ABSTRACT
OBJECTIVE@#To explore incidence, risk factors and the relationship between preoperative heart failure and prognosis in elderly patients with hip fracture.@*METHODS@#A retrospective analysis was performed on 1 569 elderly patients with hip fracture treated from January 2012 to December 2019, including 522 males and 1 047 females, aged 81.00 (75.00, 90.00) years old;896 intertrochanteric fractures and 673 femoral neck fractures. Patients were divided into heart failure and non-heart failure groups according to whether they developed heart failure before surgery, and heart failure was set as the dependent variable, with independent variables including age, gender, fracture type, comorbidities and hematological indicators, etc. Univariate analysis was performed at first, and independent variables with statistical differences were included in multivariate Logistic regression analysis. Independent risk factors for preoperative heart failure were obtained. The length of hospital stay, perioperative complications, mortality at 30 days and 1 year after surgery were compared between heart failure and non-heart failure groups.@*RESULTS@#There were 91 patients in heart failure group, including 40 males and 51 females, aged 82.00 (79.00, 87.00) years old;55 patients with intertrochanteric fracture and 36 patients with femoral neck fracture. There were 1 478 patients in non-heart failure groups, including 482 males and 996 females, aged 81.00(75.00, 86.00) years old;841 patients with intertrochanteric fracture and 637 patients with femoral neck fracture. There were significant differences in age, sex, coronary heart disease, arrhythmia and dementia between two groups(P<0.05). Multivariate Logistic analysis of statistically significant factors showed that males(OR=1.609, P=0.032), age(OR=1.032, P=0.031), arrhythmia(OR=2.045, P=0.006), dementia (OR=2.106, P=0.014) were independent risk factor for preoperative heart failure. The 30-day and 1-year mortality rates were 9.9% and 26.4% in heart failure group and 3.6% and 13.8% in non-heart failure group, respectively;and had statistical significance between two groups (P<0.05). There were significant differences in pulmonary infection, cerebrovascular complications and cardiovascular complications between two groups (P<0.05). The duration of hospitalization in heart failure group was (16.21±10.64) d compared with that in non-heart failure group (13.26±8.00) d, and the difference was statistically significant (t=2.513, P=0.012).@*CONCLUSION@#Male, old age, arrhythmia and dementia are independent risk factors for heart failure after hip fracture in elderly patients. Patients with preoperative heart failure have a higher incidence of postoperative pulmonary infection, cerebrovascular and cardiovascular complications, higher mortality at 30 d and 1 year after surgery, and longer hospital stay.
Subject(s)
Aged , Female , Humans , Male , Aged, 80 and over , Retrospective Studies , Hip Fractures/surgery , Femoral Neck Fractures , Heart Failure/etiology , Prognosis , Heart Diseases , Risk Factors , Postoperative Complications/etiology , Dementia , Arrhythmias, CardiacABSTRACT
Objective To evaluate the feasibility of quantitative analysis software for myocardial contrast echocardiography (MCE) in assessment of myocardial perfusion.Methods According to coronary occlusion and reperfusion at different times,rabbits were divided into two groups:15 min occlusion / 30 min reperfusion (group Ⅰ) and 120 min occlusion / 60 min reperfusion (group Ⅱ).MCE was performed on all rabbits at baseline,occlusion and after reperfusion,and its images were analyzed by a new quantitative analysis software based on eliminating particle swarm optimization (EPSO) clustering algorithm,by which obtain myocardial perfusion parameters.Results (1) The values of calibrated contrast intensity (CI) in risk segments of Groups Ⅰ and Ⅱ were significantly lower than those at baseline during occlusion (t =5.104 and t =4.327,P＜0.01).After reperfusion,calibrated CI in risk segments significantly improved in Group Ⅰ (t =2.933,P＜0.01) while those remained unchanged in Group Ⅱ (P＞0.05).(2) The areas of red-coded region in color-coded map and myocardial infarction in triphenyl-tetrazolium chloride (TTC) were (21.4±12.3)% and (18.0±9.5)%,respectively.The correlation between color-coded image and TTC was 0.89 (P＜0.01).(3) The histogram in all risk segments was skew distribution during occlusion.After reperfusion,the histogram in Group Ⅰ was normal distribution while that was still skewed distribution in Group Ⅱ.Conclusion The MCE image analysis software based on EPSO clustering algorithm in the quantitative assessment of myocardial microperfusion and identification of myocardial perfusion abnormalities was feasible and of high value.
ABSTRACT
<p><b>OBJECTIVE</b>To evaluate the feasibility and value of determining myocardial perfusion and regional systolic function by myocardial contrast stress echocardiography (MCSE) with computer-assisted technique in a rabbit model of ischemia/reperfusion injury.</p><p><b>METHODS</b>Rabbits underwent 30-(Group I, n = 15) and 120-(Group II, n = 15) minute left ventricular branch of the left circumflex coronary artery occlusion foll owed by 60-minute reperfusion, dobutamine at increasing doses (5, 10, 15 and 20 microg.kg(-1).min(-1)) was then infused after reperfusion for 15 min. Bolus myocardial contrast agent was injected and MCSE performed at baseline, at the end of coronary occlusion and reperfusion, at the end of each dobutamine infusion. Images were analyzed by computer-assisted technique and myocardial calibrated contrast intensity (CI) of each segment was measured and a color-coded map was then obtained automatically (yellow: from 0 to -20 pix, blue:from -21 to -40 pix, green: from -41 to -70 pix, red: < -70 pix). The area at risk and infarct area obtained by red-coded map were compared with ex vivo results determined by fluorescent microsphere and triphenyl-tetrazolium chloride (TTC) staining. Percentage wall thickening (WT) of each risk segment at each stage were also measured.</p><p><b>RESULTS</b>(1) During occlusion, WT in the areas at risk decreased to zero or negative and the calibrated CI values were significantly lower than those at baseline. Area at risk obtained by red-coded map correlated well with that obtained by fluorescent staining (r = 0.91, P < 0.01). (2) After reperfusion and 5 microg.kg(-1).min(-1) dobutamine administration, WT and calibrated CI in all rabbits remained depressed. Calibrated CI at -70 pix was an optimal cutoff point to identify infarcted segments (sensitivity 95%, specificity 87%). The correlation between the infarct size by red-coded image and TTC was 0.89 (P < 0.01). (3) Calibrated CI and WT significantly improved in Group I rabbits while these parameters remained unchanged in Group II rabbits after increasing doses of dobutamine post ischemia.</p><p><b>CONCLUSIONS</b>Myocardial contrast stress echocardiography in combination with computer-assisted analysis technique are valuable techniques to quantitatively assess myocardial perfusion and regional systolic function and exactly identify stunned myocardium and infarcted myocardium.</p>