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Objective@#To explore the incidence and clinical characteristics of sarcopenia in hospitalized elderly patients with coronary heart disease and search for the related factors.@*Methods@#This study was a single-center observational study. According to the inclusion criteria, elderly patients hospitalized with coronary heart disease from Peking Union Medical College Hospital between December 2017 and December 2018 were enrolled. The patients were divided into sarcopenic group and non-sarcopenic group according to the diagnostic criteria of the Asian Working Group for Sarcopenia. Activities of daily living of the patients were assessed (including ADL and IADL) . Comorbidity of the patients was evaluated by the Charlson comorbidity index (CCI). Long-term medication use of the patients was recorded to assesse whether there was polypharmacy. The nutritional status of the patients was examined by the mini nutritional assessment-short form (MNA-SF). The full tandem stance time of the patients was evaluated. The history of falls over the previous year, urinary incontinence, and living conditions of the patients were also recorded. Multivariate logistic regression was used to analyze the related factors for sarcopenia of elderly patients with coronary heart disease.@*Results@#A total of 364 patients were enrolled in the study. The patients were aged 65-96 (74.6±6.5) years and there were 218 (59.9%) male patients. There were 264 cases of stable coronary heart disease and 100 cases of acute coronary syndrome. The median number of long-term used medication was 7. One hundred and fifty-two (41.8%) patients were complicated with type 2 diabetes, 38 (10.4%) patients were complicated with anxiety/depression, and 98 (26.9%) patients had the history of falls over the previous year. Eighty-two (22.5%) patients were complicated with urinary incontinence, 12 patients (3.3%) were complicated with malnutrition and 33 patients (9.2%) were living alone. There were 81 (22.3%) sarcopenic patients and 283 (77.7%) non-sarcopenic patients among all the hospitalized elderly patients with coronary heart disease. The sarcopenic patients were more older, with lower body mass index(BMI)(both P<0.001), higher CCI and more long-term used medication (both P<0.05), higher proportions of malnutrition, urinary incontinence, history of falls, and living alone (all P<0.05) compared to non-sarcopenic patients. ADL and IADL scores of sarcopenic patients were significantly lower than those of non-sarcopenic patients (both P<0.001). There was also a higher proportion of unable to accomplish full tandem stance among sarcopenic patients compared to non-sarcopenic patients (P<0.001). Moreover, higher hs-CRP level (P=0.047) , lower albumin level (P=0.004) and significantly lower prealbumin level (P<0.001) were observed in sarcopenic patients compared to non-sarcopenic patients. Stepwise multivariate binomial logistic regression analysis revealed that male (OR=5.036, 95%CI 1.782-14.230, P=0.002), low BMI (OR=0.883, 95%CI 0.796-0.980, P=0.019), as well as low prealbumin level (OR=0.990, 95%CI 0.980-1.000, P=0.045) were related factors for sarcopenia among elderly patients with coronary heart disease.@*Conclusions@#Sarcopenia is a geriatric condition commonly seen in hospitalized elderly patients with coronary heart disease. Male, low BMI, and low prealbumin level were the factors related to sarcopenia for older adults with coronary heart disease.
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Objective To explore the association between frailty and muscle performances of hospitalized elder adults with coronary artery disease.Methods A total of 122 hospitalized patients aged 65-85 years old with coronary artery disease from Department of Geriatrics and Cardiology,Peking Union Medical College Hospital between December 2017 and March 2018 were enrolled in the study.A comprehensive geriatric assessment was performed to evaluate existing comorbidity and geriatric syndromes of the patients.Frailty was assessed using the Clinical Fraity Scale.The patients were classified as frail and non-frail,according to the scale.Muscle performances were assessed using grip strength,gait speed,etc.Whole body and appendicular skeletal muscle mass was detected with bioelectrical impedance analysis in patients with reduced grip strength or slowed gait speed.Appendicular skeletal muscle index (ASMI) was calculated.Results Among all subjects,28 were with frailty (23.0％) and 94 were without (77.0％).The frail patients were older [(76.7±5.4) years vs.(72.2±5.6)years],had higher Charlson comorbidity index [2.0(1.0,2.75)vs.1.0(0,2.0)],and higher proportion of malnutrition (14.29％ vs.1.06％),urinary incontinence (39.29％ vs.15.96％),using walking-aid (28.57％ vs.6.38％),and more kinds of taken drugs (8.1±3.0 vs.6.6±2.7),than the non-frail patients.Prealbumin levels [(207.8±60.0)mg/L vs.(234.3±45.4)mg/L] were lower,and highly sensitive C-reactive protein levels [(5.89±9.57)mg/L vs.(1.89±2.49)mg/L] were higher in the frail patients than in the non-frail patients (all P＜0.05).Compared with non-frail patients,the frail patients had poorer grip strength [(19.67±7)kg vs.(29.23±8.29)kg] and slower gait speed [(0.54±0.2)m/s vs.(0.91±0.22)m/s](all P＜0.001).Spearman rank correlation analyses showed that grip strength was positively correlated with the appendicular skeletal muscle mass(r =0.811),whole body skeletal muscle mass(r =0.74) and the ASMI (r =0.783),respectively.Conclusions The incidence of frailty among hospitalized older adults with coronary artery disease is high.Poor muscle performances were common in these patients.Assessment of frailty and muscle performances can help to evaluate the overall function of older adults with cardiovascular disease in a comprehensive way.
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Objective To evaluate the expression profile of succinate dehydrogenase (SDH)B and SDHC in pheochromocytoma (PCC) and paraganglioma(PGL) (collectively abbreviated as PPGL), and their value in the early diagnosis of malignancy. Methods SDHB and SDHC immunohistochemistry were performed on 140 tumor specimens from 126 PPGL patients (PCC n＝62, PGL n＝61, PCC+PGL n＝3). Results (1) Germline mutation status of 67 patients were determined, of which, identifying 37(55.2%) patients with germline mutation: 2 (3.0%) SDHA, 18 ( 26. 9%) SDHB, 2 ( 3. 0%) SDHC, 5 ( 7. 5%) SDHD, 2 ( 3. 0%) VHL, 7 ( 10. 4%) RET, and 1(1.5%) NF1; and 30 (44.8%) individuals without known mutation. (2) Among 30 PPGLs from 27 patients with SDH-related (SDHx) mutations, 96.7%(29/30) stained negative for SDHB, 76.7%(23/30) stained negative for SDHC, while only 28.6%(14/49) and 18.4%(9/49) stained negative for SDHB and SDHC respectively in the 49 PPGLs without SDHx mutation (P<0.05). (3) The sensitivity of the SDH immunostaining in detecting the presence of germline SDHx mutation was 96.7%for SDHB and 76.7%for SDHC, while the specificity was 71.4%for SDHB and 81.6% for SDHC. ( 4 ) Among PPGLs without SDHB expression, 22. 9% were malignant. This percentage is significantly higher than that in PPGLs with preserved SDHB expression (3.8%, P<0.05). Conclusion SDHB and SDHC immunohistochemistry may serve as post-surgical screening tools to predict the presence of germline SDHx mutation in PPGLs. Negative SDHB expression calls for intense follow-up to rule out malignancy.
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Objective To prospectively analyze the impact of frailty on the short-term outcomes of coronary heart disease (CHD) and its related factors.Methods A total of 505 patients aged ≥65 years,with diagnosis of CHD in Cardiology Department and Geriatrics Department in our hospital were selected.Clinical data including geriatrics syndromes were collected by using Comprehensive Geriatrics Assessment (CGA).Frailty was defined according to the Clinical Frailty Scale (CFS).The impact of the comorbid conditions on the risk was quantified by the coronary artery disease-specific index.Patients were followed up by clinic visit or telephone consultation.Following-up items included recurrence of all-cause mortality,recurrence of cardiovascular events,and unscheduled returned visit.The impact of frailty on the prognosis of coronary heart disease was analyzed by Cox regression.Results Of the 505 patients,221 patients (43.76％) were considered to be frail elderly,in whom 126 patients (24.95％) were assessed as moderately to severely frail elderly.The incidences of comorbidities and geriatrics syndrome including incontinence,fall history,visual impairment,hearing impairment,constipation,chronic pain,sleeping disorder,dental problems,anxiety or depression,and delirium were higher in frail patients than in non-frail patients[51.1％ (113/221) vs.30.6％ (87/ 284),31.2％ (69/221) vs.19.0％ (54/284),43.9％ (97/221) vs.29.9％ (85/284),49.3％ (109/221) vs.29.6％ (84/284),60.2％ (133/221) vs.33.8％ (96/284),62.0％ (137/221) vs.46.8％ (133/284),49.3％ (109/221) vs.37.7％ (107/284),79.2％ (175/221) vs.55.6％ (158/284),11.3％ (25/221) vs.6.0％ (17/284),2.7％ (6/221) vs.0 (0/284),x2=21.831,10.053,10.510,20.519,34.894,11.481,6.886,30.695,4.624,7.803,respectively,all P＜0.05].After adjusting for sex,age,severity of illness and other coexist factors,the Cox survival analysis showed that frailty was the independent risk predictor for the all-cause mortality and unscheduled return visit in CHD patients (HR=2.881 and 1.835,95％CI:1.591-5.215 and 1.458-2.311,both P＜0.001).Conclusions Comprehensive Geriatrics Assessment and Clinical Frail Scale are useful to evaluate the clinical features in elderly CHD patients.Frailty is the independent risk predictor for the short-term prognosis including all-cause mortality and unscheduled return visit in elderly CHD patients.
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<p><b>OBJECTIVE</b>To investigate the impact of gender on early outcomes of patients with acute ST-segment elevation myocardial infarction (STEMI) who were treated with primary percutaneous coronary intervention (PCI) as their reperfusion strategy.</p><p><b>METHODS</b>The present study included consecutive patients with STEMI treated with primary PCI in our hospital from November 2003 to December 2012. Gender difference and predictors of 30 day all-cause death were examined among 957 patients, 197 of whom were women (20.6%). The impact of gender on 30 all-cause death was further evaluated by a propensity-matched analysis to adjust the differences in baseline characteristics between men and women.</p><p><b>RESULTS</b>Compared with men, women were older ((69.4±10.2) years old vs. (60.6±12.6) years old, P<0.001), more likely to have hypertension (72.1% (142/197) vs. 54.6% (415/760), P<0.001) and diabetes (45.2% (89/197) vs. 32.4% (246/760), P = 0.001), but less likely to be treated with β-blockers (85.3% (168/197) vs. 92.0% (699/760), P = 0.006) and angiotensin converting-enzyme inhibitors/angiotensin-receptor blockers (82.2% (162/197) vs. 88.4% (672/760), P = 0.024). Symptom-to-balloon time was longer in women than in men (330 (240, 600) minutes vs. 270 (180, 450) minutes, P < 0.001). Multivariate linear regression analysis of log-transformed symptom-to-balloon time revealed that female gender was an independent predictor of longer symptom-to-balloon time (β = 0.141, 95% confidence interval (CI) 0.053-0.228, P = 0.002). Women with STEMI had higher unadjusted 30 day all-cause death (12.6% vs. 4.2%, P < 0.001) than men. Female gender independently predicted 30 day all-cause mortality both with (hazard ratio (HR) = 3.497, 95% CI 1.485-8.234, P = 0.004) and without (HR = 2.495, 95% CI 1.170-5.323, P = 0.018) the adjustment for baseline characteristics by propensity-matched analysis.</p><p><b>CONCLUSIONS</b>Even with primary PCI as their reperfusion strategy, women with STEMI had higher 30 day all-cause death than men. Aggressive control of cardiovascular risk factors, adequate medical treatment and shortening of delay in reperfusion therapy might further improve the outcomes of female STEMI patients undergoing primary PCI.</p>
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Aged , Aged, 80 and over , Female , Humans , Male , Acute Disease , Cause of Death , Hypertension , Multivariate Analysis , Myocardial Infarction , Therapeutics , Percutaneous Coronary Intervention , Proportional Hazards Models , Risk Factors , Sex Factors , Time FactorsABSTRACT
<p><b>OBJECTIVE</b>To investigate the activated clotting time (ACT) level after administration of guideline-recommended dose of unfractionated heparin (UFH) and to confirm the importance of ACT monitoring in percutaneous coronary intervention (PCI).</p><p><b>METHODS</b>We performed a retrospective study on 1 062 patients undergoing elective PCI in Peking Union Medical College Hospital from May 1, 2011 to December 31, 2012. All patients were administrated weight-adjusted UFH (70-100 U/kg) based on PCI guideline of ACCF/AHA/SCAI. Patients were divided into 3 groups: ACT < 300 s (598 cases), ACT 300-350 s (183 cases) and ACT > 350 s (281 cases). ACT level and factors that may affect UFH anticoagulation were analyzed.</p><p><b>RESULTS</b>(1) The mean age was (63.0 ± 10.6) years and 751 (70.7%) patients were men. The mean weight was (70.5 ± 11.7) kg, and the mean UFH dose used was (100.7 ± 9.1) U/kg. (2) The median ACT was 285 (240-352) s after the UFH use. Pre-defined ACT target (300-350 s) was achieved only in 17.2% (183/1 062) patients. (3) Age, gender, height, weight, UFH/weight and the risk factors of coronary heart disease were similar among 3 groups (all P > 0.05). Multifactor linear correlation analysis showed that UFH/weight was related to ACT level (r = 0.07, P < 0.01), but other factors were not related to ACT level (all P > 0.05). (4) Among 598 patients with ACT < 300 s, 444 (74.2%) patients received additional UFH. No major bleeding events were observed in 1 062 patients. The incidence of minor bleeding and ischemic complications within 48 h after procedure were similar among 4 groups of ACT < 300 s with additional UFH, ACT < 300 s without additional UFH, ACT 300-350 s and ACT > 350 s (all P > 0.05).</p><p><b>CONCLUSIONS</b>In this single-center study, only a small proportion of patients reached the ACT target after administration of weight-adjusted UFH. Our results supported the recommendation of ACT monitoring in current PCI guideline to improve efficacy and safety of UFH anticoagulation therapy.</p>
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Aged , Female , Humans , Male , Middle Aged , Anticoagulants , Therapeutic Uses , Coronary Disease , Hemorrhage , Epidemiology , Heparin , Therapeutic Uses , Percutaneous Coronary Intervention , Retrospective Studies , Risk Factors , Treatment Outcome , Whole Blood Coagulation TimeABSTRACT
<p><b>OBJECTIVE</b>To explore the clinical implications of left ventricular hypertrophy (LVH) in patients with pheochromocytoma and paraganglioma (PH/PGL).</p><p><b>METHODS</b>Seventy-eight PH/PGL patients receiving medical attention at Peking Union Medical College Hospital from October 2010 to April 2013 were included in the study.Forty-six healthy people who had no hypertension, pathoglycemia, dyslipidemia history, and with normal chest X-ray, electrocardiogram and echocardiography results served as control group. Clinical symptoms and signs, levels of 24-hour urinary catecholamine, electrocardiogram and echocardiography of participants were recorded and analyzed.</p><p><b>RESULTS</b>(1)Left ventricular ejection fraction, cardiac output index, left ventricular mass index (LVMI), left atrial volume index (LAVI) and mitral E/E' were all significantly higher while mitral annulus lateral E' velocity was significantly lower in PH/PGL group than in control group (all P < 0.05). (2) LVH was associated with more prevalent acute left-sided heart failure episodes (12% (3/25) vs. 0, P = 0.030), sustained LVEF depression (12% (3/25) vs. 0, P = 0.030) and ECG ST-T segment alterations (60% (15/25) vs. 21% (11/53) , P = 0.001) in PH/PGL patients. LAVI ((30.2 ± 8.8) ml/m(2) vs. (23.8 ± 4.7) ml/m(2), P = 0.007) and mitral E/E' (11.2 ± 6.0 vs. 7.2 ± 1.4, P = 0.003) were significantly higher in patients with LVH than in patients without LVH. Mitral annulus septal ((7.8 ± 2.6) cm/s vs. (10.4 ± 3.2) cm/s, P = 0.001) and lateral ((9.3 ± 3.3) cm/s vs. (12.9 ± 2.9) cm/s, P < 0.001) E' velocity, averaged S' velocity((7.9 ± 1.6) cm/s vs. (8.8 ± 1.7) cm/s, P = 0.036) were significantly lower in LVH patients comparing to patients without LVH. (3) According to multiple linear regression analysis, age (t = 3.491, P = 0.001), gender (t = 2.899, P = 0.005), heart rate (t = 2.255, P = 0.027), and 24-hour urinary norepinephrine level (t = 3.369, P = 0.001) were independent factors affecting LVMI of PH/PGL patients.</p><p><b>CONCLUSION</b>Left ventricular hypertrophy is associated with acute left-sided heart failure, left ventricular diastolic dysfunction and elevated left ventricular filling pressure in PH/PGL patients.</p>
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Humans , Echocardiography , Electrocardiography , Heart Failure , Heart Rate , Hypertension , Hypertrophy, Left Ventricular , Pathology , Mitral Valve , Paraganglioma , Pheochromocytoma , Ventricular Function, LeftABSTRACT
Objectives We sought to determine the factors that predicted in-hospital heart failure(HF)in patients undergoing successful primary percutaneous coronary intervention(PCI)for ST-segment elevation myocardial infarction(STEMI). Methods The clinical and angiographic data were retrospectively reviewed in patients undergoing successful primary PCI for their ifrst STEMI. According to the occurrence of in-hospital HF, patients were divided into HF group and non-HF group. The incidence and predictors of in-hospital HF and its impact on prognosis were determined. Results A total of 834 patients were included, among them 94 patients (11.3%) were in the HF group and 740 patients(88.7%) were in the non-HF group. The mean age was (62.9±12.9) years and 662 patients (79.4%) were male. All-cause mortality at 30 days was signiifcantly higher in the HF group than in the non-HF group (24.5%vs. 1.5%, P<0.001). In Cox regression analysis, left anterior descending artery (LAD) as the culprit vessel (HR 2.173, 95% CI 1.12~4.212, P=0.022), ln 24 h NT-proBNP (HR 1.904, 95%CI 1.479~2.452, P<0.001), 24 h hsCRP≥11.0 mg/L (median) (HR 2.901, 95%CI 1.309~6.430, P=0.009) and baseline serum glucose (HR 1.022, 95%CI 1.000 ~ 1.044, P=0.046) were independent predictors of in-hospital HF. Receiver operator characteristic analysis identiifed 24 h NT-proBNP ≥ 1171 pg/ml (c=0.883, P < 0.001) and 24 h hsCRP ≥ 13.5 mg/L (c=0.829, P < 0.001) were the best cut-off values in discriminating in-hospital HF with a sensitivity and speciifcity of 92.5%and 76.8%for 24 h NT-proBNP, 86.0%and 77.0%for 24 h hsCRP, respectively. Even among patients with LAD as the culprit vessel, the incidence of in-hospital HF was only 0.4%in patients whose 24 h NT-proBNP was<1171 pg/ml and 24 h hsCRP was<13.5 mg/L;while the incidence of in-hospital HF was up to 60.9%in patients whose 24 h NT-proBNP≥1171 pg/ml and 24 h hsCRP≥13.5 mg/L (P<0.001). Conclusions The incidence of in-hospital HF was still high in STEMI patients even after successful primary PCI. Patients with in-hospital HF had poor prognosis. LAD as the culprit vessel, hsCRP, NT-proBNP and baseline serum glucose were independent predictors of in-hospital HF. Assessment and combined use of different serum biomarkers were effective methods to estimate the risk of in-hospital HF in STEMI patients undergoing primary PCI.
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Objective To investigate the manifestations of cardiac involvement in the patients with mucopolysacharidosis Ⅰ (MPS Ⅰ).Methods The clinical data of 10 MPS Ⅰ patients were collected.Electrocardiography (ECG) and echocardiography (Echo) were performed in all patients and then analyzed.Results Among the ten patients,seven were men.The onset age of MPS was (0.5 ～ 8.0) years old and the age of diagnosis was (1.8 ～ 20.0) years old.Two patients had grade 2 precordial systolic murmur.ECG was abnormal in three patients with right ventricular hypertrophy in two and right axis deviation in another one.Echo showed valvular thickening and insufficiency in nine patients,enlarged left atrium and ventricle in one patient,hapulmonary hypertension and right ventricular hypertrophy in two patients and abnormal left ventricular configuration in five patients.Conclusions Cardiac involvement is common in MPS Ⅰ patients and may present as valvular thickening with regurgitation,abnormal left ventricular configuration and pulmonary hypertension.The cardiac involvement progresses with age.ECG and Echo should be done regularly during follow-up of MPS Ⅰ patients.
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ObjectiveTo prepare paclitaxel-loaded nanoparticles (NPs),and to observe drug biodistribution after intravascular infusion of the NPs using a DispatchTM catheter into New Zealand rabbit abdominal aorta models.Methods Paclitaxel-loaded NPs were prepared by ultrasonication/emulsificcation/solvent evaporation technique using biodegradable poly (lactic-co-glycolic acid)(PLGA) as drug carrier.NP size and morphology was assessed by submicro-laser defractometer and scanning electron microscopy.In vitro release of paclitaxel from the NPs was performed by shaking in PBS at 37℃.The NPs was delivered into New Zealand rabbit abdominal aorta using a DispatchTM catheter.ResultsThe diameter of paclitaxel NPs was around 246 nm with very narrow size distribution.The NPs showed good spherical shape with smooth uniform surface.Paclitaxel loading in the NPs was about 19.06％ with encapsulation efficiency about 93.25％.The NPs maintained a sustained in vitro drug release for 30 days in PBS.After in vivo NP infusion,paclitaxel was detected in the vascular tissue around the infusion site and it retained in the site for 21 days.ConclusionPLGA nanoparticles as local drug delivery carrier showed great potential to maintain a high local drug concentration and prolonged drug resident time in animal model in vivo.
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Objective To study the efficacy of low dose of combined angiotensin Ⅱ type 1 receptor blockade(ARB)valsartan with angiotensin-converting enzyme inhibitor(ACEI)ramipril on the expression of the gene of angiotensin Ⅱ type 1 receptor(AT1R)and type 2 receptor(AT2R)in cardiovascular vessels and brain in SHR.Methods SHRs 7-8 weeks old were received valsartan 30 mg/(kg?d),or ramipril 1 mg/(kg?d),or valsartan 15 mg/(kg?d)combined with ramipril 0.5 mg/(kg?d)by gavage for three months.SBP,LV/BW ratio,plasma angiotensin Ⅱ,plasma and myocardial NO levels were determined.The severity of myocardial interstitial fibrosis was assessed by image analysis.ACE mRNA,AT1R mRNA and AT2R mRNA expression were detected in the LV myocardium,aorta and brain by the RT-PCR.Results Combined low dose of valsartan and ramipril was shown to reduce more significantly the expression of AT1R mRNA and ACE mRNA in myocardium,aorta and brain than valsartan or ramipril monotherapy(AT1R mRNA:P
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Objective To observe the expression and location of TF and TFPI in femoral artery atherosclerotic plaque.Methods We detected the expressions and locations of TF and TFPI in femoral artery atherosclerotic plaque by immunohistochemical and double-stain immunohistochemical method.We detected TF mRNA and TFPI mRNA expressions in atherosclerotic plaque by RT-PCR,with the normal umbilical artery as a control.ResultsThe normal umbilical artery contained little TF,TFPI and their mRNA in the adventitia.A great deal of TF,TFPI and their mRNA were found in the tunica intima of the femoral artery atherosclerotic plaque.Conclusion Expression of TF,TFPI and their mRNA of all types of cells and stroma in the proliferative tunica intima.
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Objective To investigate the involvement of mitogen-activated protein kinase(MAPK)and PI3K(phosphatidylinositol 3 kinase)/ Protein kinase B(Akt) signal transduction pathways in the mechanism of myocardium remodeling in patients with congestive heart failure(CHF).Methods Thirty nine patients of mitral valve disease with CHF were randomly selected and 30 cases of healthy persons were included as controls.Cardiac function parameters were measured by echocardiography.Concentration of AngⅡ in plasma and myocardial tissues was determined by radio immunoassay.Activity of PKC was determined by using competive prote in binding method,activity of MAPK was detected by the methods of immunoprecitipation.Immunoprecitipation was used to assay the protein expression and phosphorylation of PI3K and Akt(Protein kinase B),protein expression of C-FOS and ?-skeletal-actin in myocardial tissues.Results Pathological changes of myocardial tissues in CHF with valvular heart diseaseshowed typical myocardial remodeling.The hypertrophy was dominant at early stagy of CHF,while at end stage the characteristics include disordered alignament of the myocytes,the discontinuity and dissolving of cardiomyofibrills,destroyed subcellular organs,and the hyperplasia of interstitial tissue.AngⅡ concentration in plasm and myocardial tissues in patients with CHF was higher than those in the control group(P
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Objective To investigate the clinical characteristics of hypertrophic cardiomyopathy (HCM) in the elderly. Methods The clinical characters of HCM in 70 elderly patients were retrospectively analysed. Results Among the 196 identified HCM patients, 70 were elders. Out of them, 7 patients(10.0%) were suspected as HCM according to the clinical symptoms, 29 patients (41.4%)were suspected as other cardiac diseases, 34 (48.3%) were diagnosed HCM due to other reasons. Among the 70 patients, 12 patients(17.1%) had history of cerebrovascular diseases, 54 (77.1%) manifested symptoms after 45 years of age and 4 (5.7%) showed no obvious symptoms. Among them, 18 patients were examined by UCG for two times and HCM was diagnosed at the second time. Conclusions HCM in the elderly is not an uncommon disease. The onset of cardiac symptoms is relatively late in the elderly HCM and frequently misdiagnosed; cerebrovascular diseases are commonly seen in elderly HCM patients.
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0 05),but they had significantly longer course of disease ( P
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Objective To explore the scanning technique and image quality of coronary artery imaging with dual-source CT without oral Betaloc preparation in the patients with high heart rate.Methods 412 cases were undergone coronary imaging with dual-source CT (including plain and enhanced scans) ,among them,there were 30 cases with heart rate more than 100 bpm.Multi-planar reconstruction(MPR),maximum intensity projection(MIP) and volume rendering (VR) were performed using contrast-enhanced images.The image quality was classified into 3 grades, and coronary segments named according to AHA standard were evaluated.Results The average heart rate during enhanced scan in the 30 cases was (115.6?11.8)(101～139)bpm,the average breath hold time was (5.7?1.2) s.The best reconstruction phase was in the systolic phase. Altogether 424 coronary segments were evaluated, among them 93.9%(398/424)belonged to the first grade,5.0%(21/424)belonged to the second grade,and 1.2%(5/424) belonged to the third grade. Conclusion Without oral administration of Betaloc preparation, good coronary artery images can be obtained in the patients with high heart rate by dual-source CT.
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Thrombolytic therapy has been proved to be effective in treating acute myocardial infarction (AMI),whereas the role of urgent percutaneous transluminal coronary angioplasty (PTCA) is disputed.Results of many clinical trials show that urgent PTCA,comparing with intravenous thrombolytic agents,has more advantages in increasing reperfusion rate,lowering mortality,the rate of reinfarct and bleeding.PTCA has gradually become a routine option in the treatment of AMI.This review focus mainly on PTCA intervention of AMI without thrombolysis,after thrombolytic success,and after thrombolytic failure.
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Objective To investigate the clinical features and the findings of coronary angiography,the treatment and prognosis of patients with myocardial bridge.To increase our knowledge on myocardial bridge.Methods Fifty two patients were diagnosed as myocardial bridge by coronary angiography in our hospital from January 2001 to December 2004. Angiographically,systolic compression of the arterial lumen that disappears during diastole was considered diagnostic of a myocardial bridge.Analyse the clinical features and therapy condition.Follow patients by telephone or clinical visits.Results Our study included fifty two patients.Male patients were more than female ones and the average age was 53?12 years old.Myocardial bridge was the most common in the middle segment of the left anterior descending artery.Majority of the patients took medication,and 2 of them were treated with intracoronary stent implantation.Forty patients were followed.During a mean 1.9?1.1 years follow-up period,there was no cardiac death.25 of the patients required medication,and 1 of 2 patients who underwent stent implantation had in-stent restenosis at 3.3 years.Conclusion Patients with myocardial bridge may present with atypical chest pain.Major patients with myocardial bridge are treated with medication,and stent implants may improve patients' symptoms.The prognosis of the patients with myocardial bridge is usually good.
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90? superficial calcium is low.