黄智伟
中国医学科学院阜外医院 心内科19病区201室
OBJECTIVES:There is currently no unanimous consensus on the treatment of Takayasu's arteritis (TAK) involving the pulmonary artery, and there are very few related studies that compare the efficacies of drug-based therapy and revascularization. This study aimed to compare the long-term survival outcomes after endovascular treatment and medical therapy in TAK patients with pulmonary artery stenosis (PAS) and pulmonary hypertension (PH).METHODS:A total of 129 TAK patients with PAS and PH (women, 101; men, 28; mean age, 40.5 years) were retrospectively enrolled in this study. Data on clinical features, treatment regimens, and mortality, were collected. Patients were categorised into medical treatment (n=75) and percutaneous transluminal pulmonary angioplasty (PTPA; n=54: 52 with PTPA and 2 with stent implantation) groups. The primary endpoint was cardiac mortality. The median follow-up time was 54 (40.5, 58.5) months.RESULTS:There were no significant differences in sex, age, comorbidities, disease activity, World Health Organization (WHO) function classification, and 6-min walk distance (6MWD) between the two groups at baseline. Compared with the conservative treatment group, cardiac mortality, WHO functional class, and 6MWD were significantly improved in the PTPA group (p=0.031, p<0.001, and p=0.004, respectively).CONCLUSIONS:Under basic medicine, PTPA therapy improves the long-term survival of TAK patients with PAS and PH compared to medical treatment alone. PTPA may be a promising modality for the TAK patients with PAS and PH.
Clinical and experimental rheumatology 2023
We report a case that presented as acute myocardial infarction (AMI) caused by lymphocytic myocarditis (LM), and explore the relationship between AMI and LM. We also performed a literature search to identify publications that previously reported LM-associated myocardial infarction. Coronary angiography of our patient revealed normal coronary arteries. However, a perfusion-metabolism mismatch in the apex and mid-inferior walls supported the diagnosis of AMI, and right ventricular septal endomyocardial biopsy showed LM. Extensive viral serological tests were negative for an infectious etiology. Immunosuppressive therapy may be beneficial in patients with high-risk myocarditis who are pathologically confirmed to be virus-negative.
The Journal of international medical research 2022
The prognostic significance of d-dimer level in patients with coronary artery disease (CAD) is not fully established. This meta-analysis aimed to examine the association between elevated d-dimer level at baseline and adverse outcomes in patients with CAD. Two independent authors comprehensively searched PubMed and Embase databases from their inception to December 31, 2020. All observational studies reporting the values of baseline d-dimer level in predicting the major adverse cardiovascular events (MACEs) or survival outcomes in patients with CAD were included. The prognostic values were calculated by pooling adjusted RR with 95% CI for the highest versus the lowest d-dimer level. Thirteen studies consisting of 25 600 patients with CAD were identified. Comparison between the highest and lowest d-dimer level showed that the pooled multivariable adjusted RR was 1.69 (95% CI, 1.53-1.86) for all-cause mortality, 2.37 (95% CI, 1.52-3.69) for cardiovascular mortality, and 1.44 (95% CI, 1.19-1.74) for MACEs, respectively. Elevated blood level of d-dimer at baseline was independently associated with higher risk of MACEs, cardiovascular death, and all-cause mortality in patients with CAD. The baseline d-dimer level may have important prognostic value in patients with CAD.
Angiology 2022
BACKGROUND This retrospective study aimed to compare the effects of methylprednisolone and dexamethasone in 35 patients with anaphylactic shock due to iodinated contrast media (ICM) during cardiac catheterization. MATERIAL AND METHODS Thirty-five patients diagnosed with ICM-related anaphylactic shock were enrolled. Nineteen patients received methylprednisolone, while 16 patients received dexamethasone. RESULTS The mean age of patients was 59.8 years in the methylprednisolone group and 57.2 years in the dexamethasone group (P=0.502). Most patients were male (82.9% [26/35]). The groups were matched for cardiac function, kidney function, comorbidities, prior contrast, previous radiocontrast media reactions, and allergic tendencies (all P>0.05). The severity of coronary artery disease, assessed using the SYNTAX II score, was similar between groups (P=0.620). Six patients died from ICM-induced anaphylactic shock. There was no significant difference in mortality between the 2 groups (P=1.000). CONCLUSIONS There was no significant difference in patient mortality from anaphylactic shock associated with ICM during cardiac catheterization between the methylprednisolone and dexamethasone groups.
Medical science monitor : international medical journal of experimental and clinical research 2022
Objective:To investigate the long-term efficacy of percutaneous transluminal pulmonary angioplasty (PTPA) in patients with Takayasu arteritis (TA) and pulmonary artery stenosis and pulmonary hypertension (PH).Methods:Data from 183 lesions from 79 surgeries performed on 32 patients with TA and PH were analyzed. Symptoms, laboratory investigation results, World Health Organization (WHO) functional class, 6-min walk distance (6 MWD), hemodynamic parameters, and prognosis were analyzed at baseline and follow-up.Results:The mean (± SD) age of the 32 patients (28 female, 4 male) was 42.8 ± 11.9 years, and the median follow-up was 49.5 months (interquartile range, 26-71 months). Compared with baseline, changes in total bilirubin, N-terminal pro-brain natriuretic peptide (NT-proBNP) level, 6 MWD, and WHO score functional class demonstrated significant differences (P<0.001). Echocardiography findings, right and left ventricular diameter, tricuspid annular plane systolic excursion, and estimated pulmonary artery systolic pressure were all improved (P=0.016, P<0.001, P<0.001, and P=0.005, respectively). Importantly, repeat right heart catheterization revealed that mean pulmonary artery pressure, pulmonary vascular resistance, and cardiac index also improved significantly at follow-up (P<0.001, P<0.001, and P=0.011, respectively). Pulmonary angiography revealed post-procedure restenosis in 64 (35.0%) lesions underwent PTPA within three to six months. Among three patients who underwent stent implantation, one experienced restenosis. Two patients died during the follow-up period, one from aggravation of right heart failure after lung infection, and the other in a traffic accident.Conclusions:Results of this study indicated that PTPA significantly improved clinical symptoms, exercise tolerance, and hemodynamic parameters in patients with TA pulmonary artery stenosis and PH. More importantly, reperfusion pulmonary edema significantly decreased, and no patient died of PTPA-related complications with guidance from the pressure wire.
Frontiers in immunology 2022
OBJECTIVES:This study aimed to investigate the clinical characteristics, results, and prognostic predictors of patients with Takayasu's arteritis (TAK) along with pulmonary artery involvement (PAI).METHODS:A total of 806 patients with TAK admitted to the Fuwai Hospital were screened. Clinical symptoms, imaging features, and prognosis were analysed, and patients were categorised into those with and those without pulmonary hypertension (PH). Additionally, risk factors associated with cardiac death and repeated hospitalisation were explored.RESULTS:Among 806 patients with TAK, 142 patients with PAI were included, 90.8% (n=129) of whom had PH diagnosed by right heart catheterisation and 9.2% (n=13) of whom did not. The median follow-up time was 54 (range, 29-83) months. Sixteen patients died from right heart failure caused by PH. Patients with PH were significantly more likely to have worse outcomes than patients without PH (p=0.027). The multivariate Cox proportional regression hazard model showed that the 6-min walk distance (6MWD) and PH-targeted therapy were independent prognostic predictors of cardiac death and hospital readmissions.CONCLUSIONS:This study found that that a significant proportion of patients with TAK along with PAI had PH. Patients with PH had worse prognosis than those without. Further 6MWD and PH-targeted therapy were independent prognostic predictors of cardiac death or repeated hospitalization. In the future, multi-centre clinical studies are needed to further prospectively clarify this issue.
Clinical and experimental rheumatology 2022
INTRODUCTION:Treatment strategies to improve clinical outcomes in Takayasu's arteritis (TA) with coronary lesions have ranged from pharmacological therapy to invasive procedures, such as coronary angioplasty, stenting, and surgery. However, the therapeutic strategy for this kind of patient is still unclear. This study aimed to investigate the clinical characteristics and influence of revascularization versus medical therapy in TA patients with coronary artery involvement.METHODS:We analyzed the medical records of 806 TA patients between January 2008 and December 2019. Clinical features and treatment were analyzed, and patients were categorized into medical treatment and revascularization. Additionally, patients were sorted as percutaneous coronary intervention (PCI) and coronary artery bypass surgery (CABG) based on the strategy of revascularization.RESULTS:Ninety cases with coronary lesions induced by TA were enrolled. Among 90 cases, 39 patients adopted conservative treatment, and 51 patients received revascularization (28 subjects with PCI, 23 participants with CABG). The median follow-up time was 63 (45-91) months. There is no significant difference in cardiovascular death between medical treatment and revascularization (2/39, 5.1% vs. 5/51, 9.8%, P = 0.971). The analysis of subgroup indicated that the mortality caused by cardiovascular disease was also similar in the CABG and PCI (2/28, 7.1% vs. 3/23, 13.0%, P = 0.772). However, the proportion of restenosis is much higher in the PCI compared with that of CABG (39.3%, 8.7%, P = 0.022, respectively). Heart failure is an independent predictor of death in these patients.CONCLUSIONS:There is no significant difference in cardiovascular death between medical treatment and revascularization. The analysis of the subgroup indicated that the mortality caused by cardiovascular disease was also similar in the CABG and PCI, but the restenosis is much higher in the PCI compared with that of CABG. Heart failure is an independent predictor of death in these patients.
Rheumatology and therapy 2021
Whether the anemia increases the risk of mortality in patients with acute heart failure (AHF) remains unclear. This study aims to explore the relationship between anemia and outcomes in patients with AHF including subgroup analysis. This study included 3279 patients with hemoglobin available from the Beijing Acute Heart Failure Registry (Beijing AHF Registry) study. The primary endpoint was all-cause mortality in 1 year, and the secondary endpoint was 1-year all-cause events including all-cause death and readmission. Logistic regression models were applied to describe related variables of anemia in patients with AHF. Multivariate Cox proportional hazards models described associations of anemia with clinical outcomes in the overall cohort and subgroups. 45.4% of the patients were found anemic. They were older and had more comorbidities than non-anemic patients. Variables including older age, female, chronic kidney dysfunction (CKD), lower hematocrit, lower albumin, with loop diuretics applied, without beta-blockers, angiotensin-converting enzyme inhibitors /angiotensin receptor blockers (ACEIs/ARBs) and spironolactone applied in the emergency department (ED) were associated with anemia in AHF patients. Anemic patients had higher 1-year mortality (38.4% vs. 27.2%, p < 0.0001) and 1-year events rates (63.2% vs. 56.7%, p < 0.0001). After adjusted for covariates, anemia was associated with the increase of 1-year mortality (hazard ratio [HR] 1.278; 95% confidence interval [CI] 1.114-1.465; p = 0.0005) and 1-year events (HR 1.136; 95% CI 1.025-1.259; p = 0.0154). The severer anemia patients had higher risks both of 1-year mortality and events. In the subgroup analysis, the independent associations of anemia with 1-year mortality were shown in the subgroups including age < 75 years, male, body mass index < 25 kg/m2 and BMI ≥ 25 kg/m2, New York Heart Association (NYHA) functional class I-II and NYHA functional class III-IV, with and without cardiovascular ischemia, heart rate (HR) < 100 bpm and HR ≥ 100 bpm, systolic blood pressure (SBP) < 120 mmHg and SBP ≥ 120 mmHg, left ventricular ejection fraction (LVEF) < 40% and LVEF ≥ 40%, serum creatinine (Scr) < 133 umol/l, and with diuretics use, with and without beta-blockers use, without ACEIs/ARBs use in the ED. Anemia is associated with older age, female, CKD, volume overload, malnutrition, with loop diuretics, without beta-blockers, ACEIs/ARBs and spironolactone administration, and higher mortality and readmission in AHF. The risk associations are particular significantly obvious in younger, male, overweight, preserved LVEF, lower Scr, with diuretics and beta-blockers, without ACEIs/ARBs administration subgroups.Clinical trial No. ChiCTR-RIC-17014222.
Internal and emergency medicine 2021
BACKGROUND:The pathogenesis of chronic thromboembolic pulmonary hypertension (CTEPH) is largely unknown. Proteomics offers an approach to overview the molecular activities and signal transduction pathways involved in specific disease processes.OBJECTIVES:In this study, the expression of proteins in endarterectomized tissues from patients with CTEPH was investigated in a novel strategy to explore the pathophysiology of this disease.METHODS:We used the iTRAQ (isobaric tag for relative and absolute quantitation) approach combined with a Thermo Scientific Q Exactive MS analysis to compare the protein profiles in endarterectomized tissues from CTEPH patients and that of the control samples (mixture of cultured human pulmonary artery endothelial cells, human pulmonary artery smooth muscle cells, and human pulmonary fibroblasts). GO and KEGG analyses were performed to understand the functional classification and molecular activities of all the tissue-specific proteins, and the involved signal transduction pathways.RESULTS:Six hundred and seventy-nine tissue-specific proteins were detected. Bioinformatic analysis showed that the major biological processes involving these proteins were: response to wounding, defense response, acute inflammatory response, immune response, complement activation, and blood coagulation. The main pathways involved were: complement and coagulation cascade, systemic lupus erythematosus, extracellular matrix-receptor interaction, cell adhesion molecules, FcεRI signaling, and leukocyte transendothelial migration.CONCLUSIONS:The present study revealed that immune and defense response might play an important role in CTEPH.
Cardiology 2020
BACKGROUND:Congenital coronary-pulmonary fistulas (CPFs) are commonly unilateral; however, bilateral and multilateral fistulas are relatively rare. The steal phenomenon aroused from bilateral or multilateral CPFs, and was uncertain and seldom reported. We possess a new tool to assess the hemodynamic significance of coronary artery fistulas. This study aimed to describe the clinical presentation, diagnostic modalities, and management of the coincidentally detected congenital bilateral CPFs.CASE PRESENTATION:A case of a 52 year-old female with 10 years history of typical palpitations and chest tightness was presented. The selective coronary arteriography showed a right dominant coronary circulation without significant stenosis; however, with anomalous vessels originating from the proximal right and left anterior descending coronary arteries, draining into the pulmonary artery through a plexus of small vessels. We introduced the fractional flow reserve (FFR) to evaluate the hemodynamic significance of CPFs. The patient was successfully treated with coil embolization.CONCLUSIONS:We presented the case of a female with typical palpitations and chest tightness due to the steal phenomenon that aroused from bilateral CPFs. The fistulas were safely and successfully closed by coil embolization. We showed a new tool for the sophisticated evaluation of the hemodynamic significance of CPFs using FFR measurement and temporary occlusion of the fistula with a standard balloon. FFR could be a promising means for the treatment of decision making of the CPFs.
Journal of cardiothoracic surgery 2020
