Ischemic mitral regurgitation represents a common complication after myocardial infarction, the severity of the mitral regurgitation increases the risk of mortality. There is continuing debate regarding the management of moderate ischemic mitral regurgitation in patients undergoing surgical management. The debates lie in whether adding mitral valve surgery to coronary artery bypass grafting. So the review is about the analysis of existing evidence and expectation about it.
ObjectiveTo investigate whether metformin has protective effect on myocardial injury in patients with coronavirus disease 2019 (COVID-19) combined with coronary heart diseases and diabetes.MethodsCOVID-19 patients with coronary heart disease and diabetes who were admitted to Tongji Hospital from January 18 to April 25 in 2020 were enrolled. They were divided into a metformin group and a none-metformin group according to whether the metformin was used. The demographic characteristics, clinical symptoms, laboratory parameters, treatment and clinical outcomes of the two groups were analyzed retrospectively.ResultsThere were 29 patients in the metformin group, 3 patients (12.0%, 3/25) suffered myocardial injury and 1 (3.4%) died of acute respiratory failure complicated by septic shock; 67 patients were in the non-metformin group and 24 (37.5%, 24/64) had myocardial injury but 15 died in hospital among whom 1 died of septic shock complicated by disseminated intravascular coagulation, 1 acute respiratory failure complicated by possible cerebral hemorrhage, 2 acute respiratory failure, 1 fulminant myocarditis, 3 acute myocardial infarction and 7 cardiac arrest. The incidence of myocardial injury (12.0% vs. 37.5%, P=0.019), hospital mortality (3.4% vs. 22.4%, P=0.034) and mortality of cardiovascular events (0.0% vs. 16.4%, P=0.049) in the metformin group were significantly lower than those in the non-metformin group. Multivariate analysis showed that the use of insulins (OR=11.235, P=0.003) was an influencing factor for in-hospital mortality of patients. The use of metformin (OR=0.154, P=0.013) was positively correlated with the myocardial injury.ConclusionWhen patients with coronary heart disease and diabetes are infected with COVID-19, metformin can effectively reduce myocardial damage and has a certain effect on reducing hospital mortality. Combined with clinical considerations, it is worthy of popularization.
摘要:目的:比较不同人群踝肱指数（ABI）的测量值,探讨糖尿病大血管病变的多发性及相关性 。方法: 对2007年2月至2009年5月间在本院住院的49名经冠状动脉造影和/或心肌损伤三项及心电图临床证实心肌梗死的糖尿病患者,及50名经冠状动脉造影和/或心肌损伤三项及心电图临床证实无冠脉病变的糖尿病患者,并另选取50名无糖尿病及冠心病的对照50人共149例行下肢检查,分析各组ABI的特点。结果: 三组间ABI比较均有差异,两两比较有统计学差异(Plt;0.05),且糖尿病并冠心病患者的ABI值较对照组明显下降,两组ABI值比较有统计学差异(Plt;0.01)。 结论: 糖尿病合并冠心病与糖尿病足的发病有相关一致性,ABI降低最明显。Abstract: Objective: To explore the multiplicity and correlation of macroangiopathy in type 2 diabetes,we compared the ankle brachial index(ABI) in different populations. Methods: We analyzed the ankle brachial index(ABI) of lower extremity of 149 people in our hospital from February,2007 to May, 2009:A group,49 diabetes with myocardial infarction diagnosed by coronary angiography and / or myocardial damage check and ECG.B group,50 diabetes without myocardial infarction diagnosed by the same methods. Control group, 50 people without diabetes or coronary heart disease. Results: There were significant differences among three groups, respectively (Plt;0.05). And there was decreased ankle brachial index(ABI)in diabetes with coronary heart disease compared with the control group, with significant difference(Plt;0.01). Conclusion: There was a relation between diabetes with coronary heart disease and the incidence of diabetic foot, with obvious reduction of ankle brachial index(ABI)
ObjectiveTo evaluate the efficacy of staged carotid artery stenting and coronary artery bypass grafting in the treatment of coronary heart disease complicated with carotid stenosis. MethodsThe clinical data of patients with coronary heart disease and carotid stenosis treated in Fuwai Hospital from November 2019 to September 2021 were retrospectively analyzed. All patients underwent staged carotid artery stenting and coronary artery bypass grafting. The incidence and risk factors of severe complications such as myocardial infarction, cerebral infarction and death during the perioperative period and follow-up were analyzed. ResultsA total of 58 patients were enrolled, including 47 males and 11 females with an average age of 52-77 (64.2±5.6) years. No complications occurred before coronary artery bypass grafting. There was 1 myocardial infarction, 1 cerebral infarction and 1 death after the coronary artery bypass grafting. The early complication rate was 5.2%. During the follow-up of 18.3 months, 1 cerebral infarction and 2 deaths occurred, and the overall complication rate was 10.3%. According to Kaplan-Meier survival curve analysis, patients with symptomatic carotid stenosis (log-rank, P=0.037) and placement of close-cell (log-rank, P=0.030) had a higher risk of postoperative ischemic cerebrovascular event, and patients with previous cerebral infarction had a higher risk of postoperative severe complications (log-rank, P=0.044). ConclusionStaged carotid artery stenting and coronary artery bypass grafting is safe and feasible for the treatment of coronary heart disease complicated with carotid stenosis.
Objective To explore the factors affecting the operation of coronary artery bypass grafting with heart beating and improve the effect of the operation. MethodsFrom January 2012 to June 2016, 898 patients with coronary heart disease who received cardiovascular surgery in the Second Affiliated Hospital of Jilin University were analyzed retrospectively. All patients only underwent coronary artery bypass grafting with beating heart. Among them, 797 patients underwent the off-pump coronary artery bypass grafting (an OPCABG group, 592 males and 205 females, with an average age of 60.5±8.4 years); another 101 patients received on-pump beating heart coronary artery bypass grafting (an OPBH group, 77 males and 24 females, with an average age of 61.5±8.2 years). ResultsThe average number of grafts in the OPCABG group was 3.36±0.74, and in the OPBH group was 3.71±0.69 (P<0.05). The postoperative ventilation time (10.8±9.5 h vs. 20.6±12.3 h), ICU stay (28.8±15.5 h vs. 37.4±30.8 h), hospital stay (10.9±4.8 d vs. 14.8±8.6 d), mortality (1.1% vs. 3.0%), the utilization rate of intra-aortic balloon pump (2.4% vs. 8.9%) and extracorporeal membrane oxygenation (0.5% vs. 5.0%) were significantly different between the OPCABG group and OPBH group (all P<0.05). Twelve patients died after surgery, and the total bloodless operation ratio was 91.3%. ConclusionThe results show that most patients can achieve good results with the help of apical fixation and myocardial fixator, improved surgical techniques and methods, good anesthesia management as well as flexible and accurate use of vasoactive drugs. But extracorporeal circulation is necessary in the patients with large left ventricle, low ejection fraction and hemodynamic instability after intraoperatively moving the heart.
Objective To make an individualized treatment plan for a premature menopause female who was diagnosed as stable coronary heart disease with the symptom of frequent palpitation after physical activity for over 1 month.. Methods Seven clinical problems were put forward after assessing the patient＇s health state. We searched The Cochrane Library （Issue 2, 2005 ） , evidence-based medicine reviews （EMBtk） （1991 - 2005 ） , and MEDLINE （1991 - 2005 ） databases. Systematic review, meta-analysis and randomized controlled trials about the treatment of coronary heart disease were included. The treatment plan was developed accordingly. Results After evaluating, thirty-four studies were ehglble. The evidence indicated that three kind of drugs （aspirin, h-blockers and statins）, exercise and dietary therapy, and 75mg/d aspirin for secondary prevention, could improve the therapy effect and the prognosis by controlling LDL below 2.6 mmol/L; ACEIs should be used depending on the patient＇s condition; coronary arteriography and interventional strategy helped little for patients without coronary artery events in recent 3 months, and their cost-effectiveness was lower; hormone replacement therapy even increased the risk of thrombosis. The individualized treatment plan was developed based on the available evidence. After 2 months, the patient＇s weight declined, the symptom of angina disappeared and the lipidemia reduced to aimed level. Conclusions The individualized treatment plan based on the high quality evidence and patient＇s condition is optimal for the short-term treatment of stable coronary heart disease. However, the long-term prognostic benefits need to be confirmed by continuing follow-up.
ObjectiveTo investigate the feasibility and effectiveness of using ultrasound to evaluate the internal mammary artery (IMA) and explore the related factors affecting the quality of IMA.MethodsFrom July 2020 to January 2021, for patients who underwent coronary artery bypass grafting at the Department of Cardiovascular Surgery, Fuwai Hospital, ultrasound was applied to measure bilateral IMA at the parasternal second intercostal space. There were 62 males and 18 females with an average age of 59.9±8.3 years. The clinical data of the patients were recorded and analyzed.ResultsA total of 160 IMA were measured. The IMA was detected in 99.4% (159/160), and the one that was not measured was proved to be occluded by enhanced CT. A total of 157 (98.1%) IMA intima were smooth, 2 (1.3%) were found to have uneven intimal thickening and less smooth, and only 1 (0.6%) was occluded. The intravascular diameter, peak systolic flow rate, peak diastolic flow rate, and blood flow rate of the left second intercostal IMA were 1.9±0.3 mm, 66.8±17.7 cm/s, 6.4 (0.0, 9.7) cm/s, 19.7±9.4 mL/min; and those of the right one were 2.1±0.3 mm, 69.7±18.5 cm/s, 6.0 (0.0, 9.2) cm/s and 22.8±11.5 mL/min, respectively. IMA vessel diameter and blood flow were greater on the right than those on the left side in the same individual (P<0.01). In univariate analysis, sex and body surface area were the factors that influenced the size of the IMA vessel among different individuals, and by linear regression analysis, the size of the IMA vessel was only related to body surface area among different individuals. On univariate analysis, diabetes mellitus was the only factor affecting IMA blood flow, with a mean reduction in blood flow of 18.4% (left) and 21.7% (right) in the diabetic group (P<0.05).ConclusionPreoperative evaluation of the IMA using ultrasound over the parasternal second intercostal space is easy, noninvasive, and has a high success rate. The internal diameter of the IMA is positively correlated with body surface area, and blood flow is significantly reduced in patients with diabetes.
Objective To investigate the factors affecting the occurrence of new postoperative cardiac complications in patients undergoing esophageal cancer surgery with concomitant coronary heart disease. Methods Clinical data of patients who underwent esophageal cancer surgery with coronary heart disease at the Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University from December 2019 to June 2023 were collected. Patients were divided into two groups based on whether they experienced postoperative cardiac complications. Using the occurrence of cardiac complications as the dependent variable, a multivariate logistic regression model was established to identify related influencing factors. ResultsA total of 223 patients were included, comprising 148 males and 75 females, with an average age of (71.78±6.31) years (range 53-88 years). Seventy-one (31.84%) patients experienced at least one new cardiac complication postoperatively, including 2 acute coronary syndrome, 13 heart failure, and 59 new-onset postoperative arrhythmias. Univariate analysis showed that age, systemic immune-inflammation index, pulmonary infection, need for invasive mechanical ventilation due to respiratory failure, acute respiratory distress syndrome (ARDS), acute delirium, pleural effusion requiring drainage, and acute renal failure were risk factors for postoperative new-onset cardiac complications (all P<0.05). Multivariate logistic regression analysis identified age, postoperative length of hospital stay, ARDS, and systemic immune-inflammation index as independent risk factors for new cardiac complications in esophageal cancer patients with coronary heart disease. Conclusion Strengthening perioperative management of esophageal cancer patients, ranging from preoperative evaluation to postoperative complication treatment, is crucial. Particular attention should be paid to age, ARDS, and other indicators to improve postoperative prognoses in patients with coronary heart disease complicated by esophageal cancer.
Objective To compare the safety and efficacy of minimally invasive coronary artery bypass grafting (MICS CABG) and traditional CABG in patients with coronary heart disease (CHD) and diabetes mellitus (DM). Methods From 2019 to 2021, the patients who received CABG by the same medical group in the Minimally Invasive Cardiac Surgery Center of Beijing Anzhen Hospital were retrospectively enrolled. According to the surgery methods, the patients were divided into two groups: a MICS CABG group and a conventional group. The perioperative and postoperative follow-up data of patients were collected. The main observation results included all cause death events, myocardial infarction, cerebrovascular, revascularization, and adverse wound healing. Results According to the inclusion and exclusion criteria, 140 patients were enrolled, including 66 patients in the MICS CABG group [56 males and 10 females, aged (61.83±8.94) years], and 74 patients in the conventional group [55 males and 19 females, aged (58.61±8.26) years]. Compared with the conventional group, patients in the MICS CABG group had longer median surgical time (4.50 h vs. 4.00 h, P=0.005), less intraoperative bleeding (600.00 mL vs. 700.00 mL, P=0.020), and a lower rate of secondary debridement and suturing of surgical wounds (4.5% vs. 16.2%, P=0.023). The median follow-up time was 2.54 years. There was no statistically significant difference in the cumulative incidence of major adverse cardiac and cerebrovascular events (7.6% vs. 5.4%), all-cause mortality (0.0% vs. 0.0%), myocardial infarction (3.0% vs. 2.7%), cerebrovascular events (4.5% vs. 2.7%), or revascularization (0.0% vs. 0.0%) between the two groups of patients during the postoperative follow-up (P>0.05). Conclusion MICS CABG can achieve the same revascularization effect as traditional CABG in patients with CHD and DM. MICS CABG can effectively reduce adverse clinical outcomes or complications such as adverse chest wound healing and slow postoperative recovery of body function in patients with DM.
ObjectiveTo explore and discuss the risk factors of early onset coronary heart disease in Tibetan residents. MethodsWe selected Tibetan residents with coronary heart disease who were hospitalized in the Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region between January 2011 and May 2013, and then divided them into two groups by age (early onset and late onset coronary heart disease groups). Univariate analysis was performed between two groups by gender, family history, smoking, drinking, hypertension, diabetes, levels of blood lipid, respectively. The factors with significant differences were extracted for logistic regression. Data analysis was performed using SPSS 16.0 software. ResultsA total of 64 Tibetan residents with coronary heart disease were included, of which, 22 cases were in the early onset groups and 42 cases the late onset group. The results of univariate analysis showed that, significant differences were found in gender, family history, and levels of HDL-C and LDL-C (all P < 0.05). Besides, the results of logistic regression showed that, family history (OR=3.374, P < 0.05), high triglycerides level (OR=2.369, P < 0.05), low HDL-C level (OR=0.014, P < 0.05) and high level of LDL-C (OR=3.008, P < 0.05) were independent risk factors of early onset coronary heart disease in Tibetan residents. ConclusionPositive family history, high triglycerides level, low HDL-C level and high level of LDL-C are independent risk factors of early onset coronary heart disease in Tibetan residents.