急性心肌梗死患者脑钠肽水平与血管病变的关系

目的:探讨急性心肌梗死患者血浆脑钠肽(BNP)水平与梗死相关动脉及病变血管的关系。方法:选取2010.7-2011.7于上海市第一人民医院诊断为急性心肌梗死的患者。分为ST抬高型心梗患者和非ST抬高型心梗患者两组,比较BNP水平与血管病变的关系。结果:(1)两组患者的年龄、男女比例、高血压病与糖尿病患病率、吸烟患者比例之间无显著差异。NSTEMI患者中,既往心梗和既往经皮冠状动脉成形术(PTCA)的比例和左室射血分数明显高于STEMI患者。(2)NSTEMI患者多支血管病变比例显著高于STEMI患者并且梗死相关动脉为左回旋支(LCX)的比例显著高于STEMI患者。(3)病变血管支数与心梗患者BNP水平无关,STEMI患者左冠状动脉前降支(LAD)为IRA的患者BNP水平显著高于LCX和右冠状动脉(RCA)分别为IRA的患者。NSTEMI患者LAD、LCX和RCA分别为IRA的患者其BNP水平无显著差异。结论:STEMI患者前壁心梗BNP水平较高,NSTEMI患者BNP水平对血管病变支数和IRA无预测价值。     

ST段抬高性和非ST 段抬高性急性心肌梗死患者的冠状动脉病变特点比较

目的:比较ST段抬高性和非ST段抬高性急性心肌梗死患者的冠状动脉病变特点。方法:选取100例在我院接受24h动态心电图和冠状动脉造影检查的急性心肌梗死患者,根据心电图结果分为观察组和对照组各50例。对照组为ST段抬高性心肌梗死(STEMI)患者,观察组为非ST段抬高性心肌梗死(NSTEMI)患者,比较两组患者冠状动脉病变的差异。结果:对照组LAD(左前降支)闭塞血管比例(52.00%)显著高于观察组(18.00%),差异具有统计学意义(P0.05)。对照组LCX(回旋支)闭塞血管比例(8.00%)显著低于观察组(50.00%),差异具有统计学意义(P0.05)。对照组RCA(右冠脉主干)闭塞血管比例(40.00%)和观察组(30.00%)比较,差异无统计学意义(P0.05)。对照组单支病变比例(46.00%)明显高于观察组(12.00%),对照组三支病变比例(20.00%)明显低于观察组(48.00%)比较,差异均具有统计学意义(P0.05)。对照组二支及正常血管比例与观察组比较,差异均无统计学意义(P0.05)。对照组罪犯血管狭窄程度在76%-90%、91%-99%及完全闭塞的比例与观察组比较差异均具有统计学意义(P0.05)。罪犯血管狭窄程度在50%及50%-75%时,两组差异无统计学意义(P0.05)。两组并发症发生情况比较,差异无统计学意义(P0.05)。结论:1NSTEMI罪犯血管闭塞以LCX多见,STEMI罪犯血管闭塞以LAD多见;2NSTEMI以三支血管病变较多见,STEMI以单支病变较多见。     

Pregnancy-associated plasma protein A and proform eosinophilic major basic protein in the detection of different types of coronary artery disease

Kryptor system was proven to be a rapid, standard method for pregnancy-associated plasma protein A and proform eosinophilic major basic protein (PAPP-A/proMBP) complex detection in coronary artery disease (CAD). No age and/or gender differences in 51 controls and 110 stable coronary artery disease (SCAD) patients were found. SCAD patients did not differ from controls and no difference in PAPP-A/proMBP levels with regards to the number of affected vessels was found. In 21 unstable angina pectoris (UAP), in 35 without and 66 with ST elevation acute myocardial infarctions (NSTEMI, STEMI respectively) patients PAPP-A/proMBP levels were increased (P=0.004 and P<0.0005, respectively). PAPP-A/proMBP levels did not correlate with cardiac troponin I (cTnI) in STEMI and NSTEMI patients. PAPP-A/ proMBP increase was more frequent than cTnI (P=0.036) within the early phase of STEMI. In NSTEMI patients PAPP-A/proMBP positivity was present in 50 % of cTnI negative cases. Receiver operating characteristic (ROC) analysis revealed the highest diagnostic accuracy of PAPP-A/proMBP (0.919) in STEMI cTnI positive cases. The highest specificity/sensitivity PAPP-A/proMBP levels for particular acute coronary syndrome (ACS) types were 10.65-14.75 mIU/l. Combination of PAPP-A/proMBP with cTnI increases their diagnostic efficacy within the early phase of ACS. Our results suggest that PAPP-A/proMBP complex is involved in processes preceding vulnerable plaque development in ACS.     

急性ST段抬高型心肌梗死患者术后碎裂QRS波的影响因素及其与心肌灌注和短期预后的关系分析

摘要 目的：探讨急性ST段抬高型心肌梗死（STEMI）患者术后碎裂QRS波（fQRS）的影响因素,分析其与心肌灌注及短期预后的关系。方法：选取上海中医药大学附属曙光医院宝山分院于2017年4月～2019年4月期间收治的108例STEMI患者的临床资料行回顾性研究,术后均行12导联心电图检查,根据有无fQRS,分成fQRS组（n=52）,非fQRS组（n=56）。比较两组临床资料,经单因素及多因素Logistic回归分析明确患者术后fQRS的影响因素。比较两组心肌灌注情况,心肌灌注采用心肌呈色分级法（MBG）进行分析。随访1年,分析患者主要不良心血管事件发生率,包括心力衰竭、心绞痛、心源性死亡、心源性休克,用于评价短期预后。结果：单因素分析提示,年龄、冠脉血管病变支数、Gensini评分、心绞痛发作至血管开通时间与术后fQRS有关（P＜0.05）。多因素Logistic回归分析显示,年龄、冠脉血管病变支数、Gensini评分、心绞痛发作至血管开通时间为术后fQRS的影响因素（P＜0.05）。fQRS组MBG 3级占比为46.15%,显著低于非fQRS组的76.79%（P＜0.05）。fQRS组不良心血管事件发生率为26.92%,显著高于非fQRS组的10.71%（P＜0.05）。结论：STEMI患者术后fQRS发生的影响因素包括年龄、冠脉血管病变支数、Gensini评分以及心绞痛发作至血管开通时间,且术后fQRS可预测心肌灌注情况及增加不良心血管事件发生率。     

Fragmented QRS as a Predictor of Appropriate Implantable Cardioverter-defibrillator Therapy

Background

Fragmented QRS (fQRS) has been shown to be a marker of local myocardial conduction abnormalities and a predictor of cardiac events in selected populations. We hypothesized that the presence of a fQRS might predict arrhythmic events in patients who received an implantable cardioverter-defibrillator (ICD), regardless of the indications for implantation.

Methods and Results

A cohort of 107 consecutive patients (mean age, 53 years; 82% male) who underwent an ICD implantation was studied. We defined fQRS, on a routine 12-lead ECG, as the presence of an additional R wave or notching in the nadir of the S wave in 2 consecutive leads corresponding to a major coronary artery territory. In the presence of bundle branch block, more than 2 notches in the R or S waves in 2 consecutive leads were required to characterize fQRS. Patients were followed for 21.3±23 months for appropriate ICD therapy (antitachycardia pacing and/or shock). ICDs were implanted predominantly in patients with ischemic cardiomyopathy (N=45, 42.1%), followed by Brugada syndrome (N=26, 24.3%). fQRS presented in 42 patients (39.3%). During follow-up, patients with fQRS received more appropriate ICD therapy than those without fQRS (45.2% vs. 10.8%, P<0.0001). After adjustment for covariates, fQRS remained an independent predictor for appropriate ICD therapy (hazard ratio=5.32, 95% confidence interval=2.11-13.37, P<0.0001).

Conclusion

The presence of fQRS appeared to be directly associated with appropriate ICD therapy.     

Are There Gender Differences in Coronary Artery Disease? The Malaysian National Cardiovascular Disease Database – Percutaneous Coronary Intervention (NCVD-PCI) Registry

Objectives

To assess whether gender differences exist in the clinical presentation, angiographic severity, management and outcomes in patients with coronary artery disease (CAD).

Methods

The study comprised of 1,961 women and 8,593 men who underwent percutaneous coronary intervention (PCI) and were included in the Malaysian NCVD-PCI Registry from 2007–2009. Significant stenosis was defined as ≥70% stenosis in at least one of the epicardial vessels.

Results

Women were significantly older and had significantly higher rates of diabetes mellitus, hypertension, chronic renal failure, new onset angina and prior history of heart failure whereas smokers and past history of myocardial infarction were higher in men. In the ST-elevation myocardial infarction (STEMI) cohort, more women were in Killip class III-IV, had longer door-to-balloon time (169.5 min. vs 127.3 min, p<0.052) and significantly longer transfer time (300.4 min vs 166.3 min, p<0.039). Overall, women had significantly more left main stem (LMS) disease (1.3% vs 0.6%, p<0.003) and smaller diameter vessels (<3.0 mm: 45.5% vs 34.8%, p<0.001). In-hospital mortality rates for all PCI, STEMI, Non-STEMI (NSTEMI) and unstable angina for women and men were 1.99% vs 0.98%, Odds ratio (OR): 2.06 (95% confidence interval (CI): 1.40 to 3.01), 6.19% vs 2.88%, OR: 2.23 (95% CI: 1.31 to 3.79), 2.90% vs 0.79%, OR: 3.75 (95% CI: 1.58 to 8.90) and 1.79% vs 0.29%, OR: 6.18 (95% CI: 0.56 to 68.83), respectively. Six-month adjusted OR for mortality for all PCI, STEMI and NSTEMI in women were 2.18 (95% CI: 0.97 to 4.90), 2.68 (95% CI: 0.37 to 19.61) and 2.66 (95% CI: 0.73 to 9.69), respectively.

Conclusions

Women who underwent PCI were older with more co-morbidities. In-hospital and six-month mortality for all PCI, STEMI and NSTEMI were higher due largely to significantly more LMS disease, smaller diameter vessels, longer door-to-balloon and transfer time in women.     

冠状动脉CTA和DSA对冠心病患者的临床诊断价值比较

目的:比较冠状动脉CT血管成像(CT angiography,CTA)以及数字减影血管造影(digital subtraction angiography,DSA)诊断冠心病的临床价值差异。方法:选择2013年12月至2020年3月安徽医科大学第三附属医院、安徽医科大学第四附属医院收治的60例冠心病患者为研究对象,首先对其实施多排螺旋CT冠状动脉血管造影检测(CTA),而后2 w内再对其实施DSA检测,比较两种检测方式对不同血管狭窄程度、不同性质斑块检出率的差异,最后以DSA检测结果为金标准,评估CTA对冠状动脉狭窄诊断的一致性、灵敏度、特异度、阳性预测值和阴性预测值。结果:(1)CTA检测狭窄血管共计387支,轻度狭窄152支(39.28%),中度狭窄118支(30.49%),重度狭窄105支(27.13%),闭塞12支(3.10%);DSA检测狭窄血管392支,轻度狭窄150支(38.27%),中度狭窄124支(31.63%),重度狭窄112支(28.57%),闭塞6支(1.53%),两组各血管狭窄类型比较差异无统计学意义(P0.05);(2)CTA检测斑块69个,其中钙化斑43个(62.32%),非钙化斑26个(37.68%),DSA检测斑块61个,其中钙化斑33个(54.10%),非钙化斑28个(45.50%),两种检测方式差异无统计学意义(P0.05);(3)以DSA检测为金标准,CTA对重度及以上血管狭窄诊断一致性为99.23%,特异度为98.31%,灵敏度为99.64%,阳性预测值为99.15%,阴性预测值为99.27%。结论:与DSA相比,CTA对冠心病患者血管狭窄的诊断价值相当,且属于无创检测,在冠心病早期筛查中临床应用价值更高。     

低风险胸痛急性冠状动脉综合征患者心电图特征及其对诊断的价值研究

摘要 目的：分析低风险胸痛急性冠状动脉综合征(acute coronary syndrome,ACS)患者心电图特征及其对诊断的价值。方法：选择我院自2017年1月至2019年8月接诊的194例疑似低风险胸痛ACS患者,均采取心电图检查和冠状动脉造影检查;分析低风险胸痛ACS患者的心电图特征,观察心电图结果与冠状动脉病变支数、狭窄程度的关系,计算心电图诊断低风险胸痛ACS的特异性、敏感性等效能指标,使用受试者工作特征(receiver operating characteristic,ROC)曲线下面积(curve,AUC)定量分析ST段偏移值预测主要不良心血管事件的效能。结果：在194例疑似低风险胸痛ACS患者中,低风险胸痛ACS患者134例,低风险不稳定型心绞痛(UA)患者心电图表现以ST-T缺血性改变为主,发作时改变明显或呈现伪性改善;低风险非ST段抬高的心肌梗死(non-ST-segment elevation myocardial infarction,NSTEMI)患者心电图表现为肢体和胸导联ST段压低,T波低平、倒置,ST-T改变持续存在和呈动态衍变;低风险胸痛ACS患者心电图结果与冠状动脉病变支数无关(P＞0.05),与狭窄程度有关(P＜0.05);心电图诊断低风险胸痛ACS的特异性为71.67 %,敏感性为69.40 %,阳性预测值为84.55 %,阴性预测值为51.19 %,符合率为70.62 %;所有患者均获得随访,经ROC曲线分析,ST段偏移值预测低风险胸痛ACS患者发生主要不良心血管事件的最佳截值为1.85 mm,AUC为0.695,对比全球急性冠状动脉事件注册(GRACE)风险评分的0.675,差异无统计学意义(P＞0.05)。结论：低风险胸痛ACS患者心电图具有多样化,与冠状动脉狭窄程度有关,有助于初步诊断和风险评估,且ST段偏移值预测主要不良心血管事件的效能较好,值得进一步研究应用。     

Fragmented QRS: What Is The Meaning?

Fragmented QRS (fQRS) is a convenient marker of myocardial scar evaluated by 12-lead electrocardiogram (ECG) recording. fQRS is defined as additional spikes within the QRS complex. In patients with CAD, fQRS was associated with myocardial scar detected by single photon emission tomography and was a predictor of cardiac events. fQRS was also a predictor of mortality and arrhythmic events in patients with reduced left ventricular function. The usefulness of fQRS for detecting myocardial scar and for identifying high-risk patients has been expanded to various cardiac diseases, such as cardiac sarcoidosis, arrhythmogenic right ventricular cardiomyopathy, acute coronary syndrome, Brugada syndrome, and acquired long QT syndrome. fQRS can be applied to patients with wide QRS complexes and is associated with myocardial scar and prognosis. Myocardial scar detected by fQRS is associated with subsequent ventricular dysfunction and heart failure and is a substrate for reentrant ventricular tachyarrhythmias.     

Outflow-tract ventricular tachycardia: Can 12 lead ECG during sinus rhythm identify underlying cardiac sarcoidosis?

BackgroundPatients with outflow tract ventricular tachycardia (OTVT) with normal echocardiogram are labeled as idiopathic VT (IVT). However, a subset of these patients is subsequently diagnosed with underlying cardiac sarcoidosis (CS). Objective:Whether electrocardiogram (ECG) abnormalities in sinus rhythm (SR) can differentiate underlying CS from IVT.MethodsWe retrospectively analyzed the SR-ECGs of 42 patients with OTVT/premature ventricular complexes (PVC) and normal echocardiography. All underwent advanced imaging with cardiac magnetic resonance (CMR)/¹⁸FDG PET-CT for screening of CS. Twenty-two patients had significant abnormalities in cardiac imaging and subsequently had biopsy-proven CS (Cases). Twenty patients had normal imaging and were categorized as IVT (Controls). SR-ECGs of all patients were analyzed by 2 independent, blinded observers.ResultsBaseline characteristics were comparable. Among the ECG features analyzed – fascicular (FB) or bundle branch block (BBB) was seen in 9/22 Cases vs. 1/20 controls (p = 0.01). Among patients without FB or BBB, fragmented QRS (fQRS) was present in 9/13 cases but in none of the controls (p < 0.001). Low voltage QRS was more often seen among cases as compared to controls (10/22 vs. 3/20 p = 0.03). A stepwise algorithm based on these 3 sets of ECG findings helped to diagnose CS among patients presenting with OTVT/PVC with sensitivity of 91%, specificity of 75%, a PPV of 80%, and a NPV of 88%.ConclusionsIn patients presenting with OTVT/PVC: FB/BBB, fQRS, and low QRS voltage on the baseline ECG were more often observed among patients with underlying CS as compared to true IVT. These findings may help to distinguish underlying CS among Cases presenting with OTVT/PVC.     

Seasonal variation in myocardial infarction is limited to patients with ST-elevations on admission

Previous studies have demonstrated seasonal variation in the incidence of acute myocardial infarction (AMI) with an increase in cases during the winter months. However, they did not assess whether ST-elevation MI (STEMI) and non-ST-elevation MI (NSTEMI) exhibit similar changes. The object of this study was to compare the seasonal variation of STEMI and NSTEMI. All patients who presented with AMI and underwent coronary angiography within seven days of admission were identified via the institutional database. STEMI diagnosis required admission ECG demonstrating ST elevation in at least two continguous leads. All AMIs not meeting criteria for STEMI were defined as NSTEMI. Patients were divided into monthly and seasonal groups based on the date of admission with MI. A total of 784 patients were included: 549 patients with STEMI and 235 with NSTEMI. When STEMI patients were analyzed by season, there were 170 patients (31%) in the winter months, a statistically significant difference of excess MI (p<0.005). When NSTEMI patients were analyzed, there were 62 patients (26%) in the winter with no statistically significant difference in the seasonal variation. Our findings suggest that the previously noted seasonal variation in the incidence of AMI is limited to patients presenting with STEMI, and that there are important physiological differences between STEMI and NSTEMI, the nature of which remains to be elucidated.     

急性心肌梗死患者心电图碎裂QRS波与左心室收缩功能、心率变异性及心脏事件的关系研究

目的:探讨急性心肌梗死患者心电图碎裂QRS(f QRS)波与左心室收缩功能、心率变异性及心脏事件的关系。方法:收集2018年1月～2020年1月期间于本院进行治疗的急性心肌梗死患者124例,对患者行心电图检查,根据患者心电图是否出现f QRS波分成f QRS组(59例)和无f QRS组(65例),采用多普勒超声诊断仪对两组患者的左心室收缩功能进行检测对比,并对两组患者进行24h动态心电图检查,对两组患者的心率变异性指标进行统计对比。对两组患者进行为期3个月的随访观察,统计对比两组患者随访期间心脏事件的发生率。结果:f QRS组患者的左室射血分数(LVEF)低于无f QRS组,左心室舒张末期容积(LVEDV)、左心室舒张末期内径(LVEDD)均高于无f QRS组(P0.05)。f QRS组患者总标准差(SDNN)、两个相邻RR间期互差(PNN50)、差值均方根(RMSSD)均低于无f QRS组(P0.05)。随访期间f QRS组患者的心脏事件发生率为35.59%(21/59),高于无f QRS组患者的13.85%(9/65)(P0.05)。结论:伴有心电图f QRS波急性心肌梗死患者的左心室收缩功能降低,心率变异性指标降低,且心脏不良事件发生率增加,心电图f QRS波在一定程度上可作为急性心肌梗死患者心功能、心率变异性及心脏事件发生的监测手段。     

Tissue Doppler imaging during dipyridamole and dobutamine stress echocardiography in the diagnosis of coronary heart disease

The aim of the study was to determine the sensitivity and specificity of combined high-dose dipyridamole and dobutamine stress echocardiography (stress EchoCG) in the diagnosis of coronary artery stenotic lesions in coronary heart disease in a group of patients who were unable to perform physical exercise, by using different assessment criteria (local contractile impairments and systolic velocity changes during tissue Doppler imaging). The study enrolled 68 men who had undergone dipyridamole and dobutamine stress EchoCG, longitudinal tissue Doppler imaging, and coronary angiography. Stress EchoCG could bring up to diagnostic criteria in all the patients. Coronary angiography revealed no coronary artery lesion in 18 patients, but showed single and multiple vascular lesions in 31 and 19 patients, respectively. The sensitivity and specificity of combined stress EchoCG were significantly higher than those of stress EchoCG examination. The results of combined stress EchoCG allow one to judge to a greater validity (96% sensitivity and 100% specificity) local contractile impairments corresponding to the blood supply area in the atherosclerosis-afflicted coronary artery. Analysis of systolic velocity parameters during tissue Doppler imaging permits the diagnostic value of the technique to be insignificantly improved particularly when the test results are controversial.     

Thrombus Aspiration during Percutaneous coronary intervention in Acute non-ST-elevation myocardial infarction Study (TAPAS II)-Study design

Background and Objective. The Thrombus Aspiration during Percutaneous coronary intervention in Acute myocardial infarction Study (TAPAS) has shown that thrombus aspiration improves myocardial perfusion and clinical outcome compared with conventional primary percutaneous coronary intervention (PCI) in patients with ST-segment-elevation myocardial infarction. Impaired myocardial perfusion due to spontaneous or angioplasty-induced embolisation of atherothrombotic material also occurs in patients with non-ST-elevation myocardial infarction (NSTEMI). The aim of this study is to determine whether thrombus aspiration before stent implantation will result in improved myocardial perfusion in patients with NSTEMI compared with conventional PCI. Study design. The study is a single-centre, prospective, randomised trial with blinded evaluation of endpoints. The planned inclusion is 540 patients with acute NSTEMI who are candidates for urgent PCI. Patients are randomised to treatment with manual thrombus aspiration or to conventional PCI. The primary endpoint is the incidence of myocardial blush grade 3 after PCI. Secondary endpoints are coronary angiographic, histopathological, enzymatic, electrocardiographic and clinical outcomes including major adverse events at 30 days and one year. Implications. If thrombus aspiration leads to significant improvement of myocardial perfusion in patients with acute NSTEMI it may become part of the standard interventional approach. (Neth Heart J 2009;17:409–13.)     

Coronary heart disease diagnosis bases on the change of different parts in treadmill exercise test ECG

Summarize the value of the change of different parts in treadmill exercise test (TET) ECG to coronary heart disease (CHD) diagnosis. Four hundred and forty-five cases have been included in this investigation, which stayed in our hospital from January of 2006 to March of 2011 and underwent TET and coronary arteriography (CAG). The change of different parts in TET ECG in these patients had been retrospective summarized to determine its diagnosis value to CHD. (1) In the 445 cases of TET testers, 200 cases showed positive in TET with 150 cases of positive CAG, and 50 cases of negative CAG; 245 cases showed negative in TET with 206 cases of negative CAG, and 39 cases of positive CAG. The diagnosis sensitivity of CHD was 79.36 % (150/189), the specificity was 80.47 % (206/256), positive prediction value was 75.00 % (150/200), negative prediction value was 84.08 % (206/245), and false-positive rate was 25.00 % (50/200) with prediction accuracy of 80.00 % (356/445). (2) In the 200 cases with positive TET: 51 cases were in the limb lead group; 73 cases were in the chest lead group; and 76 cases were in the limb lead + chest lead group. There were 150 cases showing positive in CAG: 22 cases were in the limb lead group; 58 cases were in the chest lead group; and 70 cases were in the limb lead + chest lead group. The positive diagnosis rate of ST change in the chest lead was obviously higher than that of simple limb lead group (P < 0.05). (3) People with healthy coronary artery will have decreased amplitude of R wave while patients with coronary stenosis have elevated amplitude of R wave. (4) As for the T wave, the positive CAG had no statistical significance between normal T wave group and TET positive group (P > 0.05); CAG results had statistical significance between normal T wave group and TET negative group (P < 0.05). (5) Positive CAG results had no statistical significance between U-wave inversion group and TET positive group (P > 0.05); positive CAG results has statistical significance when TET negative group compared with U-wave inversion group or TET positive group (P < 0.05). TET is a relatively idea invasive diagnosis method for coronary disease, which can be utilized to evaluate the stage of CHD when integrating with the change of TET ECG.     

Soluble ST2 and Interleukin-33 Levels in Coronary Artery Disease: Relation to Disease Activity and Adverse Outcome

Objectives

ST2 is a receptor for interleukin (IL)-33. We investigated an association of soluble ST2 (sST2) and IL-33 serum levels with different clinical stages of coronary artery disease. We assessed the predictive value of sST2 and IL-33 in patients with stable angina, non-ST elevation myocardial infarction (NSTEMI) and ST elevation myocardial infarction (STEMI).

Methods

We included 373 patients of whom 178 had stable angina, 97 had NSTEMI, and 98 had STEMI. Patients were followed for a mean of 43 months. The control group consisted of 65 individuals without significant stenosis on coronary angiography. Serum levels of sST2 and IL-33 were measured by ELISAs.

Results

sST2 levels were significantly increased in patients with STEMI as compared to patients with NSTEMI and stable angina as well as with controls. IL-33 levels did not differ between the four groups. During follow-up, 37 (10%) patients died and the combined endpoint (all cause death, MI and rehospitalisation for cardiac causes) occurred in 66 (17.6%) patients. sST2 serum levels significantly predicted mortality in the total cohort. When patients were stratified according to their clinical presentation, the highest quintile of sST2 significantly predicted mortality in patients with STEMI, but not with NSTEMI or stable coronary artery disease. sST2 was a significant predictor for the combined endpoint in STEMI patients and in patients with stable angina. Serum levels of IL-33 were not associated with clinical outcome in the total cohort, but the highest quintile of IL-33 predicted mortality in patients with STEMI.

Conclusions

Serum levels of sST2 are increased in patients with acute coronary syndromes as compared to levels in patients with stable coronary artery disease and in individuals without coronary artery disease. sST2 and IL-33 were associated with mortality in patients with STEMI but not in patients with NSTEMI or stable angina.     

高龄（80-89 岁）非ST 段抬高心肌梗死早期 介入治疗的疗效观察

目的:研究调查高龄(80-89岁)非ST段抬高心肌梗死(non-ST-segment elevation myocardial infarction,NSTEMI)患者行早期经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)的有效性。方法:回顾分析2008年8月-2009年10月期间我院住院的66例80-89岁NSTEMI患者,冠状动脉造影检查后45例行PCI术,5例因为左主干病变或者严重的三支病变行冠脉搭桥(CABG)术,其余16例做保守治疗。发病到行介入治疗时间<72h。结果:45例行PCI术中42例成功,再血管化的成功率为63.6%,失败的3例PCI术病人中2例因导丝或球囊未能通过病变,1例为顽固性室速。共植入支架80枚,术后梗死相关动脉血流均达到TIMI2-3级。术后死亡2例(心源性休克、颅内出血各1例),死亡率为4.8%。住院期间出血并发症较高,有4(9.5%)例(穿刺部位血肿2例,消化道、颅内出血各1例)。住院期间无再发心肌梗死,偶发心绞痛2例。结论:穿刺尽管高龄(80-89岁)非ST段抬高心肌梗死冠脉早期介入主要出血事件较多,但可改善住院期间的预后。     

血清NLR、GDF-15及TRPC1与老年心力衰竭患者相关性分析

摘要 目的：探讨血清中性粒细胞与淋巴细胞比值（NLR）、生长分化因子-15（GDF-15）及瞬时受体电位通道1（TRPC1）与老年心力衰竭患者相关性。方法：选取我院2020年1月到2022年10月收治的100例老年慢性心力衰竭患者作为研究对象,将其分为心力衰竭组,另选取同期来我院体检的101名健康老年人作为对照组,98例心律失常老年患者作为心律失常组,对比三组受检者血清NLR、GDF-15及TRPC1水平,并应用受试者工作（ROC）曲线分析血清NLR、GDF-15及TRPC1对老年慢性心力衰竭的诊断价值。并依照NYHA心功能分级标准对100例心力衰竭患者进行评价,其中Ⅱ级23例,Ⅲ级38例,Ⅳ级39例,对比不同心功能分级患者血清NLR、GDF-15及TRPC1表达水平,应用Spearman相关分析分析血清NLR、GDF-15及TRPC1与老年心力衰竭患者心功能的相关性。结果：三组受检者血清NLR、GDF-15及TRPC1水平对比差异显著,心力衰竭组明显高于心律失常组和对照组（P＜0.05）;通过绘制ROC曲线,分析表1中组间具有明显差异的指标,确定其对老年心力衰竭的诊断效能,结果显示,曲线下面积（AUC）从依次为NLR（0.688）、GDF-15（0.667）、TRPC1（0.656）、三者联合（0.671）。NLR诊断灵敏度为67.61 %,特异度为66.85 %,GDF-15诊断灵敏度为60.03 %,特异度为67.53 %,TRPC1诊断灵敏度为61.24 %,特异度为66.53 %,三者联合诊断灵敏度为74.58 %,特异度为86.32 %;不同级别心功能的心力衰竭患者血清NLR、GDF-15及TRPC1水平对比差异显著,Ⅳ级心功能明显高于Ⅲ级、Ⅱ级（P＜0.05）;Spearman相关分析结果显示：NLR、GDF-15及TRPC1水平与老年心力衰竭患者心功能呈正相关（P＜0.05）。结论：血清NLR、GDF-15及TRPC1三者联合对于老年心力衰竭诊断灵敏度和特异度较高,且与患者心功能具有明显相关性,临床可考虑应用NLR、GDF-15及TRPC1作为超声心动图补充诊断手段,为临床诊断提供参考意见。     

心肺运动试验用于冠心病诊断价值的临床研究*

目的: 评估心肺运动试验（CPET）相关指标对于冠心病的诊断价值。方法: 选择156例疑诊为冠心病的患者（病情相对稳定,年龄在18~80岁）行CPET、运动负荷心电图及冠状动脉造影,以冠状动脉造影结果为标准,分析CPET相关指标（峰值摄氧量％预计值Peak VO₂%pred、峰值氧脉搏％预计值Peak O₂ pulse%pred、摄氧量对应功率的做功效率（ΔVO₂/ΔWR）诊断冠心病的敏感度、特异度及其诊断价值。结果: Peak VO₂%pred的最佳截断点是≤69%pred,其诊断冠心病的敏感度为55.1%,特异度为77.0%,AUC为0.698。Peak O₂ pulse%pred最佳截断点诊断冠心病的敏感度为50.7%,特异度为72.4%,AUC为 0.58。ΔVO₂/ΔWR最佳截断点处其诊断冠心病的敏感度为44.9%,特异度为87.4%,AUC为0.647。Peak VO₂%pred及ΔVO₂/ΔWR敏感度远高于负荷心电图,差异有统计学意义（P<0.01）。结论: CPET部分指标诊断冠心病的敏感度优于运动负荷心电图,最佳截断点处特异度及诊断价值均较高,而且CPET本身也包括连续动态全程心电图分析,不建议各自分割使用,主张所有指标整体整合分析使用。CPET相关指标对冠心病诊断有预测价值,可以早期、较准确的诊断冠心病。