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Objective To explore the predictive value of Tei index and plasma brain natriuretic peptide(BNP) on major adverse cardiovascular events(MACE) during long term follow up in the patients with anteriormyocardial infarction(MI).Methods A total of 238 patients with anterior MI were selected and divided into four groups according to the median of Tei index and BNP:G1 group(Tei≤0.66,BNP≤532.60 ng/mL,n=70),G2 group(Tei≤0.66,BNP＞532.60 ng/mL,n=51),G3 group(Tei＞0.66,BNP≤532.60 ng/mL,n=50) and G4 group(Tei＞0.66,BNP＞532.60 ng/mL,n=67).The follow up end was the MACE occurrence.Results There was a significant positive correlation between the Tei index and BNP(r=0.582,P=0.000).Tei entered the BNP regression equation(β=0.658,P＜0.05).The MACE-free survival rate had no statistical difference among 4 groups(x2 =9.975,P=0.019).The Cox regression analysis showed that Tei index and BNP were the independent predictive factors for MACE.Tei combined with BNP had stronger predictive value to MACE(AUC=0.781,95CI:0.721-0.841,P=0.000),its sensitivity was 72.52％ and specificity was 76.89％.Conclusion Tei combined with BNP has stronger predictive value for anterior MI during long term follow up.
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Objective To investigate the differences of pre-hospital delay time in acute ST-elevation myocardial infarction (STEMI)between the advanced age group(>75 years old)and control group(≤75 years old).Methods Four hundreds patients with STEMI in the cardiology and emergency departments of the First Affiliated Hospital and Affiliated Luoyang Central Hospital of Zhengzhou University from January 2013 to March 2015 were selected and divided into two groups according to the age,the ad-vanced age group (>75 years old)and control group(≤75 years old).The patients′data were inquired and recorded for conducting the statistical analysis.Results The proportion of pre-hospital delay time < 6 h in the advanced age group was significantly lower than that in the control group and the time for conducting coronary angiography was longer than that in the control group,the differences were statistically significant(P <0.05).The mortality rates of intra-hospital,on 30 d and half a year after discharge in the advanced age group were higher than those in the control group,the differences between the two groups were statistically signif-icant (P <0.05).Conclusion The advanced age patients receiving active therapy are relatively less,which is mainly due to the wor-ry on the age related adverse reactions.
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Objective: To study the relationship between insulin resistance (IR) and coronary collateral circulation in patients with impaired glucose tolerance (IGT). Methods: A total of 227 patients with coronary angiography (CAG) were studied. There were 131 patients with male gender and the average patient’s age was (53.2 ± 11.0) years. IR (HOMA2-IR) index was measured by HOMA2 method, the severity level of coronary stenosis was assessed by Gensini scoring system, collateral circulation condition was determined by Rentrop classiifcation. 187 IGT patients were divided into 4 groups: Rentrop 0 group,n=55, Rentrop 1 group,n=42, Rentrop 2 group,n=39 and Rentrop 3 group,n=51; in addition, Control group,n=40 patients with normal glucose tolerance and coronary stenosis<50%. Results: Compared with Control group, all patients in 4 Rentrop groups had increased 2h-PBG, HbA1c, HOMA2-IR and Gensini score, while decreased fasting insulin (FINS), allP<0.05. Compared with Rentrop 3 group and Rentrop 2 group, the patients in Rentrop 1 group and Rentrop 0 group had elevated 2h-PBG, HbA1c, HOMA2-IR and Gensini score, while Rentrop 0 group had reduced FINS, allP<0.05. Multivariable regression analysis showed that HOMA2-IR index (R=0.518,P<0.05), HbA1c (R=1.916, P<0.05), 2h-PBG (R=2.130,P<0.05) and FINS (R=1.547,P<0.05) might be related to the severity of coronary stenosis. Binary regression analysis indicated that poor collateral circulation (the patients in Rentrop 0 group and Rentrop 1 group) was related to HOMA2-IR index (OR=1.679, 95% CI 1.101-2.558,P=0.016). Conclusion: HOMA2-IR index could be signiifcantly higher in patients with IGT combining chronic coronary occlusion. IR was the independent risk factor for the severity of coronary stenosis and coronary collateral formation.
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Objective Gene linkage would be processed in order to make sure if an autosomal dominant congenital hyperthyroidism family has genetic linking relationship with the known hyperthyroidism disease genes,TSHR or THRB.Methods Microsatellite marked gene linkage was done with the use of three microsatellite markers,D14S74,D3S2338 and D3S1266,whose chromosomal locations were very close to TSHR or THRB gene,and the results were analyzed by Genemapper 3.5 Software.Results LOD scores of the three markers were all less than 1,revealing that there were no linking relationships between TSHR or THRB gene and this hyperthyroidism family,further reflecting this family might have a new disease gene other than TSHR and THRB.Conclusion There might be new disease genes responsible for autosomal dominant congenital hyperthyroidism.
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@#With water immersion, the water exerts a pressure on the body surface. Thus there is a blood volume shift from the periphery to the central circulation, resulting in marked volume loading of the thorax and heart. This article illustrated hemodynamic and hurohumoral responses of hydrotherapy, and dicussed whether patients with left ventricular dysfunction (LVD) or chronic heart failure (CHF) can immerse, take balneotherapy, exercise in the water and swimming. A positive effect of therapeutic warm-water tub bathing has been observed in patients with LVD and CHF, which was assumed to be from afterload reduction due to peripheral vasodilatation caused by the warm water. Optimal swimming as used for cardiovascular training programs may be allowed exclusively for NYHA class Ⅱ patients with myocardial infarction older than 6 weeks, myocarditis suffered more than 6 months ago, and cardiomyopathy. Patients with previous severe myocardial infarctions and/or CHF may bathe in a half sitting position, but immersed no deeper than the xiphoid process, because immersion up to the neck could produce abnormal increase in mean pulmonary pressure and pulmonary capillary wedge pressure temporarily. In coronary artery disease (CAD) patients with reduced LV function the heart is working more efficiently with mild cycling in water than cycling outside of water. Decompensated heart failure is the absolute contraindication to hydrotherapy.
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objective To evaluate the vulnerability of coronary artery plaque with coronary angiography(CAG),intravascular ultrasound(IVUS)and the levels of plasma inflammatory markers.Methods 58 consecutive patients with lesion of a single blood vessel demonstrated successfully by CAG were randomly divided into 3 groups based on the angiographic morphology of the the lesions:type Ⅰ lesion group(n=16),type Ⅱ lesion group(n=25),type Ⅲ lesion group(n=17).Meantime,a control group of stable angina(n=17)was established.A subgroup of 28 patients(including 18 acute coonary sysdrome (ACS)patients and 10 stable angina control patients)who underwent IVUS study were analyzed.Then the plasma levels of high sensitivity CRP(hs-CRP),matrix metalloproteinase(MMP,including MMP-2 and MMP-9),CD40 ligand(CD40 L)and pregnancy associated plasma protein-A(PAPP-A)were measured with ELISA.Analyses were performed by statistical package SPSS 11.0.Results The plasma levels of MMP-2,MMP-9 and PAPP-A in typeⅡ lesion group were significantly higher than the other groups(P＜0.05,0.05,0.001,respectively).In type Ⅱ lesion group,linear correlation analysis manifested significantly positive correlation between levels of hs-CRP and MMP-2(r=0.508);MMP-2 and MMP-9,CD40 L,PAPP-A(r=0.647,0.704,0.751,respectively);MMP-9 and CD40L,PAPP-A(r=0.491,0.639,respectively);CD40L and PAPP-A(r=0.896).IVUS subgroup analysis showed that the area of plaques and plaques burden in culprit lesion,the incidence of high-risk plaques,remodeling index(RI)and positive remodeling percentage in ACS patients were significantly greater than those in the control group(P=0.000,0.037,0.028,0.015,0.040,respectively).Compared with the control group,the plasma levels of hs-CRP,MMP-2,MMP-9 and PAPP-A were markedly elevated(P=0.033,0.000,0.000,0.027,respectively).Conclusions CAG and IVUS combined with the study on plasma levels of inflammation mediators were helpful in judging the vulnerability of coronary artery plaques.
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The atherosclerotic plaque vulnerability may be related to inflammation,immunity,metabolism and blood clotting.One of the key factors affecting plaque stability is inflammatory reaction.This study was to investigate the relationship between vulnerability of coronary artery plaque evaluated with coronary angiography (CAG),intravascular ultrasound (IVUS) and the levels of plasma inflammatory markers.Methods Fifty-eight consecutive patients with acute coronary syndrome who had coronary lesion of a single vessel were divided into 3 groups based on angiographic morphology of the lesions:type Ⅰ lesion group (n =16),type Ⅱ lesion group (n =25) and type Ⅲ lesion group (n =17).The control group consisted of 17 patients with stable angina.Plasma levels of high sensitivity C reaction protein (hs-CRP),matrix metalloproteinase (MMP,including MMP-2 and MMP-9),CD40 ligand (CD40L) and pregnancy associated plasma protein-A (PAPP-A) were measured by ELISA.A subgroup of 28 patients (including 18 ACS patients and 10 stable angina control patients) who underwent IVUS study,were analyzed.Results The plasma levels of MMP-2,MMP-9 and PAPP-A in type Ⅱ lesion group were significantly higher than those in other groups (all P＜0.05).In type Ⅱ lesion group,linear correlation analyses showed significant positive correlation between levels of hs-CRP and MMP-2 (r=0.508);MMP-2 and MMP-9,CD40L,PAPP-A (r=0.647,0.704 and 0.751,respectively);MMP-9 and CD40L,PAPP-A (r=0.491 and 0.639,respectively);CD40L and PAPP-A (r=0.896).IVUS subgroup analysis showed that the area of plaques and plaque burden in culprit lesion,the incidence of high-risk plaques,remodeling index (RI) and positive remodeling percentage in ACS patients were significantly greater than those in control subgroup (P=0.000,0.037,0.028,0.015 and 0.040,respectively).Compared with control subgroup,the plasma levels of hs-CRP,MMP-2,MMP-9 and PAPP-A were markedly elevated (P=0.033,0.000,0.000 and 0.027,respectively).Conclusions CAG and IVUS combined with study on plasma levels of inflammation mediators are helpful in judging the vulnerability of coronary artery plaques.(J Geriatr Cardiol 2008;5:207-211)
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Objective To examine the use of reperfusion strategies in elderly patients with acute myocardial infarction (AMI) and investigate the factors affecting its use. Methods This survey population consisted of 338 consecutive elderly patients with AMI( t65 years) who were admitted to the department of cardiology of Beijing Military General Hospital between December 2003 and November 2007. The patients were divided into two groups based on the receiving of reperfusion strategies : a reperfusion group ( n = 252) and a non-reperfusion therapeutic group ( n = 86). Qualitative data were compared between the two groups using Chi-square tests and multiple binary logistic regression was used to determine the relationship between various patient-related factors with the probability of choosing reperfusion therapies or not. Results About 74. 6% of the elderly patients with AMI recevied reperfusion strategies [62. 2% pereutaneons coronary intervention (PCI) and 12.4% thrembelysis]. Stepwise logistic regression analysis revealed that age ≥ 75 years( OR = 0. 255, P = 0. 000), history of angina ( OR = 0. 570, P = 0. 016 ) and high Killip classification ( OR =0. 671 ,P =0. 012) were confirmed factors for receiving less reperfusion therapy. Meanwhile, inferior wall myocardial infarction (MI) with complicating right ventricular MI( OR =4. 585,P =0. 002) ,sweating ( OR = 1. 970, P = 0. 016), unbearable symptoms ( OR = 1. 836, P = 0. 038 ) and medical insurance ( OR =1. 968,P =0. 029) were independent predictors for receiving reperfusion therapy. Intracranial hemorrhage (2.8% vs 7. 1%,P =0.000), left ventricular ejection time <45% (12% vs 31%,P =0.016) and mortality rate within 1 year(2. 3% vs 4. 7%, P = 0. 039) were obviously decreased in the PCI group as compared with the thrembelysis group. Conclusions Aging, medical history of angina, high Killip classification, inferior MI with complicating fight ventricular MI, sweating, unbearable symptoms and medical insurance were independent predictors for receiving reperfusion strategies.
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@#ObjectiveTo examine the relationship between ankle brachial index (ABI) and the extent of coronary stenosis and evaluate the usefulness of ABI to predict the extent of coronary stenosis in old patients.Methods118 patients with coronary angiography were examined by ABI and hemostatic factors evaluation in addition to history collection.ResultsABI was inversely and significantly associated with Gensini score. ABI reduced significantly (P<0.001) in the patients with 3-vessel or left main coronary artery disease (CAD). But there were no significant differences in ABI among the patients with no CAD, 1-vessel or 2-vessel CAD. The corresponding area under the ROC curve was 0.75±0.045, with 95% CI=0.67～0.84 (P<0.001) in ABI in 3-vessel or left main CAD. When ABI≤0.9, it had a relatively high specificity (89.1%) and sensitivity (55.6%) for predicting the presence of 3-vessel disease or left main CAD.ConclusionIn the old patients, ABI is inversely and significantly associated with the extent of coronary stenosis, and ABI≤0.9 has a relatively high specificity and sensitivity for predicting the presence of 3-vessel or left main CAD.