Background: Cardiovascular events, the leading cause of death among diabetic patients, are usually under-diagnosed due to subclinical presentation. Methods: We conducted a cross-sectional study from March-2019 to Sept...Background: Cardiovascular events, the leading cause of death among diabetic patients, are usually under-diagnosed due to subclinical presentation. Methods: We conducted a cross-sectional study from March-2019 to September-2020, in two reference hospitals in Yaoundé, Cameroon, to assess the prevalence of asymptomatic Left Ventricular Diastolic Dysfunction (LVDD) and Silent Myocardial Infarction (SMI) and potentially associated factors. Results: Out of 95 participants (mean age ± SD: 43 ± 7 years;M/F sex-ratio 1.6), 22 (23.1%;95% CI: 15.8% - 32.6%) had LVDD and fewer (n = 13, 13.6%;95% CI: 8.2% - 22.0%) had SMI, p = 0.86. Though not statistically significant, patients with ≥5 years diabetes duration, as well as patients with HbA1C ≥ 7.5% had two-fold increased risk of LVDD (p = 0.22 and p = 0.15 respectively). LVDD was significantly higher in patients with SMI (29% vs 6.3%, p Conclusion: The significant presence of asymptomatic cardiovascular manifestations in this population entails mandatory preventive screening, especially, in patients with long standing diabetes and poor glycemic control, to allow timely detection and management.展开更多
Background and Objective Diastolic dysfunction of the left ventricle is a mechanical abnormality diagnosed primarily by echocardiogram, and can be distinguished into three separate degrees based on the severity of red...Background and Objective Diastolic dysfunction of the left ventricle is a mechanical abnormality diagnosed primarily by echocardiogram, and can be distinguished into three separate degrees based on the severity of reduction in passive compliance and active myocardial relaxation. Methods A literature search was performed for basic science studies, clinical studies and major practice guidelines on the subject of diastolic dysfunction and diastolic heart failure. Important findings were analyzed and correlated with regard to clinical relevance. Results Left ventricular diastolic dysfunction appears to compromise exercise tolerance and is believed to contribute to the pathophysiology in patients with diastolic heart failure. In the clinical setting, however, oftentimes no clear distinction is made between echocardiographically diagnosed diastolic dysfunction and diastolic heart failure, and adequate treatment recommendations are sparse and aimed to prevent worsening and progression of clinical symptoms. To date, there is a lack of high powered trials assessing the possible progression rate from echocardiographically diagnosed diastolic dysfunction to the clinical diagnosis of diastolic heart failure. Furthermore, there are no solid indices to assess the degree of severity of diastolic dysfunction or its progression. Pure right ventricular diastolic dysfunction appears to be even less understood and under-recognized, although it may play a role in the development of both right and left heart failure. Currently there are few but interesting data on the possible interaction between ventricles with diastolic dysfunction and the overall affect on the development of heart failure. Conclusions The timeline and progression of diastolic dysfunction to diastolic heart failure have not been well established and warrant further investigation.展开更多
Objective. To investigate the effect of left ventricular diastolic dysfunction on the pathogenesis of angina decubitus (AD). Methods. The study population consisted of three groups: 20 individuals without cardiovascul...Objective. To investigate the effect of left ventricular diastolic dysfunction on the pathogenesis of angina decubitus (AD). Methods. The study population consisted of three groups: 20 individuals without cardiovascular disease were studied as group Ⅰ.Group Ⅱ included 20 patents with coronary artery disease and without AD. Thirty-one patients with AD and ejection fraction(EF)>50% were studied as group Ⅲ. Group Ⅱ and Ⅲ were matched for age, EF and extent of coronary artery disease. Results. Left ventriculography (LVG) showed that left ventricular (LV) first 1/3 filling fraction(1/3FF) was significantly lower in group Ⅲ than in group Ⅱ and Ⅰ(both P<0001),but LV late 1/3 FF was much higher in group Ⅲ than in group Ⅱ and Ⅰ(P<005, P<001). Left ventricular end-diastolic pressure(LVEDP)was markedly increased before and after LVG in group Ⅱ and Ⅲ as compared with group Ⅰ (both P<005, both P<0001). The difference of LVEDP caused by left atrial contraction (left atrial contraction pressure difference, LACPD)before and after LVG was much higher in group Ⅲ than in group Ⅰ ( P<001, P<0001). Howevere,there were significant differences in LVEDP and in LACPD between before and after LVG only in group Ⅲ (both P<001). Conclusion. The patients with AD have LV diastolic dysfunction, which may be closely related to the pathogenesis of angina decubitus.展开更多
Heart failure with preserved left ventricular function is a common problem among elderly patients. Given that diastolic heart failure (DHF) occurs in up to 50% of all heart failure admissions, and that incidence incre...Heart failure with preserved left ventricular function is a common problem among elderly patients. Given that diastolic heart failure (DHF) occurs in up to 50% of all heart failure admissions, and that incidence increases with age, knowledge of current recommendations for its diagnosis and treatment are extremely important for the elderly population. Causes of DHF include the aging process itself, hypertension, left ventricular hypertrophy, aortic stenosis, and hypertrophic obstructive cardiomyopathy. The patient with DHF may present with signs and symptoms similar to those observed in systolic heart failure. Treatment goals for the patient with DHF include achieving normal volume status, improving relaxation of the left ventricle, regression of hypertrophy if possible, and management of any co-morbidities that may aggravate the clinical status of patients with DHF. Hopefully, in the future, further data from randomized clinical trials will allow a more defined approach to care in these patients.展开更多
BACKGROUND:Few studies investigated serum uric acid levels in patients with acute STelevation myocardial infarction(STEMI).The study was to assess the clinical value of serum uric acid levels in patients with acute ST...BACKGROUND:Few studies investigated serum uric acid levels in patients with acute STelevation myocardial infarction(STEMI).The study was to assess the clinical value of serum uric acid levels in patients with acute ST-elevation myocardial infarction(STEMI).METHODS:Totally 502 consecutive patients with STEMI were retrospectively studied from January 2005 to December 2010.The level of serum lipid,echocardiographic data and in-hospital major adverse cardiovascular events(MACE) in patients with hyperuricemia(n=119) were compared with those in patients without hyperuricemia(n=383).The relationship between the level of serum uric acid and the degree of diseased coronary artery was analyzed.All data were analyzed with SPSS version 17.0 software for Student's t test,the Chi-square test and Pearson's correlation coefficient analysis.RESULTS:Serum uric acid level was positively correlated with serum triglyceride level.Hyperlipidemia was more common in hyperuricemia patients than in non-hyperuricemia patients(43.7%vs.33.7%,P=0.047),and serum triglyceride level was significantly higher in hyperuricemia patients(2.11±1.24 vs.1.78±1.38,P=0.014).But no significant association was observed between serum uric acid level and one or more diseased vessels(P>0.05).Left ventricular end-diastolic diameter(LVEDd) was larger in hyperuricemia patients than in non-hyperuricemia patients(53.52±6.19 vs.52.18±4.89,P=0.041).The higher rate of left systolic dysfunction and diastolic dysfunction was discovered in hyperuricemia patients(36.4%vs.15.1%,P<0.001;68.2%vs.55.8%,P=0.023).Also,hyperuricemia patients were more likely to have in-hospital MACE(P<0.05).CONCLUSIONS:Serum uric acid level is positively correlated with serum triglyceride level,but not with the severity of coronary artery disease.Hyperuricemia patients with STEMI tend to have a higher rate of left systolic dysfunction and diastolic dysfunction and more likely to have more in-hospital MACE.展开更多
Advanced heart failure has been traditionally treated via either heart transplantation,continuous inotropes,consideration for hospice and more recently via left ventricular assist devices(LVAD).Heart transplantation h...Advanced heart failure has been traditionally treated via either heart transplantation,continuous inotropes,consideration for hospice and more recently via left ventricular assist devices(LVAD).Heart transplantation has been limited by organ availability and the futility of other options has thrust LVAD therapy into the mainstream of therapy for end stage heart failure.Improvements in technology and survival combined with improvements in the quality of life have made LVADs a viable option for many patients suffering from heart failure.The question of when to implant these devices in those patients with advanced,yet still ambulatory heart failure remains a controversial topic.We discuss the current state of LVAD therapy and the risk vs benefit of these devices in the treatment of heart failure.展开更多
文摘Background: Cardiovascular events, the leading cause of death among diabetic patients, are usually under-diagnosed due to subclinical presentation. Methods: We conducted a cross-sectional study from March-2019 to September-2020, in two reference hospitals in Yaoundé, Cameroon, to assess the prevalence of asymptomatic Left Ventricular Diastolic Dysfunction (LVDD) and Silent Myocardial Infarction (SMI) and potentially associated factors. Results: Out of 95 participants (mean age ± SD: 43 ± 7 years;M/F sex-ratio 1.6), 22 (23.1%;95% CI: 15.8% - 32.6%) had LVDD and fewer (n = 13, 13.6%;95% CI: 8.2% - 22.0%) had SMI, p = 0.86. Though not statistically significant, patients with ≥5 years diabetes duration, as well as patients with HbA1C ≥ 7.5% had two-fold increased risk of LVDD (p = 0.22 and p = 0.15 respectively). LVDD was significantly higher in patients with SMI (29% vs 6.3%, p Conclusion: The significant presence of asymptomatic cardiovascular manifestations in this population entails mandatory preventive screening, especially, in patients with long standing diabetes and poor glycemic control, to allow timely detection and management.
文摘Background and Objective Diastolic dysfunction of the left ventricle is a mechanical abnormality diagnosed primarily by echocardiogram, and can be distinguished into three separate degrees based on the severity of reduction in passive compliance and active myocardial relaxation. Methods A literature search was performed for basic science studies, clinical studies and major practice guidelines on the subject of diastolic dysfunction and diastolic heart failure. Important findings were analyzed and correlated with regard to clinical relevance. Results Left ventricular diastolic dysfunction appears to compromise exercise tolerance and is believed to contribute to the pathophysiology in patients with diastolic heart failure. In the clinical setting, however, oftentimes no clear distinction is made between echocardiographically diagnosed diastolic dysfunction and diastolic heart failure, and adequate treatment recommendations are sparse and aimed to prevent worsening and progression of clinical symptoms. To date, there is a lack of high powered trials assessing the possible progression rate from echocardiographically diagnosed diastolic dysfunction to the clinical diagnosis of diastolic heart failure. Furthermore, there are no solid indices to assess the degree of severity of diastolic dysfunction or its progression. Pure right ventricular diastolic dysfunction appears to be even less understood and under-recognized, although it may play a role in the development of both right and left heart failure. Currently there are few but interesting data on the possible interaction between ventricles with diastolic dysfunction and the overall affect on the development of heart failure. Conclusions The timeline and progression of diastolic dysfunction to diastolic heart failure have not been well established and warrant further investigation.
文摘Objective. To investigate the effect of left ventricular diastolic dysfunction on the pathogenesis of angina decubitus (AD). Methods. The study population consisted of three groups: 20 individuals without cardiovascular disease were studied as group Ⅰ.Group Ⅱ included 20 patents with coronary artery disease and without AD. Thirty-one patients with AD and ejection fraction(EF)>50% were studied as group Ⅲ. Group Ⅱ and Ⅲ were matched for age, EF and extent of coronary artery disease. Results. Left ventriculography (LVG) showed that left ventricular (LV) first 1/3 filling fraction(1/3FF) was significantly lower in group Ⅲ than in group Ⅱ and Ⅰ(both P<0001),but LV late 1/3 FF was much higher in group Ⅲ than in group Ⅱ and Ⅰ(P<005, P<001). Left ventricular end-diastolic pressure(LVEDP)was markedly increased before and after LVG in group Ⅱ and Ⅲ as compared with group Ⅰ (both P<005, both P<0001). The difference of LVEDP caused by left atrial contraction (left atrial contraction pressure difference, LACPD)before and after LVG was much higher in group Ⅲ than in group Ⅰ ( P<001, P<0001). Howevere,there were significant differences in LVEDP and in LACPD between before and after LVG only in group Ⅲ (both P<001). Conclusion. The patients with AD have LV diastolic dysfunction, which may be closely related to the pathogenesis of angina decubitus.
文摘Heart failure with preserved left ventricular function is a common problem among elderly patients. Given that diastolic heart failure (DHF) occurs in up to 50% of all heart failure admissions, and that incidence increases with age, knowledge of current recommendations for its diagnosis and treatment are extremely important for the elderly population. Causes of DHF include the aging process itself, hypertension, left ventricular hypertrophy, aortic stenosis, and hypertrophic obstructive cardiomyopathy. The patient with DHF may present with signs and symptoms similar to those observed in systolic heart failure. Treatment goals for the patient with DHF include achieving normal volume status, improving relaxation of the left ventricle, regression of hypertrophy if possible, and management of any co-morbidities that may aggravate the clinical status of patients with DHF. Hopefully, in the future, further data from randomized clinical trials will allow a more defined approach to care in these patients.
文摘BACKGROUND:Few studies investigated serum uric acid levels in patients with acute STelevation myocardial infarction(STEMI).The study was to assess the clinical value of serum uric acid levels in patients with acute ST-elevation myocardial infarction(STEMI).METHODS:Totally 502 consecutive patients with STEMI were retrospectively studied from January 2005 to December 2010.The level of serum lipid,echocardiographic data and in-hospital major adverse cardiovascular events(MACE) in patients with hyperuricemia(n=119) were compared with those in patients without hyperuricemia(n=383).The relationship between the level of serum uric acid and the degree of diseased coronary artery was analyzed.All data were analyzed with SPSS version 17.0 software for Student's t test,the Chi-square test and Pearson's correlation coefficient analysis.RESULTS:Serum uric acid level was positively correlated with serum triglyceride level.Hyperlipidemia was more common in hyperuricemia patients than in non-hyperuricemia patients(43.7%vs.33.7%,P=0.047),and serum triglyceride level was significantly higher in hyperuricemia patients(2.11±1.24 vs.1.78±1.38,P=0.014).But no significant association was observed between serum uric acid level and one or more diseased vessels(P>0.05).Left ventricular end-diastolic diameter(LVEDd) was larger in hyperuricemia patients than in non-hyperuricemia patients(53.52±6.19 vs.52.18±4.89,P=0.041).The higher rate of left systolic dysfunction and diastolic dysfunction was discovered in hyperuricemia patients(36.4%vs.15.1%,P<0.001;68.2%vs.55.8%,P=0.023).Also,hyperuricemia patients were more likely to have in-hospital MACE(P<0.05).CONCLUSIONS:Serum uric acid level is positively correlated with serum triglyceride level,but not with the severity of coronary artery disease.Hyperuricemia patients with STEMI tend to have a higher rate of left systolic dysfunction and diastolic dysfunction and more likely to have more in-hospital MACE.
文摘Advanced heart failure has been traditionally treated via either heart transplantation,continuous inotropes,consideration for hospice and more recently via left ventricular assist devices(LVAD).Heart transplantation has been limited by organ availability and the futility of other options has thrust LVAD therapy into the mainstream of therapy for end stage heart failure.Improvements in technology and survival combined with improvements in the quality of life have made LVADs a viable option for many patients suffering from heart failure.The question of when to implant these devices in those patients with advanced,yet still ambulatory heart failure remains a controversial topic.We discuss the current state of LVAD therapy and the risk vs benefit of these devices in the treatment of heart failure.
