Prediction of AF in Heart Failure With Preserved Ejection Fraction: Incremental Value of Left Atrial Strain

ObjectivesThis study sought to identify the factors associated with incident atrial fibrillation (AF) in a well-characterized heart failure with preserved ejection fraction (HFpEF) population, with special focus on left atrial (LA) strain.BackgroundAF is associated with HFpEF, with adverse consequences. Effective risk evaluation might allow the initiation of protective strategies.MethodsClinical evaluation and echocardiography, including measurements of peak atrial longitudinal strain (PALS), peak atrial contraction strain (PACS), and LA volume index (LAVI), were obtained in 170 patients with symptomatic HFpEF (mean age, 65 ± 8 years), free of baseline AF. AF was identified by standard 12-lead electrocardiogram, review of relevant medical records (including Holter documentation), and surveillance with a portable single-lead electrocardiogram device over 2 weeks. Results were validated in the 103 patients with HFpEF from the Karolinska-Rennes (KaRen) study.ResultsOver a median follow-up of 49 months, incident AF was identified in 39 patients (23%). Patients who developed AF were older; had higher clinical risk scores, brain natriuretic peptide, creatinine, LAVI, and LV mass; lower LA strain and exercise capacity; and more impaired LV diastolic function. PACS, PALS, and LAVI were the most predictive parameters for AF (area under receiver-operating characteristic curve: 0.76 for PACS, 0.71 for PALS, and 0.72 for LAVI). Nested Cox regression models showed that the predictive value of PACS and PALS was independent from and incremental to clinical data, LAVI, and E/e’ ratio. Classification and regression trees analysis identified PACS ≤12.7%, PALS ≤29.4%, and LAVI >34.3 ml/m² as discriminatory nodes for AF, with a 33-fold greater hazard of AF (p < 0.001) in patients categorized as high risk. The classification and regression trees algorithm discriminated high and low AF risk in the validation cohort.ConclusionsPACS and PALS provide incremental predictive information about incident AF in HFpEF. The inclusion of these LA strain components to the diagnostic algorithm may help guide screening and further monitoring for AF risk in this population.     

基于UPLC/Q-TOF MS/MS的稳心颗粒主要成分分析及鉴定

[目的]采用超高效液相色谱-四级杆-飞行时间质谱(UPLC/Q-TOF MS/MS)技术,对稳心颗粒中的化学成分进行初步分析。[方法]采用ACQUITY UPLC BEH C18色谱柱(2.1 mm×100 mm,1.7μm),以乙腈-水(含体积比0.1%甲酸)为流动相梯度洗脱,流速为0.3 mL/min,电喷雾电离源,正/负离子双模式检测,通过UPLC/Q-TOF MS/MS所得到的化合物分子量以及MS/MS碰撞解离碎片,结合文献报道,对稳心颗粒的主要化学成分进行分析鉴定。[结果]结合文献报道和一级MS、二级MS/MS高分辨质谱数据,对其中68个化合物进行了初步鉴定,结果显示,稳心颗粒成分以糖类、皂苷类、黄酮类为主,其中三七皂苷R1、人参皂苷Rg1、人参皂苷Rb1丰度较高。[结论] UPLC/Q-TOF MS/MS技术是鉴定中药复方成分的有效手段,本研究首次利用该技术对稳心颗粒的主要成分进行定性分析,为阐明该复方药效物质基础、探讨其作用机制及其质量控制提供了有效的科学依据。     

稳心颗粒联合尼可地尔治疗缺血性心肌病房性心律失常临床观察

目的探讨缺血性心肌病伴房性心律失常采用稳心颗粒联合尼可地尔治疗的临床效果。方法选择2017年1月—2019年1月收治的缺血性心肌病伴房性心律失常患者114例,遵照不同治疗原则分组标准分为对照组和研究组,各57例,2组入院后均采用常规基础治疗,对照组在基础治疗的基础上给予稳心颗粒进行治疗。研究组在对照组的基础上联合应用尼可地尔进行治疗,比较2组治疗效果、心功能情况、P波离散程度、6 min步行试验距离以及不良反应。结果研究组治疗总有效率为96.49%,显著高于对照组(80.70%),差异有显著性意义(P<0.05)。研究组心功能、P波离散程度、6 min步行距离以及脑钠素水平均显著好于对照组,差异均存在统计学意义(P<0.05),但2组患者用药后不良反应发生率比较,差异无统计学意义(P>0.05)。结论稳心颗粒联合尼可地尔应用于缺血性心肌病伴房性心律失常患者的治疗中,能够显著提高治疗效果,改善心脏功能,且未见明显不良反应,好于单一用药,值得推广。     

血塞通软胶囊联合比索洛尔治疗2型糖尿病合并左室舒张功能减退临床观察

目的探讨血塞通软胶囊联合比索洛尔治疗2型糖尿病合并左室舒张功能减退的临床效果。方法选择2017年8月-2018年8月治疗的2型糖尿病合并左室舒张功能减退的患者120例,依据随机数字的方法分为对照组(60例)和观察组(60例),患者入院后均常规治疗,对照组在常规治疗基础上给予比索洛尔,观察组在对照组治疗方法基础上给予血塞通软胶囊。对两组治疗前后的空腹血糖(FPG),餐后2 h血糖(2hPG),糖化血红蛋白(HbA1c),E波峰值流速/A波峰值流速(E/A),E峰减速时间(EDT),左心室容舒张时间(IVRT),血清B型尿钠肽(BNP)浓度进行比较。对两组的治疗效果进行比较。对治疗过程中的不良反应进行对比。结果经过治疗后,对照组的FPG从(7.85±0.67)mmol/L降低到(6.45±0.48)mmol/L,2 hPG从(12.21±1.23)mmol/L降低到(9.35±1.45)mmol/L,HbA1c从(9.31±0.95)%降低到(8.22±0.68)%,观察组的FPG从(7.89±0.71)mmol/L降低到(5.88±0.23)mmol/L,2hPG从(12.37±1.35)mmol/L降低到(8.27±1.34)mmol/L,HbA1c从(9.38±0.88)%降低到(7.14±0.71)%,观察组的变化幅度大于对照组,数据差异均具有统计学意义(t=8.295,4.237,8.509,P<0.05),经过治疗后,对照组的E/A从(0.83±0.13)升高到(0.98±0.17),EDT从(80.51±5.47)ms升高到(92.81±6.23)ms,IVRT从(121.48±7.79)ms升高到(131.51±7.66)ms,观察组的E/A从(0.84±0.12)升高到(1.18±0.21),EDT从(81.65±5.67)ms升高到(98.57±6.72)ms,IVRT从(120.98±7.81)ms升高到(139.25±6.81)ms,观察组的变化幅度大于对照组,数据差异均具有统计学意义(t=-5.734,-4.869,-5.849,P<0.05),经过治疗后,对照组的血清BNP浓度从(222.56±43.25)ng/L降低到(167.11±27.61)ng/L,观察组的血清BNP浓度从(228.92±44.91)ng/L降低到(131.25±25.07)ng/L,观察组的变化幅度大于对照组,数据差异均具有统计学意义(t=7.448,P<0.05),观察组治疗效果优于对照组,数据差异具有统计学意义(z=-2.184,P<0.05),两组的头晕[8.33%(5/60)vs.5.00%(3/60)],水肿[3.33%(2/60)vs.6.67%(4/60)],面部潮红[11.67%(7/60)vs.8.33%(5/60)],头痛[5.00%(3/60)vs.1.67%(1/60)],发生率数据差异均不具有统计学意义(χ^2=0.134,0.175,0.370,0.259,P>0.05)。结论利用血塞通软胶囊联合比索洛尔治疗2型糖尿病合并左室舒张功能减退的患者,可以改善血糖指标和心室功能指标,提升治疗效果,安全性良好。     

Role of subcutaneous implantable loop recorder for the diagnosis of arrhythmias in Brugada syndrome: A United Kingdom single-center experience

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