Plasma hemoglobin concentration was related to estimated glomerular filtration rate in elderly patients with ischemic Cardiomyopatny

Objectlves To stuaythe relationship between plasma hemoglobin concentration and estimated glomerular filtration rate (eGFR)in elderly patients with ischemic cardiomyopathy (ICM).Methods Clinical data of patients with coronary heart disease who weredischarged from The First Affiliated Hospital,Chongqing Medicai University between 2005 and 2007 were analyzed retrospectively.Echocardiography resuIts.plasma hemoglobin and creatinine concentration were abstracted from the medical records.The study included235 Chinese Han patients with age 60 years and older with angiography confwmed coronary heart disease.silent myocardial ischemia orangina pectoris,of whom 154 had ICM defined as left ventricular end-diastolic diameter(LVDd),male≥56mm,female≥51 mm(63.51±7.70 mm)measured by M-mode echocardiography.The differences in plasma hemoglobin concentration were analyzed retrospec-were no significant changes in plasma hemoglobin concentration and eGFR;however,plasma hernoglobin concentration was related toeGFR significantly positively in elderly patients with ICM due to coronary heart disease.     

Plasma hemoglobin concentration was related to estimated glomerular filtration rate in elderly patients with ischemic cardiomyopathy

Objectives To study the relationship between plasma hemoglobin concentration and estimated glomerular filtration rate （eGFR） in elderly patients with ischemic cardiomyopathy （ICM）.Methods Clinical data of patients with coronary heart disease who were discharged from The First Affiliated Hospital,Chongqing Medical University between 2005 and 2007 were analyzed retrospectively. Echocardiography results,plasma hemoglobin and creatinine concentration were abstracted from the medical records.The study included 235 Chinese Hart patients with age 60 years and older with angiography confirmed coronary heart disease,silent myocardial ischemia or angina pectoris,of whom 154 had ICM defined as left ventricular end-diastolic diameter （LVDd）,male≥56 mm,female≥51 mm （63. 51±7.70 mm） measured by M-mode echocardiography.The differences in plasma hemoglobin concentration were analyzed retrospec- tively between patients with and without ICM,and between patients with an eGFR<60 ml·min^-1·1.73m^-2 and those with an eGFR≥60 ml·min^-1·1.73m^-2.Results There were no significant differences in plasma hemoglobin concentration and eGFR between ICM and non-ICM group (118.49±20.52 g·L^-1 vs.115.80±23.32 g·L^-1 and 75.13±24.21 ml·min^-1·1.73m^-2 vs.79.09±28.41 ml·min^{- 1}·1.73m^-2,respectively,both P>0.05).However,in both ICM and non-ICM groups,plasma hemoglobin concentration was lower in those with an eGFR<60 ml·min^-1·1.73m^-2 compared with compared with those with an eGFR≥60 ml·min^-1·1.73m^-2 group (112. 29±18.61 g·L^-1 vs.119.92±20.74L^-1,P<0.05);plasma hemoglobin concentration was related positively to eGFR.Conclusions There were no significant changes in plasma hemoglobin concentration and eGFR;however,plasma hemoglobin concentration was related to eGFR significantly positively in elderly patients with ICM due to coronar     

Warfarin and Uric Acid after Myocardial Infarction

ABSTRACT In order to assess the influence of warfarin on serum urate concentration, changes in serum urate were studied in 50 patients after myocardial infarction. The patients studied were part of a prospective, randomized placebo-controlled study of warfarin after myocardial infarction. Twenty-three of the patients were treated with warfarin and 27 received placebo. The mean uric acid level fell in both groups during an average of 10 months (range 6-20 months), the reduction being of the same order of magnitude in either group. This implies that warfarin, in contrast to some other oral anticoagulants, does not exert any uric acid lowering effect.     

血尿酸与冠心病的关系及其机制的研究进展

尿酸是人体内嘌呤代谢的终产物,目前认为血尿酸与冠心病的发生发展及转归密切相关。现就血尿酸与冠心病关系的研究进展作一综述。     

血清尿酸水平与冠状动脉粥样硬化性心脏病

冠状动脉粥样硬化性心脏病的危险因素众多,对于已明确的可控因素,应积极干预,对新的危险因素的探讨,有利于对冠状动脉粥样硬化性心脏病的早期干预治疗。该文对血清尿酸水平与血压、血糖、胰岛素抵抗、肥胖等冠状动脉粥样硬化性心脏病危险因素的关系及其是否为冠状动脉粥样硬化性心脏病的独立危险因素进行综述。     

心肌代谢药物治疗缺血性心脏病的研究进展

近年来通过改变心肌代谢发挥抗心绞痛作用的一类药物受到关注。这类代谢药物主要通过诱导游离脂肪酸代谢向葡萄糖代谢的转换,从而增加单位氧耗生成三磷酸腺苷供能物质的量而发挥抗心绞痛作用。适用于冠心病、肥厚型心肌病、非手术主动脉狭窄和慢性心力衰竭心肌缺血的治疗。代谢药物有可能成为缺血性心脏病患者药物治疗新的选择。现对4种心肌代谢药物进行综述。     

血清尿酸和总胆红素水平与冠心病的相关性研究

目的：探讨血尿酸、总胆红素水平与冠心病的关系。方法：回顾性分析204例行选择性冠状动脉造影的病人，按冠状动脉狭窄程度分为对照组、单支组、双支组和多支病变组，分析不同组别血尿酸、总胆红素的差异及其与冠状动脉病变程度的相关性。结果：冠心病各亚组血尿酸明显高于对照组（p〈0．01），总胆红素水平明显低于对照组（p〈0．01）。血尿酸随冠状动脉病变程度的加重而增高，与之呈正相关（p〈0．01），总胆红素水平随冠状动脉病变程度的加重而降低，与之呈负相关（p〈0．01）。Logistic回归分析显示冠心病的发病与血尿酸、总胆红素有关。结论：血尿酸升高、总胆红素降低与冠心病严重程度密是冠心病疾病的独立危险因素。     

丹参酮ⅡA磺酸钠注射液对冠心病病人血尿酸水平的影响

目的观察应用丹参酮ⅡA磺酸钠注射液治疗1周及2周后冠心病病人血尿酸水平的变化。方法将330例冠心病病人分为治疗组与对照组。治疗组234例,其中无症状高尿酸血症病人109例,为1组,血尿酸水平正常者125例,为2组;对照组96例,其中无症状高尿酸血症病人42例,为3组,血尿酸水平正常者56例,为4组。所有病人入院当日或次日测量静脉血尿酸水平,1周后及2周后分别复查静脉血尿酸水平。比较治疗前后各组血尿酸水平的变化。结果各组病人治疗1周及2周后尿酸水平均有下降,1组下降最明显,与其他3组比较差异有统计学意义(P<0.05或P<0.01)。结论丹参酮ⅡA磺酸钠注射液对无症状高尿酸血症的冠心病病人有降低血尿酸水平的作用。     

Silent myocardial ischemia: prognostic significance and therapeutic implications

Evidence is now accumulating which strongly suggests that prognosis of patients with painless myocardial ischemia determined either by ambulatory ECG monitoring or exercise testing may be no different than the prognosis of patients who have overt clinical manifestations of myocardial ischemia associated with transient ischemic ECG changes. In my view the goal of therapy for patients with clinical manifestations of coronary artery disease should be the elimination of myocardial ischemia. Medical therapy, coronary angioplasty, or coronary artery surgery should be rendered and then followed by objective documentation of therapeutic efficacy.     

老年冠心病无症状心肌缺血患者预后的相关因素分析

目的探讨冠心病无症状心肌缺血(SMI)老年患者相关临床特征和再发心脏事件的关系,评价其对预后的影响。方法随访216例老年冠心病SMI患者2~7(平均5.01)年。记录年龄、性别、高血压、糖尿病、高脂血症、吸烟、心肌梗死病史、室性心律失常、左室肥厚、SMI持续时间、ST段压低程度等临床特征和动态心电图参数,并记录心肌梗死和心源性死亡发生情况。结果共有27例患者出现心肌梗死或心源性死亡,7年累积再发心脏事件率为14.54%。Cox多因素分析表明,年龄、左室肥厚、心肌梗死病史和高脂血症是再发心脏事件的独立危险因素。结论积极消除或减轻上述危险因素,将有助于改善这些患者的预后。     

动态心电图对无症状性心肌缺血的诊断价值

目的评价动态心电图在无症状性心肌缺血中的诊断价值及临床意义方法对60例确诊为冠心病的患者进行24h动态心电图检查,记录其ST段压低阵数及当时有无自觉症状和持续时间,并进行比较。结果有缺血型ST段改变者56例,占91%,其中有症状者18例,占30%,无症状者42例,占70%,ST段压低共160阵,有症状19阵,占31%,无症状者41阵,占69%。结论冠心病时无症状性心肌缺血十分常见。动态心电图提高了其检出率,对评估无症状性心肌缺血的预后有更重要的意义。     

Nocturnal myocardial ischemic events and sleep-disordered breathing in patients with coronary artery disease

Objective To investigate the occurrence of nocturnal myocardial ischemia and its relationship with sleep-disordered breathing(apneas and oxygen desaturations)in patients with angina pectoris undergoing coronary an-giography.Methods Eighty-two men and 14 women referred for consideration of coronary intervention wererandomly selected.Observation by an overnight sleep monitor and Holter recording were performed to studysleep-disordered breathing(oxyhemoglobin desaturations≥4% and apnea-hypopneas),heart rates,and ST-seg-ment depressions(≥1mm,≥1 min).Results Nocturnal ST-segment depressions occurred in 37% of thepatients.ST-segment depression within 2 min after an apnea-hypopnea or desaturation occurred in 17% of thepatients.This temporal association was seen in 21% of the patients with nocturnal ST-segment depressions,morefrequendy in men(P<0.05)and more frequently in those with severe disordered breathing(P<0.05).Mostof these ST-segment depressions were preceded by a series of breathing events:repeated apnea-hypopneas or de-saturations or both in 73% of the patients.Conclusions Episodes of nocturnal myocardial ischemia are com-mon in patients with angina pectoris.A temporal relationship between sleep-disordered breathing and myocardialischemia was present in some of our patients,and occurs more frequently in men and in those with severely dis-ordered breathing.(J Geriatr Cardiol 2004;1(2):90-94.)     

Prevalence,characteristics, and risk stratification of electrocardiographic and symptomatic silence of myocardial ischemia despite scintigraphically evidenced ischemia in symptomatic patients presenting with severe coronary artery stenosis

Symptoms of angina pectoris and transient ST-segment depression are most commonly used to evidence acute myocardial ischemia during exercise testing. However, the diagnostic accuracy of either or both criteria in relation to clinical characteristics and the patient's exercise response has been a subject of controversy. The prevalence and severity of symptoms of angina pectoris and/or ST-segment depression were studied prospectively in 147 consecutive patients with a history of daily angina pectoris, scintigraphic evidence of exercise-induced myocardial ischemia, and coronary artery stenosis >75%. Logistic regression analysis was applied to determine absence of any or both criteria by the clinical characteristics or exercise response of the patient. During exercise testing, ST-segment response failed to prove scintigraphically evidenced myocardial ischemia in 14/147 patients (10%) and 35/147 patients (24%) when ST-segment depression ≥0.1 in either ≥1 or ≥2 ECG leads was chosen. Symptoms of angina pectoris were found to be absent in 69/147 patients (47%). Only 58 patients (40%) suffered from angina and met the ECG criterion at the time of scintigraphic myocardial ischemia. Absence of ST-segment depression was best predicted by clinical variables such as large myocardial infarction (increase: 2.6 times, p = 0.007), number of stenoses ≥2 (2.0 times, p = 0.023), and presence of diabetes mellitus (4.3 times, p = 0.035). Painless myocardial ischemia was only determined by blood response to exercising. Thus, a double product > 23 increased the risk of painless myocardial ischemia by 1.5 times (p = 0.017). In multivariate analysis, only blood pressure response, infarction size, and the number of diseased vessels were found to be independent predictors of the absence of angina pectoris or ST-segment depression during myocardial ischemia.     

血尿酸和胆红素与冠心病关系的探讨

目的研究冠心病病人血尿酸和血胆红素水平的变化,探讨其与冠心病发生、发展的关系.方法 108例病人经冠状动脉造影分为冠心病组(53例)和非冠心病组(55例),入院后次日晨空腹抽取静脉血,检测血尿酸和血胆红素水平.结果冠心病组病人血尿酸水平明显升高(P<0.05),总胆红素与间接胆红素水平显著降低,但直接胆红素水平无明显差异.结论血尿酸水平升高和血胆红素浓度降低与冠心病相关,早期干预有可能预防心血管事件的发生.     

The Effect of Mibefradil on Ischemic Episodes With and Without Increase in Heart Rate

Myocardial ischemia during daily life can be induced by increased demand and by increased coronary tone. The purpose of this study was to assess the mechanism of action of mibefradil, a new T-channel calcium blocker that is a vasodilator with negative chronotropic properties. Included in this study were 114 patients with chronic stable angina pectoris and ischemic episodes during baseline 48-hour ambulatory ECG monitoring (AEM). After a placebo run-in period patients received 50 mg, 100 mg, or 150 mg of mibefradil per day and repeat 48 hours AEM was performed. Ischemic episodes were divided into 2 categories: Type I is those in which an increase in heart rate >10% preceded the development of 1 mm ST depression; Type II is those with 10% increase in heart rate. Of the 625 ischemic episodes recorded at baseline, 83% were Type I and 17% were Type II. At 50 mg mibefradil dose, there was a significant decrease in the number of Type I ischemic episodes but not of Type II. At doses of 100 mg and 150 mg/day, there was a significant decrease in frequency of both Types of ischemic episodes. At a low dose of 50 mg/day, mibefradil reduces ischemia predominantly by preventing an increase in heart rate, while at higher doses of 100 mg and 150 mg/day, it also acted as a vasodilator suppressing episodes associated with increased coronary tone.     

Elevated pain threshold in patients with effort-induced angina pectoris and asymptomatic myocardial ischemia during exercise test

The purpose of the present study was to analyze the prevalence of asymptomatic (silent) myocardial ischemia during exercise testing among patients with effort-induced angina pectoris, and further, to compare the pain threshold of patients with symptomatic and asymptomatic myocardial ischemia. A group of 26 patients comprised the study. In half of the patients myocardial ischemia during the exercise testing was silent and in one half it was symptomatic. Asymptomatic myocardial ischemia was defined as an asymptomatic ST-segment depression greater than or equal to 0.1 mV, lasting longer than 60 s during an exercise test. In patients with asymptomatic ischemia the pain thresholds both on toe and finger were significantly higher than in patients with symptomatic ischemia: mean values were 10.1 versus 4.9 mA on the toes, p less than 0.025, and 8.4 versus 2.5 mA on the fingers, p less than 0.01. We conclude that asymptomatic myocardial ischemia during exercise test is seen often in patients with angina pectoris and that this may be due to an increased pain threshold.     

Long-term results of coronary artery bypass surgery for unstable angina: incidence of mortality,myocardial infarction,and angina resumption

To determine if routine treadmill testing would be helpful in identifying patients at high risk for subsequent events, the first 81 patients to undergo coronary artery bypass0 surgery for unstable angina pectoris at Stanford University Medical Center were reevaluated at four intervals after surgery. Evaluations, including assessment of angina pectoris and a treadmill test, were done at mean times of 18,40, and 72 months after surgery. At a mean time of 90 months postoperatively, angina status was determined in survivors. The prevalence of angina rose from 19% during the first year to 53% during the fourth and fifth postoperative years. Cardiac deaths and myocardial infarctions were frequent during the first postoperative year, and were more frequent in patients with three-vessel disease and those with one or more severely narrowed coronary arteries which were not bypassed. Cardiac events were rare between 12 and 36 months after operation; clinical and treadmill variables did not predict these events. During the fourth and subsequent postoperative years, the incidence of cardiac events increased. While the presence of stable angina pectoris was the clinical variable most useful prognostically, treadmill testing added additional independent prognostic information (p<0.0001). During the intervals between visits 1 and 2, and visits 2 and 3, cardiac events were ten times more frequent in persons with a maximal heart rate of 130 beats/min or less on the treadmill at 18 and 40 months. We conclude that the prevalence of angina increased steadily during the first 5 postoperative years. Myocardial infarction and cardiac death rates were high during the first postoperative year, low during the second and third postoperative years, and then began to rise thereafter. The early events were more frequent in persons with three-vessel disease and one or more severely narrowed coronary arteries which were unbypassed. The late events were more frequent in persons with a maximal heart rate of 130 beats/min or less on treadmill exercise testing. No other clinical or treadmill variables added additional independent prognostic information.