7 research outputs found
Postprandial Hypotension due to a Lack of Sympathetic Compensation in Patients with Diabetes Mellitus.
Postprandial hypotension is an important hemodynamic abnormality in diabetes mellitus, but few reports are available on the relationship between autonomic dysfunction and postprandial hypotension. Ten diabetic patients and 10 healthy volunteers were recruited for this study. Postural blood pressure and heart rate changes were measured before lunch, and then the hemodynamic responses to a standardized meal were investigated. Holter electrocardiogram (ECG) monitoring was conducted for assessing spectral powers and time-domain parameters of RR variations. Postural changes from the supine to the upright position decreased the systolic blood pressure of the diabetics from 133(+-)16 to 107(+-)20 mmHg (p<0.01), but did not decrease the systolic blood pressure of the controls. The heart rate remained constant in the diabetics but was increased in the controls. Food ingestion decreased systolic blood pressure in the diabetics, with a maximum reduction of 25(+-)5 mmHg. This decrease was not associated with any changes in the ratio of low frequency to high frequency, and yet the heart rate remained almost constant. Indexes involving parasympathetic tone were not affected. Food ingestion did not affect blood pressure in the control group. These findings suggest that lack of compensatory sympathetic activation is a factor contributing to postprandial hypotension in diabetics, and that parasympathetic drive does not make a significant contribution to this condition
Prognostic significance of right bundle branch block in patients with acute inferior myocardial infarction
There is little information available concerning the influence of right bundle branch block (RBBB) on the prognosis of patients with inferior myocardial infarction (MI). In this study we evaluated the influence
of RBBB on the short-term prognosis of patients with inferior MI. Our study subjects were 1,265 hospitalized patients with Q wave MI. Patients were divided into 4 groups based on the presence or absence of RBBB and on the location of the infarction. RBBB was classified into 4 categories according
to the timing of its appearance and its duration as new permanent, transient, old and age indeterminate.
In-hospital death and pulmonary congestion were observed more frequently in patients with RBBB than in those without RBBB. Moreover, in inferior MI as in anterior MI, in-hospital death and pulmonary congestion occurred more frequently in new permanent RBBB patients than in patients with other types of RBBB. Multivariate regression analysis reveals that new permanent RBBB was a strong independent predictor for an adverse short-term prognosis in patients with inferior MI, as well as in patients with anterior MI. New permanent RBBB during inferior MI is a strong independent predictor for increased in-hospital mortality, regardless of the infarction location.</p
Incidence and Outcomes of Out-of-Hospital Cardiac Arrest in the Eastern Part of Yamaguchi Prefecture
Fibrosisâ4 index reflects right ventricular function and prognosis in heart failure with preserved ejection fraction
Abstract Aims Fibrosisâ4 index (FIBâ4 index), calculated by age, aspartate aminotransferase, alanine aminotransferase, and platelet count, is a simple marker to evaluate liver fibrosis and is associated with rightâsided heart failure. However, the clinical relevance of FIBâ4 in patients with heart failure with preserved ejection fraction (HFpEF) remains unclear. We investigated the prognostic implication of the FIBâ4 index regarding right ventricular dysfunction in patients with HFpEF. Methods and results This prospective study included 116 consecutive HFpEF patients (mean age 79 years, 43% male) hospitalized with acute decompensated heart failure. We evaluated the association of the FIBâ4 index with right ventricular function determined by tricuspid annular plane systolic excursion (TAPSE) and tricuspid lateral annular systolic velocity (Sâ˛) before discharge. Cox regression analysis was performed to evaluate the association between the FIBâ4 index and major adverse cardiovascular events (MACE) defined as the composite of cardiovascular death, readmission for heart failure, nonfatal myocardial infarction, and nonfatal stroke. FIBâ4 index before discharge was significantly lower than that at admission (2.62 [1.92â3.46] and 3.03 [2.05â4.67], median [interquartile range], P < 0.001). Left ventricular ejection fraction, TAPSE, and SⲠbefore discharge were 62.7 (55.9â68.6) %, 17.5 ¹ 4.6 mm (mean ¹ standard deviation), and 10.0 (8.0â12.0) cm/s, respectively. In multiple linear regression analysis, the FIBâ4 index before discharge was inversely correlated with TAPSE (β minus;0.244, P = 0.014) and SⲠ(β â0.266, P = 0.009). During a median followâup of 736 days, 37 MACE occurred. Multivariate Cox regression analysis revealed that a high FIBâ4 index before discharge (per 1 point) was a significant predictor of MACE (hazard ratio 1.270, 95% confidence interval 1.052â1.532) after adjustment for male, serum creatinine, and haemoglobin. Receiver operating characteristic analysis indicated that the optimal cutâoff value of FIBâ4 index before discharge to predict MACE was 3.11. KaplanâMeier survival analysis showed that patients with a FIBâ4 index before discharge âĽ3.11 had a significantly poorer prognosis than patients with FIBâ4 index before discharge <3.11 (P = 0.029). Patients with an FIBâ4 index âĽ3.11 had a 2.202âfold (95% confidence interval 1.110â4.368) increased risk of MACE compared with those with an FIBâ4 index <3.11 after adjustment for male, serum creatinine, and haemoglobin. Conclusions An increase in the FIBâ4 index was associated with right ventricular dysfunction and a higher risk of future MACE in patients with HFpEF