Association between anticardiolipin antibodies and recurrent cardiac events in patients with acute coronary syndrome

To determine whether the presence of anticardiolipin (aCL) antibodies in patients with acute coronary syndrome is predictive of recurrent cardiac events in hospital stay and follow-up. The study population consisted of 80 patients with acute coronary syndrome. IgM and IgG aCL levels were determined before hospital discharge. We divided the patients into those with an aCL IgG >or= 40 IgG phospholipid units (group I, n = 30) and those with an aCL IgG < 40 IgG phospholipid units (group II, n = 50). All patients underwent coronary angiography. Follow-up coronary angiography was performed 12 months after percutaneous coronary intervention (PCI). Infectious and autoimmune diseases were exclusion criteria. Patients were observed to determine overall mortality, reinfarction, and restenosis. There were no differences between the groups with respect to the prevalence of hypertension, diabetes mellitus, and cigarette smoking, sex, or ejection fraction. The prevalence of left ventricular thrombus was similar between the groups (group I: 16% versus group II: 16.7%, P > 0.05). Although the presence of left atrial thrombus was much more frequent in cardiolipin positive patients (13% versus 4%, respectively), the difference was not statistically significant (P = 0.19). Restenosis was observed in 40% of the cardiolipin positive patients and 14% of the cardiolipin negative patients (P < 0.01). There was no significant association between reinfarction and anticardiolipin positivity during follow-up (26% versus 10%, P > 0.05). In group I patients, in-hospital mortality was somewhat more frequent compared to group II patients (4% versus 10%), but the difference was not statistically significant (P = 0.27). One year mortality was similar between the groups. These results suggest that 1) restenosis occurs more frequently in anticardiolipin positive patients and 2) no association is evident between positive aCL and mortality, reinfarction, and intracardiac thrombus.     

急性冠状动脉综合征患者经皮冠状动脉介入治疗成形术中血栓抽吸对术后1年心脏事件的影响

目的研究血栓抽吸技术对急性冠状动脉综合征(ACS)患者术后1年内心血管不良事件(MACE)的影响。方法 142例ACS患者随机行常规经皮冠状动脉介入治疗成形术(PCI)(59例)及PCI+血栓抽吸术(83例)。观察患者术中TIMI血流分级,左心室舒张末径、左心室射血分数和MACE发生情况。结果非ST段抬高型心肌梗死(NSTEMI)和STEMI患者行常规PCI组术后MACE发生率分别为50.0%和38.1%;血栓抽吸+PCI组术后MACE发生率分别为8.3%和11.1%,差异均有统计学意义(均为P<0.05)。结论 ACS患者在常规PCI术中联合血栓抽吸能降低术中无复流几率,减少患者术后MACE的发生。     

Cystatin-C as a predictor for major adverse cardiac events in patients with acute coronary syndrome

Cystatin-C (CYS-C) has emerged as a highly sensitive marker of even a mildly impaired glomerular filtration rate. Experimental studies have suggested that its inhibitory effects on cysteine protease may help to prevent plaque destabilisation. We aimed to evaluate the predictive value of CYS-C level for major adverse cardiac events (MACE) including mortality and morbidity during the hospital stay and 3-month follow-up period.MethodsSeventy-five patients were hospitalised for acute coronary syndrome (ACS). Another control group consisted of patients who were presented with chest pain but no evidence of ischaemic heart disease documented by laboratory markers and angiography. Serum CYS-C levels were measured during the first 24 h of admission. Patients with an abnormal creatinine-derived glomerular filtration rate (GFR) were excluded. Coronary angiography was performed for the entire study population.ResultsIn group I, the mean CYS-C was 1.836 ± 0.782 mg/l vs. 0.991 ± 0.163 mg/l in the control group (P < 0.000). Cystatin-C showed a moderate correlation with total cholesterol in group I (r = 0.5) and with LDL (r = 0.367, P < 0.01). CYS-C showed a moderate positive correlation with the number of diseased vessels (r = 0.419, P < 0.01) and a moderate significant positive correlation with Killip classification (r = 0.349). Smoking was the only predictor associated with a high CYS-C level in the multivariate regression analysis (P = 0.033). CYS-C was an independent predictor of MACE and heart failure complications either in-hospital or during follow-up (P < 0.05).ConclusionsCYS-C could be a useful marker for diagnosing coronary arteriosclerosis. An elevated CYS-C in patients with ACS is an independent predictor of MACE either in-hospital or during follow-up.     

The effects of clarithromycin treatment on cardiac events in acute coronary syndrome patients]

OBJECTIVE: The assessment of short duration early clarithromycin treatment on major cardiac events in acute coronary syndrome patients. METHODS: One hundred and thirteen patients with acute coronary syndrome had been enrolled in the study in a prospective manner. Fifty-seven of 113 patients received peroral clarithromycin 1g/day for 14 days in addition to standard therapy. The remaining 56 patients were considered as control group. The treatment and control groups had similar major cardiac risk factors such as diabetes, hypertension, dyslipidemia and smoking habits. The occurrence of unstable angina pectoris, non-ST elevation myocardial infarction and ST elevation myocardial infarction was comparable in both groups. The use of thrombolytic therapy and glycoprotein IIb/IIIa receptor blockers administration was also similar in both groups. The patients were followed for major cardiac events for 6 months. RESULTS: During the follow-up, no difference was observed between groups in the occurrence of unstable angina pectoris, myocardial infarction, the need for revascularization with percutaneous coronary intervention or cardiac surgery and cardiac death. We observed a reduction of myocardial infarction and cardiac death occurrence and an increase in the necessity of percutaneous interventions in the treatment group even though this difference did not reach statistical significance. CONCLUSION: No benefit of short duration early clarithromycin therapy was observed in the occurrence of major cardiac events in acute coronary syndromes. Studies with longer treatment and follow-up period using different antibiotics are necessary to elucidate the possible effect of antibiotics on major cardiac events in patients with acute coronary syndrome.     

Sudden cardiac death in patients with rheumatoid arthritis

An increased cardiovascular morbidity and mortality, including the risk of sudden cardiac death(SCD), has been shown in patients with rheumatoid arthritis(RA). Abnormalities in autonomic markers such as heart rate variability and ventricular repolarization parameters, such as QTc interval and QT dispersion, have been associated with sudden death in patients with RA. The interplay between these parameters and inflammation that is known to exist with RA is of growing interest. In this article, we review the prevalence and predictors of SCD in patients with RA and describe the potential underlying mechanisms, which may contribute to this. We also review the impact of biologic agents on arrhythmic risk as well as cardiovascular morbidity and mortality.     

肱踝脉搏波速度对老年男性急性冠状动脉综合征后再发心血管事件的预测价值

目的 探讨肱踝脉搏波速度(baPWV)对老年男性急性冠状动脉综合征后再发心血管事件的预测价值.方法 选择急性冠状动脉综合征人院的老年男性患者118例,年龄61～92岁,平均(76.6±6.7)岁.测量baPWV、血生化指标等.随访时间平均(617±297)d,记录终点事件(不稳定性心绞痛、心力衰竭、心原性死亡、脑卒中等)的发生情况.结果 无事件组90例,baPWV为(17.48±3.54)m/s,有终点事件组和主要终点事件组baPWV分别为(21.91±4.86)m/s和(24.48±4.39)m/s,与无事件组比较差异有统计学意义(均P＜0.05).共有28例患者发生心血管事件30人次,其中主要终点事件12人次.采用受试者工作特征曲线确定baPWV预测全部终点事件的截断点为19.51 m/s,主要终点事件的截断点为20.52 m/s.多变量Cox比例风险模型显示以上两个截断点的相对危险度差异均有统计学意义(P＜0.01),分别为全部终点事件相对危险度1.37(95%可信区间:1.16～1.63),主要终点事件相对危险度=1.71(95%可信区间:1.23～2.36).结论 baPWV能够作为老年男性急性冠状动脉综合征后再发心血管事件的预测指标.     

肱踝脉搏波速度对老年男性急性冠状动脉综合征后再发心血管事件的预测价值

Objective To explore whether brachial-ankle pulse wave velocity (baPWV) can be used as a predictor of recurrent cardiovascular events in elderly male patients with acute coronary syndrome (ACS). Methods The baPWV and biochemical indicators were measured in 118 elderly men with ACS, aged 61-92 years (mean age 76.6±6.7 years). During the follow-up period (617±297 days), all cardiovascular events (unstable angina, heart failure, cardiac death and stroke, etc.)were recorded. Results The baPWV was (17.48±3.54)m/s in non-event group(n=90),(21.91±4.86) m/s in event group and (24.48±4.39) m/s in major endpoint event group, respectively (both P＜0. 05). There were 30 cardiovascular events that occurred in 28 patients, including 12 major endpoint events. The receiver operating characteristic curve demonstrated that the cut-off point of baPWV for predicting a cardiovascular event was 19.51 m/s and that for predicting a major endpoint event was 20.52m/s. The multivariate Cox proportional hazards model demonstrated that the above cut-off points had significantly relative risk for cardiovascular event: 1.37(95% CI: 1.16-1.63)and for major event:1.71(95% CI: 1.23-2.36). Conclusions The baPWV can be used as a predictor of recurrent cardiovascular events in elderly men with ACS.     

肱踝脉搏波速度对老年男性急性冠状动脉综合征后再发心血管事件的预测价值

Objective To explore whether brachial-ankle pulse wave velocity (baPWV) can be used as a predictor of recurrent cardiovascular events in elderly male patients with acute coronary syndrome (ACS). Methods The baPWV and biochemical indicators were measured in 118 elderly men with ACS, aged 61-92 years (mean age 76.6±6.7 years). During the follow-up period (617±297 days), all cardiovascular events (unstable angina, heart failure, cardiac death and stroke, etc.)were recorded. Results The baPWV was (17.48±3.54)m/s in non-event group(n=90),(21.91±4.86) m/s in event group and (24.48±4.39) m/s in major endpoint event group, respectively (both P＜0. 05). There were 30 cardiovascular events that occurred in 28 patients, including 12 major endpoint events. The receiver operating characteristic curve demonstrated that the cut-off point of baPWV for predicting a cardiovascular event was 19.51 m/s and that for predicting a major endpoint event was 20.52m/s. The multivariate Cox proportional hazards model demonstrated that the above cut-off points had significantly relative risk for cardiovascular event: 1.37(95% CI: 1.16-1.63)and for major event:1.71(95% CI: 1.23-2.36). Conclusions The baPWV can be used as a predictor of recurrent cardiovascular events in elderly men with ACS.     

Effects of high-dose statin administered prior to coronary angioplasty on the incidence of cardiac events in patients with acute coronary syndrome

INTRODUCTION: Statins given after acute coronary syndrome without ST elevation (NSTE-ACS) reduce the incidence of major adverse cardiac events (MACE) in long-term follow-up. AIM: To evaluate the effects of high-dose statin administered in patients with NSTE ACS and increased CRP level prior to percutaneous coronary intervention (PCI) on the incidence of MACE in long-term follow-up. METHODS: The study involved 140 consecutive patients with NSTE ACS and increased CRP level at baseline. Patients from group A (n=54) did not receive statin before PCI, whereas subjects in group B (n=86) were given 80 mg of atorvastatin. Patients in both groups received typical cardiological therapy including aspirin, thienopyridine and low molecular weight heparin. After PCI all patients received 40 mg of atorvastatin. Incidence of MACE (death, myocardial infarction (MI), re-PCI) during long-term followup was evaluated in both groups. RESULTS: Study groups did not differ with respect to demographic parameters and rate of ischaemic heart disease risk factors. Also, no differences occurred regarding CRP level (group A vs. B: hsCRP 10.8+/-1.8 mg/l vs. 8.2+/-2.8 mg/l; p=NS) and TIMI Risk Score (group A vs. B: 4.3+/-0.71 vs. 4.37+/-0.79; p=NS). During long-term follow-up the incidence of MI (9.25% vs. 1.2%, p=0.03), composite endpoint: death + MI (14.8% vs. 2.32%, p=0.013) and death + MI + re PCI (25.9% vs. 8.1%, p=0.006) was significantly higher in group A than group B. CONCLUSIONS: Administration of high-dose statin in NSTE ACS patients before PCI was associated with significant reduction of MACE in long-term follow-up. This effect was observed despite the same therapy given after PCI.     

急性冠脉综合征行PCI患者残粒脂蛋白-胆固醇水平与主要不良心血管事件的相关性研究

目的 研究急性冠脉综合征(ACS)行急诊经皮冠状动脉介入治疗(PCI)患者残粒脂蛋白-胆固醇(RLP-C)水平与主要不良心血管事件(MACE)的关系.方法 选择在江苏省苏北人民医院心脏科住院的ACS并行急诊PCI患者143例为研究对象,入院时检测其RLP-C水平,依据RLP-C定标值将患者分为高水平组(n=42)及低水...     

Evaluation of cerebrovascular events in patients with rheumatoid arthritis]

OBJECTIVE: We evaluated cerebrovascular events (cerebral infarction or cerebral bleeding) in patients with rheumatoid arthritis (RA). METHODS: Prognosis and the causes of death among 1100 RA patients from 1995 to 1999, were analyzed. 34 RA patients were complicated by cerebrovascular events. About them, hemoglobin, platelet, C-reactive protein, rheumatoid factor, total cholesterol, triglyceride, duration of disease, functional class, and dose of steroids per day were measured. RESULT: Among 1100 patients with RA, 90 died at the age of 70.2. Of these patients, 24 (26.7%) died of cerebrovascular events, 19 (21.1%) of heart failure, 16 (17.8%) of infectious diseases, 10 (11.1%) of malignant tumors, and 9 (10%) of renal failure. When RA patients who died of cerebrovascular events were compared with those who died of other causes, the dose of steroid was significantly lower and the age was higher in RA patients who died of cerebrovascular events. However, there were no significant differences in total cholesterol and triglyceride levels between the two groups. Although the major cause of death in RA patients was reported to be complication by cardiovascular diseases, infectious diseases, or renal failure, the frequency of deaths was higher in elderly RA patients complicated by cerebrovascular events. When the frequency of complication by cerebrovascular events was investigated in all RA patients including those who survived, 24 died and 10 survived. The frequency of complication by cerebral infarction was higher than that of complication by cerebral bleeding in RA patients who died of cerebral events. CONCLUSION: RA patients can live longer with improvements in care and treatment, the number of elderly RA patients who may died of complication by cerebrovascular events may gradually increase.     

Menopausal syndrome in female patients with rheumatoid arthritis

This study was performed to assess the relationship between joint symptoms in rheumatoid arthritis (RA) and symptoms in menopausal syndrome. Detailed analyses of the clinical course, laboratory data, joint symptoms, and symptoms of menopausal syndrome were performed for five patients with stage I and monocyclic-type RA. The age when joint symptoms first appeared coincided with the age of menopause in all patients, and the mean age was 51.0 years. The mean period from menopause to this study was 5.4 years. All patients showed more than six menopausal syndrome symptoms. Two patients were confirmed gynecologically to have definite menopausal syndrome, and accordingly hormone replacement therapy (HRT) was given. In one patient, the polyarthralgia disappeared after she received HRT. All the American College of Rheumatology (ACR) criteria, with the exception of subcutaneous nodules, can be explained as symptoms related to estrogen deficiency in menopausal syndrome because estrogen regulates the production of inflammatory cytokines such as IL-1, IL-6, and TNFα, and these cytokines are produced in greater abundance in conditions of estrogen deficiency. Estrogen deficiency at the menopause influences joint symptoms and inflammatory parameters in rheumatoid arthritis. Estrogen deficiency in menopausal syndrome may induce joint symptoms resembling RA. Received: November 2, 2000 / Accepted: February 14, 2001     

Menopausal syndrome in female patients with rheumatoid arthritis

Abstract

This study was performed to assess the relationship between joint symptoms in rheumatoid arthritis (RA) and symptoms in menopausal syndrome. Detailed analyses of the clinical course, laboratory data, joint symptoms, and symptoms of menopausal syndrome were performed for five patients with stage I and monocyclic-type RA. The age when joint symptoms first appeared coincided with the age of menopause in all patients, and the mean age was 51.0 years. The mean period from menopause to this study was 5.4 years. All patients showed more than six menopausal syndrome symptoms. Two patients were confirmed gynecologically to have definite menopausal syndrome, and accordingly hormone replacement therapy (HRT) was given. In one patient, the polyarthralgia disappeared after she received HRT. All the American College of Rheumatology (ACR) criteria, with the exception of subcutaneous nodules, can be explained as symptoms related to estrogen deficiency in menopausal syndrome because estrogen regulates the production of inflammatory cytokines such as IL-1, IL-6, and TNFα, and these cytokines are produced in greater abundance in conditions of estrogen deficiency. Estrogen deficiency at the menopause influences joint symptoms and inflammatory parameters in rheumatoid arthritis. Estrogen deficiency in menopausal syndrome may induce joint symptoms resembling RA.     

38例症状性长QT综合征患者心脏事件复发诱因分析

目的:评估症状性先天性长QT综合征（congenital long QT syndrome,cLQTS）患者心脏事件复发的主要诱因。方法:本研究为回顾性病例分析。在2014年11月至2020年2月就诊于北京清华长庚医院的66例症状性cLQTS患者中,选取首次就诊后心脏事件复发的38例为研究对象。采集患者性别、发病和就诊...     

基线血小板-白细胞聚集体水平对非ST段抬高型急性冠状动脉综合征患者近期预后的预测价值

目的:探讨基线血小板-白细胞聚集体(PLA)水平对非ST段抬高型急性冠状动脉综合征(NSTE-ACS)患者近期主要不良心脏事件(MACE)的预测价值。方法:共纳入114例患者,其中NSTE-ACS组72例,对照组42例,比较两组患者相关临床资料;采用全球急性冠状动脉事件注册(GRACE)评分将NSTE-ACS患者分为低危组和高危组,比较两组PLA、血小板-单核细胞聚集体(PMA)、血小板-中性粒细胞聚集体(PNA)及血小板-淋巴细胞聚集体(Ply A)水平,并对PLA、PMA、PNA及Ply A水平与GRACE评分分数进行Spearman相关性检验;对NSTE-ACS组患者近期(出院后8个月内)MACE进行随访,使用受试者工作特征(ROC)曲线评价基线PLA水平对NST-ACS患者近期MACE的预测价值。结果:与对照组相比,NSTE-ACS组PLA、PMA、PNA及PLy A显著升高(P0.01);高危组NSTE-ACS患者PLA、PMA、PNA及PLy A较低危组升高(P0.01);NSTE-ACS患者GRACE评分分数与基线PLA、PMA、PNA及Ply A水平均成正相关(分别为r=0.597、r=0.634、r=0.487和r=0.435,均P0.05);经随访,共有14%的NSTE-ACS患者发生了近期MACE;入院时PLA水平预测NSTE-ACS组出院后8个月内MACE的ROC曲线下面积为0.753(95%CI:0.737-0.779,P0.05)。结论:基线PLA水平升高可能预示NSTE-ACS患者的不稳定状态;基线PLA水平不仅可用于NSTE-ACS患者的早期快速危险分层,还可对NSTE-ACS患者近期MACE进行预测。     

QT dispersion and cardiac involvement in patients with rheumatoid arthritis

OBJECTIVE: To investigate the dispersion of repolarization variables in patients with rheumatoid arthritis (RA). METHODS: Electrocardiography (ECG) and Doppler echocardiography were performed on 40 patients with RA, which were divided into two groups according to the duration of disease and in 48 healthy controls. RESULTS: All patients had significantly longer QT dispersion (QTd) and corrected QT dispersion (QTc-d) values (p<0.05). The mean values of diastolic function variables were significantly different in all patients compared to healthy controls (p<0.05). There were no statistically significant differences between patient groups in terms of diastolic function variables except IVRT. However, QTd and QTc-d were significantly longer in patients with disease duration over 5 years (p<0.05). CONCLUSION: We conclude that repolarization heterogeneity and diastolic dysfunction are commonly seen in RA, and QTd is significantly longer in those patients with a disease duration over 5 years compared to those with new onset RA.     

类风湿性关节炎心脏损害的临床分析

目的 :探讨类风湿性关节炎 ( RA)心脏损害的发生率及其临床特征 ,并评价彩色多普勒超声心动图在 RA伴有心脏损害中的诊断价值。方法 :对 1 999年 4月～ 2 0 0 0年 6月在我院住院确诊为 RA并在心血管系统方面检查资料较完整的 1 45例患者的心脏损害情况进行回顾性分析。结果 :心脏损害的发生率 2 9.7% ( 4 3/1 45) ,其中心包炎 6例 ( 4 .1 % ) ,心肌病变 1 7例 ( 1 1 .7% ) ,心律失常 8例 ( 5.5% ) ,瓣膜病变 2 2例 ( 1 5.2 % )。结论 :RA所致的心脏损害并非少见 ,超声心动图检查在 RA心脏损害的诊断中具有很重要的诊断价值。