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1.
目的:探究替米沙坦对冠心病合并糖尿病肾病患者疗效的影响情况。方法:56例探究目标对象均为某院接收的冠心病合并糖尿病肾病患者,挑选时间2018年6月~2019年6月。将"计算机表法"作为分组的参考,分配为参照组(n=28例)执行依那普利治疗,探究组(n=28例)执行替米沙坦治疗。结果:探究组的LVEF、LVEDd、肌酐、24h尿蛋白4项指标与参照组相比,差异有统计学意义(P<0.05);收缩压、舒张压、空腹血糖、餐后2h血糖4项指标与参照组相比,差异没有统计学意义(P>0.05)。结论:冠心病合并糖尿病肾病患者选择替米沙坦治疗后,心室功能的重构以及肾脏预后结局均得到改善,且临床效果比依那普利好,值得借鉴。 相似文献
2.
目的：研究PTCA及血管支架安装治疗急性心肌梗死的时机选择与心脏功能关系。方法：本组78例,分为两组。A组为6h以内急诊,直接行PTCA血管支架安装的病人29例,男：女为23：6,平均年龄51．6±12．7岁。B组为49例,男：女为38：11,年龄52．3±11．5岁。急性期静脉溶栓（6h内）后于24～72h补救PTCA及血管支架安装的病人。结果：术后1周、4周做超声心动图检查,其左室射血分数（LVEF）情况A组VSB组：第1周0．52±0．07VS0．51±0．07（P＞0．05）,第4周0.58±0.08VS0．52±0．06（P＜0．05）。结论：急性心肌梗死病人在发病6h内行PTCA及支架安装能及时地使血运重建,达到改善心脏功能的作用。 相似文献
3.
目的：研究可否用左室重量表达并判定左心功能不全的可能性。方法：将左心功能不全按NYHA标准分成4个级别,每级1组,并设正常对照组,用超声心动图测量同一个病人的左室射血分数（LVEF）和左室重量。用SAS统计软件做方差分析。结果：LVEF与左心功能不全高度负相关（R＝－0．77270）,左室重量与左心功能不全高度正相关（R＝0．73421）。LVEF、左室重量各级指标间差别显著（n＝153,F＝64．85,P＜0．01;n＝153,F＝53．39,P＜0．0001）。各级与对照组比统,LVEF指标从Ⅱ级开始方有显著差别（P＜0．05）;而左室重量指标从Ⅰ级开始就有显著差别（P＜0．05）。结论：LVEF与左室重量指标均与左心功能不全高度相关,但心功能Ⅰ级的病人,左室重量指标更为敏感。 相似文献
4.
目的 评价芪苈强心胶囊联合米力农治疗慢性心力衰竭的临床疗效.方法 选取2018年1月-2020年6月内蒙古包钢医院慢性心力衰竭患者140例作为研究对象,随机将患者分为对照组和观察组,每组各70例.对照组以米力农注射液0.5 μg/(kg·min)持续泵入72h,继以0.5μg/(kg·min)每日1次泵入,共4d.观察... 相似文献
5.
目的：探讨严重感染及感染性休克患者血清脑钠肽（BNP）变化及其对心功能预后的预测作用。方法：对我院68例严重感染及感染性休克的患者进行前瞻性研究,68例患者进入重症监护病房（ICU）24 h内测动脉血BNP及左心室射血分数（LVEF）。根据患者LVEF水平分为心功能正常组和心功能不全组,比较两组患者BNP水平;患者住院28 d死亡19例作为死亡组,存活49例,作为存活组,回顾性分析两组BNP水平,用ROC曲线评价BNP预测死亡的临界值。结果：①心功能不全组患者BNP水平显著高于心功能正常组患者BNP水平（P〈0.05）。②死亡组患者BNP水平显著高于存活组BNP水平（P〈0.05）,患者BNP水平〉691.8 ng/L为预测死亡的临界值,敏感度为91.7%,特异度为80.7%。结论：严重感染及感染性休克患者BNP水平显著升高,BNP对于患者心功能的预后具有一定的预测价值。 相似文献
6.
目的 探讨帕金森病患者血糖和左心室射血分数(LVEF)的变化及其与预后的关系.方法 选取2010年10月～2012年10月广东省河源市人民医院(以下简称“我院”)收治的帕金森病患者48例作为观察组,另选取30例我院同期健康查体者作为对照组.检测两组空腹血糖(FBG)、LVEF和洛文斯顿作业疗法认知评定量表(LOTCA)得分.观察组患者均接受相应的治疗和为期2年的随访.比较治疗前后观察组FBG和LVEF水平变化、LOTCA得分变化及患者病死率,分析观察组FBG和LVEF水平与LOTCA得分及病死率的关系,并采用ROC曲线分析观察组FBG和LVEF水平对其预后和认知功能损伤的预测价值.结果 与对照组比较,观察组治疗前FBG水平升高,LVEF水平下降;治疗1个月和3个月FBG均较治疗前下降,LVEF和LOTCA得分则均较治疗前升高,差异有统计学意义(P＜0.05).观察组患者病死率为8.33％,且死亡患者FBG水平均高于存活患者,LVEF则低于存活患者(P＜0.05).Pearson相关性分析结果显示,帕金森病患者LVEF与其LOTCA得分呈弱相关(r=0.279,P＜0.05),FBG与其LOTCA得分则均呈显著负相关(r=-0.876,P＜0.05).进一步ROC曲线分析结果显示,帕金森病患者FBG及LVEF联合预测其认知功能损伤和不良预后的曲线下面积、灵敏度和准确性均较高.结论 帕金森病患者FBG和LVEF水平均与认知功能损伤和预后相关,且对其预后的预测价值良好,这可能与高血糖水平造成神经损伤和帕金森病患者心脑血管系统继发性改变相关.因此帕金森病患者FBG升高和LVEF降低时需警惕其不良预后的发生并及时干预以改善患者预后. 相似文献
7.
Andreas W. Schoenenberger André Moser Dominic Bertschi Peter Wenaweser Stephan Windecker Thierry Carrel Andreas E. Stuck Stefan Stortecky 《JACC: Cardiovascular Interventions》2018,11(4):395-403
Objectives
This study sought to evaluate whether frailty improves mortality prediction in combination with the conventional scores.Background
European System for Cardiac Operative Risk Evaluation (EuroSCORE) or Society of Thoracic Surgeons (STS) score have not been evaluated in combined models with frailty for mortality prediction after transcatheter aortic valve replacement (TAVR).Methods
This prospective cohort comprised 330 consecutive TAVR patients ≥70 years of age. Conventional scores and a frailty index (based on assessment of cognition, mobility, nutrition, and activities of daily living) were evaluated to predict 1-year all-cause mortality using Cox proportional hazards regression (providing hazard ratios [HRs] with confidence intervals [CIs]) and measures of test performance (providing likelihood ratio [LR] chi-square test statistic and C-statistic [CS]).Results
All risk scores were predictive of the outcome (EuroSCORE, HR: 1.90 [95% CI: 1.45 to 2.48], LR chi-square test statistic 19.29, C-statistic 0.67; STS score, HR: 1.51 [95% CI: 1.21 to 1.88], LR chi-square test statistic 11.05, C-statistic 0.64; frailty index, HR: 3.29 [95% CI: 1.98 to 5.47], LR chi-square test statistic 22.28, C-statistic 0.66). A combination of the frailty index with either EuroSCORE (LR chi-square test statistic 38.27, C-statistic 0.72) or STS score (LR chi-square test statistic 28.71, C-statistic 0.68) improved mortality prediction. The frailty index accounted for 58.2% and 77.6% of the predictive information in the combined model with EuroSCORE and STS score, respectively. Net reclassification improvement and integrated discrimination improvement confirmed that the added frailty index improved risk prediction.Conclusions
This is the first study showing that the assessment of frailty significantly enhances prediction of 1-year mortality after TAVR in combined risk models with conventional risk scores and relevantly contributes to this improvement. 相似文献8.
James L. Januzzi Annabel A. Chen-Tournoux Robert H. Christenson Gheorghe Doros Judd E. Hollander Phillip D. Levy John T. Nagurney Richard M. Nowak Peter S. Pang Darshita Patel W. Franklin Peacock E. Joy Rivers Elizabeth L. Walters Hanna K. Gaggin 《Journal of the American College of Cardiology》2018,71(11):1191-1200
Background
Contemporary reconsideration of diagnostic N-terminal pro–B-type natriuretic peptide (NT-proBNP) cutoffs for diagnosis of heart failure (HF) is needed.Objectives
This study sought to evaluate the diagnostic performance of NT-proBNP for acute HF in patients with dyspnea in the emergency department (ED) setting.Methods
Dyspneic patients presenting to 19 EDs in North America were enrolled and had blood drawn for subsequent NT-proBNP measurement. Primary endpoints were positive predictive values of age-stratified cutoffs (450, 900, and 1,800 pg/ml) for diagnosis of acute HF and negative predictive value of the rule-out cutoff to exclude acute HF. Secondary endpoints included sensitivity, specificity, and positive (+) and negative (?) likelihood ratios (LRs) for acute HF.Results
Of 1,461 subjects, 277 (19%) were adjudicated as having acute HF. The area under the receiver-operating characteristic curve for diagnosis of acute HF was 0.91 (95% confidence interval [CI]: 0.90 to 0.93; p < 0.001). Sensitivity for age stratified cutoffs of 450, 900, and 1,800 pg/ml was 85.7%, 79.3%, and 75.9%, respectively; specificity was 93.9%, 84.0%, and 75.0%, respectively. Positive predictive values were 53.6%, 58.4%, and 62.0%, respectively. Overall LR+ across age-dependent cutoffs was 5.99 (95% CI: 5.05 to 6.93); individual LR+ for age-dependent cutoffs was 14.08, 4.95, and 3.03, respectively. The sensitivity and negative predictive value for the rule-out cutoff of 300 pg/ml were 93.9% and 98.0%, respectively; LR? was 0.09 (95% CI: 0.05 to 0.13).Conclusions
In acutely dyspneic patients seen in the ED setting, age-stratified NT-proBNP cutpoints may aid in the diagnosis of acute HF. An NT-proBNP <300 pg/ml strongly excludes the presence of acute HF. 相似文献9.
Ioanna Kosmidou Shmuel Chen A. Pieter Kappetein Patrick W. Serruys Bernard J. Gersh John D. Puskas David E. Kandzari David P. Taggart Marie-Claude Morice Paweł E. Buszman Andrzej Bochenek Erick Schampaert Pierre Pagé Joseph F. Sabik Thomas McAndrew Björn Redfors Ori Ben-Yehuda Gregg W. Stone 《Journal of the American College of Cardiology》2018,71(7):739-748
Background
There is limited information on the incidence and prognostic impact of new-onset atrial fibrillation (NOAF) following percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for left main coronary artery disease (LMCAD).Objectives
This study sought to determine the incidence of NOAF following PCI and CABG for LMCAD and its effect on 3-year cardiovascular outcomes.Methods
In the EXCEL (Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial, 1,905 patients with LMCAD and low or intermediate SYNTAX scores were randomized to PCI with everolimus-eluting stents versus CABG. Outcomes were analyzed according to the development of NOAF during the initial hospitalization following revascularization.Results
Among 1,812 patients without atrial fibrillation on presentation, NOAF developed at a mean of 2.7 ± 2.5 days after revascularization in 162 patients (8.9%), including 161 of 893 (18.0%) CABG-treated patients and 1 of 919 (0.1%) PCI-treated patients (p < 0.0001). Older age, greater body mass index, and reduced left ventricular ejection fraction were independent predictors of NOAF in patients undergoing CABG. Patients with versus without NOAF had a significantly longer duration of hospitalization, were more likely to be discharged on anticoagulant therapy, and had an increased 30-day rate of Thrombolysis In Myocardial Infarction major or minor bleeding (14.2% vs. 5.5%; p < 0.0001). By multivariable analysis, NOAF after CABG was an independent predictor of 3-year stroke (6.6% vs. 2.4%; adjusted hazard ratio [HR]: 4.19; 95% confidence interval [CI]: 1.74 to 10.11; p = 0.001), death (11.4% vs. 4.3%; adjusted HR: 3.02; 95% CI: 1.60 to 5.70; p = 0.0006), and the primary composite endpoint of death, MI, or stroke (22.6% vs. 12.8%; adjusted HR: 2.13; 95% CI: 1.39 to 3.25; p = 0.0004).Conclusions
In patients with LMCAD undergoing revascularization in the EXCEL trial, NOAF was common after CABG but extremely rare after PCI. The development of NOAF was strongly associated with subsequent death and stroke in CABG-treated patients. Further studies are warranted to determine whether prophylactic strategies to prevent or treat atrial fibrillation may improve prognosis in patients with LMCAD who are undergoing CABG. (Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization [EXCEL]; NCT01205776) 相似文献10.
Michelle K. York Deepak K. Gupta Cassandra F. Reynolds Eric Farber-Eger Quinn S. Wells Katherine N. Bachmann Meng Xu Frank E. Harrell Thomas J. Wang 《Journal of the American College of Cardiology》2018,71(19):2079-2088