快速心室起搏诱导犬心力衰竭模型成功的时限观察

目的:观察快速心室起搏诱导犬心力衰竭模型的不同起搏时限对犬心功能、肾脏血流量的影响。方法:①实验于2004-03/2005-06在哈尔滨医科大学第一临床医学院实验外科完成。选用健康成年杂种家犬27只。随机分为3组:假手术组(n=6),起搏2周组(n=6),起搏4周组(n=7),起搏6周组(n=8)。②麻醉犬,左侧卧位,切开、悬吊心包,固定螺旋型心外膜起搏电极于右-室心尖部,连接实验用VOO型埋藏式起博器,于犬背部皮下造皮囊埋置起博器,恢复1周后起搏2,4,6周(起搏2,4,6周组),起搏频率均为240次/min;假手术组埋置起博器后不起搏。③采用彩色多普勒超声诊断仪测定各组犬左心室收缩末内径、左心室舒张末内径、左心室射血分数、心排血量、收缩期室间隔厚度、舒张期室间隔厚度、收缩期左心室后壁厚度、舒张期左心室后壁厚度。计算肾脏血浆流量(π×双肾动脉内径2×双肾动脉最大血流速度×0.57×60/4)。④组间计量资料差异比较采用单因素方差分析,两两比较用q检验,组内比较用配对t检验。结果:起搏6周组起搏期间死亡2只,最终进入结果分析:假手术组6只,起搏2,4,6周组分别6,7,6只。①起搏4和6周组犬心排血量、左室射血分数、肾脏血浆流量明显低于假手术组和起搏2周组(P<0.05～0.01),左心室收缩末内径、左心室舒张末内径明显大于假手术组和起搏2周组(P<0.05～0.01)。②起搏4和6周组犬收缩期室间隔厚度、舒张期室间隔厚度、收缩期左心室后壁厚度、舒张期左心室后壁厚度明显小于假手术组和起搏2周组(P<0.05～0.01)。起搏2周组犬收缩期左心室后壁厚度均明显小于假手术组(P<0.05)。结论:快速心室起搏所致的犬心力衰竭模型呈时间依赖性,起搏4周犬心功能、肾血流明显下降而生存率高。     

心脏彩色多普勒超声对慢性心力衰竭患者的诊断价值分析

目的：分析心脏彩色多普勒超声对慢性心力衰竭患者的诊断价值。方法：选取2020年1月—2023年1月苏州市第九人民医院收治的冠心病患者64例为研究对象,根据冠状动脉造影（coronary angiography,CAG）检查结果分为慢性心衰组（冠心病引起的慢性心力衰竭患者40例）、对照组（单一冠心病患者24例）,并将慢性心衰组根据心功能等级不同分为三个亚组（Ⅱ级组、Ⅲ级组、Ⅳ级组）,所有患者均进行心电图、心脏彩色多普勒超声检查,观察超声检查结果,分析心电图与心脏彩色多普勒超声检查诊断慢性心力衰竭价值。结果：慢性心衰组左心室收缩末期内径（LVESD）、左心室舒张末期内径（LVEDD）、左房内径（LA）、二尖瓣舒张早期与舒张晚期血流峰值速度比值（E/A）均显著大于对照组,左心室射血分数（LVEF）显著低于对照组（P <0.01）。慢性心衰组中Ⅱ级组、Ⅲ级组、Ⅳ级组心脏彩色多普勒超声检查结果显示,Ⅳ级组LVESD、LVEDD、LA、E/A高于Ⅲ级组、Ⅱ级组,LVEF低于Ⅲ级组、Ⅱ级组,差异有统计学意义（P<0.05）。心脏彩色多普勒超声检查诊断慢性心力衰竭特异度、灵敏度、准确率均高...     

射血分数保留心力衰竭的心室同步性评价及再同步化治疗

射血分数保留的心力衰竭（heart failure with preserved ejection fraction,HFPEF）是指射血分数正常（＞55％）或保留射血功能（40％ ～55％）的心力衰竭[1].既往HFPEF常被称为舒张性心力衰竭（diastolic heart failure,DHF）,以区别于收缩性心力衰竭（systolic heart failure,SHF）即射血分数减低性心力衰竭（heartailure with reduced ejection fraction,HFREF）,由于左心室舒张功能障碍不单存在于HFPEF,在HFREF患者中也广泛存在,所以取消DHF而以HFPEF取代.HFPEF随人口老龄化而呈增多趋势,作为最常见的心力衰竭形式,发病已超过射血分数减低的心力衰竭[2].HFPEF在老年人更多见（平均年龄73 ～ 79岁）,女性发病经常高于男性（女性发病占发病者61％～76％,约8％～10％大于80岁的女性存在HFPEF,而在同龄男性中仅有4％～6％受累）,另外长期高血压者更常见[3].     

慢性左心力衰竭患者延长的心电图QRS波群时限对血浆NT-proBNP、LVEF和NYHA心功能的预测价值

目的：通过比较不同QRS波群时限的慢性左心力衰竭患者血浆氨基末端脑钠肽前体（NT—proBNP）、LVEF和NYHA心功能分级的差异,探讨延长的心电图QRS波群时限对血浆NT—proBNP、LVEF和NYHA心功能的预测价值。方法：入选82例临床明确诊断为慢性左心力衰竭的患者,根据入院时心电图QRS波群时限分为QRS波群时限〈110ms组（47例）和QRS波群时限≥110ms组（35例）,比较两组患者血浆NT-proBNP水平、LVEF和NYHA心功能分级的差异。结果：QRS波群时限≥110ms组患者血浆NT—proBNP水平更高,而LVEF值更低,NYHA心功能分级更高。结论：慢性左心力衰竭患者入院时心电图QRS波群时限能较好地反映患者NT—proBNP水平、LVEF和NYHA心功能分级水平。     

射血分数正常的心力衰竭患者临床特点分析

多年来,心力衰竭～直被认为是左心室收缩力明显减弱或左心室射血分数降低的临床表现,然而,近几年的临床研究,对左心室射血分数正常的心力衰竭（heart failure with normal ejection fraction,HFNEF）逐渐受到重视。流行病学资料显示,HFNEF占所有心力衰竭患者的30％～70％,老年患者甚至更高。本文回顾性分析本院230例心力衰竭患者的临床资料,以探究HFNEF的临床特点。     

达格列净对射血分数降低的心力衰竭患者的效果观察

目的 探讨达格列净对射血分数降低的心力衰竭(HFrEF)患者CXC趋化因子配体16(CXCL16)、基质细胞衍生因子-1(SDF-1)及亲环素A(CypA)水平的影响。方法 将156例HFrEF患者按照干预治疗方案的不同分为干预组和对照组,每组78例。对照组采用常规标准化药物干预治疗,干预组在对照组基础上加用达格列净治疗。比较2组总有效率;比较2组治疗前后CXCL16、SDF-1、CypA水平的变化;采用Spearman相关系数分析CXCL16、SDF-1、CypA与临床疗效的相关性;比较2组治疗前后N末端B型利钠肽原(NT-proBNP)、超敏C反应蛋白(hs-CRP)、心肌肌钙蛋白I(cTnI)、肿瘤坏死因子-α(TNF-α)水平;比较2组治疗前后心室重塑指标[左室舒张末期内径(LVEDd)、左室收缩末期内径(LVESd)、左心室射血分数(LVEF)]的变化;采用Pearson相关系数分析CXCL16、SDF-1、CypA与心室重塑指标的相关性。结果 干预组总有效率为89.74%,高于对照组的73.08%,差异有统计学意义(P<0.05)。2组治疗后CXCL16、CypA水平...     

组织多普勒超声评价交感神经阻滞对扩张型心肌病左心室心肌收缩力的影响

目的观察心交感神经阻滞对扩张型心肌病左心室心肌收缩力的影响。方法随机选取30例扩张型心肌病患者,分为对照组(16例)和治疗组(14例)。对照组给予常规抗心力衰竭治疗,治疗组在给予对照组治疗的同时,以0.5%利多卡因每2h经硬膜外导管推注一次(夜间睡眠除外),阻滞心区交感神经(胸1-5)。所有患者于治疗前和治疗后1个月行经胸心脏超声检查,测量左心房收缩末期内径(LAD),左心室舒张末期内径(LVEDd),短轴缩短率(FS),射血分数(EF),二尖瓣环后间隔、侧壁、前壁、下壁、前间隔、后壁的组织峰值收缩速度(Sm)和运动距离(D),计算6个位点的峰值收缩速度和运动距离平均值(MSm和MD),比较两组上述指标的差异。结果治疗组LAD和LVEDd均显著缩小,EF和FS明显增加,对照组上述指标无显著改善。同对照组比,治疗组MSm和MD均显著增加[MSm(4.91±0.56)cm/s对(4.09±0.82)cm/s,P<0.05;MD(0.61±0.18)cm对(0.41±0.18)cm,P<0.05]。左心室射血分数改善与MSm和MD的变化显著相关(MSmr=0.576,P=0.001;MDr=0.526,P=0.003)。结论对于扩张型心肌病,心区交感神经阻滞较常规治疗能显著缩小左心腔径,尤为突出的是它能更有力地增强心肌的收缩力,改善左心室收缩功能。     

Left ventricular and biventricular pacing in congestive heart failure

Dual-chamber pacing improved hemodynamics acutely in a subset of patients with left ventricular (LV) dysfunction but conveyed no long-term symptomatic benefit in most. More recently, LV pacing and biventricular (multisite) pacing have been used to improve systolic contractility by altering the electrical and mechanical ventricular activation sequence in patients with severe congestive heart failure (CHF) and intraventricular conduction delay or left bundle branch block (LBBB). Intraventricular conduction delay and LBBB cause dyssynchronous right ventricular and LV contraction and worsen LV dysfunction in cardiomyopathies. Both LV and biventricular cardiac pacing are thought to improve cardiac function in this situation by effecting a more coordinated and efficient ventricular contraction. Short-term hemodynamic studies have shown improvement in LV systolic function, which seems more pronounced with monoventricular LV pacing than with biventricular pacing. Recent clinical studies in limited numbers of patients suggest long-term clinical benefit of biventricular pacing in patients with severe CHF symptoms. Continuing and future studies will demonstrate whether and in which patients LV and biventricular pacing are permanently effective and equivalent and which pacing site within the LV produces the most beneficial hemodynamic results.     

Biventricular pacing for congestive heart failure

Resynchronization with biventricular pacing is a relatively new and important nonpharmacological therapy for patients with heart failure. A prolonged PR interval, a wide QRS, and left bundle branch block are typical conduction disturbances associated with left ventricular dysfunction. The intraventricular conduction delays often lead to loss of synchronization of ventricular contraction, thus contributing to additional problems for the heart failure patient. Biventricular pacing offers (surgically implanted leads implies a thoracotomy or mini-thoracotomy for an epicardial lead and not the preferred transvenous approach) for an endocardial lead, considerable promise for improving the quality of life, exercise tolerance, as well as for decreasing hospitalization for patients with Class III or Class IV heart failure.     

Pathophysiological roles of endogenous endothelin-1 in dogs with chronic heart failure produced by rapid right ventricular pacing.

This study was designed to analyze the pathophysiological role of the endogenous endothelin (ET) system and the therapeutic approach to congestive heart failure (CHF) with ET(A)/ET(B) receptor antagonists in a canine CHF model. After 3 weeks of rapid right ventricular pacing (240 beats/min), concentrations of immunoreactive ET-1 in dogs increased approximately 2-fold in plasma and in the left and right ventricles but not in the lung. There were no meaningful changes in the density and affinity of total ET receptors, or in the ratio of ET(A) to ET(B) receptors. To clarify the functional role of endogenous ET, we examined the effects of acute injection of J-104132 (1 and 3 mg/kg i.v.), an ET(A)/ET(B) receptor antagonist, on cardiovascular and renal function in dogs with CHF. Compared with vehicle, J-104132 at both doses significantly decreased pulmonary artery pressure (PAP), pulmonary capillary wedge pressure (PCWP), and mean arterial pressure (MAP), and increased cardiac output (CO) and renal blood flow. J-104132 had no effects on heart rate and cardiac contractility. In addition, we examined whether J-104132 has an additive effect in the presence of enalaprilat. J-104132 (1 mg/kg i.v.) administered after enalaprilat (0.05 mg/kg i.v.) induced further decreases in MAP, PCWP and PAP, and further increases in CO, resulting in further decreases in total peripheral resistance. These results indicate that the endogenous ET system is exaggerated in CHF and has a detrimental effect on cardiac function. Therefore, J-104132 given alone or as combination therapy may play a beneficial role in the treatment of CHF in humans.     

双心室起搏治疗充血性心力衰竭

１引言充血性心力衰竭ＣＨＦ是常见的难治性心脏疾病,其患病率和病死率一直居高不下,全世界估计有２２５０万ＣＨＦ患者而且以每年２００万的速度递增,晚期ＣＨＦ的５年病死率高达５０％,心功能越差,病死率越高。ＣＨＦ已成为导致心血管疾病死亡的重要原因。虽然药物治疗ＣＨＦ已经取得了重要进展,尤其是血管紧张素转化酶抑制药和β受体阻滞药的应用已使ＣＨＦ患者的生存率和生活质量明显改善,但对晚期心功能纽约心脏学会,ＮＹＨＡⅢ～Ⅳ级的ＣＨＦ患者预后仍较差。心脏移植治疗是治疗晚期ＣＨＦ的最佳方法,但供体的…     

心力衰竭犬心房结构重构的实验研究

目的观察右室快速起搏建立心力衰竭犬模型的效果,探讨心房结构重构在心力衰竭与心房颤动形成过程中的作用机制。方法13只犬随机分为起搏组(n=7)和假手术组(n=6),于左、右心房各缝植4对电极,起搏电极缝植在右室心尖,连接实验用VOO型起搏器,快速心室起搏(220次/分)6周,建立心力衰竭犬模型,分别于起搏前、起搏6周后,应用经食管超声心动图测量左房收缩末容积;采用双平面Simpson法测量左室舒张期末和收缩期末容积,得出左室射血分数和心输出量,并应用光镜和电镜观察心房肌的超微结构。结果①假手术组术前和术后心脏各参数无明显变化。②起搏6周后,起搏组与假手术组比较,左房收缩末容积显著增大[(23.2±4.1)vs(13.5±1.9)cm3,P<0.01],左室舒张末期容积显著增大[(56.2±11.3)vs(33.7±9.6)cm3,P<0.01],左室收缩末期容积显著增大[(38.4±8.4)vs(14.5±8.6)cm3,P<0.01],射血分数显著降低[(31.4±10.2)vs(56.8±4.5)%,P<0.01],心输出量著降低[(1.2±0.5)vs(2.8±1.6)L/min,P<0.01]。③病理学结果显示起搏犬心房肌细胞变性、肌纤维溶解、线粒体肿胀以及间质胶原增生、水肿。结论心房结构重构是心力衰竭犬发生心房颤动的重要原因。     

葛根素注射液联合厄贝沙坦对心室快速起搏心力衰竭实验犬心房颤动及心房纤维化的影响

目的观察葛根素注射液联合厄贝沙坦对心室快速起搏致充血性心力衰竭（congestive heartfailure,CHF）实验犬心房颤动及心房纤维化的影响。方法选择健康成年杂种犬21只,随机令为正常组对照组、cI—IF模型组和TMP治疗组。采用右心室快速起搏建立实验犬CHF模型。Butst刺激诱发心房颤动（atrial fibrin;tripn,LVEF）。超声心动图仪检测实验犬左心室射血分数（1eft ventricular ejection fraction,LVEF）。Mallory’s三色法染色检测心房组织纤维比程度。采用放射免疫法测定血桨血管紧张素1[和醛固酮的浓度,测定血清m型前肢原氨基末端肽（amino．tedllldall～eptldcoflype Ⅲ procollagen,PⅢNP）、层粘连蛋白（lalTlmln,I．N）和透明质酸（hyaltlronlcacid,HA）的水平。结果CHF模型组LVEF较正常对照组明显下降（P〈0．01）;AF发生率、持续性AF发生率及AF持续时间较正常对照组均明显增加（P〈0．01）;左右心房纤维化程度较正常对照组亦有明显增加（P〈0．01）;AF持续时间与左心房纤维比程度呈密切正相关（r=0．84,P=0．018）;血浆血管紧张素Ⅱ、醛固酮以及血清PⅢNP、HA水平较正常对照组均有明显升高（P〈0．05或P〈0．01）;LN比较则无统计学差异;血浆血管紧张素Ⅱ水平与醛固酮水平均呈密切正相关（r=0．759,P=0．182）。治疗组LVEF较亡I-IF;模型组有明显改善（P〈0．05）;持续性AF发生率较CHF模型组有明显降低（P〈G．05）;左右心房纤维化程度较CHF模型组均有明显减轻（P〈0．01）。结论葛根素注射液联合厄贝沙坦可减轻Ⅱ-IF时心房纤维比的程度,这可能是其减少CHF时AF发生率及持续时间的机制之一。     

Performance of left ventricular versus biventricular pacing in chronic heart failure assessed by stress echocardiography

Acute hemodynamic studies suggest that resynchronization therapy using single-site left ventricular pacing (LVP) is equivalent to biventricular pacing (BIVP). The aim of this study was to assess the performance of LVP versus BIVP during exercise by means of stress echocardiography. A total of 28 patients (25 men and 3 women, mean age 60.9 +/- 8 years) with advanced chronic heart failure and impaired ventricular conduction (QRS > 150 ms) were studied. Patients were randomly allocated to either BIVP or LVP mode with a crossover on the next day and cardiac output was estimated at rest and during each stage of bicycle ergometry in supine position by means of velocity time integral formula. Maximum exercise level was comparable for both pacing modes (up to 100 W) and no significant differences were revealed either in heart rate or in blood pressure at rest and during any step of exercise. LVP was associated with significantly higher cardiac output at rest (3.2 +/- 0.5 vs 2.8 +/- 0.6 l/min, P < 0.01) and during low level exercise (4.4 +/- 0.8 vs 3.9 +/- 0.8 l/min at 25 W, P < 0.05) as compared with BIVP. There was a trend towards higher cardiac output for LVP even at higher levels of exercise. These effects were predominantly confined to patients with idiopathic dilated cardiomyopathy. It is concluded that cardiac resynchronization therapy using single-site LVP results in better hemodynamic response as compared with BIVP, both at rest and during physical exercise.     

自体骨髓单个核细胞移植起搏器诱导心力衰竭犬心功能变化 病理图像分析心脏切片胶原纤维定量的客观价值

背景:干细胞再生可修复受损心肌,但目前利用骨髓单个核细胞移植治疗非缺血性心力衰竭的研究相对甚少.目的:探讨自体骨髓单个核细胞心肌移植后,对起搏器诱导的心力衰竭模型犬心功能的影响.方法:细胞移植组、模型对照组犬均通过快速右室心尖部起搏建立心力衰竭模型.造模后,细胞移植组通过心肌直接注射法分多点注入CM-DiI标记的骨髓单个核细胞悬液,模型对照组同法注入等量生理盐水.4周后取材,取心尖、前壁和室间隔心肌,FITC标记心肌肌钙蛋白,观察心肌纤维化程度,测定心肌胶原容积分数,并进行血流动力学检查.结果与结论:细胞移植组可见CM-DiI和FITC双重染色的双阳性的细胞,呈黄色荧光;模型对照组仅可见FITC染色的绿色荧光图像.苏木精-伊红及Masson染色结果示,模型对照组间质中可见炎性细胞浸润,呈显著间质纤维化和心肌细胞纤维化;而细胞移植组未见明显间质炎性细胞浸润,间质无心肌细胞纤维化,提示快速右室心尖部起搏可成功建立犬心力衰竭模型.与模型对照组比较,移植后4周细胞移植组心尖、前壁、室间隔的胶原容积分数均明显降低(P < 0.05),射血分数明显升高 (P < 0.05),左室舒张末期内径及左室收缩末内径均无明显变化(P > 0.05).说明自体骨髓单个核细胞在心力衰竭犬心肌中可增殖分化为心肌样细胞,并改善心功能,其机制可能与抑制心力衰竭心肌纤维化进程有关.     

Reproducibility of echocardiography in chronic congestive heart failure

The purpose of this study was to define the reproducibility of serial echocardiographic measurements of left ventricular size and function. Fourteen patients in stable condition after heart failure (Group I) had five weekly outpatient echocardiograms performed by a single technician with blinded interpretation. The average end-diastolic diameter (EDD) of all patients was 68 mm, with a mean standard deviation of 4 mm and a 95% confidence interval of 8 mm. The average end-systolic diameter (ESD) was 58 mm; the 95% confidence interval was 6 mm. The % Δ D averaged 15.7%; the 95% confidence interval was 5.6%. A group of four patients with heart failure (Group II) had daily echocardiograms while undergoing continuous hemodynamic monitoring. Pulmonary capillary blood pressure and thermodilution cardiac outputs were stable throughout the 4-day study period. Daily morning echographic measurements were constant, with the 95% confidence interval of the EDD being only 4 mm. The ESD and % Δ D had 95% confidence intervals of 2 mm and 3.2%, respectively. The narrow range of measurements (narrow confidence intervals) demonstrates the excellent reproducibility of these echocardiographic parameters.