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Chronic kidney disease: an independent risk factor of all-cause mortality for elderly chinese patients with chronic heart failure

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Journal of geriatric cardiology 2012年第4期9卷 355��-360页

作者： Shi-Hui Fu Bing Zhu Yu-Xiao Zhang Shuang-Yan Yi Yuan Liu Tie-Hui Xiao Liang Wang Yong-Yi Bai Cai-Yi Lu Ping Ye Lei-Ming Luo Department of geriatric cardiology Chinese PLA General Hospital Beijing 100853 China institute of geriatric cardiology Chinese PLA General Hospital Beijing 100853 China

Objective To evaluate the prognostic value of chronic kidney disease (CKD) in elderly chinese patients with chronic heart failure (CHF). Methods The study consisted of 327 elderly patients with CHF. All-cause mortality was chosen as an endpoint over the median follow-up period of 345 days. Cox regression analysis was used to identify the risk factors of mortality. Results The median age of the entire cohort was 85 years (60��100 years). The mortality for 168 elderly patients with CHF and CKD (51.4% of entire cohort) was 39.9% (67 deaths), which was higher than the mortality for CHF patientswithout CKD [25.2% (40/159 deaths)] and the mortality for entire cohort with CHF [32.7% (107/327 deaths)]. The Cox regression analysis showed that old age [hazard ratio (HR): 1.033; 95% confidence interval (95%CI): 1.004��1.064], CKD(HR: 1.705; 95%CI: 1.132��2.567), CHF New York HeartAssociation (NYHA) class IV (HR: 1.913; 95% CI: 1.284��2.851), acute myocardial infarction (AMI) (HR: 1.696; 95% CI: 1.036��2.777), elevated resting heart rate (HR: 1.021; 95% CI: 1.009��1.033), and decreased plasma albumin (HR: 0.883; 95% CI: 0.843��0.925) were independent risk factors of mortality for elderly patientswith CHF. Conclusions CKDwas an independent risk factor of mortality for elderly chinese patientswith CHF.

关键词： Chronic heart failure Chronic kidney disease Risk factor The aged

Effect of continuous positive airway pressure ventilation on nocturnal ST-segment changes in patients with sleep-disordered breathing

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Journal of geriatric cardiology 2007年第2期4卷 101-104页

作者： Wenli Zhang Shiwen Wang Rui Chen Mohan Liu Lin Wang Lei Gao Caiyi Lu institute of geriatric cardiology Chinese PLA General Hospital Beijing 100853 China Institute of Geriatric Cardiology Chinese PLA General Hospital Beijing 100853 China Institute of Geriatric Cardiology Chinese PLA General Hospital Beijing 100853 China Institute of Geriatric Cardiology Chinese PLA General Hospital Beijing 100853 China Institute of Geriatric Cardiology Chinese PLA General Hospital Beijing 100853 China Institute of Geriatric Cardiology Chinese PLA General Hospital Beijing 100853 China Institute of Geriatric Cardiology Chinese PLA General Hospital Beijing 100853 China

Objective To determine whether sleep-disordered breathing (SDB) may lead to nocturnal myocardial ischemia and whether the severity of this ischemia may be relieved by nasal continuous positive airway pressure (CPAP). Methods Overnight polysomnogram examination and simultaneous 3-channel Holter monitoring were performed on 76 patients with moderate to severe SDB and no history of coronary heart disease. All the cases were treated with CPAP for one night. ST depression was defined as a ST segment decrease of more than 1 mm from baseline and lasting 1 min or more. The total duration (minutes) of ST depression was indexed to the total sleep time (minutes per hour of sleep). Results Twenty-eight patients (37%) showed ST segment depression during their sleep. Before CPAP treatment, the respiratory disturbance index (RDI) and arousal index were significantly higher during periods of ST depression than when ST segments were isoelectric, whereas no significant difference was found in blood oxygen saturation (SaO2). After the CPAP treatment of patients with ST depression, the duration of ST depression was significantly reduced from 36.8±18.9 to 11.4±13.2 min/h (P<0.05). ST depression-related indexes, including RDI, arousal index and the percentage of sleep time spent at SaO2 below 90% (TS90/ TST), were all significantly decreased, with RDI from 63.4±23.8 to 8.1±6.6 /h, arousal index from 51.2±18.9 to 9.6±5.4 /h, and TS90/ TST from 50.6±21.4 to 12.9±14.7% (P<0.05). Conclusion ST-segment depression is rather common in patients with moderate to severe SDB, and CPAP treatment can significantly reduce the duration of ST depression. ST depression in these patients may reflect the myocardial ischemia that really exists and the non-ischemic changes associated with recurrent SDB.

关键词： ST-segment depression myocardial ischemia sleep-disordered breathing continuous positive airway pressure

Medical comorbidities at admission is predictive for 30-day in-hospital mortality in patients with acute myocardial infarction： analysis of 5161 cases

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Journal of geriatric cardiology 2011年第1期8卷 31-34页

作者： Xue-Dong Yang Yu-Sheng Zhao Yu-Feng Li Xin-Hong Guo institute of geriatric cardiology Chinese PLA General Hospital Beijing 100853 China

Background The present study investigated the prognostic value of medical comorbidities at admission for 30-day in-hospital mortality in patients with acute myocardial infarction （AMI）. Methods A total of 5161 patients with AMI were admitted in chinese pla general hospital between January 1, 1993 and December 31, 2007. Medical comorbidities including hypertension, diabetes mellitus, previous myocardial infarction, valvular heart disease, chronic obstructive pulmonary disease （COPD）, renal insufficiency, previous stroke, atrial fibrillation and anemia, were identified at admission. The patients were divided into 4 groups based on the number of medical comorbidities at admission （0, 1, 2, and ≥3）. Cox regression analysis was used to calculate relative risk （RR） and 95% confidence intervals （CI）, with adjustment for age, sex, heart failure and percutaneous coronary intervention （PCI）. Results The mean age of the studied population was 63.9 ± 13.6 years, and 80.1% of the patients were male. In 74.6% of the patients at least one comorbidity were identified. Hypertension （50.7%）, diabetes mellitus （24.0%） and previous myocardial infarction （12%） were the leading common comorbidities at admission. The 30-day in-hospital mortality in patients with 0, 1, 2, and ≥3 comorbidities at admission （7.2%） was 4.9%, 7.2%, 11.1%, and 20.3%, respectively. The presence of 2 or more comorbidities was associated with higher 30-day in-hospital mortality compared with patients without comorbidity （RR： 1.41, 95% CI： 1.13-1.77, P = 0.003, and RR： 1.95, 95% CI： 1.59-2.39, P = 0.000, respectively）. Conclusions Medical comorbidities were frequently found in patients with AMI. AMI patients with more comorbidities had a higher 30-day in-hospital mortality might be predictive of early poor outcome in patients with AMI.

关键词： acute myocardial infarction comorbidity mortality

Cancer risk in older people receiving statin therapy： a meta-analysis of randomized controlled trials

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Journal of geriatric cardiology 2016年第8期13卷 693-700页

作者： Hong-Wei LIU Su-Yan BIAN Qi-Wei ZHU Yue-Xiang ZHAO Department of geriatric cardiology Chinese PLA General Hospital Beijing China

Background Although statins are well tolerated by most aged people, their potential carcinogenicity is considered as one of the big-gest factors limiting the use of statins. The aim of the present study was to determine the risk of cancer in people aged over 60 years receiving statin therapy. Methods A comprehensive search for articles published up to December 2015 was performed, reviews of each randomized controlled trials （RCTs） that compared the effects of statin mono-therapy with placebo on the risk of cancer in people aged 〉 60 years were conducted and data abstracted. All the included studies were evaluated for publication bias and heterogeneity. Pooled odds ratios （OR） estimates and 95% confidence intervals （CIs） were calculated using the random effects model. Results A total of 12 RCTs, involving 62,927 patients （31,517 in statin therapy group and 31,410 in control group）, with a follow-up duration of 1.9-5.4 years, contributed to the analysis. The statin therapy did not affect the overall incidence of cancer （OR = 1.03, 95% CI： 0.94-1.14, P = 0.52）; subgroup analyses showed that neither the variety nor the chemical properties of the statins accounted for the incidence of cancer in older people. Conclusions Our meta- analysis findings do not support a potential cancer risk of statin treatment in people over 60 years old. Further targeted researches with a longer follow-up duration are warranted to confirm this issue.

关键词： Cancer Meta-analysis Older people Statins

Six-month results of a biodegradable polymer and rapamycin-coating stent for coronary artery disease

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Journal of geriatric cardiology 2006年第2期3卷 67-70页

作者： Yuxiao ZHANG Caiyi LU Qiao XUE Peng LIU Wei YAN Rui CHEN institute of geriatric cardiology General Hospital of Chinese PLA Beijing 100853 China Institute of Geriatric Cardiology General Hospital of Chinese PLA Beijing 100853 China Institute of Geriatric Cardiology General Hospital of Chinese PLA Beijing 100853 China Institute of Geriatric Cardiology General Hospital of Chinese PLA Beijing 100853 China Institute of Geriatric Cardiology General Hospital of Chinese PLA Beijing 100853 China Institute of Geriatric Cardiology General Hospital of Chinese PLA Beijing 100853 China

Objective To assess the safety and efficacy of a novel biodegradable polymer and rapamycin-coating stent, the EXCEL stent, in the treatment of coronary artery disease (CAD), as compared with the CypherTM stent. Methods In this prospective, non-randomized study, 60 consecutive patients with symptomatic CAD received either an EXCEL stent (n=32), or a CypherTM stent(n=28),according to their respective treatment intention. Follow-up angiography was performed at a mean of 180±40 days. The primary endpoint of the study was the occurrence of a major adverse cardiac event (MACE), including death, myocardial infarction, or target-vessel revascularization during the 6 months after stenting. The secondary end points included the in-stent late luminal loss (LLL), percentage of in-stent stenosis of the luminal diameter, and the rate of restenosis (luminal narrowing of 50 percent or more) at 6 months. Results There were no significant differences between the two groups in baseline characteristics, including the distribution of target vessel and lesion types. During the follow up period of 6 months, there were no occurrences of MACE in either group. Twenty-seven patients(84%) in the EXCEL group and 10 (36 %) in the CypherTM group underwent quantitative coronary angiography at 6 months. For these patients, no restenosis occurred, and there were no differences in the in-stent stenosis of the luminal diameter (5.98±5.52% vs 5.21 ±6.3%,P＞0.05) and the LLL (-0.02±0.09 mm vs -0.01±0.07 mm, P＞0.05). Conclusions Compared with the CypherTM stent, the EXCEL Stent with biodegradable polymer and rapamycin-coating showed similar efficacy in the prevention of neointimal proliferation, restenosis, and associated clinical events in CAD patients.

关键词： coronary artery disease stent, rapamycin biodegradable polymer

Blood pressure circadian rhythm and heart rate turbulence in hypertensive patients: relationship with left ventricular hypertrophy

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Journal of geriatric cardiology 2009年第1期6卷 38-41页

作者： Mei Zhu Mohan Liu Xinhong Guo Shiwen Wang institute of geriatric cardiology Chinese PLA General Hospital Beijing 100853 China Institute of Geriatric Cardiology Chinese PLA General Hospital Beijing 100853 China Institute of Geriatric Cardiology Chinese PLA General Hospital Beijing 100853 China Institute of Geriatric Cardiology Chinese PLA General Hospital Beijing 100853 China

Objective To investigate the relationship of blood pressure circadian rhythm with myocardial hypertrophy and the changes of autonomic nerve function in patients with essential hypertension (EH). Methods Eighty-two female patients with essential hypertension (EH) underwent 24-hours ambulatory blood pressure monitorings (ABPM), dynamic electrocardiogram (Holter) and echocardiography examination. Patients were classified into non-dipping group (n=40) and dipping group (n=42) according to the result of ABPM. Left ventricular mass index (LVMI), heart rate variability (HRV) in time domain (including SDNN, SDANN, rMSSD, PNN50) and heart rate turbulence (HRT) parameters (including turbulence onset [TO] and turbulence slope [TS]) were measured. Results Compared with those in dipping group, patients in non-dipping group have higher incidence of LVH (19.0% vs 52.5%, P<0.01), greater mean LVMI (112.39±12.79 g/m2 vs 121.98±13.35 g/m2, P<0.01), decreased PNN50 and rMSSD. TS value was decreased while TO was increased in non-dipping group compared with those in dipping group (both P <0.01); patients with LVH showed decreased TS and increased TO, compared with those without LVH. Conclusion In female patients with EH, non-dipping blood pressure circadian is associated with higher incidence of LVH. The HRV and HRT were more remarkably blunted in non-dipping patients, as well as those with LVH.

关键词： Hypertension myocardial hypertrophy heart rate variability heart rate turbulence

Secular trends in the etiology and comorbidity of hospitalized patients with congestive heart failure: A single-center retrospective study

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Journal of geriatric cardiology 2012年第4期9卷 361-365页

作者： Zhi-Yong Pei Yu-Sheng Zhao Jia-Yue Li Qiao Xue Lei Gao Shi-Wen Wang institute of geriatric cardiology Chinese PLA General Hospital Beijing 100853 China Department of Geriatric Cardiology Beijing Military General Hospital Beijing 100700 China institute of geriatric cardiology Chinese PLA General Hospital Beijing 100853 China

Objective To assess the secular trends in the etiology and comorbidity ofpatients hospitalized with congestive heart failure (CHF).Methods Data of 7,319 patients (mean age 59.6 years, 62.1% male) with a primary discharge diagnosis of CHF, hospitalized from January 1, 1993 to December 31, 2007 at the chinese People’s Liberation Army (pla) general hospital were extracted and analyzed. These patients were divided into three groups according to hospitalization period: 1993–1997 (n = 1623), 1998–2002 (n = 2444), and 2003–2007 (n = 3252). The etiological characteristics and comorbidities were assessed. Results Over the study period, the proportion of patients with ischemic heart disease (IHD) increased from 37.2% during the period 1993–1997 to 46.8% during the period 2003–2007, while that with valvular heart disease (VHD) decreased from 35.2%during the period 1993–1997 to 16.6% during the period 2003–2007 (both P chinese patients during the last two decades.

关键词： Atrial fibrillation Comorbidity Congestive heart failure Etiology hospitalization

Central Venous Catheter-related Thrombosis in Senile Male Patients: New Risk Factors and Predictors

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2015年第3期35卷 445-449页

作者：柳高付治卿朱平李世军 Department of geriatric cardiology Chinese PLA General Hospital

Central venous catheterization（CVC）-related venous thrombosis is a common but serious clinical complication, thus prevention and treatment on this problem should be extensively investigated. In this research, we aimed to investigate the incidence rate of CVC-related venous thrombosis in senile patients and give a further discussion on the related risk factors and predictors. A total of 324 hospitalized senile male patients subjected to CVC were selected. Retrospective investigation and analysis were conducted on age, underlying diseases, clinical medications, catheterization position and side, catheter retention time, and incidence of CVC-related venous thrombosis complications. Basic laboratory test results during catheterization and thrombogenesis were also collected and analyzed. Among the 324 patients, 20 cases（6.17%） of CVC-related venous thrombosis were diagnoseds. The incidence rate of CVC-related venous thrombosis in subclavian vein catheterization was significantly lower than that in femoral vein catheterization（P〈0.01） and that in internal jugular vein catheterization（P〈0.05）. No statistically significant difference was found between femoral vein catheterization and internal jugular vein catheterization（P〉0.05）. Previous venous thrombosis history（P〈0.01）, high lactate dehydrogenase level（P〈0.01）, low high-density lipoprotein（HDL） level（P〈0.05）, and low albumin level（P〈0.05） were found as risk factors or predictors of CVC-related venous thrombosis in senile male patients. Subclavian vein catheterization was the most appropriate choice among senile patients to decrease the incidence of CVC-related venous thrombosis. Previous venous thrombosis history, high lactate dehydrogenase level, low HDL level, and low albumin level were important risk factors in predicting CVC-related venous thrombosis.

关键词： risk factors central venous catheterization-related venous thrombosis senile male patients

Vascular protection by high-density lipoprotein-associated sphingosine-1- phosphate

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Journal of geriatric cardiology 2017年第11期14卷 696-702页

作者： Xi WANG Fan WANG Department of geriatric cardiology Chinese PLA General Hospital Beijing 100853 China

Epidemiological studies and animal experiments have consistently demonstrated cardiovascular protection by high-density lipoprotein （HDL）. Findings from a growing number of studies further indicate that sphingosine-l-phosphate （S1P） mediates many of the beneficial effects of HDL on the cardiovascular system, including vasodilatation, angiogenesis, maintenance of endothelial barrier function, and protec- tion against atherosclerosis and ischemiaJreperfusion injury. In this review, we summarize the most recent literature investigating the effects of HDL-S 1 P on cardiovascular health and highlight potential opportunities for clinical translation of these findings.

关键词： ApoM HDL-associated S1P Vascular function