Intramyocardial Dissecting Hematoma after Acute Myocardial Infarction-Echocardiographic Features and Clinical Outcome.

OBJECTIVES: Intramyocardial dissecting hematoma (IDH) after acute myocardial infarction (MI) is a rare form of subacute cardiac rupture and hence management uncertainties. The objective of this study was to describe the clinical course of a small series of IDH patients and to review the available evidence for managing similar cases. METHODS: Eight IDH patients from our center had echocardiographic, coronary angiographic and clinical outcome data reviewed. PubMed was also searched for IDH following MI. Cases were divided into three groups and compared according to the dissection location. RESULTS: In our 8 patients, 3 had septal, 1 right ventricular (RV), and 4 left ventricular (LV) dissection. Five were medically treated and 3 surgically repaired. Reviewing the literature revealed 68 IDH patients, of mean age 66 ± 10 years, 43 males. The percentage of IDH involving the LV free wall, septal, and RV free wall were 47%, 26.5%, and 26.5%, respectively. In the cohort as a whole, mortality was not different between surgically and medically treated patients (33.3% vs. 54.3%, P = 0.08), neither based on the IDH location (P = 0.49). While surgical and medical treatment of the LV free wall (20.0% vs. 40.9%, P = 0.25) and septal (46.2% vs. 60.0%, P = 0.60) were not different, surgical repair of RV free wall had significantly better survival (30.0% vs. 87.5%, P = 0.015). The LVEF (P = 0.82), mitral regurgitation (P = 0.49) failed to predict mortality. CONCLUSION: While survival following medical and surgical treatment of LV IDH is not different, patients with RV free wall dissection benefit significantly from surgical repair.

Oxygen radical absorbance capacity of different varieties of strawberry and the antioxidant stability in storage.

Total antioxidant capacity of different varieties of strawberry (Ningfeng, Ningyu, Zijin 4, Toyonoka, Benihope, Sweet Charlie) in different developmental stages (including green unripe stages, half red stages, and red ripe stages) was investigated by oxygen radical absorbance capacity (ORAC) assay. In addition, effects of the antioxidant properties of strawberry stored at 4 °C or -18 °C for a period of five months were studied. The results showed that antioxidant capacity of strawberry changed based on tested part, developmental stage, variety, and time of collection. Calyces had significantly higher ORAC values compared with fruits. Strawberry fruits had higher ORAC values during the green unripe stages than the half red stages and red ripe stages. Strawberries got higher ORAC values during short-time storage, and then decreased during long-time storage. Samples stored at -18 °C exhibited higher antioxidant capacity than those stored at 4 °C, while vacuum treatment could further increase ORAC values. The results indicated the potential market role of strawberries as a functional food and could provide great value in preventing oxidation reaction in food processing and storage for the dietary industry.

Recombinant tissue plasminogen activator plus heparin compared with heparin alone for patients with acute submassive pulmonary embolism: one-year outcome.

OBJECTIVE: To evaluate the long-term effects of thrombolysis on patients with submassive pulmonary embolism (PE). METHODS: Data of 136 patients with acute submassive PE and low risk of bleeding were prospectively collected from January 2005 to October 2011 in a single medical center. Patients received recombinant tissue plasminogen activator (r-tPA) plus low molecular weight heparin (LMWH, TT group, n = 79) or LMWH alone (AT group, n = 57), depending on treating physician's recommendation and patient's preference. Echocardiography was performed at admission, 24 h, 6 and 12 months to evaluate right ventricular function. Computed tomography pulmonary angiography (CTPA) and lung perfusion scan were performed on admission, at 7 days, 6 and 12 months to evaluate clot burden. RESULTS: Seventy-nine patients received r-tPA plus LMWH (TT group) while 57 received LMWH alone (AT group). The baseline characteristics and risk factors did not differ between the two groups. Respiratory rate, heart rate, and systolic blood pressure improved within two hours in both groups. Systolic pulmonary arterial pressure and tricuspid regurgitation improved to a greater extent in the TT group at 24 h, and at 12 months (P < 0.001), as compared to those in the AT group. At one week, and 12 months, clot burden decreased more in AT group, as compared to that in AT group (P < 0.001). There was no death due to bleeding in both groups. Recurrent PE were similar in both groups (2.5% in TT vs. 1.8% in AT). The rates of minor hemorrhages were 6.3% in TT group and 1.8% in AT group (P < 0.05). CONCLUSION: In submassive PE patient who has low risk of bleeding, thrombolysis plus anticoagulation can lead to greater improvement of right ventricular dysfunction and clot burden reduction as compared to anticoagulation therapy alone.

[Improvement in left ventricular filling properties after thrombolysis and anticoagulant therapy with heparin for acute pulmonary thromboembolism].

OBJECTIVE: The purpose of the present study mainly aimed to evaluate whether thrombolysis and heparin anticoagulation for acute pulmonary thromboembolism (PTE) could improve the abnormal left ventricular diastolic filling induced by acute PTE. METHODS: A total of 71 acute PTE patients (36 males and 35 females; age 64 ± 13 years, range 24 - 87 years) admitted to the emergency intensive care unit of Beijing Anzhen Hospital were consecutively recruited from January of 2006 to June of 2011. Fifty-one age-and gender-matched healthy controls (29 males and 22 females, age 61 ± 9 years, range 31 - 79 years) were also recruited from Health Center during the same period of time. PTE patients were classified into 2 treatment subgroups according to initial therapy, thrombolysis subgroup (n = 37) and direct anticoagulation subgroup with heparin (n = 34). Pre- and post-treatment, trans-thoracic Doppler echocardiography was used to assess left ventricular diameters and diastolic filling patterns. Trans-mitral flow velocities including early (E) and late atrial (A) filling velocities were measured, and E/A ratio was calculated reflecting the relative contribution of early and atrial filling. RESULTS: Compared with healthy controls, patients with acute PTE had significantly smaller left ventricular end-diastolic diameter (t = 3.629, P < 0.001), lower mitral E velocity and E/A ratio (t = 5.296, 6.510, both P < 0.001), and higher A velocity (t = 3.065, P < 0.01). After initial treatment including thrombolysis and direct anticoagulation with heparin for all patients with acute PTE, left ventricular end-diastolic diameter and end-systolic diameter were enlarged significantly (t = 5.284, 3.983, both P < 0.001), and mitral E velocity and E/A ratio were increased significantly (t = 3.452, 2.604, P < 0.05, respectively). Subgroup analysis revealed that, both thrombolytic therapy and anticoagulation with heparin could significantly enlarge left ventricular end-diastolic diameter (t = 4.145, 3.269, respectively) and end-systolic diameter (t = 4.145, 3.269, respectively, all P < 0.050), and increase mitral E velocity (t = 2.505, 2.492, P < 0.05, respectively). Compared with healthy controls, even after initial treatment with thrombolysis or heparin anticoagulation, PTE patients still showed lower mitral E velocity and E/A ratio (t = 2.615, 3.837, P < 0.05, respectively), and higher A velocity (t = 3.290, P < 0.01). CONCLUSION: The results strongly suggest that initial treatment for acute PTE with thrombolysis and heparin anticoagulation could improve the abnormal left ventricular diastolic filling induced by acute PTE.

Survey of antioxidant capacity and phenolic composition of blueberry, blackberry, and strawberry in Nanjing.

Berries are a good source of natural antioxidants. In the present study, the total antioxidant capacity and phenolic composition of three berry fruits (blueberry, blackberry, and strawberry) cultivated in Nanjing were investigated. Blueberry, with a Trolox equivalent antioxidant capacity (TEAC) value of 14.98 mmol Trolox/100 g dry weight (DW), exhibited the strongest total antioxidant capacity using both the 2,2-azinobis(3-ethylbenzothiazoline-6-sulfonic acid) diammonium salt (ABTS) and the 2,2-diphenyl-1-picrylhydrazyl (DPPH) methods. Blueberry also had the highest total phenolic content (TPC, 9.44 mg gallic acid/g DW), total flavonoid content (TFC, 36.08 mg rutin/g DW), and total anthocyanidin content (TAC, 24.38 mg catechin/g DW). A preliminary analysis using high performance liquid chromatography (HPLC) showed that the blueberry, blackberry, and strawberry samples tested contained a range of phenolic acids (including gallic acid, protocatechuic acid, p-hydroxybenzoic acid, vanillic acid, caffeic acid, p-coumaric acid, ferulic acid, ellagic acid, and cinnamic acid) and various types of flavonoids (flavone: luteolin; flavonols: rutin, myricetin, quercetrin, and quercetin; flavanols: gallocatechin, epigallocatechin, catechin, and catechin gallate; anthocyanidins: malvidin-3-galactoside, malvidin-3-glucoside, and cyanidin). In particular, the blueberries had high levels of proanthocyanidins and anthocyanidins, which might be responsible for their strong antioxidant activities. These results indicate a potential market role for berries (especially blueberries) as a functional food ingredient or nutraceutical.

[Assessment of left ventricular systolic function and diastolic filling characteristics in patients with pulmonary thromboembolism].

OBJECTIVE: The purpose of the present study aimed to evaluate the left ventricular systolic function and diastolic filling characteristics in pulmonary thromboembolism (PTE). METHODS: A total of 102 patients with PTE, including acute or acute on chronic PTE, were consecutively recruited from January of 2006 to December of 2010. The patients [53 males and 49 females; age (64 ± 14) years, range 23 - 85 years] all underwent Doppler echocardiographic assessment before thrombolytic therapy or within 24 h of hospital admission to the emergency intensive care unit of Beijing Anzhen hospital. Fifty-one age- and gender-matched healthy controls [29 males and 22 females; age (61 ± 9) years, range 31-79 years] were recruited from the Health Center. One hundred and sixty age- and gender-matched coronary artery disease (CAD) patients [90 males and 70 females, age (61 ± 11) years, range 29 - 81 years] with positive coronary artery angiography were also included as controls during the period of January of 2009 through December of 2010. Trans-thoracic Doppler echocardiography was used to assess the trans-mitral filling pattern and left ventricular systolic function in all the subjects. The trans-mitral blood flow peak of early (E) wave less than that of the auricular (A) wave, or the ratio of E/A greater than 2, were defined as abnormal left ventricular diastolic filling. Left ventricular ejection fraction (LVEF) greater than 50% was defined as preserved systolic function. The prevalence of abnormal left ventricular diastolic filling and systolic dysfunction were compared with Chi-square test between the PTE patients and the 2 control groups. RESULTS: Tricuspid regurgitation was identified in 72.5% (74/102) of the 102 PTE patients, abnormal left ventricular diastolic filling was detected in 77.5% (79/102) of the PTE patients, and 95.1% (97/102) of the PTE patients had preserved left ventricular systolic function with LVEF of > 50%. Further analysis revealed that the abnormal left ventricular diastolic filling was more frequent in PTE patients with CAD and/or hypertension than in other PTE patients (χ(2) = 5.280, P < 0.05), 85.2% (52/61) and 65.9% (27/41), respectively. Overall, the prevalence of abnormal left ventricular diastolic filling in PTE patients (77.5%, 79/102) was significantly higher than that in healthy controls (25.5%, 13/51, χ(2) = 38.300, P < 0.001), and the fraction of left ventricular systolic dysfunction was significantly lower (4.9%, 5/102) than that in CAD patients (29.4%, 47/160, χ(2) = 23.450, P < 0.001). In the PTE patients with neither CAD nor hypertension, the abnormal left ventricular diastolic filling was still more frequent (65.9%, 27/41) than in healthy controls (25.5%, 13/51, χ(2) = 15.070, P < 0.001), but there was no significant difference when compared with that in CAD patients (73.8%, 118/160, χ(2) = 1.013, P > 0.05). CONCLUSIONS: The results strongly suggest that abnormal left ventricular diastolic filling constitutes a common and a major form of left ventricular dysfunction in PTE patients. It indicates that enhanced alertness to and early identification of abnormal left ventricular diastolic filling may play an important role in improving prognosis for PTE.