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SUMMARY OBJECTIVE: Epicardial adipose tissue is a special form of visceral fat surrounding the heart. It is associated with cardiac and metabolic diseases. Epicardial adipose tissue is associated with risk factors for heart failure with preserved ejection fraction, such as obesity, metabolic syndrome, hypertension, and diabetes. In this study, we examined the importance of Epicardial adipose tissue as a predictor of heart failure with preserved ejection fraction. METHODS: Patients who were admitted to the Dicle University Medicine Faculty Heart Hospital between November 2013 and August 2014 were recruited for the study. The heart failure group consisted of 30 patients who were admitted to the cardiac intensive care unit, and the control group consisted of 30 patients who were admitted to cardiology polyclinics. We care about patients' demographic and clinical features to be similar. Heart failure was diagnosed according to the European Cardiology Society 2012 heart failure guidelines. Epicardial adipose tissue was measured with a transthoracic parasternal long axis with an echocardiography device (GE Vivid S6). We compared the Epicardial adipose tissue measurements between the two groups. RESULTS: Epicardial adipose tissue was higher in patients with heart failure with preserved ejection fraction than in the control group (9.21±0.82 and 7.13±1.39 mm, respectively; p<0.001). Echocardiographic findings associated with left ventricular hypertrophy were intact ventricular septum (13.03±0.57 and 12.11±2.22 mm, respectively; p=0.013) and left ventricular mass index (131.13±18.00 and 117.90±20.30 g/m2, respectively; p=0.010). Findings associated with left ventricular diastolic dysfunction were as follows: left atrial volume index (60.71±21.53 and 44.92±9.93 mL/m2, respectively; p<0.001) and E/è (13.87±3.88 and 10.12±2.44, respectively; p<0.001) were higher in patients with heart failure with preserved ejection fraction than in the control group. Body mass index was not a significant indicator of obesity (p=0.097), but waist circumference was a significant indicator of visceral obesity (p<0.001). Logistic regression analyses indicated that Epicardial adipose tissue, age, left atrial volume index, left ventricular mass index, waist circumference, and E/é were significant in the Heart failure group; Epicardial adipose tissue was significant (p=0.012), and waist circumference significance was borderline (p=0.045). CONCLUSIONS: Epicardial adipose tissue was higher in patients with HF than in the control group, and Epicardial adipose tissue was a predictor of heart failure with preserved ejection fraction. In patients with heart failure with preserved ejection fraction, increased Epicardial adipose tissue means that Epicardial adipose tissue can be used as a biomarker of inflammation in the pathophysiology of heart failure with preserved ejection fraction.
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Introducción: La falla cardiaca es una enfermedad de alta prevalencia mundial y de gran interés para la salud pública. En Colombia constituye una de las principales causas de mortalidad de origen cardiovascular, por lo cual es importante determinar los factores de riesgo asociados con la mortalidad intrahospitalaria en estos pacientes. Materiales y métodos: Estudio de cohorte retrospectiva que incluyó a 260 pacientes con diagnóstico de falla cardiaca aguda atendidos en el Hospital Universitario San Rafael de Tunja (Colombia) entre enero de 2019 y enero de 2022. Con un análisis univariado y bivariado se construyó un modelo de regresión de Cox para determinar los factores asociados con mortalidad intrahospitalaria, y como desenlaces secundarios se determinó la incidencia de mortalidad intrahospitalaria a 10 días, el reingreso y el tiempo de estancia hospitalaria. Resultados: La incidencia de mortalidad intrahospitalaria a los 10 días fue del 10 %, el reingreso hospitalario se presentó en el 21,2 % de los pacientes, la media de estancia hospitalaria fue de 9,31 días. Los factores de riesgo para mortalidad intrahospitalaria estadísticamente significativos fueron la clasificación clínica de Stevenson C o L (HR: 3,2; IC: 1,12-9,39; p = 0,03) y la clase funcional del paciente a su ingreso NYHA III o IV (HR: 2,76; IC: 1,02-7,53; p = 0,04). Conclusiones: La clasificación clínica de Stevenson C o L y la clase funcional según NYHA III o IV demostraron ser factores de riesgo independientes de mortalidad intrahospitalaria. Se sugiere identificar tempranamente a estos pacientes, ya que podría asegurar una mayor supervivencia
Introduction: Heart failure is an illness of high prevalence at world level, and therefore one of great interest for public health. In Colombia, it is one of the leading causes of death from cardiovascular cause. For this reason, it is important to determine the risk factors associated to intrahospital morta-lity in these patients. Materials and methods: Retrospective cohort study that included 260 patients diagnosed with acute heart failure treated in San Rafael University Hospital in Tunja between January 2019 and January 2022. A univariate and a bivariate analysis were carried out calculating Hazard Ratio and p values. With these results, a Cox regression model was made to determine the associated factors in intrahos-pital mortality; in addition, the incidence of intrahospital mortality 10 days after admission; readmis-sions; and length of hospital stay were determined as secondary outcomes. Results: The incidence of intrahospital mortality 10 days after admission was of 10%; hospital read-missions occurred for 21.2% of the patients; the mean in hospital stay was of 9.31 days; the statis-tically significant risk factors for intrahospital mortality were Stevenson's clinical classification C or L (HR: 3.2; IC: 1.12-9.39; p = 0.03] and the patient's functional class at the time of admission NYHA III or IV (HR: 2.76; IC: 1.02-7.53; p = 0.04]. Conclusion: Stevenson's clinical classification C or L and the functional class NYHA III or IV emerge as independent risk factors for intrahospital mortality. Early identification of these patients is suggested for an increased rate of survival.
Introdução: a insuficiência cardíaca é uma doença de elevada prevalência em todo o mundo e que suscita grades preocupações em termos de saúde pública. Na Colômbia, esta é uma das principais causas de mortalidade cardiovascular, pelo que é importante determinar os fatores de risco associados à mortalidade intra-hospitalar nestes pacientes. Materiais e métodos: Estudo retrospectivo que inclui 260 pacientes com diagnostico de insuficiência cardíaca aguda tratados no Hospital Universitário San Rafael da cidade de Tunja (Colômbia) entre janeiro de 2019 e janeiro de 2022. Foi construído um modelo de regressão de Cox utilizando análises univariada e bivariada para determinar os fatores associados à mortalidade intra-hospitalar. A inci-dência de mortalidade intra-hospitalar aos 10 dias, a readmissão e a duração do internamento foram determinados como resultados secundários. Resultados: A incidência de mortalidade intra-hospitalar aos 10 dias foi de 10%, a readmissão ocorreu em 21,2% dos pacientes e o tempo médio de internamento foi de 9,31 dias. Os fatores de risco estatis-ticamente significativos para a mortalidade intra-hospitalar foram a classificação clínica de Stevenson C ou L (HR: 3,2; IC: 1,12-9,39; p = 0,03) e a classe funcional do paciente na admissão NYHA III ou IV (HR: 2,76; IC: 1,02-7,53; p = 0,04). Conclusões: A classificação clínica C ou L de Stevenson e a classe funcional III ou IV da NYHA provaram ser fatores de risco independentes para a mortalidade intra-hospitalar. A identificação precoce destes pacientes é sugerida, uma vez que pode assegurar uma sobrevivência mais longa
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Insuficiência Cardíaca , Doenças Cardiovasculares , Mortalidade Hospitalar , Insuficiência Cardíaca Diastólica , Insuficiência Cardíaca SistólicaRESUMO
Background: Evaluate the clinical profile of patients presenting with heart failure having normal or preserved ejection fraction and to determine the prevalence of comorbid illnesses in these patients.Methods: The study was carried out on patients that presented with heart failure at the Vadilal Sarabhai hospital, Ahmedabad between September 2014-2016. Heart failure patients with normal ejection fraction (>50%) were selected. Socio-demographic, vital signs, data of 2D Echocardiography and Tissue Doppler study were collected. The patients were classified as per the Echocardiographic study into four categories. Different laboratory parameters were compared in patients with respect to (a) grade of Hypertension (b), grade of anemia (c), HbA1c levels. Statistical analysis was done using the SPSS software v20. Mann-Whitney and Kruskal-Wallis tests were performed to compare the means between different study groups.Results: Out of the 70 patients, a majority (47%) belonged to the Grade 2 (pseudo-normalized) group of diastolic dysfunctions with most of them having only dyspnea and pedal edema (33%). 58.6% patients required intensive care for at least one day. Regarding co-morbidities 27 (38.6%) had hypertension, 34 (48.6%) were diabetic and 49(70%) had anemia. Patients with higher grade of dysfunction had higher HbA1c (p=0.023) and worsening anemia (p=0.003).Conclusions: Authors concluded that it is of prime importance to find, prevent and treat the comorbidities along with targeted therapies for HFpEF. Further evaluation can be done for clinical applicability of different markers including HbA1c and U.ACR for renal dysfunction in HFpEF.
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Background: Noninvasive assessment of diastolic filling by Doppler echocardiography provides important information about left ventricular (LV) status in selected subsets of patients. This study was designed to assess whether the lateral mitral annular velocity as assessed by tissue Doppler imaging is associated with invasive measures of diastolic LV performance in patients with diastolic and systolic heart failure. Aim of the study was to compare the diagnostic accuracy of lateral mitral annular E/E? as an estimate of LV filling pressure with invasive LVEDP measurement in subjects with systolic or purely diastolic heart failure.Methods: Total 100 patients were studied, 50 patients with diastolic heart failure and 50 patients with systolic heart failure in patients undergoing diagnostic coronary angiogram. Detailed 2D Echocardiography, Trans mitral Doppler and Tissue Doppler velocities of lateral mitral annulus was obtained. The ratio of peak mitral velocity (E) to lateral mitral annular velocity (E?) by TDI (E/E?) was calculated.Results: The ratio of E/E? in diastolic group was 13.4�9 and in systolic group it was 13.7�2. The mean LVEDP in diastolic heart failure patients was 14.3�5 and 14.2�9 in systolic heart failure patients. The ratio of E/E? showed a better correlation with LVEDP. E/E? <8 accurately predicted normal LVEDP, and E/E? >15 identified increased LVEDP ?15mmHg.Conclusions: E/E? is a reliable estimate of LV filling pressures in subjects with systolic and diastolic heart failure. In subjects with diastolic heart failure, E/E? seems helpful to identify those with truly elevated LV filling pressures. In patients with diastolic heart failure and normal E/E?, a search for other causes of symptoms (pulmonary disease, obesity and so forth) may be warranted.
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BACKGROUND: Diabetes mellitus (DM) increases risk of heart failure. It has been shown that diabetes leads to DM-cardiomyopathy, characterized by systolic and diastolic dysfunction. Pre-transplant diastolic dysfunction, has been associated with poor graft outcome and mortality. We assessed the hypothesis that end-stage liver disease (ESLD) patients with diabetes (DM-ESLD), have more advanced cardiac systolic and diastolic dysfunction, compared to ESLD patients without diabetes (Non DM-ESLD).METHODS: We retrospectively evaluated preoperative echocardiography of 1,319 consecutive liver transplant recipients (1,007 Non DM-ESLD vs. 312 DM-ESLD [23.7%]) January 2012–May 2016. Systolic and diastolic indices, such as left ventricular ejection fraction, transmital E/A ratio, tissue doppler s′, e′ velocity, and E/e′ ratio (index of left ventricular end-diastolic pressure), were compared using 1:2 propensity-score matching.RESULTS: DM-ESLD patients showed no differences in systolic indices of left ventricular ejection fraction and s′ velocity, whereas diastolic indices of E/A ratio ≤ 1 (49.0% vs. 40.2% P = 0.014), e′ velocity (median = 7.0 vs. 7.4 cm/s, P < 0.001) and E/e′ ratio (10.9 ± 3.2 vs. 10.1 ± 3.0, P < 0.001), showed worse diastolic function compare with Non DM-ESLD patients, respectively.CONCLUSIONS: DM-ESLD patients suffer higher degree of diastolic dysfunction compared with Non DM-ESLD patients. Based on this, careful preoperative screening for diastolic dysfunction in DM-ESLD patients is encouraged, because poor transplant outcomes have been noted in patients with preoperative diastolic dysfunction.
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Humanos , Diabetes Mellitus , Ecocardiografia , Insuficiência Cardíaca , Insuficiência Cardíaca Diastólica , Insuficiência Cardíaca Sistólica , Cirrose Hepática , Hepatopatias , Fígado , Programas de Rastreamento , Mortalidade , Pontuação de Propensão , Estudos Retrospectivos , Volume Sistólico , Transplantados , TransplantesRESUMO
Objective: To study the effect of Buyang Huanwu Tang on myocardial energy metabolism in rats with diastolic heart failure (DHF) based on adenosine monophosphate (AMP)-activated protein kinase (AMPK)/peroxisome proliferators-activated receptors α (PPARα) signaling pathway,and investigate its mechanism of action.Method: The 48 SD rats were randomly divided into sham operation group and model group.DHF rat model was established by abdominal aorta constriction method.The successfully modeled rats were randomly divided into model group,Buyang Huanwu Tang group (12.72 g·kg-1·d-1),metoprolol tartrate group (0.004 5 g·kg-1·d-1),with corresponding drugs in each group by intragastric administration.The sham operation group and model group were given with equal amount of deionized water,once a day.After 8 weeks of continuous drug intervention,the contents of adenosine monophosphate (AMP),adenosine diphosphate (ADP) and adenosine triphophate (ATP) in peripheral blood of rats were determined by enzyme linked immunosorbent assay (ELISA).The changes of myocardial mitochondrial ultrastructure were detected by electron microscope.The protein expression levels of AMPK,PPARα and peroxisome proliferator-activated receptor-γ coactivator-1α(PGC-1α) in rat myocardium were detected by Western blot.Result: As compared with sham operation group,the contents of AMP and ADP in model group were increased significantly,and ATP content was decreased significantly (PPPPα and PGC-1α protein in the model group were decreased significantly (Pα and PGC-1α protein in Buyang Huanwu Tang group and metoprolol tartrate group were increased significantly (PConclusion: Buyang Huanwu Tang may improve the energy metabolism of the failed heart and delay the progression of heart failure by improving the structure and function of mitochondria,activating AMPK and up-regulating the expression of AMPK/PPARα signaling pathway.
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BACKGROUND: Femoral neck fracture is common in the elderly population. Acute kidney injury (AKI) is an important risk factor for mortality in patients who have had such fracture. We evaluated the incidence of AKI in patients who had femoral neck fracture and identified risk factors for AKI and mortality. METHODS: This was an observational cohort study including 285 patients who were ≥ 65 years of age and who underwent femoral neck fracture surgery between 2013 and 2017. RESULTS: The mean age was 78.63 ± 6.75 years. A total of 67 (23.5%) patients developed AKI during the hospital stay: 57 (85.1%), 5 (7.5%), and 5 (7.5%) patients were classified as having stage 1, 2, and 3 AKI, respectively. Patients with AKI had a lower baseline estimated glomerular filtration rate and higher left atrial dimension, left ventricular mass index, pulmonary artery pressure, and the ratio of early mitral inflow velocity to early diastolic mitral annulus velocity (E/e’) and were more likely to have diabetes or hypertension (HTN) (P < 0.05). The presence of HTN (odds ratio [OR], 4.570; 95% confidence interval [CI], 1.632–12.797) higher E/e’ (OR, 1.105; 95% CI, 1.019–1.198), and lower hemoglobin (OR, 0.704; 95% CI, 0.528–0.938) were independently associated with a higher risk for developing AKI. Severe AKI (OR, 24.743; 95% CI, 2.822–212.401) was associated with a higher risk of mortality. CONCLUSION: Elderly patients with femoral neck fracture had a high incidence of AKI. Diastolic dysfunction was associated with AKI. Severe AKI was associated with in-hospital mortality.
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Idoso , Humanos , Injúria Renal Aguda , Estudos de Coortes , Fraturas do Colo Femoral , Colo do Fêmur , Taxa de Filtração Glomerular , Insuficiência Cardíaca Diastólica , Mortalidade Hospitalar , Hipertensão , Incidência , Tempo de Internação , Mortalidade , Artéria Pulmonar , Fatores de RiscoRESUMO
BACKGROUND/AIMS: Left ventricular diastolic dysfunction (LVDD) is an early manifestation of cardiac dysfunction in patients with liver cirrhosis (LC). However, the effect of LVDD on survival has not been clarified, especially in decompensated LC. METHODS: We prospectively enrolled 70 patients with decompensated LC, including ascites or variceal bleeding, at Daejeon St. Mary's Hospital from April 2013 to April 2015. The cardiac function of these patients was evaluated using 2D echocardiography with tissue Doppler imaging. The diagnosis of LVDD was based on the American Society of Echocardiography guidelines. The primary endpoint was overall survival. RESULTS: Forty-four patients (62.9%) had LVDD. During follow-up (22.3 months), 18 patients died (16 with LVDD and 2 without LVDD). The survival rate was significantly lower in patients with LVDD than in those without LVDD (31.1 months vs. 42.6 months, P=0.01). In a multivariate analysis, the Child-Pugh score and LVDD were independent predictors of survival. Moreover, patients with a ratio of early filling velocity to early diastolic mitral annular velocity (E/e') ≥ 10 (LVDD grade 2) had lower survival than patients with E/e' ratio < 10. CONCLUSIONS: The presence of LVDD is associated with poor survival in patients with decompensated LC. Therefore, it may be important to monitor and closely follow LVDD patients.
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Humanos , Ascite , Cardiomiopatias , Diagnóstico , Ecocardiografia , Varizes Esofágicas e Gástricas , Seguimentos , Insuficiência Cardíaca Diastólica , Cirrose Hepática , Fígado , Análise Multivariada , Prognóstico , Estudos Prospectivos , Taxa de SobrevidaRESUMO
The risk factors of diastolic heart failure include among others: hypertension,diabetes,myocardial ischemia and aging.The underlying mechanisms for this cardiac complication are incompletely understood.With the increase of aging of the population,the prevalence and mortality of diastolic heart failure is rising gradually.It seriously affects the life quality and life span of people.In order to more truly reveal the underlying mechanisms of diastolic heart failure and to develope novel therapeutic strategies,the experimental animal models are extremely important.The present review focuses on providing an overview of the characteristics of these models for the growing number of investigators who seek to understand the pathology of diastolic heart failure.
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Objectives To explore the clinical effect of coupling meglumine cyclic adenylate (MCA)and the human granulocyte colony-ostimulating factor (G-CSF)on rat with diastolic heart failure(DHF).Methods Totally 60 rats of DHF model were evenly divided into 4 groups according to random number:Control group(n=15,control),Model group(n=15,DHF model),MCA group(n =15,treated with MCA)and MCA+GCSF group(n=15,treated with MCA plus G-CSF).MCA group were administered by intragastric injection of MCA 30 mg/kg/d for 15 d,MCA+G-CSF group were administered by intragastric injection of MCA 30 mg/kg/d and plus G-CSF 100 μg/kg/d for 15 d,while Control group and Model group were given same volume of saline solution.BIOPAC SYSTEM was used to analyze the model establishment.The mRNA levels of GATA-4 and Cx43 were measured by RT-PCR.The protein expressions of GATA-4,Cx43,cTNI and c-kit were measured with western blotting.ELISA and flow cytometry were used to detect cAMP and differentiation rate of bone marrow mesenchymal stem cells (BMSCs),respectively.Results Compared with MCA group,the denaturation degree of myocardial tissues in DHF rat was significantly improved than in MCA+G-CSF group.Moreover,the level of GATA-4 (1.62 ± 0.09),Cx43 (1.02 ± 0.07),cTNI (1.42 ± 0.12),c-kit (0.65±0.02),cAMP(283.67± 18.09)nmol/L and BMSCs cell differentiation rate(38.62 ± 1.52)％ in MCA + GCSF group were significantly promoted (all P＜ 0.05)than in MCA group,GATA-4 (0.82±0.07),Cx43 (0.52±0.05),cTNI(0.86 ± 0.13),c-kit (0.48 ± 0.03),cAMP(198.83 ± 16.03) nmol/L and BMSCs cell differentiation rate (19.82 ± 0.89)％.Conclusions The combination of MCA with G-CSF is significantly improved DHF than single MAC treatment,which may regulate BMSCs differentiation though cAMP/PKA signaling pathways.
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OBJECTIVE:To compare the efficacy and safety of metoprolol and bisoprolol in the treatment of diastolic heart fail-ure. METHODS:150 patients with diastolic heart failure were randomly divided into group A(75 cases) and group B(75 cases). All patients received aspirin,angiotensin-converting enzyme inhibitors,angiotensin receptor antagonists,calcium antagonists,di-uretic and cardiac drugs and other conventional treatment;based on it,group A received Metoprolol tartrate tablet with initial dose of 6.25 mg,orally,twice a day,then increased to 100-200 mg based on improvement and tolerability;group B received 1.25 mg Metoprolol tartrate tablet,orally,once a day,then increased to 10 mg based on improvement and tolerability. The treatment course for 2 groups was 12 weeks. Clinical efficacy,and left ventricular end systolic diameter(LVESD),left ventricular ejection fraction (LVEF)and left ventricular end-diastolic diameter(LVEDD),myocardial performance index(LVTei index),brain natriuretic pep-tide(BNP),interleukin(IL)-1,IL-6,tumor necrosis factor(TNF)-α before and after treatment,and incidence of adverse reactions in 2 groups were observed. RESULTS:The efficacy in group B was significantly higher than group A,incidence of adverse reac-tions were significantly lower than group A,the differences were statistically significant (P0.05). Af-ter treatment,LVESD,LVEDD,LVTei index,BNP,IL-1,IL-6 and TNF-α in 2 groups were significantly lower than before,and group B was lower than group A,LVEF was significantly higher than before,and group B was higher than group A,the differenc-es were statistically significant(P<0.05). CONCLUSIONS:Based on the conventional treatment,bisoprolol is significantly superi-or to metoprolol in terms of efficacy,relieving clinical symptoms and improving cardiac functions in the treatment of diastolic heart failure,with better safety.
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Half of the heart failure patients are the diastolic heart failure (DHF) patients, and the occurrence of DHF increases as the patients’ age increases, which has seriously affected the quality of life of the elderly. However, there is presently no valid medication of DHF, thus the treatment of DHF is one of the hotspot of the medicine research. This article reviewsed the TCM in the cognition and treatment of DHF these years, in order to provide references for TCM in treating DHF.
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It is recognized that the increasing prevalence of diastolic heart failure in adults has signifi-cantly worsen the quality of life and shorten lifespan.However,the assessment and diagnostic criterion of dias-tolic heart failure in children is controversial.The diagnosis and treatment of DHF are mainly based on small samples of clinical research and clinical experience.There is no effective treatment plan of diastolic heart failure from evidence-based medicine.In this article,we review the progress of diastolic heart failure in children in as-pects of its pathological mechanism,clinical manifestations,function evaluation,diagnosis and treatment.
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Objetivo: describir las alteraciones ecocardiográficas encontradas en pacientes con diagnóstico de preeclampsia severa.Materiales y métodos: estudio de corte transversal. Se describen los hallazgos ecocardiográficos en las pacientes con preeclampsia severa (PS), de acuerdo con los criterios del Congreso Americano de Obstetras y Ginecólogos, atendidas en un hospital universitario de referencia ubicado en Bogotá (Colombia), entre enero 1 de 2012 y junio 30 de 2014. Se excluyeron las pacientes con control adecuado de tensión arterial o con patología cardiaca estructural previa conocida. Se describen las variables sociodemográficas, clínicas y los hallazgos ecocardiográficos más frecuentes, globalmente y por momento de aparición. Se presentan los datos mediante estadística descriptiva.Resultados: se diagnosticaron 228 pacientes con PS. A 124 se les realizó ecocardiograma: en 8 de ellas el informe de ecocardiografía fue no concluyente. Se hallaron 78 pacientes (67 %) con alguna alteración. Los principales hallazgos fueron: hipertensión pulmonar leve, n = 34 (29 %); hipertrofia del ventrículo izquierdo, n = 32 (27 %); hipertensión pulmonar moderada, n = 21 (18 %); disfunción diastólica, n = 16 (13 %). Las pacientes con PS pretérmino (69 %) presentaron alteraciones ecocardiográficas más frecuentes que las pacientes a término (20 %) y que las que comenzaron con PS en el puerperio (11 %). La disfunción diastólica se presentó más en pacientes con preeclampsia que comenzó en el puerperio.Conclusiones: la prevalencia de alteraciones ecocardiográficas en PS es del 67 %, con mayor frecuencia de hipertensión pulmonar e hipertrofia ventricular izquierda. Se requieren más estudios que validen estos hallazgos regionalmente.
Objective: To describe echographic abnormalities found in patients diagnosed with severe preeclampsia.Materials and methods: Cross-sectional study describing ultrasound findings in patients with severe preeclampsia (SP) in accordance with the criteria of the American Congress of Obstetricians and Gynecologists. The patients were seen in a referral teaching hospital in Bogota (Colombia), between January 1, 2012 and June 30, 2014. Patients with adequate blood pressure control or with known pre-existing structural heart disease were excluded. Social, demographic and clinical variables are described, as well as the most frequent global echographic findings, also by time of onset. The data are presented using descriptive statistics.Results: Overall, 228 patients were diagnosed with SP. An echographic examination was performed in 124 and in 8 of them the echographic report was non-conclusive. Some form of abnormality was found in 78 patients (67 %). Mild pulmonary hypertension [n=34 (29 %)], left-ventricular hypertrophy [n=32 (27 %)], moderate pulmonary hy per tension [n=21 (18 %)] and diastolic dysfunction [n= 16 (13 %)] were the main findings observed. Echographic abnormalities were found more frequently in patients with pre-term SP (69 %) than in term patients (20 %) or those who developed SP during the post-partum period (11 %). Diastolic dysfunction was found to occur more frequently in patients who developed preeclampsia in the post-partum period.Conclusions: The prevalence of echographic abnormalities in SP is 67 %, the most frequent being pulmonary hypertension and left ventricular hypertrophy. More studies are needed in order to validate these findings regionally.
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Adulto , Feminino , Gravidez , Ecocardiografia , Insuficiência Cardíaca Diastólica , Insuficiência Cardíaca Sistólica , Pré-Eclâmpsia , Remodelação VentricularRESUMO
Background: Heart failure (HF) has become a main cardiac problem. Doppler echocardiography has been used to examine left ventricular (LV) diastolic filling dynamics. Limitations of this modality suggest the need for other objective measures of diastolic HF. Aim of the Study: The hypothesis of this study is to assess the utility of N-terminal pro-B type natriuretic peptide (NTproBNP) in the diagnostic evaluation of diastolic HF in comparison with tissue Doppler imaging (TDI) recordings. Methods: A prospective study was carried out between May 2010 and December 2011. Patients with signs and symptoms of HF with normal LV systolic function by 2D-echocardiography were recruited. M-mode and 2-dimensional images, left atrial volume index (LAVI), spectral and TDI of the mitral annulus were obtained for all the patients. NTproBNP levels were measured with a bedside immunoassay. Results: We found linear correlation between NTproBNP levels and grade of diastolic dysfunction (DD), LAVI, ratio of mitral velocity to early diastolic velocity of the mitral annulus (E/E’) [r=0.72, p<0.001]. Patients with elevated left ventricular end diastolic pressure, defined as E/E’>15 (n =18), had the highest NTproBNP levels (3028±2674pg/mL). NTproBNP levels (4146±2887.43 pg/mL) were highest in patients with grade III DD. A receiver operator characteristic curve showed NTproBNP value, 286 pg/mL, the best cut-off for diagnosing diastolic HF with a sensitivity of 89% and a specificity of 100%. Conclusions: Plasma NTproBNP levels can reliably estimate LV filling pressures in patients with HF and normal systolic function which might help to reinforce the diagnosis of “diastolic HF”.
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Objective To study the relationship between the severity of diastolic heart failure(DHF)and bone mineral density in the elderly. Methods Totally 80 elderly patients aged over 80 years who were tested as normal for cardiac diastolic function by Doppler tissue imaging(DTI) were selected and divided into four groups by the e/a ratio,i.e.,the normal group(n=18),the DHF 1 group(0.8≤e/a<1,n=25),the DHF 2 group (0.6≤e/a<0.8,n=22),and the DHF 3 group(e/a<0.6,n=15). And the other 20 healthy people by physical examination were set as the normal control group.All subjects underwent bone mineral density(BMD)measurement(including femoral neck,total femoral hip and lumbar vertebra 1?4) by dual energy X?ray absorptiometry. Results Bone mineral density(BMD)was significantly decreased(P<0.05)in DHF groups(DHF 1,DHF 2,and DHF 3). Bone mineral density significantly decreased along with the severity of DHF. Bone mineral density was positively correlated with the e/a ratio in the elderly with DHF(r=0.75,P<0.01). Conclusion The severity of diastolic heart failure is closely related to bone mineral density in the elderly. The severity of diastolic heart failure could predict osteoporosis.
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Objective To study the efficacy and safety of Fasudil in treatment of elderly diastolic heart fail -ure related pulmonary hypertension ,and provide evidence for clinical treatment .Methods 70 cases of elderly dias-tolic heart failure related pulmonary hypertension were divided into the study group and control group of 35 cases in each group according to random number table methods ,the two groups were given beta blockers ,angiotensin converting enzyme inhibitors and other drugs for treatment ,the study group was given fasudil on basis of that ,6min walking dis-tance,pulmonary artery systolic pressure ,arterial partial pressure of oxygen ( PaO2) of two groups before and after treatment as well as the changes of blood pressure and heart rate of the study group before and after treatment were compared.Results Before treatment,6min walking distance,pulmonary artery systolic pressure and PaO2 of the two groups were (290.3 ±1.3)m,(83.3 ±0.9)mmHg,(66.3 ±1.4)mmHg and (289.2 ±1.1)m,(82.9 ±0.8)mm-Hg,(65.9 ±1.3)mmHg showed no statistical significance (t=2.392,4.927,5.132,P=0.073,0.069,0.063),after treatment,6min walking distance ,pulmonary artery systolic pressure and PaO 2 of the study group were (410.4 ±2.3) m,(60.1 ±1.1) mmHg,(89.3 ±0.6) mmHg significantly better than those of the control group ,with statistically significant difference(t=8.918,9.142,11.319,P =0.024,0.019,0.017);the systolic blood pressure,diastolic pressure and heart rate of the study group before and after treatment were (132.8 ±2.1)mmHg,(84.3 ±1.1)mm-Hg,(69.2 ±1.4) times/min and (133.2 ±1.9) mmHg,(83.9 ±0.9) mmHg,(68.9 ±1.3) times/min showed no statistical significance(t=4.193,4.018,3.987,P=0.061,0.078,0.068).Conclusion Fasudil has a better effect in treatment of elderly diastolic heart failure related pulmonary hypertension ,which can significantly reduce the pulmo-nary artery pressure ,and has a little effect on the heart ,with high safety .
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Objective: To assess the clinical value of serum N-terminal pro-brain natriuretic peptide (NT-ProBNP) values in elder patients with heart failure (HF). Methods: According to NYHA classiifcation, a total of 384 HF patients were divided into 4 groups as NYHA I group, n=35, NYHA II group, n=89, NYHA III group, n=163, NYHA IV group, n=97;and Control group, n=69 normal subjects. The NT-ProBNP and troponin (cTn1) levels were examined in systolic HF and diastolic HF patients, the relationship between NT-ProBNP and left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD) were studied. Results: For NT-ProBNP levels, Control group and NYHA I group were similar, P>0.05; while it was different among each HF groups, P0.05;while NYHA III group and NYHA IV group were different from other groups, P Conclusion: NT-ProBNP may better reflect the cardiac structural and functional changes in HF patients, it is important for HF early diagnosis and prognosis in clinical practice.
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Objective To study the impact of alprostadil on serum high-sensitivity C-reactive protein ( hs-CRP) and troponin I( cTnI) in patients with diastolic heart failure.Methods 92 patients with diastolic heart failure were randomly divided into the two groups,the control group and the observation group,46 cases in each group.The control group used the conventional treatment and the observation group on the basis of conventional therapy plus al-prostadil.Two groups were treated for 4 weeks.They were measured filling velocity ratio (E/A) in patients with early and late peak atrial contraction,stroke volume (SV),left ventricular end-diastolic diameter (LVEDD),6min walking distance and serum hs-CRP, cTnI before and after treatment.Results There were no significant difference about LVEDD,E/A and SV(t=0.,0.261,0.445,all P>0.05).After treatment for four weeks,LVEDD were (53.1 ± 5.1)mm and (47.3 ±4.7)mm,LVEDD of the two groups had significantly decreased (t=4.601,9.331,P0.05).After 4 weeks of treatment,the serum hs-CRP,cTnI were significantly lower in both groups (t=3.612,8.772,2.924, 5.164,P<0.05,P<0.01),and compared with the control,the observation group reduced more significantly (t=3.061,7.114,P<0.05).Conclusion Alprostadil can decrease serum hs-CRP and cTnI of patients with diastolic heart failure.
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ObjectiveTo investigate the laws of distribution and combination of traditional Chinese medicine (TCM) syndromes of patients with diastolic heart failure (DHF); To research the relevance between TCM syndromes and DHF.Methods A four diagnostic information survey was conducted among 124 DHF patients in order to analyze their basic information and information about TCM four diagnostic methods. Statistical analysis method was used to determine the syndrome types of the DHF patients and the features of syndrome combination.ResultsMost DHF patients were in their sixties or seventies, the number of female patients was larger than that of male patients, and their heart function was in II or III grade. Qi deficiency, phlegm turbidity, Qi stagnation, blood stasis, water stagnation, Yang deficiency and Yin deficiency were the common syndromes. Two-card combination and three-card combination were more common, mainly with Qi deficiency, phlegm turbidity or blood stasis as the main patterns of manifestation. Conclusion This research could provide a clinical basis for the establishment of the standard for the TCM syndromes DHF.