Objective The management of hypertrophic obstructive cardiomyopathy is not well-defined in the elderly.Medical therapy with 3-blockers and calcium-channel blockers are the mainstay therapy for symptomatic patients.Myo...Objective The management of hypertrophic obstructive cardiomyopathy is not well-defined in the elderly.Medical therapy with 3-blockers and calcium-channel blockers are the mainstay therapy for symptomatic patients.Myomectomy is usually reserved for patients who fail medical therapy. Alcohol septal ablation has been recently introduced as an alternative therapy. Patients and Methods Ninety-five patients older than 65 years of age were included. All patients have completed one year of follow-up. The mean age was 72 ± 5 years, 47 patients were females, 10 patients with history of hypertension. Results The mean rise in CK post alcohol ablation was 1052 ± 430IU. The mean NYHA class decreased from 2.9 ± 0.6 to 1.2 ± 0.5 ( P ＜ 0.001 ). The exercise duration on treadmill testing increased from 328 ± 260 s to 349 ± 39 s. The mean resting left ventricular outflow tract gradient decreased from 65 ± 37 mmHg to 16 ± 29 mmHg at one year. One patient died in the hospital after coronary artery bypass grafting that was done subsequent to spiral dissection of the left anterior descending artery during ablation. Thirteen patients developed complete heart block immediately after ablation requiring pacing therapy. Conclusions Alcohol septal ablation seems to be an effective alternative therapeutic option for elderly patients with hypertrophic obstructive cardiomyopathy. Larger studies with longer follow-up are needed.展开更多
The levels of plasma renin activity(PRA), (?) II(ATII), serum sodiurnand urinary sodium excretion within 24 h m heart failure (?) were (?), in onder to studythe effect of sodium on the PRA and ATII levels in heart (?)...The levels of plasma renin activity(PRA), (?) II(ATII), serum sodiurnand urinary sodium excretion within 24 h m heart failure (?) were (?), in onder to studythe effect of sodium on the PRA and ATII levels in heart (?) patients The (?) showed thatthe PRA and ATII levels were higher left heart falure patents than those in nonnal persons andright heart failure patients, but the serum sodium and urinary sodium excretion left heart failurepatients was lower than that of normal persons and right heart failure patients that patients withleft heart failure were of high renin activity type and patients with right heart failure were of low ornormal renin activity type and that in heart failure patients the PRA and ATII level and urinary so-dium excretion were inversely conelated We suggest that it may be useful in selecting drugs forheart failure (?) when the patients are divided into subgroups by PRA and sodium index.展开更多
An increased lung to heart ratio(LHR) on thallium-201(Tl- 201) stress myocardial perfusion imaging(MPI) is a predictor of adverse cardiac events and identifies people with extensive coronary artery disease(CAD). The i...An increased lung to heart ratio(LHR) on thallium-201(Tl- 201) stress myocardial perfusion imaging(MPI) is a predictor of adverse cardiac events and identifies people with extensive coronary artery disease(CAD). The implications of increased LHR in patients undergoing stress technetium- 99m(tc- 99m) sestamibi are developing. Our aim is to evaluate the relationship between increased LHR and extent of CAD in patients undergoing tc- 99m sestamibi MPI. Methods: We reviewed the records and images of 530 consecutive subjects who underwent exercise or adenosine tc- 99 m sestamibi MPI. One hundred thirty-two had transient or partially reversible myocardial perfusion defects and 79(exercise=34, adenosine=45, male=43, female=36, mean age=61 years) of these underwent coronary angiography(study population). The average LHR of these 79 subjects was compared to 79 patients(control population) with normal scans(exercise=50, adenosine=29, male=34, female=45, mean age=60 years). Results: The mean LHR(± SE) in subjects with normal scans was 0.30± 0.01. The mean LHR for those with abnormal scans and single vessel CAD who underwent exercise was 0.32± 0.01 and pharmacological stress was 0.31± 0.01. There was no statistically significant difference between the LHR of those with a normal scan and those with single vessel disease and an abnormal scan. However, there was a statistically significant association between the elevated LHR and multi-vessel CAD. The mean LHR for subjects with multi-vessel CAD with exercise was 0.39± 0.01(p=0.000) and for adenosine was 0.39± 0.02(p=0.000). Conclusion: An elevated LHR in patients undergoing exercise or pharmacological tc- 99m MPI correlates with multi-vessel CAD.展开更多
To the Editor： Exercise-induced ST-segment elevation is an uncommon clinical scenario with a prevalence of0.15%, ST-segment elevation during exercise is a marker of both transient and severe ischemia. Appropriate tre...To the Editor： Exercise-induced ST-segment elevation is an uncommon clinical scenario with a prevalence of0.15%, ST-segment elevation during exercise is a marker of both transient and severe ischemia. Appropriate treatment is crucial becanse corollary vasospasm can result in acute coronary syndrome, syncope, life-threatening cardiac arrhythmias, and even out-of-hospital cardiac arrest.Here, we report on a patient with exercise-induced myocardial ischemia and life-threatening cardiac arrhythmias due to coronary vasospasm.展开更多
文摘Objective The management of hypertrophic obstructive cardiomyopathy is not well-defined in the elderly.Medical therapy with 3-blockers and calcium-channel blockers are the mainstay therapy for symptomatic patients.Myomectomy is usually reserved for patients who fail medical therapy. Alcohol septal ablation has been recently introduced as an alternative therapy. Patients and Methods Ninety-five patients older than 65 years of age were included. All patients have completed one year of follow-up. The mean age was 72 ± 5 years, 47 patients were females, 10 patients with history of hypertension. Results The mean rise in CK post alcohol ablation was 1052 ± 430IU. The mean NYHA class decreased from 2.9 ± 0.6 to 1.2 ± 0.5 ( P ＜ 0.001 ). The exercise duration on treadmill testing increased from 328 ± 260 s to 349 ± 39 s. The mean resting left ventricular outflow tract gradient decreased from 65 ± 37 mmHg to 16 ± 29 mmHg at one year. One patient died in the hospital after coronary artery bypass grafting that was done subsequent to spiral dissection of the left anterior descending artery during ablation. Thirteen patients developed complete heart block immediately after ablation requiring pacing therapy. Conclusions Alcohol septal ablation seems to be an effective alternative therapeutic option for elderly patients with hypertrophic obstructive cardiomyopathy. Larger studies with longer follow-up are needed.
文摘The levels of plasma renin activity(PRA), (?) II(ATII), serum sodiurnand urinary sodium excretion within 24 h m heart failure (?) were (?), in onder to studythe effect of sodium on the PRA and ATII levels in heart (?) patients The (?) showed thatthe PRA and ATII levels were higher left heart falure patents than those in nonnal persons andright heart failure patients, but the serum sodium and urinary sodium excretion left heart failurepatients was lower than that of normal persons and right heart failure patients that patients withleft heart failure were of high renin activity type and patients with right heart failure were of low ornormal renin activity type and that in heart failure patients the PRA and ATII level and urinary so-dium excretion were inversely conelated We suggest that it may be useful in selecting drugs forheart failure (?) when the patients are divided into subgroups by PRA and sodium index.
文摘An increased lung to heart ratio(LHR) on thallium-201(Tl- 201) stress myocardial perfusion imaging(MPI) is a predictor of adverse cardiac events and identifies people with extensive coronary artery disease(CAD). The implications of increased LHR in patients undergoing stress technetium- 99m(tc- 99m) sestamibi are developing. Our aim is to evaluate the relationship between increased LHR and extent of CAD in patients undergoing tc- 99m sestamibi MPI. Methods: We reviewed the records and images of 530 consecutive subjects who underwent exercise or adenosine tc- 99 m sestamibi MPI. One hundred thirty-two had transient or partially reversible myocardial perfusion defects and 79(exercise=34, adenosine=45, male=43, female=36, mean age=61 years) of these underwent coronary angiography(study population). The average LHR of these 79 subjects was compared to 79 patients(control population) with normal scans(exercise=50, adenosine=29, male=34, female=45, mean age=60 years). Results: The mean LHR(± SE) in subjects with normal scans was 0.30± 0.01. The mean LHR for those with abnormal scans and single vessel CAD who underwent exercise was 0.32± 0.01 and pharmacological stress was 0.31± 0.01. There was no statistically significant difference between the LHR of those with a normal scan and those with single vessel disease and an abnormal scan. However, there was a statistically significant association between the elevated LHR and multi-vessel CAD. The mean LHR for subjects with multi-vessel CAD with exercise was 0.39± 0.01(p=0.000) and for adenosine was 0.39± 0.02(p=0.000). Conclusion: An elevated LHR in patients undergoing exercise or pharmacological tc- 99m MPI correlates with multi-vessel CAD.
文摘To the Editor： Exercise-induced ST-segment elevation is an uncommon clinical scenario with a prevalence of0.15%, ST-segment elevation during exercise is a marker of both transient and severe ischemia. Appropriate treatment is crucial becanse corollary vasospasm can result in acute coronary syndrome, syncope, life-threatening cardiac arrhythmias, and even out-of-hospital cardiac arrest.Here, we report on a patient with exercise-induced myocardial ischemia and life-threatening cardiac arrhythmias due to coronary vasospasm.
