Ultrasonic cardiogram and MiRNA-21 analysis of cardiac dysfunction in patients with cardiac arrest following cardiopulmonary resuscitation

The association of left ventricular fraction shortening with cardiovascular events in peritoneal dialysis patients

BACKGROUND

Peritoneal dialysis (PD) patients have a high incidence of cardiovascular events (CVEs). Left ventricular fraction shortening (LVFS), one of the echocardiographic parameters, is an independent risk factor for mortality in previous studies. The aim of this study was to evaluate associations between LVFS and CVEs in PD patients.

METHODS

This was a single-center observational cohort study. Seven hundred and eighty-four PD patients were enrolled from 1 January 2012 to 1 June 2021 and followed until 1 June 2022. The primary outcome was the incidence of CVEs. PD patients were categorized into three groups according to the tertiles of LVFS levels (tertile 1-tertile 3). Kaplan-Meier method, Cox proportional hazard models and competing risk regression models were used for survival analysis. The areas under the curve (AUC) of receiver-operating characteristic analysis was used to determine the predictive values of LVFS for CVEs. A preplanned subgroup analysis was assessed according to age, gender, and the presence of hypertension and dyslipidemia, etc.

RESULTS

During a median follow-up period of 42.3 months (interquartile range 24.0-79.0 months), 259 CVEs occurred. Compared to the other two groups respectively, patients in tertile 3 group had the lowest incidence of CVEs (24.5% vs 31.6% vs 43.0%, respectively, p < 0.05). After multiple adjustments, the tertile 3 group was associated with the 45.1% decrease in the CVEs hazard compared to that of the tertile1 group (SHR = 0.549, 95%CI: 0.395-0.762, p < 0.001). Subgroup analysis demonstrated that tertile 1 group as the reference, the association between LVFS and CVEs in tertile 3 group was robust among female patients (HR = 0.506, 95%CI: 0.309-0.829, p = 0.007), aged < 45 years (HR = 0.496, 95%CI: 0.331-0.744, p = 0.001), history of hypertension (HR = 0.586, 95%CI: 0.349-0.872, p = 0.008) and combined with dyslipidemia (HR = 0.464, 95%CI: 0.269-0.799, p = 0.006).

CONCLUSIONS

This study suggests that LVFS is independently associated with the increased risk of CVEs in PD patients, especially those with aged < 45 years, female, with hypertension and dyslipidemia.

Application Value of Emergency Bedside Echocardiography in Early Warning of Acute and Severe Shock and Clinical Classification

Objective

A case-control study was conducted to explore the application value of emergency bedside echocardiography in early warning of acute and severe shock and clinical classification.

Methods

A total of 135 critically ill patients admitted to ICU from August 2019 to November 2020 were divided into shock group (n = 53) and nonshock group (n = 82) according to the occurrence of shock. The internal diameter index of inferior vena cava was measured and recorded by bedside ultrasound in patients with shock before and after treatment and in patients without shock. Shock index and inferior vena cava diameter deformation index (SCI) were calculated according to the results. The diagnostic time and curative effect of different ultrasonic examination methods for the types of shock were compared and analyzed.

Results

At admission, the maximum and minimum ventilation of inferior vena cava in patients without shock were higher than those in the shock group, and the internal diameter deformation index of inferior vena cava in the shock group was higher than that in the shock group (P < 0.05). In the shock group, IVCmax and IVCmin before and after treatment were higher than those before resuscitation, while SCI was lower than that before resuscitation. The results of ROC curve analysis showed that SCI and IVCmin were significantly better than IVCmax and IVCmin in predicting shock area and slightly better than IVCmin. There was significant difference in diagnosis time between the two groups (P < 0.05). The specificity, positive predictive value, and negative predictive value of emergency ultrasound diagnosis were lower than those of clinical diagnosis (P < 0.05). The sensitivity, specificity, positive predictive value, and negative predictive value of emergency ultrasound diagnosis were lower than those of clinical diagnosis (P < 0.05). The sensitivity and positive predictive value of the emergency ultrasound group were higher than those of the routine ultrasound group (P < 0.05). The diagnosis rate of shock type AUC in the emergency ultrasound group was 0.854, and the diagnostic value was high.

Conclusion

IVCmax, IVCmin, and SCI obtained by bedside ultrasound have certain clinical significance for the diagnosis and treatment of shock. Emergency bedside ultrasound examination and measurement of shock patients are helpful to quickly evaluate and identify the types of early shock.