Background The diagnostic delay of cardiac amyloidosis(CA)is known to be substantially long.A prolonged time from symptoms onset to diagnosis negatively impacts quality of life and life expectancy of the affected pati...Background The diagnostic delay of cardiac amyloidosis(CA)is known to be substantially long.A prolonged time from symptoms onset to diagnosis negatively impacts quality of life and life expectancy of the affected patients.We aim to describe the role of the incidental finding of amyloid deposits in prostatic tissue as an early marker of CA.Methods A systematic cardiological evaluation,comprising ECG,echocardiogram and 99mTc-DPD scintigraphy,was offered to a cohort of 19 patients with incidental prostatic amyloidosis(PA)findings,propectively detected between 2014-2023,to assess cardiac involvement.Results The median age of the patients was 80.2 years(IQR:74.9-82.6 years).Histopathological study revealed amyloid deposits within the walls of small vessels(predominantly small arteries)in 18 patients and mainly in the stroma in the remaining case.All of them were immunohistochemically positive for transthyretin(ATTR)except one patient,with known myeloma,which was unconclusive fo ATTR.Clonal dyscrasia was excluded in the rest of the patients.Thirteen patients(68.4%)underwent all cardiological tests,4 patients(21.1%)underwent only ECG and echocardiographic evaluation and two patients(10.5%)refused to undergo any cardiological study.Among 13 individuals undergoing the complete evaluation,six patients were eventually diagnosed with CA(46.15%).All of them were asymptomatic from a cardiovascular point of view at the time of the prostate biopsy.Conclusion The finding of PA should prompt a complete cardiovascular examination,given the significant percentage of patients eventually diagnosed with early-stage CA.Multidisciplinary collaboration among different medical specialists must be encouraged,given the potential clinical impact of CA early diagnosis.展开更多
Lactate, as a metabolite of easy and quick assessment, has been studied over time in critically ill patients in order to evaluate its prognostic ability. The present review is focused on the prognostic role of lactate...Lactate, as a metabolite of easy and quick assessment, has been studied over time in critically ill patients in order to evaluate its prognostic ability. The present review is focused on the prognostic role of lactate levels in acute cardiac patients(that is with acute coronary syndrome, cardiogenic shock, cardiac arrest, non including post cardiac surgery patients). In patients with STelevation myocardial infarction treated with mechanical revascularization, hyperlactatemia identified a subset of patients at higher risk for early death and in-hospital complications, being strictly related mainly to hemodynamic derangement. The prognostic impact of hyperlactatemia on mortality has been documented in patients with cardiogenic shock and in those with cardiac arrest even if there is no cut-off value of lactate to be associated with worse outcome or to guide resuscitation or hemodynamic management. Therapeutic hypothermia seems to affect per se lactate values which have been shown to progressively decrease during hypothermia. The mechanism(s) accounting for lactate levels during hypothemia seem to be multiple ranging from the metabolic effects of reduced temperatures to the hemodynamic effects of hypothermia(i.e., reduced need of vasopressor agents). Serial lactate measurements over time, or lactate clearance, have been reported to be clinically more reliable than lactate absolute value also in acute cardiac patients. Despite differences in study design, timing of lactate measurements and type of acute cardiac conditions(i.e., cardiogenic shock, cardiac arrest, refractory cardiac arrest), available evidence strongly suggests that higher lactate levels can be observed on admission in non-survivors and that higher lactate clearance is associated with better outcome.展开更多
AIM: To assess the safety of therapeutic hypothermia(TH) concerning arrhythmias we analyzed serial electrocardiograms(ECG) during TH.METHODS: All patients recovered from a cardiac arrest with Glasgow < 9 at admissi...AIM: To assess the safety of therapeutic hypothermia(TH) concerning arrhythmias we analyzed serial electrocardiograms(ECG) during TH.METHODS: All patients recovered from a cardiac arrest with Glasgow < 9 at admission were treated with induced mild TH to 32-34℃. TH was obtained with cool fluid infusion or a specific intravascular device. Twelvelead ECG before,during,and after TH,as well as ECG telemetry data was recorded in all patients. From a total of 54 patients admitted with cardiac arrest during the study period,47 patients had the 3 ECG and telemetry data available. ECG analysis was blinded and performed with manual caliper by two independent cardiologists from blinded copies of original ECG,recorded at 25 mm/s and 10 mm/m V. Coronary care unit staff analyzed ECG telemetry for rhythm disturbances. Variables measured in ECG were rhythm,RR,PR,QT and corrected QT(QTc by Bazett formula,measured in lead v2) intervals,QRS duration,presence of Osborn's J wave and U wave,as well as ST segment displacement and T wave amplitude in leads Ⅱ,v2 and v5.RESULTS: Heart rate went down an average of 19 bpm during hypothermia and increased again 16 bpm with rewarming(P < 0.0005,both). There was a nonsignificant prolongation of the PR interval during TH and a significant decrease with rewarming(P = 0.041). QRS duration significantly prolonged(P = 0.041) with TH and shortened back(P < 0.005) with rewarming. QTc interval presented a mean prolongation of 58 ms(P < 0.005) during TH and a significant shortening with rewarming of 22.2 ms(P = 0.017). Osborn or J wave was found in 21.3% of the patients. New arrhythmias occurred in 38.3% of the patients. Most frequent arrhythmia was non-sustained ventricular tachycardia(19.1%),followed by severe bradycardia or paced rhythm(10.6%),accelerated nodal rhythm(8.5%) and atrial fibrillation(6.4%). No life threatening arrhythmias(sustained ventricular tachycardia,polymorphic ventricular tachycardia or ventricular fibrillation) occurred during TH. CONCLUSION: A 38.3% of patients had cardiac arrhythmias during TH but without life-threatening arrhythmias. A concern may rise when inducing TH to patients with long QT syndrome.展开更多
BACKGROUND There is a high risk for sudden cardiac death(SCD) in certain patient groups that would not meet criteria for implantable cardioverter defibrillator(ICD) therapy.In conditions such as hypertrophic cardiomyo...BACKGROUND There is a high risk for sudden cardiac death(SCD) in certain patient groups that would not meet criteria for implantable cardioverter defibrillator(ICD) therapy.In conditions such as hypertrophic cardiomyopathy(HCM) there are clear risk scores that help define patients who are high risk for SCD and would benefit from ICD therapy. There are however many areas of uncertainty such as certain patients post myocardial infarction(MI). These patients are high risk for SCD but there is no clear tool for risk stratifying such patients.AIM To assess risk factors for sudden cardiac death in major cardiac disorders and to help select patients who might benefit from Wearable cardiac defibrillators(WCD).METHODS A literature search was performed looking for risk factors for SCD in patients post-MI, patients with left ventricular systolic dysfunction(LVSD), HCM, long QT syndrome(LQTS). There were 41 studies included and risk factors and the relative risks for SCD were compiled in table form.RESULTS We extracted data on relative risk for SCD of specific variables such as age,gender, ejection fraction. The greatest risk factors for SCD in post MI patients was the presence of diabetes [Hazard ratio(HR) 1.90-3.80], in patient with LVSD was ventricular tachycardia(Relative risk 3.50), in LQTS was a prolonged QTc(HR36.53) and in patients with HCM was LVH greater than 20 mm(HR 3.10). A proportion of patients currently not suitable for ICD might benefit from a WCDCONCLUSION There is a very high risk of SCD post MI, in patients with LVSD, HCM and LQTS even in those who do not meet criteria for ICD implantation. These patients may be candidates for a WCD. The development of more sensitive risk calculators to predict SCD is necessary in these patients to help guide treatment.展开更多
BACKGROUND Cardiovascular diseases(CVD)have been shown to be the greatest cause of death worldwide and rates continue to increase.It is recommended that CVD patients attend cardiac rehabilitation(CR)following a cardia...BACKGROUND Cardiovascular diseases(CVD)have been shown to be the greatest cause of death worldwide and rates continue to increase.It is recommended that CVD patients attend cardiac rehabilitation(CR)following a cardiac event to reduce mortality,improve recovery and positively influence behaviour around CVD risk factors.Despite the recognised benefits and international recommendations for exercisebased CR,uptake and attendance remain suboptimal.A greater understanding of CR barriers and facilitators is required,not least to inform service development.Through understanding current cardiac patients’attitudes and opinions around CR and physical activity(PA)could inform patient-led improvements.Moreover,through understanding aspects of CR and PA that participants like/dislike could provide healthcare providers and policy makers with information around what elements to target in the future.AIM To investigate participants’attitudes and opinions around CR and PA.METHODS This study employed a cross-sectional survey design on 567 cardiac patients.Cardiac patients who were referred for standard CR classes at a hospital in the Scottish Highlands,from May 2016 to May 2017 were sampled.As part of a larger survey,the current study analysed the free-text responses to 5 open-ended questions included within the wider survey.Questions were related to the participants’experience of CR,reasons for non-attendance,ideas to increase attendance and their opinions on PA.Qualitative data were analysed using a 6-step,reflexive thematic analysis.RESULTS Two main topic areas were explored:“Cardiac rehabilitation experience”and“physical activity”.Self-efficacy was increased as a result of attending CR due to exercising with similar individuals and the safe environment offered.Barriers ranged from age and health to distance and starting times of the classes which increased travel time and costs.Moreover,responses demonstrated a lack of information and communication around the classes.Respondents highlighted that the provision of more classes and classes being held out with working hours,in addition to a greater variety would increase attendance.In terms of PA,respondents viewed this as different to the CR experience.Responses demonstrated increased freedom when conducting PA with regards to the location,time and type of exercise conducted.CONCLUSION Changes to the structure of CR may prove important in creating long term behaviour change after completing the rehabilitation programme.展开更多
Objective: This study investigated the effects of cardiac rehabilitation exercise protocols on physical function (PF) in patients with chronic heart failure (CHF). Study Design and Setting: This randomized controlled ...Objective: This study investigated the effects of cardiac rehabilitation exercise protocols on physical function (PF) in patients with chronic heart failure (CHF). Study Design and Setting: This randomized controlled trial recruited 70 patients who are in stage II CHF with ejection fraction (≤40%) from a Nigerian university teaching hospital. They were randomly assigned into Exercise Group (EG: n = 35) or Control Group (CG: n = 35). Physical function, activity of daily living (ADL), distance walked in six minutes and grip strength were assessed using a validated ADL questionnaire, six minute walk test and a hand dynamometer respectively. In addition to medication, EG underwent aerobic and upper extremity resistance exercises thrice weekly for eight weeks while CG used medications only. Data were analyzed using descriptive and inferential statistics. Alpha level was at p p > 0.05). Significant improvements were noticed at fourth week among participants’ ADL (30.0% ± 6.0%), 6MWD (321.7 ± 26.3 m) and VO<sub>2</sub> max (8.9 ± 0.4 mL/kg/min) variables within the exercise EG but no significant changes were observed in the CG (p > 0.05). Participants in EG demonstrated more significant improvements in ADL (15.0% ± 5.0%), 6MWD (406.0 ± 29.7 m) and VO<sub>2</sub> max (10.3 ± 0.5 mL/kg/min) (p p > 0.05). Conclusions: Cardiac rehabilitation exercise protocols involving self-paced walking, sit-to-stand and upper extremity dynamic strength training improved activity of daily living, walking and functional capacity in patients with stable chronic heart failure.展开更多
Background: Adrenal and parathyroid insufficiency are uncommon in patients with transfusion dependent Beta Thalassemia (β-TM). Further, myocardial echocardiographic abnormalities are recognized but with a variable ou...Background: Adrenal and parathyroid insufficiency are uncommon in patients with transfusion dependent Beta Thalassemia (β-TM). Further, myocardial echocardiographic abnormalities are recognized but with a variable outcomes Aim: The aim is to determine the prevalence of adrenal and parathyroid insufficiency in patient with transfusion dependent β-TM. And to assess left ventricle systolic and diastolic function using Pulsed Doppler (PD) and Tissue Doppler (DT) echocardiogram. Methods:The study was conducted on patients with β-TM (n = 99, age 15.92 ± 8.92 years) and compared with an age-matched controls (n = 98 age 15.79 ± 8.94 years). In all participants echocardiographic indices of M mode and PD and TD were performed. Blood samples were withdrawn for measuring the serum cortisol, parathyroid and Ferritin. Correlation between the level of cortisol and ferritin level was evaluated. Results: Patients with β-TM compared with controls, had significantly thicker LV septal wall index of 0.65 ± 0.26 vs 0.44 ± 0.2190, p 0.001 and LV posterior wall of 0.65 ± 0.235 vs 0.43 ± 0.214, p ± 5.5 vs 5.0 ± 5.6, p = 0.23. Furthermore patients with β-TM had higher E/A ratio (1.54 ± 0.18 vs 1.23 ± 0.17, p 0.01) and shorter deceleration time (DT) (170.53 ± 13.3 vs 210.50 ± 19.20 m sec, p 0.01). The ratio of transmitral E wave velocity to the tissue Doppler E wave at the basal septal mitral annulus (E/Em) was significantly higher in β-TM group (19.68 ± 2.81 vs 13.86 ± 1.41, p 0.05). The tissue Doppler systolic wave (Sm) velocity and the early diastolic wave (Em) were significantly lower in β-TM group compared with controls with Sm, of 4.82 ± 1.2 vs 6.22 ± 2.1 cm/sec, p 0.05 and (Em) of 3.51 ± 2.7 vs 4.12 ± 2.5 cm/sec p 0.05, respectively). The tricuspid valve velocity was significantly higher in β-TM patients compared with controls (2.85 ± 0.56 vs 1.743 ± 0.47 m/sec, respectively, p 0.01). The prevalence of adrenal insufficiency in patients with β-TM was 16%, hypoparathyroidism of 4.5% weak negative correlation between serum level of cortisol and the serum Ferritin. Conclusion: Patients with β-thalassemia major had a high prevalence of subclinical adrenal insufficiency of 16%, hypoparathyroidism of 4.5% with weak negative correlation between the low level of cortisol ≤160 nmol/L and high serum ferritin. Echocardiographic Pulsed Doppler showed a restrictive LV diastolic pattern suggestive of advanced diastolic dysfunction but preserved left ventricle systolic function.展开更多
Cardiac surgery is one of the youngest surgical disciplines.Only a century ago the heart and great vessels were not surgically approachable,and any pathology affecting these structures that needed surgery inevitably l...Cardiac surgery is one of the youngest surgical disciplines.Only a century ago the heart and great vessels were not surgically approachable,and any pathology affecting these structures that needed surgery inevitably led to a poor prognosis[1].The turning point came with the introduction of modern anesthesia and,above all,with the invention of extracorporeal cardiopulmonary circulation.展开更多
BACKGROUND An epidemic of Mycobacterium chimaera (M. chimaera) infections following cardiac surgery is ongoing worldwide. The outbreak was first discovered in 2011, and it has been traced to a point source contaminati...BACKGROUND An epidemic of Mycobacterium chimaera (M. chimaera) infections following cardiac surgery is ongoing worldwide. The outbreak was first discovered in 2011, and it has been traced to a point source contamination of the LivaNova 3T heater-cooler unit, which is used also in Italy. International data are advocated to clarify the spectrum of clinical features of the disease as well as treatment options and outcome. We report a series of M. chimaera infections diagnosed in Treviso Hospital, including the first cases notified in Italy in 2016. CASE SUMMARY Since June 2016, we diagnosed a M. chimaera infection in nine patient who had undergone cardiac valve surgery between February 2011 and November 2016. The time between cardiac surgery and developing symptoms ranged from 6 to 97 mo. Unexplained fever, psychophysical decay, weight loss, and neurological symptoms were common complaints. The median duration of symptoms was 32 wk, and the longest was almost two years. A new cardiac murmur, splenomegaly, choroidoretinitis, anaemia or lymphopenia, abnormal liver function tests and hyponatremia were common findings. All the patients presented a prosthetic valve endocarditis, frequently associated to an ascending aortic pseudoneurysm or spondylodiscitis. M. chimaera was cultured from blood, bioprosthetic tissue, pericardial abscess, vertebral tissue, and bone marrow. Mortality is high in our series, reflecting the poor outcome observed in other reports. Three patients have undergone repeat cardiac surgery. Five patients are being treated with a targeted multidrug antimycobacterial regimen. CONCLUSION Patients who have undergone cardiac surgery in Italy and presenting with signs and symptoms of endocarditis must be tested for M. chimaera.展开更多
Objective： To explore and identify the concept of adherence in the context of cardiac rehabilitation. This conceptanalysis will provide a framework for clinical decision-making and intervention to improve patients’ ...Objective： To explore and identify the concept of adherence in the context of cardiac rehabilitation. This conceptanalysis will provide a framework for clinical decision-making and intervention to improve patients’ adherence tocardiac rehabilitation programme. Method： Walker and Avant’s framework was used to analysis the concept ofadherence. Results： Adherence is defined as patients collaboration with health care provider, active involvement in thetreatment regimen, and persistence in practice characterized by self-efficacy and relapse-prevention. Defining Attributesof adherence include collaboration relationship; self-efficacy promotion and relapse-prevention. Antecedents ofadherence include health care provider’s prescription, illness perceptions, social-economic and environmental factors.Patients adherence to cardiac rehabilitation programme can improve clinical outcomes. However, there is no standardinstrument to measure adherence. Conclusion： Based on the concept analysis, in order to improve patients’ adherence tocardiac rehabilitation, health care provider should invite patients active involvement in making rehabilitation plan andpromote patients’ self-efficacy and prevention relapse.展开更多
Background:The European Congenital Heart Surgeons Association(ECHSA)Congenital Heart Surgery Database(CHSD)was founded in 1999 and is open for worldwide participation.The current dataset includes a large amount of sur...Background:The European Congenital Heart Surgeons Association(ECHSA)Congenital Heart Surgery Database(CHSD)was founded in 1999 and is open for worldwide participation.The current dataset includes a large amount of surgical data from both Europe and China.The purpose of this analysis is to compare patterns of practice and outcomes among pediatric congenital heart defect surgeries in Europe and China using the ECHSA-CHSD.Methods:We examined all European(125 centers,58,261 operations)and Chinese(13 centers,23,920 operations)data in the ECHSA-CHSD from 2006-2018.Operative mortality,postoperative length of stay,median patient age and weight were calculated for the ten benchmark operations for China and Europe,respectively.Results:Benchmark procedure distribution frequencies differed between Europe and China.In China,ventricular septal defect repair comprised approximately 70%of procedures,while Norwood operations comprised less than one percent of all procedures.Neonatal cardiac procedures were rare in China overall.For procedures in STAT mortality category 1,Chinese centers had lower operative mortality rates,while procedures in categories 3 and 5 mortality is lower in European centers.Operative mortality over the time period decreased from 3.89%to 1.64%for the whole cohort,with a sharper decline in China.This drop coincides with an increase of submitted procedures over this 13-year-period.Conclusion:Chinese centers had higher programmatic volume of congenital heart surgeries,while European centers have a more complex case mix.Palliation for patients with functionally univentricular heart was performed less commonly in China.These comparison of patterns of practice and outcomes demonstrate opportunities for continuing bidirectional transcontinental collaboration and quality improvement.展开更多
Background: Acute Kidney Injury (AKI) stands as a prominent postoperative complication in on-pump cardiac surgery, with repercussions on morbidity, mortality, and hospitalization duration. Current diagnostic criteria ...Background: Acute Kidney Injury (AKI) stands as a prominent postoperative complication in on-pump cardiac surgery, with repercussions on morbidity, mortality, and hospitalization duration. Current diagnostic criteria relying on serum creatinine levels exhibit a delayed identification of AKI, prompting an exploration of alternative biomarkers. Aims and Objectives: This study is designed to overcome diagnostic constraints and explore the viability of serum Cystatin C as an early predictor of Acute Kidney Injury (AKI) in individuals undergoing on-pump cardiac surgery. The investigation aims to establish the relationship between serum Cystatin C levels and the onset of AKI in patients subjected to on-pump cardiac surgery. Primary objectives involve the assessment of the diagnostic effectiveness of serum Cystatin C, its comparison with serum creatinine, and the exploration of its potential for the early identification and treatment of AKI. Methodology: Conducted as a single-center study at the cardiac surgery department of B中央人民政府 in Bangladesh from September 2020 to August 2022, a comparative cross-sectional analysis involved 31 participants categorized into No AKI and AKI groups based on Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Data collection encompassed preoperative, post-CBP (cardiopulmonary bypass) conclusion at 2 hours, postoperative day 1, and postoperative day 2 intervals. Statistical analyses included Chi-squared tests, independent Student’s t-tests, and one-sample t-tests. Significance was set at P Results: The study revealed no significant differences in baseline characteristics between the No AKI and AKI groups, except for CPB time and cross-clamp time. Serum Cystatin C levels in the AKI group exhibited statistical significance at various time points, highlighting its potential as an early detector. Conversely, Serum Creatinine levels in the AKI group showed no statistical significance. The Receiver Operating Characteristic (ROC) curve analysis further supported the efficacy of serum Cystatin C, with an Area under the ROC Curve of 0.864 and a cut-off value of 0.55 (p Conclusion: This study supports the superior utility of serum Cystatin C as an early detector of AKI in on-pump cardiac surgery patients compared to serum creatinine. Its ability to identify AKI several hours earlier may contribute to reduced morbidity, mortality, and healthcare costs. The findings underscore the significance of exploring novel biomarkers for improved post-cardiac surgery renal function assessment.展开更多
目的构建慢性肾脏病健康教育效果评价指标体系,为开展健康教育工作提供参考依据。方法计算机检索Cochrane、PubMed、Web of Science、中国知网、万方和维普等数据库中建库至2023年6月慢性肾脏病健康教育效果评价指标体系的相关文献。最...目的构建慢性肾脏病健康教育效果评价指标体系,为开展健康教育工作提供参考依据。方法计算机检索Cochrane、PubMed、Web of Science、中国知网、万方和维普等数据库中建库至2023年6月慢性肾脏病健康教育效果评价指标体系的相关文献。最终筛选文献80篇,得到一级指标6个(满意度效果、教育效果、管理效果、经济效果、社会效果、可持续发展)。基于文献检索基础,参照《慢性肾脏病健康教育规范》地方标准及“观众-社会-经济-可持续”评估指标体系模型,结合健康教育工作实际,初步拟定慢性肾脏病健康教育效果评价指标体系(一级指标6个,二级指标20个)。制作专家函询问卷,包括卷首语、专家基本信息调查表、专家熟悉程度与判断依据、专家意见表。于2023年8月至9月,采用电子邮件发放专家函询问卷,函询2轮,间隔时间为2周。第1轮专家函询结束后,研究小组根据专家意见和指标筛选原则进行修改,形成第2轮专家函询问卷。采用χ^(2)检验进行统计学分析;积极性采用问卷回收率和意见提出率表示;权威性采用权威系数表示;协调程度及一致性分别采用肯德尔和谐系数、变异系数表示;采用层次分析法确定一、二级指标权重。结果本研究共纳入慢性肾脏病及科普领域专家28名,男8名,女20名;年龄:≥30~<35岁14名,≥35~<40岁5名,≥40岁9名;学历:本科17名,硕士5名,博士6名;工作年限:<10年17名,≥10~<20年5名,≥20年6名;职称:中级9名,副高级15名,正高级4名;健康教育活动频率:每天1~2次8名,每周1~2次6名,每月1~2次8名,每季度1~2次4名,每年1~2次2名。2轮专家函询问卷回收率分别为100.00%(28/28)、92.86%(26/28)。在第1轮专家函询中,有16名专家以文字或口头形式提出意见,占比57.14%。2轮专家权威系数分别为0.804、0.839。第1轮专家函询中的一、二级指标肯德尔和谐系数分别为0.263、0.211,第2轮为0.316、0.272,两轮比较,差异均有统计学意义(均P<0.05)。第1轮专家函询一级指标变异系数为0~0.196,无增删;二级指标变异系数为0~0.286,修改4项。第2轮专家函询一、二级指标均无增删,最终构建包括6个一级指标和27个二级指标的慢性肾脏病患者健康教育效果评价指标体系。满意度及教育效果权重均为0.173,管理效果为0.172,经济效果为0.170,社会效果为0.163,可持续发展效果为0.018。结论慢性肾脏病健康教育效果评价指标体系科学合理,内容全面,针对性强,可用于评价慢性肾脏病患者健康教育活动。展开更多
目的探讨组长负责制分层管理在心脏重症监护病房(coronary care unit,CCU)护理管理中的应用价值。方法选取2022年1月—2023年12月在徐州市中心医院心脏监护室工作的26名护理人员作为研究对象,2022年1—12月实施常规管理为对照组,2023年1...目的探讨组长负责制分层管理在心脏重症监护病房(coronary care unit,CCU)护理管理中的应用价值。方法选取2022年1月—2023年12月在徐州市中心医院心脏监护室工作的26名护理人员作为研究对象,2022年1—12月实施常规管理为对照组,2023年1—12月实施组长负责制分层管理为研究组,比较两组护理人员的护理质量、考核成绩、管理满意度及护理风险事件发生情况。结果研究组护理质量、考核成绩均高于对照组,差异均有统计学意义(P均<0.05)。研究组的管理满意度为96.15%(25/26),高于对照组的69.23%(18/26),差异有统计学意义(χ^(2)=4.837,P<0.05)。研究组未发生护理风险事件,对照组发生3起护理风险事件。结论在CCU护理管理中应用组长负责制分层管理,可提升护理质量,提高管理效果,减少护理风险事件。展开更多
文摘Background The diagnostic delay of cardiac amyloidosis(CA)is known to be substantially long.A prolonged time from symptoms onset to diagnosis negatively impacts quality of life and life expectancy of the affected patients.We aim to describe the role of the incidental finding of amyloid deposits in prostatic tissue as an early marker of CA.Methods A systematic cardiological evaluation,comprising ECG,echocardiogram and 99mTc-DPD scintigraphy,was offered to a cohort of 19 patients with incidental prostatic amyloidosis(PA)findings,propectively detected between 2014-2023,to assess cardiac involvement.Results The median age of the patients was 80.2 years(IQR:74.9-82.6 years).Histopathological study revealed amyloid deposits within the walls of small vessels(predominantly small arteries)in 18 patients and mainly in the stroma in the remaining case.All of them were immunohistochemically positive for transthyretin(ATTR)except one patient,with known myeloma,which was unconclusive fo ATTR.Clonal dyscrasia was excluded in the rest of the patients.Thirteen patients(68.4%)underwent all cardiological tests,4 patients(21.1%)underwent only ECG and echocardiographic evaluation and two patients(10.5%)refused to undergo any cardiological study.Among 13 individuals undergoing the complete evaluation,six patients were eventually diagnosed with CA(46.15%).All of them were asymptomatic from a cardiovascular point of view at the time of the prostate biopsy.Conclusion The finding of PA should prompt a complete cardiovascular examination,given the significant percentage of patients eventually diagnosed with early-stage CA.Multidisciplinary collaboration among different medical specialists must be encouraged,given the potential clinical impact of CA early diagnosis.
文摘Lactate, as a metabolite of easy and quick assessment, has been studied over time in critically ill patients in order to evaluate its prognostic ability. The present review is focused on the prognostic role of lactate levels in acute cardiac patients(that is with acute coronary syndrome, cardiogenic shock, cardiac arrest, non including post cardiac surgery patients). In patients with STelevation myocardial infarction treated with mechanical revascularization, hyperlactatemia identified a subset of patients at higher risk for early death and in-hospital complications, being strictly related mainly to hemodynamic derangement. The prognostic impact of hyperlactatemia on mortality has been documented in patients with cardiogenic shock and in those with cardiac arrest even if there is no cut-off value of lactate to be associated with worse outcome or to guide resuscitation or hemodynamic management. Therapeutic hypothermia seems to affect per se lactate values which have been shown to progressively decrease during hypothermia. The mechanism(s) accounting for lactate levels during hypothemia seem to be multiple ranging from the metabolic effects of reduced temperatures to the hemodynamic effects of hypothermia(i.e., reduced need of vasopressor agents). Serial lactate measurements over time, or lactate clearance, have been reported to be clinically more reliable than lactate absolute value also in acute cardiac patients. Despite differences in study design, timing of lactate measurements and type of acute cardiac conditions(i.e., cardiogenic shock, cardiac arrest, refractory cardiac arrest), available evidence strongly suggests that higher lactate levels can be observed on admission in non-survivors and that higher lactate clearance is associated with better outcome.
文摘AIM: To assess the safety of therapeutic hypothermia(TH) concerning arrhythmias we analyzed serial electrocardiograms(ECG) during TH.METHODS: All patients recovered from a cardiac arrest with Glasgow < 9 at admission were treated with induced mild TH to 32-34℃. TH was obtained with cool fluid infusion or a specific intravascular device. Twelvelead ECG before,during,and after TH,as well as ECG telemetry data was recorded in all patients. From a total of 54 patients admitted with cardiac arrest during the study period,47 patients had the 3 ECG and telemetry data available. ECG analysis was blinded and performed with manual caliper by two independent cardiologists from blinded copies of original ECG,recorded at 25 mm/s and 10 mm/m V. Coronary care unit staff analyzed ECG telemetry for rhythm disturbances. Variables measured in ECG were rhythm,RR,PR,QT and corrected QT(QTc by Bazett formula,measured in lead v2) intervals,QRS duration,presence of Osborn's J wave and U wave,as well as ST segment displacement and T wave amplitude in leads Ⅱ,v2 and v5.RESULTS: Heart rate went down an average of 19 bpm during hypothermia and increased again 16 bpm with rewarming(P < 0.0005,both). There was a nonsignificant prolongation of the PR interval during TH and a significant decrease with rewarming(P = 0.041). QRS duration significantly prolonged(P = 0.041) with TH and shortened back(P < 0.005) with rewarming. QTc interval presented a mean prolongation of 58 ms(P < 0.005) during TH and a significant shortening with rewarming of 22.2 ms(P = 0.017). Osborn or J wave was found in 21.3% of the patients. New arrhythmias occurred in 38.3% of the patients. Most frequent arrhythmia was non-sustained ventricular tachycardia(19.1%),followed by severe bradycardia or paced rhythm(10.6%),accelerated nodal rhythm(8.5%) and atrial fibrillation(6.4%). No life threatening arrhythmias(sustained ventricular tachycardia,polymorphic ventricular tachycardia or ventricular fibrillation) occurred during TH. CONCLUSION: A 38.3% of patients had cardiac arrhythmias during TH but without life-threatening arrhythmias. A concern may rise when inducing TH to patients with long QT syndrome.
文摘BACKGROUND There is a high risk for sudden cardiac death(SCD) in certain patient groups that would not meet criteria for implantable cardioverter defibrillator(ICD) therapy.In conditions such as hypertrophic cardiomyopathy(HCM) there are clear risk scores that help define patients who are high risk for SCD and would benefit from ICD therapy. There are however many areas of uncertainty such as certain patients post myocardial infarction(MI). These patients are high risk for SCD but there is no clear tool for risk stratifying such patients.AIM To assess risk factors for sudden cardiac death in major cardiac disorders and to help select patients who might benefit from Wearable cardiac defibrillators(WCD).METHODS A literature search was performed looking for risk factors for SCD in patients post-MI, patients with left ventricular systolic dysfunction(LVSD), HCM, long QT syndrome(LQTS). There were 41 studies included and risk factors and the relative risks for SCD were compiled in table form.RESULTS We extracted data on relative risk for SCD of specific variables such as age,gender, ejection fraction. The greatest risk factors for SCD in post MI patients was the presence of diabetes [Hazard ratio(HR) 1.90-3.80], in patient with LVSD was ventricular tachycardia(Relative risk 3.50), in LQTS was a prolonged QTc(HR36.53) and in patients with HCM was LVH greater than 20 mm(HR 3.10). A proportion of patients currently not suitable for ICD might benefit from a WCDCONCLUSION There is a very high risk of SCD post MI, in patients with LVSD, HCM and LQTS even in those who do not meet criteria for ICD implantation. These patients may be candidates for a WCD. The development of more sensitive risk calculators to predict SCD is necessary in these patients to help guide treatment.
文摘BACKGROUND Cardiovascular diseases(CVD)have been shown to be the greatest cause of death worldwide and rates continue to increase.It is recommended that CVD patients attend cardiac rehabilitation(CR)following a cardiac event to reduce mortality,improve recovery and positively influence behaviour around CVD risk factors.Despite the recognised benefits and international recommendations for exercisebased CR,uptake and attendance remain suboptimal.A greater understanding of CR barriers and facilitators is required,not least to inform service development.Through understanding current cardiac patients’attitudes and opinions around CR and physical activity(PA)could inform patient-led improvements.Moreover,through understanding aspects of CR and PA that participants like/dislike could provide healthcare providers and policy makers with information around what elements to target in the future.AIM To investigate participants’attitudes and opinions around CR and PA.METHODS This study employed a cross-sectional survey design on 567 cardiac patients.Cardiac patients who were referred for standard CR classes at a hospital in the Scottish Highlands,from May 2016 to May 2017 were sampled.As part of a larger survey,the current study analysed the free-text responses to 5 open-ended questions included within the wider survey.Questions were related to the participants’experience of CR,reasons for non-attendance,ideas to increase attendance and their opinions on PA.Qualitative data were analysed using a 6-step,reflexive thematic analysis.RESULTS Two main topic areas were explored:“Cardiac rehabilitation experience”and“physical activity”.Self-efficacy was increased as a result of attending CR due to exercising with similar individuals and the safe environment offered.Barriers ranged from age and health to distance and starting times of the classes which increased travel time and costs.Moreover,responses demonstrated a lack of information and communication around the classes.Respondents highlighted that the provision of more classes and classes being held out with working hours,in addition to a greater variety would increase attendance.In terms of PA,respondents viewed this as different to the CR experience.Responses demonstrated increased freedom when conducting PA with regards to the location,time and type of exercise conducted.CONCLUSION Changes to the structure of CR may prove important in creating long term behaviour change after completing the rehabilitation programme.
文摘Objective: This study investigated the effects of cardiac rehabilitation exercise protocols on physical function (PF) in patients with chronic heart failure (CHF). Study Design and Setting: This randomized controlled trial recruited 70 patients who are in stage II CHF with ejection fraction (≤40%) from a Nigerian university teaching hospital. They were randomly assigned into Exercise Group (EG: n = 35) or Control Group (CG: n = 35). Physical function, activity of daily living (ADL), distance walked in six minutes and grip strength were assessed using a validated ADL questionnaire, six minute walk test and a hand dynamometer respectively. In addition to medication, EG underwent aerobic and upper extremity resistance exercises thrice weekly for eight weeks while CG used medications only. Data were analyzed using descriptive and inferential statistics. Alpha level was at p p > 0.05). Significant improvements were noticed at fourth week among participants’ ADL (30.0% ± 6.0%), 6MWD (321.7 ± 26.3 m) and VO<sub>2</sub> max (8.9 ± 0.4 mL/kg/min) variables within the exercise EG but no significant changes were observed in the CG (p > 0.05). Participants in EG demonstrated more significant improvements in ADL (15.0% ± 5.0%), 6MWD (406.0 ± 29.7 m) and VO<sub>2</sub> max (10.3 ± 0.5 mL/kg/min) (p p > 0.05). Conclusions: Cardiac rehabilitation exercise protocols involving self-paced walking, sit-to-stand and upper extremity dynamic strength training improved activity of daily living, walking and functional capacity in patients with stable chronic heart failure.
文摘Background: Adrenal and parathyroid insufficiency are uncommon in patients with transfusion dependent Beta Thalassemia (β-TM). Further, myocardial echocardiographic abnormalities are recognized but with a variable outcomes Aim: The aim is to determine the prevalence of adrenal and parathyroid insufficiency in patient with transfusion dependent β-TM. And to assess left ventricle systolic and diastolic function using Pulsed Doppler (PD) and Tissue Doppler (DT) echocardiogram. Methods:The study was conducted on patients with β-TM (n = 99, age 15.92 ± 8.92 years) and compared with an age-matched controls (n = 98 age 15.79 ± 8.94 years). In all participants echocardiographic indices of M mode and PD and TD were performed. Blood samples were withdrawn for measuring the serum cortisol, parathyroid and Ferritin. Correlation between the level of cortisol and ferritin level was evaluated. Results: Patients with β-TM compared with controls, had significantly thicker LV septal wall index of 0.65 ± 0.26 vs 0.44 ± 0.2190, p 0.001 and LV posterior wall of 0.65 ± 0.235 vs 0.43 ± 0.214, p ± 5.5 vs 5.0 ± 5.6, p = 0.23. Furthermore patients with β-TM had higher E/A ratio (1.54 ± 0.18 vs 1.23 ± 0.17, p 0.01) and shorter deceleration time (DT) (170.53 ± 13.3 vs 210.50 ± 19.20 m sec, p 0.01). The ratio of transmitral E wave velocity to the tissue Doppler E wave at the basal septal mitral annulus (E/Em) was significantly higher in β-TM group (19.68 ± 2.81 vs 13.86 ± 1.41, p 0.05). The tissue Doppler systolic wave (Sm) velocity and the early diastolic wave (Em) were significantly lower in β-TM group compared with controls with Sm, of 4.82 ± 1.2 vs 6.22 ± 2.1 cm/sec, p 0.05 and (Em) of 3.51 ± 2.7 vs 4.12 ± 2.5 cm/sec p 0.05, respectively). The tricuspid valve velocity was significantly higher in β-TM patients compared with controls (2.85 ± 0.56 vs 1.743 ± 0.47 m/sec, respectively, p 0.01). The prevalence of adrenal insufficiency in patients with β-TM was 16%, hypoparathyroidism of 4.5% weak negative correlation between serum level of cortisol and the serum Ferritin. Conclusion: Patients with β-thalassemia major had a high prevalence of subclinical adrenal insufficiency of 16%, hypoparathyroidism of 4.5% with weak negative correlation between the low level of cortisol ≤160 nmol/L and high serum ferritin. Echocardiographic Pulsed Doppler showed a restrictive LV diastolic pattern suggestive of advanced diastolic dysfunction but preserved left ventricle systolic function.
文摘Cardiac surgery is one of the youngest surgical disciplines.Only a century ago the heart and great vessels were not surgically approachable,and any pathology affecting these structures that needed surgery inevitably led to a poor prognosis[1].The turning point came with the introduction of modern anesthesia and,above all,with the invention of extracorporeal cardiopulmonary circulation.
文摘BACKGROUND An epidemic of Mycobacterium chimaera (M. chimaera) infections following cardiac surgery is ongoing worldwide. The outbreak was first discovered in 2011, and it has been traced to a point source contamination of the LivaNova 3T heater-cooler unit, which is used also in Italy. International data are advocated to clarify the spectrum of clinical features of the disease as well as treatment options and outcome. We report a series of M. chimaera infections diagnosed in Treviso Hospital, including the first cases notified in Italy in 2016. CASE SUMMARY Since June 2016, we diagnosed a M. chimaera infection in nine patient who had undergone cardiac valve surgery between February 2011 and November 2016. The time between cardiac surgery and developing symptoms ranged from 6 to 97 mo. Unexplained fever, psychophysical decay, weight loss, and neurological symptoms were common complaints. The median duration of symptoms was 32 wk, and the longest was almost two years. A new cardiac murmur, splenomegaly, choroidoretinitis, anaemia or lymphopenia, abnormal liver function tests and hyponatremia were common findings. All the patients presented a prosthetic valve endocarditis, frequently associated to an ascending aortic pseudoneurysm or spondylodiscitis. M. chimaera was cultured from blood, bioprosthetic tissue, pericardial abscess, vertebral tissue, and bone marrow. Mortality is high in our series, reflecting the poor outcome observed in other reports. Three patients have undergone repeat cardiac surgery. Five patients are being treated with a targeted multidrug antimycobacterial regimen. CONCLUSION Patients who have undergone cardiac surgery in Italy and presenting with signs and symptoms of endocarditis must be tested for M. chimaera.
文摘Objective： To explore and identify the concept of adherence in the context of cardiac rehabilitation. This conceptanalysis will provide a framework for clinical decision-making and intervention to improve patients’ adherence tocardiac rehabilitation programme. Method： Walker and Avant’s framework was used to analysis the concept ofadherence. Results： Adherence is defined as patients collaboration with health care provider, active involvement in thetreatment regimen, and persistence in practice characterized by self-efficacy and relapse-prevention. Defining Attributesof adherence include collaboration relationship; self-efficacy promotion and relapse-prevention. Antecedents ofadherence include health care provider’s prescription, illness perceptions, social-economic and environmental factors.Patients adherence to cardiac rehabilitation programme can improve clinical outcomes. However, there is no standardinstrument to measure adherence. Conclusion： Based on the concept analysis, in order to improve patients’ adherence tocardiac rehabilitation, health care provider should invite patients active involvement in making rehabilitation plan andpromote patients’ self-efficacy and prevention relapse.
文摘Background:The European Congenital Heart Surgeons Association(ECHSA)Congenital Heart Surgery Database(CHSD)was founded in 1999 and is open for worldwide participation.The current dataset includes a large amount of surgical data from both Europe and China.The purpose of this analysis is to compare patterns of practice and outcomes among pediatric congenital heart defect surgeries in Europe and China using the ECHSA-CHSD.Methods:We examined all European(125 centers,58,261 operations)and Chinese(13 centers,23,920 operations)data in the ECHSA-CHSD from 2006-2018.Operative mortality,postoperative length of stay,median patient age and weight were calculated for the ten benchmark operations for China and Europe,respectively.Results:Benchmark procedure distribution frequencies differed between Europe and China.In China,ventricular septal defect repair comprised approximately 70%of procedures,while Norwood operations comprised less than one percent of all procedures.Neonatal cardiac procedures were rare in China overall.For procedures in STAT mortality category 1,Chinese centers had lower operative mortality rates,while procedures in categories 3 and 5 mortality is lower in European centers.Operative mortality over the time period decreased from 3.89%to 1.64%for the whole cohort,with a sharper decline in China.This drop coincides with an increase of submitted procedures over this 13-year-period.Conclusion:Chinese centers had higher programmatic volume of congenital heart surgeries,while European centers have a more complex case mix.Palliation for patients with functionally univentricular heart was performed less commonly in China.These comparison of patterns of practice and outcomes demonstrate opportunities for continuing bidirectional transcontinental collaboration and quality improvement.
文摘Background: Acute Kidney Injury (AKI) stands as a prominent postoperative complication in on-pump cardiac surgery, with repercussions on morbidity, mortality, and hospitalization duration. Current diagnostic criteria relying on serum creatinine levels exhibit a delayed identification of AKI, prompting an exploration of alternative biomarkers. Aims and Objectives: This study is designed to overcome diagnostic constraints and explore the viability of serum Cystatin C as an early predictor of Acute Kidney Injury (AKI) in individuals undergoing on-pump cardiac surgery. The investigation aims to establish the relationship between serum Cystatin C levels and the onset of AKI in patients subjected to on-pump cardiac surgery. Primary objectives involve the assessment of the diagnostic effectiveness of serum Cystatin C, its comparison with serum creatinine, and the exploration of its potential for the early identification and treatment of AKI. Methodology: Conducted as a single-center study at the cardiac surgery department of B中央人民政府 in Bangladesh from September 2020 to August 2022, a comparative cross-sectional analysis involved 31 participants categorized into No AKI and AKI groups based on Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Data collection encompassed preoperative, post-CBP (cardiopulmonary bypass) conclusion at 2 hours, postoperative day 1, and postoperative day 2 intervals. Statistical analyses included Chi-squared tests, independent Student’s t-tests, and one-sample t-tests. Significance was set at P Results: The study revealed no significant differences in baseline characteristics between the No AKI and AKI groups, except for CPB time and cross-clamp time. Serum Cystatin C levels in the AKI group exhibited statistical significance at various time points, highlighting its potential as an early detector. Conversely, Serum Creatinine levels in the AKI group showed no statistical significance. The Receiver Operating Characteristic (ROC) curve analysis further supported the efficacy of serum Cystatin C, with an Area under the ROC Curve of 0.864 and a cut-off value of 0.55 (p Conclusion: This study supports the superior utility of serum Cystatin C as an early detector of AKI in on-pump cardiac surgery patients compared to serum creatinine. Its ability to identify AKI several hours earlier may contribute to reduced morbidity, mortality, and healthcare costs. The findings underscore the significance of exploring novel biomarkers for improved post-cardiac surgery renal function assessment.
文摘目的构建慢性肾脏病健康教育效果评价指标体系,为开展健康教育工作提供参考依据。方法计算机检索Cochrane、PubMed、Web of Science、中国知网、万方和维普等数据库中建库至2023年6月慢性肾脏病健康教育效果评价指标体系的相关文献。最终筛选文献80篇,得到一级指标6个(满意度效果、教育效果、管理效果、经济效果、社会效果、可持续发展)。基于文献检索基础,参照《慢性肾脏病健康教育规范》地方标准及“观众-社会-经济-可持续”评估指标体系模型,结合健康教育工作实际,初步拟定慢性肾脏病健康教育效果评价指标体系(一级指标6个,二级指标20个)。制作专家函询问卷,包括卷首语、专家基本信息调查表、专家熟悉程度与判断依据、专家意见表。于2023年8月至9月,采用电子邮件发放专家函询问卷,函询2轮,间隔时间为2周。第1轮专家函询结束后,研究小组根据专家意见和指标筛选原则进行修改,形成第2轮专家函询问卷。采用χ^(2)检验进行统计学分析;积极性采用问卷回收率和意见提出率表示;权威性采用权威系数表示;协调程度及一致性分别采用肯德尔和谐系数、变异系数表示;采用层次分析法确定一、二级指标权重。结果本研究共纳入慢性肾脏病及科普领域专家28名,男8名,女20名;年龄:≥30~<35岁14名,≥35~<40岁5名,≥40岁9名;学历:本科17名,硕士5名,博士6名;工作年限:<10年17名,≥10~<20年5名,≥20年6名;职称:中级9名,副高级15名,正高级4名;健康教育活动频率:每天1~2次8名,每周1~2次6名,每月1~2次8名,每季度1~2次4名,每年1~2次2名。2轮专家函询问卷回收率分别为100.00%(28/28)、92.86%(26/28)。在第1轮专家函询中,有16名专家以文字或口头形式提出意见,占比57.14%。2轮专家权威系数分别为0.804、0.839。第1轮专家函询中的一、二级指标肯德尔和谐系数分别为0.263、0.211,第2轮为0.316、0.272,两轮比较,差异均有统计学意义(均P<0.05)。第1轮专家函询一级指标变异系数为0~0.196,无增删;二级指标变异系数为0~0.286,修改4项。第2轮专家函询一、二级指标均无增删,最终构建包括6个一级指标和27个二级指标的慢性肾脏病患者健康教育效果评价指标体系。满意度及教育效果权重均为0.173,管理效果为0.172,经济效果为0.170,社会效果为0.163,可持续发展效果为0.018。结论慢性肾脏病健康教育效果评价指标体系科学合理,内容全面,针对性强,可用于评价慢性肾脏病患者健康教育活动。
文摘目的探讨组长负责制分层管理在心脏重症监护病房(coronary care unit,CCU)护理管理中的应用价值。方法选取2022年1月—2023年12月在徐州市中心医院心脏监护室工作的26名护理人员作为研究对象,2022年1—12月实施常规管理为对照组,2023年1—12月实施组长负责制分层管理为研究组,比较两组护理人员的护理质量、考核成绩、管理满意度及护理风险事件发生情况。结果研究组护理质量、考核成绩均高于对照组,差异均有统计学意义(P均<0.05)。研究组的管理满意度为96.15%(25/26),高于对照组的69.23%(18/26),差异有统计学意义(χ^(2)=4.837,P<0.05)。研究组未发生护理风险事件,对照组发生3起护理风险事件。结论在CCU护理管理中应用组长负责制分层管理,可提升护理质量,提高管理效果,减少护理风险事件。
