[Value of quantitative tissue velocity imaging in the evaluation of cardiac function and diagnosis of left heart failure].

OBJECTIVE: To investigate the value of quantitative tissue velocity imaging (QTVI) echocardiography in the evaluation of cardiac function and the diagnosis of left heart failure. METHODS: 30 heart failure (HF) patients, aged 66 +/- 12 (39 - 86), and 32 normal controls, 66 +/- 12 (40 - 82) underwent conventional echocardiography, and QTVI. Left ventricular ejection fraction (LVEF) was calculated by Simpson's formula. Mitral annulus peak systolic velocity (Vs) and systolic displacement (Ds) from posteroseptal, lateral, anteroseptal, posterior, anterior, and inferior segments were determined by QTVI, and the mean Vs and Ds were calculated. The values of mean Vs and Ds of the HF patients and those of the normal controls, and the values of mean Vs and Ds of the HF patients before and after treatment were compared. The correlation of the mean Vs and Ds with LVEF was analyzed. RESULTS: The mean Vs of the HF patients was 2.8 cm/s +/- 0.6 cm/s, significantly lower than that of the normal controls (6.4 cm/s +/- 0.9 cm/s, P < 0.01). The mean Vs of the HF patients after treatment was 3.5 cm/s +/- 1.1 cm/s, significantly higher than that before treatment (2.8 cm/s +/- 0.6 cm/s, P < 0.01). The mean Ds of the HF patients was 5.2 mm +/- 1.5 mm, significantly lower than that of the normal controls (11.6 mm +/- 1.5 mm, P < 0.01). The mean Ds of the HF patients after treatment was 6.5 mm +/- 2.0 mm, significantly higher than that before treatment (5.2 mm +/- 1.5 mm, P < 0.01). The mean Vs and mean Ds were positively correlated with LVEF (r = 0.87, P < 0.01, and r = 0.89, P < 0.01). The area under the curve (AUC) of receiver operator characteristic (ROC) was 0.95 for the mean Vs to diagnose HF. The mean Vs < or = 4.42 cm/s was used as a cut-off point to diagnosis left HF with a sensitivity of 97.5% a specificity of 90.2%, and an accuracy rating of 95.1%. The AUC of ROC was 0.96 for the mean Ds to diagnose HF. The mean Ds < or = 8.49 mm was used as a cut-off point to diagnose left HF with a sensitivity of 97.5%, a specificity of 87.8%, and an accuracy rating was 95.1%. CONCLUSION: The mean systolic velocity and mean systolic displacement of mitral annulus determined by QTVI help evaluate the left ventricular systolic function. The value of the diagnosis is significant in left HF.

Acarbose, the α-glucosidase inhibitor, attenuates the blood pressure and splanchnic blood flow responses to meal in elderly patients with postprandial hypotension concomitant with abnormal glucose metabolism.

OBJECTIVES: Postprandial hypotension (PPH) is a unique clinical phenomenon in the elderly, but its underlying pathogenesis has not been completely elucidated, and drug treatment is still in clinical exploratory stage. The aim of the study was to evaluate the relationship between the fall in postprandial blood pressure and splanchnic blood flow, and to provide a theoretical basis for the treatment of PPH by taking acarbose. PATIENTS AND METHODS: The study included 20 elderly inpatients diagnosed with PPH concomitant with abnormal glucose metabolism at stable condition. They were treated with 50 mg acarbose with their meal to observe the changes in blood pressure, heart rate, and blood glucose level, and to monitor the hemodynamics of the superior mesenteric artery (SMA) before and after treatment. RESULTS: Without acarbose treatment, patients after a meal had significantly decreased systolic and diastolic blood pressure, faster postprandial heart rate, higher postprandial glucose level at each period, and increased postprandial SMA blood flow compared with that at fasting state (P<0.05). Acarbose treatment significantly attenuated the decrease of postprandial systolic blood pressures from 35.50±12.66 to 22.25±6.90 mmHg (P=0.000), the increase of heart rate from 9.67±5.94 to 5.33±3.20 beats/min (P=0.016), the increase of postprandial blood glucose from 3.55±1.69 to 2.28±1.61 mmol/l (P=0.000), the increase of postprandial SMA blood flow from 496.80±147.15 to 374.55±97.89 ml/min (P=0.031), and the incidence of PPH, syncope, falls, dizziness, weakness, and angina pectoris (P<0.05). The maximal decrease of postprandial systolic blood pressure was positively associated with the maximal increase in postprandial SMA blood flow (r=0.351, P=0.026). Acarbose treatment showed no significant side effects. CONCLUSION: The increase in postprandial splanchnic perfusion is one of the reasons for PPH formation. Acarbose may exert its role in PPH treatment by reducing postprandial gastrointestinal blood perfusion. Giving 50 mg acarbose with a meal to treat PPH concomitant with abnormal glucose metabolism is effective and safe in very old patients.

[The apply of Cosmopost ceramic posts in clinic].

OBJECTIVE: To investigate the manufacture method and the effects of Cosmopost ceramic posts, to summarize the indications of Cosmopost ceramic post in clinic. METHODS: 228 pieces Cosmopost ceramic posts and cores were made for 96 patients. 2l7 pieces full ceramic crowns and 8 pieces full ceramic bridgs for Cosmopost ceramic posts and cores were made. The fitness of Cosmopost ceramic post were checked, and the color of all full ceramic crowns and full ceramic bridgs were checked in clinic. The amount of loosening and broken in all restorations were checked every year in clinic. follow up 2 - 3 years. RESULTS: 1 Cosmopost ceramic post was fracture about 1.5 mm before the full ceramic crown was worn. 227 pieces Cosmopost ceramic posts were perfect. All of the full ceramic crowns and bridgs for full ceramic posts were excellent in color. No loosening and broken cases were checked in 0.5 - 3 years. But the indications of Cosmopost ceramic posts were strict in clinic. CONCLUSION: Cosmopost ceramic post has natural aesthetic effect and good strength. it can be used in clinic.