Cardiac structure and function improvements in coronary artery disease combined with severe obstructive sleep apnea/hypopnea syndrome patients via noninvasive positive pressure ventilation therapy.

OBJECTIVE: The aim of this study was to investigate the effects of a noninvasive positive pressure ventilation therapy on cardiac structure and function in patients with coronary heart disease combined with obstructive sleep apnea/hypopnea syndrome (OSAHS). PATIENTS AND METHODS: Eighty patients with coronary heart disease OSAHS were divided randomly into treatment (n=40) and control (n=40) groups. Both groups received standard medications. The treatment group received additional noninvasive mechanical ventilation support for at least 3 h (3-6 h) every night. On the first day after selection and 3 months afterwards, participants were examined with echocardiograms, 24-h ambulatory blood pressure monitoring, and blood analyses. Primary endpoints were left ventricular end-diastolic diameter, left ventricular end-systolic diameter, left ventricular ejection fraction, left atrial diameter as well as serum concentrations of N-terminal prohormone of brain natriuretic peptide, and high-sensitive C-reactive protein. Secondary endpoints included cardiac death, nonfatal myocardial infarction, and hospitalization. RESULTS: After the 3-month study period, patients in the treatment group showed significantly improved left ventricular end-diastolic diameter (P=0.02), left ventricular end-systolic diameter (P=0.035), left ventricular ejection fraction (P=0.05), and left atrial diameter (P=0.02) values, and their serum N-terminal prohormone of brain natriuretic peptide (P=0.01) and high-sensitive C-reactive protein (P=0.04) concentrations were significantly improved compared with the control group. During the 3 months, three cardiovascular complications occurred in the treatment group versus nine in the control group (P<0.05). CONCLUSION: For patients with coronary heart disease combined with OSAHS, noninvasive mechanical ventilation therapy can significantly improve heart functions and reduce the occurrence of cardiovascular complications.

Noninvasive positive pressure ventilation therapy can improve cardiac structure and function in patients with coronary artery disease combined with severe obstructive sleep apnea/hypopnea syndrome.

BACKGROUND: To investigate the effects of a noninvasive positive pressure ventilation therapy on cardiac structure and function in patients with coronary heart disease combined with obstructive sleep apnea/hypopnea syndrome (OSAHS). METHODS: 80 coronary heart disease OSAHS patients from three hospitals in Shanghai were randomly divided into treatment (n=40) and control (n=40) groups. Both groups received standard medications. The treatment group received an additional noninvasive mechanical ventilation support for at least 3 hours (3-6 hours) every night. On the first day after selection and 3 months afterwards participants were examined with echocardiograms, a 24-hour ambulatory blood pressure monitoring and blood analyses. Primary endpoints were left ventricular end diastolic diameter (LVEDd), left ventricular end systolic diameter (LVESd) and left ventricular ejection fraction (LVEF) as well as serum concentrations of N-terminal prohormone of brain natriuretic peptide (NT-ProBNP) and high sensitive C-reactive protein (hsCRP). Secondary endpoints included cardiac death, nonfatal myocardial infarction and hospitalization. RESULTS: After the 3 months study period, patients in the treatment group showed significant better improvements of LVEDd (p=0.02), LVESd (0.035) and LVEF (0.05) and their serum NT-ProBNP (p=0.01) and hsCRP (p=0.04) concentrations were significantly better improved than in the control group. During the 3 months, 3 cardiovascular complications occurred in the treatment group and 9 in the control group (p<0.05). CONCLUSIONS: For patients with coronary heart disease combined with obstructive sleep apnea/hypopnea syndrome, noninvasive mechanical ventilation therapy can significantly reduce left ventricular end systolic and end diastolic diameters, improve heart function and reduce the occurrence of cardiovascular complications.

Warfarin compared with aspirin for older Chinese patients with stable coronary heart diseases and atrial fibrillation complications.

OBJECTIVE: To compare the therapeutic warfarin and aspirin efficacies for treatments of atrial fibrillation (AF) complicated with stable coronary heart disease particularly in older Chinese patients. METHODS: In our prospective study 101 patients with AF and stable coronary heart disease older than 80 years were randomized into two groups. One group (n = 51) basically received 1.25 mg/day warfarin per os, followed by addition of 0.5 - 1.0 mg/day from day 3 - 5 if the international normalized ratio (INR) was initially < 1.5 and in order to achieve a maintained INR between 1.6 and 2.5 (warfarin group). The second group (n = 50) received 100 mg aspirin per day (control group). All patients were medicated and monitored for a period of 2 years. The primary endpoint was the occurrence of ischemic stroke or systemic embolism, and the composite secondary endpoint was non-fatal myocardial infarction and all causes of death. For safety evaluation, the hemorrhage rates were recorded. RESULTS: The warfarin medication was superior regarding the overall occurrence of ischemic stroke or systemic embolism as well as non-fatal myocardial infarction and all causes of death outcomes compared to aspirin administration during the 2 years of medication (17.6% vs. 36.0%, p = 0.03), while there was no significant difference of mild (5 vs. 4), severe (2 vs. 1), and fatal (1 vs. 1) hemorrhage incidences between the warfarin and aspirin groups (p > 0.05). CONCLUSION: Warfarin was found to be more efficacious than aspirin for an anticoagulation therapy of older Chinese patients with AF and stable coronary heart disease.