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Objective:To investigate the changes in N-terminal pro-B-type natriuretic peptide (NT-proBNP) and its role in predicting major adverse cardiac events (MACEs) in patients with end-stage heart failure (ESHF) before and after implanted a HeartCon left ventricular assist device (LVAD).Methods:The retrospective study included 30 ESHF patients [23 males and 7 females, aged 54.5 (40.8, 60.0) years], who were admitted to TEDA International Cardiovascular Disease Hospital from September 15, 2020 to June 20, 2023 to receive treatment with HeartCon LVAD implantation. Their clinical data were analyzed and NT-proBNP concentrations in their blood samples were measured preoperatively and during the follow-up period. Patients were followed regularly and MACEs, including cardiac death and rehospitalization for right heart failure, were recorded within 6 months of discharge; Logistic regression was used for prognostic analysis, and Receiver Operator Characteristic (ROC) curves were used to assess the adjunctive diagnostic value of NT-proBNP for poor prognosis in LVAD patients. The cut-off values for diagnosing poor prognosis by NT-proBNP were divided into two groups, and survival analysis was performed by Kaplan-Meier and tested by log rank; Cox regression was performed to analyze whether high levels of NT-proBNP at 6 months of follow-up wsa a risk factor for poor prognosis in patients with LVAD.Results:The median preoperative NT-proBNP level in 30 ESHF patients successfully implanted with HeartCon LVADs was 3 251.0 (1 544.5, 6 401.5) pg/ml. It decreased significantly 7 days postoperatively (3 251.0 vs. 1 815.0 pg/ml, P<0.05), and then the decreasing trend slowed. It decreased to 1 182.0 (620.0, 3 385.3) pg/ml on the 90th post-operative day. The preoperative NT-proBNP>3 251.0 pg/ml group had a longer postoperative hospital stay (47 d vs 33 d, Z=-2.138, P=0.032). Multivariate logistic regression analysis, only NT-proBNP at 7 days postoperatively was found to predict poor prognosis in LVAD patients, with an OR of 1.001 ( P=0.01); ROC curves were analyzed for the adjunctive diagnostic value of 7-day postoperative NT-proBNP levels for poor prognosis (cut-off value of 2 083.0 pg/ml), with an AUC of 0.833 ( P=0.002); The Kaplan-Meier survival analysis showed that the time to MACEs within 6 months was significantly shorter in the group with NT-proBNP>2 083.0 pg/mL on postoperative day 7 than in the group with NT-proBNP≤2 083.0 pg/ml (3.538±0.689 vs. 5.471±0.323 months, P=0.004); Cox regression analysis showed that the risk of MACEs was 4.25 times higher in the 7-day postoperative NT-proBNP>2 083.0 pg/ml group than in the NT-proBNP≤2 083.0 pg/ml group ( HR=4.25, P=0.035). Conclusions:The higher the preoperative NT-proBNP level, the longer the postoperative hospital stay in HeartCon LVAD patients. NT-proBNP levels decrease most significantly on postoperative day 7 and is a risk factor for MACEs. It may be used as a prognostic predictor in ESHF patients with implanted LVADs.
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Objective:To investigate the relationship between peripheral blood sST2 level and prognosis in patients with heart failure (HFpEF) complicated with hypertension with ejection fraction preservation.Methods:A total of 122 patients with HFpEF hospitalized in Teda International Cardiovascular Hospital and Baoding First Central Hospital from May 5, 2021 to March 9, 2023 were selected. According to whether they were combined with hypertension, they were divided into HFpEF combined with hypertension group (73 cases, 32 males, (67.56±12.06) years old). There were 41 females (70.61±9.95 years old) and 49 males (67.00±11.64 years old) in the HFpEF group alone. There were 24 female patients (70.12±7.49 years old). sST2 levels in peripheral blood were compared between the two groups.HFpEF patients with hypertension were grouped by hypertension grade and prognosis, and the difference of sST2 in different groups was compared. Logistic regression was used for multivariate analysis. ROC curve to evaluate the diagnostic value of sST2 in the poor prognosis of HFpEF patients with hypertension. Patients were followed up regularly and major adverse cardiac events were recorded within 6 months after discharge, including cardiogenic death and heart failure re-hospitalization. The critical value of poor prognosis diagnosed by sST2 was divided into two groups, survival analysis was performed by Kaplan-Meier,and the Log Rank test was performed. Cox regression analysis was performed to determine whether high levels of sST2 were a risk factor for poor prognosis after 6 months of follow-up.Results:There was no significant difference in sST2 in HFpEF combined with hypertension and HFpEF alone ( P>0.05). sST2 was higher in grade 2 and 3 than in grade 1 hypertension (23.83 ng/ml vs. 12.68 ng/ml, Z=-2.778, P=0.005; 22.54 ng/ml vs. 12.68 ng/ml, Z=-2.865, P=0.004); BNP was higher in grade 3 hypertension than in grade 1 hypertension (582.95 pg/ml vs. 154.50 pg/ml, Z=-2.101, P<0.05). sST2 and BNP were higher in the poor prognosis group than in the good prognosis group (30.10 ng/ml vs. 18.95 ng/ml, Z=-2.803; 685.00 pg/ml vs. 347.50 pg/ml, Z=-2.385), all P<0.05. Logistic regression analysis showed that sST2 was a risk factor for poor prognosis ( OR=1.045, P=0.013). The auxiliary diagnostic value of sST2 level in HFpEF patients with hypertension was analyzed by ROC curve (AUC was 0.721, P<0.05). The incidence of cardiac adverse events in sST2>29.12 group was higher than that in sST2≤29.12 group (44.00% vs. 14.58%), and the difference was statistically significant (χ 2=7.657, P=0.006). Kaplan-Meier survival analysis showed that the percentage of patients with no endpoint event in the sST2≤29.12 group was higher than that in the sST2>29.12 group ( P=0.003).Cox regression analysis showed that the risk of endpoint event in sST2>29.12 group was 3.879 times that in sST2≤29.12 group ( OR=3.879, P=0.011). Conclusions:sST2 level can be used as an indicator of poor prognosis in HFpEF patients with hypertension, and can be used to stratify the risk of HFpEF patients. High levels of sST2 are associated with major adverse cardiac events.
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<p><b>OBJECTIVE</b>To observe the difference in the clinical efficacy on female chronic pyelonephritis between abdominal cluster-needling therapy and western medicine so as to explore the optimal therapeutic method for the disease.</p><p><b>METHODS</b>Seventy cases of female chronic pyelonephritis were randomized into an abdominal cluster-needling group and levofloxacin group, 35 cases in each one. In the abdominal cluster-needling group, the lower abdominal point was selected in combination with Zusanli (ST 36), Sanyinjiao (SP 6) and Taixi (KI 3). The treatment was given once a day and 10 treatments made one session. In the levofloxacin group, levofloxacin capsules were prescribed for oral administration, once a day. Three months later, the clinical efficacy was observed before and after treatment in two groups.</p><p><b>RESULTS</b>The curative rate was 65.7% (23/35) and the total effective rate was 100.0% (35/35) in the abdominal cluster-needling group. The curative rate was 22.9%, (8/35) and the total effective rate was 71.4% (25/35) in the levofloxacin group. The clinical efficacy in the abdominal cluster-needling group was superior to that in the levofloxacin group (P < 0.01, P < 0.05).</p><p><b>CONCLUSION</b>The abdominal cluster-needling therapy achieves the significant efficacy on female chronic pyelonephritis and it is the optimal therapy for the disease.</p>
Assuntos
Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Pontos de Acupuntura , Terapia por Acupuntura , Doença Crônica , Terapêutica , Pielonefrite , Terapêutica , Resultado do TratamentoRESUMO
Massive hemorrhage from infected anastomosed site between the graft artery and the external iliac artery is one of the most serious complications of renal transplantation. Clinically, it is a rare but fatal occasion. We reported here one case of hemorrhage with infection in the iliac artery anastomosed site treated successfully with hypogastric artery autograft interposition in March 2003.