Hemodialysis Patients with High-Flow Arteriovenous Fistulas: An Evaluation of the Impact on Cardiac Function.

Purpose: : Patients undergoing hemodialysis often experience changes in cardiac function when they have a high-flow arteriovenous fistula (AVF). This study aimed to assess the effect of high-flow AVFs on cardiac function in patients undergoing hemodialysis. Materials and Methods: : A longitudinal study was conducted on hemodialysis patients with high-flow AVFs. Echocardiographic parameters, such as left ventricular ejection fraction (LVEF), left atrial diameter (LAD), left ventricular end-diastolic dimension (LVEDD), right ventricular end-diastolic dimension (RVEDD), inferior vena cava diameter (IVCD), systolic blood pressure, and diastolic blood pressure, were measured and compared before and after AVF creation. Results: : One hundred hemodialysis patients with high-flow AVFs (mean age: 55.95±13.39 years, mean body mass index: 24.71±3.43 kg/m²) were studied. LVEF significantly decreased (51.10%±5.39% to 47.50%±5.79%), while LAD, LVEDD, and IVCD significantly increased after AVF creation (P<0.05). Systolic (132.49±16.42 mmHg to 146.60±17.43 mmHg) and diastolic (79.98±8.40 mmHg to 83.33±9.68 mmHg) blood pressure substantially rose post-fistularization (P<0.001). Notably, LVEF reduction was more significant in brachio-cephalic AVFs (46.29%±4.24%) compared to distal radio-cephalic or snuffbox AVFs (49.17%±7.15%) (P=0.014). Conclusion: : High-flow AVFs can significantly affect echocardiographic parameters in hemodialysis patients, thereby increasing the risk of cardiac failure. Close cardiac monitoring may be necessary for early intervention. Distal AVFs may be preferable in patients with decreased cardiac function.

Evaluation of left ventricular and left atrial volumetric function from native MR multislice 4D flow magnitude data.

OBJECTIVES: To assess the feasibility, precision, and accuracy of left ventricular (LV) and left atrial (LA) volumetric function evaluation from native magnetic resonance (MR) multislice 4D flow magnitude images. MATERIALS & METHODS: In this prospective study, 60 subjects without signs or symptoms of heart failure underwent 3T native cardiac MR multislice 4D flow and bSSFP-cine realtime imaging. LV and LA volumetric function parameters were evaluated from 4D flow magnitude (4D flow-cine) and bSSFP-cine data using standard software to obtain end-diastolic volume (EDV), end-systolic volume (ESV), ejection-fraction (EF), stroke-volume (SV), LV muscle mass (LVM), LA maximum volume, LA minimum volume, and LA total ejection fraction (LATEF). Stroke volumes derived from both imaging methods were further compared to 4D pulmonary artery flow-derived net forward volumes (NFV). Methods were compared by correlation and Bland-Altman analysis. RESULTS: Volumetric function parameters from 4D flow-cine and bSSFP-cine showed high to very high correlations (r = 0.83-0.98). SV, LA volumes and LATEF did not differ between methods. LV end-diastolic and end-systolic volumes were slightly underestimated (EDV: -2.9 ± 5.8 mL; ESV: -2.3 ± 3.8 mL), EF was slightly overestimated (EF: 0.9 ± 2.6%), and LV mass was considerably overestimated (LVM: 39.0 ± 11.4 g) by 4D flow-cine imaging. SVs from both methods correlated very highly with NFV (r = 0.91 in both cases) and did not differ from NFV. CONCLUSION: Native multislice 4D flow magnitude data allows precise evaluation of LV and LA volumetric parameters; however, apart from SV, LV volumetric parameters demonstrate bias and need to be referred to their respective normal values. CLINICAL RELEVANCE STATEMENT: Volumetric function assessment from native multislice 4D flow magnitude images can be performed with routinely used clinical software, facilitating the application of 4D flow as a one-stop-shop functional cardiac MR exam, providing consistent, simultaneously acquired, volume and flow data. KEY POINTS: • Native multislice 4D flow imaging allows evaluation of volumetric left ventricular and atrial function parameters. • Left ventricular and left atrial function parameters derived from native multislice 4D flow data correlate highly with corresponding standard cine-derived parameters. • Multislice 4D flow-derived volumetric stroke volume and net forward volume do not differ.

Impact of the evaluation method on 4D flow-derived diastolic transmitral and myocardial peak velocities: Comparison with echocardiography.

PURPOSE: To compare agreement of different evaluation methods of magnetic resonance (MR) 4D flow-derived diastolic transmitral and myocardial peak velocities as well as their ratios, using echocardiography as reference. METHODS: In this prospective study, 60 subjects without symptoms of cardiovascular disease underwent echocardiography and non-contrast 3 T MR 4D flow imaging of the heart. Early- (E) and late-diastolic (A) transmitral peak filling velocities were evaluated from 4D flow data using three different strategies: 1) at the mitral valve tips in short-axis orientation (SA-method), 2) between the mitral valve tips in 4-chamber orientation (4-chamber-method), and 3) as maximal velocities in the transmitral inflow volume (max-velocity-method). Septal, lateral and average early-diastolic myocardial peak velocities (e') were derived from the myocardial tissue in the vicinity of the mitral valve. 4D flow parameters were compared with echocardiography by correlation and Bland-Altman analysis. RESULTS: All 4D flow-derived E, A and E/A values correlated with echocardiography (r = 0.65-0.73, 0.75-0.83 and 0.74-0.86, respectively). While the SA- and 4-chamber-methods substantially underestimated E and A compared to echocardiography (p < 0.001), the max-velocity-method provided E (p = 0.13) and E/A (p = 0.07) without significant bias. Septal, lateral and average e' from 4D flow as well as the max-velocity-method-derived E/e' correlated with echocardiographic measurements (r = 0.64-0.81) and showed no significant bias (p = 0.26-0.54). CONCLUSION: MR 4D flow imaging allows precise and accurate evaluation of transmitral and myocardial peak velocities for characterization of LV diastolic function without significant bias to echocardiography, when transmitral velocities are assessed from the transmitral inflow volume. This enables the use of validated echocardiography threshold values.

MR 4D flow-derived left atrial acceleration factor for differentiating advanced left ventricular diastolic dysfunction.

OBJECTIVES: The magnetic resonance (MR) 4D flow imaging-derived left atrial (LA) acceleration factor α was recently introduced as a means to non-invasively estimate LA pressure. We aimed to investigate the association of α with the severity of left ventricular (LV) diastolic dysfunction using echocardiography as the reference method. METHODS: Echocardiographic assessment of LV diastolic function and 3-T cardiac MR 4D flow imaging were prospectively performed in 94 subjects (44 male/50 female; mean age, 62 ± 12 years). LA early diastolic peak outflow velocity (vE), systolic peak inflow velocity (vS), and early diastolic peak inflow velocity (vD) were evaluated from 4D flow data. α was calculated from α = vE / [(vS + vD) / 2]. Mean parameter values were compared by t-test; diagnostic performance of α in predicting diastolic (dys)function was investigated by receiver operating characteristic curve analysis. RESULTS: Mean α values were 1.17 ± 0.14, 1.20 ± 0.08, 1.33 ± 0.15, 1.77 ± 0.18, and 2.79 ± 0.69 for grade 0 (n = 51), indeterminate (n = 9), grade I (n = 13), grade II (n = 13), and grade III (n = 8) LV diastolic (dys)function, respectively. α differed between subjects with non-advanced (grade < II) and advanced (grade ≥ II) diastolic dysfunction (1.20 ± 0.15 vs. 2.16 ± 0.66, p < 0.001). The area under the curve (AUC) for detection of advanced diastolic dysfunction was 0.998 (95% CI: 0.958-1.000), yielding sensitivity of 100% (95% CI: 84-100%) and specificity of 99% (95% CI: 93-100%) at cut-off α ≥ 1.58. The AUC for differentiating grade III diastolic dysfunction was also 0.998 (95% CI: 0.976-1.000) at cut-off α ≥ 2.14. CONCLUSION: The 4D flow-derived LA acceleration factor α allows grade II and grade III diastolic dysfunction to be distinguished from non-advanced grades as well as from each other. CLINICAL RELEVANCE STATEMENT: As a single continuous parameter, the 4D flow-derived LA acceleration factor α shows potential to simplify the multi-parametric imaging algorithm for diagnosis of advanced LV diastolic dysfunction, thereby identifying patients at increased risk for cardiovascular events. KEY POINTS: • Detection of advanced diastolic dysfunction is typically performed using a complex, multi-parametric approach. • The 4D flow-derived left atrial acceleration factor α alone allows accurate detection of advanced left ventricular diastolic dysfunction. • As a single continuous parameter, the left atrial acceleration factor α could simplify the diagnosis of advanced diastolic dysfunction.

Cardiac function, myocardial fat deposition, and lipid profile in young smokers: a cross-sectional study.

Background: There is a possibility that cardiac morphometric characteristics are associated with the lipid profile, that is, the composition and concentration of triglycerides, total cholesterol, HDL, LDL, and others lipoproteins in young smokers without comorbidities. Thus, this study aimed to evaluate the association of cardiac morphometric characteristics, myocardial fat deposition, and smoking cessation with the lipid profile of young smokers. Methods: A clinical and laboratory evaluation of lipids and the smoking status was performed on 57 individuals, including both a smoker group and a control group. Cardiac magnetic resonance imaging (MRI) with proton spectroscopy was performed to identify cardiac changes and triglyceride (TG) deposition in myocardial tissue. Results: No differences were observed between the groups (control vs. smokers) in relation to the amount of myocardial TG deposition (p = 0.47); however, when TG deposition was correlated with cardiac MRI variables, a positive correlation was identified between smoking history and myocardial TG deposition [hazard ratio (95% CI), 0.07 (0.03-0.12); p = 0.002]. Furthermore, it was observed that the smoking group had lower high-density lipoprotein cholesterol [51 (45.5-59.5) mg/dl vs. 43 (36-49.5) mg/dl, p = 0.003] and higher TG [73 (58-110) mg/dl vs. 122 (73.5-133) mg/dl, p = 0.01] and very-low-density lipoprotein cholesterol [14.6 (11.6-22.2) mg/dl vs. 24.4 (14.7-26.6) mg/dl, p = 0.01] values. In the control and smoking groups, a negative correlation between TGs and the diameter of the aortic root lumen and positive correlation with the thickness of the interventricular septum and end-diastolic volume (EDV) of both the right ventricle (RV) and left ventricle (LV) were noted. Moreover, in the RV, positive correlations with the end-systolic volume (ESV) index (ESVI), stroke volume (SV), ESV, and EDV were observed. Regarding serum free fatty acids, we found a negative correlation between their values and the diameter of the lumen of the ascending aortic vessel. Lipoprotein lipase showed a positive correlation with the SV index of the RV and negative correlation with the diameter of the lumen of the ascending aortic vessel. Conclusion: Several associations were observed regarding cardiac morphometric characteristics, myocardial fat deposition, and smoking cessation with the lipid profile of young smokers.

Efficacy of sacubitril and valsartan combined with bisoprolol in the treatment of chronic heart failure and its effect on N-terminal pro-brain natriuretic peptide level / 中国基层医药

Objective:To investigate the clinical efficacy of sacubitril and valsartan combined with bisoprolol in the treatment of chronic heart failure and its effect on N-terminal pro-brain natriuretic peptide (NT-pro BNP) level.Methods:The clinical data of 89 patients with chronic heart failure who received treatment in Jinan 2 nd People's Hospital from January 2020 to April 2022 were retrospectively analyzed. These patients were divided into Group A ( n = 48) and Group B ( n = 41) according to different treatment methods. Group A was treated with sacubitril and valsartan combined with bisoprolol. Group B was treated with sacubitril and valsartan combined with metoprolol. All patients were treated for 3 months. Clinical efficacy as well as heart function and NT-pro BNP level pre- and post-treatment were compared between the two groups. The incidence of adverse reactions was calculated in each group. Results:Total response rate in group A was significantly higher than that in group B [95.83% (46/48) vs. 82.93% (34/41), χ2 = 4.05, P < 0.05]. After treatment, the left ventricular ejection fraction in both groups increased significantly and the left ventricular ejection fraction in group A was significantly higher than that in group B ( t = 2.19, P < 0.05). After treatment, NT-pro BNP level in group A was (416.51 ± 30.56) ng/L, which was significantly lower than (450.20 ± 35.79) ng/L in group B ( t = 4.79, P < 0.001). There was no significant difference in the incidence of adverse reactions between the two groups ( P > 0.05). Conclusion:The efficacy of sacubitril and valsartan combined with bisoprolol in the treatment of chronic heart failure is superior to that of sacubitril and valsartan combined with metoprolol. The former can greatly decrease NT-pro BNP level. Corresponding drugs can be selected for the treatment of chronic heart failure according to the actual needs of patients.

Application of percutaneous coronary intervention in patients with acute coronary syndrome in county-level hospitals / 中国基层医药

Objective:To investigate the application value of percutaneous coronary intervention in patients with acute coronary syndrome in county-level hospitals.Methods:The clinical data of 51 patients with acute coronary syndrome who received treatment in Feng Tai People's Hospital from January 2020 to January 2022 were retrospectively analyzed. They were divided into a control group ( n = 25) and an observation group ( n = 26). The control group was given standard dual antiplatelet and statin drugs. The observation group underwent percutaneous coronary intervention and stent implantation based on conventional drug treatment. All patients were followed up for 1 year. Cardiac function indexes left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDD) were compared between the two groups. The number of readmissions, length of hospital stay, quality of life score, medication, the incidence of complications, and the incidence of adverse cardiovascular events were compared between the two groups. Results:Before treatment, there were no significant differences in LVEF and LVEDD between the two groups (both P > 0.05). After treatment, LVEF was increased, and LVEDD was decreased in each group compared with before treatment. After treatment, LVEF and LVEDD in the observation group were (50.34 ± 5.97)% and (49.01 ± 5.02) mm, respectively, which were significantly superior to (45.61 ± 5.42)% and (52.12 ± 5.24) mm in the control group ( t = -2.96, 2.17, both P < 0.05). After treatment, the number of readmissions in the observation group was significantly less than that in the control group [(0.8 ± 0.1) times vs. (2.1 ± 0.3) times, t = 20.14, P < 0.001]. The length of hospital stay in the observation group was significantly shorter than that in the control group [(12.4 ± 3.1) days vs. (25.3 ± 3.9) days, t = 13.10, P < 0.001]. Quality of life score in the observation group was significantly higher than that in the control group [(85.3 ± 5.9) points vs. (72.5 ± 5.2) points, t = -8.19, P < 0.001]. After treatment, the incidence of adverse cardiovascular events in the observation group was significantly lower than that in the control group [3.9% (1/26) vs. 28.0% (7/25), χ2 = 3.94, P = 0.041). Conclusion:Use of percutaneous coronary intervention in patients with acute coronary syndrome in county-level hospitals is feasible. It can improve patients' cardiac function and has a remarkable clinical effect with a low incidence of adverse cardiovascular events.

Effects of phentolamine on cardiac function, myocardial injury index, and hemodynamics in septic patients with myocardial injury / 中国基层医药

Objective:To investigate the efficacy of phenolamine in the treatment of sepsis-induced myocardial dysfunction and its effect on cardiac function, myocardial injury index, and hemodynamics in patients.Methods:The clinical data of 79 patients with sepsis-induced myocardial dysfunction who received treatment in Huangshi Central Hospital, Edong Healthcare Group from February 2017 to February 2020 were retrospectively analyzed. These patients were divided into a control group (without phenolamine treatment, n = 41) and an observation group (with phenolamine treatment, n = 38) according to whether they received phenolamine treatment or not. Clinical efficacy, cardiac function, myocardial injury index, and hemodynamic index pre- and post-treatment were compared between the two groups. Results:There was no significant difference in 28-day mortality rate between the two groups ( P > 0.05). Intensive care unit length of stay and mechanical ventilation duration in the observation group were (9.33 ± 3.52) days and 83.00 (28.50, 138.00) hours, which were significantly shorter than (12.17 ± 4.15) days and 111.00 (47.50, 169.00) hours in the control group ( t = 3.26, Z = -2.27, both P < 0.05). The response rate in the observation group was significantly higher than that in the control group [81.58% (31/38) vs. 60.98% (25/41), χ2 = 4.05, P < 0.05]. After 7 days of treatment, the left ventricular ejection fraction in each group was significantly increased, and the left ventricular end-diastolic diameter and left ventricular end-systolic diameter in each group were significantly decreased compared with before treatment (all P < 0.05). After 7 days of treatment, the left ventricular ejection fraction in the observation group was significantly higher than that in the control group ( t = 3.29, P < 0.05), and left ventricular end-diastolic diameter and left ventricular end-systolic diameter were significantly lower than those in the control group ( t = 5.94, 11.21, both P < 0.05). N-terminal pro-brain natriuretic peptide and cardiac troponin I levels in each group were significantly decreased with time (both P < 0.05). At 24 and 72 hours and 7 days after treatment, N-terminal pro-brain natriuretic peptide and cardiac troponin I levels in the observation group were significantly lower than those in the control group (both P < 0.05). After 7 days of treatment, heart rate in each group decreased significantly compared with that before treatment (both P < 0.05), mean arterial pressure, cardiac index, and stroke output index in each group increased significantly compared with those before treatment (all P < 0.05). After 7 days of treatment, heart rate in the observation group was significantly lower than that in the control group ( t = 4.90, P < 0.05), and mean arterial pressure, cardiac index, and stroke output index in the observation group were significantly higher than those in the control group ( t = 4.37, 3.23, 6.01, all P < 0.05). Conclusion:Phentolamine can improve hemodynamics, reduce myocardial injury and improve cardiac function in patients with sepsis-induced myocardial dysfunction.

Índice de rendimiento biventricular del corazón fetal

Objetivo. Proponer un índice de rendimiento biventricular basado en los valores promedio de la duración del ciclo cardíaco de cada uno de los ventrículos, determinar la variable incluida en el estudio con la correlación estadística más significativa, establecer valores de referencia que permitan identificar el trabajo de cada ventrículo en función de dicha variable y obtener un índice de gasto biventricular equilibrado. Metodología. Estudio prospectivo y transversal en fetos de 168 gestantes, en embarazos entre las 16 y 38 semanas sin patologías materno-fetales. Se obtuvieron ondas de velocidad de flujo de ambas válvulas atrioventriculares y el tiempo total del ciclo sístole-diástole se calculó en milisegundos para cada válvula. Se calcularon promedios, desviación estándar y puntuación Z del tiempo sistólico-diastólico para cada ventrículo y el índice de rendimiento ventricular individual dividiendo el valor obtenido entre la frecuencia cardiaca fetal. Se obtuvo el valor promedio de ambos y este, al ser dividido por la frecuencia cardíaca, permitió obtener el índice de rendimiento biventricular para establecer la correlación entre este, la frecuencia cardiaca fetal y la edad de gestación. Resultados. Se halló valores de tiempo sistólico-diastólico en milisegundos para el ventrículo derecho de 420,8 (DE ±28,3) y para el ventrículo izquierdo de 418,8 (DE ±26,3), sin diferencias estadísticamente significativas (p=0,371). La correlación con la frecuencia cardíaca fetal resultó negativa para ambos ventrículos (-0,491 y -0,553; p<0,05). El tiempo promedio biventricular fue de 418,37 ms (± 20,59) y la correlación con la edad gestacional de 0,48 (p<0,05); la correlación con la frecuencia cardiaca fetal fue negativa, -0,50 (p<0,05). El índice de rendimiento biventricular mostró valores de 2,8 (extremos 2,4 (P5) y 3,4 (P95)). La correlación entre el índice de rendimiento biventricular y la frecuencia cardiaca fetal fue 0,78 (p<0,05), de menor grado (0,27) con la edad gestacional. Conclusiones. Se demostró que los tiempos sistólico-diastólicos de cada ventrículo no difirieron entre sí y se correlacionaron de manera negativa con la frecuencia cardiaca fetal. Se comprobó que es posible evaluar el ciclo cardíaco fetal de cada ventrículo mediante el índice de rendimiento ventricular, así como calificar con el índice de rendimiento biventricular el gasto cardíaco combinado como equilibrado.

Objectives: To propose a biventricular performance index based on the average values of the duration of the cardiac cycle of each of the ventricles, to determine the variable included in the study with the most significant statistical correlation, to establish reference values that allow the work of each ventricle to be identified according to this variable, and to obtain a balanced biventricular output index. Methodology: Prospective and cross-sectional study in fetuses of 168 pregnant women, in pregnancies between 16 and 38 weeks without maternal-fetal pathologies. Flow velocity waves were obtained from both atrioventricular valves and the total systole-diastole cycle time was calculated in milliseconds for each valve. Averages, standard deviation, and Z-score were calculated of the systolic-diastolic time for each ventricle and the individual ventricular performance index (VPI) were calculated by dividing the value obtained by the fetal heart rate (FHR). The average value of both was obtained and this, when divided by the heart rate, made it possible to obtain the biventricular performance index (BPI) to establish the correlation between this, the fetal heart rate and gestational age. Results: Systolic-diastolic time values in milliseconds for the right ventricle were 420.8 (SD ±28.3) and for the left ventricle 418.8 (SD ±26.3), with no statistically significant differences (p<0.371). The correlation with the FHR was negative for both ventricles: (-0.491 and -0.553; p<0.05). The mean biventricular time was 418.37 ms (±20.59) and the correlation with gestational age was 0.48 (p<0.05); the correlation with FHR was negative, -0.50 (p<0.05).The BPI showed values of 2.8 (extremes 2.4 (P5) and 3.4 (P95)). The correlation between BPI and FHR was 0.78 (p<0.05) and of lesser degree with gestational age (0.27; p<0.05). Conclusions: It was demonstrated that the systolic-diastolic times of each ventricle did not differ from each other and were negatively correlated with fetal heart rate. It was shown that it is possible to evaluate the fetal cardiac cycle of each ventricle by means of the ventricular performance index as well as to qualify with the biventricular performance index the combined cardiac output as balanced.

Prediction of Cardiac Resynchronization Therapy Response Using a Lead Placement Score Derived From 4-Dimensional Computed Tomography.

BACKGROUND: Cardiac resynchronization therapy (CRT) is an effective treatment for patients with heart failure; however, 30% of patients do not respond to the treatment. We sought to derive patient-specific left ventricle maps of lead placement scores (LPS) that highlight target pacing lead sites for achieving a higher probability of CRT response. METHODS: Eighty-two subjects recruited for the ImagingCRT trial (Empiric Versus Imaging Guided Left Ventricular Lead Placement in Cardiac Resynchronization Therapy) were retrospectively analyzed. All 82 subjects had 2 contrast-enhanced full cardiac cycle 4-dimensional computed tomography scans: a baseline and a 6-month follow-up scan. CRT response was defined as a reduction in computed tomography-derived end-systolic volume ≥15%. Eight left ventricle features derived from the baseline scans were used to train a support vector machine via a bagging approach. An LPS map over the left ventricle was created for each subject as a linear combination of the support vector machine feature weights and the subject's own feature vector. Performance for distinguishing responders was performed on the original 82 subjects. RESULTS: Fifty-two (63%) subjects were responders. Subjects with an LPS≤Q1 (lower-quartile) had a posttest probability of responding of 14% (3/21), while subjects with an LPS≥ Q3 (upper-quartile) had a posttest probability of responding of 90% (19/21). Subjects with Q1

Continuous Arrhythmia Monitoring in Pediatric and Adult Patients With Left Ventricular Noncompaction.

Patients with left ventricular noncompaction (LVNC) are at risk of clinically significant arrhythmias and sudden death. We evaluated whether implantable loop recorders could detect significant arrhythmias that might be missed in these patients during annual Holter monitoring. Selected pediatric and adult patients with LVNC who consented to implantable loop recorder placement were monitored for 3 years (study duration, 10 April 2014-9 December 2019). Fourteen subjects were included (age range, 6.5-36.4 yr; 8 males). Of 13 patients who remained after one device extrusion, one underwent implantable cardioverter-defibrillator placement. Four patients (31%) had significant arrhythmias: atrial tachycardia (n=2), nonsustained ventricular tachycardia (n=1), and atrial fibrillation (n=1). All 4 events were clinically asymptomatic and not associated with left ventricular ejection fraction. In addition, a high frequency of benign arrhythmic patterns was detected. Implantable loop recorders enable continuous, long-term detection of important subclinical arrhythmias in selected patients who have LVNC. These devices may prove to be most valuable in patients who have LVNC and moderate or greater ventricular dysfunction.

Effects of open-lung strategy on cardiopulmonary function in frail elderly patients undergoing laparoscopic surgery / 中华麻醉学杂志

Objective:To evaluate the effect of open-lung strategy (OLS) on cardiopulmonary function in frail elderly patients undergoing laparoscopic surgery.Methods:Eighty-four frail elderly patients aged 65-80 yr, with body mass index of 18.5-30.0 kg/m 2, of American Society of Anesthesiologists physical status Ⅱor Ⅲ, with preoperative Fried frailty phenotype scale score ≥3, undergoing elective laparoscopic radical rectal cancer or radical prostate cancer surgery under general anesthesia, were divided into 2 groups ( n=42 each) by the random number table method: OLS group and non-OLS group (NOLS group). The patients underwent recruitment maneuvers and individualized positive end-expiratory pressure (PEEP) in OLS group, while patients received fixed PEEP (5 cmH 2O) in NOLS group.At 10 min after endotracheal intubation (T 0, baseline value), immediately after the peak of recruitment maneuvers (T 1), 30 min (T 2) and 1 h (T 3) after individualized PEEP setting and 10 min before the end of surgery (T 4), cardiac function indexes were measured by transoesophageal echocardiography, optic nerve sheath diameter was measured, and the arterial blood gas analysis indexes and pulmonary function indexes were recorded.The levels of serum cardiac troponin T, creatine kinase-MB and precursor of type B natriuretic peptide were determined by chemiluminescence before surgery and at 1 and 2 days after surgery.The postoperative pulmonary complications within 7 days after surgery and postoperative outcomes were also recorded. Results:Eighty-one patients were finally enrolled, with 41 in NOLS group and 40 in OLS group.Compared with NOLS group, the left ventricular end diastolic area, left ventricular ejection fraction, stroke volume, ratio of early mitral flow velocity to early mitral annulus velocity, mitral annular plane systolic excursion, left ventricular global longitudinal strain, right ventricular end diastolic area, right ventricular fractional area change, tricuspid annular plane systolic excusion and right ventricular global longitudinal strain were significantly decreased at T 1, 2 ( P<0.05), and no significant change was found in the indices mentioned above at the remaining time points ( P>0.05), PaO 2, oxygenation index, and lung compliance were increased at T 1-4, PaCO 2 and alveolar arterial partial pressure difference of oxygen were decreased, the total incidence of pulmonary complications was reduced within 7 days after operation, and the duration of postanesthesia care unit stay, time to first out-of-bed activity and postoperative length of hospital stay were shortened ( P<0.05), and no significant change was found in optic nerve sheath diameter and concentrations of serum cardiac troponin T, creatine kinase-MB, and precursor of type B natriuretic peptide at each time point in OLS group ( P>0.05). Conclusions:OLS can improve lung function in frail elderly patients, which is helpful for patient prognosis without causing negative cardiac effects, and can be safely used for intraoperative airway management in frail elderly patients without obvious cardiac dysfunction.

High-flux versus low-flux hemodialysis for end-stage renal disease in the older adults / 中国基层医药

Objective:To investigate the effects of high-flux versus low-flux hemodialysis on end-stage renal disease in older adults and evaluate its effects on myocardial injury indexes and micro-inflammatory response indexes. Methods:Seventy-two patients with ESRD who received treatment in Affiliated Hospital of Shaoxing University from January 2019 to January 2020 were included in this study. They were randomly assigned to receive either low-flux hemodialysis (control group, n = 36) or high-flux hemodialysis (observation group, n = 36). All patients received 6 months of treatment. Micro-inflammatory response indexes and renal function indexes pre- and post-treatment, and reverse reactions were observed in each group. Results:Serum interleukin-6, tumor necrosis factor α, and high-sensitivity C-reactive protein levels post-treatment in the observation group were (7.16 ± 1.32) ng/L, (2.10 ± 0.36) pg/L, (2.20 ± 1.06) mg/L respectively, which were significantly lower than those in the control group [(10.45 ± 1.42) ng/L, (5.22 ± 0.65) pg/L, (3.84 ± 1.57) mg/L, t = 10.19, 25.19, 5.19, all P < 0.001]. Serum parathyroid hormone, B-type natriuretic peptide, and cardiac troponin T levels post-treatment in the observation group were (520.36 ± 95.65) pmol/L, (0.45 ± 0.10) μg/L, (15.05 ± 6.37) ng/L, respectively, which were significantly lower than those in the control group [(830.25 ± 102.35) pmol/L, (0.85 ± 0.13) μg/L, (30.25 ± 6.59) ng/L, t = 13.27, 14.63, 9.95, all P < 0.001]. The total response rate was significantly higher in the observation group than in the control group [75.00% (27/36) vs. 47.22% (19/36), χ2 = 3.85, P < 0.05]. The overall incidence of adverse reactions was significantly lower in the observation group than in the control group [19.44% (7/36) vs. 41.67% (15/36), χ2 = 4.18, P < 0.05). Conclusion:High-flux hemodialysis can highly improve the control effect of micro-inflammatory responses and alleviate myocardial injury in older adult patients with end-stage renal disease. High-flux hemodialysis is more effective and safer than low-flux hemodialysis.

Effects of driving pressure-guided individualized PEEP ventilation on intraoperative cardiac function in elderly patients undergoing laparoscopic surgery / 中华麻醉学杂志

Objective:To evaluate the effect of driving pressure-guided individualized PEEP ventilation on intraoperative cardiac function in elderly patients undergoing laparoscopic surgery.Methods:Seventy American Society of Anesthesiologists physical statusⅠor Ⅱ patients, aged 60-75 yr, with body mass index of 18-25 kg/m 2, with left ventricular ejection fraction (LVEF)>50%, undergoing elective laparoscopic radical gastrectomy under general anesthesia, were divided into 2 groups ( n=35 each) by the random number table method: conventional PEEP ventilation group (group P) and driving pressure-guided individualized PEEP ventilation group (group D). The patients were mechanically ventilated in the volume-controlled ventilation mode, with a V T of 7 ml/kg, an inspired oxygen concentration of 60%, an inspiratory/expiratory ratio of 1∶2, and an end-inspiratory pause time of 10%.In group P, 5 cmH 2O PEEP was given for ventilation from 5 min after the establishment of pneumoperitoneum until the end of operation.In group D, driving pressure-guided individualized PEEP titration was performed at 5 min after the establishment of pneumoperitoneum, and ventilation was maintained with the titrated individualized PEEP until the pneumoperitoneum was closed.After the pneumoperitoneum was closed, group D underwent driving pressure-directed individualized PEEP again, and ventilation was maintained with re-titrated PEEP until the end of surgery.Before pneumoperitoneum (T 0), at 5 min after establishment of pneumoperitoneum (T 1), 5 min of PEEP ventilation (T 2), 30 min of PEEP ventilation (T 3) and 5 min after the end of pneumoperitoneum (T 4), MAP was recorded, LVEF, global longitudinal strain of left ventricle, tricuspid annular systolic displacement, early diastolic peak velocity (E peak) of mitral valve and tricuspid valve orifice, early diastolic peak velocity (e′) and systole peak velocity (S′) of mitral valve and tricuspid valve annulus were measured using transesophageal ultrasonography, and myocardial performance index (MPI) and E/e′ were calculated. Results:Compared with group P, MAP, LVEF, mitral valve annulus S′, global longitudinal strain of left ventricle, tricuspid valve annulus S′, and tricuspid annular systolic displacement were significantly decreased at T 2 and T 3, and left ventricular MPI, mitral valve E/e′, right ventricular MPI and tricuspid E/e′ were increased in group D ( P<0.05). Conclusions:Driving pressure-guided individualized PEEP ventilation can decrease the cardiac function during pneumoperitoneum in elderly patients undergoing laparoscopic surgery.

Triptolide improves myocardial fibrosis in rats through inhibition of nuclear factor kappa B and NLR family pyrin domain containing 3 inflammasome pathway.

Myocardial fibrosis (MF) is the result of persistent and repeated aggravation of myocardial ischemia and hypoxia, leading to the gradual development of heart failure of chronic ischemic heart disease. Triptolide (TPL) is identified to be involved in the treatment for MF. This study aims to explore the mechanism of TPL in the treatment of MF. The MF rat model was established, subcutaneously injected with isoproterenol and treated by subcutaneous injection of TPL. The cardiac function of each group was evaluated, including LVEF, LVFS, LVES, and LVED. The expressions of ANP, BNP, inflammatory related factors (IL-1ß, IL-18, TNF-α, MCP-1, VCAM-1), NLRP3 inflammasome factors (NLRP3, ASC) and fibrosis related factors (TGF-ß1, COL1, and COL3) in rats were dete cted. H&E staining and Masson staining were used to observe myocardial cell inflammation and fibrosis of rats. Western blot was used to detect the p-P65 and t-P65 levels in nucleoprotein of rat myocardial tissues. LVED and LVES of MF group were significantly upregulated, LVEF and LVFS were significantly downregulated, while TPL treatment reversed these trends; TPL treatment downregulated the tissue injury and improved the pathological damage of MF rats. TPL treatment downregulated the levels of inflammatory factors and fibrosis factors, and inhibited the activation of NLRP3 inflammasome. Activation of NLRP3 inflammasome or NF-κB pathway reversed the effect of TPL on MF. Collectively, TPL inhibited the activation of NLRP3 inflammasome by inhibiting NF-κB pathway, and improved MF in MF rats.

Study on cardiovascular monitoring and diagnosis of athletes / Estudo de monitoramento cardiovascular e diagnóstico de atletas / Estudio de monitoreo cardiovascular y diagnóstico de atletas

ABSTRACT Introduction: The study and collection of athletes' heart function index parameters and the correct and reasonable evaluation of body functions can effectively adjust training plans and avoid athletes' bodily exhaustion. Objective: To study the diagnosis of myocardial injury by cardiovascular monitoring in athletes from two aspects: extraction of characteristic parameters of heart function and research of signal processing. Methods: The heart function intelligent evaluation algorithm was studied by using multi-source information fusion, and embedded technology; miniature sensors were used as well. Results: The incidence of severe ventricular arrhythmia was lower in both groups. The incidence of sinus arrhythmia and intermittent second degree I atrioventricular block in the high-intensity group was significantly higher than that in the control group. The number of atrial and ventricular premature beats was lower in the control group, but increased significantly in the high-intensity group. Conclusions: This study applied the theory of multi-source information fusion to carry out representative research on the intelligent monitoring and evaluation of the heart function of elite athletes, centering on the application requirements of the heart function monitoring of elite athletes. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução: O estudo e a coleta de parâmetros indiciais da função cardíaca em atletas e a avaliação correta e razoável das funções corporais podem, efetivamente, levar ao ajuste de planos de treinamento e evitar a sobrecarga física de atletas. Objetivo: Estudar o diagnóstico da lesão miocárdica pelo monitoramento cardiovascular em atletas a partir de dois aspectos: a extração de parâmetros característicos da função cardíaca e a pesquisa do processamento de sinais. Métodos: O algoritmo de avaliação inteligente da função cardíaca foi estudado usando a fusão de informações de múltiplas fontes, além da tecnologia embarcada. Sensores em miniatura também foram usados. Resultados: A incidência de arritmia ventricular severa era menor nos dois grupos. A incidência de arritmia sinusal e o bloqueio atrioventricular de segundo grau do tipo I intermitente no grupo de alta intensidade foi significativamente mais alta do que no grupo de controle. O número de batidas prematuras atriais e ventriculares era menor no grupo de controle, mas aumentava consideravelmente no grupo de alta intensidade. Conclusões: Este estudo aplicou a teoria da fusão de informações de múltiplas fontes para conduzir uma pesquisa importante sobre o monitoramento e avaliação inteligentes da função cardíaca de atletas de elite, enfocando as exigências de aplicação do monitoramento da função cardíaca de atletas de elite. Nível de evidência II; Estudos terapêuticos - investigação de resultados de tratamento.

RESUMEN Introducción: El estudio y la recogida de parámetros indíciales de la función cardíaca en atletas y la evaluación correcta y razonable de las funciones corporales pueden efectivamente llevar al ajuste de planes de entrenamiento y evitar la sobrecarga física de atletas. Objetivo: Estudiar el diagnóstico de la lesión miocárdica a través del monitoreo cardiovascular en atletas a partir de dos aspectos: la extracción de parámetros característicos de la función cardíaca y la investigación del procesamiento de señales. Métodos: El algoritmo de evaluación inteligente de la función cerebral se estudió utilizando la fusión de informaciones de múltiples fuentes, además de la tecnología embebida. Sensores en miniatura también se utilizaron. Resultados: La incidencia de taquicardia ventricular severa era menor en los dos grupos. La incidencia de arritmia sinusal y bloqueo auriculoventricular de segundo grado del tipo I intermitente en el grupo de alta intensidad fue significativamente más alta que en el grupo de control. El número de contracciones prematuras auriculares y ventriculares era menor en el grupo de control, pero aumentaba considerablemente en el grupo de alta intensidad. Conclusiones: Este estudio aplicó la teoría de la fusión de informaciones de múltiples fuentes para conducir una investigación importante sobre el monitoreo y evaluación inteligentes de la función cardiaca de atletas de élite, centrando las exigencias de aplicación del monitoreo de la función cardíaca de atletas de élite. Nivel de evidencia II; Estudios terapéuticos - investigación de resultados de tratamiento.

A detection system of exercise electrocardiogram / Um sistema de detecção de eletrocardiograma de exercício / Un sistema de detección de electrocardiograma de ejercicio

ABSTRACT Introduction: A new exercise electrocardiogram (ECG) detection system was investigated in this study to diagnose and analyze cardiopulmonary function and related diseases in a comprehensive and timely manner and improve the accuracy of diagnosis. Besides, its reliability and clinical applicability were judged. Objective: A new type of exercise ECG detection system was constructed by adding parameters such as respiratory mechanics, carbon dioxide, and oxygen concentration monitoring based on the traditional ECG detection system. Methods: The new system constructed in this study carried out the ECG signal detection, ECG acquisition module, blood pressure and respiratory mechanics detection and conducted a standard conformance test. Results: The heart rate accuracy detected by the exercise ECG system was greatly higher than that of the doctor's manual detection (P < 0.05). The accuracy of the new exercise ECG detection system increased obviously in contrast to that of the manual detection result (P < 0.05). The key technical index input noise and input impedance test results (24.5 μV and 12.4 MΩ) of the exercise ECG detection system conformed to the standard (< 30 μV and > 2.5 MΩ). The common-mode rejection and sampling rate test results (103.5 dB and 515 Hz) of key technical indicators in the exercise ECG detection system were all in line with the standards (≥89 dB and ≥500 Hz). Conclusion: The complete exercise ECG detection system was constructed through the ECG acquisition module, blood pressure detection, and respiratory mechanics detection module. In addition, this system could be applied to detect ECG monitoring indicators with high accuracy and reliability, which could also be extensively adopted in clinical diagnosis. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução: Um novo sistema de detecção de eletrocardiograma de exercício (ECG) foi investigado neste estudo para diagnosticar e analisar a função cardiopulmonar e doenças relacionadas de maneira abrangente e oportuna e melhorar a precisão do diagnóstico. Além disso, sua confiabilidade e aplicabilidade clínica foram julgadas. Objetivo: Um novo tipo de sistema de detecção de ECG de esforço foi construído adicionando parâmetros como mecânica respiratória, dióxido de carbono e monitoramento da concentração de oxigênio com base no sistema de detecção de ECG tradicional. Métodos: O novo sistema construído neste estudo realizou a detecção do sinal de ECG, módulo de aquisição de ECG e detecção de pressão arterial e mecânica respiratória, e conduziu um teste de conformidade padrão. Resultados: A precisão da frequência cardíaca detectada pelo sistema de ECG de esforço foi muito maior do que a detecção manual do médico (P <0,05). A precisão do novo sistema de detecção de ECG de esforço aumentou obviamente em contraste com o resultado da detecção manual (P <0,05). O ruído de entrada do índice técnico principal e os resultados do teste de impedância de entrada (24,5 μV e 12,4 MΩ) do sistema de detecção de ECG de esforço estão em conformidade com o padrão (<30 μV e> 2,5 MΩ). A rejeição do modo comum e os resultados do teste de taxa de amostragem (103,5 dB e 515 Hz) dos indicadores técnicos principais no sistema de detecção de ECG de esforço estavam todos alinhados com os padrões (≥89 dB e ≥500 Hz). Conclusão: O sistema completo de detecção de ECG de esforço foi construído através da combinação de módulo de aquisição de ECG, detecção de pressão arterial e módulo de detecção de mecânica respiratória. Além disso, esse sistema poderia ser aplicado à detecção de indicadores de monitoramento de ECG com alta precisão e confiabilidade, o que poderia ser amplamente adotado no diagnóstico clínico. Nível de evidência II; Estudos terapêuticos- investigação dos resultados do tratamento.

RESUMEN Introducción: En este estudio se investigó un nuevo sistema de detección de electrocardiograma de esfuerzo (ECG) para diagnosticar y analizar la función cardiopulmonar y enfermedades relacionadas de manera integral y oportuna, y mejorar la precisión del diagnóstico. Además, se evaluó su confiabilidad y aplicabilidad clínica. Objetivo: Se construyó un nuevo tipo de sistema de detección de ECG de ejercicio agregando parámetros como la mecánica respiratoria, el dióxido de carbono y el monitoreo de la concentración de oxígeno sobre la base del sistema de detección de ECG tradicional. Métodos: El nuevo sistema construido en este estudio llevó a cabo la detección de la señal de ECG, el módulo de adquisición de ECG y la detección de la presión arterial y la mecánica respiratoria, y realizó una prueba de conformidad estándar. Resultados: la precisión de la frecuencia cardíaca detectada por el sistema de ECG de ejercicio fue mucho mayor que la de la detección manual del médico (P <0,05). La precisión del nuevo sistema de detección de ECG de esfuerzo aumentó obviamente en contraste con el resultado de la detección manual (P <0.05). Los resultados de la prueba de impedancia de entrada y ruido de entrada de índice técnico clave (24,5 μV y 12,4 MΩ) del sistema de detección de ECG de esfuerzo cumplieron con el estándar (<30 μV y> 2,5 MΩ). Los resultados de la prueba de frecuencia de muestreo y rechazo en modo común (103,5 dB y 515 Hz) de los indicadores técnicos clave en el sistema de detección de ECG de esfuerzo estaban en línea con los estándares (≥89 dB y ≥500 Hz). Conclusión: El sistema completo de detección de ECG de ejercicio se construyó mediante la combinación del módulo de adquisición de ECG, la detección de la presión arterial y el módulo de detección de la mecánica respiratoria. Además, este sistema podría aplicarse a la detección de indicadores de monitoreo de ECG con alta precisión y confiabilidad, que también podría adoptarse ampliamente en el diagnóstico clínico. Nivel de evidencia II; Estudios terapéuticos- investigación de los resultados del tratamiento.

Cardiac Function is Preserved in Adolescents With Well-Controlled Type 1 Diabetes and a Normal Physical Fitness: A Cross-Sectional Study.

OBJECTIVES: Cardiovascular diseases and exercise intolerance elevate mortality in type 1 diabetes (T1D). Left ventricular systolic and diastolic function are already affected in adolescents with T1D, displaying poor glycemic control (glycated hemoglobin [A1C]>7.5%) and exercise intolerance. We investigated the extent to which left ventricular function is affected by disease severity/duration and whether this is related to exercise capacity. METHODS: Transthoracic echocardiography was performed in 19 adolescents with T1D (14.8±1.9 years old, A1C 7.4±0.9%) and 19 controls (14.4±1.3 years old, A1C 5.3±0.2%), matched for age and Tanner stage. Diastolic and systolic (ejection fraction [EF]) function were assessed. Cardiopulmonary exercise testing was used to evaluate exercise capacity, as measured by peak oxygen uptake (VO2peak). RESULTS: VO2peak and left ventricular systolic and diastolic function were similar in both groups. Within the T1D group, EF was negatively associated with disease duration (r=-0.79 corrected for age, standardized body mass index, glucose variability and VO2peak; p=0.011). Regression analyses revealed that 37.6% of the variance in EF could be attributed to disease duration. CONCLUSIONS: Although left ventricular systolic and diastolic function are preserved in T1D with adequate exercise capacity, disease duration negatively affects EF. The detrimental effects of T1D seem to be driven by disease duration, rather than by disease severity, at least during adolescence. Young patients with T1D may, therefore, benefit from cardiovascular evaluation in order to detect cardiovascular abnormalities early in the disease course, and, therefore, improve long-term cardiovascular health.