Objective To investigate whether angiotensin converting enzyme (ACE) have significant relation to permanent atrial fibrillation (Af) with mitral valvular diseases. Methods 124 consecutive lone mitral valvular disease patients who need surgery were studied. At baseline, all patients underwent a physical examination, 12lead electrocardiography and echocardiography. The plasma ACE level was measured in all patients by a radioimmunoassay technique. Patients who had permanent Af formed the Af group, and those who still kept sinus rhythm (SR) comprised the SR group. In Af group, patients were separated into two groups by the subgroup of mitral valvular disease ［mitral stenosis(MS) and mitral regurgitation(MR)］, then formed MSAf group and MRAf group. Results Af was diagnosed in 47.58% (59/124) of lone mitral valvular disease patients. Patients who had Af were older (by 6 years) than sinus rhythm patients and more frequently had a history of stroke. Mitral stenosis patients were easy to have Af (60.53% vs. 27.08%，Plt;0.05). The plasma level of ACEwas significantly higher in Af group than that in SR group (72.60 ±22.03 U/L vs. 56.40±17.96 U/L，Plt;0.05). In Af group, the ACE level in MSAf group was higher than that in MRAf group (82.92±18.75 U/L vs. 66.25±21.10 U/L，Plt;0.05). Mitral stenosis patients more frequently had a history of stroke than that of mitral regurgitation patients. Af correlated significantly with the level of ACE (r=0.089, P=0.021) and left atrial dimension (r=0.447, P=0.033). Conclusion We validated and extended the hypothesis that increasing ACE level predicted an increasing risk of Af in mitral valvular diseases. It was expressed significantly in mitral stenosis patients especially.
Objective To explore the role of thrombus precursor protein(TPP) in the monitoring of anticoagulation in the patients with atrial fibrillation (Af) after mechanical heart valve replacement, and suggest the reasonable anticoagulant range. Methods Ninety patients were divided into Af group (n=45), sinus rhythm group (SR group, n=45), and control group (20 patients with non-valvular heart diseases), according to whether Af exist after mitral valve replacement. TPP concentrations and International Normalized Ratio(INR) in the anticoagulant patients were analyzed. Results In patients after mechanical mitral valve replacement, plasma TPP concentrations in both SR group and Af group were lower than that in control group (Plt;0.05,0.01), their INR value were higher than that in control group (Plt;0.01), and Af group had higher plasma TPP concentrations than that in SR group((Plt;)0.05). It was found that there existed contradictions between INR and plasma TPP concentrations in Af group. There were 28 patients with plasma TPP concentrations below 6 μg/ml and without spontaneous bleeding complications in the group with Af, who might be at the optimal anticoagulant status. Their 95% confidence of INR value was 1.90-2.30 and their plasma TPP concentration was 4.29±0.75μg/ml. Conclusion Patients with Af after mechanical heart valve replacement might have higher risk of thromboembolism, INR between 1.90 - 2.30 and plasma TPP concentration between 2.84-6.00 μg/ml might be the optimal anticoagulant therapeutic range.
【Abstract】ObjectiveTo review the epidemiology, etiology, pathology, clinical presentation, diagnosis and treatment, recurrance and prognosis of Mondor disease. MethodsLiteratures on Mondor disease were reviewed, and our study of Mondor disease was also included. ResultsMondor disease is difficult to diagnose, but is with good prognosis in most patients. It’s unclear whether Mondor disease is associated with the etiology of breast cancer. ConclusionThe diagnosis and therapy of Mondor disease are important, especially when it is accompanied with breast cancer.