Introduction: At the beginning of the COVID-19 pandemic, a drop in the number of patients treated for cardiac emergencies raised concern about cardiovascular mortality in that period. An increase in care delay for pat...Introduction: At the beginning of the COVID-19 pandemic, a drop in the number of patients treated for cardiac emergencies raised concern about cardiovascular mortality in that period. An increase in care delay for patients with ST-segment elevation myocardial infarction (STEMI) may have affected clinical outcomes. Objectives: To analyze delay times and clinical outcomes of patients with STEMI undergoing primary percutaneous coronary intervention (PPCI), before and during the COVID-19 pandemic. Methods: Retrospective observational study that included patients with STEMI undergoing PPCI from December 2018 to July 2021. The COVID-19 pandemic cases were divided into two groups: pandemic I—from March to August 2020;and pandemic II—from September 2020 to July 2021. Patients were compared according to the period of hospitalization. Primary outcomes were delay times in assistance and clinical outcomes (acute kidney injury [AKI], post-procedural vascular complications and in-hospital mortality). Results: 108 patients were included, 39 (36.1%) in the pre-pandemic period, 13 (12.1%) in pandemic I and 56 (51.8%) in pandemic II. Time from onset of symptoms to arrival at the service and door-to-balloon time did not differ significantly among groups. Vascular complications were more frequent during the pandemic (I and II) than in the pre-pandemic period (2.5% pre-pandemic vs 15.4% pandemic vs 12.5% pandemic II;p = 0.03). AKI incidence was similar in all three periods. There was a non-significant increase in in-hospital mortality during the COVID-19 pandemic. Conclusion: In patients with STEMI, there was an increase in vascular complications and a trend toward increased mortality during the COVID-19 pandemic. Delay times to admission and reperfusion did not differ significantly between before and during the pandemic.展开更多
Background Quantitatively assessing myocardial perfusion and its reserve is of great importance for the diagnosis and stratification of patients with coronary artery disease （ CAD）, and represents an important goal ...Background Quantitatively assessing myocardial perfusion and its reserve is of great importance for the diagnosis and stratification of patients with coronary artery disease （ CAD）, and represents an important goal of myocardial contrast echocardiography. In this study we sought to test the usefulness of low dose dobutamine stress real-time myocardial contrast echocardiography （RT-MCE） in the assessment of CAD, and to explore the relationship between perfusion reserve and contractile reserve. Methods Twenty-six patients with suspected or clinical diagnosed CAD were enrolled and underwent RT-MCE at baseline and under low dose dobutamine stress, and subsequent coronary angiography. RT-MCE images were analyzed quantitatively from microbubble replenishment curves for myocardial perfusion and its reserve. Results At baseline, significant differences in beta （0.28± 0. 12, 0. 25± 0. 09, 0.22 ± 0. 06, 0. 20± 0.07 respectively, P 〈0. 01） and A x beta （1.37 ±0. 46, 1.28±0. 47, 1. 13 ±0. 37, 0.91±0. 32, respectively, P 〈0. 01 ） were observed among four segment groups with graded coronary artery stenosis severity （normal; 30% -69% stenosis; 70% -90% stenosis; and beyond 90% stenosis） , but not observed in parameter A. When under stress, significant differences in A （5.73 ± 1.28, 5.63 ± 1.01,4.96 ±0.81,4.57 _＋0.62, respectively, P〈0.01）, beta （0.67 ±0. 17, 0.55 ±0. 19, 0.32 ±0. 13, 0.25 ±0.08, respectively, P 〈0.01） and A x beta （3.81 ± 1.20, 3. 11±1.17, 1.59 ±0. 82, 1. 12 _＋0. 37, respectively, P 〈0. 01 ） were observed among the formerly mentioned groups. Graded decreases in A reserve （ 1.20 ±0. 53, 1.11 ±0. 16, 0.98 ±0. 12, 0. 99 ±0.13, respectively, P〈0.01）, beta reserve （2.65 ±1.07, 2. 32±0.82, 1.44±0.40, 1.29±0.34, respectively, P〈0.01） and A xbeta reserve （3.05 ± 1.63, 2.59 ±1.01, 1.42 ±0.44, 1.27±0.34, respectively, P 〈 0. 01 ） could also be observed with increasing coronary stenosis severity. In five segments groups scored by WMS （ 1 - 5 ） , concordance between contractile function and myocardial perfusion could be found both at rest （beta： 0.28±0. 11, 0. 22 ±0. 08, 0. 21 ±0.05, 0. 17 ±0.05,0. 19 ±0.06, respectively, P 〈0.01; A xbeta： 1.29 ±0.48, 0.98 ±0.45, 0.94±0.29, 0.76 ±0.30, 0.92 ±0.32, respectively, P〈 0.01） and under stress （beta： 0.59 ±0.20, 0.35 ±0.15, 0.27 ±0.08, 0. 17±0.05, 0.20±0.05, respectively, P〈0.01; A xbeta： 3.07 ±1.38, 1.62±0.82, 1.28 ±0.40, 0.78 ±0.24, 0.93 v0.22, respectively, P 〈0. 01 ）. This concordance is also valid in terms of the reserves, and the MCE parameters in segments with ameliorated contractile function are significantly higher than in those without. Conclusions Quantitative RT-MCE in conjunction with dobutamine stress shows promise in identifying and stratifying CAD and in exploring the perfusion-contractile correlation.展开更多
Objective To investigate the influence and mechanism of incidence of atrioventricular block (AVB) treated with thrombolytic therapy in acute inferior myocardial infarction (AIMI).Methods A total of 46 patients with A...Objective To investigate the influence and mechanism of incidence of atrioventricular block (AVB) treated with thrombolytic therapy in acute inferior myocardial infarction (AIMI).Methods A total of 46 patients with AIMI were divided into the thrombolytic group (n = 23) and the nonthrornboytic group (n = 23). Intravenous or intracoronary urokinase was given to the former group. We observed the advancing courses of AVB, and further assessed the relationship between occurrence of AVB and stenosis of infarct-related artery (IRA) with coronary angiography.Results Two cases died of Ⅲ o AVB in the non-thrombolytic group, but none was found in the thrombolytic group. The occurrence rate of AVB was similar in both groups; but that of Ⅲ ° AVB was much lower in the thrombolytic group (4 cases) than that in the non-thrombolytic group (11 cases, P ＜ 0.05), and the duration of AVB decreased from 201 ± 113 hours to 102±60 hours after thrombolytic therapy ( P＜0.01 ),which was mainly due to the decrease of AVB in the vanishing interval, but not in the developing interval.The coronary angiography demonstrated that there were an increasing reperfusion flow and a decreasing coronary stenosis of the infarct-related artery after thrombolytic therapy.Conclusion Thrombolytic therapy can reduce the incidence of severe AVB, shorten its duration and decrease the mortality by increasing the coronary reperfusion flow in the patients with AIMI.展开更多
Background Cardiac troponin-I （cTnl） is one of the three regulatory subunits of the cardiac troponin which has the high sensibility and specificity of responding to myocardial injury. Studies have demonstrated that ...Background Cardiac troponin-I （cTnl） is one of the three regulatory subunits of the cardiac troponin which has the high sensibility and specificity of responding to myocardial injury. Studies have demonstrated that cTnl is released into the blood stream within hours following acute myocardial reperfusion injury. The clinical utility of cTnl for the assessment of myocardial damage is that it is more specific than creatine kinase MB （CKMB）. This study investigated cTnl as a sensitive marker of myocardial reperfusion injury and its clinical value on beating heart surgery with right sub-axiliary incision. Methods From December 2002 through December 2004, 100 patients with atrial septal defect （ASD）, ventricular septal defect （VSD）, atrial septal defect and ventricular septal defect （ASD＋VSD）, and tetralogy of Fallot were randomly divided into two groups： the treatment group （n=50） was operated on with a beating heart under extracorporeal circulation （ECC）, and the control group （n=50） on an conventional arresting heart under ECC. The two groups both used a right sub-axillary incision. Blood samples from a central venous catheter （CVC） were collected before, at the end of aortic clamping, immediately after discontinue cardiopulmonary bypass （CPB）, 3, 6, 24, and 48 hours after operation. The Abbott Axsym system with hol-automation fluorescent immunity analyzer was used for the quantitative determination of cTnl. cTnl was detected to investigate the effect of myocardial ischemia reperfusion injury and the clinical value of beating heart surgery with right sub-axillary incision. Results There were no significant differences between the two groups before operation. At the end of aortic clamping and thereafter, cTnl significantly increased in both groups, and reached the peak point at 6 hours after operation. At all the tested points, cTnl was significantly higher in the control group than the beating heart group （P 〈0.05）, especially at 6 hours post operation （P 〈0.01）. The operating time and ECC duration were shortened and the dosage of dopamine was decreased, when compared with the control group. Conclusions There was less cTnl measured in the beating heart group than in the control group after CPB, demonstrating that beating heart surgery may significantly reduce myocardial reperfusion injury. Chin Med J 2009; 122（2）： 150-152展开更多
文摘Introduction: At the beginning of the COVID-19 pandemic, a drop in the number of patients treated for cardiac emergencies raised concern about cardiovascular mortality in that period. An increase in care delay for patients with ST-segment elevation myocardial infarction (STEMI) may have affected clinical outcomes. Objectives: To analyze delay times and clinical outcomes of patients with STEMI undergoing primary percutaneous coronary intervention (PPCI), before and during the COVID-19 pandemic. Methods: Retrospective observational study that included patients with STEMI undergoing PPCI from December 2018 to July 2021. The COVID-19 pandemic cases were divided into two groups: pandemic I—from March to August 2020;and pandemic II—from September 2020 to July 2021. Patients were compared according to the period of hospitalization. Primary outcomes were delay times in assistance and clinical outcomes (acute kidney injury [AKI], post-procedural vascular complications and in-hospital mortality). Results: 108 patients were included, 39 (36.1%) in the pre-pandemic period, 13 (12.1%) in pandemic I and 56 (51.8%) in pandemic II. Time from onset of symptoms to arrival at the service and door-to-balloon time did not differ significantly among groups. Vascular complications were more frequent during the pandemic (I and II) than in the pre-pandemic period (2.5% pre-pandemic vs 15.4% pandemic vs 12.5% pandemic II;p = 0.03). AKI incidence was similar in all three periods. There was a non-significant increase in in-hospital mortality during the COVID-19 pandemic. Conclusion: In patients with STEMI, there was an increase in vascular complications and a trend toward increased mortality during the COVID-19 pandemic. Delay times to admission and reperfusion did not differ significantly between before and during the pandemic.
文摘Background Quantitatively assessing myocardial perfusion and its reserve is of great importance for the diagnosis and stratification of patients with coronary artery disease （ CAD）, and represents an important goal of myocardial contrast echocardiography. In this study we sought to test the usefulness of low dose dobutamine stress real-time myocardial contrast echocardiography （RT-MCE） in the assessment of CAD, and to explore the relationship between perfusion reserve and contractile reserve. Methods Twenty-six patients with suspected or clinical diagnosed CAD were enrolled and underwent RT-MCE at baseline and under low dose dobutamine stress, and subsequent coronary angiography. RT-MCE images were analyzed quantitatively from microbubble replenishment curves for myocardial perfusion and its reserve. Results At baseline, significant differences in beta （0.28± 0. 12, 0. 25± 0. 09, 0.22 ± 0. 06, 0. 20± 0.07 respectively, P 〈0. 01） and A x beta （1.37 ±0. 46, 1.28±0. 47, 1. 13 ±0. 37, 0.91±0. 32, respectively, P 〈0. 01 ） were observed among four segment groups with graded coronary artery stenosis severity （normal; 30% -69% stenosis; 70% -90% stenosis; and beyond 90% stenosis） , but not observed in parameter A. When under stress, significant differences in A （5.73 ± 1.28, 5.63 ± 1.01,4.96 ±0.81,4.57 _＋0.62, respectively, P〈0.01）, beta （0.67 ±0. 17, 0.55 ±0. 19, 0.32 ±0. 13, 0.25 ±0.08, respectively, P 〈0.01） and A x beta （3.81 ± 1.20, 3. 11±1.17, 1.59 ±0. 82, 1. 12 _＋0. 37, respectively, P 〈0. 01 ） were observed among the formerly mentioned groups. Graded decreases in A reserve （ 1.20 ±0. 53, 1.11 ±0. 16, 0.98 ±0. 12, 0. 99 ±0.13, respectively, P〈0.01）, beta reserve （2.65 ±1.07, 2. 32±0.82, 1.44±0.40, 1.29±0.34, respectively, P〈0.01） and A xbeta reserve （3.05 ± 1.63, 2.59 ±1.01, 1.42 ±0.44, 1.27±0.34, respectively, P 〈 0. 01 ） could also be observed with increasing coronary stenosis severity. In five segments groups scored by WMS （ 1 - 5 ） , concordance between contractile function and myocardial perfusion could be found both at rest （beta： 0.28±0. 11, 0. 22 ±0. 08, 0. 21 ±0.05, 0. 17 ±0.05,0. 19 ±0.06, respectively, P 〈0.01; A xbeta： 1.29 ±0.48, 0.98 ±0.45, 0.94±0.29, 0.76 ±0.30, 0.92 ±0.32, respectively, P〈 0.01） and under stress （beta： 0.59 ±0.20, 0.35 ±0.15, 0.27 ±0.08, 0. 17±0.05, 0.20±0.05, respectively, P〈0.01; A xbeta： 3.07 ±1.38, 1.62±0.82, 1.28 ±0.40, 0.78 ±0.24, 0.93 v0.22, respectively, P 〈0. 01 ）. This concordance is also valid in terms of the reserves, and the MCE parameters in segments with ameliorated contractile function are significantly higher than in those without. Conclusions Quantitative RT-MCE in conjunction with dobutamine stress shows promise in identifying and stratifying CAD and in exploring the perfusion-contractile correlation.
文摘Objective To investigate the influence and mechanism of incidence of atrioventricular block (AVB) treated with thrombolytic therapy in acute inferior myocardial infarction (AIMI).Methods A total of 46 patients with AIMI were divided into the thrombolytic group (n = 23) and the nonthrornboytic group (n = 23). Intravenous or intracoronary urokinase was given to the former group. We observed the advancing courses of AVB, and further assessed the relationship between occurrence of AVB and stenosis of infarct-related artery (IRA) with coronary angiography.Results Two cases died of Ⅲ o AVB in the non-thrombolytic group, but none was found in the thrombolytic group. The occurrence rate of AVB was similar in both groups; but that of Ⅲ ° AVB was much lower in the thrombolytic group (4 cases) than that in the non-thrombolytic group (11 cases, P ＜ 0.05), and the duration of AVB decreased from 201 ± 113 hours to 102±60 hours after thrombolytic therapy ( P＜0.01 ),which was mainly due to the decrease of AVB in the vanishing interval, but not in the developing interval.The coronary angiography demonstrated that there were an increasing reperfusion flow and a decreasing coronary stenosis of the infarct-related artery after thrombolytic therapy.Conclusion Thrombolytic therapy can reduce the incidence of severe AVB, shorten its duration and decrease the mortality by increasing the coronary reperfusion flow in the patients with AIMI.
文摘Background Cardiac troponin-I （cTnl） is one of the three regulatory subunits of the cardiac troponin which has the high sensibility and specificity of responding to myocardial injury. Studies have demonstrated that cTnl is released into the blood stream within hours following acute myocardial reperfusion injury. The clinical utility of cTnl for the assessment of myocardial damage is that it is more specific than creatine kinase MB （CKMB）. This study investigated cTnl as a sensitive marker of myocardial reperfusion injury and its clinical value on beating heart surgery with right sub-axiliary incision. Methods From December 2002 through December 2004, 100 patients with atrial septal defect （ASD）, ventricular septal defect （VSD）, atrial septal defect and ventricular septal defect （ASD＋VSD）, and tetralogy of Fallot were randomly divided into two groups： the treatment group （n=50） was operated on with a beating heart under extracorporeal circulation （ECC）, and the control group （n=50） on an conventional arresting heart under ECC. The two groups both used a right sub-axillary incision. Blood samples from a central venous catheter （CVC） were collected before, at the end of aortic clamping, immediately after discontinue cardiopulmonary bypass （CPB）, 3, 6, 24, and 48 hours after operation. The Abbott Axsym system with hol-automation fluorescent immunity analyzer was used for the quantitative determination of cTnl. cTnl was detected to investigate the effect of myocardial ischemia reperfusion injury and the clinical value of beating heart surgery with right sub-axillary incision. Results There were no significant differences between the two groups before operation. At the end of aortic clamping and thereafter, cTnl significantly increased in both groups, and reached the peak point at 6 hours after operation. At all the tested points, cTnl was significantly higher in the control group than the beating heart group （P 〈0.05）, especially at 6 hours post operation （P 〈0.01）. The operating time and ECC duration were shortened and the dosage of dopamine was decreased, when compared with the control group. Conclusions There was less cTnl measured in the beating heart group than in the control group after CPB, demonstrating that beating heart surgery may significantly reduce myocardial reperfusion injury. Chin Med J 2009; 122（2）： 150-152
