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Objective:To study the effects of different doses of atorvastatin combined with valsartan on blood pressure variability (BPV) and circadian rhythm in patients with hypertension.Methods:Eighty patients with grade 2 and grade 3 hypertension from March 2018 to March 2019 in Hefei First People′s Hospital were divided into low-dose group (20 mg/d atorvastatin combined with valsartan) and high-dose group (40 mg/d atorvastatin combined with valsartan) according to the random number table method. The efficacy after 8 weeks of treatment was compared between the two groups. The BPV, circadian rhythm, vascular endothelial factors [nitric oxide (NO), endothelin (ET)], serum disease-related factors [human cartilage glycoprotein (YKL-40), soluble intercellular adhesion molecule-1(sICAM-1), folate] and blood lipids [total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C)] were recorded before treatment and 8 weeks after treatment, and the occurrence of adverse reactions during medicine was counted in the two group.Results:After 8 weeks of treatment, the total effective rate was 97.50%(39/40) in low-dose group and was 92.50%(37/40) in high-dose group, and there was no significant difference in the total effective rate between the two groups ( P>0.05). After 8 weeks of treatment, the 24 h SBPV, daytime SBPV, nighttime SBPV, 24 h DBPV, daytime DBPV and circadian rhythm in the two groups were significantly decreased compared with those before treatment, and the 24 h SBPV, daytime SBPV, daytime DBPV and circadian rhythm in high-dose group were significantly lower than those in low-dose group: (9.53 ± 1.73)% vs. (10.89 ± 1.98)%, (9.14 ± 1.90)% vs. (10.33 ± 2.07)%, (11.56 ± 2.78)% vs. (13.06 ± 3.16)%, (4.78 ± 1.56)% vs. (5.70 ± 1.81)%( P<0.05). After 8 weeks of treatment, the levels of NO, folate and HDL-C in the two groups were significantly increased compared with those before treatment, and the levels with in high-dose group were significantly higher than those in low-dose group: (67.16 ± 13.14) μmol/L vs.(60.53 ± 12.50) μmol/L, (14.94 ± 2.07) mmol/L vs.(13.83 ± 2.28) mmol/L, (1.42 ± 0.15) mmol/L vs. (1.31 ± 0.18)mmol/L ( P<0.05). The levels of ET, YKL-40, sICAM-1, TC, TG and LDL-C in the two groups were significantly decreased compared with those before treatment, and the levels in high-dose group were significantly lower than those in low-dose group: (33.63 ± 5.15) ng/L vs. (37.44 ± 5.13) ng/L, (32.68 ± 6.16) μg/L vs. (36.94 ± 6.03) μg/L, (203.78 ± 41.19) ng/L vs. (249.93 ± 50.81) ng/L, (6.78 ± 1.03) mmol/L vs. (7.38 ± 1.30) mmol/L, (2.88 ± 0.61) mmol/L vs. (3.39 ± 0.85) mmol/L, (3.14 ± 1.05) mmol/L vs. (3.85 ± 1.44) mmol/L ( P<0.05). Conclusions:Different doses of atorvastatin combined with valsartan are effective in the treatment of hypertension, but high dose of atorvastatin combined with valsartan has better effects on blood pressure variability and circadian rhythm, and can effectively improve vascular endothelial function.
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Objective:To explore the effect of continuous improvement of emergency procedures in different departments on reperfusion and prognosis of patients with acute ST segment elevation myocardial infarction after chest pain center certification.Methods:From March 2018 to July 2019, the clinical data of 206 patients with acute ST segment elevation myocardial infarction and percutaneous coronary intervention diagnosed in the chest pain center of the Third Affiliated Hospital of Anhui Medical University&Hefei First People′s Hospital were analyzed retrospectively.Ninety-eight patients admitted before certification were set as the control group, and 108 patients admitted after certification were set as the study group.The patients in the study group and the experimental group were compared in terms of the time from the onset to the initial medical contact, the time from the entrance to the implantation of balloon dilation, the time from the initial medical contact to the implantation of balloon dilation, the time of total ischemia and the incidence of major cardiovascular adverse events 30 days after percutaneous coronary intervention.Logistic regression analysis was used to analyze the influencing factors of major adverse cardiovascular events 30 days after operation.Results:Compared with the control group, the time from initial medical contact to implantation of balloon was (84.5 (73.0, 96.0) min), the time of total ischemia was (205.0(159.8, 307.0) min), the time from entrance to implantation of balloon was (72.5(58.3, 83.8) min) in the study group, which was (112.0(93.0, 132.5) min, 241.0(199.0, 329.0) min, 78.0(68.0, 96.5) min was significantly shorter than that of the control group, and the difference was statistically significant (all P<0.05). The time from the onset of disease to the initial medical contact in the study group was slightly shorter than that in the control group(124.5 (77.3, 201.0) min and 130.0 (76.3, 216.0) min), there was no significant difference ( P>0.05). Compared with the control group, the incidence of major cardiovascular adverse events in the study group was lower 30 days after operation (16.7%(18/108) and 28.6%(28/98)), the difference was statistically significant( P=0.040). According to the results of multivariate logistic regression analysis, Killip Ⅲ, Ⅳ ( OR 2.618, 95% CI1.244-5.509, P=0.011), the time from onset to initial medical contact>90 min ( OR 4.562, 95% CI 2.167-9.603, P<0.001), the time from entrance to implantation of balloon>60 min ( OR 2.227, 95% CI1.087-4.563, P=0.029) was an independent risk factor for major adverse cardiovascular events 30 days after operation. Conclusion:The continuous improvement of chest pain center process can promote the rational utilization of medical resources in the region, more effectively shorten the treatment time of myocardial infarction patients, and reduce the occurrence of major cardiovascular adverse events within 30 days after operation.
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Objective To investigate the advantage and disadvantage of the right ventricular outflow septal pacing.Methods Eighty patients requiring pacemaker because of slow arrhythmia were randomly divided into the active fixation group and passive fixation group.The implantation time, radiation exposure time and changes of electrocardiogram were compared between 2 groups,and the heart function changes 1 year after treatment were observed by color Doppler ultrasound.Results The implantation time and radiation exposure time in active fixation group were significantly longer than those in passive fixation group: (20.00 ± 3.48) min vs.(15.00 ± 2.67) min and (9.45 ± 3.48) min vs.(6.78 ± 2.67)min,and there were statistical differences(P<0.05).The QRS duration and QTc duration in active fixation group were significantly shorter than those in passive fixation group:(0.119 2 ± 0.042 1)s vs.(0.142 3 ± 0.032 4)s and(0.403 5 ± 0.026 8)s vs.(0.442 7 ± 0.054 1)s,and there were statistical differences(P<0.05).In active fixation group,there were no statistical differences in left atrial diameter, left ventricular end-diastolic diameter, left ventricular minor axis decurtaion rate and left ventricular ejection fraction, compared before treatment and 1 year after treatment (P>0.05).Conclusions The application of the active electrode lead in the right outflow trace septal pacing is more associated with wider physiological ventricular function.
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Objective To investigate the changes of heart rate deceleration capacity(DC)in patients with unstable angina pectoris(UAP)and its correlation with the scope and severity of coronary artery disease. Methods From September 2016 to January 2017,one hundred and nine patients with UAP and 52 with non-coronary artery disease were diagnosed in the department of cardiology in the Third Affiliated Hospital of Anhui Medical University. They were all measured with 24h dynamic electrocardiogram and the corresponding analysis software was used to analyze the results,and the difference in deceleration capacity between the two groups was compared. The severity and the number of coronary artery lesions were compared with different deceleration capacity in UAP patients. The relationship between deceleration capacity and the number of coronary artery stenosis, the scope and severity of coronary artery lesions were then analyzed. Results The deceleration capacity value of UAP group was significantly lower than that of the control group((5.10 ± 1.34)vs.(6.03 ±1.40),t=-3.775,P<0.01). The number of coronary artery lesions and Gensini score in group deceleration capacity>4.5 ms were smaller than those in group deceleration capacity ≤4.5 ms((1.67± 0.77)branches vs. (26.76±25.31)branches;(21.27±5.541)points vs.(42.69±8.61)points)(t= -3.910,-2.277,P<0.05). The deceleration capacity value was negatively correlated with the number of coronary artery stenosis(r=-0.206,P<0.01)and the Gensini score(r=-0.358, P<0.01)in patients with UAP. Conclusion Deceleration capacity decreased in patients with UAP and it was closely associated with the severity and the scope of coronary artery lesions.
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Objective To evaluate the accuracy of dual-source CT (DSCT) in diagnosing the degree of coronary artery stenosis,and compare it with coronary artery angiography (CAG).Methods One hundred patients with suspected coronary heart disease,clinical diagnosis of angina pectoris,myocardial infarction and patients after percutaneous coronary intervention,were given DSCT and CAG examination.The CAG results were considered as the reference standard,and the results of the two examinations were compared.The sensitivity,specificity,positive predictive value and negative predictive value of DSCT in diagnosing coronary artery stenosis (mild ＜ 50％,middle 50％-75％,severe ≥75％) were computed.Results CAG displayed coronary artery 1320 segments,DSCT displayed coronary artery 1287 segments,the appreciable rate was 97.5％.The sensitivity of DSCT in diagnosing mild,middle and severe coronary artery stenosis were 64.4％ (105/163),88.7％ (235/265) and 97.4％ (187/192),specificity all were 99.7％ (617/619),positive predictive value were 98.1％ (105/107),99.2％ (235/237) and 98.9％ (187/189),negative predictive valne were 91.4％ (617/675),95.4％ (617/647) and 99.2％ (617/622).There was significant correlation between DSCT and CAG in diagnosing coronary artery stenosis by Spearman test (P＜ 0.01).Conclusions The results of DSCT have high accordance with CAG in diagnosing coronary artery stenosis.It is a kind of non-invasive examination with low cost,and could reduce the pain of invasive examination.So DSCT is a good choice in diagnosing coronary artery disease.
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Objective To evaluate the association between parameters of heart rate turbulence (HRT) and the severity of the coronary arteries disease. Methods 60 patients with unstable angina pectoris (UAP) who under-went angiographic examination and 40 healthy controls were chosen. HRT including turbulence onset (TO), turbu-lence slope (TS) and turbulence dynamicity (TD) were determined by 24 h ambulatory electrocardiogram(Hoher) in all the patients. The value of above indices were compared between UAP group and control group,and between subgroups of UAP. The correlation of HRT with the severity of coronary arteries diseases was analyzed. Results The levels of TO and TD in patients with UAP were significantly higher than those in controls [(1.18±0.88) % vs lower TS (P<0.05) and higher TD (P<0.05 ) than those in patients with coronary single vessel lesion. The same -0.296, P<0.05 ) and coronary artery stenosis score (r=-0.372, P<0.05 ) ; TD was positively correlated with number of abnormal coronary artery (r=0.353, P<0.01 ) and coronary artery stenosis score (r=0.510, P < 0.05). Conclusion . HRT is impaired in patients with UAP,especially the changes of TS and TD is signflcant,and is correlated with the severity of coronary arteries disease. TD is not influenced by premature ventricualr contractionheart rate so the combinatoin of TD and TS might be used as objective index in predicting the severity of the coronary arteries disease.