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Humans , Stroke Volume/physiology , Heart Failure/physiopathology , Heart Failure/therapyABSTRACT
Objective To investigate the clinical significance of red blood cell distribution width in the early diagnosis of patients with chronic heart failure.Methods Seventy eight cases of chronic heart failure patients from November 2011 to November 2013 in our hospital were recruited in this study,and were divided into three different heart failure groups (Ⅱ,Ⅲ,and Ⅳ) according to the degree of heart failure; 40 healthy cases were used as control group.The red blood cell distribution width was measured among four groups.The relationship of the red blood cell distribution width and chronic heart failure was analyzed.According to the red blood cell distribution width data,patients were grouped into ＜ 13.1％,13.1％ ～ 14.5％,and ＞ 14.5％ groups.The eventual fatality rates were compared among three groups with different red blood cell distribution width.Results (1) The red blood cell distribution width was (11.63 ±0.71)％,(13.11 ±1.08)％,(14.31 ±1.52)％,and (16.83 ±0.71)％ in the healthy group,andⅡ,Ⅲ,and Ⅳ heart failure groups,respectively.The red blood cell distribution width was gradually increased with the degree of heart failure,with a statistically significant difference among four groups (P ＜ 0.05).(2) The mortality was 0 (0/32),14.8％ (4/29),and 41.2％ (7/ 17) in different red blood cell distribution width groups (＜ 13.1％,13.1％ ～ 14.5％,and ＞ 14.5％),respectively.The mortality was gradually increased with the increased red blood cell distribution width,with a statistically significant difference among three groups (P ＜ 0.05).Conclusions Red blood cell distribution width is of great importance to detect disease degree of chronic heart failure and can guide one to effectively evaluate disease processes and therapeutic effect.
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Objective To investigate serum galectin-3 levels in patients with chronic heart failure and evaluate its clinical significance for heart failure.Methods A total of 108 chronic heart failure patients were selected.The selected patients were divided into three groups according to the classification of New York Heart Association (NYHA,from degree Ⅱ to Ⅳ).In addition,30 healthy persons were chosen as control group.All the patients received cardiac ultrasound examination.Plasma levels of N-terminal probrain natriuretic peptide (NT-proBNP),serum levels of galectin-3 and interleukin-6 (IL-6) were measured and analyzed.Results Galectin-3 levels were significantly higher in chronic heart failure patients compared with control group(P ＜ 0.05).In chronic heart failure group,the increase of serum concentration of galectin-3 was correlated with the degree of NYHA function classification.Correlation analysis showed that blood level of galectin 3 was strongly positive correlation with concentration of NT-proBNP and IL-6.There was no correlation between galectin-3 with the cause of heart failure,left ventricular diameter(LVD),and left ventricular ejection fraction (LVEF).Conclusions The levels of galectin-3 was significantly increased in chronic heart failure,and was correlated with degree of heart failure.Galectin-3 might be a new biomarker of heart failure and could provide additive value to NT-proBNP levels in the diagnosis of heart failure.
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La amiloidosis es una enfermedad infiltrativa sistémica que compromete el corazón y representa una causa importante de miocardiopatía restrictiva. En esta presentación se describe el caso de una paciente con insuficiencia cardíaca (IC) secundaria a miocardiopatía infiltrativa por depósito amiloide y obstrucción dinámica del tracto de salida del ventrículo izquierdo. El diagnóstico hematológico fue de mieloma múltiple por cadenas livianas y se demostró amiloidosis en dos tejidos extracardíacos. El ecocardiograma reveló aumento de los espesores parietales con obstrucción dinámica subaórtica significativa y la resonancia cardíaca mostró un patrón compatible con infiltración amiloide. La biopsia endomiocárdica confirmó la amiloidosis cardíaca. La publicación de este caso constituye la primera comunicación en nuestro país de esta forma de presentación atípica de amiloidosis cardíaca.
Primary amyloidosis is a systemic infiltrative disease that compromises the heart and represents an important cause of restrictive cardiomyopathy. We describe the case of a patient with heart failure secondary to an infiltrative cardiomyopathy with amyloid deposition and dynamic left ventricular outflow tract obstruction. The hematological diagnosis was light chain multiple myeloma with presence of amyloidosis in two extracardiac tissues. The echocardiogram revealed substantial wall thickening with significant dynamic subaortic obstruction; the magnetic resonance imaging showed a pattern suggestive of amyloid infiltration. An endomyocardial biopsy confirmed the diagnosis of cardiac amyloidosis. This is the first case of this atypical presentation of cardiac amyloidosis reported in our country.
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Objetivos: revisar dados da literatura relacionados ao uso da ultrassonografia pulmonar como método diagnóstico na insuficiência cardíaca agudamente descompensada. Fonte de Dados: artigos pesquisados na base de dados PubMed e edições recentes de livros. Síntese dos Dados: a insuficiência cardíaca descompensada consiste em uma síndrome altamente prevalente nos serviços de emergência. Frequentemente, o diagnóstico diferencial com outras síndromes associadas à insuficiência respiratória aguda representa uma tarefa complexa para o médico da sala de emergência, visto que a análise clínica e a radiografia de tórax não apresentam suficiente especificidade. A ultrassonografia pulmonar vem sendo estudada como uma nova técnica para o diagnóstico de insuficiência cardíaca aguda. Conclusões: a ultrassonografia pulmonar possui boa sensibilidade e especificidade para edema pulmonar intersticial, além de ter baixo custo e ser de fácil aprendizado. Portanto, apresenta boa aplicabilidade para direcionamento diagnóstico, tanto para confirmação de edema intersticial, quanto para exclusão de outras morbidades.
Aims: To review literature data concerning the use of pulmonary ultrasonography as a diagnostic method in acute decompensated heart failure. Source of Data: Articles found in the PubMed database and recent editions of books. Summary of Findings: Acute decompensated heart failure is a highly prevalent condition in the emergency room. The differential diagnosis from other syndromes associated with acute respiratory failure often represents a complex task for the emergency room physician, since clinical examination and chest radiography do not have sufficient specificity. Pulmonary ultrasonography has been studied as a new technique for the diagnosis of acute heart failure. Conclusions: Pulmonary ultrasonography has good sensitivity and specificity for pulmonary interstitial edema, in addition to low cost and ease of learning. Hence it has a good applicability for targeting diagnosis, both for confirmation of interstitial edema and for excluding other illnesses.