冠心病患者平板运动试验中QT离散度变化与运动诱发的缺血性室性心律失常的关系

冠心病是猝死的最重要原因之一，其猝死的原因多为恶性室性心律失常。近年来QT离散度(QTd)增加被认为是预测恶性心律失常的指标。本文通过测定分析40例冠D病患者平板运动试验前、后QTd变化，探讨冠心病患者运动诱发的缺血性室性心律失常的发生与QTd增加的关系。     

160例平板运动试验诱发心律失常分析

目的：分析平板运动试验诱发心律失常的特点。方法：选择160例患者应用标准Bruce方案进行次极量平板运动试验,同步监测血压和12导联心电图,记录运动前、运动中及恢复期的血压和心电图。结果：160例运动试验诱发心律失常共36例,发生率为22.5%,运动试验阳性组心律失常发生率（44.9%）高于阴性组（12.7%）。结论：运动试验可辅助临床对冠心病的诊断,运动试验阳性组诱发的心律失常多于阴性组,以室性心律失常多见,运动中、运动后发生心律失常可能与心肌缺血等因素有关。     

活动平板运动试验室性早搏分析

目的：评价活动平板运动试验室性早搏(室早)的临床意义。方法：在活动平板运动试验中观察室早QRS间期、定位、电压、出现时间、室性心律失常性质等指标的变化，并与冠脉造影结果进行对照分析。结果：在136例的活动平板活动试验中，室早ORS间期与活动平板运动试验的结果、冠脉造影的结果相关，室早QRS间期≥0．14s冠脉造影阳性率显性升高。且随着冠脉狭窄程度增加、累及冠脉病变范围越多，室早QRS间期则越宽。冠脉造影阳性中89．83％室早来源于左心室(除左后支外)，而阴性组仅10．17％例来源于左室，大部分来源于右室及左后支。QRS低电压与活动平板运动试验的结果相关，且随着冠脉狭窄增加，低电压增多。但与冠脉病变范围无关。室性心律失常严重程度与冠脉造影结果相关，冠脉狭窄程度增加、累及冠脉病变范围越多，室性心律失常则越严重。结论：室早在活动平板运动试验中可能有一定临床意义。活动平板运动试验中如室早QRS间期0．14s以上，起源于左室，低电压，Lown氏分级≥3级对冠心病的诊断有一定指导意义。     

联合右胸导联心电图运动试验改善冠心病的诊断

目的　常规 12导联心电图运动试验是诊断冠心病的一种不完善的无创伤性方法。本文尝试加做右胸导联 ,以提高运动试验诊断冠心病的检出率。方法　本文研究了 2 5 4例患者 ,男性 2 18例 ,女性 2 7例 ,年龄在 37～ 74岁之间 ,平均年龄 5 2± 8岁 ,分别行平板运动试验、2 0 1铊心肌显像及冠状动脉造影。平板运动试验中 ,每个患者均描记标准 12导联及右胸 3个导联 (V3R、V4R及V5 R)心电图 ,并进行分析结果　冠状动脉造影显示 34例患者冠状动脉正常 ,85例为单支血管病变 ,84例为 2支血管病变 ,42例为 3支血管病变。对于单支血管病变的诊断 ,标…     

室性心动过速的十二导联动态心电图分析

目的：分析室性心动过速十二导联动态心电图特点.方法：探讨67例患者的室性心动过速患者的临床诊断、室性心动过速发作QRS波的形态、伴发其他心电图异常、及室性心动过速的昼夜规律.结果：室性心动过速以冠心病发生率最高（38.8％）;伴随房性心律失常发生率为80.6％,心肌缺血改变为62.7％;室性心动过速发作0：00～3：59发生率最高,为19.6％,4：00～7：59室性心动过速发生率最低,为12.9％,其他时段无明显规律.室性心动过速QRS波形态呈右束支阻滞型（V1V2呈R、Rs、Qr型）及多形性室性心动过速为67.1％,病理性室性心动过速起源多为左室.结论：室性心动过速中器质性病变尤其是冠心病患者发生率较高,易伴发房性心律失常及心肌缺血性改变,室性心动过速无明显昼夜节律,病理性室性心动过速起源多为左室,佐证室性心动过速为病理性改变.     

PCI对冠心病并发室性心律失常的影响

目的 探讨PCI对冠心病并发室性心律失常的影响.方法 54例冠心病并发室性心律失常患者,按标准方法 行冠状动脉造影及支架植入术,术前、术后动态心电图检查,观察心律失常变化.结果 术后1周,54例患者46例室性心律失常消失或明显减少,8例变化不明显,总有效率85.2%,QTd明显减小.结论 PCI对冠心病并发室性心律失常有一定的治疗作用,远期效果有待进一步观察.     

冠心病慢性心力衰竭患者室性心律失常患者治疗探析

目的：研究探讨冠心病慢性心力衰竭患者室性心律失常的临床治疗方法和治疗效果。方法选取我院收治的冠心病慢性心力衰竭并室性心律失常的患者100例作为研究对象,将其随机分为两组,每组50例。对照组患者给予常规治疗方法治疗(包括吸氧,对盐分的摄取量进行控制并补充钾镁,给予洋地黄和螺内酯进行治疗等),观察组患者在对照组的基础上给予胺碘酮静脉注射治疗,经过一段时间的治疗,比较两组患者的临床治疗效果。结果对两组患者的治疗有效率进行比较可见,观察组患者显效27例,有效18例,无效5例,总治疗有效率为90.0%;对照组患者显效17例,有效18例,无效15例,总治疗有效率为70.0%;两组患者的治疗有效率比较差异显著,且P<0.05,具有统计学意义。结论在常规治疗的基础上给予冠心病慢性心力衰竭并室性心律失常的患者胺碘酮静注治疗的临床效果显著,能有效缓解患者的主要临床症状,控制心律失常的发生,值得临床推广应用。     

隐匿型冠心病平板运动试验分析

目的：探讨平板运动试验对隐匿型冠心病的诊断价值。方法：对107例不典型胸部疼痛的患，平静心电图检查正常而临床疑似冠心病，行平板运动试验。对其结果进行回顾性分析。结果：53例患的心电图出现不同程度的异常改变，阳性率49．5％。结论：平板运动试验对隐匿型冠心病有较高的辅助诊断价值。     

平板运动试验临床应用研究

目的：研究平板运动在实际临床应用中的价值.方法：对552例患儿进行运动试验检查.结果：室性早搏患儿运动试验阳性者判定为病理性,并给予抗心律失常药物治疗.其他心律失常患儿运动试验均为阴性.T波改变及ST段变化患儿运动试验阳性者,结合病史给予治疗.结论：平板运动对于心律失常的诊断、评估预后及治疗有重要意义,对评估运动诱发不明原因症状也很有帮助.     

12导联动态心电图、常规心电图在冠心病无症状性心肌缺血伴发心律失常诊断中的应用效果对比

目的对比分析12导联动态心电图、常规心电图在冠心病无症状性心肌缺血伴发心律失常诊断中的临床应用价值。方法选取2018年5月~2020年5月我院心血管科室收治的120例冠心病患者作为研究对象,全部患者均进行常规心电图以及12导联动态心电图检查,在常规心电图检查完成后实施动态心电图检查,采用12导动态心电记录仪对病人进行24h心电变化连续监测。将所有患者的检查诊断结果记录在册,对比分析两种方法的诊断效果。结果 12导联动态心电图检出心肌缺血阳性率为66.67%,显著高于常规心电图检出率38.33%,差异具有统计学意义(P<0.05);在两种心电图中,房性心律失常(二、三联律及成对期)、房室传导阻滞检出率相比无明显差异(P>0.05);但12导联动态心电图室性心律失常(早发及二、三联律)、房性心律失常(早发期)检出率均显著高于常规心电图,差异具有统计学意义(P<0.05)。结论 12导联动态心电图在冠心病无症状性心肌缺血伴发心律失常的诊断中检出率更高,临床使用价值高。     

Evidence of a selective increase in cardiac sympathetic activity in patients with sustained ventricular arrhythmias

BACKGROUND. Although enhanced efferent cardiac sympathetic nervous activity has been proposed as an important factor in the genesis of ventricular arrhythmias and sudden cardiac death, direct clinical evidence has been lacking. METHODS. We measured the rates of total and cardiac norepinephrine spillover into the plasma, which reflect respectively overall and cardiac sympathetic nervous activity, in 12 patients who had recovered from a spontaneous, sustained episode of ventricular tachycardia or ventricular fibrillation outside the hospital 4 to 48 days earlier. The results were compared with those from three age-matched reference groups without a history of ventricular arrhythmias: 12 patients with coronary artery disease, 6 patients with chest pain but normal coronary arteries, and 12 healthy, normal subjects. RESULTS. The patients who had had ventricular arrhythmias had reduced left ventricular ejection fractions, as compared with the patients with coronary artery disease or chest pain (mean [+/- SE], 46 +/- 3 percent vs. 58 +/- 4 percent and 69 +/- 5 percent, respectively; P less than 0.003). The rates of total norepinephrine spillover into the plasma were similar in the three reference groups, but 80 percent higher in the patients with ventricular arrhythmias (P less than 0.005). The rate of cardiac norepinephrine spillover was 450 percent higher in these patients (176 +/- 39 pmol per minute, as compared with 32 +/- 8 pmol per minute in the normal subjects; P less than 0.001), a disproportionate increase relative to the increase in total spillover, which indicated selective activation of the cardiac sympathetic outflow. This increase in cardiac norepinephrine spillover was probably caused by a reduction in left ventricular function. CONCLUSIONS. These results suggest that in some patients major ventricular arrhythmias are associated with and perhaps caused by sustained and selective cardiac sympathetic activation. We speculate that depressed ventricular function was present before the ventricular arrhythmia occurred, and that this resulted in reflex cardiac sympathetic activation, which in turn contributed to the genesis of the arrhythmia.     

非体外循环下冠状动脉旁路移植围术期血浆脑钠肽释放及其相关性研究

背景：B型脑钠肽已成为心血管疾病诊断重要的血清标志物,作为心血管疾病危险因素分层的重要因子。 目的：分析冠状动脉旁路移植前后B型脑钠肽与各项血流动力学参数的关系。 方法：选择30例冠心病行冠脉旁路移植患者,分为左室射血分数≥ 50%心功能正常患者13例;左室射血分数< 50%心功能不全患者17例。观察患者移植前1 d、移植后7 h、移植后1,3,5,7 d血浆B型脑钠肽水平变化趋势,分析移植前后B型脑钠肽与心功能各项指标的相关关系。 结果与结论：左室射血分数≥ 50%组患者冠脉旁路移植前后血浆B型脑钠肽水平显著低于左室射血分数< 50%组;组内比较移植后血浆B型脑钠肽水平均显著高于移植前(P < 0.05或P < 0.001)。患者冠脉旁路移植前B型脑钠肽水平与纽约心脏病协会心功能分级、左房内径、左室内径呈正相关(r=0.61;r=0．34;r=0．67);与左室射血分数、心排血量呈负相关(r=-0.75;r=-0.70)。患者移植后B型脑钠肽峰值浓度与出院前纽约心脏病协会心功能分级、超声心动图左室舒张末期内径、肺动脉压力呈正相关(r=0.72;r=0.70;r=0.45)。结果说明冠心病患者冠脉旁路移植前血浆B型脑钠肽质量浓度与左心室射血分数及左心室舒张末期内径有很好的相关性,能准确反映冠脉旁路移植前后的心功能状态。 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程全文链接：     

心衰患者房性心律失常动态心电图分析

目的:分析充血性心力衰竭(心衰)患者房性心律失常的动态心电图特点。方法:选择心衰患者42例,非心衰患者40例,分析24h动态心电图。结果:心衰组房性早搏、短阵房性心动过速、心房扑动、心房颤动的发生率明显高于对照组。结论:心衰患者房性心律失常的发生率较高,其存在与心衰患者预后也有密切关系。     

糖尿病合并冠状动脉狭窄患者左室造影前后左室舒张末压差值比较研究

目的 探讨糖尿病对合并冠状动脉狭窄患者左室造影前后舒张末压差值和左室功能的影响。方法 选择行冠状动脉造影及左室造影的患者834例，其中无冠脉病变的患者172例，冠状动脉狭窄的患者662例。根据其有无糖尿病，将之分为糖尿病合并冠状动脉狭窄组(DM组)110人，及单纯冠状动脉狭窄组(非DM组)552人，所有病人都进行左室造影，测定左室射血分数(EF)，造影前后左室舒张末压(D1、D2)。结果 DM组患者造影前后左室舒张末压的差值(D3)明显高于非DM组的患者，两组间的射血分数无明显差异，年龄增加、糖尿病、EF的降低，与造影前后左室舒张末压的差值呈负相关。结论 糖尿病合并冠状动脉狭窄患者可以在心脏的收缩功能发生异常之前，表现出对心脏舒张功能的损害，而造影前后，左室舒张末压的差值可以更为敏感地反映左室舒张功能的改变。     

The acute effect of ajmaline on ventricular arrhythmia after cardiac surgery

The acute effect of ajmaline was investigated in the treatment of postoperative ventricular arrhythmias. Ajmaline (Glurytmal--Giulini Pharma GMBH) was applied intravenously in 15 patients suffering from ventricular premature beats (Lown II--IV/b), tachycardia and/or ventricular fibrillation after open heart surgery. Ajmaline infusion produced in 40% of the cases a total suppression and in 100% a significant improvement of malignant ventricular arrhythmia. In patients with recurrent and resistant ventricular tachycardia, ajmaline proved effective even when other antiarrhythmic drugs had failed. It was shown to be effective in reducing ventricular premature contractions and recurrent ventricular tachycardia after heart surgery, without haemodynamic side effects. Because of recurrent ventricular premature beats in 11 patients after acute ajmaline administration further oral application of prajmalium bitartarate (Neo-Gilurytmal) was necessary. The maintenance of these patients on oral ajmaline treatment seemed important.     

Chagas' heart disease in the United States

BACKGROUND AND METHODS. Chagas' heart disease is believed to be rare in the United States, although many persons from countries where the disease is endemic reside here. We performed a retrospective case review and prospective follow-up of 25 patients with Chagas' heart disease and no obstructive coronary artery disease on angiography. RESULTS. The patients mainly presented with symptomatic atrioventricular block, congestive heart failure, anginal chest pain, sudden death averted by resuscitation, or sustained ventricular tachycardia. Of the 25 patients, 18 had been treated for coronary artery disease or idiopathic dilated cardiomyopathy for up to 108 months before the diagnosis of Chagas' disease was considered. The electrocardiograms frequently suggested coronary artery disease. Six of the seven patients who had exercise thallium-perfusion scans had abnormalities suggesting ischemia or infarction. A left ventricular aneurysm was found in 14 of the 25 patients, segmental akinesia or hypokinesia in 5, and diffuse hypokinesia in 3. Programmed ventricular stimulation performed in 13 patients induced sustained ventricular tachycardia in 9 and nonsustained ventricular tachycardia in 2. Actuarial survival (mean +/- SE) after four years for the entire group was 56 +/- 12 percent; it was 32 +/- 16 percent among those with global left ventricular dysfunction, and 78 +/- 14 percent among those without such dysfunction (P = 0.03). Only patients with left ventricular dysfunction or an aneurysm died (four-year survival, 45 +/- 14 percent, as compared with 100 percent for the remaining patients; P = 0.0002). Heart failure and left ventricular aneurysm or dysfunction were the only independent predictors of death. Nine patients required permanent pacemakers. CONCLUSIONS. In the United States, Chagas' heart disease commonly mimics coronary artery disease or idiopathic dilated cardiomyopathy. The prognosis is poor for patients with heart failure or left ventricular aneurysm or dysfunction. The disease may be underdiagnosed in the United States.     

Congenital heart defect in a patient with deletion of chromosome 7q

We describe a premature male infant with a terminal deletion of 7q [del(7) (pter----q34:)]. Manifestations include low birth weight, hypertelorism, bilateral cleft lip and palate, cryptorchidism, and a complex congenital heart defect. The latter consisted of hypoplasia of the main pulmonary artery, absent pulmonary valve, ventricular septal defect, and anomalous right pulmonary artery. We briefly review the spectrum of heart defects seen with chromosome 7 deletions, and comment on the incidence of this unusual heart lesion.     

Long-term outcome in asymptomatic men with exercise-induced premature ventricular depolarizations

BACKGROUND: Exercise testing is widely used in the diagnosis of coronary artery disease, but the long-term outcome for asymptomatic persons with exercise-induced premature ventricular depolarizations remains unclear. We used data from the Paris Prospective Study I to assess the long-term outcome for such persons. METHODS: A total of 6101 asymptomatic French men (42 to 53 years of age) who were free of clinically detectable cardiovascular disease underwent a standardized graded exercise test between 1967 and 1972. Subjects were prospectively classified as having or not having frequent premature ventricular depolarizations (a run of two or more consecutive premature ventricular depolarizations or premature ventricular depolarizations constituting more than 10 percent of all ventricular depolarizations during any of the 30-second electrocardiographic recordings). RESULTS: During exercise, 138 subjects had frequent premature ventricular depolarizations. After 23 years of follow-up, these subjects had a higher risk of death from cardiovascular causes than the men without frequent premature ventricular depolarizations during exercise (relative risk, 2.67; 95 percent confidence interval, 1.76 to 4.07). In a multivariate model, with adjustment for age, body-mass index, heart rate at rest, systolic blood pressure, tobacco use, level of physical activity, presence or absence of diabetes, total cholesterol level, and the presence or absence of premature ventricular depolarizations before exercise and during recovery from exercise, both an exercise test that was positive for ischemia and the occurrence of frequent premature ventricular depolarizations during exercise remained independently associated with an increased risk of death from cardiovascular causes, with similar relative risks (2.63 [95 percent confidence interval, 1.93 to 3.59] and 2.53 [95 percent confidence interval, 1.65 to 3.88], respectively). CONCLUSIONS: The occurrence of frequent premature ventricular depolarizations during exercise in asymptomatic middle-aged men is associated with a long-term increase in the risk of death from cardiovascular causes.     

Zacopride缺血后适应抑制大鼠缺血/再灌注性心律失常

目的:探讨心肌内向整流钾通道(K_(ir))激动剂zacopride缺血后适应对大鼠缺血/再灌注性心律失常的影响及可能的电生理学机制。方法:SD大鼠Langendorff离体灌流心脏和在体麻醉大鼠冠状动脉左前降支结扎15 min后松扎15 min诱发缺血/再灌注性心律失常。在冠状动脉左前降支松扎前3 min给予zacopride,观察缺血后适应对再灌注性心律失常的影响。胶原酶法分离大鼠单个心室肌细胞,应用全细胞膜片钳技术观察zacopride对心室肌细胞缺氧/复氧致延迟后除极的影响和对细胞膜表面ATP敏感性钾通道(KATP)的影响。结果:大鼠离体心脏再灌注时预先给予0.1~10μmol/L zacopride可有效抑制再灌注性心律失常的发生。其中0.1μmol/L zacopride为最大效应浓度,可使期前收缩数减少,室速和室颤发生率均下降,持续时间均缩短;再灌前3 min将1μmol/L BaCl_2和0.1μmol/L zacopride同时灌流心脏,BaCl_2可部分逆转zacopride的保护效应(P0.01),表明zacopride的后适应保护与其增强K_(ir)电流的作用有关。在1.5~5μg/kg剂量范围内,zacopride对大鼠在体再灌注诱发的室速和室颤有明显抑制效应,但对期前收缩数无明显影响。1.5μg/kg zacopride抗心律失常的效应与阳性对照药利多卡因(7.5 mg/kg)相似。进一步研究发现zacopride可有效抑制缺氧/复氧所致心室肌细胞延迟后除极,降低其发生率(P0.01)。Zacopride的上述效应与K_(ATP)无关。结论:Zacopride对大鼠缺血/再灌注性心律失常的抑制作用是由激活心肌细胞K_(ir)介导的。激活K_(ir)并消除延迟后除极所诱发的触发性活动可能是zacopride缺血后适应的主要机制。