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Objective To explore the therapeutic efficacy of automatic peritoneal dialysis on elderly patients with cardiorenal syndrome(CRS).Methods A total of 260 elderly CRS patients treated at our hospital from January 2019 to January 2022 were recruited,and then randomly divided into an observation group and a control group,with 130 cases in each group.The control group received conventional basic treatment and symptomatic treatment,while the observation group received automated peritoneal dialysis treatment on this basis.Cardiac function indicators,renal function indicators,inflammatory factors,MAP and heart rate were compared between the two groups.Re-sults After treatment,significantly lower LVESD(26.29±1.19 mm vs 29.59±1.84 mm),LVEDD(47.43±1.39 mm vs 51.81±1.34 mm),LAD(30.74±1.15 mm vs 33.11±0.88 mm),and levels of NT-proBNP(1034.74±313.61 ng/L vs 2634.02±853.67 ng/L),urea(16.69±3.57 mmol/L vs 32.67±4.54 mmol/L),cystatin C(0.47±0.13 mg/L vs 0.61±0.15 mg/L),creatinine(254.74±41.15 mmol/L vs 394.09±38.61 mmol/L),TNF-α(144.14±23.16 mg/L vs 183.97± 23.37 mg/L)and hs-CRP(4.09±1.03 μg/L vs 5.45±1.17 μg/L),and higher LVEF(39.14± 4.48％vs 35.64±5.27％)were observed in the observation group than the control group(all P＜0.01).There were no significant differences in heart rate and MAP between the two groups before and after treatment(P＞0.05).Conclusion Automatic peritoneal dialysis can improve the cardiac and renal function and reduce inflammatory response in elderly CRS patients,and show positive significance for improving prognosis.
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Objective:To correlate neutrophil/lymphocyte ratio (NLR) with cardiac function in patients with acute myocardial infarction (ACI) after percutaneous coronary intervention (PCI) and investigate its clinical value in predicting major adverse cardiovascular events (MACEs) in patients.Methods:A total of 120 patients with AMI who underwent PCI at Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from March 2020 to February 2023 were included in this prospective study. The difference in NLR measured 1 day after PCI relative to that measured at 5 days after surgery (?NLR) was correlated with cardiac function ultrasound indicators measured at 3 months after surgery, myocardial injury, and inflammatory biochemical indicators at 1 day after surgery. The MACEs occurring within 3 months after surgery were recorded. The value of ΔNLR recorded during the early stage after PCI for predicting MACEs in patients with AMI was evaluated.Results:At 3 months after surgery, 13 out of 120 patients with AMI (10.83%) had MACEs. The ?NLR in patients with AMI who had MACEs was (3.55 ± 0.47), which was significantly higher than (2.06 ± 0.34) in patients with AMI who had no MACEs ( t = 17.25, P < 0.001). An optimal critical value of ?NLR for predicting MACEs after PCI in patients with AMI was 2.75, with an area under the receiver operating characteristic curve of 0.972, a sensitivity of 90.70%, and a specificity of 91.10%. Conclusion:Increased NLR during the early stage after PCI in patients with AMI is closely related to decreased cardiac function, and worsened myocardial injury and inflammatory reactions. Changes in NLR after PCI in patients with AMI have a highly valuable value for predicting MACEs in these patients.
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Objective:To correlate serum Nesfatin-1, N-terminal pro-brain natriuretic peptide (NT-proBNP), and cystatin C (CysC) levels with myocardial enzymes and cardiac function in patients with acute ST-elevation myocardial infarction (STEMI).Methods:This is a case-control study. A total of 100 patients with acute STEMI who received treatment at Lishui People's Hospital from January 2020 to December 2022 were included in the STEMI group. An additional 80 healthy controls who concurrently received physical examinations in the same hospital were included in the control group. Serum levels of Nesfatin-1, NT-proBNP, CysC, creatine kinase-MB (CK-MB), and cardiac troponin I (cTnI) levels were determined in each group. Left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVDD), and left ventricular end-systolic diameter (LVDS) were measured using color Doppler ultrasound. Correlation analysis was performed.Results:Serum Nesfatin-1 level in the STEMI group was (89.96 ± 15.25) ng/L, which was significantly lower than (226.36 ± 37.47) ng/L in the control group ( t = 33.15, P < 0.05). Serum levels of NT-proBNP and CysC in the STEMI group were (1 325.12 ± 378.48) ng/L and (1.37 ± 0.24) mg/L, which were significantly higher than (78.95 ± 13.42) ng/L and (0.79 ± 0.16) mg/L in the control group ( t = -29.42, -18.56, both P < 0.05). Serum CK-MB and cTnI levels in the STEMI group were (46.51 ± 12.14) U/L and (1.13 ± 0.25) U/L, respectively, which were significantly higher than (12.23 ± 4.01) U/L and (0.09 ± 0.02) U/L in the control group ( t = -24.06, -37.09, both P < 0.05). The LVEF in the STEMI group was (37.84 ± 5.45)%, which was significantly lower than (72.41 ± 4.26)% in the control group ( t = 46.49, P < 0.05). The LVDD and LVDS in the STEMI group were (40.92 ± 5.25) mm and (58.98 ± 6.25) mm, which were significantly higher than (19.86 ± 3.36) mm and (34.21 ± 4.38) mm in the control group ( t = -31.13, -30.03, both P < 0.05). Serum Nesfatin-1 level was positively correlated with LVEF ( r = 0.572), but it was negatively correlated with serum CK-MB and cTnI levels, LVDD, and LVDS ( r = -0.498, -0.617, -0.506, -0.534, all P < 0.05). Serum NT-proBNP and CysC levels were negatively correlated with LVEF ( r = -0.653, -0.607), but they were positively correlated with serum CK-MB and cTnI levels, LVDD, and LVDS ( r = 0.582, 0.526, 0.712, 0.565, 0.631, 0.578, 0.659, 0.635, all P < 0.05). Conclusion:Serum Nesfatin-1 levels decrease, while serum NT-proBNP and CysC levels increase in patients with acute STEMI. Serum Nesfatin-1, NT-proBNP, and CysC levels are closely related to myocardial enzymes and cardiac function.
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Resumo Fundamento: A cardiomiopatia associada à lipodistrofia parcial (LP) ainda não foi bem descrita. Objetivo: Caracterizar a morfologia e a função cardíaca na LP. Métodos: Pacientes com LP e controles foram avaliados prospectivamente por ecocardiografia transtorácica e ecocardiografia por speckle-tracking (Strain Longitudinal Global, SLG). A relação entre as variáveis ecocardiográficas e o diagnóstico de LP foi testada com modelos de regressão, considerando o efeito da pressão arterial sistólica (PAS). Adotou-se um nível de significância de 5%. Resultados: Vinte e nove pacientes com LP foram comparados com 17 controles. Eles não se diferiram quanto à idade (p=0,94), sexo ou índice de massa corporal (p= 0,05). Os pacientes com LP apresentaram PAS estatisticamente mais alta (p=0,02) em comparação aos controles. Ainda, os pacientes com LP apresentaram maior dimensão do átrio (37,3 ± 4,4 vs. 32,1 ± 4,3 mm, p= 0,001) e maior volume atrial (30,2 ± 7,2 vs. 24,9 ± 9,0 mL/m2, p=0,02), massa do Ventrículo Esquerdo (VE) (79,3 ± 17,4 vs. 67,1 ± 19,4; p=0,02), e parâmetros sistólicos reduzidos do VE (E' lateral, p= 0,001) (E' septal, p= 0,001), (razão E/E', p= 0,02). A fração de ejeção do VE (64,7 ± 4,6 vs. 62,2 ± 4,4 %, p = 0,08) e o SLG não foram estatisticamente diferentes entre os grupos (-17,1±2,7 vs-18.0 ± 2,0%, p= 0,25). Observou-se uma reação positiva do átrio esquerdo (β 5,6; p<0,001), espessura da parede posterior (β 1,3; p=0,011), E' lateral (β -3,5; p=0,002) e E' septal (β -3,2; p<0,001) com o diagnóstico de LP, mesmo após o ajuste para a PAS. Conclusão: Os pacientes com LP apresentam hipertrofia do VE, aumento do átrio esquerdo, e disfunção diastólica do VE apesar de fração de ejeção do VE e SLG preservados. Os parâmetros ecocardiográficos estão relacionados com o diagnóstico de LP, independentemente da PAS.
Abstract Background: Cardiomyopathy associated with partial lipodystrophy (PL) has not been well described yet. Objective: To characterize cardiac morphology and function in PL. Methods: Patients with familial PL and controls were prospectively assessed by transthoracic echocardiography and with speckle-tracking echocardiography (global longitudinal strain, GLS). The relationship between echocardiographic variables and PL diagnosis was tested with regression models, considering the effect of systolic blood pressure (SBP). Significance level of 5% was adopted. Results: Twenty-nine patients with PL were compared to 17 controls. They did not differ in age (p=0.94), gender or body mass index (p= 0.05). Patients with PL had statistically higher SBP (p=0.02) than controls. Also, PL patients had higher left atrial dimension (37.3 ± 4.4 vs. 32.1 ± 4.3 mm, p= 0.001) and left atrial (30.2 ± 7.2 vs. 24.9 ± 9.0 mL/m2,p=0.02), left ventricular (LV) mass (79.3 ± 17.4 vs. 67.1 ± 19.4, p=0.02), and reduced diastolic LV parameters (E' lateral, p= 0.001) (E' septal, p= 0.001), (E/E' ratio, p= 0.02). LV ejection fraction (64.7 ± 4.6 vs. 62.2 ± 4.4 %, p= 0.08) and GLS were not statistically different between groups (-17.1 ± 2.7 vs. -18.0 ± 2.0 %, p= 0.25). There was a positive relationship of left atrium (β 5.6, p<0.001), posterior wall thickness, (β 1.3, p=0.011), E' lateral (β -3.5, p=0.002) and E' septal (β -3.2, p<0.001) with PL diagnosis, even after adjusted for SBP. Conclusion: LP patients have LV hypertrophy, left atrial enlargement, and LV diastolic dysfunction although preserved LVEF and GLS. Echocardiographic parameters are related to PL diagnosis independent of SBP.
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Objective:To investigate the efficacy of phenolamine in the treatment of sepsis-induced myocardial dysfunction and its effect on cardiac function, myocardial injury index, and hemodynamics in patients.Methods:The clinical data of 79 patients with sepsis-induced myocardial dysfunction who received treatment in Huangshi Central Hospital, Edong Healthcare Group from February 2017 to February 2020 were retrospectively analyzed. These patients were divided into a control group (without phenolamine treatment, n = 41) and an observation group (with phenolamine treatment, n = 38) according to whether they received phenolamine treatment or not. Clinical efficacy, cardiac function, myocardial injury index, and hemodynamic index pre- and post-treatment were compared between the two groups. Results:There was no significant difference in 28-day mortality rate between the two groups ( P > 0.05). Intensive care unit length of stay and mechanical ventilation duration in the observation group were (9.33 ± 3.52) days and 83.00 (28.50, 138.00) hours, which were significantly shorter than (12.17 ± 4.15) days and 111.00 (47.50, 169.00) hours in the control group ( t = 3.26, Z = -2.27, both P < 0.05). The response rate in the observation group was significantly higher than that in the control group [81.58% (31/38) vs. 60.98% (25/41), χ2 = 4.05, P < 0.05]. After 7 days of treatment, the left ventricular ejection fraction in each group was significantly increased, and the left ventricular end-diastolic diameter and left ventricular end-systolic diameter in each group were significantly decreased compared with before treatment (all P < 0.05). After 7 days of treatment, the left ventricular ejection fraction in the observation group was significantly higher than that in the control group ( t = 3.29, P < 0.05), and left ventricular end-diastolic diameter and left ventricular end-systolic diameter were significantly lower than those in the control group ( t = 5.94, 11.21, both P < 0.05). N-terminal pro-brain natriuretic peptide and cardiac troponin I levels in each group were significantly decreased with time (both P < 0.05). At 24 and 72 hours and 7 days after treatment, N-terminal pro-brain natriuretic peptide and cardiac troponin I levels in the observation group were significantly lower than those in the control group (both P < 0.05). After 7 days of treatment, heart rate in each group decreased significantly compared with that before treatment (both P < 0.05), mean arterial pressure, cardiac index, and stroke output index in each group increased significantly compared with those before treatment (all P < 0.05). After 7 days of treatment, heart rate in the observation group was significantly lower than that in the control group ( t = 4.90, P < 0.05), and mean arterial pressure, cardiac index, and stroke output index in the observation group were significantly higher than those in the control group ( t = 4.37, 3.23, 6.01, all P < 0.05). Conclusion:Phentolamine can improve hemodynamics, reduce myocardial injury and improve cardiac function in patients with sepsis-induced myocardial dysfunction.
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Objective:To investigate the application value of percutaneous coronary intervention in patients with acute coronary syndrome in county-level hospitals.Methods:The clinical data of 51 patients with acute coronary syndrome who received treatment in Feng Tai People's Hospital from January 2020 to January 2022 were retrospectively analyzed. They were divided into a control group ( n = 25) and an observation group ( n = 26). The control group was given standard dual antiplatelet and statin drugs. The observation group underwent percutaneous coronary intervention and stent implantation based on conventional drug treatment. All patients were followed up for 1 year. Cardiac function indexes left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDD) were compared between the two groups. The number of readmissions, length of hospital stay, quality of life score, medication, the incidence of complications, and the incidence of adverse cardiovascular events were compared between the two groups. Results:Before treatment, there were no significant differences in LVEF and LVEDD between the two groups (both P > 0.05). After treatment, LVEF was increased, and LVEDD was decreased in each group compared with before treatment. After treatment, LVEF and LVEDD in the observation group were (50.34 ± 5.97)% and (49.01 ± 5.02) mm, respectively, which were significantly superior to (45.61 ± 5.42)% and (52.12 ± 5.24) mm in the control group ( t = -2.96, 2.17, both P < 0.05). After treatment, the number of readmissions in the observation group was significantly less than that in the control group [(0.8 ± 0.1) times vs. (2.1 ± 0.3) times, t = 20.14, P < 0.001]. The length of hospital stay in the observation group was significantly shorter than that in the control group [(12.4 ± 3.1) days vs. (25.3 ± 3.9) days, t = 13.10, P < 0.001]. Quality of life score in the observation group was significantly higher than that in the control group [(85.3 ± 5.9) points vs. (72.5 ± 5.2) points, t = -8.19, P < 0.001]. After treatment, the incidence of adverse cardiovascular events in the observation group was significantly lower than that in the control group [3.9% (1/26) vs. 28.0% (7/25), χ2 = 3.94, P = 0.041). Conclusion:Use of percutaneous coronary intervention in patients with acute coronary syndrome in county-level hospitals is feasible. It can improve patients' cardiac function and has a remarkable clinical effect with a low incidence of adverse cardiovascular events.
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Objective:To investigate the clinical efficacy of sacubitril and valsartan combined with bisoprolol in the treatment of chronic heart failure and its effect on N-terminal pro-brain natriuretic peptide (NT-pro BNP) level.Methods:The clinical data of 89 patients with chronic heart failure who received treatment in Jinan 2 nd People's Hospital from January 2020 to April 2022 were retrospectively analyzed. These patients were divided into Group A ( n = 48) and Group B ( n = 41) according to different treatment methods. Group A was treated with sacubitril and valsartan combined with bisoprolol. Group B was treated with sacubitril and valsartan combined with metoprolol. All patients were treated for 3 months. Clinical efficacy as well as heart function and NT-pro BNP level pre- and post-treatment were compared between the two groups. The incidence of adverse reactions was calculated in each group. Results:Total response rate in group A was significantly higher than that in group B [95.83% (46/48) vs. 82.93% (34/41), χ2 = 4.05, P < 0.05]. After treatment, the left ventricular ejection fraction in both groups increased significantly and the left ventricular ejection fraction in group A was significantly higher than that in group B ( t = 2.19, P < 0.05). After treatment, NT-pro BNP level in group A was (416.51 ± 30.56) ng/L, which was significantly lower than (450.20 ± 35.79) ng/L in group B ( t = 4.79, P < 0.001). There was no significant difference in the incidence of adverse reactions between the two groups ( P > 0.05). Conclusion:The efficacy of sacubitril and valsartan combined with bisoprolol in the treatment of chronic heart failure is superior to that of sacubitril and valsartan combined with metoprolol. The former can greatly decrease NT-pro BNP level. Corresponding drugs can be selected for the treatment of chronic heart failure according to the actual needs of patients.
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Objective:To explore the prognostic value of the serum concentration of human soluble stromelysin-2(sST2)combined with ultrasonic left ventricular diastolic function parameters for elderly patients with septic shock.Methods:This prospective study involved 150 elderly patients with septic shock admitted to the intensive care unit(ICU)of the First Hospital of Jiaxing between May 2019 and May 2022.Data on the following parameters were recorded on days 1, 3, 5, and 7 in the ICU: sST2 concentration, mitral early-diastolic inflow peak velocity(E), mitral late-diastolic inflow peak velocity(A), E/A ratio, early diastolic mitral annular velocity(e'), and E/e' ratio.According to the 28-day prognostic outcome obtained during follow-up, patients were divided into a survival group and a death group to compare differences in values of the above parameters between the two groups and at different time points.Logistic regression was used to analyze independent risk factors for 28-day mortality.The receiver operating characteristic(ROC)curve was used to analyze the predictive value for 28-day mortality, and further risk stratification was performed according to optimal cut-off values to compare differences in 28-day mortality under different risk stratification methods.The Kaplan-Meier survival curve was used to compare 28-day cumulative survival under different risk stratification methods and analyze the predictive value of the combination of the parameters for 28-day mortality.Results:On day 5 following ICU admission, e' was lower and E/e' and sST2 were higher in the death group than in the survival group.Univariate and multivariate Logistic regression analysis suggested that sST2(odds ratio: 1.010, P<0.001)was an independent risk factor for 28-day mortality in elderly patients with septic shock.sST2 had a sensitivity of 50.2%, a specificity of 79.1%, and an area under the curve of 0.660 for predicting 28-day mortality in patients with septic shock.The sST2 concentration was 89.3 μg/L on day 5 after ICU admission, which was the clinical cutoff point for predicting 28-day mortality.Based on the risk stratification of sST2 levels, the 28-day mortality rate was higher in the sST2>89.3 μg/L group than in the sST2≤89.3 μg/L group.Kaplan-Meier survival analysis showed that the 28-day cumulative survival rate was significantly lower in the sST2>89.3 μg/L group than in the sST2≤89.3 μg/L group(44.0% vs.66.7%, log-rank test: χ2=9.101, P=0.003).The receiver operating characteristic curve showed that the combination of sST2, e', and E/e' significantly improved the prediction efficiency of 28-day mortality in elderly patients with septic shock, with an area under the curve of 0.844, a sensitivity of 89.7%, and a specificity of 66.5%. Conclusions:sST2 is an independent risk factor for 28-day mortality in elderly patients with septic shock.When combined with e' and E/e', sST2 can more accurately evaluate the survival prognosis of these patients.