Objectives To assess the prevalence of systolic dyssynchrony of the left ventricular （LV） walls in patients of heart failure（HF） with a normal QRS duration by Doppler tissue imaging （DTI）. Methods 20 patients of...Objectives To assess the prevalence of systolic dyssynchrony of the left ventricular （LV） walls in patients of heart failure（HF） with a normal QRS duration by Doppler tissue imaging （DTI）. Methods 20 patients of HF with a normal QRS duration and 20 healthy individuals were investigated with DTI to quantitatively analyze their pulsed-wave Doppler spectrum of basal and middle segments in six walls of left ventricle. The time between the onset of the QRS complex of the surface ECG and the onset of the systolic wave of pulsed-wave Doppler spectrum was measured （TS）. LV systolic synchronization was assessed by the maximal difference （MD） in time of TS, the standard deviation （SD） and the coefficient of variation （CV） of TS in the all 12 LV segments. Results When a TS-MD of TS〉 53.08 ms, a TS-SD of TS 〉18.08 ms and a TS-CV of TS 〉 0.91 （＋1.65 SD of normal controls） was used to define significant systolic dyssynchrony, the prevalence of systolic dyssynchrony was 55.0 %, 55.0 % and 55.0 %, respectively, in the HF patients group, significantly higher than those in the normal control and the locations of delayed contraction of these patients were different. Conclusions LV systolic dyssynchrony could be commonly demonstrated by DTI in HF patients with a normal QRS duration. This finding will support the view about the possibility that more HF patients could benefit from cardiac resynchronization therapy.展开更多
Objectives To analyses heart rate （HR） distribution of healthy adults in the south China community and evaluate relative risk of HR to total cause of death and cardiac cerebral vascular death. Methods Analytical dat...Objectives To analyses heart rate （HR） distribution of healthy adults in the south China community and evaluate relative risk of HR to total cause of death and cardiac cerebral vascular death. Methods Analytical data come from the baseline survey and follow-up visits in the PRC-USA Collaborative Study of Cardiovascular Epidemiology in urban and rural samples of Guangzhou. The baseline survey was initiated in 1983 and 1984, and rescanned in 1987 and 1988. Since 1991 Follow-up visits for endpoint events were carried once every two years. Average follow-up year was 16.2 from baseline to 2000. People excluded from cardiac cerebral vascular disease, diabetes and other various chronic diseases were regarded as ＂healthy adults＂. Heart rates of these subjects were measured on resting electrocardiogram. Endpoint evens include： total cause of death, first attack of coronary disease and cerebral vascular events. SAS software was used for analysis. Cox Proportional Hazards model was used to evaluate the impact of HR on total death and cardiac cerebral vascular disease. Results A total of 4570 men and women aged 35-55 years from urban and rural Guangzhou were investigated. 3493 healthy subjects were enrolled in the analysis, including 1694 men and 1799 women. Mean oftheHRis （67.9 ±10.6） beats/min （bpm） in the whole population, （66.3±10.7）bpm in men and （69.3± 10.4） in women. The 52 percentile of the HR was 51 in men and 54 in women. The 952 percentile of the HR was 85 in men and 88 in women. Single correlation analysis showed there was negative relationship between age and HR, but it was only statistical significant in female. Analysis with Cox Proportional Hazards model show that HR 〈 50 bpm tops the risk of total causes of death （1.725）and HR 50-59 bpm decreased the risk of total causes of death （0.843）. Relative risk of cardiac cerebral vascular events exceeds 1 when HR 〈 50 and 〉90 bpm （1.486 and 7.008 respectively）. It was less than 1 in other groups but there was no significant difference between each group. Conclusions Traditional normal range of HR in adult should be adjusted. In certain extent lower HR is advantageous to decrease cardiac cerebral vascular events, total causes of death and has better prognosis.展开更多
Heart failure with preserved ejection fraction(HFPEF)is common and represents a major challenge in cardiovascular medicine.Most of the current treatment of HFPEF is based on morbidity benefits and symptom reduction.Va...Heart failure with preserved ejection fraction(HFPEF)is common and represents a major challenge in cardiovascular medicine.Most of the current treatment of HFPEF is based on morbidity benefits and symptom reduction.Various pharmacological interventions available for heart failure with reduced ejection fraction have not been supported by clinical studies for HFPEF.Addressing the specific aetiology and aggressive risk factor modification remain the mainstay in the treatment of HFPEF.We present a brief overview of the currently recommended therapeutic options with available evidence.展开更多
Objective: To explore the changes of coagulation activity and the characters of anticoagulation early after mechanical heart valve replacement. Methods: All patients only took warfarin orally for anticoagulation. The ...Objective: To explore the changes of coagulation activity and the characters of anticoagulation early after mechanical heart valve replacement. Methods: All patients only took warfarin orally for anticoagulation. The predicted international normalized ratio (INR) was 1.5 to 2.0. Several coagulation markers were monitored early after valve replacement. Complications associated with anticoagulation were recorded and analyzed. The patients were divided into three groups based on the number and position of mechanical valve prothesis, including group M (mitral valve replacement), group A (aortic valve replacement) and group D (mitral and aortic valve replacement).Comparison was made between the three groups. Results: Three events of mild cerebral embolism and five events of mild bleeding occurred during the early postoperative period. One patient suffered from mild cerebral embolism on the 4th day after operation, accompanied by large volume of pericardial drainage. Two patients with bleeding had lower INRs than predicted range. However, INR in one patient with mild cerebral embolism was in the predicted range. There was no significant difference in thrombo time (TT), activated partial thromboplastin time (APTT) and INR on the 3rd day after operation compared to those before operation; meanwhile, plasma fibrinogen (FIB) concentration was higher than that before operation (P<0.05). INR had no significant changes on the 2nd day after the beginning of anticoagulation compared to that before operation; however, INR was significantly elevated on the 4th day (P<0.05). Warfarin doses and INRs were similar among the three groups, but FIB concentrations in plasma were higher in groups M and D than in group A (P<0.01). Conclusion: Hypercoagulabale state exists early after mechanical heart valve replacement. When anticoagulation begins is determined by the change of coagulation markers, not by the volume of chest or pericardial drainage. INR can not accurately reflect the coagulation state sometimes, especially during the first 3 days after anticoagulation. The number and position of mechanical valve prothesis could affect coagulation state. Therefore, anticoagulation therapy should be regulated accordingly.展开更多
Background: In recent decades, the hospital admission due to heart failure with normal ejection fraction (HFnEF) or diastolic heart failure has increased particularly in elderly patients. However, sufficient data rega...Background: In recent decades, the hospital admission due to heart failure with normal ejection fraction (HFnEF) or diastolic heart failure has increased particularly in elderly patients. However, sufficient data regarding prevalence, etiologies and treatment of diastolic heart failure are not available for Indian population. So, we carried out an observational study to determine clinical profile and medical therapy for patients experiencing diastolic heart failure. Methods: This was prospective observational study carried out in rural area of India for the period of 12 months. All the patients diagnosed with heart failure with normal ejection fraction were included in the study. If the patient was having severe anemia (hemoglobin 8.00 g/dl), hemodynamically significant valvular disease, prosthetic valve replacement, and ventricular pacemaker, they were excluded. Results: A total of 53 patients diagnosed with HFnEF were included in the study. There were 24 male patients. Hypertension, CAD and diabetes mellitus were present in 33, 24 and 16 patients respectively. 18 patients developed severe diastolic dysfunction and more common in female as compared to male (37.9% vs. 33.3%). Most frequently observed clinical feature was tachycardia (96% cases) followed by pedal edema (86%). The patients were treated according to underlying cause. Conclusions: Diastolic heart failure is more common in elderly patients. In Indian population, diastolic heart failure has been associated with hypertension, diabetes mellitus and coronary artery diseases in most of the cases.展开更多
文摘Objectives To assess the prevalence of systolic dyssynchrony of the left ventricular （LV） walls in patients of heart failure（HF） with a normal QRS duration by Doppler tissue imaging （DTI）. Methods 20 patients of HF with a normal QRS duration and 20 healthy individuals were investigated with DTI to quantitatively analyze their pulsed-wave Doppler spectrum of basal and middle segments in six walls of left ventricle. The time between the onset of the QRS complex of the surface ECG and the onset of the systolic wave of pulsed-wave Doppler spectrum was measured （TS）. LV systolic synchronization was assessed by the maximal difference （MD） in time of TS, the standard deviation （SD） and the coefficient of variation （CV） of TS in the all 12 LV segments. Results When a TS-MD of TS〉 53.08 ms, a TS-SD of TS 〉18.08 ms and a TS-CV of TS 〉 0.91 （＋1.65 SD of normal controls） was used to define significant systolic dyssynchrony, the prevalence of systolic dyssynchrony was 55.0 %, 55.0 % and 55.0 %, respectively, in the HF patients group, significantly higher than those in the normal control and the locations of delayed contraction of these patients were different. Conclusions LV systolic dyssynchrony could be commonly demonstrated by DTI in HF patients with a normal QRS duration. This finding will support the view about the possibility that more HF patients could benefit from cardiac resynchronization therapy.
文摘Objectives To analyses heart rate （HR） distribution of healthy adults in the south China community and evaluate relative risk of HR to total cause of death and cardiac cerebral vascular death. Methods Analytical data come from the baseline survey and follow-up visits in the PRC-USA Collaborative Study of Cardiovascular Epidemiology in urban and rural samples of Guangzhou. The baseline survey was initiated in 1983 and 1984, and rescanned in 1987 and 1988. Since 1991 Follow-up visits for endpoint events were carried once every two years. Average follow-up year was 16.2 from baseline to 2000. People excluded from cardiac cerebral vascular disease, diabetes and other various chronic diseases were regarded as ＂healthy adults＂. Heart rates of these subjects were measured on resting electrocardiogram. Endpoint evens include： total cause of death, first attack of coronary disease and cerebral vascular events. SAS software was used for analysis. Cox Proportional Hazards model was used to evaluate the impact of HR on total death and cardiac cerebral vascular disease. Results A total of 4570 men and women aged 35-55 years from urban and rural Guangzhou were investigated. 3493 healthy subjects were enrolled in the analysis, including 1694 men and 1799 women. Mean oftheHRis （67.9 ±10.6） beats/min （bpm） in the whole population, （66.3±10.7）bpm in men and （69.3± 10.4） in women. The 52 percentile of the HR was 51 in men and 54 in women. The 952 percentile of the HR was 85 in men and 88 in women. Single correlation analysis showed there was negative relationship between age and HR, but it was only statistical significant in female. Analysis with Cox Proportional Hazards model show that HR 〈 50 bpm tops the risk of total causes of death （1.725）and HR 50-59 bpm decreased the risk of total causes of death （0.843）. Relative risk of cardiac cerebral vascular events exceeds 1 when HR 〈 50 and 〉90 bpm （1.486 and 7.008 respectively）. It was less than 1 in other groups but there was no significant difference between each group. Conclusions Traditional normal range of HR in adult should be adjusted. In certain extent lower HR is advantageous to decrease cardiac cerebral vascular events, total causes of death and has better prognosis.
文摘Heart failure with preserved ejection fraction(HFPEF)is common and represents a major challenge in cardiovascular medicine.Most of the current treatment of HFPEF is based on morbidity benefits and symptom reduction.Various pharmacological interventions available for heart failure with reduced ejection fraction have not been supported by clinical studies for HFPEF.Addressing the specific aetiology and aggressive risk factor modification remain the mainstay in the treatment of HFPEF.We present a brief overview of the currently recommended therapeutic options with available evidence.
文摘Objective: To explore the changes of coagulation activity and the characters of anticoagulation early after mechanical heart valve replacement. Methods: All patients only took warfarin orally for anticoagulation. The predicted international normalized ratio (INR) was 1.5 to 2.0. Several coagulation markers were monitored early after valve replacement. Complications associated with anticoagulation were recorded and analyzed. The patients were divided into three groups based on the number and position of mechanical valve prothesis, including group M (mitral valve replacement), group A (aortic valve replacement) and group D (mitral and aortic valve replacement).Comparison was made between the three groups. Results: Three events of mild cerebral embolism and five events of mild bleeding occurred during the early postoperative period. One patient suffered from mild cerebral embolism on the 4th day after operation, accompanied by large volume of pericardial drainage. Two patients with bleeding had lower INRs than predicted range. However, INR in one patient with mild cerebral embolism was in the predicted range. There was no significant difference in thrombo time (TT), activated partial thromboplastin time (APTT) and INR on the 3rd day after operation compared to those before operation; meanwhile, plasma fibrinogen (FIB) concentration was higher than that before operation (P<0.05). INR had no significant changes on the 2nd day after the beginning of anticoagulation compared to that before operation; however, INR was significantly elevated on the 4th day (P<0.05). Warfarin doses and INRs were similar among the three groups, but FIB concentrations in plasma were higher in groups M and D than in group A (P<0.01). Conclusion: Hypercoagulabale state exists early after mechanical heart valve replacement. When anticoagulation begins is determined by the change of coagulation markers, not by the volume of chest or pericardial drainage. INR can not accurately reflect the coagulation state sometimes, especially during the first 3 days after anticoagulation. The number and position of mechanical valve prothesis could affect coagulation state. Therefore, anticoagulation therapy should be regulated accordingly.
文摘Background: In recent decades, the hospital admission due to heart failure with normal ejection fraction (HFnEF) or diastolic heart failure has increased particularly in elderly patients. However, sufficient data regarding prevalence, etiologies and treatment of diastolic heart failure are not available for Indian population. So, we carried out an observational study to determine clinical profile and medical therapy for patients experiencing diastolic heart failure. Methods: This was prospective observational study carried out in rural area of India for the period of 12 months. All the patients diagnosed with heart failure with normal ejection fraction were included in the study. If the patient was having severe anemia (hemoglobin 8.00 g/dl), hemodynamically significant valvular disease, prosthetic valve replacement, and ventricular pacemaker, they were excluded. Results: A total of 53 patients diagnosed with HFnEF were included in the study. There were 24 male patients. Hypertension, CAD and diabetes mellitus were present in 33, 24 and 16 patients respectively. 18 patients developed severe diastolic dysfunction and more common in female as compared to male (37.9% vs. 33.3%). Most frequently observed clinical feature was tachycardia (96% cases) followed by pedal edema (86%). The patients were treated according to underlying cause. Conclusions: Diastolic heart failure is more common in elderly patients. In Indian population, diastolic heart failure has been associated with hypertension, diabetes mellitus and coronary artery diseases in most of the cases.
