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4.
Zhonghua Xin Xue Guan Bing Za Zhi ; 48(3): 211-216, 2020 Mar 24.
Artículo en Chino | MEDLINE | ID: mdl-32234178

RESUMEN

Objective: To evaluate the relationship between the brain glucose metabolism and left ventricular function parameters, and to explore the cerebral glucose metabolism reduction regions in patients with ischemic heart disease (IHD). Methods: A total of 110 consecutive IHD patients who underwent gated (99)Tc(m)-sestamibi (MIBI) SPECT/CT myocardial perfusion imaging, gated (18)F-fluorodeoxyglucose (FDG) PET/CT myocardial and brain glucose metabolic imaging within three days in Beijing Anzhen Hospital from April 2016 to October 2017, were enrolled in this study. Left ventricular functional parameters of SPECT/CT and PET/CT including end-diastolic volume (EDV), end-systolic volume (ESV) and left ventricular ejection fraction (LVEF) were analyzed by QGS software. Viable myocardium and myocardial infarction region were determined by 17-segment and 5 score system, and the ratio of viable myocardium and scar myocardium was calculated. According to the range of viable myocardium, the patients were divided into viable myocardium<10% group (n=44), viable myocardium 10%-<20% group (n=36) and viable myocardium≥20% group (n=30). Pearson correlation analysis was used to analyze the correlation between the range of viable myocardium and scar myocardium and the level of cerebral glucose metabolism. Brain glucose metabolism determined by the mean of standardized uptake value (SUV(mean)) was analyzed by SPM. The ratio of SUV(mean) in whole brain and SUV(mean) in cerebellum were calculated, namely taget/background ratio (TBR). Differences in cerebral glucose metabolism among various groups were analyzed by SPM. Results: There were 101 males, and age was (57±10) years in this cohort. The extent of viable myocardium and the extent of scar, LVEF evaluated by SPECT/CT and PET/CT were significantly correlated with TBR (r=0.280, r=-0.329, r=0.188, r=0.215 respectively,all P<0.05). TBR value was significantly lower in viable myocardium<10% group, compared with viable myocardium 10%-<20% group (1.25±0.97 vs. 1.32±0.17, P<0.05) and viable myocardium≥20% group (1.25±0.97 vs. 1.34±0.16, P<0.05). Furthermore, in comparison with viable myocardium≥20% group, the hypo-metabolic regions of viable myocardium<10% group were located in the precuneus, frontal lobe, postcentral gyrus, parietal lobe, temporal lobe, and so on. Conclusions: There is a correlation between impaired left ventricular function and brain glucose metabolism in IHD patients. In IHD patients with low myocardial viability, the level of glucose metabolism in the whole brain is decreased, especially in the brain functional areas related to cognitive function.


Asunto(s)
Tomografía Computarizada por Tomografía de Emisión de Positrones , Anciano , Encéfalo , Fluorodesoxiglucosa F18 , Glucosa , Humanos , Masculino , Persona de Mediana Edad , Radiofármacos , Volumen Sistólico , Tomografía Computarizada de Emisión de Fotón Único , Función Ventricular Izquierda
5.
Kardiologiia ; 60(1): 23-27, 2020 Feb 05.
Artículo en Ruso | MEDLINE | ID: mdl-32245351

RESUMEN

OBJECTIVE: Build a prognostic model using clinical, laboratory, and instrumental data to predict mortality in patients with midrange left ventricular ejection fraction (mrLVEF) within two years after hospitalization for acute decompensated heart failure (ADHF). MATERIALS AND METHODS: The study included 121 patients hospitalized for ADHF with mrLVEF ranging from 40% to 49.9% (91 males and 30 females, mean age 64.6±14.8 years). The independent sample used to validate the statistical model included 71 patients with ADHF and mrLVEF with a mean age of 65.59±12.12 years. Sex distribution of the independent sample was 51 males (70.8% of the independent sample), 20 females (27.8% of the total independent sample). In-hospital mortality of patients included in the study was 4.2%, and long-term mortality was 36.8%. We developed a tool to assess the risk of two-year mortality using classification trees. RESULTS: The root node is the red blood cell distribution width-coefficient of variation (RDW-CV); its diagnostic value in this model was 13.3%. The second-level nodes are glomerular filtration rate (GFR), with a cutoff level of 35 mL/min/1.73 m2, and chronic kidney disease (CKD). The third-level nodes are sex, the anterior-posterior dimension of the left atrium, with the cutoff level >47 mm, and low red blood cell count <4.22x1012/L. The estimated sensitivity of the model is 71.4%; estimated specificity is 85.7%. CONCLUSION: This model can be used to assess long-term mortality risk and identify groups of patients with mrLVEF who require closer monitoring.


Asunto(s)
Insuficiencia Cardíaca , Ventrículos Cardíacos , Anciano , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Volumen Sistólico , Función Ventricular Izquierda
6.
BMC Res Notes ; 13(1): 196, 2020 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-32238188

RESUMEN

OBJECTIVES: Right ventricular dysfunction impacts the prognosis of various heart diseases. We set-out to examine which right ventricular functional parameters after STEMI and NSTEMI have prognostic value. Of 297 eligible participants, 266 (149 STEMI and 117 NSTEMI) completed follow-up. All patients underwent Grace score and 2D-echocardiography within 24 h. Outcome was defined as occurrence of Major Adverse Cardiovascular events (MACE), such as death, recurrent ischaemia, arrhythmia, reinfarction, stroke or heart failure, within 30 days. Patients were categorized into patients with MACE and patients without MACE. RESULTS: In STEMI-patients, compared to those without MACE, patients with MACE experienced higher grace score, left ventricle (LV) end-systolic volume, LV end-systolic dimension and wall motion score index values, but lower tricuspid annular plane systolic excursion, right ventricle (RV) fractional area change, Tricuspid S' wave peak systolic velocity and LV ejection fraction. Nevertheless, in NSTEMI-patients, those with MACE exhibited higher left atrial volume index values, but lower tricuspid annular plane systolic excursion, RV fractional area change, S' wave peak systolic velocity and LVEF. Right ventricular fractional area change < 37.5%, tricuspid annular plane systolic excursion < 15.8 mm and Tricuspid S' peak systolic velocity < 9.67 cm/s are independent predictors of MACE within first 30 days after STEMI and NSTEMI.


Asunto(s)
Enfermedades Cardiovasculares/etiología , Infarto del Miocardio/complicaciones , Disfunción Ventricular Derecha/fisiopatología , Anciano , Ecocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Infarto del Miocardio con Elevación del ST , Volumen Sistólico , Sístole , Función Ventricular Izquierda
7.
Adv Exp Med Biol ; 1177: 269-295, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32246448

RESUMEN

Heart failure (HF) is defined as a clinical syndrome resulting from structural or functional impairment of ventricular fillings or ejections of blood. Currently, HF is divided into three groups which include HF with reduced ejection fraction (HFrEF), HF with preserved ejection fraction (HFpEF) and HF with midrange EF (HFmrEF). Even though major advances have been made in treating HFrEF during the past decades, heart failure is a fatal disease. In this review, we briefly summarize the current advances in pharmaceutical managements for heart failure, which includes drugs used in acute heart failure as well as those that prevent heart failure progression, in each category major clinical trials are also described. In addition, information about some of potential new drugs are also mentioned. Traditional Chinese medicine also shows its potential in treating HF, and we are still lack of medicine to treat HFpEF.


Asunto(s)
Insuficiencia Cardíaca/tratamiento farmacológico , Progresión de la Enfermedad , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/fisiopatología , Humanos , Volumen Sistólico/efectos de los fármacos , Disfunción Ventricular Izquierda/complicaciones , Disfunción Ventricular Izquierda/tratamiento farmacológico , Disfunción Ventricular Izquierda/fisiopatología
8.
Rev Med Liege ; 75(4): 233-239, 2020 Apr.
Artículo en Francés | MEDLINE | ID: mdl-32267111

RESUMEN

The strategy for the management of type 2 diabetes (T2D) has been updated late 2019-2020 by a group of experts of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). The indications of two pharmacological classes that have demonstrated a cardiovascular and renal protection, i.e. sodium-glucose cotransporter type 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1AR), are now extended because of the favourable results of recent clinical trials. In patients with T2D at high cardiovascular risk (even without previous event, but with indicators of atherosclerotic disease), the addition of these antidiabetic agents to metformin background therapy is now recommended independently of the glycated haemo¬globin (HbA1c) level. For SGLT2i, the prescription may be extended to patients with an estimated glomerular filtration rate down to 30 (instead of 60) ml/min/1.73 m², in particular in patients with progressive renal disease and albuminuria and in patients at risk of heart failure, especially if left ventricular ejection fraction is reduced. However, these new proposals could not be applied stricto sensu because of strict reimbursement criteria based upon HbA1c currently applied in our country.


Asunto(s)
Diabetes Mellitus Tipo 2 , Hipoglucemiantes , Disfunción Ventricular Izquierda/complicaciones , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Humanos , Hipoglucemiantes/uso terapéutico , Riñón , Enfermedades Renales/complicaciones , Volumen Sistólico , Función Ventricular Izquierda
10.
Medicine (Baltimore) ; 99(14): e19526, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32243368

RESUMEN

BACKGROUND: Danhong injection (DHI) has been widely in the treatment of chronic heart failure (CHF) in China; however, there is not enough clinical evidence DHI for treating CHF. METHODS: Two researchers will search literatures of DHI for CHF in databases. Extracted data are analyzed with Review Manager 5.3 software. The selected studies should be conducted quality evaluation, forest plots and funnel plots will be run by RevMan5.3. RESULTS: This systematic review validates the clinical efficacy and safety of DHI in the treatment of CHF through the analysis of New York Heart Association functional classification, left ventricular ejection fraction, left ventricular end-diastolic dimension, cardiac output, brain natriuretic peptide, adverse events. CONCLUSIONS: This systematic review will be provided a rational clinical evidence to evaluate the effectiveness and safety of DHI for the treatment of CHF. REGISTRATION NUMBER: PROSPERO CRD42019144686.


Asunto(s)
Medicamentos Herbarios Chinos/uso terapéutico , Insuficiencia Cardíaca/tratamiento farmacológico , Enfermedad Crónica , Medicamentos Herbarios Chinos/administración & dosificación , Medicamentos Herbarios Chinos/efectos adversos , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Proyectos de Investigación , Volumen Sistólico/efectos de los fármacos , Función Ventricular Izquierda/efectos de los fármacos
11.
Monaldi Arch Chest Dis ; 90(1)2020 Mar 27.
Artículo en Inglés | MEDLINE | ID: mdl-32225996

RESUMEN

Exercise oscillatory ventilation (EOV) is an ominous sign in heart failure due to reduced left ventricular ejection fraction (HFrEF) whatever it is represented. But EOV is detected also in normal healthy individuals and in other cardiovascular disease (CVD) patients, however, its prevalence in these is not completed clear. The aim was to describe the occurrence of EOV in healthy subjects and the overall population all CVD patients who performing symptom limited cardiopulmonary exercise testing (CPET). Healthy subjects were divided in athletes and normal subjects, while, CVD patients were subdivided into: i) t hose with preserved left ventricular ejection fraction (LVEF); ii) those with mild to moderate impairment of LVEF (41-49%); iii) those with severe impairment of LVEF (≤40%); iv) HFrEF or with preserved LVEF (HFpEF); and iv) patients after heart transplantation (HXT). EOV was observed only in CVD patients and in those with depressed LVEF; the prevalence of EOV was observed 1.9% (3/55) those with mild to moderate impairment of LVEF (41-49%), 3.4% (56/1613) those with severe impairment of LVEF (≤40%), and 7.3% (214/2903) in HFrEF); no EOV was observed in CVD with preserved LVEF. Kremser's EOV was observed in patients, and, particularly, in those with systolic function impairment. Moreover, as EOV impacts prognosis in HFrEF, its occurrence can modify prognostic-decision models. Even though, EOV prevalence was derived from largest single center population, more studies are needed to tackle the EOV prevalence in different CVD conditions and in normal subjects.


Asunto(s)
Enfermedades Cardiovasculares , Respiración de Cheyne-Stokes/etiología , Insuficiencia Cardíaca , Disfunción Ventricular Izquierda , Atletas , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/fisiopatología , Estudios de Casos y Controles , Técnicas de Apoyo para la Decisión , Prueba de Esfuerzo , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/fisiopatología , Humanos , Consumo de Oxígeno , Pronóstico , Volumen Sistólico , Disfunción Ventricular Izquierda/complicaciones , Disfunción Ventricular Izquierda/diagnóstico , Función Ventricular Izquierda
16.
Int Heart J ; 61(2): 289-294, 2020 Mar 28.
Artículo en Inglés | MEDLINE | ID: mdl-32173701

RESUMEN

High heart rate (HR) is associated with increased risks of adverse outcomes in patients with heart failure. This study aimed to evaluate which measures of HR were associated with all-cause mortality in patients with heart failure and reduced ejection fraction (HFrEF). This study involved 741 HFrEF patients (age 65.1 ± 14.7 years, 71% male) who underwent 24 hour Holter electrocardiogram and resting electrocardiogram within 7 days between 2011 and 2015. We examined the associations of resting, 24 hour, and nighttime HRs with all-cause mortality. Nighttime and 24 hour HRs were determined as the mean HRs between 11:00 p.m. and 7:00 a.m. and over 24 hours, respectively. Nighty patients (12.1%) died during the 2-year follow-up. Resting, nighttime, and 24 hour HRs were significantly associated with all-cause mortality, also after adjusting for conventional risk factors. Resting HR did not remain as an independent factor when 24 hour HR (hazard ratio 1.10, 95% confidence interval 1.04-1.18) was included in the model. Including nighttime HR (hazard ratio 1.11, 95% confidence interval 1.05-1.17) in the model also eliminated 24 hour HR as an independent variable. Compared with the lowest quartile of nighttime HR (< 65 beats/minute), the highest quartile of nighttime HR (> 87 beats/minute) was significantly associated with a higher risk of all-cause mortality (hazard ratio 2.89, 95% CI 1.49-5.60). In conclusion, 24 hour HR and nighttime HR were significantly associated with an increased risk of mortality in patients with HFrEF. Nighttime HR appeared to be more strongly associated with all-cause mortality compared with 24 hour HR.


Asunto(s)
Insuficiencia Cardíaca/mortalidad , Frecuencia Cardíaca , Anciano , Anciano de 80 o más Años , Ritmo Circadiano , Femenino , Insuficiencia Cardíaca/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Volumen Sistólico , Taiwán/epidemiología
18.
Eur J Endocrinol ; 182(5): 481-488, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32209724

RESUMEN

Aims: Patients with type 1 diabetes have a high risk of cardiovascular disease. Yet, the importance of routine assessment of myocardial function in patients with type 1 diabetes is not known. Thus, we examined the prognostic importance of NT-proBNP and E/e', an echocardiographic measure of diastolic function, in type 1 diabetes patients with preserved left ventricular ejection fraction (LVEF) and without known heart disease. Methods and results: Type 1 diabetes patients without known heart disease and LVEF ≥45% enrolled in the Thousand and 1 study were included and followed through nationwide registries. The risk of major cardiovascular events (MACE) and death associated with levels of NT-proBNP and E/e' was examined. Of 960 patients, median follow-up of 6.3 years (Q1-Q3: 5.7-7.0), 121 (12%) experienced MACE and 51 (5%) died. Increased levels of both NT-proBNP and E/e' were associated with worse outcomes (adjusted hazard ratios for MACE = 1.56 (1.23-1.98) and 4.29 (2.25-8.16) per Loge increase for NT-proBNP and E/e', respectively). NT-proBNP and E/e' combined significantly improved the discrimination power of the Steno T1D risk engine (MACE, C-index: 0.813 (0.779-0.847) vs 0.779 (0.742-0.816); P = 0.0001; All-cause mortality, C-index 0.855 (0.806-0.903) vs 0.828 (0.776-0.880); P = 0.03). Conclusion: In patients with type 1 diabetes, preserved ejection fraction, and no known heart disease, NT-proBNP and E/e' were associated with increased risk of MACE and all-cause mortality. The risks associated with NT-proBNP and E/e' combined identified patients at remarkably high risk.


Asunto(s)
Enfermedades Cardiovasculares/sangre , Enfermedades Cardiovasculares/diagnóstico por imagen , Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 1/diagnóstico por imagen , Ecocardiografía/métodos , Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , Adulto , Anciano , Estudios de Cohortes , Estudios Transversales , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Pronóstico , Volumen Sistólico/fisiología , Función Ventricular Izquierda/fisiología
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