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Clinical benefit of left atrial appendage closure in octogenarians

Journal of Geriatric cardiology 2021年第11期18卷 886-896页

作者： Yamen Mohrez Steffen Gloekler Steffen Schnupp Wasim Allakkis Xiao-Xia Liu Monika Fuerholz Johannes Brachmann Stephan Windecker Stephan Achenbach Bernhard Meier Caroline Kleinecke department of cardiology Klinikum CoburgCoburgGermany Cardiovascular department University Hospital of BernBernSwitzerland department of cardiology Klinikum HochrheinWaldshut-TiengenGermany Depart-ment of cardiology Beijing Anzhen HospitalBeijingChina department of cardiology Friedrich-Alexander Uni-versity Erlangen-NuernbergErlangenGermany

OBJECTIVES Whether left atrial appendage closure(LAAC)in octogenarians yield similar net clinical benefit compared to younger patients,was the purpose of the present *** Two real-world LAAC registries,enrolling 744 consecutive Amplatzer and Watchman patients from 2009 to 2018,were retrospectively *** All events are reported per 100 *** hundred and sixty one octogenarians and 483 non-octogenarians with a mean follow-up of 1.7±1.3 and 2.3±1.6 years,and a total of 1,502 patient-years were *** had a higher risk for stroke(CHA2DS2-VASc score:5.2±1.2 vs.4.3±1.7,P<0.0001)and bleeding(HAS-BLED score:3.3±0.8 vs.3.1±1.1,P=0.001).The combined safety endpoint of major periprocedural complications and major bleeding events at follow-up was comparable(30/446,6.7%vs.47/1056,4.4%;hazard ratio[HR]=1.2;95%confidence interval[CI]:0.73−1.98;P=0.48)between the *** efficacy endpoint of all-cause stroke,systemic embolism,and cardiovascular/unexplained death occurred more often in octogenarians(61/446,13.7%vs.80/1056,7.6%;HR=7.0;95%CI:4.53−10.93;P<0.0001).Overall,octogenarians had a lower net clinical benefit,i.e.,the composite of all above mentioned hazards,from LAAC compared to younger patients(82/446,18.4%vs.116/1056,11.0%;HR=4.6;95%CI:3.11−7.0;P<0.0001).Compared to the anticipated stroke rate,the observed rate de-creased by 41%in octogenarians and 53%in *** observed bleeding rate was reduced by 10%octogenarians and 41%*** LAAC can be performed with similar safety in octogenarians as compared to younger *** the long-term,it both reduces stroke and bleeding events,although to a lesser extent than in non-octogenarians.

关键词： atrial closure younger

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Autologous transplantation of bone marrow mononuclear cells improved heart function after myocardial infarction

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Acta Pharmacologica Sinica 2004年第7期25卷 30-40页

作者： Guo-sheng LIN1, Jing-jun Lü, Xue-jun JIANG, Xiao-yan LI, Geng-shan LI department of cardiology, Renmin Hospitalof Wuhan University, Wuhan 430060, China department of cardiology Renmin Hospital of Wuhan University Wuhan 430060

AIM: To investigate whether autologous transplantation of adult stem cells could improve post-infarcted heart function. METHODS: Bone marrow mononuclear cells (MNCs) were isolated from adult rabbits’ tibias after coronary ligation. These cells were exposed to 5-azacytidine 10 μmol/L for 24 h on the third day of culture. After being labeled with bromodeoxyuridine (BrdU), the cells were auto-transplanted into bordering zone of the infarcted area at 2 weeks after injury. The animals were killed at 3 days, 2 weeks, 1 month, and 2 months after transplantation, respectively. The left ventricular functions, capillary density, and cardiac nerve density were measured and the differentiation of the engrafted cells was determined by immunostaining. RESULTS: BrdU-labeled MNCs were well aligned with the host cardiomyocytes. Parts of them were incorporated into capillary and arteriolar vessel walls. In addition to inducing angiogenic ligands (basic fibroblast growth factor, vascular endothelial growth factor) and imflammation cytokines (interleukin 1-β) during the early period of MNCs implantation, MNCs induced 2.0-fold increase in capillary density as well. Moreover, GAP43-positive and TH-positive nerve density were markedly higher in the MNCs-treated groups than that in the non-treated hearts. Left ventricular ejection fraction, LV+dp/dtmax, and LV-dp/dtmax were 47 %, 67 %, and 55 % in MNCs-treated heart respectively, which was higher than that of the control heart, whereas left ventricular end-diastolic volume, left ventricular end-diastolic diameter, and left ventricular end-diastolic pressure were 45 %, 22 %, and 50 % respectively in MNCs-treated heart, which was lower than that of the control heart at 2 months after cell transplantation. CONCLUSION: Autologous transplantation of MNCs induced angiogenesis and nerve sprouting and improved left ventricular diastolic function.

关键词： autologous transplantation bone marrow cells stem cell left ventricular function angiogenesis nerve regeneration myocardial infarction

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Intracoronary arterial retrograde thrombolysis with percutaneous coronary intervention: a novel use of thrombolytic to treat acute ST-segment elevation myocardial infarction

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Journal of Geriatric cardiology 2019年第6期16卷 458-467页

作者： Jin-Wen TIAN Mei ZHU Feng-Qi WANG Ke LI Chao-Fei ZHOU Bo LI Min WANG Jue-Lin DENG Bo JIANG Jing BAI Yi GUO Rong-Jie JIN Zhao ZHANG Ying LIN Ji-Hang WANG Shi-Hao ZHAO Ming-Zhi SHEN department of cardiology Hainan Hospital of PLA General Hospital Hainan China department of cardiology Chinese PLA General Hospital Beijing China

Background Clearance of coronary arterial thrombosis is necessary in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing urgent percutaneous coronary intervention (PCI). There is currently no highly-recommended method of thrombus removal during interventional procedures. We describe a new method for opening culprit vessels to treat STEMI: intracoronary arterial retrograde thrombolysis (ICART) with PCI. Methods & Results Eight patients underwent ICART. The guidewire was advanced to the distal coronary artery through the occlusion lesion. Then, we inserted a microcatheter into the distal end of the occluded coronary artery over the guidewire. Urokinase (5–10 wu) mixed with contrast agents was slowly injected into the occluded section of the coronary artery through the microcatheter. The intracoronary thrombus gradually dissolved in 3–17 min, and the effect of thrombolysis was visible in real time. Stents were then implanted according to the characteristics of the recanalized culprit lesion to achieve full revascularization. One patient experienced premature ventricular contraction during vascular revascularization, and no malignant arrhythmias were seen in any patient. No reflow or slow flow was not observed post PCI. Thrombolysis in myocardial infarction flow grade and myocardial blush grade post-primary PCI was 3 in all eight patients. No patients experienced bleeding or stroke. Conclusions ICART was accurate and effective for treating intracoronary thrombi in patients with STEMI in this preliminary study. ICART was an effective, feasible, and simple approach to the management of STEMI, and no intraprocedural complications occurred in any of the patients. ICART may be a breakthrough in the treatment of acute STEMI.

关键词： ST elevation myocardial infarction Therapeutic thrombolysis Thrombus Urokinase

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Analyses of risk factors and prognosis for new-onset atrial fibrillation in elderly patients after dual-chamber pacemaker implantation

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Journal of Geriatric cardiology 2018年第10期15卷 628-633页

作者： Xiao-Li CHEN Xue-Jun REN Zhuo LIANG Zhi-Hong HAN Tao ZHANG Zhi LUO department of cardiology Beijing Geriatric HospitalBeijingChina department of cardiology Beijing Anzhen HospitalCapital Medical UniversityBeijingChina

Objective To retrospectively identify risk factors and the prognosis for new-onset atrial fibrillation (AF)after implantation of dual-chamber pacemakers in elderly *** Consecutive patients aged >65years who underwent their first implantation of a dual-chamber permanent pacemaker in Beijing Anzhen Hospital from October 2013to May 2016were *** complete program- ming and follow-up data were ***-up end points included new-onset AF and major adverse cardiovascular and cerebrovascular *** Altogether,322patients were enrolled,with new-onset AF observed in 79(24.5%)during their *** analysis identified four independent predictors of new-onset AF in elderly patients after pacemaker implantation:hypertension (HR =3.040, 95%CI:1.09-3.05,P =0.00),age (HR =1.966,95%CI:1.57-3.68,P =0.01);left atrial enlargement (HR =1.645,95%CI:1.05-1.25,P = 0.03);high ventricular pacing rate (HR =1.137,95%CI:1.01-1.06,P =0.01).Univariable analysis indicated that the CHA2DS2-VASc score was also a risk factor for AF (HR =1.368,95%CI:1.178-1.589,P =0.002),whereas multivariable regression analysis did not. Kaplan-Meier survival analysis showed that the risk for ischemic stroke was significantly higher in the new-onset AF group than in the non-AF group (P <0.05).Conclusion Hypertension,age,left atrial enlargement,and high ventricular pacing rate were independent predictors of new-onset AF in elderly patients after implantation of a permanent ***-onset AF increased the risk for ischemic stroke.

关键词： Atrial fibrillation Dual-chamber pacemaker Elderly Ischernic stroke

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Alternative access site choice after initial radial access site failure for coronary angiography and intervention

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Journal of Geriatric cardiology 2018年第9期15卷 585-590页

作者： Dionysios Gatzopoulos Aggeliki Rigatou Eleftherios Kontopodis Ioannis Tsiafoutis Maria Agelaki Efstathios Lazaris Konstantinos Kintis Sotirios Patsilinakos Michael Koutouzis The Second department of cardiology Hellenic Red Cross Hospital of Athens Athens Greece cardiology department 'Konstantopoulio ' General Hospital Athens Greece

Background Transradial access for coronary catheterization is more technically challenging compared to the traditional transfemoral approach and radial access failure is quite common. The aim of this study is to describe the additional steps after initial radial access site failure in a high specialized forearm approach center. Methods A retrospective evaluation of all coronary catheterizations performed in our department between January 2016 and December 2016 was performed, with focus on arterial access. Results One thousand three hundred forty six procedures were evaluated. The initial access site used was right radial [1173 procedures （87.1%）], left radial [120 procedures （8.9%）], fight ulnar [7 procedures （0.5%）], left ulnar [40 procedures （2.9%）] and femoral approach [6 procedures （0.4%）]. Radial artery can- nulation failure was observed in 37 procedures （2.9% of 1293 procedures with initial radial approach）. Failure of procedure completion after successful radial sheath insertion was observed in 46 procedures （3.6%）. The alternative access site after initial radial approach failure was contralateral radial [43 procedures （51.8%）], ipsilateral ulnar [22 procedures （26.5%）, contralateral ulnar [12 patients （14.5%）] and femoral approach [6 procedures （7.2%）]. Conclusion Forearm arteries can be used as alternative access site after initial radial approach failure in order to reduce the use of femoral approach during cardiac catheterization.

关键词： Access site Femoral Radial Ulnar

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Systematic review of anastomotic complications of esophagojejunostomy after laparoscopic total gastrectomy

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World Journal of Gastroenterology 2015年第32期21卷 9656-9665页

作者： Mikito Inokuchi Sho Otsuki Yoshitaka Fujimori Yuya Sato Masatoshi Nakagawa Kazuyuki Kojima department of Surgical Oncology Tokyo Medical and Dental University department of Minimally invasive Surgery Tokyo Medical and Dental University

AIM: To investigate the anastomotic complications ofesophagojejunostomy(EJS) after laparoscopic total gastrectomy(LTG), we reviewed retrospective ***: A literature search was conducted in Pub Med for studies published from January 1, 1994 through January 31, 2015. The search terms included "laparoscopic," "total gastrectomy," and "gastric cancer." First, we selected 16 non-randomized controlled trials(RCTs) comparing LTG with open total gastrectomy(OTG) and conducted an updated meta-analysis of anastomotic complications after total gastrectomy. The Newcastle-Ottawa scoring system(NOS) was used to assess the quality of the non-RCTs included in this study. Next, we reviewed anastomotic complications in 46 case studies of LTG to compare the various procedures for EJS. RESULTS: The overall incidence of anastomotic leakage associated with EJS was 3.0%(30 of 984 patients) among LTG procedures and 2.1%(31 of 1500 patients) among OTG procedures in the 16 non-RCTs. The incidence of anastomotic leakage did not differ significantly between LTG and OTG(odds OR = 1.42, 95%CI: 0.86-2.33, P = 0.17, I2 = 0%). Anastomotic stenosis related to EJS was reported in 72(2.9%) of 2484 patients, and the incidence was 3.2% among LTG procedures and 2.7% among OTG procedures. The incidence of anastomotic stenosis related to EJS was slightly, but not significantly, higher in LTG than in OTG(OR = 1.55, 95%CI: 0.94-2.54, P = 0.08, I2 = 0%). The various procedures for LTG were classified into six categories in the review of case studies of LTG. The incidence of EJS leakage was similar(1.1% to 3.2%), although the incidence of EJS stenosis was relatively high when the Or VilTM device was used(8.8%) compared with other procedures(1.0% to 3.6%).CONCLUSION:The incidence of anastomotic complications associated with EJS was not different between LTG and OTG. Anastomotic stenosis was relatively common when the Or VilTM device was used.

关键词： Gastric cancer Laparoscopic Gastrectomy Anastomosi

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Long-term follow-up of antithrombotic management patterns in patients with acute coronary syndrome in China

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Journal of Geriatric cardiology 2020年第5期17卷 246-255,I0002-I0004页

作者： Xiao-Ning HAN Shu-Bin QIAO Jun-Bo GE Ya-Ling HAN Ji-Yan CHEN Zu-Yi YUAN Bo YU Jie JIANG Yong HUO department of cardiology Peking University First HospitalBeijingChina National Center for Cardiovascular Diseases Fuwai HospitalBeijingChina department of cardiology Zhongshan Hospital Affiliated to Fudan UniversityGuangzhouChina department of cardiology the General Hospital of Shenyang MilitaryShenyangChina department of cardiology Guangdong General HospitalGuangzhouChina department of cardiology the First Affiliated Hospital of Xi’an Jiaotong UniversityXi’anChina department of cardiology the Second Affiliated Hospital of Harbin Medical UniversityHarbinChina

Objective To describe the long-term antithrombotic management patterns(AMPs)and clinical outcomes of Chinese patients with acute coronary syndrome(ACS).Methods This was an observational,multicenter,longitudinal cohort extension study of Chinese patients who had completed the EPICOR Asia 2-year follow-up study post-hospitalization for an ACS *** in AMP and clinical outcomes for up to 5 years post-ACS event were *** Overall,2334 patients with ACS were enrolled at 49 *** mean age was 61.6 years and 76.3%were *** study end,2093 patients completed the 3-year *** baseline(2 years post-ACS event),72.4%of patents received one antiplatelet(AP)medication,with aspirin being the preferred one.A small proportion of patients(21.5%)was treated with two or more APs(2+AP),and even fewer patients(6.1%)did not receive any AP medication at *** study completion,the proportion of patients without AP therapy increased to 13.6%,while the percentage of patients on one AP and 2+AP decreased to 69.3%and 17.1%,***,a higher incidence of clinical events(composite of all-cause mortality,myocardial infarction,stroke)was observed for the 2+AP(13.2%)subgroup than for the no AP(10.5%)and one AP(8.6%)***,the 2+AP subgroup exhibited the greatest number of bleeding events,outpatient visits,and hospitalization *** myocardial infarction or stroke,bleeding events prompted an adjustment in *** Most patients in China received at least one AP medication up to 5 years after an ACS event.

关键词： Acute coronary syndrome Antithrombotic agents Antithrombotic management patterns Observational study Real-world

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Hemogram-derived ratios as prognostic markers for major adverse cardiovascular events in patients with non-ST-segment elevation myocardial infarction

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World Journal of Methodology 2025年第2期15卷 125-136页

作者： Emir Bećirović Minela Bećirović SabinaŠegalo Amir Bećirović Semir Hadžić Kenana Ljuca Emsel Papić Lamija Ferhatbegović Malik Ejubović Amira JagodićEjubović Amila Kovčić ArminŠljivo Emir Begagić department of Intensive Care University Clinical Center TuzlaTuzla 75000Bosnia and Herzegovina department of Nephrology University Clinical Center TuzlaTuzla 75000Bosnia and Herzegovina department of Laboratory Technologies Faculty of Health SciencesUniversity of SarajevoSarajevo 71000Bosnia and Herzegovina department of Endocrinology University Clinical Center TuzlaTuzla 75000Bosnia and Herzegovina School of Medicine University of TuzlaTuzla 75000Bosnia and Herzegovina department for Internal Diseases and Hemodialysis Canton Hospital ZenicaZenica 72000Bosnia and Herzegovina department of Internal Medicine Canton Hospital ZenicaZenica 72000Bosnia and Herzegovina department of Radiotherapy University Clinical Center TuzlaTuzla 75000Bosnia and Herzegovina department of cardiology University Clinical Center SarajevoSarajevo 72000Bosnia and Herzegovina department of General Medicine University of ZenicaSchool of MedicineZenica 72000Bosnia and Herzegovina

BACKGROUND Non-ST segment elevation myocardial infarction(NSTEMI)poses significant challenges in clinical management due to its diverse *** the prognostic role of hematological parameters and derived ratios in NSTEMI patients could aid in risk stratification and improve patient *** To evaluate the predictive value of hemogram-derived ratios for major adverse cardiovascular events(MACE)in NSTEMI patients,potentially improving clinical *** A prospective,observational cohort study was conducted in 2021 at the Internal Medicine Clinic of the University Hospital in Tuzla,Bosnia and *** study included 170 patients with NSTEMI,who were divided into a group with MACE and a control group without ***,the MACE group was subdivided into lethal and non-lethal groups for prognostic *** hematological parameters,an additional 13 hematological-derived ratios(HDRs)were monitored,and their prognostic role was *** Hematological parameters did not significantly differ between non-ST segment elevation myocardial infarction(NSTEMI)patients with MACE and a control group at T1 and ***,significant disparities emerged in HDRs among NSTEMI patients with lethal and non-lethal outcomes ***,neutrophil-to-lymphocyte ratio(NLR)and platelet-to-lymphocyte ratio(PLR)were elevated in lethal ***,C-reactive protein-to-lymphocyte ratio(CRP/Ly)at T1(>4.737)demonstrated predictive value[odds ratio(OR):3.690,P=0.024].Both NLR at T1(>4.076)and T2(>4.667)emerged as significant predictors,with NLR at T2 exhibiting the highest diagnostic performance,as indicated by an area under the curve of 0.811(95%CI:0.727-0.859)and OR of 4.915(95%CI:1.917-12.602,P=0.001),emphasizing its important role as a prognostic *** This study highlights the significant prognostic value of hemogram-derived indexes in predicting MACE among NSTEMI *** follow-up,NLR,PLR,and CRP/Ly off

关键词： Hemogram-derived ratios Prognostic markers Neutrophil-to-lymphocyte ratio Myocardial infarction

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Systolic and Diastolic Strain Measurements Show Left Ventricular Dysfunction in Women with Turner Syndrome

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Congenital Heart Disease 2021年第4期16卷 357-368页

作者： Allard T.van den Hoven Sultan Yilmazer Lidia R.Bons Roderick W.Jvan Grootel L.W.Geenen An M.van Berendoncks Anthonie L.Duijnhouwer Hans-Marc J.Siebelink Jolien W.Roos-Hesselink Annemien E.van den Bosch department of Congenital cardiology Erasmus MCRotterdamNetherlands department of cardiology Radboud University Medical CenterNijmegenNetherlands department of cardiology Leiden University Medical CenterRotterdamNetherlands

Aim:This study aimed to describe the systolic left ventricular global longitudinal strain(LvGLS)and left ventricular peak early diastolic strain rate(Sre)in adult women with Turner syndrome(TS)and to determine its relationship with exercise capacity and clinical ***:In this cross-sectional cohort study,consecutively included adult TS women underwent an electrocardiogram,transthoracic echocardiogram(TTE)and cardiopulmonary exercise test(CPET)on the same *** and Sre were measured using 2D speckle tracking analysis(STE)and compared with age-matched healthy female ***:Ninety-four adult women(age 36±13 years)with TS and 32 healthy age-matched female controls were *** with TS had a significantly impaired/reduced systolic LvGLS(–17.82±2.98%vs.–21.80±1.85%,p0.001),compared to healthy female ***,TS women had reduced diastolic function as measured by conventional echocardiographic parameters:A higher A-wave(p<0.001),lower E/A-ratio(p=0.001),longer deceleration time(p=0.006),and a higher E/E’-ratio(p<0.001).Women with TS also had a significantly reduced maximal workload(p=0.033),reduced oxygen uptake(p<0.001)and a reduced maximal heart rate(p<0.001)during *** linear regression analysis revealed that Age,karyotype and QT-duration were significantly associated with Sre,but not with LvGLS,in the TS ***:Systolic and diastolic strain and exercise capacity were significantly reduced in TS women compared to healthy *** correlation between strain itself and exercise capacity could be demonstrated,but correlations with conventional TTE parameters and baseline characteristics were found.

关键词： Turnersyndrome speckletracking echocardiography strain exercise capacity

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Inferior pancreaticoduodenal artery pseudoaneurysm in a patient with calculous cholecystitis: A case report

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World Journal of Clinical Cases 2019年第18期7卷 2851-2856页

作者： Qiao-Dong Xu Song-Gang Gu Jia-Hong Liang Shao-Dong Zheng Zhi-Hua Lin Pei-Dong Zhang Jiang Yan department of Biliary-Pancreatic Minimally invasive Surgery The First Affiliated Hospital of Shantou University Medical College

BACKGROUND Pancreaticoduodenal artery (PDA) aneurysms are extremely rare. The complicated clinical presentations and high incidence of rupture make it difficult to diagnose and treat. PDA pseudoaneurysms often rupture into the gastrointestinal tract and result in life-threatening gastrointestinal hemorrhage. CASE SUMMARY A 69-year-old man was admitted to our hospital due to right upward abdominal pain. A computed tomography (CT) scan demonstrated acute cholecystitis and cholecystolithiasis. Percutaneous gallbladder drainage was performed subsequently. He was discharged after 3 d and readmitted to hospital for cholecystectomy as arranged 1 mo later. A repeat CT scan revealed an emerging enhancing mass between the pancreatic head and the descending duodenum. Then, he suffered hematochezia and hemorrhagic shock suddenly. Emergency percutaneous angiogram was performed and selective catheterization of the superior mesenteric artery demonstrated a pseudoaneurysm in the inferior PDA. Coil embolization was performed and his clinical condition improved quickly after embolization and blood transfusion. He underwent laparoscopic cholecystectomy and was discharged from hospital after surgery under satisfactory conditions. CONCLUSION PDA pseudoaneurysms are uncommon. Acute haemorrhage is a severe complication of pseudoaneurysm with high mortality which clinicians should pay attention to.

关键词： Calculous cholecystitis Inferior pancreaticoduodenal artery pseudoaneurysm Gastrointestinal haemorrhage Coil embolization Case report

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