Diabetes and impaired fasting glucose as predictors of morbidity and mortality in male coronary artery disease patients with reduced left ventricular function

OBJECTIVES: To evaluate the prognostic value of impaired fasting glucose and diabetes mellitus in male patients with coronary artery disease and poor left ventricular function. METHODS AND RESULTS: From a prospective database on patients referred for gated myocardial perfusion imaging between 1998 and 2002 all male patients with a history of coronary artery disease and poor left ventricular function were selected. Poor function was defined as left ventricular ejection fraction < or = 40%. Subjects were classified as non-diabetics with fasting blood glucose levels < 110 mg/dL, non-diabetics with impaired fasting glucose (fasting blood glucose between 110 and 125 mg/dL) and diabetics. Median follow-up was 2.7years. End points were all-cause mortality, cardiac death and hospitalization for heart failure. One hundred and sixty patients were selected (age 65 +/- 9 years and left ventricular ejection fraction 29 +/- 8%). In univariate analysis atrial fibrillation, NYHA class, glycaemia and diabetes mellitus discriminated between survivors and non-survivors. In Cox multivariate regression analysis for all-cause mortality only NYHA class and diabetes mellitus remained significant. Kaplan Meier analysis showed that diabetics had the worst survival and non-diabetics with glucose < 110 mg/dL had the best survival. Non-diabetics with impaired fasting glucose had intermediate survival. Analysis for cardiac death/hospitalization for heart failure showed similar results. CONCLUSION: In male patients with coronary artery disease and impaired left ventricular function diabetes mellitus and fasting glucose are strongly predictive of poor outcome. Diabetics have the worst prognosis but non-diabetics with impaired fasting glucose also are at higher risk compared to nondiabetics with low fasting blood glucose.     

冠心病合并糖尿病患者冠状动脉旁路移植术长期预后及危险因素的探讨

目的 探讨糖尿病及其合并症对冠状动脉旁路移植术长期预后的影响。方法 将226例连续行冠状动脉主路移植术的冠心病患者分为糖尿病组（116例）和非糖尿病组（110例），应用多变量分析方法分析两组患者术前及术后的临床特征，并随访术后总死亡率及心脏性死亡的发生率，探讨糖尿病组心脏性死亡的预测因素。结果 两组术前及术后的临床特征、既往心肌梗死病史及冠状动脉病变支数等差异无显著性。结果 两组术前及术后的临床特征、既往心肌梗死病史及冠状动脉病变支数等差异无显著性。平均随访3.5年总死亡率两组差异无显著性，但心脏性死亡的发生率糖尿病组明显高于非糖尿病组（15％与3％，P＜0.01）。糖尿病和术后低左室射血分数与心脏性死亡的发生率密切相关（95％可信区间1.29-15.20)。糖尿病组的心脏性主要是猝死、心力衰竭和心肌梗死。术后低左室射血分数、女性及糖尿病肾病是主要预测因素。结论 冠心病合并糖尿病患者冠状动脉旁路移植术长期预后不良，特别在低左室射血分数、女性及糖尿病肾病患者心脏性死亡的发生率高，预后差。应加强对糖尿病患者冠状动脉旁路移植术后心、肾功能障碍的治疗。     

Diabetes mellitus and its impact on long-term outcomes after coronary artery bypass graft surgery

Diabetes mellitus (DM) is an important risk factor for accelerated atherosclerosis and increases cardiovascular disease. Several studies found a higher mortality rate in postoperative diabetic patients than in non-diabetic patients. However, other studies found conflicting evidence on bypass graft dysfunction in patients with diabetes mellitus. We therefore investigated the influence of diabetes mellitus on the long-term outcome after coronary artery bypass surgery (CABG). In this prospective study, 936 consecutive CABG patients were included. These patients were divided into three groups: patients without diabetes mellitus, patients with diabetes mellitus using oral drugs (non-insulin-treated DM) and patients with diabetes mellitus using insulin (insulin-treated DM). The three groups were compared for mortality and (angiographic) bypass graft dysfunction. Of the 936 included patients, 720 (76.8%) patients were non-diabetics, 138 (14.7%) were non-insulin-treated DM, and 78 (8.3%) patients were insulin-treated DM. Follow-up was achieved in all patients, at a mean of 33 months. Mortality was significantly higher in patients with insulin-treated DM, compared with non-insulin-treated DM or non-diabetic patients (P = 0.003). Fourteen (1.5%) patients suffered a myocardial infarction after CABG. A coronary angiography was performed in 77 (8.2%) patients during follow-up, proven bypass graft dysfunction was found in 41 (53.2%) patients. There was no significant difference in bypass graft dysfunction between the three groups. Diabetes mellitus has a significant impact on long-term follow-up after coronary surgery. Particularly insulin dependency is related to an increased mortality. However, diabetes has no influence on angiographically proven bypass graft dysfunction.     

Long-term follow-up of coronary artery disease presenting in young adults

OBJECTIVES: This study evaluated long-term survival and predictors of elevated risk for young adults diagnosed with coronary artery disease (CAD). BACKGROUND: Coronary artery disease is rarely seen in young adults. Traditional cardiac risk factors have been studied in small series; however, many questions exist. METHODS: We identified 843 patients under age 40 with CAD diagnosed by coronary angiography from 1975 to 1985. Death, hypertension, gender, family history, prior myocardial infarction (MI), diabetes, heart failure, angina class, number of diseased vessels, ejection fraction (EF), Q-wave infarction, in-hospital death, and initial therapy were studied. Patients were followed for 15 years. RESULTS: The mean age was 35 for women (n = 94) and 36 for men (n = 729). The average EF was 55%. Fifty-eight percent of the subjects had single-vessel disease, and 10% were diabetic. The strongest predictors of long-term mortality were a prior MI (hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.00 to 1.73), New York Heart Association class II heart failure (HR 1.75, 95% CI 1.03 to 2.97), and active tobacco use (HR 1.59, 95% CI 1.14 to 2.21). Revascularization, rather than medical therapy, was associated with lower mortality (coronary angioplasty: HR 0.51, 95% CI 0.32 to 0.81; coronary artery bypass graft: HR 0.68, 95% CI 0.50 to 0.94). Overall mortality was 30% at 15 years. Patients with diabetes had 15-year mortality of 65%. Those with prior MI had 15-year mortality of 45%, and patients with an EF <30% a mortality of 83% at 15 years. CONCLUSIONS: Coronary disease in young adults can carry a poor long-term prognosis. A prior MI, diabetes, active tobacco abuse, and lower EF predict a significantly higher mortality.     

Cumulative incidence of coronary lesions with vulnerable characteristics in patients with stable angina pectoris: an intravascular ultrasound and angiographic study

BACKGROUND: The impact of allograft vasculopathy on the coronary circulation and consequently on cardiac outcome may be expressed by coronary flow reserve (CFR) impairment. Therefore, we aimed to evaluate CFR and its relation to cardiac events in heart transplant patients. METHODS: Twenty-three patients, 2 female, with left ventricular ejection fraction >45% were studied 76+/-30 months after heart transplantation. They were divided into 2 groups according to coronary angiography: Group A, 10 patients with significant coronary artery disease (stenosis> or =50%) and group B, 13 patients without significant stenosis. Twenty healthy subjects, 13 female, served as controls. Coronary flow velocity reserve (CFVR) was assessed by transesophageal echocardiography and calculated as the ratio of maximal (i.v. adenosine, 140 microg/kg/min) to baseline coronary velocities. Patients were followed for a mean of 25 months for cardiac events. RESULTS: Compared to controls, heart transplant groups showed significantly higher baseline coronary flow velocities (51+/-27, 38+/-12 and 32+/-12 cm/s, respectively) and lower maximal coronary velocities (90+/-52, 112+/-33 and 118+/-24 cm/s), resulting in a reduced CFVR (1.9+/-1.0, 3.0+/-0.5 and 3.8+/-1.2). Multivariate analysis identified heart transplantation and epicardial coronary artery disease as the only variables independently related to CFVR. Hypertension was positively related to baseline while diabetes inversely related to maximal coronary flow velocities. A CFVR <2.3 was a marker for cardiac events (4 deaths, 1 heart failure). CONCLUSION: CFVR impairment, particularly in the presence of epicardial coronary artery disease, follows heart transplantation and is associated with a worse outcome.     

The impact of diabetes mellitus at the time of heart transplantation on long-term survival

AIMS/HYPOTHESIS: To analyse the impact of diabetes mellitus (DM) at the time of heart transplantation on long-term survival and incidence of transplant coronary artery disease (TxCAD). METHODS: We analysed 773 consecutive adult heart transplant recipients who underwent primary heart transplantation from May 1986 until December 2000. The cohort consisted of 140 patients with diabetes mellitus (with DM, men 82%) and 633 patients without (wo DM, men 84%) diabetes mellitus at the time of transplantation. The patients were documented as to survival and incidence of TxCAD. RESULTS: Patients with diabetes mellitus were older compared to those without diabetes mellitus (with DM 54.9+/-6.8a vs wo DM 49.7+/-10.8a; p=0.0001), they had a higher incidence of ischaemic cardiomyopathy prior to transplantation (with DM 52% vs wo DM 30%; p=0.0001), but reduced long-term survival (10 year survival: with DM 40% vs wo DM 58%; log-rank=0.025). Surprisingly, the incidence of transplant coronary artery disease (TxCAD) was comparable at 10 years (with DM 28% vs wo DM 22%; log-rank=0.625). In multivariate Cox proportional hazard analysis, diabetes mellitus present at the time of heart transplantation (HR 1.594; 95%CI 1.009-2.518; p=0.045), but not age (HR 0.990; 95%CI 0.965-1.014; p=0.404) was an independent predictor affecting long-term survival. CONCLUSION/INTERPRETATION: The presence of diabetes mellitus at the time of heart transplantation adversely affects long-term patient survival, but does not predict the occurrence of transplant coronary artery disease. The definite mechanisms of adverse survival primarily seem to relate to generally impaired global organ function. Despite a less favourable long-term outcome, our data still justify heart transplantation in end-stage heart failure patients with diabetes mellitus.     

Cardiac evaluation of candidates for kidney transplantation: value of exercise radionuclide angiocardiography

In view of the high incidence and mortality of coronary artery disease (CAD) in patients with kidney transplantation, a systematic cardiac evaluation was prospectively performed in 103 uraemic patients eligible for transplantation. After clinical examination, 28 patients with symptoms of CAD or diabetes mellitus were referred directly for coronary angiography, whereas the remaining 75 patients had rest and exercise radionuclide angiocardiography for evaluation of possible asymptomatic CAD. Among them, left ventricular ejection fraction was below 40% at rest or fell during exercise by at least 5 EF% in 12 patients; coronary angiography in nine showed CAD in four and hypertensive heart disease in five. In the remaining 63 (of 75) patients without severe resting left ventricular dysfunction or exercise ischaemia, the follow-up of 28 +/- 7 months revealed no clinical manifestation of CAD. Overall incidence of CAD in symptomatic and asymptomatic patients during a follow-up of 27 months after cardiac evaluation was 20 and 25% in nondiabetic and diabetic candidates for kidney transplantation, respectively (P = n.s.). Thus, clinical examination combined with exercise radionuclide angiocardiography in patients without signs or symptoms of heart disease had a high predictive accuracy for presence or absence of late manifestations of CAD. Exercise radionuclide angiocardiography is therefore a useful method for screening kidney transplantation candidates for asymptomatic CAD.     

Heart transplantation in cardiomyopathy

Within the spectrum of presently accepted candidates for heart transplantation, end-stage heart failure in dilated cardiomyopathy has become the principle indication. Although several indicators of poor prognosis have been specified, the decision for heart transplantation is primarily made on clinical grounds. Expected long-term survival after transplantation is 60 to 80% at one year and more than 50% at five years. Since July, 1983, 50 patients underwent orthotopic heart transplantation, 38 of whom had been suffering from dilated cardiomyopathy. Ages ranged from nine to 54 years with a mean of 40 years. At present, 38 patients are alive, 34 are discharged from hospital, 14 have returned to work or school. Physical capacity and cardiac function are normal. There was no difference between the cardiomyopathy patients and the coronary artery disease patients with respect to rate and severity of rejection episodes, infection and long-term findings. Heart transplantation is considered a promising routine treatment for end-stage heart failure in particular in younger patients with dilated cardiomyopathy.     

Prognosis following first acute myocardial infarction in Type 2 diabetes: a comparative population study.

AIMS: To estimate the incidence of death and macrovascular complications after a first myocardial infarction for patients with Type 2 diabetes. RESEARCH DESIGN: In a retrospective, incidence cohort study in the Tayside Region of Scotland we studied all patients hospitalized with a diagnosis of first acute myocardial infarction from 1 April 1993 to 31 December 1994. The primary endpoint was time to death. Secondary endpoints were 2-year incidence of hospital admission for angina, myocardial infarction, stroke, heart failure, coronary angiography, coronary artery bypass graft (CABG) and percutaneous transluminal coronary angioplasty (PTCA). RESULTS: The 147 patients with Type 2 diabetes had significantly worse survival with an increase in relative hazard of 67% compared with non-diabetic patients. After adjustment for age, sex, smoking status, prior heart failure, prior angina, delay to hospitalization, site of infarction, drug therapy with aspirin, beta-blockers, streptokinase and hyperlipidaemia and treated hypertension, Type 2 diabetes was still associated with a 40% higher death rate compared with people without diabetes (P < 0.05) There was no significant difference in death rates in those aged over 70 years, but an indication of a trend in younger individuals with a four-fold increase in death rate in those with diabetes aged < 60 years, compared with a rate ratio of 2.6 in those with diabetes aged 61-70 years. CONCLUSIONS: Among hospitalized patients with first acute myocardial infarction, Type 2 diabetes mellitus is consistently associated with increased mortality and increased hospital admission for heart failure. The estimated 4-year survival rate is only 50%. Our results indicate that younger subjects with Type 2 diabetes and acute myocardial infarction are a high-risk group deserving of special study, and support the argument for aggressive targeting of coronary risk factors among patients with Type 2 diabetes.     

生物可吸收聚合物涂层药物洗脱支架与耐用聚合物涂层药物洗脱支架在冠心病合并糖尿病患者中应用的比较:临床试验Meta分析

目的 分析在冠心病合并糖尿病患者中应用生物可吸收聚合物涂层药物洗脱支架的有效性和安全性.方法 检索国内外数据库,检索对比生物可吸收聚合物涂层药物洗脱支架(BP-DES)与耐用聚合物涂层药物洗脱支架(DP-DES)在冠心病合并糖尿病患者应用的临床随机对照试验,主要结果为靶病变失败率、靶血管血运重建率、靶病变血运重建率以及...     

冠心病合并2型糖尿病患者冠状动脉病变严重程度的研究

目的:探讨2型糖尿病与冠状动脉病变严重程度的关系。方法:对象为选择性冠状动脉造影确诊的冠心病患者266例,其中合并2型糖尿病者96例,无糖尿病者170例。计算冠脉病变支数和进行Gensini冠脉病变评分。结果:冠心病合并2型糖尿病患者的冠脉病变Gensini评分和三支病变者明显多于不合并2型糖尿病的冠心病患者(P<0.05);简单直线相关分析表明,甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、体重指数等与冠状动脉病变严重程度显著相关(P均<0.01)。结论:冠心病患者合并2型糖尿病将加重冠状动脉病变严重程度。     

Heart surgery in the elderly

Heart surgery has been performed in an increasing number of elderly patients in the recent years. Currently about 20 % of all patients in cardiac surgery are older than 75 years, however their number is increasing constantly. Valve replacement (mainly aortic valve replacement, AVR), coronary artery bypass grafting (CABG) or combined procedures (AVR and CABG) are the most common procedures in the elderly. However, surgical therapy of heart failure, implantation of assist devices or cardiac transplantation have been performed only in a limited number of elderly patients. Surgical pathways in the therapy of coronary artery disease or valve disease are described. Furthermore, age related morbidity and mortality and related surgical options to improve the outcome are discussed.     

Radial artery graft use and off-pump coronary artery bypass surgery outcome

Radial artery is commonly used as a conduit for surgical revascularization. There is scarce data on the effect of radial artery use on outcome following off-pump coronary artery bypass. We prospectively evaluated 591 patients undergoing off-pump coronary artery bypass. Radial artery grafts were used in 398 of these patients (mean age, 67.6 +/- 10.4 years; mean follow-up, 37.7 +/- 13.4 months). Symptom recurrence (angina, congestive heart failure), adverse cardiac events (myocardial infarction, coronary re-intervention, sudden cardiac death), and overall mortality were recorded. Multivariate Cox regression analysis was used to evaluate predictors of endpoints. Patients with and without radial artery grafts were similar with respect to preoperative risk factors. Recurrent angina developed in 29 patients, congestive heart failure in 5, and myocardial infarction in 9. Coronary arteriography was performed in 27 patients, and 23 underwent re-intervention. Radial artery graft was an independent predictor of increased symptom recurrence and adverse cardiac events. Patients with radial artery grafts also had a tendency towards more angina recurrence, coronary re-intervention, and sudden cardiac death.     

Mortality, mode of death and risk indicators for death during 5 years after coronary artery bypass grafting among patients with and without a history of diabetes mellitus

OBJECTIVE: To describe mortality, mode of death, risk indicators for death and symptoms of angina pectoris among survivors during 5 years after coronary artery bypass grafting (CABG) among patients with and without a history of diabetes mellitus. METHODS: All patients in western Sweden who underwent CABG without concomitant valve surgery and who had no previous CABG between June 1988 and June 1991 were entered prospectively in this study. After 5 years, information on deaths that had occurred was obtained for the analysis. RESULTS: In all, 1998 patients were included in the analysis; 242 (12%) had a history of diabetes. Among the non-diabetic patients, 5-year mortality was 12.5%; the corresponding relative risk for diabetic patients was 2.1 (95% confidence interval 1.6 to 2.9). A history of diabetes was an independent risk indicator of death; there was no significant interaction between any other risk indicator and diabetes. Independent risk indicators for death among diabetic patients were: current smoking, renal dysfunction and left ventricular ejection fraction < 0.40. Compared with non-diabetic patients, those with diabetes more frequently died in hospital, died a cardiac death, or had death associated with the development of acute myocardial infarction and with symptoms of congestive heart failure. Among survivors, diabetic patients tended to have more angina pectoris 5 years after CABG than did those without diabetes. CONCLUSION: During a period of 5 years after CABG, diabetic patients had a mortality twice that of non-diabetic patients. The increased risk included death in hospital, cardiac death and death associated with development of acute myocardial infarction and with symptoms of congestive heart failure.     

Longitudinal follow-up and outcomes among a population with chronic kidney disease in a large managed care organization

BACKGROUND: Chronic kidney disease is the primary cause of end-stage renal disease in the United States. The purpose of this study was to understand the natural history of chronic kidney disease with regard to progression to renal replacement therapy (transplant or dialysis) and death in a representative patient population. METHODS: In 1996 we identified 27 998 patients in our health plan who had estimated glomerular filtration rates of less than 90 mL/min per 1.73 m(2) on 2 separate measurements at least 90 days apart. We followed up patients from the index date of the first glomerular filtration rates of less than 90 mL/min per 1.73 m(2) until renal replacement therapy, death, disenrollment from the health plan, or June 30, 2001. We extracted from the computerized medical records the prevalence of the following comorbidities at the index date and end point: hypertension, diabetes mellitus, coronary artery disease, congestive heart failure, hyperlipidemia, and renal anemia. RESULTS: Our data showed that the rate of renal replacement therapy over the 5-year observation period was 1.1%, 1.3%, and 19.9%, respectively, for the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (K/DOQI) stages 2, 3, and 4, but that the mortality rate was 19.5%, 24.3%, and 45.7%. Thus, death was far more common than dialysis at all stages. In addition, congestive heart failure, coronary artery disease, diabetes, and anemia were more prevalent in the patients who died but hypertension prevalence was similar across all stages. CONCLUSION: Our data suggest that efforts to reduce mortality in this population should be focused on treatment and prevention of coronary artery disease, congestive heart failure, diabetes mellitus, and anemia.     

Factors affecting long-term survival (>10 years) after cardiac transplantation in the cyclosporine era

OBJECTIVES: The aim of this study was to determine long-term survival (>10 years) after cardiac transplantation in the cyclosporine era and identify risk factors influencing long-term survival. BACKGROUND: Despite the availability of newer modalities for heart failure, cardiac transplantation remains the treatment of choice for end-stage heart disease. METHODS: Between 1983 and 1988, 195 patients underwent heart transplantation at a single center for the treatment of end-stage heart disease. Multivariable logistic regression analysis of pretransplant risk factors affecting long-term survival after cardiac transplantation included various recipient and donor demographic, immunologic and peritransplant variables. RESULTS: Among the group of 195 cardiac transplant recipients, actuarial survival was 72%, 58% and 39% at 1, 5 and 10 years respectively. In the 65 patients who survived >10 years, mean cardiac index was 2.91/m2 and mean ejection fraction was 58%. Transplant-related coronary artery disease (TRCAD) was detected in only 14 of the 65 patients (22%). By multivariable analysis, the only risk factor found to adversely affect long-term survival was a pretransplant diagnosis of ischemic cardiomyopathy (p = 0.04). CONCLUSIONS: Long-term survivors maintain normal hemodynamic function of their allografts with a low prevalence of TRCAD. It is possible that similar risk factors that lead to coronary artery disease in native vessels continue to operate in the post-transplant period, thereby contributing to adverse outcomes after cardiac transplantation. Aggressive preventive and therapeutic measures are essential to limit the risk factors for development of coronary atherosclerosis and enable long-term survival after cardiac transplantation.     

Utilization efficacy of noninvasive and invasive cardiac testing among stable cardiac patients undergoing noncardiac surgery.

BACKGROUND: Patients with coronary artery disease are at increased risk from noncardiac surgery. We examined a population of cardiac patients undergoing noncardiac surgery to determine whether coronary angiography was successfully utilized to identify and treat ischemic heart disease. Our hypothesis was that cardiac complications would not differ between the group of patients who underwent coronary angiography and the group that did not. METHODS: We conducted a secondary analysis from a prospective, cohort study of 314 patients with stable cardiac disease undergoing elective noncardiac surgery. The cohort was stratified by history of coronary arteriography. Follow-up extended postoperatively for a minimum of 30 days or until discharge if later. RESULTS: Of this cohort, 37.9% of the patients had a coronary angiogram at a median interval of 19 months (range, 1 day-13 years) before surgery. Among the 15 cardiac deaths (4.8%), 14 patients had compensated congestive heart failure and/or diabetes. The two arms were similar by surgical risk. Despite a higher clinical risk (P<.001), the catheterized vs. noncatheterized arm exhibited a similar cardiac morbidity and a lower cardiac mortality (0.8% vs. 7.2%, P=.01). The lower cardiac mortality persisted whether the patients were recently or remotely catheterized and whether revascularized or not. CONCLUSION: Coronary arteriography is associated with mortality risk-reduction among stable cardiac patients undergoing intermediate-to-high-risk noncardiac surgery, but is unwarranted for low-risk procedures. A higher risk linked to diabetes and congestive heart failure suggests underutilization of noninvasive testing and coronary arteriography among patients with these diagnoses and stable cardiac disease.     

Endothelial dysfunction in patients with chronic heart failure is independently associated with increased incidence of hospitalization, cardiac transplantation, or death.

BACKGROUND: Endothelial dysfunction of coronary and peripheral arteries has been demonstrated in patients with chronic heart failure (CHF) and appears to be associated with functional implications. However, it is unknown whether endothelial dysfunction in CHF is independently associated with impaired outcome or progression of the disease. METHODS AND RESULTS: We assessed the follow-up of 67 consecutive patients with CHF [New York Heart Association (NYHA) functional class II-III] in which flow-dependent, endothelium-mediated vasodilation (FDD) of the radial artery was assessed by high resolution ultrasound. The primary endpoint was defined by cardiac death, hospitalization due to worsening of heart failure (NYHA class IV, pulmonary oedema), or heart transplantation. Cox regression analysis was used to determine whether FDD was associated with these heart failure-related events. During a median follow-up of 45.7 months 24 patients had an event: 18 patients were hospitalized due to worsening of heart failure or heart transplantation, six patients died for cardiac reasons. Cox regression analysis demonstrated that FDD (P<0.01), diabetes mellitus (P<0.01), and ejection fraction (P<0.01) were independent predictive factors for the occurrence of the primary endpoint. The Kaplan-Meier survival curve revealed a significantly better clinical outcome in patients with FDD above the median (6.2%) compared with those with FDD below the median (P<0.013). CONCLUSION: These observations suggest that endothelium-mediated vasodilation represents an independent predictor of cardiac death and hospitalization in patients with CHF, consistent with the notion that endothelium-derived nitric oxide may play a protective role in heart failure.     

机械循环辅助装置治疗围手术期急性心肺功能衰竭

目的:观察心室辅助(VAD)、体外膜式氧合(ECMO)及主动脉内气囊反搏(IABP)等机械循环辅助装置治疗围手术期急性心肺功能衰竭的疗效。方法:回顾2005年1月至2006年12月我院心脏外科监护病房224例围手术期进行循环辅助患者临床资料,VAD4例、ECMO47例及IABP173例。结果:VAD死亡2例(50%),ECMO死亡23例(48.9%),IABP死亡49例(28.3%)。并发症为感染27例、肾功能衰竭需要透析26例、出血23例、下肢缺血15例及脑并发症7例。结论:机械辅助是救治围手术期急性心肺功能衰竭的有效方法,应根据患者病情选择适合的辅助方式并及早放置,防治并发症对提高成功率非常重要。     

Progression of coronary atherosclerotic disease assessed by cinevideodensitometry: relation to clinical risk factors

Progression of coronary artery stenosis was measured using a quantitative, computer-assisted cinevideodensitometric method in 144 arterial segments in 44 subjects undergoing coronary arteriography on two separate occasions at least 6 months apart. Projected coronary arteriograms were digitized into 512 X 512 pixel mode and percent stenosis was calculated by comparing background-corrected videodensitometric values over stenotic and normal segments. Subjects underwent repeat coronary arteriography because of worsening symptoms of angina or heart failure; subjects with renal failure, coronary artery bypass grafts or cardiac transplant were excluded. Clinical variables determined at the time of the first arteriogram included age, sex, serum cholesterol, systolic blood pressure and presence or absence of cigarette smoking, diabetes mellitus and left ventricular hypertrophy. The mean interval between arteriograms was 29.3 months. Overall progression of coronary stenosis was observed in 40 of the 44 subjects; the mean progression at 24 months was 39% (90% confidence interval, 33 to 45%) and at 36 months was 48% (40 to 56%). The degree of overall progression was related to the length of time between arteriograms (F = 5.81, p less than 0.05) and to serum cholesterol level (F = 4.37, p less than 0.05). These data indicate that using an accurate, quantitative method, it is possible to measure progression of coronary artery atherosclerosis within 2 to 3 years of the initial arteriogram. Serum cholesterol appears to be an important determinant of disease progression.