Effects of perstarium on the systolic and diastolic functions of the myocardium in patients with chronic cardiac failure

The aim of the study was to assess prestarium effects on systolic and diastolic cardiac functions in 38 patients with ischemic heart disease and chronic cardiac failure (NYHA functional class II-IV) by biventricular balanced radioventriculography. Both left and right ventricular diastolic dysfunction was found. A course of prestarium treatment caused different alterations in ventricular contractility. 64.2% patients of those who had right ventricular ejection fraction < 40% achieved an increase in right and left ventricular ejection fraction. Improved diastolic function of the myocardium was registered in 71% patients.     

Growth hormone improves cardiac function in rats with experimental myocardial infarction

Accumulating evidence suggests from experimental and clinical studies beneficial effects of growth hormone (GH) on contractility, although concomitant cardiac hypertrophy, generally considered to be a cardiovascular risk factor, has also been reported. In the present study, we combine a rat model with impaired cardiac performance after myocardial infarction (MI) with echocardiographic evaluation of GH effects on cardiac structure and function. We have used a rat model with ligation of the left coronary artery in normal, growing male rats resulting in subsequent impaired cardiac performance. After 6 weeks' recovery, blind transthoracic echocardiography was performed to determine infarction size, cardiac geometry and performance. Rats with no signs of myocardial infarction were excluded from the study. After randomization, the rats were treated with daily s.c. injections of saline ( n  = 8) or recombinant human growth hormone (rhGH) ( n  = 6) at a dose of approximately 1 mg kg⁻¹ body weight for 1 week. A new blind echocardiography examination was performed after treatment demonstrating a 13% increase in ejection fraction (EF) and a 50% increase in cardiac index in GH-treated rats compared with control rats ( P  < 0.01). Moreover, GH caused a significant decrease in end-systolic volume. There were no significant changes in left ventricular (LV) or interventricular wall thickness, LV dimensions, heart rate or diastolic function. No effects were seen on LV weight, cardiac insulin-like growth factor (IGF) I, IGF-I receptor and GH receptor mRNA content. GH in a physiological dose improves systolic function in an experimental model of heart failure without signs of hypertrophy, suggesting a potential role as a therapeutic agent in the treatment of heart failure and merits further investigation.     

慢性肾脏病非透析患者血清半胱氨酸蛋白酶抑制剂C与心脏功能和生化指标的关系

目的研究血清半胱氨酸蛋白酶抑制剂C（CystatinC，CysC）与慢性肾脏病（CKD）非透析患者的心功能不全和生化指标的关系。方法选择哈尔滨医科大学附属第一医院肾内科198例慢性肾脏病（Cronic kidney disease，CKD）非透析患者与25例高血压对照组患者采用乳胶颗粒增强比浊法检测血CystatinC水平，分析其与心脏彩超结果、既往心血管疾病史和生化指标的关系。结果非透析CKD患者CystatinC水平与对照组相比显著升高，Spearman相关分析显示CystatinC与LVDd、LVDs、LVMI呈正相关，与EF呈负相关：比肌酐的相关性高。多元回归分析发现心力衰竭是CyatatinC升高的独立危险因子.LVMI、既往心血管事件、GFR、白蛋白是影响血CystatinC水平的独立危险因素。结论在CKD非透析患者中CysC水平和心功能相关，其意义值得进一步研究。     

缬沙坦对维持性血液透析患者心脏功能和结构的影响

目的 探讨缬沙坦对维持性血液透析(maintenance hemodialysis,MHD)患者心脏功能和结构的影响.方法 100例MHD患者,随机分为缬沙坦治疗组与对照组,治疗前及治疗后使用超声心动图测定心脏结构指标:左房收缩末期内径(LADs)、左室舒张末期内径(LVEDd)、室间隔舒张末期厚度(IVSTd)、左室后壁舒张末期厚度(LVPWTd),左房内径指数(LAI)、左心室心肌重量指数(LVMI)、相对室壁厚度(RWT);心脏功能指标:左室射血分数(LVEF),左室短轴缩短率(FS),二尖瓣口舒张早期和晚期最大血流速度比(E/A)各项指标测定.结果 治疗组MHD患者心脏结构指标:左房收缩末期内径(LADs)、左室舒张末期内径(LVEDd)、室间隔舒张末期厚度(IVSTd)、左室后壁舒张末期厚度(LVPWTd),左房内径指数(LAD、左心室心肌重量指数(LVMI)值均明显低于对照组,二者差异有统计学意义(P＜0.05),两组相对室壁厚度(RWT)相比没有明显的差异(P＞0.05).心脏功能指标:左室射血分数(LVEF),左室短轴缩短率(FS),二尖瓣口舒张早期和晚期最大血流速度比(E/A)值较对照组明显增高(P＜0.05).结论 缬沙坦可以改善MHD患者的心脏结构和功能.     

心肌缺血预适应对急性心肌梗死左室重构的影响

目的:探讨心肌缺血预适应对急性心肌梗死左室重构的影响。方法:选择急性心肌梗死患者104例,分为缺血预适应组(n=53)及非缺血预适应组(n=51),分别于入院后24 h、1周、1个月及3个月行超声心动图检查,测量左心室舒张末期容积指数、左心室收缩末期容积指数和左心室射血分数。结果:缺血预适应组与非缺血预适应组于术后1个月及3个月左心室容积均减小,左心室射血分数升高;术后3个月两组左心室舒张期末容积指数分别为(62.3±5.4)mL/m2,(66.4±5.6)mL/m2,左心室收缩期末容积指数分别为(30.1±3.2)mL/m2,(33.9±5.7)mL/m2,左心室射血分数分别为(0.53±0.05)%,(0.50±0.04)%,差异有统计学意义。结论:缺血预适应对急性心肌梗死具有保护作用,可减轻左心室重构。     

超声4D-RV-volume技术对原发性高血压患者右室收缩功能的评估价值

目的 探讨超声四维右心室容积定量分析(4D-RV-Volume)技术评估原发性高血压患者右室收缩功能的临床应用。方法 选择84例原发性高血压患者,按照左心室质量指数(LVMI)不同分为正常LVMI组(44例)和高LVMI组(40例),选择同期健康体检人员45例作为对照组,记录各组左室舒张末期内径(LVIDD )、左室收缩末期内径(LVESD)、左室后壁厚度(LVPWT)、室间隔厚度(IVST)、左室射血分数(LVEF)、三尖瓣环收缩期位移(TAPSE)、三尖瓣脉冲多普勒频谱舒张早、晚期峰值速度的比值(E/A)、肺动脉收缩压(PASP)和右室Tei指数,4D-RV-Volume技术获得右室舒张末期容积(RVEDV)、右室收缩末期容积(RVESV)、右室射血分数(RVEF)、右心室游离壁纵向应变率(RVFLS)、室间隔纵向应变率(RVSLS)、面积变化分数(RVFAC)等参数。结果 高LVMI组LVIDD、LVESD、LVPWT、IVST、RVEDV、RVESV均高于对照组(P<0.05),LVEF低于对照组(P<0.05);高LVMI组TAPSE高于对照组和正常LVMI组(P<0.05);对照组、正常LVMI组、高LVMI组E/A、RVFLS、RVFAC、RVEF呈降低趋势(P<0.05),PASP、右室Tei指数呈升高趋势(P<0.05)。RVSLS低于正常组和对照组(P<0.05)。RVEF值与右室Tei指数、PASP呈负相关(r=-0.513、-0.470,P<0.05),与TAPSE呈正相关(r=0.607,P<0.05)。4D-RV-Volume技术检测右心室RVEDV、RVESV、RVEF在不同观察者之间具有良好的一致性。结论 4D-RV-Volume技术可定量分析原发性高血压患者右心室结构和功能,为高血压患者病情评估和心血管并发症的防治提供依据。     

左卡尼汀治疗缺血性心肌病心力衰竭的临床价值

目的探讨左卡尼汀治疗缺血性心肌病心力衰竭的临床价值。方法选取本院诊治的缺血性心肌病心力衰竭患者127例,随机被分为两组,常规治疗患者63例为对照组,常规治疗加用左卡尼汀患者64例为观察组,疗程3个月,比较两组临床病症改善情况、临床指标改变情况、临床疗效及不良反应。结果治疗后,两组左心室射血分数、左心室短轴缩短率、心输出量、每搏输出量、6分钟步行距离均明显增加,两组左心室舒张末期内径、左心室收缩末期内径、血浆B型钠尿肽均明显减小。观察组左心室射血分数、左心室短轴缩短率、心输出量、每搏输出量、6分钟步行距离均明显大于对照组,观察组左心室舒张末期内径、左心室收缩末期内径、血浆B型钠尿肽均明显小于对照组,观察组胸闷病症消失率、气短病症消失率、乏力病症消失率、水肿病症消失率、治疗总有效率均明显高于对照组(均P0.05)。结论左卡尼汀可明显改善缺血性心肌病心力衰竭患者的临床病症,显著改善患者的临床指标,临床疗效显著,引发的不良反应较少,具有较高的安全性。     

A case and review of acromegaly-induced cardiomyopathy and the relationship between growth hormone and heart failure: cause or cure or neither or both?

Growth hormone plays an integral role in the development and maintenance of structure and function of the heart. Specific involvement of the heart in acromegaly is termed acromegalic cardiomyopathy, manifested as concentric left ventricular hypertrophy and diastolic dys-function. Left untreated, it ultimately progresses to systolic heart failure. Heart failure from acromegalic cardiomyopathy is one of the most common causes of death in acromegaly. Current treatment options include different approaches to lower elevated growth hormone levels with improvement in symptoms, exercise tolerance, and echocardiographic improvement in regression of left ventricular hypertrophy and indices of diastolic dysfunction. On the other hand, growth hormone is essential for cardiac growth and function and exerts beneficial and protective effects on the cardiovascular system. Its potential role as adjunctive therapy in the treatment of heart failure as derived from experimental studies and clinical trials is discussed.     

The role of intracardiac hemodynamic parameters in prognosis of cardiac failure in myocardial infarction patients

Two-dimensional echocardiography was used to study intracardiac hemodynamics (end systolic, end diastolic volumes and left atrial ejection fraction; end systolic, end diastolic volumes and left ventricular fraction; mean pressure in the pulmonary artery; myocardial mass of the left ventricle) in 49 patients 2, 10 and 30 days after onset of macrofocal myocardial infarction (MI). It was found that patients with and without cardiac failure after one year of the diseases significantly differed by volume and function of the left ventricle and atrium registered since MI day 2. Probability of cardiac failure in the postinfarction period may be estimated since the disease day 2 by an increase in the end-systolic and end-diastolic volumes and left ventricular ejection fraction. A restrictive type of left ventricular diastolic dysfunction is one of the early prognostic criteria of cardiac failure in postinfarction period.     

伊伐布雷定对急性失代偿性左心室射血分数降低型心力衰竭患者的近期疗效

目的 对急性失代偿性射血分数降低型心力衰竭（ADHFrEF）患者在常规药物治疗基础上加用伊伐布雷定,观察伊伐布雷定的临床疗效及安全性。方法 50例ADHFrEF患者随机分入对照组和观察组。对照组给予基础抗心衰治疗,观察组在对照组治疗基础上,加用伊伐布雷定5 mg,每日两次,口服,根据心率反应调整剂量。比较两组治疗前后患者心率、血压、心功能指标、血浆生化指标、平均住院时间以及主要不良心血管事件和不良反应。结果 两组患者治疗后,平均心率（HR）、BNP水平均较治疗前显著下降,6分钟步行距离（6MD）和左心室射血分数（LVEF）较治疗前显著提高（均P<0.05）,左心室舒张末内径（LVEDD）和心室收缩末内径（LVESD）较治疗前缩小（均P<0.05）。与对照组比较,伊伐布雷定可进一步减慢心率,提高6MD和LVEF（均P<0.05）。结论 在基础抗心衰治疗基础上加用伊伐布雷定能进一步改善ADHFrEF患者心脏功能、提高患者运动耐量。     

L-肉碱对维持性血液透析患者慢性左心功能不全的疗效观察

目的观察L-肉碱(LC)对伴有左心室收缩功能减退的维持性血液透析(HD)患者的疗效.方法入选患者随机分为贝那普利组(A组)和贝那普利组 LC组(B组),疗程6个月,观察两组治疗前后心脏结构和功能的变化.结果两组治疗前后心脏左心室收缩功能、舒张功能、左心室重量指数都显著性改善,但仅左心室收缩功能在B组比A组显著性提高.结论对伴有左心室收缩功能减退的HD患者补充LC可以提高其左心室收缩功能,而对舒张功能,左心室重量指数无显著性改善.     

Invasive diagnostic technique and technology for heart failure

Technology and techniques of cardiac catheterization to assess the ventricular function have been developed in the recent decades. The approach for assessing function is based on the measurement of cardiac output which depends on preload, afterload and ventricular contractility. Clinical application of Frank-Starling principle is useful for characterizing human heart failure. Conventionally, the isovolumic phase index(peak positive dP/dt) and ejection phase index (ejection fraction) have been applied to evaluate ventricular systolic function. Recently, ventricular diastolic function as well as systolic function can be estimated using ventricular pressure-volume loops obtained by simultaneous measurement of pressure and volume. The slope of end-systolic pressure-volume relation represents a load-independent index of ventricular contractility and assessing ventricular end-diastolic pressure-volume relation can express ventricular passive diastolic compliance for the evaluation of human heart failure.     

高浓度极化液联合曲美他嗪对急性心肌梗死面积及心功能的影响

目的：评价高浓度极化液（GIK）联合曲美他嗪经代谢途径治疗对急性心肌梗死（AMI）患者梗死面积及心功能的影响。方法：将46例急性前壁心肌梗死患者随机分为代谢药物治疗组（n=25）和对照组（n=21）,记录每例患者入院即刻和第1、3、7、14天12导联心电图。用Wagner的QRS记分预测梗死面积。于治疗14d后行核素心血池心室造影,判断心功能。结果：经代谢途径治疗后第7、14天,QRS记分较对照组显著降低,梗死面积的扩大、保护缺血心肌的损伤及改善心功能均有显著疗效。     

维持性血液透析患者血清甲状旁腺激素水平与心功能评价的相关性研究

目的 探讨维持性血液透析（MHD）患者全段甲状旁腺激素（iPTH）水平的变化与左心室结构和功能的相关性,评估iPTH对MHD合并心力衰竭早期诊断、治疗及判定预后的临床价值。方法 随机选取沈阳军区总医院血液净化科186名MHD患者。入选标准为：血液透析3次／周,每次4h;年龄在18～75岁;透析年限6个月以上,10年以下;无急性心血管事件。利用放免法检测患者透析前iPTH水平、电化学发光免疫分析法检测透析血浆B型钠尿肽前体（pro—BNP）水平。左心室肥厚（LVH）可由心脏超声检查判断。超声心动图检测患者左心房内径（LAD）、左心室舒张末内径（LVDd）、室间隔厚度（IVST）、左心室后壁厚度（LVPwT）、左心室射血分数（LVEF）等,计算左心室重量（LVM）,左心室心肌重量指数（LVMI）。根据2009年KDIGO指南iPTH水平的目标范围,按iPTH正常参考值上限水平2～9倍为界将患者分为3组,探讨iPTH与MHD患者左心功能的关系。结果 iPTH≥549．9pg／ml组患者的LAD、LVMI、LVDd、IVST、LVPwT显著高于iPTH≤122．2pg／ml,122．2～549．9pg／ml组（P〈0．05）。随着iPTH的增长,患者pro—BNP水平升高,有统计学差异（P〈0．05）。随着iPTH的增长,iPTH与NYHA心功能分级呈正相关,血清iPTH水平与LAD、LVMI、LVDd、LVDs、IVST、LVPwT、左心室收缩功能、pro—BNP呈正相关（P〈0．05）,与LVEF呈负相关（P〈0．05）。结论 MHD患者iPTH水平与左心室功能密切相关,可能成为诊断及评估患者心功能的一个重要标志物。     

肝硬化左心功能彩色多普勒超声显像观察

目的　探讨肝硬化高动力循环对心功能的影响。方法　应用彩色多普勒超声检查 2 8例肝硬化患者和 2 0例正常人左室收缩末内径 ,舒张末内径 ,二尖瓣口E峰、A峰峰值流速、VE/VA比值、E峰减速时间 (DT)和左室等容舒张松弛时间 (IVRT) ,评价左室收缩、泵血功能和左室舒张功能。结果　肝硬化患者左心收缩、泵血功能与正常人无显著差异 (P >0 .0 5 ) ,但左心舒张功能减低 (P <0 .0 5 ) ,肝硬化失代偿合并腹水的患者舒张功能受累尤为严重 (P <0 .0 5 )。结论　在肝硬化高动力循环状态下 ,心室舒张功能减低 ,收缩、泵血功能无明显变化     

Regression of left ventricular hypertrophy with losartan potassium therapy in patients with hypertension

The aim of this study was to assess the effects of losartan potassium, an angiotensin II receptor antagonist, on systolic blood pressure; diastolic blood pressure; and left ventricular dimensions, functions, and mass index (LVMI) in patients with mild-to-moderate essential hypertension. Twenty patients aged 40 to 65 years with either uncontrolled or previously untreated hypertension and echocardio-graphically documented left ventricular hyptertrophy (LVH) defined by LVMI >130 g/m² for men and >110 g/m² for women were included in the study. Blood pressure measurements were taken at 2-week intervals. Blood samples were taken before treatment and after 3 months of treatment for determination of lipid concentrations and other laboratory variables used to monitor safety, and two-dimensional M-mode and Doppler echocardiographic measurements were obtained. Losartan was associated with a statistically significant reduction of mean systolic blood pressure from 173 ± 6 mm Hg to 135 ± 10 mm Hg and diastolic blood pressure from 100 ± 4 mm Hg to 82 ± 7 mm Hg without a change in heart rate. Significant decreases were identified in interventricular septal and left ventricular posterior wall thicknesses (from 12.5 ± 0.8 mm to 11.5 ± 0.8 mm and 12.1 ± 1.0 mm to 11.1 ± 0.8 mm, respectively). LVMI decreased from 138.8 ± 18.7 g/m² to 126.0 ± 21.8 g/m² after 3 months of treatment. Left ventricular dimensions and ejection fraction did not change significantly compared with baseline values. The Doppler echocardiographic assessment of mitral E/A ratio, which is a marker of diastolic function, increased significantly from baseline. Except for a significant increase in mean serum lactate dehydrogenase activity, laboratory findings (including serum lipid concentrations) remained constant. No clinical adverse effects attributable to losartan were observed. Results of this study suggest that losartan is an effective, well-tolerated drug that reduces LVH, improves left ventricular diastolic functions, and controls systolic and diastolic blood pressures in patients with mild-to-moderate essential hypertension.     

三维斑点追踪成像评价血液透析伴发瓣膜钙化患者左室收缩功能

目的应用三维斑点追踪成像(3D-STI)定量评价血液透析伴发瓣膜钙化患者的左室收缩功能。方法 55例血液透析患者根据是否伴发瓣膜钙化分为钙化组26例和无钙化组29例,另选健康志愿者30例为正常对照组。各组分别行常规超声心动图和3D-STI检查,测量室间隔厚度(IVST)、左室后壁舒张末期厚度(LVPWT)、左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)、左室射血分数(LVEF)、左室整体峰值纵向应变(GLS)、整体圆周应变(GCS)、整体面积应变(GAS)、整体径向应变(GRS)及左室心肌质量(LVM),计算左室心肌质量指数(LVMI);分析各组上述参数的差异。结果与正常对照组比较,钙化组和无钙化组IVSd、LVPWd及LVMI均显著增加,GLS、GCS、GAS、GRS均显著降低(均P<0.05),LVEDD、LVESD、LVEF各组比较差异均无统计学意义。与无钙化组比较,钙化组IVSd、LVPWd及LVMI均显著增加,GLS、GCS、GAS、GRS均显著降低(均P<0.05)。结论血液透析患者左室收缩功能减低,伴有瓣膜钙化者左室重构和左室收缩功能受损更明显;3D-STI可准确评价血液透析伴发瓣膜钙化患者的左室收缩功能,具有较好的临床应用价值。     

高压氧治疗左室射血分数正常的心力衰竭6分钟步行试验评价

目的观察6分钟步行试验（6MWT）评价高压氧对左室射血分数正常的心力衰竭（HFNEF）患者心功能的影响。方法随机将100例HFNEF患者随机分为两组,对照组50例应用常规抗心衰药物治疗,治疗组在常规药物治疗基础上加用高压氧治疗,应用彩色多普勒超声检测治疗前及治疗后3个月左心室舒张功能指标,按不同心功能分级行6MWT,研究两者的相关性。结果两组治疗后,左室舒张功能指标[等容舒张时间（IVRT）、舒张早期二尖瓣血流速度E峰（E）、舒张晚期血流速度A峰（A）、E／A、E峰减速时间（DT）]均明显改善（P〈0．01）,治疗组与对照组比较差异有统计学意义（P〈0．05）。不同心功能组6MWT距离均明显增加,差异有显著统计学意义（P〈0．01）,治疗组与对照组比较差异有统计学意义（P〈0．05）。结论高压氧治疗,能显著的改善HFNEF患者的心功能状态,改善心衰患者的运动耐量。6MWT作为量化评价指标,客观、实用,是一种值得推广的评价心力衰竭治疗效果的方法。     

Diagnosis and management of diastolic dysfunction and heart failure

Diastolic heart failure occurs when signs and symptoms of heart failure are present but left ventricular systolic function is preserved (i.e., ejection fraction greater than 45 percent). The incidence of diastolic heart failure increases with age; therefore, 50 percent of older patients with heart failure may have isolated diastolic dysfunction. With early diagnosis and proper management the prognosis of diastolic dysfunction is more favorable than that of systolic dysfunction. Distinguishing diastolic from systolic heart failure is essential because the optimal therapy for one may aggravate the other. Although diastolic heart failure is clinically and radiographically indistinguishable from systolic heart failure, normal ejection fraction and abnormal diastolic function in the presence of symptoms and signs of heart failure confirm diastolic heart failure. The pharmacologic therapies of choice for diastolic heart failure are angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, diuretics, and beta blockers.     

Effect of cordaron on systolic and diastolic functions of the left ventricle in patients with a mixed form of chronic low cardiac output and cardiac arrhythmias

AIM: To study effects of cordaron on central hemodynamics reflecting systolic and diastolic functions of the left ventricle (LV) in patients with a mixed form of chronic cardiac failure--a systolic dysfunction and LV diastolic dysfunction type I. MATERIAL AND METHODS: 14 patients with a mixed form of chronic heart failure (CHF) and cardiac arrhythmia were followed up for 6 months. All the patients received ACE inhibitors, diuretics, nitrates and, additionally, cordaron in a supporting dose 200-300 mg/day. Control of central hemodynamics was made with echocardiography before, 1, 3 and 6 months of therapy. RESULTS: For 6 months of therapy LV ejection fraction increased by 16%. LV diastolic function improved, primarily, due to a rise of the E max (by 52% for 6 months of therapy). This reflected early diastolic filling of the LV. Improvement of LV diastolic function was associated with heart rate decrease. CONCLUSION: Cordaron used in addition to ACE inhibitors, diuretics, nitrates improves both systolic and diastolic LV function in patients with a mixed form of CHF.