Precordial chest pain in patients with chronic Chagas disease

Precordial chest pain affects about 15% to 33% of patients with chronic Chagas disease. In the absence of megaesophagus, it should be ascribed to chronic Chagas heart disease. Precordial chest pain is atypical because it can usually neither be associated to physical exercise nor be alleviated by nitroglycerin. However, in certain circumstances, precordial chest pain can masquerade as acute coronary syndrome. Although obstructive coronary artery disease can occasionally be found, microvascular angina seems to be the mechanism behind such phenomenon. Precordial chest pain not always has a benign clinical course; sometimes, it can herald a dismal prognosis. On the basis of cases previously reported, it seems that nitrates, betablockers and/or calcium channel blockers can be of value in the treatment of this condition.     

Graves病患者血清氨基端-脑钠肽前体水平的变化

目的 研究Graves病(GD)甲亢患者血清氨基端.脑钠肽前体(NT-proBNP)的变化特点及临床意义.方法 入选GD患者269例,其中初发患者90例.测定血清甲状腺激素、促甲状腺素受体抗体(TRAb)和NT-proBNP水平.结果 血清NT-pmBNP与FT3(r=0.260,P<0.01)、FT4(r=0.297,P<0.01)和心率正相关(r=0.251,P<0.05);与超敏TSH(sTSH)负相关(r=-0.157,P<0.01).校正年龄、性别和体重指数(BMI)后,血清NT-pmBNP仍与FT3、FT4和TRAb正相关(均P<0.01).校正血清FT3,FT4、sTSH、TRAb、年龄、性别、BMI后,初发组和治疗组的血清NT-proBNP差异仍有统计学意义(P<0.01),血清FT4对NT-pwBNP有显著影响(P<0.01),NT-proBNP水平的升高在甲亢已经控制的患者中同样存在.结论 GD患者血清NT-pwBNP水平随着FT4的升高而明显上升,不受性别、年龄和BMI的影响.监测血清NT-pmBNP有助于了解GD患者的血管僵硬度和容量变化,为早期防治甲亢引起的心血管疾病提供依据.     

急性心肌梗死及扩张型心肌病心力衰竭患者血浆NT-proBNP、NT-proCNP水平比较

目的探讨急性心肌梗死(AMI)及扩张型心肌病(DCM)心力衰竭患者血浆N端脑钠肽前体(NT-proBNP)和N端C型利钠尿肽前体(NT-proCNP)水平的差异。方法 2012年1月~2012年12月,连续入选心力衰竭的患者117例,其中AMI组、DCM组患者分别为89例及28例,同期健康体检对照组76例,分别检测及比较三组人群血浆NT-proBNP和NT-proCNP的水平及差异。结果健康对照组NT-proBNP水平[(5.8±1.2)pmol/L]明显低于AMI组[(57.6±21.3)pmol/L](P0.05)和DCM组[(51.7±19.8)pmol/L](P0.05),差异统计学意义;AMI组和DCM组NT-proBNP水平无统计学差异(P0.05)。健康对照组NT-proCNP水平[(4.1±1.2)pmol/L]低于AMI组[(21.2±4.8)pmol/L](P0.05)和DCM组[(6.9±1.5)pmol/L](P0.05),AMI组NT-proCNP水平明显高于DCM组(P0.05),差异统计学意义。结论 AMI及DCM心力衰竭患者血浆NT-proBNP水平无明显差异,而NT-proCNP水平有较大差异。     

氨基末端B型脑钠肽前体与非梗阻性肥厚型心肌病患者左心室舒张功能的相关性研究

目的探讨血浆氨基末端B型脑钠肽前体(NT-proBNP)水平与非梗阻性肥厚型心肌病(HNCM)患者左心室舒张功能的关系。方法选择46例HNCM患者,20名健康体检者作为对照组,电化学发光法检测两组血浆NT-proBNP水平,超声心动图、组织多普勒显像(TDI)检测室间隔厚度、射血分数和反映左心室舒张功能的参数。结果HNCM组患者平均NT-proBNP血浆水平明显高于对照组(P<0.001);NT-proBNP血浆水平与以下左心室舒张功能参数均呈正相关:二尖瓣室间隔侧舒张早期最大运动速度e(r=0.74,P<0.001)、e与二尖瓣室间隔侧舒张晚期最大运动速度a比值e/a(r=0.69,P<0.001)、心房收缩开始至左室流出道内心室收缩期前流速开始的间期A-Ar(r=0.63,P=0.029)、Tei指数(r=0.63,P<0.001)、肺静脉频谱收缩期肺静脉血流速度S与舒张期肺静脉血流速度D的比值S/D(r=0.62,P<0.001)、等容舒张时间(IVRT)(r=0.56,P<0.001)、二尖瓣血流频谱舒张早期充盈峰值速度E(r=0.54,P<0.001)、a(r=0.53,P<0.001)、二尖瓣血流频谱舒张晚期充盈峰值流速A(r=0.36,P=0.02)、E/A(r=0.47,P<0.001)。多因素Logistic回归分析显示,e/a、S/D是NT-proBNP血浆水平的独立影响因素。结论NT-proBNP血浆水平与超声心动图左心室舒张功能参数间存在明显的正相关性,可以作为评价HNCM患者左心室舒张功能不全的客观指标。     

心电图评价致心律失常性右心室心肌病病变程度的临床价值

目的 分析致心律失常性右心室心肌病(ARVC)患者的病变程度与心电图表现之间的关系.方法 分析61例已确诊的ARVC患者,根据心脏核磁共振成像(MRI)检查结果,将其按病变侵犯部位分为右心室局部病变组、右心室弥漫病变组、双心室病变组,分析比较三组的心电图特征.结果 心脏MRI结果显示右心室局部病变组19例(31%),右心室弥漫病变组28例(46%),双心室病变组14例(23%).心电图正常者3例,三组中各1例.伴有Epsilon波的患者24例(39%)、V1～V3导联的QRS波时限≥110 ms的患者21例(34%)、V1～V3导联S波升支≥55 ms的患者17例(28%)、完全右束支传导阻滞的患者10例(16%)、病理性Q波的患者9例(15%),这些指标的发生率均随病变程度的加重而增高(右心室局部病变组＜右心室弥漫病变组＜双心室病变组).Epsilon波、V1～V3导联的QRS波时限≥110 ms、完全性右束支传导阻滞(RBBB)、病理性Q波的发生率在双心室病变组中要高于右心室局部病变组,且两组间比较差异有统计学意义(P＜0.05).V1～V3导联S波升支≥55 ms的发生率在双心室病变组中要高于右心室局部病变组,且两组间比较差异有统计学意义(P＜0.05);在双心室病变组要高于右心室弥漫病变组,且两组间比较差异均有统计学意义(P均＜0.05).一度房室传导阻滞的发生率在双心室病变组中要高于右心室弥漫病变组,且两组间比较差异有统计学意义(P＜0.05).右心室局部病变组患者心电图T波倒置多局限于V1导联,右心室弥漫病变组和双心室病变组T波倒置多数表现于胸前导联V1～V3或超过V3导联的胸前导联、以及下壁导联.结论 心电图正常并不能排除ARVC.ARVC患者T波倒置在12导联心电图上具有很高的发生率,并且T波倒置在胸部导联的延伸与病变程度是相关的,T波倒置的范围可以提示ARVC病变累及的程度.

Abstract：

Objective To analyze the relationship between electrocardiographic (ECG) features and disease severity in patients with the arrhythmogenic right ventricular cardiomyopathy (ARVC). Method The study group consisted of 61 subjects with a definite diagnosis of ARVC on the basis of published guideline criteria and patients were divided into 3 subgroups according to the extent of diseased myocardium defined by cardiac magnetic resonance imaging (MRI): Group A: local involvement (n = 19, 31% ), Group B: diffuse involvement of whole right ventricle ( n = 28, 46% ) and Group C: involvement of both right and left ventricles ( n = 14, 23% ). Results Normal electrocardiogram was shown in 1 patient in each group.Epsilon wave was detected in 24 (39%) patients, QRS duration was prolonged [≥ 110 ms( V1 -V3 )] in 21 (34%) patients, S-wave upstroke was prolonged (≥55 ms) in 17 (28%) patients, complete right branch bundle block was evidenced in 10 ( 16% ) patients and pathologic Q waves was found in 9 ( 15% ) patients. The incidence of above abnormal ECG changes was increased in proportion to the degree of disease severity (group A ＜ group B ＜ group C). Incidence of Epsilon wave and prolonged QRS duration [≥ 110 ms (V1 - V3 )] were significantly higher in Group C than in Group A. Incidence of prolonged S-wave upstroke ( ≥55 ms) was significantly higher in Group C than in Group A and Group B. T-wave inversion in V1 leads was often found in Group A. T-wave inversion in inferior leads ( V1 - V3 leads or beyond V3 ) was often presented in Group B and Group C. Conclusions Normal ECG does not exclude the possibility of diagnosis of ARVC. The extent of T-wave inversion in the precordial leads and incidence of Epsilon wave, prolonged QRS duration [≥ 110 ms (Vt -V3 )] and prolonged S-wave upstroke ( ≥55 ms) were related to degree of disease severity in patients with ARVC.     

Association between anaemia and N-terminal pro-B-type natriuretic peptide (NT-proBNP): findings from the Heart and Soul Study

BACKGROUND: Anaemia is associated with elevated levels of natriuretic peptides. Whether the association of anaemia with natriuretic peptides is independent of other cardiovascular risk factors is unclear. METHODS: This was a cross-sectional study of 809 ambulatory patients with coronary heart disease (CHD) and no history of heart failure (HF). We evaluated the extent to which the relationship between haemoglobin and N-terminal pro-B-type natriuretic peptide (NT-proBNP) was explained by differences in cardiovascular risk factors, inflammation, and kidney dysfunction. RESULTS: Of the 809 participants, 189 (23%) had anaemia (haemoglobin <13 g/dL). Haemoglobin (as a continuous variable) was inversely associated with log NT-proBNP (beta coefficient -.28, p<.0001). This association was considerably attenuated after accounting for cardiovascular risk factors, C-reactive protein, and kidney dysfunction. However, haemoglobin remained independently associated with log NT-proBNP even after adjustment for these variables (beta coefficient -.11, p=0.0003). Each 1 g/dL decrease in haemoglobin was associated with a 20% greater odds of having NT-proBNP in the highest quartile. CONCLUSIONS: The relationship between anaemia and NT-proBNP is largely explained by differences in cardiovascular risk factors, ventricular function, myocardial ischaemia, inflammation, and kidney function. Nonetheless, haemoglobin appears to be inversely associated with NT-proBNP even after adjustment for these risk factors.     

红细胞分布宽度联合NT-proBNP预测ST段抬高型心肌梗死急诊PCI后心电图ST段回落不良的临床价值

目的探讨红细胞分布宽度(RDW)联合N末端脑钠肽前体(NT-proBNP)预测ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入(PCI)后心电图ST段回落不良的临床价值。方法2017年1月至2019年1月252例接受急诊PCI治疗的STEMI患者,按照PCI后60min时的心电图ST段回落情况分为ST段回落不良组和ST段回落良好组,比较两组临床资料、RDW和NT-proBNP。结果ST段回落不良组Killip分级≥2级、前壁心肌梗死比例、胸痛到球囊扩张时间、入院时肌酸激酶同工酶(CK-MB)、超敏C反应蛋白(hs-CRP)、血尿酸(UA)、纤维蛋白原、甘油三酯(TG)高于ST段回落良好组,差异均有统计学意义(均P<0.01)。ST段回落不良组NT-proBNP[(4310.34±1514.65)pg/ml]显著高于ST段回落良好组[(2714.71±854.56)pg/ml](t=12.545,P<0.01)。ST段回落不良组RDW[(15.94±1.24)%]显著高于ST段回落良好组[(14.67±1.18)%](t=4.331,P<0.01)。多元logistic回归方程显示NT-proBNP、RDW是STEMI患者PCI后ST段回落不良的独立危险因素(均P<0.01)。NT-proBNP和RDW预测PCI后ST段回落的ROC曲线下面积分别为0.771和0.689,联合NT-proBNP和RDW预测的ROC曲线下面积为0.849(0.738~0.920),显著高于两者单独预测的面积(Z=2.910,P<0.05)。结论RDW联合NT-proBNP有助于预测STEMI患者PCI后ST段回落不良。     

心力衰竭患者血浆脑钠素浓度与心功能的关系

目的 :研究心力衰竭 ( HF)患者血浆心房肽 ( ANP)、脑钠素 ( BNP)浓度与心脏原发疾病、HF严重程度及左室功能的关系。方法 :用放射免疫法测定 75例 HF患者 ( HF组 )及 60例健康体检者 (对照组 )血浆 ANP、BNP浓度 ;用 Swan- Ganz漂浮导管测定心脏指数 ( CI)和肺毛细血管楔入压 ( PCWP) ;用放射性核素 99m锝心血池扫描测定左室射血分数 ( L VEF)。结果 :HF组血浆 ANP、BNP浓度显著高于对照组 ( P <0 .0 1)。且均随着Forrester分级程度的加重而显著增加。血浆 ANP浓度与 PCWP之间具有良好的正相关 ( r =0 .64,P <0 .0 1)。血浆 BNP浓度与 CI、L VEF之间具有良好的负相关 (分别 r =- 0 .76,r=- 0 .78,均 P <0 .0 1)。HF组中心肌梗死者的血浆 BNP浓度显著高于心脏瓣膜病和扩张型心肌病者 ( P<0 .0 1)。结论 :HF患者血浆 ANP、BNP浓度随着 HF严重程度的增加而升高 ;心肌梗死后 HF患者血浆 BNP浓度的升高更加明显 ;HF患者的血浆 BNP浓度能较好地反映左心室功能状态     

脑钠肽和氨基末端B型钠尿肽前体与心脏术后心房颤动关系的荟萃分析

目的 通过荟萃分析综合评价术前脑钠肽(BNP)水平、氨基末端B型钠尿肽前体(NT-proBNP)水平与心脏术后心房颤动(房颤)的关系.方法 制定原始文献的纳入标准、排除标准及检索策略,检索多个中英文文摘数据库和全文数据库,对检索的文献进行质量评价后,应用RevMan5.1分析软件进行不均一性和敏感性分析,采用固定效应或随机效应模型计算合并后的综合效应.结果 14篇文献符合纳入及排除标准.术后房颤(POAF)组术前BNP水平[SMD=0.69,95％ CI(0.35,1.03),Z=4.01,P＜0.05]、NT-proBNP水平[WMD=127.46,95％ CI(18.91,236.01),Z=2.30,P=0.02]高于术后非房颤组,差异有统计学意义.结论 POAF组术前BNP/NT-proBNP水平高于非POAF组,术前BNP/NT-proBNP水平能预测术后房颤的发生.     

Economic evaluation of Chagas disease screening of pregnant Latin American women and of their infants in a non endemic area

Migration is a channel through which Chagas disease is imported, and vertical transmission is a channel through which the disease is spread in non-endemic countries. This study presents the economic evaluation of Chagas disease screening in pregnant women from Latin America and in their newborns in a non endemic area such as Spain. The economic impact of Chagas disease screening is tested through two decision models, one for the newborn and one for the mother, against the alternative hypothesis of no screening for either the newborn or the mother. Results show that the option “no test” is dominated by the option “test”. The cost effectiveness ratio in the “newborn model” was 22 €/QALYs gained in the case of screening and 125 €/QALYs gained in the case of no screening. The cost effectiveness ratio in the “mother model” was 96 €/QALYs gained in the case of screening and 1675 €/QALYs gained in the case of no screening. Probabilistic sensitivity analysis highlighted the reduction of uncertainty in the screening option. Threshold analysis assessed that even with a drop in Chagas prevalence from 3.4% to 0.9%, a drop in the probability of vertical transmission from 7.3% to 2.24% and with an increase of screening costs up to €37.5, “test” option would still be preferred to “no test”. The current study proved Chagas screening of all Latin American women giving birth in Spain and of their infants to be the best strategy compared to the non-screening option and provides useful information for health policy makers in their decision making process.     

Relationship between heart failure and the early NT-proBNP in burn patients

Background Myocardial damage often occurs after burns.Previously,cardiac enzyme profile was often measured to determine myocardial injury,but was hardly specific.In this study,we investigated early changes of plasma N-terminal pro-brain natriuretic peptide(NT-proBNP) over time and its diagnostic value in burned patients.Methods 39 patients with heat burned were assigned to heart failure group(n = 9),control group(n = 30).Plasma NT-ProBNP and troponin I(cTnT) were measured at 1st,3rd,5th days and 7th day,and patients were subdivided into 2 groups according to their cardiac function.Results Nine patients had heart failure(27.7%) and their NT-proBNP was 1676.03 ± 2190.41 pg /L.Significant difference was found between the heart failure group and control group(P < 0.01).Conclusion NT-proBNP is related to the severity of burning and can well reflect the status of myocardial injury in patients with severe burn,and can be used as an ideal marker for myocardial injury in burned patients.     

阵发性心房颤动患者血清N-末端脑钠肽前体水平变化及其临床意义

目的:观察心房颤动(房颤)对非瓣膜性心脏病患者血清N-末端脑钠肽前体(NT-proBNP)水平的影响,并探讨其临床意义.方法:采用ELISA法测定98例非瓣膜性心脏病阵发性房颤及40例窦性心律患者血清NT-proBNP水平.对阵发性房颤患者采取药物复律,测定复律前后血清NT-proBNP水平变化.结果:阵发性房颤患者血清NT-proBNP水平明显高于窦性心律患者(P＜0.01);成功复律的阵发性房颤患者复律前NT-proBNP水平明显高于成功复律后(P＜0.01);未成功复律者复律前后NT-proBNP水平比较差异无统计学意义(P＞0.05);成功复律者复律前的NT-proBNP水平明显低于未成功复律者(P＜0.01).结论:房颤是影响脑钠肽分泌的重要因素,入院时血清NT-proBNP水平对房颤药物复律效果具有预测价值.     

老年慢性心力衰竭患者N末端钠尿肽前体与心脏功能的相关性研究

目的探讨老年慢性心力衰竭(CHF)患者N末端钠尿肽前体(NT-proBNP)与心脏功能的相关性。方法选择老年CHF患者133例为CHF组,另选正常体检者116例为对照组。2组均行超声进行心脏功能检测;采用ELISA法检测NT-proBNP水平。结果与对照组比较,CHF组患者左心室舒张末内径(LVEDD)、左心室收缩末内径(LVESD)、Tei指数及NT-proBNP明显升高,LVEF、左心室短轴缩短率(LVFS)及二尖瓣舒张早期血流峰值(E)和舒张晚期血流峰值(A)均明显降低(P<0.05)。随着心功能分级的上升,LVEDD、LVESD、Tei指数以及NT-proBNP明显升高(P<0.05),LVEF、LVFS及E/A比值明显降低(P<0.05)。NT-proBNP与LVEF、LVFS、E/A比值呈负相关,与Tei指数、LVEDD、LVESD呈正相关。多因素回归分析显示,LVEF、LVFS、心功能分级和Tei指数是影响NT-proBNP的主要因素。结论 NT-proBNP升高与老年CHF患者心脏功能损害程度相关。     

高血压病合并糖尿病患者血浆hs-CRP、BNP与左室功能关系的研究

目的探讨高血压病合并2型糖尿病（EH＋DM）患者血浆高敏C反应蛋白（high-sensitivity C-re-active protein,hs-CRP）及B型脑钠肽（brain natriuretic peptide,BNP）与左室功能不全的关系。方法单纯高血压病患者104例,高血压病合并2型糖尿病患者55例,采用酶联免疫吸附法（ELISA）检测血浆hs-CRP、BNP,彩色超声多普勒测定左心室射血分数（LVEF）及相关指标,结合体表面积计算左心室质量指数（LVMI）,比较两组患者血浆hs-CRP、BNP水平及与LVEF及LVMI关系。结果高血压病合并2型糖尿病组LVMI及血浆hs-CRP、BNP明显高于单纯高血压病组,而LVEF显著低于单纯高血压病组,差异有统计学差异;偏相关分析hs-CRP、BNP与LVMI正相关,r值分别是0.44、0.54（P〈0.01）;hs-CRP、BNP与LVEF负相关,r值分别是-0.32、-0.31（P〈0.01）;hs-CRP与BNP正相关,r值为0.62（P〈0.01）。结论 hs-CRP和BNP对评价高血压合并糖尿病患者左心功能有一定的意义。