ABSTRACT
BACKGROUND@#The long-term predicted value of microvolt T-wave alternans (MTWA) for ventricular tachyarrhythmia in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) remains unclear. Our study explored the characteristics of MTWA and its prognostic value when combined with an electrophysiologic study (EPS) in patients with ARVC.@*METHODS@#All patients underwent non-invasive MTWA examination with modified moving average (MMA) analysis and an EPS. A positive event was defined as the first occurrence of sudden cardiac death, documented sustained ventricular tachycardia (VT), ventricular fibrillation, or the administration of appropriate implantable cardioverter defibrillator therapy including shock or anti-tachycardia pacing.@*RESULTS@#Thirty-five patients with ARVC (age 38.6 ± 11.0 years; 28 males) with preserved left ventricular (LV) function were recruited. The maximal TWA value (MaxValt) was 17.0 (11.0-27.0) μV. Sustained VT was induced in 22 patients by the EPS. During a median follow-up of 99.9 ± 7.7 months, 15 patients had positive clinical events. When inducible VT was combined with the MaxValt, the area under the curve improved from 0.739 to 0.797. The receiver operating characteristic curve showed that a MaxValt of 23.5 μV was the optimal cutoff value to identify positive events. The multivariate Cox regression model for survival showed that MTWA (MaxValt, hazard ratio [HR], 1.06; 95% confidence interval [CI], 1.01-1.11; P = 0.01) and inducible VT (HR, 5.98; 95% CI, 1.33-26.8; P = 0.01) independently predicted positive events in patients with ARVC.@*CONCLUSIONS@#MTWA assessment with MMA analysis complemented by an EPS might provide improved prognostic ability in patients with ARVC with preserved LV function during long-term follow-up.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Arrhythmias, Cardiac , Diagnosis , Arrhythmogenic Right Ventricular Dysplasia , Diagnosis , Electrocardiography , Methods , Electrophysiology , Methods , Exercise Test , Follow-Up Studies , Tachycardia, Ventricular , Diagnosis , Ventricular Function, Left , PhysiologyABSTRACT
Background@#The long-term predicted value of microvolt T-wave alternans (MTWA) for ventricular tachyarrhythmia in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) remains unclear. Our study explored the characteristics of MTWA and its prognostic value when combined with an electrophysiologic study (EPS) in patients with ARVC.@*Methods@#All patients underwent non-invasive MTWA examination with modified moving average (MMA) analysis and an EPS. A positive event was defined as the first occurrence of sudden cardiac death, documented sustained ventricular tachycardia (VT), ventricular fibrillation, or the administration of appropriate implantable cardioverter defibrillator therapy including shock or antitachycardia pacing.@*Results@#Thirty-five patients with ARVC (age 38.6 ± 11.0 years; 28 males) with preserved left ventricular (LV) function were recruited. The maximal TWA value (MaxValt) was 17.0 (11.0–27.0) μV. Sustained VT was induced in 22 patients by the EPS. During a median follow-up of 99.9 ± 7.7 months, 15 patients had positive clinical events. When inducible VT was combined with the MaxValt, the area under the curve improved from 0.739 to 0.797. The receiver operating characteristic curve showed that a MaxValt of 23.5 μV was the optimal cutoff value to identify positive events. The multivariate Cox regression model for survival showed that MTWA (MaxValt, hazard ratio [HR], 1.06; 95% confidence interval [CI], 1.01–1.11; P = 0.01) and inducible VT (HR, 5.98; 95% CI, 1.33–26.8; P = 0.01) independently predicted positive events in patients with ARVC.@*Conclusions@#MTWA assessment with MMA analysis complemented by an EPS might provide improved prognostic ability in patients with ARVC with preserved LV function during long-term follow-up.
ABSTRACT
Objective To explore the changes of bowel functions in mild asphyxial full-term neonates and evaluate the possible effect of glutamine (Gln) on intestinal barrier function.Methods A prospective,blind,randomized controlled clinical study was conducted in neonatal ward and maternity ward of the Affiliated Hospital of Guangdong Medical College.Thirty-seven mild asphyxial neonates and 15 normal neonates were included.The 37 asphyxiated term infants were randomly divided into 2 groups:asphyxia group and asphyxia control group.The 20 infants in the asphyxia group were given Gln [0.3 g/(kg · d)] based on supporting treatment,added in breast milk or formula,3 times in daily.The 17 infants in asphyxia control group were fed with equal amount of 9 g/L saline supplementation.The same term 15 normal neonates as healthy control group were breast fed in obstetrics.The intervention lasted 1 week.Blood samples were collected from the 3 groups on day 1,3 and 7.The serum DAO and D-lactic acid levels were detected to evaluate the gastrointestinal function.Results Demographic and management characteristics of the 3 groups were similar.And there was no difference(P ＞0.05) between asphyxial neonates and normal neonates in clinical manifestation,including type of feeding,delivery mode,etc.A statistical difference (P ＜ 0.05) was found in factors of amniotic fluid turbidity and umbilical cord between asphyxial control group and healthy control group.Compared with asphyxia control study,the content of serum DAO and D-lactic acid on day 1,day 3,day 7 were clearly lower in healthy control group,and the differe-nces were statistically significant(all P ＜ 0.05).The levels of DAO and D-lactic acid in healthy control group were significantly lower than those of asphyxia control group (all P ＜ 0.05).No adverse effect or treating intolerance were noted.Conclusions Mild asphyxia neonatorum impaired the gut barrier function.Compared with placebo,glutamine supplementation can improve the intestinal mucosal barrier function to bettery recovery in asphyxial neonates.