Prognostic evaluation of cardiac markers in early diagnosis of cardiac dysfunction in sepsis / 实用医学杂志

Objective To study the application value of myocardial markers combined with BNP in the early diagnosis of cardiac dysfunction in patients with sepsis. Methods diagnosed patients 66 cases as the research object of this paper,on the basis of 3~5 days in 66 patients with left ventricular ejection fraction after admission of LVEF > 50% and LVEF 50%and LVEF<50%two groups:3,5 days when the BNP value was significantly higher than that of non cardiac injury heart injury;cardiac injury group EF was negatively correlated with TNI value ,value and blood 3~5 days EF troponin levels in patients admitted to hospital after the show was negatively correlated;the concentration of EF and patients admitted to the hospital after twelfth days of blood troponin value is displayed as a negative correlation. TNI can directly reflect the cardiac function of patients. Research shows that the BNP value had a significant positive correlation in fifth days and APACHE Ⅱ score. Conclusion the data show that TNI and BNP can directly reflect the sepsis patients with heart dysfunction ,that BNP combined with TNI can effectively evaluate the clinical treatment of severe sepsis and septic shock patients ,prognosis has high significance.

Ultrasonic study of the right heart function of patients with pulmonary hypertension in ICU / 实用医学杂志

Objective To investigate the valuable echocardiographic parameters and to evaluate theright heart function of patients with pulmonary hypertension in ICU. Methods From March 2015 to February 2016,30 patients with pulmonary hypertension in the intensive care unit(ICU) of Dongzhimen hospital were enrolled in the experimental group,and another 33 patients without pulmonary hypertension in ICU were enrolled in the control group. All of the patients were given bedside echocardiography examination. Results Significant differences in the right atrial diameter and area ,the base diameter of the right ventricle ,the intermediate diameter portion ,the distal inner diameter of the proximal end of the right ventricular outflow tract ,the main pulmonary artery diameter ,the Tei index and the E/A were observed between the two groups. However ,no significant differences in the right ventricular free wall thickness,TAPSE,RVFAC,VREF and DT were foundbetween the two groups. Conclusion Tei index,the diameter of the right heart and the main pulmonary artery diameter are proposed to be the promising echocardiographic parameters to evaluate the right heart function of patients with pulmonary hypertension in ICU.

Insuficiência cardíaca, exercício físico e sistema inflamatório / Heart failure, exercise training and systemic inflammatory

Fundamentação: No contexto do tratamento da insuficiência cardíaca (IC) se torna relevante a melhor compreensão das repercussões da interação entre exercício físico e inflamação, tendo em vista a forte influência de ambos na evolução clínica dos portadores da síndrome. Objetivo: Busca de informações sobre as repercussões do exercício físico no perfil inflamatório de pacientes com IC. Métodos: Busca por periódicos nas bases de dados, CONCHRANE, PUBMED, LILACS. Os seguintes termos MeSH foram utilizados: heart failure, inflammatory mediators e exercise. Os estudos foram selecionados por dois avaliadores, segundo critérios do instrumento Delphi List. Resultados: Dezenove ensaios clínicos controlados foram selecionados. Os estudos foram semelhantes quanto à modalidade e protocolos de exercícios físicos utilizados na investigação dos efeitos no comportamento dos mediadores inflamatórios, havendo, entretanto, predominância no uso da atividade aeróbica de moderada intensidade. Os desfechos dos estudos mostram redução crônica de citocinas pró-inflamatória de ação sistêmica e cardíaca, como também de ação endotelial e de apoptose celular em decorrência do exercício físico. Nenhum estudo avaliou a influência do exercício de alta intensidade sobre os marcadores inflamatórios. Conclusões: Tem sido demonstrado que o exercício físico utilizado predominantemente de forma aeróbica com intensidade moderada proporciona estabilização e diminuição dos marcadores pró-inflamatórios, algo desejável no tratamento da IC. Não foram encontrados estudos evidenciando o efeito isolado do exercício resistido, assim como o efeito do exercício de alta intensidade sobre os marcadores inflamatórios em pacientes com insuficiência cardíaca.

Síndrome cardiorrenal: Nuevas perspectivas / Cardiorenal syndrome: New perspectives

La disfunción cardiaca y la renal coexisten con alta prevalencia. Se ha definido a esta entidad clínica como síndrome cardiorrenal y una de sus características principales es la resistencia al tratamiento. Se han descrito múltiples hipótesis para explicar su fisiopatología, como la desregulación hemodinámica y, recientemente, mecanismos neurohumorales e inmunológicos que intervienen en su desarrollo y perpetuación. Se clasifica de acuerdo con su forma de presentación y componentes fisiopatológicos. Existen distintos enfoques terapéuticos para controlar o limitar el progreso de la enfermedad. Esta revisión discute y analiza la información actual sobre la fisiopatología, la clasificación y el tratamiento de esta entidad.

There is a high prevalence of heart failure associated to kidney failure or viceversa. This association has been defined as a clinical entity: cardiorenal syndrome and one of its main characteristics is the resistance to treatment. Multiple hypotheses have been proposed to explain the pathophysiology of this syndrome, such as hemodynamic deregulation and recently, other neurohormonal and immunological mechanisms involved in the development and perpetuation of this pathology. Classifications have been based on the form of presentation or physiopathological manifestations. Different therapeutic approaches have been proposed to control or limit the progress of this disease. This review discusses and analyzes the current information on pathophysiology, different classifications and treatment.

Mechanisms for the Defects in Phospholipid Signal Transduction in Diabetic Cardiomyopathy.

Although diabetic cardiomyopathy is associated with heart dysfunction and disturbance in cardiac sarcolemmal membrane phospholipid composition, the role of the different phospholipases and their related signaling mechanisms to altered function of the heart in diabetes is not completely understood. Thus, understanding the pathophysiology of cardiovascular abnormalities in diabetes, as well as identifying defects in various components of the phospholipid signaling pathways, that could serve as therapeutic targets, is warranted. Accordingly, this review provides an outline of the role of and the mechanisms for the defects in phospholipase A2, C and D-mediated signal transduction in the diabetic heart. In addition, the potential of different phospholipases as targets for drug development for the prevention/treatment of heart disease in diabetes is discussed.

RELATION OF PERIOPERATIVE SERUM THYROID HORMONE CHANGES TO HEART DYSFUNCTION IN PATIENTS UNDERGONE CARDIAC VALVE REPLACEMENT / 药物分析学报

Objective To explore the relationship between perioperative serum thyroid hormone changes and heart dysfunction in patients undergone cardiac valve replacement. Methods The serum concentrations of free tri- iodothyronine (),free thyroxine (),total total reverse and thyroid-stimulating hor- mone (TSH) in 20 patients undergone routine rheumatic mitral valve replacement were determined by radioim- munoassay at preoperation, the end of myocardial ischemia, and 2,6,12,24 and 48h postoperation, respectively. The alteration hormones above mentioned were comparatively analysed of the normal heart function group (group I,n = 14) and heart dysfunction group (group I ,n=6) after surgery. ResultsIn comparing group I with group I , the more severe the chronic congestive heart failure, the lower the thyroid hormone level before operation;and subse- quently both progressively lowered T3 level and acute heart dysfunction emerged after operation. The decreased extent of serum thyroid hormone was closely parallel to the severity of heart dysfunction. GonclusionPerioperatively, de- creased serum FT3 and TT3 concentrations are at least an important humoral factor aggravating heart dysfunction, and the patients with preoperative low T3 should be considered as high-risk valvular surgical cases.