Dapagliflozin and sacubitril on myocardial microperfusion in patients with post-acute myocardial infarction heart failure and type 2 diabetes

BACKGROUND Coronary heart disease and type 2 diabetes mellitus(T2DM)frequently coexist,creating a complex and challenging clinical scenario,particularly when complicated with acute myocardial infarction(AMI).AIM To examine the effects of dapagliflozin combined with sakubactrovalsartan sodium tablets on myocardial microperfusion.METHODS In total,98 patients were categorized into control(n=47)and observation(n=51)groups.The control group received noxital,while the observation group was treated with dapagliflozin combined with noxital for 6 months.Changes in myocardial microperfusion,blood glucose level,cardiac function,N-terminal prohormone of brain natriuretic peptide(NT-proBNP)level,growth differentiation factor-15(GDF-15)level,and other related factors were compared between the two groups.Additionally,the incidence of major adverse cardiovascular events(MACE)and adverse reactions were calculated.RESULTS After treatment,in the observation and control groups,the corrected thrombolysis in myocardial infarction frame counts were 37.12±5.02 and 48.23±4.66,respectively.The NT-proBNP levels were 1502.65±255.87 and 2015.23±286.31 pg/mL,the N-terminal pro-atrial natriuretic peptide(NT-proANP)levels were 1415.69±213.05 and 1875.52±241.02 ng/mL,the GDF-15 levels were 0.87±0.43 and 1.21±0.56 g/L,and the high-sensitivity C-reactive protein(hs-CRP)levels were 6.54±1.56 and 8.77±1.94 mg/L,respectively,with statistically significant differences(P<0.05).The cumulative incidence of MACEs in the observation group was significantly lower than that in the control group(P<0.05).The incidence of adverse reactions was 13.73%(7/51)in the observation group and 10.64%(5/47)in the control group,with no statistically significant difference(P>0.05).CONCLUSION Dapagliflozin combined with nocinto can improve myocardial microperfusion and left ventricular remodeling and reduce MACE incidence in patients with post-AMI heart failure and T2DM.The underlying mechanism may be related to the reduction in the expression levels of NT-proANP,GDF-15,and hs-CRP.

Repeated measurement of growth-differentiation factor-15in Chinese Han patients with post-myocardial infarction chronic heart failure

Background Growth-differentiation factor-15(GDF-15)is a promising prognostic biomarker in patients with chronic heart failure (CHF).Comparatively little is known about the value of repeated measurement of GDF-15with CI-IF in Chinese Han population.This study sought to identify the clinical value of repeated measurement of GDF-15in Chinese Han patients with post-myocardial infarction CHF. Methods In total,232consecutive Chinese Hart patients with post-myocardial infarction CHF were enrolled prospectively from January 2014to June 2016.The plasma concentration of GDF-15was determined on admission and over 12months.Patients were followed up for all-cause death and a composite outcome of major adverse cardiac events (MACE)included all-cause death,myocardial infarction and first heart failure (HF)re-hospitalization.Association with other clinical variables and adverse outcomes of repeated measurement of GDF-15 was explored.Results The median baseline GDF-15level was 2025ng/L.Baseline GDF-15was moderately associated with baseline N-terminal pro-B type nalriuretic peptide (NT-proBNP)(coefficient 0.561,P <0.001).During a median follow-up of 20months,there were 53deaths and 100MACE.GDF-I5remained an independent predictor of all-cause death (adjusted hazard ratio 1.826per 1Ln U,95%CI: 1.037-8.360;P =0.037)and MACE (adjusted hazard ratio 2.243per I Ln U,95%CI:1.181-1.775;P <0.001)adjusted for established risk factors.Repeated measurement of GDF-15was performed in 173survivals over 12months.Increase of GDF-15over 12months was associ- ated with dilatation of left ventricle and acted as an independent predictor of subsequent all-canse death (adjusted HR =3.164,95%CI: 1.245~.041;P =0.015).In the joint model,GDF-15was also shown to be a risk factor for all-cause death (HR =2.749,95%CI: 1.667-3.831;P <0.001)and MACE (FIR =2.434,95%CI:1.425-3.443;P <0.001).Conclusions Repeated measurements of GDF-15 have promising prognostic value of the risk of all-cause death in Chinese Han patients with CI-IF post-myocardial infarction.GDF-15may influence the post-myocardial infarction CI-IF through the path physiological pathway of myocardial remodeling.

Post-myocardial infarction giant left ventricular pseudoaneurysm presenting with severe heart failure

Left ventricle(LV) pseudoaneurysm is a late mechanical complication of myocardial infarction.A giant LV pseudoaneurysm is a rare presentation.We report a case of giant LV pseudoaneurysm in a post-MI patient who presented with gross congestive heart failure.The patient had a successful surgical repair of the aneurysm and had a favorable 3-mo outcome.The imaging modality and surgical treatment of the pseudoaneurysm are discussed.

Renal impairment and heart failure with preserved ejection fraction early post-myocardial infarction

AIM:To study if impaired renal function is associated with increased risk of peri-infarct heart failure (HF) in patients with preserved ejection fraction (EF).METHODS:Patients with occluded infarct-related arteries (IRAs) between 1 to 28 d after myocardial infarction (MI) were grouped into chronic kidney disease (CKD) stages based on estimated glomerular filtration rate (eGFR).Rates of early post-MI HF were compared among eGFR groups.Logistic regression was used to explore independent predictors of HF.RESULTS:Reduced eGFR was present in 71.1% of 2160 patients,with significant renal impairment (eGFR < 60 mL/min every 1.73 m2) in 14.8%.The prevalence of HF was higher with worsening renal function:15.5%,17.8% and 29.4% in patients with CKD stages 1,2 and 3 or 4,respectively (P < 0.0001),despite a small absolute difference in mean EF across eGFR groups:48.2 ± 10.0,47.9 ± 11.3 and 46.2 ± 12.1,respectively (P=0.02).The prevalence of HF was again higher with worsening renal function among patients with preserved EF:10.1%,13.6% and 23.6% (P < 0.0001),but this relationship was not significant among patients with depressed EF:27.1%,26.2% and 37.9% (P= 0.071).Moreover,eGFR was an independent correlate of HF in patients with preserved EF (P=0.003) but not in patients with depressed EF (P=0.181).CONCLUSION:A significant proportion of post-MI patients with occluded IRAs have impaired renal function.Impaired renal function was associated with an increased rate of early post-MI HF,the association being strongest in patients with preserved EF.These findings have implications for management of peri-infarct HF.

TCMATHF:a bioinformatics platform to predict pharmacological action of drug and dynamic molecular changes against from myocardial infarction to heart failure

OBJECTIVE To investigate the characteristics and regulations of medication in different stages of disease by constructing a dynamic disease network and a cellular feature network spanning from myocardial infarction to heart failure.METHODS Based on transcrip⁃tome and single-cell sequencing data from a mouse model of left anterior descending coro⁃nary artery ligation,a dynamic early-middle-late network and cellular feature network were con⁃structed by integrating differential gene expres⁃sion trends and biological functions.The robust⁃ness of the perturbation effect of traditional Chi⁃nese medicine(TCM)on the disease network was calculated based on multi-target TCM,and we acquired the foundational data by analyzing the results of effectiveness.The predictive plat⁃form was scrutinized and assessed with regards to the functional attributes of FDA approveddrugs and compound prescriptions,in order to determine the primary stages of intervention and the drug patterns actions in the progression of heart failure.RESULTS In this study,we devel⁃oped a prediction and analysis platform for assessing the efficacy of drugs using a networkbased approach.The accuracy of the system was validated by FDA approved-drugs.It was found that blood-activating drugs,heat-clearing drugs,and phlegm-expelling drugs exhibited favorable intervention effects during the early to middle stages of the disease by investigating the effects of single herbs and TCM prescriptions on disease progression.Similarly,phlegm-expelling drugs,spirit-nourishing drugs,and diuretic showed better intervention effects during the mid⁃dle to late stages.These findings were consis⁃tent with the clinical use of drugs.Analysis of the clustering heatmap results of TCM prescriptions revealed that the formulas aimed at qi stagnation and blood stasis had a strong effect in early stage,while the formulas for qi and yin deficiency and cardiorenal yang deficiency had a strong effect in the middle to late stages.Furthermore,analysis of the single-cell feature network demon⁃strated that TCM had advantages in modulating the changes in fibroblasts,myofibroblasts,endo⁃thelial cells,and granulocytes during the patho⁃logical process.Additionally,most prescriptions exhibited strong perturbation effects on the fea⁃ture network of NK-T cells,granulocytes,macro⁃phages,and myofibroblasts.CONCLUSION This platform quantitatively evaluates the primary action stages and characteristics of TCM and for⁃mulas involved in the dynamic process of myo⁃cardial infarction to heart failure based on the effective prediction of the efficacy of TCM and FDA approved-drugs.It provides reference for the precise clinical application of TCM and formu⁃las with multiple targets and multiple pathways.

Dapagliflozin in heart failure and type 2 diabetes:Efficacy,cardiac and renal effects,safety

BACKGROUND Heart failure(HF),especially HF with reduced ejection fraction(HFrEF),presents complex challenges,particularly in the aging population where it often coexists with type 2 diabetes mellitus(T2DM).AIM To analyze the effect of dapagliflozin treatment on cardiac,renal function,and safety in patients with HFrEF combined with T2DM.METHODS Patients with T2DM complicated with HFrEF who underwent treatment in our hospital from February 2018 to March 2023 were retrospectively analyzed as the subjects of this study.The propensity score matching method was used,and a total of 102 eligible samples were scaled.The clinical efficacy of the two groups was evaluated at the end of the treatment,comparing the results of blood glucose,insulin,cardiac function,markers of myocardial injury,renal function indexes,and 6-min walk test(6MWT)before and after the treatment.We compared the occurrence of adverse effects on the treatment process of the two groups of patients.The incidence of adverse outcomes in patients within six months of treatment was counted.RESULTS The overall clinical efficacy rate of patients in the study group was significantly higher than that of patients in the control group(P=0.013).After treatment,the pancreatic beta-cell function index,left ventricular ejection fraction,and glomerular filtration rate of patients in the study group were significantly higher than control group(P<0.001),while their fasting plasma glucose,2-h postprandial glucose,glycosylated hemoglobin,insulin resistance index,left ventricular end-systolic diameter,left ventricular end-diastolic diameter,cardiac troponin I,creatine kinase-MB,N-terminal pro b-type natriuretic peptide,serum creatinine,and blood urea nitrogen were significantly lower than those of the control group.After treatment,patients in the study group had a significantly higher 6MWT than those in the control group(P<0.001).Hypoglycemic reaction(P=0.647),urinary tract infection(P=0.558),gastrointestinal adverse effect(P=0.307),respiratory disturbance(P=0.558),and angioedema(P=0.647)were not statistically different.There was no significant difference between the incidence of adverse outcomes between the two groups(P=0.250).CONCLUSION Dapagliflozin significantly enhances clinical efficacy,cardiac and renal function,and ambulatory capacity in patients with HFrEF and T2DM without an increased risk of adverse effects or outcomes.

Coronary artery disease and heart failure:Late-breaking trials presented at American Heart Association scientific session 2023

The late-breaking science presented at the 2023 scientific session of the American Heart Association paves the way for future pragmatic trials and provides meaningful information to guide management strategies in coronary artery disease and heart failure(HF).The dapagliflozin in patient with acute myocardial infarction(DAPA-MI)trial showed that dapagliflozin use among patients with acute MI without a history of diabetes mellitus or chronic HF has better cardiometabolic outcomes compared with placebo,with no difference in cardiovascular outcomes.The MINT trial showed that in patients with acute MI and anemia(Hgb<10 g/dL),a liberal transfusion goal(Hgb≥10 g/dL)was not superior to a restrictive strategy(Hgb 7-8 g/dL)with respect to 30-day all-cause death and recurrent MI.The ORBITA-2 trial showed that among patients with stable angina and coronary stenoses causing ischemia on little or no antianginal therapy,percutaneous coronary intervention results in greater improvements in anginal frequency and exercise times compared with a sham procedure.The ARIES-HM3 trial showed that in patients with advanced HF who received a HeartMate 3 levitated left ventricular assist device and were anticoagulated with a vitamin K antagonist,placebo was noninferior to daily aspirin with respect to the composite endpoint of bleeding and thrombotic events at 1 year.The TEAMMATE trial showed that everolimus with low-dose tacrolimus is safe in children and young adults when given≥6 months after cardiac transplantation.Providing patients being treated for HF with reduced ejection fraction(HFrEF)with specific out-of-pocket(OOP)costs for multiple medication options at the time of the clinical encounter may reduce‘contingency planning’and increase the extent to which patients are taking the medications decided upon.The primary outcome,which was cost-informed decisionmaking,defined as the clinician or patient mentioning costs of HFrEF medication,occurred in 49%of encounters with the checklist only control group compared with 68%of encounters in the OOP cost group.

Effects of rh BNP after PCI on non-invasive hemodynamic in acute myocardial infarction patients with left heart failure

Objective: To investigate the effects of exogenous recombinant human brain natriuretic peptide(rh BNP) after primary percutaneous coronary intervention(PCI) on non-invasive hemodynamic in acute myocardial infarction patients with left ventricular failure. Methods: A number of 96 acute myocardial infarction patients accompanied with heart failure after PCI hospitalized in the People's Hospital of Sanya during February 2012 to October 2015 were selected. They were randomly divided into the therapy group(n = 50) and control group(n = 46). On the basis of routine treatment, patients in the therapy group were treated with intravenous rh BNP(1.5 μg/kg was intravenous injection with uniform speed of 3 min, followed by continuous infusion 0.007 5 μg/kg·min for 72 h), while the control group received conventional treatment. Bio Z-2011 non-invasive hemodynamic real-time monitoring system was used to monitor the hemodynamic parameters changes and the leves of plasma pro-BNP, serum creatinine, serum potassium, serum sodium and urine volume of each group before and after treating for 30 min, 1 h, 3 h, 6 h, 12 h, 24 h, 48 h, 72 h. Results: Patients in the therapy group showed no effect on heart rate, while after 30 min of intravenous injection of rh BNP, CO, CI, SV, and SI increased significantly and LVET and TFC reduced at the same time, which had certain effect on blood pressure(SBP/DBP). Compared with the control group, the therapy group showed a faster and more effective improvement on haemodynamics. Conclusions: Acute myocardial infarction patients complicated with left heart failure after primary PCI can significantly improve hemodynamics by treating with rh BNP.

Heart failure after myocardial infarction in the era of primary percutaneous coronary intervention:Mechanisms,incidence and identification of patients at risk

Myocardial infarction(MI) remains the most common cause of heart failure(HF) worldwide. For almost 50 years HF has been recognised as a determinant ofadverse prognosis after MI, but efforts to promote myocardial repair have failed to translate into clinical therapies. Primary percutaneous coronary intervention(PPCI) has driven improved early survival after MI, but its impact on the incidence of downstream HF is debated. The effects of PPCI are confounded by the changing epidemiology of MI and HF, with an ageing patient demographic, an increasing proportion of non-STelevation myocardial infarction, and the recognition of HF with preserved ejection fraction. Herein we review the mechanisms of HF after MI and discuss contemporary data on its incidence and outcomes. We review current and emerging strategies for early detection of patients at risk of HF after MI, with a view to identification of patient cohorts for novel therapeutic agents.

Correlation between growth differentiation factor-15 and collagen metabolism indicators in patients with myocardial infarction and heart failure

BackgroundGrowth differentiation factor （GDF）-15, a divergent member of the transforming growth factor beta super-family does appear to be up-regulated in response to experimental pressure overload and progression of heart failure （HF）. HF frequently develops after myocardial infarction （MI）, contributing to worse outcome. The aim of this study is to assess the correlation between GDF-15 levels and markers related to collagen turnover in different stages of HF.MethodsThe study consists of a cohort of 179 patients, including stable angina pectoris patients （AP group,n= 50）, old MI patients without HF （OMI group,n = 56）, old MI patients with HF （OMI-HF group,n= 38） and normal Control group （n = 35）. Both indicators reflecting the synthesis and degradation rates of collagen including precollagen I N-terminal peptide （PINP）, type I collagen carboxy-terminal peptide （ICTP）, precollagen III N-terminal peptide （PIIINP） and GDF-15 were measured using an enzyme-linked inmunosorbent assay.ResultsThe plasma GDF-15 level was higher in OMI-HF group （1373.4 ± 275.4 ng/L） than OMI group （1036.1 ± 248.6 ng/L）, AP group （784.6 ± 222.4 ng/L） and Control group （483.8 ± 186.4 ng/L） （P〈 0.001）. The indi-cators of collagen turnover （ICTP, PINP, PIIINP） all increased in the OMI-HF group compared with Control group （3.03 ± 1.02μg/Lvs. 2.08 ± 0.95μg/L, 22.2 ± 6.6μg/Lvs. 16.7 ± 5.1μg/L and 13.2 ± 7.9μg/Lvs. 6.4 ± 2.1μg/L, respectively;P〈 0.01）. GDF-15 positively cor-related with ICTP and PIIINP （r = 0.302,P〈 0.001 andr= 0.206,P= 0.006, respectively）. GDF-15 positively correlated to the echocardio-graphic diastolic indicators E/Em and left atrial pressure （r= 0.349 and r= 0.358, respectively;P〈 0.01）, and inversely correlated to the systolic indicators left ventricular ejection fraction and the average of peak systolic myocardial velocities （Sm） （r=-0.623 and r=-0.365, respectively;P〈 0.01）.ConclusionPlasma GDF-15 is associated with the indicators of type I and III collagen turnover.

Development and course of heart failure after a myocardial infarction in younger and older people

Background Acute myocardial infarction （AMI） is a common cause of heart failure （HF）, which can develop soon after AMI and may persist or resolve or develop late. HF after an MI is a major source of mortality. The cumulative incidence, prevalence and resolution of HF after MI in different age groups are poorly described. This study describes the natural history of HF after AMI according to age. Methods Patients with AMI during 1998 were identified from hospital records. HF was defined as treatment of symptoms and signs of HF with loop diuretics and was considered to have resolved if loop diuretic therapy could be stopped without recurrence of symptoms. Patients were cate- gorised into those aged 〈 65 years, 65-75 years, and 〉 75 years. Results Of 896 patients, 311,297 and 288 were aged 〈 65, 65-75 and 〉75 years and of whom 24%, 57% and 82% had died respectively by December 2005. Of these deaths, 24 （8%）, 68 （23%） and 107 （37%） oc- curred during the index admission, many associated with acute HF. A further 37 （12%）, 63 （21%） and 82 （29%） developed HF that persisted until discharge, of whom 15, 44 and 62 subsequently died. After discharge, 53 （24%）, 55 （40%） and 37 （47%） patients developed I-IF for the first time, of whom 26%, 62% and 76% subsequently died. Death was preceded by the development of HF in 35 （70%）, 93 （91%） and 107 （85%） in aged 〈 65 years, 65-75 years and 〉75 years, respectively. Conclusions The risk of developing HF and of dying after an MI in- creases progressively with age. Regardless of age, most deaths after a MI are preceded by the development of HF.

Clinical study of recombinant human brain natriuretic peptide in patients with acute myocardial infarction complicating congestive heart failure

Objectives To observe the efficacy and safety of recombinant human brain natriuretic peptide(rh-BNP) on patients with acute myocardial infarction complicating congestive heart failure.Methods 40 patients with acute myocardial infarction complicated by congestive heart failure were randomly divided into control group and treatment group of 20 cases.The control group,15 cases of acute anterior myocardial infarction,5 cases of acute inferior wall myocardial infarction, 15 males and 5 females,aged 55-70 years,mean age 58±12 years;treated 16 cases of acute anterior myocardial infarction,4 cases of acute myocardial infarction,16 males and 4 females,aged 56-70 years,mean age 59±11 years;two groups of age,gender,severity of disease and vascular lesions no significant difference and comparable(P】0.05).Conventional group were given aspirin,clopidogrel, statins,Inotropic,diuretic and vasodilator therapy.In the con- ventional treatment group based on the use of recombinant human brain natriuretic peptide(new bios,Tibet Pharmaceutical Co.,Ltd.Chengdu Nuodikang biopharmaceutical production, usage:1.5μg/Kg intravenous injection(impact), then 0.0075μg-0.01μg/(kg·min)infusion rate).Continuous medication 72 h.The clinical symptoms observed for 3 days in patients before treatment and after treatment,heart rate,blood pressure and left ventricular ejection fraction (LVEF) and tumor necrosis factor(TNF-α),brain natriuretic peptide(BNP) levels were measured.Results In control group,8 cases markedly effect,5 cases effect and 7 cases no effect,the total effective rate was 65%;In treatment group,13 cases markedly effect,6 cases effect and 1 cases no effect,the total effective rate was 95%,compared with two groups P New bios treatment group significantly increased cardiac index(CI) in patients with heart failure and left ventricular ejection fraction(LVEF) than the control group(all P【0.05),further reduce the levels of tumor necrosis (TNF-α) and brain natriuretic peptide(BNP).Conclusions rh-BNP can improve symptoms and heart function,reduced plasma tumor necrosis factor(TNF-α) and BNP levels of acute myocardial infarction patients with congestive heart failure,the treatment safe and reliable.As small sample size observed,larger sample to be accumulated to further evaluate its efficacy and safety.

The effect of Rhodiolae treating chronic myocardial infarction with heart failure on left ventricular remodeling and serum inflammatory factors

Objective:To explore the effect of rhodiolae treating chronic myocardial infarction with heart failure on left ventricular remodeling and serum inflammatory factors.Methods:A total of 100 cases of chronic myocardial infarction with heart failure were selected and randomly divided into treatment group and control group with 50 cases in each group, the control group was treated with strong heart, dehydration, nutrition myocardium, infection prevention and western comprehensive treatment, the treatment group was given rhodiola treatment based on the western medicine treatment, compared the changes of left ventricular remodeling indexes and serum inflammatory factors of two group patients before treatment (T0), 1 months of treatment (T1), 3 months of treatment (T2).Results: (1) There was statistical significance difference at different time points LVEF, LVEDD, LVESD, LVSTD, LVPWTD. LVEF, LVSTD, LVPWTD: T2 > T1 > T0, LVEDD, LVESD: T2 < T1 < T0;In treatment group LVEF, LVSTD and LVPWTD increased, and the decline rate of LVEDD and LVESD was higher than that of control group;(2) There was statistically significant difference in different time points of IL-6, hs-CRP, and NT-proBNP, serum IL-6, hsCRP and NT-proBNP levels: T2 < T1 < T0;The serum IL-6, hs-CRP and NT-proBNP levels of treatment group decreased more than control group.Conclusion: Rhodiolae is helpful to improve the left ventricular remodeling and serum inflammatory factors in patients with chronic myocardial infarction and heart failure.

Peripheral blood stem cells transplantation in patients with heart failure after myocardial infarction:their efficiency and safety

Objective To compare the efficiency and safety of intracoronary transplantation of peripheral blood stem cells (PBSC) between elderly and younger patients with heart failure after myocardial infarction (MI). Methods Twenty-five patients with heart failure after MI were divided into aged group(≥60 years,n=13) and non-aged group(<60years,n=12)to receive intracoronary PBSC transplantation (PBSCT) following bone marrow cells mobilized by granulocyte colony-stimulating factor(G-CSF). Clinical data including coronary lesion characteristic, left ventricular shape,infarct region area and cardiac function, as well as adverse side effects between the two groups were compared. Left ventricular function was evaluated before and 6 months after the treatment by single photon emission computed tomography(SPECT). Results At 6 months, the left ventricular ejection fraction (LVEF) and 6 minute walk test (6MWT) distance increased, while the left ventricular diastolic diameter (LVDd) decreased significantly in both groups. There were no significant difference between the two groups in absolute change in the cardiac function parameters. Conclusions The present study demonstrated that autologous intracoronary PBSCT might be safe and feasible for both old and younger patients with heart failure after MI and left ventricular function is significantly improved.(J Geriatr Cardiol 2007;4:233-237.)

Pheochromocytoma as a cause of repeated acute myocardial infarctions,heart failure,and transient erythrocytosis:A case report and review of the literature

BACKGROUND Pheochromocytoma is a rare catecholamines-secreting tumor arising from chromaffin cells in the adrenal medulla.It classically presents with paroxysmal hypertension,headaches,palpitations,sweating,and metabolic disorders.Atypical presentations such as acute myocardial infarction,heart failure,cardiomyopathy,stroke,and transient erythrocytosis have been infrequently documented.CASE SUMMARY We describe the case of a 72-year-old man diagnosed with pheochromocytoma presenting with non-ST segment elevation myocardial infarction,heart failure,and transient erythrocytosis with nonobstructed coronary arteries.This was his second heart attack.The patient was previously diagnosed with myocardial infarction,and an immense mass was found on the left adrenal gland 3 years prior.Based on clinical and laboratory findings,a diagnosis of pheochromocytoma was confirmed.His coronary angiogram showed nonobstructed coronary arteries except for a myocardial bridge in the left anterior descending branch.This was a form of type-2 myocardial infarction.The myocardial cell lesions were caused by sudden secretion of catecholamines by the pheochromocytoma.Even more atypically,his hemoglobin level was obviously elevated at admission,but after a few days of treatment with an alpha-adrenergic receptor blocker,it dropped to normal levels without additional treatment.CONCLUSION Pheochromocytoma may be a cause of acute myocardial infarction,heart failure,and transient erythrocytosis.

Meta-analysis of the efficacy and safety of rhbnp in the treatment of acute myocardial infarction with heart failure

Objective:Systematic review of the efficacy and safety of neoactivin re-acute myocardial infarction with heart failure.Methods:The computer retrieved CNKI,Wan Fang,Weipu Chinese Science and Technology Periodicals Database(VIP),China Biomedical Literature Database(CBM),Medline,Cochrane Library,and Clinical Trail.Gov collected clinical randomized controlled trials(RCTs)of neoactivin in the treatment of acute myocardial infarction with heart failure from the establishment of the database to December 2019.Data were extracted according to the Jadad scale,disease inclusion and exclusion criteria,and RevMan 5.3 software was used for Meta analysis.Results:A total of 23 RCTs were included,with a total of 2024 patients,including 1012 patients in the control group(conventional treatment with western medicine)and 1012 patients in the test group(on the basis of the control group+neoactivin treatment).Meta analysis results show that:in the total effective rate,the test group was better than the control group,and the difference was statistically significant(OR=4.30,95%CI[3.26,5.67],P<0.00001);In terms of left ventricular ejection fraction,the test group was better than the control group,and the difference was statistically significant(OR=1.58,95%CI[1.27,1.90],P<0.00001).In terms of the left ventricular end-diastolic diameter,the test group was better than the control group,with a statistical difference Significance(OR=-0.91,95%CI[-1.50,-0.33],P=0.002);In terms of stroke volume,the test group was better than the control group,and the difference was statistically significant(OR=1.24,95%CI[0.55,1.94],P=0.0005);In terms of brain natriuretic peptide precursors,the experimental group was better than the control group,the difference was statistically significant(OR=-4.37,95%CI[-6.21,-3.25],P<0.00001);In terms of heart rate,the test group was better than the control group,and the difference was statistically significant(OR=-13.70,95%CI[-14.95,-12.46],P<0.00001);In terms of systolic blood pressure,the test group was better than the control Group,the difference was statistically significant(OR=-12.38,95%CI[-17.98,-6.79],P<0.00001);In diastolic blood pressure,the test group was better than the control group Group,the difference was statistically significant(OR=-7.42,95%CI[-8.53,-6.30],P<0.00001);In terms of adverse reactions,the difference was not statistically significant(OR=0.95,95%CI[0.29,3.16],P=0.94).Conclusions:In patients with acute myocardial infarction and heart failure,the timely application of neoactivin treatment can improve clinical efficacy,improve cardiac function,inhibit ventricular remodeling,improve blood pressure and heart rate,which has good clinical efficacy and safety.

Yiqi Huoxue traditional Chinese decoction affect ventricular remodeling in rats with heart failure after myocardial infarction by regulating osteopontin expression

Objective:To investigate the mechanism of Yiqi Huoxue traditional Chinese medicine affecting the osteopontin(OPN)level in myocardial tissue and improving ventricular remodeling in heart failure rats after myocardial infarction.Methods:Forty SPF-grade SD male rats were prepared,and 10 rats were reserved as blank controls.The remaining rats were prepared by anterior descending coronary artery ligation combined with reduced diet and exhausted swimming to prepare a rat model of heart failure after myocardial infarction.The rats in the blank group and the model group were orally administered with distilled water,the Chinese medicine group was administered with Yiqi Huoxue Chinese medicine decoction,and the western medicine group was administered with captopril.After 6 weeks of treatment,small animal ultrasound was used to detect changes in ventricular structure and function in rats.Kill all the rats,and take myocardial tissue,observe the morphological changes of myocardial tissu under a light microscope.Use real-time quantitative PCR to detect the expression of OPN mRNA in rat myocardial tissue,and use immunohistochemical method to detect the expression of OPN protein in myocardial tissue.Results:Compared with the blank group,the left ventricular ejection fraction(EF),left ventricular short axis shortening fraction(FS)of the model group were significantly reduced,and the left ventricular end-diastolic diameter(LVEDD)and left ventricular end-systolic diameter(LVESD)were significantly increased,OPN mRNA and protein expression were significantly up-regulated(P<0.01),and myocardial structure disorder was seen under light microscope.Compared with the model group,the EF and FS of the Chinese medicine group and the Western medicine group were both significantly increased,the LVEDD and LVESD were significantly reduced,the expressions of OPN mRNA and protein were significantly reduced(P<0.01),and the myocardial structure was significantly improved under light microscopy.There was no statistically significant difference between the western medicine group and the traditional Chinese medicine group(P>0.05).Conclusion:Yiqi Huoxue Chinese medicine may reduce the expression of OPN in myocardial tissue,improve ventricular remodeling,improve cardiac function and prevent heart failure after myocardial infarction.

Reducing Readmission Rates in Heart Failure and Acute Myocardial Infarction by Pharmacy Intervention

Background： Hospital readmissions are common, costly and largely preventable. Objectives： To evaluate the impact of a pharmacy-led medication discharge and post discharge counseling program on 30 day readmission rates for HF （heart failure） and AMI （acute myocardial infarction）. Methods： Three month prospective, quality improvement, pilot study with I-IF and AMI patients who received pre-discharge and post-discharge medication counseling from December 2013 to February 2014 whose 30 day readmission rates were compared to readmission rates from the previous fiscal year.Results： Fifty-one patients were included in the study. Primary endpoint of30-day readmission rates showed a 33.9% decrease for AMI and a 50.1% decrease for HF in readmission rates compared to the previous fiscal year, with a potential annual savings of $458,800. The study also identified 25.5% of patients having at least one medication error that was identified through medication reconciliation. Conclusions： Pharmacy provided medication reconciliation and medication discharge counseling reduced readmission rates as well as decreased medication errors. There is also a potential for significant health cost savings.

Effect of perindopril on the myocardial energy consumption in patients with heart failure after myocardial infarction

Objective:To explore the clinical efficacy of perinodopril in the treatment of heart failure in patients after myocardial infarction and effect on the myocardial energy consumption. Methods:A total of 87 patients with heart failure after myocardial infarction who were admitted in our hospital from August, 2014 to October, 2015 were included in the study and divided into the routine dose group (n=43, perinodopril 4 mg/d) and high dose group (n=44, perinodopril 8 mg/d) according to the long-term oral dose. All the patients were given perinodopril, continuously for 6 months. The changes of blood pressure and serum biochemical indicators before and after treatment in the two groups were compared. The changes of cardiac function indicators and myocardial energy consumption indicators before and after treatment in the two groups were compared. 6MWT 6 months and 1 year after treatment in the two groups was calculated.Results: The plasma BNP and H-FABP levels, LVEDD, LVESD, MEE, and cESS after treatment in the two groups were significantly reduced when compared with before treatment, and those in the high dose group were significantly lower than those in the low dose group. LVEF and FS after treatment in the two groups were significantly increased, and those in the high dose group were significantly greater than those in the routine dose group. The seurm potassium level after treatment in the high dose group was significantly elevated when compared with before treatment, but was not significantly different from that in the routine dose group. SBP, DBP, and Scr levels after treatment in the two groups were not significantly changed. 6MWT 6 months and 1 year after treatment in the high dose group was significantly greater than that in the routine dose group.Conclusions: Perinodopril in a high dose can significantly reduce the plasma BNP and H-FABP levels in patients with heart failure after myocardial infarction, inhibit the ventricular remodeling, promote the recovery of systolic function, reduce the myocardial energy consumption, and will not affect the blood pressure, serum potassium, and renal function, with efficacy significantly superior to that in a low dose;moreover, it has a certain safety.

Effect of recombinant human brain natriuretic peptide on serum inflammatory factors, neuroendocrine hormones and cardiac function in patients with acute myocardial infarction complicated with heart failure

Objective:To investigate the effect of recombinant human brain natriuretic peptide (BNP) on inflammatory factors, neuroendocrine hormones and cardiac function indexes in patients with acute myocardial infarction complicated with heart failure.Methods:A total of91 cases of acute myocardial infarction with heart failure patients were divided into the control group (n=44) and observation group (n=47) according to the random data table, two groups of patients were given conventional treatment, based on this, the control group was given intravenous infusion of Nitroglycerin Injection treatment, the observation group received intravenous injection of recombinant human brain natriuretic peptide treatment, compared serum inflammatory factors, neuroendocrine hormone and cardiac function and other indexes of two groups before and after treatment.Results: there was no significant difference between the two groups before treatment. After treatment, the levels of TNF-α, hs-CRP, IL-6, MCP-1, LVESD and LVEDD in the two groups were significantly lower than those within the group before treatment, and the observation group was significantly lower than the control group;The two groups after treatment LVEF levels were significantly higher than those in the group before treatment, and the observation group was significantly higher than that of control group;the observation group after treatment PRA, Ang II and ALD and NE levels were significantly lower than those before treatment, and was significantly lower than the control group after treatment, the difference was significant, PRA, Ang, ALD and NE levels of control group before and after the treatment was no significant difference.Conclusion:recombinant human brain natriuretic peptide in the treatment of acute myocardial infarction with heart failure can effectively reduce the serum inflammatory factors and neuroendocrine hormone levels, improve heart function, and have a certain clinical value.