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1.
Chin Med J (Engl) ; 131(5): 527-531, 2018 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-29483385

RESUMO

BACKGROUND: Percutaneous transluminal septal myocardial ablation (PTSMA) and modified Morrow septal myectomy (MMSM) are two invasive strategies used to relieve obstruction in patients with hypertrophic cardiomyopathy (HCM). This study aimed to determine the clinical outcome of these two strategies. METHODS: From January 2011 to January 2015, 226 patients with HCM were treated, 68 by PTSMA and 158 by MMSM. Both ultrasonic cardiograms and heart functional class were recorded before, after operations and in the follow-up. Categorical variables were compared using Chi-square or Fisher's exact tests. Quantitative variables were compared using the paired samples t-test. RESULTS: Interventricular septal thickness was significantly reduced in both groups (21.27 ± 4.43 mm vs. 18.72 ± 4.13 mm for PTSMA, t = 3.469, P < 0.001, and 21.83 ± 5.03 mm vs. 16.57 ± 3.95 mm for MMSM, t = 10.349, P < 0.001, respectively). The left ventricular outflow tract (LVOT) pressure gradient (PG) significantly decreased after the operations in two groups (70.30 ± 44.79 mmHg vs. 39.78 ± 22.07 mmHg for PTSMA, t = 5.041, P < 0.001, and 74.58 ± 45.52 mmHg vs. 13.95 ± 9.94 mmHg for MMSM, t = 16.357, P < 0.001, respectively). Seven patients (10.29%) in the PTSMA group required a repeat operation in the follow-up. Eight (11.76%) patients were evaluated for New York Heart Association (NYHA) III/IV in the PTSMA group, which was significantly more than the five (3.16%) in the same NYHA classes for the MMSM group at follow-up. Less than 15% of patients in the PTSMA group and none of the patients in the MMSM group complained of chest pain during follow-up. CONCLUSIONS: Both strategies can not only relieve LVOT PG but also improve heart function in patients with HCM. However, MMSM might provide a more reliable reduction in gradients compared to PTSMA.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Cardiomiopatia Hipertrófica/cirurgia , Septos Cardíacos/cirurgia , Adulto , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Ablação por Cateter/métodos , Ecocardiografia , Feminino , Septos Cardíacos/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
2.
J Geriatr Cardiol ; 14(4): 261-265, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28663764

RESUMO

BACKGROUND: Transvenous lead placement is the standard approach for left ventricular (LV) pacing in cardiac resynchronization therapy (CRT), while the open chest access epicardial lead placement is currently the most frequently used second choice. Our study aimed to compare the ventricular electromechanical synchronicity in patients with heart failure after CRT with these two different LV pacing techniques. METHODS: We enrolled 33 consecutive patients with refractory heart failure secondly to dilated cardiomyopathy who were eligible for CRT in this study. Nineteen patients received transvenous (TV group) while 14 received open chest (OP group) LV lead pacing. Intra- and inter-ventricular electromechanical synchronicity was assessed by tissue Doppler imaging (TDI) before and one year after CRT procedure. RESULTS: Before CRT procedure, the mean QRS-duration, maximum time difference to systolic peak velocity among 12 left ventricle segments (LV Ts-12), standard deviation of time difference to systolic peak velocity of 12 left ventricle segments (LV Ts-SD), and inter-ventricular mechanical delay (IVMD) in OP and TV group were 166 ± 17 ms and 170 ± 21 ms, 391 ± 42 ms and 397 ± 36 ms, 144 ± 30 ms and 148 ± 22 ms, 58 ± 25 ms and 60 ± 36 ms, respectively (all P > 0.05). At one year after the CRT, the mean QRS-duration, LV Ts-12, LV Ts-SD, and IVMD in TV and OP group were 128 ± 14 ms and 141 ± 22 ms (P = 0.031), 136 ± 37 ms and 294 ± 119 ms (P = 0.023), 50 ± 22 ms and 96 ± 34 ms (P = 0.015), 27 ± 11 ms and 27 ± 26 ms (P = 0.86), respectively. The LV lead implantation procedure time was 53.4 ± 16.3 min for OP group and 136 ± 35.1 min for TV group (P = 0.016). The mean LV pacing threshold increased significantly from 1.7 ± 0.6 V/0.5 ms to 2.3 ± 1.6 V/0.5 ms (P < 0.05) in TV group while it remained stable in the OP group. CONCLUSIONS: Compared to conventional endovascular approach, open chest access of LV pacing for CRT leads to better improvement of the intraventricular synchronization.

3.
Zhonghua Xin Xue Guan Bing Za Zhi ; 41(7): 563-7, 2013 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-24284182

RESUMO

OBJECTIVE: To explore the relationship between estimated glomerular filtration rate level and clinical characteristics and outcome in coronary artery disease (CAD) patients with normal serum creatinine. METHOD: A total of 548 hospitalized and angiographic CAD patients with normal fasting serum creatinine were enrolled. The kidney function was estimated by using the abbreviated modification of diet in renal disease (MDRD) study equation. Patients were divided into three groups according to eGFR tertiles: high eGFR group (eGFR > 88.15 ml×min(-1)×1.73 m(-2), n = 184); intermediate group ZU(70.30 ml× min(-1)×1.73 m(-2) < eGFR ≤ 88.15 ml×min(-1)×1.73 m(-2), n = 187); low eGFR group (eGFR ≤ 70.30 ml × min(-1)×1.73 m(-2), n = 177). Clinical data and cardiovascular risk factors were recorded after admission and during (14.02 ± 8.31) months follow up. The primary end point was combined major adverse cardiovascular and cerebral events (MACCE) including death, targeted vascular revascularization, non-fatal myocardial infarction, rehospitalization due to unstable angina and heart failure, and transient ischemic attack (TIA) and stroke. RESULTS: Patients in intermediate and low eGFR groups were older, more males, had more severe coronary artery disease, higher level of hsCRP, higher incidence of hypertension, and lower smoking rate than those in high eGFR group (all P < 0.05). A total of 89 MACCE were recorded during follow up. The level of eGFR was significantly lower in patients with MACCE than patients without MACCE [(73.76 ± 19.81) ml×min(-1)×1.73 m(-2) vs. (84.97 ± 23.42) ml×min(-1)×1.73 m(-2), P < 0.05]. Univariate and multivariate Cox regression analysis showed that eGFR was an independent predictor of MACCE in patients with CAD (univariate analysis: RR = 0.99, 95%CI:0.973-0.997, P < 0.05; multivariate analysis: RR = 0.98, 95%CI:0.976-0.998, P < 0.05). Kaplan-Meier survival analysis suggested that patients with low eGFR was linked with a decreased event free survival ratio (log-rank χ(2) = 7.271, P < 0.05). CONCLUSIONS: eGFR level in CAD patients with normal serum creatinine is associated with coronary artery severity, inflammation level and serves as an independent predictor for MACCE in this patient cohort.


Assuntos
Doença da Artéria Coronariana/diagnóstico , Taxa de Filtração Glomerular , Idoso , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/fisiopatologia , Creatinina/sangue , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico
4.
Zhonghua Xin Xue Guan Bing Za Zhi ; 41(7): 594-7, 2013 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-24284189

RESUMO

OBJECTIVE: To analyze the clinical characterization of Danon disease caused by the mutation of lysosome-associated membrane protein-2 (LAMP-2) gene. METHODS: The clinical features, serum biochemical index, electrocardiogram and echocardiography data were retrospectively reviewed in 5 patients with genetically confirmed Danon disease. Mean follow-up period was (56 ± 6) months. RESULTS: Five patients including 2 men and 3 women in 2 unrelated families with 2 novel mutations in the exon 3 (c.189-190TGdel) and 8 (c.1205Cdel) of the LAMP-2 gene were identified. All patients had cardiomyopathy, 1 patient (1/5) had skeletal myopathy, and none of the patients had mental retardation. The two male patients presented cardiac symptoms at the age of 9 and 10 years, respectively, and all female patients were asymptomatic. Biochemical analysis showed that serum creatine kinase and liver transaminase enzyme were increased in 2 patients (2/5). Abnormal electrocardiogram was observed in all patients, and 2 patients (2/5) had ventricular preexcitation. During the follow-up. One male patient died of cardiac failure at the age of 18 years and three months, and the symptoms of the other male patients rapidly developed with the evolution from hypertrophic cardiomyopathy into dilated cardiomyopathy. However, all female patients remained asymptomatic, and repeat echocardiography indicated only mild ventricular hypertrophy during follow up. CONCLUSION: Patients with Danon disease mainly present hypertrophic cardiomyopathy, and sometimes presents with skeletal myopathy. The disorder occurs at early, age and progresses quickly and ends with poor prognosis in male patients. Other clinical features include elevations of serum creatine kinase and liver transaminase enzyme, ventricular preexcitation on electrocardiogram, and ventricular hypertrophy detected by echocardiography. Female patients remain asymptomatic till now in our cohort.


Assuntos
Doença de Depósito de Glicogênio Tipo IIb/diagnóstico , Proteína 2 de Membrana Associada ao Lisossomo/genética , Mutação , Adolescente , Feminino , Doença de Depósito de Glicogênio Tipo IIb/genética , Humanos , Masculino , Estudos Retrospectivos
6.
Zhongguo Wei Zhong Bing Ji Jiu Yi Xue ; 24(12): 734-8, 2012 Dec.
Artigo em Chinês | MEDLINE | ID: mdl-23168202

RESUMO

OBJECTIVE: To explore the relationship between reduced left ventricular ejection fraction (LVEF) and characteristics of coronary artery disease (CAD) and investigate the association between reduced LVEF and cardiovascular prognosis. METHODS: A total of 677 hospitalized patients with angiographic CAD were enrolled. All patients' clinical data were recorded. LVEF were measured, high sensitive C-reactive protein (hs-CRP), white blood cell (WBC) and classic cardiovascular risk factors were recorded after admission. All patients were followed up from admission. The primary end point was combination occurrence of major adverse cardiovascular and cerebral events (MACCE), including death, targeted vascular revascularization, non-fatal myocardial infarction and rehospitalization due to unstable angina or heart failure, transient ischemic attack or stroke. RESULTS: All patients were tracked for (15±12) months, and patients were divided into normal LVEF group (LVEF≥0.50, n=585) and reduced LVEF group (LVEF<0.50, n=92) according to LVEF level. Compared with normal LVEF group, reduced LVEF group had more severe coronary stenosis (Gensini score: 62.85±41.45 vs. 47.68±33.26, P<0.05), a higher level of WBC and hs-CRP (WBC: 7.60±2.71 ×10(9)/L vs. 7.09±2.13 ×10(9)/L, hs-CRP: 5.68±3.97 mg/L vs. 3.97±3.75 mg/L, both P<0.05). A total of 146 MACCE occurred during follow-up periods. Compared with no-MACCE group, LVEF levels were significantly lower in MACCE group (0.576±0.113 vs. 0.603±0.101) and there were a higher level of hs-CRP and Gensini score in MACCE group (hs-CRP: 5.26±3.99 mg/L vs. 3.91±3.72 mg/L, Gensini score: 53.72±35.50 vs. 48.63±34.59, all P<0.05). Moreover, both of univariate and multivariate Cox regression analysis indicated LVEF be an independent predictor of MACCE in patients with CAD [univariate: relative risk (RR)=0.974, 95% confidence interval (95%CI) 0.960 to 0.988, P=0.000; multivariate: RR=0.979, 95%CI 0.961 to 0.998, P=0.033]. Kaplan-Meier analysis suggested that patients with reduced LVEF had an increased MACCE occurrence (χ(2)=14.56, P<0.05). CONCLUSION: LVEF level may be associated with coronary artery severity, and could be independently predict the prognosis of CAD.


Assuntos
Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/fisiopatologia , Volume Sistólico , Função Ventricular Esquerda , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos
7.
Chin Med J (Engl) ; 124(7): 1105-8, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21542976

RESUMO

We report the effects of biventricular pacing in a patient with hypertrophic obstructive cardiomyopathy (HOCM) refractory to medical therapy. A 58-year-old man with HOCM had suffered from dyspnea, chest pain and palpitation for 5 years. Cardiac catheterization showed a left ventricular outflow tract (LVOT) gradient of 80 mmHg. He refused septal myomectomy and the septal ablation was not available. Based on intraoperative pressure measurements, he was implanted with biventricular pacing and LVOT gradient decreased to 10 mmHg. During the follow-up period of 6 months, the patient's symptoms were markedly improved. Biventricular pacing may be an alternative therapy for patients with HOCM.


Assuntos
Terapia de Ressincronização Cardíaca/métodos , Cardiomiopatia Hipertrófica/terapia , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Cardiomiopatia Hipertrófica/patologia , Angiografia Coronária , Eletrocardiografia , Humanos , Masculino , Pessoa de Meia-Idade
8.
Zhonghua Xin Xue Guan Bing Za Zhi ; 38(7): 614-7, 2010 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-21055284

RESUMO

OBJECTIVE: Ventricular resynchronization might be achieved via minimally invasive left ventricular epicardial lead placement. METHOD: Six patients with congestive heart failure underwent minimally invasive left ventricular epicardial lead placement after failed coronary sinus cannulation were followed up for 1 year, cardiac function and LV lead threshold were evaluated. RESULTS: There were no in-hospital deaths, intraoperative complications and diaphragm stimulation. Correct lead positioning was achieved in all 6 patients. LV lead thresholds remained unchanged [(1.2 ± 0.5) V vs (1.1 ± 0.4) V, P = 0.68] at 12 months follow-up. Improvements on 6 min walking test [(327 ± 77) m vs (267 ± 68) m, P = 0.001], LVEF [(26.1 ± 6.0)% vs (38.2 ± 4.7)%, P = 0.004], and NYHA functional class were evidenced at 12 months follow-up. CONCLUSION: Minimally invasive left ventricular epicardial lead placement is a safe and reliable technique and should be considered as an alternative option in case of difficult coronary venous anatomy and inability to position the lead for resynchronization therapy.


Assuntos
Estimulação Cardíaca Artificial/métodos , Insuficiência Cardíaca/cirurgia , Ventrículos do Coração/cirurgia , Pericárdio/cirurgia , Adulto , Terapia de Ressincronização Cardíaca , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
9.
Zhonghua Xin Xue Guan Bing Za Zhi ; 38(5): 420-4, 2010 May.
Artigo em Chinês | MEDLINE | ID: mdl-20654101

RESUMO

OBJECTIVE: To investigate the clinical and myopathological characteristics and desmin mutations in patients with desminopathy associated cardiomyopathy from 5 Chinese families. METHODS: Thirty-six individuals (18 male, 18 female) were from 4 autosomal dominant inherited families and 1 sporadic case. Nineteen patients manifested myopathy followed by cardiomyopathy; 13 patients presented with isolated cardiomyopathy; 1 patient had isolated myopathy; 3 patients died of cardiac diseases without detailed clinical information. Out of the 23 patients underwent electrocardiogram examinations, 20 patients showed kinds of abnormalities in cardiac conduction block. Echocardiogram revealed dilated cardiomyopathy in one case, hypertrophic cardiomyopathy in one case, and restrictive cardiomyopathy in two cases. Muscle specimens from 7 different patients were performed for histological, immunohistochemistry and ultrastructural examinations. All exons of the desmin gene were screened in 21 patients, 17 asymptomatic family individuals and 50 Chinese controls. RESULTS: Muscle biopsies revealed multiple proteins aggregated in muscle fibers, also supported by immunostaining and electroscopic examinations. Five novel heterogeneous mutations were identified in 4 families and one sporadic case. CONCLUSIONS: Novel mutations of desmin gene were linked with cardiomyopathy in patients from 5 Chinese families with desminopathy.


Assuntos
Cardiomiopatias/genética , Desmina/genética , Mutação , Adolescente , Adulto , Povo Asiático/genética , Cardiomiopatias/diagnóstico , Análise Mutacional de DNA , Éxons , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Linhagem
10.
Zhonghua Nei Ke Za Zhi ; 48(6): 462-4, 2009 Jun.
Artigo em Chinês | MEDLINE | ID: mdl-19954039

RESUMO

OBJECTIVE: Fabry' s disease is a rare X-linked recessive disease. Its cardiac manifestations are not well recognized. METHODS: The data of 3 patients from different Chinese kindreds with Fabry's disease and cardiac manifestations who seeked medical advice in our department in 2007 were analyzed. The age, sex, family history, main symptoms, ECG and echocardiographic findings were recorded for all the patients. The diagnostic criteria of Fabry's disease was based on alpha-galactosidase (alpha-GAL) quantity in white blood cells. RESULTS: All of the patients were female. Their age was from 41 to 57. Two of them had the typical symptoms of Fabry's disease in their young age. All of them had family history of the disease and cardiac symptoms. ECG showed ST-T change and echocardiography showed hypertrophy of left ventricule of different degrees. Their alpha-galactosidase level in white blood cells was lower than normal. The alpha-galactosidase level in patient 1 was the lowest. Her cardiac symptoms were most serious in the three patients and she had involvement of other organs. CONCLUSION: Patients with Fabry's disease may have cardiac manifestations. Family history, typical symptoms in young age and the characteristics of multisystemic disorder are helpful clues to the diagnosis.


Assuntos
Doença de Fabry/diagnóstico , Adulto , Doença de Fabry/metabolismo , Doença de Fabry/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Miocárdio/patologia , alfa-Galactosidase/metabolismo
11.
Zhonghua Xin Xue Guan Bing Za Zhi ; 37(4): 320-3, 2009 Apr.
Artigo em Chinês | MEDLINE | ID: mdl-19791467

RESUMO

OBJECTIVE: To explore the clinical characteristics of patients with inherited hypertrophic cardiomyopathy. METHODS: The clinical characteristics, electrocardiogram, serum chemistry and diagnostic methods were retrospectively investigated in 5 patients with inherited hypertrophic cardiomyopathy. RESULTS: The electrocardiograms of all patients were abnormal, with prominent left ventricular voltage and ST-T changes. One male patient with clinicopathological features of early onset, muscle weakness, ventricular preexcitation, elevations of two serum proteins and intracytoplasmic vacuoles containing autophagic material and glycogen in biceps brachial muscle cells was diagnosed Danon's disease. Mitochondrial cardiomyopathy was diagnosed in one male patient with early onset, short PR interval and biopsy findings of ragged-red fibers in biceps brachial muscle. Three patients were diagnosed as Fabry's disease with clinical characteristics including pain and acroparesthesias, angiokeratoma and decrease of alpha-galactosidase A activity. CONCLUSION: Some of the rare inherited hypertrophic cardiomyopathy might easily be clinically misdiagnosed as hypertrophic cardiomyopathy, systemic and careful case history inquiring and specific relevant examinations would help to make the right diagnosis in these patients.


Assuntos
Cardiomiopatia Hipertrófica Familiar/diagnóstico , Adolescente , Adulto , Cardiomiopatia Hipertrófica Familiar/genética , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
12.
Zhonghua Xin Xue Guan Bing Za Zhi ; 37(12): 1085-7, 2009 Dec.
Artigo em Chinês | MEDLINE | ID: mdl-20193178

RESUMO

OBJECTIVE: To observe serum troponin I (TNI) level in patients with hypertrophic cardiomyopathy (HCM). METHOD: Six hundreds and twelve HCM patients were analyzed prospectively from January 1990 to November 2007.Ultracardiography were detected for all the patients. The diagnostic criteria of HCM is ventricular wall thickness more than 15 mm. Serum TNI level was measured in 116 patients with HCM. Clinical data including age, gender, history, main symptoms, NYHA grade, coronary angiograph, electrocardiogram and echocardiography were compared between patients with normal and increased TNI levels. RESULTS: In 116 patients who detected TNI, 62 of them (53.4%) had a degree higher than normal. The median TNI value of all these patients is 0.07 ng/ml (0 - 4.38 ng/ml). Sixty-nine patients (59.5%) had undergone coronary angiography. Only 9 of them (13.0%) could be diagnosised as coronary heart disease. The TNI values of HCM patients with or without coronary heart disease were similar. The factors related to a higher TNI value included maximal depth of ventricule (P < 0.05), significant T inversion (P < 0.01) and chest pain (P < 0.05). Compared to all the 612 patients, the ones who detected serum TNI were likely to have chest pain (45.7% vs. 34.5%, P < 0.01) and significant T inversion (75.9% vs. 30.1%, P < 0.01). CONCLUSION: Increased serum TNI could be seen in half of HCM patients, especially in those patients with chest pain or significant T inversion. It is therefore important to different these patients from patients with acute coronary syndrome.


Assuntos
Cardiomiopatia Hipertrófica/sangue , Cardiomiopatia Hipertrófica/diagnóstico , Troponina I/sangue , Adulto , Doença das Coronárias/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
14.
Zhonghua Nei Ke Za Zhi ; 47(6): 475-7, 2008 Jun.
Artigo em Chinês | MEDLINE | ID: mdl-19040064

RESUMO

OBJECTIVE: To observe the incidence and predictors of atrial fibrillation in hypertrophic cardiomyopathy (HCM). METHODS: 612 HCM patients were analyzed prospectively from July 1990 to November 2007. The age, sex, height, weight, medical history, main symptoms and incidence of atrial fibrillation were recorded. RESULTS: The patients' mean age was (47.8 +/- 14.9). 414 patients (67.6%) were male. 377 patients (61.6%) had left ventricular outflow truct obstruction. 94 patients (15.4%) and atrial fibrillation. 43 patients (6.0%) had sustained and 51 patients (9.4%) had paroxysmal. The patients with atrial fibrillation were older in age and were predominantly female. Their medical history were longer, left atrial diameter (LAD) longer and plasma B-type natriuretic peptide (BNP) higher. logistic regression analysis indicated that the medical history (P = 0.012), LAD (P = 0.0001) and BNP (P = 0.017) were the independent predictors of atrial fibrillation in HCM. Atrial fibrillation was accompanied by a decrease in functional status and an increase in risk of stroke. CONCLUSIONS: The incidence of atrial fibrillation in HCM was high. The medical history, LAD and BNP were the independent predictors of its occurrence.


Assuntos
Fibrilação Atrial/epidemiologia , Cardiomiopatia Hipertrófica/epidemiologia , Adulto , Fibrilação Atrial/etiologia , Cardiomiopatia Hipertrófica/complicações , Suscetibilidade a Doenças , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
15.
Zhonghua Xin Xue Guan Bing Za Zhi ; 35(7): 603-6, 2007 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-17961422

RESUMO

OBJECTIVE: To investigate the efficacy and safety of adding pravastatin (Pra) on top of standard therapy in non-ischemic heart failure patients. METHODS: A total of 61 patients hospitalized in our hospital from Jan 2005 to Jul 2006 were randomly divided into pravastatin group (Pra 20 mg/d on top of standard therapy, n = 30) and control group (standard therapy, n = 31) and followed 6 months. The changes on cardiac function, flow-mediated vasodilatation (FMD) of brachial artery, plasma TNF-alpha level, liver and kidney function were observed. RESULTS: In Pra treated patients, FMD of brachial artery significantly increased after 3 months treatments and NYHA stage significantly improved, plasma BNP, TNF-alpha levels and left ventricular end-diastolic dimension significantly decreased, LVEF significantly increased significantly 6 months post therapy compared to baseline (all P < 0.01). In control group, the patients' NYHA stage also significantly improved (P < 0.05) and LVEF tended to be higher (P = 0.052) while FMD, plasma BNP and TNF-alpha levels remained unchanged at 6 months post therapy compared to baseline. In Pra group, the level of TC (P < 0.05) and LDL-C (P = 0.051) also significantly decreased while HDL-C remained unchanged 6 months post therapy. One patient in Pra group discontinued the study drug because of anaphylaxis. No event on liver and kidney dysfunction was noticed. CONCLUSION: Pravastatin was effective and safe in treating non-ischemic heart failure patients and can significantly improve left ventricular remodeling, endothelial and cardiac functions as well as reduce the levels of inflammatory factors.


Assuntos
Insuficiência Cardíaca/tratamento farmacológico , Pravastatina/uso terapêutico , Adulto , Feminino , Insuficiência Cardíaca/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Função Ventricular Esquerda
16.
Zhonghua Xin Xue Guan Bing Za Zhi ; 35(4): 333-6, 2007 Apr.
Artigo em Chinês | MEDLINE | ID: mdl-17711659

RESUMO

OBJECTIVE: To compare the safety and efficacy of transcoronary ablation of septal hypertrophy (TASH) versus dual-chamber cardiac pacing (PM) for the treatment of aged > 60 years old) patients with hypertrophic obstructive cardiomyopathy (HOCM). METHODS: Medically uncontrolled symptomatic aged patients with hypertrophic obstructive cardiomyopathy (HOCM, n = 23) were treated by transcoronary ablation of septal hypertrophy (TASH, n = 15) or dual-chamber cardiac pacing (PM, n = 8) and followed up for 24 months. Two patients needed permanent pacemaker after TASH were excluded from the analysis. RESULTS: NYHA class improved from 3.2 +/- 0.7 to 1.5 +/- 0.5 and from 3.0 +/- 0.1 to 1.9 +/- 0.6 and general symptomatic score decreased from 5.9 +/- 1.6 to 1.8 +/- 0.7 and from 4.5 +/- 1.3 to 2.3 +/- 1.6 post TASH or PM treatments, respectively (all P < 0.01 vs. baseline). The decrease of left ventricular outflow pressure gradient (PG) was (80.0 +/- 35.5) mm Hg (1 mmHg = 0.133 kPa) and (49.3 +/- 37.7) mmHg post TASH and PM treatments respectively (all P < 0.05 vs. baseline) and the PG decrease was more significant in TASH group compared to PM group (P < 0.01). Interventricular septal thickness was significantly reduced post TASH [(22 +/- 4) mm vs. (17 +/- 3) mm, P < 0.05] and remained unchanged in PM group. Three patients with paroxysmal atrial fibrillation (2 patients in TASH group and 1 in PM group) developed chronic atrial fibrillation during the follow-up. CONCLUSIONS: Both therapeutic approaches-TASH and PM implantation, significantly reduced PG and significantly improved NYHA class and general symptomatic score in aged symptomatic patients with HOCM. TASH was superior to PM in terms of PG decrease and general symptomatic score improvement.


Assuntos
Estimulação Cardíaca Artificial , Cardiomiopatia Hipertrófica/terapia , Ablação por Cateter , Septos Cardíacos/cirurgia , Idoso , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Marca-Passo Artificial , Estudos Prospectivos , Resultado do Tratamento , Obstrução do Fluxo Ventricular Externo/terapia
17.
Zhonghua Xin Xue Guan Bing Za Zhi ; 35(6): 540-3, 2007 Jun.
Artigo em Chinês | MEDLINE | ID: mdl-17711715

RESUMO

OBJECTIVE: To compare the safety and efficacy of myocardial contrast enhancement (MCE)-guided and angio-pressure (AP)-guided transcoronary ablation of septal hypertrophy (TASH) for patients with hypertrophic obstructive cardiomyopathy (HOCM). METHODS: TASH was performed under MCE-guide (n = 47, group I) or AP-guide (n = 25, group II) for drug-refractory patients with HOCM. Myocardial perfusion imaging (MPI) data as well as other clinical data were compared. RESULTS: TASH both under MCE-guide or AP-guide resulted in similar and significant reduction of left ventricular outflow tract gradient (PG) and associated with significant symptom improvement (all P < 0.001). Dosage of ethanol use, peak-level of CK-MB and ablated myocardial area and incidence of arrhythmia were also similar between the two groups.Similar left ventricular/atrial dimension changes post TASH were observed in the 2 groups during follow-up. However, the first selected septal vessels were changed under MCE in 6 patients. CONCLUSIONS: Our data demonstrated that the MCE-guided TASH was not superior to AP-guided TASH in safety and efficacy. However, MCE-guided TASH can avoid the misplace of ethanol to avoid innocent myocardial ablation.


Assuntos
Cateterismo Cardíaco/métodos , Cardiomiopatia Hipertrófica/terapia , Ablação por Cateter/métodos , Adulto , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Imagem de Perfusão do Miocárdio , Ultrassonografia
19.
Zhonghua Nei Ke Za Zhi ; 46(10): 801-5, 2007 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-18218225

RESUMO

OBJECTIVE: The aim of this study was to observe the cardiopulmonary responses to exercise in patients with hypertrophic obstructive cardiomyopathy (HOCM) and to evaluate the effectiveness of percutaneous transluminal septal myocardial ablation (PTSMA). METHODS: Eighty-five patients with HOCM received cardiopulmonary exercise test using a cycle ergometer. Twenty sedentary volunteers served as controls. All patients underwent maximal cardiopulmonary exercise test without severe complication. Among them 20 patients received PTSMA, and the cardiopulmonary exercise test was repeated 1 - 3 months and 6 - 12 months after the intervention. RESULTS: The peak oxygen uptake attained on the test, maximum oxygen pulse and anaerobic threshold were reduced in patients with HOCM compared with the control group (P < 0.01). Patients in New York Heart Association class I had higher cardiopulmonary indexes than those in classes II and III. For those with PTSMA there was a significant increase in peak oxygen uptake, maximum oxygen pulse and anaerobic threshold 1 - 3 months after PTSMA (P < 0.05), but there was no further change after 6 - 12 months. CONCLUSION: The results show that cardiopulmonary exercise testing for patients with HOCM is safe. There are severe abnormalities in exercise responses during incremental upright exercise in HOCM patients. PTSMA is a promising nonsurgical procedure for subjective exercise limitation in patients with HOCM. Long-term observations for the patients with this procedure are necessary.


Assuntos
Cardiomiopatia Hipertrófica/fisiopatologia , Cardiomiopatia Hipertrófica/terapia , Ablação por Cateter , Exercício Físico/fisiologia , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Testes de Função Respiratória/métodos , Resultado do Tratamento
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