Changes in atrial natriuretic factor during preload reduction with nitroglycerin in patients with congestive heart failure

Summary. Nine patients with congestive heart failure, New York Heart Association class II-III, were evaluated with right heart catheterization. Plasma atrial natriuretic factor (ANF) was determined in blood samples from the pulmonary artery simultaneously with recordings of right atrial, pulmonary arterial, pulmonary capillary wedge and systemic arterial pressures and heart rate during preload reduction with 0·5 mg nitroglycerin sublingually. Basal plasma ANF levels were higher in patients with congestive heart failure compared to normal controls, and correlated to right atrial, pulmonary arterial, and pulmonary capillary wedge pressures. After nitroglycerin all patients had reductions in right atrial, pulmonary arterial, and pulmonary capillary wedge pressures and a simultaneous decrease in plasma ANF concentrations, reaching lowest values after 10 min. Central pressures and plasma ANF rose to baseline values within 30 min. After nitroglycerin plasma ANF concentrations correlated to pulmonary arterial and pulmonary capillary wedge pressures, while changes in plasma ANF correlated to changes in right atrial and pulmonary arterial pressures. These results provide further evidence that ANF is released by a pressure-sensitive mechanism and demonstrates that ANF secretion in relation to central pressure variations is preserved in patients with congestive heart failure and that the response is rapid.     

Feasibility of treatment of lower limb edema with calf muscle pump stimulation in chronic heart failure

Background

Persons with chronic heart failure may exhibit a decrease in functional ability related to lower extremity edema in spite of optimal diuretic therapy and salt restrictions.

Aim

The aim of this pilot prospective clinical study was to test the feasibility of using exogenous calf muscle pump stimulation to decrease lower leg edema and thus improve functional status and quality of life.

Methods

Six subjects entered into this study and agreed to use the intervention 30 min/day for one month. DXA was used to assess lower extremity composition.

Results

Device use averaged approximately 1 h/day and resulted in a reduction in the lean mass of the legs of 0.5 kg (range = 0.08-1.0 L; p = 0.03). Linear regression analysis of reduction of lower limb edema against daily usage suggests that increased utilization of calf muscle pump stimulation was associated with increased water losses, although this trend was not significant (R² = 0.4, p = 0.18).

Conclusion

This pilot indicates that exogenous calf muscle pump stimulation could be a useful and safe addition to the patients' treatment regimes, but further studies testing a more typical population with heart failure is warranted.     

甲状腺素治疗老年充血性心衰的临床观察

[目的]探讨小荆量甲状腺素片对老年充血性心力衰竭(CHF)的治疗效果.[方法]对比观察46例老年CHF患者及24例健康对照基础甲状腺激素水平,选择有甲状腺激素水平变化的CHF患者38例,随机分为观察组(18例)和治疗组(20例).观察组按常规治疗;治疗组在常规治疗的基础上加用左甲状腺素钠片,25 mg/d,观察4周,对比治疗前后两组的甲状腺素水平及心功能改善情况.[结果]CHF患者基础甲状腺激素水平低于正常,降低程度与心功能相关.治疗后观察组及治疗组甲状腺水平及心功能均有改善,治疗组改善更为明显.[结论]小剂量甲状腺素可用于老年CHF的治疗.     

Topic-Based,Recent Literature Review on Pulmonary Hypertension

Pulmonary hypertension is a complex condition but a relatively common manifestation of severe cardiopulmonary disease. By contrast, pulmonary arterial hypertension is uncommon and is more prevalent in young women. To better categorize patients and to guide clinical decision-making, 5 diagnostic groups and associated subgroups characterize the spectrum of disease. A multidisciplinary approach to evaluation and treatment is recommended by published guidelines and often entails referral to a designated pulmonary hypertension center. Several key publications during the last couple of years merit review. The PubMed database was searched for English-language studies and guidelines relating to pulmonary hypertension. The following terms were searched, alone and in combination: pulmonary hypertension, pulmonary arterial hypertension, portopulmonary hypertension, and chronic thromboembolic pulmonary hypertension. The focus was on those publications with new information on evaluation and management of pulmonary hypertension between January 1, 2019, and January 31, 2021. Of the subgroups, 2 were of particular interest for this review: portopulmonary hypertension and chronic thromboembolic pulmonary hypertension. Last, available data on the impact of the coronavirus disease 2019 pandemic and newer treatment agents in early trials were selectively reviewed. The review is therefore intended to serve as a practical, focused review of important topics germane to those clinicians caring for patients with pulmonary hypertension.     

Prospectively Electrocardiogram-Gated High-Pitch Spiral Acquisition Mode Dual-Source CT Coronary Angiography in Patients with High Heart Rates: Comparison with Retrospective Electrocardiogram-Gated Spiral Acquisition Mode

Objective

To assess the image quality and effective radiation dose of prospectively electrocardiogram (ECG)-gated high-pitch spiral acquisition mode (flash mode) of dual-source CT (DSCT) coronary angiography (CTCA) in patients with high heart rates (HRs) as compared with retrospectively ECG-gated spiral acquisition mode.

Materials and Methods

Two hundred and sixty-eight consecutive patients (132 female, mean age: 55 ± 11 years) with mean HR > 65 beats per minute (bpm) were prospectively included in this study. The patients were divided into two groups. Collection was performed in group A CTCA using flash mode setting at 20-30% of the R-R interval, and retrospectively ECG-gated spiral acquisition mode in group B. The image noise, contrast-to-noise ratio (CNR), image quality scores, effective radiation dose and influencing factors on image quality between the two groups were assessed.

Results

There were no significant differences in image quality scores and proportions of non-diagnostic coronary artery segments between two groups (image quality scores: 1.064 ± 0.306 [group A] vs. 1.084 ± 0.327 [group B], p = 0.063; proportion of non-diagnostic coronary artery segments: segment-based analysis 1.52% (group A) vs. 1.74% (group B), p = 0.345; patient-based analysis 7.5% (group A) vs. 6.7% (group B), p = 0.812). The estimated radiation dose was 1.0 ± 0.16 mSv in group A and 7.1 ± 1.05 mSv in group B (p = 0.001).

Conclusion

In conclusion, in patients with HRs > 65 bpm without cardiac arrhythmia, the prospectively high-pitch spiral-acquisition mode with image-acquired timing set at 20-30% of the R-R interval provides a similar image quality and low rate of non-diagnostic coronary segments to the retrospectively ECG-gated low-pitch spiral acquisition mode, with significant reduction of radiation exposure.     

222例冠心病的血液流变学观察

本文作者对 ２２２例冠心病进行血液流变学各项指标测定，并与正常健康人 ４０例作对照分析，结果冠心病患者在血液粘滞性，红血球聚集性及血液凝固性等各方面都有非常明显的变化，说明血流变指标的升高可作为冠心病诊断的重要参考。其中７４例使用蝮蛇抗栓酶治疗在用药前后进行血流变各项指标检测，除血小板计数外，其余各项指标用药前后有明显差异或非常明显差异，说明蝮蛇抗栓酶有解聚，降粘、除纤、抗凝、溶栓等作用。     

M-mode magnetic resonance imaging: a new modality for assessing cardiac function

Summary. Magnetic resonance imaging (MRI) studies of the heart have been used for some years, but there are few tools available to quantify cardiac motion. A method has been developed that creates an M-mode MRI image, analogous to the one used in echocardiography, to display motion along a line as a function of time. The M-mode image is created from MRI images acquired with an ordinary gradient echo cine sequence. In a cinematographic display of the images, a cursor line can be positioned in order to determine the orientation of the measurement. A resampling algorithm then calculates the appearance of the M-mode image along the cursor line. The MRI method has been compared to echocardiographic M-mode in a phantom study and by measuring mitral and tricuspid annulus motion in 20 normal subjects. The phantom study showed no significant differences between MRI and echocardiographic M-mode measurements (difference mm). The annulus motion exhibits a similar pattern using both methods and the measured amplitudes are in close agreement. M-mode MRI provides similar information to echocardiography, but the cursor line can be placed arbitrarily within the image plane and the method is thus not limited to certain acoustic windows. This makes M-mode MRI a promising technique for assessing cardiac motion.     

Assessment of the Chronotropic Response at the Anaerobic Threshold: An Objective Measure of Chronotropic Function

MEINE, M., et al. : Assessment of the Chronotropic Response at the Anaerobic Threshold: An Objective Measure of Chronotropic Function. The evaluation of the heart rate response to exercise is important for the diagnosis of chronotropic incompetence and the assessment of a rate responsive algorithm of sensorcontrolled pacemakers. The aim of the present study was to examine a classification of the chronotropic response at an individually moderate exercise level. Sixteen pacemaker patients (patient group, age 62.9 ± 7.6 years ) with sick sinus syndrome and 15 age‐matched healthy subjects (control group, age 57.6 ± 9.4 years ) underwent a maximum cardiopulmonary exercise test on a treadmill after a protocol with individually selected incremental steps. To analyze the patients' intrinsic heart rate response, the rate responsive mode of the pacemaker was switched off. Chronotropic incompetence was diagnosed in eight patients whose maximal heart rate was < 80% of the age‐predicted heart rate. The heart rate at the anaerobic threshold was significantly lower in the chronotropically incompetent subgroup than in the chronotropically competent patients and the healthy subjects (85.9 ± 6.6 beats/min vs 100.3 ± 9.9 beats/min and 112.9 ± 11.7 beats/min , respectively). The chronotropic slope of the heart rate reserve as a function of the metabolic reserve was significantly higher in the control group than in the patient groups with either mild or severe chronotropic incompetence (0.94 ± 0.17 vs 0.64 ± 0.08 and 0.43 ± 0.14 , respectively). Furthermore, the chronotropically incompetent response could be divided into a linear type with and without a threshold, an exponential, and a logarithmic type. The anaerobic threshold was an objectively detectable breakpoint at an individually moderate exercise level that could be used for characterization of chronotropic function. At the anaerobic threshold, a physiological heart rate response was about 220 ‐ age – 50 beats/min. A deviation of more than 10 beats/min below this physiological value characterized chronotropic incompetence.     

Cardiac rehabilitation knowledge in patients with coronary heart disease in Baoding city of China: A cross-sectional study

ObjectiveThe purpose of this study is to assess the awareness on cardiac rehabilitation (CR) in patients with coronary heart disease (CHD).MethodsInpatients diagnosed with coronary heart disease were recruited from 3 hospitals in this study. The study employed a cardiac structured questionnaire to assess respondents' level of awareness, and bivariate to analyze the sociodemographic factors that influence the awareness on CR.ResultsOf all 500 participants, 66.40% were male and the mean age was 62.51 $\pm$ 9.96 years. The mean score of knowledge was 44.00 $\pm$ 17.00 (score range: 0–93), and the mean level of awareness was 47.31% (awareness range: 0–100%). The highest mean level of awareness was in the reexamination subscale (98%) and the lower were in the basic information about CR program, SP optimized medication and heart rate subscale. Bivariate analysis showed that higher age was associated with less knowledge. Patients with higher education level and better income status had better knowledge. And patients who lived in rural and had no jobs had less knowledge.ConclusionsThis study showed low levels of awareness on CR program in CHD patients in Baoding. Therefore, the need for health education is indicated in this study to improve the awareness on CR among CHD patients.     

von Willebrand factor, endothelial dysfunction, and cardiovascular disease

von Willebrand factor (VWF), a glycoprotein involved in arterial thrombus formation, is released into the circulation by secretion from endothelial cells. Plasma VWF levels are determined by genetic factors including ABO blood groups and VWF mutations, and by non-genetic factors including aging, impaired nitric oxide production, inflammation, free radical production and diabetes. Plasma VWF levels have been proposed as a risk factor for cardiovascular events. Although they are only weakly associated with the risk of coronary heart disease (CHD) in the general population, they are a more promising CHD risk factor in high-risk populations with previous cardiovascular events, diabetes or old age. However, is it still unclear whether VWF levels directly determine the rate and severity of arterial thrombus formation or whether they merely reflect alteration in other endothelial functions. The future status of VWF levels as a cardiovascular risk factor depends on additional studies on the genetic determinants of both VWF levels and cardiovascular outcomes. Further studies on VWF levels as a predictor of the risk of stroke (rather than CHD) in elderly or other high-risk population are also promising. Such studies could lead to the clinical use of plasma VWF levels to refine the estimation of the cardiovascular risk and of the expected benefit of antithrombotic agents.