Clinical features of 17 cases of rhabdomyolysis / 中华心血管病杂志

<p><b>OBJECTIVE</b>We retrospectively analyzed the causes, diagnosis, clinical characteristics, treatment and prognosis of 17 patients with rhabdomyolysis.</p><p><b>METHODS</b>Rhabdomyolysis cases diagnosed from January 2005 to March 2014 in our department were included.</p><p><b>RESULTS</b>A total of 17 rhabdomyolysis patients (male 13, mean age (60.4 ± 15.7) years) were analyzed.Four cases had coronary heart disease combined with hypertension, hyperlipaemia, atrial fibrillation, 10 cases had dilated cardiomyopathy combined with coronary heart disease, hyperlipaemia, atrial fibrillation, 8 cases had atrial fibrillation combined with hypertension, coronary heart disease, hyperlipaemia, 1 patient had pulmonary embolism combined with hyperlipaemia, 1 patient had aortic dissection combined with hypertension, 10 hypertension patients were combined with coronary heart disease, hyperlipaemia, atrial fibrillation, aortic dissection and 1 patient with ventricular tachycardia was combined with depression.Various degrees of liver and kidney dysfunction, reduced hemoglobin and myoglobinuria were found in all patients.Fever was found in 7 cases, relevant neurological signs in 5 cases. Digestive tract discomfort and muscle weakness or muscle pain symptoms were seen in all patients during hospitalization. All cases underwent renal replacement therapy and respirator was used in 14 patients to support breathing. Post therapy, 10 cases improved but 7 cases died. All 17 patients had history of statin use.</p><p><b>CONCLUSION</b>Statin may be the major cause of rhabdomyolysis in these patients, and the mortality of rhabdomyolysis is high despite various therapy stratigies.</p>

The Predictive Value of Fractional Flow Reserve Level for Long-term Prognosis in Patients After Coronary Drug-eluting Stent Implantation / 中国循环杂志

Objective: To explore the predictive value of fractional lfow reserve (FFR) level for long-term prognosis in patients after coronary drug-eluting stent (DES) implantation, and to analyze the relevant factors affecting the level of post-operative FFR. Methods: A total of 135 patients who received DES implantation in our hospital from 2012-01 to 2013-07 with coronary intermediate lesion at (50-80) % were studied. The relevant factors for MACE occurrence were studied by multivariate logistic regression analysis, the post-stent FFR level for predicting the long term prognosis after DES implantation was ifnally analyzed by ROC curve. Results: All patients ifnished 1 year follow-up study including 104 male and 31 female with the mean age of (63 ± 9) years. The post-stent FFR level was lower in MACE group than that in Non-MACE group, (0.82 ± 0.07) vs (0.87 ± 0.06),P=0.004. Multivariate logistic regression analysis presented that the higher level of post-stent FFR was the protective factor for MACE occurrence (OR=0.212,P=0.039); the post-stent FFR level had certain predictive value for MACE occurrence at 1 year after DES implantation (AUC=0.706,P=0.006); Kaplan-Meier survival study showed that the patients with post-stent FFR<0.875 had the less MACE occurrence than those with FFR≥0.875,P=0.012. Multivariate logistic regression analysis also indicated that post-stent FFR≥0.875 was positively related to right coronary target vessel, higher pre-operative FFR level and larger stent diameter.Conclusion: Post-stent FFR level had certain predictive value for MACE occurrence in patients at 1 year after DES implantation, the patients with post-stent FFR≥0.875 had the lower MACE occurrence rate than those with FFR<0.875.

Clinical characteristics of 42 patients with cardiac amyloidosis / 中华内科杂志

Objective To characterize the clinical features of patients with cardiac amyloidosis (CA).Methods Totally 42 patients with CA admitted to Guangdong General Hospital since 2008 were included and retrospectively analyzed in the present study.CA was confirmed by abdomen and endocardium biopsy examination.Clinical manifestations,electrocardiogram and echocardiography were collected for the evaluation.Results Several clinic features are common in CA.In the present study,37 cases (88.1％) presented with chest tightness,dyspnea,20 cases(47.6％) with chest pain,27 cases(64.3％) with right heart failure,27 cases (64.3％) with fatigue,and 30 cases (71.4％) with renal insufficiency and proteinuria.Electrocardiogram (ECG) showed that 32 of the patients (76.2％) were with low voltage in limb leads,29 cases (69％) of them were with poor R wave progression in precordial leads,17 cases (40.5％) with ST-T change,28 cases(66.7％) with pseudo-necrotic Q wave and 36 cases (85.7％) with various kinds of arrhythmia.Echocardiography indicated that all of the subjects (100％) were with different degrees of left ventricular posterior wall or ventricular septal thickness,and left atrial hypertrophy with different degree of myocardial grain appearance or ground-glass opacity.Thirty-six cases (85.7％) were with pericardial effusion,and 27 cases (64.3％) were with abnormal left ventricular eject function.Conclusion For those who were with unexplained clinical cardiac insufficiency,renal insufficiency,myocardial hypertrophy,but normal of ventricular size in echocardiography and low voltage on ECG limb leads,a tissue biopsy from abdomen,labial glands or endocardium should be considered in the diagnosis of CA.