目的探究红细胞分布宽度-白蛋白比值(red cell distribution width to albumin ratio,RAR)与接受静脉-动脉体外膜肺氧合(veno-arterial extracorporeal membrane oxygenation,VA-ECMO)支持的急性暴发性心肌炎(acute fulminant myocardit...目的探究红细胞分布宽度-白蛋白比值(red cell distribution width to albumin ratio,RAR)与接受静脉-动脉体外膜肺氧合(veno-arterial extracorporeal membrane oxygenation,VA-ECMO)支持的急性暴发性心肌炎(acute fulminant myocarditis,AFM)患儿院内死亡风险的关联性。方法选取2015年7月至2022年8月于中国人民解放军总医院第七医学中心及其他6个ECMO中心因AFM接受VA-ECMO治疗的患儿125例。根据受试者操作特征曲线(receiver operator characteristic curve,ROC曲线)确定RAR截断值,并分为RAR<0.38组和RAR≥0.38组。采用二元Logistic回归评估RAR与院内死亡风险的关联性。结果研究期间36例(28.8%)患儿发生院内死亡。校正潜在混杂因素后,RAR每增加1个标准差,院内死亡风险增加93%(OR=1.93,95%CI:1.1~3.39,P=0.022)。与RAR<0.38组相比,RAR≥0.38的院内风险增加6.5倍(OR=7.5,95%CI:1.85~30.32,P=0.005)。限制性立方样条图显示,RAR与院内死亡风险之间存在正线性关系(Pnonlinear=0.325)。亚组分析发现,性别与RAR在评估院内死亡发生风险上存在交互作用。结论RAR升高与AFM患儿VA-ECMO院内死亡高风险相关,提示RAR可能是临床预后判断的新型分子标志物。展开更多
The features of myocardial strains from speckle-tracking echocardiography (STE) have not been well defined in fulminant myocarditis (FM) patients.In this study,changes in the left ventricular ejection fraction (LVEF) ...The features of myocardial strains from speckle-tracking echocardiography (STE) have not been well defined in fulminant myocarditis (FM) patients.In this study,changes in the left ventricular ejection fraction (LVEF) and global and layer-specific myocardial strains over time were monitored.We aimed to determine the echocardiographic patterns of FM and ascertain their significance in FM treatment.Twenty patients who were clinically diagnosed with FM and received mechanical life support were prospectively enrolled.Conventional echocardiographic measurements were obtained,and serial strain echocardiography was performed from admission to hospital discharge until LVEF recovery (> 50%).Global/regional peak systolic longitudinal strains (GLS/RLS) and layer-specific longitudinal strains were quantified,and their changes with time were monitored in 14 FM patients.All patients had severely impaired cardiac function.Steep improvement in LVEF and GLS were observed within 6 days.Layer-specific strain analysis showed that reduction at admission or recovery at discharge in the endocardium and epicardium strains were equal.In conclusion,FM patients who received mechanical circulatory supports exhibited steep improvement in ventricular function within 6 days.The patchy and diffused distribution pattern of reduced RLS and equally and severely impaired strain in the endocardium and epicardium are valuable features in the diagnosis of FM.展开更多
Background Acute myocarditis(AMC)can cause poor outcomes or even death in children.We aimed to identify AMC risk factors and create a mortality prediction model for AMC in children at hospital admission.Methods This w...Background Acute myocarditis(AMC)can cause poor outcomes or even death in children.We aimed to identify AMC risk factors and create a mortality prediction model for AMC in children at hospital admission.Methods This was a single-center retrospective cohort study of AMC children hospitalized between January 2016 and January 2020.The demographics,clinical examinations,types of AMC,and laboratory results were collected at hospital admission.In-hospital survival or death was documented.Clinical characteristics associated with death were evaluated.Results Among 67 children,51 survived,and 16 died.The most common symptom was digestive disorder(67.2%).Based on the Bayesian model averaging and Hosmer–Lemeshow test,we created a final best mortality prediction model(acute myocarditis death risk score,AMCDRS)that included ten variables(male sex,fever,congestive heart failure,left-ventricular ejection fraction<50%,pulmonary edema,ventricular tachycardia,lactic acid value>4,fulminant myocarditis,abnormal creatine kinase-MB,and hypotension).Despite differences in the characteristics of the validation cohort,the model discrimination was only marginally lower,with an AUC of 0.781(95%confidence interval=0.675–0.852)compared with the derivation cohort.Model calibration likewise indicated acceptable fit(Hosmer‒Lemeshow goodness-of-fit,P¼=0.10).Conclusions Multiple factors were associated with increased mortality in children with AMC.The prediction model AMCDRS might be used at hospital admission to accurately identify AMC in children who are at an increased risk of death.展开更多
文摘目的:通过分析成人急性暴发性心肌炎(acute fulminant myocarditis,AFM)患者的临床特征和治疗结局,探究其院内死亡相关的风险因素。方法:通过对2008年1月至2022年12月,首都医科大学附属北京天坛医院收治的成人AFM患者进行回顾性研究,对比院内死亡患者与存活患者的人群特征、临床表现、治疗和结局,分析AFM患者院内死亡的相关危险因素。结果:共有91例患者符合AFM标准,并纳入了该研究,其中院内死亡者31例(34.1%),存活并出院者60例(65.9%)。与存活者相比,院内死亡患者出现胸痛、多器官衰竭(multiple organ failure,MOF)和ST段抬高比例明显增多,收缩压和舒张压明显降低,LVEF降低,乳酸水平升高,且需要心肺复苏、主动脉内球囊反搏支持和机械通气的更大可能性更大(P<0.05)。上述10个因素也是单因素Logistic回归分析中院内死亡的预测因素,而多变量分析显示胸痛(OR=18.06,95%CI:1.47~221.81)、低收缩压(OR=0.94,95%CI:10.86~0.99)、入院时高水平的乳酸(OR=1.99,95%CI:11.14~3.46)是成人AFM患者院内死亡的主要危险因素。结论:住院期间死亡的成年AFM患者的特征是胸痛、ST段抬高、血压和LVEF降低、入院时乳酸水平升高,入院时胸痛、收缩压降低和乳酸水平升高可能提示患者住院死亡的风险升高。
文摘目的探究红细胞分布宽度-白蛋白比值(red cell distribution width to albumin ratio,RAR)与接受静脉-动脉体外膜肺氧合(veno-arterial extracorporeal membrane oxygenation,VA-ECMO)支持的急性暴发性心肌炎(acute fulminant myocarditis,AFM)患儿院内死亡风险的关联性。方法选取2015年7月至2022年8月于中国人民解放军总医院第七医学中心及其他6个ECMO中心因AFM接受VA-ECMO治疗的患儿125例。根据受试者操作特征曲线(receiver operator characteristic curve,ROC曲线)确定RAR截断值,并分为RAR<0.38组和RAR≥0.38组。采用二元Logistic回归评估RAR与院内死亡风险的关联性。结果研究期间36例(28.8%)患儿发生院内死亡。校正潜在混杂因素后,RAR每增加1个标准差,院内死亡风险增加93%(OR=1.93,95%CI:1.1~3.39,P=0.022)。与RAR<0.38组相比,RAR≥0.38的院内风险增加6.5倍(OR=7.5,95%CI:1.85~30.32,P=0.005)。限制性立方样条图显示,RAR与院内死亡风险之间存在正线性关系(Pnonlinear=0.325)。亚组分析发现,性别与RAR在评估院内死亡发生风险上存在交互作用。结论RAR升高与AFM患儿VA-ECMO院内死亡高风险相关,提示RAR可能是临床预后判断的新型分子标志物。
基金The project was supported by the grant from the National Natural Science Foundation of China(Nos.81873535 and 81570367)We thank Dr.Jonathan R.Linder who gave us helpful suggestions in writing the manuscript.
文摘The features of myocardial strains from speckle-tracking echocardiography (STE) have not been well defined in fulminant myocarditis (FM) patients.In this study,changes in the left ventricular ejection fraction (LVEF) and global and layer-specific myocardial strains over time were monitored.We aimed to determine the echocardiographic patterns of FM and ascertain their significance in FM treatment.Twenty patients who were clinically diagnosed with FM and received mechanical life support were prospectively enrolled.Conventional echocardiographic measurements were obtained,and serial strain echocardiography was performed from admission to hospital discharge until LVEF recovery (> 50%).Global/regional peak systolic longitudinal strains (GLS/RLS) and layer-specific longitudinal strains were quantified,and their changes with time were monitored in 14 FM patients.All patients had severely impaired cardiac function.Steep improvement in LVEF and GLS were observed within 6 days.Layer-specific strain analysis showed that reduction at admission or recovery at discharge in the endocardium and epicardium strains were equal.In conclusion,FM patients who received mechanical circulatory supports exhibited steep improvement in ventricular function within 6 days.The patchy and diffused distribution pattern of reduced RLS and equally and severely impaired strain in the endocardium and epicardium are valuable features in the diagnosis of FM.
基金Shanghai Top Priority Clinical Medical Center Project(No.2017ZZ01008-001).
文摘Background Acute myocarditis(AMC)can cause poor outcomes or even death in children.We aimed to identify AMC risk factors and create a mortality prediction model for AMC in children at hospital admission.Methods This was a single-center retrospective cohort study of AMC children hospitalized between January 2016 and January 2020.The demographics,clinical examinations,types of AMC,and laboratory results were collected at hospital admission.In-hospital survival or death was documented.Clinical characteristics associated with death were evaluated.Results Among 67 children,51 survived,and 16 died.The most common symptom was digestive disorder(67.2%).Based on the Bayesian model averaging and Hosmer–Lemeshow test,we created a final best mortality prediction model(acute myocarditis death risk score,AMCDRS)that included ten variables(male sex,fever,congestive heart failure,left-ventricular ejection fraction<50%,pulmonary edema,ventricular tachycardia,lactic acid value>4,fulminant myocarditis,abnormal creatine kinase-MB,and hypotension).Despite differences in the characteristics of the validation cohort,the model discrimination was only marginally lower,with an AUC of 0.781(95%confidence interval=0.675–0.852)compared with the derivation cohort.Model calibration likewise indicated acceptable fit(Hosmer‒Lemeshow goodness-of-fit,P¼=0.10).Conclusions Multiple factors were associated with increased mortality in children with AMC.The prediction model AMCDRS might be used at hospital admission to accurately identify AMC in children who are at an increased risk of death.
