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Objective To assess and compare the incidence,clinical characteristics,treatment,and prognosis of acute heart failure patients from different grades hospitals in Beijing.Methods In this prospective internet prognosis registered study (Beijing AHF Registry),a total of 3 335 consecutive patients admitted to 14 emergency departments in Beijing from January 1st 2011 to September 23rd 2012 were enrolled.According to hospital grade,these patients were divided into two groups,349 patients were from secondary hospitals,and 2 956 patients were from tertiary hospitals.Results Among the 3 335 patients,the medium age was 71 (58,79) years,and male accounted for 53.16％.The most common underlying disease were coronary disease (43.27％),hypertension (17.73％),cardiomyopathy (16.07％) etc.The average treatment time in Emergency Department was 66.82 h.The emergency department mortality rate was 3.81％ (127 cases).The 30-day and 1-year cumulative all-cause mortality were 15.3％ and 32.27％,respectively.The 30-day and 1-year cumulative all-cause readmission were 15.64％ and 46.89％,respectively.Compared with patients in tertiary hospitals,patients in secondary hospitals had more onset acute heart failure patients (63.64％ vs.49.93％),shorter emergency department treatment time (12 h vs.41 h),lower discharge rate (3.43％ vs.37.45％) and emergency department mortality(1.58％ vs.4.09％).Compared with those in tertiary hospitals,1-year cumulative all-cause mortality (25.6％ vs.33.2％),cardiovascular disease mortality (20.2％ vs.26.0％),aggravated heart failure mortality (22.4％ vs.28.8％) were lower in secondary hospitals.Following propensity score matching,compared to tertiary hospitals,patients in secondary hospitals showed lower utilization rate of beta-blockers and ACEFARB (4.51％ vs.28.17％,1.41％ vs.9.58％),except the pironolactone.Conclusion Acute heart failure in emergency department is associated with a high mortality rate and readmission rate.There is still a big gap between guidelines recommend medication current treatments for acute heart failure.
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Objective To investigate the reliability of electrocardiographic (ECG) signal for the accurate assessment of myocardial ischemia in order to evaluate the clinical value of remote real-time ECG monitoring system based on GPRS in patients with acute ST-elevation myocardial infarction (STEMI).Methods A total of 60 STEMI patients admitted between April 2008 and December 2010 were enrolled.All subjects were given the remote real-time ECG monitoring and routine 12 leads ECG monitoring at the same time.They were divided into remote ECG group and the 12 leads ECG group.The remote real-time ECG monitoring collects electrocardiosignal to imitate V1,V3,V5 lead and Ⅰ lead.P wave duration,PR interval,duration of time limit of QRS wave and T wave,QT interval,and the P wave amplitude,QRS wave amplitude,R-(Q + S),T wave amplitude were measured,and the detectability rate of arrhythmia and the definited diagnosis rate of ST segment elevation in accordance with clinical manifestion were compared in each group with different parameters.The data were analyzed by t test,rank sum test,Pearson correlation analysis,Spearman's rank correlation and the chi-square test.Results In STEMI patients,there were no statistical differences in time limits and amplitude of waves on ECG between the two groups (P ＞ 0.05),and the correlations between parameters of two groups were found to be close (P ＜ 0.01).There was no difference in the detectability rate of cardiac arrhythmia between two groups (P ＞ 0.05),and no difference in the rate of correct diagnosis of elevated ST segment between two groups (P ＞ 0.05),except V1 lead (P ＜ 0.05).Conclusions The sensitivity of the change in ST segment of the two groups is similar,and the remote real-time ECG monitoring can help determine the location of myocardial ischemia.
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Objective To investigate the effects of atorvastatin on the improvement of cardiac function of mice with myocarditis.Methods A total of 146 Balb/c mice were divided into four groups randomly(random number).The viral myocarditis(VMC)model was made by Coxsakie virus B3(CVB)injected intra-abdominally.Four groups were normal group(n =18),VMC group(n =60),Control group (n=18)and VMCtreatment group(n =50).The mice of control group were treated with atorvastatin without VMC,and the mice of VMC treatment group were with VMC and were given atorvastatin for 2 weeks.Echocardiograms were used 3,7,10,14,21,and 30 days after virus inoculation.Blood samples were collected for cardiac troponin-Ⅰ detection at the same time.Myocardial inflammation was examined by using histochemistry staining.The changes of myocardial collagen fiber,myocardial cells and various organelles were examined by electron microscope.Results Compared with VMC group,the cumulative survival rate of VMC group treatment group was higher(87.0％ vs 59.2％)after treatment with atorvastatin for 30 days (P =0.008),and the improvement of pathological features after treatment with atorvastatin was found 10,14,21 and 30 days after the inoculation.Compared with control group,the cardiac function was decreased in the CVB infected mice 7 days after virus challenge[(69.82 ±5.12)vs(89.23 ±2.01),P ＜0.01]and compared with VMC group,the EF values of VMC treatment group were significantly higher 7,14,21and 30 days after virus inoculation.The differences in cTnI values between VMC group and CVB treatment group were statistically significant 7,10,14 and 21 days after virus challenge.Conclusions These results demonstrate that atorvastatin improves survival rates and the histological features in CVB3m-induced myocarditis.It can improve the heart function of CVB infected mice.Atorvastatin could be a treatment of choice for VMC.
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Objective: To analysis the clinical characteristic and pathogenic bacterium of infective endocarditis (IE),and to compare the pathogenic microorganism and vegetation localization between the prosthetic valve endocarditis (PVE) and the native valve endocarditis (NVE).Methods: The data was collected from 266 in-patients who fulfilled Duke Criteria for IE from May 2003 to May 2008 in our hospital.The demographics and clinical data were analyzed retrospectively.Results: There were 243/266 of IE patients suffered from basic heart disease,among them,101 patients with congenital heart disease,77 patients with non-rheumatic valvular heart disease,62 with rheumatic heart disease and 3 with other heart disease.There were 218 (82%) patients with identified vegetation,and the most common vegetation localized at aortic valve,mitral valve,and aortic plus mitral valve in turn.Bacterial cultures were positive in 49.5% of patients.The proportion of Gram-Negative bacillus and Fungi infection had risen in IE.Detection rate of vegetation was lower in PVE patients than that in NVE patients (P<0.01).However,the positive bacterial culture rate was higher in PVE than in NVE (P<0.01).Streptococcus,coagulase negative staphylococcus,gram-negative bacteria showed significant difference between the two groups (P<0.05).The spectrum of microorganism was different between the early and the late PVE patients.The in-hospital mortality rate of PVE was higher than NVE.Conclusion: The spectrum and pathogenic bacterium of IE had changed obviously during the past years.Early diagnosis,bacterial culture with correct antibacterial treatment,transesophageal echocardiography,and active prevention of nosocomial infection should be essential for the disease control.