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外周动脉疾病患者对多巴酚丁胺负荷超声心动图检查变时性反应的预后意义

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世界核心医学期刊文摘（心脏病学分册） 2005年第7期1卷 56-57页

作者： Chaowalit N. Maalouf J.F. Rooke T.W. P.A. Pellikka 闫庆峰 Dr. Mayo clinic 200 First Street SW Rochester MN 55905 United States

Chronotropic response is important during exercise stress testing. Less is known about its role after dobutamine stress echocardiography. In addition, limited information exists regarding the long-term prognostic value of dobutamine stress echocardiography in patients who have peripheral arterial disease. We studied 2,138 patients who had peripheral arterial disease(1,317 men, 70±10 years old) and who underwent dobutamine stress echocardiography. Follow-up was completed for all-cause mortality and cardiovascular morbidity(nonfatal myocardial infarction and coronary revascularization). Death and cardiovascular morbidity occurred in 961 patients(45%)-and 348 patients(16%), respectively, during a follow-up of 6.1±2.7 years. failure to achieve 85%of age-predicted maximal heart rate(hazard ratio[HR] 1.34, 95%confidence interval[CI] 1.16 to 1.54, p=0.0001) and percent of abnormal segments at peak stress(HR/10%increment 1.04, 95%CI 1.01 to 1.07, p=0.02) were independent predictors of mortality and morbidity(HR 1.35, 95%CI 1.06 to 1.71, p=0.01 and HR 1.14, 95%CI 1.08 to 1.20, pheart rate during normal dobutamine stress echocardiography on 1-, 3-, 5-, and 10-year survival probabilities was comparable to that of ischemia(86%vs 88%, 75%vs 71%, 62%vs 59%, and 33%vs 32%, respectively; p=0.8). In a stepwise multivariate model, dobutamine stress echocardiography had incremental value over clinical data and echocardiographic data at rest for predicting rates of mortality(model chi-square increase from 301 to 322, pdisease.

关键词：负荷超声心动图多巴酚丁胺变时性外周动脉疾病预后意义运动负荷试验血运重建术预后价值最大心率全因死亡率

Recurrence of lymphangioleiomyomatosis: Nine years after a bilateral lung transplantation

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World Journal of Transplantation 2016年第1期6卷 249-254页

作者： Khawaja S Zaki Zahra Aryan Atul C Mehta Olufemi Akindipe Marie Budev Respiratory Institute Cleveland Clinic Lerner College of Medicine Bouncore Family Endowed Chair in Lung Transplantation Cleveland Clinic

Lymphangioleiomyomatosis(LAM) is a rare, slowly progressive lethal lung disease primary afflicting young women. LAM is characterized by proliferation of abnormal smooth muscle cells that target the lungs, causing cystic destruction and eventual respiratory failure leading to death. Recent ten year mortality due to end stage LAM has been reported to be approximately 10%-20%, but may vary. The decline in lung function in LAM is gradual, occurring at a rate of about 3% to 15% per year but can vary from patient to patient. But recently therapy with mammalian target of rapamycin(m TOR) inhibitors such as sirolimus has shown promising results in the stabilization of lung function and reduction of chylous effusions in LAM. Lung transplantation is a viable option for patients who continue to have decline in lung function despite m TOR therapy. Unique issues that may occur post-transplant in a recipient with LAM include development of chylous effusion and a risk of recurrence. We describe a case of LAM recurrence in a bilateral lung transplant recipient who developed histological findings of LAM nine years after transplantation.

关键词： Lymphangioleiomyomatosis Mammalian target of rapamycin inhibitors Lung transplantation Sirolimus Lung rejection

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胸主动脉假性动脉瘤的外科治疗

世界核心医学期刊文摘（心脏病学分册） 2006年第12期2卷 59-60页

作者： Atik F.A. Navia J.L. Svensson L.G. 张步升 Department of Thoracic and Cardiovascular Surgery The Cleveland Clinic Foundation Cleveland OH United States Dr.

Objectives: To examine the clinical profiles, operative outcomes, and late results of patients with pseudoaneurysm of the thoracic aorta. Methods: From 1990 to 2002, 60 patients underwent repair of aortic pseudoaneurysm: ascending aorta in 70%, ascending aorta and arch in 15%, descending aorta in 10%, and arch alone in 5%. Mean age was 53±15 years, and 70%were men. Of these, 50(83%) had undergone previous cardiac surgery, including 22(37%) composite valve graft operations. The preferred cannulation site was femoral-femoral(n=27, 45%), with deep hypothermic circulatory arrest in 62%and retrograde cerebral perfusion in 33%; more recently, however, axillary cannulation has been preferred. Results: Principal etiologies were graft infection in ascending aorta pseudoaneurysm and trauma in descending aorta pseudoaneurysm. Fifteen patients(25%) presented with chest pain, 13(22%) with heart failure, and 20%with moderate or severe aortic regurgitation. The pseudoaneurysm was resected and the aorta replaced(n=45, 75%) or repaired(n=15, 25%) using various methods. Hospital mortality was 6.7%(n=4). Reexploration for bleeding was required in 8.3%, and 3.3%had postoperative stroke. At 30 days, 5 years, and 10 years, survival was 94%, 74%, and 60%and freedom from reoperation was 95%, 77%, and 67%, respectively. Conclusions: Most patients with aortic pseudoaneurysm require ascending aorta and/or arch replacement, which can be accomplished with low operative mortality and morbidity. Long-term survival and freedom from reoperation in these young patients parallel those expected for complex cardiac and aortic disease.

关键词：主动脉假性动脉瘤患者升主动脉主动脉升部

heart failure in general and cardiac transplant patients with COVID-19

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World Journal of Cardiology 2022年第7期14卷 392-402页

作者： Munish Sharma Gowthami Sai Kogilathota Jagirdhar Kalpalatha K Guntupalli Rahul Kashyap Salim Surani Department of Medicine Baylor College of MedicineHoustonTX 77030United States Department of Medicine St Michaels'Medical CenterNewarkNJ 07102United States Department of Pulmonary Critical Care and SleepBaylor College of MedicineHoustonTX 77030United States Department of Anesthesiology Mayo ClinicRochesterMN 55905United States Department of Medicine Texas A&M UniversityBryanTX 77807United States

Coronavirus disease 2019(COVID-19)is primarily an infection of the respiratory tract,but it can have multisystem *** complications of COVID-19 can range from acute myocardial injury,cardiac arrhythmias,or heart failure,amongst *** failure(HF)in COVID-19 can be a de novo process or due to worsening of pre-existing cardiovascular *** in a patient with COVID-19 not only poses challenges in clinical presentation and management of COVID-19 but also affect prognosis of the *** article aims to succinctly revisit the implications of this pandemic regarding pre-existing HF or new-onset HF based on prevailing *** also focuses on the management and special recommendations from prior studies and guidelines.

关键词： COVID-19 Coronavirus Cardiomyopathy heart failure Cardiomyopathy

Fatal Leptospirosis Case in Pediatric Patient: clinical Case

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Open Journal of Medical Microbiology 2013年第1期3卷 12-17页

作者： Laura I. Santiago García Citlalli Martínez Cruz Irma Zamudio Lugo Beatriz Rivas Sánchez Oscar Velasco Castrejón Joel Navarrete Espinosa clinic of Tropical Medicine Unit of Experimental Medicine School of Medicine UNAM Mexico Coordination of Epidemiologic Surveillance Unit of Public Health IMSS Mexico City Mexico Division of Hospital Epidemiologic Children’s Hospital CMN Century XXI IMSS Mexico City Mexico

Introduction: Leptospirosis is a worldwide zoonosis. It is transmitted through the urine of infected animals. Currently, there is an increase of reports in many countries. In humans, it presents an ample clinical spectrum, which goes from an asymptomatic infection up to Weil syndrome, which is generally fatal. clinical Case: A male, 6 years of age, who started with onset fever and jaundice, handled in private means, diagnosed as viral hepatitis “A” and was referred to an institutional hospital where hepatomegaly and splenomegaly were detected. His evolution was towards graveness and, therefore, he was referred to a third level hospital with reactive Hepatitis diagnosis and to rule out lymphoma. On admission, he presented liver and kidney failure, as well as metabolic acidosis and pulmonary haemorrhage that led to death 6 hours later. Confirmatory tests for hepatitis were negative;biopsies were taken post-mortem for Leptospira diagnosis, which were positive in liver and kidney. Conclusions: Leptospirosis is a disease that may be manifested in multiple ways. It is important the understanding of this disease by the physician to improve the diagnosis and, for general population, to avoid exposure. The examination of the epidemiological history of the patient is essential.

关键词： Leptospirosis Fatal Pediatric México

clinic Evaluation of heart failure of Old People in the Department of Internal Medicine of Point G University Hospital from 2008 to 2012

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Open Journal of Internal Medicine 2019年第3期9卷 83-88页

作者： Assétou Soukho Kaya Abdel Kader Traoré Djibril Sy Djenebou Traoré Ilo Diall Youssouf Fofana Ibahima Amadou Dembélé Boua Daoud Camara Mamadou Saliou Karim Dao Mamadou Cissoko Kaly Kéï ta Barry Boubacar Sangaré Mamadou Mallé Alassane A. Doumbia Hadiza A. Kaï lou Mamadou Dembélé Hamar Alassane Traoré Department of Internal Medicine Point G University Hospital Bamako Mali Department of Cardiac disease Point G University Hospital Bamako Mali Department of Internal Medicine of Children and Mothers Le Luxembourg University Hospital Bamako Mali Internal Medicine Service Nianankoro Fomba Hospital Ségou Mali

Justification: heart failure (HF) is the evolutionary end of all cardiac diseases. Given the aging population, the rate of incidence is increasing among the elderly. Objectives: The study aims to determine the prevalence of heart failure in the elderly;to describe the clinical aspects;describe etiologies;describe the therapeutic aspects;and describe the evolution of heart failure among the elderly. Method: This was a retrospective study over five years on the operating records of patients hospitalized in the internal medicine department of Hospital Point G. Result: The study included records of 22 elderly patients who were with heart failure of a total of 595 patients hospitalized from 1st January 2008 to 31st December 2012. The prevalence rate was 3.7%, and the average age was 67 ± 7.79 years. The sex ratio was equal to 1. HTA accounted for the cardiovascular risk factors in 77.3%. 72.7% of patients had the symptom of dyspnea and 95.5% of patients had the symptom of IMO. According to the cardiac ultrasound, dilation of the OG represented 68.2% of cases, followed by impaired LVEF (63.6%). The etiologies of IC were represented by dilated cardiomyopathy (95.5%), followed by 13.6% in cardiothyreosis. Drug treatment was dominated by the use of diuretics, ACE inhibitors and sodium diet respectively 95.5%;81.8% and 45.5% of cases. The clinical outcome was favorable in 73%. We recorded four (4) cases of death, which accounted for 18% of patients.

关键词： heart failure clinic Etiology Therapeutics The Elder

Calcineurin Inhibitor Use and Myoclonus Association. Is There a clinical Implication?

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Open Journal of Anesthesiology 2021年第4期11卷 85-98页

作者： Ricardo E. Verdiner Ruben Casado Arroyo Mohammad Rauf Chaudhry Narjeet Khurmi Karl Poterack Andy Gorlin Arun Jayaraman Gustavo Rodriguez Department of Anesthesiology Mayo Clinic Arizona Phoenix USA Department of Medicine Universite Libre de Bruxelles Brussels Belgium Department of Neurology Texas Tech University Lubbock USA Department of Neurology Texas Tech University Health Science Center of El Paso Lubbock USA

Background: Calcineurin Inhibitors (CNIs) play a pivotal role in anti rejection therapy for transplant patients. Neurotoxicity is a known side effect that usually manifests as encephalopathy but myoclonus has also been described. Perioperative myoclonus as a manifestation of neurotoxicity, has not been well studied. Methods: We retrospectively reviewed data from 842,762 patients from the Nationwide Inpatient Sample (NIS) database from January 2011 to December 2014. Of those records we compared 56,423 patients requiring CNIs and undergoing heart Transplant (HT) with 786,339 patients undergoing Coronary Artery Bypass Graft (CABG) surgery as controls. The objective was to study the rates of myoclonus in patients undergoing cardiac surgery, especially those requiring CNIs, and study the outcome of those patients with myoclonus. The NIS database from January 2011 to December 2014 was the source for the analysis. Patients with underlying epilepsy or hypo-ischemic encephalopathy based on ICD-9-CM codes were excluded from the study. Results: A total of 147 patients (0.26%) were found to have myoclonus in the HT group versus 338 patients (0.04%) in the CABG group, p disease which was higher in the HT group. The difference remained statistically significant after adjusting for confounders. Patients with myoclonus in both groups were more likely to have acute kidney injury and have a prolonged length of stay. Only patients with myoclonus in the CABG group had higher rates of discharge disposition to a nursing home and higher rates of in-Hospital mortality. A trend towards higher in-Hospital mortality was found in patients with myoclonus in the HT group. Conclusion: In this study we have compared the rate of myoclonus found in HT patients versus CABG patients. We have identified calcineurin inhibitors as potentially contributing to myoclonus due to its neurotoxic effects. The st

关键词： Calcineurin Inhibitors Myoclonus Neurotoxicity Perioperative Mortality Renal failure Tacrolimus Mycophenolate Endothelial Health Blood Brain Barrier

慢性阻塞性肺病稳定期老年患者中未被发现的心衰

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世界核心医学期刊文摘（心脏病学分册） 2006年第1期2卷 48-48页

作者： Rutten F. H. Cramer M.-J. M. Grobbee D. E. 黄浙勇 Utrecht heart failure Organisation(UHFO) Julius Center for Health Sciences and Primary Care University Medical Center Utrecht PO Box 85060 Stratenum 6.101 3508 AB Utrecht Netherlands

Aims: To establish the prevalence of unrecognized heart failure in elderly patients with a diagnosis of chronic obstructive pulmonary disease, in a stable phase of their disease. Methods and results: In a cross-sectional study, patients ≥65 years of age, classified as having chronic obstructive pulmonary disease by their general practitioner and not known with a cardiologist-confirmed diagnosis of heart failure, were invited to our out-patient clinic. Four hundred and five participants underwent an extensive diagnostic work-up, including medical history and physical examination, followed by chest radiography, electrocardiography, echocardiography, and pulmonary function tests. As reference(i.e.‘gold’) standard the consensus opinion of an expert panel was used. The panel based the diagnosis of heart failure on all available results from the diagnostic assessment, guided by the diagnostic principles of the European Society of Cardiology(ESC) for heart failure(i.e., symptoms and echocardiographic systolic and/or diastolic dysfunction). The diagnosis of chronic obstructive pulmonary disease was based on the diagnostic criteria of the Global Initiative(GOLD) for chronic obstructive pulmonary disease. Of 405 participating patients with a diagnosis of chronic obstructive pulmonary disease, 83(20.5%, 95%CI 16.7-24.8) had previously unrecognized heart failure(42 patients systolic, 41 ‘isolated’diastolic, and none right-sided heart failure). In total, 244(60.2%) patients had chronic obstructive pulmonary disease according to the GOLD criteria and 50(20.5%, 95%CI 15.6-26.1) patients combined with unrecognized heart failure. Conclusion: Unrecognized heart failure is very common in elderly patients with stable chronic obstructive pulmonary disease. Closer co-operation among general practitioners, pulmonologists, and cardiologists is necessary to improve detection and adequate treatment of heart failure in this large patient population.

关键词：慢性阻塞性肺病老年患者稳定期心衰欧洲心脏病学会诊断性检查超声心动图胸部X线检查舒张功能不全横断面研究

峰值耗氧量作为使用β受体阻断剂治疗的心衰患者的死亡预测指标

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世界核心医学期刊文摘（心脏病学分册） 2005年第10期1卷 35-36页

作者： O' Neill J. O. Young J. B. Pothier C. E. Lauer M. S. 高登峰 Dept. of Cardiovascular Medicine Cleveland Clinic Foundation 9500 EuclidAveClevelandOH44195United States

Peak oxygen uptake(peak VO2) is a strong predictor of mortality and is commonly used in the evaluation of patients for cardiac transplantation. β-Blockers reduce mortality in patients with heart failure, without influencing peak VO2, raising the possibility that peak VO2 is no longer suitable as an indicator of prognosis in these patients. Methods and Results-We analyzed prospectively gathered data on 2105 patients referred for cardiopulmonary testing for all-cause mortality and for occurrence of death or transplantation. Patients receiving β-blockers were younger, more likely to have coronary disease, and had a greater mean ejection fraction but had a similar peak VO2. There were 555 deaths(26% ) and 194(9% ) transplants during a median follow-up of 3.5 years. Peak VO2 was a predictor of mortality irrespective of β-blocker use; a decrease of 1 mL· kg- 1· min- 1 resulted in an adjusted hazard ratio(HR) of 1.13(95% CI 1.09 to 1.17, Pheart failure even in the setting of β-blockade. Because of improved survival in patients treated with β-blockers, the cut point value of 14 mg· kg- 1· min- 1 for referral for cardiac transplantation in these patients requires reevaluation, and a lower cut point may be more appropriate.

关键词： β受体阻断剂耗氧量射血分数心脏移植全因死亡率预后改善预后预测心肺功能检查临界值