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Relationship between Aortic Root Diameter and Type 2 Diabetes in Hypertensive Patients 高血压患者主动脉根直径与2型糖尿病的关系
Pub Date : 2023-02-08 DOI: 10.9734/ca/2023/v12i2314
Ahmed Mohamed Elhosary, Amany Mohamed Allaithy, Mohamed Ahmed Abd-alaal, H. Kassem
Background: Diabetes mellitus (DM) involves a series of metabolic conditions associated with hyperglycaemia which is caused by defects in insulin secretion and./or insulin action. The aim of this work was assessment of the relationship between Aortic Root (AOR) diameter and type 2 diabetes mellitus (T2DM) in Hypertension (HTN) cases. Methods: This prospective case control study was carried out on 80 HTN cases. Cases were divided in to three groups: Group A (30 HTN cases) with type 2 DM with good metabolic control (Hb AIC ≤ 7.0), group B: (30 HTN cases) with type 2 DM with poor metabolic control (Hb AIC > 7.0) and C (Control group) 20 HTN, non-DM subjects of the same age and sex group with no other comorbid conditions. Results: FS had a significant decline in group A (P2 = 0.001) and in group B (P3 <0.001) than C. EF had a significant difference among all groups (P <0.001). Early wave declaration time (DT) had a significant decline in group A (P2 = 0.049) and in group B (P3= 0.023) than C. Tissue doppler early velocity wave had a significant difference among all groups (P = 0.004). Tissue doppler early velocity wave had a significant decline in group A and B than C. (P2 = 0.038. P3 = 0.003). Conclusions: AOR in HTN cases had a significant decline in DM cases compared with non-DM cases. In our results, glycaemic control didn’t play a significant role in aortic root.
背景:糖尿病(DM)涉及一系列与高血糖相关的代谢疾病,这是由胰岛素分泌缺陷引起的。/或胰岛素作用本研究的目的是评估高血压(HTN)患者主动脉根部(AOR)直径与2型糖尿病(T2DM)之间的关系。方法:对80例HTN患者进行前瞻性病例对照研究。2型糖尿病代谢控制良好(Hb AIC≤7.0)的A组(30例HTN)、2型糖尿病代谢控制不佳(Hb AIC > 7.0)的B组(30例HTN)和C组(对照组)20例HTN,同年龄、性别、无其他合并症的非糖尿病受试者。结果:a组FS较c组显著下降(P2 = 0.001), B组FS较c组显著下降(P3 <0.001), EF组间差异有统计学意义(P <0.001)。组织多普勒早期速度波在a组(P2 = 0.049)、B组(P3= 0.023)较c组明显下降,各组间差异有统计学意义(P = 0.004)。a、B组组织多普勒早期速度波明显低于c组(p = 0.038)。P3 = 0.003)。结论:与非糖尿病患者相比,HTN患者的AOR明显下降。在我们的研究结果中,血糖控制对主动脉根部没有显著作用。
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引用次数: 0
Coronary Artery Ectasia as a Predictor of Major Adverse Cardiac Events in Patients with Acute ST Elevation Myocardial Infarction 冠状动脉扩张是急性ST段抬高型心肌梗死患者主要不良心脏事件的预测因子
Pub Date : 2023-02-06 DOI: 10.9734/ca/2023/v12i2312
Ahmed Saleh Saad, Ayman Ahmed Gaafar, M. Salama, Randa Mohamed Abd El-Mageed
Background: Coronary artery ectasia (CAE) is characterised as localised or widespread non-obstructive lesions of the epicardial coronary arteries with a luminal dilation more than 1.5 times the neighbouring normal segments or vessel diameter. Isolated CAE is CAE in the absence of severe coronary artery stenosis. This aberrant dilatation of coronary arteries can produce angina pectoris and even myocardial infarction in people without coronary artery disease owing to vasospasm, dissection, or thrombus. The purpose of this study was to evaluate the connection between                 CAE and major adverse cardiac events (MACE) following acute myocardial infarction with ST elevation. Methods: This was a prospective cohort study which was carried out on 300 cases. Cases were divided into two groups: Group I: including about 22 STEMI cases with CAE and Group II: including about 278 STEMI cases without CAE. All cases in this study were subjected to full history taking, clinical examination, laboratory tests, standard 12-leads ECG, resting transthoracic echocardiography (TTE), and coronary angiography. Results:  Regarding MACE in the studied groups, Incidence of reinfarction and cardiac death were significant higher in cases with STEMI and CAE than cases with STEMI alone. In univariate regression analysis, CAE (OR: 3.59, p value =0.022) was a significant predictor of cardiac death but age, male sex, and EF were not. Also, in multivariate regression analysis CAE (OR: 3.49, p value =0.029) was a significant predictor of cardiac death but age, male sex, and EF were not smoking with high warfarin consumption. Further, Markis classification 1 and 3 were the most frequent phenotype among cases. In STEMI cases, the incidence of reinfarction and cardiac death were significantly higher in cases with STEMI and CAE than cases with STEMI alone. So, CAE is a significant predictor of cardiac death.
背景:冠状动脉扩张(CAE)的特征是局部或广泛的非阻塞性心外膜冠状动脉病变,其管腔扩张超过邻近正常节段或血管直径的1.5倍。孤立性CAE是指没有严重冠状动脉狭窄的CAE。没有冠状动脉疾病的人,由于血管痉挛、夹层或血栓,冠状动脉异常扩张可引起心绞痛甚至心肌梗死。本研究的目的是评估急性心肌梗死伴ST段抬高后CAE与主要心脏不良事件(MACE)之间的关系。方法:采用前瞻性队列研究,纳入300例患者。病例分为两组:第一组包括约22例伴有CAE的STEMI病例,第二组包括约278例无CAE的STEMI病例。本研究所有病例均进行了完整的病史记录、临床检查、实验室检查、标准12导联心电图、静息经胸超声心动图(TTE)和冠状动脉造影。结果:在MACE方面,STEMI和CAE合并组的再梗死发生率和心源性死亡发生率均显著高于STEMI单独组。在单因素回归分析中,CAE (OR: 3.59, p值=0.022)是心源性死亡的显著预测因子,而年龄、男性性别和EF不是。此外,在多变量回归分析中,CAE (OR: 3.49, p值=0.029)是心源性死亡的显著预测因子,但年龄、男性和EF与不吸烟且华法林摄入量高无关。此外,Markis 1型和3型是病例中最常见的表型。在STEMI病例中,合并STEMI和CAE的再梗死和心源性死亡的发生率明显高于单独STEMI的病例。因此,CAE是心源性死亡的重要预测因子。
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引用次数: 0
Hemoglobin Level as a Predictor of Major Adverse Cardiovascular Events and Short-term Outcomes in Stemi Patient Treated with Pharmacoinvasive Strategy versus Primary PCI 血红蛋白水平作为Stemi患者接受药物侵入策略与首次PCI治疗的主要不良心血管事件和短期预后的预测因子
Pub Date : 2023-02-06 DOI: 10.9734/ca/2023/v12i2313
Ahmad Zakaria Abd-el-Sadek Al-Rossasy, Amany Mohammad Al-Laithy, Yasser Hussein El-Barbary, Magdy Mohammad Al-Masry
Background: Anaemia is prevalent among cases with acute coronary syndrome (ACS) and has been linked to poor clinical prognosis. Guidelines for cases with ST-segment elevation myocardial infarction (STEMI) recommend timely primary percutaneous coronary intervention (pPCI) as the preferred reperfusion strategy. If timely pPCI cannot be performed, a pharmacoinvasive strategy (PI) is recommended within 12 hours of symptom onset. The aim of this work was to study and assess the impact of hemoglobin level as a predictor of MACE and short-term outcomes in cases treated with Primary PCI vs pharmacoinvasive strategy. Methods: This prospective case-control observational study was conducted on 100 cases that were divided into 2 groups. Group I consisted of 50 anaemic cases & group II consisted of 50 cases that were not anaemic. Both groups were subdivided into A subgroups that underwent revascularization by pPCI and B subgroups that underwent revascularization by pharmacoinvasive strategy. Results: There was no significant difference in LVEF, infarct site and final TIMI flow, the anaemic groups showed statistically significant more total MACE than non-anaemic groups whether revascularized by pPCI or pharmacoinvasive strategy. As expected, anaemic cases tended to have higher bleeding complications especially those undergoing pharmacoinvasive strategy. The anaemic cases also were less likely to be discharged on RAAS and beta blockers. Conclusions: Anaemic cases whether revascularized with pPCI or pharmacoinvasive strategy tend to have higher incidence of MACE and major bleeding with no significant difference in mortality. There was no significant difference between LVEF between the study groups.
背景:贫血在急性冠脉综合征(ACS)患者中普遍存在,并与不良临床预后有关。st段抬高型心肌梗死(STEMI)的指南推荐及时的经皮冠状动脉介入治疗(pPCI)作为首选的再灌注策略。如果不能及时进行pPCI,建议在症状出现后12小时内采用药物侵入策略(PI)。这项工作的目的是研究和评估血红蛋白水平作为原发性PCI治疗与药物侵入治疗病例MACE和短期预后预测因子的影响。方法:采用前瞻性病例对照观察研究,将100例患者分为两组。第一组有50例贫血,第二组有50例非贫血。两组再分为A亚组采用pPCI进行血运重建,B亚组采用药物侵入策略进行血运重建。结果:两组患者LVEF、梗死部位及最终TIMI流量均无统计学差异,无论是pPCI血运重建还是药物侵入策略,贫血组总MACE均高于非贫血组,差异均有统计学意义。正如预期的那样,贫血病例往往有更高的出血并发症,特别是那些采用药物侵入策略的病例。贫血病例在使用RAAS和受体阻滞剂后出院的可能性也较小。结论:无论采用pPCI还是药物侵入策略,贫血患者的MACE和大出血发生率均较高,但死亡率无显著差异。两组间LVEF无显著差异。
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引用次数: 0
Role of P Wave Duration and Tissue Doppler Imaging as Predictive Indicators for Paroxysmal Atrial Fibrillation in Hypertensive Patients P波持续时间和组织多普勒成像对高血压患者阵发性心房颤动的预测作用
Pub Date : 2023-02-04 DOI: 10.9734/ca/2023/v12i1311
Mostafa Osama Awad, Dina Abd Elsalam Mostafa, M. Naseem, Ehab Abd Elwahab Hamdy
Background: Atrial fibrillation (AF) is the most prevalent chronic arrhythmia in the heart. AF accounts for one-third of rhythm disorder hospitalizations. AF increases profoundly the risk of stroke, heart failure, and death. This study used P-wave and transthoracic echocardiography with tissue Doppler imaging (TDI) to determine paroxysmal AF predictors in hypertensive individuals. Methods: This case control study was performed on 100 hypertensive adult patients. They were classified into two equal group: Group I included hypertensive patients diagnosed to have paroxysmal AF. Group II (control group) included hypertensive patients with normal sinus rhythm. All subjects were subjected to electrocardiographic and conventional and tissue Doppler Imaging measurements. Results:  Pmax had significantly increased in PAF patients compared to sinus rhythm patients.  PAL, PAR, PAI, LR, LI and IR had significantly increased in PAF patients compared to sinus rhythm patients. In Multivariate logistic regression analysis, Pmax, PAL, PAI, PAR, LR, LI and IR were found to be independent predictors for PAF. Therefore, Pmax, PAL PAI, PAR, LR, LI and IR were found to be significant predictors for PAF. Best cut-off values for Pmax, PAL, PAI, PAR, LR,  LI and IR were: (118, 81, 61, 49.9, 34, 20 and 16 ms) with sensitivity (76, 96, 96, 88, 82, 86 and 77.5 ), specificity (84, 100, 98, 92, 78, 82 and 76) and the AUC of (0.850, 0.979, 0.987, 0.961, 0.836,  0.891 and 0.798) respectively. Conclusions: Electrocardiographic P-wave analysis and echocardiographic TDI may identify hypertension patients at risk for paroxysmal AF, since the combination of Pmax and TDI may help in predicting the development of AF in hypertensive individuals.
背景:心房颤动(AF)是最常见的心脏慢性心律失常。房颤占心律失常住院的三分之一。房颤大大增加了中风、心力衰竭和死亡的风险。本研究采用p波和经胸超声心动图结合组织多普勒成像(TDI)来确定高血压患者阵发性心房颤动的预测因素。方法:对100例成人高血压患者进行病例对照研究。将患者分为两组:1组为诊断为阵发性房颤的高血压患者;2组为窦性心律正常的高血压患者(对照组)。所有受试者均接受心电图、常规和组织多普勒成像测量。结果:与窦性心律患者相比,PAF患者的Pmax明显升高。与窦性心律患者相比,PAF患者PAL、PAR、PAI、LR、LI和IR明显升高。多因素logistic回归分析发现Pmax、PAL、PAI、PAR、LR、LI和IR是PAF的独立预测因子。因此,Pmax、PAL PAI、PAR、LR、LI和IR是PAF的显著预测因子。Pmax、PAL、PAI、PAR、LR、LI和IR的最佳临界值分别为:(118、81、61、49.9、34、20和16 ms),敏感性(76、96、96、88、82、86和77.5),特异性(84、100、98、92、78、82和76),AUC分别为(0.850、0.979、0.987、0.961、0.836、0.891和0.798)。结论:心电图p波分析和超声心动图TDI可以识别有阵发性房颤风险的高血压患者,因为Pmax和TDI的结合可能有助于预测高血压个体房颤的发展。
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引用次数: 0
Differences in Cardiovascular Remodeling in Kidney Transplant Recipients and Peritoneal Dialysis Patients 肾移植受者与腹膜透析患者心血管重塑的差异
Pub Date : 2023-01-30 DOI: 10.9734/ca/2023/v12i1310
Rebić Damir, Hamzić-Mehmedbašić Aida, Džubur Alen, Granov Nermir, H. Senad
Aims: Cardiovascular disease (CVD) is the leading cause of death in dialysis patients as well as in kidney transplant recipients (KTx). Left ventricular hypertrophy (LVH) starts early during the course of chronic kidney disease and is a strong predictor of CVD. We hypothesised that kidney transplant is significantly associated with improvement in cardiovascular reserve. We conducted a prospective study to compare changes in CV before and after kidney transplantation in patients with ESRD who received KTx to control individuals who received PD but did not receive a KTx. Study Design: A Case-Control Study. Place and Duration of Study: Clinic for nephrology Clinical Center University of Sarajevo, Bosnia and Herzegovina. Methodology: In this case-control study, we included 50 KTx from the Kidney Transplant Outpatient Clinic for nephrology Clinical Center. For each 50 KTx, PD outpatients matched for gender and age were recruited.  All patients underwent transthoracic echocardiography, and LV (left ventricular) mass (LVM), LV mass index (LVMi), and indices of cardiac function were measured. In the small subgroup of 18 KTx, we retrospectively assessed and compared the LVMI measurements, during dialysis and the post-transplant period. Results: The prevalence of LVH was 24% in KTx patients and 72% in PD patients (NS). KTx had significantly lower LVM, LVMi levels, E/A ratio, FS, and LA diameter compared  with the PD group, while the EF and other echocardiographic parameters did not differ. In the subgroup of 18 KTx, LVMi levels after transplantation were significantly lower than dialysis LVMi levels. Conclusion: LVH is the most frequent cardiac abnormality at the time of kidney transplantation. After KTx, the reduction of LVH and diastolic dysfunction was significant. CV remodelling after successful KTx is related to better kidney function, and can explain better outcomes for patients with kidney transplants over patients on long-term dialysis.
目的:心血管疾病(CVD)是透析患者和肾移植受者(KTx)死亡的主要原因。左心室肥厚(LVH)在慢性肾脏疾病的早期开始,是CVD的一个强有力的预测因子。我们假设肾脏移植与心血管储备的改善显著相关。我们进行了一项前瞻性研究,比较接受KTx的ESRD患者与接受PD但未接受KTx的对照患者肾移植前后CV的变化。研究设计:病例对照研究。学习地点和时间:波斯尼亚和黑塞哥维那萨拉热窝大学肾病临床中心临床。方法:在这项病例对照研究中,我们纳入了来自肾内科临床中心肾移植门诊的50名KTx患者。每50 KTx,招募符合性别和年龄的PD门诊患者。所有患者均行经胸超声心动图检查,测量左室质量(LVM)、左室质量指数(LVMi)及心功能指标。在18 KTx的小亚组中,我们回顾性地评估并比较了透析期间和移植后的LVMI测量值。结果:KTx患者LVH患病率为24%,PD患者(NS)为72%。与PD组相比,KTx组LVM、LVMi水平、E/A比、FS、LA直径明显降低,EF等超声心动图参数无显著差异。在18 KTx亚组中,移植后LVMi水平显著低于透析后LVMi水平。结论:LVH是肾移植时最常见的心脏异常。KTx后LVH和舒张功能障碍明显降低。KTx成功后的CV重构与更好的肾功能有关,并且可以解释肾移植患者比长期透析患者的预后更好。
{"title":"Differences in Cardiovascular Remodeling in Kidney Transplant Recipients and Peritoneal Dialysis Patients","authors":"Rebić Damir, Hamzić-Mehmedbašić Aida, Džubur Alen, Granov Nermir, H. Senad","doi":"10.9734/ca/2023/v12i1310","DOIUrl":"https://doi.org/10.9734/ca/2023/v12i1310","url":null,"abstract":"Aims: Cardiovascular disease (CVD) is the leading cause of death in dialysis patients as well as in kidney transplant recipients (KTx). Left ventricular hypertrophy (LVH) starts early during the course of chronic kidney disease and is a strong predictor of CVD. We hypothesised that kidney transplant is significantly associated with improvement in cardiovascular reserve. We conducted a prospective study to compare changes in CV before and after kidney transplantation in patients with ESRD who received KTx to control individuals who received PD but did not receive a KTx. \u0000Study Design: A Case-Control Study. \u0000Place and Duration of Study: Clinic for nephrology Clinical Center University of Sarajevo, Bosnia and Herzegovina. \u0000Methodology: In this case-control study, we included 50 KTx from the Kidney Transplant Outpatient Clinic for nephrology Clinical Center. For each 50 KTx, PD outpatients matched for gender and age were recruited.  All patients underwent transthoracic echocardiography, and LV (left ventricular) mass (LVM), LV mass index (LVMi), and indices of cardiac function were measured. In the small subgroup of 18 KTx, we retrospectively assessed and compared the LVMI measurements, during dialysis and the post-transplant period. \u0000Results: The prevalence of LVH was 24% in KTx patients and 72% in PD patients (NS). KTx had significantly lower LVM, LVMi levels, E/A ratio, FS, and LA diameter compared  with the PD group, while the EF and other echocardiographic parameters did not differ. In the subgroup of 18 KTx, LVMi levels after transplantation were significantly lower than dialysis LVMi levels. \u0000Conclusion: LVH is the most frequent cardiac abnormality at the time of kidney transplantation. After KTx, the reduction of LVH and diastolic dysfunction was significant. CV remodelling after successful KTx is related to better kidney function, and can explain better outcomes for patients with kidney transplants over patients on long-term dialysis.","PeriodicalId":431606,"journal":{"name":"Cardiology and Angiology: An International Journal","volume":"50 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130992490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Efficacy and Safety of Fixed-Dose Combination of Efonidipine and Telmisartan in Stage II Hypertensive Patients: Results from Randomized Clinical Trial 依福尼平和替米沙坦固定剂量联合治疗II期高血压的疗效和安全性:随机临床试验结果
Pub Date : 2023-01-28 DOI: 10.9734/ca/2023/v12i1309
B. Dewan, S. Shinde, Shweta Kondekar
Aim: The aim of this study was to evaluate the anti-hypertensive efficacy of a fixed-dose combination (FDC) of Efonidipine 40 mg and Telmisartan 40 mg in Stage II hypertensive patients. Study Design:  Multicentric, randomized, double-blind, parallel, comparative Phase III clinical trial. Methodology: This clinical trial was conducted at six geographically distributed sites across India and enrolled 240 Stage II hypertensive patients. They were randomized into two groups in a ratio of 1:1 using computer-generated block randomization to receive E+T (FDC of Efonidipine 40 mg + Telmisartan 40mg) or C+T (FDC of Cilnidipine 10 mg + Telmisartan 40 mg) group intervention once daily for a period of 90 days. The study site staff, investigator and patients were blinded to the treatment allocation.  The primary endpoint of the study evaluated the mean reduction in sitting systolic BP (SBP) and diastolic BP (DBP) from baseline to day 90 whereas the secondary endpoints assessed were mean reduction in BP from baseline to day 30 & 60, patients achieving target BP (<140/90 mmHg) and the safety and tolerability of the investigational products based on the incidences of adverse events (AEs) reported.  Results: A total of 118 subjects were randomized to the E+T group wherein the mean (±SD) SBP and DBP at baseline was 167.25 ± 4.68/107.26 ± 5.19 mmHg. After 30 days of treatment with the E+T group, the mean reduction in SBP/DBP of 29.37/18.06 mmHg was observed whereas at Day 60 reduction of 38.55/22.69 mmHg was seen from the baseline. At Day 90, SBP/DBP decreased to 119.41±14.99/81.67±4.29 mmHg with a mean reduction of 47.94/25.89 mmHg in the E+T group. During the study period, the difference in systolic blood pressure between the treatments with E+T and C+T was -0.48 mmHg, with the two-sided 95% confidence interval (CI) ranging from -4.54 to 3.58 mmHg. The corresponding difference in diastolic blood pressure was -0.77 (95% CI: -2.60 to 1.06) mm Hg. The upper boundary of the 95% CI was below the margin of 10 mmHg, confirming the non-inferiority of E+T to C+T. A total of 92% of patients who had been assigned to E+T treatment achieved their target BP goal. Only one patient reported an adverse event with E+T treatment. No unexpected AEs were reported in the E+T group suggesting its good safety and tolerability. Overall, the E+T treatment was effective, safe and well-tolerated by the patients for 90 days. Conclusion: It was concluded that the FDC of Efonidipine 40 mg and Telmisartan 40 mg was efficacious in the management of Stage II hypertension.
目的:本研究的目的是评价依福尼地平40mg与替米沙坦40mg固定剂量联合用药对II期高血压患者的降压效果。研究设计:多中心、随机、双盲、平行、比较III期临床试验。方法:该临床试验在印度六个地理分布的地点进行,招募了240例II期高血压患者。采用计算机生成的分组随机法将患者按1:1的比例随机分为两组,分别接受E+T (Efonidipine 40mg +替米沙坦40mg的FDC)或C+T (Cilnidipine 10 mg +替米沙坦40mg的FDC)组干预,每天1次,为期90天。研究现场的工作人员、研究者和患者对治疗分配不知情。该研究的主要终点评估了从基线到第90天坐位收缩压(SBP)和舒张压(DBP)的平均降低,而评估的次要终点是从基线到第30天和第60天的平均血压降低,患者达到目标血压(<140/90 mmHg),以及基于不良事件(ae)发生率的研究产品的安全性和耐受性。结果:118例受试者随机分为E+T组,基线时收缩压和舒张压的平均值(±SD)为167.25±4.68/107.26±5.19 mmHg。E+T组治疗30天后,收缩压/舒张压平均降低29.37/18.06 mmHg,而在第60天,从基线来看,收缩压/舒张压平均降低38.55/22.69 mmHg。第90天,E+T组收缩压/舒张压降至119.41±14.99/81.67±4.29 mmHg,平均降低47.94/25.89 mmHg。在研究期间,E+T治疗与C+T治疗的收缩压差异为-0.48 mmHg,双侧95%置信区间(CI)为-4.54 ~ 3.58 mmHg。相应的舒张压差异为-0.77 mm Hg (95% CI: -2.60 ~ 1.06)。95% CI的上边界低于10 mmHg,证实E+T对C+T的非劣效性。接受E+T治疗的患者中,有92%达到了血压目标。只有一名患者报告了E+T治疗的不良事件。E+T组未发生意外不良反应,提示其具有良好的安全性和耐受性。总体而言,90天内E+T治疗有效、安全且耐受性良好。结论:Efonidipine 40mg和替米沙坦40mg的FDC治疗II期高血压是有效的。
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引用次数: 0
A Clinical Analysis of Phlebolymphedema and Its Relationship with Physical Activity and Disability 白淋巴水肿的临床分析及其与运动和残疾的关系
Pub Date : 2023-01-18 DOI: 10.9734/ca/2023/v12i1308
Luis López-Montoya, Y. Cabanillas, Joceline S. Aguirre, K. G. Saenz-Ramirez, Maria T. Zarate-Sánchez, Angel D. Lopez, Rafael Ugarte, Brayan Patiño-Palma
Background: The clinical features and epidemiological data about patients with phebolymphedema or lymphedema related to Chronic Venous Disease in Mexico is limited and has been understudied; at the same time, the relationships between its clinical features, physical activity level and disability remained unknown. Methods: This is a longitudinal cohort study based on the analysis of clinical data of 90 patients gathered between 2021 and 2022. The statistical analysis was carried out using the software SPSS version 25 and GrandhPad Prism 8; a descriptive analysis was developed using measures of central tendency for the variables of a quantitative nature and frequency distribution for those categorical variables. The behavior of the variables was revealed through the Shapiro-Wilk statistic. The mean difference analysis was carried out with the Student’s T for independent samples. To identify the effect of gender, age, and severity of the disease on the study variables, a three-way analysis of variance was obtained with a Sidak comparison analysis. For the associations between qualitative and dichotomous nature variables, the Chi-Square statistic was obtained along with the odds ratio to determine the intensity of the relationships found. Results: A total of 90 patients were included in the analysis; 71% (64) were female and 29% (26) were male; with a mean age of 62.7 years old (± 30.5). A mean BMI of 33.2, 79.9% (77) of patients reached overweight and obesity ranges. 50% (45) of patients reported disability to perform one or more daily life activities related to the disease’s condition (signs, symptoms, volume). Only 12% (10) of all patients performed at or above the minimum physical activity recommended for their population group, and 88% (80) of patients had no physical activity or performed under the proper population group’s recommendation of minimal physical activity. It was found that the practice of physical activity, the number of compromised segments, the stage of the pathology, and the presence of cardiological and metabolic antecedents provide a statistically significant association with disability. Notable statistical difference among sex as a risk factor was not found. Regarding the BMI, the only differences were observed in the level of severity of the disease, regardless of the presence of any disability (p=0.006), evidencing that the greater the severity, the higher the BMI in both men and women. About physical activity, it is observed that inactivity or minimal practice of physical activity is a risk factor for referred disability (p<0.05), since it is prolonged that the non-practice of physical activity increases by 230% the chances of referring a disability associated to the disease compared to those people who referred to practice minimal or above minimal physical activity; the presence of a cardiological and/or metabolic history is related to an increase of about 150% to 180% of presenting disability compared to patients who d
背景:墨西哥淋巴水肿或慢性静脉疾病相关淋巴水肿患者的临床特征和流行病学资料有限,尚未得到充分研究;同时,其临床特征、体力活动水平与残疾之间的关系尚不清楚。方法:本研究是一项纵向队列研究,基于对2021 - 2022年间收集的90例患者的临床资料进行分析。采用SPSS version 25和GrandhPad Prism 8软件进行统计分析;描述性分析是利用集中趋势的措施,为定量性质的变量和频率分布的这些分类变量。通过Shapiro-Wilk统计量揭示了变量的行为。对独立样本采用Student’s T进行均值差异分析。为了确定性别、年龄和疾病严重程度对研究变量的影响,采用Sidak比较分析进行三方方差分析。对于定性和二分性自然变量之间的关联,卡方统计量与比值比一起获得,以确定所发现的关系的强度。结果:共纳入90例患者;女性64例(71%),男性26例(29%);平均年龄62.7岁(±30.5岁)。平均BMI为33.2,79.9%(77例)的患者达到超重和肥胖范围。50%(45)的患者报告无法进行一项或多项与疾病状况(体征、症状、体积)相关的日常生活活动。在所有患者中,只有12%(10)的患者达到或超过了他们所在人群推荐的最低体力活动,88%(80)的患者没有任何体力活动或按照适当人群推荐的最低体力活动进行体力活动。研究发现,体育锻炼、受损节段的数量、病理分期以及心脏病和代谢前因的存在,在统计上与残疾有显著的关联。在性别作为危险因素方面没有发现显著的统计学差异。在BMI方面,唯一的差异是在疾病的严重程度上,而不考虑是否存在任何残疾(p=0.006),这表明疾病的严重程度越高,男性和女性的BMI越高。关于身体活动,可以观察到,不活动或很少进行身体活动是转诊残疾的一个危险因素(p<0.05),因为与进行最少或超过最少身体活动的人相比,不进行身体活动的人转诊与疾病相关的残疾的机会增加了230%;与没有这些病理的患者相比,心脏病和/或代谢史的存在与出现残疾的患者增加约150%至180%有关。结论:本研究揭示了90例白淋巴水肿患者的临床和流行病学特征及其与运动水平和报告残疾的关系。需要进一步的研究来提高和拓宽对白淋巴水肿的临床特征及其相关性的认识。
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引用次数: 0
Short Term Outcome of Percutaneous Coronary Intervention in Anaemic Patients Presenting with Coronary Artery Diseases 经皮冠状动脉介入治疗伴有冠状动脉疾病的贫血患者的近期疗效
Pub Date : 2023-01-02 DOI: 10.9734/ca/2023/v12i1307
Moaz Emad El Din El Saiyed, M. Nassar, Ehab Abd El Lateif El Gendy, S. Badr
Background: Percutaneous coronary intervention (PCI) has been an effective and widely used treatment for patients with coronary artery disease (CAD). The presence of anaemia in critically ill patients undergoing surgical procedures has been associated with worse clinical outcomes. Hence, the current study was conducted to assess short term outcome of percutaneous coronary interventions in anaemic patients presenting with coronary artery diseases. Methods: This prospective observational study enrolled 200 patients who underwent PCI. Patients were classified into 2 groups: anaemic patients and non-anaemic patients. The anaemic patients were furtherly be classified according to severity of anaemia into 3 grades mild anaemia, moderate anaemia, and severe anaemia. All cases were subjected to complete history taking, clinical examination and baseline laboratory tests: including CBC, serum urea and creatinine, cardiac enzymes include serum troponin, CK-MB and standard 12-lead ECG. Results: The mean Heart Rate was statistically significantly higher in the anaemic group as compared with the non-anaemic group. The mean Ejection Fraction was statistically significantly lower in the anaemic group as compared with the non-anaemic group. The percentage of LM affection in the anaemic group was statistically significantly higher as compared with the non-anaemic group. The incidence of arrythmia in the anaemic group was statistically significantly higher as compared with the non-anaemic group. Severe anaemic and low EF% patients were associated with higher incidence of stroke and MI. Conclusions: Patients with baseline anaemia before PCI have a higher incidence of PCI associated complications. Therefore, anaemia could be a predictor of PCI related complications.
背景:经皮冠状动脉介入治疗(PCI)已成为冠状动脉疾病(CAD)患者有效且广泛应用的治疗方法。在接受外科手术的危重患者中存在贫血与较差的临床结果相关。因此,本研究旨在评估经皮冠状动脉介入治疗伴有冠状动脉疾病的贫血患者的短期疗效。方法:这项前瞻性观察性研究纳入了200例接受PCI治疗的患者。患者分为两组:贫血患者和非贫血患者。根据贫血的严重程度将贫血患者进一步分为轻度贫血、中度贫血和重度贫血3个级别。所有病例均进行了完整的病史记录、临床检查和基线实验室检查:包括CBC、血清尿素和肌酐、心脏酶包括血清肌钙蛋白、CK-MB和标准12导联心电图。结果:贫血组的平均心率明显高于非贫血组。与非贫血组相比,贫血组的平均射血分数有统计学意义上的显著降低。与非贫血组相比,贫血组的LM影响百分比具有统计学意义。与非贫血组相比,贫血组的心律失常发生率有统计学意义。重度贫血和低EF%患者卒中和心肌梗死发生率较高。结论:PCI术前基线贫血患者PCI相关并发症发生率较高。因此,贫血可能是PCI相关并发症的预测指标。
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引用次数: 0
A Comparative Study between Pharmacoinvasive Strategy and Primary Percutaneous Coronary Angioplasty on Left Ventricle Function in Patients Presenting by Acute ST Segment Elevation Myocardial Infarction 药物侵入策略与经皮冠状动脉成形术对急性ST段抬高型心肌梗死患者左心室功能影响的比较研究
Pub Date : 2022-12-27 DOI: 10.9734/ca/2022/v11i4306
Samar Samir Mohamed Mady, M. Ashmawy, Sahar Abd Allah El-Shedody, I. K. Ibrahim
Background: Ischemic heart disease is considered the most common cause of death, worldwide. It accounts for 1.8 million deaths annually in Europe alone. According to the center for disease control (CDC) it’s the most common cause of deaths in Egypt accounting for more than one fifth of the total death count per year (21%), followed by stroke, then cancer. Aim: This work aimed to study and assess the efficacy of a pharmacoinvasive strategy compared with a primary PCI strategy on the left ventricle function in treatment of patient with myocardial infarction. Methods: Our study was prospective non randomized which compares between two groups, both of which had first time acute STEMI admitted to our Tanta University Hospital within the accepted time, which are (group 1) patients who had primary PCI for the infract related artery as a reperfusion therapy and (group 2) patients who had thrombolytic followed by coronary angiography with a window to PCI (pharmacoinvasive technique). Coronary angiography was performed either immediately in case of failed thrombolytic therapy or within 3-24 hrs. Following thrombolytic in case of successful thrombolytic. Both groups presented to the hospital within the accepted time window for reperfusion therapy either (thrombolytic or primary PCI), within 12 hrs. Results: The study compared between the two groups in the acute stage during hospitalization of the patients and after discharge according to Clinical outcomes: (mortality, major adverse cardiac events (MACE) as heart failure symptoms, re-infarction and Cardiac death),angiographic findings (base line TIMI flow score and final TIMI score, single or multi-vessel disease), angiographic complications as dissection and no-reflow, occurrence of contrast induced nephropathy and cerebrovascular events and LV systolic function assessment by echocardiography. Conclusion: In this study, we highlighted the importance of total ischemic time and importance of patient and system related delays in influencing outcomes of STEMI.
背景:缺血性心脏病被认为是世界范围内最常见的死亡原因。仅在欧洲,每年就有180万人死于该病。根据疾病控制中心(CDC)的数据,这是埃及最常见的死亡原因,占每年总死亡人数的五分之一以上(21%),其次是中风,然后是癌症。目的:本研究旨在研究和评估药物侵入策略与初级PCI策略对心肌梗死患者左心室功能的影响。方法:本研究采用前瞻性、非随机化的方法,比较两组在规定时间内首次入院的急性STEMI患者,即(1组)对梗死相关动脉行PCI再灌注治疗的患者和(2组)溶栓后行冠脉造影有窗期PCI(药物侵入技术)的患者。如果溶栓治疗失败,立即或在3-24小时内进行冠状动脉造影。在成功溶栓的情况下进行溶栓。两组患者均在12小时内接受再灌注治疗(溶栓治疗或首次PCI治疗)。结果:对两组患者在住院期间急性期和出院后的临床结局进行比较:(死亡率,主要心脏不良事件(MACE),如心力衰竭症状,再梗死和心源性死亡),血管造影结果(基线TIMI血流评分和最终TIMI评分,单血管或多血管疾病),血管造影并发症,如夹层和无回流,造影剂肾病和脑血管事件的发生以及超声心动图评估左室收缩功能。结论:在本研究中,我们强调了总缺血时间以及患者和系统相关延迟对影响STEMI预后的重要性。
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引用次数: 0
Is Portable Cardiopulmonary Ultrasound the Future of Heart Failure Diagnosis? 便携式心肺超声是心力衰竭诊断的未来吗?
Pub Date : 2022-12-24 DOI: 10.9734/ca/2022/v11i4305
El Mousaid Meriem, Errami Amine, Couissi Abdessamad, Haboub Meryem, Habbal Rachida
Aim of the Study: Heart failure is a major problem of public health in Morroco , pulmonary congestion is a key sign which can be easly detected by pulmonary sonography via interlobular septal thickening. The aim of this study was to establish a link Between kerley B lines in the lung and signs of pulmonary congestion. In addition to assess the evolution of these parameters in response to diuretic treatment. Materials and Methods: We prospectively evaluate 118 patients who presented to the emergency of IBN Rochd Hospital in Casablanca with sensation of breathlessness at baseline, 7 days, one month and 3 months for kerley B lines, NYHA Class of dyspnea and the levels of NT pro bnp. the duration of this study was 4 months. Results: Kerley B lines were present in 87.4% of patients initially, 67.6% had elevated levels of NT-probnp and 53%,30%,16% had dyspnea Class II, III and IV respectively. Diuretic treatment have shown a similar improvement of kerley B lines, levels of NT pro bnp and the class of dyspnea . In deed after a follow up of 3 month : only 7 % of patients had persistant kerley b lines, NT pro bnp levels were high in only 7.6% these findings were concordant with the clinical symptomatolgy. Hence only 7% of our patients suffered from dyspnea at moderate efforts at the end of the study. Conclusion: We demonstrated in this study a positive correlation between kerley b lines and levels of NT pro-bnp. These findings may facilitate the orientation of patients within the emergency department and help to initiate heart failure treatment rapidely.
研究目的:心力衰竭是摩洛哥公共卫生的一个主要问题,肺充血是肺超声通过小叶间隔增厚很容易发现的一个关键标志。本研究的目的是建立肺部凯利B线与肺充血体征之间的联系。此外,评估这些参数的演变响应利尿剂治疗。材料和方法:我们前瞻性评估118例在卡萨布兰卡IBN Rochd医院就诊的急诊患者在基线、7天、1个月和3个月时的kerley B线、NYHA呼吸困难等级和NT pro bnp水平。研究时间为4个月。结果:87.4%的患者最初存在Kerley B系,67.6%的患者NT-probnp水平升高,53%、30%、16%的患者分别出现II级、III级和IV级呼吸困难。利尿剂治疗对kerley B线、NT亲bnp水平和呼吸困难程度也有类似的改善。在3个月的随访后:只有7%的患者有持续的kerley b线,只有7.6%的患者NT亲bnp水平高,这些发现与临床症状一致。因此,在研究结束时,只有7%的患者在适度的努力下出现呼吸困难。结论:我们在本研究中证实kerley b系与NT pro-bnp水平呈正相关。这些发现可能有助于急诊科患者的定位,并有助于快速启动心力衰竭治疗。
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引用次数: 0
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Cardiology and Angiology: An International Journal
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