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Objective To investigate the changes in serum matrix metalloproteinase(MMP)-2 and MMP-9 and their relationship with serum B-type brain natriuretic peptide(BNP)in patients with chronic heart failure.Methods MMP-2,MMP-9 and serum BNP levels were measured in 184 patients with chronic heart failure and 61 healthy controls.The relationship between changes in MMP-2 and-9 and serum BNP was analyzed.Results Chronic heart failure was categorized into grade Ⅱ,Ⅲ and Ⅳ according to NYHA.In grade Ⅱ,Ⅲ and Ⅳ and the control group,the levels of MMP-2 were(309.1±60.1)nmol/L,(422.6±89.6)nmol/L,(694.8±126.2)nmol/L and(217.2±26.3)nmol/L respectively,and the levels of MMP-9 were (321.2±63.2)nmol/L,(454.4±96.3)nmol/L,(634.1±51.2)nmol/L and(210.8±23.6)nmol/L respectively.The levels of MMP-2 and MMP-9 were significantly higher in chronic heart failure subgroups than in the control group(F=3.65,12.52;P=0.000,0.000).According to the pairwise comparison among the chronic heart failure subgroups,the levels of serum MMP-2 and MMP-9 were significantly higher in NYHA Ⅳ grade than in NYHA Ⅲ grade,and higher in NYHA Ⅲ grade than in NYHA Ⅱ grade(all P<0.05).In patients with chronic heart failure groups,MMP-2 was positively correlated with serum BNP(r=0.866,P=0.000),and with MMP-9(r=0.516,P=0.001).Conclusions MMP-2 and MMP-9 levels might be closely correlated with chronic heart failure and show an upward trend with the progression of chronic heart failure.The levels of MMP-2 and MMP-9 are associated with BNP,which indicates that clinical monitoring of the serum level changes can provide a certain reference for diagnosis,treatment and prognosis in patients with chronic heart failure.
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Objective To investigate the relationship between the systolic/diastolic orthostatic hypotension(OH S/OH-D) and myocardial infarction (MI) in the elderly.Methods 200 subjects without myocardial infarction (MI) aged 60 years and over in our urban district were selected.The orthostatic and supine blood pressure and heart rate were measured in supine position after resting for more than 5 minutes and at 0 and 2 minutes after standing.All eases were divided into systolic orthostatic hypotension(OH-S)or diastolic orthostatic hypotension(OH-D)groups based on the results of orthostatic hypotension,and followed up by telephone with mean period of 325 days.The primary endpoint was MI occurrence for analyzing the correlation between OH-S/OH-D and MI incidence.Results The prevalence rate of OH in this cohort was 38％,with OH-S 20％ and OH-D 18％.In the very elderly group(≥80 years)versus the elderly group,the occurrences of 0H and OH-S were(27％ vs.21 ％,P =0.036;22 ％ vs.15 ％,P =0.020),respectively,while no significant difference was found in OH-D between the two groups.After 325 day follow up,the prevalence of MI was significantly(P＜ 0.05)higher in the OH positive subjects than in the 0H negative subjects,which result was the same as the prevalence of MI in OH-S or and OH-D group.After adjusting for age,supine blood pressure,creatinine and cerebrovascular history,logistic regression analysis showed that MI was correlated with OH(HR 15.72,95％CI 3.29～74.23,P=0.002),OH-S(HR 8.552,95％CI 2.51～30.21,P=0.004)and OH-D(HR 3.80,95 ％CI 1.14～13.80,P=0.042).Compared with OH-D,OH-S had more significant correlation with MI.Conclusions Orthostatic hypotension,particularly systolic orthostatic hypotension,is common in elderly patients.The OH-S and OH-D have a significant correlation with MI.
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Objective: To investigate the effect of nocturnal hypertension in essential hypertension (EH) patients with early renal dysfunction. Methods: A total of 182 EH patients were enrolled in this study. According to weather the average night blood pressure (BP) > 120/70 mmHg, the patients were divided into 2 groups: Nocturnal hypertension group,n=89 and Control group,n=93. The levels of urine micro albumin (mALB), podocalyxin (PCX) and serum Cyst-C were examined and compared between 2 groups. Results:① For BP: the average systolic and diastolic BP in Nocturnal hypertension group were higher than those in Control group as SBP (138.05 ± 6.33) mmHg vs (102.51 ± 8.76) mmHg, DBP (84.11 ± 6.32) mmHg vs (70.03 ± 4.56) mmHg, P<0.05. ② For renal dysfunction biomarkers: several biomarker levels were higher in Nocturnal hypertension group than those in Control group as mALB (13.60 ± 0.69) mg vs (10.04 ± 0.73) mg, PCX (5.35 ± 1.69) ng/ml vs (2.05 ± 0.88) ng/ml and serum Cyst-C (1.35 ± 0.69) mg/L vs (1.02 ± 0.44) mg/L, allP<0.05.③ For correlation study: In Nocturnal hypertension group, the PCX level was positively correlated to the levels of mALB (r=0.675,P<0.05), Cyst-C (r=0.734,P<0.05), night BP (r=0.830, P<0.05) and the duration EH (r=0.688,P<0.05). Conclusion: EH patients with nocturnal hypertension have more incidences to suffer from renal dysfunction, the examination of mALB, PCX and Cyst-C are beneifciary for the early diagnosis in relevant patients.
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Objective: To explore the clinical response on cardiac resynchronization therapy (CRT) in patients of chronic heart failure (CHF) with different QRS wave morphology. Methods: A total of 52 CHF patients received CRT in our hospital and the Seventh People's Hospital of Zhengzhou City from 2010-03 to 2013-07 were retrospectively studied. The patients were divided into 3 groups: True-complete left bundle branch block (t-CLBBB) group,n=20, Classic LBBB (CLBBB) group,n=15 and IVCD group,n=17. The general clinical condition, the indexes of echocardiography at 6 months of follow-up study including left ventricular end diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), NYHA classiifcation and 6-MWT were examined and compared among different groups. Results: In general clinical condition, the ratio of non-ischemic heart disease patients in t-CLBBB group was higher than those in CLBBB group and IVCD group, allP<0.05. By 6 months follow-up study, LVEDD in t-CLBBB group (62.6 ± 8.9) mm was lower than those in CLBBB group (70.0 ± 8.9) mm and IVCD group (72.8 ± 8.0) mm, LVEF was higher in t-CLBBB group (38.5 ± 6.2) % than those in CLBBB group (31.7 ± 6.7) % and IVCD group (30.1 ± 6.7) %. NYHA classiifcation in t-CLBBB group (2.00 ± 0.45) grade was lower than those in CLBBB group (2.73 ± 0.80) grade and IVCD group (3.12 ± 0.78) grade . 6-MWT in t-CLBBB group (302.0 ± 57.9) m was longer than those in CLBBB group (257.3 ± 59.0) m and IVCD group (220.2 ± 57.9) m, allP<0.05. Conclusion: CRT is an effective method for treating CHD patients, different QRS morphology may have different response, the patients with t-CLBBB would make better response.
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Objective: To evaluate the short-term effect of thrombus aspiration catheters combining tiroifban medication for myocardial tissue reperfusion recovery in patients with acute ST-elevation myocardial infarction (STEMI). Methods: A total of 105 STEMI patients with percutaneous coronary intervention (PCI) in our hospital from 2011-05 to 2013-05 were studied, there were 73 male and 32 female with the mean age of (58.39 ± 10.37) years. The patients were randomly divided into 2 groups, Group A, the patients received thrombus aspiration catheters with intravenous tiroifban, n=53 and Group B, the patients received tiroifban and PCI, n=52. The basic clinical features, myocardial tissue perfusion level, major adverse cardiovascular events (MACE) at post operative and in-hospital period were recorded, the cardiac function was examined by echocardiography at 6 months after PCI in both groups. Results: The basic clinical features were similar between 2 groups. The thrombolysis in myocardial infarction trial (TIMI) 3 lfow rate was higher in Group A than that in Group B (92.45% vs 55.77%), P=0.000. TIMI 2 and TIMI 0~1 lfow rates were lower in Group A than that in Group B (7.55%vs 26.92%), P=0.008 and (0%vs 17.31%), P=0.002. The adjusted TIMI frame was lower in Group A (27.26±5.50) vs (38.98±5.42), P0.05. Conclusion:Thrombus aspiration catheters combining tiroifban medication may obviously improve the myocardial tissue reperfusion and the short-term cardiac function in STEMI patients after PCI, it could reduce the incidence of no-relfow without increasing MACE.
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Objective To evaluate the value of mean platelet volume (MPV) in identifying the location of infarct at left circumflex artery (LCX) in patients with non-ST-elevation myocardial infarction (NSTEMI).Methods In this retrospective study,184 consecutive patients with NSTEMI were eligible to be enrolled from January 1,2009 to June 30,2011 and laboratory examinations including platelet count,B-type natriuretic peptide (BNP),troponins test (TnI),C-reactive protein and serum creatinine (SCr) were done.The demographics and detailed history of patients were documented.In addition,left ventricular ejection fraction (LVEF) test and coronary angiography to determine the culprit vessel implicating in infarction were carried out in all enrolled patients.The patients were categorized into LCX group and N-LCX group according to culprit vessel.Results Of 184 patients,68 patients were in LCX group and 116 patients had left anterior descending artery (LAD) lesion or right coronary artery (RCA) lesion.High percent of LCX infarction were found in patients with high MPV level and low BNP level,and in smokers.And lower proportion of those patients had previous percutaneous coronary artery intervention.The results showed that MPV was larger in patients with LCX infarction than that in patients with LAD or RCA.Receiver operating characteristic curve showed the area under curve was 0.75 (95％ CI:0.675-0.826).An optimized cut off point at 9.15 fL of MPV showed 83.8％ sensitivity and 63.8％ specificity for prediction of LCX infarction.Multivariate analysis also showed that MPV was the only independent predictor of a LCX infarction in patients with NSTEMI [OR=1.32,(95％ CI:1.031-1.688),P＜0.05].Conclusions MPV was the only independent factor associated with LCX infarction in patients with NSTEMI.