OBJECTIVE: To study incident and clinical characteristics of the coronary microcirculation dysfunction (CMD) in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI) by myocardial contrast echocardiography (MCE) and to explore the predictive value of CMD for in-hospital acute heart failure event. METHODS: One hundred and forty five patients with AMI who had received PCI and completed MCE during hospitalization in Peking University People' s Hospital from November 2015 to July 2021 were enrolled in our study. The patients were divided into CMD group and normal group according to the coronary microcirculation status detected by MCE. Clinical data and MCE data of the two groups were collected and analyzed. The acute heart failure event during hospitalization was described. A multivariate Logistic regression model was built to analyze the risk of acute heart failure in patients with CMD. A receiver operating characteristic (ROC) curve was drawn to evaluate the value of CMD in predicting acute heart failure event. RESULTS: CMD detected by MCE occurred in 87 patients (60%). Compared with normal group, patients with CMD had higher troponin I (TnI) peak level [52.8 (8.1, 84.0) μg/L vs. 18.9 (5.7, 56.1) μg/L, P=0.005], poorer Killip grade on admission (P=0.030), different culprit vessel (P < 0.001) and more patients had thrombolysis in myocardial infarction (TIMI) flow pre-PCI less than grade 3 in culprit vessel (65.1% vs. 43.1%, P=0.025). Meanwhile, patients with CMD had poorer left ventricular ejection fraction (LVEF) [52% (43%, 58%) vs. 61% (54%, 66%)], poorer global longitudinal strain (GLS) [-11.2% (-8.7%, -14.0%) vs.-13.9% (-10.8%, -17.0%)] and worse wall motion score index (WMSI) (1.58±0.36 vs. 1.25± 0.24) (P all < 0.001). Acute left heart failure happened in 13.8% of the CMD patients, which were significant higher than that in the patients with normal coronary microcirculation perfusion (1.7%, P=0.013). After correcting for the culprit vessel, the TIMI flow pre-PCI in the culprit vessel and the peak TnI value, the risk of acute left heart failure in the patients with CMD was still high (OR=9.120, 95%CI: 1.152-72.192, P=0.036). The area under ROC curve (AUC) was 0.677 (95%CI: 0.551-0.804, P=0.035). CONCLUSION The incidence of CMD detected by MCE in patients with AMI post-PCI was 60%. Patients with CMD have a higher risk of acute left heart failure during hospitalization.
Humans ; Heart Failure/physiopathology* ; Microcirculation ; Percutaneous Coronary Intervention/adverse effects* ; Myocardial Infarction/complications* ; Male ; Female ; Hospitalization ; Middle Aged ; Aged ; Echocardiography ; Coronary Circulation ; Predictive Value of Tests ; Troponin I/blood*

Objectives:To evaluate the impact of global longitudinal strain(GLS)for prognosis in ST-segment elevation myocardial infarction(STEMI)patients after percutaneous coronary intervention(PCI). Methods:We enrolled 156 STEMI patients who underwent PCI and spackle tracking imaging(STI)during hospitalization from September 2020 to August 2023.Patients with Killip Ⅱ-Ⅳ at baseline were excluded,138 patients were finally included.GLS was detected by STI.Patients were divided into more impaired group(GLS>-11.7%,n=57)and less impaired group(GLS≤-11.7%,n=81)according to Youden index.Clinical characteristics and echocardiography data were analyzed.Patients were followed up for a median of 21(13,28)months.Heart failure events were compared between the two groups. Results:The peak troponin I(TnI)was significantly higher in patients with GLS>-11.7%than those with GLS≤-11.7%at admission(85 160[31 297,214 226]pg/ml vs.34 942[13 571,92 713]pg/ml,P<0.001).Culprit vessel was different between the 2 groups(P<0.001).Compared with patients with GLS≤-11.7%,patients with GLS>-11.7%had lower left ventricular ejection fraction(LVEF)([60.1±8.7]%vs.[49.2±8.3]%,P<0.001),higher proportion of regional wall motion abnormality(90.1%vs.100%,P=0.015).Both LVEF and GLS recovered in patients with GLS>-11.7%during follow-up,but remained lower as compared to patients with GLS≤-11.7%(both P<0.001).The median follow-up time was 21(13,28)months.After adjusting age,sex,culprit vessel and peak TnI,the risk of heart failure of patients with GLS>-11.7%was significant higher(HR=9.123,95%CI:1.720-43.394,P=0.009). Conclusions:STEMI patients with more impaired GLS have a higher risk of heart failure post PCI.

Objective To explore the risk factors for perioperative myocardial infarction(PMI) in aged patients undergoing nonneurologic and noncardiac surgery.Methods A total of 9285 inpatients aged 65 or above receiving nonneurologic and noncardiac surgery at Peking University People's Hospital from November 2012 to May 2016 were retrospectively recruited to our study.Patients who had suffered PMI were assigned to a myocardial infarction group(MI group)and others were allocated to a nonmyocardial infarction group(non-MI group).Clinical manifestations,comorbidities,preoperative laboratory test results,polypharmacy,characteristics of operation and anesthesia,and prognosis were analyzed and compared between the two groups.A multivariate logistic regression model was built to evaluate risk factors for PMI in aged patients undergoing nonneurologic and noncardiac surgery.Results PMI occurred in 12 patients(0.13％).Previous stroke or transient ischemic attack(TIA) history (OR =159.254,P ＜ 0.001),cardiovascular heart disease (CHD) history (OR=33.645,P ＜0.001),and chronic kidney disease(CKD) (OR =19.393,P =0.003) were independent risk factors for PMI in aged patients undergoing nonneurologic and noncardiac surgery.PMI was associated with longer hospitalization[29 (15 59) days vs.9 (6-15) days,P ＜ 0.001] and higher mortality(58.3 ％).Conclusions Previous stroke or TIA history,CHD history,and CKD are independent risk factors for PMI in aged patients undergoing nonneurologic and noncardiac surgery.The incidence of PMI in patients with these risk factors is not high,but the mortality will be high and hospitalization will be prolonged once PMI occurs.Patients with these characteristics need more careful perioperative care.

Objective To explore effects of monitored anesthesia care (MAC) on gastrointestinal endoscopy.Methods All patients who underwent gastrointestinal endoscopy in Peking University People's Hospital from September 2010 to September 2015 were analyzed retrospectively and divided into two groups:the MAC group and control group by usage of MAC.Success rates of removal of foreign bodies by upper gastrointestinal endoscopy were compared between two groups during this period.Detection rates of ectopia of gastric mucosa in upper esophagus were compared between two groups from September 2014 to September 2015 when esophagogastroduodenoscopy was performed.The monthly cases of gastrointestinal endoscopies were compared between the two groups,which were separately collected from one MAC operating table and one routine operating table from September 2014 to September 2015.Results The success rate of removal of foreign bodies in the MAC group was higher than that in the control group (100.0％ VS 89.7％,x2 =11.737,P=0.001).The detection rate of ectopia of gastric mucosa in upper esophagus in the MAC group was higher than that in the control group(4.3％ VS 1.7％,x2 =58.751,P＜0.001).The monthly cases of gastrointestinal endoscopies in the MAC group was higher than that in the control group(350.2±36.2 cases VS 213.2±27.9 cases,t =17.591,P＜0.001).Conclusion The use of MAC for gastrointestinal endoscopy improves operating success rate,accuracy and operating time.MAC in gastrointestinal endoscopy can be recommended.

Objective To develop a risk index scoring for predicting perioperative mortality risk in aged patients undergoing non-neurologic and non-cardiovascular surgery.Methods A total of 11 144 inpatients aged ＞65 years old undergoing non-neurologic and non-cardiovascular surgery in the People's Hospital of Peking University from December 2012 to March 2016 were selected and divided into the death group and survival group.The following variables were compared between the 2 groups:general data,comorbidities,preoperative laboratory tests and operation anesthesia.A multivariate Logistic regression analysis was performed on the risk factors for perioperative death in this group.The Bootstrapping method was performed for conducting internal validation.The parameters weighing of risk index scoring was established by correcting the partial regression coefficient of equation.Results The perioperative mortality was 1.0％ (111 cases).Eight independent predicting factors were obtained by the regression analysis.Then the risk index scoring was defined:classification of the Association of American Physicians (grade Ⅰ:0 point;grade 1:3 points;grade Ⅲ or 1:4 points),BMI(＜24 kg/m2:0 point;＞24 kg/m2:-1 point),renal insufficiency(1 point),chronic obstructive pulmonary disease(3 points),diabetes needing insulin treatment(2 points),preoperative hypoalbuminemia (1 point),preoperative hyponatremia (1 point) and general anesthesia (1 point).The patients with risk scores＜6 points were classified as low risk,patients with risk score 6-7 points were classified as intermediate risk and those with risk score＞ 7 were classified as high risk.The actual predicting risk of perioperative death in high risk patients ＞10％.The perioperative mortality risk index exhibited better diagnostic recognition ability (c-statistic=0.878).Conclusion The perioperative mortality risk of aged patients undergoing non-neurologic and non-cardiovascular surgery can be predicted by the risk index scoring,which can help to screen the high-risk individuals of perioperative death in order to give more carefully perioperative management.

Objective To compare the efficacy and efficiency of simulation-based training of flexible fibreoptic intubation in novices with virtual reality simulator.Methods A total of 46 anaesthesia residents in their first stage of training in anaesthesiology with no experience in flexible fibreoptic intubation at Peking University People's Hospital were enrolled in the study,and were divided into 2 groups randomly,which were virtual reality simulator group (group S,n=23) and manikin group (group M,n=23).The group S was then trained for 25 times on simulator,while the group M did the same processes on manikin.After training,participants in both groups had their performance assessed with the fibrescope evaluated through the oral route using a simulation manikin,who were instructed to attempt to advance the fibrescope 5 consecutive times to view the carina in the shortest amount of time.The time required to view the carina of each practice during training in both groups were recorded as pooled data to construct group learning curves with the application of SPSS 20.0.By using repeated measures analysis of variance and Ttest,the procedure time and global rating scale (GRS) of fibreoptic bronchoscope manipulation ability were compared between groups,so did the participant's confidence between before and after the training both within-subjects and between-subjects.Results The plateaus in the learning curves were achieved after 19 (15,26) practice sessions in group S and 24 (19,31) in group M,respectively.There was no significant difference in the procedure time [(13.7 ± 6.6) s and (11.9 ±4.1) s] and GRS [(3.9 ±0.4) vs.(3.7 ±0.3)]between groups.There were significant increases in participant's confidences in both groups after training [group S:(1.8 ± 0.5) vs.(3.9 ± 0.6),t=10.928,P=0.000;group M:(2.0 ± 0.7) vs.(3.9 ± 0.5),t=15.306,P=0.000],but there was no significant difference between groups.Conclusion The simulation-based training of flexible fibreoptic intubation in novices with virtual reality simulator is more efficient than the one with manikin,but the similar effects can be achieved in both modalities,after adequate trainings.In the related training a balance between time cost and economic cost should be considered and the appropriate teaching methods and forms should be taken.