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Objective@#To evaluate the efficacy and safety of Qili Qiangxin Capsule (QLQXC) combined with western medicine in patients with ischemic cardiomyopathy (ICM) comorbid with heart failure (HF) for clinical application.@*Methods@#We searched relevant references in Chinese databases including China National Knowledge Infrastructure (CNKI), China Scientific Journal Database (VIP), Wanfang Database, and China Biology Medicine (CBM), as well as English databases including PubMed and Embase, from the foundation of the database to January 8, 2023, without language restrictions. All statistical analyses, including subgroup and sensitivity analyses, were performed using the Review Manager (version 5.4) and Stata (version 15.0).@*Results@#QLQXC combined with western medicine significantly increased the endpoints of overall response rate (ORR) (P< 0.000 01), left ventricular ejection fraction (LVEF) (P< 0.000 01), the score of Minnesota Living with Heart Failure Questionnaire (MLHFQ) (P = 0.000 2), and 6-minute walking distance (6MWD) (P < 0.000 01), decreased left ventricular end-diastolic diameter (LVEDD) (P < 0.000 01), left ventricular end-systolic diameter (LVESD) (P = 0.03), and pro-brain natriuretic peptide (pro-BNP) (P < 0.000 01), and reduced the incidence of rehospitalization (P = 0.000 3) and adverse events (AEs) (P = 0.000 6) compared with those under the conventional western therapy alone. Nonetheless, no significant difference was observed in reducing the mortality between the QLQXC combined with western medicine group and the western medicine group (P = 0.30).@*Conclusion@#The combination therapy of QLQXC with western medicine can potentiate cardiac function and raise the quality of life in patients with ICM comorbid with HF.
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Aim:To determine the factors associated with an inadequate response to adenosine infusion during cardiac stress magnetic resonance imaging (MRI). Study Design: It is a retrospective cohort study. Introduction: Stress cardiac MRI is a highly accurate and non?invasive method to diagnose coronary artery disease (CAD). Stress MRI is performed by inducing stress with adenosine infusion.There is an increase in systemic andmyocardial blood flow (MBF) with vasodilator agents. Capillaries are maximally dilated in a diseased artery and cannot sustain increased myocardial oxygen demand. It results in delayed delivery of contrast, which leads to an area of perfusion defect in the myocardium. These perfusion defects can be accurately seen by cardiovascular magnetic resonance (CMR) and help in the prognosis of patients. Methods: A retrospective study on patients subjected to cardiac stress MRI was conducted in a Tertiary Care Cardiac Center from January 2019 to January 2022. In total, 99 patients underwent adenosine stress perfusion cardiac MRI. All patients received an adenosine infusion of 140 mcg/kg/min for 2 min. Subsequently, the dosage was increased by 20 mcg/kg/min every 2 min to a maximum of 210 mcg/kg/min until an adequate stress response was achieved. Adequate stress was defined as two or more of the following criteria: 1) Increase in heart rate >/= 10 beats perminute. 2) Decrease in systolic blood pressure SBP by >/= 10mmHg Symptoms like chest discomfort, breathlessness, and headache. Patients who satisfied two or more of the above criteria were labeled as responders and the patients who did not satisfy the above criteria with the maximum dose of 210 mcg/kg/min of adenosine infusion were labeled as non?responders. Multivariable logistic regression analysis with forward and backward stepwise selection was used to identify predictors in non?responders. Basic demographic variables with P value </= 0.2 were examined for inclusion in the model. A P value </= 0.05 was considered significant. Results: Nine patients (9.1%) showed inadequate stress response to adenosine infusion even with a maximum dose of 210 mcg/kg/min. Multivariate logistic regression analysis showed that left ventricular end?diastolic volume (LVEDV) was a predictor of inadequate response to adenosine infusion. Conclusion: Inadequate stress response to adenosine occurred in 9.1% of subjects with an infusion of 140–210 ug/kg/min. LVEDV is an independent and strong predictor in non?responders.
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Objective:To investigate the relationship between left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDD), wall motion score (WMS) of echocardiographic indexes and serum heart type fatty acid binding protein (h-FABP), chitinase-3 like protein-1 (YKL-40) and their predictive value for prognosis in patients with acute myocardial infarction (AMI).Methods:A retrospective selection of 130 AMI patients admitted from January 2020 to March 2021 in the University of Hong Kong Shenzhen Hospital were selected as the research objects. According to whether major adverse cardiovascular events or death occurred within 30 d, they were divided into a good prognosis group (85 cases) and a poor prognosis group (45 cases). The echocardiographic indexes, serum h-FABP and YKL-40 levels were compared between the two groups, the correlation between serum indexes and color Doppler ultrasound indexes and the value of echocardiographic indexes for prognosis were also analyzed.Results:When the poor prognosis group was admitted to the hospital and after 1 week of treatment, the LVEF was lower than that in good prognosis group: (40.12±4.10)% vs. (44.37±5.06)% and (47.62±4.83)% vs. (53.29±5.31)%; the LVEDD, WMS, serum h-FABP and YKL-40 level were higher than those in good prognosis group: (52.78±3.67) mm vs. (49.16±3.14) mm and (48.35±4.08) mm vs. (44.20±3.72) mm, (23.42±3.11) scores vs. (20.09±2.87) scores and (20.07±3.70) scores vs. (15.20±2.34) scores, (28.76±4.22) mg/L vs. (22.35±3.19) mg/L and (20.04±3.33) mg/L vs. (14.20±2.76) mg/L, (40.17±5.10) μg/L vs. (34.83±3.25) μg/L and (32.09±4.38) μg/L vs. (27.20±3.07) μg/L, and there were statistical differences ( P<0.05). LVEF was negatively correlated with serum h-FABP and YKL-40 neither at admission nor 1 week after treatment, and LVEDD and WMS were positively correlated with serum h-FABP and YKL-40 ( P<0.05). The areas under the curve for combined prediction of prognosis by LVEF, LVEDD, and WMS was the largest at 0.873. The survival rates of high-risk patients indicated with LVEF, LVEDD, and WMS were lower than that of low-risk patients: 56.52% vs. 90.91%, 52.38% vs. 91.67%, and 54.17% vs. 95.24%, and there were statistical differences ( P<0.05). Conclusions:The echocardiographic parameters LVEF, LVEDD and WMS in patients with AMI are closely related to serum h-FABP and YKL-40, which can provide an objective basis for the evaluation of myocardial pathophysiological changes. Moreover, the combined detection of LVEF, LVEDD, and WMS can be used to further assess the prognostic survival status, with a positive significance for guiding clinical treatment plans.
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Objective:To explore the risk factors for atrial fibrillation(AF)in elderly Chinese patients with severe valvular heart disease(VHD).Methods:This was a cross-sectional study and consecutively enrolled 978 elderly patients with severe VHD diagnosed in 18 Class A tertiary hospitals across the country from September 2021 to March 2022, including 322(32.9%)patients with concurrent AF.Clinical and echocardiographic data were collected to analyze the risk factors for AF.Results:Among VHD patients, compared with the non-AF group, the AF group was older, had a higher female ratio, higher diastolic blood pressure, higher proportions with cerebrovascular disease and chronic kidney disease, lower serum low density lipoprotein cholesterol and higher serum creatinine, amino-terminal A-type natriuretion peptide and glycosylated hemoglobin.As for echocardiographic parameters, the left atrial diameter was larger, the left ventricular end-diastolic diameter, interventricular septum thickness, and left ventricular posterior wall thickness were smaller in the AF group than in the non-AF group.All of the differences were statistically significant(all P<0.05). The results of multivariate Logistic regression analysis showed that the left atrial anteroposterior diameter increased( OR=1.166, P<0.01), the left ventricular end-diastolic diameter decreased( OR=0.929, P<0.01), and advanced age( OR=1.051, P<0.05)was an independent risk factor for elderly VHD patients with concurrent AF. Conclusions:In elderly patients with severe VHD, advanced age, an increased left atrial anteroposterior diameter, and a decreased left ventricular end-diastolic diameter were independently associated with AF.Therefore, evaluation of cardiac structure and regular follow-up should be performed in elderly patients with severe VHD for early intervention to reduce the incidence of AF.
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@#Objective To explore the risk factors for 24-hour death in acute type A aortic dissection (ATAAD) patients with conservative treatment. Methods From January 2009 to January 2018, 243 ATAAD patients who received non-surgical intervention were admitted in Beijing Anzhen Hospital, including 167 males and 76 females with an average age of 53.0±12.0 years. The risk factors for 24-hour mortality were analyzed. Results The total in-hospital mortality rate was 37.9% (93/243), and 13.6% (33/243) patients died within 24 hours of onset. We found that left ventricular end diastolic diameter [LVEDD, OR=0.45, 95%CI (0.25, 0.83), P<0.01] and aortic regurgitation [OR=7.26, 95%CI (1.67, 31.53), P<0.01] were independent risk factors for 24-hour death in patients with ATAAD. Conclusion In this study, LVEDD and aortic regurgitation are identified as independent risk factors for 24-hour mortality in ATAAD patients. Therefore, patients with aortic regurgitation and small LVEDD should be treated with sugery as soon as possible.
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Background: Noninvasive assessment of diastolic filling by Doppler echocardiography provides important information about left ventricular (LV) status in selected subsets of patients. This study was designed to assess whether the lateral mitral annular velocity as assessed by tissue Doppler imaging is associated with invasive measures of diastolic LV performance in patients with diastolic and systolic heart failure. Aim of the study was to compare the diagnostic accuracy of lateral mitral annular E/E? as an estimate of LV filling pressure with invasive LVEDP measurement in subjects with systolic or purely diastolic heart failure.Methods: Total 100 patients were studied, 50 patients with diastolic heart failure and 50 patients with systolic heart failure in patients undergoing diagnostic coronary angiogram. Detailed 2D Echocardiography, Trans mitral Doppler and Tissue Doppler velocities of lateral mitral annulus was obtained. The ratio of peak mitral velocity (E) to lateral mitral annular velocity (E?) by TDI (E/E?) was calculated.Results: The ratio of E/E? in diastolic group was 13.4�9 and in systolic group it was 13.7�2. The mean LVEDP in diastolic heart failure patients was 14.3�5 and 14.2�9 in systolic heart failure patients. The ratio of E/E? showed a better correlation with LVEDP. E/E? <8 accurately predicted normal LVEDP, and E/E? >15 identified increased LVEDP ?15mmHg.Conclusions: E/E? is a reliable estimate of LV filling pressures in subjects with systolic and diastolic heart failure. In subjects with diastolic heart failure, E/E? seems helpful to identify those with truly elevated LV filling pressures. In patients with diastolic heart failure and normal E/E?, a search for other causes of symptoms (pulmonary disease, obesity and so forth) may be warranted.
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Aims and Objectives: The aims of the study were to find out the correlation between coronary angiographic findings and hemodynamic parameters derived from impedance cardiography (ICG) and echo-Doppler study. Patients, Materials and Methods: A total of 200 patients of acute myocardial infarction having chest pain, ST elevation in two or more contiguous leads of electrocardiogram (ECG), biomarker positivity, echocardiographic evidence of regional wall motion abnormality (RWMA), and coronary angiographic evidence of coronary lesions were recruited. Subjects unwilling to participate, moribund, critically ill subjects, and patients with concomitant heart failure, arrhythmia, and valvular lesions were excluded from the study. GE™ Vivid 7 Dimension machine was used for ECG-gated echo-Doppler studies. The left ventricular ejection fraction (LVEF), stroke volume (SV), RWMA, diastolic function, etc., were observed. ICG measured LVEDV, LVESV, LVEF, and other parameters particularly amplitudes of the different waves. Coronary angiography (CAG) was done in the Cath Lab having “Siemens™ Axiom Artis Zee (floor)” equipment. Results and Analysis: Results-analysis revealed there is negative correlation (Pearson’s correlation coefficient, r = −0.8) between augmentation pressure and coronary angiographic stenosis percentage and P value is also significant (P = 0.034). Pulse pressure (PP) also is positively correlated (r = −0.78) with coronary angiographic stenosis percentage and P value is also significant (P = 0.027). There is a negative correlation (r = −0.259) between augmentation index (AIx) and coronary angiographic lesions and that is statistically significant (P = 0.03). Conclusion: There is a positive correlation between ICG -derived hemodynamic parameters and the percentage stenosis of coronary arteries. Rise of augmentation pressure and PP in the ICG waveform is associated with coronary artery disease severity. AIx is negatively correlated with severity of coronary arterial stenosis
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Objective To investigate the relationship between plasma activin A (ACTA),B－type natriuretic peptide(BNP),growth differentiation factor －15 (GDF－15) and interleukin－6 ( IL－6) levels and heart failure. Methods From January 2017 to December 2018,80 patients with acute heart failure admitted to Lishui Central Hospitalwere selected as observation group.According to NYHA cardiac function classification , 23 patients were classified as grade II,30 patients were classified as grade Ⅲand 27 patients were classified as grade Ⅳ.Another 60 healthy people were selected as control group from January 2017 to December 2018.The left ventricular end －diastolic diameter(LVEDD) and left ventricular ejection fraction (LVEF) were measured by Doppler echocardiography ,and the levels of ACTA, BNP, GDF －15 and IL －6 were measured by ELISA.Results The plasma ACTA [(2.43 ± 0.54)ng／mL],BNP[(219.31 ±34.25)ng／L],GDF－15[(854.31 ±46.57)ng／L],IL－6[(183.25 ±39.89)ng／L] in the observation group were significantly higher than those in the control group [(0.32 ±0.10) ng／mL,(16.74 ± 3.89)ng／L,(467.52 ±60.91)ng／L,(40.31 ±6.57) ng／L]( t＝29.859,45.553,42.591,27.455,all P＜0.05). The LVEDD[(65.73 ±5.38) mm] in the observation group was higher than that in the control group [(47.83 ± 4.31)mm],while the LVEF[(39.82 ±3.56)%]was lower than that in the control group [(64.32 ±4.16)%]( t＝21.170,37.475,all P＜0.05).The ACTA [(3.98 ±0.58) ng／mL],BNP[(304.21 ±41.30) ng／L],GDF－15 [(989.83 ±50.38) ng／L],IL－6[(249.81 ±45.61) ng／L] in grad Ⅳ group were lower than those in grade Ⅱgroup[(1.17 ±0.21)ng／mL,(135.42 ±23.98)ng／L,(735.24 ±41.87)ng／L,(120.74 ±33.45)ng／L] and gradeⅢgroup[(2.41 ±0.52)ng／mL,(217.27 ±35.46)ng／L,(861.32 ±53.46) ng／L,(185.42 ±42.31) ng／L] ( F＝8.391,23.154,17.849,14.568,all P＜0.05).The plasma levels of ACTA,BNP,GDF－15 and IL－6 in gradeⅢgroup were lower than those in gradeⅡgroup (t＝10.764,9.517,9.322,6.025,all P＜0.05).The LVEDD[(72.31 ± 5.91) mm] in grade Ⅳ group was higher than that in grade Ⅱ group [(58.98 ±4.64) mm] and grade Ⅲ group [(66.01 ±5.48) mm], and the LVEF [( 29.97 ±3.36)%] was lower than that in grade Ⅱ group [(51.54 ± 3.27)%]and gradeⅢgroup[(40.35 ±3.81)%],the differences were statistically significant (F＝12.415,9.829, all P＜0.05).The LVEDD in grade Ⅲgroup was higher than that in grade Ⅱgroup,and the LVEF was lower than that in gradeⅡgroup,the differences were statistically significant ( t ＝4.176,10.856,all P＜0.05).Conclusion The levels of ACTA,BNP,GDF－15 and IL－6 in plasma are increased in patients with acute heart failure ,and are closely related to the progress of the disease.They can be used as diagnostic and prognostic indicators of acute heart failure.
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Objective@#To investigate the relationship between plasma activin A(ACTA), B-type natriuretic peptide(BNP), growth differentiation factor-15 (GDF-15) and interleukin-6 (IL-6) levels and heart failure.@*Methods@#From January 2017 to December 2018, 80 patients with acute heart failure admitted to Lishui Central Hospital were selected as observation group.According to NYHA cardiac function classification, 23 patients were classified as grade II, 30 patients were classified as grade Ⅲ and 27 patients were classified as grade Ⅳ.Another 60 healthy people were selected as control group from January 2017 to December 2018.The left ventricular end-diastolic diameter(LVEDD) and left ventricular ejection fraction(LVEF) were measured by Doppler echocardiography, and the levels of ACTA, BNP, GDF-15 and IL-6 were measured by ELISA.@*Results@#The plasma ACTA[(2.43±0.54)ng/mL], BNP[(219.31±34.25)ng/L], GDF-15[(854.31±46.57)ng/L], IL-6[(183.25±39.89)ng/L]in the observation group were significantly higher than those in the control group[(0.32±0.10)ng/mL, (16.74±3.89)ng/L, (467.52±60.91)ng/L, (40.31±6.57)ng/L](t=29.859, 45.553, 42.591, 27.455, all P<0.05). The LVEDD[(65.73±5.38)mm] in the observation group was higher than that in the control group[(47.83±4.31)mm], while the LVEF[(39.82±3.56)%]was lower than that in the control group[(64.32±4.16)%](t=21.170, 37.475, all P<0.05). The ACTA[(3.98±0.58)ng/mL], BNP[(304.21±41.30)ng/L], GDF-15[(989.83±50.38)ng/L], IL-6[(249.81±45.61)ng/L] in grad Ⅳ group were lower than those in grade Ⅱ group[(1.17±0.21)ng/mL, (135.42±23.98)ng/L, (735.24±41.87)ng/L, (120.74±33.45)ng/L] and grade Ⅲ group[(2.41±0.52)ng/mL, (217.27±35.46)ng/L, (861.32±53.46)ng/L, (185.42±42.31)ng/L](F=8.391, 23.154, 17.849, 14.568, all P<0.05). The plasma levels of ACTA, BNP, GDF-15 and IL-6 in gradeⅢgroup were lower than those in grade Ⅱ group (t=10.764, 9.517, 9.322, 6.025, all P<0.05). The LVEDD[(72.31±5.91)mm]in grade Ⅳ group was higher than that in grade Ⅱ group[(58.98±4.64)mm]and grade Ⅲ group[(66.01±5.48)mm], and the LVEF[(29.97±3.36)%]was lower than that in grade Ⅱ group[(51.54±3.27)%]and grade Ⅲ group[(40.35±3.81)%], the differences were statistically significant (F=12.415, 9.829, all P<0.05). The LVEDD in grade Ⅲ group was higher than that in grade Ⅱ group, and the LVEF was lower than that in gradeⅡgroup, the differences were statistically significant(t=4.176, 10.856, all P<0.05).@*Conclusion@#The levels of ACTA, BNP, GDF-15 and IL-6 in plasma are increased in patients with acute heart failure, and are closely related to the progress of the disease.They can be used as diagnostic and prognostic indicators of acute heart failure.
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Objective To evaluate the left ventricular diastolic function of patients with normal left ventricular ejection fraction ( LVEF) by echocardiography and real‐time cardiac catheter measurement ,and improve the accuracy and reliability of echocardiographic diagnosis . Methods One hundred and twenty patients with know n or suspected coronary artery disease w ho underwent coronary angiography and left ventricular catheterization were prospectively selected from July 2017 to January 2018 in the Affiliated Hospital of Jiangsu University . According to the left ventricular end diastolic pressure ( LVEDP) real‐time measurement ,the patients were divided into groups of LVEDP ≤15 mm Hg ( 43 cases ) and LVEDP ＞ 15 mm Hg ( 77 cases) . General data were compared and the difference of echocardiographic parameters between the two groups were analyzed ,and the ROC curve of each echocardiographic parameter for diagnosing LVEDP was draw n . Results T he parameters including flow propagation velocity ( VP) ,the ratio of filling fraction of E and A ( E/A) ,early diastolic filling deceleration time ( DT ) ,the duration of mitral A ( A‐dur ,) mitral annulus velocity at the septal side ( e′sep) ,systolic pulmonary venous flow velocity ( PVs) ,diastolic pulmonary venous flow velocity ( PVd ) and PVs/PVd were used to the diagnosis of the increasing of LVEDP ,however their accuracies were low ( AUC between 0 .5～0 .7) . T he parameters including left atrial volume index ( LAVI ) , tricuspid regurgitation ( T Rmax ) ,mitral annulus velocity in lateral wall of left ventricle ( e′lat ) ,average e′,E/e′sep ,E/e′lat ,average E/e′,velocity of pulmonary vein atrial reversal ( PVa) ,pulmonary vein atrial reversal duration ( Pva‐dur) ,the difference between the duration of pulmonary venous A wave and mitral A wave( PvaD‐AD) were also used to the diagnosis of the increasing of LVEDP , but their accuracies were still poor ( AUC between 0 .7～0 .9 ) . According to the real‐time left ventricular pressure measurement and different parameters of echocardiography ,the multivariate regression equation :LVEDP＝ 0 .292 LAVI + 0 .35 PVa + 0 .04 T Rmax + 0 .075 ( PvaD‐AD ) －0 .109 PVs －6 .773 was put forward as a correction standard ,the accuracy of the diagnosis of LVEDP was significantly improved ( AUC ＝0 .922) . Conclusions T he assessment of left ventricular diastolic function needs to be performed comprehensively with multiple parameters . T he multiple regression equation can accurately evaluate left ventricular diastolic function in patients with normal LVEF .
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Objective Cardiac chamber dimensions are race and anthropometry dependent. We determined the age and gender specific 3-Dimensional echocardiographic (3DE) reference values for dimensions and function of left ventricle (LV) and left atrium (LA) in normal Indian adults. Methods This single center prospective study enrolled 133 adult Indians free of heart disease and/or hypertensions, subjecting them to 3DE measurements of left atrial (LA) & left ventricular (LV) volumes, function and left ventricular mass (LVM). The higher limits of normal cut-offs were determined for these parameters and their dependency on age, gender and anthropometry were analyzed. Results The body surface area (BSA) corrected higher limit cut-offs were: 59.37 ml/m2 for LV end diastolic volume (59.19 ml/m2 and 59.61 ml/m2 for men and women, respectively; P = NS); 23.48 ml/m2 for LV end systolic volume (23.27 ml/m2 and 23.11 ml/m2 for men and women, P = NS). Mean LVEF was 64.79% ± 7.26 (62.99% ± 6.51 and 67.05% ± 7.58 in men and women, P = NS). Men had higher LVM than women (119.79 g±23.95 vs. 103.26 g±23.76, P < 0.001), this difference disappeared after BSA indexing. The higher limit cut-offs for normal LA volumes were 20.49 ml for minimum volume (21.18 ml and 19.46 ml for men and women, P = NS) and 39.76 ml for maximum volume (39.60 ml and 40.03 ml in men and women, P = NS). The parameters were smaller compared to western populations but the differences attenuated after BSA indexing. Conclusions The study reports normal 3DE parameters of size and function of left heart chambers in Indians.
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@#Objective We probed how to predict left ventricular ejection fraction (LVEF) of the ischaemic cardiomyopathy (ICM) patients would be improved apparently after revascularization. Methods Between July 2010 and December 2015, 245 ICM patients (30%≤LVEF≤40%) with coronary bypass grafting (CABG) were retrospectively observed. Among them, 146 patients were accompanied by ischemic mitral regurgitation (IMR) (146/245, 59.6%), and 41 patients underwent mitral valvuloplasty or replacement because of more than moderate IMR. There were 13 patients early death, and other 232 patients who were followed up over 6 months were divided into two groups based on whether or not post-operative LVEF increased by 10%: a LVEF recovered group (group A, 124 patients) and a non-recovered group (group B, 108 patients). Results Preoperative NT-proBNP in the group A was significantly higher than that in the group B (P=0.036). There were less patients with myocardial infarction in the group A than that in the group B (P=0.047), and more with angina pectoris in the group A than that in the group B (P=0.024). There was no significant difference in the extent of mitral regurgitation or mitral surgery between the groups A and B (P>0.05). There were lower left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD) and left ventricular end-diastolic volume (LVEDV) in the group A than those in the group B (P<0.05). Multivariate analysis revealed that preoperative LVEDD dilated apparently and no angina pectoris existed before surgery were independent risk factors for LVEF with no recovery in the ICM patients (30%≤LVEF≤40%) after revascularization. The LVEDD of 245 patients (including 13 early deaths) was 41-71 mm. We found that the ICM patients with LVEDD ≥60 mm were more likely to signify the unfavourable prognosis (χ2=8.63, P=0.003, OR=2.21, 95% confidence interval 1.25 to 3.91). Conclusion Preoperative LVEDD dilated and no angina pectoris before surgery are independent risk factors for LVEF with no recovery in the ICM patients (30%≤LVEF≤40%) after revascularization. LVEDD≥60 mm can be regarded as the preoperative forecasting factors for the unfavourable prognosis in the ICM patients (30%≤LVEF≤40%) after revascularization.
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Objective To evaluate the effect of obstructive jaundice on the accuracy of left ventricular end-diastolic volume (LVEDV) and stroke volume variability (SVV) in monitoring fluid responsiveness.Methods Thirty patients of both sexes,aged 45-60 yr,weighing 55-70 kg,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,with New York Heart Association Ⅰ,scheduled for elective pancreatoduodenectomy,were divided into 2 groups according to the serum total bilirubin levels:A group (serum total bilirubin ≥ 17 μmmol/L,n =16) and B group (serum total bilirubin＜ 17 μmmol/L,n =14).Six percent hydroxyethyl starch 500 ml was infused over 40 min after anesthesia induction.The parameters of VigileoTM such as cardiac output (CO),SVV,systemic vascular resistance (SVR) and pulmonary capillary wedge pressure and indices measured by transesophageal three-dimensional echocardiography such as LVEDV,left ventricular end-systolic volume,CO',left ventricular ejection fraction (LVEF) and ratio of mitral peak velocity of early filling (E) to early diastolic mitral annular velocity (e',E/e'ratio) were recorded before and after fluid loading.Results Compared with that before fluid loading,SVV was significantly decreased in two groups,and CO,LVEDV,CO'and LVEF were significantly increased in group B,and E/e'ratio was significantly increased in group A (P＜0.05).Compared with group B,CO,SVR,CO'and LVEF were significantly decreased,and pulmonary capillary wedge pressure was increased in group A (P＜0.05).Conclusion Obstructive jaundice causes decrease in the accuracy of LVEDV in monitoring fluid responsiveness and no effect on SVV.
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Objective To investigate the effects of distal thrombolysis versus thrombus aspiration on myocardial perf usion and prognosis in patients with acute ST segment elevation myocardial infarction(AMI)during emergency percutaneous coronary intervention(PCI). Methods 96 patients with acute ST segment elevation myocardial infarction(onset<6 hours)were randomly divided into thrombolysis group and distal thrombus aspiration group. Patients in the distal thrombolysis group(n=46)received transcatheter urokinase injection to the occlusive segment followed by balloon dilatation or stenting. Patients in the thrombus aspiration group(n=50)were given thrombus aspiration after balloon angioplasty or stenting. Patients were followed up for 30 days after operation. The coronary blood flow and myocardial perfusion were compared between the 2 groups. The incidence of major adverse cardiac events(MACE)and left ventricular systolic function after 30 days were compared. Results There was 1 case in the distal thrombolysis group (0.2%)and 6 case in the thrombus aspiration group(12%)presented with TIMI fl ow≤grade Ⅱ(P=0.008). A 65.2% of patients in the distal thrombolysis and 42.0% of patients in the thrombus aspiration group achieved > 50% of ST segment resolution in 2 hours(P=0.019). At 30-day follow up,the LVEF was found higher in the thrombolysis group compared with the aspiration group(54.1±8.6)% vs.(50.8±7.3)%,P=0.047 but the LVEDD(44.3±7.2)mm vs.(46.5±6.8)mm,P=0.038 and NT-proBNP levels(117.8±71.8)μg/L vs.(161.2±72.3)μg/L,P=0.025 were found significantly lower in the thrombolysis group. Conclusions For the ST segment elevation myocardial infarction,distal thrombolysis,when compared with thrombus aspiration,may reduce the incidence of slow flow and no reflow,and may improve the left ventricular systolic function.
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Objective To compare the effects of levosimendan (Levo) and recombinant human brain natriuretic peptide (rhBNP) in patients with acute decompensated heart failure (ADHF). Methods Seventy-five patients were included into this randomized positive-controlled and parallel-group study to receive either Levo (Levo group), rhBNP (rhBNP group) or dobutamine therapy (control group). Heart rate, respiratory rate, 24-hour urine volume,improvement in six-minute walk-test after 72-h treatment were compared between three groups. The blood level of BNP and values of left ventricular end dia?stolic diameter (LVEDD) and left ventricular ejection fraction (LVEF) after one-week treatment were compared between three groups. Results After 72-h treatment, heart rate and respiratory rate were significantly decreased, and 24-hour urine volume, six-minute walk-test were significantly increased in three groups (P0.05), but the LVEDD was improved barely (P>0.05). The improvements were more significant in Levo group and rhBNP group compared to those of control group (P<0.05). There were no significant differenc?es in improvements between Levo group and rhBNP group. The common adverse reactions were hypotension and ventricular premature beats. There were no significant differences in adverse event rates between three groups (P<0.05). Conclusion As compared with dobutamine, Levo and rhBNP have optimized efficacy, fewer side effects and good safety in the treatment of ADHF. They are worth of clinical application.
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Ventriculo-Peritoneal shunt is the most commonly performed surgery for hydrocephalus, universally Many complications are reported, of which the shunt malfunction and infection are most commonly encountered. These common complications can be minimized, by precautions like– senior surgeons operating shunt cases, as the first case in the operation, with minimal personnel in the operation and thoroughly scrubbing the part for minimum five minutes. However, in few cases, – even in the experienced hands and with all precautions, some rare complications like extrusion of the lower end through anus, vagina, into scrotum were described. In our experience of over 15 years, wide range of complications was seen apart from malfunction and infection. Exposure of the part of shunt system, with excoriation of overlying skin, peritubal leaks, disconnection of shunt system with CSF leaking out, loculation in between the loops of bowel/ omentum, extrusion of the lower end through anus etc. were encountered and probable factors for these unusual complications were discussed.
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Objective: To evaluate the preliminary effect for serum albumin (ALB) level in patients with chronic heart failure (CHF) treated by cardiac resynchronization (CRT). Methods: A total of 54 CHF patients treated in our hospital from 2009-01 to 2013-12 were studied. The patients were divided into 2 groups: CRT group and Control group, in which the patients were treated by medication. n=27 in each group. The blood test of biochemistry, 24 hour dynamic ECG monitoring with QRS duration, echocardiography, ALB level, heart rate (HR), left ventricular end-diastolic dimension (LVEDD) and left ventricular ejection fraction (LVEF) were recorded at admission as baseline information, and the above examinations were repeated 2 to 3 times during 6-15 months of follow-up period. Results: The age, gender and baseline information were similar between 2 groups. Compared with admission, during followed-up period, CRT group had increased ALB, LVEF, P Conclusion: CRT could improve the cardiac function and increase ALB in CHF patients, therefore serum ALB level might be related to CRT efifcacy at certain degree.
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Objective: To evaluate the post-operative mortality of left ventricular end-diastolic pressure (LVEDP) during primary percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods: We retrospectively analyzed 255 patients with new onset of STEMI who received primary PCI in our hospital and all patients received LVEDP measurement before coronary artery opening. According to LVEDP value, the patients were divided into 2 groups: LVEDP≤14 mmHg group,n=155 and LVEDP>14 mmHg group,n=100. The post-operative mortality up to 6 months was observed, and the effect of LVEDP on death rate was studied by Cox regression analysis. Results: Compared with LVEDP≤14 mmHg group, the patients in LVEDP>14 mmHg group had the 6 months mortality at HR=4.26, 95% CI (1.13-16.08),P=0.03. Relevant study presented that LVEDP was slightly related to LVEF (r=-0.267, P=0.001) and BNP (r=-0.154,P=0.041). Multi-regression analysis indicated that with adjusted LVEF and BNP, LVEDP was the independent predictor for post-operative mortality up to 6 months in acute STEMI patients after PCI. Conclusion: The LVEDP value measured during PCI procedure is the independent predictor for mortality after PCI in patients with new onset of STEMI.
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Objective: To assess the clinical value of serum N-terminal pro-brain natriuretic peptide (NT-ProBNP) values in elder patients with heart failure (HF). Methods: According to NYHA classiifcation, a total of 384 HF patients were divided into 4 groups as NYHA I group, n=35, NYHA II group, n=89, NYHA III group, n=163, NYHA IV group, n=97;and Control group, n=69 normal subjects. The NT-ProBNP and troponin (cTn1) levels were examined in systolic HF and diastolic HF patients, the relationship between NT-ProBNP and left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD) were studied. Results: For NT-ProBNP levels, Control group and NYHA I group were similar, P>0.05; while it was different among each HF groups, P0.05;while NYHA III group and NYHA IV group were different from other groups, P Conclusion: NT-ProBNP may better reflect the cardiac structural and functional changes in HF patients, it is important for HF early diagnosis and prognosis in clinical practice.
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This study was aimed to observe the influence of Kang-Xian Y i-Xin (KXYX) formula on the heart size and cardiac function of patients with dilated cardiomyopathy (DCM). A total of 85 cases were randomly divided into the treatment group (43 cases) and the control group (42 cases, with 1 death case). Both groups were treated with routine western medicine. And the KXYX formula was combined in the treatment group once a day. Six months later, changes of the left ventricular end diastolic diameter (LVEDD), left atrial diameter (LAd), ejection fraction (EF) and fractional shortening (FS) were observed by ultrasonography. The results showed that both groups can reduce the LVEDD and Lad. And the effect was obvious in the treatment group (P< 0.05). There was significant difference in the LVEDD of both groups after treatment (P< 0.05). The EF and FS were raised obviously in both groups. There was significant difference before and after treatment in the treatment group (P < 0.01). There was statistical differ-ence between groups after treatment (P< 0.05). It was concluded that the KXYX formula can decrease the LVEDD, Lad, enhance EF and FS, in order to promote the cardiac function of patients with DCM.