ABSTRACT
Objectives:To observe the clinical features and factorsrelated to treatment decision for hospitalizedpatients with mitral regurgitation (MR). Methods:A total of 3 450 consecutivepatients with transthoracic echocardiography (TTE) confirmed moderate to severe MR admitted in our hospital from 2014-01-01 to 2015-12-31 were enrolled. Base on therapeutic method, the patients were divided into 2 groups:Surgery group, n=1 845 and Medication group, n=1 605. The baseline data including TTE results were collected, clinical features were compared between 2 groups and factors related to treatment decision were analyzed. Results:Mean age of this patient cohort was (54.8±13.8) years including 26.99% (931/3 450) patients aged ≥65 years. The most common etiology was primary MR, 324 (9.39%) patients were asymptomatic at admission and decreased left ventricular ejection fraction (LVEF) was evidenced in 55.28% (1 907) patients. Total in-hospital mortality was 0.75% (26). Compared with Medication group, the patients in Surgery group were younger ([52.65±12.01] years vs [57.39±15.25] years), prevalence of severe MR (56.69% vs 26.79%) and primary MR (89.49% vs 39.00%), as well as LVEF value ([61.62±9.20] % vs [48.00±17.53] %) were higher (all P＜0.001).Logistic regression analysis indicated that age (OR=0.561, 95% CI 0.503-0.627), MR etiology (OR=3.062, 95% CI 2.565-3.654), MR grade (OR=0.103, 95% CI 0.085-0.126) and LVEF (OR=2.478, 95% CI 2.147-2.860) were the determinants for treatmentdecision making in hospitalized patients with moderate to severe MR. Conclusions:In this patient cohort, there are considerable proportion of aged patients with moderate to severe MR. Primary MRis the major etiology. 46.52% patients received conservative therpay instead of surgery, older age,secondary MR, moderate MR and decreased LVEF are the major reasons for choosing conservative therapy in this patient cohort.
ABSTRACT
Objectives: To explore the association between HbA1c level and the degree of coronary artery disease in patients with stable coronary artery disease (CAD) and type 2 diabetes mellitus (T2DM). Methods: A total of 3 068 patients with stable coronary artery disease and T2DM treated with percutaneous coronary intervention (PCI) from 2014-07 to 2015-06 in Fuwai hospital were included in this retrospective study. Patients were divided into three groups according to SYNTAX score: mild lesions group (SYNTAX score: 0 to 22, n=2 661),moderate lesion group (SYNTAX score: 23 to 32, n=342), and severe lesion group (SYNTAX score > 32, n=65). The relationship between the level of HbA1c and the severity of coronary lesions in patients with T2DM was analyzed using ordered Logistic regression. Results: There were 65 (2.1%) patients with SYNTAX score> 32 and 407 (13.3%) patients with SYNTAX score >22. In SYNTAX score > 32 group, mostly patients had advanced age,longer duration of hyperlipidemia and coronary disease, higher percent of old myocardial infarction and family history of coronary artery disease. Blood glucose levels and HbA1c levels increased and left ventricular ejection fraction decreasedin proportion with increasing SYNTAX score. Patients with SYNTAX score between 23 and 32 had the highest percent of the left anterior descending coronary artery and right coronary artery lesion, followed by left circumflex artery and left main trunk lesion. However, in patients with SYNTAX score> 32, the right coronary artery was the most common culprit artery. The incidence of coronary chronic total occlusions, mean lesion number and the average number of stents increased in proportion with increasing SYNTAX score (P<0.001). Multiple regression analysis showed that HbA1c level (OR:3.51,95%CI:2.90-4.25,P<0.001), duration of CAD (OR:1.06,95%CI:1.01-1.10,P<0.01) and current smoking (OR:1.49, 95%CI: 1.27-1.89,P<0.05)were positively associated with the severity of coronary artery lesions. Conclusions: Diffuse and severe multiple coronary artery lesions are the characteristic changes of patients with stable CAD complicating T2DM.HbA1c level is an important risk factor affecting the complexity and severity of the coronary artery lesions in these patients.
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Objective: To summarize the clinical features and treatment status for elderly in-hospital patients with mitral regurgitation (MR). Methods: A single center retrospective study was conducted in 1 741 patients admitted in our hospital from 2014-05-01 to 2015-04-30 with echocardiography confirmed moderate to severe MR. The patients were divided into 2 groups: Elderly group, n=680(39.06%)patients≥60 years of age and Non-elderly group,n=1 061(60.94%)patients<60 years.Clinical features and treatment status were studied and compared between 2 groups. Results: The mean age in Elderly group was (66.98±5.94) years and the most common type was degenerative MR (41.18%). Compared with Non-elderly group, Elderly group had more patients combining coronary artery disease (37.79% vs 17.43% ), more risk factors of atherosclerosis such as hypertension (45.44% vs 25.17%), diabetes (19.56% vs 8.48%) and hyperglycemia (35.29% vs 19.51%) all P<0.05; Elderly group had the higher EuroSCORE Ⅱ score (5.54±2.42) vs (3.15±1.66), greater left ventricular end diastolic diameter (57.72±12.37) mm vs (57.33±10.19) mm and less patients combining multiple valve disease (35.59% vs 40.81%), less patients received surgical treatment (54.71% vs 63.9%), all P<0.05. The surgery procedures (mitral valve replacement or mitral-plasty) were similar between 2 groups; compared with Non-elderly group, Elderly group had the higher application rate of bio-prosthetic valve (53.88% vs 18.67%), P<0.001. Conclusion: About 40% in-hospital moderate to severe MR patients were the elderly crowd, the most common pathogenesis was degenerative changes which leaded the higher incidences of cardiac complications, worse cardiac function and the higher risk scores for surgical treatment, there were less patients received surgery.