Objective To investigate the impact of simvastatin on blood lipid and the incidence of atrial fibrillation and ischemic-related events in patients with acute myocardial infarction accompanied by paroxysmal atrial fibr...Objective To investigate the impact of simvastatin on blood lipid and the incidence of atrial fibrillation and ischemic-related events in patients with acute myocardial infarction accompanied by paroxysmal atrial fibrillation. Methods One hundred and three patients with acute myocardial infarction and paroxysmal atrial fibrillation were selected as subjects,and were divided into a simvastatin group and a control group. Forty-five patients were in the simvastatin group,who took simvastatin 20mg/d orally for 18 months;fifty-eight patients were in the control group,and received conventional therapy except for statins. All patients were followed up for 18 months. The level of blood lipid,recurrence rate of paroxysmal atrial fibrillation,incidence rate of persistent or permanent atrial fibrillation,and the ischemic-related events were investigated and compared between the two groups. Results ① The levels of blood lipids did not change significantly in the control group(P>0.05) ;concentrations of total cholesterol(TC) and low density lipoprotein cholesterol(LDL-C) decreased significantly after treatment of simvastatin(P<0.05) . ② Recurrence of atrial fibrillation was observed in five patients during 18 months follow-up in the simvastatin group(11.1%) ,whereas it occurred in 14 patients of the control group(24. 1%,P<0.05) ;the occurrence rate of persistent or permanent atrial fibrillation in the simvastatin group was 4.4%,which was lower than that of control(12.1%,P<0.05) . ③ Nine patients had ischemic-related events in the simvastatin group(20.0%) ,with three heart failures(6.6%) ,two rehospitalizations for deterioration of coronary heart diseases(4.4%) ,three cardiac deaths(6.6%) ,and one cerebral stroke(2.2%) ,which was lower evidently than in the control group(41.4%,P<0.05) . Conclusions Simvastatin can not only decrease the levels of serum TC and LDL-C but also prevent the occurrence of atrial fibrillation and ischemic-related events.展开更多
Atrial fibrillation is an increasingly common significant arrhythmia with potentially serious outcomes. Myocardial infarction is a common consequence of atherosclerosis and coronary artery disease. When the two condit...Atrial fibrillation is an increasingly common significant arrhythmia with potentially serious outcomes. Myocardial infarction is a common consequence of atherosclerosis and coronary artery disease. When the two conditions occur together, the consequences can be compounded. This article briefly reviews some of the potentials for the relationship.展开更多
1 Introduction Inflammation is one of the main mechanisms in the pathogenesis of atherosclerosis,and the interest to the evaluation of inflammatory biomarkers in coronary artery disease(CAD)has been increasing over th...1 Introduction Inflammation is one of the main mechanisms in the pathogenesis of atherosclerosis,and the interest to the evaluation of inflammatory biomarkers in coronary artery disease(CAD)has been increasing over the last decade.[1,2]Destabilization of chronic artery plaques,which leads to acute coronary syndromes,has been associated with inflammatory status.[1,3]。展开更多
It is known that the Wolff-Parkinson-White syndrome （WPW） may either mimic myocardial infarction （MI） or mask the ECG changes of MI. Thus, the diagnosis of MI coexisting with WPW is frequently difficult. Furthermo...It is known that the Wolff-Parkinson-White syndrome （WPW） may either mimic myocardial infarction （MI） or mask the ECG changes of MI. Thus, the diagnosis of MI coexisting with WPW is frequently difficult. Furthermore, patients with WPW occurring acute MI may be life threat- ening. Therefore, early recognition and correct treatment allows rapid restoration of normal sinus rhythm and may decrease morbidity and mortality.展开更多
Most cases of sudden cardiac death are attributed to sustained ventricular tachyarrhythmias(VTs), triggered by acute coronary occlusion. Autonomic dysfunction, an important arrhythmogenic mechanism in this setting, is...Most cases of sudden cardiac death are attributed to sustained ventricular tachyarrhythmias(VTs), triggered by acute coronary occlusion. Autonomic dysfunction, an important arrhythmogenic mechanism in this setting, is being actively investigated, aiming at the advent of preventive strategies. Recent experimental studies have shown vagal withdrawal after anterior myocardial infarction, coinciding with high incidence of VTs, followed by more gradual sympathetic activation coinciding with a second arrhythmia peak. This article summarizes recent knowledge on this intriguing topic, generating hypotheses that can be investigated in future experimental and clinical studies.展开更多
BACKGROUND:Few studies have reported the effect of aldosterone receptor antagonist(ARA) on myocardial remodeling after acute myocardial infarction(AMI).This study was undertaken to investigate the preventive effect of...BACKGROUND:Few studies have reported the effect of aldosterone receptor antagonist(ARA) on myocardial remodeling after acute myocardial infarction(AMI).This study was undertaken to investigate the preventive effect of ARA on myocardial remodeling after AMI.METHODS:A total of 616 patients who had been admitted into the CCU of the First Affiliated Hospital of Harbin Medical University from January 2008 to January 2010 were studied prospectively.Only 528 patients were observed completely,including 266 of the control group and 262 of the treatment group.There was no statistical difference in age,gender,medical history,admission situation,and treatment between the two groups(P>0.05).The preventive effects of spironolactone on cardiac remodeling,left ventricular function,renal function and blood levels of potassium were evaluated by echocardiography,serum potassium and serum creatinine at one-month and one-year follow-up.RESULTS:The echocardiography indicators such as LVESD,LVEDD,LVEF,LAD-ML and LADSI were significantly improved in the treatment group compared with the control group at one year(P<0.05).In the treatment group,LVESD,LVEDD,LVPWT,LVEF,LAD-ML and LAD-SI were more significantly improved at one year than one month(P<0.05,P=0.007 to LVEF),and in the control group LVEF was more significantly improved at one year than one month(P=0.0277).There were no significant differences in serum potassium and serum creatinine levels between the two groups.CONCLUSION:On the basis of conventional treatment,the early combination of low-dose spironolactone(20 mg/d) could inhibit cardiac remodeling at late stage and prevent heart fadure.展开更多
Background: To study the influence of blood lipid levels on hemorrhagic transformation(HT) and prognosis after acute cerebral infarction(ACI).Methods: Patients with ACI within 72 h of symptoms onset between January 1 ...Background: To study the influence of blood lipid levels on hemorrhagic transformation(HT) and prognosis after acute cerebral infarction(ACI).Methods: Patients with ACI within 72 h of symptoms onset between January 1 st, 2015, and December 31 st, 2016, were retrospectively analyzed. Patients were divided into group A(without HT) and group B(HT). The outcomes were assessed after 3 months of disease onset using the modified Rankin Scale(m RS). An m RS score of 0–2 points indicated excellent prognosis, and an m RS score of 3–6 points indicated poor prognosis.Results: A total of 732 patients conformed to the inclusion criteria, including 628 in group A and 104 in group B. The incidence of HT was 14.2%, and the median onset time was 2 d(interquartile range, 1–7 d). The percentages of patients with large infarct size and cortex involvement in group B were 80.8% and 79.8%, respectively, which were both significantly higher than those in group A(28.7 and 33.4%, respectively). The incidence rate of atrial fibrillation(AF) in group B was significantly higher than that in group A(39.4% vs. 13.9%, P<0.001). The adjusted multivariate analysis results showed that large infarct size, cortex involvement and AF were independent risk factors of HT, while total cholesterol(TC) was a protective factor of HT(OR=0.359, 95% CI 0.136–0.944, P=0.038). With every 1 mmol/L reduction in normal TC levels, the risk of HT increased by 64.1%. The mortality and morbidity at 3 months in group B(21.2% and 76.7%, respectively) were both significantly higher than those in group A(8.0% and 42.8%, respectively). The adjusted multivariate analysis results showed that large infarct size(OR=12.178, 95% CI 5.390–27.516, P<0.001) was an independent risk factor of long-term unfavorable outcomes, whereas low-density lipoprotein cholesterol(LDL-C) was a protective factor(OR=0.538, 95% CI 0.300–0.964, P=0.037). With every 1 mmol/L reduction in normal LDL-C levels, the risk of an unfavorable outcome increased by 46.2%. Major therapies, including intravenous recombinant human tissue plasminogen activator(r TPA), intensive lipid-lowering statins and anti-platelets, were not significantly related to either HT or long-term, post-ACI poor prognosis.Conclusions: For patients with large infarct sizes, especially those with cortex involvement, AF, or lower levels of TC, the risk of HT might increase after ACI. The risk of a long-term unfavorable outcome in these patients might increase with a reduction in LDL-C.展开更多
Background Atrial fibrillation （AF） occurs commonly in patients with acute myocardial infarction （MI） and is associated with an increased long-term mortality. This study aimed to investigate the clinical character...Background Atrial fibrillation （AF） occurs commonly in patients with acute myocardial infarction （MI） and is associated with an increased long-term mortality. This study aimed to investigate the clinical characteristics and outcomes of AF in in-hospital elderly Chinese patients with acute MI. Methods A total of 967 patients with acute MI, aged 〉65 years, were categorized on the basis of the absence or presence of AF. Patients with documented AF were classified into two subgroups： the ongoing AF group and the new-onset AF group. We retrospectively evaluated the clinical profile, in-hospital outcomes, and effects of revascularization on the incidence of AF in elderly patients with acute MI. Results AF was documented in 100 （11.53%） patients and the incidence of new-onset AF was 6.51% during hospitalization. History of old MI and cerebrovascular events were more common in patients with AF than in those without AF （P 〈0.001, P 〈0.01, respectively）. The incidence of AF was higher in patients with non-ST elevated MI （P=0.014）, inferior wall MI （P=0.004） and cardiac function of Killip class Ⅲ or Ⅳ （P=-0.008）. Patients with AF had more complication of pneumonia （P=0.003） and longer hospital stay. Left circumflex coronary artery involvement was more common in patients with AF （compared with patients without AF, P 〈0.001）. Percutaneous coronary intervention or coronary artery bypass grafting significantly decreased the incidence of new-onset AF from 7.97% to 3.82% （P=0.017）. AF depended to heart failure, increased the in-hospital mortality. Conclusions AF is common in elderly patients with acute MI and is associated with poorer clinical outcomes. Revascularization reduces the incidence of AF and thus improves the clinical outcomes in these patients.展开更多
Background： Recent observational studies have shown that patients with higher Killips score （〉Ⅰ） have higher risk of new-onset atrial fibrillation （NOAF） following acute myocardial infarction （AMI）, while oth...Background： Recent observational studies have shown that patients with higher Killips score （〉Ⅰ） have higher risk of new-onset atrial fibrillation （NOAF） following acute myocardial infarction （AMI）, while others drew a neutral conclusion. The ultimate predictive value of high Killips class on NOAF remained obscure. Methods： PubMed, Web of Science, China National Knowledge Infrastructure, and the Cochrane Controlled Trials Register Databases were searched until February 2015. Of the 3732 initially identified studies, 5 observational studies with 10,053 patients were analyzed. Results： The meta-analysis of these studies showed that higher Killips score on admission was associated with higher incidence of NOAF following AMI （odds ratio 2.29, 95% confidence intcrwd 1.96 2.67, P 〈 0.00001 ）, while no significant differences exist among individual trials （P =0.14 and I^2= 43%）. Conclusions： Killips class 〉I was associated with the higher opportunity of developing NOAF following AMI.展开更多
In this paper,we concentrate on updating the clinical research on sodium-glucose cotransporter inhibitors(SGLTis)for patients with type 2 diabetes who have heart failure with a preserved injection fraction,acute heart...In this paper,we concentrate on updating the clinical research on sodium-glucose cotransporter inhibitors(SGLTis)for patients with type 2 diabetes who have heart failure with a preserved injection fraction,acute heart failure,atrial fibrillation,primary prevention of atherosclerotic cardiovascular disease/cardiovascular disease,and acute myocardial infarction.We searched the data of randomized controlled trials and meta-analyses of SGLTis in patients with diabetes from PubMed between January 1,2020 and April 6,2024 for our review.According to our review,certain SGLTis(empagliflozin,dapagliflozin,canagliflozin,and tofogliflozin),but not sodium-glucose cotransporter 1 inhibitor(SGLT1i),exhibit relatively superior clinical safety and effectiveness for treating the abovementioned diseases.Proper utilization of SGLTis in these patients can foster clinical improvement and offer an alternative medication option.However,clinical trials involving SGLTis for certain diseases have relatively small sample sizes,brief intervention durations,and conclusions based on weak evidence,necessitating additional data.These findings are significant and valuable for providing a more comprehensive reference and new possibilities for the clinical utilization and scientific exploration of SGLTis.展开更多
文摘Objective To investigate the impact of simvastatin on blood lipid and the incidence of atrial fibrillation and ischemic-related events in patients with acute myocardial infarction accompanied by paroxysmal atrial fibrillation. Methods One hundred and three patients with acute myocardial infarction and paroxysmal atrial fibrillation were selected as subjects,and were divided into a simvastatin group and a control group. Forty-five patients were in the simvastatin group,who took simvastatin 20mg/d orally for 18 months;fifty-eight patients were in the control group,and received conventional therapy except for statins. All patients were followed up for 18 months. The level of blood lipid,recurrence rate of paroxysmal atrial fibrillation,incidence rate of persistent or permanent atrial fibrillation,and the ischemic-related events were investigated and compared between the two groups. Results ① The levels of blood lipids did not change significantly in the control group(P>0.05) ;concentrations of total cholesterol(TC) and low density lipoprotein cholesterol(LDL-C) decreased significantly after treatment of simvastatin(P<0.05) . ② Recurrence of atrial fibrillation was observed in five patients during 18 months follow-up in the simvastatin group(11.1%) ,whereas it occurred in 14 patients of the control group(24. 1%,P<0.05) ;the occurrence rate of persistent or permanent atrial fibrillation in the simvastatin group was 4.4%,which was lower than that of control(12.1%,P<0.05) . ③ Nine patients had ischemic-related events in the simvastatin group(20.0%) ,with three heart failures(6.6%) ,two rehospitalizations for deterioration of coronary heart diseases(4.4%) ,three cardiac deaths(6.6%) ,and one cerebral stroke(2.2%) ,which was lower evidently than in the control group(41.4%,P<0.05) . Conclusions Simvastatin can not only decrease the levels of serum TC and LDL-C but also prevent the occurrence of atrial fibrillation and ischemic-related events.
文摘Atrial fibrillation is an increasingly common significant arrhythmia with potentially serious outcomes. Myocardial infarction is a common consequence of atherosclerosis and coronary artery disease. When the two conditions occur together, the consequences can be compounded. This article briefly reviews some of the potentials for the relationship.
基金Supported by the Ministry of Science and Higher Education grant(#MD-2314.2020.7).The authors declare no conflict of interest.
文摘1 Introduction Inflammation is one of the main mechanisms in the pathogenesis of atherosclerosis,and the interest to the evaluation of inflammatory biomarkers in coronary artery disease(CAD)has been increasing over the last decade.[1,2]Destabilization of chronic artery plaques,which leads to acute coronary syndromes,has been associated with inflammatory status.[1,3]。
文摘It is known that the Wolff-Parkinson-White syndrome （WPW） may either mimic myocardial infarction （MI） or mask the ECG changes of MI. Thus, the diagnosis of MI coexisting with WPW is frequently difficult. Furthermore, patients with WPW occurring acute MI may be life threat- ening. Therefore, early recognition and correct treatment allows rapid restoration of normal sinus rhythm and may decrease morbidity and mortality.
文摘Most cases of sudden cardiac death are attributed to sustained ventricular tachyarrhythmias(VTs), triggered by acute coronary occlusion. Autonomic dysfunction, an important arrhythmogenic mechanism in this setting, is being actively investigated, aiming at the advent of preventive strategies. Recent experimental studies have shown vagal withdrawal after anterior myocardial infarction, coinciding with high incidence of VTs, followed by more gradual sympathetic activation coinciding with a second arrhythmia peak. This article summarizes recent knowledge on this intriguing topic, generating hypotheses that can be investigated in future experimental and clinical studies.
基金supported by a grant from Science and Technology Planning Project of Heilongjiang Province,China(GB08C402-01)
文摘BACKGROUND:Few studies have reported the effect of aldosterone receptor antagonist(ARA) on myocardial remodeling after acute myocardial infarction(AMI).This study was undertaken to investigate the preventive effect of ARA on myocardial remodeling after AMI.METHODS:A total of 616 patients who had been admitted into the CCU of the First Affiliated Hospital of Harbin Medical University from January 2008 to January 2010 were studied prospectively.Only 528 patients were observed completely,including 266 of the control group and 262 of the treatment group.There was no statistical difference in age,gender,medical history,admission situation,and treatment between the two groups(P>0.05).The preventive effects of spironolactone on cardiac remodeling,left ventricular function,renal function and blood levels of potassium were evaluated by echocardiography,serum potassium and serum creatinine at one-month and one-year follow-up.RESULTS:The echocardiography indicators such as LVESD,LVEDD,LVEF,LAD-ML and LADSI were significantly improved in the treatment group compared with the control group at one year(P<0.05).In the treatment group,LVESD,LVEDD,LVPWT,LVEF,LAD-ML and LAD-SI were more significantly improved at one year than one month(P<0.05,P=0.007 to LVEF),and in the control group LVEF was more significantly improved at one year than one month(P=0.0277).There were no significant differences in serum potassium and serum creatinine levels between the two groups.CONCLUSION:On the basis of conventional treatment,the early combination of low-dose spironolactone(20 mg/d) could inhibit cardiac remodeling at late stage and prevent heart fadure.
文摘Background: To study the influence of blood lipid levels on hemorrhagic transformation(HT) and prognosis after acute cerebral infarction(ACI).Methods: Patients with ACI within 72 h of symptoms onset between January 1 st, 2015, and December 31 st, 2016, were retrospectively analyzed. Patients were divided into group A(without HT) and group B(HT). The outcomes were assessed after 3 months of disease onset using the modified Rankin Scale(m RS). An m RS score of 0–2 points indicated excellent prognosis, and an m RS score of 3–6 points indicated poor prognosis.Results: A total of 732 patients conformed to the inclusion criteria, including 628 in group A and 104 in group B. The incidence of HT was 14.2%, and the median onset time was 2 d(interquartile range, 1–7 d). The percentages of patients with large infarct size and cortex involvement in group B were 80.8% and 79.8%, respectively, which were both significantly higher than those in group A(28.7 and 33.4%, respectively). The incidence rate of atrial fibrillation(AF) in group B was significantly higher than that in group A(39.4% vs. 13.9%, P<0.001). The adjusted multivariate analysis results showed that large infarct size, cortex involvement and AF were independent risk factors of HT, while total cholesterol(TC) was a protective factor of HT(OR=0.359, 95% CI 0.136–0.944, P=0.038). With every 1 mmol/L reduction in normal TC levels, the risk of HT increased by 64.1%. The mortality and morbidity at 3 months in group B(21.2% and 76.7%, respectively) were both significantly higher than those in group A(8.0% and 42.8%, respectively). The adjusted multivariate analysis results showed that large infarct size(OR=12.178, 95% CI 5.390–27.516, P<0.001) was an independent risk factor of long-term unfavorable outcomes, whereas low-density lipoprotein cholesterol(LDL-C) was a protective factor(OR=0.538, 95% CI 0.300–0.964, P=0.037). With every 1 mmol/L reduction in normal LDL-C levels, the risk of an unfavorable outcome increased by 46.2%. Major therapies, including intravenous recombinant human tissue plasminogen activator(r TPA), intensive lipid-lowering statins and anti-platelets, were not significantly related to either HT or long-term, post-ACI poor prognosis.Conclusions: For patients with large infarct sizes, especially those with cortex involvement, AF, or lower levels of TC, the risk of HT might increase after ACI. The risk of a long-term unfavorable outcome in these patients might increase with a reduction in LDL-C.
文摘Background Atrial fibrillation （AF） occurs commonly in patients with acute myocardial infarction （MI） and is associated with an increased long-term mortality. This study aimed to investigate the clinical characteristics and outcomes of AF in in-hospital elderly Chinese patients with acute MI. Methods A total of 967 patients with acute MI, aged 〉65 years, were categorized on the basis of the absence or presence of AF. Patients with documented AF were classified into two subgroups： the ongoing AF group and the new-onset AF group. We retrospectively evaluated the clinical profile, in-hospital outcomes, and effects of revascularization on the incidence of AF in elderly patients with acute MI. Results AF was documented in 100 （11.53%） patients and the incidence of new-onset AF was 6.51% during hospitalization. History of old MI and cerebrovascular events were more common in patients with AF than in those without AF （P 〈0.001, P 〈0.01, respectively）. The incidence of AF was higher in patients with non-ST elevated MI （P=0.014）, inferior wall MI （P=0.004） and cardiac function of Killip class Ⅲ or Ⅳ （P=-0.008）. Patients with AF had more complication of pneumonia （P=0.003） and longer hospital stay. Left circumflex coronary artery involvement was more common in patients with AF （compared with patients without AF, P 〈0.001）. Percutaneous coronary intervention or coronary artery bypass grafting significantly decreased the incidence of new-onset AF from 7.97% to 3.82% （P=0.017）. AF depended to heart failure, increased the in-hospital mortality. Conclusions AF is common in elderly patients with acute MI and is associated with poorer clinical outcomes. Revascularization reduces the incidence of AF and thus improves the clinical outcomes in these patients.
基金Source of Support： This study was partly supported by grants from the National Natural Science Foundation of China （No. 30900618, No. 81270245）. Conflict of Interest： None declared.
文摘Background： Recent observational studies have shown that patients with higher Killips score （〉Ⅰ） have higher risk of new-onset atrial fibrillation （NOAF） following acute myocardial infarction （AMI）, while others drew a neutral conclusion. The ultimate predictive value of high Killips class on NOAF remained obscure. Methods： PubMed, Web of Science, China National Knowledge Infrastructure, and the Cochrane Controlled Trials Register Databases were searched until February 2015. Of the 3732 initially identified studies, 5 observational studies with 10,053 patients were analyzed. Results： The meta-analysis of these studies showed that higher Killips score on admission was associated with higher incidence of NOAF following AMI （odds ratio 2.29, 95% confidence intcrwd 1.96 2.67, P 〈 0.00001 ）, while no significant differences exist among individual trials （P =0.14 and I^2= 43%）. Conclusions： Killips class 〉I was associated with the higher opportunity of developing NOAF following AMI.
文摘In this paper,we concentrate on updating the clinical research on sodium-glucose cotransporter inhibitors(SGLTis)for patients with type 2 diabetes who have heart failure with a preserved injection fraction,acute heart failure,atrial fibrillation,primary prevention of atherosclerotic cardiovascular disease/cardiovascular disease,and acute myocardial infarction.We searched the data of randomized controlled trials and meta-analyses of SGLTis in patients with diabetes from PubMed between January 1,2020 and April 6,2024 for our review.According to our review,certain SGLTis(empagliflozin,dapagliflozin,canagliflozin,and tofogliflozin),but not sodium-glucose cotransporter 1 inhibitor(SGLT1i),exhibit relatively superior clinical safety and effectiveness for treating the abovementioned diseases.Proper utilization of SGLTis in these patients can foster clinical improvement and offer an alternative medication option.However,clinical trials involving SGLTis for certain diseases have relatively small sample sizes,brief intervention durations,and conclusions based on weak evidence,necessitating additional data.These findings are significant and valuable for providing a more comprehensive reference and new possibilities for the clinical utilization and scientific exploration of SGLTis.
