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BackgroundThe relationship between lipids and coronary artery disease has been well established. However, this is not the case between lipids and heart failure. Ironically, high lipid levels are associated with better outcomes in heart failure, but the mechan-isms underlying the phenomenon are not fully understood. This study was performed to test the hypothesis that reduced intestinal lipid absorption due to venous congestion may lead to low lipid levels.MethodsWe collected data of clinical characteristics, echocardio-graph, and lipid profile in 442 unselected patients with congestive heart failure. Correlations between lipid levels[including total cho-lesterol(TCL), high-density lipoprotein cholesterol(HDL-C), low-density lipoprotein cholesterol(LDL-C), and triglycerides(TG)]and right ventricle end diastolic diameter (RVEDD), left ventricle end diastolic diameter (LVEDD), right atrium diameter (RA), left atrium diameter (LA), or left ventricle ejection fraction (LVEF) were analyzed using Pearson correlation and partial correlation. RVEDD, LVEDD, RA, and LA were indexed to the body surface area.ResultsThere was a significantly inverse correlation between TCL le-vels and RVEDD (r=-0.34,P<0.001) and RA (r=-0.36,P<0.001). Other lipids such as LDL-C, HDL-C, and TG had asimilar inverse correlation with RVEDD and RA. All these correlations remained unchanged after adjusting for age, gender, smoking status, physical activity levels, comorbidities, and medication use.ConclusionsLipid levels were inversely correlated to RVEDD in patients with congestive heart failure; however, because this was an observational study, further investigation is needed to verify our results as wellas identify a causal relationship, if any.
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Objective To investigate the relationship of T peak-T end (Tp-Te) interval and Tp-Te interval disper-sion (Tp-Ted) in different periods of myocardial ischemia in patients with acute myocardial infarction (AMI), and to assess the clinical significance of Tp-Te and Tp-Ted for prediction of the ventricular arrhythmia (VA). Methods A total of 80 pa-tients with AMI were enrolled in the study. The sizes and changes of Tp-Te and Tp-Ted were observed during the acute phase and recovery phase in patients. The differences of Tp-Te and Tp-Ted were compared between ventricular tachycardia group (A group), ventricular premature beats group (B group) and non- ventricular arrhythmia group (C group). Results The values of Tp-Te and Tp-Ted were obviously longer in acute period [(125.22±17.70) ms and (54.76±13.26) ms] than those in recovery period[ (113.84±17.37) ms and (42.06±13.95)ms] (P<0.01). The values of Tp-Te and Tp-Ted were signifi-cantly longer in A group[ (134.82±19.56) ms and (62.00±15.19) ms] than those in B [(122.94±15.09) ms and (54.09±10.56) ms ]and C group [(110.09±15.21) ms and (45.27±9.85) ms]. The values were higher in B group than those of C group. Con-clusion The Tp-Te interval and Tp-Ted prolongated in acute phase than those of recovery phase in patients with AMI. Tp-Te interval and Tp-Ted can be used as an important index to predict VA in patients with AMI.
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Background Hyperuricemia is frequently present in patients with heart failure. Many pathological conditions, such as tissue ischemia, renal function impairment, cardiac function impairment, metabolic syndrome, and inflammatory status, may impact uric acid (UA) metabolism. This study was to assess their potential relations to UA metabolism in heart failure. Methods We retrospectively assessed clinical characteristics, echocardiological, renal, metabolic and inflammatory variables selected on the basis of previous evidence of their involvement in cardiovascular diseases and UA metabolism in a large cohort of randomly selected adults with congestive heart failure (n = 553). By clustering of indices, those variables were explored using factor analysis. Results In factor analysis, serum uric acid (SUA) formed part of a principal cluster of renal functional variables which included serum creatinine (SCr) and blood urea nitrogen (BUN). Univariate correlation coefficients between variables of patients with congestive heart failure showed that the strongest correlations for SUA were with BUN (r = 0.48, P < 0.001) and SCr (r = 0.47, P < 0.001). Conclusions There was an inverse relationship between SUA levels and measures of renal function in patients with congestive heart failure. The strong correlation between SUA and SCr and BUN levels suggests that elevated SUA concentrations reflect an impairment of renal function in heart failure.
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BACKGROUND:The early reperfusion of the infarct-related artery in acute myocardial infarction (AMI) may significantly improve the symptoms and prognosis of patients.However,reperfusion is also followed by ischemia-reperfusion injury and there are no very effective ways to manage this severe problem at present.OBJECTIVE:To evaluate the protective effects of intracoronary adenosine infusion on myocardium in patients with AMI during percutaneous coronary intervention(PCI).DESIGN:Double-blinded and randomized controlled study.SETTING:First Hospital of Hebei Medical University and Third Hospital of Shijiazhuang City.PARTICIPANTS:The clinical triel was performed in 50 eligible patients at the Department of Cardiology,the First Hospital of Hebei Medical University and the Third Hospital of Shijiazhuang City from December 2004 to April 2006.Patients were eligible if they were age 30 years or older and admitted with ST-segment elevation myocardial infarction (STEMI).The diagnosis of STEMI was based on episodes of chest pain persisting at least 30 minutes but no longer than 12 hours and proving unresponsive to nitrates,electrocardiogram (ECG) ST-segment elevation of at least 2 contiguous ECG leads,and 2-fold creatine kinase (CK) elevation above the maximum peak in the normal range.The physicians obtained written informed consent from each patient.The patients were randomly assigned into two groups:those who received intra-coronary adenosine (23 patients) and those who received placebo (saline,27 patients).There were no significant differences between two groups in general condition,characteristics of coronary angiograms and intervention procedure(P＞0.05).METHODS:After the patients were admitted in hospital,general emergence managements were given.All patients received 300 mg aspirin and 300 mg clopidogrel. While the patients remained stable,the left and right coronary arteriography was done before the balloon was inflated.10 mL saline (control group) or adenosine (300 μg+10 mL saline) was immediately given by intracoronary injection within one minute.Then the stenting was performed.Coronary flow of the infarct-related artery (IRA) was assessed by the method of thrombolysis in myocardial infarction (TIMI) grading.MAIN OUTCOME MEASURES:①The peaks of serum levels of cardiac biomarkers were assessed every 4 hours in the first day of admission and then every day up to discharge.②The 12-lead ECG was done 1 hour before coronary angiography and after PCI,the sum of ST-segment resolution (STR) was calculated.③The left ventricular ejection fraction (LVEF) was calculated and measured by echocardiogram on the 3rd day and the fourth week after PCI in modified Simpson's method.RESULTS:All of 50 patients with AMI were involved in the final analysis.①Cardiac biomarkers and sum of STR:The peak levels of serum CK,CK-MB and cardiac troponin Ⅰ (cTnI) in adenosine group were significantly lower than those in control group (t=2.31,z=2.83,2.22;P＜0.05).Sum of STR in one hour after PCI of adenosine group were significantly higher than those in control group (z=2.10,P＜0.05).The lower level of the markers in adenosine group showed the mild myocardial injury.The infarcted patients with more rapid ST-segment resolution in adenosine group meant the better recovery in the electrocardiogram.②Left ventricular function:LVEF at the fourth week of PCI (both adenosine and control group) were better than those on the third day (t=1.45,2.30;P＜0.01).LVEF in adenosine group were significantly higher than control group on the fourth week after PCI.TIMI flow:TIMI 3 flow in the two groups was 22 patients for control group and 19 patients for adenosine group.There was no significant difference between the two groups(P＞0.05).③Side-effect:Four(17.39%) patients in adenosine group and 1(3.70%) patient in control group developed significant sinus bradycardia requiring pacing.However,the incidence of bradycardia requiring pacing was not significantly different between the two groups(Fisher exact,P=0.129).CONCLUSIONS:Intracoronary adenosine infusion during PCI significantly alleviated ischemia-reperfusion injury and improved the left ventricular function in AMI.Intracoronary adenosine infusion in patients with AMI during PCI was safe and feasible.
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Objective To evaluate the myocardial protective effects of intracoronary(IC)adenosine infusion in patients with coronary heart disease during percutaneous coronary intervention(PCI).Methods A total of 111 enrolled patients were randomised to receive infusions of saline(control group,55 patients)or adenosine(adenosine group,56 patients).10 mL saline(control group)or 300 ?g adenosine(adenosine group)was given by intracoronary(IC)injection within 1 minute.The peak level of ST-segment elevation in IC electrocardiograms(IC-ECG)and the peak level of cardiac triponin I(cTnI)was analyzed and left ventricular ejection fraction(LVEF)was measured.For the patients with acute myocardial infarction(AMI),coronary flow of the infract-related artery was assessed by the method of thrombolysis in myocardial infarction grading.The peak level of sum ST-segment resolution(STR)was measured after one hour of PCI.Results The peak level of serum cTnI in adenosine group was lower than the control group(P
