Clinical features of 17 cases of rhabdomyolysis / 中华心血管病杂志

<p><b>OBJECTIVE</b>We retrospectively analyzed the causes, diagnosis, clinical characteristics, treatment and prognosis of 17 patients with rhabdomyolysis.</p><p><b>METHODS</b>Rhabdomyolysis cases diagnosed from January 2005 to March 2014 in our department were included.</p><p><b>RESULTS</b>A total of 17 rhabdomyolysis patients (male 13, mean age (60.4 ± 15.7) years) were analyzed.Four cases had coronary heart disease combined with hypertension, hyperlipaemia, atrial fibrillation, 10 cases had dilated cardiomyopathy combined with coronary heart disease, hyperlipaemia, atrial fibrillation, 8 cases had atrial fibrillation combined with hypertension, coronary heart disease, hyperlipaemia, 1 patient had pulmonary embolism combined with hyperlipaemia, 1 patient had aortic dissection combined with hypertension, 10 hypertension patients were combined with coronary heart disease, hyperlipaemia, atrial fibrillation, aortic dissection and 1 patient with ventricular tachycardia was combined with depression.Various degrees of liver and kidney dysfunction, reduced hemoglobin and myoglobinuria were found in all patients.Fever was found in 7 cases, relevant neurological signs in 5 cases. Digestive tract discomfort and muscle weakness or muscle pain symptoms were seen in all patients during hospitalization. All cases underwent renal replacement therapy and respirator was used in 14 patients to support breathing. Post therapy, 10 cases improved but 7 cases died. All 17 patients had history of statin use.</p><p><b>CONCLUSION</b>Statin may be the major cause of rhabdomyolysis in these patients, and the mortality of rhabdomyolysis is high despite various therapy stratigies.</p>

The Predictive Value of Fractional Flow Reserve Level for Long-term Prognosis in Patients After Coronary Drug-eluting Stent Implantation / 中国循环杂志

Objective: To explore the predictive value of fractional lfow reserve (FFR) level for long-term prognosis in patients after coronary drug-eluting stent (DES) implantation, and to analyze the relevant factors affecting the level of post-operative FFR. Methods: A total of 135 patients who received DES implantation in our hospital from 2012-01 to 2013-07 with coronary intermediate lesion at (50-80) % were studied. The relevant factors for MACE occurrence were studied by multivariate logistic regression analysis, the post-stent FFR level for predicting the long term prognosis after DES implantation was ifnally analyzed by ROC curve. Results: All patients ifnished 1 year follow-up study including 104 male and 31 female with the mean age of (63 ± 9) years. The post-stent FFR level was lower in MACE group than that in Non-MACE group, (0.82 ± 0.07) vs (0.87 ± 0.06),P=0.004. Multivariate logistic regression analysis presented that the higher level of post-stent FFR was the protective factor for MACE occurrence (OR=0.212,P=0.039); the post-stent FFR level had certain predictive value for MACE occurrence at 1 year after DES implantation (AUC=0.706,P=0.006); Kaplan-Meier survival study showed that the patients with post-stent FFR<0.875 had the less MACE occurrence than those with FFR≥0.875,P=0.012. Multivariate logistic regression analysis also indicated that post-stent FFR≥0.875 was positively related to right coronary target vessel, higher pre-operative FFR level and larger stent diameter.Conclusion: Post-stent FFR level had certain predictive value for MACE occurrence in patients at 1 year after DES implantation, the patients with post-stent FFR≥0.875 had the lower MACE occurrence rate than those with FFR<0.875.

Department of Cardiology, Guangdong General Hospital, Guangdong Cardiovascular Institute, Guangzhou 510080, China / 中国医学影像学杂志

PurposeTo investigate the relationship between left atrial volume index (LAVI) and severity of coronary lesions in patients with stable angina pectoris, so as to provide information for the evaluation of the severity of coronary artery disease (CAD). Materials and MethodsAccording to the results of coronary angiography, 279 patients with stable angina pectoris and 92 healthy people were as control group, all subjects were divided into four groups: control group (n=92), single-vessel CAD group (n=116), double-vessel CAD group (n=93) and triple-vessel group (n=70). Each group was compared in the aspects of demographic characteristics, history of illness, liver and kidney functions and parameter's difference in echocardiogram; the correlation between LAVI and Gensini score was analyzed; and the receiver operating characteristic (ROC) curve was used to identify the predictive value of LAVI in severity of coronary lesions.ResultsCompared with the control group, the double-vessel and triple-vessel CAD groups had significantly larger left atrial diameter (P<0.05). In triple-vessel CAD group, the left atrial diameter was significantly larger than that in the single-vessel CAD group (P<0.05), and the left ventricular end-diastolic diameter was significantly larger than that in the control group and in the single-vessel CAD group (P<0.05), and the E/Em and LVMI were significantly higher than those in other groups (P<0.05). The LAVI was higher in patients with CAD compared with those in the control group and the LAVI in the triple-vessel CAD group was significantly higher than that in single-vessel CAD group and double-vessel CAD group (P<0.05); the LAVI was correlated positively with Gensini score (r=0.499,P<0.01). LAVI had certain value in predicting triple-vessel CAD (AUC=0.782,P<0.01). The results of multi-factor Logistic regression analysis showed that male patients with hypertension, mitral reflux, and multi-vessel CAD were more likely to had high LAVI.Conclusion The worsening LV diastolic function is associated with the increasing severity of coronary artery lesions, and LAVI may have predictive value for severity of CAD.

Association between apolipoprotein A1-75 bp gene polymorphisms and risk for dyslipidemia and coronary artery disease / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the relationship between the apolipoprotein ApoA1-75 bp polymorphism and risk for dyslipidemia and coronary artery disease (CAD).</p><p><b>METHODS</b>A total of 723 patients (mean age (62.4 ± 10.2) years old) admitted to Guangdong General Hospital from 2011 to 2013 were enrolled. They were subdivided into CAD group (n = 444) and non-CAD (n = 279) group according to the result of coronary angiography (CAG). Clinical data including the profiles of lipids, -75 bp gene polymorphisms and Gensini scores were analyzed to determine the correlation between -75 bp gene polymorphisms, lipid profile and CAD.</p><p><b>RESULT</b>Frequency of male gender, history of diabetes and smoking, TC, TG, LDL-C and ApoB level were significantly higher and HDL-C level was significantly lower in CAD group than in non-CAD group (all P < 0.05). Frequency of A allele was significantly lower in CAD group than in non-CAD group (43.7% (194/444) vs. 56.6% (158/279) , P = 0.003). The ApoA1-75 bp gene polymorphism was significantly correlated with CAD (P < 0.005). Multivariate logistic regression analysis showed that -75 bp gene polymorphism mutation (OR = 0.649, P = 0.021) is an independent protective factor for coronary heart disease.</p><p><b>CONCLUSION</b>ApoA1-75 bp gene polymorphism is linked with risk of dyslipidemia and CAD.</p>

Clinical characteristics of 42 patients with cardiac amyloidosis / 中华内科杂志

Objective To characterize the clinical features of patients with cardiac amyloidosis (CA).Methods Totally 42 patients with CA admitted to Guangdong General Hospital since 2008 were included and retrospectively analyzed in the present study.CA was confirmed by abdomen and endocardium biopsy examination.Clinical manifestations,electrocardiogram and echocardiography were collected for the evaluation.Results Several clinic features are common in CA.In the present study,37 cases (88.1％) presented with chest tightness,dyspnea,20 cases(47.6％) with chest pain,27 cases(64.3％) with right heart failure,27 cases (64.3％) with fatigue,and 30 cases (71.4％) with renal insufficiency and proteinuria.Electrocardiogram (ECG) showed that 32 of the patients (76.2％) were with low voltage in limb leads,29 cases (69％) of them were with poor R wave progression in precordial leads,17 cases (40.5％) with ST-T change,28 cases(66.7％) with pseudo-necrotic Q wave and 36 cases (85.7％) with various kinds of arrhythmia.Echocardiography indicated that all of the subjects (100％) were with different degrees of left ventricular posterior wall or ventricular septal thickness,and left atrial hypertrophy with different degree of myocardial grain appearance or ground-glass opacity.Thirty-six cases (85.7％) were with pericardial effusion,and 27 cases (64.3％) were with abnormal left ventricular eject function.Conclusion For those who were with unexplained clinical cardiac insufficiency,renal insufficiency,myocardial hypertrophy,but normal of ventricular size in echocardiography and low voltage on ECG limb leads,a tissue biopsy from abdomen,labial glands or endocardium should be considered in the diagnosis of CA.

The diagnostic value of left atrial volume index for heart failure with preserved ejection fraction / 实用医学杂志

Objective To explore the value of left atrium volume index (LAVI) in the diagnosis of heart failure with preserved ejection fraction (HFPEF). Methods Seventy-seven patients with HFPEF and 33 patients without HFPEF who had been treated from May 2012 to September 2013 in Guangdong General Hospital were en-rolled. The clinical data and a series of ultrasound parameters were collected and analysed. The relationship between LAVI, LAV, and other indexes of diastolic function was determined by Pearson correlation analysis. The value of LAVI and LAV for diagnosing HFPEF was compared by the ROC curve. Results LAVI and LAV of were signifi-cantly greater in HFPEF group than in non-HFPEF group. LAV and LAVI were significantly associated wtih HEPEF. The area under the ROC curve (AUC) of LAVI increased significantly as compared with the AUC of LAV (0.832 vs. 0.799, P<0.05). With a cut-off value of 30 mL/m2, the specificity and sensitivity for diagnosing HEPEF were 64.9%and 84.8%, respectively. Conclusions LAVI may be valuable in the diagnosis of HFPEF.