Enhanced external counterpulsation Extemal counterpulsation （ECP） was originally conceived to be a circulatory assist device to promote blood flow to areas of the heart muscle that were lacking adequate blood suppl...Enhanced external counterpulsation Extemal counterpulsation （ECP） was originally conceived to be a circulatory assist device to promote blood flow to areas of the heart muscle that were lacking adequate blood supply due to obstruction of the coronary artery. During ECP the lower extremities are compressed to squeeze both arterial and venous blood back to the heart during diastole, increasing coronary perfusion pressure and right ventricular filling. The compression is released during systole,展开更多
The current issue of the Journal of Geriatric Cardiology contains an interesting paper by Dr. Yixin Song and colleagues raising important issues in the diagnosis and management of heart failure in elderly patients. Re...The current issue of the Journal of Geriatric Cardiology contains an interesting paper by Dr. Yixin Song and colleagues raising important issues in the diagnosis and management of heart failure in elderly patients. Readers of this journal are in all likelihood aware that the epidemic of heart failure is of great impact medically and economically worldwide.展开更多
Aims: We sought to determine whether the incidence of and survival following congestive heart failure(CHF) in patients with atrial fibrillation(AF) have changed over time. Methods and results: Olmsted County, Minnesot...Aims: We sought to determine whether the incidence of and survival following congestive heart failure(CHF) in patients with atrial fibrillation(AF) have changed over time. Methods and results: Olmsted County, Minnesota residents diagnosed with first AF during 1980-2000 were identified and followed in medical records to 2004. The trends of incidence and survival of CHF over time were assessed. Of the 3288 subjects(mean age 71±15 years) diagnosed with first AF and without CHF prior to or at AF diagnosis, 790(24%) developed a first CHF during a mean follow-up of 6.1±5.2 years(unadjusted incidence, 44 per 1000 person years). Age-and sex-adjusted CHF incidence was unrelated to calendar year of AF diagnosis(P=0.86). The age-and sex-adjusted mortality risk following CHF was higher than that in patients without CHF(hazard ratio 3.4, 95%confidence interval 3.1-3.8, P< 0.0001). There were no detectable changes over time with respect to the absolute(P=0.94) or the relative(P=0.68) mortality risk after CHF diagnosis. Conclusion: In this study spanning two decades, there appeared to have been no significant reduction in terms of the incidence and mortality risk of CHF following first AF diagnosis.展开更多
Background: Data derived from stress myocardial perfusion imaging(MPI) carry prognostic significance in young patients with hypertrophic cardiomyopathy(HCM), but there are limited data on the utility of stress MPI in ...Background: Data derived from stress myocardial perfusion imaging(MPI) carry prognostic significance in young patients with hypertrophic cardiomyopathy(HCM), but there are limited data on the utility of stress MPI in patients with HCM who are older. This study examined the prognostic significance of stress MPI in an adult population of patients with HCM. Methods: We examined 158 patients with HCM(aged 60± 16 years, 61% men) who underwent exercise or pharmacologic stress MPI. Summed stress score(SSS, normal=56) and summed reversibility scores were calculated for each patient. Follow- up was complete in 157(99% ) patients at a median duration of 5.2 years. Results: Normal single- photon emission computed tomography(SPECT) images were present in 38% of the population. Summed stress score(P=.01) and summed reversibility score(P=.03) were both significantly associated with cardiovascular death. Survival at 10 years was significantly better in those with normal versus abnormal SPECT(89% vs 67% , P= .04). Ten- year survival also was better in those without versus those with ischemia(90% vs 64% , P=.02). Five- year survival could be stratified by SSS risk categories: low risk(SSS ≥ 53), 97% ; intermediate risk(SSS=48- 52), 94% ; and high risk(SSS ≤ 47), 79% (P=.04). Bivariate models of SSS and other significant covariates supported an independent relation of SSS to cardiovascular death. Conclusions: In an older population of patients with HCM referred for SPECT imaging, abnormal stress MPI identifies those at increased risk of cardiovascular death.展开更多
文摘Enhanced external counterpulsation Extemal counterpulsation （ECP） was originally conceived to be a circulatory assist device to promote blood flow to areas of the heart muscle that were lacking adequate blood supply due to obstruction of the coronary artery. During ECP the lower extremities are compressed to squeeze both arterial and venous blood back to the heart during diastole, increasing coronary perfusion pressure and right ventricular filling. The compression is released during systole,
文摘The current issue of the Journal of Geriatric Cardiology contains an interesting paper by Dr. Yixin Song and colleagues raising important issues in the diagnosis and management of heart failure in elderly patients. Readers of this journal are in all likelihood aware that the epidemic of heart failure is of great impact medically and economically worldwide.
文摘Aims: We sought to determine whether the incidence of and survival following congestive heart failure(CHF) in patients with atrial fibrillation(AF) have changed over time. Methods and results: Olmsted County, Minnesota residents diagnosed with first AF during 1980-2000 were identified and followed in medical records to 2004. The trends of incidence and survival of CHF over time were assessed. Of the 3288 subjects(mean age 71±15 years) diagnosed with first AF and without CHF prior to or at AF diagnosis, 790(24%) developed a first CHF during a mean follow-up of 6.1±5.2 years(unadjusted incidence, 44 per 1000 person years). Age-and sex-adjusted CHF incidence was unrelated to calendar year of AF diagnosis(P=0.86). The age-and sex-adjusted mortality risk following CHF was higher than that in patients without CHF(hazard ratio 3.4, 95%confidence interval 3.1-3.8, P< 0.0001). There were no detectable changes over time with respect to the absolute(P=0.94) or the relative(P=0.68) mortality risk after CHF diagnosis. Conclusion: In this study spanning two decades, there appeared to have been no significant reduction in terms of the incidence and mortality risk of CHF following first AF diagnosis.
文摘Background: Data derived from stress myocardial perfusion imaging(MPI) carry prognostic significance in young patients with hypertrophic cardiomyopathy(HCM), but there are limited data on the utility of stress MPI in patients with HCM who are older. This study examined the prognostic significance of stress MPI in an adult population of patients with HCM. Methods: We examined 158 patients with HCM(aged 60± 16 years, 61% men) who underwent exercise or pharmacologic stress MPI. Summed stress score(SSS, normal=56) and summed reversibility scores were calculated for each patient. Follow- up was complete in 157(99% ) patients at a median duration of 5.2 years. Results: Normal single- photon emission computed tomography(SPECT) images were present in 38% of the population. Summed stress score(P=.01) and summed reversibility score(P=.03) were both significantly associated with cardiovascular death. Survival at 10 years was significantly better in those with normal versus abnormal SPECT(89% vs 67% , P= .04). Ten- year survival also was better in those without versus those with ischemia(90% vs 64% , P=.02). Five- year survival could be stratified by SSS risk categories: low risk(SSS ≥ 53), 97% ; intermediate risk(SSS=48- 52), 94% ; and high risk(SSS ≤ 47), 79% (P=.04). Bivariate models of SSS and other significant covariates supported an independent relation of SSS to cardiovascular death. Conclusions: In an older population of patients with HCM referred for SPECT imaging, abnormal stress MPI identifies those at increased risk of cardiovascular death.
