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<p><b>OBJECTIVE</b>To investigate the impact of cardiac resynchronization therapy (CRT) on left ventricular systolic function evaluated by velocity vector imaging (VVI) in refractory heart failure patients and the predictive value of VVI on CRT responses.</p><p><b>METHODS</b>This study included 38 patients with medically refractory heart failure (HF) patients underwent CRT in our department from May 2007 to April 2011. Left ventricular long axis dyssynchrony indexes including time to peak of systolic velocity (Ts max-min), standard deviation of the time to peak of systolic velocity (Ts-SD) before and at 3-6 months post CRT. CRT response was defined as 15% decrease in left ventricular end-systolic volume. ROC curve and the area under the curve (AUC) were calculated.</p><p><b>RESULTS</b>Twenty-four patients were defined as responder. No significant difference was observed between responders and non-responders in medical therapy. When using Ts max-min to predict response, the AUC of ROC curves was 0.76 ± 0.07. The sensitivity and specifity was 70.8% and 77.8% respectively with Ts max-min ≥ 124.0 ms. When using Ts-SD to predict response, the AUC of ROC curves was 0.82 ± 0.07. The sensitivity and specifity was 79.2% and 71.2% respectively with Ts-SD ≥ 40.5.</p><p><b>CONCLUSION</b>Ts-SD is a useful index to predict CRT response in refractory HF patients.</p>
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Humans , Area Under Curve , Cardiac Resynchronization Therapy , Heart Failure , ROC Curve , Stroke Volume , Systole , Ventricular Function, LeftABSTRACT
AIM: To determine the effect of exogenous phosphocreatine (PCr) at different concentrations on transient outward potassium (Ito) current in rat ischemic ventricular mid-myocardial (M) cells and to explore the antiarrhythmia mechanism in the treatment of ischemic heart disease. METHODS: M cells were isolated enzymatically from left ventricular mid-myocardium of rats. Peak Ito current was recorded by patch-clamp technique in the whole-cell configuration when M cells were superfused with normal Tyrode solution,simple ischemic solution,and simulated ischemic solution containing PCr at concentrations of 5,10,20 and 30 mmol/L for 10 min. RESULTS: Peak Ito current density of M cells superfused with simple simulated ischemic solution was significantly reduced by (76.1±6.3)% (P0.05). CONCLUSION: PCr reverses the inhibition of Ito current under ischemic condition in M cells,which may be the mechanism responsible for arrhythmia prevention in ischemic heart disease. PCr at concentrations of 0～10 mmol/L exerts significant dose-effect relationship.
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AIM: To make a comparison between 64-multidetector computed tomography (64-MDCT) and coronary angiography (CAG) for assessing the clinical significance of coronary lesions and the coincidence rate of these two methods. METHODS: From May 2005 to July 2006, totally 85 patients, who were suspected or diagnosed as coronary atherosclerotic heart disease, were performed with both 64-MDCT and CAG in the General Hospital of Chinese PLA. They included 64 males and 21 females, aged 41-83 years, with a mean of 61 years. Informed consents were obtained from all the patients. Coronary artery stenosis was detected with the stenosis rate of diameter method and area method, which was calculated by 64-MDCT and analysis software for vessels. Coronary luminal diameter was evaluated as normal, mild stenosis (25%-49%), mild-moderate stenosis (50%-74%), moderate-severe stenosis (75%-94%), severe stenosis (95%-99%), and occlusion (100%). RESULTS: The 64-MDCT images were evaluated for the existence of occlusions or significant stenosis (≥50% lumen reduction) in native coronary arteries. Its coincidence rate with CAG was 89% in left coronary artery main stem, 93% in left anterior descending coronary artery, 68% in left circumflex coronary artery, and 48% in right coronary artery. CONCLUSION: The 64-MDCT has a high diagnostic accuracy in detecting coronary artery stenosis, and is identical with CAG in the assessment of left coronary artery main stem and left anterior descending coronary artery. Thus it is potential for the clinical application on the evaluation of coronary artery stenosis, qualitative and quantitative detection of coronary atherosclerotic plaque.
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BACKGROUND: The occurrence and severity of acute high-altitude disease(AHAD) are determined by the speed entering the highland, the altitude of highland and seasons. The association between obesity and AHAD has not been fully investigated.OBJECTIVE: To investigate the association between obesity and acute high-altitude in people exposed rapidly to the highland.DESIGN: Comparative observation.SETTING: Department of Cardiology, General Hospital of Chinese PLA and Department of Cardiology, Tibetan General Hospital of Chinese PLA.PARTICIPANTS: The experiment was conducted at the Department of Cardiology, General Hospital of Tibetan Military Area Command of Chinese PLA in August 2006. Totally 82 Henan subjects aged 28-45 years were selected from the male workers constructing the Qinghai-Tibet Railway and their managers with acute high-altitude exposure. They had never been to the highland before, and all agreed to the detection.METHODS: ①Every subject completed the AHAD self-report questionnaire at sea level and 12 hours and 24 hours after ascending high-altitude. The items in the questionnaire included symptoms of headache, gastrointestinal symptoms,fatigue or weakness, dizziness, and insomnia. Each symptom was graded from 0-3 with 0 as no symptoms, 1 as mild symptoms, 2 as moderate symptoms, and 3 as severe symptoms and a total score of 15. A score of 4 or more could by identified as AHAD. ②The height and body mass were measured to calculate the body mass (BMI). Those with BMI≥28 kg/m2 served as the obesity group [n =39, mean age (35±8) years], and those with BMI of 18.5-23.9 kg/m2 as the normal body mass group [n =43, mean age (35±8) years]. ③Arterial blood was taken to evaluate arterial oxygen saturation (SO2), arterial oxygen pressure (PaO2) and arterial carbon dioxide pressure (PaCO2) at baseline and 24 hours after ascending high-altitude. ④The measurement data was compared by t test.MAIN OUTCOME MEASURES: BMI, vital capacity of lungs, SO2, PaO2 and PaCO2 levels of obese and normal people.RESULTS: Totally 39 obese people and 43 normal people were involved in the result analysis. ①AHAD score: No symptom was reported at sea level in all participants (scored 0), but the AHAD scores in the obesity group were significantly higher than those in normal group 12-hour and 24-hour after ascending high-altitude. ②Blood gas analysis:At sea level, there were no statistical differences in the levels of SO2, PaO2, and PaCO2 between two groups (P ＞ 0.05).But 24 hours after ascending high-altitude, SO2 and PaO2 of the obesity group were much lower than in the normal group (P＜ 0.01), and PaCO2 was significantly higher than in the normal group (P＜ 0.01).CONCLUSION: Obese men are more vulnerable to high-altitude hypoxia than people with normal body mass. Obesity is an important risk factor for the development of acute high-altitude disease.
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Objective To approach the dynamic change in the membrane protein on platelet microparticles of patient with anti-platelet therapy, and look for a new test which are helpful to supervise the anti-platelet therapy. Method We collected blood samples from the patient with myocardial infarction ( n =9) treated with ticlopidine (250 mg?2 in the first and second day, 250 mg/day from the third to sixth day)in different time (before treatment, and 4 d, 5 d, 6 d, 9 d, 10 d after treatment), and examine the percent of PAC-1 + PMP or CD62p + PMP in the samples by activating platelet with 20 ?mol ADP. Result By activating platelet with 20 ?mol ADP, the percent of CD62p + PMP at different time (before treatment, and 4 d, 5 d, 6 d, 9 d, 10 d after treatment) were 84.3%?3.6%, 81.4%?3.4%, 70.3%?2.7%, 70.6%?3.2%, 83.5%?2.8%, 85.4%?2.1%,as of PAC-1 + PMP were 85.3%?3.5%, 82.5%?2.2%, 72.3%?3.5%, 72.4%?3.3%, 85.4?3.4%, 86.0%?3.8%. The percent of CD62p + PMP and PAC-1 + PMP in 5 d obviously increase ( P
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Objective To observe the analgesic effects of patient-controlled intravenous analgesia (PCIA) and continuous infusion of morphine into epidural space(CIEA) after suprapubic transvesical prostatectomy. Methods Seventy-five patients undergoing suprapubic transvesical prostatectomy were randomly assigned to PCIA group,CIEA group and control group. In PCIA group, 2 0mg/h morphine as a recommended dose would be injected intravenously by the patient through a self-controlled analgesic delivery system in which another 1 mg morphine could be injected whenever patient felt pain until the pain relieved. The lockout time was 20 minutes. In CIEA group, 0 08 mg/h morphine was injected into epidural space. 50～75mg of pethidine was injected whenever the control group patients felt pain. VAS(vision simulate score), frequency and duration of bladder spasm, discontinuance time of bladder irrigation and BP were observed. Results The CIEA and PCIA group were superior to the control group with characteristics of stable analgesic effect, shorter duration and lower frequency of bladder spasm and shorter time of bladder irrigation(P0 05); but the PCIA group had longer gastrointestinal function recovery time(P