心脏再同步治疗AV、VV间期优化对缺血性与扩张性心肌病的疗效比较

目的比较AV、VV间期优化的心脏再同步治疗(CRT)对缺血性与扩张性心肌病患者的疗效。方法 2例缺血性心肌病与24例扩张性心肌病患者因心力衰竭植入CRT的患者分别于术后1 w及6个月行超声心动图以及组织多普勒,测定左心室舒张末期直径(LVED)、射血分数(LVEF)、舒张期二尖瓣反流速度时间积分(VTImr)、主动脉瓣射血时间速度积分(VTIa)、右心室侧壁与左心室壁收缩达峰时间差及间隔对左心室后壁的运动延迟时间差(SPWMD)。植入术后1 w在超声指导下行AV、VV间期优化。结果 AV、VV间期优化后随访6个月,缺血性心肌病组与扩张性心肌病组比较:LVED(P=0.48)及LVEF(P=0.88)均无差异;VTIa(P=0.55)及VTImr(P=0.98)均无差别;右心室侧壁与左心室壁收缩达峰时间差(P=0.49)及SPWMD(P=0.15)均无差异。结论缺血性心肌病组与扩张性心肌病对AV、VV间期优化的CRT均反应良好,两者无明显差异。     

定期超声心动图引导下AV及VV间期优化在心脏再同步治疗中的长期疗效观察

目的 探讨定期超声心动图引导下优化AV及VV间期在长期心脏再同步治疗(CRT)中的临床价值.方法 回顾分析2002年6月至2012年10月新疆医科大学第一附属医院心脏中心成功植入CRT或心脏再同步治疗除颤器(CRT-D)的慢性心力衰竭患者108例.根据AV及W间期优化频率分为定期系统优化组(n=35)及非定期系统优化组(n=73).经过长期随访比较2组患者长期疗效.非致命心血管事件或因心力衰竭进展死亡为主要终点事件,左心房内径(LAD)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心室射血分数(LVEF)作为次要终点事件.结果 2组患者基线特征、随访时间(P=0.122)及应答率(P=0.524)差异无统计学意义.定期系统优化组非致命性心血管事件或因心力衰竭进展死亡较未定期优化组发生率更低(P=0.035).多因素Cox分析中,未定期系统优化显著提高患者非致命性心血管事件或因心力衰竭进展死亡发生风险(风险比3.192,95％ CI l.536 ～5.176,P=0.012).定期系统优化显著提高患者心功能(NYHA分级,P＜0.001),生存质量评分(P=0.001)及6min步行试验(6-MWT,P=0.002).此外定期系统优化组LAD较未定期优化组显著缩小(P=0.009),LVEF(P=0.039)显著提高.结论 定期超声心动图引导下AV及VV间期优化能够提高CRT长期疗效.     

心电图在CRT治疗VV间期优化中的应用

目的比较心脏再同步治疗(CRT)VV间期的超声心动图优化方法与心电图优化方法的相关性。方法入选36例CRT植入术后大于3个月的病例,选择左室领先30ms、双室同步、右室领先30ms、60ms5种VV间期,用超声心动图VTI替代每搏输出量,并设立相应VV间期为最佳VV间期。两种心电图优化方法同时进行。第1种为QRS波时限法:描记出最窄QRS波为最佳VV间期。第2种为心室间激动延迟法:即分别在胸前导联(最好V1或V2导联)记录从起搏信号到QRS波形态最早出现变化的间期,仅左室起搏时所获得的间期记为T1,仅右室起搏时获得的间期记为T2。T2-T1代表最佳VV间期。结果超声优化的最佳VV间期左室领先为负值,左室与在后第1种心电图优化方法与VTI符合率64%(r=0.61,p<0.01);第2种心电图优化方法符合率为86%(r=0.82,p<0.001);联合上述两种心电图方法,其符合率达92%(r=0.90,p<0.0001)结论 CRT的VV间期优化中,与超声心动图优化对比,联合两种心电图方法其相关性最高。     

心脏再同步化治疗中A-V间期优化对早期心功能的影响

目的评价A-V延迟优化对心脏再同步治疗(CRT)病人早期心功能的影响,指导临床心脏再同步化治疗后A-V延迟间期的程控优化设置。方法对心脏再同步化治疗病人在程控左右心室同步收缩前提下,经组织多普勒超声(TDI)测量A-V延迟优化前后相应左室射血分数(LVEF)、左室舒张末内径(LVEDd)、每搏输出量(SV)及主动脉瓣口的速度-时间积分(VTI)等即刻心功能指标。结果 4例行心脏再同步化治疗的病人A-V延迟优化后LVEF、SV及VTI与优化前均明显升高(P0.05),而优化后LVEDd与优化前比较差异无统计学意义。结论 CRT起搏治疗在保障了心室舒缩同步的前提下,通过最佳的A-V延迟优化,对早期血流动力学的改善起着重要作用,临床上应重视对CRT治疗病人A-V延迟的优化设置。     

动态优化AV/VV间期心脏再同步治疗慢性心力衰竭的临床观察

目的: 观察动态优化AV/VV间期心脏再同步治疗（cardiac resynchronization therapy,CRT）治疗慢性心力衰竭（CHF）的短中期疗效。方法: 12例CHF晚期患者接受CRT治疗,分别于植入前、植入术后3、6个月在超声心动图指导下优化房室（AV）间期和室室（VV）间期,同时观察心腔结构、二尖瓣返流及心电图、脑钠尿肽（BNP）检查等,评价CRT临床疗效。结果: 最佳优化AV间期120～180（158±19）ms和VV间期4～28（16±7）ms,临床症状改善,六分钟步行距离由(257±23)m增加至(344±21)m,QRS时限由（136±17）ms降至(109±12)ms(P<0.01,P<0.05)。植入后左室舒张末内径（LVEDD）较植入前明显缩小［(71±10) mm vs. (54±4),P<0.05］; 左室射血分数（LVEF）提高［(0.308±0.022) vs. (0.531±0.085),P<0.01］;血浆BNP值由植入前（876±415）ng/L降至(70±28)ng/L(P<0.05)。结论: 动态程控AV/VV间期可以提高CRT对CHF患者短、中期疗效。     

心电图与超声心动图优化VV间期的对比研究

目的 评价心电图在心脏再同步治疗（CRT）患者VV间期优化中的作用.方法 入选30例心功能Ⅲ～Ⅳ级（NYHA分级）CRT患者（男27例,女3例）,年龄42 ～79（63.3±10.6）岁.植入1个月后,分别程控为单独右心室起搏和单独左心室起搏,记录体表心电图.左心室起搏时,记录胸前导联从起搏信号到QRS波起始部假δ波结束之间的间期（T1）;右心室起搏时,记录胸前导联从起搏信号到QRS波开始改变之间的间期（T2）.T1 -T2的值为从心室侧壁与间隔部同步除极左心室所需的时间延迟,为最佳左-右心室激动的间期（Optimal VV间期）.同时采用超声扫描测定不同VV间期时的主动脉速度时间积分（VTI）,产生最大VTI间期为最佳VV间期,对比两种方法结果.结果 超声优化最佳VV间期在左心室领先起搏-30 ms、-70 ms时分别有20例、5例;左、右心室同步起搏（0 ～5 ms）时有3例;右心室领先起搏＋30 ms时有2例.心电图优化最佳VV间期在左心室领先起搏-30 ms、-70 ms时分别有19例和5例;左、右心室同步起搏时有4例;右心室领先起搏＋30 ms时有2例.两种方法相关性良好.结论 采用心电图可计算出CRT患者最佳VV间期,与超声心动图相关性良好.     

房间阻滞对心脏再同步治疗后新发心房颤动的影响

目的 评价房间阻滞对心脏再同步治疗(CRT)术后新发心房颤动(房颤)的影响.方法 69例接受心脏再同步治疗除颤器(CRT-D)的慢性心力衰竭患者根据体表心电图Ⅰ导联或aVL导联或V1导联P波时限及形态,分为:房间阻滞组(17例)、房间传导正常组(52例).术后1、3、6、12个月随访,复查超声心动图(UCG)及24 h动态心电图(DCG),并根据患者术后心功能改善情况决定是否接受超声指导下起搏器优化.结果 与房间传导正常组相比,房间阻滞组新发房颤率(41.1％对11.5％,P=0.012)明显增高,而且大多数患者在术后早期(术后1周)即出现新发房颤.此外,房间阻滞组超声指导下起搏器优化率(41.1％对11.5％,P=0.012)也明显增高,并且需要更长的AV/PV间期.结论 房间阻滞增加CRT-D术后新发房颤的风险.     

超声心动图引导下心脏再同步化治疗的优化调节

目的 应用超声心动图技术优化调节心脏再同步化治疗(CRT)的疗效.方法 接受CRT的慢性心力衰竭患者30例,在超声心动图引导下进行优化AV间期和VV间期.结果 30例患者CRT优化后心功能得到改善,左室充盈时间较优化前增加,二尖瓣返流减少;左室内各室壁收缩期达峰时间标准差减少,左室流出道速度时间积分上升,左室收缩末容积减少.结论 超声引导下AV间期和VV间期优化能够提高CRT临床疗效.     

组织多普勒超声评价窄QRS间期患者心脏再同步治疗效果

目的组织多普勒超声（TDI）指导下评价窄QRS间期合并心室不同步患者行心脏再同步治疗（CRT）对临床预后的影响。方法91例经超声心动图和TD[确诊为心脏收缩不同步的慢件心力衰竭患者,按是否接受CRT分为CRT组（窄QRS间期21例,宽QRS间期22例）和对照组（宽QRS间期25例,窄QRS间期23例）。对所有患者进行1年的随访,评价心功能及生存率。结果CRT组6min步行试验、生活质量积分、心功能（NYHA分级）明显改善。超声心动图及TDI结果显示,CRT组左心室收缩未容积、左心室舒张末容积明显减少,射血分数明显增加。与各对照组亚组相比,CRT组中窄QRS亚组心功能改善,6min步行试验距离、左心室射血分数、生活质量积分明垃增加,左心室收缩末容积和左心窀舒张末容积明显减少。结论在TDI指导下,窄QRS间期慢性心力衰竭可以从CRT中获益。     

应用超声心动图评价CRT疗效

目的 研究超声心动图对心脏再同步化(CRT)治疗心力衰竭患者的疗效评价.方法 选择2018年1月至2020年1月期间,于我院接受CRT治疗的心力衰竭患者18例,所有患者均于术后行AV与VV间期优化,总结患者术前术后的心功能指标与心脏同步化指标变化.结果 术后1周,患者各项心功能与心脏同步指标与术前相比均无明显差异(p＜...     

急性心肌梗死院前延迟的研究进展

就诊延迟直接影响急性心肌梗死的预后,就诊延迟可分为院前延迟及院内延迟。与院内延迟相比院前延迟影响因素更多,时间往往更长,因此如何缩短院前延迟更具临床意义。在此就院前延迟的概念、意义、影响因素及可能缩短院前延迟的方法做一简要综述。     

Patient Delay in Patients With ST-elevation Acute Myocardial Infarction

Objectives To examine patient delay (PD) in seeking treatment among patients with ST-elevation myocardial infarction (STEMI) and to identify factors influencing PD. Methods patients with STEMI were divided into two groups based on PD: Short PD group (PD ≤ 60 minutes after onset of symptoms) and long PD group ( > 60 minutes after symptom onset). A questionnaire developed to assess demographic characteristics, clinical factors and psychological factors. Patients were interviewed within 72 hours of admission to 2 hospitals. Results 329 consecutive confirmed STEMI patients (Mean age 61years; 72.5% men) with a median PD of 90 min and a pre-hospital delay time 170 min were studied, PD was less than 1 hours in 47.4% of patients, while more than 1 hours in 52.6%, In univariate analyses, patients with short PD were witness onset, progress course of symptom, severe pain, death anxiety, knowing AMI as a deadly disease and its presentation, taking the symptom seriously. Patients with longer PD were age ≥65 year, nocturnal onset, experienced their symptoms at home, gradual onset, 'waited to see whether symptoms disappeared', 'worried about troubling others', 'took pain medication' and preinfarction angina. A stepwise multiple regression analysis further suggested that the following inde-pendent contributors to a late decision to seek medical help (relative risk, 95% confidence interval): taking pain medication (15.97; 1.70～149.8 ), wanting to wait and see (6.46; 1.92～21.74), not wanting to bother anybody (6.42; 2.87～14.34), preinfarct angina (2.73; 1.20～6.19), age ≥65 years (2.51; 1.15～5.48), gradual onset (2.40; 1.05～5.44), severe pain(0.38, 0.17～0.85), witness onset (0.27, 0.10～0.70), taking symptoms seriously (0.019; 0.08～0.46). Conclusions Age ≥65 years, gradual onset, witness onset, severe pain, preinfarct angina, emotional responses and coping strategies are the independent factors associated with patient delay or decision time in patients with AMI. Emotional responses and coping strategies are the major determinants of patient delay. Modification of these emotional factors might best be achieved by patients and public education.     

Delay in diagnosis of tuberculosis and related factors from a district in Kerala,India

BackgroundEarly diagnosis and treatment of tuberculosis is of vital importance both to cure patients and to reduce transmission for effective control of tuberculosis, It is important to know whether tuberculosis is diagnosed in time and also what causes delay if any.ObjectivesThe study was conducted with the objective of knowing the time taken to diagnose tuberculosis from the onset of symptoms and to identify the causes for delay if any.MethodsA study was conducted in the District of Malapppuram Kerala, South India among newly diagnosed smear positive tuberculosis patients. 489 patients were interviewed soon after diagnosis and their socio-demographic characteristics and details from onset of symptoms to diagnosis were collected using a structured format.ResultsThe mean time taken by the patient for consultation after onset was 36 days and the mean time for diagnosis was 42 days and total time until diagnosis was 78 days. 72.8% patients consult within 6 weeks of onset and 74.7% are diagnosed within 6 weeks of consultation. The delay for diagnosis was more with private institutions. Diagnosis took less time when government facilities are consulted and when cough was a prominent symptom. Socio demographic factors are seen not affecting the time.ConclusionsThere is delay in diagnosing tuberculosis especially with private health providers and more efforts are required to reduce the same.     

Delay time in suspected acute myocardial infarction and the importance of its modification

This paper summarizes the present knowledge of delay time in suspected acute myocardial infarction. More than 50% of deaths in acute myocardial infarction occur outside of the hospital setting. Recent experiences indicate that early and even late mortality can be dramatically reduced by intervention in the early phase. This points up the importance of bringing patients with suspected acute myocardial infarction to the hospital as early in the course of MI as possible. The predominating cause of delay is the time it takes for the patient to decide to go to hospital regardless of a previous history of cardiovascular disease. Patients arriving in hospital in later stages of MI are at a very high risk of mortality. Therefore one of the most important problems to be resolved is how to reduce delay time in suspected acute myocardial infarction. Such efforts have been surprisingly few. Limited experiences indicate that public education can reduce delay time dramatically.     

Delay from Diagnosis to Surgery in Transferred Type A Aortic Dissection

Objectives

The purpose of this research is to analyze factors associated with delays to surgical management of Type A acute aortic dissection patients.

Delay discounting by adolescents experimenting with cigarette smoking

Aims To evaluate delay discounting and self‐reported impulsive behavior in a sample of adolescents experimenting with cigarette smoking compared with adolescents who had never smoked or were daily smokers. Design A cross‐sectional design was used to compare smoking‐status groups. Setting Columbus, Ohio, a city of approximately 780 000 people. Participants A sample of 141 male and female adolescents with a mean age of 15.37 (standard deviation = 1.09) years. Measurements Primary measures included a computerized assessment of delay discounting, a self‐report assessment of impulsivity [Barratt Impulsiveness Scale—adolescent (BIS‐11‐A)] and verifications of cigarette smoking status (breath carbon monoxide and urinary cotinine level). Findings Smokers discounted more by delay and had higher impulsivity scores than non‐smokers. Experimenters had scores intermediate to those of smokers and non‐smokers on both measures. In some analyses the difference between experimenters and non‐smokers was significant, with experimenters showing greater delay discounting, but in no case did experimenters differ significantly from the smokers. Conclusions Young people who experiment with cigarettes appear to be similar to those who smoke regularly in terms of tendency to discount future gains and report impulsive tendencies, and generally higher in these traits than non‐smokers.     

Ethnicity and Delay in Measles Vaccination in a Nairobi Slum

The influence of ethnicity on vaccination uptake in urban slums in Kenya is largely unknown. We examined the disparities in timeliness and coverage of measles vaccination associated with ethnicity in the Korogocho slum of Nairobi. The study used data from the Maternal and Child Health component of the Urbanization, Poverty and Health Dynamics Research Programme undertaken in the Korogocho and Viwandani slums by the African Population and Health Research Center from 2006 to 2010. Vaccination information was collected from children recruited into the study during the first year after birth, and a sub-sample of 2,317 who had been followed throughout the period and had the required information on measles vaccination was included in the analysis. Cox regression analysis was used to determine the association of ethnicity with delayed measles in the slum. We found significant disparities in the coverage and timeliness of measles vaccination between the ethnic groups in Korogocho. The Luhya and minor ethnic groups in the slum were more likely than the Kikuyu to have delayed measles vaccination. Ethnic groups with a high proportion of children with delayed measles vaccination need to be targeted to address cultural barriers to vaccination as part of efforts to improve coverage in urban slums.     

Delay discounting and the alcohol Stroop in heavy drinking adolescents

AIMS: To investigate whether adolescent heavy drinkers exhibit biased cognitive processing of alcohol-related cues and impulsive decision making. DESIGN: A between-subjects design was employed. SETTING: Classrooms in a single sixth-form college in Merseyside, UK. PARTICIPANTS: Ninety adolescent students (mean age 16.83 years), of whom 38% were identified as heavy drinkers and 36% were identified as light drinkers, based on a tertile split of their weekly alcohol consumption. MEASUREMENTS: Participants provided information about alcohol consumption before completing measures of alcohol craving, delay discounting and an "alcohol Stroop" in which they were required to name the colour in which alcohol-related and matched control words were printed. FINDINGS: Compared to light drinkers, heavy drinkers showed more pronounced discounting of delayed hypothetical monetary and alcohol rewards, which is indicative of a more short-term focus in decision making in heavy drinkers. Heavy drinkers were also slower to colour-name alcohol-related words, which indicates an attentional bias for alcohol-related cues. In all participants, measures of delay discounting and attentional bias were correlated moderately with each other, and also with the level of alcohol consumption and with alcohol craving. CONCLUSIONS: In adolescents, heavy alcohol use is associated with biased attentional processing of alcohol-related cues and a shorter-term focus in decision making.     

急性心肌梗死患者延迟就诊的性别差异

对于急性心肌梗死患者来说,其治疗的关键是能否在症状发生后尽快开通闭塞的冠状动脉,开通越早,获益越大。然而许多国家的研究发现大部分心肌梗死患者存在不同程度的延迟,其平均院前延误时间为1.5~6h,而且发现女性患者无论是院前延迟时间还是院内延迟时间,无论是接受溶栓治疗还是接受PCI治疗,其延迟均显著长于男性,尤其是老年女性患者。进一步分析原因发现,可能与女性的症状学特点、社会因素及心理因素有关。