冠心病患者左心功能的改变

目的:观察不同程度冠心病患者左心功能的变化。方法;78例冠心病患者分成稳定性心绞痛(SA)、不稳定性心绞痛(UA)、急性心肌梗死(AMI)和陈旧性心肌梗死(OMI)4组,并与30例健康成人(对照组)比较。采用无创伤自动检测仪及彩色多普勒血流显像仪测定心功能指标;心排血指数(CI),外周阻力(TPR),左室射血前期(PEP)及左室射血时间(LVET);左室收缩功能:射血分数,每搏量,心搏出量;左室舒张功能:A峰,E峰,峰值速度比值,峰值充盈,标准化充盈速度。结果:AMI和OMI组心功能明显减低(P<0.01):CI减少,TPR增高,PEP延长,LVET缩短,左室收缩功能减弱,舒张功能降低;UA和SA组心功能减低(P<0.05～<0.01);AMI和OMI组比UA和SA组心功能减低有显著差异(P<0.05)。结论;冠心病随病情加重,心功能明显恶化。     

超声心动图评价冠心病左房容积及功能改变的研究进展

冠心病(Coronary artery disease)是最常见的心血管疾病之一,是导致心血管事件发生的主要原因。左心房(LA)在整个心脏功能中起着重要的作用。最近临床上的研究大多关注左心房的功能,并证实左心房扩大不仅是预测心肌梗死和血管重建的独立因素,而且也是急性心肌梗死后全因死亡率增加的一个重要指标。本综述的目的是总结评估左心房大小和功能参数的各种超声心动图方法。     

微血管性心绞痛患者亚临床甲减与心功能的关系研究

目的 探讨冠状动脉微血管性心绞痛（coronary microvascular angina,CMVA）患者亚临床型甲状腺功能减退症（subclinical hypothyroidism,SCH）对心脏射血功能的影响。方法 应用智业电子病历系统选择2015年5月至2019年5月在我院诊断为CMVA的患者165例为CMVA组,根据是否伴SCH再分亚组为：甲功正常组和SCH组;选择同期健康查体者116例为对照组。应用化学发光免疫法测定甲状腺激素和生化指标,采用彩色超声心动图评价心脏功能。结果 CMVA组SCH患病率和TPOAb阳性率显著高于对照组（29.7% 比16.4% 和26.1% 比18.1%;P<0.05）。CMVA组TC、TG、HDL-C、LDL-C、CRP、尿酸、ApoB和E/A与对照组比较差异有统计学意义（分别为5.25±1.26和4.53±0.65、1.33±0.67和1.02±0.31、1.18±0.28和1.56±0.33、3.25±0.83和3.02±0.18、3.21±0.55和2.83±0.33、357±72和268±81、1.17±0.30和0.86±0.27、0.78±1.54和1.15±1.43;均P<0.05）。CMVA伴SCH组与甲功正常组比较,E/A比值显著降低（分别为0.61±1.47和1.16±1.62）,差异有统计学意义（P<0.05）。CMVA患者的TSH水平与LVEF和E/A比值相关,r 值分别为0.205和0.305,P均<0.05;FT3水平与E/A比值相关,r=0.260,P<0.05。结论 CMVA患者SCH影响了心脏的射血功能,参与了CMVA的发生和发展,其机制可能与脂质代谢有关。     

Improvement in left ventricular diastolic function in patients with stable angina after chronic treatment with verapamil and nicardipine

A placebo-controlled double-blind randomized crossover studywas carried out to assess the effects of chronic therapy withtwo calcium antagonists on left ventricular diastolic functionin patients with stable angina. Ventricular function was assessedusing equilibrium radionuclide angiography and the data wasanalysed using an automated algorithm. The mean±SD ejectionfraction on placebo was 59±10% and this remained unchangedon both verapamil (59 ±9%; P = NS) and nicardipine (58±7%; P = NS). Verapamil increased the peak filling rateindex (P<0.001) and first one-third filling fraction (P<0.005).Nicardipine increased the peak filling rate index (P < 0.005),but did not alter the other diastolic indices. Early fillingrate index was not altered by either drug. Comparison of theeffects of nicardipine and verapamil revealed no significantdifferences in ejection fraction, peak filling rate index orearly filling rate index. However, verapamil showed a greaterimprovement in time to peak filling rate and first one-thirdfilling fraction (P<0.01, P<0.01, respectively) comparedwith nicardipine. Heart rate (P<0.002) and systolic bloodpressure (P<0.01) were also lower on verapamil than on nicardipine.These data suggest that left ventricular ‘relaxation’abnormalities may be detected in patients with chronic anginapectons before systolic dysfunction becomes apparent and thatthese abnormalities may be partially corrected by calcium antagonists.     

Effect of vericiguat on left ventricular structure and function in patients with heart failure with reduced ejection fraction: The VICTORIA echocardiographic substudy

Aim

Vericiguat significantly reduced the primary composite outcome of heart failure (HF) hospitalization or cardiovascular death in the VICTORIA trial. It is unknown if these outcome benefits are related to reverse left ventricular (LV) remodelling with vericiguat in patients with HF with reduced ejection fraction (HFrEF). The aim of this study was to compare the effects of vericiguat versus placebo on LV structure and function after 8 months of therapy in patients with HFrEF.

Methods and results

Standardized transthoracic echocardiography (TTE) was performed at baseline and after 8 months of therapy in a subset of HFrEF patients in VICTORIA. The co-primary endpoints were changes in LV end-systolic volume index (LVESVI) and LV ejection fraction (LVEF). Quality assurance and central reading were performed by an echocardiographic core laboratory blinded to treatment assignment. A total of 419 patients (208 vericiguat, 211 placebo) with high-quality paired TTE at baseline and 8 months were included. Baseline clinical characteristics were well balanced between treatment groups and echocardiographic characteristics were representative of patients with HFrEF. LVESVI significantly declined (60.7 ± 26.8 to 56.8 ± 30.4 ml/m²; p < 0.01) and LVEF significantly increased (33.0 ± 9.4% to 36.1 ± 10.2%; p < 0.01) in the vericiguat group, but similarly in the placebo group (absolute changes for vericiguat vs. placebo: LVESVI −3.8 ± 15.4 vs. −7.1 ± 20.5 ml/m²; p = 0.07 and LVEF +3.2 ± 8.0% vs. +2.4 ± 7.6%; p = 0.31). The absolute rate per 100 patient-years of the primary composite endpoint at 8 months tended to be lower in the vericiguat group (19.8) than the placebo group (29.6) (p = 0.07).

Conclusions

In this pre-specified echocardiographic study, significant improvements in LV structure and function occurred over 8 months in both vericiguat and placebo in a high-risk HFrEF population with recent worsening HF. Further studies are warranted to define the mechanisms of vericiguat's benefit in HFrEF.     

慢性心力衰竭患者心功能恢复的相关因素研究

目的:分析影响慢性心力衰竭(CHF)患者心功能恢复的相关因素。方法:连续入选232例诊断为CHF并至少随访1年的患者,记录患者临床和生化资料,并定期行超声心动图检测。Logistic回归分析评估影响CHF患者心功能恢复的相关因素。结果:232例患者中56例患者心功能恢复,176例患者心功能未恢复。扩张型心肌病患者较缺血性心肌病患者心功能更易恢复(P0.05),围生期心肌病患者预后良好。与体质量正常或过轻患者相比,体质量指数(BMI)较高的CHF患者心功能更易恢复(P0.05)。心功能恢复患者基础心率偏快,β受体阻滞剂耐受剂量较大,药物治疗后心率下降较明显(P均0.001)。Logistic回归分析显示,患者心功能恢复与CHF病因(OR=1.322,95%CI:1.256~1.392,P=0.04)和β受体阻滞剂剂量(OR=2.483,95%CI:2.359~2.614,P0.001)相关。结论:CHF病因和β受体阻滞剂剂量与CHF患者心功能恢复相关,BMI及基础心率较高患者心功能易于恢复。     

冠心病左心功能不全时肺静脉内径的变化

目的　探索肺静脉内径变化在诊断冠心病左心功能不全时的临床意义。方法　应用二维超声心动图测定 90例正常健康者和 13 2例冠心病患者不同心功能分级时肺静脉显示情况及其内径和左心室射血分数 ,同时测量左心室长轴与主动脉长轴之间的夹角 ,并与正常组对照。结果　冠心病组左心室长轴与主动脉长轴之间的夹角变小 ,右上、左上、左下肺静脉显示率低于正常对照组 ,右下肺静脉显示率高于正常对照组 ,而且心功能越低其显示率越高。左心功能 ～ 级时肺静脉内径与正常对照组相比无明显变化 ,左心功能 ～ 级时肺静脉内径与正常对照组相比明显增宽 (P<0 .0 5 )。结论　左心功能轻、中度减退时不引起肺静脉形态学变化 ,当肺静脉内径增宽 (≥ 1.2 5 cm)时 ,提示临床上存在严重左心功能不全 (左心功能≥ ～ 级 ) ,可作为超声诊断冠心病患者左心功能不全的肺静脉指标     

Improving risk assessment with cardiac testing in peripheral arterial disease

Purpose

The study’s objective was to evaluate the prognostic value of left ventricular ejection fraction and stress-induced ischemia during dobutamine stress echocardiography, in addition to ankle-brachial index measurements and clinical risk factors in patients with suspected or known peripheral arterial disease.

Methods

In 852 patients with suspected or known peripheral arterial disease (mean age 63 years, 70% male), the ankle-brachial index was measured, left ventricular ejection fraction was assessed, and all patients underwent additional stress testing. Endpoints were all-cause mortality and hard cardiac events (cardiac death or nonfatal myocardial infarction).

Results

During a mean follow-up of 7.6 ± 4.4 years, death occurred in 288 patients (34%), and hard cardiac events occurred in 216 patients (25%). Mean left ventricular ejection fraction was 50% ± 17%, and stress-induced ischemia was observed in 352 patients (41%). In multivariate analysis with adjustment for clinical risk factors and ankle-brachial index, each 5% decrease in left ventricular ejection fraction was associated with increased all-cause mortality (hazard ratio [HR] 1.05, 95% confidence interval [CI], 1.02-1.09) and hard events (HR 1.14, 95% CI, 1.08-1.21). Stress-induced ischemia also independently predicted all-cause mortality (HR 2.01, 95% CI, 1.38-2.79) and hard events (HR 2.06, 95% CI, 1.39-3.08). Left ventricular ejection fraction and stress-induced ischemia provided incremental prognostic information over clinical data and ankle-brachial index values (P <.001).

Conclusions

Left ventricular ejection fraction and stress-induced ischemia independently predict long-term outcome and improve prognostic risk assessment, in addition to ankle-brachial index and clinical risk factors in patients with suspected or known peripheral arterial disease.     

冠心病左心室舒张功能对心肌复极离散度的影响

为观察左心室舒张功能与心肌复极离散度的关系,采用脉冲多普勒测定左心室收缩功能正常的56例冠心病及20例健康人的左心室舒张功能,同时描记并测量两组病人心电图有关指数。结果显示:(1)冠心病组病人E、A、A/E、Q-T_d、Q-T_(cd)、J-T_d、J-T_(cd)改变较对照组明显(P<0.01)。(2)冠心病组E、1/2DecT与Q-T_d、J-T_d、J-T_(cd)呈显著负相关(P<0.01)。(3)健康对照组病人E、A、A/E、1/2DecT与Q-T_d、Q-T_(cd)、J-T_(cd)的相关性分析,差异无显著意义(P>0.05)。提示冠心病有左心室舒张功能异常病人的心肌复极离散度增加,冠心病人左心室舒张功能异常与心肌复极之间有良好的相关性。     

冠心病稳定性心绞痛患者血浆髓过氧化物酶的变化

目的观察冠心病稳定性心绞痛患者血浆髓过氧化物酶（MPO）水平。方法选择2个种族的573例已行冠状动脉造影患者，其中295例为冠心病稳定性心绞痛组（SAP组），278例非冠心病稳定性心绞痛为对照组。分别测血浆MPO水平及空腹血浆总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、甘油三酯、葡萄糖、空腹血浆胰岛素、脂联素、纤维蛋白原、超敏C反应蛋白和Ⅶ因子浓度，并采用Spearman法对冠心病稳定性心绞痛的危险因素进行相关性分析。结果MPO水平SAP组为126．3（95．8～160．2）mg／L，对照组为123．6（97．4～150．0）mg／L，差异无统计学意义（P〉0．05）；黑人男性、白人男性、黑人女性及白人女性MPO水平分别为119．6（94．8～146．9）、124．6（99．9～154．6）、124．0（93．3～152．3）mg／L及127．5（95．3～159．8）mg／L，4组比较差异无统计学意义（P〉0．05）。MPO水平与Ⅶ因子（r=0．251，P〈0．01）、空腹血糖（r=0．095，P〈0．05）、甘油三酯（r=0．186，P〈0．01）、总胆固醇（r=0．081，P〈0．05）、超敏C反应蛋白（r=0．123，P〈0．01）和纤维蛋白原（r=0．077，P〈0．01）呈正相关；与脂联素（r=0．115，P〈0．01）呈负相关。结论冠心病稳定性心绞痛患者血浆MPO水平未升高，不是冠心病稳定性心绞痛患者的预测因子，且在性别、种族间无差异。     

Effects of ranolazine in symptomatic patients with stable coronary artery disease. A systematic review and meta-analysis

Background

Ranolazine (R), as add-on therapy in symptomatic patients with chronic stable coronary artery disease (CAD), has been tested in randomized clinical studies. Aim of the study was to assess in a meta-analysis the effects of R on angina, nitroglycerin consumption, functional capacity, electrocardiographic signs of ischemia and hemodynamic parameters in patients with chronic CAD.

Methods

Randomized trials assessing the effects of R compared to control on exercise duration, time to onset of angina, time to 1 mm ST-segment depression, weekly nitroglycerin consumption and weekly angina frequency were included in the analysis. The effects of R compared to control on heart rate and blood pressure were also analyzed.

Results

Six trials enrolling 9223 patients were included in the analysis. At trough and peak levels, R compared to control significantly improved exercise duration, time to onset of angina and time to 1 mm ST-segment depression. Additionally, R compared to control significantly reduced weekly angina frequency and weekly nitroglycerin consumption. Finally, R compared to control did not significantly reduce supine systolic and diastolic blood pressure as well as heart rate, standing heart rate and diastolic blood pressure, whereas it modestly reduced standing systolic blood pressure. At sensitivity analysis, results were not influenced by concomitant background therapy.

Conclusions

In symptomatic patients with chronic CAD, R, added to conventional therapy, effectively reduces angina frequency and sublingual nitroglycerin consumption while prolonging exercise duration as well as time to onset of ischemia and to onset of angina with no substantial effects on blood pressure and heart rate.     

严重左心室功能不全冠心病患者冠状动脉内支架术疗效研究

目的　研究左心室 (左室 )功能不全冠心病患者冠状动脉 (冠脉 )内支架术的疗效及预后。方法　包括 6 6例左室功能不全 (射血分数≤ 0 35 ) (左室功能不全组 )和同期 6 6例年龄、性别及一般情况匹配但左室功能正常的行冠脉内支架术冠心病患者 (对照组 )。比较两组冠脉病变程度 ,冠脉内支架术中及术后随访情况。结果　与对照组相比 ,左室功能不全组多支冠脉病变患者明显增多 ( 6 7%和 4 7% ,P <0 0 5 ) ,完全血运重建率降低 ( 6 5 %和 82 % ,P <0 0 5 ) ;两组术中并发症发生率及支架术成功率均相似 (分别为 3%和 0 % ;95 %和 96 % ,P >0 0 5 )。平均随访二年发现左室功能不全组支架术后左室射血分数明显提高 (术后 0 35± 0 11和术前 0 30± 0 0 4 ,P <0 0 5 ) ,无严重心脏不良事件 ,生存率和对照组相似 ( 80 %和 86 % ,P >0 0 5 )。结论　冠脉内支架术对左室功能不全冠心病患者安全有效 ,术后患者远期生存率与左室功能正常者相似     

Impact of C-reactive protein and fibrinogen on cardiovascular prognosis in patients with stable angina pectoris: the AtheroGene study.

AIMS: C-reactive protein and fibrinogen have been extensively studied and shown to be predictive for a first cardiovascular event in healthy individuals. We evaluated the potential clinical use of C-reactive protein and fibrinogen in patients already suffering from coronary artery disease (CAD). METHODS AND RESULTS: In a substudy of the prospective AtheroGene registry, we assessed in 1806 patients with documented CAD and stable angina pectoris, the risk of cardiovascular death and non-fatal myocardial infarction (n=183) over a median follow-up of 3.5 (maximum 7.7) years according to baseline levels of C-reactive protein and fibrinogen. C-reactive protein and fibrinogen were associated with future cardiovascular events, such as an increment in one standard deviation of C-reactive protein is associated with a 1.15-fold (95% CI 1.05-1.27, P=0.002) increase, an increment of one standard deviation of fibrinogen with a 1.27-fold (95% CI 1.12-1.43, P<0.0005) increase in hazard risk in the models adjusted for age and sex. Adjustment for traditional risk factors and clinical confounders did not significantly attenuate this relationship. In a comparison of a basic model (traditional risk factors; AUC=0.68) with models additionally including either C-reactive protein (AUC=0.69) or fibrinogen (AUC=0.70), only little additional predictive information over that obtained from assessment of traditional risk factors was obtained. CONCLUSION: In patients with documented CAD, C-reactive protein and fibrinogen were predictive for future cardiovascular risk, but did not provide further information on top of that obtained from models including traditional risk factors. Our data emphasize the clinical importance of traditional risk factors in patients with CAD.     

Assessment of the influence of spinal cord stimulation on left ventricular function in patients with severe angina pectoris: an echocardiographic study

Patients with severe, widespread coronary atherosclerosis andpatients who have undergone several coronary artery bypass operationsare often poor candidates for coronary bypass surgery (CABG).Spinal cord stimulation (SCS) has been shown to have an anti-anginaleffect that is probably associated with an anti-ischaemic effect.In the present investigation, 15 patients with severe angina(mean age 64 years, range 49–71) were studied. All patientshad a history of intractable angina pectoris despite optimalmedical treatment and previous coronary bypass operation. Thepatients had multi-vessel disease and graft occlusion or graftstenosis on postoperative coronary angiograms. Left ventricular function was assessed echocardiographicallyat rest and during provocation with adenosine infusion in acontrol session without treatment and during treatment withSCS. The recovery time was at least 3h. The decrease in the ejection fraction during adenosine infusionwas more pronounced in the control situation (44 to 37%; P<0.05)than during SCS (48 to 44%; ns), and the time to echocardiographicsigns of dysfunction and to angina/pain during adenosine infusionwas significantly prolonged during SCS (P<0.001). In addition,the recovery time for these parameters was shorter during SCS(Plt;0.001). It is concluded that the deterioration in left ventricular functionduring adenosine provocation was less pronounced with SCS thanwithout. This possible anti-ischaemic effect is in agreementwith results from earlier studies.     

冠脏病变对心脏左室舒缩功能的影响

目的：通过超声心动图检查，探讨冠脏病变对左室收缩，舒张功能的影响。方法：67例行冠状动脉造影检查，据检查结果被分成冠心病组（46例），正常对照组（25例），分别行超声心动图检查，测量其每搏量，心输出量，左室短轴缩短率，射血分数，二尖瓣口E，A峰血流速度（E，A峰值）及E／A比值。结果：与正常对照组比较，冠心病组收缩功能指标中每搏量增加（P＜0．01）。舒张功能指标中E峰降低（P＜0．05），A峰升高（P＜0．01），E／A比值降低（P＜0．01）。结论：冠脉病变影响心脏功能，早期先影响舒张功能。     

糖化血红蛋白水平与冠状动脉病变支数及心功能的相关性研究

目的：探讨血清糖化血红蛋白（HbA1c）水平与冠心病患者冠状动脉病变支数和心功能的关系。方法对253例入住我院并接受冠状动脉造影检查确诊为冠心病的患者,按HbAlc水平分为3组：正常组（HbA1c≤5.6％,n=75）、临界组（HbA1c 5.7％～6.4％,n=85）、升高组（HbA1c≥6.5%,n=89）。根据冠状动脉病变支数分为单支病变组（n＝95）、双支病变组（n＝103）和多支病变组（n＝55）,分析HbA1c水平与冠状动脉病变支数及心功能的相关性。结果 HbAlc水平与冠状动脉病变支数呈正相关（r=0.75,P＜0.01）。HbAlc水平三支病变组高于双支病变组,双支病变组高于单支病变组,临界组和升高组的左心室舒张末期内径（LVEDd）及B型脑钠肽（BNP）均高于正常组,左心室射血分数（LVEF）均低于正常组,升高组的LVEDd及BNP高于临界组、LVEF低于临界组（均P＜0.01）。HbAlc水平与LVEDd及BNP水平均呈正相关（r=0.73、0.62,均P＜0.05）,与LVEF呈负相关（r=-0.58,P＜0.05）。结论 HbAlc增高者冠状动脉病变支数较多,左心室腔较大,心功能较差。     

Amlodipine reduces myocardial ischaemia during exercise without compromising left ventricular function in patients with silent ischaemia: a randomised, double-blind, placebo-controlled study

BACKGROUND: Left ventricular systolic function is reduced during episodes of silent ischaemia in patients with coronary artery disease (CAD). In most normal subjects left ventricular ejection fraction (LVEF) increases at least 5% during exercise whereas LVEF often remains unchanged or decreases in patients with CAD. The anti-ischaemic effect of calcium antagonists is well documented including a capability to reduce exercise-induced electrocardiographic ST-depressions, whereas the effect of these drugs on LV volume changes during exercise in patients with silent ischaemia is unknown. AIM: The aim of this study was to evaluate the effect of amlodipine on rest and exercise LVEF in patients with silent ischaemia. METHODS: Twenty-one patients completed a double-blind placebo-controlled cross-over study. Conventional exercise test and radionuclide cardiographies during exercise were used for determining haemodynamic parameters. RESULTS: Exercise-induced electrocardiographic ST-depressions were reduced in 83% of the patients having ST-deviations during placebo even though 10 patients were already treated with a beta-blocker. Amlodipine did not affect left ventricular systolic function compared to placebo, neither at rest nor during exercise. CONCLUSION: The results indicated that amlodipine is a safe anti-ischaemic drug in patients with silent ischaemia concerning cardiac function.     

超声心动图对心肌梗死后患者左心室重构及其与心功能关系的研究

目的　探讨超声心动图评价心肌梗死后左心室重构及其对心功能影响的价值。方法　应用多普勒超声测量 45例心肌梗死患者和 2 0例健康人对照组左心室大小、左心室收缩功能和舒张功能指标 ,并进行比较。结果　45例患者中 ,2 5例收缩功能异常 (EF=38.2 4± 9.43% ) ,其左心室增大及形态改变最明显 (L VDd 5 .94± 0 .95 cm )。另外 2 0例收缩功能正常 (EF=6 2 .0 0± 5 .96 % ) ,其左心室大小及形态无明显改变 (L VDd=5 .0 4± 0 .37cm)。两组比较差异显著 ,P<0 .0 0 1。两组心肌梗死患者均比正常对照组舒张功能 E峰减低、A峰增高、E/ A比值减小、DC减慢 P<0 .0 1。结论　心肌梗死后左心室重构与心功能变化密切相关。由左心室重构而引起的心脏扩大及球形改变 ,可进而影响心功能 ,导致心力衰竭发生     

Global and regional left ventricular function assessment with 16-detector row CT: comparison with echocardiography and cardiovascular magnetic resonance.

AIMS: To compare multidetector row computed tomography (MDCT) global and regional left ventricular (LV) function assessment with echocardiography and cardiovascular magnetic resonance (CMR). METHODS AND RESULTS: In 25 patients, who were referred for noninvasive angiography with 16-detector row CT, LV function assessment was also performed. A subsequent echocardiogram was performed, and in a subgroup of patients, CMR examination was completed to evaluate LV function. For global function assessment, the LV ejection fraction (LVEF) was calculated. Regional LV function was scored using a 17-segment model and a 4-point scoring system. MDCT agreed well with echocardiography for the assessment of LVEF (r=0.96; bias 0.54%; p<0.0001) and regional LV function (kappa=0.78). Eight patients had no contra-indications and gave informed consent for CMR examination. A fair correlation between MDCT and CMR was demonstrated in the assessment of LVEF (r=0.86; bias -1.5%; p<0.01). Regional LV function agreement between MDCT and CMR was good (kappa=0.86). CONCLUSION: MDCT agreed well with both echocardiography and CMR in the assessment of global and regional LV function. Global and regional LV function may accurately be evaluated by 16-detector row CT, and can be added to a routine CT image analysis protocol without need for additional contrast or imaging time.