Troponin I measurement after acute myocardial infarction and its correlation with left ventricular ejection fraction

Background: After acute myocardial infarction (MI), a patient's prognosis is closely related to the extent of irreversibly damaged myocardium. The evaluation of infarctsize after acute MI (AMD) is important for predicting the subsequent clinical course. Cardiac troponin I (cTnl) is accepted as a highly reliable biochemical marker for detecting myocardial damage, and its use in the diagnosis of acute MI (AMI) is increasing. Its concentration is unaffected by thrombolysis after the first12 hours, following which it shows a stable plateau for about 48 hours.Methods: This study investigated the value of a single cTnl concentration, estimated 12-48 hours after admission, to provide an integrated measurement of the degree of cardiac damage following first acute MI, and its correlation with left ventricular ejection fraction (LVEF). This study of troponin I measurement after acute MI and its correlation with LVEF was conducted during the period between October 2019 and October 2021 at SMIMER hospital, Surat. Results: This study shows a strong negative correlation between cTnI concentration measured between 12-48 hours post MI and echocardiographic LVEF. It was also found that cTnl concentration more than 3.8 ng/ml is a sensitive (100%) and specific (78.12%) indicator of LVEF <40% after a first acute MI. It can be considered as a significant prognostic marker.Conclusions:In conclusion, cTnl shows excellent promise as a marker of infarct size, and for the assessment of LVEF; and may potentially replace the CPK-MB as the cardiac specific marker for AMI detection.

Three-dimensional speckle tracking imaging for quantitative evaluation of left ventricular global strain in renal transplant recipients / 器官移植

Objective To evaluate the application value of three-dimensional speckle tracking imaging (3D-STI) in quantitatively evaluating the left ventricular global strain in recipients within 3 months after renal transplantation. Methods Clinical data including blood pressure, serum creatinine and tacrolimus blood concentration of 34 renal transplant recipients were collected before operation, 7 d, 1 month and 3 months after operation, respectively. Meanwhile, conventional echocardiography and 3D-STI examination were performed. Echocardiographic parameters [left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV) and left ventricular ejection fraction (LVEF)] and 3D-STI parameters [left ventricular global peak longitudinal strain (GPLS), global peak circumferential strain (GPCS), global peak radial strain (GPRS) and global peak area strain (GPAS)] of recipients were collected. The changes of these parameters before operation, 7 d, 1 month and 3 months after operation were statistically compared. The changing characteristic and application value of 3D-STI in quantitatively evaluating the left ventricular global strain in recipients within 3 months after renal transplantation were evaluated. Results LVEF and GPCS did not significantly differ at different time points (all P > 0.05), whereas LVEDV, LVESV, GPLS, GPAS and GPRS significantly differed at different time points from preoperative to within postoperative 3 months (all P < 0.001). GPLS, GPAS and GPRS trended to decline within postoperative 1 month, and slightly increased at 3 months after operation, which was still lower than the preoperative levels. Conclusions Application of 3D-STI may sensitively detect the changes of left ventricular global strain in recipients after renal transplantation when no significant variations are observed in postoperative LVEF. Compared with conventional echocardiography, 3D-STI may more accurately evaluate the changes of left ventricular global strain in recipients after renal transplantation.

Creatina fosfocinasa MB como marcador diagnóstico de disfunción miocárdica en pacientes pediátricos con quemadura eléctrica / Creatine phosphokinase MB levels as a diagnostic marker of myocardial dysfunction in pediatric patients with electrical burns

Resumen Introducción: La disminución de la fracción de eyección ventricular izquierda (FEVI) como consecuencia de una disfunción ventricular se reporta dentro de las alteraciones cardiacas secundarias a una lesión eléctrica. Como complemento de la exploración física, la ecografía cardiaca enfocada (FoCUS) permite una evaluación rápida, no invasiva, que da información para contribuir a tomar mejores decisiones terapéuticas, sobre todo en pacientes en estado crítico. El objetivo de este estudio fue explorar la utilidad de la creatina fosfocinasa MB (CPK-MB) como marcador diagnóstico de disfunción miocárdica en pacientes de 6 a 18 años con quemadura eléctrica. Métodos: Durante el periodo de noviembre de 2018 a agosto de 2019 se llevó a cabo un estudio transversal analítico de 10 pacientes, de 6 a 18 años de edad, con quemadura eléctrica, en quienes se obtuvo el porcentaje de FEVI a través del protocolo FoCUS. Posteriormente, el porcentaje de FEVI se correlacionó con los valores de CPK-MB y el porcentaje de superficie corporal quemada (SCQ) en las primeras 24 horas después de la lesión. Resultados: Se encontraron 10 casos de quemadura eléctrica, ocho de sexo masculino y dos de sexo femenino, con una media de edad de 13 años. El 80% de estos casos presentó disminución leve de la FEVI (45-59%). Al realizar el protocolo FoCUS se reportó hipocinesia miocárdica en siete pacientes. Se encontró una correlación moderada entre la FEVI y los valores de CPK-MB (r = −0.671), aunque no se observó correlación entre la FEVI y la SCQ. Conclusiones: La ecografía cardiaca influye en la toma de decisiones y mejora el pronóstico de estos pacientes.

Abstract Background: The decrease of the left ventricular ejection fraction (LVEF) as consequence of a ventricular dysfunction is reported in cardiac alterations secondary to electrical injury. The focused cardiac ultrasound (FoCUS) helps to complete the clinical examination because it allows a faster non-invasive evaluation, and provides information that contributes to make better therapeutic decisions, especially those for patients in critical condition. The objective of this study was to explore the utility of creatine phosphokinase MB (CPK-MB) as a diagnostic tool of myocardial dysfunction in patients from 6 to 18 years old with electrical burn. Methods: From November 2018 to August 2019, we conducted a transversal analytic study of 10 children with electric burn (6 to 18 years of age), in whom the percentage of LVEF was obtained through the FoCUS protocol in the first 24 hours after injury. Results: We found 10 cases of electrical burn injury, eight males and two females, with an average of 13 years of age. Eighty percent of these cases showed a slight decrease in LVEF (45-59%). When performing the FoCUS protocol, myocardial hypokinesia was reported in seven patients. We observed a moderate correlation between LVEF and CPK-MB levels (r = −0.671), and no correlation between LVEF and body surface area affected by the electrical burn. Conclusions: The cardiac ultrasound influences decision making to improve the prognosis of these patients.

Relationship of Off-Pump Coronary Artery Bypass Surgery with the Cardiac Enzyme Troponin T, LVEF, TAPSE and Post-Operative Recovery.

Cardiovascular diseases (CVD) are the leading cause of death globally including India. Ischemic heart disease is the most common cause of death. There is a sharp rise in Off Pump Coronary Artery Bypass Surgery (OPCAB), which increases cardiac enzymes like Troponin T, that is used as prognostic guide. In triple vessel disease 40 to 50% cases involve right ventricle, therefore along with left ventricular ejection fraction (LVEF), Tricuspid Annular Plane Systolic Excursion (TAPSE) can be used as a prognostic guide, which can be measured by noninvasive doppler echocardiography.METHODSPatients with specific criteria who underwent OPCAB surgery from January 2018 to March 2019 were studied. Both pre- and post-operative (14-16 hours) Troponin T (TropT) sensitivity tests were done and only preoperative Trop T negative patients were selected for the study. Postoperative patients were divided into 2 groups, TropT positive and negative. Echocardiography was done on the day before surgery, on postoperative day 5 (POD5) and postoperative day 30 (POD30). Results were compared between the two groups.RESULTSAmong 88 patients thus selected, 34 patients (38.63%) were Trop T positive, and 54 patients (61.37%) were Trop T negative. On post-operative day 5, increase in brain natriuretic peptide (BNP), decrease in TAPSE and decrease in haemoglobin were significant in Trop T positive group. Need for ventilation and postoperative hospital stay were significantly prolonged in positive groups. In POD30, decrease in albumin, decrease in LVEF and TAPSE all are significant in TropT positive group.CONCLUSIONSIt is important to determine the prognosis of OPCAB patients in early postoperative period. Troponin T has a significant prognostic value in OPCAB patients supported by LVEF and TAPSE.

Meta-Analysis for Effect of Danhong Injection on Cardiac Function and TIMI During Perioperative PCI in Acute Myocardial Infarction / 中国实验方剂学杂志

<b>Objective::Evaluate the effects of Danhong injection for perioperative percutaneous coronary intervention (PCI) on cardiac function and thrombolysis in myocardial infarction (TIMI) in patients with acute myocardial infarction (AMI). <b>Method::Computer retrieving CNKI, Wanfang database, VIP database, PubMed, CBM, Web of Science, The Cochrane Library, gathering Danhong injection in percutaneous coronary intervention perioperative application in the treatment of acute myocardial infarction clinic trials. The Cochrane risk evaluation is adopted to improve the quality of literature evaluation, with Revman 5.3 software for Meta-analysis. <b>Result::Participants included in 12 clinic trials contains a total of 1 131 patients, including 569 patients in Danhong treatment and 562 patients in control group. The results showed that compared with conventional treatment, Danhong injection treated patients had LVEF increased obviously [mean difference (MD)=6.62, 95% confidence interval (CI) (4.91, 8.34), <italic>P</italic><0.000 01], the number of TIMI class 3 patients significantly increased[relative risk (RR)=0.22, 95%CI(0.12, 0.41), <italic>P</italic><0.000 01], and BNP levels significantly decreased [MD=151.86, 95%CI (-247.00, -56.72), <italic>P</italic>=0.002]. <b>Conclusion::Danhong injection can improve the function of acute myocardial infarction after percutaneous coronary intervention.

Correlation of troponin-I level with left ventricular systolic dysfunction after first attack of non-ST segment elevation myocardial infarction

Background: Coronary Heart Disease (CHD) is the most common category of the heart disease and is found to be the single most important cause that leads to premature death in the developed world. Recognizing a patient with ACS is important because the diagnosis triggers both triage and management. cTnI is 100% tissue-specific for the myocardium and it has shown itself as a very sensitive and specific marker for AMI. Ventricular function is the best predictor of death after an ACS. It serves as a marker of myocardial damage and provides information on systolic function as well as diagnosis and prognosis. The study aimed at investigating the impact of LVEF on elevated troponin-I level in patients with first attack of NSTEMI.Methods: This cross-sectional analytical study was conducted in the department of cardiology in Mymensingh Medical College Hospital from December, 2015 to November, 2016. Total 130 first attack of NSTEMI patients were included considering inclusion and exclusion criteria. The sample population was divided into two groups: Group-I: Patients with first attack of NSTEMI with LVEF: ≥55%. Group-II: Patients with first attack of NSTEMI with LVEF: <55%. Then LVEF and troponin-I levels were correlated using Pearson’s correlation coefficient test.Results: In this study mean troponin-I of group-I and group-II were 5.53±7.43 and 16.46±15.79ng/ml respectively. It was statistically significant (p<0.05). The mean LVEF value of groups were 65.31±10.30% and 40.17±4.62% respectively. It was statistically significant (p<0.05). The echocardiography showed that patients with high troponin-I level had low LVEF and patients with low troponin-I level had preserved LVEF. Analysis showed that patients with highest level of troponin-I had severe left ventricular systolic dysfunction (LVEF <35%) and vice versa-the patients with the lowest levels of troponin-I had preserved systolic function (LVEF ≥55%). In our study, it also showed that the levels of troponin-I had negative correlation with LVEF levels with medium strength of association (r= -0.5394, p=0.001). Our study also discovered that Troponin-I level ≥6.6ng/ml is a very sensitive and specific marker for LV systolic dysfunction.Conclusions: The study has enabled the research team to conclude that the higher is the Troponin-I level the lower is the LVEF level and thus more severe is the LV systolic dysfunction in first attack of NSTEMI patients.

A Study of LVEF in Patients of Subclinical Thyroid Dysfunction with Heart Failure

Heart failure is clinically defined as a syndrome caused by cardiac dysfunction generally resulting from myocardial muscle dysfunction or loss. Heart failure is a leading cause of hospitalization in people older than 65. Extensive evidence indicates that the cardiovascular system responds to the minimal but persistent changes in circulating thyroid hormone levels, which are typical of individuals with subclinical thyroid dysfunction. Subclinical hypothyroidism is associated with impaired LV diastolic function and subtle systolic dysfunction and an enhanced risk for atherosclerosis and myocardial infarction. Methods: A total of 200 patients between age group of 45 to 75 yrs, presenting in medical emergency and medical outdoor of Guru Nanak Dev Hospital, Government Medical College Amritsar with heart failure were studied.Comparison of Thyroid Profile and LVEF was done at Baseline, 3 months and 6 months. Results: The change in TSH, FT3, FT4, LVEF was significant at 3 months and 6 months as compared to baseline. Changes in FT4, LVEF, were significant at 3 months and 6 months, thus signifying progression of disease and worsening of cardiac functions. Conclusion: In treatment group in subclinical hyporthyroidism patients, after comparing the thyroid profile and 2D Echocardiography after 6 months; TSH, LVEF both have shown improvement (p <0.05).

Clinical study on transcription and protein expression of tumor necrosis factor α mRNA in peripheral blood and activation of signal path PI3K/AKT in patients with chronic heart failure / 实用医学杂志

Objective The study was to investigate the activation of tumor necrosis factor α (TNF-α) mRNA transcription and protein expression in peripheral blood and activation of signal path PI3K/AKT in patients with chronic heart failure. Methods From February 2015 to April 2018, 244 patients with heart failure in the cardiovascular department of our hospital were selected as heart failure group, while 244 healthy cases were enrolled as the control group at the same time. The peripheral blood samples of two groups were collected. We detected the transcription and protein expression of TNF-α mRNA and the activation of PI3K, AKT in peripheral blood. The left ventricular ejection fraction (LVEF) were measured in two groups. The correlations between influencing factors and LVEF were analyzed. Results The levels of PI3K, AKT in the heart failure group were higher than those in the control group. The differences were statistically significant respectively (P < 0.05). The mRNA relative content and protein content of TNF-α in peripheral blood mononuclear cells of heart failure group were higher compared with those of control group (P < 0.05). The LVEF of heart failure group was significantly lower than that of the control group (34.50 ± 6.33) ％ versus (55.60 ± 2.49) ％, P < 0.001). Among 244 patients with heart failure, Spearman correlation analysis showed that there were significant positive correlations between TNF-a mRNA and protein expression levels and the levels of PI3K, AKT respectively (P < 0.05). Multiple factors unconditional Logistic regression analysis showed that the TNF-α mRNA, protein expression and PI3K, AKT levels in peripheral blood were independent risk factors for LVEF (P < 0.05). Conclusion The expression levels of PI3K, AKT and TNF-α are all significantly increased in chronic heart failure patients, which could participate in the occurrence and development of heart failure.

Distres respiratorio agudo post aislamiento percutáneo de venas pulmonares / Post-isolation acute respiratory distress percutaneous pulmonary veins

Resumen Paciente de 48 años con historia de fibrilación auricular paroxística, dislipidemia y antecedente de ablación de vía accesoria (2013). Anti coagulado con Rivaroxaban 20 mg PO. Paciente es llevado a aislamiento percutáneo de venas pulmonares (AVP) con sistema de navegación tridimensional Carto 3. 48 horas post AVP inicia con cuadro de distrés respiratorio agudo que requiere hospitalización en unidad de cuido intensivo, que resuelve con manejo diurético y antiinflamatorio. Describimos la importancia del manejo hídrico en relación al AVP.

Abstract 48 years old male, previous history of paroxysmal atrial fibrillation, hiperlipemia and previous accesory pathway ablation an 2013. Anticoagulated with Rivaroxaban 20mg PO. Patient underwent pulmonary vein insolation (PVI) with Carto 3 tridimensional navigation and mapping system. Discharged on day 1 after PVI, readmitted with acute respiratory distress that required intensive care unit admission that resolves with diuretics and anti-inflammatory management. We describe the role of hydric management related with PVI procedure.

Sustained ventricular tachycardia (VT) in coronary artery disease (CAD): A study from tertiary care center in north India

Background: Ventricular Tachycardia (VT) constitutes an important manifestation of coronary artery disease (CAD). VT can occur in the immediate acute myocardial infarction (MI) period, further complicating the management. VT also occurs after long duration of acute coronary syndrome (ACS) in the healed MI. Aim: The aim of our study was to evaluate the epidemiology, clinical presentation, hemodynamic status, treatment received and finally the outcome of CAD patients manifesting as sustained VT. Materials and methods: This prospective study was conducted at Sher I Kashmir Institute of Medical Sciences (SKIMS), a tertiary care center in Srinagar, Jammu and Kashmir, India, between August 2013 to May 2016. All the cases of definite sustained VT already admitted in the hospital or Rahul Sudan, Mehroz Ahmed, Khursheed Aslam, Irfan Yaqoob, Gunjan Gupta, Shantanu Aggarwal. Sustained ventricular tachycardia (VT) in coronary artery disease (CAD): A study from tertiary care center in north India. IAIM, 2018; 5(2): 160- 167. Page 161 presenting in the emergency department including those who developed VT during the course of acute MI were evaluated. Results: In our study, a total of 35 patients of CAD manifesting as sustained VT were observed. Majority of these patients were males. The most common presenting symptom was chest pain seen in a total of 14 patients. A total of 23 patients (66%) were hemodynamically stable at the time of VT. A decreased Left Ventricular Ejection Fraction (LVEF <50%) was seen in 18 patients (51%). Monomorphic VT was seen in a total of 28 patients (80%) and the rest of 7 patients showed polymorphic VT. Mortality was seen in 8 patients (23%). Conclusion: Polymorphic pattern of sustained VT, hemodynamic instability at the time of VT and a decreased LVEF are associated with increased mortality in patients of CAD manifesting as VT.

The predictive significance of LVEF and NT-proBNP in early prognosis assess of Untypical NSTE-ACS / 实用医学杂志

Objective To investigate whether echocardiography left ventricular ejection fraction (LVEF) and NT-proBNP could be an early detective marker for patients with untypical NSTE-ACS. Methods A total of 248 ACS cases admitted to the emergency department of our hospital from January 1,2015 to June 31,2016 were retrospectively reviewed. The data included age,gender,past medical history,D-dimer,MB isoenzyme of creatine kinase(CK-MB),cardiac troponin I(cTnI),the precursor of the N-terminal pro-brain natriuretic peptide(NT-proBNP),electrocardiogram(ECG)before treatment,and the CK-MB,cTnI and LVEF,the treatment of percuta-neous coronary intervention(PCI)or thrombolytic by drugs. Survival condition and time from onset to death were recorded. According to the results of multivariate logistic regression analysis ,receiver operating characteristic curve(ROC curve)and fitting curve were drawn. The association between the LVEF and NT-proBNP before the treatment and prognosis of ACS was analyzed. Results NSTE-ACS patients with chief complaint of chest pain were less than those of STE-ACS(33.6% vs. 70.1%,P=0.003). Pre-hospital time was longer than that of STE-ACS group(67.92 ± 116.89 vs. 30.65 ± 55.59,P = 0.006). CTNI(4.37 ± 12.53 vs. 9.62 ± 18.00,P=0.011)and LVEF(53.51 ± 14.51 vs. 56.26 ± 12.30,P=0.019)were less than that of the STE-ACS group. NT-proBNP was higher than that of the STE-ACS group(2288.37 ± 4612.10 vs. 1506.84 ± 1722.51,P=0.038). mortality rates was higher than the STE-ACS group((15.3%vs. 6.8%,P=0.036). Multivariate logistic regression analysis showed that LVEF values was correlated to 28-day death(B =-0.097 ,P=0.022). The ROC curves showed that LVEF values was negative correlated with the 28-day death. However,combination of LVEF and NT-proBNP was better than single LVEF values. LVEF values was negative correlated with the NT-proBNP(r =-0.263,P=0.001), LVEF values had greater and longer survival time(B=0.401,P=0.045)but NT-proBNP was not related to surviv-al time.(B=0.00,P=0.931). Conclusion LVEF and NT-proBNP are correlated with the early risk assessment of patients with ACS,but was not correlated with the time from onset to death. The decrease in LVEF values at the early stage of NSTE-ACS may be helpful to indicate the critical condition of the ACS patients.

Predictive value of ventricular wall motion score and left ventricular ejection fraction on prognosis of heart fail in patients with acute myocardial infaction / 实用医学杂志

Objective To explore the prognostic value of ventricular wall motion score (WMS) and left ventricular ejection fraction (LVEF) in patients with acute myocardial infarction (AMI) combined with heart failure (HF) in the recent 12 months Methods We selected hospitalized AMI patients in our department from Jan. 2014 to Nov. 2014. Cardiac ultrasound was performed to detect WMS and LVEF within 48 hours and during the 6?month follow?up period and the occurrence of HF was recorded. Results Totally 127 AMI patients were recruited, including 20 cases combined with HF. The WMS was higher in HF group than those in non?HF group (23.55 ± 3.73 vs 20.11 ± 3.13, P<0.01), while the LVEF in HF group was lower than those in non?HF group (48.77 ± 8.08 vs 56.99 ± 5.17, P<0.01). Multiple logistic regression analysis revealed that WMS and LVEF were both independent predictors of HF in the recent 12 months (P < 0.05). The prediction effect of WMS ROC curve area was 0.81 (P < 0.01) , and LVEF 0.76 (P < 0.05). WMS and LVEF combined assessment area under ROC curve was 0.82 (P < 0.01). Conclusion WMS and LVEF are independent predictors of HF in patients with AMI in the recent 12 months and the combined application of WMS and LVEF can significantly improve the prediction effect.

Dobutamine versus levosimendan for patients with acute decompensated heart failure / Dobutamina versus levosimendán en pacientes con insuficiencia cardiaca agudizada

Introduction: Heart failure remains a highly frequent cause of hospitalization; with a high morbidity and mortality. Objectives: The aim of this study is to compare the 30-day in hospital survival of patients treated with Levosimendan vs. Dobutamine in acute decompensated heart failure. Secondary aims will be to compare the measurement of LVEF before and after inotropic and length of hospital stay. Material and methods: Observational, descriptive, retrospective study. All adult patients were admitted to the Hospital Christus Muguerza Alta Especialidad, with acute decompensated heart failure diagnosis and have required inotropic support in the period January 2013 to September 2015 were collected. Results: 83 patients were included, however only 38 met the inclusion criteria. Of the 38 patients 20 (53%) were prescribed levosimendan and 18 (47%) dobutamine. The average age in both groups was 62.2 years (± 15.6) of levosimendan versus dobutamine 78.8 years (± 10.6) (p = 0.0005). Survival at 30 days was 100% in levosimendan versus 77.8% in dobutamine (p = 0.0274). In days of hospital stay it was 9.3 days (± 5.1) levosimendan and 13.8 days (± 6.5) in dobutamine (p = 0.02). postinotropic LVEF change was 18.3% (± 6.2) levosimendan versus 18.7% (± 9.9) dobutamine (p = 0.88). Conclusions: The use of dobutamine leads to a lower survival to 30 days, in addition to longer hospital stay. However no difference in LVEF values ​​at admission or inotropic post.

Introducción: La insuficiencia cardiaca agudizada continúa siendo una causa altamente frecuente de hospitalización con una gran morbimortalidad. Objetivos: El objetivo primario es comparar la sobrevida a 30 días de los pacientes tratados con levosimendán versus dobutamina en insuficiencia cardiaca agudizada. Como objetivo secundario será comparar la determinación de la FEVI pre- y post-inotrópico y días de estancia hospitalaria. Material y métodos: Estudio observacional, descriptivo, retrospectivo. Se recabaron todos los pacientes adultos que hayan ingresado en el Hospital Christus Muguerza Alta Especialidad, con diagnóstico de insuficiencia cardiaca agudizada y que hayan requerido el apoyo de inotrópicos, en el periodo comprendido de enero de 2013 a septiembre de 2015. Resultados: Se documentaron 83 pacientes con diagnóstico de insuficiencia cardiaca agudizada, de los cuales sólo 38 cumplieron con los criterios de inclusión. De los 38 pacientes a 20 (53%) se les indicó levosimendán y a 18 (47%) dobutamina. La media de edad en ambos grupos fue de 62.2 años (±15.6) de levosimendán versus 78.8 años de dobutamina (±10.6) (p = 0.0005). La supervivencia a 30 días fue de 77.8% en dobutamina versus 100% levosimendán (p = 0.0274). En días de estancia hospitalaria fue de 9.3 días (± 5.1) en levosimendán y de 13.8 días (± 6.5) en dobutamina (p = 0.02). El cambio FEVI postinotrópico fue de 18.3% (± 6.2) levosimendán versus 18.7% (± 9.9) dobutamina (p = 0.88). Conclusiones: El uso de Dobutamina conlleva a una menor sobrevida a 30 días, además de tener mayor estancia hospitalaria. Sin embargo no hay diferencia en los valores de FEVI al ingreso ni postinotrópico.

Changes and its clinical significance of the plasma growth differentiation factor-15 in patients with chronic congestive heart failure / 天津医药

Objective To investigate the changes and clinical significance of the plasma growth differentiation factor-15 (GDF-15) in patients with chronic congestive heart failure (CHF). Methods A total of 100 patients with CHF were in?cluded in this study (CHF group), and 30 healthy persons were used as control group. CHF group was divided into heart func? tionⅡgrade (n=35),Ⅲgrade (n=32),Ⅳgrade (n=33) groups in accordance with New York Heart Association (NYHA). And CHF group was also divided into left ventricular ejection fraction (LVEF)<0.4 grade (n=52) and LVEF≥0.4 grade (n=48) groups in accordance with LVEF of patients. The plasma GDF-15 and brain natriuretic peptide (BNP) levels were detected by ELISA. The values of LVEF, left ventricular end-diastolic diameter (LVDd), left ventricular systolic diameter (LVDs) and left ventricular fractional shortening (LVFS) were detected by echocardiography. The correlation of GDF-15, NYHA classifi?cation, BNP and index of echocardiography was analyzed between groups. Results Compared with control group, the levels of BNP, GDF-15, LVDd and LVDs were significantly higher in heart failure group, and values of LVEF and LVFS were sig?nificantly lower (P<0.05). The plasma levels of BNP, GDF-15, LVDd and LVDs were in turn increased in control group, LVEF≥0.4 grade group and LVEF<0.4 grade group. The plasma levels of LVFS were in turn decreased, in control group, LVEF≥0.4 grade group and LVEF<0.4 grade group (P<0.05). There were positive correlations between the plasma levels of GDF-15 and BNP, NYHA, LVDd and LVDs (r=0.524, 0.286, 0.453 and 0.531, P<0.05). The plasma level of GDF-15 was negatively correlated with LVEF and LVFS (r=-0.592,-0.587,P<0.05). Conclusion The plasma level of GDF-15 can be used as a new marker for diagnosis, treatment and prognosis in patients with chronic congestive heart failure.

Correlation of left ventricular ejection fraction as well as serum levels of NT-proBNP, Hcy and D-D with different traditional Chinese medicine syndrome types of chronic heart failure / 天津医药

Objective To investigate the correlation of left ventricular ejection fraction (LVEF) as well as serum levels of NT-proBNP, Hcy and D-Dimer (D-D) with different traditional Chinese medicine (TCM) syndrome types of chronic heart failure (CHF). Methods A total of 178 CHF patients were divided into heart function normal ejection fracture group (HF?NEF, n=86) and heart function reduction (HFREF, n=92) according to their LVEF performance. Another 35 cases with nor?mal cardiac function were included in control group. All CHF patients was also divided into 3 TCM syndrome types:both de?ficiency of Qi and Yin syndrome group(n=64),Qi asthenia causing blood stasis syndrome group(n=59) andYang defi?ciency water stop group (n=55). All patients were examined with cardiac color doppler and LVEF values were recorded. And serum NT-proBNP、Hcyand D-D levels were all quantified. Results As to serum levels of NT-proBNP, Hcy and D-D, they were higher in HFREF group than those in HFNEF group than those in control group. On the other hand, LVEF was lowest in HFREF group but highest in control group. All differences were statistically significant (P<0.05). Among patient in HFNEF group, LVEF in theYang deficiency water stop groupwas lower than that inboth deficiency of Qi and Yin syn?drome group(P<0.05). Serum levels of NT-proBNP, Hcy, and D-D were not significantly different between different TCM syndrome groups. By contrast, among patients in HFREF group, LVEF values did not differ significantly between different TCM syndrome groups. Serum level of NT-proBNP was lower inboth deficiency of Qi and Yin syndrome groupthan that inQi asthenia causing blood stasis syndrome group than that in Yang deficiency water stop group. As to serum levels of Hcy and D-D, they are higher inYang deficiency water stop groupthat those inboth deficiency of Qi and Yin syndrome group and Qi asthenia causing blood stasis syndrome group(P<0.05). Conclusion Patients with different TCM syn?drome types of CHF present different levels of serum NT-proBNP, Hcy, D-D level and LVEF. Changes of indicators in HFREF groups are more obvious than they did in HFNEF group.

Smoking and Hypertension: A Study in Subjects Admitted to Hospital for Cardiovascular Diseases.

Aims: There is a general consensus in considering cigarette smoking as a major risk factor for cardiovascular diseases: a direct causal association between smoking and hypertension however is questioned. The present paper reports a study on the effect of cigarette smoking and of other clinical parameters on hypertension in a sample of subjects admitted to Hospital for Cardiovascular Diseases (CVD). Study Design: Observational study. Place and Duration of Study: Department of Cardiology Valmontone Hospital and Department of Biomedicine and Prevention, University of Rome Tor Vergata, between April 2007- December 2013. Methodology: We have studied 335 subjects admitted to the Hospital for Cardiovascular Diseases. Statistical analyses were in the study that was approved by the Ethical Committee. We have considered hypertension in relation to smoking, diabetes, age and sex. Results: Multivariate statistical analyses have shown a high significant effect of age (P<.001) and diabetes (P<.01) on hypertension and a border line effect of smoke (P=.05). No effect of sex has been detected (P=.47). The proportion of subjects with hypertension is positively correlated with the number of risk factors examined. Conclusion: Our data indicate that an independent effect of smoking on blood pressure is relatively small and suggest an additive effect of the variables considered on the risk of hypertension.

Nursing care and clinical observation of Levosimendan in decompensated heart failure / 中国实用护理杂志

Objective To observe levosimendan-induced hemodynamic improvement of chronic decompensated heart failure patients and adverse effects,and sum up the nursing experience of Levosimendan.Methods Sixty-three patients with decompensated heart failure were treated with Levosimendan,based on optimized conventional treatment for heart failure.Aminoterminal pro-brain natriuretic peptide (NT-proBNP) and left ventricle ejective fraction (LVEF) were measured at baseline and one week after Levosimendan administration.In addition,we summarized the clinical observation,adverse effects and nursing experiences of treatment with Levosimendan in decompensated heart failure patients.Results Levosimendan increased 24-hour urine output in patients at the first day after treatment.This effect of levosimendan persisted for 7 days at least.We observed an improvement in LVEF and a reduction of NT-pro-BNP at 7 days after the initiation of levosimendan treatment.Clinical efficiency of levosimendan in patients was 84.1％ in this study.Twenty two patients(34.9％) experienced different adverse events.Conclusions Levosimendan therapy can improve cardiac function and reduce BNP in patients with decompensated heart failure.The rate of adverse effects of Levosimendan is high.It is important to enhance therapy effect by careful nursing and observing variety state during treatment with Levosimendan.These data will be useful for the nursing care of Levosimendan in clinical practice.

Relation Between Level of CA125 and Heart Function as well as Myocardial Remodeling in Patients with Congestive Heart Failure / 医学研究杂志

Objective To study the relation between the level of serum carbohydrate antigen-125 (CA125) and heart function as well as the myocardial remodeling in patients with congestive heart failure(CHF). Methods 79 patients with CHF were divided into three groups based on the standard of New York Heart Association Classification. 25 healthy persons were served as control group. Level of CA125 was measured by MEIA. NT-proBNP was detected by Roche Cardiac Reading instrument. TNF-? was measured by radioimmunoassay. Left ventricular mass index (LVMI),left atrial volume index (LAVI) and left ventricular ejection fraction (LVEF) were detected by echocardiography. The levels of CA125,NT-proBNP,TNF-?,LVMI,LAVI and LVEF in different groups were compared.The relationship between CA125 and NT- proBNP,TNF-?,LVMI,LAVI and LVEF was evaluate.Results Levels of CA125,NT-proBNP,TNF-?,LVMI and LAVI in patients with CHF were much higher than those without CHF. The LVEF was much lower in NYHA Ⅲ and NYHA Ⅳ group than that in without CHF and NYHAⅠgroup. Conclusion CA125 was positively associated with the NT-proBNP,TNF-? and LVMI.

Role of N-terminal pro-brain natriuretic peptide in differentiating heart failure in the patients with acute dyspnea / 中国实用内科杂志

Objective To study the differential diagnostic value of serum N-terminal pro-brain natriuretic peptide(NT-proBNP)in the patients with acute dyspnea.Methods Sixty-two patients in Medical Department of the People's Hospital of Huangpu were included in this study.Patients were divided into two groups:dyspneic patients with heart failure and without heart failure.Thirty healthy cases were selected as the control group.The concentration of serum NT-proBNP,LVEF was determined in all cases.We analyzed the relationship between NT-proBNP and LVEF.Furthermore we analyzed the relationship between NT-proBNP and the NYHA Class.Results LVEF of the control group,dyspneic patients without heart failure and with heart failure was(60.82?5.53)%,(55.92?5.62)% and(40.25?4.85)%.It had significant difference in the control group,dyspneic patients without heart failure and with heart failure(P

Post-stress Measurements of Left Ventricular Function With Gated Perfusion SPECT: Comparison with Resting Measurements by using Exercise and Adenosine Stress

BACKGROUND AND OBJECTIVES: This study was designed to investigate the relationship between myocardial perfusion defect in single photon emission tomography(SPECT) and the difference in left ventricular functional parameters obtained after stress and at rest. MATERIALS AND METHODS: Eighty five patients known to have coronary artery disease (CAD) or suspected to have CAD underwent gated Tc-99m sestamibi SPECT using one or separate day rest/stress protocol. We compared post-stress left ventricular ejection fraction (LVEF-s) with that at rest (LVEF-r) in gated myocardial SPECT. We considered myocardial stunning was developed when LVEF was >5% lower than that at rest. METHODS: Forty one (48%) patients demonstrated reversible or irreversible perfusion defects in gated perfusion SPECT (group 1). Forty four (52%) patients demonstrated normal perfusion status (group 2). In group 1, LVEF-s was significantly lower than that at rest([mean+/-SD] 46+/-15.5 vs 48+/-16.0 respectively, p5% lower than LVEF-r. CONCLUSION: The LVEF obtained after stress with gated SPECT may not reflect true resting values. We recommend gated myocardial perfusion SPECT should be performed also at rest especially in patients with myocardial perfusion defects.