satisfied than are others with the quality of their ambulatory AIDS care. Presented in part at the annual meeting of the Society of General Internal Medicine, April 30, 1993, Arlington, Virginia. Supported by the Agency for Health Care Policy and Research, grant number HS06239.     

分析老年糖尿病患者应用甘精胰岛素联合阿卡波糖治疗的效果

目的探讨甘精胰岛素联合阿卡波糖在老年糖尿病患者中的临床疗效。方法选取该院2018年7月—2019年7月收治的113例老年糖尿病患者作为研究对象,经随机数字表法,划分A组(n=56,阿卡波糖)和B组(n=57,甘精胰岛素+阿卡波糖),比较两组临床疗效、血糖指标。结果B组患者临床治疗总有效率显著高于A组;经治疗,B组患者空腹血糖(FBG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbAlc)水平明显低于A组。两组之间比较差异有统计学意义(P<0.05)。结论在老年糖尿病患者中应用甘精胰岛素+阿卡波糖,临床疗效显著,使患者的空腹血糖、餐后2 h血糖、糖化血红蛋白等指标得到了明显改善,安全性强。     

Treatment of patients with Eisenmenger's syndrome with Bosentan

We treated prospectively 14 patients with Eisenmenger's syndrome, with a mean age of 10 years, ranging from 3 to 18 years. Treatment continued for 12 months, and demonstrated a lasting symptomatic improvement, but no improvement in terms of mean saturation of oxygen over 24 hours. Exercise capacity, as judged by peak uptake of oxygen, worsened in the six patients able to perform a treadmill test. The symptomatic benefit from dual blockage of endothelin receptors in these patients may be due to mechanisms other than selective pulmonary vasodilatation alone.     

小剂量垂体后叶素合并硝酸甘油治疗咯血

目的评价小剂量垂体后叶素联合硝酸甘油治疗咯血的疗效及不良反应。方法将50例咯血患者随机分为两组,治疗组在常规治疗基础上（n=26）应用小剂量垂体后叶素联合硝酸甘油;对照组（n=24）在常规治疗基础上仅应用小剂量垂体后叶素。分析其疗效及不良反应。结果48小时后治疗组有效率96.15％（25／26）,对照组有效率58.33％（14／24）,差异有统计学意义（P=0.012）;治疗组对血压影响小,无统计学意义（P〉0.05）,对照组能引起血压升高的副作用（P〈0.05）;治疗组出现头晕头痛、胸闷、心悸、腹痛、腹泻、恶心呕吐、出汗、面色苍白等不良反应比对照组少,差异有统计学意义（P〈0.05）。结论小剂量垂体后叶素联合硝酸甘油治疗中量咯血比垂体后叶素单药治疗中量咯血疗效明显提高,且能减少垂体后叶素不良反应。     

Complications associated with the treatment of haemophiliacs with inhibitors

To examine the safety profile of products used to treat inhibitor patients unresponsive to factor VIII, a review of published clinical experience was performed. The products evaluated were activated prothrombin complex concentrates (aPCCs), such as AUTOPLEX® T, porcine factor VIII and recombinant activated factor VII (rVIIa). Safety characteristics included potential for transmission of infectious agents, anamnesis, thrombogenicity, thrombocytopenia and allergic reactions. While viral transmission has been virtually eliminated, the risk is theoretically higher with plasma-derived products such as aPCC and porcine factor VIII than with rVIIa, although contamination of cultured cells is a concern. Anamnesis occurs with aPCCs and porcine factor VIII, and may induce resistance to further therapy with porcine factor VIII. Thrombosis and disseminated intravascular coagulation are very infrequently reported in patients exposed to aPCCs and rVIIa, and never with porcine factor VIII. The latter is occasionally associated with thrombocytopenia, but this uncommonly limits treatment with this agent. Lastly, allergic reactions occur with about equal frequency with all products, but anaphylaxis is mainly a concern after administration of porcine factor VIII. In conclusion, products currently available are reasonably safe. Considerations such as efficacy, availability, ease of administration and cost must also be considered in making treatment choices.     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.