缺血性心肌病心力衰竭患者心脏收缩和舒张功能及其再住院率与曲美他嗪的干预效应

目的：观察曲美他嗪对缺血性心肌病心力衰竭患者心脏收缩和舒张的影响，并分析1年内再住院率情况。方法：选择2003-01／2004-01哈尔滨医科大学第一临床医学院心内科门诊及住院缺血性心肌病患者168例，全部病例均符合世界卫生组织1979年冠心病缺血性心肌病的诊断标准，并自愿参加研究，男86例，女82例，平均年龄(59&;#177;13)岁，心力衰竭的诊断标准按照纽约心脏病学会(NYHA)分级标准为Ⅱ～Ⅳ级。曲美他溱治疗组在常规治疗基础上给予曲美他嗪治疗；常规治疗组给予常规药物治疗。采用超声于治疗前、后4周、1年测定两组的心搏出量，心脏指数，左室射血分数，E峰和A峰流速比值(E／A)，等容舒张时间，随访1年内两组再住院例次。结果：治疗后4周曲美他嗪治疗组和常规治疗组无脱落。治疗后1年曲美他嗪治疗组、常规治疗组因死亡各脱落3，15例，进入结果分析例数分别为83，67例。治疗后4周曲美他嗪治疗组患者心搏出量、心脏指数、左室射血分数、E峰与A峰流速比值[(58．6&;#177;10．2)mL，(4．4&;#177;0．6)L／(min．m^2，(38．6&;#177;10.8)％，(0．82&;#177;0．2)cm／s]显高于治疗前[(52．3&;#177;11．4)mL，(3．1&;#177;0．7)L／(min．m^2，(34．8&;#177;7．6)％，(0．69&;#177;0．1)cm／s，t=2．48～2．98，P&;lt;0．05]。等容舒张时间[(122．5&;#177;21．6)ms]明显短于治疗前[(158．3&;#177;29．2)ms，(τ=2．56，P&;lt;0．05)]。治疗后1年曲美他嗪治疗组患者心搏出量、心脏指数、左室射血分数、E峰与A峰流速比值[(76．9&;#177;16．8)mL，(5．6&;#177;1．1)L／(min．m^2，(54．2&;#177;14.2)％，(1．38&;#177;0．6)cm／s]明显高于治疗前及常规治疗组[(60．4&;#177;11．8)ml，(3．5&;#177;0．8)L／(min．m^2),(36．1&;#177;8．2)％，(0．70&;#177;0．4)cm／s，τ=2.36～2.78，P&;lt;0．05]，等容舒张时间[(88．4&;#177;24．5)ms]明显短于治疗前及常规治疗组[(155．8&;#177;30．2)ms，τ=2．56，2．89,P&;lt;0．05]。曲美他嗪治疗组1年内再住院10例次，再住院率12％(10／86)，常规治疗组31例次，再住院率38％(31／82)，两组差异明显(X^2=114．21，112．86,P&;lt;0．05)。结论：在缺血性心肌病心力衰竭的康复治疗中长期使用曲美他嗪可改善心脏收缩及舒张功能，明显改善患者预后功能而降低再住院率。     

曲美他嗪治疗缺血性心肌病心力衰竭的临床观察

曲美他嗪(trimetazidine)商品名称万爽力,是具有抗缺血作用而不影响心肌氧耗和血供的哌嗪类化合物,已广泛用于缺血性心肌病、心绞痛、心肌梗死的治疗。本研究旨在观察曲美他嗪对缺血性心肌病心力衰竭患者心脏功能、结构的影响。     

曲美他嗪治疗老年缺血性心肌病心力衰竭的疗效

【目的】探讨曲美他嗪对老年缺血性心肌病（ICD）心力衰竭的疗效。【方法】将58例老年ICD随机分为两组，对照组采用常规抗心衰治疗，试验组则在常规治疗的基础之上加用曲美他嗪每天60mg，连续观察12周．【结果】试验组心衰缓解程度、超声心动图心功能各项指标、6min步行试验以及再次入院率显著优于对照组（P〈0．05）．【结论】老年ICD心衰患者在常规治疗基础上，服用曲美他嗪可以进一步缓解心衰程度，改善心功能，降低再次入院率，从而提高生活质量，改善疾病预后。     

曲美他嗪改善缺血性心肌病心功能的临床观察

目的：探讨曲美他嗪对缺血性心肌病患者心脏收缩和舒张功能及运动耐量的影响。方法：观察心功能Ⅱ～Ⅲ级的缺血性心肌病患者58例，其中曲美他嗪组28例，对照组30例。分别测定用药前及用药6个月后两组患者的超声心动图心功能指标CI、LVEF、VE／VA及6min步行距离。结果：用药6个月后曲美他嗪组患者的CI、LVEF、6min步行距离较对照组显著增高（P〈0．05），但VA／VE与对照组相比无显著性差异（P〉0．05）。结论：曲美他嗪通过改善缺血心肌细胞的能量代谢，可保护缺缸心肌细胞的功能，从而改善心脏的收缩功能及运动耐量。     

曲美他嗪对缺血性心脏病心力衰竭患者心室重塑和心功能的影响

【目的】探讨曲美他嗪 (trimetazidine,TMZ)对缺血性心脏病心力衰竭患者心室重塑和心功能的影响。【方法】缺血性心脏病心力衰竭患者 78例 ,左室射血分数≤ 4 0 % ,心功能 (NYHA)Ⅱ～Ⅳ级 ,常规治疗基础上随机分为TMZ组 (n =4 0 ) )和对照组 (n =38)。治疗 6个月 ,观察曲美他嗪对心室重塑和心功能的影响。【结果】经过 6个月治疗 ,TMZ治疗组症状和心功能改善 ,与对照组比较左室收缩末容积下降 [(15 9.2±4 6 .7)mlvs (179.8± 4 8.5 )ml,P <0 .0 5 ],左室收缩末内径减小 [(32 .7± 4 .1)mmvs (39.5± 3.9)mm ,P <0 .0 5 ],左室射血分数显著提高 [(48.6± 9.5 ) %vs (35 .2± 8.7) % ,P <0 .0 1];与基线比较左室舒张末容积下降 (P <0 .0 5 ) ,左室舒张末内径减小 (P <0 .0 5 ) ,但两组间无统计学差异。【结论】在心力衰竭标准治疗基础上 ,应用TMZ能显著改善缺血性心脏病心力衰竭患者心室重塑和心功能。     

曲美他嗪对慢性心力衰竭心功能的影响分析

目的观察曲美他嗪对慢性心力衰竭患者心功能的影响。方法选择慢性心力衰竭患者82例,随机分为对照组41例给予常规抗心力衰竭治疗,治疗组41例在常规抗心力衰竭治疗基础上加用曲美他嗪,比较两组疗效。结果曲美他嗪治疗组治疗6个月后超声心动图检测指标明显改善。各观察指标治疗组与对照组比较差异均有统计学意义（P〈0.05）。结论曲美他嗪联合常规慢性心力衰竭治疗改善心脏功能有明显疗效。     

曲美他嗪治疗缺血性心肌病的临床观察

目的 观察曲美他嗪治疗缺血性心肌病的临床疗效和安全性.方法 选择缺血性心肌病患者80例,LEVF均小于40%,NYHA心功能分级在Ⅲ～Ⅳ级.随机分成两组,对照组给予常规药物治疗;治疗组在常规治疗上加用曲美他嗪.观察6个月.结果 治疗组与对照组相比,3个月和6个月时LEVF、心功能分级及6 min步行实验结果改善明显(P<0.05),再住院次数明显减少,无明显不良反应.结论 曲美他嗪可以明显改善缺血性心肌病的心功能,且安全有效.     

曲美他嗪治疗扩张型心肌病心力衰竭疗效观察

目的观察曲美他嗪对扩张型心肌病心力衰竭（心衰）的疗效。方法选择100例扩张型心肌病心力衰竭患者分为两组（曲美他嗪治疗组50例和对照组50例）进行观察比较。结果治疗后曲美他嗪组与对照组比较左室射血分数明显提高（P〈0.01）,心功能明显改善。此外,治疗组全身血管阻力（SVR）明显降低（P〈0.01）,对照组无明显变化。结论曲美他嗪能改善扩张型心肌病心力衰竭患者的心功能。     

曲美他嗪治疗缺血性心脏病心力衰竭临床观察

目的：观察曲美他嗪治疗缺血性心脏病心力衰竭的临床疗效。方法：140例冠心病患者随机分为两组：治疗组72例采用常规治疗及口服曲美他嗪，每次20mg，3次/d；对照组68例采用常规治疗，治疗组总有效率93.06%，而对照组总有效率83.82%，两组疗效差异有统计学意义（P〈0.05）。结论：在常规治疗基础上应用曲美他嗪可以进一步改善患者心脏收缩功能，提高患者的运动耐量、耐受性良好。     

曲美他嗪治疗慢性心力衰竭临床观察

慢性心力衰竭（CHF）是心血管内科的常见病之一,是一种严重危害人类健康的疾病。我科采用曲美他嗪配合常规药物治疗慢性心力衰竭患者50例,取得满意效果,现报告如下。     

Effect of levosimendan on right ventricular systolic and diastolic functions in patients with ischaemic heart failure

OBJECTIVES: Levosimendan is a novel positive inotropic calcium sensitiser agent used in acute left heart failure. In this study, the effect of levosimendan on the right ventricular systolic and diastolic functions was evaluated by tissue Doppler comparing them with dobutamine in patients with ischaemic heart failure. METHODS: Patients having an acute decompensated heart failure with ischaemic cardiomyopathy and left ventricular ejection fraction <40% were included in the study. Before and 24-h after treatment, peak systolic (Sa), peak early (Ea), peak late (Aa) diastolic annular velocities and Ea/Aa ratio from tricuspid lateral annulus by tissue Doppler and systolic pulmonary artery pressure (SPAP) were measured. RESULTS: Sa, Ea and the Ea/Aa ratio were significantly increased in the levosimendan group whereas SPAP was significantly reduced. In the dobutamine group, no significant differences were observed in the Sa, Ea, Aa and Ea/Aa ratio in spite of a significant reduction in SPAP. Decrease in SPAP was greater in the levosimendan group (p=0.002). CONCLUSION: Levosimendan improves right ventricular systolic and diastolic functions.     

曲美他嗪治疗缺血性心肌病心力衰竭的疗效评价

目的评价曲美他嗪治疗缺血性心肌病心力衰竭的临床疗效.方法采用随机、单盲对照及组间对照,将42例缺血性心肌病心力衰竭患者分为曲美他嗪组(21例),服用曲美他嗪20mg,3次/d;常规治疗组(对照组,21例),疗程均为8周,观察两组治疗前后临床疗效、左室射血分数(LVEF)、左室舒张末期容积(EDV)、左室收缩末期容积(ESV)、6min步行距离.结果治疗后曲美他嗪组总有效率76.2%,对照组总有效率52.4%,治疗后与治疗前相比LVEF、EDV、ESV,6min步行距离等相关参数均有显著改善(P＜0.05),曲美他嗪组与对照组比较差异有显著性意义(P＜0.05);未发现与药物相关的不良反应.结论曲美他嗪能改善缺血性心肌病患者心功能,值得临床推广应用.     

缺血性与非缺血性心肌病左室收缩不同步的对比研究

目的：应用组织同步显像技术（Tissue synchronization imaging,TSI）评价缺血性心肌病（ICM）和扩张型心肌病（DCM）心力衰竭患者左室内收缩的不同步性。方法：ICM患者20例（ICM组）和DCM患者23例（DCM组）作为病例组,30例健康志愿者作为对照组,采集心尖四腔观、心尖二腔观及心尖长轴观三个心动周期的组织速度图像。启动TSI模式,获取左室六个壁12个取样点心肌组织的达峰值速度时间（TS）,计算间隔后壁间延迟（△TS-P）、间隔侧壁间延迟（△TS-L）、基底段最大延迟（△TB-max）、基底段达峰值时间标准差（△TB-SD）、所有节段最大延迟（△Tmax）和左室所有节段标准差（TSD）。对比ICM组、DCM组及对照组之间左室收缩不同步性的差异。结果：ICM组和DCM组六个壁的TS均高于对照组（P<0.05或P<0.01）,在各同步性参数中,与对照组相比,ICM组和DCM组Tmax、TSD、△TB-max和△TB-SD明显延长,差异有统计学意义（P<0.05）,ICM组和DCM组间比较,仅TSD差异有统计学意义（P<0.05）,ICM组最大延迟的部位多发生在室间隔和下壁,DCM组最大延迟的部位多位于侧后壁。结论：ICM和DCM心衰患者左室壁收缩明显不同步,且二组之间的不同步存在差异。     

螺内酯对充血性心力衰竭患者心率变异性的影响

目的　探讨醛固酮受体拮抗剂螺内酯对充血性心力衰竭 (congestiveheartfailure,CHF)患者心脏自主神经活动的影响。方法　比较 3 2例CHF患者在螺内酯治疗前、第 4周及 16周时心率变异性 (heartreatvariability ,HRV)各项指标和心功能变化。结果　螺内酯 ( 40mg/d)治疗 4周时 ,左室收缩功能无显著变化 ( P >0 .0 5 ) ,治疗 16周时 ,左室收缩功能明显改善 ( P <0 .0 5 ) ;治疗前、治疗 4周和 16周时 ,代表心率总变异程度的全部正常R R间期标准差 (standarddeviationofallnormalsinusR Rintervalsover 2 4hours,SDNN)分别为 ( 98.5± 3 2 .0 )、( 115 .4± 3 5 .6)和( 118.1± 3 5 .0 )ms,差异有统计学意义 (P <0 .0 5 ) ;代表迷走神经功能的正常相邻R R间期差值的均方根 (rootmeansquareofthesuccessivenormalsinusR Rintervaldifference ,rMSSD)分别为 ( 2 8.3± 14.6)、( 3 5 .3± 13 .3 )和 ( 3 8.1±13 .9)ms ,差异有统计学意义 (P <0 .0 1)。结论　螺内酯可以提高CHF患者心脏迷走神经张力 ,使HRV得到改善     

Early diastolic strain rate predicts response to heart failure therapy in patients with dilated cardiomyopathy

The aim of this prospective study was to assess the value of speckle tracking echocardiographic (2D-STE) parameters to predict response to heart failure therapy in patients with dilated cardiomyopathy (DCM). Eighty-seven patients (mean age 51 ± 13 years) with DCM, defined as ejection fraction (EF) <45 %, left ventricular (LV) end-diastolic diameter >112 % of normal range derived from age and body surface area. Based on 2D-STE following parameters were extracted from three apical views of the LV: global longitudinal strain, systolic and diastolic strain rate (SR_E). Mechanical dispersion was calculated as standard deviation of time-to-peak strain values including all LV segments. After receiving heart failure therapy (mean 39 ± 11 months, range 3–60 months) 50 patients reached combined endpoint defined as following: death, heart transplantation, rehospitalization due to heart failure, and absence of improvement in EF. On stepwise multivariate regression analysis, SR_E was independently of EF and LV volumes predictive for combined endpoint (OR 0.44, 95 %CI 0.27–0.70, p = 0.001) with an area under the ROC-curve (AUC) of 0.91. In patients with cQRS duration ≤120 ms mechanical dispersion was predictive for combined endpoint with the highest AUC (OR 1.53, 95 %CI 1.08–2.16, p = 0.002; AUC = 0.94). In this study, SR_E, a surrogate parameter of myocardial relaxation, was able to predict a response to heart failure therapy in patients with DCM. In patients with narrow QRS complex, mechanical dispersion yielded the highest predictive value. Parameters of 2D-STE may contribute to risk stratification in this patient population.     

Effect of diabetes mellitus on heart rate variability in patients with congestive heart failure

This study sought to determine if the severity of autonomic perturbations in patients with heart failure are affected by the presence of diabetes. Decreased HRV is frequent in diabetic patients free of clinically apparent heart disease and has been invoked as a risk factor for sudden cardiac death. However, reduced HRV is also commonly present in patients with left ventricular dysfunction. The effect of diabetes on autonomic dysfunction in this setting is not known. Holter ECGs from 69 diabetic patients and 85 nondiabetic control subjects with heart failure were analyzed. The severity of autonomic dysfunction was assessed using 24-hour time- and frequency-domain HRV analysis. Prognostically important time- and frequency-domain HRV measures (SDNN, SDANN5, total power, and ultra-low frequency power) were not different between the two groups. Time- and frequency-domain parameters modulated by parasympathetic tone (pNN50, RMSSD, and HF power) were depressed to a similar degree in the diabetic and the nondiabetic groups. The low frequency power was significantly lower in diabetic patients (5.8 +/- 0.7 vs 5.3 +/- 1.0, P = 0.02). The ratio of low to high frequency power was substantially lower in the diabetic group (2.2 +/- 0.2 vs 1.4 +/- 0.2, P < 0.0001). These differences were more apparent in insulin-treated diabetics. In the presence of heart failure, HRV parameters that are most predictive of adverse outcome are similar in diabetic and nondiabetic patients. Furthermore, during increased sympathetic stimulation in the setting of heart failure, diabetes does not worsen parasympathetic withdrawal but may mitigate sympathetic activation.     

胺碘酮对缺血性心肌病心力衰竭患者肿瘤坏死因子-α的影响

目的探讨胺碘酮对缺血性心肌病心力衰竭患者血清肿瘤坏死因子α(TNFα)及外周血单核细胞(PBMC)分泌TNFα的影响。方法缺血性心肌病心力衰竭患者41例随机分为对照组和胺碘酮治疗组,用放射免疫法测定治疗前后各组患者血清TNFα浓度;取患者静脉血并分离PBMC,分别加入胺碘酮和脂多糖等,使胺碘酮终浓度分别为0、0.1、1、10μmol/L进行培养,经24h孵化后取上清液,用放射免疫法测定培养上清液TNFα含量。结果在体外胺碘酮对缺血性心肌病心力衰竭患者PBMC分泌TNFα有抑制作用,并呈剂量依赖性;胺碘酮治疗后心力衰竭患者血清TNFα升高(P<0.05)。结论胺碘酮可使缺血性心肌病心力衰竭患者血清TNFα升高;在体外,胺碘酮能抑制心力衰竭患者PBMC分泌TNFα,这种作用可能与胺碘酮治疗心力衰竭的有益作用无关。     

Endogenous endothelin-1 depresses left ventricular systolic and diastolic performance in congestive heart failure

Endothelin-1 (ET-1) is a positive inotrope in normal hearts; however, the direct cardiac effects of endogenous ET-1 in congestive heart failure (CHF) are unknown. We evaluated the cardiac responses to endogenous ET-1 using an ETA and ETB receptor blocker (L-754,142) in seven conscious dogs before and after pacing-induced CHF. Before CHF, when the plasma ET-1 was 7.3 +/- 1.7 fmol/ml, L-754,142 caused no significant alterations in heart rate, left ventricular (LV) end-systolic pressure, total systemic resistance, and the time constant of LV relaxation (tau). LV contractile performance, measured by the slopes of LV pressure (P)-volume (V) relation (EES), dP/dtmax-end-diastolic V relation (dE/dtmax), and stroke work-end-diastolic V relation, was also unaffected. After CHF, when the plasma ET-1 was significantly increased to 14.1 +/- 3.0 fmol/ml (p <.05), L-754,142 produced a significant decreases in LV end-systolic pressure (101 +/- 11 versus 93 +/- 8 mm Hg) and total systemic resistance (0.084 +/- 0.022 versus 0.065 +/- 0.15 mm Hg/ml/min). The tau (42 +/- 12 versus 38 +/- 10 ms), mean left atrial P (22 +/- 5 versus 18 +/- 4 mm Hg) (p <.05), and minimum LVP were also significantly decreased. After CHF, the slopes of P-V relations, EES (3.4 +/- 0.4 versus 4.8 +/- 0.8 mm Hg/ml), dE/dtmax (42.4 +/- 7.8 versus 50.0 +/- 7.8 mm Hg/s/ml), and stroke work-end-diastolic V relation (58.1 +/- 3.3 versus 72.4 +/- 5.2 mm Hg) (p <.05) all increased after L-754,142, indicating enhanced contractility. Before CHF, low levels of endogenous ET-1 have little cardiac effect. However, after CHF, elevated endogenous ET-1 produces arterial vasoconstriction, slows LV relaxation, and depresses LV contractile performance. Thus, elevated endogenous ET-1 may contribute to the functional impairment in CHF in this canine model.     

实时三维超声心动图评价缺血性心肌病心力衰竭患者左室收缩同步性

目的应用实时三维超声心动图评价缺血性心肌病(ICM)所致慢性心力衰竭患者左室收缩同步性,并分析收缩不同步性指数(SDI)与左室射血分数(LVEF)的相关性。方法选择缺血性心肌病引起心力衰竭患者53例为ICM组,体检健康者50例为对照组。应用实时三维超声心动图测量其左室舒张末容积(EDV)、收缩末容积(ESV)和LVEF,16节段(除外心尖帽)收缩达最小容积时间的标准差并以R-R间期校正后百分数作为左室SDI。结果与对照组比较,ICM组EDV增高,LVEF降低,左室SDI增高,差异均有统计学意义(P0.01)。ICM组SDI与LVEF呈高度负相关(r=-0.72,P=0.000),对照组SDI与LVEF呈低度负相关(r=-0.31,P=0.020)。结论 ICM心力衰竭患者相较对照组左室内存在明显收缩不同步,且SDI与左室收缩功能存在负相关。     

应变率显像对肥厚型心肌病心肌收缩和舒张功能的研究

目的　通过应变率显像评价肥厚型心肌病患者肥厚心肌的局部收缩和舒张功能。方法　10例肥厚型心肌病患者(HCM)与 20例正常对照者,获取左室室间隔长轴方向基底段、中段和心尖段的心肌应变率曲线,及中段肥厚的室间隔三层心肌的应变率曲线,测定应变率数值 (SR),包括收缩期峰值SR、舒张早期峰值SR和舒张晚期峰值SR,测量左室射血分数(EF)和二尖瓣口血流的E、A峰值。结果　HCM组肥厚节段心肌收缩期和舒张期的SR均低于正常组相应节段的测值(P<0. 05)。HCM组肥厚节段内层、中层及外层心肌收缩期和舒张期的SR均低于正常组对应节段各层的相应测值(P<0. 05)。HCM组肥厚节段各层心肌收缩期和舒张期SR之间的差异无显著性意义。两组间的EF和E/A值差异无显著性意义。结论　肥厚型心肌病肥厚心肌的SR明显降低,其各层之间SR的差异无显著性意义。