The efficacy of intravenous immunoglobulin (IVIG) in the treatment of acute myocarditis remains controversial. The aim of this study was to conduct a meta-analysis to assess the efficacy of IVIG in children and adults with acute myocarditis.We searched PubMed, Scopus, Embase, Medline, the Cochrane Library, Google Scholar, and the Clinical-Trials.gov website. Eligible studies were clinical trials of patients with acute myocarditis who received IVIG therapy. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were used to estimate the outcomes.Thirteen studies with 1534 cases were incorporated into our meta-analysis. Pooled results showed that IVIG therapy significantly reduced in-hospital mortality (OR: 0.44, 95% CI 0.17 to 0.71, P < 0.001) and improved the left ventricular ejection fraction (LVEF) (OR: 1.73, 95% CI 1.34 to 2.13, P < 0.001) in acute myocarditis patients. Furthermore, patients with acute fulminant myocarditis (AFM) exhibited a significantly higher survival rate (OR: 2.80, 95% CI 1.16 to 6.77, P = 0.022) in the IVIG group.IVIG therapy can not only result in lower in-hospital mortality and superior recovery of left ventricular function in patients with acute myocarditis, but also increase the survival rate of AFM patients. The present study provides some supportive evidence for IVIG therapy in acute myocarditis patients. (Int Heart J 2019; 60: 359-365)
AimsThere are no unified criteria for diagnosing heart failure with preserved ejection fraction (HFpEF). The aim of this study was to evaluate the present main diagnostic criteria and to discover which parameters and strategies are more valuable. Methods and resultsEchocardiographic data and plasma N-terminal pro-brain natriuretic peptide levels were assessed in a derivation cohort (n ¼ 236) and a validation cohort (n ¼ 98). Both cohorts included normal controls, patients with hypertensive heart disease without heart failure and patients with HFpEF. In the derivation cohort, the ratio of early mitral inflow velocity to tissue Doppler velocity at lateral mitral annulus (lateral E/e' ≥ 12), left atrial volume index (LAVI ≥ 34 mL/m 2 ), and the difference between duration of reversed pulmonary vein atrial systole flow and duration of mitral A wave flow (Ard -Ad . 30 ms) had the greatest diagnostic value among all the single parameters. A brief strategy that consisted of either: (i) lateral E/e' ≥ 12; or (ii) 12 . lateral E/e' ≥ 8, with either LAVI ≥ 34 mL/m 2 or Ard-Ad . 30 ms, provided good diagnostic accuracy for identifying diastolic dysfunction in HFpEF, with a sensitivity of 77% and specificity of 81%. These observations were confirmed in the validation cohort. ConclusionEchocardiographic parameters including lateral E/e', LAVI, and Ard-Ad have the greatest value in diagnosing HFpEF. A brief strategy that included these three parameters had great diagnostic value and would be simple to use in clinic practice.--
How to identify the early signs of hypertensive heart disease is the key to block or reverse the process of heart failure. The aim of this study was to evaluate the predictive value of left atrial (LA) enlargement in the early stage of hypertensive heart disease and to explore the correlations between LA enlargement and heart failure with normal ejection fraction (HFnEF), as well as the metabolic syndrome (MetS). Baseline clinical characteristics, biochemical indices, electrocardiographic and echocardiographic data were collected from 341 consecutive patients with essential hypertension. Among those patients, LA enlargement was more frequently presented than LV enlargement (57.2% vs 17.9%). Compared with patients without HFnEF, the prevalence of LA enlargement was higher in patients with HFnEF (82.9% vs 49.0%, P<.0001). From grade 2 to grade 3 hypertension, LA size was significantly larger in patients with MetS (P<.01) than those without. Multivariate linear regression analyses showed that age, body mass index, waist circumference, triglyceride level, and left ventricular diameter were independent predictors of LA enlargement. The simple measurement for identification of LA enlargement potentially allows early recognition of those patients at risk for heart failure, particularly among patients with MetS. J Clin Hypertens (Greenwich). 2014;16:192-197. ª2014 Wiley Periodicals, Inc.Recent epidemiological data show that more than 200 million adults present with hypertension in China, which was found as the second leading cause of heart failure. From hypertension to hypertensive heart disease is a slow and progressive process, and persistent high pressure load may lead to compensatory left ventricular (LV) hypertrophy. LV hypertrophy or enlargement confirmed by electrocardiography (ECG) or echocardiography is about 10% to 30% in unselected hypertensive patients. Previous studies 1 have shown that echocardiographic left atrial (LA) enlargement occurring before LV hypertrophy is an early sign of hypertensive heart disease. LA volume provides a sensitive morphophysiologic expression of the severity of LV diastolic dysfunction, and appears to be a useful index of cardiovascular risk and disease burden, and LA volume indexed to body surface is independently associated with outcome of cardiovascular diseases.2 A report by Nicolaou and colleagues 3 has recently revealed that the metabolic syndrome (MetS) increases LA diameter in paroxysmal atrial fibrillation patients and obesity was an important covariate of LA size in hypertensive patients. However, the prevalence of LA enlargement and its correlation to heart failure with normal ejection fraction (HFnEF) and MetS have not been assessed in Chinese hypertensive patients.The aims of the present study were 3-fold: (1) to investigate the prevalence of LA enlargement in patients with essential hypertension; (2) to assess the relationship between LA enlargement and HFnEF, as well as MetS; and (3) to explore independent predictors of LA enlargement.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.