Impact of loop diuretics on blood sodium in patients hospitalized for heart failure / 中华心血管病杂志

<p><b>OBJECTIVE</b>To observe the level of blood sodium in patients hospitalized for heart failure with water-sodium retention treated with loop diuretics and risk factors of low blood sodium.</p><p><b>METHODS</b>We selected 1 378 acute decompensated heart failure patients who visited Anzhen Hospital, and they are treated with loop diuretics, 259 patients with weight loses more than 1 kg in one week was enrolled in the final analysis, and divided into 3 groups: Group A (weight reduction between 1-3 kg), Group B (weight reduction between 3-5 kg) and Group C (weight reduction over 5 kg). Blood sodium, creatinine and uric acid were compared among groups and risk factors of low blood sodium were analyzed.</p><p><b>RESULTS</b>Blood sodium was similar before and post loop diuretics treatment in Group A, and reduced in group B ((138.28 ± 3.73) mmol/L vs. (139.34 ± 3.66) mmol/L, P < 0.05) and in Group C((137.60 ± 4.07) mmol/L vs. (139.44 ± 4.12) mmol/L, P < 0.05). Forty-six (17.8%) patients developed hyponatremia post loop diuretics treatment. Duration of loop diuretics use was the independent risk infector for hyponatremia (OR = 1.191, 95%CI 1.010-1.385).</p><p><b>CONCLUSIONS</b>Loop diuretics use is safe for treating hospitalized patients for heart failure with water-sodium retention and the risk of developing hyponatremia is low. Duration of loop diuretics use is the independent risk factor of hyponatremia.</p>

Neuregulin-1 inhibits myocardial cell apoptosis by attenuating mitochondrial stress in rats with heart failure after myocardial infarction / 中华老年医学杂志

Objective To study the effect of Neuregulin-1 (NRG) on rat heart failure(HF) after myocardial infarction,and to investigate the underlying mechanism involving in NRG-mediated cardioprotection.Methods 60 adult Wister rats underwent sham operation (n=12) or coronary ligation (n=48) to induce HF.Four weeks after ligation,28 animals with HF were randomly divided into NRG group (rats received rhNRG-1 10 μg · kg-1 · d-1 intravenously for 10 days) or HF group (rats received an equal volume of water intravenously for 10 days).Left ventricular function was detected by echocardiography.Mitochondrial ultrastructure in non-infarcted myocardium was observed by transmission electronic microscopy.Cell apoptosis was detected by terminal-deoxynucleoitidyl transferase mediated nick end labeling (TUNEL) assay.Mitochondrial membrane potential was measured by immunofluorescence method.Caspase-3 activity was determined by commercial kit.The expression of cytochrome C protein in cytoplasm was detected by Western blot.Results Compared with HF group,the left ventricular end-systolic diameter was decreased,and left ventricular ejection fraction and fractional shortening were increased in NRG group (P＜0.05 or 0.01).Apoptosis index was reduced inNRG group as compared with HFgroup [(18.1±3.0)％ vs.(11.9±1.4)％,P＜0.01].Mitochondrial membrane potential was increased and the release of cytochrome c in cytoplasm was reduced in NRG group as compared with HF group [(249.8±7.4) mV vs.(222.2±7.5) mV,(0.356±0.024) vs.(0.664±0.085),both P＜0.01].Caspase-3 activity was decreased in NRG group as compared with HF group (P＜0.01).Conclusions NRG attenuats mitochondrial stress and inhibits myocardial cells apoptosis in heart failure rats after myocardial infarction,which may play an important role in the cardioprotection by NRG.

Drug eluting stents in renal functional insufficiency patients and its influence on stent thrombosis / 中国综合临床

Objective To understand the application of drug eluting stent (DES) in renal functional insufficient patients, and to assess its safety and effectiveness, especially the occurrence of stent thrombosis(ST) after DES implantation and its related factors. Methods The subjects were all the patients underwent percutaneous coronary intervention (PCI) as well as at least one DES admitted to Beijing Anzhen Hospital consecutively from July 2003 to June 2005. All patients were divided into 2 groups: Group Ⅰ with normal or mild renal insufficiency (Ccr≥60 ml/min),and Group Ⅱ with moderate to severe renal functional insufficiency (Ccr ＜ 60 ml/min). All of the clinical, angiography and intervention data were recorded. ST was adjudicated by the definition of ARC Dublin. The rates of MACCE in hospital and during the follow-up between the 2 groups were compared. Results There were 2377 patients enrolled in the study, of which 2020 ( 85.0% ) patients presented Ccr ≥ 60 ml/min, and 357( 15.0% ) presented Ccr ＜ 60ml/min. The case fatality during follow-up in group Ⅰ was significantly higher than that in group Ⅱ (4. 5% vs. 1.2%, P ＜ 0. 001 ). However, the incidences of ST were not significantly different between each stage of disease( P ＞0. 05 ). The results from Cox regression showed that renal functional insufficiency was not a risk factor of death,whereas multivessel coronary artery disease [OR = 1. 929(95% CI: 1. 178 -3. 157),P =0. 009] ,diabetes [OR = 1. 914(95% CI:1. 055 -3. 470) ,P =0. 033] and age [OR = 1. 051 (95% CI:1. 005 -1. 099 ) ,P = 0. 030] were independent risk factor of death after DES implantation in patients with moderate to severe renal functional insufficiency. Conclusions Compared with normal renal function or mild renal patients, the longterm case fatality is higher in moderate and severe renal functional insufficiency patients. However, the higher case fatality does not due to the increase of ST.

Effects of simvastatin on heme oxygenase-1 expression and ventricular remodeling in rats with non -ischemic heart failure / 中华老年医学杂志

Objective To investigate the effect of simvastatin on heme oxygenase (HO) -1expression and ventricular remodeling in rats with non-ischemic heart failure. Methods Seventy eight male Wistar rats were randomized into three groups: normal control group (n = 18), model group and simvastatin group (n= 60). Male Wistar rats in model and simvastatin group were given adrimycin(ADR) in an accumulated dose of 15 mg/kg for two weeks (2.5 mg /kg, peritoneal injection, three times per week), and 8 rats were dead. The survival rats (n= 52) were then randomly divided into two groups: model group (n=26) and simvastatin group (n=26), and 6 rats were dead in model group, while 7 dead in simvastatin group at the end of the study. Then rats in simvastatin treatment group(n=19)were given simvastatin 20 mg·kg-1·d-1 by gavage for four weeks,and rats in model group (n=20) and in control group (n=18) were treated with 5% glucose by gavage.At the forth week, another 9 rats were selected into the study and given ADR with an accumulated dose of 15 mg/kg for two weeks. The hemodynamics, mRNA expression of HO-1 in myocardium, left ventricular function as well as hydroxyproline were measured at the end of the sixth week. Results At the sixth week, compared with control group, systolic (+) and diastolic (-) function of the left ventricule (±LVdp/dtmax) of rats in model group and simvastatin group were reduced significantly, and the reduction amplitudes of + LVdp/dtmax and -LVdp/dtmax were 28.2%, 11.9% and 33.0%,27.9%,4, respectively (F = 4.899,3. 890, all P<0.01). The + LVdp/dtmax of rats in simvastatin group was higher than that in model group (F= 2.461, P<0.05). The content of myocardium hydroxyproline was elevated from the end of the second week [(485.0±52.9)g/kg vs. (364.0±41.6)g/kg,F=0.441 ,P<0.01]. At the end of the sixth week, the content of myocardium hydroxyproline of model group elevated continuously [(572.9±75.4) g/kg vs. (485.0±52.9)g/kg, F=0.654,P<0.05], but not for simvastatin group [(475.9±86.5) g/kg vs. (485.0±52.9)g/kg, P>0.05]. The mRNA expression of HO-1 in myocardium 'in model group was higher than that in control group [(0.6217±0.1229) vs. (0.2475±0.1053), F = 0.128, P < 0.01]. The mRNA expression of myocardium HO-1 was increased further by simvastatin treatment [(0.7860±0.1133) vs. (0.6217±0.1229),F=3.622,P<0.05]. Conclusions Compared with control group, the myocardial HO-1expression of heart failure rats is increased. Simvastatin treatment enhances the myocardium HO-1 expression further and alleviates myocardial injury and the degree of heart failure.

Study on the prognosis of drug-eluting stent implantation in the elderly patients with coronary heart disease / 中华老年医学杂志

Objective To evaluate the prognosis of drug-during stent (DES) implantation in elderly patients versus non-elderly patients, and to determine the clinical outcome of complete revascularization strategy versus incomplete revascularization strategy in elderly patients. Methods Patients who were treated with at least 1 DES in our hospital were enrolled in the study. They were divided into 3 groups: the elderly group (aged 75～89 years), the presenium group (age 60～74years) and the non-elderly group (aged 40～59 years). The patients aged 60～89 years were further divided into complete revascularization group and incomplete revascularization group according the Percutaneous interventional the rapy (PCI) strategy. Clinical characteristics, angiographical and interventional data were collected. Results The success rate of PCI procedure was 99.3% in elderly group(n=137), 98.7% in presenium group(n= 1006), and 99.3% in non-elderly group(n= 1031).There were no significant differences among the three groups(P>0.05). The in-hospital mortality was highest in the elderly group among the three groups (1.5%, 0.4%, 0.1%, P<0.05), but the in-hospital rates of re-infarction, repeated revascularization and stroke had no significant differences among the three groups (P>0.05). During follow-up, the rates of death and stroke were highest in the elderly group(3.1%, 2.3%, 0.7%, P<0. 01;1.5% , 1.3%, 0.3%, P<0.05, respectively),but the rates of re-infarction and repeated revascularization among the three groups had no significant differences (all P>0.05). By Cox regression analysis, serum creatinine (OR= 2.961,95%CI=1. 643～5.338,P<0.01), gender (OR=2.661,95%C1=1.376～5.145 ,P<0.01), age(OR=2.687,95%CI=1.329～5.434, P<0.01), multi-vessel disease(OR= 1.735,95 %CI= 1.132～2.661, P<0.05), and old myocardial infarction (OR = 2.041 ; 95% CI = 1.026～4.061; P<0.05) were the independent predictors for all-cause death in patients aged 60～74 years. The in-hospital mortality was higher in the incomplete revascularization group than in complete revascularization group in patients aged 60～74 years (1.4% vs. 0.2%, P<0.05). Multiple logistic regression analysis revealed that the incomplete revascularization strategy was not the independent predictor of in-hospital death (OR=0.307; 95%CI=0.011～8.467; P>0.05). Conclusions Although DES implanting is successfully procedured in presenium and elderly patients, it is associated with higher in-hospital mortality, especially in patients aged ≥75 years . Presenium and elderly patients are to be more benefit from complete revascularization strategy, but the incomplete revascularization strategy does not influence the long-term outcomes.

An analysis of the prognostic factors of acute myocardial infarction in different gender / 中华内科杂志

Objective To analyse the prognostic factors of ST-elevation acute myocardial infarction men and women. Methods The data of 904 in-hospital patients with ST-elevation myocardial infarction were collected from the database of our hospital during 2003-2004 and 728 of them were followod-up. The patients were divided into groups of male and female. Results Women had more accompanying diseases such as diabetes mellitus (DM) and hypertension than men; left ventricular ejection fraction(LVEF) was lower in female. The rate of successful reperfusion was lower in women than men (P < 0.05). Mortality rate was higher in women. 728(202 female) patients were followed up. The use of β-blockers were statistically different between two groups during follow-up. In the female group, LVEF was lower significantly and the rate of reodmission for heart failure and myocardial infarction as well as that of mortality was higher (P< 0.05). Multivariate analysis showed that sex difference was an independent risk factor for in-hospital mortality (OR = 2. 130,95% CI 0. 954-4.754, P = 0. 045) , but not for mortality in the followed-up period and readrnission. Conclusion There are many factors leading to the poor prognosis of ST-elevation acute myocardial infarction in women. It is essential to pay more attention to its clinical characteristics and begin intervention of the risk factors earlier so as to improve the prognosis.

Revascularization of coronary artery disease in patients with left ventricular ejection fraction ≤40 % / 中国综合临床

Objective To investigate the effect of PCI/CABG for the patients with coronary artery disease(CAD) with LVEF≤40%. Methods 196 CAD patients with LVEF≤40% were divided into PCI (n = 106) and CABG group (n=90). The clinical factors, revaseularization, medication, and in-hospital and follow-up malignant cardiological events(MACCE) were retrospectively compared,and the survival curve were drew by COX regression.Results Survival rate of the PCI group and CABG group in 30-day (96% vs. 94% ), 1-year(95 % vs. 92% ), and 2-year(93% vs. 87% )were similar. There was no MACCE within 30 days in the two groups(92% vs. 92% ) and 1-year survival rate without MACCE was similar in the two groups(86% vs. 88% ). CABG group had higher 2- year survival rate without MACCE than PCI group (83%vs. 72% ). But the COX survival curves of the two group were not signifi-cantly different (P=0. 662). Conclusion The patients with LVEF ≤ 40% undergoing PCI have short-term and long-term survival rate similar to those accepting CABG.

Cardiac manifestations of Fabry's disease / 中华内科杂志

Objective Fabry' s disease is a rare X-linked recessive disease. Its cardiac manifestations are not well recognized. Methods The data of 3 patients from different Chinese kindreds with Fabry's disease and cardiac manifestations who seeked medical advice in our department in 2007 were analyzed. The age, sex, family history, main symptoms, ECG and echocardiographic findings were recorded for all the patients. The diagnostic criteria of Fabry's disease was based on α-galactosidase (α-GAL) quantity in white blood cells. Results All of the patients were female. Their age was from 41 to 57. Two of them had the typical symptoms of Fabry's disease in their young age. All of them had family history of the disease and cardiac symptoms. ECG showed ST-T change and echocardiography showed hypertrophy of left ventricule of different degrees. Their α-galactosidase level in white blood cells was lower than normal. The α-galactosidase level in patient 1 was the lowest. Her cardiac symptoms were most serious in the three patients and she had involvement of other organs. Conclusion Patients with Fabry's disease may have cardiac manifestations. Family history, typical symptoms in young age and the characteristics of multi-systemic disorder are helpful clues to the diagnosis.

Anemia as an independent predictor of poor long-term outcomes after percutaneous coronary intervention / 中华内科杂志

Objective To assess whether anemia is an independent predictor of poor long-term outcome after percutaneous coronary intervention(PCI).Methods The second drug-eluting stent impact on revascularization registry(DESIRE-2)is a single-center registry of 6005 patients undergoing coronary revascularization from July 2003 to September.2005.We examined the clinical data and outcome of 3809 PCI patients based on hemoglobin(Hb)value before the interventional procedure.Patients were classified as anemia using the World Health Organization deftnition(＜120 g/L in women and＜130g/L in men). 744 of the 3809 patients were anemic.We compared the clinical features and prognosis of the patients with or without anemia.Results Anemic patients were older and had a higher percentage of comorbidities as compared with the nonanemic ones.When compared with nonanemic patients,anemic patients had higher mortality(4.7%VS 1.5%,P＜0.001)and higher major adverse event end points,including nonfatal myocardial infarction,stroke and revascularization(14.0%vs10.8%,P=0.014).After adjustment for comorbidities,anemia was associated with a higher risk of mortality after percutaneous coronary intervention(RR 2.216,95%CI 1.019-4.428;P=0.024).Conclusions Anemia is an independent predictor of mortality after PCI.Since PCI iS a common procedure and anemia is a frequent condition in the general population,strategies for the management of anemic PCI patients should be developed.

The incidence and predictors of atrial fibrillation in hypertrophic cardiomyopathy / 中华内科杂志

Objective To observe the incidence and predictors of atrial fibrillation in hypertrophic cardiomyopathy (HCM).Methods 612 HCM patients were analyzed prospectively from July 1990 to November 2007.The age,sex,height,weight,medical history,main symptoms and incidence of atrial fibrillation were recorded.Results The patients'mean age was (47.8±14.9).414 patients(67.6%) were male.377 patients (61.6%)had left ventrieular outflow truer obstruction.94 patients(15.4%)and atrial fibrillation.43 patients(6.O%)had sustained and 51 patients (9.4%) had paroxysmal.The patients with atrial fibrillation were older in age and were predominantly female.Their medical history were longer,left atrial diameter(LAD)longer and plasma B-type natriuretie peptide(BNP)higher.logistic regression analysis indicated that the medical history(P=0.012),LAD(P=0.0001) and BNP (P=0.017)were the independent predictors of atrial fibrillation in HCM.Atrial fibrillation was accompanied by a decrease in functional status and an increase in risk of stroke.Conclusions The incidence of atrial fibrillation in HCM was high.The medical history.LAD and BNP were the independent predictors of its occurrence.

Effect of anemia on long-term outcomes in patients with acute coronary syndrome undergoing percutaneous coronary intervention / 中国综合临床

Objective To assess the effect of anemia on long-term outcomes in patients with acute coronary syndrome(ACS) undergoing pereutaneous coronary intervention(PCI). Methods In 3136 patients presenting with ACS,636 patients were anemic. The clinical features, mortality and major cardiocerebral events including non-fatal acute myocardial infaret,revascularization and non-fatal cerebral stroke were compared in patients with or without anemia. The average follow-up period was 550 days. Results Anemic patients were older and had a higher percentage of comorbidities compared with nonanemic cohorts. Compared with nonanemic patients, anemic patients had higher mortality (4.7% versus 1.5% ,P <0. 001) and a higher major adverse end point events,including nonfatalmyocardial infarction, stroke and revaseularization (14.2% versus 11.0%, P = 0.032). After adjustment for comorbidities, anemia was associated with a higher risk of mortality after percutaneous coronary intervention (adjusted hazard rate ratioRR2. 166 ;95% CI 1. 298-3. 612 ;P =0.003). Conclusion Anemia before PCI is an independent factor for predicting the long-term mortality of ACS.

Safety and in-hospital clinical outcome of percutaneous coronary intervention within 24 hours after admission in patients with non-ST-elevation acute coronary syndrome / 中华急诊医学杂志

24 hours) PCI. Results Among 1013 patients enrolled in the SUNDAY registry, 438 (male 74.8%, unstable angina 94.1%) received PCI after CAG, 35 patients received PCI within 24 hours [(1.0?0.0) day, group I], and 403 after 24 hours [ (7.5 ? 7.3) days, group II] of hospitalization (P

Percutaneous transluminal septal myocardial ablation in patients with hypertrophic obstructive cardiomyopathy / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the immediate and follow-up results of percutaneous transluminal septal myocardial ablation (PTSMA) in patients with hypertrophic obstructive cardiomyopathy (HOCM).</p><p><b>METHODS</b>Fifteen symptomatic, drug-refractory patients with HOCM underwent PTSMA procedures with application of a myocardial contrast echocardiography (MCE) intra-procedure. Before and after the procedure, clinical evaluations were obtained in all patients, who were followed up for a mean period of 8.6 +/- 3.8 (6-20) months.</p><p><b>RESULTS</b>Immediate left ventricular outflow tract gradient (LVOTG) reduction was achieved (77.93 +/- 22 mm Hg vs 14.8 +/- 15 mm Hg, P < 0.0001) after the procedure with a mean decrease of 5.75 +/- 2.87 mm Hg of left ventricular end diastolic pressure (P < 0.001). Follow up results revealed that ventricular remodelling occurred mainly 1-3 months after the procedure, but without evidence of ventricular dilation and contract dysfunction. Heart function (NYHA) was greatly improved (3.4 +/- 0.5 vs 1.1 +/- 0.4, P < 0.001) and exercise endurance increased. A renewed increase of LVOTG was found in 2 patients during follow-up.</p><p><b>CONCLUSIONS</b>LVOTG was greatly decreased in HOCM patients undergoing a PTSMA procedure, and their symptoms were greatly improved without cardiac complications during follow-up. Sub-selection and reopening of target vessels were the causes of renewed increase of LVOTG, and this can be avoided with the accumulation of experience. This is a promising method for the treatment of symptomatic patients with HOCM.</p>

The observation of right chest electric admittance plethsmography in patients with coronary heart disease / 中国介入心脏病学杂志

The right chest electric admittance plethsmography (RCEAP) is a simple no invasive and reliable method in detecting the blood flow volume in the pulmomary artery and vein, an indirection of the left heart function. In this clinical study, the RCEAP, left heart catheterization for measurement of LVEDP and coronary angiogram and echocardiography for investigating the LVEF were performed on 34 patients with coronary heart disease. Of these 34 patients,24 had single or no left vessel lesion (Group A), 10 had left main coronary artery or its double branches lesions (Group B) ;8 underwent percutaneous trans-lumin coronary angioplasty (PTCA)and 10 had coronary artery bypass graft (CABG).The data obtained were analysed and compared to evaluate their respective diagnostic values. Correlation analysis demonstrated the values of hc/hz ratio, ha/hz ratio were moderated with LVEDP(r = 0. 68 or 0. 73,P

Establishment and evaluation of rat model of acute stress during chronic heart failure / 西安交通大学学报(医学版)

Objective To establish the rat model of acute stress during chronic heart failure and evaluate it.Methods Male Wistar rats were injected adrimycin(ADR)via abdominal cavity to induce heart failure.Cardiovascular dynamics and heart pathology were measured.Rats with heart failure received bacterial lipopolysaccharide(LPS)0.2 mg/kg by peritoneal injection to induce acute stress,and we measured blood pressure,heart rate and the expression of HO-1 after LPS injection.Results ADR peritoneal injection led to heart failure successfully.Compared with that in normal group,left ventricular function(?LVdp/dtmax)of rats in model group reduced significantly,and myocardial fibrosis and hypertrophy occurred,too.LPS peritoneal injection led to acute stress in rats with heart failure.Heart rate and blood pressure began to rise 0.5 h after LPS injection and reached at 1 h after LPS injection.The expression of myocardium HO-1 increased at 6 h and was significantly higher at 12 h after LPS injection.The expression of HO-1 was higher in model group than in normal group.Conclusion LPS peritoneal injection successfully leads to acute stress in rats with heart failure,providing a reliable model for study of decompensated heart failure.