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Objective:To explore the effect of aerobic exercise combined with diet management on volume overload and cardiac function in patients with peritoneal dialysis.Methods:A total of 100 patients who received peritoneal dialysis in the Second Affiliated Hospital of Xi ′an Jiaotong University from August 2017 to March 2019 were recruited in the present study. Patients were randomly divided into intervention group and control group according to the random number table (50 cases in each group). The control group received routine nursing, while the intervention group carried out aerobic exercise combined with diet management on the basis of routine nursing. Before and after 6 months of intervention, the volume status, edema degree and cardiac function were compared between the two groups. Results:After 6 months of intervention, the levels of body weight, 24 h urine volume, 24 h ultrafiltration volume, systolic pressure, extracellular water, and extracellular water/total body water were (58.99 ± 7.30) kg, (366.41 ± 66.92) ml, (565.08 ± 102.24) ml, (142.64 ± 11.70) mmHg (1 mmHg=0.133 kPa), (12.30 ± 2.01) L, 0.39 ± 0.08 in the intervention group, significantly lower than in the control group (63.46 ± 12.90) kg, (431.90 ± 78.92) ml, (625.35 ± 91.31) ml, (150.11 ± 11.44) mmHg, (14.37 ± 4.12) L, 0.43 ± 0.07, the differences were statistically significant ( t values were 2.026-4.208, all P<0.05); the left ventricular ejection fractions, E/A were (61.38 ± 9.42)%, 1.15 ± 0.35 in the intervention group, significantly higher than in the control group (57.04 ± 7.83)% and 1.00 ± 0.29, the differences were statistically significant ( t values were 2.358, 2.113, all P<0.05). After 6 months of intervention, the normal ratio increased and Ⅲ grade ratio decreased in the intervention group, the difference of edema degree between the two groups was statistically significant ( Z value was 3.153, P<0.01). Conclusions:Aerobic exercise combined with diet management can effectively control the volume overload status and improve the cardiac function of patients with peritoneal dialysis.
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Background: Patent Ductus Arteriosus (PDA) is a common congenital disorder. As an isolated lesion, PDA constitutes 6 to 11% of all congenital heart disease. PDA needs closure to eliminate pulmonary over circulation leading to volume overload of left ventricle, pulmonary vascular obstructed disease.Methods: This retrospective study was carried out in pediatric cardiology unit of Institute of Postgraduate Medical Education and Research, Kolkata from September 2005 to August 2016, which included 503 patients.Results: Device closure was attempted in 492 patient’s Procedural success was achieved in 85% cases on table, in who check aortogram revealed complete closure of PDA. In 15% cases, residual shunt was present. In 12% of cases, residual shunt disappeared during follow-up echocardiogram over 6-month follow-up. In 3% cases, small shunt remained at 6-month and 1-year follow up.Conclusion: Transcatheter closure of PDA by duct occluder is safe and effective with good mid-term outcome. The optimum assessment of ductul size and anatomy is crucial for optimum device size, which prevents residual shunt, device embolization and protrusion.
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Objective To explore the effect of health education based on behavioral phased transformation theory in remote peritoneal dialysis patients in remote mountainous areas. Methods Totally 84 cases of peritoneal dialysis catheterization in our hospital from April 2016 to May in-2018 were selected as the research subjects. After discharge, home peritoneal dialysis was performed. According to the random number table method, 42 cases in each group were divided into observation group and control group. The control group was given routine treatment and traditional health education. On the basis of conventional treatment, the observation group established a behavior based phased transformation of health education as a means of intervention. The two groups were all intervened for 6 months. Volume status and self-care behavior were evaluated and compared between the two groups within one week of admission and six months after intervention. Results Before intervention, there was no significant difference in the capacity load between the observation group and the control group (P>0.05). The systolic and diastolic blood pressures of the observation group after intervention were (131.21±11.73) mmHg (1 mmHg=0.133kPa) and (80.24 ±10.62) mmHg respectively, which were significantly lower than those of the control group (140.31 ± 12.87) mmHg and (85.75 ± 11.73) mmHg, with significant differences (t=3.455, 2.302, P < 0.05); and the ultrafiltration volume of the observation group after intervention was (385.15 ± 105.1.8) ml was significantly higher than that of the control group (320.02 ± 126.87) ml, with significant difference (t=2.561, P < 0.05); there was no significant difference in body mass and urine volume between the two groups after intervention (P>0.05).The total score of the self-care ability scale in the observation group was (122.11 ± 8.52) points, which was significantly higher than that in the control group (94.24 ± 10.71) points . The difference was statistically significant(t=313.198, P<0.01). Conclusion Health education based on the theory of behavioral phased transformation can help patients with peritoneal dialysis in remote mountainous areas to improve their capacity and improve their self-protection behavior, which has educational guiding significance.
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Objective@#To explore the effect of health education based on behavioral phased transformation theory in remote peritoneal dialysis patients in remote mountainous areas.@*Methods@#Totally 84 cases of peritoneal dialysis catheterization in our hospital from April 2016 to May in -2018 were selected as the research subjects. After discharge, home peritoneal dialysis was performed. According to the random number table method, 42 cases in each group were divided into observation group and control group. The control group was given routine treatment and traditional health education. On the basis of conventional treatment, the observation group established a behavior based phased transformation of health education as a means of intervention. The two groups were all intervened for 6 months. Volume status and self-care behavior were evaluated and compared between the two groups within one week of admission and six months after intervention.@*Results@#Before intervention, there was no significant difference in the capacity load between the observation group and the control group (P>0.05). The systolic and diastolic blood pressures of the observation group after intervention were (131.21±11.73) mmHg (1 mmHg=0.133kPa) and (80.24 ±10.62) mmHg respectively, which were significantly lower than those of the control group (140.31 ± 12.87) mmHg and (85.75 ± 11.73) mmHg, with significant differences (t=3.455, 2.302, P < 0.05); and the ultrafiltration volume of the observation group after intervention was (385.15 ± 105.1.8) ml was significantly higher than that of the control group (320.02±126.87) ml, with significant difference (t=2.561, P < 0.05); there was no significant difference in body mass and urine volume between the two groups after intervention (P > 0.05).The total score of the self-care ability scale in the observation group was (122.11 ± 8.52) points, which was significantly higher than that in the control group (94.24 ± 10.71) points. The difference was statistically significant (t=313.198, P<0.01) .@*Conclusion@#Health education based on the theory of behavioral phased transformation can help patients with peritoneal dialysis in remote mountainous areas to improve their capacity and improve their self-protection behavior, which has educational guiding significance.
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Objective To investigate whether the change of cardiac output (CO) with bed head raising (BHR) combined with passive leg raising (PLR) can be used to assess volume overload in critical patients.Methods A prospective observational diagnostic trial was designed. The patients who underwent fluid resuscitation 6 hours or more, and admitted to intensive care unit (ICU) of Meizhou People's Hospital in Guangdong Province from January to December in 2016 were enrolled. Volume overload were identified with the criteria including the increasing of pulmonary rales, the higher levels of N-terminal brain natriuretic peptide (NT-proBNP) and new pulmonary exudates in chest radiograph. CO and heart rate (HR) were monitored with impedance cardiography at supine position and BHR by 30°(BHR30), 60° (BHR60), and PLR in all patients. The changes of CO (?CO30,?CO60,?COPLR) and HR (?HR30,?HR60,?HRPLR) were calculated at different positions. The receiver operating characteristic curve (ROC) was used to evaluate the predictive values of?CO30,?CO60 and combination of?CO60 and?COPLR on volume overload.Results A total of 62 patients were enrolled in this study, with 44 males and 18 females, age of (58.9±15.9) years, a body mass index of (22.7±2.4) kg/m2, and an acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score of 18.7±4.4. The CO of 32 patients with volume overload was significantly increased at BHR30 or BHR60 compared with supine position [?CO30 was (14.5±11.5)%,?CO60 was (26.9±17.5)%, bothP 0.05). There was no consistent change of CO at BHR30 or BHR60 compared with supine position in 30 patients without volume overload,?CO30 was (-3.4±9.1)% (P 0.05), while CO was significantly increased after PLR,?COPLR was (12.4±11.3)% (P < 0.01). There was no significant change of HR after BHR and PLR in patients with volume overload and non volume overload. ROC curve showed that when the cut-off value of ΔCO30≥3.3%, the area under ROC curve (AUC) was 0.903±0.039, the sensitivity was 90.6%, the specificity was 80.0%, and the accuracy was 85.5% for predicting volume overload; when the cut-off value of ΔCO60≥5.6%, the AUC was 0.911±0.036, the sensitivity was 96.9%, the specificity was 73.3%, and the accuracy was 85.5% for predicting volume overload. If volume overload was assessed by the increase of ΔCO60 combining with the decrease of ΔCOPLR, the AUC was 0.928±0.034, the optimal cut-off value for the new combined predictive indicator in predicting volume overload was -0.008, and the sensitivity, specificity, accuracy was 96.9%, 83.3%, 90.3%, respectively, and its evaluation effect is better than the use of ΔCO30 or ΔCO60 alone.Conclusion The change of CO with BHR combined with PLR can be used to accurately evaluate volume overload in patient with critically illness.
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BackgroundThe relationship between lipids and coronary artery disease has been well established. However, this is not the case between lipids and heart failure. Ironically, high lipid levels are associated with better outcomes in heart failure, but the mechan-isms underlying the phenomenon are not fully understood. This study was performed to test the hypothesis that reduced intestinal lipid absorption due to venous congestion may lead to low lipid levels.MethodsWe collected data of clinical characteristics, echocardio-graph, and lipid profile in 442 unselected patients with congestive heart failure. Correlations between lipid levels[including total cho-lesterol(TCL), high-density lipoprotein cholesterol(HDL-C), low-density lipoprotein cholesterol(LDL-C), and triglycerides(TG)]and right ventricle end diastolic diameter (RVEDD), left ventricle end diastolic diameter (LVEDD), right atrium diameter (RA), left atrium diameter (LA), or left ventricle ejection fraction (LVEF) were analyzed using Pearson correlation and partial correlation. RVEDD, LVEDD, RA, and LA were indexed to the body surface area.ResultsThere was a significantly inverse correlation between TCL le-vels and RVEDD (r=-0.34,P<0.001) and RA (r=-0.36,P<0.001). Other lipids such as LDL-C, HDL-C, and TG had asimilar inverse correlation with RVEDD and RA. All these correlations remained unchanged after adjusting for age, gender, smoking status, physical activity levels, comorbidities, and medication use.ConclusionsLipid levels were inversely correlated to RVEDD in patients with congestive heart failure; however, because this was an observational study, further investigation is needed to verify our results as wellas identify a causal relationship, if any.
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Objective To evaluate the effect of volume management on volume overload among continuous ambulatory peritoneal dialysis (CAPD).Methods The literature were searched by the databases of PubMed,ScienceDirect,Ovid,Cochrane Library,Chinese Science and Technology Periodical Databases (VIP),China National Knowledge Infrastructure (CNKI).Data were analyzed with RevMan5.0 software.Results Ten literatures were included in this study.The results of Meta-analysis revealed that volume management could significantly reduce the body weight,degree of edema and systolic blood pressure.However,no significant difference on the diastolic blood pressure appeared.Conclusions Body weight,degree of edema and systolic blood pressure can be improved by effective volume management.Further study about effect of volume control on diastolic blood pressure should be provided in the future.
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PURPOSE: We investigated the relationship between severity of pulmonary regurgitation (PR), exercise capacity, right ventricular (RV) volume overload and RV function in the patients with long-term follow-up after repair of tetralogy of Fallot (TOF). METHODS: To evaluate exercise capacity, cardiopulmonary exercise test (CPX) was performed in 26 patients and 18 normal controls on a treadmill, and maximal oxygen consumption (VO(2max)) and anaerobic threshold (AT) were compared among the two groups. To assess severity of PR, RV volume and function, magnetic resonance imaging (MRI) study was performed in the patient group and the PR fraction (%), RV end-diastolic volume (EDV), end-systolic volume (ESV) and ejection fraction(EF) were measured. Patient group was divided into two subgroups by age and influences of PR on RV volume and function were compared among these subgroups. RESULTS: VO(2max) and AT were significantly decreased in the patients in comparison to the control subjects (28.9+/-10.4 vs 38.1+/-9.9 ml/kg/min, P=0.01; 0.98+/-0.53 vs 1.44+/-0.59 l/min, P=0.03). PR fraction inversely correlated with the VO(2max) (r=-0.58, P<0.01) and had a tendency toward inverse correlation with AT (r=-0.35, P=0.15). In young age group less than 15 years, no significant correlation between RVEDV, RVESV, corrected QRS duration (cQRS) and PR fraction (r=0.48, P=0.19; r=0.45, P=0.22; r=0.12, P=0.76) was observed, but in old age group, RV volume (RVEDV: r=0.73, P=0.01; RVESV: r=0.61, P=0.04) and the cQRS (r=0.66, P=0.03) were increased according to the severity of PR. RVEDV and RVESV showed inverse correlations with RVEF (r-0.59, P=0.003; r= -0.78, P<0.001), and RVEF showed positive correlation with VO(2max) (r=0.62, P=0.04). CONCLUSION: Patients in long-term follow-up after repair of TOF showed impaired exercise capacity than normal subjects. PR has a negative influence on the exercise tolerance in this group of patients, and the deleterious effects of PR on RV volume and QRS prolongation may related with the age and/or duration of PR. RV volume overload may deteriorate RV function and cause resultant exercise impairment.
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Humans , Anaerobic Threshold , Exercise Test , Exercise Tolerance , Follow-Up Studies , Magnetic Resonance Imaging , Oxygen Consumption , Pulmonary Valve Insufficiency , Tetralogy of FallotABSTRACT
BACKGROUND: B-type natriuretic peptide (BNP) regulates excretion of water and sodium in the kidney, and serum levels of BNP are increased in the settings of decreased ventricular contractility and myocardial overload. Serum levels of BNP and renal function are important prognostic factors in congestive heart failure, and when renal function deteriorates, BNP level is increased. This study aimed to assess the clinical benefits of BNP measurement in patients with chronic kidney disease (CKD) for prediction of congestive heart failure (CHF). METHODS: Serum levels of BNP were measured in 75 patients with CKD who admitted to Soonchunhyang university Bucheon hospital between the period of April 2003 and April 2004. The clinical data, laboratory findings and echocardiographic findings in these patients were compared retrospectively. RESULTS: The average BNP level of the 75 patients was 1,645.3+/-1,830.9 pg/mL. There were no differences in BNP levels between K/DOQI CKD stages. Levels of BNP were higher in CKD patients with heart failure compared to those without heart failure. BNP levels showed a negative correlation to left ventricular ejection fraction and significant elevation in patients with pulmonary congestion and weight gain on admission. There was no difference in BNP levels in patients with or without left vetricular hypertrophy, and diabetes mellitus. The best cutoff level of BNP for evaluation of heart failure in patients with CKD was 500 pg/mL, with a sensitivity of 78%, specificity of 53%, positive predictive value of 34%, and negative predictive value of 88%, respectively. CONCLUSION: BNP levels showed no difference with the degree of renal failure in patients with CKD, and levels were increased with heart failure in patients with CKD. We discovered though, that in patients with CKD the measurement of serum BNP is a useful factor in assessment of coexisting heart failure, volume status and ischemic heart disease.
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Humans , Diabetes Mellitus , Echocardiography , Estrogens, Conjugated (USP) , Heart Failure , Hypertrophy , Kidney , Myocardial Ischemia , Natriuretic Peptide, Brain , Renal Insufficiency , Renal Insufficiency, Chronic , Retrospective Studies , Sensitivity and Specificity , Sodium , Stroke Volume , Weight GainABSTRACT
BACKGROUND AND OBJECTIVES: Left ventricle burdened by longstanding volume-overload, undergoes various structural and functional alterations. Accordingly, the expressions of multiple classes of genes are likely to be altered. However, the profile of gene expressions, specifically in a volume-overloaded left ventricle in humans, has not been explored. SUBJECTS AND METHODS: The pattern of gene expression was studied, using a cDNA microarray, in myocardium from 4 normal subjects and 5 patients with chronic regurgitant valvular heart disease whose end-diastolic left ventricular dimension measures 65 mm or more, but whose systolic function remained preserved. RESULTS: We identified 58 differentially expressed genes that were functionally classifiable in the volume-overloaded myocardium. Those genes involved in cell cycle/growth (up/down-regulation: 9/1), signal transduction (4/1) were mostly overexpressed in the volume-overloaded myocardium. The distributions of the gene expressions were variable for those involved in transcription/translation (up/down-regulation: 6/7) and apoptosis (2/2). The genes related to the myocyte structure (troponin T3, tropomyosin, etc)(up/down-regulation: 1/10), as well as those related to metabolism (2/5), were underexpressed. The gene expression patterns from RT-PCR and Western blot, with randomly selected genes, were similar to those from the cDNA microarray. CONCLUSION: Altered expression was identified in multiple genes in the volume-overloaded human left ventricle prior to the development of heart failure. The genes related to cell growth and signal transduction were mostly overexpressed, while those related to cellular structure and metabolism appeared to be underexpressed. These results might help in the elucidation of cellular mechanisms for the remodeling process associated with chronic volume-overloading.
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Humans , Apoptosis , Blotting, Western , Cellular Structures , Gene Expression , Heart Failure , Heart Valve Diseases , Heart Ventricles , Heart , Metabolism , Muscle Cells , Myocardium , Oligonucleotide Array Sequence Analysis , Signal Transduction , Transcriptome , TropomyosinABSTRACT
Objective: To study the possible mechanism of malnutrition in peritoneal dialysis patients. Methods: Multicenter prospective cohort study was designed . Forty-four peritoneal dialysis patients who survived two years after a cross-sectional study were included in the present study. We divided our patients into two groups according to the dietary protein intake(DPI) during follow-up period, DPI lower than 0.78 g/( kg?d) or DPI higher than 0.78 g/( kg?d). Patients' nutritional status was evaluated during the cross-sectional study and at the end of follow-up. 22 patients were divided into two groups according to the nutritional status improved or worsened in subjective global assessment (SGA) during the follow-up period. Besides nutritional status, patient's residual renal function, volume status and the incidence of cardiovascular event during the follow-up period were also evaluated. Results: Based on SGA , the incidence of malnutrition in low-DPI group was 60.9% in the cross-sectioned study and 45.5% after the follow-up. In high-DPI group, it decreased from 57.1% to 28.6%. The residual renal function declined significantly in worse nutritional status group, the incidences of volume overload and cardiovascular events during follow-up study were significantly higher in worse nutritional status group than that in improved nutritional status group. Conclusion: Malnutrition in peritoneal dialysis patients may not be simply due to lower protein intake. The changes in residual renal function, fluid overload and cardiovascular disease, accompanied with low dietary protein intake may be the possible cause of malnutrition in peritoneal dialysis patients.
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Coronary artery fistula is an unusual anomaly in elderly patients that consists of a communication bet- ween one of the coronary arteries and other cardiac chambers or veins. It causes many cardiac compli- cations due to hemodynamic changes, and thus has recognized its clinical significance. It occurs usually in congenital origin, but also occurs secondarily in traumatic or neoplastic or artherosclerotic coronary diseases. Congenital coronary artery fistula is a very rare congenital anomaly that results in multiple hemodynamic complications. It has reported rarely in elderly patients, that induces myocardial ischemia due to coronary steal syndrome and heart failure that caused by diastolic volume overload via a left to left shunt. We observed a 68-year-old male patient with exertional chest pain and dyspnea, in whom selective coronary angiography revealed abnormal reticular communication between left anterior descending artery and left circumflex artery and drained to left ventricle through multiple microfistulous channels. We report this patient case who complicated by myocardial ischemia and left ventricular failure those caused by hemodynamic complication due to multiple coronary artery-left ventricular fistulae.
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Aged , Humans , Male , Arteries , Cations , Chest Pain , Coronary Angiography , Coronary Disease , Coronary Vessels , Dyspnea , Fistula , Heart Failure , Heart Ventricles , Heart , Hemodynamics , Myocardial Ischemia , VeinsABSTRACT
Coronary artery fistula is an unusual anomaly in elderly patients that consists of a communication bet- ween one of the coronary arteries and other cardiac chambers or veins. It causes many cardiac compli- cations due to hemodynamic changes, and thus has recognized its clinical significance. It occurs usually in congenital origin, but also occurs secondarily in traumatic or neoplastic or artherosclerotic coronary diseases. Congenital coronary artery fistula is a very rare congenital anomaly that results in multiple hemodynamic complications. It has reported rarely in elderly patients, that induces myocardial ischemia due to coronary steal syndrome and heart failure that caused by diastolic volume overload via a left to left shunt. We observed a 68-year-old male patient with exertional chest pain and dyspnea, in whom selective coronary angiography revealed abnormal reticular communication between left anterior descending artery and left circumflex artery and drained to left ventricle through multiple microfistulous channels. We report this patient case who complicated by myocardial ischemia and left ventricular failure those caused by hemodynamic complication due to multiple coronary artery-left ventricular fistulae.
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Aged , Humans , Male , Arteries , Cations , Chest Pain , Coronary Angiography , Coronary Disease , Coronary Vessels , Dyspnea , Fistula , Heart Failure , Heart Ventricles , Heart , Hemodynamics , Myocardial Ischemia , VeinsABSTRACT
To observe the effects of total flavones of Metasequoia glyptostroboides Hu et Cheng (TFM) on volume-overload cardiac hypertrophy and the expression of c-Fos protein in rat. Methods Volume-overload cardiac hypertrophy of rat was induced by aortocaval shunts. The rats were given ig TFM (400, 40 and 4 mg/kg/d). c-Fos protein in the ventricles were measured by immunocytochemical study. Results TFM at the above dosage decreased heart weight and contents of RNA and protein in the myocardium, inhibited the expression of c-Fos protein in the ventricles. Conclusion TFM can prevent volume-overload cardiac hypertrophy in rats. The inhibitory effects on the expression of c-Fos protein may be its mechanism in the molecular level.
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The precise measurement of fluid balance in hemodialysis patients is an important component for assessment of dialysis adequacy and predicting intradialytic morbidity. In most centers, fluid removal by ultrafiltration is targeted to a patient's dry weight, but dry weight estimated by trial-and-error method is often imprecise. ANP(atrial natriuretic peptide) and cGMP(cyclic guanosine 3', 5'-monophophate) are biochemical markers for volume overload. We hypothesized that plasma values of ANP and cGMP before and after hemodialysis might be useful for evaluating ideal dry body weight and volume status in maintenance hemodialysis patients. To test this hypothesis, we examined 36 stable hemodialysis patients without fluid overload for a minimum of three months at our hospital. In all patients, plasma ANP and cGMP were measured by radioimmunoassay(RIA) method immediately before and after hemodialysis. Thirteen normal healthy controls were studied to define the normal range of plasma ANP and cGMP value. We correlated plasma values of ANP and cGMP in paitents with corresponding difference of P(difference between actual weight and estimated ideal dry weight) and mean arterial blood pressure(MAP). The results are as follows : 1) Compared with healthy controls, the hemodialysis patients had significantly elevated plasma values of ANP and cGMP. The plasma ANP and cGMP values after dialysis were significantly decreased compared to those before dialysis(p<0.01). 2) There was positive correlation between the levels of ANP and cGMP(p<0.01). 3) Predialytic difference of P was significantly positive correlated to predialytic cGMP(r= 0.73, p<0.01). It was also appeared to be increased tendency by increasing value of predialytic ANP, but the difference was statistically not significant. 4) Predialytic MAP had significant positive correlation to predialytic ANP(r=0.47, p<0.01). It was also increased by predialytic cGMP, but the difference was statistically not significant. In conclusion, plasma values of ANP and cGMP might be helpful clinical markers for evaluating volume status and assessing dry weight in maintenance hemodialysis patients.
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Humans , Atrial Natriuretic Factor , Biomarkers , Body Weight , Dialysis , Guanosine , Plasma , Reference Values , Renal Dialysis , Ultrafiltration , Water-Electrolyte BalanceABSTRACT
AIM: To compare the evaluations for the structure and function of the hypertrophic hearts induced by volume overload or pressure overload in rats. METHODS: Volume overload-induced cardiac hypertrophy was established by abdominal aortacaval fistula (ACF) and pressure overload-induced cardiac hypertrophy was developed by constriction of aorta (CA). The cardiac structure and function were analyzed by echocardiography, hemodynamic determination, heart weight measurement and histological examination. RESULTS: Heart weight of rats in all the operated groups was increased compared to the sham-operated groups. In 1-week ACF group, the internal diameter (0.67?0.03)cm vs (0.60?0.02)cm, P