高血压患者左室舒张功能与左室肥厚的关系及随龄改变

为探讨原发性高血压 (以下简称高血压 )患者的左室舒张功能和左室肥厚的关系及其随龄改变 ,抽取 1995年 2月至 2 0 0 2年 7月间门诊高血压患者 4 81例为高血压组 ,以同期体检健康者 2 54 3例为对照组 ,年龄 10～ 80岁 ,并将原发性高血压患者分为 3级 ,每级中按性别分 2组。采用惠普 2 50 0彩色多普勒超声诊断系统检测 2组的室间隔厚度、左室后壁厚度、E/A等指标。使用SPSS软件进行统计学处理分析。结果 :高血压和正常对照组相比E/A显著下降 ,室间隔和左室后壁显著增厚 (P <0 .0 1)。 2个组的E/A均随年龄下降 ,而室间隔厚度随年龄增厚 ,且室间隔厚度和E/A呈显著负偏相关 (P <0 .0 1)。在高血压分级组中 ,Ⅰ～Ⅲ级高血压组中男性的室间隔厚度均厚于女性 (均P <0 .0 1) ,Ⅰ、Ⅱ级高血压组中男性的左室后壁厚度厚于女性 (P <0 .0 5,P <0 .0 1) ,Ⅰ级高血压组中女性的E/A低于男性 (P <0 .0 5)。提示 :左室舒张功能随着年龄的增加而降低 ,而且和高血压左室肥厚呈负偏相关关系 ,性别对其也有一定的影响     

Obstructive sleep apnea, hypertension, and their interaction on arterial stiffness and heart remodeling

STUDY OBJECTIVES: Obstructive sleep apnea (OSA) and hypertension are independently associated with increased stiffness of large arteries that may contribute to left ventricular (LV) remodeling. We sought to investigate the impact of OSA, hypertension, and their association with arterial stiffness and heart structure. DESIGN: We studied 60 middle-aged subjects classified into four groups according to the absence or presence of severe OSA with and without hypertension. All participants were free of other comorbidities. The groups were matched for age, sex, and body mass index. MEASUREMENTS AND RESULTS: Full polysomnography, pulse-wave velocity (PWV), and transthoracic echocardiography were performed in all participants. Compared with normotensive subjects without OSA, PWV, left atrial diameter, interventricular septal thickness, LV posterior wall thickness, LV mass index, and percentage of LV hypertrophy had similar increases in normotensive OSA and patients with hypertension and no OSA (p < 0.05 for all comparisons), with a significant further increase in PWV, LV mass index, and percentage of LV hypertrophy in subjects with OSA and hypertension. Multivariate regression analysis showed that PWV was associated with systolic BP (p < 0.001) and apnea-hypopnea index (p = 0.002). The only independent variable associated with LV mass index was PWV (p < 0.0001). CONCLUSIONS: Severe OSA and hypertension are associated with arterial stiffness and heart structure abnormalities of similar magnitude, with additive effects when both conditions coexist. Increased large arterial stiffness contributes to ventricular afterload and may help to explain heart remodeling in both OSA and hypertension.     

Preclinical signs of liver and cardiac damage in youth with metabolically healthy obese phenotype

Background and aims

We aimed to evaluate whether the metabolically healthy obese (MHO) phenotype was associated with hepatic steatosis (HS) or left ventricular hypertrophy (LVH) in young people with overweight (OW), obesity (OB) and morbid obesity (MOB) and whether the prevalence of these comorbidities was affected by OB severity.

肥厚型心肌病QT离散度及其与左室重量关系的研究

目的　观察肥厚型心肌病 (HCM )患者QT离散度 (QTd)与左室重量 (LVM)关系 ,探讨HCM患者心室肌复极电活动稳定性及引起其不稳定的主要原因。方法　HCM患者 6 4例 ;梗阻组 (HOCM ) 33人 ;非梗阻组 (HNCM ) 31例 ;对照组健康人 32例。三组均做 12导联同步心电图及超声心动图。测定三组QTd、心率校正的QT离散度 (QTcd)、舒张期左室内径 (LVEDD) ,舒张期室间隔厚度 (IVST)及左室后壁厚度 (LVPWT) ,计算出LVM。结果　①HCM组 (包括HOCM组和HNCM组 )LVM、IVST、QTd、QTcd较正常对照组显著提高 (P <0 0 5 ) ;HOCM组与HNCM组上述指标无统计学差别(P >0 0 5 ) ;②HCM患者QTd与LVM呈正相关 ,r为 0 32 5 ;③HCM患者QTd与IVST呈正相关 ,r为 0 4 6 3。结论　HCM患者心室肌复极电活动有着不稳定性及不同步性 ,具有很强的心律失常易感性和心律失常源性 ,可能与左室肥厚的程度 ,重量的增加有关 ,与LVOT有无梗阻无关。     

脑干听觉诱发电位对颅内静脉窦血栓形成昏迷患者预后的评估

目的：研究脑干听觉诱发电位（BAEP）对评估颅内静脉窦血栓形成（IVST）昏迷患者预后中的作用。方法：对24例经临床及影像学证实的IVST昏迷患者进行BAEP检测，记录双侧Ⅰ波、Ⅲ波、Ⅴ波峰潜伏期及Ⅰ-Ⅲ波、Ⅲ-Ⅴ波的波间潜伏期，并与格拉斯哥量表（GCS）评分结果及31例健康人群的BAEP相应潜伏期及波间潜伏期作比较。结果：24例IVST昏迷患者中17例Ⅰ波、Ⅲ波、Ⅴ波的潜伏期及Ⅰ-Ⅲ波、Ⅲ-Ⅴ波的波问潜伏期均有不同程度的异常，另7例患者双侧的Ⅲ波、V波消失，Ⅲ、Ⅴ波存在或双侧消失的IVST昏迷患者之间的预后，经X^2检验，差异有统计学意义（P〈0．05）。结论：24例患者的BAEP检查结果与临床判断相吻合。BAEP可为IVST昏迷患者预后的判定提供客观依据。     

肥厚型心肌病发病年龄与心肌肥厚的探讨

目的 探讨肥厚型心肌病（HCM）的发病年龄及其与心肌肥厚程度之间的关系。方法 收集24年来收治的42例HCM病例的临床资料进行回顾性分析。结果 HCM发病的平均年龄为62．1岁，50岁以上病例超过83％，且舒张期末室间隔厚度（IVST）、IVST／左室后壁厚度均明显小于50岁以下者。结论 近年来HCM发病年龄呈现老龄化趋势，随年龄增长心肌肥厚程度反而减轻，两者呈负相关。     

Combined use of high-sensitivity C-reactive protein and apolipoprotein B/apolipoprotein A-1 ratio prior to elective coronary angiography and oral glucose tolerance tests

Objectives

The study aimed to investigate the predictive value of the combination of high-sensitivity C-reactive protein (hs-CRP) and apolipoprotein B (apoB)/apoA-1 ratio for the outcomes of coronary angiography (CAG), echocardiography and oral glucose tolerance tests (OGTTs).

Design and methods

Hs-CRP, apoB, apoA-1, and the profiles of CAG, echocardiography and OGTTs as well as traditional risk factors were measured in 1757 cardiology patients.

Results

Hs-CRP or apoB/apoA-1 ratio was significantly correlated with the presence and severity of angiographic profiles, the levels of left ventricular (LV) ejection fraction, LV mass and LV mass index, and the presence of abnormal glucose metabolism. The combination of hs-CRP and apoB/apoA-1 ratio had greater correlation with abnormal glucose metabolism than its individual components in patients with normal fasting glucose, and was an independent predictor for coronary artery disease.

Conclusions

The combination of hs-CRP and apoB/apoA-1 ratio may be a strong predictor for coronary artery disease and abnormal glucose metabolism.     

Comparison of classifications for heart failure in children undergoing valvular surgery

OBJECTIVES: To characterize correlations between clinical classifications of heart failure and diagnostic workup. STUDY DESIGN: Pre- and postoperative characteristics of 20 children with heart failure secondary to valvular rheumatic disease were studied. RESULTS: Both scoring systems correlated with N-terminal pro-brain natriuretic peptide (N-proBNP) but not with troponin I (TnI). The PHFI correlated with N-proBNP, end-systolic wall stress, left ventricular mass index and left atrium to aorta diameter ratio. No correlation could be established between modified Ross score, or the New York Heart Association (NYHA) grade and echocardiographic measurements. Cardiothoracic and Sokolow indexes were correlated with the PHFI as well as to the NYHA classification. CONCLUSION: In this study, PHFI seems better correlated with radiologic, electrocardiographic, echocardiographic, and biologic assessment of heart failure in children. Clinical severity was correlated with N-proBNP but not with TnI.