简介:objectivesTodemonstratethephenomenaandexplorethecausesofanemiainpatientswithchronicheartfailure(CHF).MethodsToobservethephenomenaofanemiainpatientswithCHF,atotalof276patientswithCHFwereincludedinthisretrospectivestudy.Theclinicalcharacteristicsofthepatientsare;meanage69.2±11.0years;male151,female125;NYHAⅢandⅣ115(41.7%).Results①Amongthe276patientswithCHF,81(29.4%)hadanemia(Meanhemoglobulinconcentration101.5±13.0g/L).②PatientswithAnemiaweremorelikelytobefemaleandtohavegreaterNYHA(ⅢorⅣ)(P<0.05),higherserumcreatinine,aswellaslowerserumalbuminandlow-densitylipoproteinlevels(P<0.01).③AweaknegativecorrelationwasalsonotedbetweenthelevelofNYHAandhemoglobulin.④Therewasnosignificantdifferenceinage,theprimarycardiacetiologyoftheCHF,thehistoryofdiabetes,leftventricularenddiastolicdiameter,andleftventricularejectionfractionbetweenCHFpatientwithandwithoutanemia.ConclusionsTheprevalenceofanemiaishighamongpatientswithCHF.TheanemiapatientswithCHFtendtobefemale,havegreatercardiacandrenalfunctionalimpairment,butwithlowerserumalbuminandLDLthatsuggestssomedegreeofmalnutrition.
简介:ObjectivesToinvestigatetheclinicalmanifestationsofhypertrophiccardiomyopathy(HCM),andtofindouttheclinicalcluestoavoidmisdiagnosisandprovidereferenceforfutureclinicaldiagnosisandtreatment.MethodsAretrospectiveanalysisof42consecutivepatientswithHCMhospitalizedinourhospitalbetweenJanuary1995andDecember2002wasexplored.BasedonthefamilyhistoryofHCM,clinicalmanifestations,electrocar-diogram,echocardiogram,coronaryangiographyandleftventriculography,theclinicalcharacteristicsbetweenHCMpatientswithleftventricularoutflowtractobstruction(HOCM)andHCMpatientswithoutobstruction(HNOCM)werecompared.Thecausesofmisdiagnosisandlosingdiagnosiswereanalysis.Results13patientswereinHOCMgroupand29patientswereinHNOCMgroup.MorepatientswithsyncopewereinHOCMgroupthaninHNOCMgroup(6/13vs.2/29,P<0.05).PatientswithejectivemurmurwereinHOCMgrouponly(P<0.01).Leftventricularoutflowtractpressuregradient(LVOTPG)onlyobservedinHOCMgroup(P<0.01).Ventriculartachycardiawasseeninbothgroups.28outof42patients(66.67%)hadmisdiagnosis,and4outof42patients(9.53%)hadlosingdiagnosis.Thus,coronaryheartdisease(CHD)hadthehighestrateofmisdiagnosis.Therewere20CHDpatients(71.43%)among28patientswithmisdiagnosis.Hypertensionwasin3,congenitalheartin2,cerebro-embolismin2,andmyocarditisin1.ConclusionsForapatientwithfamilyhistoryorsuddendeathhistoryofHCM,unexplainedsyncopeepisodes,chestpain(angina),especiallyinyoung,anejectionmurmuralongtheleftsternumborder,thepresenceofnarrowanddeepQwaves,orinversionofgiantTwavesinV3-V6,atrialfibrillationand/orcerebra-embolismechocardiogramshouldbegiven.CAGandLVGarenecessaryonlyiftheresultofechoisnegative,andthepatientswithsuspectedHCMorCHD.
简介:Over20yearsofresearchhasledtothenowwidelyacceptedroleofcardiacresynchronizationtherapy(CRT)inmedicallyrefractory,mildtoseveresystolicheartfailure(HF)withincreasedQRSduration.Inadditiontoconferringamortalitybenefit,CRThasbeenshowntoreduceHFhospitalizationratesandimprovefunctionalstatusinthispopulation.However,notallpatientsconsistentlydemonstrateapositiveresponsetoCRT.EffortstoimproveresponsetoCRThavefocusedonimprovingpatientselectionandoptimizingdeviceimplantationandfollow-up,therebycorrectingelectricalandmechanicaldyssynchrony.Inthisarticlewereviewthepathobiologyofcardiacdyssynchrony,therationalefortheuseofCRT,thehistoryandthestateoftheartofCRT,andguidelinesandrecommendationsforCRT,whilealsofocusingontheareasofcontroversyandpotentialfutureapplications.
简介:目的分析脑静脉窦血栓形成的临床资料,总结其早期诊断和治疗的经验。方法收集2005年4月至2007年4月收住我科的13例确诊颅内静脉窦血栓形成患者的临床资料,并结合文献进行分析。结果本组13例病例中84.6%,有明确的病因,其中非感染性因素占61.3%;84.6%的患者以头痛为首发临床表现,所有病人均有脑脊液压力升高;CT和MRI检查的阳性率分别为33.3%和80%,而MRV阳性率达到100%;D-二聚体升高者60%。所有患者确诊后即予抗凝治疗以及控制癫痫、降颅压等对症治疗,治愈6例,好转6例,死亡1例,再通率46%。结论脑静脉窦血栓形成易被误诊,头颅MRI/与MRV结合检查是诊断CVST的最好方法;早期诊断、早期治疗可以改善CVST患者的预后。
简介:ObjectivesToinvestigatetheclinicalfeatureofacutepulmonaryembolism.MethodsRetrospectiveclinicalanalysiswasperformedaccordingtothedataof38casesofpulmonaryembolism.ResultsThereweregrounddiseasesandpredisposingfactorsin36casesofpulmonaryembolismamong38cases,theratiowas94.7%,amongthetotalpredisposingfactors,tumor,cardiovasculardisease,venousthrombosisoflowerextremity,smokingandlong-termbedwerecommon.Therewasnospecificityinclinicalfeature,physicalsignandroutchestXray,electrocardiography,andtheirappearanceswerediversified.Therewerespecificityandsensitivityinechocardiogram(UCG)andD-dimertosomeextent.But,thefinaldiagnosismustdependonsomespecialexaminations,suchasselectivepulmonaryarteriography,CTPA,MRAandsoon.ConclusionsThespecialexaminationsmustbedonetomakeadefinitediagnosistoconfirmpulmonaryembolismwhenthehighriskfactorsandgrounddiseasesareexisting.Itisnecessarytosomecaseswhentheclinicalfeaturecannotbeexplainedbyotherdiseases.
简介:OjbectiveTofindtheindependentpredictorsforrestenosisaftercoronarystenting.MethodsQuantitativeangiographywasperformedon60cases(67successfullydilatedlesions)afterangio-plastyover6-monthsfollow-up,andbothunivariateandmultivariatelogisticregressionanalysisweredonetoi-dentifythecorrelationsofrestenosiswithclinicalfactors.ResultsThetotalrestenosisratewas31.3%(21of67lesions),andaccordingtounivariateanalysisthepatientswhounderwentcoronarystenting≥3.5mmhadalowerrateofrestenosis(P<0.01).Collateralcirculationtotheobstructionsite,highmaximalinflationpressure,smokingandthelessminimallumendiameterafterPTCAmadetherateofrestenosishigherower(P<0.05).Multivariatelogisticregressionanalysisshowedthatcoronarystenting≥3.5mmhadalowrateofrestenosis,buthighmaximalinflationpressureandsmokingmadetherestenosisratehigher.ConclusionCoronarystentsize,maximalinflationpressureand.smokin
简介:BackgroundPregnancycomplicatingpulmonaryarterialhypertension(PAH)isalife-threateningobstetricalcomplication.FewstudieshavereportedtheclinicalcharacteristicsandoutcomesofpregnantwomenwithPAH.MethodsRetrospectivelyanalysiswasconductedon86casesofpregnantwomenwithPAHattheDepartmentofObstetricinGuangdongGeneralHospitalbetween2009and2014.Dataincludedpatients'age,theetiologiesofPAH,clinicalclassificationoftheNewYorkHeartAssociation(NYHA),gestationalweeks,deliverymode,maternalandfetaloutcomes.Results1Therewere2casesofidiopathicpulmonaryarterialhypertension(IPAH)and84casesofsecondarypulmonaryarterialhypertension.Thelatterwascomposedby40(47.61%)casesofcongenitalheartdisease(CHD),38(45.23%)casesofrheumaticheartdisease(RHD),3(3.57%)casesofsystemiclupuserythematosus(SLE)and1(1.19%)caseofpartialhydatidiformmole.ThenumberofpatientsclassifiedinNYHAI~IVwere8(9.30%),41(47.67%),26(30.23%)and11(12.7%),respectively.Andthemortalitywas3.48%(3/86).2Amongthe86patients,31(36.04%)womengavebirthattermand36(41.86%)hadprematuredelivery.Inaddition,16(18.6%)womenhadanabortionlessthan28weeks.Therewereatotalof65(75.58%)livebirths,61(93.84%)ofwhomweredeliveredviacesareansection,whiletheother4(6.15%)werevaginaldeliveries.3Patientsweredividedinto3groups,12ofmild(<40mmHg),35ofmoderate(40~70mmHg)and39ofsevere(≥70mmHg)regardingthepulmonaryarterysystolicpressure(sPAP)measuredbyultrasound.WedefinedtheformertwoasgroupAandthelatterasgroupB.Thesignificancewasseenstatisticallyingestationalweeks(32.86±8.86gvs28.76±9.84),therateoftransferringtoICU(19.14%vs53.84%),neonatalbirth-weight(2725.69±467.43vs2044.82±665.75g),APGARscoring(9.97±0.16vs8.68±2.08),maternalstatusofheartfunctionandadversepregnantoutcomes,whencomparedgroupAwithB.AlltheP-valuesmentionedabovew
简介:ObjectiveFortycasesofIAMIwereexaminedwithcoronaryangiographyinordertostudytherelationshipofthevesselswiththeECGofIAMI.MethodsForcoronaryangiographyJudkin’smethodwasused;IAMIwasdiagnosedbythe1979WHO’sstandardofISHDandECGwasseparatelymeasuredbytwodoctors.ResultsMostofIAMIwithpolybranchcoronaryoritscollateraldisease(32.5%and42.5%)andonly10cases(25%)withsinglebranchcoronarydisease,whoseECGswereuntypical.ConclusionIAMIwithsingle-branchcoronarydiseasemightexpressasmildsymptomsandhavenotypicalECGchange.WhiletypicalECGchangeemerges,thecoronaryarteryalwaysshowedpoly-branchdiseaseorcollateralbranchobstructionandthediseasewouldbeadvanced.ItisimportanttopaymoreattentiontothecasesofIAMIwithoutclassicECGchangesoastogivediagnosisandtreatmentthemintime.
简介:BackgroundAtrialfibrillation(AF)wasusedtobeconsideredasnongeneticsdisorder,butrecentstudieshaverevealedthatgeneticsvariantsconferredsusceptibilitytoAFdevelopment,butmostwithlimitedevidence.Inordertosystematicallyevaluatetheoverallcontributionsofgene-diseaseassociationstudiestocurrentunderstandingsofthegeneticsusceptibilitytoatrialfibrillation,weperformasystematicreviewandmeta-analysisbasedoncomprehensivesearches.MethodAllstudiesontheassociationsofgeneticsvariantswithAFriskwereidentifiedbysearchingthefollowingdatabases:Medline,Embase,BIOSIS,GlobalHealth,LILACSandCBMDisc.Oddsratios(CI)and95%confidenceintervals(CI)werecalculatedunderhomozygotecomparison(HC),dominantmodel(DM)andrecessivemodel(RM),respectively.ResultsAtotalof41studieson32genesand72polymorphismslocationswereidentified.ThesummaryORwasstatisticallysignificantassociationsin23(31.94%)singlenucleotidepolymorphisms(SNPs).Thegenesinrenin-angiotensin-aldosteronesystem(RAAS)andionchannelswerethemostlystudied.FourSNPs(50.00%)inRAASgenesweresignificantlyassociatedwithAFsusceptibility:ACEI/D(HC:OR=1.53,95%CI:1.14-2.0DM:OR=1.47,95%CI:0.86-1.53;RM:OR=0.49,95%CI:0.41-0.59);AGTA-20C(HC:OR=1.56,95%CI:1.41-2.12);AGTM235T(HC:OR=2.37,95%CI:1.21-4.65).StatisticallysignificantassociationswerealsofoundinthefollowinggenesandSNPs:ABCA1G1051A,BCHEG1615A,CETPA1061G,I405V,TaqIB,CRPC1444T,EDN2A985G,eNOST-786C,IL-10T-819C,A-592C,MinKG38S,KCNH2rs1805120,Kir3.4C171T,G810T,MMP2C-1306T,FactorⅡG20210A,SCN5AH58R,SLC26A8I639V,G-proteinβ-subunitC825T,chromatosome4q25rs2200733andrs10033464.ConclusionsNearlyone-thirdofSNPswerestatisticallysignificantassociatedwithAFrisk,withvariantsinRAASgenesmosthighlysignificantassociation.Morestudiesonawiderangeofgenesaremerited.
简介:ObjectivesToanalyzetheriskfactorsforrecurrenthemorrhageaftercraniotomyforhypertensivecerebralhemorrhage(HCH).MethodsClinicaldatafrom162HCHpatientswhounderwentsurgerywereretrospectivelyanalyzedforthecorrelationbetweenrecurrenthemorrhageandgender,age,durationofhypertension,historyofdiabetesmellitusandhypercholesterolemia,siteandvolumeofhemorrhageandpost-surgicalsystolicanddiastolicpressure.ResultsPost-surgicalrecurrenthemorrhagewasfoundin24patients.Withmulti-variateregressionanalysis,historyofdiabetes,long-termhypertensionandhigherpost-surgicalsystolicpressurewereprovedpositivelycorrelatedtotheincidenceofrecurrenthemorrhageaftercraniotomyforhypertensivecerebralhemorrhage(P<0.05).ConclusionsRiskfactorsforrecurrenthemorrhageaftercraniotomyforhypertensivecerebralhemorrhagearehistoryofdiabetes,long-termhypertensionandhigherpost-surgicalsystolicpressure.Patientswithdiabetesandhypertensionareathigherriskforcerebralhemorrhageorpost-surgicalrecurrenthemorrhage.Effectivecontrolonbloodpressureaftersurgerycanreducetheincidenceofrecurrenthemorrhageaftersurgeryforhypertensivecerebralhemorrhage.
简介:ObjectivesToassesswhetherstatinsreduceall-causemortalityandCVeventsinelderlypeoplewithoutestablishedCVdisease.BackgroundSinceageingofthepopulationissteadilyraising,preventionofcardiovascular(CV)diseaseintheelderlyisrelevant.InelderlypatientswithpreviousCVevents,useofstatinsisrecommendedbyguidelines,whereasbenefitsofthesedrugsinelderlysubjectswithoutpreviousCVeventsarestilldebated.MethodsRandomizedtrialscomparingstatinsversusplaceboandreportingall-causeandCVmortality,myocardialinfarction(MI),stroke,andnewcanceronsetinelderly(>65yearsold)subjectswithoutestablishedCVdiseasewereincluded.ResultsEighttrialsenrolling24,674subjects(42.7%females;meanage73.0+2.9;meanfollow-up3.5+1.5years)wereincludedinanalyses.Statins,comparedtoplacebo,significantlyreducedtheriskofMIby39.4%(relativerisk[RR]:0.606[95%confidenceinterval(CI):0.434to0.847];P=0.003),aswellastheriskofstrokeby23.8%(RR:0.762[CI:0.626to0.926];P=0.006).Incontrast,theriskofall-causedeath(RR:0.941[CI:0.856to1.035];P=0.210)andofCVdeath(RR:0.907[CI:0.686to1.199];P=0.493)werenotsignificantlyreduced.Newcanceronsetdidnotdifferbetweenstatin-comparedtoplacebotreatedsubjects(RR:0.989[CI:0.851to1.151];P=0.890).ConclusionsPInelderlysubjectsathighCVriskwithoutestablishedCVdisease,statinssignificantlyreducetheincidenceofMIandstroke,butdonotsignificantlyprolongsurvivalintheshort-term.
简介:Toanalyzetheclinicalcharacteristicsof216patientswithnon-STsegmentelevationmyocardialinfarction(NSTEMI).MethodsAretrospectiveanalysiswasused.TwohundredandsixteenNSTEMIpatientsweredividedintotwogroups:①accordingtotheage:age<65yearsgroupandage≥65yearsgroup;②accordingtothrombolysisinmyocardialischemiatrial(TIMI)IIBriskstratificationscoringsystem:score<4groupand≥4group;③accordingtoserumcreatinine(sCr)level:sCrlevel≤178μmol·L-1groupand>178μmol·L-1group.Sevenhundredandeightysixacutemyocardialinfarction(AMI)patientsduringthesameperiodweredividedintoSTsegmentelevationmyocardialinfarction(STEMI)groupandNSTEMIgroup.Clinicalcharacteristicsofthepatientsinthetwogroupswerecompared.Results①ThenumberofNSTEMIpatientsinage≥65yearsgroupissignificantlygreaterthanthatinage<65yearsgroup.Studyrevealedthatthepatientsinage≥65yearsgroupwerewithoutchestpain,hadhypertension,dyslipidemia,atrialfibrillation,cardiacandrenaldysfunction(sCr>178μmol·L-1)andtriplevesseldisease.Fewerpatientsinthisgroupreceivedcoronaryarteryangiography(CAG),percutaneouscoronaryintervention(PCI)andcoronaryarterybypassgraft(CABG).Morenumberofdeathsinthisgroupcomparedwiththeage<65yearsgroup.②ThenumberofNSTEMIpatientsinTIMIscore>4groupissignificantlygreaterthanthatinTIMIscore<4group.Fourmajorcomplicationssuchasacuteleftventricularfailure,cardiogenicshock,seriousarrhythmiaanddeaths,increasedsignificantlyinTIMIscore>4groupcomparingwithTIMIscore≤4group.③Obviously,morenumberofelderlypatients,non-insulindependantdiabetesmellitus(NIDDM),patientswithcardiactroponinT(CTnT)>3.0ng·L-1anddeathsoccurredinsCr>178μmol·L-1group.④STEMIandNSTEMIpatientswerecomparedinsametimeframeasfollows:fewerNSTEMIpatientsandmoreelderlypatientshadnochestpain,NIDDM,hypert
简介:ObjectivesTodeterminethesafetyandvalueofesophagealradiographyasameansoflocatingtransseptalpuncture.Methods486patientswhounderwenttransseptalpuncturewererandomizedintotwogroups.Anesophagusradiographicmethodoflocatingtansseptalpuncturesitewasappliedinthestudygroup(n=243)andmodified-Rosslocatingmethodwasusedinthecontrolgroup(n=243).Aftersuccessfullocation,transseptalpuncturewasmade.Weobservedthesuccessrateandincidencecomplicationsinthe2groups.ResultsLeftatriumimpressioninthestudygroupwasclearlyseen.Nonethelessin120casesofcontrolgroup,theleftatriasilhouettewasnotclearlyvisualised.Thesuccessrateoflocatingtransseptalpuncturesiteinthestudygroupandcontrolgroupwere100%and50.6%respectively(P<0.001).Thesuccessrateoftransseptalpunctureinthestudygroupandcontrolgroupwas99.6%and45.7%respectively(P<0.001).Therewerenocomplicationsassociatedwithpunctureinthestudygroupandpericardialtamponadeoccurredin1controlpatient.ConclusionsTheesophagusradiographicmethodoflocatingtransseptalpuncturesiteisaccurate,safeandsimpletoperform.Transseptalpuncturehasahighsuccessratewithfewcomplications.