Despite overwhelming evidence from large randomized clinical trials supporting a clear benefit of low-density lipoprotein cholesterol(LDL-C)lowering therapy on the primary and secondary prevention of atherosclerotic c...Despite overwhelming evidence from large randomized clinical trials supporting a clear benefit of low-density lipoprotein cholesterol(LDL-C)lowering therapy on the primary and secondary prevention of atherosclerotic cardiovascular disease,data from epidemiological and clinical observations demonstrated an increased incidence of hemorrhagic stroke in patients with low LDL-C exposure(<70 mg/dL),especially among East Asians.Meanwhile,emerging studies have reported a paradoxical phenomenon in which hypercholesterolemia is associated with better short-term outcomes in acute coronary syndrome patients,the"lipid paradox."The underlying mechanism for these two closely connected clinical observations is not clear.This review aimed to summarize the evolution and clinical implications of these two low LDL-C related concepts,and proposed a"double-hit"hypothesis that may help explain these phenomena.It is worth noting that in the era of increasing use of high-intensity LDL-C lowering and dual antiplatelet strategies in atherosclerotic cardiovascular disease in patients receiving percutaneous coronary intervention,balancing the risk of thrombosis with bleeding complication should be a priority in clinical practice.Our hypothesis may raise clinicians’awareness to identify potential high risk patients with low LDL-C(<70 mg/dL),especially among East Asians.展开更多
BACKGROUND Cardiac injury may occur after acute pathology of central nervous system(CNS)without any evidence of primary cardiac diseases.The resulting structural and/or functional changes are called cerebrocardiac syn...BACKGROUND Cardiac injury may occur after acute pathology of central nervous system(CNS)without any evidence of primary cardiac diseases.The resulting structural and/or functional changes are called cerebrocardiac syndrome(CCS).The great majority of studies have been performed in patients with subarachnoid hemorrhage(SAH),while CCS data after intracerebral hemorrhage(ICH)are rare.It may cause diagnostic and therapeutic pitfalls for the clinician due to a lack of specific clinical manifestations and diagnostic methods.Understanding the underlying pathophysiological and molecular mechanism(s)following cerebrovascular incidents will help to implement prevention and treatment strategies to improve the prognosis.CASE SUMMARY A 37-year-old man with a history of hypertension presented to our department on an emergency basis because of a sudden dizziness and left limb weakness.Cerebral computed tomography(CT)suggested ICH in the occipital and parietal lobes,and the chosen emergency treatment was hematoma evacuation.Left ventricular(LV)dysfunction occurred after the next 48 h and the electrocardiogram(ECG)showed non-ST elevation myocardial infarction.CCS was suspected first in the context of ICH due to the negative result of the coronary CT angiogram.CONCLUSION Misinterpretation of ischemic-like ECGs may lead to unnecessary or hazardous interventions and cause undue delay of rehabilitation after stroke.Our objective is to highlight the clinical implications of CCS and we hope the differential diagnoses will be considered in patients with acute CNS diseases.展开更多
BACKGROUND： It has been reported that cerebrovascular disease causes changes in electrocardiogram results. OBJECTIVE： To investigate changes in electrocardiogram results in patients with intracerebral bematoma enlar...BACKGROUND： It has been reported that cerebrovascular disease causes changes in electrocardiogram results. OBJECTIVE： To investigate changes in electrocardiogram results in patients with intracerebral bematoma enlargement. DESIGN, TIME AND SETTING： The present case-retrospective analysis study was performed at the Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2005 to October 2006. PARTICIPANTS： A total of 225 intracerebral hemorrhage patients （142 males and 83 females） that were hospitalized at the Department of Neurology were enrolled the present study. The patient selection was in accordance with diagnostic criteria from the Fourth National Cerebrovascular Disease Congress of China in 1995, and diagnosis was confirmed using computed tomography. All patients underwent computed tomography twice within 24 hours following intracerebral hemorrhage, and were subjected to electrocardiogram examination after admission. METHODS： According to hematoma enlargement following intracerebral hemorrhage, all patients were divided into hematoma enlargement （n = 20） and non-hematoma enlargement （n = 205） groups. Because of the large patient number difference between the two groups, the hematoma enlargement group was matched with the non-hematoma enlargement group. Patients meeting these conditions were included in the non-hematoma enlargement group. Finally, 75 patients were included in the final analysis, 19 in the hematoma enlargement group and 56 in the non-hematoma enlargement group. Clinical data from the two groups were statistically analyzed. MAIN OUTCOME MEASURES： The incidence of electrocardiographic abnormalities between the hematoma enlargement and non-hematoma enlargement groups. RESULTS： In the hematoma enlargement group, 15 patients （79%） developed electrocardiographic abnormafities. In the non-hematoma enlargement group, 24 patients （43%） presented with electrocardiographic abnormalities. There were significant differences in electrocardiographic abnormalities between the groups （P 〈 0.01）. CONCLUSION： Patients with electrocardiographic abnormalities suffered from hematoma enlargement following admission.展开更多
基金supported by the National Natural Science Foundation of China(Nos.81570335,81970304)a grant from Tianjin Municipal Science and Technology Commission,China(No.18ZXZNSY00290)
文摘Despite overwhelming evidence from large randomized clinical trials supporting a clear benefit of low-density lipoprotein cholesterol(LDL-C)lowering therapy on the primary and secondary prevention of atherosclerotic cardiovascular disease,data from epidemiological and clinical observations demonstrated an increased incidence of hemorrhagic stroke in patients with low LDL-C exposure(<70 mg/dL),especially among East Asians.Meanwhile,emerging studies have reported a paradoxical phenomenon in which hypercholesterolemia is associated with better short-term outcomes in acute coronary syndrome patients,the"lipid paradox."The underlying mechanism for these two closely connected clinical observations is not clear.This review aimed to summarize the evolution and clinical implications of these two low LDL-C related concepts,and proposed a"double-hit"hypothesis that may help explain these phenomena.It is worth noting that in the era of increasing use of high-intensity LDL-C lowering and dual antiplatelet strategies in atherosclerotic cardiovascular disease in patients receiving percutaneous coronary intervention,balancing the risk of thrombosis with bleeding complication should be a priority in clinical practice.Our hypothesis may raise clinicians’awareness to identify potential high risk patients with low LDL-C(<70 mg/dL),especially among East Asians.
文摘BACKGROUND Cardiac injury may occur after acute pathology of central nervous system(CNS)without any evidence of primary cardiac diseases.The resulting structural and/or functional changes are called cerebrocardiac syndrome(CCS).The great majority of studies have been performed in patients with subarachnoid hemorrhage(SAH),while CCS data after intracerebral hemorrhage(ICH)are rare.It may cause diagnostic and therapeutic pitfalls for the clinician due to a lack of specific clinical manifestations and diagnostic methods.Understanding the underlying pathophysiological and molecular mechanism(s)following cerebrovascular incidents will help to implement prevention and treatment strategies to improve the prognosis.CASE SUMMARY A 37-year-old man with a history of hypertension presented to our department on an emergency basis because of a sudden dizziness and left limb weakness.Cerebral computed tomography(CT)suggested ICH in the occipital and parietal lobes,and the chosen emergency treatment was hematoma evacuation.Left ventricular(LV)dysfunction occurred after the next 48 h and the electrocardiogram(ECG)showed non-ST elevation myocardial infarction.CCS was suspected first in the context of ICH due to the negative result of the coronary CT angiogram.CONCLUSION Misinterpretation of ischemic-like ECGs may lead to unnecessary or hazardous interventions and cause undue delay of rehabilitation after stroke.Our objective is to highlight the clinical implications of CCS and we hope the differential diagnoses will be considered in patients with acute CNS diseases.
基金the National Natural Science Foundation of China, No. 30570628, 30770751
文摘BACKGROUND： It has been reported that cerebrovascular disease causes changes in electrocardiogram results. OBJECTIVE： To investigate changes in electrocardiogram results in patients with intracerebral bematoma enlargement. DESIGN, TIME AND SETTING： The present case-retrospective analysis study was performed at the Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2005 to October 2006. PARTICIPANTS： A total of 225 intracerebral hemorrhage patients （142 males and 83 females） that were hospitalized at the Department of Neurology were enrolled the present study. The patient selection was in accordance with diagnostic criteria from the Fourth National Cerebrovascular Disease Congress of China in 1995, and diagnosis was confirmed using computed tomography. All patients underwent computed tomography twice within 24 hours following intracerebral hemorrhage, and were subjected to electrocardiogram examination after admission. METHODS： According to hematoma enlargement following intracerebral hemorrhage, all patients were divided into hematoma enlargement （n = 20） and non-hematoma enlargement （n = 205） groups. Because of the large patient number difference between the two groups, the hematoma enlargement group was matched with the non-hematoma enlargement group. Patients meeting these conditions were included in the non-hematoma enlargement group. Finally, 75 patients were included in the final analysis, 19 in the hematoma enlargement group and 56 in the non-hematoma enlargement group. Clinical data from the two groups were statistically analyzed. MAIN OUTCOME MEASURES： The incidence of electrocardiographic abnormalities between the hematoma enlargement and non-hematoma enlargement groups. RESULTS： In the hematoma enlargement group, 15 patients （79%） developed electrocardiographic abnormafities. In the non-hematoma enlargement group, 24 patients （43%） presented with electrocardiographic abnormalities. There were significant differences in electrocardiographic abnormalities between the groups （P 〈 0.01）. CONCLUSION： Patients with electrocardiographic abnormalities suffered from hematoma enlargement following admission.
