Elderly Coronary Heart Disease Patients Research Articles

Study on correlation between property of coronary artery lesion and degree of coronary artery stenosis of elderly patients with coronary heart disease.

Objective:To discuss the influence of coronary artery lesion of elderly patients with coronary heart disease (CHD) on left ventricular remodeling.Methods:Retrospective selection method was used to choose 80 elderly CHD patients who received coronary angiogram examination in Baoding First Central Hospital from January 2014 to February 2018 as the objects of study. According to coronary artery lesion, the patients were classified into single vessel lesion group (single vessel group) and multi-vessel lesion group (multi-vessel group, the number of lesion vessels≧2). Single vessel group included 60 patients, and multi-vessel group includes 20 patients. Intravascular unltrasound was applied to record coronary plaque property of all patients and transthoracic echocardiography was used to record left ventricular remodeling. Later correlation analysis was carried out.Results:The proportion of calcified plaque and mixed plaque was higher than that of single vessel group, and the differences had statistical significance (P<0.05). Left ventricular end diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV) of multi-vessel group were higher than that of single vessel group, while left ventricular ejection fraction (LVEF) was lower than that of single vessel group. The differences had statistical significance (P<0.05). Linear correlation analysis showed coronary artery lesion was positively correlated with LVEF and calcified plaque (r=0.287, 0.371, P<0.05). Multiple linear regression analysis showed LVEF, calcified plaque and LDL-C were independent risk factors of multi-vessel coronary artery lesion of old CHD patients (P<0.05).Conclusion:The number of coronary artery lesions is significantly correlated with left ventricular remodeling, and can increase the proportion of calcified plaque and mixed plaque, thus leading to left ventricular remodeling abnormity.

Inflammation markers are associated with frailty in elderly patients with coronary heart disease.

The neutrophil-to-lymphocyte ratio (NLR) and red blood cell distribution width (RDW) are important indicators of adverse outcomes and have predictive value for many diseases; however, the relationships between frailty, and the NLR and RDW in patients with coronary heart disease (CHD) have not been determined. In this cross-sectional study, we investigated the association between frailty, and the NLR and RDW in elderly CHD patients ≥ 60 years of age. Frailty was defined according to frailty phenotype. Of 345 patients enrolled in the study, 22.6%, 58.3%, and 19.1% were characterized as robust, pre-frail, and frail, respectively. A significant positive correlation was observed between frailty and the NLR (r = 0.169) and RDW (r = 0.196). After adjusting for confounders, linear regression analyses showed that participants in the 4th quartile of the NLR or RDW were more likely to have a higher frailty phenotype score. Based on multivariable logistic regression, patients in the 4th quartile of the NLR and RDW, the fully-adjusted odds ratios for incident frailty were 2.894 (p = 0.011) and 2.494 (p = 0.040), respectively. Our findings indicate that frailty is associated with the NLR and RDW in elderly patients with CHD.

Application of nursing outcomes classification in self-control of risk factors in elderly coronary heart disease patients

Objective To evaluate the ability of controlling risk factors in elderly patients with coronary heart disease (CHD) with nursing outcomes classification (NOC) . Methods A total of 146 elderly CHD patients treated in Daqing Longnan Hospital, the Fifth Affiliated Hospital of Qiqihar Medical School between January and June 2016 were enrolled in the study. All the study subjects were divided into control group (n=70) and experimental group (n=76) by random number table method. The control group was given routine nursing, while the experimental group was analyzed by the Risk Control: Cardiovascular Health and Cardiac Pumping Effect scales in NOC system 1 month after discharge and given interventions. The indicators of NOC of the patients and assessment of nursing staff were compared between the two groups. Results The differences in the scores of NOC indicators between control group and experimental group were statistically significant (P<0.05) . The indicators were angina pectoris, medication compliance, cognitive status, peripheral pulse, systolic blood pressure, diastolic blood pressure, recognition of cardiovascular risk, and monitoring of blood pressure, applying stress management techniques, participating in cholesterol screening, following recommendations for preventive measures related to over-the-counter drugs, participating in aerobic exercise, recognizing the ability to change behavior, and avoiding smoking. The relevant knowledge level and skill assessment of the responsible nurses in the experimental group were better than those in the control group (P<0.05) . Conclusions The ability to control risk factors in elderly patients with CHD needs to be strengthened from the perspective of patients. Individualized programs should be implemented according to patients' specific conditions. Key words: Aged; Coronary heart disease; Nursing outcomes classification

HUBUNGAN ASUPAN ZAT GIZI MAKRO DAN PROFIL LIPID DENGAN KEJADIAN PENYAKIT JANTUNG KORONER PADA PASIEN LANSIA DI RUMAH SAKIT ISLAM JEMURSARI SURABAYA

Coronary Heart Disease (CHD) is a condition where plaque build up inside the coronary artery which could lead to heart attack. One of the factors that affects CHD is food consumption pattern that can increase lipid level so the heart could not get any nutrition optimally. The research was aimed to analyze the relationship between food consumption pattern, and lipid profi le with CHD in elderly patients of Jemursari Islamic General Hospital, Surabaya. The study was a case control design with 20 of case patients who had CHD history and 20 of control patients with dyslipidemia. The analysis used chi-square test for the variables such as carbohydrates and fat intake, meal frequency, total cholesterol level, Low Density Lipoprotein (LDL), and triglycerides level. The result showed that there is relationship between fat intake and CHD (p=0.002; OR=13.500; 95%CI), but there were no relationship between carbohydrates intake (p= 0.105), meal frequency (p=0.451), total cholesterol level (p = 0.237), Low-Density Lipoprotein (LDL) (p = 0.054), and triglycerides level (p=0.341), with CHD in dyslipidemia elderly patient. Elderly patients is expected to maintain their nutrient intake, especially fat intake in order to reduce the chance of CHD.

Features and clinical significance of cardiopulmonary exercise testing in elderly patients with coronary heart disease

Objective To examine the features and clinical significance of cardiopulmonary exercise testing(CPET)in elderly patients with coronary heart disease. Methods A retrospective study was conducted at the Fifth Affiliated Hospital of Zhengzhou University from September 2015 to August 2017.Fifty-nine elderly inpatients who had undergone coronary angiography and CPET were enrolled.The mean age was 61.5 years, and there were 48 males and 11 females.Based on the results of coronary angiography, patients were divided into a coronary heart disease(CAD)group(n=40)and a non-CAD group(n=19). Meanwhile, according to the degree of coronary stenosis assessed by angiography, the CAD group was further divided into two subgroups(Group A: coronary stenosis, 50%-70%, n=25; Group B: coronary stenosis, >70%, n=15). All results of CPET were compared between the groups. Results Patients in the CAD group were significantly associated with a lower anaerobic threshold(855.8±207.0)ml/min vs.(976.5±231.8)ml/min, a lower peak VO2(1 371.5±388.8)ml/min vs.(1652.8±435.5)ml/min, a lower percentage of peak VO2(18.3±4.7)ml·min-1·kg-1vs.(22.0±4.4)ml·min-1·kg-1, a lower peak O2-pulse(65.6±14.8)% vs.(85.5±14.9)% and a lower ΔVO2/ΔWR slope to expected value(8.0±1.1)ml·min-1·W-1vs.(9.1±1.5)ml·min-1·W-1, compared with those in the non-CAD group(all P ATand ΔVO2/ΔWRRatio to expected value were lower in Group B(7.5±1.3 vs.8.3±1.0, t=2.317, P=0.026), (6.2±1.9 vs.7.6±1.2, t=2.815, P=0.008)and(0.7±0.2vs.0.9±0.1, t=2.957, P=0.005). There was no difference in ΔVO2/ΔWR 0.05). Conclusions Exercise tolerance is lower in elderly CAD patients than those without CAD, and ΔVO2/ΔWR is decreased during the process of exercise, especially after the AT, which may be associated with low cardiac output due to left ventricular myocardial ischemia.This finding suggests that CPET can provide evidence of ischemia in patients with coronary heart disease and is valuable for the development of diagnostic and therapeutic strategies. Key words: Exercise test; Coronary disease; Myocardial ischemia

Metabolic profiles of adipose-derived and bone marrow-derived stromal cells from elderly coronary heart disease patients by capillary liquid chromatography quadrupole time-of-flight mass spectrometry.

Adipose-tissue derived mesenchymal stem cell (ADSC)-based therapy is a promising option for patients with atherosclerotic conditions, including coronary artery disease. However, the potential differences in the metabolic characteristics between bone marrow-derived mesenchymal stem cells (BMSCs) and ADSCs have remained to be fully elucidated. The present study aimed to compare the metabolic profiles of BMSCs and ADSCs via liquid chromatography quadrupole time-of-flight mass spectrometry. BMSCs and ADSCs obtained from elderly coronary heart disease patients were cultured, and after three passages, supernatants of each cell type were collected and systematically analysed. Substantial differences were detected between the metabolite signatures of ADSCs and BMSCs. In addition, further analysis using partial least-squares discriminant analysis score plots indicated significant differences between the supernatants of the two cell types. The following metabolites were deemed to be responsible for the potential differences in the metabolic characteristics of BMSCs and ADSCs: D-lactic acid, hydroxyindoleacetaldehyde, α-D-glucose, bovinic acid, 9,10-epoxyoctadecenoic acid, glyceraldehyde, phenylpyruvic acid, L-octanoylcarnitine, retinyl ester, α-ketoisovaleric acid, guanidoacetic acid, N-acetylneuraminic acid, imidazoleacetic acid riboside, sphingosine and pseudouridine 5′-phosphate. Based on these findings, there may be significant differences in the following metabolic pathways: The linoleic acid metabolic pathway, galactose metabolism, argentines and proline metabolism, retinol metabolism, glycine and serine metabolism, galactose metabolism, and amino sugar and nucleotide sugar metabolism. In conclusion, substantial differences in metabolic characteristics were detected between BMSCs and ADSCs, which may be associated with the different efficacies of atherosclerosis therapies employing these cell types.

Effect of solution-focused approach on self perceived burden and negative emotion in elderly patients with coronary heart disease complicated with type 2 diabetes

Objective To explore the effect of solution-focused approach on self perceived burden, anxiety and depression in elderly patients with coronary heart disease complicated with type 2 diabetes. Methods From January to June 2016, 76 elderly patients with coronary heart disease complicated with type 2 diabetes from inpatients department of Wuxi Second People's Hospital were selected as the research objects by convenience sampling method. The patients were divided into control group and observation group by random number table, each with 38 cases. Patients in the control group were given routine nursing and patients of the observation group were given solution-focused approach intervention on the basis of routine nursing. Self-perceived burden scale, self-rating anxiety scale and self-rating depression scale were used to evaluate the effect of intervention. Results Compared with the score before intervention, there was statistical difference in the self-perceived burden score after intervention in two groups (P 0.05) . After 3-month intervention, the self perceived burden score of the observation group was lower than that of the control group (P 0.05) . After 3-month intervention, the score of anxiety and depression in the intervention group was significantly lower than that in the control group (P<0.05) . Conclusions Solution focused approach can reduce the self-perceived burden of the elderly coronary heart disease patients with type 2 diabetes and alleviate the patients' negative emotions effectively. Key words: Anxiety; Depression; Aged; Coronary heart disease; Diabetes mellitus, type 2; Solution focused approach; Self-perceived burden

Confrontation as a Mediator between Sense of Coherence and Self-management Behaviors among Elderly Patients with Coronary Heart Disease in North China

Self-management is critical to improve health outcomes of elderly patients with coronary heart disease (CHD). Sense of coherence (SOC) is found to be linked with self-management behaviors. However, their deeper relationship is not clear. The purposes of this study were to investigate the association between SOC and self-management behaviors among elderly CHD patients in China, and whether confrontation mediates this association. A cross-sectional design was used. A total of 275 elderly patients with CHD recruited from the cardiology department in a general hospital in North China were surveyed from October 2015 to April 2016. SOC, confrontation, and self-management behaviors were measured using the Chinese version of the SOC scale, subscale of Medical Coping Modes Questionnaire-Confrontation, and the CHD self-management scale, respectively. Correlation analysis and path analysis were conducted to analyze the data. The mean (±standard deviation) scores of SOC, confrontation, and self-management behaviors were 62.20 (±9.61), 19.55 (±3.15), and 76.17 (±10.63), respectively. Correlation analysis showed that SOC, confrontation, and self-management behaviors were significantly correlated with each other. Path analysis indicated that SOC exerted a direct effect on self-management behaviors, whereas could affect self-management indirectly via confrontation. Bootstrap test result showed that confrontation played a mediating role (β=.20, p<.001) in the relationship between SOC and self-management behaviors. SOC was related to self-management behaviors, whereas confrontation mediated the effect of SOC on self-management behaviors. In practice, the role of confrontation coping should be valued when developing strategies to strengthen SOC and to improve self-management practice among elderly CHD patients.

Factors associated with upper gastrointestinal bleeding in elderly coronary heart disease patients treated with aspirin

Factors associated with upper gastrointestinal bleeding in elderly coronary heart disease patients treated with aspirin

Current status and influence factors of ACEI/ARB application in elderly coronary heart disease outpatients complicated with diabetes mellitus in China

Objective: To investigate the current status and influence factors of ACEI/ARB application in elderly coronary heart disease outpatients complicated with diabetes mellitus in 21 provinces of China. Methods: In this multicenter, non-intervention and cross-sectional survey, the elderly coronary heart disease patients aged 60 years or over were recruited from 165 hospitals in 21 provinces across China from April to July 2011. Current status and influence factors of ACEI/ARB application among 1 789 cases with diabetes mellitus were investigated in the survey. Results: Totally, 1 069 patients used ACEI/ARB drugs (59.8%); proportion of ACEI (544 cases, 30.4%) drugs were the same as ARB drugs (533 cases, 29.8%) in terms of usage of drug types, and combination of the two drugs were taken by 28 cases (1.6%) at the same time. ACEI/ARB usage decreased with the increasing of age, and the rate of drug usage in male patients was slightly higher than that in female, however there was no statistical difference (both P>0.05); the rate of usage of ACEI/ARB drugs gradually decreased with increasing of coronary heart disease or diabetes duration (P<0.05); the rates of usage of ACEI/ARB drugs in hypertension, dyslipidemia, myocardial infarction, renal insufficiency patients and patients received revascularization therapy were significantly higher (all P<0.05). Multivariable logistic regression analysis showed that hypertension (OR=3.016, 95%CI: 1.376-4.887), dyslipidemia (OR=1.489, 95%CI: 1.114-2.031), revascularization (OR=2.291, 95%CI: 1.276-3.277), myocardial infarction (OR=2.561, 95%CI: 1.571-4.545), renal insufficiency (OR=1.337, 95%CI: 1.145-2.013), and insulin treatment (OR=1.584, 95%CI: 1.084-2.511) were positively correlated with ACEI/ARB usage (P<0.05); and coronary heart disease duration was negatively correlated with ACEI/ARB drugs usage (duration 5-10 years: OR=0.621, 95%CI: 0.416-0.823; duration >10 years, OR=0.664, 95%CI: 0.471-0.840). Conclusions: The rate of usage of ACEI/ARB drugs in elderly coronary heart disease outpatients complicated with diabetes mellitus is still low, however, patients with hypertension, dyslipidemia, myocardial infarction, renal insufficiency and patients received revascularization therapy and insulin treatment are more likely to use ACEI/ARB drugs.

Effects of body mass index on blood pressure control rate in elderly coronary heart disease outpatients with hypertension

Objective: To explore the influences of body mass index (BMI) on blood pressure control rate in elderly coronary heart disease (CHD) outpatients with hypertension. Methods: In this multicenter, non-intervention and cross-sectional survey, the elderly coronary heart disease patients with hypertension aged 60 years or over were recruited from 165 hospitals in 21 provinces or cities across China from April to July 2011, and 5 140 cases of elderly CHD patients with hypertension were finally included into the study. The cases were divided into low BMI group (n=130 cases), normal body mass index (BMI) group (n=1 390 cases), overweight (n=2 418 cases), obesity group (n=662 cases) according to the different levels of BMI. Clinical data and blood pressure control rate were compared among the groups, and relationships of different BMI levels with blood pressure control rate were analyzed by the binary classification unconditioned Logistic regression equation. Results: There was a statistically significant difference in blood pressure control rate of general population, men and women patients among low BMI group, normal BMI group, overweight and obesity group (χ2=66.346, 58.995, 26.044, respectively, P<0.001), blood pressure failure rate in obesity group (73.7%) was higher than that in overweight group (65.8%) and normal BMI group (57.5%) (P<0.05), and overweight group was also higher than normal BMI group (P<0.05); blood pressure failure rate in obesity men was higher than that in normal BMI and low BMI group (P<0.05), overweight group was higher than normal BMI group (P<0.05); blood pressure failure rate in obesity women was higher than that in normal BMI and low BMI group (P<0.05). There was a statistically significant difference in blood pressure control rate of different age groups (60-70, 71-80, >80 years old) among low BMI group, normal BMI group, overweight and obesity group (χ2=37.729, 20.007, 15.538, respectively, P<0.001). Blood pressure failure rate in obesity patients with 60-70 years old was higher than that in overweight and normal BMI group (P<0.05), blood pressure failure rates in obesity and overweight patients with 71-80 and > 80 years old were also higher than those in normal BMI group (P<0.05). Multivariable Logistic regression equation showed that overweight in overall population (OR=1.313, 95%CI 1.170-1.731, P<0.05), obesity (OR=2.295, 95%CI 2.295-1.496, P<0.05) were independent risk factors for blood pressure failure rate, in addition, obesity was also risk factor for blood pressure failure rate in men and women patients. Conclusions: Increased BMI has an adverse effect on blood pressure control rate in elderly CHD outpatients with hypertension, and may be the independent risk for blood pressure failure rate in those patients. Much more attention should be given to control BMI level so as to increase the blood pressure success rate and improve the patients' prognosis.

Risk Factors of Perioperative Cardiac Events in Elderly Patients with Coronary Heart Disease Undergoing Non-cardiac Surgery

To identify the incidence and risk factors of perioperative major adverse cardiac events (MACE) in elderly patients with coronary heart disease (CHD) undergoing non-cardiac surgery. We prospectively analyzed the clinical data of 360 CHD patients who aged 75 years or older undergoing elective intermediate-to high-risk surgery in five medical centers across China from January 2008 to January 2010. The clinical variables included the 12-lead ECG and Troponin I levels after surgery. The combined outcome was defined as all the perioperative MACE in hospital. The risk factors of MACE and their indexes were analyzed with univariate analysis and multivariable logistic regression in SPSS software,together with a risk scoring and stratification system established. Perioperative MACE occurred in 11.94% of elderly CHD patients undergoing non-cardiac surgery. Seven independent risk factors of perioperative MACE for this population were identified,which included angina within 6 months (P=0.001), hypertension(P=0.014), preoperative haematocrit (HCT) <40% (P=0.050), serum creatinine (Scr)>150 mmol/L (P=0.014), ejection fraction(EF) <50% (P=0.019), intraoperative hyoxemia (P=0.019), and operative time>150 min (P=0.001). The risk indexes of these factors were 4,3,3,6,4,5, and 4, respectively. The rate of perioperative MACE increased significantly as the level of risk stratification elevated. Elderly CHD patients undergoing non-cardiac surgery are at high risk of perioperative MACE. Angina within 6 months,hypertension, preoperative HCT<40%, Scr>150 mmol/L, EF<50%, intraoperative hyoxemia, and operative time>150 min can increase the risk of MACE. The risk scoring and stratification system based on the risk factor index can be a valuable parameter for assessing the perioperative cardiac risk of noncardiac surgery for elderly CHD patients.

Correlation between frailty and coronary heart disease in the elderly

Objective To prospectively analyze the impact of frailty on the short-term outcomes of coronary heart disease (CHD) and its related factors. Methods A total of 505 patients aged ≥65 years, with diagnosis of CHD in Cardiology Department and Geriatrics Department in our hospital were selected. Clinical data including geriatrics syndromes were collected by using Comprehensive Geriatrics Assessment (CGA). Frailty was defined according to the Clinical Frailty Scale (CFS). The impact of the comorbid conditions on the risk was quantified by the coronary artery disease-specific index. Patients were followed up by clinic visit or telephone consultation. Following-up items included recurrence of all-cause mortality, recurrence of cardiovascular events, and unscheduled returned visit. The impact of frailty on the prognosis of coronary heart disease was analyzed by Cox regression. Results Of the 505 patients, 221 patients (43.76%) were considered to be frail elderly, in whom 126 patients (24.95%) were assessed as moderately to severely frail elderly. The incidences of comorbidities and geriatrics syndrome including incontinence, fall history, visual impairment, hearing impairment, constipation, chronic pain, sleeping disorder, dental problems, anxiety or depression, and delirium were higher in frail patients than in non-frail patients〔51.1% (113/221)vs. 30.6% (87/284), 31.2% (69/221) vs. 19.0% (54/284), 43.9% (97/221) vs. 29.9% (85/284), 49.3% (109/221) vs. 29.6% (84/284), 60.2% (133/221) vs. 33.8% (96/284), 62.0% (137/221) vs. 46.8% (133/284), 49.3% (109/221) vs. 37.7% (107/284), 79.2% (175/221) vs. 55.6% (158/284), 11.3% (25/221) vs. 6.0% (17/284), 2.7% (6/221) vs. 0 (0/284), χ2=21.831, 10.053, 10.510, 20.519, 34.894, 11.481, 6.886, 30.695, 4.624, 7.803, respectively, all P<0.05〕. After adjusting for sex, age, severity of illness and other coexist factors, the Cox survival analysis showed that frailty was the independent risk predictor for the all-cause mortality and unscheduled return visit in CHD patients (HR=2.881 and 1.835, 95%CI: 1.591-5.215 and 1.458-2.311, both P<0.001). Conclusions Comprehensive Geriatrics Assessment and Clinical Frail Scale are useful to evaluate the clinical features in elderly CHD patients. Frailty is the independent risk predictor for the short-term prognosis including all-cause mortality and unscheduled return visit in elderly CHD patients. Key words: Coronary disease; Frail elderly; Risk assessment

Current status of blood pressure control rate and antihypertensive drug use in the elderly coronary heart disease patients with diabetes mellitus and hypertension

To investigate the current status of blood pressure control rate and the use of antihypertensive drugs in elderly patients with coronary heart disease, diabetes mellitus and hypertension. The elderly coronary heart disease patients with diabetes mellitus and hypertension (≥ 60 years old) were recruited from 165 hospitals in 21 provinces or cities across China from April to July 2011 in this multicenter, non-intervention and cross-sectional survey. The current status of blood pressure control rate in different antihypertensive target value, methods for application in antihypertensive drugs and standardized treatment recommended by guideline were investigated in the survey. 1 379 cases were eventually selected from the total 7 962 elderly patients (accounted for 17.3%). (1) The blood pressure control rate was 17.1% for antihypertensive target value (<130/80 mmHg); the control rate for 140/80 mmHg was 27.5%; the control rate for 140/90 mmHg was 39.6%; the success rate for 150/90 mmHg were 51.7%; control rate of elderly patient (≥ 70 years old) gradually increased with increasing of age; success rate of elderly patient (≥ 85 years old) was the highest, whereas control rate of elderly patient aged 71-71 years old was lowest; success rate for male patients was close to female patients, and success rate for men were slightly higher than those in women; (2) 1 347 cases had clear medication history (32 cases were missed) in the survey, 1 317 effective cases received antihypertensive therapy (effective rate was 97.8%, 1 317/1 347); the more commonly used drugs were angiotensin receptor blockers (ARB) /angiotensin converting enzyme inhibitors (ACEI) (usage rate was 76.8%), followed by dihydropyridine calcium channel blockers (CCB) (65.5%), β-blockers (usage rate was 44.6%), thiazide diuretics (26.3%) respectively; (3) combinations of two drugs was the most common way in antihypertensive medication (accounted for 41.2%), three drugs or more was 28.9%, and single drug was 23.9%; CCB was the commonly used single drug (accounted for 8.8%); combinations of CCB and ARB were the most common way in combination of two drugs(11.7%), CCB combined with ARB and β-blockers was frequently used in combination of three drugs or more (9.2%); (4) 987 cases received standardized treatment recommended by guideline (accounted for 76.6%); the percentage of standardized usage in combinations of two drugs was 71.9%, the percentage of standard usage in combinations of three drugs or more was 66.1%. The percentage of antihypertensive therapy is high, however, the overall blood pressure control rate is low. ACEI /ARB are the major drugs in antihypertensive medication, diuretic drugs are now rarely used; combined medication is the common method of antihypertensive therapy; the consciousness following the guidelines has improved, but still need to be strengthened.

Application of comprehensive geriatric assessment nursing model on the quality of life in elderly patients with coronary heart disease

Objective To explore the effects of the comprehensive geriatric assessment （ CGA） nursing model on the quality of life in elderly patients with coronary heart disease （ CHD ） .Methods A total of 143 cases of hospitalized elderly patients with CHD were randomly divided into two groups , from January 2012 to June 2013 .The control group （ 69 cases ） was given the cardiovascular specialty nursing and the CGA group （74 cases） was given the cardiovascular nursing based on the CGA nursing model .The scores of patients ’ physical strength, illness, medical condition, general life, social psychology, working and interpersonal relationship were surveyed using the questionnaire of quality of life in patients with cardiovascular diseases （ CQQC） when patients first admitted to the hospital and 6 months after discharge .Results In the CGA group , 75.7%patients had two or more kinds of elder problems , within which 67.6% was depression, 66.2% was sleep disorder, 62.2% were hearing disability and 60.8% was visual disability.Before the intervention, the scores of quality of life between groups had no significant differences （P 〉0.05）.After the nursing intervention, the scores of physical strength , illness, medical condition, general life, social psychology, working and interpersonal condition in the CGA group were （10.86 ±5.06）, （8.75 ±4.54）, （5.90 ±0.40）, （5.22 ±1.95）, （8.41 ±3.22）, （0.97 ±0.66） and （40.11 ±9.05）.Those scores in the control group were （7.35 ±4.12）, （4.57 ±0.85）, （4.72 ±0.82）, （3.85 ±1.45）, （3.67 ±1.52）, （0.70 ±0.64） and （24.86 ±4.43）.The differences of scores between groups were significant （ t =4.541, 7.545, 11.137, 4.720, 11.095, 2.470, 12.653, respectively;P 〈0.05 ）.Conclusions Based on the comprehensive evaluation, the CGA nursing model can play a positive role in clinical nursing of elderly CHD patients , and it also can improve the quality of life in elderly patients with CHD . Key words: Coronary heart disease; Quality of life; Comprehensive geriatric assessment

Effect of Trimetazidine on Recurrent Angina Pectoris and Left Ventricular Structure in Elderly Multivessel Coronary Heart Disease Patients with Diabetes Mellitus After Drug-Eluting Stent Implantation: A Single-Centre, Prospective, Randomized, Double-Blind Study at 2-Year Follow-Up

Trimetazidine has been shown to improve angina pectoris and left ventricular (LV) function in diabetic patients with ischaemic cardiomyopathy. The objective of this study was to evaluate the effects of trimetazidine on recurrent angina pectoris and LV structure after drug-eluting stent (DES) implantation in elderly multivessel coronary heart disease (CHD) patients with diabetes mellitus (DM) and a left ventricular ejection fraction (LVEF) of ≥ 50 %. This was a single-centre, prospective, randomized, double-blind evaluation study. Between January 2010 and September 2010, 700 CHD patients with DM who were aged ≥ 65 years and undergoing coronary angiography at An Zhen Hospital (Beijing, China) were recruited and prospectively randomized to receive trimetazidine (20 mg three times daily) or placebo after DES implantation as an addition to conventional CHD treatment. The primary end points were the incidence of recurrent angina pectoris and measures of various echocardiographic parameters, which included LVEF. At 2-year follow-up, patients in the trimetazidine group (n = 255) showed significant improvements in the incidence (P = 0.024) and severity of angina pectoris, compared with the control group, as well as silent myocardial ischaemia (P = 0.009) and angina pectoris-free survival (P = 0.011). LV function and structure in trimetazidine-treated patients were relatively stable at 2-year follow-up, while they deteriorated in the control group (n = 255) with a significant difference between groups (all P < 0.01). The E peak to A peak (E/A) ratio in trimetazidine-treated patients and in the control group decreased after 2 years; the E/A ratio in trimetazidine-treated patients was slightly better than that in the control group, without a significant difference (P = 0.170). There was no significant difference in event-free survival for the composite end point including death, myocardial infarction, cerebrovascular accident (P = 0.422) and subsequent revascularization (P = 0.073). Adjunctive therapy with trimetazidine after DES implantation can have a beneficial effect on recurrent angina pectoris as well as LV function and structure in elderly multivessel CHD patients with DM.

Effect of trimetazidine on recurrent angina and left ventricular function in elderly multivessel coronary heart disease patients with diabetes mellitus after elective percutaneous coronary interventio

Objective: To evaluate the effect of trimetazidine (TMZ) on recurrent angina and left ventricular function in elderly multivessel coronary heart disease (CHD) patients with diabetes mellitus (DM) after elective percutaneous coronary intervention (PCI). Methods: In this single-center, prospective, randomized evaluation study, 400 patients with DM aged 65 and over undergoing coronary angiography were recruited to randomly receive or not TMZ (20 mg three times daily orally) as an addition to the conventional treatment of CHD at admission before angiography. Recurrent angina and echocardiogram were followed at 2 years after PCI. Results: Two hundred and fifty-one patients who successfully underwent elective PCI were finally enrolled, 125 in the TMZ group and 126 in the control group. At 2-year follow up, patients in the TMZ group showed a significant improvement in the proportion of angina patients (40 (31.2%) vs 58 (46.0%), P=0.023) and angina-free survival (P=0.003). The independent predictors of 2-year recurrent angina included no TMZ treatment, current smoking, hypercholesterolemia and BMI. TMZ-treated patients showed a significant greater left ventricular function and smaller left ventricular diastolic and systolic diameters compared with patients in the control group (LVEF: 65.65±3.870% vs 62.34±3.008%; LVEDD: 47.6±4.637 mm vs 50.86±3.597 mm; LVESD: 31.00±4.255 vs 33.06±3.371 mm, all P<0.01). E:A ratio in TMZ-treated patients was better than that in the control group without significant difference (0.849±0.256 vs 0.808±0.313, P=0.464). Although there was a trend towards a decrease in cumulative cardiovascular events in TMZ-treated patients, there was no significant difference in event–free survival for composite major adverse cardiac events including death, MI, TVR and hospitalization for cardiac causes (P=0.163). Conclusion: Adjunctive therapy of TMZ (20 mg tid) after PCI reduces the occurrence of recurrent angina, improve left ventricular function and inhibit left ventricular remodeling in elderly multivessel CHD patients with DM.

Professor ya-ling han.

Professor Ya-Ling Han (Figure 1), a famous cardiologist in China, was born in Wuhan, Hubei province, in 1953. She graduated from Harbin Medical University in 1978. After getting her doctorate in 1994 from Shanghai Second Military Medical University, professor Han worked as the director and professor of the Department of Cardiology. She then worked as the vice president at Shenyang Northern Hospital since 1997. For the past two decades, she has been persistently leading the development of percutaneous coronary intervention (PCI) technique for complex coronary lesions and high risk patients. From 1998 to 1999 she received PCI Fellow training in Singapore National Heart Center for professional enhancement. Figure 1. Professor Ya-Ling Han Professor Han is a leading expert in the field of interventional therapy of coronary heart disease in China, especially in critical acute myocardial infarction, elderly coronary heart disease patients concomitant with multiple organ dysfunction, left main, chronic total occlusive and multi-vessel coronary diseases. In the past 20 years, professor Han and her colleagues have performed more than 30,000 cardiovascular interventional procedures with a successful rate over 99%. During the same period, many new techniques in coronary intervention have been established, including ‘improved tiny crush stent technology’ and ‘multi-wire plaque crushing technology’, etc. In addition, Professor Han has made contributions in improving PCI adjunctive pharmacology. She is the first to propose high dose clopidogrel, triple antiplatelet therapy and individualized antiplatelet strategy, which had been referenced and recommended by foreign expert and international conferences. Professor Han was in charge of many clinical studies such as the CREATE study, a 5-year large scale multicenter “real world” clinical study on efficacy and safety of domestic biodegradable DES in China, through which she found that 12-month dual antiplatelet was not inferior to 6-month treatment. The findings of the many clinical studies led by Professor Han have been published in leading international cardiology journals and contribute to the current management of coronary heart disease. Although an accomplished cardiovascular clinician who dedicated most of her energy and time on the diagnosis and treatment of her patients, Professor Han also committed to basic research of cardiology. She and her colleagues have investigated the biological role of CREG against vascular restenosis and atherosclerotic inflammation after PCI, which provide innovative insights into the early prevention of these diseases, the role and molecular mechanisms of CREG during embryonic blood vessel formation, and the regulation of CREG gene on iPS cell-based cardiogenesis. Professor Han, together with her colleagues, has obtained funding from Natural Science Foundation of China for 8 times, and one of which was the key project of national natural science funding. Professor Han have published over 400 research papers both in national and international journals. Professor Han now is the adjunct professors and doctoral supervisor for the Third Military Medical University, the Fourth Military Medical University and the Medical University of Dalian. She has been supervised research work for more than 120 post graduates. Professor Han has been awarded with numerous awards for her outstanding clinical, academic and social service work, such as National ‘Young Star in Medical Sciences’ award in 1996, ‘National Distinguished Woman’ and ‘Outstanding Award of Chinese Interventional Cardiology’ in 2005, ‘Second Prize of National Scientific and Technological Progress’ in 2008, ‘The 11th Five-Year Military Medical Major Science and Technology Achievement Award’ in 2010. Professor Han's achievements are recognized by medical community. She was elected to be the Vice President of Chinese Cardiovascular Society of Chinese Medical Association, the Vice President of Cardiovascular Branch in Chinese Medical Doctor Association. She also served in many editorial boards of medical journals. She is an Associate Editor of Chinese Journal of Cardiology and a vice Chief Editor of Cardiovascular Therapeutics. Professor Han is a member of FACC and FESC.

Elderly Patients and Coronary Heart Disease on Response to Treadmill Exercise Test

To study the response of the cardiovascular system, to exercise tolerance in-patients over 75 years old with coronary heart disease (CHD), and to evaluate the significance of the parameters of the treadmill exercise test (TET). 110 patients received TET and coronary artery angiography. They were divided into two groups: the elderly patients group included 50 patients over 75 years old, and the control group included 60 patients under 60 years old. (1) With aging, there were much more CHD patients in the positive TET (P < 0.05) than in the negative TET (P > 0.05). (2) The parameters of TET for the elderly CHD patients group, included exercise time, peak heart rate, and the onset of ST depression, were lower than the control group (P < 0.05). There was no statistical significance between the two groups in the extent and duration of ST depression (P < 0.05). (1) In TET, the elderly patients had the higher diagnostic value on CHD. (2) The elderly patients with CHD had the lower endurance to exercise test.

Biomarker levels, left ventricular dysfunction, and severity of coronary pathology in elderly patients with coronary heart disease

Aim. To assess the levels of selected biomarkers and the type of left ventricular (LV) dysfunction in geriatric patients, in regard to their age, gender, and the severity of coronary artery pathology. Material and methods. In total, 135 geriatric patients with coronary heart disease (CHD) were examined. The diagnostic algorithm was based on the results of coagulogram, blood biochemistry, measurement of C-reactive protein (CRP) levels, treadmill test, echocardiography (EchoCG), coronary angiography (CA), and LV ventriculography (LVG). Results. Decreased hematocrit levels (p&lt;0,05), increased levels of urea (p&lt;0,05) and creatinine (p&lt;0,05), reduced LV ejection fraction (p&lt;0,05), increased end-diastolic volume (p&lt;0,05), as well as restrictive type of LV dysfunction, were among age-dependent determinants of angina progression in elderly patients. The major determinant of ischemia severity was multi-vessel coronary pathology, manifested in higher angina classes, reduced exercise capacity (p&lt;0,05), and impaired local LV contractility (p&lt;0,05). Conclusion. To objectively assess the severity of clinical course of CHD in elderly patients, the following data should be taken into account: hematocrit and CRP levels, increased levels of creatinine and urea, and the results of EchoCG, CA, and LVG.