Diabetes affects every organ in the body and cardiovascular disease accounts for two-thirds of the mortality in the diabetic population.Diabetes-related heart disease occurs in the form of coronary artery disease(CAD)...Diabetes affects every organ in the body and cardiovascular disease accounts for two-thirds of the mortality in the diabetic population.Diabetes-related heart disease occurs in the form of coronary artery disease(CAD),cardiac autonomic neuropathy or diabetic cardiomyopathy(DbCM).The prevalence of cardiac failure is high in the diabetic population and DbCM is a common but underestimated cause of heart failure in diabetes.The pathogenesis of diabetic cardiomyopathy is yet to be clearly defined.Hyperglycemia,dyslipidemia and inflammation are thought to play key roles in the generation of reactive oxygen or nitrogen species which are in turn implicated.The myocardial interstitium undergoes alterations resulting in abnormal contractile function noted in DbCM.In the early stages of the disease diastolic dysfunction is the only abnormality,but systolic dysfunction supervenes in the later stages with impaired left ventricular ejection fraction.Transmitral Doppler echocardiography is usually used to assess diastolic dysfunction,but tissue Doppler Imaging and Cardiac Magnetic Resonance Imaging are being increasingly used recently for early detection of DbCM.The management of DbCM involves improvement in lifestyle,control of glucose and lipid abnormalities,and treatment of hypertension and CAD,if present.The role of vasoactive drugs and antioxidants is being explored.This review discusses the pathophysiology,diagnostic evaluation and management options of DbCM.展开更多
Background: We examined the usefulness of tissue Doppler imaging in evaluating the diastolic dysfunction and assessed the prognostic value of ratio between early mitral inflow velocity and mitral annular early diastol...Background: We examined the usefulness of tissue Doppler imaging in evaluating the diastolic dysfunction and assessed the prognostic value of ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/e’) in unselected patients with acute ST-elevation myocardial infarction (STEMI). Methods: Patients presenting with acute STEMI at Osmania General Hospital, Hyderabad, India between January-2012 and June-2012 were examined in this study. All patients underwent echocardiographic examination comprising Doppler assessment of transmitral flow velocities (peak E-wave velocity) and Doppler tissue imaging of the medial mitral valve annulus (e’). All patients were followed up for 6 months and all-cause mortality was measured as the study endpoint. Role of E/e’ ratio as a predictor of survival after acute STEMI was evaluated by a comparative analysis of patients with E/e’ ≤15 and >15. Results: A total of 50 patients with acute STEMI (mean age: 52.2 ± 13.2 years;80% males) were analyzed in this study. Of them, 23 (46%) patients had an E/e’ >15. Clinical parameters such as Killip class ≥2 as well as left ventricular ejection fraction of 15. Five (10%) patients died during the 6-month follow-up period. All deaths occurred among patients from the E/e’ >15 group, indicating that E/e’ is an effective predictor of overall survival. Conclusion: E/e’ ratio was identified as a strong predictor of survival after acute myocardial infarction and can be suitable for risk-stratification of patients in this setting. Further studies are warranted to substantiate the findings.展开更多
Background Sepsis-induced myocardial dysfunction is a common complication and the main cause of mor- tality in patients with sepsis. At present, there is still lack of specific early diagnosis index of the disease. Ou...Background Sepsis-induced myocardial dysfunction is a common complication and the main cause of mor- tality in patients with sepsis. At present, there is still lack of specific early diagnosis index of the disease. Our study was aimed to investigate the diagnosis and prognosis evaluation value of b-type natriuretic peptide （BNP） combined with the ratio of early diastolic transmitral inflow velocity （E） to early diastolic mitral annulus velocity （e＇） （Ee＇） in sepsis-induced myocardial dysfunction, so as to apply them as early warning indicators of the disease. Methods Sixty-six cases of patients with sepsis were selected and divided into disorder group （myocardial dys- function, n=28） and normal group （normal myocardial function, n=38）. Ee＇ of patients at the same time of LVEF detection, plasma BNP levels and APACHE ]l score and the 28 d survival rate of the two groups were also deter- mined and compared. The correlations of between plasma BNP levels and Ee＇ in sepsis patients with myocardial dysfunction with LVEF, APACHE l] score and 28 d survival rate were analyzed, and the value of them in combi- nation for predicting the 28 d survival rate was analyzed. Results Compared with the normal group, Plasma BNP levels, Ee＇ and APACHE 1] scores in the disorder group were increased （P 〈 0.05）. The 28 d survival rate of the patients in the disorder group was lower than that in the normal group （42.68% vs. 73.68%; P 〈 0.05）. Com- pared with the survival patients in the disorder group, plasma BNP levels, Ee＇ and APACHE I[ scores of the dead patients in disorder group were higher, while LVEF in the dead patient in disorder group was lower （P 〈 0.05）. Spearman unconditional correlation analysis and Logistic multiple regression analysis model results showed that plasma BNP levels and Ee＇ in sepsis patients with myocardial dysfunction were correlated with LVEF, 28d sur- vival rate and APACHE lI score. ROC curve analysis showed that values of plasma BNP levels and Ee＇ in sepsis patients with myocardial dysfunction were better in predicting the 28 d survival rate, while their combination was the best. Conclusions Plasma BNP levels and Ee＇ in sepsis patients with myocardial dysfunction are correlated with the severity and prognosis, therefore, provide reference indexes for the assessment of severity and prognosis of patients with sepsis and myocardial dysfunction.展开更多
文摘Diabetes affects every organ in the body and cardiovascular disease accounts for two-thirds of the mortality in the diabetic population.Diabetes-related heart disease occurs in the form of coronary artery disease(CAD),cardiac autonomic neuropathy or diabetic cardiomyopathy(DbCM).The prevalence of cardiac failure is high in the diabetic population and DbCM is a common but underestimated cause of heart failure in diabetes.The pathogenesis of diabetic cardiomyopathy is yet to be clearly defined.Hyperglycemia,dyslipidemia and inflammation are thought to play key roles in the generation of reactive oxygen or nitrogen species which are in turn implicated.The myocardial interstitium undergoes alterations resulting in abnormal contractile function noted in DbCM.In the early stages of the disease diastolic dysfunction is the only abnormality,but systolic dysfunction supervenes in the later stages with impaired left ventricular ejection fraction.Transmitral Doppler echocardiography is usually used to assess diastolic dysfunction,but tissue Doppler Imaging and Cardiac Magnetic Resonance Imaging are being increasingly used recently for early detection of DbCM.The management of DbCM involves improvement in lifestyle,control of glucose and lipid abnormalities,and treatment of hypertension and CAD,if present.The role of vasoactive drugs and antioxidants is being explored.This review discusses the pathophysiology,diagnostic evaluation and management options of DbCM.
文摘Background: We examined the usefulness of tissue Doppler imaging in evaluating the diastolic dysfunction and assessed the prognostic value of ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/e’) in unselected patients with acute ST-elevation myocardial infarction (STEMI). Methods: Patients presenting with acute STEMI at Osmania General Hospital, Hyderabad, India between January-2012 and June-2012 were examined in this study. All patients underwent echocardiographic examination comprising Doppler assessment of transmitral flow velocities (peak E-wave velocity) and Doppler tissue imaging of the medial mitral valve annulus (e’). All patients were followed up for 6 months and all-cause mortality was measured as the study endpoint. Role of E/e’ ratio as a predictor of survival after acute STEMI was evaluated by a comparative analysis of patients with E/e’ ≤15 and >15. Results: A total of 50 patients with acute STEMI (mean age: 52.2 ± 13.2 years;80% males) were analyzed in this study. Of them, 23 (46%) patients had an E/e’ >15. Clinical parameters such as Killip class ≥2 as well as left ventricular ejection fraction of 15. Five (10%) patients died during the 6-month follow-up period. All deaths occurred among patients from the E/e’ >15 group, indicating that E/e’ is an effective predictor of overall survival. Conclusion: E/e’ ratio was identified as a strong predictor of survival after acute myocardial infarction and can be suitable for risk-stratification of patients in this setting. Further studies are warranted to substantiate the findings.
基金supported by Foshan City Health and Family Planning Bureau medical research project(No.20160229)
文摘Background Sepsis-induced myocardial dysfunction is a common complication and the main cause of mor- tality in patients with sepsis. At present, there is still lack of specific early diagnosis index of the disease. Our study was aimed to investigate the diagnosis and prognosis evaluation value of b-type natriuretic peptide （BNP） combined with the ratio of early diastolic transmitral inflow velocity （E） to early diastolic mitral annulus velocity （e＇） （Ee＇） in sepsis-induced myocardial dysfunction, so as to apply them as early warning indicators of the disease. Methods Sixty-six cases of patients with sepsis were selected and divided into disorder group （myocardial dys- function, n=28） and normal group （normal myocardial function, n=38）. Ee＇ of patients at the same time of LVEF detection, plasma BNP levels and APACHE ]l score and the 28 d survival rate of the two groups were also deter- mined and compared. The correlations of between plasma BNP levels and Ee＇ in sepsis patients with myocardial dysfunction with LVEF, APACHE l] score and 28 d survival rate were analyzed, and the value of them in combi- nation for predicting the 28 d survival rate was analyzed. Results Compared with the normal group, Plasma BNP levels, Ee＇ and APACHE 1] scores in the disorder group were increased （P 〈 0.05）. The 28 d survival rate of the patients in the disorder group was lower than that in the normal group （42.68% vs. 73.68%; P 〈 0.05）. Com- pared with the survival patients in the disorder group, plasma BNP levels, Ee＇ and APACHE I[ scores of the dead patients in disorder group were higher, while LVEF in the dead patient in disorder group was lower （P 〈 0.05）. Spearman unconditional correlation analysis and Logistic multiple regression analysis model results showed that plasma BNP levels and Ee＇ in sepsis patients with myocardial dysfunction were correlated with LVEF, 28d sur- vival rate and APACHE lI score. ROC curve analysis showed that values of plasma BNP levels and Ee＇ in sepsis patients with myocardial dysfunction were better in predicting the 28 d survival rate, while their combination was the best. Conclusions Plasma BNP levels and Ee＇ in sepsis patients with myocardial dysfunction are correlated with the severity and prognosis, therefore, provide reference indexes for the assessment of severity and prognosis of patients with sepsis and myocardial dysfunction.
