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1.
Benjamin Laliberte Brent N. Reed Sandeep Devabhakthuni Kristin Watson Vijay Ivaturi Tao Liu Stephen S. Gottlieb 《Journal of cardiac failure》2017,23(10):746-752
Background
Heart failure (HF) is associated with high 30-day readmission rates and places significant financial burden on the health care system. The aim of this study was to determine if the duration of observation on an oral loop diuretic before discharge is associated with a reduction in 30-day HF readmission in patients with acute decompensated HF (ADHF).Methods and Results
This was a retrospective study of adult patients admitted for ADHF at a large academic medical center. A total of 123 patients were included. Baseline characteristics were similar between groups. The primary outcome of 30-day HF readmission occurred in 11 of 61 patients (18%) observed on an oral loop diuretic for <24 hours and in 2 of 62 patients (3.2%) observed on an oral loop diuretic for ≥24 hours (P?=?.023). Readmissions for 60- and 90-day HF were also significantly lower in patients observed for ≥24 hours (P?=?.014 and P?=?.049, respectively). Associations became stronger after multivariate analysis (P?<?.001). Observation for <24 hours and previous admission within 30 days were independent predictors of 30-day HF readmission (P?=?.03).Conclusions
Observation of patients on an oral loop diuretic for <24 hours was associated with significantly higher 30-day HF readmission. Therefore, observation on an oral loop diuretic for ≥24 hours before discharge in patients presenting with ADHF should be strongly considered. 相似文献2.
Kevin Damman Serge Masson Donata Lucci Marco Gorini Renato Urso Aldo P. Maggioni Luigi Tavazzi Luigi Tarantini Gianni Tognoni Adriaan Voors Roberto Latini 《Journal of cardiac failure》2017,23(1):2-9
Background
Data on the natural change in renal function in patients with chronic heart failure (HF) are limited.Methods and Results
Estimated glomerular filtration rate (eGFR) was assessed over 36 months in 6934 patients included in the GISSI-HF study. Associations from baseline, changes in renal function, and occurrence of cardiovascular death or HF hospitalization were assessed. Mean age was 67 years, mainly men (78%), and mean eGFR was 68?mL???min?1???1.73?m?2. Change in eGFR in the 1st year was ?1.5?±?16?mL???min?1???1.73?m?2, and over 36 months it was ?3.7?±?18?mL???min?1???1.73?m?2. Over the latter period, only 25% deteriorated ≥1 Kidney Disease Outcomes Quality Initiatives (KDOQI) class of chronic kidney disease (CKD). Fifteen percent of patients had >15?mL???min?1???1.73?m?2 decrease in eGFR in the 1st 12 months. Lower eGFR was associated with outcome: hazard ratio (HR) 1.10, 95% confidence interval (CI) 1.08–1.10 (P?<?.001) per 10?mL???min?1???1.73?m?2 decrease, as well as every 10?mL???min?1???1.73?m?2 decrease over the 1st year (HR 1.10, 95% CI 1.04–1.17; P?<?.001). A deterioration in eGFR >15?mL???min?1???1.73?m?2 in the 1st year showed the highest risk of events (HR 1.22, 95% CI 1.10–1.36; P?<?.001).Conclusions
Mean decrease in renal function over time in patients with chronic HF was modest. Only 25% deteriorated ≥1 KDOQI class of CKD after 3 years. Any decrease in eGFR over time was associated with strongly increased event rates. 相似文献3.
Merrick Miles Bret D. Alvis Kyle Hocking Franz Baudenbacher Christy Guth Joann Lindenfeld Colleen Brophy Susan Eagle 《Journal of cardiac failure》2018,24(8):525-532
Background
To determine the feasibility of peripheral intravenous volume analysis (PIVA) of venous waveforms for assessing volume overload in patients admitted to the hospital with acute decompensated heart failure (ADHF).Methods
Venous waveforms were captured from a peripheral intravenous catheter in subjects admitted for ADHF and healthy age-matched controls. Admission PIVA signal, brain natriuretic peptide, and chest radiographic measurements were related to the net volume removed during diuresis.Results
ADHF patients had a significantly greater PIVA signal on admission compared with the control group (P?=?.0013, n?=?18). At discharge, ADHF patients had a PIVA signal similar to the control group. PIVA signal, not brain natriuretic peptide or chest radiographic measures, accurately predicted the amount of volume removed during diuresis (R2?=?0.781, n?=?14). PIVA signal at time of discharge greater than 0.20, demonstrated 83.3% 120-day readmission rate.Conclusions
This study demonstrates the feasibility of PIVA for assessment of volume overload in patients admitted to the hospital with ADHF. 相似文献4.
Purpose
We hypothesized that heart period (HP) variability in the low frequency (LF) band is due to transient fluctuations of about 10?s in HP sequences, associated with fluctuations in blood pressure.Methods
10 healthy subjects, mean age 36?y, had HP and blood pressure acquired for 10?min each. Nonrandom HP fluctuations (ripples) lasting 6.7–20?s were detected using time-scrambled surrogate sequences as controls.Results
Ripples were 99?±?40?ms in amplitude, in concatenates 23.4?±?7.4?s long. They co-occurred with similar blood pressure ripples with amplitudes 5?±?5?mm?Hg, correlating with them with r2?=?0.68?±?0.10, slope 23.9?±?10.8?ms/mm?Hg, at an optimum lag of 2.16?±?0.63 beats. A second HP structure consisting of transient tachycardias of 140?±?53?ms lasting 15.1?±?6.1 occurred singly. Together the two structures contributed 84%?±?8% of the total power in the LF band.Conclusion
The LF band is caused by two types of HP structures that occur at discrete times. 相似文献5.
WILLIAM A. M. ESTEVES M.D. LUCAS LODI‐JUNQUEIRA M.D. M.Sc. CIRILO P. FONSECA NETO M.D. TIMOTHY C. TAN M.D. Ph.D. BRUNO R. NASCIMENTO M.D. M.Sc. PRAVEEN MEHROTRA M.D. MARCIA M. BARBOSA M.D. Ph.D. ANTONIO LUIZ P. RIBEIRO M.D. Ph.D. MARIA CARMO P. NUNES M.D. Ph.D. 《Journal of interventional cardiology》2013,26(5):501-508
Objectives
We aimed to explore the relationship between brain natriuretic peptide (BNP) levels and right ventricular (RV) function in patients with mitral stenosis (MS), and to investigate the hemodynamic parameters that predict reduction of BNP levels after percutaneous mitral valvuloplasty (PMV).Background
Few studies have evaluated BNP in the context of MS, specifically the impact of the RV stroke work (RVSW) on serum BNP levels has not been defined.Methods
Thirty patients with symptomatic rheumatic MS in sinus rhythm who were referred for a PMV were enrolled. Right and left heart pressures were obtained before and after valvuloplasty. RVSW index (RVSWI) was calculated by cardiac catheterization.Results
Basal BNP levels were elevated in MS patients and correlated with several hemodynamic parameters including pulmonary pressure, pulmonary vascular resistance index, cardiac index (CI), and RVSWI. In multivariate analysis, CI and RVSWI were independent predictors of raised basal BNP levels. PMV resulted in a significant decrease in the RVSWI with a concurrent increase in CI (2.4 ± 0.43 to 2.9 ± 0.8 L/min/m2, P = 0.010). Overall, plasma BNP levels significantly decreased from 124 (63/234) to 73 (48/148) pg/ml postvalvuloplasty. Multivariate analysis revealed that the reduction of left atrial (LA) pressure post‐PMV was an independent predictor of change in BNP levels.Conclusions
Elevated baseline BNP level in MS patients was independently associated with CI and RVSWI. Plasma BNP levels were reduced after successful PMV, which was associated with the reduction of the LA pressure. (J Interven Cardiol 2013;26:501‐508)6.
Introduction
The administration of loop diuretics in the management of acute decompensated heart failure (ADHF) whether IV boluses or continuous infusion is still controversial. We intended to evaluate differences between the two administration routes on the thoracic fluid content (TFC) and the renal functions.Methods
Sixty patients with ADHF admitted to the critical care medicine department (Cairo University, Egypt) were initially enrolled in the study. Twenty patients were excluded due to EF?>?40%, myocardial infarction within 30?days, and baseline serum creatinine level?>?4.0?mg/dL. Furosemide (120?mg/day) was given to the remaining 40 pts who continued the study after 1:1 randomization to either continuous infusion (group-I, 20 pts) or three equal intermittent daily doses (group-II, 20 pts). Subsequent dose titration was allowed after 24 h, but not earlier, according to patient’s response. No other diuretic medications were allowed. All patients were daily evaluated for NYHA class, urine output, TFC, body weight, serum K+, and renal chemistry.Results
The median age (Q1–Q3) was 54.5 (43.8–63.8) years old with 24 (60%) males. Apart from TFC which was significantly higher in group-I, the admission demographic, clinical, laboratory and co-morbid conditions were similar in both groups. There was statistically insignificant tendency for increased urine output during the 1st and 2nd days in group-I compared to group-II (p?=?.08). The body weight was decreased during the 1st day by 2 (1.5–2.5) kg in group-I compared to 1.5 (1–2) kg in group-II, (p?=?.03). These changes became insignificant during the 2nd day (p?=?.4). The decrease of TFC was significantly higher in group-I than in group-II [10 (6.3–14.5) vs 7 (3.3–9.8)?kΩ?1 during the first day and 8 (6–11) vs 6 (3.3–8.5)?kΩ?1 during the second day in groups-I&II respectively, P?=?.02 for both]. There was similar NYHA class improvement in both groups (p?=?.7). The serum creatinine was increased by 0.2 (0.1–0.5) vs 0 (?0.1 to 0.2)?mg% and the CrCl was decreased by 7.4 (4.5–12.3) vs 3.1 (0.2–8.8)?ml/min in groups-I&II respectively (p?=?.009 and .02 respectively).Conclusions
We concluded that continuous furosemide infusion in ADHF might cause greater weight loss and more decrease in TFC with no symptomatic improvement and possibly with more nephrotoxic effect. 相似文献7.
Anke Schwandt Dominik Bergis Michael Denkinger Katja S.C. Gollisch Dirk Sandig Harald Stingl Stefan Zimny Reinhard W. Holl 《Journal of diabetes and its complications》2018,32(10):940-946
Aims
To investigate risk factors for declining renal function among subjects with type-1-diabetes.Methods
Observational study based on data from the diabetes registry DPV. 4424 type-1-diabetes subjects aged ≥18?years, age at onset <18?years were identified. Modification of Diet in Renal Disease (MDRD) equation was used to estimate glomerular filtration rate (eGFR). Annual rate of renal decline was estimated for each patient using hierarchic linear regression models. Additional regression models were fitted to adjust for covariates.Results
Median age was 26 [Q1; Q3: 21; 39]?years. Annual decline of renal function was ?1.22 (95% CI: ?1.50; ?0.94)?ml/min/1.73?m2. At baseline, higher eGFR was related to more rapid decline compared to impaired or reduced eGFR (GFR?≥?90: ?2.06 (?2.35; ?1.76), 60?≤?GFR?<?90: 0.45 (0.08; 0.81), GFR?<?60: 0.52 (?0.24; 1.29)?ml/min/1.73?m2, p?<?0.01). During follow-up, the highest decline was associated with reduced renal function, whereas the lowest decline was related to normal kidney function (p?<?0.01). Poor metabolic control (p?=?0.04), hypertension (p?<?0.01) and albuminuria (p?=?0.03) were associated with more rapid loss of kidney function. No difference was observed among insulin regimen.Conclusion
Among this large type-1-diabetes cohort, more rapid loss of kidney function was related to higher baseline eGFR, log-term worse metabolic control and diabetic comorbidities. 相似文献8.
Caitlin C. Jorgenson Steven C. Chase Lyle J. Olson Bruce D. Johnson 《Journal of cardiac failure》2018,24(7):479-483
Background
Periodic breathing (PB) is often observed in patients with HF at rest, with sleep and during exercise. However, mechanisms underlying abnormal ventilatory control are not entirely established.Methods
Eleven subjects with HF (10 males, age = 69?±?12?y) and 12 age-matched control subjects (8 males, age = 65?±?9?y) participated in the study. PB was defined as a peak in the 0.003–0.04?Hz frequency range of the flow signal during 6 minutes of awake resting breathing. Thoracic blood volumes (Vt, thorax; Vh, heart; Vp, pulmonary), mean transit times (MTTs), and extravascular lung water (EVLW) were quantified using computerized tomography.Results
PB was observed in 7 subjects with HF and was associated with worse functional status. The HF PB-present group had thoracic blood volumes nearly double those of control and HF PB-absent subjects (volumes reported as mL/m2 body surface area, P values vs control: control = 813?±?246, HF PB-absent = 822?±?161 P?=?.981, HF PB-present = 1579?±?548 P?=?.002). PB was associated with longer pulmonary MTT (control = 6.7?±?1.2 s, HF PB-absent = 6.0?±?0.8 s, HF PB-present = 8.4?±?1.6 s; P?=?.033, HF PB-present vs HF PB-absent). EVLW was not elevated in the PB group.Conclusions
Subjects with HF and PB at rest have greater centralization of blood volume. 相似文献9.
Laura Prohaska Zahra Mahmoudjafari Leyla Shune Anurag Singh Tara Lin Sunil Abhyankar Siddhartha Ganguly Dennis Grauer Joseph McGuirk Lisa Clough 《Hematology/oncology and stem cell therapy》2018,11(4):233-240
Objective/background
Clostridium difficile infection (CDI) is a potential complication during hematopoietic stem cell transplantation (HSCT), and no specific recommendations exist regarding treatment of CDI in allogeneic SCT patients. Use of metronidazole and oral vancomycin has been associated with clinical failure. Fidaxomicin has previously been found noninferior to the use of oral vancomycin for the treatment of CDI, and no studies have compared the use of oral vancomycin with fidaxomicin for the treatment of CDI in allogeneic SCT.Methods
This retrospective chart review included 96 allogeneic SCT recipients who developed CDI within 100?days following transplantation. Participants were treated with oral vancomycin (n?=?52) or fidaxomicin (n?=?44). The primary outcome was clinical cure, defined as no need for further retreatment 2?days following completion of initial CDI treatment. Secondary outcomes were global cure, treatment failure, and recurrent disease.Results
No differences in clinical cure were observed between patients receiving oral vancomycin or fidaxomicin (75% vs. 75%, p?=?1.00). Secondary outcomes were similar between oral vancomycin and fidaxomicin in regards to global cure (66% vs. 67%, p?=?.508), treatment failure (28% vs. 27%, p?=?.571), and recurrent disease (7% vs. 5%, p?=?.747). In a subanalysis of individuals that developed acute graft-versus-host disease following CDI, the difference in mean onset of acute graft-versus-host disease was 21.03?days in the oral vancomycin group versus 32.88?days in the fidaxomicin group (p?=?.0031).Conclusion
The findings of this study suggest that oral vancomycin and fidaxomicin are comparable options for CDI treatment in allogeneic SCT patients within 100?days following transplant. 相似文献10.
Sanjay de Mel Yunxin Chen Adeline Lin Teck Guan Soh Melissa Ooi Eng Soo Yap Lara Kristina Sioco Donato Nurul Aidah Abdul Halim Joanna Mah Karen Lim Li Mei Poon Belinda Tan Hui Li Lim Liang Piu Koh Bee Choo Tai Zhaojin Chen Wee Joo Chng Lip Kun Tan 《Hematology/oncology and stem cell therapy》2018,11(4):225-232
Background
High dose Cyclophosphamide (Cy) and Vinorelbine Cyclophosphamide (Vino-Cy) are stem cell (SC) mobilisation options for patients with multiple myeloma (MM). We present a comparison of mobilisation outcomes using these regimens.Patients and methods
Vino-Cy patients received Vinorelbine 25?mg/m2 on day 1, cyclophosphamide 1500?mg/m2 on day 2, and pegylated GCSF on day 4 or GCSF 10?mcg/kg/day from day 4 onwards. Cy patients were given cyclophosphamide 4000?mg/m2 on day 1 and GCSF10?mcg/kg/day from day 5 onwards. The target CD34?+?SC collection was 5?×?106?per kg/BW.Results
149 patients were included. SC collection was lower in the Vino-Cy group (8.20?×?106/Kg BW) compared to the Cy group (11.43?×?106/Kg BW), with adjusted geometric mean ratio of 0.59 (95% CI 0.41 to 0.86, p?=?0.006). Time taken to achieve an adequate PB SC count was shorter for Vino-Cy (9?±?1?day compared to 12?±?2?days for Cy, adjusted absolute mean difference ?3.95, 95% CI ?4.85 to ?3.06, P?<?.001). Mobilisation related toxicities (in particular, neutropaenic fever) were greater for Cy.Conclusion
Vino-Cy is a potential alternative to Cy given the need for effective mobilisation protocols with acceptable toxicity. 相似文献11.
Wei Huang Rudolf K.F. Oliveira Han Lei David M. Systrom Aaron B. Waxman 《Journal of cardiac failure》2018,24(3):169-176
Background
In heart failure with preserved ejection fraction (HFpEF), the prognostic value of pulmonary vascular dysfunction (PV-dysfunction), identified by elevated pulmonary vascular resistance (PVR) at peak exercise, is not completely understood. We evaluated the long-term prognostic implications of PV-dysfunction in HFpEF during exercise in consecutive patients undergoing invasive cardiopulmonary exercise testing for unexplained dyspnea.Methods
Patients with HFpEF were classified into 2 main groups: resting HFpEF (n?=?104, 62% female, age 61 years) with a pulmonary arterial wedge pressure (PAWP)?>15?mmHg at rest; and exercise HFpEF (eHFpEF; n?=?81) with a PAWP?<15?mmHg at rest, but >20?mmHg during exercise. The eHFpEF group was further subdivided into eHFpEF + PV-dysfunction (peak PVR?≥80 dynes/s/cm?5; n?=?55, 60% female, age 64) group and eHFpEF – PV-dysfunction (peak PVR?<80 dynes/s/cm?5; n?=?26, 42% female, age 54 years) group. Outcomes were analyzed for the first 9 years of follow-up and included any cause mortality and heart failure (HF)-related hospitalizations. The mean follow-up time was 6.7?±?2.6 years (0.5–9.0).Results
Mortality rate did not differ among the groups. However, survival free of HF-related hospitalization was lower for the eHFpEF + PV-dysfunction group compared with eHFpEF – PV-dysfunction (P?=?.01). These findings were similar between eHFpEF + PV-dysfunction and the resting HFpEF group (P?=?.774). By Cox analysis, peak PVR ≥80 dynes/s/cm?5 was a predictor of HF-related hospitalization for eHFpEF (hazard ratio 5.73, 95% confidence interval 1.05–31.22, P?=?.01). In conclusion, the present study provides insight into the impact of PV-dysfunction on outcomes of patients with exercise-induced HFpEF. An elevated peak PVR is associated with a high risk of HF-related hospitalization. 相似文献12.
Lulu Abushaban Thinakar Vel Mariappa Jebaraj Rathinasamy Prem N. Sharma 《Journal of the Saudi Heart Association》2018,30(2):86-94
Objective
To establish normal reference ranges and Z-scores for aortic diameters in preterm infants according to the body surface area and assess their correlation with body weight, body surface area, and gestational age.Patients and methods
In a prospective study, 268 preterm infants who fulfilled the criteria for inclusion were examined. Echocardiograms were performed to measure the ascending aorta, transverse aorta, and aortic isthmus diameters on 0?days to 6?days of life and at weekly intervals until the babies reached 36?weeks. Body surface area was divided into 13 groups from 0.07?m2 to 0.19?m2.Results
The mean gestational age was 29.8 [± 2.38 standard deviation (SD)] weeks, ranging from 24?weeks to 35?weeks. The mean body weight was 1479 (± 413?SD) g, ranging from 588?g to 3380?g, and the mean body surface area was 0.13?m2, ranging from 0.07?m2 to 0.19?m2. All the aortic diameters correlated well with both body weight and body surface area. Reference ranges with the mean?±?SD, range, and Z-scores were calculated for aortic diameters according to the body surface area. A significant gradual increase was observed in ascending aorta, transverse aorta, and aortic isthmus diameters with increasing body surface area. Overall, a progressive and significant increase in ascending aorta, transverse aorta, and aortic isthmus diameters was observed during the first 9?weeks of life.Conclusion
The ascending aorta, transverse aorta, and aortic isthmus diameters exhibited a significant correlation with the body surface area and body weight. This study provides reference data with Z-scores that can be used as a normal reference tool for the ascending aorta, transverse aorta, and aortic isthmus diameters for preterm infants based on the body surface area. 相似文献13.
Lluis Asmarats Mathieu Bernier Gilles O’Hara Jean-Michel Paradis Kim O’Connor Jonathan Beaudoin Sylvie Bilodeau Rafael Cavalcanti Jean Champagne Josep Rodés-Cabau 《Journal of interventional cardiac electrophysiology》2018,53(2):151-157
Purpose
Percutaneous left atrial appendage (LAA) closure has become a valid alternative to anticoagulation therapy for the prevention of thromboembolic events in patients with atrial fibrillation (AF). However, scarce data exist on the impact of LAA closure on left atrial and ventricular function. We sought to assess the acute hemodynamic changes associated with percutaneous LAA closure in patients with paroxysmal AF.Methods
The study population consisted of 31 patients (mean age 73?±?10 years; 49% women) with paroxysmal AF who underwent successful percutaneous LAA closure. All patients were in sinus rhythm and underwent 2D transthoracic echocardiography at baseline and the day after the procedure. A subset of 14 patients underwent preprocedural cardiac computed tomography (CT) with 3D LA and LAA reconstruction.Results
Left ventricular systolic function parameters and LA volumetric indexes remained unchanged after the procedure. No significant changes in left ventricular stroke volume (72.4?±?16.0 vs. 73.3?±?15.7 mL, p?=?0.55) or LA stroke volume (total 15.6?±?4.2 vs. 14.6?±?4.2 mL, p?=?0.21; passive 9.0?±?2.8 vs. 8.3?±?2.6 mL, p?=?0.31; active 10.3?±?5.6 vs. 10.0?±?6.4 mL, p?=?0.72) occurred following LAA closure. Mean ratio of LAA to LA volume by 3D CT was 10.2?±?2.3%. No correlation was found between LAA/LA ratio and changes in LA stroke volume (r?=?0.35, p?=?0.22) or left ventricular stroke volume (r?=?0.28, p?=?0.33).Conclusions
The LAA accounts for about 10% of the total LA volume, but percutaneous LAA closure did not translate into any significant changes in LA and left ventricular function.14.
Suzanne Elize van Wijngaarden Vasileios Kamperidis Ibtihal Al-Amri Frank van der Kley Martin J. Schalij Nina Ajmone Marsan Jeroen J. Bax Victoria Delgado 《Journal of cardiac failure》2018,24(3):137-145
Aims
To evaluate the effects of MitraClip on left ventricular (LV) and left atrial (LA) myocardial wall stress as assessed with the use of N-terminal pro–B-type natriuretic peptide (NT-proBNP) and strain imaging.Methods and results
Sixty-five patients with symptomatic moderate and severe mitral regurgitation (MR; age 75?±?9 y, 57% male, 89% functional MR) treated with the use of MitraClip were evaluated. Patients were divided according to 6-month NT-proBNP tertiles. Changes in echocardiographic parameters over 6 months were assessed. Reductions in LV end-diastolic volumes (178?±?77?mL to 170?±?79?mL; P?=?.045) and LV end-systolic volumes (120?±?70?mL to 111?±?69?mL; P?=?.040) were observed in the overall population. Interestingly, low–NT-proBNP–tertile patients showed slight improvements in LV and LA longitudinal strain, whereas high–NT-proBNP–tertile patients showed impairment.Conclusions
Although MitraClip induces hemodynamic unloading in patients with predominantly functional MR, myocardial wall stress is not consistently improved. In patients with reduced NT-proBNP, improvements in LA volume index and LV and LA strains were observed. Patients who showed an increase in NT-proBNP exhibited impairment in LV and LA strain, suggesting an increase of myocardial wall stress. 相似文献15.
Henrik Ø. Hjortkjær Tonny Jensen Jannik Hilsted Ulrik M. Mogensen Helle Corinth Peter Rossing Lars Køber Klaus F. Kofoed 《Journal of diabetes and its complications》2019,33(2):171-177
Aims
Type 1 diabetes is associated with increased cardiovascular (CV) morbidity and mortality, and cardiovascular autonomic neuropathy (CAN) is an important CV risk factor. The study aimed to explore associations between CAN and altered cardiac chamber sizes in persons with type 1 diabetes.Methods
This was a cross-sectional study of 71 asymptomatic, normoalbuminuric participants with long-term type 1 diabetes (39 with CAN, determined by >1 abnormal autonomic function test) examined with cardiac multi detector computed tomography scans, which allowed measurements of left ventricular mass and all four cardiac chamber volumes. Cardiac chambers were indexed according to body surface area (ml/m2 or g/m2).Results
Persons with and without CAN had mean?±?SD age of 57?±?7 and 50?±?8?years (p?<?0.001) and diabetes duration of 36?±?11 and 32?±?9?years (p?<?0.05), respectively. Increasing autonomic dysfunction, evaluated by decrease in heart rate variability during deep breathing (in beats per minute), was associated with larger right (?0.5, 95% CI ?1.0 to ?0.0, p?<?0.05) and trend towards larger left (?0.4, 95% CI ?0.8–0.0, p?<?0.1) ventricular volumes in multivariable linear regression.Conclusions
Our results suggest that impaired autonomic function may be associated with modest enlargement of ventricular volumes; this might be an early sign of progression towards heart failure. 相似文献16.
Background
The beneficial effects of atrial septal defect (ASD) device closure on electrical cardiac remodeling are well established. The timing at which these effects starts to take place has yet to be determined.Objectives
To determine the immediate and short term effects of ASD device closure on cardiac electric remodeling in children.Methods
30 pediatric patients were subjected to 12 lead Electrocardiogram immediately before ASD device closure, 24 h post procedure, 1 and 6?months after. The maximum and minimum P wave and QT durations in any of the 12 leads were recorded and P wave and QT dispersions were calculated and compared using paired T test.Results
The immediate 24?h follow up electrocardiogram showed significant decrease in P maximum (140.2?±?6 versus 130.67?±?5.4?ms), P dispersion (49.73?±?9.01 versus 41.43?±?7.65?ms), PR interval (188.7?±?6.06?ms versus 182.73?±?5.8?ms), QRS duration (134.4?±?4.97?ms versus 127.87?±?4.44), QT maximum (619.07?±?15.73?ms versus 613.43?±?11.87), and QT dispersion (67.6?±?5.31 versus 62.6?±?4.68?ms) (P?=?0.001). After 1?month all the parameters measured showed further significant decrease with P dispersion reaching 32.13?±?6 (P?=?0.001) and QT dispersion reaching 55.0?±?4.76 (P?=?0.001). These effects were maintained 6?months post device closure.Conclusion
Percutaneous ASD device closure can reverse electrical changes in atrial and ventricular myocardium as early as the first 24 h post device closure. 相似文献17.
18.
D. Marshall Brinkley Laura J. Burpee Sunit-Preet Chaudhry Jennifer A. Smallwood JoAnn Lindenfeld Neal K. Lakdawala Akshay S. Desai Lynne W. Stevenson 《Journal of cardiac failure》2018,24(6):349-354
Background
Admission for diuresis remains a common and costly event in patients with advanced heart failure (HF). We tested whether spot urine sodium could identify patients likely to respond to ambulatory diuretic infusion without hospitalization.Methods and Results
We prospectively followed 176 consecutive patients with advanced heart failure receiving intravenous furosemide for congestion in an ambulatory clinic. Spot urine sodium was measured in 1st voided urine after diuretic infusion and compared with 3-hour urine output and subsequent risk of 30-day hospitalization or emergency department (ED) visit.Spot urine sodium was significantly associated with urine output in a model adjusted for age, renal function, and blood urea nitrogen (P?=?.02). Higher urine sodium was associated with lower risk of hospitalization or ED visit within 30 days (odds ratio [OR] 0.82 [95% confidence interval 0.72–0.94] per 10?mmol/L increase; P?<?.001), in a model adjusted for hemoglobin (OR 0.80 [0.66–0.97]; P?=?.02) and systolic blood pressure (OR 0.82 [0.67–1.0]; P?=?.05). Spot urine sodium ≥65?mmol/L and urine output ≥1200?mL identified a lower-risk group for outpatient management.Conclusion
High spot urine sodium after diuretic administration identifies HF patients likely to respond to an ambulatory diuretic infusion with lower rates of hospitalization or ED visits at 30 days. 相似文献19.
Timothy M. Hughes Kaycee M. Sink Jeff D. Williamson Christina E. Hugenschmidt Benjamin C. Wagner Christopher T. Whitlow Jianzhao Xu S. Carrie Smith Lenore J. Launer Joshua I. Barzilay Faramarz Ismail-Beigi R. Nick Bryan Fang-Chi Hsu Donald W. Bowden Joseph A. Maldjian Jasmin Divers Barry I. Freedman 《Journal of diabetes and its complications》2018,32(10):916-921
Background
Relationships between cognitive function and brain structure remain poorly defined in African Americans with type 2 diabetes.Methods
Cognitive testing and cerebral magnetic resonance imaging in African Americans from the Diabetes Heart Study Memory IN Diabetes (n?=?480) and Action to Control Cardiovascular Risk in Diabetes MIND (n?=?104) studies were examined for associations. Cerebral gray matter volume (GMV), white matter volume (WMV) and white matter lesion volume (WMLV) and cognitive performance (Mini-mental State Exam [MMSE and 3MSE], Digit Symbol Coding (DSC), Stroop test, and Rey Auditory Verbal Learning Test) were recorded. Multivariable models adjusted for age, sex, BMI, scanner, intracranial volume, education, diabetes duration, HbA1c, LDL-cholesterol, smoking, hypertension and cardiovascular disease assessed associations between cognitive tests and brain volumes by study and meta-analysis.Results
Mean(SD) participant age was 60.1(7.9) years, diabetes duration 12.1(7.7) years, and HbA1c 8.3(1.7)%. In the fully-adjusted meta-analysis, lower GMV associated with poorer global performance on MMSE/3MSE (?=?7.1?×?10?3, SE 2.4?×?10?3, p?=?3.6?×?10?3), higher WMLV associated with poorer performance on DSC (?=??3?×?10?2, SE 6.4?×?10?3, p?=?5.2?×?10?5) and higher WMV associated with poorer MMSE/3MSE performance (?=??7.1?×?10?3, SE?=?2.4?×?10?3, p?=?3.6?×?10?3).Conclusions
In African Americans with diabetes, smaller GMV and increased WMLV associated with poorer performance on tests of global cognitive and executive function. These data suggest that WML burden and gray matter atrophy associate with cognitive performance independent of diabetes-related factors in this population. 相似文献20.
Colleen Juricek Teruhiko Imamura Ann Nguyen Ben Chung Daniel Rodgers Nitasha Sarswat Gene Kim Jayant Raikhelkar Takeyoshi Ota Tae Song Daniel Burkhoff Gabriel Sayer Valluvan Jeevanandam Nir Uriel 《Journal of cardiac failure》2018,24(4):249-254