QT离散度对慢性充血性心力衰竭的临床意义

本文分析６６例ＮＹＨＡ分级法心功能Ⅲ－Ⅳ级的慢性充血性心力衰竭患者治疗前后ＱＴ离散度，并与正常组对照，结果表明：１．ＣＨＦ组较正常对照组ＱＴｄ显著延长，不同病因组间无差异；２．住院观察期间，ＱＴｄ在非持续性室速组及死于慢性心衰的病人组无显著延长，１例心性猝死者ＱＴｄ显著处长；３．治疗好转后ＱＴｄ呈下降趋势，治疗无效，恶化者ＱＴｄ进一步延长。     

美托洛尔对慢性心力衰竭患者QT离散度的影响

目的探讨美托洛尔对慢性心力衰竭患者QT离散度的影响。方法采用对比研究,美托洛尔组在常规治疗组的基础上加美托洛尔口服治疗,所有病例均随访观察6个月,分别测定入院当天、6周和6月时的QTd,同时观察平均心率的变化和严重心律失常(频发,多源或RonT现象的室性早搏,室性心动过速,心室颤动)的发生情况。结果美托洛尔组QTd从入院时为68.1±24.3ms,6周后下降为53.4±25.6ms,6个月下降为45.3±31.0ms;恶性室性心律失常的发生率入院时为64.1%,6周后为30.8%,6个月后为12.8%;对照组QTd分别为67.3±27.8ms、60.9±31.2ms和58.6±28.1ms,恶性室性心律失常的发生率分别为53.8%、41.0%和38.5%。结论美托洛尔能改善慢性心力衰竭患者的QTd,降低恶性室性心律失常的发生率。     

QT离散度对心衰患者心脏事件的预测价值

目的探讨QT离散度(QTd)、校正QT离散度(QTcd)及心率校正QT间期(QTc)对心衰患者心脏事件的预测价值。方法回顾性研究了106例充血性心力衰竭(CHF)患者QTd、QTcd、及QTc的资料。结果心脏事件发生组CHF病人(Ⅰ组)QTd、QTcd、QTc、QTcd/QTc与无心脏事件发生组(Ⅱ组)比较有显著的统计学差异(P<0.05、<0.01、<0.05、<0.001)。结论QTd、QTcd、QTc、QTcd/QTc是心衰病人心脏事件独立预测因子,QTcd/QTc准确性最高。     

老年充血性心力衰竭患者QT离散度的临床意义

ＱＴ离散度 (ＱＴｄ)反映心室肌复极的不均一性 ,在许多心脏病中具有预测恶性心律失常的价值。我们观察了 65例老年人充血性心力衰竭病人的ＱＴｄ ,以探讨ＱＴｄ在老年充血性心力衰竭患者中的临床意义。1　资料与方法选择近 2年资料较完整的住院老年充血性心力衰竭患者共 65例 ,其中男 43例 ,女 2 2例 ,年龄 60～82 (平均 68 4)岁 ,平均心衰病程 5 5年。按ＮＹＨＡ心功能分级标准 ,心功能Ⅳ级 46例 (70 8% ) ,心功能Ⅲ级3 1例 (2 9 2 % ) ;超声心动图检查发现均有心脏扩大 ,平均左室舒张末期内径 (ＬＶＤ)为(66± 5 2 )ｍｍ。室性心律失…     

左卡尼汀对急性心肌梗死患者QT离散度及心率变异性的影响

目的研究左卡尼汀对急性心肌梗死（AMI）患者QT离散度（QTd和QTcd）心率变异性（HaY）的影响。方法120例AMI患者被随机分为常规治疗组（60例）和左卡尼汀治疗组（60例）。两组均给予常规治疗,左卡尼汀治疗组在此基础上加用左卡尼汀3．0g静脉滴注,每日1次,14d为一个疗程。评价治疗前后QT离散度和心率变异性指标的改变。结果与治疗前比较,两组患者QTd、QTcd明显降低（P〈0．05或P〈0．01）,各项时域指标均明显升高（P〈0．05或P〈0．01）,频域指标LF、LF／HF降低,HF升高（P〈0．05或P〈0．01）,两组治疗后比较差异有统计学意义（P〈0.05）。结论左卡尼汀可以显著缩短AMI患者QT离散度,提高心率变异性,改善缺血心肌电不稳定性。     

左旋卡尼汀对心力衰竭患者血清游离脂肪酸浓度的影响

目的 :探讨左旋卡尼汀 （L - CN ）治疗充血性心力衰竭 （CHF）的临床疗效及对血清游离脂肪酸 （FFA ）浓度的影响。方法 :CHF患者 5 0例 ,分为 L - CN组 （2 5例 ）和对照组 （2 5例 ）。对照组采用常规药物治疗 ,L - CN组常规药物加L - CN治疗 ,采用酶比色法测定治疗前、后血清 FFA浓度 ,并观察心功能改变情况。结果 :CHF患者治疗后血清中FFA浓度较治疗前明显下降 （P<0 .0 5或 P<0 .0 1） ,且 L - CN组 FFA浓度在治疗后显著低于对照组 （P<0 .0 5 ） ;治疗后两组心功能较治疗前明显改善 ,L - CN组心功能改善程度较对照组更明显 ,L - CN组治疗显效率及总有效率均高于对照组 （P<0 .0 5 ）。结论 :L - CN治疗不但能改善心功能 ,而且能降低血清 FFA水平。     

充血性心力衰竭患者P波离散度与QT离散度的关系及意义

目的探讨慢性充血性心力衰竭(CHF)患者P波离散度(Pd)与QT离散度(QTd)的关系及意义。方法选择CHF患者43例为观察组,正常人41例为对照组,窦性心率下测量体表12导联心电图的Pd和QTd进行分析。结果①CHF组的Pd和QTd明显大于对照组(P<0.01);②Pd与QTd呈显著正相关(r=0.43,P<0.05);③QTd>100ms组Pd明显大于QTd<100ms组(P<0.05)。结论在CHF患者中Pd与QTd存在相关性,这对CHF患者发生心律失常的病理生理、预测和治疗等可能有一定意义。     

充血性心力衰竭患者QT离散度与室性心律失常的关系

<正> 近几年来,人们发现QT间期离散度(QTd)具有一定的临床意义.本文分析100例重度(心功能Ⅲ、Ⅳ级)充血性心力衰竭(CHF)患者QTd与严重室性心律失常的关系.1 对象与方法1.1 对象全部病例均系本院住院患者.根据Framingham心力衰竭诊断标准,确诊为充血性心力衰竭;按NYHA分级评定心功能,随机选择心功能Ⅲ、Ⅳ级患者为观察对象.共观察101例,男性76例,女性24例,平均年龄59.3岁.     

左旋卡尼汀治疗老年充血性心力衰竭效果

目的　观察国产左旋卡尼汀在治疗老年人充血性心力衰竭中的作用。方法　选择 6 5岁以上有慢性充血性心力衰竭病人 6 5例 ,随机分常规治疗组 (地高辛、ACEL、ARB、利尿剂、血管扩张剂等 )和左旋卡尼汀组 (在常规治疗基础上加用国产左旋卡尼汀 )。结果　左旋卡尼汀组疗效明显优于对照组 (P <0 0 0 1)。结论用左旋卡尼汀治疗老年人充血性心力衰竭安全有效 ,而且能改善预后。     

Circadian Pattern of the QT Dispersion Using Three Orthogonal Leads of a Holter ECG in Patients with Heart Failure

This study evaluated: (1) if three orthogonal leads (3-OL) can provide the same information about QT dispersion (QT-D) as 12-lead ECG; (2) the circadian pattern of QT-D adopting 3-OL during 24-hour Holter monitoring; (3) if the QT-D circadian pattern is influenced by therapy. In the first part of the study, we evidenced a significant direct correlation (r = 0.91; P < 0.0005) between QT-D values of 12 ECG leads and of 3-OL simultaneously recorded in 15 normal subjects and 11 patients with myocardial infarction. The second part of the study evaluated the circadian pattern of QT-D adopting 3-OL during Holter (ELA Medical, Mod. Synesis) monitoring in 15 patients with congestive heart failure (CHF: aged 73 ± 8 yrs. III NYHA) in pharmacological washout and after 10 days of therapy (furosemide, digoxin, captopril) and in 15 age-matched normal subjects (N: aged 70 ± J yrs). Mean QT-D values of CHF before therapy were significantly higher at each hour than those of N (always P < 0.001). Mean hourly QT-D values after therapy were significantly lower than those before therapy (P < 0.03 up to P < 0.001), except for the value at 9:00 A.M. Our results suggest that: (1) 3-OL can evaluate QT-D as much as the usual 12-lead ECG; (2) the use of 3-OL during Holter monitoring allows the evaluation of the QT dispersion circadian pattern both in N and in CHF; and (3) therapy is able to modify the circadian pattern of QT-D.     

QT Intervals and QT Dispersion Determined from a 12‐Lead 24‐Hour Holter Recording in Patients with Coronary Artery Disease and Patients with Heart Failure

Background: QT dispersion is considered an index of spatial inhomogeneity of repolarization duration and increased dispersion of ventricular repolarization is supposed to increase the risk of ventricular arrhythmia. Circadian variation in QT dispersion was investigated. Methods: Three different modes of lead selection was used: all 12‐leads (QTdisp 12), only precordial leads (QTdisp 6), and one pair of preselected leads (QTdisp 2) in a 24‐hour Holter recording every fourth hour each comprising 10 consecutive measurements in 54 healthy subjects, 29 patients with coronary artery disease (CAD), and 29 patients with heart failure (HF). Results: A significant circadian variation was observed in healthy subjects when modes QTdisp 12 and QTdisp 6 were used (Mean ± SD 35.58 ± 16.48 ms; P < 0.0001; and 28.82 ± 16.02 ms; P < 0.0001, respectively), and in patients with CAD (Mean ± SD 37.86 ± 17.87 ms; P < 0.01; and 28.72 ± 17.06 ms; P < 0.0001, respectively), whereas no circadian variation was observed in QTdisp 2. No circadian variation was observed in patients with HF irrespectively of lead selection. Patients with CAD without myocardial infarction (MI) had a circadian variation in QTdisp 12 (Mean ± SD 33.13 ± 14.86 ms; P < 0.05), whereas no circadian variation was observed in patients with MI (Mean ± SD 40.35 ± 18.80 ms; P = NS). Conclusions: Circadian variation of QT dispersion was detected in healthy subjects and in patients with uncomplicated CAD, but not in those who had suffered a previous MI and in patients with HF. The number of leads among which selection of the longest and shortest QT intervals took place was critical for the disclosure of circadian variation of QT dispersion.     

盐酸苯那普利对冠心病心力衰竭患者校正后QT间期离散度的影响

目的：探讨盐酸苯那普利对冠心病心力衰竭患者校正后ＱＴ间期离散度（ＱＴｃｄ）的影响及发生机制。方法：采用随机双盲法对４０例冠心病心力衰竭患者（ＮＹＨＡⅡ～Ⅲ级）口服盐酸苯那普利（治疗组２０例）和安慰剂（安慰剂组２０例）治疗６周，并对治疗前后的ＱＴｃｄ、左心室射血分数（ＬＶＥＦ）、血管紧张素Ⅱ及醛固酮进行检测及分析。并设正常组２０例作对照。结果：经盐酸苯那普利治疗后，ＬＶＥＦ明显提高，ＱＴｃｄ、血管紧张素Ⅱ、醛固酮明显降低；ＬＶＥＦ和血管紧张素Ⅱ呈一定负相关（ｒ＝－０．２９９，Ｐ＜０．０５），但不呈线性关系；ＬＶＥＦ和醛固酮呈负相关，但相关性更弱（ｒ＝－０．１４５，Ｐ＞０．０５），且ＬＶＥＦ也和ＱＴｃｄ呈一定负相关（ｒ＝－０．２９８，Ｐ＜０．０５）。结论：盐酸苯那普利治疗冠心病心力衰竭除与其能阻滞肾素—血管紧张素—醛固酮系统有关外，还与其能降低ＱＴｃｄ有关     

美托洛尔对充血性心力衰竭患者QT离散度的影响及临床意义

目的探讨美托洛尔对充血性心力衰竭（CHF）患者QT离散度的影响及临床意义。方法将56例CHF患者随机分为治疗组（28例）和对照组（28例）,对照组采用常规治疗,治疗组在常规治疗的基础上加用美托洛尔,并作治疗前后的QTd测量及比较。结果QTd与心功能受损的程度呈正相关;CHF伴室性心律失常者QTd大于不伴室性心律失常者（P〈0.05）;给予美托洛尔治疗后CHF患者QTd明显缩短（P〈0.05）。结论CHF患者QTd明显增大。美托洛尔可使QTd缩小,对防治室性心律失常和猝死有重要意义。     

银杏达莫注射液对冠心病PCI术后患者QT离散度的影响

目的观察银杏达莫注射液对冠心病(CHD)患者PCI术后QT离散度(QTd)的影响,进一步探讨其临床应用价值。方法 216例冠心病接受PCI治疗患者,随机分为银杏达莫干预组112例,常规治疗组104例,分别测量两组患者手术前后及术后10d的QTd。同时测定对照者QTd。结果 (1)冠心病患者QTd较对照者明显延长,差异有统计学意义(P<0.05)。(2)两组患者PCI术后QTd明显缩短,差异有统计学意义(P<0.05)。(3)常规治疗组QTd术后10d较术后1d有下降趋势,但差异无统计学意义;银杏达莫干预组术后10d较术后1d QTd明显下降,差异有统计学意义。(4)术后10d,银杏达莫干预组较常规治疗组QTd明显缩短,差异有统计学意义。结论银杏达莫注射液可有效降低冠心病PCI术后患者的QTd,有很好的临床使用价值。     

同时行平板运动试验、QT离散度检查对冠心病诊断价值的研究

探讨同时行平板运动试验 (ETT)和测量QT间期离散度 (QTd)对反映冠状动脉病变的价值及应用前景。与冠状动脉造影结果对照分析 83例临床诊断或疑诊为冠心病患者的ETT、QTd(试验中ST段下移最大时或最大负荷心率时 )的结果。结果 :①ETT、QTd和系列法双项复合试验的灵敏性分别为 71.7%、79.2 %和 5 6 .6 % ;特异性分别为70 %、80 %和 96 .7% ;阳性预测值分别为 80 .9%、87.5 %和 96 .8% ;阴性预测值分别为 5 8.3%、6 8.6 %和 5 5 .8%。②ETT和QTd的灵敏性主要取决于受检人群、冠状动脉病变的支数和位置 ,QTd诊断单支、三支和前降支血管病变的灵敏性高于ETT(分别为 71.4 %vs 5 7.1% ;10 0 %vs 90 % ;92 .3%vs 76 .9% ) ,但均无统计学意义。结论 :同时行平板运动试验、QTd检查诊断冠心病较其单项检测具有更高的特异性和阳性预测值。     

HE4 Serum Levels Are Associated with Heart Failure Severity in Patients With Chronic Heart Failure

Background

The novel biomarker human epididymis protein 4 (HE4) shows prognostic value in acute heart failure (HF) patients. We measured HE4 levels in patients with chronic heart failure (CHF) and correlated them to HF severity, kidney function, and HF biomarkers, and determined its predictive value.

抑郁对慢性心力衰竭患者的影响

慢性心力衰竭患者常伴有抑郁,而抑郁又对慢性心力衰竭的发生和发展产生影响,现就抑郁对慢性心力衰竭患者的临床影响、发生机制及相关治疗做一综述。