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1.
Medicine (Baltimore) ; 100(36): e27046, 2021 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-34516494

RESUMO

ABSTRACT: To investigate how high-intensity exercise influences an athlete's myocardial resilience and the correlation between myocardial resilience and markers of myocardial ischemic injury.Fifteen swimmers participated in high-intensity exercises. Cardiac ultrasound was performed before and after exercise on each subject. Left ventricular general strain, systolic general strain rate, and the differences (▴general strain and ▴ general strain rate, respectively), before and after exercise were analyzed. Blood was collected at the morning of the exercise day and 6 hours after exercise to measure cardiac enzyme indicators.The correlation between myocardial resilience and markers of myocardial injury were evaluated. Most cardiac enzymes concentrations increased after exercise (P < .05). Cardiac troponin I, creatine kinase MB, and cardiac troponin T were all correlated with the degree of ▴ peak strain (differential value of posterior wall basal segment before and after exercise) and ▴ peak strain rate (differential value before and after exercise) (P < .05).After high-intensity exercise, the concentrations of creatine kinase MB and cardiac troponin T in the blood are positively correlated with two-dimensional ultrasound deformation indices, proving the fact that the seindices can be used as a diagnostic basis for myocardial injury, and are more sensitive than general strain. The two-dimensional strain echocardiogram is non-invasive and easily accepted by the patient. It can make up for the shortage of myocardial enzymes in the injury areas, including weak timeliness and the inability to locate injury.


Assuntos
Atletas , Creatina Quinase Forma MB/sangue , Exercício Físico , Miocárdio , Natação , Troponina T/sangue , Função Ventricular Esquerda/fisiologia , Adolescente , Biomarcadores/sangue , Ecocardiografia , Feminino , Humanos , Masculino
2.
Zhonghua Xin Xue Guan Bing Za Zhi ; 49(9): 894-899, 2021 Sep 24.
Artigo em Chinês | MEDLINE | ID: mdl-34530597

RESUMO

Objective: To summarize the efficacy of combined treatment strategy of mechanical circulation support devices and immunomodulation therapy for patients with fulminant myocarditis. Method: We retrospectively analyzed the clinical data and outcomes of 37 fulminant myocarditis patients complicating cardiogenic shock, who were hospitalized from October 2017 to December 2019 in our department. Patients received guideline therapy according to "Chinese expert consensus statement on clinical diagnosis and treatment of fulminant myocarditis in adults"issued by Chinese Society of Cardiology of Chinese Medical Association. Patients were divided into IABP group (n=19), ECMO group (n=5) and IABP+ECMO group (n=13) according to different mechanical circulation support regimen. The treatment effectiveness among various groups were compared. The major endpoint was in-hospital mortality. The duration and outcome of mechanical circulation support were also analyzed. Furthermore, relationships between baseline data, proportion of different treatments (including medicine treatment, temporary pacemaker and continuous renal replacement treatment, immunomodulation therapy) and clinical outcome were analyzed. Results: The age of the 37 patients in the cohort was (37.4±17.0) years, and there were 22 male among them. Immunomodulation therapy included glucocorticoid (methylprednisolone) and intravenous immunoglobin. At admission, blood pressure was (70.21±17.37)mmHg(1 mmHg=0.133 kPa),heart rate was(100±30)beat/minutes,there were 10 cases of Ⅲ° atrioventricular block and all received temporary pacemaker implantation, 12 cases of ventricular tachycardia and fibrillation,1 patient received temporary pacemaker implantation due to electronic storm, peak cardiac troponin I level was (18.61±9.55)µg/L, peak B type natriuretic peptide level was 1 670(518,3 410)ng/L,left ventricular ejection fraction (LVEF) was(32.3±10.4)%. Thirty-four out of the 37 patients survived and 3 patients died. Hospital duration was (22.7±8.2)days, LVEF was (50.1±10.5)% at discharge. Lactic acid level was significantly higher in IABP+ECMO group than in IABP group and ECMO group(P<0.001 or =0.005),LVEF was significantly lower in IABP+ECMO group than in IABP group(P=0.004),the proportion of ventilator usage was higher in IABO+ECMO group than in IABP group (P<0.05). Survival rate was similar among the three groups. Conclusion: Comprehensive treatment regimen with combined mechanical circulation support and immunomodulation therapy as the core strategies is effective in the treatment of fulminant myocarditis complicated with cardiogenic shock.


Assuntos
Oxigenação por Membrana Extracorpórea , Miocardite , Adulto , Humanos , Imunomodulação , Masculino , Pessoa de Meia-Idade , Miocardite/terapia , Estudos Retrospectivos , Choque Cardiogênico/terapia , Volume Sistólico , Resultado do Tratamento , Função Ventricular Esquerda , Adulto Jovem
3.
Zhonghua Xin Xue Guan Bing Za Zhi ; 49(9): 900-904, 2021 Sep 24.
Artigo em Chinês | MEDLINE | ID: mdl-34530598

RESUMO

Objectives: To explore the impact of strength sport on heart structure by echocardiography (ECHO) and cardiac resonance imaging (CMR). Methods: This is a case control study. A total of 14 male weightlifter athletes who underwent physical examination in Peking University Third Hospital from January 16, 2019 to November 1, 2019 were included in this study. Fourteen age-matched healthy Chinese men served as the control group. ECHO and CMR were used to detect the heart structure and function of the participants. Results: The age of athlete group was (21±3) years, and the training time was (9±4) years. The weekly exercise time of athlete group was more than 15 hours, while that of control group was less than 3 hours. ECHO-derived interventricular septal (IVS) thickness value ((9.3±1.3) mm vs. (8.1±0.5) mm, P=0.006) and CMR-derived IVS value ((11.0±1.5) mm vs. (10.0±0.5) mm, P=0.003) was both significantly higher in the athlete group than in the control group. For the athlete group, the indicators of left ventricular volume measured by ECHO (left ventricular end diastolic volume (LVEDV), left ventricular end diastolic volume index (LVEDVI), left ventricular end systolic volume, left ventricular end systolic volume index) and IVS thickness were significantly lower than those measured by CMR (all P<0.05). Left ventricular ejection fraction ((67.0±3.8)% vs. (59.0±3.9)%, P<0.001) and left ventricular global longitudinal strain ((19.3±2.9)% vs. (11.2±1.2)%, P<0.001) values measured by ECHO were significantly higher than those measured by CMR. There was no significant difference in the proportion of subjects with the left ventricular end diastolic diameter, LVEDV and LVEDVI above the upper limit of normal as measured by ECHOs and CMR (all P>0.05). IVS values measured by ECHO were all within the normal range, and CMR showed that 9 (9/14) weightlifter athletes had IVS>11 mm with a maximum thickness of 13.8 mm, which occurred in the inferoseptum. Conclusion: Weightlifter sport could result in thickening of the left ventricular inferoseptum, and CMR is superior to ECHO in detecting the thickening of the left ventricular wall, which serves as a helpful tool for sports medicine supervision.


Assuntos
Função Ventricular Esquerda , Septo Interventricular , Adolescente , Adulto , Atletas , Estudos de Casos e Controles , China , Ecocardiografia , Humanos , Imageamento por Ressonância Magnética , Masculino , Volume Sistólico , Adulto Jovem
4.
Zhonghua Xin Xue Guan Bing Za Zhi ; 49(9): 912-919, 2021 Sep 24.
Artigo em Chinês | MEDLINE | ID: mdl-34530600

RESUMO

Objective: To investigate the effect of neuregulin-1(NRG-1) on cardiac glucose metabolism in Sprague Dawley (SD) rats with experimental myocardial infarction (MI). Methods: Adult male SD rats were randomly divided into three groups: the sham-operated group, MI group, and MI+NRG1 group. The rat MI model was established via ligation of the left anterior descending coronary artery. Two weeks after operation, echocardiography was performed, MI rats with left ventricular ejection fraction (LVEF) between 0.3-0.5 were selected and randomly assigned to MI group and MI+NRG-1 group. Rats in MI+NRG-1 group were treated with recombinant human NRG-1ß (100 µg/kg) via tail vein at 2 weeks after operation (twice per week for 6 weeks); while rats in sham-operated group and MI group received equal volume of physiological saline. By the end of administration, echocardiography and small animal positron emission tomography (PET) were performed to detect cardiac function and myocardial glucose uptake. Myocardial morphology and collagen volume fraction, cardiomyocyte apoptosis and reactive oxygen species (ROS) production were evaluated by histopathologic analysis. Myocardial pyruvate dehydrogenase (PDH) and citrate synthase (CS) activity, as well as ATP production were detected by commercial kits. The mRNA and protein expression levels of NRG-1, p-ErbB4, and key factors involved in glucose metabolism (including Glut-4, HK2, PDK4, PDH, CS) were detected by quantitative real-time PCR (qRT-PCR) and Western blot assay, respectively. Results: With the MI model successfully established, the left ventricular ejection fraction(LVEF) and left ventricular shortening fraction(LVFS) were significantly lower in MI group and MI+NRG-1 group than that in sham group (both P<0.01), while there was no significant difference between MI group and MI+NRG-1 group(all P>0.05). After 6 weeks of NRG-1ß intervention, the LVEF and LVFS were significantly higher in MI+NRG-1 group than in MI group (both P<0.01). By the end of experiment, PET imaging showed that the mean standardized uptake value (SUVmean) were lower in MI+NRG-1 group than in the sham group (4.06±0.28 vs. 5.18±0.37, P<0.01), while significantly higher than that in MI group (4.06±0.28 vs.2.86±0.49, P<0.01). Histopathological analysis showed that compared with MI group, rats in MI+NRG-1 group exhibited significantly decreased left ventricle collagen volume fraction ((7.83±1.24) % vs. (18.31±3.58) %, P<0.01), cardiomyocyte apoptosis((37.98±4.26)% vs. (67.04±5.38)%, P<0.01), and DHE fluorescence intensity(0.057 28±0.007 06 vs. 0.076 94±0.008 46, P<0.01), indicating that NRG-1ß could reduce ROS production. PDH activity, CS activity, and ATP production were significantly higher in MI+NRG-1 group than in MI group (all P<0.05). qRT-PCR demonstrated an upregulated Glut-4, HK2 and CS, but downregulated PDK4 mRNA expression in MI+NRG-1 group compared with MI group (all P<0.01). Western blot assay showed significantly higher protein expression of NRG-1, p-ErbB4, Glut-4, HK2, PDH, CS in MI+NRG-1 group than in MI group (all P<0.01). Conclusion: NRG-1 could improve glucose uptake and utilization in myocardium by activating phosphorylation of myocardial ErbB4 receptor in MI rats, thus providing a therapeutic option for improving energy metabolism after MI.


Assuntos
Infarto do Miocárdio , Neuregulina-1 , Animais , Glucose , Masculino , Infarto do Miocárdio/tratamento farmacológico , Miocárdio , Ratos , Ratos Sprague-Dawley , Volume Sistólico , Função Ventricular Esquerda
5.
Ann Palliat Med ; 10(8): 8684-8691, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34488357

RESUMO

BACKGROUND: The aim of this study was to observe the effect of Sacubitril/Valsartan on cardiac function and remodeling in patients with heart failure with reduced ejection fraction (HFrEF). METHODS: A total of 120 patients with HFrEF were selected and given standard heart failure treatment according to the 2017 ACC/AHA/HFSA guidelines. Regardless of whether patients had taken Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers (ACEI/ARB) medications previously, after admission they were treated with the minimum effective dose of Sacubitril/Valsartan according to their blood pressure reading. Baseline clinical data were recorded and patients were followed up at 1, 3, 6, 9, and 12 months post discharge, during which time the dose of Sacubitril/Valsartan was gradually increased to the maximum tolerated dose (dose range 25-200 mg/twice daily). During follow-up, N-terminal pro-brain natriuretic peptide (NT-proBNP), left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), and left atrium diameter (LAD) were monitored; a 6-minute walking test and Kansas City Cardiomyopathy Questionnaire (KCCQ) scores were recorded; and adverse reactions were collected. RESULTS: Over the course of the 12-month follow-up, the plasma concentrations of NT-proBNP were significantly reduced compared with the baseline, and the longer the follow-up time, the lower the NT-proBNP levels were (P<0.05). Similarly, LVEDD, LVESD and LAD were significantly smaller at 12 months than at baseline, and the longer the follow-up time, the smaller the internal diameter was (P<0.05). The LVEF, 6-minute walking distance and KCCQ scores increased significantly from baseline (P<0.05), whereas eGFR and serum potassium levels showed no significant change compared with the baseline. CONCLUSIONS: Sacubitril/Valsartan demonstrated a remarkable ability to improve cardiac function and to control cardiac remodeling with a high degree of safety in patients with HFrEF.


Assuntos
Insuficiência Cardíaca , Assistência ao Convalescente , Aminobutiratos , Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Compostos de Bifenilo , Combinação de Medicamentos , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Alta do Paciente , Volume Sistólico , Resultado do Tratamento , Valsartana , Função Ventricular Esquerda , Remodelação Ventricular
6.
JNMA J Nepal Med Assoc ; 59(233): 46-50, 2021 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-34508458

RESUMO

INTRODUCTION: Atrial fibrillation is the most prevalent supraventricular arrhythmia responsible for the large morbidity and mortality burden worldwide. There are various causes of atrial fibrillation that may affect the prognosis of patients. This study was intended to determine different echocardiographic findings in patients with atrial fibrillation in a tertiary care center. METHODS: A descriptive cross-sectional study was conducted at Manmohan Cardiothoracic Vascular and Transplant Center, Institute of Medicine, among 175 patients with atrial fibrillation admitted in the cardiology department from June 2017 to October 2018. It was approved by the Institutional Review Board of the Institute of Medicine (Ref.:411(6-11-E)2/073/074). Convenience sampling was used. Statistical analysis was done using Statistical Package for Social Sciences version 21.0. RESULTS: A total of 175 patients with atrial fibrillation were enrolled where Rheumatic heart disease 68 (38.9%) was the leading cause in which 54 (79.4%) had mitral valve lesion, 1 (1.5%) had aortic valve lesion and rest had a combination of both. The mixed lesion of mitral stenosis and mitral regurgitation was the commonest. The left atrium size was larger in valvular atrial fibrillation (47.296±651mm). The left ventricular systolic dysfunction was seen more in non-valvular atrial fibrillation. The commonest site of thrombus formation was left atrium 7 (63.6%). CONCLUSIONS: Atrial fibrillation was common in rheumatic heart disease, especially mixed lesions of mitral stenosis and regurgitation. Valvular atrial fibrillation had a larger left atrium. The thrombus was seen in mitral stenosis and left ventricular systolic dysfunction. The left atrium size and left ventricular ejection fraction were associated with the occurrence of atrial fibrillation.


Assuntos
Fibrilação Atrial , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/epidemiologia , Estudos Transversais , Ecocardiografia , Átrios do Coração/diagnóstico por imagem , Humanos , Nepal/epidemiologia , Volume Sistólico , Centros de Atenção Terciária , Função Ventricular Esquerda
7.
Zhongguo Dang Dai Er Ke Za Zhi ; 23(8): 821-827, 2021 Aug 15.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-34511172

RESUMO

OBJECTIVES: To study the change in regional oxygen saturation (rSO2) of intestinal tissue in preterm infants with hemodynamically significant patent ductus arteriosus (hsPDA) by near-infrared spectroscopy, and the clinical significance of the change in intestinal oxygen level in preterm infants with hsPDA. METHODS: The preterm infants with patent ductus arteriosus (PDA) who had gestational age <32 weeks and/or birth weight <1 500 g were prospectively enrolled, who were admitted to the Department of Neonatology, Shenzhen Longgang Central Hospital from October 2017 to October 2020.According to the diagnostic criteria for hsPDA, the preterm infants with patent ductus arteriosus (PDA) were divided into two groups: hsPDA and non-hsPDA. According to closure of the ductus arteriosus after oral administration of ibuprofen, the preterm infants in the hsPDA group were subdivided into two groups: hsPDA closure and hsPDA non-closure. Hemodynamic parameters were measured at diagnosis of PDA and after treatment, and the level of intestinal tissue rSO2 was monitored continuously to analyze its change. RESULTS: A total of 241 preterm infants with PDA were enrolled, with 55 infants (22.8%) in the hsPDA group and 186 infants (77.2%) in the non-hsPDA group. There were 36 infants (65%) in the hsPDA closure group and 19 infants (35%) in the hsPDA non-closure group. Compared with the non-hsPDA group, the hsPDA group had a significantly higher left atrial diameter/aortic root diameter ratio and significantly lower left ventricular ejection fraction and fractional shortening (P<0.05). At each time point within 6 hours after diagnosis (1, 2, 4, and 6 hours), the hsPDA group had significantly lower intestinal tissue rSO2 than the non-hsPDA group (P<0.05), and intestinal tissue rSO2 gradually decreased over time in the hsPDA group (P<0.05), with the lowest level of 0.448±0.014 at 6 hours. Compared with the hsPDA non-closure group, the hsPDA closure group had a significantly lower left atrial diameter/aortic root diameter ratio and significantly higher left ventricular ejection fraction and fractional shortening (P<0.05). At each time point within 48-96 hours after treatment (48, 72, and 96 hours), the hsPDA closure group had significantly higher intestinal tissue rSO2 than the hsPDA non-closure group (P<0.05), and intestinal tissue rSO2 gradually increased since 24 hours after treatment in the hsPDA closure group (P<0.05), with the highest level of 0.578±0.031 at 96 hours. CONCLUSIONS: hsPDA has an impact on intestinal tissue oxygenation in preterm infants, and continuous monitoring of intestinal tissue rSO2 by near-infrared spectroscopy can help to guide the clinical management of hsPDA in preterm infants.


Assuntos
Permeabilidade do Canal Arterial , Permeabilidade do Canal Arterial/diagnóstico por imagem , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Oxigênio , Estudos Prospectivos , Espectroscopia de Luz Próxima ao Infravermelho , Volume Sistólico , Função Ventricular Esquerda
8.
Arq Bras Cardiol ; 117(2): 300-306, 2021 08.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34495223

RESUMO

BACKGROUND: The classification of heart failure (HF) by phenotypes has a great relevance in clinical practice. OBJECTIVE: The study aimed to analyze the prevalence, clinical characteristics, and outcomes between HF phenotypes in the primary care setting. METHODS: This is an analysis of a cohort study including 560 individuals, aged ≥ 45 years, who were randomly selected in a primary care program. All participants underwent clinical evaluations, b-type natriuretic peptide (BNP) measurements, electrocardiogram, and echocardiography in a single day. HF with left ventricular ejection fraction (LVEF) < 40% was classified as HF with reduced ejection fraction (HFrEF), LVEF 40% to 49% as HF with mid-range ejection fraction (HFmrEF) and LVEF ≥ 50% as HF with preserved ejection fraction (HFpEF). After 5 years, the patients were reassessed as to the occurrence of the composite outcome of death from any cause or hospitalization for cardiovascular disease. RESULTS: Of the 560 patients included, 51 patients had HF (9.1%), 11 of whom had HFrEF (21.6%), 10 had HFmrEF (19.6%) and 30 had HFpEF (58.8%). HFmrEF was similar to HFpEF in BNP levels (p < 0.001), left ventricular mass index (p = 0.037), and left atrial volume index (p < 0.001). The HFmrEF phenotype was similar to HFrEF regarding coronary artery disease (p = 0.009). After 5 years, patients with HFmrEF had a better prognosis when compared to patients with HFpEF and HFrEF (p < 0.001). CONCLUSION: The prevalence of ICFEI was similar to that observed in previous studies. ICFEI presented characteristics similar to ICFEP in this study. Our data show that ICFEi had a better prognosis compared to the other two phenotypes.


Assuntos
Insuficiência Cardíaca , Estudos de Coortes , Humanos , Fenótipo , Atenção Primária à Saúde , Prognóstico , Volume Sistólico , Função Ventricular Esquerda
10.
Angiol Sosud Khir ; 27(3): 125-130, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34528596

RESUMO

AIM: To study the effect of type 2 diabetes mellitus on changes of intracardiac haemodynamics and myocardial morphology in patients with ischaemic heart disease and a postinfarction aneurysm of the left ventricle before and after corrective operations on the heart. PATIENTS AND METHODS: The study included 79 patients with ischaemic heart disease and a chronic aneurysm of the left ventricle (Group I - patients with type 2 diabetes mellitus (n=27), mean age 57.5±3.9 years, average number of shunts 2.9±0.6; Group II - patients without diabetes mellitus (n=52), mean age 55,3 ±7.1 years, average number of shunts - 2.7±0.3). In the preoperative period all patients were examined taking into account the functional class of angina pectoris, with the assessment of the left ventricular ejection fraction, end-diastolic index, end-systolic index, sphericity index. All patients underwent coronary artery bypass grafting and surgical restoration of the normal geometry of the left ventricle according to the Menicanty technique with the target end-systolic index of 60 ml/m2, during which 39 patients from both groups were subjected to intraoperative biopsy of the left ventricular myocardium and right atrial auricle. RESULTS: The intergroup analysis revealed no statistically significant differences in age, angina pectoris class, level of arterial pressure between the groups. Neither were there statistically significant differences in the echocardiographic parameters at the preoperative stage. In the postoperative period, we detected a significant decrease in the end-systolic and end-diastolic volumes of the left ventricle in both groups, with a statistically significant increase of the left ventricular ejection fraction observed only in non-diabetic patients. One year after the operation, such patients still continued to demonstrate more favourable parameters of the systolic and diastolic functions of the left ventricle. A detailed analysis with determining the delta of the alterations in the parameters revealed more significant positive dynamics in the postoperative period in patients with ischaemic heart disease not associated with type 2 diabetes mellitus. CONCLUSION: The obtained findings are indicative of negative dynamics of the course of chronic ischaemic heart disease aggravated by type 2 diabetes mellitus after reconstruction of the left ventricle. Macro- and microangiopathy in type 2 diabetes mellitus significantly deteriorated the myocardial trophism. Subsequent bleedings draw phagocytic cells into the myocardial stroma, thus adversely affecting the further prognosis and course of the disease, since we demonstrated that the presence of inflammatory infiltrate in the myocardial stroma is a key factor of unfavourable outcomes of surgical treatment of patients with ischaemic cardiomyopathy.


Assuntos
Doença da Artéria Coronariana , Diabetes Mellitus Tipo 2 , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Humanos , Pessoa de Meia-Idade , Volume Sistólico , Função Ventricular Esquerda
11.
J Int Med Res ; 49(9): 3000605211041439, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34521238

RESUMO

OBJECTIVE: The effect of renin-angiotensin system inhibitors (RASIs) in patients with heart failure (HF) and atrial fibrillation (AF) remains unclear. This study aimed to investigate associations between RASI use and all-cause mortality and cardiovascular outcomes in patients with AF and HF. METHODS: Using data from the China Atrial Fibrillation Registry study, we included 938 patients with AF and HF with a left ventricular ejection fraction <50%. Cox regression models for RASIs vs. non-RASIs with all-cause mortality as the primary outcome were fitted in a 1:1 propensity score-matched cohort. A sensitivity analysis was performed by using a multivariable time-dependent Cox regression model. As an internal control, we assessed the relation between ß-blocker use and all-cause mortality. RESULTS: During a mean follow-up of 35 months, the risk of all-cause mortality was similar in RASI users compared with non-users (hazard ratio: 0.92; 95% confidence interval: 0.67-1.26). Similar results were obtained in the sensitivity analysis. In contrast, ß-blocker use was associated with significantly lower all-cause mortality in the same population. CONCLUSIONS: RASI use was not associated with better outcomes in patients with AF and HF in this prospective cohort, which raises questions about their value in this specific subset.Trail Registration: ChiCTR-OCH-13003729.


Assuntos
Fibrilação Atrial , Insuficiência Cardíaca , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , China , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Pontuação de Propensão , Estudos Prospectivos , Sistema de Registros , Sistema Renina-Angiotensina , Volume Sistólico , Função Ventricular Esquerda
12.
Wiad Lek ; 74(8): 1850-1855, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34537732

RESUMO

OBJECTIVE: The aim: To study the predictive power of demographic, hemodynamic and electrocardiographic factors for atrial fibrillation recurrence after radiofrequency ablation (RFA) in patients with chronic heart failure. PATIENTS AND METHODS: Materials and methods: Study included 120 patients, aged 59,80±10,08 years old with chronic heart failure with preserved left ventricular ejection fraction who were undergo RFA due to atrial fibrillation (AF). A standard 12-lead electrocardiogram (ECG) was registered. Before the procedure the standard echocardiographic parameters were obtained. After 12 months, patients were divided into 2 groups: non-recurrence group and recurrence group. RESULTS: Results: As a result of prospective follow-up within 12 months AF recurrences were observed in 32 patients (27%), 88 patients remained non-recurrent (73%). The left atrium (LA) diameter and aortic root diameter were lager in the recurrence group (4,59±0,45 vs. 4,08±0,61 cm, p<0,001; 3,37±0,60 vs. 2,80±0,67 cm, p<0,001). The AF recurrence group before RFA had a significantly longer QTc interval than the non-recurrence group (387,23±2,31 vs. 341,22±8,91 ms, p<0,010). ROC curve analysis revealed LA diameter the most sensitive factor for AF recurrence after RFA. CONCLUSION: Conclusions: QTc duration before radiofrequency ablation and its prolongation after intervention are independent predictors of atrial fibrillation recurrence; left atrium diameter before ablation is a highly sensitive predictor in patients with chronic heart failure with preserved left ventricular ejection fraction.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Insuficiência Cardíaca , Ablação por Radiofrequência , Fibrilação Atrial/cirurgia , Criança , Átrios do Coração , Humanos , Estudos Prospectivos , Recidiva , Volume Sistólico , Resultado do Tratamento , Função Ventricular Esquerda
13.
Rev Med Liege ; 76(7-8): 583-587, 2021 Jul.
Artigo em Francês | MEDLINE | ID: mdl-34357707

RESUMO

We report the case of a 61-year old patient with signs and symptoms of heart failure with mid-range left ventricular ejection fraction and moderate mitral regurgitation of mixed etiology (rheumatic heart disease, toxic and ischemic). The dynamic behaviour of the mitral regurgitation was revealed by an acute episode of pulmonary edema in the context of an abrupt elevation of blood pressure inducing an increase in left ventricular afterload. Dynamic mitral regurgitation must be considered in any patient with exercise dyspnea who has a moderate mitral regurgitation in resting conditions or in patients with repeated acute pulmonary edema without an obvious cause. Exercise stress echocardiography is the best diagnostic test to explore the dynamic behaviour of the mitral regurgitation. Surgery or percutaneous treatment may be proposed in severe cases.


Assuntos
Insuficiência da Valva Mitral , Edema Pulmonar , Teste de Esforço , Humanos , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/diagnóstico por imagem , Edema Pulmonar/diagnóstico , Edema Pulmonar/etiologia , Volume Sistólico , Função Ventricular Esquerda
14.
Ann Palliat Med ; 10(7): 7823-7831, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34353069

RESUMO

BACKGROUND: Acute myocardial infarction (AMI) is the most common critical illness clinically. Percutaneous coronary intervention (PCI) can help patients with AMI by reopening their blocked blood vessels and improving clinical symptoms. Clinical practice has confirmed that rehabilitation training after PCI could significantly promote the recovery of patients' heart function, reduce cardiovascular events, and have a positive significance for prognosis. This study aimed to explore the effect of kinetic energy progressive exercise (PEKE) applied to patients with AMI after PCI. METHODS: From April 2019 to April 2020, a total of 98 patients with AMI after PCI in our hospital were randomly allocated to PEKE group and routine intervention (RI) group. The RI group adopted routine intervention, while the PEKE group introduced PEKE intervention on the basis of the RI group. The incidence of adverse events (AEs), motor function, cardiac function, and quality of life (QoL) before and after intervention were compared between the two groups. RESULTS: Compared with the RI group, the incidence of AEs in the PEKE group was significantly reduced (χ2=4.404, P=0.036). After 6 months of intervention, the maximum exercise load and metabolic equivalent of the PEKE group were greater than those of the RI group (t=7.114, 4.565; P=0.000, 0.000). After 6 months of intervention, the left ventricular ejection fraction (LVEF) of the PEKE group was greater than that of the RI group (t=6.826, P=0.000), and there were no significant differences in left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV) compared with the RI group (t=1.253, 1.147; P=0.213, 0.254). After 6 months of intervention, the PEKE group's symptoms, physical function, cognitive function, psychosocial function, and satisfaction scores were greater than those in the RI group (t=5.991, 4.612, 7.165, 5.731, 5.468; P=0.000, 0.000, 0.000, 0.000, 0.000). CONCLUSIONS: We applied PEKE was to AMI patients with after PCI, and it was shown to effectively reduce AEs, improve the patients' exercise ability and cardiac function, and improve their QoL. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: ChiCTR2100046123.


Assuntos
Infarto do Miocárdio , Intervenção Coronária Percutânea , Humanos , Infarto do Miocárdio/terapia , Qualidade de Vida , Volume Sistólico , Resultado do Tratamento , Função Ventricular Esquerda
15.
Ann Palliat Med ; 10(7): 8034-8042, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34353088

RESUMO

BACKGROUND: Percutaneous coronary intervention (PCI) has become increasingly mature and has gradually become the main treatment for coronary heart disease (CHD). However, evaluation of myocardial reperfusion after PCI remains a major clinical challenge. This study aimed to explore the VVI technique in evaluating the effect, prognosis, and follow-up of CHD patients after percutaneous coronary intervention. We performed a quantitative analysis of left ventricular myocardial contractile strain and dyssynchrony before and after stent implantation in patients by VVI. METHODS: Thirty-five patients diagnosed with CHD who underwent percutaneous coronary stenting (PCI) in the Department of Cardiovascular Medicine, Affiliated Hospital of Jiangnan University from March 2019 to October 2020 were selected as the case group. Continuous dynamic two-dimensional images of the patient's left ventricle were analyzed using VVI at 1 day before PCI (group A), 7 days after PCI (group B), and 30 days after PCI (group C). The patients' left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), left ventricle ejection fraction (LVEF), peak longitudinal strain, and peak radial strain of myocardial contraction were measured. The VVI images of 35 healthy subjects who underwent physical examination in the outpatient department of our hospital from March 2019 to October 2020 were selected as controls. RESULTS: There were no significant differences in the LVEF, LVEDD, and LVESD between the case and control groups (P>0.05). The peak systolic longitudinal and radial strain values at 1 month after treatment were higher than those before treatment. The differences among myocardial segments were statistically significant, except for the apical septum, base anterior, apical anterior, and base inferior segments (P<0.05). The peak systolic longitudinal and radial strain values at 1 week after treatment were not significantly different from those at 1 month after treatment, except for the base anterior septum, mid anterior, posterior, and inferior myocardial segments (P>0.05). CONCLUSIONS: VVI technology can comprehensively and objectively evaluate the overall and local myocardial function of the left ventricle, thereby providing a novel method for the clinical treatment of CHD as well as the evaluation of curative effect and prognosis.


Assuntos
Doença das Coronárias , Intervenção Coronária Percutânea , Ventrículos do Coração/diagnóstico por imagem , Humanos , Stents , Função Ventricular Esquerda
16.
BMJ Open ; 11(8): e045302, 2021 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-34341035

RESUMO

INTRODUCTION: Recent studies have shown that the His-Purkinje system pacing (HPSP) can achieve electrocardiomechanical synchronisation, and thus improve cardiac function. For patients with pacing-induced cardiomyopathy (PICM) who should be treated with pacemaker upgrade, the HPSP is a viable alternative to cardiac resynchronisation therapy (CRT). However, no randomised controlled trial has been performed to evaluate the efficacy and safety of HPSP in patients with PICM. The present study compared the efficacy and safety of HPSP with that of traditional CRT in the treatment of patients with PICM. METHODS AND ANALYSIS: This study is a single-centre, randomised controlled non-inferiority trial. This trial was carried out at the cardiac centre of Beijing Anzhen Hospital. A total of 46 patients with PICM who needed pacemaker upgrade treatment between January 2022 and December 2023 will be enrolled in this study. Patients will be randomised into an investigational group (HPSP) and a control group (CRT) at a 1:1 ratio. The primary outcome is the duration of QRS complex (QRS width), and the secondary outcomes are NT-proBNP (N terminal pro B type natriuretic peptide), C reactive protein, the number of antibiotics used, left ventricular ejection fraction, end systolic volume, end diastolic volume, the hospitalisation duration, the incidence of postoperative infection, pacemaker parameters (threshold, sensing and impedance), the 6-minute walking test, and quality of life (36-Item Short Form Survey scale), all-cause mortality, cardiovascular death, heart failure-related rehospitalisation rate, other rehospitalisation rates, major complication rates and procedure costs. ETHICS AND DISSEMINATION: This study has been approved by the Beijing Anzhen Hospital Medical Ethics Committee (No. 2020043X). TRIAL REGISTRATION NUMBER: Chinese Clinical Trial Registry (ChiCTR2000034265).


Assuntos
Terapia de Ressincronização Cardíaca , Cardiomiopatias , Insuficiência Cardíaca , Cardiomiopatias/terapia , Insuficiência Cardíaca/terapia , Humanos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Volume Sistólico , Resultado do Tratamento , Função Ventricular Esquerda
17.
J Am Heart Assoc ; 10(16): e021428, 2021 08 17.
Artigo em Inglês | MEDLINE | ID: mdl-34365798

RESUMO

Background Cardiac dysfunction is a prominent feature of multisystem inflammatory syndrome in children (MIS-C), yet the etiology is poorly understood. We determined whether dysfunction is global or regional, and whether it is associated with the cytokine milieu, microangiopathy, or severity of shock. Methods and Results We analyzed echocardiographic parameters of myocardial deformation and compared global and segmental left ventricular strain between 43 cases with MIS-C ≤18 years old and 40 controls. Primary outcomes included left ventricular global longitudinal strain, right ventricular free wall strain), and left atrial strain. We evaluated relationships between strain and profiles of 10 proinflammatory cytokines, microangiopathic features (soluble C5b9), and vasoactive-inotropic requirements. Compared with controls, cases with MIS-C had significant impairments in all parameters of systolic and diastolic function. 65% of cases with MIS-C had abnormal left ventricular function (|global longitudinal strain|<17%), although elevations of cytokines were modest. All left ventricular segments were involved, without apical or basal dominance to suggest acute stress cardiomyopathy. Worse global longitudinal strain correlated with higher ratios of interleukin-6 (ρ -0.43) and interleukin-8 (ρ -0.43) to total hypercytokinemia, but not absolute levels of interleukin-6 or interleukin-8, or total hypercytokinemia. Similarly, worse right ventricular free wall strain correlated with higher relative interleukin-8 expression (ρ -0.59). There were no significant associations between function and microangiopathy or vasoactive-inotropic requirements. Conclusions Myocardial function is globally decreased in MIS-C and not explained by acute stress cardiomyopathy. Cardiac dysfunction may be driven by the relative skew of the immune response toward interleukin-6 and interleukin-8 pathways, more so than degree of hyperinflammation, refining the current paradigm of myocardial involvement in MIS-C.


Assuntos
Função do Átrio Esquerdo , COVID-19/complicações , Síndrome da Liberação de Citocina/etiologia , Citocinas/sangue , Cardiopatias/etiologia , Mediadores da Inflamação/sangue , Síndrome de Resposta Inflamatória Sistêmica/complicações , Função Ventricular Esquerda , Função Ventricular Direita , Adolescente , Fatores Etários , Biomarcadores/sangue , COVID-19/diagnóstico , COVID-19/imunologia , Criança , Estudos Transversais , Síndrome da Liberação de Citocina/diagnóstico , Síndrome da Liberação de Citocina/imunologia , Ecocardiografia , Feminino , Cardiopatias/diagnóstico por imagem , Cardiopatias/imunologia , Cardiopatias/fisiopatologia , Humanos , Masculino , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/imunologia
18.
Health Qual Life Outcomes ; 19(1): 197, 2021 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-34404411

RESUMO

BACKGROUND: The study aimed to evaluate the long-term change of health-related quality of life (HRQOL) and to identify predictors of HRQOL 5 years after cardiac surgery. METHODS: Consecutive adult patients, undergoing elective cardiac surgery were enrolled in the study. HRQOL was measured using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) questionnaire before and 5-years after cardiac surgery. A multivariate latent change modeling approach was used for data analysis. RESULTS: 210 participants (30.5% female) were reached at 5-year follow-up and included in final data analysis. The study revealed, after controlling for gender effects, a significant long-term positive change, in physical functioning (PF, Mslope = 19.79, p < 0.001), social functioning (SF, Mslope = 17.27, p < 0.001), vitality (VT, Mslope = 6.309, p < 0.001) and mental health (MH, Mslope = 8.40, p < .001) in the total sample. Lower education was associated with an increase in PF (Mslope = 24.09, p < 0.001) and VT (Mslope = 8.39, p < 0.001), more complicated surgery (other than the coronary artery bypass graft (CABG) predicted increase in general health (GH, Mslope = 6.76, p = 0.005). Arrhythmia was a significant predictor for lower pre- and post-operative VT and SF. CONCLUSIONS: Overall HRQOL in our sample improved from baseline to five years postoperatively. Further studies including larger patient groups are needed to confirm these findings.


Assuntos
Procedimentos Cirúrgicos Cardíacos/psicologia , Qualidade de Vida/psicologia , Adulto , Feminino , Seguimentos , Humanos , Masculino , Saúde Mental , Volume Sistólico , Inquéritos e Questionários , Função Ventricular Esquerda
19.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 33(7): 809-814, 2021 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-34412749

RESUMO

OBJECTIVE: To analyze the prognostic risk factors of patients with sepsis and the clinical characteristics of patients with septic myocardial injury. METHODS: A retrospective study was conducted. The clinical data of 300 patients with sepsis admitted to emergency department of Zhongshan Hospital of Fudan University from September 2017 to June 2020 were enrolled, including basic information, blood test indicators and auxiliary inspection indicators. The patients were grouped according to myocardial injury and the clinical characteristics of patients with septic myocardial injury were analyzed. According to 28-day prognosis, they were divided into survival group and non-survival group. The differences in various indicators between the two groups were compared, and binary Logistic regression was used to explore independent risk factors for death in patients with sepsis. RESULTS: In 300 patients, 47 patients were excluded for previous heart disease or lack of the main inspections, and 253 patients were enrolled finally. (1) Myocardial injury occurred in 136 out of 253 patients (53.8%), and 117 without myocardial injury. Compared with the non-myocardial injury group, the myocardial injury group had higher blood white blood cell count [WBC (×109/L): 9.7 (6.7, 13.4) vs. 8.3 (5.4, 12.2)] and procalcitonin [PCT (µg/L): 0.61 (0.18, 4.63) vs. 0.23 (0.09, 0.99)] at admission, and more Staphylococcal infections (17.6% vs. 2.6%), more arrhythmia (sinus tachycardia: 30.9% vs. 23.1%), more ST-T changes (26.5% vs. 23.1%), lower left ventricular ejection fraction [LVEF: 0.60 (0.54, 0.65) vs. 0.62 (0.60, 0.66)], higher pulmonary artery systolic pressure [PASP (mmHg, 1 mmHg = 0.133 kPa): 38.0 (32.2, 46.0) vs. 33.0 (30.0, 40.2)], and worse prognosis (28-day mortality: 44.1% vs. 6.0%, all P < 0.05). Logistic regression analysis showed that PCT increased [odds ratio (OR) = 1.039, 95% confidence interval (95%CI) was 1.018-1.060, P < 0.01], LVEF decreased (OR = 0.828, 95%CI was 0.729-0.941, P < 0.01) and sinus tachycardia (OR = 3.512, 95%CI was 1.417-8.702, P < 0.01) were clinical characteristics of septic patients with myocardial injury. (2) A total of 186 of the 253 patients survived, and 67 died with 28-day mortality of 26.5%. Compared with the survival group, non-survival group had higher myocardial markers and inflammation markers at admission [cardiac troponin T (cTnT, µg/L): 0.06 (0.02, 0.17) vs. 0.02 (0.01, 0.05), N-terminal pro-brain natriuretic peptide (NT-proBNP, ng/L): 3 037.0 (1 308.7, 12 033.7) vs. 893.9 (272.8, 2 825.5), creatine kinase (CK, U/L): 144.5 (57.5, 660.8) vs. 89.5 (47.8, 201.0), WBC (×109/L): 10.5 (6.7, 14.6) vs. 8.6 (6.0, 12.0), C-reactive protein (CRP, mg/L): 89.2 (54.8, 128.5) vs. 63.8 (19.3, 105.6), PCT (µg/L): 2.13 (0.31, 11.79) vs. 0.28 (0.10, 1.25), all P < 0.05], and more sinus tachycardia and atrial arrhythmia (41.8% vs. 22.0%, 29.9% vs. 17.7%, both P < 0.05). Logistic regression analysis showed that cTnT increased (OR = 2.115, 95%CI was 1.189-5.459, P < 0.05), sinus tachycardia (OR = 2.557, 95%CI was 1.103-5.929, P < 0.05) and atrial arrhythmia (OR = 2.474, 95%CI was 1.025-5.969, P < 0.05) were independent risk factors for 28-day death in patients with sepsis. CONCLUSIONS: Myocardial injury is an independent risk factor for death in patients with sepsis. PCT elevation, LVEF decreased and sinus tachycardia are main characteristics of patients with septic myocardial injury, which should attract clinical attention.


Assuntos
Sepse , Função Ventricular Esquerda , Humanos , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Volume Sistólico
20.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 33(7): 838-843, 2021 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-34412754

RESUMO

OBJECTIVE: To evaluate the dynamic changes of pulmonary arterial pressure (PAP) and cardiac function in neonates with pulmonary or extra-pulmonary acute respiratory distress syndrome (ARDSp/ARDSexp). METHODS: An observational study was conducted. A total of 128 neonates with ARDS admitted to neonatology department of the Affiliated Yancheng Hospital of Southeast University Medical College from January 2016 to December 2020 were enrolled, with 67 neonates in ARDSp group and 61 neonates in ARDSexp group. After starting mechanical ventilation, oxygenation index [OI, OI = mean airway pressure (Pmean)×fraction of inspired oxygen (FiO2)/arterial partial pressure of oxygen (PaO2)×100], PAP, cardiac function parameters [cardiac index (CI), left ventricular ejection fraction (LVEF), right ventricular Tei (RV-Tei)], and plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) were compared between the two groups; the incidence of pulmonary arterial hypertension [PAH, pulmonary artery systolic pressure (PASP) was more than 35 mmHg (1 mmHg = 0.133 kPa) or more than 2/3 of the systolic blood pressure of the body circulation] of neonates was recorded. The correlation between PAP and NT-proBNP was analyzed by Pearson correlation method. The dynamically changes in PAP and RV-Tei before and after using Milrinone in neonates with ARDSp and ARDSexp combined with moderate-severe PAH (PASP 50-69 mmHg was moderate, and PASP ≥ 70 mmHg was severe) were observed. The duration of mechanical ventilation, total length of hospital stay and prognosis were recorded; Kaplan-Meier survival curve was drawn to analyze the 28-day survival of the two groups. RESULTS: The occurrence rate of PAH in ARDSp group was significantly higher than that in ARDSexp group (97.01% vs. 70.49%, P < 0.01). OI, PAP, NT-proBNP and RV-Tei were also higher [OI: 17.61±6.12 vs. 11.04±5.35, PAP (mmHg): 64.27±9.54 vs. 53.61±6.47, NT-proBNP (ng/L): 23 126.32±1 485.14 vs. 18 624.24±1 647.15, RV-Tei: 0.61±0.22 vs. 0.52±0.19, all P < 0.05], but there was no significant difference in CI or LVEF between the two groups. Pearson correlation analysis showed that PAP was significantly positively correlated with NT-proBNP (r = 0.918, P < 0.01). There were 97 ARDS neonates with moderate-severe PAH with 63 in ARDSp group and 34 in ARDSexp group. Both PAP and RV-Tei in the two group showed a decreasing trend with the prolongation of Milrinone treatment, the decrease was more significant in the ARDSexp group compared with ARDSp group, the difference was statistically significant at 72 hours of treatment [PAP (mmHg): 38.42±8.95 vs. 45.67±13.32, RV-Tei: 0.58±0.19 vs. 0.61±0.13, both P < 0.05]; there was no significant difference in PAP or RV-Tei before extubation between the two groups. The duration of mechanical ventilation and the total length of hospital stay in ARDSp group were significantly longer than those in ARDSexp group [duration of mechanical ventilation (days): 10.12±1.36 vs. 6.31±1.31, total length of hospital stay (days): 16.52±3.25 vs. 13.12±3.57, both P < 0.01]. Kaplan-Meier survival curve showed that neonate in ARDSp group had a significantly lower 28-day cumulative survival rate as compared with ARDSexp group (82.09% vs. 95.01%; Log-Rank test: χ2 = 5.062, P = 0.025). CONCLUSIONS: Both PAP and RV-Tei were significantly increased in neonates with ARDS, PAP in neonates with ARDSp were significantly higher than that in neonates with ARDSexp. Dynamic monitoring of PAP and RV-Tei can reflect the severity of ARDS in neonates, and targeted intervention of pulmonary surfactant combined with Milinone for improving oxygenation and reducing PAP is one of the effective methods for the treatment of PAH.


Assuntos
Síndrome do Desconforto Respiratório , Pressão Arterial , Humanos , Recém-Nascido , Pulmão , Volume Sistólico , Função Ventricular Esquerda
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