2019 Vol. 16, No. 5
Display Method:
2019, 16(5): 406-413.
doi: 10.11909/j.issn.1671-5411.2019.05.001
Abstract:
Objective To observe the effect of Danhong injection (DI) in patients with acute ST-segment elevation myocardial infarction (STEMI) at a high risk of no-reflow (NR) during primary percutaneous coronary intervention (PCI). Methods Patients were placed in a DI group and control group. The DI group was given DI and the control group was given physiologic saline. The administration lasted 4 to 6 days in both groups after PCI. Cardiac magnetic resonance (CMR) was carried out during the perioperative period (7 ± 2 days). The primary endpoint of the study was myocardial infarct size (IS) imaged on delayed-enhancement CMR. The secondary endpoint was major adverse cardiac events observed 6 months after PCI. Results In total, 160 high-risk NR patients were enrolled, and 110 patients completed the CMR examination. According to postoperative CMR, the Myocardial Salvage Index and left ventricular ejection fraction were higher in the DI group (56.9 ± 13.2 vs. 47.7 ± 16.6, P = 0.00; 49.3% ± 6.9% vs. 46.2% ± 7.7%, P = 0.03, respectively), whereas the IS was lower (19.7% ± 5.6% vs. 22.2% ± 6.5%, P = 0.04), compared with that in the control group. These differences were observed to be significant. After 6 months, the prevalence of major adverse cardiac events in the DI group decreased compared with that in the control group, but the differences were not observed to be significant (P > 0.05). Conclusion The application of DI can reduce the myocardial IS in STEMI patients at a high risk of NR during primary PCI.
Objective To observe the effect of Danhong injection (DI) in patients with acute ST-segment elevation myocardial infarction (STEMI) at a high risk of no-reflow (NR) during primary percutaneous coronary intervention (PCI). Methods Patients were placed in a DI group and control group. The DI group was given DI and the control group was given physiologic saline. The administration lasted 4 to 6 days in both groups after PCI. Cardiac magnetic resonance (CMR) was carried out during the perioperative period (7 ± 2 days). The primary endpoint of the study was myocardial infarct size (IS) imaged on delayed-enhancement CMR. The secondary endpoint was major adverse cardiac events observed 6 months after PCI. Results In total, 160 high-risk NR patients were enrolled, and 110 patients completed the CMR examination. According to postoperative CMR, the Myocardial Salvage Index and left ventricular ejection fraction were higher in the DI group (56.9 ± 13.2 vs. 47.7 ± 16.6, P = 0.00; 49.3% ± 6.9% vs. 46.2% ± 7.7%, P = 0.03, respectively), whereas the IS was lower (19.7% ± 5.6% vs. 22.2% ± 6.5%, P = 0.04), compared with that in the control group. These differences were observed to be significant. After 6 months, the prevalence of major adverse cardiac events in the DI group decreased compared with that in the control group, but the differences were not observed to be significant (P > 0.05). Conclusion The application of DI can reduce the myocardial IS in STEMI patients at a high risk of NR during primary PCI.
2019, 16(5): 387-394.
doi: 10.11909/j.issn.1671-5411.2019.05.006
Abstract:
Background Although recent studies have indicated that both orthostatic hypotension and orthostatic hypertension independently predict cardiovascular events, the underlying mechanisms are still controversial. The aim of the study was to investigate the relationships between orthostatic changes and organ damage in subjects over 60 years old. Methods This is a prospective observational cohort study. One thousand nine hundred and ninety-seven subjects over 60 years old were enrolled. Participants were grouped according to whether they had a drop > 20 mmHg in systolic or > 10 mmHg in diastolic BP (orthostatic hypotension), an increase in mean orthostatic systolic blood pressure > 20 mm Hg (orthostatic hypertension), or normal changes within 3 min of orthostatism. Multiple regression modeling was used to investigate the relationship between orthostatic hypotension, orthostatic hypertension and subclinical organ damage with adjustment for confounders. Results Orthostatic hypotension and orthostatic hypertension were found in 461 (23.1%) and 189 (9.5%) participants, respec?tively. Measurement of carotid intima-media thickness (IMT), brachial-ankle pulse wave velocity (baPWV), clearance of creatinine, and microalbuminuria were associated with orthostatic hypotension; measurement of IMT and baPWV were associated with orthostatic hypertension in a cruse model. After adjustment, IMT [odds ratio (OR), 95% confidence interval (CI) per one-SD increment: 1.385, 1.052-1.823; P = 0.02], baPWV (OR: 1.627, 95% CI: 1.041-2.544; P = 0.033) and microalbuminuria (OR: 1.401, 95% CI: 1.002-1.958; P = 0.049) were still associated with orthostatic hypotension, while orthostatic hypertension was only associated with IMT (OR: 1.730, 95%CI: 1.143-2.618; P = 0.009). Conclusions Orthostatic hypotension seems to be independently correlated with increased carotid atherosclerosis, arterial stiffness and renal damage in subjects over 60 years old. Orthostatic hypertension correlates with carotid atherosclerosis only.
Background Although recent studies have indicated that both orthostatic hypotension and orthostatic hypertension independently predict cardiovascular events, the underlying mechanisms are still controversial. The aim of the study was to investigate the relationships between orthostatic changes and organ damage in subjects over 60 years old. Methods This is a prospective observational cohort study. One thousand nine hundred and ninety-seven subjects over 60 years old were enrolled. Participants were grouped according to whether they had a drop > 20 mmHg in systolic or > 10 mmHg in diastolic BP (orthostatic hypotension), an increase in mean orthostatic systolic blood pressure > 20 mm Hg (orthostatic hypertension), or normal changes within 3 min of orthostatism. Multiple regression modeling was used to investigate the relationship between orthostatic hypotension, orthostatic hypertension and subclinical organ damage with adjustment for confounders. Results Orthostatic hypotension and orthostatic hypertension were found in 461 (23.1%) and 189 (9.5%) participants, respec?tively. Measurement of carotid intima-media thickness (IMT), brachial-ankle pulse wave velocity (baPWV), clearance of creatinine, and microalbuminuria were associated with orthostatic hypotension; measurement of IMT and baPWV were associated with orthostatic hypertension in a cruse model. After adjustment, IMT [odds ratio (OR), 95% confidence interval (CI) per one-SD increment: 1.385, 1.052-1.823; P = 0.02], baPWV (OR: 1.627, 95% CI: 1.041-2.544; P = 0.033) and microalbuminuria (OR: 1.401, 95% CI: 1.002-1.958; P = 0.049) were still associated with orthostatic hypotension, while orthostatic hypertension was only associated with IMT (OR: 1.730, 95%CI: 1.143-2.618; P = 0.009). Conclusions Orthostatic hypotension seems to be independently correlated with increased carotid atherosclerosis, arterial stiffness and renal damage in subjects over 60 years old. Orthostatic hypertension correlates with carotid atherosclerosis only.
2019, 16(5): 395-400.
doi: 10.11909/j.issn.1671-5411.2019.05.002
Abstract:
Background Diabetes is frequently associated with poor prognosis among acute myocardial infarction (AMI) patients. Patients with these comorbidities often have atypical symptoms and subsequent delay in treatment. Few studies have reported detailed AMI symptoms in patients with diabetes. This study compared AMI symptoms and presentation characteristics between diabetics and non-diabetics. Methods We included patients from the China AMI registry diagnosed with AMI between January 2013 and September 2014. Baseline characteristics, symptomology, and delay in treatment were compared between diabetics and non-diabetics. Multivariable logistic regression analysis was used to explore independent predictors of atypical symptoms. Results A total of 4450 (20.2%) patients had diabetes. They were older, more often women, higher in body mass index, and more likely to have non-ST segment elevation myocardial infarction. Fewer diabetic patients presented with persistent precordial chest pain (63.1% vs. 68%, P vs. 65.6%, P vs. 18.3%, P = 0.0123), and incontinence (0.4% vs. 0.7%, P = 0.0093). Time to hospital presentation was longer among patients with diabetes than those without. In multivariable analysis, diabetes was identified as an independent predictor of atypical symptoms (OR: 1.112, 95% CI: 1.034?1.196). Conclusions Our study is the first large-scale study providing evidence that diabetics are less likely to present with typical chest pain and more likely to experience treatment delay when suffering from an AMI. Our results may increase clinician awareness of recognizing AMI patients rapidly to reduce diagnosis and treatment delay, particularly in the context of diabetes.
Background Diabetes is frequently associated with poor prognosis among acute myocardial infarction (AMI) patients. Patients with these comorbidities often have atypical symptoms and subsequent delay in treatment. Few studies have reported detailed AMI symptoms in patients with diabetes. This study compared AMI symptoms and presentation characteristics between diabetics and non-diabetics. Methods We included patients from the China AMI registry diagnosed with AMI between January 2013 and September 2014. Baseline characteristics, symptomology, and delay in treatment were compared between diabetics and non-diabetics. Multivariable logistic regression analysis was used to explore independent predictors of atypical symptoms. Results A total of 4450 (20.2%) patients had diabetes. They were older, more often women, higher in body mass index, and more likely to have non-ST segment elevation myocardial infarction. Fewer diabetic patients presented with persistent precordial chest pain (63.1% vs. 68%, P vs. 65.6%, P vs. 18.3%, P = 0.0123), and incontinence (0.4% vs. 0.7%, P = 0.0093). Time to hospital presentation was longer among patients with diabetes than those without. In multivariable analysis, diabetes was identified as an independent predictor of atypical symptoms (OR: 1.112, 95% CI: 1.034?1.196). Conclusions Our study is the first large-scale study providing evidence that diabetics are less likely to present with typical chest pain and more likely to experience treatment delay when suffering from an AMI. Our results may increase clinician awareness of recognizing AMI patients rapidly to reduce diagnosis and treatment delay, particularly in the context of diabetes.
2019, 16(5): 401-405.
doi: 10.11909/j.issn.1671-5411.2019.05.004
Abstract:
Objective To observe the effect of Danhong injection (DI) in patients with acute ST-segment elevation myocardial infarction (STEMI) at a high risk of no-reflow (NR) during primary percutaneous coronary intervention (PCI). Methods Patients were placed in a DI group and control group. The DI group was given DI and the control group was given physiologic saline. The administration lasted 4 to 6 days in both groups after PCI. Cardiac magnetic resonance (CMR) was carried out during the perioperative period (7 ± 2 days). The primary endpoint of the study was myocardial infarct size (IS) imaged on delayed-enhancement CMR. The secondary endpoint was major adverse cardiac events observed 6 months after PCI. Results In total, 160 high-risk NR patients were enrolled, and 110 patients completed the CMR examination. According to postoperative CMR, the Myocardial Salvage Index and left ventricular ejection fraction were higher in the DI group (56.9 ± 13.2 vs. 47.7 ± 16.6, P = 0.00; 49.3 ± 6.9% vs. 46.2 ± 7.7%, P = 0.03, respectively), whereas the IS was lower (19.7 ± 5.6% vs. 22.2 ± 6.5%, P = 0.04), compared with that in the control group. These differences were observed to be significant. After 6 months, the prevalence of major adverse cardiac events in the DI group decreased compared with that in the control group, but the differences were not observed to be significant (P > 0.05). Conclusion The application of DI can reduce the myocardial IS in STEMI patients at a high risk of NR during primary PCI.
Objective To observe the effect of Danhong injection (DI) in patients with acute ST-segment elevation myocardial infarction (STEMI) at a high risk of no-reflow (NR) during primary percutaneous coronary intervention (PCI). Methods Patients were placed in a DI group and control group. The DI group was given DI and the control group was given physiologic saline. The administration lasted 4 to 6 days in both groups after PCI. Cardiac magnetic resonance (CMR) was carried out during the perioperative period (7 ± 2 days). The primary endpoint of the study was myocardial infarct size (IS) imaged on delayed-enhancement CMR. The secondary endpoint was major adverse cardiac events observed 6 months after PCI. Results In total, 160 high-risk NR patients were enrolled, and 110 patients completed the CMR examination. According to postoperative CMR, the Myocardial Salvage Index and left ventricular ejection fraction were higher in the DI group (56.9 ± 13.2 vs. 47.7 ± 16.6, P = 0.00; 49.3 ± 6.9% vs. 46.2 ± 7.7%, P = 0.03, respectively), whereas the IS was lower (19.7 ± 5.6% vs. 22.2 ± 6.5%, P = 0.04), compared with that in the control group. These differences were observed to be significant. After 6 months, the prevalence of major adverse cardiac events in the DI group decreased compared with that in the control group, but the differences were not observed to be significant (P > 0.05). Conclusion The application of DI can reduce the myocardial IS in STEMI patients at a high risk of NR during primary PCI.
2019, 16(5): 429-430.
doi: 10.11909/j.issn.1671-5411.2019.05.007
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2019, 16(5): 414-420.
doi: 10.11909/j.issn.1671-5411.2019.05.010
Abstract:
Heart failure (HF) in the elderly, besides being a leading cause of mortality and morbidity, is rapidly increasing in prevalence with patients aged 65 and older accounting for more than 75% of heart failure hospitalizations. Elderly patients have historically been unrepresented in clinical HF trials and often present with multiple comorbidities, including frailty, depression, nutritional, functional and cognitive impairments. Additionally, pharmacologic challenges such as adherence to therapy, polypharmacy, altered drug pharmacokinetics and/or renal derangements make them less likely to receive guideline-directed medical therapies for HF. Recognition of these various interrelated domains is key and should prompt a multidisciplinary, holistic management approach so as to optimize prognosis in this vulnerable subset of the population.
Heart failure (HF) in the elderly, besides being a leading cause of mortality and morbidity, is rapidly increasing in prevalence with patients aged 65 and older accounting for more than 75% of heart failure hospitalizations. Elderly patients have historically been unrepresented in clinical HF trials and often present with multiple comorbidities, including frailty, depression, nutritional, functional and cognitive impairments. Additionally, pharmacologic challenges such as adherence to therapy, polypharmacy, altered drug pharmacokinetics and/or renal derangements make them less likely to receive guideline-directed medical therapies for HF. Recognition of these various interrelated domains is key and should prompt a multidisciplinary, holistic management approach so as to optimize prognosis in this vulnerable subset of the population.
2019, 16(5): 421-428.
doi: 10.11909/j.issn.1671-5411.2019.05.009
Abstract:
Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome characterized by symptoms and sings of heart failure with elevated left ventricular filling pressures at rest or during exercise. It is the most common type of heart failure in the elderly and its preva-lence increases with age and is higher in females at any given age. HFpEF is frequently accompanied of comorbid conditions such as diabe-tes mellitus, obesity, atrial fibrillation and renal dysfunction. The diagnosis relies in the integration of clinical information, laboratory data and interpretation of cardiac imaging and hemodynamic findings at rest and during exercise. Conditions that have a specific treatment such as coronary artery disease, valvular disease, cardiac amyloidosis and constrictive pericarditis should be considered and evaluated as appropriate. Aggressive management of comorbidities, optimization of blood pressure control and volume status using diuretics as needed are among the current treatment recommendations. There are no specific therapies that have shown to decrease mortality in HFpEF. In symptomatic patients with history of hospital admission for decompensated heart failure, the implantation of a wireless pulmonary artery pressure monitor should be considered. Finally, given the high mortality of this condition, goals of care discussion should be initiated early and involvement of pallia-tive care medicine should be considered.
Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome characterized by symptoms and sings of heart failure with elevated left ventricular filling pressures at rest or during exercise. It is the most common type of heart failure in the elderly and its preva-lence increases with age and is higher in females at any given age. HFpEF is frequently accompanied of comorbid conditions such as diabe-tes mellitus, obesity, atrial fibrillation and renal dysfunction. The diagnosis relies in the integration of clinical information, laboratory data and interpretation of cardiac imaging and hemodynamic findings at rest and during exercise. Conditions that have a specific treatment such as coronary artery disease, valvular disease, cardiac amyloidosis and constrictive pericarditis should be considered and evaluated as appropriate. Aggressive management of comorbidities, optimization of blood pressure control and volume status using diuretics as needed are among the current treatment recommendations. There are no specific therapies that have shown to decrease mortality in HFpEF. In symptomatic patients with history of hospital admission for decompensated heart failure, the implantation of a wireless pulmonary artery pressure monitor should be considered. Finally, given the high mortality of this condition, goals of care discussion should be initiated early and involvement of pallia-tive care medicine should be considered.
2019, 16(5): 431-433.
doi: 10.11909/j.issn.1671-5411.2019.05.003
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2019, 16(5): 434-436.
doi: 10.11909/j.issn.1671-5411.2019.05.005
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2019, 16(5): 437-438.
doi: 10.11909/j.issn.1671-5411.2019.05.008
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