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1.
Medicine (Baltimore) ; 100(3): e23947, 2021 Jan 22.
Artículo en Inglés | MEDLINE | ID: mdl-33545971

RESUMEN

BACKGROUND: Subclinical hypothyroidism (SCH) can increase the risk of heart failure (HF) clinically. However, thyroxine therapy for patients with HF and SCH has the risk of developing tachyarrhythmias. At present, there is no sufficient evidence-based medical evidence for levothyroxine in the therapy of this situation, and the treatment issue is still controversial. Therefore, our meta-analysis aims to assess the effectiveness and safety of thyroxine therapy for patients with HF and SCH. METHODS: We searched the related randomized controlled trials that have been published in the following 7 electronic databases: PubMed, Cochrane Library, EMBASE, Chongqing VIP, China National Knowledge Infrastructure, Chinese biomedical literature database, and Wan Fang database. The treatment group was treated with routine HF therapy plus thyroxine, while the control group was treated with HF routine therapy. Main outcome measures effective rate and New York Heart Association classification; Secondary outcome measures included: left ventricular ejection fraction, quality of life score, brain natriuretic peptide / N-terminal pro brain natriuretic peptide, 6-minute walk test, and adverse events. After screening studies and extracting data, we will use Cochrane collaborative tools to evaluate the risk of bias to assess the methodological quality of the included randomized controlled trials. We will use STATA 14.0 software for data synthesis and statistical analysis. Both subgroup analysis and sensitivity analysis will be used to detect potential sources of heterogeneity. In addition, we will use sensitivity analysis to test the stability of the outcomes. If possible, we will perform a funnel chart and Eggers test evaluate publication bias. The quality of the evidence will be evaluated through the grades of recommendations assessment, development, and evaluation system. RESULTS: Our findings will be published in peer-reviewed journals. CONCLUSION: This research will provide evidence about the efficacy and safety of thyroxine in the treatment of patients with HF and SCH. Objective to provide evidence-based medicine basis for thyroxine treatment of patients with SCH and HF. REGISTRATION NUMBER: INPLASY2020100062.


Asunto(s)
Protocolos Clínicos , Insuficiencia Cardíaca/tratamiento farmacológico , Hipotiroidismo/tratamiento farmacológico , Tiroxina/uso terapéutico , Insuficiencia Cardíaca/fisiopatología , Humanos , Hipotiroidismo/fisiopatología , Metaanálisis como Asunto , Revisiones Sistemáticas como Asunto
2.
Sensors (Basel) ; 21(3)2021 Jan 28.
Artículo en Inglés | MEDLINE | ID: mdl-33525556

RESUMEN

Heart failure (HF) is a major health care issue, and the incidence of HF is only expected to grow further. Due to the frequent hospitalizations, HF places a major burden on the available hospital and healthcare resources. In the future, HF care should not only be organized solely at the clinical ward and outpatient clinics, but remote monitoring strategies are urgently needed to guide, monitor, and treat chronic HF patients remotely from their homes as well. The intuitiveness and relatively low costs of non-invasive remote monitoring tools make them an appealing and emerging concept for developing new medical apps and devices. The recent COVID-19 pandemic and the associated transition of patient care outside the hospital will boost the development of remote monitoring tools, and many strategies will be reinvented with modern tools. However, it is important to look carefully at the inconsistencies that have been reported in non-invasive remote monitoring effectiveness. With this review, we provide an up-to-date overview of the available evidence on non-invasive remote monitoring in chronic HF patients and provide future perspectives that may significantly benefit the broader group of HF patients.


Asunto(s)
Continuidad de la Atención al Paciente/tendencias , Insuficiencia Cardíaca/terapia , Monitoreo Fisiológico/métodos , Telemedicina/tendencias , Insuficiencia Cardíaca/diagnóstico , Humanos , Pandemias , Telemetría , Teleenfermería
3.
Medicine (Baltimore) ; 100(7): e24414, 2021 Feb 19.
Artículo en Inglés | MEDLINE | ID: mdl-33607775

RESUMEN

BACKGROUND: Coronary heart disease is a serious cardiovascular disease. There is coronary atherosclerosis, resulting in lumen stenosis, blockage, and then the symptoms of insufficient blood supply and hypoxia in the myocardium. Chronic heart failure is a kind of syndrome with abnormal ventricular filling and ejection function, which is the final stage of the development of coronary heart disease. At present, the treatment plan of Western medicine can significantly reduce the hospitalization rate, but it is still not satisfactory for the prognosis and mortality of patients. Shenfu injection has advantages in the treatment of heart failure in patients with coronary heart disease, but there is a lack of standard clinical studies to verify it, so the purpose of this randomized controlled study is to evaluate the efficacy and safety of Shenfu injection combined with sodium nitroprusside in the treatment of chronic heart failure in patients with coronary heart disease. METHODS: This is a prospective randomized controlled trial to study the efficacy and safety of Shenfu injection combined with sodium nitroprusside in the treatment of chronic heart failure in patients with coronary heart disease. The patients will be randomly divided into a treatment group and the control group according to 1:1, in which the treatment group is treated with Shenfu injection combined with sodium nitroprusside, and the control group is treated with sodium nitroprusside alone. Both groups will be treated with standard treatment for 7 days and followed up for 30 days to pay attention to their efficacy and safety indexes. The observation indexes include TCM syndrome score, N-terminal pro-brain natriuretic peptide, left ventricular ejection fraction, brain natriuretic peptide, left ventricular end-systolic diameter, left ventricular end-diastolic diameter, stroke volume, adverse reactions and so on. We will use SPSS 25.0 software for data analysis. DISCUSSION: This study will evaluate the efficacy and safety of Shenfu injection combined with sodium nitroprusside in the treatment of chronic heart failure in patients with coronary heart disease. The results of this experiment will provide a clinical basis for Shenfu injection combined with sodium nitroprusside in the treatment of chronic heart failure in coronary heart disease. TRIAL REGISTRATION: DOI 10.17605/OSF.IO/4KNG3.


Asunto(s)
Medicamentos Herbarios Chinos/administración & dosificación , Insuficiencia Cardíaca/tratamiento farmacológico , Nitroprusiato/uso terapéutico , Vasodilatadores/uso terapéutico , Adulto , Anciano , Quimioterapia Combinada , Femenino , Humanos , Inyecciones , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Ensayos Clínicos Controlados Aleatorios como Asunto
4.
MMW Fortschr Med ; 163(2): 26, 2021 02.
Artículo en Alemán | MEDLINE | ID: mdl-33527278
5.
JAMA ; 325(6): 542-551, 2021 02 09.
Artículo en Inglés | MEDLINE | ID: mdl-33560320

RESUMEN

Importance: Endurance exercise is effective in improving peak oxygen consumption (peak V̇o2) in patients with heart failure with preserved ejection fraction (HFpEF). However, it remains unknown whether differing modes of exercise have different effects. Objective: To determine whether high-intensity interval training, moderate continuous training, and guideline-based advice on physical activity have different effects on change in peak V̇o2 in patients with HFpEF. Design, Setting, and Participants: Randomized clinical trial at 5 sites (Berlin, Leipzig, and Munich, Germany; Antwerp, Belgium; and Trondheim, Norway) from July 2014 to September 2018. From 532 screened patients, 180 sedentary patients with chronic, stable HFpEF were enrolled. Outcomes were analyzed by core laboratories blinded to treatment groups; however, the patients and staff conducting the evaluations were not blinded. Interventions: Patients were randomly assigned (1:1:1; n = 60 per group) to high-intensity interval training (3 × 38 minutes/week), moderate continuous training (5 × 40 minutes/week), or guideline control (1-time advice on physical activity according to guidelines) for 12 months (3 months in clinic followed by 9 months telemedically supervised home-based exercise). Main Outcomes and Measures: Primary end point was change in peak V̇o2 after 3 months, with the minimal clinically important difference set at 2.5 mL/kg/min. Secondary end points included changes in metrics of cardiorespiratory fitness, diastolic function, and natriuretic peptides after 3 and 12 months. Results: Among 180 patients who were randomized (mean age, 70 years; 120 women [67%]), 166 (92%) and 154 (86%) completed evaluation at 3 and 12 months, respectively. Change in peak V̇o2 over 3 months for high-intensity interval training vs guideline control was 1.1 vs -0.6 mL/kg/min (difference, 1.5 [95% CI, 0.4 to 2.7]); for moderate continuous training vs guideline control, 1.6 vs -0.6 mL/kg/min (difference, 2.0 [95% CI, 0.9 to 3.1]); and for high-intensity interval training vs moderate continuous training, 1.1 vs 1.6 mL/kg/min (difference, -0.4 [95% CI, -1.4 to 0.6]). No comparisons were statistically significant after 12 months. There were no significant changes in diastolic function or natriuretic peptides. Acute coronary syndrome was recorded in 4 high-intensity interval training patients (7%), 3 moderate continuous training patients (5%), and 5 guideline control patients (8%). Conclusions and Relevance: Among patients with HFpEF, there was no statistically significant difference in change in peak V̇o2 at 3 months between those assigned to high-intensity interval vs moderate continuous training, and neither group met the prespecified minimal clinically important difference compared with the guideline control. These findings do not support either high-intensity interval training or moderate continuous training compared with guideline-based physical activity for patients with HFpEF. Trial Registration: ClinicalTrials.gov Identifier: NCT02078947.


Asunto(s)
Terapia por Ejercicio/métodos , Ejercicio Físico , Insuficiencia Cardíaca/metabolismo , Entrenamiento de Intervalos de Alta Intensidad , Consumo de Oxígeno , Anciano , Medicina Basada en la Evidencia , Tolerancia al Ejercicio , Femenino , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/terapia , Humanos , Masculino , Guías de Práctica Clínica como Asunto , Volumen Sistólico
6.
BMC Pulm Med ; 21(1): 52, 2021 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-33546651

RESUMEN

OBJECTIVE: To develop and validate a clinical risk prediction score for noninvasive ventilation (NIV) failure defined as intubation after a trial of NIV in non-surgical patients. DESIGN: Retrospective cohort study of a multihospital electronic health record database. PATIENTS: Non-surgical adult patients receiving NIV as the first method of ventilation within two days of hospitalization. MEASUREMENT: Primary outcome was intubation after a trial of NIV. We used a non-random split of the cohort based on year of admission for model development and validation. We included subjects admitted in years 2010-2014 to develop a risk prediction model and built a parsimonious risk scoring model using multivariable logistic regression. We validated the model in the cohort of subjects hospitalized in 2015 and 2016. MAIN RESULTS: Of all the 47,749 patients started on NIV, 11.7% were intubated. Compared with NIV success, those who were intubated had worse mortality (25.2% vs. 8.9%). Strongest independent predictors for intubation were organ failure, principal diagnosis group (substance abuse/psychosis, neurological conditions, pneumonia, and sepsis), use of invasive ventilation in the prior year, low body mass index, and tachypnea. The c-statistic was 0.81, 0.80 and 0.81 respectively, in the derivation, validation and full cohorts. We constructed three risk categories of the scoring system built on the full cohort; the median and interquartile range of risk of intubation was: 2.3% [1.9%-2.8%] for low risk group; 9.3% [6.3%-13.5%] for intermediate risk category; and 35.7% [31.0%-45.8%] for high risk category. CONCLUSIONS: In patients started on NIV, we found that in addition to factors known to be associated with intubation, neurological, substance abuse, or psychiatric diagnoses were highly predictive for intubation. The prognostic score that we have developed may provide quantitative guidance for decision-making in patients who are started on NIV.


Asunto(s)
Reglas de Decisión Clínica , Intubación Intratraqueal/estadística & datos numéricos , Ventilación no Invasiva , Insuficiencia Respiratoria/terapia , Afroamericanos/estadística & datos numéricos , Anciano , Asma/epidemiología , Estudios de Cohortes , Registros Electrónicos de Salud , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Insuficiencia Cardíaca/epidemiología , Mortalidad Hospitalaria , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Infarto del Miocardio/epidemiología , Enfermedades del Sistema Nervioso/epidemiología , Neumonía/epidemiología , Trastornos Psicóticos/epidemiología , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Respiración Artificial/estadística & datos numéricos , Insuficiencia Respiratoria/epidemiología , Estudios Retrospectivos , Medición de Riesgo , Sepsis/epidemiología , Accidente Cerebrovascular/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Insuficiencia del Tratamiento
7.
Medicine (Baltimore) ; 100(5): e24117, 2021 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-33592862

RESUMEN

BACKGROUND: Homocysteine (Hcy) is one of the main factors leading to arteriosclerosis, which is closely related to cardiovascular disease. Recent studies have found that serum Hcy levels are increased in patients with chronic heart failure (CHF), and it is speculated that Hcy may be a risk factor for CHF, but evidence-based medicine evidence is lacking. The aim of this study was to investigate the correlation between serum Hcy levels and CHF by means of systematic review. METHODS: The databases of PubMed, Embase, The Cochrance Library, Web of Science, CNKI (China National Knowledge Infrastructure), VIP (China Science and Technology Journal Database), Wanfang and China Biology Medicine disc were searched by computer. In addition, Baidu Scholar and Google Scholar were manually searched to collect all case-control studies related to serum Hcy and CHF. The search time limit was from database establishment to November 2020. Two reviewers independently screened the literatures, extracted the data and evaluated the risk of bias of the included literatures. RESULTS: In this study, we evaluated the correlation between serum Hcy levels and CHF by the levels of serum Hcy in CHF patients and non-CHF patients. CONCLUSIONS: This study will provide reliable evidence for the clinical value of serum Hcy in the field of CHF disease. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/QMPRC.


Asunto(s)
Insuficiencia Cardíaca/sangre , Homocisteína/análisis , Enfermedad Crónica , Insuficiencia Cardíaca/fisiopatología , Humanos , Metaanálisis como Asunto , Proyectos de Investigación , Revisiones Sistemáticas como Asunto
8.
Adv Clin Exp Med ; 30(1): 67-75, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33529509

RESUMEN

BACKGROUND: Despite the progress in the treatment of heart failure with reduced ejection fraction (HFrEF), the prognosis remains unfavorable. OBJECTIVES: To evaluate the effectiveness, tolerance and safety after one-year follow-up of Polish patients with stable chronic HFrEF treated with sacubitril/valsartan. MATERIAL AND METHODS: This was an observational multicenter study conducted in 3 centers (Kraków, Lódz and Warszawa) specializing in heart failure (HF). We enrolled 89 HFrEF patients (aged 59.3 ±13.5 years, 82% males) in NYHA class II-IV (ambulatory). Clinical, laboratory and echocardiographic parameters were evaluated at baseline and after a one-year follow-up. The composite endpoint was defined as death or urgent HF hospitalization. RESULTS: After 1 year, 80% of patients used 50% or more of the target dose of sacubitril/valsartan. After a year of treatment, there were significant improvements of HF symptoms, N-terminal prohormone B-type natriuretic peptide (NT proBNP), ejection fraction (EF), and distance in six-minute walk test (6MWP) (all p < 0.001). Patients treated with the highest dose of sacubitril/valsartan exhibited the greatest benefits. The safety profile was favorable and consistent with that previously reported; however, therapy discontinuation due to side effects occurred in 11% of patients. The independent predictors for composite endpoint (n = 24, 26.9%) were history of HF hospitalization, tricuspid annular plane systolic excursion (TAPSE) and angiotensin-converting-enzyme inhibitor (ACEI)-naive patients. CONCLUSIONS: Treatment of chronic HFrEF patients with sacubitril/valsartan is safe and is associated with significant clinical and objective improvement. The non-survivors had more advanced HF, so the initiation and uptitration of sacubitril/valsartan should be done early.


Asunto(s)
Aminobutiratos/uso terapéutico , Insuficiencia Cardíaca , Tetrazoles/uso terapéutico , Anciano , Antagonistas de Receptores de Angiotensina/efectos adversos , Combinación de Medicamentos , Femenino , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Polonia , Volumen Sistólico , Valsartán
9.
Rev Soc Bras Med Trop ; 54: e07892020, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33533821

RESUMEN

Covid-19 is a novel infectious disease whose spectrum of presentation ranges from absence of symptoms to widespread interstitial pneumonia associated with severe acute respiratory syndrome (SARS), leading to significant mortality. Given the systemic pattern of Covid-19, there are many factors that can influence patient's functional capacity after acute infection and the identification of such factors can contribute to the development of specific rehabilitation strategies. Pulmonary impairment is the primary cause of hospitalization due to Covid-19, and can progress to SARS as well as increase length of hospitalization. Moreover, cardiac involvement is observed in approximately 30% of hospitalized patients, with an increased risk of acute myocarditis, myocardial injury, and heart failure, which may compromise functional capacity in the long-term. Thromboembolic complications have also been reported in some patients with Covid-19 and are associated with a poor prognosis. Musculoskeletal complications may result from long periods of hospitalization and immobility, and can include fatigue, muscle weakness and polyneuropathy. Studies that address the functional capacity of patients after Covid-19 infection are still scarce. However, based on knowledge from the multiple systemic complications associated with Covid-19, it is reasonable to suggest that most patients, especially those who underwent prolonged hospitalization, will need a multiprofessional rehabilitation program. Further studies are needed to evaluate the functional impact and the rehabilitation strategies for patients affected by Covid-19.


Asunto(s)
Insuficiencia Cardíaca , Miocarditis , Hospitalización , Humanos
10.
Int Heart J ; 62(1): 23-32, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33518662

RESUMEN

The aim of this study was to explore potential predictive biomarkers and therapeutic targets of post-infarct heart failure (HF) using bioinformatics analyses.CEL raw data of GSE59867 and GSE62646 were downloaded from the GEO database. Differentially expressed genes (DEGs) between patients with ST-segment elevation myocardial infarction (STEMI) and those with stable coronary artery disease (CAD) at admission and DEGs between admission and 6 months after myocardial infarction (MI) in patients with STEMI were analyzed. A gene ontology (GO) analysis and a gene set enrichment analysis (GSEA) were performed, and a protein-protein interaction network was constructed. Critical genes were further analyzed.In total, 147 DEGs were screened between STEMI and CAD at admission, and 62 DEGs were identified in patients with STEMI between admission and 6 months after MI. The results of GO and GSEA indicate that neutrophils, neutrophil-related immunity responses, and monocytes/macrophages play important roles in MI pathogenesis. SLED1 expression was higher in patients with HF than in those without HF at admission and 1 month after MI. GSEA indicates that mTORC1 activation, E2F targets, G2M checkpoint, and MYC targets v1 inhibition may play key roles in the development of post-infarct HF. Furthermore, SLED1 may be involved in the development of post-infarct HF by activating mTORC1 and inhibiting E2F targets, G2M checkpoint, and MYC targets v1.SLED1 may be a novel biomarker of post-infarct HF and may serve as a potential therapeutic target in this disease.


Asunto(s)
Proteína Mayor Básica del Eosinófilo/metabolismo , Insuficiencia Cardíaca/metabolismo , Infarto del Miocardio con Elevación del ST/complicaciones , Biomarcadores/metabolismo , Proteína Mayor Básica del Eosinófilo/genética , Perfilación de la Expresión Génica , Insuficiencia Cardíaca/genética , Humanos , Mapas de Interacción de Proteínas , Infarto del Miocardio con Elevación del ST/genética , Infarto del Miocardio con Elevación del ST/metabolismo
11.
Int Heart J ; 62(1): 4-8, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33518664

RESUMEN

Functional mitral regurgitation (FMR) frequently coexists with left ventricular systolic dysfunction and advanced heart failure, and typically has poor clinical outcomes. Although various therapeutic options including cardiac resynchronization therapy and surgical mitral intervention, have been proposed, an optimal treatment strategy for functional mitral regurgitation has not yet been established. Over the last decade, transcatheter mitral valve repair using MitraClip has emerged as a novel alternative therapeutic option for functional mitral regurgitation. In 2018, the COAPT trial demonstrated that MitraClip treatment reduced rehospitalization due to heart failure and all-cause death in patients with functional mitral regurgitation and heart failure. As a consequence, the MitraClip has become a very promising potential treatment for functional mitral regurgitation. In this review, we discuss and summarize the current status and future perspectives of the treatment for functional mitral regurgitation and heart failure.


Asunto(s)
Procedimientos Endovasculares/instrumentación , Insuficiencia Cardíaca/complicaciones , Anuloplastia de la Válvula Mitral/instrumentación , Insuficiencia de la Válvula Mitral/cirugía , Humanos , Insuficiencia de la Válvula Mitral/complicaciones
14.
Kardiologiia ; 60(12): 13-47, 2021 Jan 19.
Artículo en Ruso | MEDLINE | ID: mdl-33522467

RESUMEN

The document focuses on key issues of diuretic therapy in CHF from the standpoint of current views on the pathogenesis of edema syndrome, its diagnosis, and characteristics of using diuretics in various clinical situations.


Asunto(s)
Diuréticos , Insuficiencia Cardíaca , Enfermedad Crónica , Insuficiencia Cardíaca/tratamiento farmacológico , Humanos , Federación de Rusia
15.
Kardiologiia ; 60(12): 48-63, 2021 Jan 19.
Artículo en Ruso | MEDLINE | ID: mdl-33522468

RESUMEN

Diagnosis of heart failure with preserved ejection fraction (HFpEF) is associated with certain difficulties since many patients with HFpEF have a slight left ventricular diastolic dysfunction and normal filling pressure at rest. Diagnosis of HFpEF is improved by using diastolic transthoracic stress-echocardiography with dosed exercise (or diastolic stress test), which allows detection of increased filling pressure during the exercise. The present expert consensus explains the requirement for using the diastolic stress test in diagnosing HFpEF from clinical and pathophysiological standpoints; defines indications for the test with a description of its methodological aspects; and addresses issues of using the test in special patient groups.


Asunto(s)
Investigación Biomédica , Cardiología , Insuficiencia Cardíaca , Consenso , Ecocardiografía , Ecocardiografía de Estrés , Prueba de Esfuerzo , Insuficiencia Cardíaca/diagnóstico por imagen , Humanos , Federación de Rusia , Volumen Sistólico , Función Ventricular Izquierda , Carga de Trabajo
17.
Yonsei Med J ; 62(2): 129-136, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33527792

RESUMEN

PURPOSE: Acute decompensated heart failure (ADHF) caused by ischemic heart disease is associated with higher mortality and requires immediate diagnosis. Recently, novel methods to diagnose non-ST elevation myocardial infarction (NSTEMI) using high-sensitivity cardiac troponin have been applied. We compared the clinical utility of high-sensitivity troponin I (hS-TnI), delta troponin I, and other traditional methods to diagnose NSTEMI in patients with ADHF. MATERIALS AND METHODS: This retrospective cross-sectional study was conducted to analyze patients with ADHF who underwent hS-TnI evaluation of 0-2-h protocol in our emergency department. Patients were grouped according to a diagnosis of NSTEMI. RESULTS: A total of 524 ADHF [ADHF with NSTEMI, n=109 (20.8%)] patients were enrolled in this analysis. The mean values of hS-TnI (ng/mL) in the ADHF with and without NSTEMI groups were 2.44±5.60 and 0.25±0.91, respectively. Multivariable analysis revealed that regional wall-motion abnormality, T-wave inversion/hyperacute T wave, and initial and delta hS-TnI were predictive factors for NSTEMI. Laboratory values related to cardiac biomarkers, including hS-TnI [odds ratio (OR) (95% confidence interval, CI): 2.18], and the delta hS-TnI [OR (95% CI): 1.55] were significant predictors of NSTEMI. Moreover, receiver operating characteristic analysis showed that the areas under receiver operating characteristic curves for electrocardiographic abnormalities, initial hS-TnI, and delta hS-TnI were 0.794, 0.802, and 0.773, respectively. CONCLUSION: For diagnosis of suspected NSTEMI in patients with ADHF, initial hS-TnI assay has similar predictive value as ischemic changes on electrocardiogram and superior predictive value than delta hS-TnI calculated by the 0-2-h protocol.


Asunto(s)
Bioensayo , Insuficiencia Cardíaca/complicaciones , Infarto del Miocardio/complicaciones , Infarto del Miocardio/diagnóstico , Troponina I/metabolismo , Anciano , Biomarcadores , Estudios Transversales , Diagnóstico Diferencial , Electrocardiografía , Servicio de Urgencia en Hospital , Femenino , Insuficiencia Cardíaca/diagnóstico por imagen , Humanos , Modelos Logísticos , Masculino , Análisis Multivariante , Infarto del Miocardio/diagnóstico por imagen , Péptido Natriurético Encefálico/metabolismo , Curva ROC , Estudios Retrospectivos
18.
Medicine (Baltimore) ; 100(6): e24301, 2021 Feb 12.
Artículo en Inglés | MEDLINE | ID: mdl-33578525

RESUMEN

RATIONALE: Marfan syndrome (MFS) has been defined as a genetic disorder that affects various systems such as the musculoskeletal, orbital, and cardiovascular systems. Neonatal MFS is considered rare and the most severe form of MFS is characterized by rapidly progressive atrioventricular valve dysfunction, often leading to death during early childhood due to congestive heart failure. PATIENT CONCERNS: A newborn with neonatal MFS and severe cardiac involvement. He presented various severe clinical features such as arachnodactyly, camptodactyly, elbow and knee joint contracture, senile facial appearance, and deep settling with down-slanting palpebral fissure, hypoplastic ear cartilage, sagging mouth, brachycephaly, and ectopia lentis. DIAGNOSIS: Genetic analysis revealed a novel mutation at nucleotide 3964 (c.3964 + 1 G > T) in intron 32 of the fibrillin-1 gene. This mutation is identified to be in the so-called neonatal region of fibrillin-1 exon 24 to 32, as reported previously. INTERVENTIONS: The patient was managed medically for improving the low cardiac output according to severe mitral regurgitation and aortic regurgitation. Afterload reduction, full sedation, and use of diuretic were attempted to improve the oliguria and heart failure. OUTCOMES: Despite the medical management, aortic regurgitation, mitral regurgitation, pulmonary hypertension, and cardiac contractility got worse. Surgical treatment is essential to prolong the patient's life, however, considerations for the grave progression of the disease make families decide to continue palliative care instead of surgical treatment. A few months after birth, he presented with rapidly progressive aortic regurgitation, mitral regurgitation, and congestive heart failure leading to death. CONCLUSIONS: This review demonstrated the prominent characteristics of neonatal MFS mutations, it would be helpful for the recognition of novel neonatal MFS variants and valuable for the understanding of the genotype-phenotype correlations and using the plans for managements and counseling in neonatal MFS.


Asunto(s)
Anomalías Congénitas/genética , Fibrilina-1/genética , Intrones/genética , Síndrome de Marfan/genética , Anomalías Cardiovasculares/complicaciones , Sistema Cardiovascular/patología , Anomalías Congénitas/etiología , Exones/genética , Resultado Fatal , Fibrilinas/genética , Insuficiencia Cardíaca/tratamiento farmacológico , Humanos , Recién Nacido , Masculino , Mutación , Oliguria/tratamiento farmacológico
19.
Medicine (Baltimore) ; 100(3): e24113, 2021 Jan 22.
Artículo en Inglés | MEDLINE | ID: mdl-33546020

RESUMEN

BACKGROUND: Coronary heart disease (CHD) is an important cause of chronic heart failure, and chronic heart failure is also a serious complication in the end stage of coronary heart disease. At present, there is no specific treatment plan. Shenfu injection has advantages in the treatment of heart failure in patients with coronary heart disease, but there is a lack of standard clinical study to verify this. Therefore, the purpose of this randomized controlled trial is to evaluate the efficacy and safety of Shenfu injection combined with furosemide in the treatment of chronic heart failure in patients with coronary heart disease. METHODS: This is a prospective randomized controlled trial to study the efficacy and safety of Shenfu injection combined with furosemide in the treatment of coronary heart disease and chronic heart failure. This study will be approved by the clinical research ethics committee of our hospital. The patients will be randomly divided into two groups according to 1:1:(a) Shenfu injection combined with furosemide group and (b) simple furosemide group. Standard treatment for 7 days followed up for 30 days at the same time, pay attention to its efficacy and safety indicators. The total effective rate of cardiac function improvement, left ventricular ejection fraction (LVEF), N-terminal pro-brain natriuretic peptide (NT-pro BNP), 6-minute walk test (6-MWTD), and adverse reactions will be observed. Data will be analyzed using the statistical software package SPSS version 25.0 (Chicago, IL). DISCUSSION: This study will evaluate the efficacy and safety of Shenfu injection combined with furosemide in the treatment of coronary heart disease with chronic heart failure. The results of this experiment will provide a clinical basis for Shenfu injection combined with furosemide in the treatment of coronary heart disease and chronic heart failure. OSF REGISTRATION NUMBER: doi: 10.17605/OSF.IO/27FPM.


Asunto(s)
Enfermedad Coronaria/tratamiento farmacológico , Diuréticos/uso terapéutico , Medicamentos Herbarios Chinos/uso terapéutico , Furosemida/uso terapéutico , Insuficiencia Cardíaca/tratamiento farmacológico , Enfermedad Crónica/tratamiento farmacológico , Enfermedad Coronaria/complicaciones , Quimioterapia Combinada , Insuficiencia Cardíaca/complicaciones , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto
20.
Nat Commun ; 12(1): 869, 2021 02 08.
Artículo en Inglés | MEDLINE | ID: mdl-33558521

RESUMEN

The beating heart possesses the intrinsic ability to adapt cardiac output to changes in mechanical load. The century-old Frank-Starling law and Anrep effect have documented that stretching the heart during diastolic filling increases its contractile force. However, the molecular mechanotransduction mechanism and its impact on cardiac health and disease remain elusive. Here we show that the mechanically activated Piezo1 channel converts mechanical stretch of cardiomyocytes into Ca2+ and reactive oxygen species (ROS) signaling, which critically determines the mechanical activity of the heart. Either cardiac-specific knockout or overexpression of Piezo1 in mice results in defective Ca2+ and ROS signaling and the development of cardiomyopathy, demonstrating a homeostatic role of Piezo1. Piezo1 is pathologically upregulated in both mouse and human diseased hearts via an autonomic response of cardiomyocytes. Thus, Piezo1 serves as a key cardiac mechanotransducer for initiating mechano-chemo transduction and consequently maintaining normal heart function, and might represent a novel therapeutic target for treating human heart diseases.


Asunto(s)
Canales Iónicos/metabolismo , Mecanotransducción Celular , Miocardio/metabolismo , Animales , Arritmias Cardíacas/metabolismo , Arritmias Cardíacas/fisiopatología , Calcio/metabolismo , Señalización del Calcio , Cardiomiopatías/metabolismo , Cardiomiopatías/fisiopatología , Eliminación de Gen , Insuficiencia Cardíaca/metabolismo , Insuficiencia Cardíaca/fisiopatología , Pruebas de Función Cardíaca , Homeostasis , Ratones Noqueados , Miocitos Cardíacos/metabolismo , Especificidad de Órganos , Pirazinas/metabolismo , Especies Reactivas de Oxígeno/metabolismo , Tiadiazoles/metabolismo , Regulación hacia Arriba
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