美托洛尔治疗慢性心力衰竭患者临床疗效观察

目的观察美托洛尔对慢性心力衰竭患者的症状、心率、心功能及心室重塑的影响。方法选择慢性心力衰竭患者[左心室舒张末期内径(LVEDD)≥57mm,左心室射血分数≤0.42,NYHA心功能分级Ⅱ-Ⅳ级]经治疗随访达1年者共103例,分美托洛尔治疗组53例和对照组50例。应用Holter及心脏彩色超声仪测定基线值及2个月、6个月、1年心率、左心室结构及功能指标变化。结果经过1年治疗,治疗组与对照组比较左心室射血分数升高,有显著性差异[(44.84±7.20)%VS(38.76±8.56)%,P<0.01)],左心室舒张末内径明显减小(62.11±9.8mm VS 64.96±10.1mm,P<0.01),治疗组与对照组比较平均心率明显减慢(65±6.2次/分VS71±8.6次/分,P<0.05)。结论在强心、利尿、血管紧张素转换酶抑制剂治疗基础上,应用美托洛尔能显著改善慢性心力衰竭患者的症状、心功能和心室重塑。     

卡维地洛与美托洛尔治疗缺血性心脏病心力衰竭的疗效观察

目的:观察卡维地洛和美托洛尔对缺血性心脏病心力衰竭患者的临床疗效。方法:缺血性心脏病心力衰竭患者80例,左室射血分数（LVEF）≤0.45,心功能（NYHA）ⅡⅣ级,常规治疗基础上随机分为卡维地洛组和美托洛尔组,治疗3月后,观察两种药物对心功能及运动耐量的影响。应用心脏彩色超声仪测定心功能基线值及3月后的变化。用6 m in步行距离测定运动耐量的改善程度。结果:经过3月的治疗,卡维地洛组与美托洛尔组心率、血压、运动耐量改善程度及心功能均有明显改善,且卡维地洛组6 m in步行试验结果,收缩压、舒张压变化及左室收缩末容积（LVESV）、左室舒张末容积（LVEDV）、LVEF改善程度明显优于美托洛尔组（P<0.01）。结论:在常规治疗基础上卡维地洛、美托洛尔对缺血性心脏病的治疗均有显著效果,前者在改善运动耐量、LVEDV、LVESV及心室射血方面更优。     

双心室起搏治疗慢性心力衰竭的近期疗效评价

目的观察双心室起搏在心力衰竭治疗中改善心功能和逆转左心室重塑的作用. 方法20例充血性心力衰竭患者植入了双心室起搏器,其中男性14例,女性6例,平均年龄(63 ±13)岁,心功能NYHA分级III～IV级,射血分数<40%,伴有QRS>140ms.在起搏器植入前、双心室起搏治疗3个月后以及停止起搏1个月后进行一系列评价.结果起搏治疗3个月后,左心室射血分数、心输出量及左心室充盈时间增加,二尖瓣反流、左心室舒张末期容积 [(196±69)ml vs (159±64)ml, P<0.01] 和收缩末期容积 [(155±71)ml vs (117±56)ml, P<0.01] 减少,患者6 min步行距离 [(332±89)m vs (372±76)m , P<0.05] 及生活质量提高.以上疗效为起搏依赖性,停止起搏1个月后,各指标均有不同程度的下降.结论对于心功能为NYHA分级 III级或IV级伴有室内传导阻滞的心力衰竭患者,同步化双心室起搏治疗能逆转左心室重塑,改善心功能.     

琥珀酸美托洛尔控释片对充血性心力衰竭患者心室重构及心功能的影响

目的探讨琥珀酸美托洛尔控释片对慢性充血性心力衰竭患者心功能的影响。方法慢性充血性心力衰竭患者60例，心功能（NYHA）Ⅱ～Ⅳ级，常规治疗基础上随机分为治疗组和对照组。治疗6个月，治疗组给与琥珀酸美托洛尔控释片，观察其对心室重塑、心功能的影响。应用心脏彩色超声仪测定治疗前后左室结构及功能指标变化，临床评价心功能改善情况。结果治疗6个月，美托洛尔治疗组症状和心功能改善，与对照组比较左室射血分数上升[（36．1±1．9）％VS（29．5±1．70％，P〈0．01]、左室收缩末容积下降[（165．5±45．0）mlVS（181．0±44．0）ml，P〈0．05]；左室舒张末容积有下降趋势（P〈0．05）；但两组间无统计学差异。结论在强心、利尿、血管紧张素转化酶抑制剂基础上，应用琥珀酸美托洛尔控释片能显著改善充血性心力衰竭患者心功能，改善心室重塑。     

美托洛尔治疗慢性心力衰竭患者68例临床疗效观察

目的:观察美托洛尔对慢性心力衰竭患者的症状、心功能及心室重塑的影响.方法:随机选择慢性心力衰竭患者[左心室舒张末期内径(LVDD)≥58 mm,左心室射血分数≤0.45,NYHA心功能Ⅱ～Ⅳ级]经治疗随访达8个月者共68例,包括治疗组38例[美托洛尔剂量平均为(42.075±12.100)mg/d(6.25 mg～25 mg/次,2次/日或3次/日)]和对照组30例.治疗8个月,观察美托洛尔对患者症状、心室重塑及心功能的影响.应用心脏彩色超声仪测定基线值及2个月、5个月、8个月左心室结构及功能指标变化.结果:经过8个月治疗,治疗组与对照组比较左心室射血分数升高,有极显著性差异(0.50±0.02 vs 0.41±0.02,P＜0.01),左心室收缩末期容积下降,有极显著性差异[(165.5±39.3)ml vs(183.1±39.3)ml,P＜0.01];治疗组治疗后与治疗前比较左心室舒张末期容积下降,亦有显著性差异(P＜0.05).结论:在强心,利尿,血管紧张素转换酶抑制剂治疗基础上,应用美托洛尔能显著改善慢性心力衰竭患者的症状、心功能和心室重塑.     

卡维地洛对充血性心力衰竭患者心功能的影响

目的　探讨卡维地洛对充血性心力衰竭患者心功能的影响。　方法　充血性心力衰竭患者 6 2例(其中扩张性心肌病心力衰竭患者 15例 ,缺血性心脏病心力衰竭患者 4 7例 ) ,左室射血分数 (LVEF)≤ 4 0 % ,心功能(NYHA)Ⅱ～Ⅳ级 ,常规治疗 (洋地黄 ,利尿剂 ,ACEI)基础上随机分为卡维地洛试验组和安慰剂对照组。应用心脏彩色超声仪测定治疗前及治疗后 1个月 ,3个月左室结构和功能指标的变化。观察卡维地洛治疗三个月后对心功能的影响。　结果　卡维地洛平均用量为 2 1 1mg d± 9 6mg d。经过 3个月治疗 ,试验组症状和心功能改善 ,与对照组比较左室射血分数上升 (P <0 0 0 2 ) ,左室收缩末容积下降 (P <0 0 5 ) ;左室舒张末容积与对照组比较虽无统计学差异但与治疗前比较亦明显下降 (P <0 0 5 )。　结论　在洋地黄、利尿剂、ACEI的治疗基础上 ,应用卡维地洛能显著改善充血性心力衰竭患者的心功能 ,改善心室结构 ,且疗效与应用剂量无关。     

比索洛尔治疗充血性心力衰竭临床观察

目的　观察比索洛尔对充血性心力衰竭患者心室重塑及心功能的影响。方法　充血性心衰患者 10 4例 ,左室射血分数 <4 0 % ,心功能 (NYHA)Ⅱ～Ⅳ级 ,常规治疗 (强心、利尿、ACEI)基础上随机分为比索洛尔组和对照组。观察心功能、左室舒张末内径 (LVEDD)、左室收缩末内径 (LVESD)、射血分数 (EF)。结果　观察 6个月 ,比索洛尔平均用量 ( 4 35± 1 19)mg/d。比索洛尔组症状和心功能改善 ,与对照组比较 ,临床有效率上升 (P <0 0 5 ) ,LVEDD和LVESD改善 ,EF值升高 (P <0 0 1)。结论　比索洛尔可改善充血性心衰患者的心功能 ,改善心室重塑     

心脏再同步化治疗慢性心力衰竭临床观察

目的观察心脏再同步化治疗(CRT)慢性心力衰竭(CHF)的疗效。方法 11例慢性心力衰竭患者行CRT,术后随访12个月,观察心功能、QRS时限、左室射血分数(LVEF)及相关心功能超声指标。结果 9例患者治疗后心功能均有明显改善,心功能NYHA分级从(3.5±0.4)级改善为(2.3±0.4)级,QRS时限从(157.0±21.4)ms缩短至(131.0±23.6)ms,LVEF从(26.7±5.2)%提高至(39.7±7.9)%;以上观察指标治疗前后比较差异均有统计学意义(P<0.05)。2例分别在植入起搏器后2个月及7个月死亡。结论 CRT通过改善心脏收缩同步性,提高左室射血分数,从而改善心功能,提高生活质量和运动能力。     

心脏再同步治疗慢性心力衰竭的中远期疗效观察

目的观察双心室再同步起搏治疗慢性心力衰竭(CHF)的临床疗效。方法28例慢性心力衰竭合并室内阻滞患者行双心室再同步起搏治疗,全部患者均经冠状静脉窦植入左心室导线1根至心脏静脉,术后平均随访20.6个月,观察心功能,QRS波宽度,左心室收缩、舒张末内径,左心室射血分数,二尖瓣反流面积。结果24例患者治疗后心功能改善,有效率85.7%,心功能从Ⅲ~Ⅳ级(NYHA分级)改善为Ⅱ~Ⅲ级,QRS波从(160±58)ms缩短至(132±53)ms,P<0.05,左心室舒张末内径、收缩末内径分别从(73.54±9.96)mm、(64.25±11.32)mm缩小至(68.75±8.63)mm和(58.51±10.78)mm,P<0.01,左心室射血分数从0.23±0.09提高至0.32±0.10,P<0.01,二尖瓣反流面积从(8.03±4.27)cm2减少至(5.15±4.02)cm2,P<0.01。结论双心室再同步起搏是慢性心力衰竭治疗的有效方法。     

心脏再同步化治疗对慢性心力衰竭病人心功能的影响

目的观察心脏再同步化治疗对慢性心力衰竭心功能的临床疗效。方法选择2011年8月—2014年7月行心脏再同步化治疗心衰病人41例,比较病人治疗前,治疗后3个月及6个月左室射血分数、左室舒张末期容积、左室收缩期末期容积、每博输出量等左心功能超声指标,术后6个月病人心功能分级,6min步行距离等指标。结果治疗后3个月及治疗后6个月,左室射血分数,左室舒张末期容积及左室收缩期末期容积较治疗前显著改善(P0.05)。治疗后6个月,左室射血分数及每搏输出量较治疗前及治疗后3个月显著提高(P0.05)。治疗后6个月心功能分级较治疗前显著改善,6 min步行距离较治疗前显著延长(P0.05)。结论心脏再同步化治疗可显著改善慢性心力衰竭病人左心功能,提高生活质量。     

Relationship of auscultatory fourth heart sound to the quantitated left atrial filling fraction

The fourth heart sound (S4) has been associated with vigorous atrial contraction. However, the presence of S4 has not been previously correlated with quantitated left atrial filling fraction. In this study, the presence of an auscultatory S4 was compared with the Doppler echocardiographically quantitated left atrial filling fraction in 41 consecutive patients in whom S4 was judged to be present or absent according to the consensus of cardiologists. Left atrial filling fraction in patients with S4 was 49% and was significantly greater than 33% found in patients without S4 (p less than 0.005). Using atrial filling fraction of 35% as a dividing line, S4 had a sensitivity of 84% and a specificity of 75% for determining left atrial filling fraction greater than or equal to 35%. Furthermore, of 25 patients with S4, 21 (84%) had atrial filling fraction greater than or equal to or less than 35%, and of 16 patients without S4, 12 (75%) had atrial filling fraction less than 35%. Thus, the presence or the absence of S4 is quantitatively related to the left atrial filling fraction and appears to predict atrial filling fraction greater than or equal to or less than 35% reasonably well.     

Amyloid disease of the heart

A 70-year-old woman with a history of hypertension had been well until 3 years before when she developed atrial fibrillation and subsequently congestive heart failure. The heart failure became worse and she had three fainting spells. Low voltage on electrocardiogram and global hypokinesis on echocardiography were suggestive of cardiac amyloidosis. The patient died suddenly of intractable ventricular fibrillation. Autopsy confirmed heavy infiltration of the myocardium by amyloid.     

Acute heart failure and valvular heart disease: A scientific statement of the Heart Failure Association,the Association for Acute CardioVascular Care and the European Association of Percutaneous Cardiovascular Interventions of the European Society of Cardiology

Acute heart failure (AHF) represents a broad spectrum of disease states, resulting from the interaction between an acute precipitant and a patient's underlying cardiac substrate and comorbidities. Valvular heart disease (VHD) is frequently associated with AHF. AHF may result from several precipitants that add an acute haemodynamic stress superimposed on a chronic valvular lesion or may occur as a consequence of a new significant valvular lesion. Regardless of the mechanism, clinical presentation may vary from acute decompensated heart failure to cardiogenic shock. Assessing the severity of VHD as well as the correlation between VHD severity and symptoms may be difficult in patients with AHF because of the rapid variation in loading conditions, concomitant destabilization of the associated comorbidities and the presence of combined valvular lesions. Evidence-based interventions targeting VHD in settings of AHF have yet to be identified, as patients with severe VHD are often excluded from randomized trials in AHF, so results from these trials do not generalize to those with VHD. Furthermore, there are not rigorously conducted randomized controlled trials in the setting of VHD and AHF, most of the data coming from observational studies. Thus, distinct to chronic settings, current guidelines are very elusive when patients with severe VHD present with AHF, and a clear-cut strategy could not be yet defined. Given the paucity of evidence in this subset of AHF patients, the aim of this scientific statement is to describe the epidemiology, pathophysiology, and overall treatment approach for patients with VHD who present with AHF.     

参附注射液治疗老年慢性肺源性心脏病的临床观察

目的观察参附注射液治疗肺心病心功能不全的治疗效果。方法将82例患者随机分为两组,对照组42例予常规综合治疗,治疗组40例在综合治疗基础上使用参附注射液,疗程10 d。结果治疗组在显效率,总有效率,改善血氧分压指标等方面与对照组差异有显著性（P〈0.05）。结论肺心病心功能不全在常规综合治疗基础上联合使用参附注射液可提高疗效。     

Does digoxin have a place in the treatment of the child with congenital heart disease?

Summary The place of digoxin in the pediatric cardiologist's armamentarium remains uncertain. As an antiarrhythmic, its use in the Wolff-Parkinson-White syndrome is obsolete, but it remains useful in the treatment of the chronic atrial fibrillation seen in some patients postoperatively and in children with dilated cardiomyopathy. The efficacy of digoxin in heart failure is unproven. There is some evidence of improvement in non invasive left ventricular contractile indices in neonates and infants, but it is unclear whether this is associated with sustained clinical improvement. There is even less evidence of its effectiveness in the older child. Whilst the measurement of any effect will undoubtedly be difficult, the time has come for double-blind, placebo-controlled trials in selected groups of patients. These should be designed not only to test the notion that digoxin does not improve ventricular function, but also to embrace the possibility that its administration may result in clinical improvement over and above that following diuretics alone. An absence of proof of efficacy must be distinguished from no efficacy—more data are needed.JSC is supported by the Hyman Marks Pediatric Research Fund.     

左心室部分切除术治疗终末期心力衰竭

目的　对终末期扩张型心肌病患者采用外科左心室部分切除术减小左心室容积 ,并观察缓解心力衰竭 (心衰 )的疗效。方法　 4例患有进行性加重的充血性心衰患者的病因分别为原发性(2例 )、瓣膜性(1例 )和缺血性 (1例 )心肌病 ,所采用的术式包括“乳头肌间室壁切除”1例及“超乳头肌室壁切除”3例 (后者含二尖瓣替换)。同期手术还包括主动脉瓣替换 2例和冠状动脉搭桥 1例。结果　所有患者都顺利脱离体外循环 ,并在术后 (2 5± 2 )小时拔除气管插管。心输出量由术前 (2 0±0 2 )升 /min增至术后 (4 1±0 3 )升 /min(P =0 .0 0 1)。除 1例患者 3周后死于细菌性纵隔感染所致败血症外 ,另 3例平均 14天后出院。随访 (最多达 2 2个月 )证实这 3例患者均保持在纽约心脏协会心功能Ⅰ级。结论　左心室部分切除术为终末期扩张型心肌病患者缓解心衰症状 ,早期临床效果良好。     

New concepts on development of the second heart field

Background Congenital heart diseases（CHDs） account for the majority of life-threatening congenital anomalies at birth. CHDs are outcomes of developmental disorders of heart during embryogenesis. Here, we reviewed the development of cardiac progenitors, called the second heart field（SHF）. And it is also the major origin of the outflow tract（OFT）, right ventricle and most of the atria.