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Objective To investigate the clinical characteristics and prognostic factors after percutaneous coronary intervention of women with the first non-ST-segment elevation myoeardial infarction.Methods A total of 123 female patients with AMI,including 70 patients with NSTEMI and 53 patients with ST-segment elevation myocardial infarction (STEMI),who received PCI within 24 hours of onset were selected from June 2013 to June 2015.The clinical data were compared between patients with NSTEMI and with STEMI.Cox regression model was used to analyze the prognostic factors for the elderly patients with NSTEMI.Results The female patients with NSTEMI had more cases of patients with hypertension (48 vs.26),diabetes (38 vs.38) and hyperlipidemia (52 vs.29)than the female patients with STEMI.Significant differences in systolic blood pressure [(134.31±22.26)mmHg vs.(125.04 ± 19.63) mmHg],levels of white blood cell [(9.02 ± 3.75) 109/L vs.(11.37 ± 3.63) 109/L] and troponin Ⅰ [(8.63 ± 18.34) μg/L vs.(18.79 ± 27.76) μg/L] were observed in the above two groups (l P ＜ 0.05,respectively).The rates of revascularization,major adverse cardiovascular events in NSTEMI group were higher than those in STEMI group during 1 year after discharge (47.7％ vs.28.0％,62.9％ vs.35.8％) (P ＜ 0.05,respectively).Cox survival analysis showed that white blood cell (HR =1.241) and troponin-Ⅰ (HR =1.026) elevation were the risk prognostic factors after PCI for women with the first NSTEMI.Conclusion More hypertension,diabetes,hyperlipidemia and higher levels of systolic blood pressure,lower levels of white blood cell and troponin Ⅰ were observed in women with the first NSTEMI.The long-term prognosis of female patients with NSTEMI is poor.And elevated levels of white blood cell and troponin-Ⅰ were the risk prognostic factors after PCI for women with the first NSTEMI.
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Objective@#To analyze pre- and post-operation electrocardiograms (ECGs) features of patients underwent orthotopic heart transplantation (OHT), and provide evidences for identifying and analyzing post OHT ECGs.@*Methods@#Nine hundreds and ninty-eight pre- and post- OHT standard 12-leads ECGs from 110 consecutive patients, who underwent OHT in our hospital from May 2008 to May 2014, were analyzed.@*Results@#The mean heart rate(HR)was (86.9±16.4) beats per minute before OHT, and (100.0±0.4) beats per minute after OHT. P wave′s amplitude, duration, amplitude multiplied by duration of donor heart in lead Ⅱ were (0.124±0.069)mV, (111.1±17.2)ms, (14.34±9.51)mV·ms before OHT; (0.054±0.037)mV, (86.9±27.0)ms, (5.02±4.03)mV·ms at 1 month after OHT; (0.073±0.049)mV, (93.9±17.5) ms, (7.00±4.81)mV·ms at 6 years after OHT. ECGs rotation occurred in 83.64%(92/110) patients after OHT, and prevalence of clockwise rotation was 76.36%(84/110). Sinus tachycardia was evidenced in 99.09%(109/110) patients after OHT, and incomplete right bundle branch block was present in 60.91%(67/110) patients after OHT. Pseudo complete atrioventricular block mostly occurred at 2 days after OHT. Prevalence of double sinus rhythm was 27.95%(263/941) post OHT, 40% of them occurred between the 1st and the 2nd month post OHT; the atrial rate of recipient hearts was (104.0±10.2) beats per minucte between the 3rd and the 6th month post OHT, and was (95.3±4.2) beats per minucte between the 4th year and the 5th year. P wave′s amplitude, duration, amplitude multiplied by duration of recipient heart in lead Ⅱ were (0.066±0.055) mV, (52.8±34.7) ms, (4.67±4.95) mV·ms at 1 month after OHT, (0.043±0.040)mV, (44.4±40.5) ms , (3.11±3.61) mV·ms between the 1st year and 2nd year after OHT. The absolute value of P-wave(originating from the donor heart) terminal force in chest leads increased in 48.99%(461/941) patients post OHT, the P-wave terminal force of V1 , V2 and V3 were -0.044(-0.066, -0.028), -0.060(-0.087, -0.038), -0.035(-0.056, 0) mm·s. Notched P wave in chest leads was presented in 10.31%(97/941) patients post OHT. PR segment depression in chest leads occurred in 60.24%(100/166) patients between the 3rd month and the 6th month, the incidence of PR segment depression in V1 , V2 and V3 was 21.04%(198/941), 37.41%(352/941) and 28.69%(270/941), respectively.@*Conclusions@#OHT is related to significantly changed ECGs. The mean HR increased significantly after OHT, then decreased gradually after half a year to one year, but it was still higher than preoperative mean HR after five or six years; the P waves of donor heart were usually inconspicuous or small in first month after OHT, and they became bigger after 2 months, and their duration and amplitude then became relatively steady afterwards. ECGs rotation, especially the clockwise rotation, was common post OHT. A variety of arrhythmias originating from the donor heart including sinus tachycardia and incomplete right bundle branch block could be found. Pseudo complete atrioventricular block could also be found in the early phase after OHT. With the extension of time, the incidence of double sinus rhythm reduced gradually. The atrial rate and P wave of recipient heart presented with a tendency to become lower. The absolute value of P-waves(originating from the donor heart) terminal force in chest leads (mainly V1, V2 and V3) increased, notched P waves in chest leads (mainly V1, V2) and PR segments depression in chest leads (mainly V2, V3 and V4) also belong to typical post OHT ECGs features.
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Objective: To explore the relationship between expression of tumor necrosis factor-α( TNF-α) and electrophysiological heterogeneity in isolated heart tissues and isolated rat ventricular myocytes.The arrhythmogenic mechanisms of TNF-αwere further studied.Methods:Langendorff perfused heart tissues models were used to verify the arrhythmogenic effects of TNF-α.The monophasic action potentials( MAPs) of the endocardium and epicardium from the isolated heart tissues were recorded by elec-trophysiological experiments.The isolated rat ventricular myocytes were obtained by enzymatic dissociation.K+currents(Ito,IK1)were recorded by using whole cell patch clamp technique.Results: Compared to the control group, the difference in MAPD between endocardium and epicardium dramatically increased with TNF-α( P<0.05 ) .TNF-αcould cause MAP duration ( MAPD ) prolongation, and a single dose of TNF-αdifferentially affected the MAPs of endocardium and epicardium of isolated heart tissues.Compared to the control group,the K+currents(Ito,IK1)were dose-dependently decreased with TNF-αin rat ventricular myocytes(P<0.05).However, etanercept had no effects on the MAPD in the absence of TNF-α.Conclusion:TNF-α-induced heterogeneity of MAPD between the endo-cardium and epicardium may provide the substrate for the onset of ventricular arrhythmias during acute myocardial infarction.The effect might be associated with TNF-αcontribute to re-entrant ventricular arrhythmias which resulted from decreased K+currents(Ito,IK1).