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Predicting cardiovascular events in out-of-hospital patients presenting with atypical chest pain and complete left bundle branch block: role of CTA and echocardiographic Global Longitudinal Strain

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Journal of geriatric Cardiology 2024年第7期21卷 760-767页

作者： Guido Pastorini Fabio Anastasio Anna Botto Valentina Tardivo Mauro Feola Cardiology Division Regina Montis Regalis HospitalASLCN1Mondovi’Italy intensive care Regina Montis Re-galis HospitalASLCN1 Mondovi’Italy School of Geriatry University of MedicineTurinItaly

Background Out-of-hospital patients presenting with atypical chest pain and complete left bundle branch block(LBBB)have to be stratified for the presence of coronary artery disease and the risk of developing heart failure(HF).We investigated the pro-gnostic role of coronary CT-angiography(CTA)and echocardiographic global longitudinal strain(GLS)in those patients in a mid-term *** Out-of-hospital patients with LBBB underwent echocardiography and a 64-slice CT angiography were evaluated *** of HF or a cardiovascular death were the events *** Seventy-eight patients(32 female;mean age:66.0±10.4 years were *** a follow-up of 33 months(IQR:17-77),one patient(1.5%)experienced a cardiovascular death,14 patients(17.9%)required urgent outpatient visits due to acute de-compensated HF(12 hospitalizations).Echocardiography showed a slightly reduced left ventricular ejection fraction(LVEF)(50.0%±9.8%)and GLS within the normal range(-16.2%±4.1%).CTA analysis showed coronary stenosis>50%in 28 patients(35.9%).A high Agatston score(>100)was observed in 29.5%.Notably,25 patients(32.1%)were diagnosed with left main coron-ary artery disease and 15 patients(16.7%)underwent revascularization during the follow *** associations were ob-served between events and LVEF(P=0.001),diastolic dysfunction grade≥2(P=0.02),GLS(P<0.001),multiple coronary stenos-is(P=0.04)and Agatston score(P=0.05).Multivariate analysis confirmed the relationships with LVEF(R^(2)=0.89,P<0.001),dia-stolic dysfunction(R^(2)=3.30,P=0.04),GLS(R^(2)=1.43,P<0.001),and Agatston score(R^(2)=1.01,P=0.05).Conclusions In patients with complete LBBB,CTA and GLS identified those at a high risk of development HF.

关键词： patients echocardiographic branch

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Potential impact of specific therapy on pregnant women with pulmonary arterial hypertension without cardiac shunt:a descriptive study in northern China

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Emergency and Critical care Medicine 2024年第2期4卷 60-66页

作者： Weida Lu Min Li Fuqing Ji Hua Feng Guo Li Qiushang Ji Hongyu Zhang Xiaopei Cui Department of geriatric Medicine&Shandong Key Laboratory Cardiovascular Proteomics Qilu Hospital of Shandong UniversityJinanShandongChina intensive care unit of Cardiac Surgery Shandong Provincial Qianfoshan Hospitalthe First Hospital Affiliated with Shandong First Medical UniversityAffiliated Hospital of Shandong UniversityJinanShandongChina Department of Cardiology Linyi Central HospitalLinyiShandongChina Department of Gastroenterology Shandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinanShandongChina Department of Pulmonary and Critical care Medicine the Affiliated Hospital of Qingdao UniversityQingdaoShandongChina Department of Cardiology Qilu Hospital of Shandong UniversityJinanShandongChina

Background:Pregnancy in women with pulmonary arterial hypertension(PAH)is a fatal condition,despite the effectiveness of PAH-specific *** coverage status and effect of specific therapies in pregnant patients with PAH without cardiac shunts in China remain *** investigate this issue,we conducted a multicenter retrospective study in northern ***:The study included 85 patients who were admitted to 4 clinical centers in Shandong Province between October 2010 and August *** endpoint events included(1)maternal death and/or(2)major adverse cardiac events,both occurring during pregnancy or within 6 weeks ***:Although the overall mortality rate was encouraging(11.8%),the number of patients receiving PAH-specific therapies was extremely low(28.2%).Moreover,only 15.3%of patients received adequate duration of PAH-specific therapy(≥4 weeks)before delivery,and this subgroup showed the lowest major adverse cardiac events rate(7.7%)compared with that in the untreated(19.7%)and short-time treated groups(<4 weeks;54.5%).Conclusion:Pregnant patients with PAH without cardiac shunts face significantly increased mortality ***-term PAH-specific therapy does not guarantee favorable maternal *** screening,early identification,and timely intervention are expected to improve maternal outcomes in pregnant women with PAH.

关键词： Major adverse cardiac events Maternal mortality Pregnancy outcome Pulmonary arterial hypertension Specific therapy

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Cerebral autoregulation-directed optimal blood pressure management reduced the risk of delirium in patients with septic shock

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Journal of intensive Medicine 2024年第3期4卷 376-383页

作者： Qianyi Peng Xia Liu Meilin Ai Li Huang Li Li Wei Liu Chunguang Zhao Chenghuan Hu Lina Zhang Department of Critical care Medicine Xiangya HospitalCentral South UniversityChangshaHunanChina Hunan Provincial Clinical Research Center for Critical care Medicine Xiangya HospitalCentral South UniversityChangshaHunanChina National Clinical Research Center for geriatric Disorders Xiangya HospitalCentral South UniversityChangshaHunanChina

Background When resuscitating patients with septic shock,cerebrovascular reactivity parameters are calculated by monitoring regional cerebral oxygen saturation(rSO_(2))using near-infrared spectroscopy to determine the optimal blood ***,we aimed to analyze the impact of cerebral autoregulation-directed optimal blood pressure management on the incidence of delirium and the prognosis of patients with septic *** This prospective randomized controlled clinical study was conducted in the Xiangya Hospital of Central South University,***-one patients with septic shock(December 2020–May 2022)were enrolled and randomly allocated to the experimental(n=26)or control group(n=25).Using the ICM+software,we monitored the dynamic changes in rSO_(2) and mean arterial pressure(MAP)and calculated the cerebrovascular reactivity parameter tissue oxygen reactivity index to determine the optimal blood pressure to maintain normal cerebral autoregulation function during resuscitation in the experimental *** control group was treated according to the Surviving Sepsis Campaign *** in the incidence of delirium and 28-day mortality between the two groups were compared,and the risk factors were *** The 51 patients,including 39 male and 12 female,had a mean age of(57.0±14.9)*** incidence of delirium was 40.1%(23/51),and the 28-day mortality rate was 29.4%(15/51).The mean MAP during the first 24 h of intensive care unit(ICU)admission was higher([84.5±12.2]mmHg vs.[77.4±11.8]mmHg,P=0.040),and the incidence of delirium was lower(30.8%vs.60.0%,P=0.036)in the experimental group than in the control *** use of cerebral autoregulation-directed optimal blood pressure(odds ratio[OR]=0.090,95%confidence interval[CI]:0.009 to 0.923,P=0.043)and length of ICU stay(OR=1.473,95%CI:1.093 to 1.985,P=0.011)were risk factors for delirium during septic *** drug dose(OR=8.445,95%CI:1.26 to 56.576,P=0.028)and partial pressure of o

关键词： Septic shock Cerebral regional oxygen saturation Optimal blood pressure Delirium Mortality

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Study on the impact of comprehensive geriatric assessment on anxiety and depression in chronic obstructive pulmonary disease patients

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World Journal of Clinical Cases 2024年第20期12卷 4057-4064页

作者： Xian-Rong Shi Wen-Li Wu Chun-Yan Li Jiao Ao Hai-Xia Xiong Jing Guo Yan Fang Department of Nursing The First People’s Hospital of Jiangxia DistrictWuhan 430000Hubei ProvinceChina Respiratory and Critical care Medicine The First People’s Hospital of Jiangxia DistrictWuhan 430000Hubei ProvinceChina Department of intensive care Medicine The First People’s Hospital of Jiangxia DistrictWuhan 430000Hubei ProvinceChina

BACKGROUND Psychological factors such as anxiety and depression will not only aggravate the symptoms of chronic obstructive pulmonary disease(COPD)patients and reduce the quality of life of patients,but also affect the treatment effect and long-term ***,it is of great significance to explore the clinical application of senile comprehensive assessment in the treatment of COPD and its influence on psychological factors such as anxiety and *** To explore the clinical application of comprehensive geriatric assessment in COPD care and its impact on anxiety and depression in elderly *** In this retrospective study,60 patients with COPD who were hospitalized in our hospital from 2019 to 2020 were randomly divided into two groups with 30 patients in each *** control group was given routine nursing,and the observation group was given comprehensive *** symptoms,quality of life[COPD assessment test(CAT)score],anxiety and depression Hamilton Anxiety Rating Scale(HAMA)and Hamilton Depression Rating Scale(HAMD)were compared between the two *** CAT scores in the observation group decreased from an average of 24.5 points at admission to an average of 18.3 points at discharge,and in the control group from an average of 24.7 points at admission to an average of 18.3 points at *** average score was 22.1(Pgeriatric assessment in COPD care has a significant effect on improving patients'clinical symptoms and quality of life,and can effectively reduce patients'anxiety and depres

关键词： Chronic obstructive pulmonary disease Comprehensive geriatric assessment Anxiety Depression Retrospective study Hamilton Anxiety Rating Scale

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Thrombolysis in elderly patients

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Journal of geriatric Cardiology 2007年第4期4卷 250-253页

作者： Santiago Herrero Jose Antonio Lapuerta-Irigoyen Pacemaker and Coronary unit Intensive Care ServiceCabuees HospitalGijon Spain Pacemaker and Coronary unit Intensive Care ServiceCabuees HospitalGijonSpain

The elderly population consists of those over age 75 years and appears to represent the fastest-growing segment of the population. Intravenous thrombolytic therapy (TT) is the most common strategy for the treatment of acute myocardial infarction (AMI) in many parts of the world. However, TT carries a higher risk of intra-cranial hemorrhage (ICH) in the elderly patients. Primary percutaneous transluminal coronary angioplasty and stenting (PCI) represents an important alternative in these elderly individuals with contraindications to TT. In developing countries, or in areas without availability of primary PCI, TT remains the only therapeutic modality. Dedicated randomized trials are needed to provide a comprehensive understanding of AMI management in the elderly group.(J Geriatr Cardiol 2007;4:250-253.)

关键词： acute myocardial infarction thrombolysis elderly

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Effects of permissive hypocaloric vs standard enteral feeding on gastrointestinal function and outcomes in sepsis

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World Journal of Gastroenterology 2021年第29期27卷 4900-4912页

作者： Jia-Kui Sun Shuai Nie Yong-Ming Chen Jing Zhou Xiang Wang Su-Ming Zhou Xin-Wei Mu Department of Critical care Medicine Nanjing First HospitalNanjing Medical UniversityNanjing 210006Jiangsu ProvinceChina Department of geriatric intensive care unit The First Affiliated Hospital of Nanjing Medical University(Jiangsu Province People’s Hospital)Nanjing 210006Jiangsu ProvinceChina

BACKGROUND Intestinal mucosal barrier injury and gastrointestinal dysfunction are important causes of ***,few studies have investigated the effects of enteral underfeeding on gastrointestinal function in ***,no consensus on goal enteral caloric intake has been reached in *** To investigate the effects of different goal caloric requirements of enteral nutrition on the gastrointestinal function and outcomes in the acute phase of *** Patients were randomly assigned to receive 30%(defined as group A),60%(group B),or 100%(group C)of goal caloric requirements of enteral nutrition in this prospective pilot clinical *** acute gastrointestinal injury(AGI)grades,incidence of feeding intolerance(FI),daily caloric intake,nutritional and inflammatory markers,and biomarkers of mucosal barrier function were collected during the first 7 d of enteral *** clinical severity and outcome variables were also *** A total of 54 septic patients were *** days to goal calorie of group C(2.55±0.82)were significantly longer than those of group A(3.50±1.51;P=0.046)or B(4.85±1.68;P<0.001).The FI incidence of group C(16.5%)was higher than that of group A(5.0%)or B(8.7%)(P=0.009).No difference in the incidence of FI symptoms was found between groups A and *** serum levels of barrier function biomarkers of group B were significantly lower than those of group A(P<0.05)on the 7th day of *** prealbumin and IL-6 levels of group A were lower than those of group B(P<0.05)on the 7th day of *** significant differences in the clinical outcome variables or 28-d mortality were found among the three *** Early moderate enteral underfeeding(60%of goal requirements)could improve the intestinal barrier function and nutritional and inflammatory status without increasing the incidence of FI symptoms in ***,further large-scale prospective clinical trials and animal studies are required to test our fin

关键词： Enteral feeding Enteral nutrition Gastrointestinal function Intestinal mucosal barrier Sepsis

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Aggressive fluid management may be associated with disease progression in suspected sepsis patients admitted to the intensive care unit: a retrospective cohort study

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World Journal of Emergency Medicine 2024年第1期15卷 52-55页

作者： Miao Bian Zhihao Wang Yanling Chen Yue Sun Hongsen Ji Yutao Wang Li Pang Department of Respiratory Qianwei Hospital of Jilin ProvinceChangchun 130012China Department of geriatrics Jilin Provincial Geriatric Medicine Clinical Research Centerthe First Hospital of Jilin UniversityChangchun 130021China Department of Emergency the First Hospital of Jilin UniversityChangchun 130021China The First Operating Room the First Hospital of Jilin UniversityChangchun 130021China

Sepsis is a lethal condition characterized by multiple organ dysfunction due to disrupted host responses to severe infections.[1]Aff ected patients often have a Sequential Organ Failure Assessment(SOFA)score≥2.[2]Patients with a SOFA score<2 and at least one of the following were considered as“suspected sepsis”:(1)quick SOFA(qSOFA)score≥2;(2)SOFA score=1;or(3)National Early Warning Score(NEWS)4-6.[3]Compared with studies on fluid resuscitation in sepsis patients,there are few studies on fluid management in patients with suspected ***,we conducted a retrospective cohort study to evaluate the relationship between fluid management and disease progression in suspected sepsis patients.

关键词： patients sepsis admitted

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ARNI and SGLT2i: a promising association to be used with caution

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Journal of geriatric Cardiology 2020年第11期17卷 728-732页

作者： Andrea Herbst Francesco Orso Marta Migliorini Simona Virciglio Silvia Tognelli Viola Camartini Alessandra Pratesi Francesco Fattirolli NiccolòMarchionni Andrea Ungar Samuele Baldasseroni Heart Failure Clinic Division of Geriatric Medicine and Intensive Care UnitAzienda Ospedaliero-Universitaria CareggiFlorenceItaly Department of Experimental and Clinical Medicine University of FlorenceItaly Department of Cardiothoracovascular Medicine Azienda Ospedaliero-Universitaria CareggiItaly

During the last years, several pharmacological treatments have significantly improved outcome of patients with heart failure with reduced ejection fraction(HFr EF) particularly by inhibiting the renin–angiotensin–aldosterone system(RAAS) and by blocking the sympathetic system.[1,2] More recently, it was demonstrated that a further positive neurohormonal modulation of RAAS and of the natriuretic peptides pathway with Sacubitril/Valsartan(Sa/Va).

关键词： Chronic heart failure Sacubitril/valsartan SGLT2i

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Risk factors for brain injury in patients with exertional heatstroke:A 5-year experience

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Chinese Journal of Traumatology 2024年第2期27卷 91-96页

作者： Li Zhong Ming Wu Zhe-Ying Liu Yan Liu Zhi-Feng Liu Department of Traditional Chinese Medicine The First Affiliated HospitalGuizhou University of Chinese MedicineGuiyang550001China Department of Infection and Critical care Medicine The Second People's Hospital of Shenzhen&First Affiliated Hospital of Shenzhen UniversityHealth Science CenterShenzhenGuangdong province518035China Department of Medical Critical care Medicine General Hospital of Southem Theatre Command of PLA.Guangzhou510010China Guangdong Branch Center National Clinical Research Center for Geriatric Diseases(Chinese PLA General Hospital)Guangzhou510010China

Purpose:Minimal data exist on brain injury in patients with exertional heatstroke(EHS)in developing *** this study,we explored the risk factors for brain injury induced by EHS 90-day after ***:A retrospective cohort study of patients with EHS was conducted in the intensive care unit of the General Hospital of Southern Theater Command of PLA in China from April 2014 to June *** were divided into non-brain injury(fully recovered)and brain injury groups(comprising deceased patients or those with neurological sequelae).The brain injury group was further subdivided into a death group and a sequela group for detailed *** information,neurological performance and information on important organ injuries in the acute stage were recorded and *** logistic regression was used to identify risk factors for brain injury after EHS and mortality risk factors for brain injury,and Kaplan-Meier survival curve was used to evaluate the effect of the neurological dysfunction on ***:Out of the 147 EHS patients,117 were enrolled,of which 96(82.1%)recovered,13(11.1%)died,and 8(6.8%)experienced neurological *** significant differences were found between non-brain injury and brain injury groups in age,hypotension,duration of consciousness disorders,time to drop core body temperature below 38.5℃,lymphocyte counts,platelet counts,procalcitonin,alanine aminotransferase,aspartate aminotransferase,creatinine,cystatin C,coagulation parameters,international normalized ratio,acute physiology and chronic health evaluation II scores,sequential organ failure assessment(SOFA)scores,and Glasgow coma scale scores(all p<0.05).Multivariate logistic regression showed that age(OR=1.090,95%CI:1.02-1.17,p=0.008),time to drop core temperature(OR=8.223,95%CI:2.30-29.40,p=0.001),and SOFA scores(OR=1.676,95%CI:1.29-2.18,p<0.001)are independent risk factors for brain injury induced by *** Kaplan-Meier curves suggest significa

关键词： Exertional heatstroke Brain injury Sequela Risk factors Disorders of consciousness

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Cardiogenic shock:approaching the truth

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Journal of geriatric Cardiology 2022年第2期19卷 95-97页

作者： Isaac Llaó Albert Ariza-Solé Cardiology Department Intensive Cardiac Care UnitBellvitge University HospitalL’Hospitalet de LlobregatBarcelonaSpain

Cardiogenic shock(CS)is a severe clinical condition characterized initially by reduced cardiac output with abnormal organ perfusion which commonly leads to a multiorgan *** expansion of cardiac critical care units,development of reperfusion networks and progress of mechanical circulatory support(MCS),mortality of CS due to acute myocardial infarction(AMI)remains as high as 40%−50%.[1]Clinical outcomes in non-AMI patients are less established but remains similarly disappointing.

关键词： cardiac mortality acute

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