The impact of continuous positive airway pressure on cardiac mechanics: Findings from a meta‐analysis of echocardiographic studies

Current evidence on the effects of continuous positive airway pressure (CPAP) on cardiac mechanics in patients with obstructive sleep apnea (OSA) is based on a few single studies. The authors investigated this topic through a meta‐analysis of speckle tracking echocardiography (STE) studies that provided data on left ventricular (LV) and right ventricular (RV) mechanics as assessed by global longitudinal strain (GLS). The PubMed, OVID‐MEDLINE, and Cochrane library databases were systematically analyzed to search English‐language review papers published from inception to January 31, 2022. Studies were identified by crossing the following terms: “obstructive sleep apnea”, “sleep quality”, “sleep disordered breathing”, “continuous positive airway pressure therapy”, “noninvasive ventilation”, “left ventricular hypertrophy”, “systolic dysfunction”, “global longitudinal strain”, “left ventricular mechanics”, “right ventricular mechanics”, “echocardiography” and “STE echocardiography”. The meta‐analysis, including a total of 337 patients with OSA from nine studies (follow‐up 2–24 months) showed a significant GLS improvement in both LV and RV after CPAP, standard mean difference (SMD) being 0.51±0.08, CI:0.36–0.66, p = .0001 and 0.28±0.07, CI:0.15–0.42, p = .0001), respectively. Corresponding SMD values for LV ejection fraction (LVEF) and tricuspid annular plane systolic excursion (TAPSE) were 0.20±0.06, CI:0.08–0.33, p = .001 and 0.08±0.06, CI: ‐0.04/0.20, p = .21. Our meta‐analysis suggests that: I) CPAP treatment exerts beneficial effects on biventricular function in patients with OSA; II) the assessment of cardiac mechanics by STE should be routinely recommended for monitoring cardiac function in this setting, due to limitations of conventional echocardiography in evaluating biventricular performance.     

大鼠心肌梗死后心肌高迁移率族蛋白HMGB1的时程变化

目的 探讨大鼠心肌梗死模型后不同时间高迁移率族蛋白(HMGB1)的时程变化.方法 结扎SD大鼠左冠状动脉前降支造成左室大面积心梗,分别于术后1、2、4、8周测心功能判断造模是否成功后开胸取心脏.分别运用实时荧光定量PCR和Western蛋白印迹技术观察心肌梗死后不同时间点HMGB1在mRNA和蛋白水平的表达变化.结果 心功能检测提示造模成功,心梗大鼠术后早期(1 w)HMGB1 mRNA表达上调(P＜0.01),而心梗后期(8周)则表达显著减少(P＜0.01).与mRNA水平变化类似,HMGB1蛋白水平在心肌梗死组大鼠术后早期(1～2周)表达水平增加(P＜0.01),而心梗后期(8周)则显著下调(P＜0.05).结论 HMGB1作为炎症调节因子,在心梗早期对心肌的炎性反应进行调控;并在心梗后期参与调节基因转录,进行心肌修复.在心梗的不同阶段对HMGB1的表达进行干预有望减少心梗并发症,改善预后.提高患者长期存活率.     

The importance of inspection in clinical cardiology: Frank's sign

The Frank''s sign (FS) is a diagonal earlobe crease running from the tragus to the edge of the auricle. In this case, we describe a 71 years‐old male patient with FS who presented to the emergency department complaining of epigastric pain. A non‐ST elevation myocardial infarction was diagnosed.     

曲美他嗪对非ST段抬高急性冠脉综合征患者心肌缺血和心率变异的影响

目的:观察曲美他嗪对非ST段抬高的急性冠脉综合症(NSTEACS)患者疗效及心率变异(HRV)的影响,评价其心肌保护作用。方法:选择NSTEACS患者74例,随机分为两组:一组使用阿司匹林、单硝酸异山梨酯、氟伐他汀、美托洛尔等常规治疗,另一组在常规治疗基础上加用曲美他嗪治疗。总观察疗程为8周,观察患者用药前后心率、血压、胸痛发作频率及持续时间、硝酸甘油每天含服次数、心肌缺血的范围及程度以及24 h动态心电图变化,进行疗效评定和HRV分析。结果:曲美他嗪组(有效率94.4%,显效率72.2%),疗效明显优于常规治疗组(有效率65.8%,显效率36.8%)(P<0.05或P<0.01)。SDNN、SDANN、rMSSD、PNN50均升高,低频谱功率(LF)、低频/高频谱功率比值(LF/HF)均降低,有统计学差异(P均<0.05)。高频谱功率(HF)升高,但无统计学差异(P<0.05)。结论:曲美他嗪能有效改善NSTEACS患者心肌缺血及HRV。     

高血压患者昼夜血压节律与无症状性心肌缺血的相关性研究

目的：研究高血压患者昼夜血压节律与无症状性心肌缺血的相关性。方法选取2012年3月—2014年3月就诊的164例原发性高血压患者为研究对象,采用问卷调查和临床检查的方式收集患者的信息,通过单因素分析和Logistic回归分析患者昼夜血压节律与无症状性心肌缺血的关系。结果在调整了年龄、文化水平、婚姻状况、吸烟状况、饮酒状况、体质指数（ BMI）、收缩压水平、舒张压水平以及血糖水平等因素后,二元Logistic回归分析结果显示相比于杓型的患者,昼夜节律为反杓型、非杓型和超杓型的患者患有心肌缺血的风险都明显升高,其OR值和95％CI分别为1．38（1．15～1．61）、1．24（1．09～1．39）和1．57（1．36～1．78）。结论对于原发性高血压病的患者,预防并发心肌缺血的关键除控制血压外,还应重视血压昼夜节律是否异常。     

超声心动图监测评价红花注射液对冠心病患者左室舒张功能的影响

目的:应用超声心动图观察红花注射液对冠心病心肌缺血患者左室舒张功能的影响。方法:随机将76例冠心病心肌缺血患者分为2组,其中38例在常规药物基础上加用红花注射液治疗为红花组,其他38例应用常规药物治疗为常规治疗组,2组均连续用药14天,对心肌缺血及心功能的相关指标作对比观察。用药前后采用常规超声心电图联合组织多普勒显像(TDI)对左室舒张功能进行检测。结果:治疗后ST段压低的次数及其持续时间与心肌缺血总负荷2组均有明显减少,与治疗前比较,有非常显著性差异(P0.01),2组疗效比较,红花组优于常规治疗组(P0.01)。红花组左室舒张功能指标(E、A、E/A、DC、Ea、Aa、Ea/Aa、E/Ea)明显改善(P0.01),常规治疗组治疗前后差异无统计学意义(P0.05)。用药期间,患者无严重不良反应。结论:红花注射液对冠心病心肌缺血有显著疗效,且能改善左室舒张功能。     

Estimates of maternal risks of pregnancy for women with hereditary haemorrhagic telangiectasia (Osler-Weber-Rendu syndrome): suggested approach for obstetric services

Objectives  Hereditary haemorrhagic telangiectasia (HHT) affects 1 in 5–8000 individuals. Pregnancy outcomes are rarely reported. The major reason is that most women do not have their HHT diagnosed prior to pregnancy. Using a large well-characterised series, we studied all pregnancies known to have occurred in HHT-affected women, whether or not their diagnosis was known at the time of pregnancy. Our aim was to estimate rates and types of major complications of HHT in pregnancy, to guide management decisions.
Design  Cohort study, with prospective, retrospective and familial components.
Setting/Population  Tertiary referral centre population.
Methods  All 262 pregnancies in the 111 women with HHT and pulmonary arteriovenous malformations (PAVMs) reviewed between 1999 and 2005 were studied. Eighty-two women (74%) did not have a diagnosis of HHT/PAVM at the time of pregnancy. 222 pregnancies in their 86 HHT-affected relatives were also studied.
Main outcome measures  PAVM bleed, stroke and maternal death.
Results  Thirteen women experienced life-threatening events during pregnancy: 1.0% (95% CI 0.1–1.9) of pregnancies resulted in a major PAVM bleed; 1.2% (0.3–2.2%) in stroke (not all were HHT related); and 1.0% (0.13–1.9%) in maternal death. All deaths occurred in women previously considered well. In women experiencing a life-threatening event, prior awareness of HHT or PAVM diagnosis was associated with improved survival ( P  = 0.041, Fisher's exact test).
Conclusions  Most HHT pregnancies proceed normally. Rare major complications, and improved survival outcome following prior recognition, means that pregnancy in a woman with HHT should be considered high risk. Recommendations for pregnancy management are provided.     

Temporal effect of Guanxin No. 2 on cardiac function, blood viscosity and angiogenesis in rats after long-term occlusion of the left anterior descending coronary artery

AIM: Cardiac infarction is one of the main causes of death in both developing and developed countries over past decades. Currently available approaches for treating patients with this disease are not satisfactory. Traditional Chinese medicines have been increasingly paid attention to. The aim of this study was to characterize the dynamic protective effects of Guanxin No. 2 decoction (GX II) on cardiac dysfunction combined with the blood viscosity and myocardial hypertrophy parameters in myocardial infarction (MI) rats. METHODS: Male Sprague-Dawley rats (180-200 g) were randomly divided into three groups: sham-operated, coronary artery ligation (CAL), and CAL plus GX II (GX II, 10.0 g raw materials/kg/d, bid, p.o.). The experiment was carried out at 4 time points as the 3rd, 7th, 14th, and 28th day after ligation. RESULT: It was found that on the one hand, GX II could significantly improve the heart function, and remarkably decrease infarct size and inhibit ventricular remodeling. On the other hand, GX II showed some unique effects such as angiogenesis which was induced in the left ventricular tissue. This result was consistent with the finding of an augmented vascular endothelial growth factor (VEGF) expression in this area. CONCLUSIONS: The studies demonstrated that GX II exerted extensively beneficial cardioprotective effect on CAL rats, it might stimulate angiogenesis of ischemic region to compensate blood supply to the heart via upregulated VEGF expression.