ABSTRACT
Objective Perioperative myocardial infarction remains a severe complication in non-cardiac surgery and is one of the major causes of death.Cardiac troponin (cTn) Ⅰ elevation is associated with short-term and long-term mortality.The aim of the study was to assess the proportion rate of cTnⅠ elevation and its clinical characteristics among patients admitted for orthopaedic surgery with or without cardiovascular events.Methods This is a retrospective study including 27 744 patients aged 50 years or older who admitted for orthopaedic surgery from 2009-2015 in Beijing Jishuitan Hospital.Results Two hundred and sixty-five patients [age (71.7±9.9) years] had cTnⅠ level＞ 0.04 μg/L with 66％ (175 patients) of them being female.Among them,59 patients were isolated troponin rise (ITR) (n=59),13 were preoperative acute myocardial infarction (AMI),and 193 were postoperative AMI.The proportion of postoperative AMI was 0.69％.Those patients were more likely to have a history of coronary artery disease or hypertension.Non-ST-segment elevation myocardial infarction (NSTEMI) was more common (93.3％) than ST-segment elevation myocardial infarction in these patients.Most of them did not experience ischemic symptoms.Totally 76.7％ of the AMI occurred within 3 days of surgery;and the in-hospital mortality rate was 10.4％.Conclusions Perioperative elevation of troponin is common in patients undergoing orthopaedic surgery.Most postoperative AMI were NSTEMI and with absent or atypical ischemia symptoms.Monitoring troponin levels and electrocardiograph in at-risk patients is needed to find most of the AMI.
ABSTRACT
Objective To explore the inhibiting effect of valsartan and spironolactone on cardiac fibrosis and the expression of integrin ? 1 and fibronectin in the heart of spontaneously hypertensive rats. Methods Eighteen 6 week old SHR were randomly divided into 3 groups with 6 in each: SHR control group, valsartan treating group(30 mg?kg -1 ?d -1 ) and spironolactone treating group ( 20 mg?kg -1 ?d -1 ). Six homogenous male WKY rats served as normal group. After 14 weeks of treatment, systolic blood pressure, left ventricular mass, the ratio of left ventricular mass to body weight (LVM/BW), collagen volume fraction(CVF) and perivascular collagen area(PVCA) were determined and compared among these groups. The expression of integrin ? 1 and fibronectin were also examined by immunohistochemical method. Results Compared with the untreated SHR S, systolic blood pressure was significantly decreased in both treatment groups. LVM/BW〔(2 84?0 14)?10 -3 vs(3 22?0 15)?10 -3 〕, CVF〔(3 21?0 22)%vs(4 00?0 28)%〕, PVCA〔(0 62?0 15)%vs(0 94?0 56)%〕 were lower in both treatment groups, these parameters in SHR V group were even lower than those in SHR S group. Compared with the untreated SHR S, the expression of integrin ? 1 was significantly reduced in SHR V group, while the expression of fibronectin was markedly reduced in both treatment groups. Conclusions Both valsartan and spironolactone could control blood pressure, and effectively inhibit the cardiac fibrosis. Valsartan could also inhibit the expression of cardiac integrin ? 1 and fibronectin, which might be the reason that valsartan is better than spironolactone in inhibiting cardiac fibrosis.