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To describe a case with acute myocardial infarction caused by gastric carcinoma-associated thrombotic thrombocytopenic purpura. A 79-year-old man was admitted with abdominal pain and pyrexia. He later developed cardiac complications and microangiopathy that indicated worsening progression. Manifold evidence confirmed the diagnosis of myocardial infarction caused by thrombotic thrombocytopenic purpura. The patient was treated mainly with plasma transfusion incorporated with steroids. This case should remind physicians to consider microangiopathy as a differential diagnosis in patients with unexplained cardiac symptoms or atypical presentation. Early diagnosis and treatment are helpful in decreasing the sequelae of this syndrome
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Objective Percutaneous coronary intervention( PCI) is effective in improving the ischemia and prognosis of pa-tients with acute myocardial infarction ( AMI) to reduce the short-term mortality.However, little research has been done on PCI in eld-erly AMI patients.The study aimed to evaluate the efficacy and the safety of percutaneous coronary intervention in elderly AMI patients (≥75 years old) . Methods 213 AMI patients who underwent emergency PCI in Jingling Hospital from January 2012 to December 2013 were divided into 2 groups:elderly group (≥75 years old, n=57) and non-elderly group (<75years old,n=156).Retrospec-tive analysis were made on the clinical data and the coronary intervention features of the patients. Results There were more patients having dyspnea, fatigue and other heart failure symptoms at the onset of first-break AMI in elderly group than in non-elderly group (21.1%vs 3.2%,P<0.0).More women (47.4% vs 16.7%,P<0.01) and more patients with hypertention or diabetes mellitus were found in elderly group.The procedure success rates with TIMI-3 flow grade of post-PCI in both groups were very high (100%). Compared with non-elderly group, the occurrence of the procedure-related complications (3.5%vs 2.6%,P=NS) and major adverse cardiac event rates (8.8%vs 6.4%,P=NS) and in-hospital mortality (5.3%vs 2.6%,P=NS) showed no significant difference.Conclusion There are more atypical clinical symptoms in elderly AMI patients. The emergency PCI in elderly AMI patients can effectively make artery unimpeded with high successful rate, few com-plications and a favorable short-term prognosis.
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Objective To evaluate the influence of C-reactive protein (CRP),insulin resistance (IR) and epicardial fat volume (EFV) on the extent of coronary atherosclerosis in patients with different body mass index(BMl).Methods One hundred and three patients with coronary artery disease were involved in current study who underwent 64-slice dual source CT and percutaneous coronary angiography.Measurements of height,weight,waist circumference (WC) were recorded,and BMI was calculated.All patients were divided into obesity group (n =45) and non-obesity group (n =58) based on BMI.EFV were calculated through 64-slice dual source CT.Blood samples were collected for biochemical examination.Gensini score were adopted to quantify the severity of coronary artery stenosis.The relationship between Gensini score and EFV,CRP and homeostasis model assessment-insulin resistance(HOMA-IR) index were statistical analyzed by SPSS16.0 software.Results The level of CRP,WC,EFV and BMI in obesity group were (11.0 ± 5.8) mg/L,(96.1 ± 7.0) cm,(122.7 ± 43.3) cm3,(27.9 ± 2.9) kg/m2 respectively,significantly higher than those in non-obesity group ((6.5 ± 3.4) mg/L,(86.4 ± 7.6) cm,(92.9 ± 39.5) cm3,(22.4 ± 1.9) kg/m2) and the differences were significant (t =2.24,6.74,3.64,11.74,and P ＜ 0.05).CRP were positively correlated with EFV (r =0.404,0.364,P ＜0.05) in both obesity and non-obesity group,While HOMA-IR were only associated with BMI in obese group(r =0.322,P ＜0.05).Gensini score in non-obesity groups were positively related with EFV and CRP (r =0.358,0.315,P ＜ 0.05),while in obesity groups were positively related with EFV,CRP and HOMA-IR(r =0.348,0.297,0.384; P ＜ 0.05).The associations between Gensini score and CRP were not significant in obesity group after adjusting BMI and WC.Multiple linear regression analysis showed that EFV and diabetes mellitus were independent risk factors of patient Gensini score.Conclusion Coronary atherosclerosis is positively related with EFV and CRP in all patients.While,coronary atherosclerosis is influenced by BMI,WC and HOMA-IR in obese group.EFV is an independent risk factor of coronary atherosclerosis.
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Objective To explore the disparity of severity of cardiac dysfunction and recovery among different glycometabolic patients in the early phase of acute myocardial infarction (AMI) . Methods Consecutive 111 AMI patients without known diabetes underwent continuous glucose monitoring. Patients with different glycometabolic status were compared in terms of cadiac dysfunction and recovery at admission and 3month follow up. Results Compared to patients with normglycemia and transient hyperglycemia, patitents with persistent hyperglycemia were more likely to grade Killip Ⅱ or above,which were 13.3% (4/30) ,33. 3% ( 12/36) ,55. 6% (25/45), 20. 0% ( 6/30), 41.7% ( 15/36 ) and 93.3% (42/45) ( Ps ＜ 0. 01 ). In-hospital left ventricular ejection fraction (LVEF), mitral valve protodiastolic E peak velocities (E) and its ratio to late diastolic (E/A) decreased significantly ( LVEF :0. 52 ± 0. 02,0. 48 ± 0. 01 and 0. 37 ± 0. 02; E: [0. 65 ± 0. 41]m/s,[0.55 ± 0.02] m/s and [0.39 ±0. 12]m/s;E/A:1. 15 ±0.08,1.02 ±0.06 and 0.61 ±0.02,respectively) ( Ps ＜ 0. 01 ), whereas LVESV and WMSI increased significantly ( LVESV: [25.83 ± 0. 51] ml,[31.26 ± 1.23] ml, [37, 72 ± 1.01] ml; WMSI: 1.5 ± 0. 3,1.8 ± 0. 2 and 2. 6 ± 0. 4, respectively) ( Ps ＜ 0. 01 )There months after AMI,patitents with persistent hyperglycemia were more likely to grade NYHA Ⅱ or above compared to patients with normglycemia and transient hyperglycemia [67.5% (27/40), 10.0% (3/30) and 11.8% (4/34),respectively] (P ＜0. 01 ). Echocardiographic recovery was observed in each group,but less in persistent hyperglycemia patients. Conclusion Cardiac function of patients with persistent hyperglycemia suffered more severely from AMI and difficult to recover.
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Objective To approach the effect of hyperglycemia on admission on the prognosis in female pa-tients with acute myocardial infarction (AMI) during hospital stay. Methods 171 female AMI patients without a history of diabetes mellitus from January 1998 to December 2007 were divided into 3 groups according to the blood glucose level on admission. Group Ⅰ included 69 cases with blood glucose <6. 1 mmol/L,group Ⅱ included 49 cases with blood glucose between 6.1 and 7.8 mmol/L,and group Ⅲ included 53 cases with blood glucose >7.8 mmoL/ L. The basic clinical profile, infarct sites, the incidence rates of the main complications and the mortality of the pa-rhythmia among group Ⅲ ,group Ⅰ and group Ⅱ were significantly different ( the incidence rate of cardiac failure was 30.43% (21/69) ,32.65% (16/49) and 58.49% (31/53), the incidence rate of cardiogenic shock was 5.80% (4/69) ,8.16% (4/49) and 24.53% (13/53) ; the incidence rate of severe arrhythmia was 24.64% (17/69) ,30. 61% (15/49) and 54.72% ( 29/53), respeetivley in group Ⅰ, group Ⅱ and group Ⅲ, P < 0.05 for each). The in-hospital mortality in group Ⅲ (28.30% (15/53) ) was remarkably higher than group Ⅰ ( 13.04% (6/69)) ,with significant difference ( P < 0.05 ). Conclusions Elevated blood glucose level on admission is associated with s markedly increased risk of cardiac failure,severe arrhythmia,cardiogenic shock and mortality during hospital stay in female patients suffering from AMI.
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Objective : To investigate the efficacy and safty of radiofrequency ablation for arrhythmia. Methods: The clinical data of 1 065 patients with arrhythmia by Radiofrequency ablation treatment were analyzed retrospectively, including 537 cases of atrioventricular nodal reentrant tachycardia, 386 cases of atrioventricular reentrant tachycardia, 59 cases of ventricular premature, 26 cases of ventricular tachycardia, 35 cases of atrial flutter, and 8 cases of paroxysmal atrial fibrillation. Results:The procedural succeed rate was 96. 80% , and complication was 1. 56%. Conclusion: Radiofrequency ablation was an safe and effective method in treating arrhythmia.
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Objective: To observe the impact of spontaneously hypertensive diabetes mellitus(SHDM) on myocardial cell structure and cardiac function.Methods: Twenty-four SD rats were equally divided into an SD(control),a DM,an SH and an SHDM group.DM and SHDM were induced in the SD and SH rats by intraperitoneal injection of streptozotocin combined with high fat diet,followed by invasive detection of the cardiac function and pathological examination of the myocardial cell structure 16 weeks later.Results: Disorganized array,decreased interspaces,scattered degenerate necrosis and damaged mitochondria were observed in the cardiac cells of the SHDM group.The left ventricular end-diastolic pressure(LVEDP) was significantly higher in the SH,DM and SHDM groups than in the SD group(P
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Objective To evaluate the therapeutic efficacy and safety of transcatheter closure of atrial septal defect (ASD) and patent ductus arteriosus (PDA) using Amplatzer occluder. Methods Routine cardiac catheterization and angiography were performed in 50 patients (23 male, 27 female, age ranging from 3 to 64 years old), including 19 cases of ASD and 31 cases of PDA under local or general anesthesia. After balloon sizing of the ASD, the optimal Amplazter septal occluder (ASO) was transmitted into the left atrial, and the left and right disks were released in turn. The Amplatzer occluder was completely released after transthoracic echocardiography confirmed that there was no residual shunts or new onset mitral valve regurgitation. The Amplatzer duct occluder (ADO) size was selected according to the narrowest point of PDA measured by angiography, and the occluder was released after the repeated angiography showed no residual shunts. Results ① The mean diameter of the ASD measured by balloon was 13-31 (23?6) mm and the diameter of ASO was (17-40) mm. The immediate closure rate was 100%. ② Angiography confirmed that closure of the ductus using ADO was achieved in 30 patients, and closure of the large size (12 mm) was achieved in 1 case of PDA patient using ASO (17 mm). No complications were encountered. Conclusion Transcatheter closure of ASD and PDA using Amplatzer device, with the advantages of simple operation, confirmative occlusion efficacy, minimal invasiveness, wide indications, and less complications, has a bright future of clinical application.
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Objective To investigate the inhibition effect of insulin on apoptosis of myocardial mitochondria in type 2 diabetic rats and its anti-apoptotic mechanism through its action on the mitochondria.Methods Type 2 diabetes mellitus (T2DM) was reproduced in male Wistar rats by intraperitoneal injection of streptozotocin (STZ,25mg/kg) and feeding with a high-fat diet.Twenty-two rats were randomly divided into three groups:the early treatment group (IE,n=7),the late treatment group (IL,n=7) and the diabetic group (DM,n=8).Another eight rats were chosen to constitute the control group.Novolin 30R was hypodermically injected into the rats in IE group in the first week and in IL group in the 4th week.Rats in DM group and control group were subcutaneously injected with an equivalent volume of normal saline.All groups were treated for eight weeks.At the end of the experiment,SOD,MDA,GSH levels,apoptotic index,mitochondrial membrane potential (?m),active oxygen and the changes in myocardial ultrastructure were compared among different groups.Results Compared with control group,blood glucose and HW/BW were higher (P
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Objective To investigate the effects of diabetic mellitus on the opening of mycardial mitochondrial permeability transition pore (MPTP) in rats,and to explore the role of the opening of MPTP in the development of diabetic cardiomyopathy.Methods Sixteen male Wistar rats were randomly divided into normal control group (NC) and diabetic mellitus group (DM) (8 each).Diabetic mellitus model was reproduced by a single intraperitoneal injection of streptozotocin (STZ).After 12 weeks,the production rate of mitochondrial reactive oxygen species (ROS) and the change in mitochondrial membrane potential (MMP) in myocardial mitochondria were assayed by fluorospectrophotometer.Cardiomyocyte apoptosis was evaluated by terminal-deoxynucleotidyl transferase mediated deoxy-UTP nick end labeling (TUNEL),and the glutathione (GSH) level in serum was measured by spectrophotometer.Results Compared with NC group [13.01?3.31U/(s?mg)],the production rate of mitochondrial ROS was significantly increased in DM group [28.79?6.11U/(s?mg),P
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Objective To investigate the effect of telmisartan on mitochondrial membrane potential and cardiomyocyte apoptosis of rats with type 1 diabetes.Methods Type 1 diabetic rat model was reproduced by intraperitoneal injection of streptozotocin to adult male Wistar rats.Sixteen diabetic rats were randomly divided into two groups (8 each):DM group and T group (rats were treated with telmisartan).Another 8 normal rats served as control (Con group).After 12 weeks,the levels of reactive oxygen species (ROS) were detected by fluorescent probe DCFH-DA,and the changes in mitochondrial membrane potential (?m) was detected by fluorescent probe JC-1.Cardiomyocyte apoptosis was evaluated by TUNEL.Results The levels of blood glucose were higher and body weight was lower in both DM and T group than in Con group at 7th day and 12th week after streptozotocin injection (P
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Objective Diabetic mellitus is one of the major threats to human health.The prevalence of diabetes mellitus is growing rapidly worldwide.Patients with diabetes mellitus are at increased risk for cardiovascular diseases.Diabetic cardiomyopathy (DC) is related to diabetes-specific metabolism,but the mechanism is not entirely clear.Recent studies suggest that abnormal myocardial energy metabolism and reduced number of myocardial cells may be the important pathophysiological mechanism that leads to heart function impairment of diabetes patients.Mitochondria are not only an important place generating cellular energy,also involved in the apoptotic and death process of cells.Therefore,mitochondrial dysfunctions play a key role in the process of DC.Mitochondrial permeability transition (MPT) is a center for information exchange within and outside the mitochondria and plays a key role in the maintenance of mitochondrial function.MPT works through the mitochondrial permeability transition pore (MPTP).In our recent studies,it was found that MPTP function changed in DC and its abnormality could be corrected by specific AT I receptor antagonist.These findings are important for better understanding DC.