Effect of ulinastatin injection on left ventricular diastolic function in patients with sepsis / 中华急诊医学杂志

Objective:To investigate the effect of ulinastatin injection on left ventricular diastolic function and prognosis in patients with sepsis.Methods:A total of 100 patients with sepsis admitted to the Intensive Care Unit from January 2021 to March 2022 were selected. According to the random number table, they were randomly (random number) divided into the control group (conventional treatment) and experimental group (conventional treatment + ulinastatin injection). The baseline data on admission were compared between the two groups. The echocardiographic indexes [mitral peak velocity of early filling/early diastolic mitral annular velocity (E/e'), early diastolic mitral annular velocity (e'), mitral peak velocity of early filling/ mitral peak velocity of late filling (E/A), and tricuspid regurgitation rate (TRV)], myocardial damage-related and cardiac function-related indicators [troponin I (cTnI), N terminal pro B type natriuretic peptide (NTproBNP)] and inflammation-related indicators [C-reaction protein (CRP), procalcitonin (PCT), erythrocyte sedimentation rate (ESR)], length of ICU stay, duration of infection control, duration of vasoactive drug use and 28-day mortality were observed and compared between the two groups on admission and 7 days after treatment.Results:On the 7th day after treatment, the levels of e 'and E/A in the experimental group were significantly higher than those in the control group, and the levels of E/e', TRV, cTnI, NTproBNP, CRP and PCT were significantly decreased ( P<0.05). There were no significant differences in duration of infection control and duration of vasoactive drug use between the experimental group and the control group ( P<0.05), but the length of ICU stay was shorter and 28-day mortality was significantly lower in the experimental group than in the control group ( P<0.05). Conclusions:Ulinastatin can reduce the degree of inflammatory response, relieve myocardial injury, improve left ventricular diastolic function, and reduce the length of ICU stay and 28-day mortality in patients with sepsis.

Suspecting and diagnosing transthyretin amyloid cardiomyopathy (ATTR-CM) in India: An Indian expert consensus

Transthyretin cardiac amyloidosis (ATTR-CM) is a rare and under-recognized disorder characterized by the aggregation of transthyretin-derived insoluble amyloid fibrils in the myocardium. Heterogeneity of symptoms at presentation, makes its diagnosis often delayed. An expert panel gathered on a virtual platform across India to conduct a meeting for developing a guiding tool for ATTR-CM diagnosis. The panel recommended younger age (40 years) for suspecting ATTR-CM and thick-walled non-dilated hypokinetic ventricle was considered as one of the important red flags. Electrocardiogram (ECG) and echocardiography (ECHO) findings were recommended as primary tests to raise the suspicion while nuclear scintigraphy and hematological tests were recommended to confirm the diagnosis and rule out amyloid light-chain (AL) amyloidosis. Cardiac magnetic resonance (CMR) and biopsy were recommended in case of ambiguity in the presence of red flags. Considering the lack of expert guidelines in the Indian scenario, a standardized diagnostic algorithm was also proposed.

Advances in the application of exosomes of mesenchymal stem cells carrying miRNA-126 in septic shock cardiac dysfunction / 中国小儿急救医学

Exosomes play important roles in cell communication and information transmission.miRNA-126 carried by mesenchymal stem cells exosomes can reduce inflammatory response and protect vascular endothelium by regulating protein expression, thus blocking or alleviating cardiac dysfunction during septic shock, which is expected to become a new way to treat septic shock cardiac dysfunction.

The predictive value of emergency bedside echocardiography on acute pancreatitis severity by assessing cardiac dysfunction / 中华急诊医学杂志

Objective:To investigate the predictive value of emergency bedside echocardiography on acute pancreatitis (AP) severity by assessing cardiac dysfunction.Methods:The clinical data used in this study was prospectively collected from AP patients in the Emergency Department of Beijing Shijitan Hospital, Capital Medical University from June 2018 to December 2020. According to the Atlanta Classification revised at the 2012 Atlanta International Conference, patients were divided into three groups of mild acute pancreatitis (MAP), moderate-severe acute pancreatitis (MSAP), and severe acute pancreatitis (SAP). The differences of comprehensive score index, blood-related index, and echocardiography-related index were compared among the three groups. Besides, the predictive factors of SAP were analyzed by Logistic regression, receiving operating characteristic (ROC) curves of subjects were drawn, and the area under the curve (AUC) was analyzed to evaluate the predictive efficiency.Results:A total of 116 patients were enrolled in this study. Compared with the non-SAP group (MAP group+MSAP group), acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score, sequential organ failure assessment (SOFA) score, Ranson score, procalcitonin, cardiac troponin I (cTnI), N-terminal pro-brain natriuretic peptide (NTproBNP), EDD, A-peak, E/A, E'/A', and stroke volume (SV) exhibited significant differences (all P<0.05). There was no significant difference in end-systolic diameter, E-peak, and left ventricular ejection fraction among the three groups ( P>0.05). Logistic regression analysis revealed that SOFA score, Ranson score, cTnI, NTproBNP, E'/A', and SV were important predictors of AP severity (all AUC>0.7). Moreover, the predictive value of echocardiography cardiac function assessment index (E'/A' +SV, AUC=0.969) and score index (SOFA score +Ranson score, AUC=0.989) for SAP was better than that of blood index (cTnI+NTproBNP, AUC=0.732). Conclusions:Echocardiographic indicators E'/A' and SV have acceptable predictive values for SAP, providing certain guiding significance for the clinical treatment of AP patients.

Application of real-time three-dimensional speckle tracking echocardiography in the evaluation of early cardiac function damage in patients with pregnancy induced hypertension / 中国基层医药

Objective:To investigate the clinical value of real-time three-dimensional speckle tracking echocardiography in the evaluation of early cardiac function damage in patients with pregnancy induced hypertension.Methods:Sixty-five pregnant women with pregnancy induced hypertension (patient group) and 65 healthy pregnant women (healthy group) who received prenatal examination and delivered between January 2018 and June 2020 in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine were included in this study. The patient and healthy groups were subjected to routine echocardiography and real-time three-dimensional speckle tracking echocardiography at 24-36 and 32-34 weeks of gestation. The imaging parameters of routine echocardiography and real-time three-dimensional speckle tracking echocardiography measured at different periods of gestation were compared between the two groups.Results:At 24-36 weeks of gestation, there were no significant difference in routine echocardiography parameters of the left ventricle between patient and healthy groups ( t = 0.793-1.748; P = 0.129-0.458). Left ventricular diameter (LVD), intra-ventricular septum diastole (IVSD) and left ventricular posterior wall diameter (LVPWD) in the patient group at 32-34 weeks of gestation were (34.97 ± 2.66) mm, (11.96 ± 1.85) mm, (12.07 ± 1.73) mm, respectively, which were significantly greater than those in the healthy group at the same time [(31.56 ± 2.58) mm, (9.17 ± 1.70) mm, (9.23 ± 1.62) mm] and those in the patient group at 24-36 weeks of gestation [(32.36 ± 2.61) mm, (10.15 ± 1.79) mm, (10.19 ± 1.64) mm, t = 5.437, 6.274, 6.319, 3.621, 4.017, 5.241, all P < 0.001]. Left ventricular ejection fraction (LVEF) in the patient group at 32-34 weeks of gestation was (54.36 ± 4.71)%, which was significantly lower than (63.27 ± 5.04)% in the healthy group at the same time and (59.65 ± 4.62) % in the healthy group at 24-36 weeks of gestation ( t = 7.682, 5.483, both P < 0.001). At 24-36 and 32-34 weeks of gestation, the absolute values of real-time three-dimensional speckle tracking echocardiography parameters left ventricular global longitudinal strain, left ventricular global circumferential strain, left ventricular global radial strain and left ventricular global area strain in the patient group were (23.45 ± 2.58)%, (34.09 ± 3.28)%, (22.03 ± 2.31)%, (34.73 ± 3.58)%, (18.63 ± 2.42)%, (30.74 ± 3.07)%, (19.56 ± 2.28)%, (25.85 ± 3.37)%, respectively, which were significantly lower than those in the healthy group [(26.27 ± 2.74)%, (37.62 ± 3.61)%, (24.67 ± 2.59)%, (39.41 ± 3.96)%, (26.10 ± 2.81)%, (37.56 ± 3.64)%, (24.82 ± 2.59)%, (40.16 ± 3.96)%, t = 4.415, 5.013, 4.724, 6.253, 10.736, 8.592, 7.627, 14.319, all P < 0.001]. In patient group, the absolute values of left ventricular global longitudinal strain, left ventricular global circumferential strain, left ventricular global radial strain and left ventricular global area strain at 32-34 weeks of gestation were (18.63 ± 2.42)%, (30.74 ± 3.07)%, (19.56 ± 2.28)%, (25.85 ± 3.37)%], respectively, which were significantly lower than those at 24-36 weeks of gestation [(23.45 ± 2.58)%, (34.09 ± 3.28)%, (22.03 ± 2.31)% (34.73 ± 3.58)%, t = 7.529, 4.785, 5.194, 8.413, all P < 0.001]. Conclusion:Real-time three-dimensional speckle tracking echocardiography is advantageous in identifying the damage to cardiac function over routine echocardiography. Findings from this study provides a great clinical guiding value for protecting the cardiac function of patients with pregnancy induced hypertension.

Energy metabolism disorders and potential therapeutic drugs in heart failure

Heart failure (HF) is a global public health problem with high morbidity and mortality. A large number of studies have shown that HF is caused by severe energy metabolism disorders, which result in an insufficient heart energy supply. This deficiency causes cardiac pump dysfunction and systemic energy metabolism failure, which determine the development of HF and recovery of heart. Current HF therapy acts by reducing heart rate and cardiac preload and afterload, treating the HF symptomatically or delaying development of the disease. Drugs aimed at cardiac energy metabolism have not yet been developed. In this review, we outline the main characteristics of cardiac energy metabolism in healthy hearts, changes in metabolism during HF, and related pathways and targets of energy metabolism. Finally, we discuss drugs that improve cardiac function

A Study of Cardiac Dysfunction in Patients of Hypothyroidism

Introduction: Thyroid disorders are probably the mostcommon endocrinal disorders affecting the populationworldwide. Hypothyroidism is associated with obesity,dyslipidemia and increased atherosclerotic cardiovasculardisease. Hypothyroidism are associated with increasedcardiovascular morbidity and mortality. The present study wasplanned to study the cardiac dysfunction in hypothyroidismcases by using non-invasive method ECG and 2 D ECHO.Material and methods: A total of 100 patients withhypothyroidism were enrolled in the study.They were clinicallyevaluated and underwent relevant investigations,includingthyroid profile, ECG and 2D ECHO for cardiac abnormalities.Results: Mean age of patients was 40.45±13.03 years.Majority of patients were females (71%). There were only29% males. Male to female ratio of study population was0.41:1. Among 100 patients,on ECG abnormal findings wereseen in 57% cases. Bradycardia alone was the most commonECG abnormality affecting 27% of patients. 25% patientsshowed low voltage complexs. A total of 5% patients showedboth bradycardia and low voltage complex. On 2D ECHO,62% patients had normal findings. Abnormal findings wereseen in 38%. Among abnormal findings, the most commonwas mild pericardial effusion (18%) followed by LVDDGrade 1 (16%), LVDD Grade 1 with mild pericardial effusion(2%) and LVDD Grade 2 respectively.Conclusion: Cardiac dysfunction was found in hypothyroidpatients.

Las múltiples caras del edema agudo de pulmón: a propósito de dos casos clínicos / The multiple faces of acute lung edema: about two clinical cases

La picadura de alacrán (alacranismo) es una causa común de envenenamiento en varias partes del mundo. El veneno del alacrán es expulsado en forma violenta e inyectado en el tejido subcutáneo de la víctima; se lo detecta en la circulación en aproximadamente 4 a 7 minutos. Los hallazgos clínicos del envenenamiento por picadura de alacrán pueden variar desde síntomas leves locales, como dolor y parestesia, hasta compromiso sistémico. La muerte se debe a las complicaciones graves; v.gr.: choque cardiogénico (debido a miocarditis adrenérgica por liberación masiva de catecolaminas) y miocarditis e isquemia (por toxicidad directa del veneno). El edema agudo de pulmón es una de las complicaciones más graves de la picadura de alacrán y se manifiesta por disnea súbita de origen cardiogénico. Nuestro país tiene diversos climas en sus diferentes zonas geográficas; por esta razón, el traslado rápido de la Costa a la Sierra a una altura superior a 2.500 m es un factor de riesgo que se explica por el cambio de la presión atmosférica brusca y rápida que produce una respuesta vasomotora exagerada en el pulmón.Palabras claves: picadura de alacrán, edema agudo de pulmón, disfunción cardiaca.

Scorpion sting or scorpionism is a common cause of poisoning in various parts of the world. Scorpion venom is violently expelled and injected into the victim's subcutaneous tissue and is detected approximately 4 to 7 minutes in general circulation. The described clinical findings of scorpion poisoning can vary from mild local symptoms such as pain and paraesthesia to systemic compromise. Sting death is due to serious complications such as: cardiogenic shock, which is the result of: adrenergic myocarditis due to massive release of catecholamines and myocarditis and ischemia due to direct poison toxicity. Acute lung edema is one of the most serious complications of scorpion sting and is manifested by a sudden dyspnea picture of cardiogenic origin. Our country has a diversity of climates due to its different geographical areas. It is for this reason that the rapid transfer from the coast to the mountains above 2500 meters high, constitutes a risk factor due to the change in atmospheric pressures being abrupt and rapid that produce exaggerated vasomotor responses at the pulmonary level.Keywords:scorpion sting, acute lung edema, cardiac dysfunction.

Low expression of microRNA-328 can predict sepsis and alleviate sepsis-induced cardiac dysfunction and inflammatory response

Sepsis often leads to cardiac dysfunction and inflammation. This study investigated the clinical value of microRNA-328 (miR-328) in sepsis and its role in cardiac dysfunction and inflammation caused by sepsis. The expression level of miR-328 in the serum of the subjects was detected by qRT-PCR. Receiver operating characteristic (ROC) curve measured the diagnostic value of miR-328 in sepsis. Rat sepsis model was established to detect left ventricular systolic pressure (LVSP), left ventricular end-diastolic pressure (LVEDP), and maximal rate of increase/decrease of left ventricular pressure (±dp/dtmax). Myocardial injury markers serum cardiac troponin I (cTnI), myocardial kinase isoenzyme (CK-MB), and inflammatory factors were detected by enzyme-linked immunosorbent assay (ELISA). miR-328 expression was assessed in serum of sepsis patients and in rat models of sepsis. The AUC of ROC curve was 0.926, sensitivity 87.60%, and specificity 86.36%. Compared with the sham group, LVSP and +dp/dtmax were decreased in the rat model of sepsis. LVEDP, -dp/dtmax, cTnI, CK-MB, tumor necrosis factor-α, interleukin (IL)-6, and IL-1β were upregulated in the rat model of sepsis. The low expression of miR-328 reversed these indicators. miR-328 is a diagnostic marker for patients with sepsis, and decreasing the expression level of miR-328 can ameliorate cardiac dysfunction and cardiac inflammation in sepsis.

Analysis of factors related to cardiac dysfunctions in patients with non-ST segment elevation acute coronary syndrome after percutaneous coronary intervention / 中国医师进修杂志

Objective To investigate the factors related to cardiac dysfunctions during the percutaneous coronary intervention (PCI) in patients with non-ST segment elevation acute coronary syndrome (NSTEACS).Methods Patients diagnosed as NSTEACS receiving PCI from September 2007 to June 2018 were collected in the data base of medical record management system in Qingdao Eighth People's Hospital.Patients with cardiac dysfunctions (≥ Killip Ⅱ grade) within 1 week after PCI were included into the case group,while patients with normal cardiac function (Killip Ⅰ grade) within 1 week after PCI were included into the control group.Firstly,baseline data of age,gender,histories of hypertension,histories of type 2 diabetes,histories of high cholesterol,histories of smoking,histories of drinking,histories of myocardial infarction,NSTEACS risk stratifications,the application of platelet glycoprotein (GP) Ⅱ b/Ⅲ a receptor antagonists,coronary artery SYNTAX scores,the dose of contrast agent during PCI,the peak cardiac troponin (cTnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP) within 24 h after admission was compared between the two groups;then,factors with statistical differences (P ＜ 0.05) were analyzed by the multivariate logistic regression;at last,variables screening was performed through the backward method and likelihood ratio test.Results A total of 3927 patients with NSTEACS receiving PCI were enrolled.Mter patients with incomplete information were eliminated,313 patients were admitted to the case group and 2 906 patients were admitted to the controlled group.After the analysis of multivariate logistic regression and variables screening,it showed that ＞ 80 years old (OR =1.758,95％ CI 1.129 to 2.367,P =0.014),increased dose of contrast agent (OR =1.083,95％ CI 1.007 to 1.274,P =0.020),the peak cTnT ＞ 0.2 μg/L (OR =2.102,95％ CI 1.703 to 3.104,P =0.031) and NT-proBNP＞450 ng/L (OR =2.243,95％ CI 1.863 to 3.257,P =0.015) after admission were the risk factors of cardiac dysfunctions.Conclusions Advanced age (＞ 80 years old),increased dose of contrast agent during PCI,the peak cTnT ＞ 0.2 μg/L and NT-proBNP ＞ 450 ng/L within 24 h after admission could raise the risk of cardiac dysfunctions in patients with NSTEACS after PCI.

Macrophage-NLRP3 Inflammasome Activation Exacerbates Cardiac Dysfunction after Ischemic Stroke in a Mouse Model of Diabetes / 神经科学通报·英文版

Ischemic stroke is one of the leading causes of death worldwide. In the post-stroke stage, cardiac dysfunction is common and is known as the brain-heart interaction. Diabetes mellitus worsens the post-stroke outcome. Stroke-induced systemic inflammation is the major causative factor for the sequential complications, but the mechanism underlying the brain-heart interaction in diabetes has not been clarified. The NLRP3 (NLR pyrin domain-containing 3) inflammasome, an important component of the inflammation after stroke, is mainly activated in M1-polarized macrophages. In this study, we found that the cardiac dysfunction induced by ischemic stroke is more severe in a mouse model of type 2 diabetes. Meanwhile, M1-polarized macrophage infiltration and NLRP3 inflammasome activation increased in the cardiac ventricle after diabetic stroke. Importantly, the NLRP3 inflammasome inhibitor CY-09 restored cardiac function, indicating that the M1-polarized macrophage-NLRP3 inflammasome activation is a pathway underlying the brain-heart interaction after diabetic stroke.

Macrophage-NLRP3 Inflammasome Activation Exacerbates Cardiac Dysfunction after Ischemic Stroke in a Mouse Model of Diabetes / 神经科学通报·英文版

Ischemic stroke is one of the leading causes of death worldwide. In the post-stroke stage, cardiac dysfunction is common and is known as the brain-heart interaction. Diabetes mellitus worsens the post-stroke outcome. Stroke-induced systemic inflammation is the major causative factor for the sequential complications, but the mechanism underlying the brain-heart interaction in diabetes has not been clarified. The NLRP3 (NLR pyrin domain-containing 3) inflammasome, an important component of the inflammation after stroke, is mainly activated in M1-polarized macrophages. In this study, we found that the cardiac dysfunction induced by ischemic stroke is more severe in a mouse model of type 2 diabetes. Meanwhile, M1-polarized macrophage infiltration and NLRP3 inflammasome activation increased in the cardiac ventricle after diabetic stroke. Importantly, the NLRP3 inflammasome inhibitor CY-09 restored cardiac function, indicating that the M1-polarized macrophage-NLRP3 inflammasome activation is a pathway underlying the brain-heart interaction after diabetic stroke.

Analysis of factors related to cardiac dysfunctions in patients with non-ST segment elevation acute coronary syndrome after percutaneous coronary intervention / 中国医师进修杂志

Objective@#To investigate the factors related to cardiac dysfunctions during the percutaneous coronary intervention (PCI) in patients with non-ST segment elevation acute coronary syndrome (NSTEACS).@*Methods@#Patients diagnosed as NSTEACS receiving PCI from September 2007 to June 2018 were collected in the data base of medical record management system in Qingdao Eighth People′s Hospital. Patients with cardiac dysfunctions (≥ Killip Ⅱ grade) within 1 week after PCI were included into the case group, while patients with normal cardiac function (Killip Ⅰ grade) within 1 week after PCI were included into the control group. Firstly, baseline data of age, gender, histories of hypertension, histories of type 2 diabetes, histories of high cholesterol, histories of smoking, histories of drinking, histories of myocardial infarction, NSTEACS risk stratifications, the application of platelet glycoprotein (GP)Ⅱb/Ⅲa receptor antagonists, coronary artery SYNTAX scores, the dose of contrast agent during PCI, the peak cardiac troponin (cTnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP) within 24 h after admission was compared between the two groups; then, factors with statistical differences (P < 0.05) were analyzed by the multivariate logistic regression; at last, variables screening was performed through the backward method and likelihood ratio test.@*Results@#A total of 3927 patients with NSTEACS receiving PCI were enrolled. After patients with incomplete information were eliminated, 313 patients were admitted to the case group and 2 906 patients were admitted to the controlled group. After the analysis of multivariate logistic regression and variables screening, it showed that >80 years old (OR = 1.758, 95% CI 1.129 to 2.367, P = 0.014), increased dose of contrast agent (OR = 1.083, 95% CI 1.007 to 1.274, P = 0.020), the peak cTnT>0.2 μg/L (OR = 2.102, 95% CI 1.703 to 3.104, P = 0.031) and NT-proBNP>450 ng/L (OR = 2.243, 95% CI 1.863 to 3.257, P = 0.015) after admission were the risk factors of cardiac dysfunctions.@*Conclusions@#Advanced age (>80 years old), increased dose of contrast agent during PCI, the peak cTnT>0.2 μg/L and NT-proBNP>450 ng/L within 24 h after admission could raise the risk of cardiac dysfunctions in patients with NSTEACS after PCI.

Effect of dripping pills on coronary microcirculation disorder and cardiac dysfunction in a porcine model of myocardial ischemia-reperfusion injury / 南方医科大学学报

OBJECTIVE@#To investigate the mechanism by which dripping pills (STDP) improves coronary microcirculation disorder (CMD) and cardiac dysfunction in a porcine model of myocardial ischemia-reperfusion injury.@*METHODS@#Fourteen minipigs were randomly selected for interventional balloon occlusion of the middle left anterior descending branch to induce CMD, and another 7 pigs received sham operation. The pig models of CMD were randomized equally into the model group and STDP-treated group. All the animals were fed with common feed for 8 weeks, and in STDP-treated group, the pigs were given STDP at the daily dose of 3 mg/kg (mixed with feed) for 8 weeks. Before and at the 8th week after the operation, the pigs underwent coronary angiography and echocardiography to determine the vessel lumen diameter and TIMI frame count (CTFC). The pathologies of the myocardium and the microvessels were examined with HE staining at the 8th week. Western blotting was used to detect the expression of silencing information regulator (Sirt1), peroxidase proliferator-activated receptor-γ coactivator-1α (PGC-1α), peroxisome proliferator-activated receptor α (PPARα), extracellular signal-regulated kinase1/2 (ERKI/2), Toll-like receptor 4 (TLR4), and uncoupling protein 2 (UCP2) in myocardial tissue.@*RESULTS@#Before and at the 8th week after the operation, the diameter of the anterior descending vessel in the 3 groups did not differ significantly ( > 0.05). At the 8th week, the number of CTFC frames in the model group increased significantly compared with that in the sham-operated group, but was obviously lowered by treatment with STDP ( < 0.05). Myocardial ischemia-reperfusion injury significantly increased the interventricular septal thickness at end-diastole, left ventricular end-diastole dimension, end-diastole volume, interventricular septal thickness at end-systole and left ventricular mass at 8 weeks after the modeling ( < 0.05), but such changes were significantly alleviated by treatment with STDP (P < 0.05). STDP treatment markedly alleviated myocardial microvascular congestion, thrombosis and peripheral inflammatory cell infiltration induced by myocardial ischemia-reperfusion, but atrophy of the myocardial muscle fiber remained distinct. STDP obviously suppressed the down-regulation of Sirt1, PGC-1α, and PPARα and the up-regulation of ERK1/ 2, TLR4, and UCP2 in the myocardial tissues induced by myocardial ischemia-reperfusion injury.@*CONCLUSIONS@#STDP has anti-inflammatory effects and regulates energy metabolism in the myocardium through modulating Sirt1, PGC-1α, PPARα, ERKI/2, TLR4, and UCP2 to improve CMD and cardiac dysfunction after myocardial ischemia-reperfusion.

Study of Cardiac Function in Alcoholic Cirrhotic Patients

Introduction: Cardiac dysfunction in patients with cirrhosisoccurs in the setting of a circulatory dysfunction characterizedby a marked splanchnic arterial vasodilation. Circulatory changescan lead to the cardiac dilatation of the left chambers and thedevelopment of functional changes in the heart. The present studyis intended to assess cardiac functions in patients of liver cirrhosis.Material and methods: It was a cross sectional study conductedamong 74 diagnosed cases of liver cirrhosis, admitted todepartment of general medicine, KIMS Hospital during the 6months study duration.Results: Overall LVDD was diagnosed in 59 cases (79.73%).Out of which, 47.29% cases presented with Stage 1 (impairedrelaxation) LVDD, Stage 2 LVDD (pseudo normal) among31.08% and only one patient had severe restrictive type of(Stage 3) LVDD.Conclusion: Left ventricular diastolic dysfunction iscommonly associated with advancement of hepaticdysfunction while systolic function is maintained till advancedhepatic failure

A prospective study on cardiac changes (electrocardiographic, enzymatic and echocardiographic) in birth asphyxiated neonates admitted in tertiary care centre

Background: Reduced myocardial performance and cardiac output following perinatal asphyxia may significantly complicate perinatal management and may contribute to increased end-organ damage and mortality. Hence the present study was done with the aim to assess the usefulness of echocardiography, electrocardiography (ECG), and cardiac enzymes in evaluating myocardial damage in perinatal asphyxia neonates and to assess their correlation with different stages of hypoxic-ischemic encephalopathy (HIE) and outcome.Methods: The study was conducted in the NICU, Department of Pediatrics, Government Chengalpattu Medical college hospital between August 2017 and August 2018 using 70 birth asphyxiated term babies. The asphyxiated babies were resuscitated as per NRP guidelines and were stratified into HIE stages as per Levene system of classification and were managed as per clinical condition. ECG grading, echo changes were noted. Creatinine kinase-MB (CKMB) levels were measured and documented after 12 hours of life among these babies and were analysed.Results: Of 70 cases, 36 (51.4%) had mild, 26 (37.1%) moderate and 8 (11.4%) severe HIE. Abnormal ECG was observed in 63 cases. Raised CKMB levels were found in 67 (95.7%) and abnormal echo findings were noted in 46 (65.7%) babies. ECG, echo changes and CKMB levels showed increasing abnormalities with increasing severity of HIE (p=0.000, 0.030 and 0.001 respectively). 8 babies in present study expired.Conclusions: Cardiac abnormalities among asphyxiated neonates requires high index of suspicion. ECG abnormalities, echo changes, elevated CK-MB levels in babies with HIE can help us identify neonates at risk of complications and guide in timely intervention that can prevent mortality of these babies and help us achieve better neurological outcome in these babies.

The relationship between left ventricular myocardial strain and different stages of cardiac dysfunction in spontaneously hypertensive rats evaluated by two‐dimensional strain echocardiography / 中华超声影像学杂志

Objective To investigate the relationship between multi‐dimensional myocardial strain and global cardiac function in different stages of cardiac dysfunction in spontaneously hypertensive rats ( SHR ) by two‐dimensional strain echocardiography . MethodsAccording to cardiac function measurements ,SHR of 28 to 102 weeks were divided into 3 groups :Normal group[ Group A , normal left ventricular ejection fraction( LVEF) and left ventricular end‐diastolic pressure( LVEDP) , n ＝13] ,diastolic dysfunction group ( Group B , normal LVEF but increased LVEDP , n ＝24) ,and systolic dysfunction group ( Group C ,decreased LVEF and increased LVEDP , n ＝ 17 ) ,with WKY rats at similar weeks of age as controls ( group a , n ＝ 7 ;group b , n ＝ 12 ; and group c , n ＝ 16 ) . Morphological parameters of left ventricular were measured by echocardiography . Using EchoPac workstation ,systolic peak longitudinal strain ,circumferential and radial strain were calculated at the left ventricular middle levels . Extracellular collagen content was observed histologically . Results Left atrial dimension increased in group B and larger in group C ,and dilated left ventricular and thickened wall were only found in group C .Systolic peak longitudinal strain of group B was significantly lower than group A and group a ( all P ＜ 0 .05 ) ,and deteriorated in group C( P ＜ 0 .05 ) ,while systolic peak circumferential and radial strain and LVEF were only significantly decreased in group C ( all P＜ 0 .05 ) ,w hile there was no significant difference between Group A and Group B( all P ＞0 .05) . Collagen content in endocardial and mid‐layer myocardium increased in group B and C , and increased epicardial collagen occurred in group C . Systolic peak longitudinal strain , circumferential and radial strain were correlated positively with LVEF( r ＝0 .65 ,0 .80 ,0 .80 ,all P ＜0 .01) . Conclusions In SHR ,systolic peak longitudinal strain obtained by echocardiography is decreased in the period of diastolic dysfunction ,w hile the damage of systolic peak circumferential and radial strain leads to the systolic dysfunction .

The diagnosis of cancer therapeutics-related cardiac dysfunction / 医学研究生学报

Cardiac dysfunction is a common and severe side-effect after cancer therapy including thoracic radiation or cytotoxic agents. With the development of the cancer therapy method and the agents, the survival time of the patients has improved while most cancer patients could live with tumor or even be cured. The rate of cancer therapeutics-related cardiac dysfunction have obviously increased which seriously affect the time and life quality of patients with tumor. But there are no authoritative consensus criteria or guideline to diagnose CTRCD at present while it is difficult to identify CTRCD with primary heart disease. In this article，we summarized some diagnosis methods which could identify early CTRCD，and then we may give early drug intervention as soon as possible to reduce the incidence and remission rate of cardiovascular events.

The relationship between left ventricular myocardial strain and different stages of cardiac dysfunction in spontaneously hypertensive rats evaluated by two-dimensional strain echocardiography / 中华超声影像学杂志

Objective@#To investigate the relationship between multi-dimensional myocardial strain and global cardiac function in different stages of cardiac dysfunction in spontaneously hypertensive rats (SHR) by two-dimensional strain echocardiography.@*Methods@#According to cardiac function measurements, SHR of 28 to 102 weeks were divided into 3 groups: Normal group[Group A, normal left ventricular ejection fraction(LVEF) and left ventricular end-diastolic pressure(LVEDP), n=13], diastolic dysfunction group (Group B, normal LVEF but increased LVEDP, n=24), and systolic dysfunction group (Group C, decreased LVEF and increased LVEDP, n=17), with WKY rats at similar weeks of age as controls (group a, n=7; group b, n=12; and group c, n=16). Morphological parameters of left ventricular were measured by echocardiography. Using EchoPac workstation, systolic peak longitudinal strain, circumferential and radial strain were calculated at the left ventricular middle levels. Extracellular collagen content was observed histologically.@*Results@#Left atrial dimension increased in group B and larger in group C, and dilated left ventricular and thickened wall were only found in group C. Systolic peak longitudinal strain of group B was significantly lower than group A and group a(all P<0.05), and deteriorated in group C(P<0.05), while systolic peak circumferential and radial strain and LVEF were only significantly decreased in group C (all P<0.05), while there was no significant difference between Group A and Group B(all P>0.05). Collagen content in endocardial and mid-layer myocardium increased in group B and C, and increased epicardial collagen occurred in group C. Systolic peak longitudinal strain, circumferential and radial strain were correlated positively with LVEF(r=0.65, 0.80, 0.80, all P<0.01).@*Conclusions@#In SHR, systolic peak longitudinal strain obtained by echocardiography is decreased in the period of diastolic dysfunction, while the damage of systolic peak circumferential and radial strain leads to the systolic dysfunction.

Prevention and Treatment of Cancer Therapeutics-related Cardiac Dysfunction / 中国医学科学院学报

Cancer therapeutics-related cardiac dysfunction(CTRCD)is receiving more attention.Risk factors assessment before cancer therapy,cardiac function monitoring during and after cancer therapy,and early detection and treatment of myocardial injury are key to preventing clinical heart failure.The incidence and severity of cardiotoxicity can be reduced by measures such as reducing drug dose,adjusting administration route,and using low toxic drugs.Cardioprotective agents including anti-heart failure drugs and dexrazoxane are important for the prevention and treatment of CTRCD.Patients with advanced heart failure may also benefit from mechanical treatments including cardiac resynchronization therapy and mechanically-assisted ventricular devices.This article reviews the recent advances in the prevention and treatment of CTRCD.