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1.
Background
Patients with heart failure with preserved ejection fraction (HFpEF) exhibit pulmonary abnormalities, but the studies to date have reported wide variability in the ventilatory equivalent for carbon dioxide (V?E/V?CO2) slope. It is possible that aging may contribute to that variability. We sought to compare ventilatory efficiency and its components in older and younger HFpEF patients during exercise.Methods and Results
Eighteen older (O; 80 ± 4 y) and 19 younger (Y; 59 ± 7 y) HFpEF patients performed cardiopulmonary exercise testing to volitional fatigue. Measurements of arterial blood gases were used to derive VD/VT, dead space ventilation, and alveolar ventilation. V?E/V?CO2 slope was greater in older compared with younger HFpEF patients (O 36 ± 7vs Y 31 ± 7; P?=?.04). At peak exercise, older HFpEF exhibited greater VD/VT compared with younger HFpEF (O 0.37 ± 0.10vs Y 0.28 ± 0.10; P < .01), whereas PaCO2 was not different between groups (P?=?.58). V?E and alveolar ventilation were similar (P > .23), but dead space ventilation was greater in older compared with younger HFpEF at peak exercise (P?=?.04).Conclusions
Older HFpEF patients exhibit greater ventilatory inefficiency resulting from elevated physiologic dead space during peak exercise compared with younger HFpEF patients. These results suggest that aging can worsen the pathophysiologic mechanisms underlying ventilatory efficiency during exercise in HFpEF. 相似文献2.
Pieter Martens Petra Nijst Matthias Dupont Wilfried Mullens 《Journal of cardiac failure》2019,25(4):240-248
Background
Progressive plasma volume (PV) expansion is a hallmark of chronic heart failure (HF), ultimately contributing to decompensated heart failure. Monitoring PV might offer prognostic information and might be a target for tailored therapy.Methods and Results
The correlation between technetium-99 (99Tc)–labeled red blood cell measured PV and calculated PV was first determined in a validation cohort. The relationship between PV status (PVS; a marker how much actual PV deviated from the ideal PV) and outcome was analyzed with the use of Cox proportional modeling in a prospective chronic HF (CHF) population (the outcome cohort). Thirty-one HF patients were included in the validation cohort. Calculated PV correlated well with 99Tc-measured PV (r?=?0.714; P?=?.001). A total of 1173 patients (HF with reduced ejection fraction [HFrEF]: n?=?872; HF with mid-range EF [HFmrEF]: n?=?229; HF with preserved EF [HFpEF]: n?=?72) were prospectively included in the outcome cohort. The mean PVS in the outcome cohort was ?6.7% ± 10%, indicating slight PV contraction. Higher PVS was independently associated with increased risk for HF hospitalization and all-cause mortality (hazard ratio 1.016; 95% confidence interval 1.006–1.027 per 1% increase in PVS; P?=?.002). Receiver operating characteristic curve analysis indicated that a PVS of ?6.5% optimally predicted absence of adverse outcome. Hazard ratio analysis indicated that CHF patients were less equipped in tolerating PV expansion in comparison to PV contraction. The use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and mineralocorticoid receptor antagonists were independently associated with a higher odds of having an optimal PVS in HFrEF and HFmrEF (all P < .05), but not in HFpEF.Conclusions
Calculated PV correlates well with measured PV in HF patients. An increase in PV is independently associated with a higher risk of adverse outcome, and a slight contraction of the predicted PV seems to be related to less adverse events. Higher dosages of renin-angiotensin-aldosterone blockers are associated with higher odds of having an optimal PV status. 相似文献3.
Sex differences in treatment and prognosis of acute coronary syndrome with interventional management
Virginia Ruiz-Pizarro Carlos Ferrera Juan Carlos Gómez-Polo Julián Palacios-Rubio Carmen Rico-García Amado Antonio Fernández-Ortiz Ana Viana-Tejedor 《Cardiovascular Revascularization Medicine》2019,20(3):183-186
Objective
Female sex has been associated with differences in diagnostic and management of acute coronary syndrome (ACS). Our aim was to analyze sex differences in ACS with interventional management in a tertiary care hospital.Methods
Patients with ACS admitted to a Spanish tertiary care referral center were included prospectively and consecutively. All patients included in the study underwent a coronary angiography.Results
From the total cohort of 1214 patients, 290 (24%) were women. Women were older (71?±?12.8 vs 64?±?13.4?years, p?<?0.001) and showed lower ischemic risk and higher hemorrhagic risk scores (GRACE 159?±?45 vs 171?±?42, p?=?0.005; CRUSADE 41?±?19 vs 28?±?17, p?<?0.001). There were no significant differences in time to coronary angiography and revascularization rates between sex groups. A lower proportion of women received high-potency antiplatelet agents (29% vs 41.3%, p?=?0.004). In-hospital evolution and one-year mortality were similar between groups.Conclusions
In our population, there were no gender differences in management and prognosis of ACS. Differences in risk profile among groups could have an influence on antiplatelet therapy. 相似文献4.
Daniel Modin Morten Sengeløv Peter Godsk Jørgensen Flemming Javier Olsen Niels Eske Bruun Thomas Fritz-Hansen Ditte Madsen Andersen Jan Skov Jensen Tor Biering-Sørensen 《Journal of cardiac failure》2019,25(2):87-96
Background
The prognostic value of LA functional measures in heart failure patients with reduced ejection fraction (HFrEF) is unclear. Therefore, this study investigated the prognostic value of left atrial (LA) functional measures such as the left atrial emptying fraction (LAEF) and the minimal LA volume compared with left atrial volume index (LAVI) in HFrEF patients.Methods and Results
A total of 818 HFrEF patients with left ventricular ejection fractions <45% underwent echocardiography. LA volumes were determined by the area-length method from the apical 2-chamber and apical 4-chamber views. LAEF, minimal LA volume indexed to body surface area (MinLAVI), and LAVI were calculated. The end point was all-cause mortality. During a median follow-up of 3.3 years (interquartile range 1.8–4.6 years), 121 patients died (14.8%). Follow-up was 100%. In a final multivariable model adjusting for clinical and echocardiographic parameters, LAEF, but not MinLAVI or LAVI, was an independent predictor of all-cause mortality in HFrEF patients: LAEF: hazard ratio (HR) 1.11 (P?=?.033) per 5% decrease; MinLAVI: HR 1.03 (P?=?.57) per 5 mL/m2 increase; LAVI: HR 1.06 (P?=?.16) per 5 mL/m2 increase.Conclusions
LAEF is an independent predictor of all-cause mortality in HFrEF patients after multivariable adjustment. LAEF provides incremental prognostic value over LAVI in risk stratification of HFrEF patients. 相似文献5.
Javed Butler Mei Yang Massimiliano Alfonzo Manzi Gregory P. Hess Mahesh J. Patel Thomas Rhodes Michael M. Givertz 《Journal of the American College of Cardiology》2019,73(8):935-944
Background
Epidemiology of patients with worsening heart failure and reduced ejection fraction (HFrEF) in the real-world setting is not well described.Objectives
The purpose of this study was to describe incidence, clinical characteristics, treatment, and outcomes of patients with HFrEF who develop worsening heart failure (HF) in the real-world setting.Methods
Data on patients with incident HFrEF from the National Cardiovascular Data Registry PINNACLE were linked to pharmacy, private practitioner, and hospital claims databases. Incidence, clinical characteristics, treatment (angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, beta-blocker, and mineralocorticoid receptor antagonist) and outcomes of patients with worsening HF, defined as ≥90 days of stable HF with subsequent worsening requiring intravenous diuretic agents, were assessed.Results
Of 11,064 HFrEF patients, 1,851 (17%) developed worsening HF on average 1.5 years following initial HF diagnosis. Patients who developed worsening HF were more likely to be African American, be octogenarians, and have higher comorbidity burden (p < 0.001). At the onset of worsening HF, 42.4% of patients were on monotherapy, 43.4% were on dual therapy, and 14.1% were on triple therapy. A total of 48%, 61%, and 98% of patients were on >50% target dose for angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, beta-blocker, and mineralocorticoid receptor antagonist, respectively. The 2-year mortality rate was 22.5%, and 56% of patients were rehospitalized within 30 days of the worsening HF event.Conclusions
In the real-world setting, 1 in 6 patients with HFrEF develop worsening HF within 18 months of HF diagnosis. These patients have a high risk for 2-year mortality and recurrent HF hospitalizations. The use of standard-of-care therapies both before and after the onset of worsening HF is low. With high unmet medical need, patients with worsening HF require novel treatment strategies as well as greater optimization of existing guideline-directed therapy. 相似文献6.
Patricia Palau Eloy Domínguez Laura López José María Ramón Raquel Heredia Jessika González Enrique Santas Vicent Bodí Gema Miñana Ernesto Valero Anna Mollar Vicente Bertomeu González Francisco J. Chorro Juan Sanchis Josep Lupón Antoni Bayés-Genís Julio Núñez 《Revista espa?ola de cardiología》2019,72(4):288-297
Introduction and objectives
Despite the prevalence of heart failure with preserved ejection fraction (HFpEF), there is currently no evidence-based effective therapy for this disease. This study sought to evaluate whether inspiratory muscle training (IMT), functional electrical stimulation (FES), or a combination of both (IMT + FES) improves 12- and 24-week exercise capacity as well as left ventricular diastolic function, biomarker profile, and quality of life in HFpEF.Methods
A total of 61 stable symptomatic patients (New York Heart Association II-III) with HFpEF were randomized (1:1:1:1) to receive a 12-week program of IMT, FES, or IMT + FES vs usual care. The primary endpoint of the study was to evaluate change in peak exercise oxygen uptake at 12 and 24 weeks. Secondary endpoints were changes in quality of life, echocardiogram parameters, and prognostic biomarkers. We used a mixed-effects model for repeated-measures to compare endpoints changes.Results
Mean age and peak exercise oxygen uptake were 74 ± 9 years and 9.9 ± 2.5 mL/min/kg, respectively. The proportion of women was 58%. At 12 weeks, the mean increase in peak exercise oxygen uptake (mL/kg/min) compared with usual care was 2.98, 2.93, and 2.47 for IMT, FES, and IMT + FES, respectively (P < .001) and this beneficial effect persisted after 6 months (1.95, 2.08, and 1.56; P < .001). Significant increases in quality of life scores were found at 12 weeks (P < .001). No other changes were found.Conclusions
In HFpEF patients with low aerobic capacity, IMT and FES were associated with a significant improvement in exercise capacity and quality of life.This trial was registered at ClinicalTrials.gov (Identifier: NCT02638961).. 相似文献7.
Objectives
To investigate the different clinical and echocardiographic predictors of evolving PH in patients with heart failure with and without reduced ejection fraction.Methods and Results
The study included 153 heart failure patients with reduced ejection fraction (HFrEF) (n = 89) and preserved ejection fraction (HFpEF) (n = 64) both of which were subdivided into 2 subgroups according to the presence of PH. All patients were subjected to detailed clinical assessment and full transthoracic echocardiogram. There were significant differences between the 2 HFrEF subgroups regarding systolic BP, presence of diabetes, dyslipidemia, diuretics usage, all LV parameters, LAD, LAV and LAV indexed to BSA, E/A ratio, DT and severity of TR. Using multivariate analysis, the presence of diabetes (P = 0.04), diuretics usage (P = 0.04), LAV (P = 0.007) and TR grade (P < 0.001) were significant independent predictors for the development of PH among HFrEF patients. There were significant differences between the 2 HFpEF subgroups regarding presence of hypertension, diuretics usage, LAD, LAA, TR severity. Using multivariate analysis, only diuretics usage (P = 0.02) and TR grade (P < 0.0001) were significant independent predictors for the development of PH among HFpEF patients.Conclusion
Neither the decrease in EF among HFrEF patients nor the DD grade in HFpEF patients act as independent predictor for evolving PH. Common independent predictors for evolving PH in both HFrEF and HFpEF patients are TR grade and use of diuretics. Other independent predictors in HFrEF and not HFpEF patients are the presence of diabetes and increased LAV. 相似文献8.
Rami M. Abazid Osama A. Smettei Ahmad Almeman Sawsan Sayed Hanaa Alsaqqa Salma M. Abdelmageed Fahad J. Alharbi Abdullah M. Alhabib Mouaz H. Al-Mallah 《Journal of the Saudi Heart Association》2019,31(1):32-40
Introduction
Image noise can negatively affect the overall quality of coronary computed tomography angiography (CCTA).Objectives
The purpose of this study was to evaluate the relationship between image noise and fat volumes in the chest wall. We also aimed to compare these with other patient-specific predictors of image noise, such as body weight (BW) and body mass index (BMI).Methods
We undertook a cross-sectional, single-center study. A tube voltage of 100?kV was used for patients with BW <85?kg and 120?kV for BW ≥85?kg. The image noise in the aortic root, single-slice fat volume (SFV) at the level of the left main coronary artery and the total fat volume of the chest (TFV) were analyzed.Results
A total of 132 consecutive patients were enrolled (mean age?±?standard deviation, 51?±?11?years; 64% male). The mean image noise was 30.5?±?11 Hounsfield units (HU). We found that patients with image noise >30?HU had significantly higher SFV (75?±?33 vs. 51?±?24, p?<?0.0001) and TFV (2206?±?927 vs. 1815?±?737, p?<?0.01) compared with patients having noise ≤30?HU, whereas BW and BMI showed no significant difference (78?±?13 vs. 81?±?14, p?<?0.34) and (28.7?±?4.7 vs. 26.8?±?3.8, p?<?0.19), respectively. Linear regression analysis showed that image noise has better correlation with SFV (R?=?0.399; p?<?0.0001); and TFV (R?=?0, p?<?0.009) than BMI (R?=?0.154, p?<?0.039) and BW (R?=?–0.102, p?=?0.12).Conclusions
Fat volume measurements of the chest wall can predict CCTA image noise better than other patient-specific predictors, such as BW and BMI. 相似文献9.
Mohamed A. El-Menoufy Abd El-Aziz A. El-Kak Mohamed A. Ahmed 《The Egyptian Rheumatologist》2019,41(2)
Background
Rheumatoid arthritis (RA) is associated with accelerated atherosclerosis which is not fully explained by traditional risk factors. Such excess risk appears to be driven by systemic inflammation.Aim of the work
Aim of the work was to compare between RA patients with and without CD4+CD28? T-cell expansion regarding carotid intima-media thickness (IMT) and brachial artery flow-mediated endothelium-dependent dilatation (FMEDD), as markers of early atherosclerosis.Patients and methods
The study was conducted on 39 female patients with no overt cardiovascular disease or risk factor and 28 age matched females as controls. Atherosclerotic changes were assessed through measurement of carotid IMT and FMEDD. CD4+CD28? T-cells were assessed by flow cytometry.Results
The mean age of the patients was 34.9?±?5?years and the disease duration of 6.1?±?2.1?years. Traditional risk factors were comparable between patients and controls. Serum homocysteine level tended to be higher in the patients (11?±?4.21?μmol/L) compared to the control (9.91?±?3.61?μmol/L). Patients had significantly higher carotid IMT (0.83?±?0.24?mm vs 0.6?±?0.15?mm, p?=?0.008) and lower FMEDD (3.27?±?1.49% vs 6.01?±?1.79%, p?=?0.002). Similarly, patients with CD4+CD28? expansion (n?=?12) had significantly higher IMT (1?±?0.23?mm) and lower FMEDD (2.25?±?1.06%) compared to those without (n?=?27) (0.76?±?0.21?mm and 3.67?±?1.47%); p?=?0.01, p?=?0.01 respectively; but not affected by receiving methotrexate or not. Laboratory investigations were comparable in patients with and without expansion.Conclusion
CD4+CD28? cells may contribute to the development of premature atherosclerosis in RA patients. Further studies are recommended to evaluate the benefit of CD4+CD28? T-cell modulation on the future development of atherosclerosis in these patients. 相似文献10.
Shingo Tsujinaga Hiroyuki Iwano Miwa Sarashina Taichi Hayashi Michito Murayama Ayako Ichikawa Masahiro Nakabachi Hisao Nishino Shinobu Yokoyama Arata Fukushima Takashi Yokota Kazunori Okada Sanae Kaga Pavlos P. Vlachos Toshihisa Anzai 《Journal of cardiac failure》2019,25(4):268-277
Background
Although the enhancement of early-diastolic intra–left ventricular pressure difference (IVPD) during exercise is considered to maintain exercise capacity, little is known about their relationship in heart failure (HF).Methods and Results
Cardiopulmonary exercise testing and exercise-stress echocardiography were performed in 50 HF patients (left ventricular [LV] ejection fraction 39 ± 15%). Echocardiographic images were obtained at rest and submaximal and peak exercise. Color M-mode Doppler images of LV inflow were used to determine IVPD. Thirty-five patients had preserved exercise capacity (peak oxygen consumption [VO2] ≥14 mL·kg?1·min?1; group 1) and 15 patients had reduced exercise capacity (group 2). During exercise, IVPD increased only in group 1 (group 1: 1.9 ± 0.9 mm Hg at rest, 4.1 ± 2.0 mm Hg at submaximum, 4.7 ± 2.1 mm Hg at peak; group 2: 1.9 ± 0.8 mm Hg at rest, 2.1 ± 0.9 mm Hg at submaximum, 2.1 ± 0.9 mm Hg at peak). Submaximal IVPD (r?=?0.54) and peak IVPD (r?=?0.69) were significantly correlated with peak VO2. Peak IVPD determined peak VO2 independently of LV ejection fraction. Moreover, submaximal IVPD could well predict the reduced exercise capacity.Conclusion
Early-diastolic IVPD during exercise was closely associated with exercise capacity in HF. In addition, submaximal IVPD could be a useful predictor of exercise capacity without peak exercise in HF patients. 相似文献11.
Erin Karlstedt Victor Jimenez-Zepeda Jonathan G. Howlett James A. White Nowell M. Fine 《Journal of cardiac failure》2019,25(3):147-153
Background
The tolerability and utility of combination doxycycline and ursodeoxycholic acid (ursodiol) amyloid fibril disruption therapy for transthyretin cardiac amyloidosis (ATTR CA) in clinical practice is poorly described.Methods and Results
We report the clinical experience of 53 ATTR CA patients treated with doxycycline and ursodiol. Six patients (11%) did not tolerate the therapy owing to dermatologic and gastrointestinal effects. Of those remaining, the median follow-up was 22 months (range 8–30), mean age was 71 ± 11years, 41 (87%) were male, and 42 (89%) had wild-type and 5 (11%) mutant ATTR. Five patients (11%) died during follow-up. There was no significant change in New York Heart Association (NYHA) functional class, cardiac biomarkers, or echocardiographic parameters during follow-up. Left ventricular (LV) global longitudinal systolic strain (GLS) improved in 16 patients (38%) (?12 ± 4% to ?17 ± 4%; P < .01). Patients whose LV GLS improved were significantly younger and had lower NYHA functional class, troponin-T, N-terminal pro–B-type natriuretic peptide (BNP), and baseline LV GLS levels compared with those whose LV GLS did not improve. Troponin-T improved in follow-up for patients whose LV GLS improved (35 ± 21 to 20 ± 14 ng/L; P?=?.06).Conclusions
Doxycycline and ursodiol therapy for treatment of ATTR CA was tolerable and was associated with stabilized markers of disease progression. LV GLS improved in patients with less advanced disease. 相似文献12.
Aim of the work
To study the clinical characteristics and health related quality of life (HRQoL) in systemic lupus erythematosus patients.Patients and methods
94 adult SLE patients were included from those attending Zagazig University Hospitals. SLE disease activity index (SLEDAI) and Systemic Lupus International Collaborative Clinics damage Index (SLICC/DI) were recorded. The health-related quality of life (HRQoL) was assessed using the lupus-QoL (LQoL) questionnaire.Results
The mean age of the patients was 36.9?±?14.1?years and disease duration 5.8?±?4?years. All LqoL domains were reduced. LQoL was significantly related to the gender, SLEDAI, SLICC/DI, erythrocyte sedimentation rate (ESR), anti-nuclear antibody (ANA) and anti-double stranded deoxyribonucleic acid (ds-DNA) (p?<?0.0001, p?<?0.0001, p?=?0.03, p?=?0.002, p?=?0.02, p?<?0.0001 respectively). The LQoL was not related to the age, disease duration and level of education. All 8 domains significantly correlated with SLEDAI and SLICC/DI. Mucocutaneous manifestations lowered emotional health (43.3?±?5.7), body image (45.3?±?6.9) and fatigue (47.3?±?9.3) domains; neuropsychiatric manifestation lowered the emotional health (43.4?±?9.7), planning (47.3?±?8.8) and intimate relationship (49.2?±?11.7); musculoskeletal manifestations mainly worsened burden to others (31.3?±?10.5), pain (47.6?±?10.4) and physical health (50.3?±?11.3) while lupus nephritis mainly decreased physical health (60.4?±?11.4), fatigue (61.2?±?5.7), burden to others (62.4?±?11.4) and emotional health (67.4?±?20.3).Conclusions
SLE is a condition associated with high unmet need and considerable burden to patients. To our knowledge, no previous study has systematically examined the clinical features as well as HRQoL of SLE patients in Sharkia Governorate, Eastern Egypt. HRQoL is a multidimensional concept that encompasses physical, emotional and social components associated with SLE manifestations. 相似文献13.
Lee Lee Wong Ruiyang Zou Lihan Zhou Jia Yuen Lim Dominic C.Y. Phua Chengcheng Liu Jenny P.C. Chong Jessica Y.X. Ng Oi Wah Liew Siew Pang Chan Yei-Tsung Chen Michelle M.Y. Chan Poh Shuan D. Yeo Tze Pin Ng Lieng H. Ling David Sim Kui Toh G. Leong Hean Y. Ong Arthur Mark Richards 《Journal of the American College of Cardiology》2019,73(11):1300-1313
Background
Clinicians need improved tools to better identify nonacute heart failure with preserved ejection fraction (HFpEF).Objectives
The purpose of this study was to derive and validate circulating microRNA signatures for nonacute heart failure (HF).Methods
Discovery and validation cohorts (N = 1,710), comprised 903 HF and 807 non-HF patients from Singapore and New Zealand (NZ). MicroRNA biomarker panel discovery in a Singapore cohort (n = 546) was independently validated in a second Singapore cohort (Validation 1; n = 448) and a NZ cohort (Validation 2; n = 716).Results
In discovery, an 8-microRNA panel identified HF with an area under the curve (AUC) 0.96, specificity 0.88, and accuracy 0.89. Corresponding metrics were 0.88, 0.66, and 0.77 in Validation 1, and 0.87, 0.58, and 0.74 in Validation 2. Combining microRNA panels with N-terminal pro–B-type natriuretic peptide (NT-proBNP) clearly improved specificity and accuracy from AUC 0.96, specificity 0.91, and accuracy 0.90 for NT-proBNP alone to corresponding metrics of 0.99, 0.99, and 0.93 in the discovery and 0.97, 0.96, and 0.93 in Validation 1. The 8-microRNA discovery panel distinguished HFpEF from HF with reduced ejection fraction with AUC 0.81, specificity 0.66, and accuracy 0.72. Corresponding metrics were 0.65, 0.41, and 0.56 in Validation 1 and 0.65, 0.41, and 0.62 in Validation 2. For phenotype categorization, combined markers achieved AUC 0.87, specificity 0.75, and accuracy 0.77 in the discovery with corresponding metrics of 0.74, 0.59, and 0.67 in Validation 1 and 0.72, 0.52, and 0.68 in Validation 2, as compared with NT-proBNP alone of AUC 0.71, specificity 0.46, and accuracy 0.62 in the discovery; with corresponding metrics of 0.72, 0.44, and 0.57 in Validation 1 and 0.69, 0.48, and 0.66 in Validation 2. Accordingly, false negative (FN) (81% Singapore and all NZ FN cases were HFpEF) as classified by a guideline-endorsed NT-proBNP ruleout threshold, were correctly reclassified by the 8-microRNA panel in the majority (72% and 88% of FN in Singapore and NZ, respectively) of cases.Conclusions
Multi-microRNA panels in combination with NT-proBNP are highly discriminatory and improved specificity and accuracy in identifying nonacute HF. These findings suggest potential utility in the identification of nonacute HF, where clinical assessment, imaging, and NT-proBNP may not be definitive, especially in HFpEF. 相似文献14.
Abbed K.M. Hameed Tamer O. El-Said Hamdia Y. Askar Basma A. ElKady 《The Egyptian Rheumatologist》2019,41(2)
Background
Numerous tools to assess activity of rheumatoid arthritis (RA) are available to use. For any marker to be a more appropriate indicator of disease activity, it should be more authentic to the patho-physiologic basis of the disease.Aim of the work
To determine the performance of serum adenosine deaminase (sADA) in measuring disease activity in RA.Patients and Methods
100 RA patients and 100 matched controls were included in the study. The disease activity score (DAS28) with erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were assessed. sADA level was determined by spectrophotometry. The sADA level was integrated in the DAS28 formulae and the corresponding values were determined.Results
The mean age of the RA patients was 61.8?±?9.7?years, 68% were females and they had a disease duration of 12.5?±?3.7?years. The mean DAS28-ESR was 4.2?±?1.3 and DAS28-CRP 3.5?±?1.1. The mean sADA was significantly higher in the patients (33.6?±?11.6?U/L) compared to the control (25.1?±?9.9?U/L) (p?<?0.001). The sADA level and DAS28-sADA did not differ according to the gender, methotrexate use, rheumatoid factor or anti-citrullinated protein autoantibodies positivity. The mean DAS28-sADA significantly increased in higher activity categories (p?<?0.001). sADA significantly correlated with the disease activity parameters. DAS28-sADA significantly correlated with DAS28-ESR (r?=?0.57, p?<?0.001) and DAS28-CRP (r?=?0.604, p?<?0.001). DAS28-sADA showed a sensitivity of 0.9 and specificity 0.69 for detection of disease activity measured with DAS28-ESR and was 0.88 and 0.65 when measured with DAS28-CRP.Conclusion
Integration of sADA in the DAS28 index can be a useful marker that reflects RA activity. 相似文献15.
Nora Cazzagon Carlo Dal Lin Giulia Famoso Roberta Montisci Irene Franceschet Annarosa Floreani Francesco Tona 《Digestive and liver disease》2019,51(4):542-548
Background
It is still not clear whether primary biliary cholangitis (PBC) is associated with abnormalities of the cardiovascular system. We aimed to assess the relationship between PBC and coronary flow reserve (CFR).Methods
Our inclusion criterion was a diagnosis of PBC with no clinical evidence of heart disease or metabolic syndrome. Coronary flow velocity in the left anterior descending coronary artery was measured using transthoracic Doppler echocardiography at rest (DFVr), and during adenosine infusion (DFVh). The corrected CFR (cCFR) was defined as the ratio of DFVh to DFVr corrected for cardiac workload (cDFVr). Microvascular resistance was also assessed in baseline (BMR) and hyperemic conditions (HMR).Results
37 PBC patients and 37 sex- and age-matched controls were considered. The cCFR was significantly lower in PBC patients (2.8?±?0.7 vs. 3.7?±?0.7, p?<?0.0001), and abnormal (≤2.5) in 13 (35%) of them, but in none of the controls (p?<?0.0001). The cDFVr was higher in patients with abnormal cCFR (29.0?±?6.0 vs. 20.4?±?4.5?cm/sec, p?<?0.0001). The CFR and cCFR did not correlate with any characteristics of PBC, comorbidities or Framingham risk scores. The BMR and HMR correlated with time since PBC diagnosis and duration of symptoms.Conclusion
The CFR is reduced in PBC, apparently due to mechanisms correlating with the time since diagnosis. In particular, the higher cDFVr with a lower basal resistance in patients with cCFR?≤?2.5 suggests a compensatory mechanism against any cardiomyocyte bioenergetics impairment. 相似文献16.
Luna Gargani Cosimo Bruni Tatiana Barskova Valentina Hartwig Martina Marinelli Maria Giovanna Trivella Marco Matucci-Cerinic Antonio L&#x;Abbate 《Seminars in arthritis and rheumatism》2019,48(5):867-873
Objectives
Systemic sclerosis (SSc) causes functional and structural microcirculatory dysfunction, affecting also distal extremities. Optical Near-InfraRed Spectroscopy (NIRS) of blood HbO2 saturation (stO2) is able to evaluate O2 delivery/consumption balance in the explored tissue. The NIRS-sensitive camera non-invasively detects stO2 values in superficial tissues, automatically generating 2D-imaging maps in real time. We aimed at testing whether NIRS hand imaging may evaluate peripheral microcirculatory dysfunction and its spatial heterogeneity in SSc patients compared to controls.Methods
Forty SSc patients (aged 55.1?±?15.6 years) and twenty-one healthy controls (aged 54.3?±?14.5years, p?=?0.89) were studied by palmar hand NIRS-2D imaging. A blood pressure cuff was applied to the forearm and 3 min ischemia was induced. Images were acquired at basal conditions and every 10 seconds during 3 minutes of ischemia and 5 minutes of reperfusion. Five regions of interest were positioned on each fingertip, from the second to the fifth finger and one on the thenar eminence.Results
A significant difference was found between controls and SSc patients in basal stO2 (84.3?±?7.5?vs. 75.4?±?10.9%, p?<?0.001), minimum stO2 (65.2?±?8.0?vs. 53.4?±?10.1%, p?<?0.001) and time to maximum stO2 during hyperemia (63?±?38?vs. 85?±?49?s, p?<?0.05). Among clinical characteristics, anti-Scl70 antibody positivity, digital ulcers history and smoke exposure affected NIRS parameters, as well as sildenafil and statins therapy. Conversely, no significant differences were found in NIRS-2D values between different nailfold-videocapillaroscopy patterns.Conclusion
NIRS-2D imaging is a simple, automated tool to non-invasively detect regional microcirculatory impairment in SSc, which seems to add significant functional information to the morphological picture of nailfold-videocapillaroscopy. 相似文献17.
L. Darwish M.M. Nguyen M. Saleem K.A. Eakin N. Herrmann K.S. Sugamori P.I. Oh P. Yang J. Mitchell K.L. Lanctôt W. Swardfager 《Journal of diabetes and its complications》2019,33(5):390-397
Background
Lower serum concentrations of the osteoblast-derived protein, osteocalcin, have been associated with poorer glycemic control, insulin resistance and atherosclerosis, and with the development of type 2 diabetes (T2DM).Methods
This study compares concentrations of two physiological forms of osteocalcin, carboxylated (cOCN) and uncarboxylated (unOCN), between participants with T2DM (n?=?20) and age-, gender- and body mass index (BMI)-matched participants without T2DM (n?=?40) among patients with coronary artery disease (CAD), and it explores relationships between osteocalcin concentrations and cardiovascular risk factors.Results
Concentrations of unOCN (2.71?±?1.86 vs. 4.70?±?2.03?ng/mL; t?=??3.635, p?=?0.001) and cOCN (8.70?±?2.27 vs. 10.77?±?3.69?ng/mL; t?=??2.30, p?=?0.025) were lower in participants with T2DM. In participants without T2DM, concentrations of cOCN were associated with fitness (VO2Peak rho?=?0.317, p?=?0.047) and lower body fat (rho?=??0.324, p?=?0.041). In participants with T2DM, lower unOCN was associated with HbA1c (rho?=??0.516, p?=?0.020). Higher body mass was associated with higher unOCN (rho?=?0.423, p?=?0.009) in participants without T2DM, but with lower concentrations of both unOCN (rho?=??0.590, p?=?0.006) and cOCN (rho?=??0.632, p?=?0.003) in participants with T2DM.Conclusion
In patients with CAD, lower osteocalcin concentrations were related to type 2 diabetes, and to adverse fitness, metabolic and obesity profiles. 相似文献18.
Vasilios Simopoulos Athanasios Hevas Apostolia Hatziefthimiou Konstantina Dipla Ioannis Skoularigis Nikolaos Tsilimingas Isaac Aidonidis 《Cardiovascular drugs and therapy / sponsored by the International Society of Cardiovascular Pharmacotherapy》2018,32(6):559-565
Purpose
Ranolazine (RAN) added to amiodarone (AMIO) has been shown to accelerate termination of postoperative atrial fibrillation (POAF) following coronary artery bypass surgery in patients without heart failure (HF). This study aimed to investigate if treatment efficacy with AMIO or AMIO + RAN differs between patients with concomitant HF with reduced or preserved ejection fraction (HFrEF or HFpEF).Methods
Patients with POAF and HFrEF (n?=?511, 446 males; 65?±?9 years) and with HFpEF (n?=?301, 257 males; 66?±?10 years) were enrolled. Onset of AF occurred 2.15?±?1.0 days after cardiac surgery, and patients within each group were randomly assigned to receive either AMIO monotherapy (300 mg in 30 min?+?1125 mg in 36 h iv) or AMIO+RAN combination (500 mg po?+?375 mg, after 6 h and 375 mg twice daily thereafter). Primary endpoint was the time to conversion of POAF within 36 h after initiation of treatment.Results
AMIO restored sinus rhythm earlier in HFrEF vs. in HFpEF patients (24.3?±?4.6 vs. 26.8?±?2.8 h, p?<?0.0001). AMIO + RAN converted POAF faster than AMIO alone in both HFrEF and HFpEF groups, with conversion times 10.4?±?4.5 h in HFrEF and 12.2?±?1.1 h in HFpEF patients (p?<?0.0001). Left atrial diameter was significantly greater in HFrEF vs. HFpEF patients (48.2?±?2.6 vs. 35.2?±?2.9 mm, p?<?0.0001). No serious adverse drug effects were observed during AF or after restoration to sinus rhythm in any of the patients enrolled.Conclusion
AMIO alone or in combination with RAN converted POAF faster in patients with reduced EF than in those with preserved EF. Thus, AMIO + RAN seems to be a valuable alternative treatment for terminating POAF in HFrEF patients.19.
Marwa A. Hammad Shaimaa M. Abdel-Latif Omaima Z. Shehata Amany M. Mohiey El-Din 《The Egyptian Rheumatologist》2019,41(1)
Background
Endothelial cell dysfunction has been described in Behçet disease (BD) not only as a cause of major vascular events but also related to chronic inflammation in different organ systems.Aim of the work
To study the relation of serum endocan, a marker of endothelial dysfunction, with clinical manifestations and disease activity in BD patients.Patients and methods
This study included 23 BD patients and 23 matched controls. Disease activity was assessed by the Behcet Disease Current Activity Form (BDCAF). Serum endocan was measured in all subjects.Results
The mean age of the patients was 32.5?±?6.8?years and they were 16 males and 7 females (M:F 2.3:1) with mean disease duration of 7?±?5.2?years. Their mean BDCAF was 2.26?±?1.32. A significant difference was found between serum endocan level among active patients 328.24?±?195.3?ng/L, inactive patients (169.8?±?35.7?ng/L) and controls (160.6?±?39.7?ng/L)(p?=?0.001). Patients with genital ulcers, papulopastular lesions and arthritis at the time of the study had higher serum endocan level than those without (p?=?0.002, p?=?0.006 and p?=?0.0001 respectively). Serum endocan levels correlated significantly with the BDCAF, neutrophil/lymphocyte ratio, platelet lymphocyte ratio and C-reactive protein (r?=?0.94, p?=?0.0001; r?=?0.82, p?=?0.0001, r?=?0.44, p?=?0.04 and r?=?0.48, p?=?0.02 respectively). The optimum serum endocan cut-off point for active BD was 191.5?ng/L with a sensitivity and specificity of 100% and 86% respectively (area under curve 0.99, 95% confidence interval 0.96-1).Conclusion
Serum endocan may serve as a potential marker of disease activity in BD. Patients with genital ulcers, papulopastular lesions and arthritis showed higher serum endocan levels. 相似文献20.
Hamdi Wafa Alaya Raja Kaffel Dhia Boughanmi Nada Zouche Imene Kchir Mohamed Montacer 《The Egyptian Rheumatologist》2019,41(1)