RESUMO
Objective To discuss the prognostic impact of atrial fibrillation (AF) in patients with chronic heart failure(CHF).Methods From January,2005 through December,2006 we studied 461 patients with a discharge diagnosis of CHF.Patients were divided by baseline rhythm in sinus rhythm(SR) or AF groups.The main endpoints were all cause death within 3 years and readmission to the hospital for heart failure.Results AF group were more likely to be older and female and to have a history of valvular disease and have a higher left ventricular ejection fraction (LVEF).However,SR group were more likely to have a history of ischemic heart disease.During 3 year follow-up,the main endpoints was higher in AF group than in those with SR group (P ＜0.01).After adjusting for other covariables,AF and age were related to increased the risk of main endpoints during 3 years follow-up (RR =1.311,95％ CI:1.002-1.715,P ＜0.05 ; RR =1.014,95％ CI:1.004-1.024,P ＜ 0.01).Conclusion AF and age were the main risk factors of increased adverse forward prognosis in patients with CHF.
RESUMO
Objective To assess the value of exercise treadmill testing (bruce protocol) in diagnosing early atherosclerotic lesions of the lower limb. Methods Between March and September 2008, 173 outpatients with high risks of peripheral arterial disease (PAD) were enrolled randomly from the cardiology clinic of Chinese PLA General Hospital. The patients were subjected to exercise treadmill testing (Bruce protocol) and ankle-brachial index (ABI) determination, as well as lower limb artery ultrasonography within one week. Using ultrasonic findings as diagnostic criteria, the diagnostic sensitivity, specificity, positive likelihood ratio and negative likelihood ratio of exercise treadmill testing for early atherosclerotic lesions of the lower limb were analyzed, and the diagnostic value of exercise treadmill testing was assessed using the ROC curve. Results After exercise, ABI decrement (R value) increased in subjects with high risks for PAD with atherosclerotic lesions of the lower limb aggravating. Using the presence of large atherosclerotic plaques (area > 20 mm2 ), atherosclerotic plaques and atherosclerotic lesions in lower limb arteries as positive diagnostic criteria, the area under curve of ROC was 0. 80 (95% CI: 0.72-0.88), 0.78 (95% CI: 0.71-0.85) and 0. 60 (95% CI: 0.44-0.76), respectively. Using the presence of large atherosclerotic plaques in lower extremities as positive diagnosis, R value was 0.80, with a sensitivity of 54. 0%, a specificity of 96. 7%, a LR+ of 16. 4, and a LR- of 0. 58, meanwhile, R value was 0. 85, with a sensitivity of 70.0%, a specificity of 91.9%, a LR + of 8.64, and a LR- of 0.33. Conclusions Exercise treadmill testing (Bruce protocol) in combination with ABI determination is a safe, accurate, objective tool for detecting early atherosclerotic lesions of the lower limb. Immediately after exercise, 0.85 is the cut-off R value appropriate for diagnosing large atherosclerotic plaques of the lower limb (area > 20 mm2).
RESUMO
Objective To investigate the clinical characteristics of the results of coronary artery CT angiography and coronary artery angiography in 36 patients with probable positive results of treadmill exercise test(TET).Methods Thirty-six patients due to chest pain received 1ET and coronary artery CT angiography and coronary artery angiography in 2 weeks after admission.The coronary plaques were categorized as noncalcified and calcified plaque on CTA images.Results In 36 patients with probable positive results of TET.23 patients were confirmed as coronary artery disease by coronary artery angiography,and the other 13patients had normal coronary artery.Of 23 coronary artery disease patients,9 patients were presented as onevessel disease,5 patients were presented as two-vessel disease,and 9 patients were presented as three-vessel disease,29 non-calcified plaques and 23 calcified plaques were demeted On CTA.Conclusion TET was useful in confirming the diagnosis of coronary artery disease.The characteristics of the coronary artery plaque is correlated with probable positive results of TET.