BACKGROUND: The level of the inactive N-terminal fragment of pro-brain(B-type) natriuretic peptide(BNP)-is a strong predictor of mortality among patients with acute coronary syndromes and may be a strong prognostic ma...BACKGROUND: The level of the inactive N-terminal fragment of pro-brain(B-type) natriuretic peptide(BNP)-is a strong predictor of mortality among patients with acute coronary syndromes and may be a strong prognostic marker in patients with chronic coronary heart disease as well. We assessed the relationship between N-terminal pro-BNP(NT-pro-BNP) levels and long-term mortality from all causes in a large cohort of patients with stable coronary heart disease. METHODS: NT-pro-BNP was measured in baseline serum samples from 1034 patients referred for angiography because of symptoms or signs of coronary heart disease. The rate of death from all causes was determined after a median follow-up of nine years. RESULTS: At follow-up, 288 patients had died. The median NT-pro-BNP level was significantly lower among patients who survived than among those who died(120 pg per milliliter[interquartile range, 50 to 318] vs. 386 pg per milliliter[interquartile range, 146 to 897], P< 0.001). Patients with NT-pro-BNP levels in the highest quartile were older, had a lower left ventricular ejection fraction(LVEF) and a lower creatinine clearance rate, and were more likely to have a history of myocardial infarction, clinically significant coronary artery disease, and diabetes than patients with NT-pro-BNP levels in the lowest quartile. In a multivariable Cox regression model, the hazard ratio for death from any cause for the patients with NT-pro-BNP levels in the fourth quartile as compared with those in the first quartile was 2.4(95 percent confidence interval, 1.5 to 4.0; P< 0.001); the NT-pro-BNP level added prognostic information beyond that provided by conventional risk factors, including the patients age; sex; family history with respect to ischemic heart disease; the presence or absence of a history of myocardial infarction, angina, hypertension, diabetes, or chronic heart failure; creatinine clearance rate; body-mass index; smoking status; plasma lipid levels; LVEF; and the presence or absence of clinically significant coronary展开更多
Objective: To test the hypothesis that the power of the received signal of harmonic power Doppler imaging(HPDI) is proportional to the bubble concentration under conditions of constant applied acoustic pressure, and t...Objective: To test the hypothesis that the power of the received signal of harmonic power Doppler imaging(HPDI) is proportional to the bubble concentration under conditions of constant applied acoustic pressure, and to determine whe-ther a new quantitative method can overcome the acoustic field inhomogeneity during myocardial contrast echocardiography(MCE) and identify perfusion abnormalities caused by myocardial infarction. Methods: The relation between Levovist concentration and contrast signal intensity(CI) of HPDI was investigated in vitro under conditions of constant acoustic pressure. MCE was performed during continuous infusion of Levovist with intermittent HPDI every sixth cardiac cycle in 11 healthy subjects and 25 patients with previous myocardial infarction. In the apical views myocardial CI(CImyo) was quantified in five myocardial segments. The CI from the left ventricular blood pool adjacent to the segment was also measured in dB and subtracted from the CImyo(relative CI(RelCI)). Results: CI had a logarithmic correlation and the calculated signal power a strong linear correlation with Levovist concentration in vitro. Thus, a difference in CI of X dB indicates a microbubble concentration ratio of 10x/10. In normal control subjects, CImyo differed between the five segments(p< 0.0001), with a lower CImyo in deeper segments. However, RelCI did not differ significantly between segments(p=0.083). RelCI was lower(p< 0.0001) in the 39 infarct segments(mean(SD)-18.6(2.8) dB) than in the 55 normal segments(mean(SD)-15.1(1.6) dB). RelCI differed more than CImyo between groups. Conclusions: The new quantitative method described can overcome the acoustic field inhomogeneity in evaluation of myocardial perfusion during MCE. RelCI represents the ratio of myocardium to blood microbubble concentrations and may correctly reflect myocardial blood volume fraction.展开更多
Little is known about the effect of revascularization in patients ≥75 years of age with symptomatic coronary artery disease(CAD) and diabetes mellitus(DM) for whom periprocedural risk and overall mortality are increa...Little is known about the effect of revascularization in patients ≥75 years of age with symptomatic coronary artery disease(CAD) and diabetes mellitus(DM) for whom periprocedural risk and overall mortality are increased. Therefore, we examined the 301 patients of the Trial of Invasive versus Medical therapy in the Elderly with symptomatic CAD(TIME) with special regard to diabetic status. Patients were randomized to an invasive versus optimized medical strategy. The median follow-up was 4.1 years(range 0.1 to 6.9). Patients with DM(n=69) had a greater incidence of hypertension(73%vs 58%, p=0.03), ≥2 risk factors(93%vs 46%, p< 0.01), previous heart failure(22%vs 12%, p=0.04), and previous myocardial infarction(59%vs 43%, p=0.02), and a lower left ventricular ejection fraction(48%vs 54%, p=0.02) than did patients without DM.Mortality was greater in patients with DM than in those without DM(41%vs 25%, p=0.01; adjusted hazard ratio 1.86, p=0.01). Revascularization improved the overall survival rate from 61%(no revascularization) to 79%(p< 0.01; adjusted hazard ratio 1.68, p=0.03), an effect similarly observed in patients with and without DM. The event-free survival rate was 11%in nonrevascularized patients with DM compared with 40%in nonrevascularized patients without DM and 41%and 53%in revascularized patients with and without DM, respectively(p< 0.01). Angina severity and antianginal drug use were similar for patients with and without DM, but those with DM performed worse in daily activities and physical functioning. In conclusion, elderly diabetic patients with chronic angina have a worse outcome than those with DM but benefit similarly from revascularization regarding symptom relief and long-term outcome. However, physical functioning related to daily activities is reduced in those with DM and may need special attention.展开更多
文摘BACKGROUND: The level of the inactive N-terminal fragment of pro-brain(B-type) natriuretic peptide(BNP)-is a strong predictor of mortality among patients with acute coronary syndromes and may be a strong prognostic marker in patients with chronic coronary heart disease as well. We assessed the relationship between N-terminal pro-BNP(NT-pro-BNP) levels and long-term mortality from all causes in a large cohort of patients with stable coronary heart disease. METHODS: NT-pro-BNP was measured in baseline serum samples from 1034 patients referred for angiography because of symptoms or signs of coronary heart disease. The rate of death from all causes was determined after a median follow-up of nine years. RESULTS: At follow-up, 288 patients had died. The median NT-pro-BNP level was significantly lower among patients who survived than among those who died(120 pg per milliliter[interquartile range, 50 to 318] vs. 386 pg per milliliter[interquartile range, 146 to 897], P< 0.001). Patients with NT-pro-BNP levels in the highest quartile were older, had a lower left ventricular ejection fraction(LVEF) and a lower creatinine clearance rate, and were more likely to have a history of myocardial infarction, clinically significant coronary artery disease, and diabetes than patients with NT-pro-BNP levels in the lowest quartile. In a multivariable Cox regression model, the hazard ratio for death from any cause for the patients with NT-pro-BNP levels in the fourth quartile as compared with those in the first quartile was 2.4(95 percent confidence interval, 1.5 to 4.0; P< 0.001); the NT-pro-BNP level added prognostic information beyond that provided by conventional risk factors, including the patients age; sex; family history with respect to ischemic heart disease; the presence or absence of a history of myocardial infarction, angina, hypertension, diabetes, or chronic heart failure; creatinine clearance rate; body-mass index; smoking status; plasma lipid levels; LVEF; and the presence or absence of clinically significant coronary
文摘Objective: To test the hypothesis that the power of the received signal of harmonic power Doppler imaging(HPDI) is proportional to the bubble concentration under conditions of constant applied acoustic pressure, and to determine whe-ther a new quantitative method can overcome the acoustic field inhomogeneity during myocardial contrast echocardiography(MCE) and identify perfusion abnormalities caused by myocardial infarction. Methods: The relation between Levovist concentration and contrast signal intensity(CI) of HPDI was investigated in vitro under conditions of constant acoustic pressure. MCE was performed during continuous infusion of Levovist with intermittent HPDI every sixth cardiac cycle in 11 healthy subjects and 25 patients with previous myocardial infarction. In the apical views myocardial CI(CImyo) was quantified in five myocardial segments. The CI from the left ventricular blood pool adjacent to the segment was also measured in dB and subtracted from the CImyo(relative CI(RelCI)). Results: CI had a logarithmic correlation and the calculated signal power a strong linear correlation with Levovist concentration in vitro. Thus, a difference in CI of X dB indicates a microbubble concentration ratio of 10x/10. In normal control subjects, CImyo differed between the five segments(p< 0.0001), with a lower CImyo in deeper segments. However, RelCI did not differ significantly between segments(p=0.083). RelCI was lower(p< 0.0001) in the 39 infarct segments(mean(SD)-18.6(2.8) dB) than in the 55 normal segments(mean(SD)-15.1(1.6) dB). RelCI differed more than CImyo between groups. Conclusions: The new quantitative method described can overcome the acoustic field inhomogeneity in evaluation of myocardial perfusion during MCE. RelCI represents the ratio of myocardium to blood microbubble concentrations and may correctly reflect myocardial blood volume fraction.
文摘Little is known about the effect of revascularization in patients ≥75 years of age with symptomatic coronary artery disease(CAD) and diabetes mellitus(DM) for whom periprocedural risk and overall mortality are increased. Therefore, we examined the 301 patients of the Trial of Invasive versus Medical therapy in the Elderly with symptomatic CAD(TIME) with special regard to diabetic status. Patients were randomized to an invasive versus optimized medical strategy. The median follow-up was 4.1 years(range 0.1 to 6.9). Patients with DM(n=69) had a greater incidence of hypertension(73%vs 58%, p=0.03), ≥2 risk factors(93%vs 46%, p< 0.01), previous heart failure(22%vs 12%, p=0.04), and previous myocardial infarction(59%vs 43%, p=0.02), and a lower left ventricular ejection fraction(48%vs 54%, p=0.02) than did patients without DM.Mortality was greater in patients with DM than in those without DM(41%vs 25%, p=0.01; adjusted hazard ratio 1.86, p=0.01). Revascularization improved the overall survival rate from 61%(no revascularization) to 79%(p< 0.01; adjusted hazard ratio 1.68, p=0.03), an effect similarly observed in patients with and without DM. The event-free survival rate was 11%in nonrevascularized patients with DM compared with 40%in nonrevascularized patients without DM and 41%and 53%in revascularized patients with and without DM, respectively(p< 0.01). Angina severity and antianginal drug use were similar for patients with and without DM, but those with DM performed worse in daily activities and physical functioning. In conclusion, elderly diabetic patients with chronic angina have a worse outcome than those with DM but benefit similarly from revascularization regarding symptom relief and long-term outcome. However, physical functioning related to daily activities is reduced in those with DM and may need special attention.
