Evaluating the Effectiveness of Emergency Ventilator Treatment for Severe Acute Left Ventricular Heart Failure

Objective:To evaluate the efficacy of emergency ventilator therapy in severe acute left heart failure.Methods:A total of 75 patients with severe acute left ventricular heart failure who were admitted to the hospital from July 2020 to July 2023 were randomly divided into two groups.Group A received additional emergency ventilator treatment,and group B received conventional treatment.The efficacy was compared.Results:The curative effect of patients with severe acute left heart failure in group A was higher than that in group B(P<0.05);all blood gas indicators in group A were better than those in group B(P<0.05);all vital signs indicators in group A were better than those in group B(P<0.05);group A was more satisfied with the treatment of severe acute left ventricular heart failure than group B(P<0.05).Conclusion:Patients with severe acute left heart failure who receive emergency ventilator treatment can stabilize vital signs,improve blood oxygen supply,and enhance curative effect.

Emergency Hybrid Correction in a Newborn with Critical Aortic Valve Stenosis with Acute Pulmonary Edema in the First Hour after Birth

Critical aortic valve stenosis in newborns is the cause of a severe clinical condition with the onset of symptoms during first hours after birth.We present a clinical case of a successful surgical correction of a critical aortic stenosis using a hybrid method applied in a newborn during the first day of life.The infant was diagnosed with a hypoplastic left heart complex with an intact atrial septum(aortic and mitral valves stenosis variant),that led to the cardiogenic shock and acute pulmonary edema.The procedure included bilateral banding of the pulmonary artery branches and atrioseptostomy with stenting of the interatrial septum.The surgery was performed through a median sternotomy.

Assessment of left atrial appendage function by transesophageal echocardiography in patients two weeks after acute coronary syndromes

Background For many years in ischemic heart disease, ventricles rather than atria received attention so not much is known about left atrial function in left ventricular ischemia. Objective Our study aimed to evaluate left atrial appendage (LAA) function by means of biplane transesophageal echocardiography in patients ten days after acute coronary syndromes (ACS). Methods The study was performed on 16 adult patients (65.9±9.9 years old) in whom transesophageal echocardiography was done 10 days after ACS. The following left atrial appendage (LAA) planimetric parameters were analyzed: LAA transversal dimension, LAA longitudinal dimension,LAA maximal area, and LAA minimal area. LAA ejection fraction was calculated and analyzed. The following LAA Doppler parameters were analyzed: the peak LAA emptying and the peak LAA filling velocities. The control group consisted of 14 patients (43±14.6 years old) without cardiovascular diseases. Results Both LAA longitudinal dimension and LAA transversal dimension were significantly higher in patients with ACS than in control patients. The same was observed for LAA maximal area. Also LAA ejection fraction was higher in patients with ACS . LAA minimal area did not differ in the patients in either group. LAA peak emptying flow (LAAE) and LAA peak filling flow (LAAF) were significantly higher in patients of the study group than of the control group. Conclusion Our study shows that two weeks after acute coronary syndrome LAA as a reservoir as well as a pump works at a higher level than it does in the control group. (J Geriatr Cardiol 2005; 2(4):198-201)

ECG after near-drowning mimicking acute coronary syndrome with left main coronary artery involvement

We present the case of a 74-year-old man with diabetes and hypertension who had to be rescued owing to a near-drowning syndrome at sea.When he was rescued,he complained of dyspnea and chest pain.An electrocardiogram(ECG)suggested acute coronary syndrome(ACS)affecting the left main coronary artery.Therefore,he was referred to our hospital for urgent coronary angiography.

Left atrial appendage in acute coronary syndromes: small but not insignificant

In this issue of Journal of Geriatric Cardiology, Dr.Piotrowski and colleagues explored the function of the left atrial appendage (LAA)-a small, blind-ended structure of the heart which has been often ignored by cardiologists.

Rescue treatment and follow-up intervention of a left main acute myocardial infarction with typical carina shift under 3D optical coherence tomography: A case report

BACKGROUND Coronary intervention for bifurcation lesions is still challenging for interventional cardiologists.Left main(LM)bifurcation lesions have a higher risk due to the vast blood supply in this area and treatment choice is difficult.Ostial compromise of the side branch decreases patient prognosis,and its management is still an issue despite the different strategies and devices available.CASE SUMMARY A 42-year-old male patient was admitted to hospital due to chest pain and syncope.Coronary angiography showed acute LM occlusion.Following thrombus aspiration,a LM bifurcation lesion remained.Coronary angiography was repeated one week later,and at the same time,3D optical coherence tomography(OCT)was carried out to better show the geometry of the bifurcation,which confirmed that the stenosis in the ostial left circumflex artery was caused by a long carina.After assessment of the plaque characteristics and the minimum lumen area,the cross-over strategy,kissing balloon inflation and proximal optimization technique were chosen to treat the bifurcation lesion.A“moving”carina was found twice during the intervention.Good stent apposition and expansion were confirmed by OCT after proximal optimization technique.The three-month follow-up showed good recovery and normal cardiac function.CONCLUSION 3D-OCT can facilitate decision-making for coronary interventions in patients with critical bifurcation lesions.

Infuences of Previous Angina Pectoris on Coronary Collateral Circulation and Left Ventricular Function in Patients with Acute Myocardial Infarction

Objective To investigate the influences of previous angina pectoris on coronary collateral circulation and left ventricular function in patients with acute myocardial infarction. Methods 307 patients with a first episode acute myocardial infarction underwent selective coronary angiography and left ventriculography. The relation of previous angina pectoris to coronary collateral circulation, peak creatine kinase and left ventricular function were analyzed. Results ①In the 307 patients, there were 192 (62. 5 % ) with previous angina [PA ( + ) group] and 115 (37. 5 % ) without [PA (-) group]. ②The peak creatine kinase (CK) and CK -MB were significantly higher in PA (-) group than in PA (+) group ( P < 0. 05 for both comparisons) . ③ Collateral circulation to infarct - related artery was more likely to be present in PA ( + ) group than in PA (-) group ( P < 0. 05) . (4) The left ventricular ejection fraction was significantly increased, and the left ventricular wall motion Cortina score decreased, in PA (+) group than in PA (-) group ( P < 0. 01 for both comparisons) . Conclusion In patients with acute myocardial infarction, previous angina pectoris may have beneficial effects on coronary collateral circulation and left ventricular function.

Recovery after acute kidney injury requiring kidney replacement therapy in patients with left ventricular assist device: A metaanalysis

BACKGROUND Acute kidney injury(AKI)is a common and severe complication after left ventricular assist device(LVAD)implantation with an incidence of 37%;13%of which require kidney replacement therapy(KRT).Severe AKI requiring KRT(AKI-KRT)in LVAD patients is associated with high short and long-term mortality compared with AKI without KRT.While kidney function recovery is associated with better outcomes,its incidence is unclear among LVAD patients with severe AKI requiring KRT.AIM To identify studies evaluating the recovery rates from severe AKI-KRT after LVAD placement,which is defined by regained kidney function resulting in the discontinuation of KRT.Random-effects and generic inverse variance method of DerSimonian-Laird were used to combine the effect estimates obtained from individual studies.METHODS A total of 268 patients from 14 cohort studies that reported severe AKI-KRT after LVAD were included.Follow-up time ranged anywhere from two weeks of LVAD implantation to 12 mo.Kidney recovery occurred in 78%of enrollees at the time of hospital discharge or within 30 d.Overall,the pooled estimated AKI recovery rate among patients with severe AKI-KRT was 50.5%(95%CI:34.0%-67.0%)at 12 mo follow up.Majority(85%)of patients used continuous-flow LVAD.While the data on pulsatile-flow LVAD was limited,subgroup analysis of continuous-flow LVAD demonstrated that pooled estimated AKI recovery rate among patients with severe AKI-KRT was 52.1%(95%CI:36.8%-67.0%).Metaregression analysis did not show a significant association between study year and AKI recovery rate(P=0.08).There was no publication bias as assessed by the funnel plot and Egger's regression asymmetry test in all analyses.RESULTS A total of 268 patients from 14 cohort studies that reported severe AKI-KRT after LVAD were included.Follow-up time ranged anywhere from two weeks of LVAD implantation to 12 mo.Kidney recovery occurred in 78%of enrollees at the time of hospital discharge or within 30 d.Overall,the pooled estimated AKI recovery rate among patients with severe AKI-KRT was 50.5%(95%CI:34.0%-67.0%)at 12 mo follow up.Majority(85%)of patients used continuous-flow LVAD.While the data on pulsatile-flow LVAD was limited,subgroup analysis of continuous-flow LVAD demonstrated that pooled estimated AKI recovery rate among patients with severe AKI-KRT was 52.1%(95%CI:36.8%-67.0%).Metaregression analysis did not show a significant association between study year and AKI recovery rate(P=0.08).There was no publication bias as assessed by the funnel plot and Egger's regression asymmetry test in all analyses.CONCLUSION Recovery from severe AKI-KRT after LVAD occurs approximately 50.5%,and it has not significantly changed over the years despite advances in medicine.

Beneficial Effects of Delayed Opening the Infarct - related Artery on Late Phase Left Ventricular Function in Acute Anterior Myocardial Infarction

Objectives To assess the effect of delayed opening the infarct - related artery (IRA) by percutanous coronary intervention (PCI) on the late phase left ventricular function after acute ante- rior myocardial infarction. Methods 64 patients with initial Q - wave anterior myocardial infarction and the infarct - related arteries were total occluded conformed by angiogram at 2 to 14 days after onset were divided into successful PCI group and control group ( not re- ceiving PCI or the IRA not re - opened). 2 - DE was performed at early phase ( about 3 weeks) , 2 and 6 months after onset of AMI respectively to detect the left ventricular function and left ventricular wall motion ab- normality (VWMA). The total congestive heart failure events were recorded during 6 months follow-up. Re- sults VWMA scores, left ventricular ejection frac- tion (LVEF) , left ventricular end - diastolic and end - systolic volume indices ( LVEDVI and LVDSVI) were similar in 2 groups at early phase and 2 months. There were no differences between early phase and 2 months in each group too. VWMA scores and LVEF did not changed at 6 months in each group compared with the early phase and 2 months ( P > 0. 05 ). But LVEDVI and LVESVI were significantly smaller in the successful PCI group than in the control group (P < 0.01, P < 0. 05). The congestive heart failure events were taken place in 19% of patients in control group com- pared with 2% in successful PCI group ( P > 0. 05 ). Conclusions Although the infarct size does not changed, delayed opening the IRA has beneficial effect to the late phase left ventricular dilatation after acuteanterior myocardial infarction.

Serum uric acid in patients with acute ST-elevation myocardial infarction

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.

Continuously Happened Three Mechanical Complications after Acute Myocardial Infarction: Report of a Rare Case

Revascularization to infarcted area after left ventricular free-wall rupture has been controversial. A 68-year-old man with acute myocardial infarction presented to our hospital and developed a left ventricular free-wall rupture. We repaired the left ventricular oozing rupture without culprit artery revascularization, however, followed by papillary muscle rupture and left ventricular blow-out rupture, which resulted in sudden death.

Acute Respiratory Distress after Knee Arthroplasty Due to Undiagnosed Atrial Myxoma

Acute postoperative respiratory distress may be caused by pneumonia, pulmonary embolism, heart failure, pneumothorax or atelectasis. We present s case report of a 78-year-old female patient who developed acute respiratory distress one day following knee arthroscopy. Because of the suspicion of pulmonary embolism, a computed tomographic angiography was made, showing the presence of an unexpected large left atrial mass, suggestive for a myxoma. She underwent successful resection of a 10 × 5 cm myxoma one week later. The report discusses the clinical manifestations of an atrial myxoma and its potentially fast growth. Bedside echocardiography should be considered the preferred diagnostic modality in case of acute postoperative respiratory distress.

Associations of Infarct Size and Regional Myocardial Function Examined by Cardiac Magnetic Resonance Feature Tracking Strain Analysis with the Infarct Location in Patients with Acute ST-Segment Elevation Myocardial Infarction

Objective To quantitatively evaluate the associations of infarct size,regional myocardial function examined by cardiac magnetic resonance feature tracking(CMR-FT)strain analysis with infarct location in patients with ST-segment elevation myocardial infarction(STEMI)treated by primary percutaneous coronary intervention.Methods Cardiac magnetic resonance images were retrospectively analyzed in 95 consecutive STEMI patients with successful reperfusion.The patients were divided into the anterior wall myocardial infarction(AWMI)and nonanterior wall myocardial infarction(NAWMI)groups.Infarct characteristics were assessed by late gadolinium enhancement.Global and regional strains and associated strain rates in the radial,circumferential and longitudinal directions were assessed by CMR-FT based on standard cine images.The associations of infarct size,regional myocardial function examined by CMR-FT strain analysis with infarct location in STEMI patients were evaluated by the Spearman or Pearsonmethod.Results There were 44 patients in the AWMI group and 51 in the NAWMI group.The extent of left ventricular enhanced mass was significantly larger in patients with AWMI compared with the NAWMI group(24.47±11.89,21.06±12.08%LV;t=3.928,P=0.008).In infarct zone analysis,strains in the radial,circumferential and longitudinal directions were remarkably declined in the AWMI group compared with the NAWMI group(z=-20.873,-20.918,-10.357,all P<0.001).The volume(end-systolic volume index),total enhanced mass and extent of enhanced mass of the left ventricular were correlated best with infarct zone strain in the AWMI group(all P<0.001).Conclusion In STEMI patients treated by percutaneous coronary intervention,myocardial damage is more extensive and regional myocardial function in the infarct zone is lower in the AWMI group compared with the NAWMI group.

急性心肌梗死合并急性左心衰患者血清铁调素/铁蛋白比值与临床救治效果的关系

目的 探讨急性心肌梗死合并急性左心衰竭(简称急性左心衰)患者血清铁调素/铁蛋白比值与临床救治效果的关系。方法 将绵阳市中心医院2020年1月至2023年5月收治的303例急性心肌梗死合并急性左心衰患者作为研究对象,根据其治疗1周的临床救治效果分为有效组与无效组,观察两组入院时、治疗1周时血清铁调素、铁蛋白及其比值变化情况,统计并比较两组一般资料及其他实验室指标包括血红蛋白、高敏肌钙蛋白、N端脑利钠肽前体等,通过点二列相关性分析入院时血清铁调素、铁蛋白及其比值与患者临床救治效果的关系,并通过受试者工作特征(ROC)曲线评价入院时血清铁调素、铁蛋白及其比值预测患者救治效果的价值;同时选取2023年5月至2023年10月医院收治的另外68例急性心肌梗死合并急性左心衰患者作为验证对象,通过ROC曲线进一步验证血清铁调素/铁蛋白比值对患者救治效果的预测价值。结果 本研究根据纳入、排除标准共选取308例患者为研究对象,最终303例患者完成救治效果评价,其中有效257例(84.82%)。与有效组比较,无效组入院时、治疗1周时血清铁调素及其与铁蛋白比值均较高,血清铁蛋白水平较低(P<0.05)。与入院时比较,有效组治疗1周时血清铁调素及其与铁蛋白比值均降低,血清铁蛋白水平均升高(P<0.05),但无效组入院时、治疗1周时血清铁调素、铁蛋白及其比值差异无统计学意义(P>0.05)。两组入院时高敏肌钙蛋白、N端脑利钠肽前体、血红蛋白水平比较差异有统计学意义(P<0.05)。点二列相关性发现,患者临床救治效果与入院时血清铁调素水平及其与铁蛋白比值呈正相关(r>0,P<0.05),与入院时血清铁蛋白水平呈负相关(r<0,P<0.05)。ROC曲线发现,入院时血清铁调素、铁蛋白及其比值对患者救治效果均有一定预测价值,且二者比值预测价值更高。加以验证的ROC曲线结果显示,入院时血清铁调素/铁蛋白比值对患者救治效果仍有良好的预测价值。结论 急性心肌梗死合并急性左心衰患者入院时血清铁调素/铁蛋白比值与临床救治效果有关,可辅助临床早期预测患者救治效果,指导救治方案的及时调整。

CT肺动脉造影推导的右心室与左心室直径比对急性肺栓塞危险分层及预后的评估价值

目的分析计算机断层扫描肺动脉造影(CTPA)推导的右心室(RV)与左心室(LV)直径比,对急性肺栓塞(APE)危险分层及预后的预测效能。方法回顾性分析2019-03至2023-04在武警贵州总队医院接受利伐他班预防急性静脉血栓的211例APE患者的电子医疗记录。根据简化版肺栓塞严重指数(sPESI)、肌钙蛋白检测、超声心动图检查将患者分为低危(n=69)、中低危(n=74)、中高危(n=68)。通过超声心动图评估RV收缩功能障碍(RVD),由影像科专家在CTPA图像上垂直于心脏长轴的单次横向扫描中测量RV和LV直径。随访90 d内的不良复合事件发生情况。结果不良结局APE患者的RV/LV更高(P<0.05),RV/LV预测APE患者短期预后的受试者工作特征曲线下面积(ROCAUC)结果为0.784,在最佳截断值(1.02)处,灵敏度79.9%,特异度75.3%。多元Logistics回归分析结果显示,RV/LV直径比>1.02为APE患者短期预后不良结局的独立危险因素。中高危患者的RV/LV直径比(1.11±0.25)高于低危(0.96±0.18)及中低危(0.99±0.28)患者(F=7.431,P=0.001)。RV/LV直径比预测中高危APE的ROCAUC为0.780。在RV/LV直径比≤1.02的70例患者中,14例(20.0%)通过超声心动图检测到RVD;在>1.02的134例患者中,77例(57.46%)通过超声心动图检测到RVD。Spearman秩相关分析结果显示,RV/LV直径比与sPESI(r_(s)=0.289)、肌酸激酶同工酶(r_(s)=0.291)、D-二聚体(r_(s)=0.386)呈正相关。结论根据CTPA推导的RV/LV直径比有助于评估APE患者的危险分层和短期不良预后。

老年急性ST段抬高型心肌梗死患者左心室血栓形成的影响因素及其Nomogram风险预测模型构建

目的探讨老年急性ST段抬高型心肌梗死(STEMI)患者左心室血栓(LVT)形成的影响因素,并构建Nomogram风险预测模型。方法将华中科技大学同济医学院附属同济医院2020年1月至2023年12月收治的873例急性STEMI患者以7∶3分为训练集(n=611)和验证集(n=262)。根据训练集患者LVT发生情况分为非LVT组(n=549)和LVT组(n=62)。多因素logistic回归分析急性STEMI患者发生LVT的影响因素;利用R软件rms程序包构建预测急性STEMI患者LVT发生风险的Nomogram模型,并通过ROC及Hosmer-Lemeshow检验验证其预测效能。结果与非LVT组比较,LVT组血红蛋白(Hb)[(131.15±15.99)g/L比(143.28±16.71)g/L]和左心室射血分数(LVEF)[(39.99±5.01)%比(45.24±6.69)%]明显较低(t=5.441、5.991,P<0.05),合并室壁瘤(37.10%比20.40%)、基线心肌梗死溶栓治疗(TIMI)血流分级0级(59.68%比44.81%)、未形成冠状动脉侧支循环(88.71%比72.13%)以及未进行急诊经皮冠状动脉介入治疗(PCI)或药物溶栓的占比(69.35%比48.82%)明显较高(χ^(2)=9.022、4.953、7.921、9.403,P<0.05)。多因素Logistic回归显示,Hb(OR=0.948)和LVEF(OR=0.868)为急性STEMI患者发生LVT的保护因素(P<0.05),合并室壁瘤(OR=6.812)、基线TIMI血流分级0级(OR=6.884)、未形成冠状动脉侧支循环(OR=7.273)、未进行急诊PCI或药物溶栓(OR=4.173)为其独立危险因素(P<0.05)。ROC分析显示,训练集AUC为0.871(95%CI 0.830~0.912),验证集为0.838(95%CI 0.731~0.945);Hosmer-Lemeshow检验中训练集χ^(2)=11.379,P=0.181,验证集χ^(2)=11.261,P=0.187。结论急性STEMI患者LVT的发生与Hb、LVEF、室壁瘤、基线TIMI分级、冠状动脉侧支循环形成及是否接受急诊PCI或药物溶栓密切相关,基于这些因素构建的Nomogram预测模型区分度及一致性良好,有助于临床预测。

急性脑卒中患者心脏电学改变研究

目的通过分析急性脑卒中患者心脏电学变化,探讨心电图评估急性脑卒中患者血压控制效果的临床价值。方法选取2023-06—2024-01郑州大学第二附属医院收治入院的急性脑卒中患者103例(脑出血50例,脑梗死53例)为研究组,原发性高血压患者61例为对照组,分析研究组临床资料和心电图特点,比较研究组和对照组的心电图改变。将研究组分为血压异常组和血压正常组,比较不同血压状态下脑出血和脑梗死患者心电图改变。结果急性脑卒中患者中脑出血患者年龄偏小,糖尿病占比高,入院收缩压/舒张压、血糖较高,差异有统计学意义(P<0.05)。脑卒中患者心电图异常率高于原发性高血压患者,以P波时限≥120 ms、P波双峰(峰间距>40 ms)、Macrua指数、左心室高电压、左心室肥大、快速性心律失常检出率较高,差异有统计学意义(P<0.05)。脑出血患者心电图异常率高于脑梗死患者,左心房/左心室肥大、心肌缺血比较差异有统计学意义(P<0.05)。血压异常的脑出血患者心电图异常率高于血压正常者,左心房/左心室肥大、心肌缺血比较差异有统计学意义(P<0.05)。血压异常的脑梗死患者快速性心律失常检出率高于血压正常者,差异有统计学意义(P<0.05)。结论急性脑卒中患者心电图异常率高,尤其高血压合并脑卒中患者心电图异常表现更加明显,心电图检查可作为诊断和评估急性脑卒中患者血压控制效果的重要依据。

泛免疫炎症值与急性心肌梗死患者PCI术后左室重构的关系

目的分析急性心肌梗死(AMI)患者泛免疫炎症值(PIIV)与经皮冠状动脉介入治疗(PCI)术后左室重构的关系。方法选取于住院期间接受PCI的AMI患者150例为AMI组、同期进行体检的健康成人150例为对照组,收集入选者的一般临床资料[性别、年龄和体质量指数(BMI)]、血细胞计数(中性粒细胞、淋巴细胞、单核细胞和血小板)、实验室检查数据[肌酸肌酶同工酶(CK-MB)、氨基末端脑钠素前体(NT-proBNP)、血糖和血脂],AMI患者分别于PCI术前、出院后第6个月时进行心脏超声检查获取左心室收缩末期容积(LVESV)、左室舒张末期容积指数(LVEDV)、左心室射出分率(LVEF);根据PIIV值的中位数(681.32),将AMI组患者分为低PIIV组(≤681.32)和高PIIV组(>681.32);于出院12个月内对AMI患者进行随访,以6个月内LVESV增加>15%为发生左室重构,收集患者12个月内再发AMI、心源性再住院和全因死亡;采用Pearson相关分析PIIV与LVEDV、LVESV和LVEF的相关性,ROC曲线分析PIIV评估AMI患者左室重构的价值,logistic回归分析AMI患者左室重构的影响因素。结果与对照组比较,AMI组患者的PIIV值升高(P<0.05);与低PIIV组比较,高PIIV组AMI患者的中性粒细胞计数、单核细胞计数、血小板计数、血糖、LVESV、LVEDV和LVEF更高,而淋巴细胞计数更低(P<0.05);与低PIIV组比较,高PIIV组AMI患者的左室重构、再发AMI和心源性再住院升高(P<0.05);PIIV与LVESV和LVEDV呈明显的正相关性(P<0.05),与LVEF呈显著负相关(P<0.05);ROC曲线提示PIIV预测AMI患者PCI术后左室重构的AUC为0.868(95%CI为0.821~0.915,P<0.05),其敏感性为89.2%、特异性为76.7%。结论PIIV在评估AMI患者PCI术后发生左室重构方面具有良好的预测价值。

益阳利水方治疗急性左心衰竭患者的疗效分析

目的探讨益阳利水方对急性左心衰竭(ALHF)患者炎症指标、心肌损伤标志物、心功能及临床疗效的影响。方法选取泰安市中医医院2022年5月至2023年5月收治的ALHF(阳虚水泛型)患者107例,按照随机数表法分成观察组54例和对照组53例,两组均给予常规西药治疗,观察组在对照组治疗的基础上给予益阳利水方。比较两组患者的炎症指标、心肌损伤标志物、心功能及临床疗效。结果治疗后观察组的治疗总有效率(88.9%)优于对照组(73.6%),差异有统计学意义(P<0.05),治疗后,两组超敏C反应蛋白、白细胞介素-6、肌钙蛋白I、肌酸激酶同工酶、N端脑钠肽前体、左室射血分数、左室收缩末期容积、左室舒张末期容积水平均较治疗前改善,观察组较对照组改善更明显(P<0.05)。结论益阳利水方治疗ALHF可有效降低患者的血清相关炎症指标,降低心肌损伤标志物水平,改善心脏功能,提高生活质量,临床疗效良好。

左西孟旦联合环磷腺苷对老年急性左心衰竭患者的疗效

目的探讨左西孟旦联合环磷腺苷对老年急性左心衰竭患者心室重构及血清肌钙蛋白I(TnI)和瞬时受体电位通道1(TRPC1)水平的影响。方法选取2022年6月到2023年11月在韩城市人民医院诊治的老年急性左心衰竭患者96例,采用信封法分为观察组和对照组,每组48例,进行前瞻性研究。观察组男25例,女23例;年龄(76.97±5.23)岁;体质量指数(25.35±2.79)kg/m^(2);心功能分级:Ⅲ级30例,Ⅳ级18例。对照组男26例,女22例;年龄(77.41±5.16)岁;体质量指数(25.14±2.62)kg/m^(2);心功能分级:Ⅲ级31例,Ⅳ级17例。两组均给予利尿、强心、扩张血管等常规干预;对照组给予环磷腺苷治疗,观察组给予左西孟旦联合环磷腺苷治疗,两组均为静脉滴注给药,治疗周期均为7 d。比较两组临床疗效、心室重构指标[室间隔厚度(IVST)、左室后壁厚度(LVPWT)、左心室质量指数(LVMI)]、心脏储备功能指标[左心室射血分数(LVEF)、左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)]、血清TnI和TRPC1水平及不良反应发生情况。采用独立样本t检验、配对样本t检验和χ^(2)检验。结果治疗后,观察组的总有效率[91.67%(44/48)]高于对照组[75.00%(36/48)](P<0.05)。治疗后,观察组心室重构指标均优于对照组[IVST:(7.45±0.82)mm比(9.04±1.11)mm、LVPWT:(8.09±0.84)mm比(8.89±1.07)mm、LVMI:(112.67±15.12)g/m^(2)比(120.21±16.83)g/m^(2)](均P<0.05)。治疗后,观察组患者的LVEF高于对照组[(56.32±6.01)%比(51.78±5.90)%],LVESD、LVEDD均低于对照组[(50.27±5.98)mm比(59.46±6.24)mm、(53.92±7.47)mm比(62.85±7.22)mm](均P<0.05)。治疗后,观察组血清TnI和TRPC1水平均低于对照组[(0.34±0.06)µg/L比(0.46±5.90)µg/L、(8.25±1.62)ng/L比(13.27±2.07)ng/L](均P<0.05)。观察组在治疗期间总不良反应发生率[16.67%(8/48)]与对照组[14.58%(7/48)]比较,差异无统计学意义(P>0.05)。结论左西孟旦联合环磷腺苷能有效改善老年急性左心衰竭患者的心室重构,提高心脏功能,降低血清TnI和TRPC1水平,有利于左心衰竭患者的康复治疗。