Gastric bypass surgery is associated with reduced subclinical myocardial injury and greater activation of the cardiac natriuretic peptide system than lifestyle intervention

AimsMorbid obesity is a risk factor for cardiovascular disease. The relative effects of Roux-en-Y gastric bypass surgery (GBS) and intensive lifestyle intervention (ILI) on subclinical myocardial injury, the activity of the cardiac natriuretic system, and systemic inflammation remain unclear.MethodsIn a 59-week non-randomized clinical trial that included 131 patients with morbid obesity, we compared the effects of GBS and ILI on concentrations of cardiac troponin T (cTnT) and I (cTnI), N-terminal pro-B-type natriuretic peptide (NT-proBNP) and C-reactive protein (CRP).ResultsIn the GBS and ILI group, median body mass index (BMI) was reduced by 14.4 kg/m² versus 3.9 kg/m², respectively (p value < 0.001). Cardiac troponins decreased after GBS, p = 0.014 (cTnT) and p = 0.065 (cTnI) and increased significantly in those treated with ILI (p values ≤ 0.021) (between-group differences for deltas: p ≤ 0.003). NT-proBNP increased in both groups, but significantly more in the GBS than in the ILI group (between-group differences for deltas: p = 0.008). CRP decreased significantly within the GBS and the ILI group, with this change significantly greater in the GBS group (between-group differences for deltas p < 0.001). The dominating mediator of the biomarker changes was weight loss. Prior coronary artery disease and diabetes were predictive of the magnitude of the changes in cTnI and NT-proBNP, respectively.ConclusionCompared to ILI, GBS was associated with reduced subclinical myocardial injury and systemic inflammation, and enhancement of the cardiac natriuretic peptide system. The biomarker changes were predominantly mediated by weight loss.     

急性心肌梗死后并发心房颤动患者RDW、ET及NT-proBNP水平变化及其与预后的关系

目的探讨急性心肌梗死后并发心房颤动患者红细胞分布宽度(RDW)、内皮素(ET)及N末端B型脑钠肽前体(NT-proBNP)水平变化及其与预后的关系。方法回顾性分析2016年3月至2018年3月本院收治的106例急性心肌梗死患者[依据患者是否并发心房颤动分为并发组(n=40)及未并发组(n=66)]的临床资料,比较两组临床资料、RDW、ET、NT-proBNP水平及预后情况,分析急性心肌梗死后并发心房颤动及其预后与RDW、ET及NT-proBNP水平的关系。结果并发组TC、左心房内径较未并发组明显扩大,左心室射血分数较未并发组明显降低,并发组RDW、ET及NT-proBNP、不良心血管事件发生率较未并发组明显升高,差异有统计学意义(P <0. 05);未发生心血管事件组LDLC、RDW、ET及NTproBNP较发生心血管事件组明显降低,差异有统计学意义(P <0. 05); RDW、ET及NT-proBNP是急性心肌梗死患者不良心血管事件发生的影响因子(OR=2.591、2.220、1.657,95%CI=1.311～5.153、1.132～4.350、1.058～2.027,P<0.05);急性心肌梗死患者左心房内径与RDW、ET及NT-proBNP呈明显正相关(P<0.05),左心室射血分数与RDW、ET及NTproBNP呈明显负相关(P<0.05)。结论急性心肌梗死后并发心房颤动及其不良预后发生与RDW、ET及NT-proBNP水平升高密切相关,三者在评估急性心肌梗死患者心房颤动及预后中有一定临床意义。     

STEMI患者PCI术后一年内发生MACE的危险因素分析

目的 探讨急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者经皮冠状动脉介入治疗(percutaneous coronary Intervention,PCI)后1年内发生主要不良心血管事件(major adverse cardiovascular events,MACE)的危险因素。方法 回顾性分析2018年11月至2019年11月在延安大学附属医院诊断为急性STEMI并接受急诊PCI的患者,收集临床资料及实验室数据,通过电话及门诊等方式按照1个月、3个月、6个月、12个月随访1年,记录MACE发生情况。根据是否发生MACE,将患者分为MACE组(66例)和非MACE组(94例)。使用t检验、 χ²检验、Logistic回归等统计学方法对数据进行分析。结果 经过1年随访,共随访到160例患者,其中66例患者发生MACE,发生率为41.5％。Logistic回归分析显示:NYHA心功能分级≥3级、吸烟、高血脂症、糖尿病、PLT及血清NT-proBNP、Scr、IMA(OR:1.010～4.197,均P＜0.05)水平是STEMI患者PCI术后发生MACE的危险因素,其中高脂血症(B=1.258;OR=1.279;95%CI:1.137～1.567)、NT-proBNP水平(B=0.972;OR=4.197;95%CI:1.973～10.362)、吸烟(B=0.846;OR=2.330;95%CI:1.125～4.824)是主要危险因素。结论 高脂血症、NT-proBNP、吸烟是STEMI患者急诊PCI术后MACE的主要危险因素。     

硝普钠联合米力农治疗心力衰竭患者的临床疗效及对IL-6、血浆NT-proBNP水平的影响

目的研究硝普钠联合米力农治疗心力衰竭(HF)患者的疗效及对患者IL-6、血浆NT-proBNP水平的影响。方法选取2018年12月至2020年6月我院收治的HF患者198例,随机分为观察组和对照组,每组各99例。对照组采用硝普钠治疗,观察组在此基础上联合米力农治疗,比较两组临床疗效、心功能指标、血清IL-6、TNF-α水平及不良反应发生情况。结果观察组临床治疗总有效率为94.95%,高于对照组的84.85%,差异有统计学意义(P0.05)。治疗前两组LVEF、LVEDd、NT-proBNP、6MWT指标比较,差异无统计学意义(P0.05);治疗后两组上述心功能指标均有所改善,观察组LVEF为(46.77±3.29)%、LVEDd为(57.46±1.24)mm、NT-proBNP为(328.64±15.88)pg/mL、6MWT为(372.64±16.79)min,明显优于对照组的(41.23±4.35)%、(58.76±0.64)mm、(672.97±16.79)pg/mL、(342.88±14.28)min,差异有统计学意义(P0.05)。治疗前两组血清IL-6、TNF-α水平比较,差异无统计学意义(P0.05);治疗后两组血清IL-6、TNF-α水平较治疗前下降,观察组IL-6为(1130.42±17.88)ng/L、TNF-α为(209.43±4.35)ng/L,均低于对照组的(1324.56±16.49)ng/L、(232.47±4.22)ng/L,差异有统计学意义(P0.05)。观察组不良反应总发生率为6.06%,低于对照组的18.18%,差异有统计学意义(P0.05)。结论硝普钠联合米力农对HF患者疗效好,能改善患者心功能、降低NT-proBNP及IL-6水平,不良反应总发生率低,具有较高的安全性。     

基于机器学习算法的NT-proBNP灰值患者心力衰竭判别模型评价

目的应用机器学习算法构建氨基末端脑钠尿肽（N-terminal pro-brain natriuretic peptide, NT-proBNP）灰值患者心力衰竭判别模型并评价。方法收集2013年1月至2018年12月在上海市浦东新区公利医院进行NT-proBNP实验室检测的患者临床资料和实验室检测信息,数据清洗后纳入研究对象,并按7∶3的比例划分训练集和测试集。用L1范数正则化和递归特征消除方法对特征进行筛选。应用基于机器学习的Logistic回归、随机森林、梯度提升树和XGBoost算法构建模型,比较4种方法构建的模型对NT-proBNP灰值患者心力衰竭判别价值。结果按重要性筛选出模型因子年龄、性别、肌酸激酶同工酶、肌酐、肌红蛋白、肌钙蛋白Ⅰ、血红蛋白、白细胞计数。Logistic回归、随机森林、梯度提升树和XGBoost四种模型灵敏度分别为58.42%、56.83%、65.74%和60.04%;特异度分别为57.47%、68.18%、60.13%、65.93%。结论基于机器学习建立的NT-proBNP灰值患者心力衰竭判别模型有一定临床价值,本研究结果应用价值有待于更大样本进行验证。     

升陷汤隔药灸治疗气虚血瘀型慢性心力衰竭的疗效及对患者血清NT-proBNP、炎症因子的影响

目的:观察升陷汤隔药灸治疗气虚血瘀型慢性心力衰竭的临床疗效及对患者血清N末端B型脑钠肽原(NT-proBNP)、炎症因子的影响。方法:将116例气虚血瘀型慢性心力衰竭患者随机分为对照组和治疗组,每组58例;对照组患者接受规范西药治疗(螺内酯片、盐酸贝那普利片、富马酸比索洛尔片、地高辛片),治疗组患者在对照组的基础上接受升陷汤隔药灸治疗,疗程为6周。观察患者治疗前后Lee氏心衰评分、6 min步行距离、中医证候评分、心脏彩超检查指标,检测NT-proBNP及血清炎症因子,统计临床疗效。结果:治疗组、对照组中医证候疗效总有效率分别为91.38%(53/58)、75.86%(44/58),心功能疗效总有效率分别为93.10%(54/58)、74.14%(43/58),两组患者中医证候疗效、心功能疗效比较,差异均有统计学意义(P<0.05)。治疗后两组患者Lee氏心衰评分、中医证候总评分、血清NT-proBNP、血清炎症因子、LVEDs、LVEDd、IVSd、LVMI均较治疗前降低,6 min步行距离、EF均较治疗前增加,差异均有统计学意义(P<0.05);治疗组患者治疗后Lee氏心衰评分、中医证候总评分、血清NT-proBNP、血清炎症因子、LVEDs、LVEDd、IVSd、LVMI均低于对照组,6 min步行距离、EF均高于对照组,差异均有统计学意义(P<0.05)。结论:升陷汤隔药灸可明显提高气虚血瘀型慢性心力衰竭患者的临床疗效,改善患者的左心室收缩功能,降低血清NT-proBNP及炎症因子的水平。     

The lowest VE/VCO2 ratio best identifies chronic thromboembolic pulmonary hypertension

Introduction

The natural history of acute pulmonary embolism (PE) under treatment is about a gradual resolution of the thrombi, and uncommonly, the development of chronic thromboembolic pulmonary hypertension (CTEPH). We hypothesized that ventilatory efficiency parameters during cardiopulmonary exercise testing (CPET) may be able to monitor the process and predict CTEPH.

Methods

15 patients rehabilitated from acute PE (total resolution of thrombi), 44 patients with chronic PE (with residual thrombi), 66 patients with CTEPH, and 36 sedentary healthy controls performed incremental CPET.

Results

The lowest VE/VCO₂ was higher in CTEPH patients than that in chronic PE and rehabilitated patients (43.4 L/min vs 29.9 L/min vs 27.1 L/min, p < 0.005). The VE/VCO₂ slope (48.4 L/min/L/min vs 29.9 L/min/L/min vs 28.0 L/min/L/min, p < 0.005) and oxygen uptake efficiency plateau (OUEP) (37.1 L/min vs 27.0 L/min vs 25.2 L/min, p < 0.005) had the similar changes. In logistic regression analysis, the lowest VE/VCO₂ ≥ 34.35 L/min was the best predictor of CTEPH (OR 159.0, 95% CI 36.0-702.3, p < 0.001). The lowest VE/VCO₂ was higher in chronic PE patients compared with the controls (29.9 L/min vs 26.5 L/min, p < 0.05), but there was no difference between the rehabilitated patients and the controls. In multiple linear regression analysis, the percentage of vascular obstruction by ventilation-perfusion lung scanning (PVO) was the most significant independent predictor for indices of ventilatory efficiency in chronic PE and rehabilitated patients.

Conclusions

CTEPH is associated with weakened ventilatory efficiency. The lowest VE/VCO2 ratio has the best capability to predict CTEPH. Ventilatory inefficiency improves along with recovery of acute PE.     

心脏康复模式对慢性心力衰竭患者心肺储备功能、生活质量及NT-proBNP水平的影响

目的探讨应用心脏康复模式对慢性心力衰竭患者心肺储备功能、生活质量及血清标志物N末端脑钠肽前体(NTproBNP)水平的影响。方法选取2013年4月至2015年4月该院心内科诊治的98例慢性心力衰竭患者为研究对象,按随机数字表法将患者分为对照组和心脏康复组,每组各49例。对照组患者予以常规慢性心力衰竭治疗与护理,康复组则在此基础之上分别予以强化心脏康复模式的干预方案,比较两组患者心肺储备功能、生活质量和NT-proBNP水平的变化。结果干预后,康复组患者心力衰竭相关知识的掌握率、去除高危因素重要性的知晓率较干预前显著提高(P0.05),对照组与干预前比较差异无统计学意义(P0.05);且康复组患者心力衰竭发生次数和间隔时间均显著优于对照组(P0.05),但两组患者并发症的发生率比较,差异无统计学意义(P0.05);干预后两组患者的生活质量评分均显著升高,且康复组患者生活质量各项指标得分值的增加幅度显著优于对照组(P0.05);康复组心肺功能指标左心室收缩期末容量(LVESV)、左心室舒张期末容量(LVEDV)、左心室射血分数(LVEF)和最大通气量(MVV)均较干预前明显增加,且4项指标的改善水平均显著高于对照组(P0.05);而其他指标干预前后差异无统计学意义(P0.05);另外,干预后两组患者NT-proBNP水平均显著下降,且康复组的降低幅度较对照组更为明显(P0.05)。结论心脏康复模式可明显提高慢性心力衰竭患者对疾病相关知识的掌握,降低复发率,延长间隔时间,提高生活质量,改善患者的心肺储备功能和NT-proBNP水平。