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Objective@#To explore the feasibility and safety of a newly developed simple and rapid axillary vein puncture technique based on the surface landmarks for pacemaker implantation.@*Methods@#From January to November 2018, we enrolled 110 patients who underwent pacemaker implantation in Beijing Anzhen Hospital. Basic clinical characteristics, such as gender, age, major diagnosis, type of pacemaker, and His-purkinje system pacing, were collected. The success rate of this axillary vein puncture technique, complications, and technical parameters of present puncture method were analyzed.@*Results@#There were 58 (52.7%) male patients in this cohort and the average aged was (70.26±10.45) years old. This "blind" axillary vein puncture method was successful in 105 out of 110 patients (95.5%). The relevant puncture-related parameters included: the distance between points "a and b" was (3.89±0.40) cm, the first angle α was (25.84±5.54)° and the second angle β was (66.18±10.26)°. There were no puncture-related complications, such as hematoma, pneumothorax and hemothorax.@*Conclusion@#The new "blind" axillary vein puncture approach is a simple, effective and safe technique for pacemaker implantation, which is easy to learn and practice and suitable for promotion.
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Objective To explore the effect of the severity of coronary artery on left ventricular diastolic function in patients with unstable angina (UA).Methods One hundred and seventy-two patients with UA consecutively from December 2010 to August 2011 were enrolled.All patients underwent coronary angiography (CAG) and echocardiography.The patients were divided into four groups according to left ventricular diastolic function by echocardiography:Thirty-eight subjects with normal(Non-HFNEF),45 subjects with mild dysfunction (Grade Ⅰ),57 subjects with moderate dysfunction(Grade Ⅱ) and 32 subjects with severe dysfunction grade (Grade Ⅲ).The effect of the severity of coronary artery on the left ventricular diastolic function was analyzed.Results There were significant difference on left atrial dimension (3.24 ± 0.50) nn vs (3.40 ±0.41) mmvs (3.56±0.44) mm vs (3.78 ±0.36) mm (F=21.454,P＜0.001),left ventricular posterior wall (0.84 ±0.11) mm vs (0.90 ±0.12) mm vs (0.92 ±0.09) ram vs (0.94 ±0.15) mm (F =10.743,P ＜ 0.001) and left ventricular mass index (105.63 ± 33.13) g/m2 vs (113.09 ± 21.55) g/m2 vs (122.26 ±41.52) g/m2 vs (132.96 ± 31.06) g/m2(F =9.746,P ＜ 0.001) among the four groups.Diastolic function was significantly correlated with the severity of coronary artery(r =0.466,P ＜ 0.001).Conclusion In the patients with UA,left ventricular diastolic function was significantly influenced by the extent of coronary artery stenosis.
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Objective To explore the difference of the clinical manifestations between the elderly and non-elderly patients with non-massive pulmonary thromboembolism (PTE) and the significance of D-dimer in the diagnosis of PTE and its dynamic change after anticoagulant therapy.Methods The clinical manifestations of 83 cases with PTE were retrospectively analysed and divided into two groups:39 elderly and 44 non-elderly.The dynamic changing of D-dimer content was determined by immunoturbidimetry(ITM) method before and 3 d after anticoagulant therapy in the two groups.Results There were no significant statistical differences in the incidence of the main symptoms:dyspnea,cough,emptysis,syncope,palpitations between the elderly and the non-elderly (x2 =2.74,0.06,0.10,0.49,0.01,P＞0.05) except for the incidence of chest pain [14 cases (35.9 ％) vs.30 cases (68.2 ％),x2 =4.95,P ＜ 0.05].No differences were found in the the main signs:shortness of breath,tachycardia,accentuation or split of second pulmonary valve sound,cyanosis,and engorgement of neck veins between the two groups (x2 =2.60,0.03,0.61,0.06,0.33,0.11,P＞0.05).D-dimer content was lower in the elderly than in the non-elderly [(1.89±1.21) mg/L vs.(4.93±3.88) mg/L,Z=-2.55,P=0.01] before anticoagulant therapy.But there was no difference in D -dimer content between the two groups 3 d after anticoagulant therapy [( 1.28 ±1.11) mg/L vs.(2.09±2.22) mg/L,Z=-7.07,P=0.50].The decreasing level of D-dimer was less prominent in the elderly than in the non-elderly [(0.61±1.01) mg/Lvs.(2.84±2.95) mg/L,Z=-3.54,P=0.001].Conclusions The main clinical manifestations are similar between the elderly and non-elderly with non-massive PTE,but the incidence of chest pain is less in the elderly than in the non-elderly.The content of D-dimer is lower in the elderly than non-elderly after PTE and its decrements are less prominent in the elderly than the non-elderly after anticoagulant therapy.
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Objectives By measuring left ventricular diastolic function and arterial stiffness,this study aims to probe into the effect of diabetes mellitus(DM) on left ventricular diastolic function and arterial stiffness,and evaluate the correlation between left ventricular diastolic funotion and arterial stiffness.Methods Seventy-six inpatients were enrolled.According to their coronary angiography,OGTF test results and past history of DM,patients were divided into controlled,CHD(coronary heart disease with no DM),and CHD+DM groups.Through invasive hemodynamic monitoring during left ventricular angiography,left ventricular end-diastolic pressure(LVEDP)and tan index were collected.Carotid-femoral pulse wave velocity(c-f PWV),reflected wave augmentation index (AIx@75) and other data reflecting the degree of arterial stiffness were collected bedside with non-invasive means.SPSS 18.0 was used for statistical analysis.Results No significant difference was found between groups for LVEDP,tau index,and AIx@75.In terms of c-f PMV,The CHD+DM group(8.79±1.59)cm/s differed significantly from the CHD group (7.43±1.42)cm/s and the controlled group(6.83±1.14)cm/s.No correlations were found between c-f PMV and LVEDP or tau index.A positive correlation was found between AIx@75 and tau index.Conclusions Compared with the controlled group and CHD patients with no DM,CHD+DM patients show worse arterial stiffness with no difference in ventricular diastolic function.There is a positive correlation between arterial stiffness and diastolic dysfunction.
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Objective To investigate the relationship between brachial-ankle pulse wave velocity (baPWV)and different stage of cardiac dysfunction.Methods 253 consecutive patients with coronary atherosclerotic heart disease were enrolled from August 2006 to February 2007.Patients were grouped according to the functional classification of New York Heart Association(NYHA).The baPWV was measured non-invasively with a VP1000 automated PWV/ABI analyzer(PWV/ABI,Colin CO.Ltd.,Komaki.Japan).At the sanle time,BNP,EF,LAEDV and LVESV were measured in all the patients.Results Brachial-ankle PWV was significantly correlated with cardiac function classification of NYHA(r=0.444.P＜O.001),BNP(r=0.394,P＜0.001)and left ventriculat end diastolic volume(r=-0.130,P＜0.05),The under area of receiver operating charachateistic(ROC)curve was 73.9%.The ROC curve demonstrated that when the value of brachial-ankle PWV was equal to or larger than 1717 cm/s(≥1717 cm/s),the sensitivity of diagnosing mild cardiac dysfunction was 72.9%and specifity 61.8%.When its value was equal to or larger than 1900 cm/s(≥1900 cm/s),the sensitivity and specificity were 61.5%and 81.9% respectively.Conclusion Brachial-ankle PWV is significantly correlated to the NYHA classification of heart failure and it may be a prospective index to diagnose early stage of cardiac dysfunction.
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Objective To investigate the association between glucose metabolism status and brachial-ankle pulse wave velocity(baPWV)in Chinese patients with coronary artery disease(CAD).Methods baPWV values were measured in 198 CAD patients.Plasma glncose,serum lipids,hsCRP and other baseline data were obtained in all the patients.According to the glucose level,the participants were divided into 3 groups:normal glucose tolerance(NGT)group,impaired glucose regulation(IGR)group and diabetes mellitus(DM)group.ResultsbaPWV values in the DM group(1807±381)cm/s were significantly higher than those in the NGT group[(1615±248)cm/s,P=0.000]and IGR group[(1674±277)cm/s.P=0.035].Multiple stepwise linear regression analyses indicated that higher baPWv values were associated with aging and hsCRP levels in 198 patients.In DM group,higher baPWV values were independently associated with aging and HbA1 C levels.Conclusions In patients with coronary artery disease.baPWV values increase with different glucose metabolism status from NGT to IGR then DM.baPWV values in the patients with DM were significantly higher than those in the other two groups.Glycemic control may ameliorate arterial stiffness.
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Objective To assess the predictive value of serum uric acid levels for cardiovascular and all-cause mortality in a large prospective population based study.Methods The study was based on 3648 participants in Shanghai and Beijing,who were inpatients with high cardiovascular(CV) risk at baseLine (2004.7 to 2005.1),and blood was taken.Follow-up for death from cardiovascular disease and any cause was complete until January 1,2006.Results The mean follow-up was 1 years.There were 303 deaths during follow-up,of which 121 were cardiovascular.Crude mortality rates were 8.3 % for all patients,6.8% for female patients (116/1715),and 9.7% (187/1933) for male patients.Among men,patients in the lower and higher uric acid groups had increased cardiac and overall mortality risks compared with patients in the normal uric acid groups.Similar relation was found in women but not statistically significant.After adjusting for other conventional risk factors (age,diabetes,hypertension,diuretic use and smoking),baseline uric acid level was still associated with increased risk for death from cardiovascular disease (P=0.005),or death from all causes (P=0.014) Conclusion Our data suggest that abnormal serum uric acid levels are independently and significantly associated with risk of cardiovascular and all-cause mortality.(J Geriatr Cardiol 2008;5:15-20)