Development and validation of a Modified Patient-Generated Subjective Global Assessment as a nutritional assessment tool in cancer patients.

BACKGROUND: Completing Patient-Generated Subjective Global Assessment (PG-SGA) questionnaires is time consuming. This study aimed to develop and validate an easy-to-use modified PG-SGA (mPG-SGA) for cancer patients. METHODS: Seventy professionals assessed the content validity, comprehensibility, and difficulty of the full PG-SGA. A survey including the PG-SGA and other questionnaires was completed by 34 071 adult hospitalized cancer patients with first cancer diagnosis or recurrent disease with any tumour comorbidities from the INSCOC study. Among them, 1558 patients were followed for 5 years after admission. Reliability and rank correlation were estimated to assess the consistency between PG-SGA items and to select mPG-SGA items. The external and internal validity, test-retest reliability, and predictive validity were tested for the mPG-SGA via comparison with both the PG-SGA and abridged PG-SGA (abPG-SGA). RESULTS: After deleting items that more than 50% of professionals considered difficult to evaluate (Worksheet 4) and items with an item-total correlation <0.1, the mPG-SGA was constructed. Nutritional status was categorized using mPG-SGA scores as well-nourished (0 points) or mildly (1-2 points), moderately (3-6 points), or severely malnourished (≥7 points) based on the area under curve (0.962, 0.989, and 0.985) and maximal sensitivity (0.924, 0.918, and 0.945) and specificity (1.000, 1.000, and 0.938) of the cut-off scores. The external and internal validity and test-retest reliability were good. Significant median overall survival differences were found among nutritional status groups categorized by the mPG-SGA: 24, 18, 14, and 10 months for well-nourished, mildly malnourished, moderately malnourished, and severely malnourished, respectively (all Ps < 0.05). Neither the PG-SGA nor the abridged PG-SGA could discriminate the median overall survival differences between the well-nourished and mildly malnourished groups. CONCLUSIONS: We systematically developed and validated the mPG-SGA as an easier-to-use nutritional assessment tool for cancer patients. The mPG-SGA appears to have better predictive validity for survival than the PG-SGA and abridged PG-SGA.

Higher serum angiopoietin 2 levels are independently associated with coronary microvascular dysfunction in patients with angina in the absence of obstructive coronary artery disease.

BACKGROUND: Angiopoietin-2 (Ang-2) is a type of endothelial growth factor involved in angiogenesis and vascular remodeling. Circulating Ang-2 levels are elevated in patients with obstructive coronary artery disease (CAD). This study aimed to evaluate the association between serum Ang-2 levels and coronary microvascular dysfunction in patients without obstructive CAD. METHODS: A total of 125 patients with angina in the absence of obstructive CAD were included in this cross-sectional study. Coronary flow reserve (CFR) was measured in the distal left anterior descending coronary artery by trans-thoracic Doppler echocardiography. The patients were divided into the following two sub-groups according to CFR: the impaired CFR group with CFR values <2.5 and the preserved CFR group with CFR values ≥2.5. Serum Ang-2 levels were determined using enzyme-linked immunosorbent assay. Independent predictors for impaired CFR were identified by binary logistic regression analysis. The receiver-operating characteristic curve was determined to evaluate the ability of serum Ang-2 in predicting impaired CFR. RESULTS: We found that age, percentage of female sex, N-terminal pro-B-type natriuretic peptide levels, Ang-2 levels (763.3 ±â€Š264.9 vs. 579.7 ±â€Š169.3 pg/mL, P < 0.001), and the left atrial volume index were significantly higher in patients with impaired CFR than in patients with preserved CFR. Serum Ang-2 levels were negatively correlated with CFR (r = -0.386, P < 0.001). Binary logistic regression analysis showed that Ang-2 (odds ratio: 1.004, 95% confidence interval [CI]: 1.001-1.006, P = 0.003) and age (odds ratio: 1.088, 95% CI: 1.023-1.156, P = 0.007) were independently associated with impaired CFR. Furthermore, Ang-2 was a significant predictor of impaired CFR on the receiver-operating characteristic curve (P < 0.001). The area under the curve was 0.712 (95% CI: 0.612-0.813). CONCLUSIONS: High serum Ang-2 levels are independently associated with impaired CFR in patients with angina in the absence of obstructive CAD.

Left atrial area index predicts adverse cardiovascular events in patients with unstable angina pectoris.

BACKGROUND: The left atrial size has been considered as a useful marker of adverse cardiovascular outcomes. However, it is not well known whether left atrial area index (LAAI) has predictive value for prognosis in patients with unstable angina pectoris (UAP). This study was aimed to assess the association between LAAI and outcomes in UAP patients. METHODS: We enrolled a total of 391 in-hospital patients diagnosed as UAP. Clinical and echocardiographic data at baseline were collected. The patients were followed for the development of adverse cardiovascular (CV) events, including hospital readmission for angina pectoris, acute myocardial infarction (AMI), congestive heart failure (CHF), stroke and all-cause mortality. RESULTS: During a mean follow-up time of 26.3 ± 8.6 months, 98 adverse CV events occurred (84 hospital readmission for angina pectoris, four AMI, four CHF, one stroke and five all-cause mortality). In a multivariate Cox model, LAAI [OR: 1.140, 95% CI: 1.016-1.279, P = 0.026], diastolic blood pressure (OR: 0.976, 95% CI: 0.956-0.996, P = 0.020) and pulse pressure (OR: 1.020, 95% CI: 1.007-1.034, P = 0.004) were independent predictors for adverse CV events in UAP patients. CONCLUSIONS: LAAI is a predictor of adverse CV events independent of clinical and other echocardiographic parameters in UAP patients.

Relationship between exercise induced elevation of left ventricular filling pressure and exercise intolerance in patients with atrial fibrillation.

BACKGROUND: Elevated left ventricular filling pressure (LVFP) is an important cause of exercise intolerance in patients with atrial fibrillation (AF). Exercise stress echocardiography could assess LVFP during exercise. The objective of this study was to investigate the relationship between exercise induced elevation of LVFP and exercise capacity in patients with AF. METHODS: This study included 145 consecutive patients (81 men and 64 women; mean age 65.5 ± 8.0 years) with persistent non-valvular AF and normal left ventricular systolic function (left ventricular ejection fraction ≥ 50%). All patients underwent a symptom-limited cardiopulmonary exercise test (CPET). Doppler echocardiography was performed both at rest and immediately after exercise. Five consecutive measurements of early diastolic mitral inflow velocity (E) and early diastolic mitral annular velocity (e') were taken and averaged. E/e' ratio was calculated. Elevated LVFP was defined as E/e' > 9, and patients with elevated LVFP at rest were excluded. RESULTS: Patients were classified into two groups according to LVFP estimated by E/e' ratio after exercise: 39 (26.9%) with elevated LVFP after exercise and 106 (73.1%) with normal LVFP. As compared with patients with normal LVFP, the ones with elevated LVFP after exercise had significantly lower peak oxygen uptake (VO2 peak) (21.7 ± 2.3 vs. 26.4 ± 3.8 mL/min per kilogram, P < 0.001), lower anaerobic threshold (19.9 ± 2.5 vs. 26.0 ± 4.0 mL/min per kilogram, P < 0.001), and shorter exercise time duration (6.2 ± 0.8 vs. 7.0 ± 1.3 min, P < 0.001). Multivariate analysis showed that age, gender and E/e' after exercise were significantly correlated with VO2 peak. CONCLUSION: Elevated LVFP estimated by E/e' ratio after exercise is independently associated with reduced exercise capacity in AF patients.

Serial changes of mean platelet volume in relation to Killip Class in patients with acute myocardial infarction and primary percutaneous coronary intervention.

INTRODUCTION: Mean platelet volume (MPV) is related to the reactivity of platelets. Among survivors of acute myocardial infarction (MI), greater MPV is known to be associated with impaired reperfusion and higher mortality. The aims of the study is to investigate the dynamic changes of MPV and the relation between MPV and cardiac function in patients with acute MI and received primary percutaneous coronary intervention (PCI). MATERIALS AND METHODS: This retrospective cohort study included patients presented during January 2008 to March 2011 to Peking University Third Hospital with ST-segment elevation MI. All patients received successful PCI. MPV was measured serially, using a Sysmex XE2100 haematology analyser, from admission to day-7 after MI. RESULTS: In 375 patients, MPV was at its highest value (10.2±1.0 fL) and correlated well with platelet distribution width (PDW, r=0.833, p<0.0001) at the admission, and then reduced by 16% within the 24 hours, together with marked weakening of its correlation with PDW. Patients with poorer ventricular function, estimated by high Killip Class (≥2, n=96), had higher MPV values at all-time points. By logistic regression model and after adjusting for related confounders, high MPV remained as an independent predictor of Killip Class ≥2 (OR 1.873, CI 95% 1.373-2.673, p=0.001). Clopidogrel pre-usage resulted in significant MPV reduction on admission. CONCLUSIONS: MPV undergoes rapid and dynamic changes during the acute phase of MI, and was higher in patients with high Killip Class, suggesting a predictive value of MPV in ventricular dysfunction and clinical outcome of acute phase of MI.

[Correlation of low density lipoprotein cholesterol with coronary flow reserve in patients with type 2 diabetes].

OBJECTIVE: To investigate whether plasma levels of low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) are associated with coronary flow reserve (CFR) in patients with type 2 diabetes mellitus (DM). METHODS: Between October 2007 and March 2012,we continuously enrolled 200 participants registered to Department of Cardiology, Peking University Third Hospital, who were divided into 2 groups: DM group (n = 95) and control group (n = 105). Quantification of CFR was administrated after rest and after adenosine by noninvasive Doppler echocardiography in all the subjects. The CFR, which was performed in the distal part of left descending artery, was used as an indicator of coronary endothelial dysfunction. RESULTS: The plasma levels of LDL-C were significantly higher in the patients with DM than in the controls [(3.05 ± 0.73) mmo/L vs. (2.74 ± 0.72) mmo/L, P = 0.003)], while the plasma levels of HDL-C were significantly lower in the patients with DM than in the controls [(1.08 ± 0.24) mmo/L vs. (1.17 ± 0.29) mmo/L, P = 0.044]. Furthermore, a lower CFR value was seen in the patients with DM than in the controls [(2.74 ± 0.63) vs. (3.20 ± 0.69), P < 0.001]. The plasma levels of LDL-C were negatively correlated with the CFR values in all the subjects (r = -0.17, P = 0.015) and in the DM group (r = -0.23, P = 0.021). The LDL-C remained independently correlated with the CFR in the DM group (P = 0.036). However,no significantly correlation was found between HDL-C and CFR in the DM group or in all the subjects. CONCLUSION: LDL-C is independently associated with CFR in patients with diabetic mellitus.

[Current status of morning blood pressure control and medication of hypertensive patients in Beijing].

OBJECTIVE: To explore the current status of morning blood pressure and medication of hypertensive patients in Beijing. METHODS: This study included 2187 hypertensive patients who visited the ambulance of our cardiology department in the morning (7:00-10:00) from March 2012 to April 2012. Patients were divided into three groups: no antihypertensive agent group, single antihypertensive drug therapy group (include CCB, ARB, ACEI, ß-blocker) and combined drug therapy group at least one month. Blood pressure control rate was compared among the groups. RESULTS: Target blood pressure was not reached in 1193 patients (54.6%), most patients took CCB and the target blood pressure was not reached in 61.7% (295/478) patients taking CCB. There was no significant difference on target blood pressure uncontrolled rate among the four single drug subgroups (CCB, ARB, ACEI, ß-blocker). The blood pressure uncontrolled rate was 46.3% (63/136) for amlodipine, 70.5% (55/78) for nifedipine and 73.8% (31/42) for felodipine. There OR of uncontrolled blood pressure rate was 0.36 (amlodipine vs. nifedipine, 95%CI:0.20-0.65) and 0.31% (amlodipine vs. felodipine, 95%CI:0.14-0.66). CONCLUSION: The morning blood pressure uncontrolled rate is high in hypertensive patients visiting Beijing tertiary hospitals. Amlodipine is possible superior to nifedipine and felodipine on morning blood pressure control in this patient cohort.

Valsartan/amlodipine compared to nifedipine GITS in patients with hypertension inadequately controlled by monotherapy.

INTRODUCTION: Current hypertension guidelines recommend single-pill combinations because they not only improve convenience and compliance to therapy and thus blood pressure (BP) control, but also reduce health-care costs. This study compared the efficacy and safety of valsartan/amlodipine single-pill combination with nifedipine gastrointestinal therapeutic system (GITS) in Chinese patients with hypertension who were inadequately controlled with monotherapy. METHODS: In this multicenter, open-label, active-controlled, parallel-group study, 564 patients with hypertension not adequately controlled by prior monotherapy were randomized to receive valsartan/amlodipine 80/5 mg or nifedipine GITS 30 mg once daily for 12 weeks. RESULTS: In the intention-to-treat analysis (n = 540), valsartan/amlodipine (n = 272) showed a least-square mean reduction of -16.6 versus -10.8 mmHg by nifedipine GITS (n = 268; mean between-treatment difference: -5.8 mmHg; P < 0.0001) from baseline to week 12. The corresponding results for mean sitting diastolic BP were -8.6 and -4.6 mmHg, respectively (difference: -4.0 mmHg; P < 0.0001). The percentage of patients achieving the BP target (<140/90 or <130/80 mmHg in the absence or presence of diabetes mellitus, respectively) was significantly higher with valsartan/amlodipine (79.0%) versus nifedipine GITS (57.4%; P < 0.0001). The overall incidence rate of adverse events was lower with valsartan/amlodipine (19.2%) than with nifedipine GITS (29.4%; P = 0.004). CONCLUSION: The valsartan/amlodipine 80/5 mg single-pill combination is well tolerated and more effective than nifedipine GITS 30 mg for BP control in Chinese patients with hypertension.

[Diagnostic accuracy of adenosine triphosphate stress echocardiography derived coronary flow reserve for detecting significant coronary stenosis].

OBJECTIVE: To assess the diagnostic accuracy of coronary flow reserve measured by transthoracic Doppler echocardiography (TTDE) associated with adenosine triphosphate (ATP) stress for detecting coronary stenosis in patients with chest pain. METHODS: A total of 125 patients scheduled for elective coronary angiography (CAG) due to chest pain were recruited. ATP stress echocardiography were performed to measure CFR in left anterior descending (LAD) by TTDE with 2 days pre-CAG. Coronary flow reserve (CFR) was calculated as peak diastolic velocity during maximum hyperemia (PDV2) divided by baseline (PDV1). According to the coronary angiography results, all patients were divided into group A (stenosis < 50% in LAD, n = 57), group B (stenosis of 50% - 75% in LAD, n = 20) and group C (stenosis > 75% in LAD, n = 48). Then CFR was compared among three groups. The receiver operating characteristic curve (ROC) was used to assess the value of CFR for detecting LAD stenosis. RESULTS: CFR was significantly different among three groups (group A: 3.02 ± 0.85, group B: 2.49 ± 0.65, group C: 1.82 ± 0.56; all P < 0.01). With ROC analysis, CFR < 2.2 was the best cut-off value for diagnosing significant LAD stenosis (area under curve: 0.86 (95% CI 0.80 to 0.93)), with sensitivity of 81%, specificity of 83% and accuracy of 82%; CFR < 2.2 for diagnosing LAD stenosis > 50% (area under curve: 0.81 (95%CI 0.74 - 0.89, P < 0.01)), with a sensitivity of 59%, a specificity of 82% and an accuracy of 70%. CONCLUSIONS: CFR measured by TTDE associated with ATP stress is a valuable tool for screening significant stenosis in patients with chest pain. Its advantages are non-invasiveness, easy availability, safety and inexpensiveness.

[Value of left atrial area index for diagnosing left ventricular diastolic dysfunction in hypertensive patients with preserved left ventricular systolic function].

OBJECTIVE: To investigate the correlation between left atrial size and left ventricular filling pressure (LVFP) and the value of left atrial size assessment on detecting diastolic dysfunction in hypertensive patients with preserved LVEF by echocardiography. METHODS: Echocardiography was performed in 346 hypertensive patients with preserved LVEF(≥ 50%), left atrial size including left atrial diameter (LAD) and left atrial area (LAA) was measured and indexed to body surface area (LADI, LAAI). The ratio of early diastolic transmitral velocity to early diastolic mitral annular velocity (E/Em) was determined and LVFP was calculated with the formula: LVFP = 1.24×E/Em + 1.9. Patients were divided into diastolic dysfunction group [DD group, LVFP > 15 mm Hg (1 mm Hg = 0.133 kPa), n = 81] and normal diastolic function group (NDF group, LVFP ≤ 15 mm Hg, n = 265). RESULTS: As compared to patients in NDF group, the patients in DD group had larger LA [LADI: (21.4 ± 2.6) mm/m(2) vs. (19.6 ± 2.4) mm/m(2); LAAI: (12.1 ± 2.6) cm(2)/m(2) vs. (10.4 ± 1.7)cm(2)/m(2); all P < 0.01]. LA size parameters were positively correlated with LVFP (r = 0.211-0.450, all P < 0.01), LAAI was best correlated with LVFP (r = 0.450, P < 0.01). ROC analysis showed that LAAI ≥ 11.4 cm(2)/m(2) diagnosed DD with a sensitivity of 63%, specificity of 74% and accuracy of 72%. CONCLUSION: Left atrium dilation correlates positively with LVFP in hypertensive patients with preserved LVEF. The LAAI is a more accurate parameter for identifying patients with diastolic dysfunction in this cohort.

Impact of uncontrolled blood pressure on diagnostic accuracy of coronary flow reserve for detecting significant coronary stenosis in hypertensive patients.

BACKGROUND: Impaired coronary flow reserve (CFR) in patients with hypertension may be caused by epicardial coronary stenosis or microvascular dysfunction. Antihypertensive treatment has been shown to improve coronary microvascular dysfunction. The aim of this study was to evaluate the impact of uncontrolled blood pressure (BP) on diagnostic accuracy of CFR for detecting significant coronary stenosis. METHODS: A total of 98 hypertensive patients scheduled for coronary angiography (CAG) due to chest pain were studied. Of them, 45 patients had uncontrolled BP (defined as the office BP ≥ 140/90 mmHg (1 mmHg = 0.133 kPa) in general hypertensive patients, or ≥ 130/80 mmHg in hypertensive individuals with diabetes mellitus), and the remaining 53 patients had well-controlled BP. CFR was measured in the left anterior descending coronary artery (LAD) during adenosine triphosphate-induced hyperemia by non-invasive transthoracic Doppler echocardiography (TTDE) within 48 hours prior to CAG. Significant LAD stenosis was defined as > 70% luminal narrowing. Diagnostic accuracy of CFR for detecting significant coronary stenosis was analyzed with a receiver operating characteristic analysis. RESULTS: CFR was significantly lower in patients with uncontrolled BP than in those with well-controlled BP (2.1 ± 0.6 vs. 2.6 ± 0.9, P < 0.01). Multivariate linear regression analysis of the study showed that the value of CFR was independently associated with the angiographically determined degree of LAD stenosis (ß = -0.445, P < 0.0001) and the presence of uncontrolled BP (ß = -0.272, P = 0.014). With a receiver operating characteristic analysis, CFR < 2.2 was the optimal cut-off value for detecting LAD stenosis in all hypertensive patients (AUC 0.83, 95%CI 0.75 - 0.91) with a sensitivity of 75%, a specificity of 78%, and an accuracy of 77%. A significant reduction of diagnostic specificity was observed in patients with uncontrolled BP compared with those with well-controlled BP (67% vs. 93%, P = 0.031). CONCLUSIONS: CFR measurement by TTDE is valuable in the diagnosis of significant coronary stenosis in hypertensive patients. However, the diagnostic specificity is reduced in patients with uncontrolled BP.

[Evaluation of arterial elasticity in initial hypertension by pulse wave velocity and wave intensity technique].

OBJECTIVE: To explore the early changes of arterial elasticity in initial hypertension through two different methods. METHODS: A total of 76 hypertensive patients (Grade 1-2, n = 32) were assigned into hypertension group while the age and gender-matched healthy population was selected as normal group (n = 44). All of them were monitored for baPWV in right carotid artery by wave intensity technique. The parameters of two methods were compared between two groups. RESULTS: Higher bi-lateral baPWV were found in the hypertension group (right: (1472 ± 198) m/s vs (1353 ± 233) m/s), (left: (1465 ± 198) m/s vs (1353 ± 241) m/s) (P < 0.05). Compared with the normal group, Patients in the hypertension group had statistically higher W(1) ((9.8 ± 3.8)×10(3) mm Hg×m×s(-3) vs (7.4 ± 2.4)×10(3)) mm Hg×m×s(-3), W(2) ((2.8 ± 1.1)×10(3) mm Hg×m×s(-3) vs (2.0 ± 1.0)×10(3) mm Hg×m×s(-3)), stiffness parameter (ß) ((6.9 ± 2.6) vs (5.1 ± 1.3)), pressure-strain elastic modulus (Ep) ((99 ± 39) kPa vs (57 ± 17) kPa), one-point wave velocity (PWVß) ((6.0 ± 1.1) m/s vs (4.6 ± 0.6) m/s), PWVWI ((6.2 ± 1.4) m/s vs (4.4 ± 1.0) m/s) (P < 0.01). R-W(1) ((100 ± 14) ms vs (103 ± 13) ms), (W(1)-W(2)) ((261 ± 20) ms vs (274 ± 15) ms) and arterial compliance (AC) ((0.8 ± 0.4) mm(2)/kPa vs (1.1 ± 0.3) mm(2)/kPa) in the hypertension group were statistically lower than those of the normal group (P < 0.05). CONCLUSION: The initial hypertensive patients may have impaired arterial elasticity during an early stage.

Studies on functional connections between the supraoptic nucleus and the stomach in rats.

The present study was to investigate whether there are functional connections between the hypothalamic supraoptic nucleus (SON) and the stomach, which is the case with the paraventricular nucleus. The rats were divided into four groups. Group I: the neuronal discharge was recorded extracellularly in the NTS, DMV or SON before and after cold physiological saline (4°C) was perfused into the stomach and effused from the duodenum. Group II: the rats were stimulated as for Group I and c-Fos expression in NTS, DMV and SON was examined. Group III: the control to Group II. Group IV: gastric motility was recorded continuously before and after microinjection of L: -Glu into the SON. In Group I, the discharge frequency increased in all the three nuclei, while in Group II, Fos expression in NTS, DMV and SON was, respectively, greater than that of Group III. In Group IV, microinjection of L: -Glu (5 nmol) into SON significantly inhibited gastric motility. These data suggest there are functional connections between SON and stomach.

[Left ventricular flow vector characteristics and the relationship between flow vector and left ventricular systolic function in patients with anterior myocardial infarction].

OBJECTIVE: To assess left ventricular vortex and flow vector features and the relationship between vector flow and left ventricular systolic function in patients with anterior myocardial infarction by echocardiography-derived vector flow mapping (VFM). METHODS: Echocardiography was performed in 31 patients with anterior myocardial infarction and 20 healthy controls. Flow vector and velocity of left ventricle were analyzed on apical 3 chambers view with color Doppler. RESULTS: (1) Left ventricular intracavitary vortex during isovolumic contraction phase could be detected in both groups. Vortex was detectable also during contraction phase and relaxation phase in patients with myocardial infarction. There was no vortex during contraction phase, and there was only small and transit vortex during relaxation phase in control group. (2)Flow vector of apex and middle segments directed to apex and was opposite to that of basal segment of left ventricle in patients with myocardial infarction and in controls [(10.6 ± 8.3) cm/s vs. -(5.8 ± 7.2) cm/s, (19.5 ± 11.8) cm/s vs. -(16.6 ± 14.7) cm/s]. During rapid relaxation phase, the velocity in apex was lower in patients with myocardial infarction than that in control group [(6.8 ± 9.8) cm/s vs. (17.6 ± 15.8) cm/s, P < 0.01]. (3) There was a negative correlation between velocity in apex and left ventricular ejection fraction (LVEF) during rapid eject phase in patients with anterior myocardial infarction (r = -0.52, P < 0.05). Velocity in apex of patients with LVEF < 50% was higher than that of patients with LVEF ≥ 50% during rapid eject phase [(13.5 ± 9.0) cm/s vs. (5.8 ± 5.1) cm/s, P < 0.05]. CONCLUSIONS: Vortex period is prolonged in patients with anterior myocardial infarction compared to normal controls during whole cardiac cycle, flow vector of apex and middle segments is directed to apex during eject phase and there is a negative correlation between velocity in apex and LVEF during rapid eject phase in patients with anterior myocardial infarction.

[Prognostic values for in-hospital event rate of early E/Em in patients with acute myocardial infarction].

OBJECTIVE: To assess the prognostic values for in-hospital event rate of tissue Doppler imaging (TDI) parameter (E/Em) after acute myocardial infarction. METHODS: A total of 289 patients with acute myocardial infarction were retrospectively examined. Their clinical data and echocardiograms were obtained. Clinical events were recorded. Patients were divided into two groups according to the value of ratio of early transmitral flow velocity to early diastolic velocity of mitral annulus (E/Em): Group E/Em < 10 (n = 152) and Group E/Em ≥ 10 (n = 137). Clinical characteristics, echocardiographic parameters and the rate of cardiac events were compared. Predictors of heart failure were identified by multivariate Logistic regression analysis. RESULTS: On echocardiography, the patients with an E/Em ratio ≥ 10 had statistically larger left atrial diameter [(39.1 ± 6.2) vs (36.0 ± 4.4) mm, P = 0.000] and left ventricular end diastolic diameter [(52.3 ± 7.3)vs (49.2 ± 5.2) mm, P = 0.000]. Worse systolic functions were found in group E/Em ≥ 10: left ventricular ejection fraction (LVEF) [(48.3 ± 11.7)% vs (56.7 ± 9.7)%, P = 0.000]. Systolic velocities of mitral annulus (Sm) [(6.6 ± 1.7) vs (8.6 ± 2.2) cm/s, P = 0.000]. Em [(6.4 ± 1.9) vs (9.4 ± 2.4) cm/s, P = 0.000] was statistically lower than that of E/Em < 10 group. Killip classes on admission were statistically higher in group E/Em ≥ 10 than those of the other group [(1.7 ± 0.9) vs (1.2 ± 0.6), P = 0.000]. So were as the ratio of heart failure (38.5% vs 13.8%, P = 0.000) and in-hospital mortality rate (4.4% vs 0.8%, P = 0.000). Logistic regression analysis demonstrated that the independent risk factors of heart failure included the value of E/Em and LVEF. CONCLUSION: Early E/Em is probably a powerful predictor for left ventricular remodeling and in-hospital heart failure in patients after acute myocardial infarction.

[Prognostic importance of abnormal glucose metabolism in chronic heart failure].

OBJECTIVE: To investigate the importance of abnormal glucose metabolism in a chronic heart failure (CHF) population. METHODS: A total of 444 patients were enrolled sequentially for decompensated CHF from January 1st, 2005 to December 31st, 2007 at our department. They were divided into diabetic (n = 153, 34.5%) and non-diabetic groups (n = 291, 65.5%). Among the non-diabetics, there were 113 (25.4%) with impaired fasting glucose (IFG) (FPG 5.6-6.9 mmol/L) and 178 (40.1%) with normal glucose levels. All subjects received a follow-up to record their clinical status, biochemical parameters and end-point events (all-cause death in one year). And the correlations of abnormal glucose metabolism and end-point events were analyzed. RESULTS: Among these patients, 83 (17.1%) died in 1 year, 31 (7.0%) were lost to follow-up; Among 83 dead patients, 15 (8.4%) were within normal glucose levels, 34 (21.2%) with IFG and 44 (28.8%) with diabetes mellitus. Compared with normal glucose level patients, the mortality rates of diabetes mellitus and IFG patients were higher (P < 0.01). There was no significant difference in mortality rate between diabetes mellitus and IFG patients. After adjustment for other prognostic attributes (age, sex and etc.), diabetes mellitus was a predictor of 1-year all-cause mortality (OR = 2.383, 95% CI: 1.317 to 4.312; P = 0.004). In diabetics, the mortality of the higher glucose level group (FPG > 7.0 mmol/L) was 30.4% and that of the lower glucose level group (FPG < or = 7.0 mmol/L) 27.4%. And there was no significant difference (P > 0.05). The FPG level could not predict the 1-year all-cause mortality. In non-diabetics, the mortality of IFG group (FPG 5.6 - 6.9 mmol/L) was significantly higher than that of normal glucose levels group (21.2% vs 8.4%, P < 0.01). IFG status predicted 1-year all-cause mortality (OR = 3.564, 95%CI: 1.494 - 8.497, P = 0.004). The FPG level was also associated with the 1-year all-cause mortality (OR = 1.791, 95%CI: 1.090 - 2.943, P = 0.021). CONCLUSION: Diabetes mellitus is an independent predictor of 1-year all-cause mortality for CHF. And IFG and a higher FPG level are associated with 1-year all-cause mortality for CHF without diabetes mellitus.

[Churg-Strauss syndrome in children: a case evolving in endomyocardiopathy].

A 13-year-old girl presented with a 1-month history of progressive exertional dyspnea (NYHA class IV) and exophthalmos for 6 months. She had a history of long-standing asthma and the presence of allergy. Hypereosinophilia and increased serum IgE levels (2472 IU/mL) were observed. Chest radiography and a high resolution CT scan documented a massive interstitial pulmonary infiltration. Echocardiography confirmed mild tricuspid regurgitation, apical obliteration of the right ventricle by fibrocalcific thickening of the endocardium and echogenic material suggestive of thrombosis. Churg-Strauss syndrome with cardiac involvement (endomyocardiopathy) was diagnosed. The patient received anticoagulation and corticosteroid therapy. In view of rapidly progressive severe endomyocardiopathy and stable hematology, the patient was referred for cardiac surgery. Histopathological examination of resected specimens confirmed laminated thrombus but without any trace of eosinophils embedded.

[Different expressions of inflammatory cytokines in two types of cardiac hypertrophy in rats].

OBJECTIVE: To compare the different expressions of cardiac inflammatory cytokines including tumor necrosis factor-alpha (TNF-alpha), interleukin-1beta(IL-1beta), interleukin-6 (IL-6) in two types of cardiac hypertrophy rat models induced by volume overload and pressure overload. METHODS: Volume overload-induced cardiac hypertrophy was established by abdominal arteriovenous fistula (ACF) and pressure overload-induced cardiac hypertrophy was developed by constriction of aorta (CA). Heart weight measurement and histological examination were performed 1 week or 2 weeks after the operation respectively. The cytokine expression was measured by enzyme linked immunosorbent assay. RESULTS: All the operated groups developed cardiac hypertrophy. The left ventricular fractional shortening of each operated group had no significant difference with the sham-operated groups respectively. As far as the total amount of each cytokine in left ventricular myocardium was concerned, compared to the sham-operated groups, IL-6 and IL-1beta both increased significantly in CA groups [IL-6(23 722+/-8 671)pg vs (17 693+/-5 705)pg,P<0.05 ;IL-1beta(335+/-95)pg vs (159+/-99) pg,P<0.01].There was no difference of TNF-alpha between operated and sham-operated groups in ACF or CA groups . CONCLUSION: The contents of IL-6 and IL-1beta in myocardium increased in pressure overload-induced cardiac hypertrophy.

[Isoproterenol regulates lipopolysaccharide-induced tumor necrosis factor-alpha and interleukin-6 production in monocytes from essential hypertensive patients.].

OBJECTIVE: To investigate the effects of beta-adrenoceptor agonist isoproterenol(ISO) on lipopolysaccharide(LPS) induced inflammatory cytokine-tumor necrosis factor-alpha(TNF-alpha) and interleukin-6(IL-6)] in monocytes from essential hypertensive patients (Stage I). METHODS: Monocytes were isolated from 17 healthy volunteers and 6 hypertensive patients' venus blood, and the monocytes were cultured with LPS (0.2 microg/L) and ISO. The concentrations of TNF-alpha and IL-6 in the cultured supernatant were measured with enzyme-linked immunosorbent assays. RESULTS: (1) TNF-alpha production induced by LPS in monocytes from hypertensive group were higher than those from control group [(1,897+/-393) ng/L vs. (975+/-473) ng/L, P<0.01]. But the differences of IL-6 production were not significant between the two groups [(5,532+/-796) ng/L vs. (6,092+/-2 249) ng/L, P>0.05]. (2) ISO inhibited extracellular TNF-alpha production induced by LPS in a dose-dependent manner. The inhibitory effects were ameliorated by beta-adrenoceptor antagonist propranolol. In contrast, ISO had no effect on the production of IL-6 induced by LPS. The difference of inhibitory effects of ISO on TNF-alpha production was not statistically significant between hypertensive group and healthy control group (P>0.05). CONCLUSION: beta-adrenergic activation inhibits TNF-alpha (but not IL-6) production induced by LPS in monocytes. The inhibitory effects were not different between early staged hypertensive patients and healthy subjects.

[Clinical and echocardiographic features of constrictive pericarditis: analysis of 36 cases with literature review].

OBJECTIVE: To analyze the clinical and echocardiographic features of constrictive pericarditis. METHODS: Thirty-six patients diagnosed as having constrictive pericarditis from Oct. 1989 to Jun. 2007 were enrolled in this retrospective study. Clinical manifestations and echocardiographic features were analyzed. RESULTS: The main clinical manifestations were fatigue, effort dyspnea(100%), and sign of pressure elevation of vena cava(97%). Echocardiographic features included thickening of pericardium(67%), abnormal motion of septal and posterior wall of left ventricle in diastole(83%, 75% respectively), left and right atrial enlargement(92%,39% respectively), early filling changes of mitral flow with respiration(93%), inferior vena cava dilation and without respiration variation(100%), mitral annulus paradoxical enhanced motion in early diastole. CONCLUSION: Clinical manifestations of pressure elevation of vena cava were indicators for diagnosis of constrictive pericarditis. Echocardiography could be a valuable method for confirming the diagnosis.