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Objective:To analyze the effect of elevated pulmonary artery pressure measured by echocardiography on clinical characteristics and adverse events in patients with acute pulmonary embolism.Methods:Retrospective analysis hospitalized patients with acute pulmonary embolism diagnosed in Beijing Anzhen Hospital Affiliated to Capital Medical University from January 1, 2018 to December 31, 2020 were divided into elevated pulmonary artery pressure group and control group according to pulmonary artery pressure measured by echocardiography. The differences between the two groups in admission baseline data, admission basic situation, admission hematology examination, admission imaging examination, in-hospital medication and in-hospital adverse events were compared.Results:A total of 568 patients with acute pulmonary embolism were included, including 178 in the elevated pulmonary artery pressure group and 390 in the control group. The data analysis of the two groups showed that the proportion of height, weight, body mass index, smoking history, coronary heart disease history, stroke history, diabetes history, chronic heart failure history, chronic obstructive pulmonary disease history and chronic renal insufficiency history in the group with elevated pulmonary artery pressure was significantly higher than that in the control group. The proportion of fracture in the group with elevated pulmonary artery pressure was significantly lower than that in the control group, and the proportion of tumor and heart rate were significantly higher than those in the control group. The hemoglobin, international standardized ratio, D-dimer, PaO 2, SaO 2, etc. of patients with elevated pulmonary artery pressure were significantly lower than those of the control group, and TnI, B-type natriuretic peptide, etc. were significantly higher than those of the control group. The left ventricular ejection fraction of patients with elevated pulmonary artery pressure was significantly lower than those of the control group, and the left ventricular end diastolic diameter, the proportion of mitral regurgitation, the proportion of tricuspid regurgitation, and the proportion of pulmonary artery embolism were significantly higher than those of the control group. The use proportion of rivaroxaban in patients with elevated pulmonary artery pressure was significantly lower than that in the control group, and the use proportion of aspirin and warfarin was significantly higher than that in the control group. The incidence of all-cause death, acute heart failure and in-hospital hemorrhage in the group with elevated pulmonary artery pressure was significantly higher than that in the control group. There was no significant difference in other indexes between the two groups. Conclusions:There are some differences in clinical characteristics and prognosis between patients with acute pulmonary embolism complicated with elevated pulmonary artery pressure and patients with normal pulmonary artery pressure. The increase of pulmonary artery pressure may increase the risk of all-cause death, acute heart failure and nosocomial bleeding to a certain extent.
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Objective To illustrate the clinical characteristics of elderly patients with Stanford type A aortic dissection and to discuss the incidence of such inpatients' adverse events. Methods A retrospective study was conducted, 588 patients with definite diagnosis of Stanford type A aortic dissection admitted to Beijing Anzhen Hospital of Capital Medical University from January 2013 to December 2015 were enrolled, and they were divided into an elderly group (≥60 years, 79 cases) and a non-elderly group (< 60 years, 509 cases). The differences of general clinical data, results of hospitalization-related examinations, medication for treatment, surgical intervention and inpatient adverse events between the two groups were compared. Results Compared with non-elderly group, the proportion of male, age, stature, body mass index (BMI), proportion of alcohol history, hemoglobin (Hb), incidence of acute liver failure in hospital in elderly group were decreased significantly [proportion of male: 60.8% (48/79) vs. 80.6% (410/504), age (years):64.81±4.66 vs. 45.05±8.63, stature (cm): 169.41±8.09 vs. 173.39±7.59, BMI (kg/m2): 24.24±2.93 vs. 25.50±3.82, proportion of alcohol history: 12.7% (10/79) vs. 22.4% (114/509), Hb (g/L): 122.62±21.14 vs. 128.42±23.44, incidence of acute liver failure: 0 (0/79) vs. 5.3% (21/509), all P < 0.05], the proportion of diabetes history, proportion of cerebrovascular diseases, all-cause mortality in this hospital in elderly group were increased significantly [proportion of diabetes history: 24.1% (62/79) vs. 8.8% (45/509), proportion of cerebrovascular diseases: 6.3% (5/79) vs. 2.2% (11/509), all-cause mortality: 16.5% (13/79) vs. 7.1% (36/509), all P < 0.05], and the left ventricular end diastolic internal diameter (LVEDD) in elderly group decreased significantly (mm: 48.38±6.11 vs. 50.77±7.56, P <0.05). Conclusion The elderly patients with Stanford type A aortic dissection suffer from more complications and higher mortality, therefore, the risk consciousness should be strengthened for the senile patients and more attention should be paid on the prevention of the elderly inpatients' adverse events.
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Objective To analyze death causes in patients with acute myocardial infarction complicated by cardiac rupture.Methods The patients who were admitted with cardiac rupture after acute myocardial infarction in Beijing Anzhen Hospital Affiliated to Capital Medical University from January 2012 to December 2014 were enrolled.These patients were divided into death group and survival group.Then statistical analysis was performed for the clinical data of these patients in two groups,Logistic regression analysis was used to analyze the risk factors with statistical significance.Results A total of 59 patients diagnosed cardiac rupture after acute myocardial infarction were enrolled in this study,including 50 patients died,and 9 patients survived.There were significant differences between the two groups of patients with clinical baseline data.Compared with the survival group,death group had higher age ((69.94 ± 9.24) years old vs.(61.56 ± 9.14) years old,t =2.511,P =0.015),the higher incidence of malignant arrhythmia (22.0％ vs.0,x2 =4.070,P =0.044),the lower proportion of alcohol abuse (12.0％ vs.44.4％,x2 =5.704,P =0.017),higher fasting blood glucose ((8.97 ±3.98) mmol/L vs.(6.06± 1.25) mmol/L,t =4.153,P＜0.01) and triglycerides ((1.78±0.50) mmol/L vs.(1.39±0.20) mmol/L,t =4.146,P＜0.01),higher proportion of pulmonary arterial hypertension(22.0％ vs.0,x2 =4.070,P =0.044) and brain natriuretic peptide (406.50 (110.00,570.28) ng/L vs.33.00 (20.00,176.00) ng/L,P=0.004),smaller the left ventricular end diastolic diameter((47.76±5.13) mm vs.(52.22 ±4.66) mm,t =-2.434,P =0.018).The use of fondaparinux sodium (26.0％ vs.0,x2 =4.920,P =0.027),heparin (48.0％ vs.88.9％,x2 =5.138,P =0.023) and nitrates (72.0％ vs.100.0％,x2 =5.361,P =0.021)were significantly differences.The occurrence of acute heart failure in patients in death group was significantly higher than the survival group (11.0％ vs.0,x2 =3.258,P =0.071),but the difference was not significant.Logistic regression analysis showed that old age (OR =1.151),fasting blood glucose (OR =1.974)and heart rupture were significandy correlated (P＜ 0.05).Conclusion Cardiac rupture patients have a high mortality rate after myocardial infarction.Advanced age and fasting blood glucose were risk factors,while the use of common heparin is protective factor.Patients should be evaluated in a timely manner to assess the prognosis and to take targeted measures.
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Objective To analyze the clinical features and prognosis of patients with acute myocardial infarction (AMI) complicated with different parts of heart rupture. Methods Patients diagnosed for AMI complicated with cardiac rupture from January 2010 to December 2015 in Beijing Anzhen Hospital were collected. All of them were divided into free wall rupture group and ventricular septal perforation group according to the rupture site. Clinical features, hospital related examination results, treatment and prognosis of these two groups were analyzed statistically. Results A total of 120 patients with AMI complicated with cardiac rupture were included in the study, including 64 patients with free wall rupture, and 56 patients with ventricular septal perforation. Compared with the ventricular septal perforation group by the single factor analysis, the patients in free wall rupture group had higher age (year: 68.88±9.31 vs. 63.86±8.68, t = 3.039, P = 0.003), lower body mass index [BMI (kg/m2): 22.74±2.07 vs. 25.21±2.99, t = -5.203, P = 0.000], higher rate of history of renal insufficiency (12.5% vs. 1.8%, χ2 = 4.942, P = 0.026), higher level of aspartate transaminase [AST (U/L): 76.00 (38.33, 197.50) vs. 33.50 (19.00, 137.50), Z = -2.788, P = 0.005], triglyceride [TG (mmol/L): 1.68±0.50 vs. 1.36±0.70, t = 2.903, P = 0.005], total cholesterol [TC (mmol/L): 4.21±0.74 vs. 3.87±1.01, t = 2.081, P = 0.040], high density lipoprotein cholesterol [HDL-C (mmol/L): 1.12±0.91 vs. 0.91±0.32, t = 2.910, P = 0.004] and cardiac troponin I [cTnI (μg/L): 18.83 (4.48, 81.68) vs. 0.82 (0.08, 8.50), Z =-5.011, P = 0.000], lower level of blood urea nitrogen [BUN (mmol/L): 7.11±3.11 vs. 10.14±6.97, t = -2.999, P = 0.004], brain natriuretic peptide [BNP (ng/L): 169.00 (98.50, 485.75) vs. 793.00 (478.75, 1 426.25), Z = -5.739, P = 0.000], and D-dimer [μg/L: 219.00 (141.00, 315.75) vs. 310.50 (188.75, 532.00), Z = -2.607, P = 0.009], smaller left ventricular end diastolic diameter [LVEDD (mm): 48.58±5.17 vs. 53.65±6.63, t = -4.631, P = 0.000] and left ventricular end systolic diameter [LVESD (mm): 33.54±5.40 vs. 37.24±6.53, t = -3.397, P = 0.001], lower proportion of left ventricular aneurysm formation [14.1% (9/64) vs. 76.8% (43/56), χ2 = 47.851, P = 0.000] and pulmonary arterial hypertension [20.3% (13/64) vs. 53.6% (30/56), χ2 = 14.368, P = 0.000], higher usage rate of aspirin [100% (64/64) vs. 75.0% (42/56), χ2 = 18.113, P = 0.000], clopidogrel usage rate [82.8% (53/6) vs. 46.4% (26/56), χ2 = 17.578, P = 0.000], ticagrelor usage rate [12.5% (8/64) vs. 1.8% (1/56), χ2 = 4.924, P = 0.026], and common heparin usage rate [53.1% (34/64) vs. 10.7% (6/56), χ2 = 24.174, P = 0.000], lower usage rate of nitrates [70.3% (45/64) vs. 85.7% (48/56), χ2 = 4.063, P = 0.044], higher percutaneous coronary intervention (PCI) operation rate [42.9% (27/64) vs. 12.5% (7/56), χ2 = 13.388, P = 0.000], lower coronary artery bypass graft (CABG) surgery rate [7.8% (5/64) vs. 48.2% (27/56), χ2 = 24.930, P = 0.000], success rate of CABG surgery [60.0% (3/5) vs. 100% (27/27), χ2 = 8.233, P = 0.004], and incidence rate of cerebral infarction in hospital [1.6% (1/64) vs. 10.7% (6/56), χ2 = 4.554, P = 0.033], higher hospital all-cause mortality [85.9% (55/64) vs. 23.2% (13/56), χ2 = 47.851, P = 0.000]. The differences of other indicators were not statistically sig nificant. Conclusions Patients with AMI complicated with free wall rupture usually have more risk factors and worse prognosis. These two types of patients should be treated with target.
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Objective: To evaluate clinical features with in-hospital and long-term prognosis of acute myocardial infarction (AMI) in patients ≤40 years of age by different genders and to analyze the predictors for major adverse cardiovascular event (MACE) occurrence. Methods: A total of 685 AMI patients ≤40 years treated in our hospital from 2012-01-01 to 2015-08-31 were consecutively enrolled. The patients were divided into 2 groups by gender: Male group,n=650 and Female group,n=35. The baseline data, clinical features, in-hospital MACE incidence were collected by telephone communication and compared between 2 groups; the long-term risk factors for MACE occurrence were analyzed. Results: The AMI ratio in male patients was 94.89%, in female was 5.11% and the onset age in Male group was higher than Female group (35.53±4.21) years vs (34.05±4.98) years,P=0.046. Compared with Female group, Male group showed the lower rates of coronary left main diseases (3.2% vs 11.4%,P=0.012) and in-hospital heart failure (8.3% vs 25.7%,P=0.001). The median follow-up time was of 727.0 (411.5, 1102.0) days and during that period, MACE occurrence rates in Male group was 46 (7.1%) cases and in Female group was 2 (5.7%) cases,P=0.758. Increased level of hs-TnI, (OR=1.003, 95% CI 1.001-1.006,P=0.020) and multi coronary artery disease (OR=1.964, 95% CI 1.018-3.790,P=0.044) were the independent predictors for long- term adverse event occurrence; while PCI (OR=0.475, 95% CI 0.241-0.936,P=0.031) was the protector for long-term prognosis in young male AMI patients. Conclusion: AMI patients≤40 years were mainly in male gender, the mean onset age in male was elder than female. Increased hs-TnI level and multi coronary artery disease were the predictors for MACE occurrence, while PCI was the protective factor for long-term prognosis in young male AMI patients.
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BACKGROUND:In vitro studies have demonstrated that basic fibroblast growth factor (bFGF) promote the differentiation of bone marrow mesenchymal stem cells (BMSCs) into cardiomyocyte-like cells. However, it is unclear whether coronary venous retroperfusion of bFGF stimulates BMSCs differentiation in vivo. OBJECTIVE:To evaluate the effects of coronary venous retroperfusion of bFGF on BMSCs differentiation in vivo. METHODS:BMSCs from 12 dogs were isolated by density gradient centrifugation and expanded in vitro. These cells were transfected by enhanced green fluorescence protein (EGFP) lentiviral vector and the transfection efficiency was analyzed. Acute myocardial infarction was induced by ligation of left anterior descending coronary artery. After 1 week, 10 survival animals were randomized to BMSCs group (n=5) and bFGF+BMSCs group (n=5). bFGF-and EGFP-positive BMSCs were reversely infused via coronary vein using over-the-wire bal oon catheter. One week after infusion, the number of EGFP-positive cells co-staining factor VIII and troponin I was compared between the two groups by immunofluorescence method. RESULTS AND CONCLUSION:BMSCs were successful y transfected by EGFP and the transfection efficiency was 85%. Immunofluorescence showed that EGFP-positive BMSCs were observed in 23.5%of slides. There were more EGFP-positive cells co-staining VIII and troponin I in the bFGF+BMSCs group than in the BMSCs group (P<0.05). Thus, the coronary venous retroperfusion of bFGF enhances the differentiation of BMSCs into vascular endothelial cells and cardiomyocytes. Combined delivery of bFGF and BMSCs can exert a synergistic effect to promote cardiac repair.