ABSTRACT
To evaluate the prognostic value of glycated haemoglobin (HbA1c) in patients with acute myocardial infarction (AMI). Methods: A total of 1952 AMI patients were retrospectively studied. Based on medical history and HbA1c level, the patients were divided into 4 groups: Diabetes mellitus (DM) group, the patients with known DM or taking hypoglycemic drugs, n=492, Newly diagnosed DM group, MD was diagnosed during hospital stay and HbA1c≥6.5%, n=128, Pre-DM group, HbA1c 5.7%-6.4%, n=783 and Non-DM group, HbA1c<5.7%, n=549. The patients were followed-up for 25.6 months, prognostic differences during hospital stay and follow-up period were assessed by single- and multi-factor analysis. Results: The in-hospital mortality in DM group, Newly diagnosed DM group, Pre-DM group and Non-DM group were 4.88%, 3.91%, 3.96% and 2.91% respectively, P=0.435. As HbA1c level increasing, the incidences of all-cause mortality, non-fatal MI and re-hospitalization were elevating, while the differences among groups were similar. The incidences of major adverse cardiovascular events (MACE) in above 4 groups were 39.84%, 35.94%, 33.97% and 27.87% respectively, P=0.001. Compared with Non-DM group, MACE incidences in the other 3 groups were as OR=1.33, 95% CI 1.05-1.69, OR=1.45, 95% CI 0.97-2.18 and OR=1.71, 95% CI 1.32-2.22 respectively, Ptrend<0.001; with adjusted baseline parameters, Ptrend=0.008. Conclusion: In our research, MACE incidence was increasing upon HbA1c level elevating in AMI patients and it was not related to in-hospital death. HbA1c level should be screened in AMI patients, lifestyle and drug intervention could be used as necessity.
ABSTRACT
Objective:To observe the relationship between non -dipper heart rate and morbidity of coronary heart disease (CHD) in patients with hypertension .Methods :According to Holter monitored results ,a total of 130 pa‐tients with essential hypertension were divided into dipper heart rate group (n= 77 ) and non -dipper heart rate group (n=53) .Ambulatory blood pressure and dynamic ECG were monitored in two groups ,and CHD was diag‐nosed according to coronary angiography results .Ambulatory blood pressure ,ambulatory heart rate and incidence rate of CHD were compared and analyzed between two groups .Results:Compared with dipper heart rate group , there was significant reduction in daytime mean heart rate [ (73.45 ± 9.57) beats/min vs .(68.77 ± 12.61) beats/min] ,but significant rise in nighttime mean heart rate [ (61.30 ± 7.62) beats/min vs .(65.49 ± 12.97) beats/min] , P0.05);.Morbidity rate of CHD in non -dipper heart rate group was significantly higher than that of dipper heart rate group (71.70% vs .29.87% ,P=0.001) .Conclusion:Compared with dipper heart rate pa‐tients ,morbidity rate of CHD significantly rises in patients with hypertension and non -dipper heart rate .It may help to reduce occurrence of CHD by monitoring circadian changes of heart rate and recover circadian heart rate rhythm while treating hypertension .
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Objective:To explore diagnostic value of nocturnal ST-T changes in 24h dynamic electrocardiogram (DCG)for coronary heart disease (CHD)and its clinical significance.Methods:A total of 103 cases,who showed ST-T changes in 24h DCG,received selective coronary angiography (CAG).Among them,the 56 patients with in-termittent nighttime significant ST-T changes were regarded as research group,while the other 47 patients with per-sistent ST-T changes were treated as control group.CAG results were compared and analyzed between two groups. Results:Compared with control group,there were significant rise in CAG positive rate (31.9% vs.67.9%),inci-dence rates of dyspnea and chest pain (27.7% vs.66.1%),hypertension (48.9% vs.71.4%),hyperlipidemia (31.9% vs.42.9%)and diabetes mellitus (17.0% vs.46.4%),percentages of lesions in left anterior descending artery (LAD,21.3% vs.57.1%),left circumflex coronary artery (LCX,14.8% vs.37.5%)and right coronary artery (RCA,12.8% vs.35.7%)in research group,P <0.05 or <0.01. Conclusion:Nocturnal ST-T signifieantly changes in 24h DCG,it possesses more diagnostic value for CHD,which can be regarded as a more sensitive index diagnosing myocardial ischemia.
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Objective The prosthesis used for aortic valve replacement (AVR) may be too small in relation to the body size, thus causing valve prosthesis-patient mismatch (PPM) and abnormally high transvalvular pressure gradients. The aim of this study was to evaluate the prevalence of PPM and the impact of PPM on hemodynamic and early mortality after AVR. Methods A total of 292 patients ( 167 males, 125 females; mean age of ( 52.8 ± 14.6 ) years, with ranging 22 - 82 years) who underwent AVR between January 2007 and December 2009 were retrospectively evaluated. Etiologies were: rheumatic in 243 cases, degenerative in 36, congenitally bicuspid aortic valve in 8, and infective endocarditis in 5. Combined operations with AVR including mitral valve replacement ( 172 cases), mitral valve repair (56 cases), tricuspid valve repair (238 cases), and coronary artery bypass grafting (32 cases). The aortic valve prosthesis effective valve orifice area (EOA) was divided by the body surface area (BSA) to obtain the EOA index (EOAI). PPM was then defined as none or mild if EOAI was ＞0.85 cm2/m2, as moderate for 0.65 -0.85 cm2/m2 and as severe for ＜0.65 cm2/m2. The mean flow rate through aortic prostheses and mean transvalvular pressure gradients were measured by color Doppler after AVR. The prevalence of PPM was compared between the different type ( mechanical or bioprosthetic valve) and the different size ( ＞21 mm or ≤21 mm) of aortic valve prostheses. The effect of PPM on hemodynamic and early mortality after AVR was also studied. Results 219 patients received mechanical AVR and 73 bioprosthetic AVR. Moderate PPM occurs more frequently with bioprosthetic AVR (6.25% versus 48.22%, P ＜0. 01 ). Bigger than 21mm prostheses were used in 191 patients and ≤21 mm prostheses in 101 patients. The prevalence of PPM was 13.61% and 33.66% respectively ( P ＜ 0. 05 ). According to the EOAI of the aortic valve prostheses,all the 219 patients were divided into two group, PPM group and non-PPM group. The mean flow rate of aortic prostheses and mean transvalvular pressure gradients in PPM group was significantly higher than those in non-PPM group [(2.66 ± 0.87 ) m/s versus ( 1. 58 ± 0.47 ) m/s, ( 26.50 ± 6.25 ) mm Hg versus ( 16.75 ± 3.46 ) mm Hg, P ＜ 0. 01]. There were 9 deaths during early period of operation, and the total 30-day operative mortality was 3.08%. The postoperative early mortality of PPM group and non-PPM group was 6.67% and 2.16% respectively, and there were significantly difference between the two group ( P ＜ 0. 05 ). Conclusion Prosthesis-patient mismatch is common present after AVR, especially in patients with bioprostheses and small size valve prostheses. PPM has a negative impact on postoperative hemodynamic and early mortality. PPM results in higher transvalvular pressure gradients and higher early mortality.