比索洛尔对逆转老年人高血压心脏病心室重构的疗效研究

目的研究比索洛尔对逆转老年人高血压以及心脏病左心室重构的疗效。方法将2012年来我院就诊或住院的156例老年高血压心脏病患者随机分为试验组和对照组,两组患者均给予同样的抗高血压及抗心力衰竭治疗,试验组在此基础上服用比索洛尔,随访6个月,测定治疗前后两组患者的血压,并进行常规超声心动图检测。结果随访6个月后,试验组收缩压和舒张压低于对照组,室间隔舒张末期厚度、左室舒张末期内径、左室舒张末期后壁厚度低于对照组,差异均有统计学意义(P<0.05)。结论比索洛尔对逆转老年人高血压心脏病心室重构的疗效良好,值得在临床上推广。     

超声心动图评价高龄高血压患者左心室收缩与舒张功能

目的探讨超声心动图各指标评估高龄老年高血压患者左心室不同构型的收缩与舒张功能的临床价值。方法将高龄老年原发性高血压患者153例,按Ganau法分为4组:正常构型组(47例)、向心性重构型组(35例)、向心性肥厚型组(33例)和离心性肥厚型组(38例);另选无心肺疾病的患者65例为正常对照组。超声心动图测量舒张末期室间隔厚度(IVS)、左心室后壁厚度(LVPW)、左心室内径(LVEDD)、二尖瓣血流频谱图舒张早期与晚期血流峰值比(E/A)、LVEF及Tei指数。结果正常对照组及以上4组E/A均<1;离心性肥厚型组LVEF明显降低(P<0.05),正常构型组、向心性重构型组、向心性肥厚型组比较无显著差异;以上4组Tei指数与正常对照组比较差异有显著性意义(P<0.05),但4组间比较无显著差异,Tei指数和E/A无相关性,Tei指数和LVEF呈负相关(r为-0.594,P<0.001)。结论Tei指数较E/A及LVEF更能全面评价高龄老年高血压患者心脏的收缩和舒张功能。     

比索洛尔治疗老年高血压患者舒张性心力衰竭的疗效观察

目的观察比索洛尔(bisoprolol,商品名博苏)对老年高血压患者舒张性心力衰竭(diastolic heartfailure,DHF)的临床疗效.方法入选老年高血压患者83例,按纽约心脏协会(New YorkHeart Association,NYHA)心功能分级Ⅱ～Ⅳ级,主要表现为舒张功能不全,随机分成比索洛尔干预组42例及对照组41例,两组患者均给予抗高血压及抗心力衰竭(congestive heart failure,CHF)的常规治疗,但对照组不用β-受体阻滞剂.比索洛尔干预组患者加用比索洛尔1.25～10mg/d,疗程6个月.比较两组患者治疗前后NYH心功能分级及左室超声舒张功能指标改善情况.结果(1)比索洛尔干预组总有效率为95%;对照组总有效率为80%,两组比较有显著性差异(P＜0.05).(2)治疗前后左室等容松弛减慢指标等容舒张时间(isovolumic relaxationtime,IVRT);左室早期充盈减慢指标二尖瓣舒张早期血流最大速度E峰、舒张早期和晚期充盈速度比值(E/A)、E峰减速时间(decelerationtime,DT);以及左房前后径(Left Atrial Diameter,LAD),收缩压、舒张压、心率(heart rate,HR)等左心室舒张功能指标明显优于治疗前(P＜0.01);比索洛尔干预组IVRT、E、E/A、DT、LAD、HR等改善明显优于对照组(P＜0.01 P＜0.05).结论比索洛尔治疗老年高血压患者的舒张性心力衰竭可显著降低心率、降压,改善心功能分级和左室舒张功能.     

B型脑利钠肽和Tei指数在高血压早期左心室舒张功能不全诊断中的意义

目的探讨B型脑利钠肽(BNP)与Tei指数在评价原发性高血压左心室舒张功能不全中的意义。方法选择高血压患者83例,分为高血压伴左心室舒张功能不全组(DHF组,35例),高血压无心力衰竭组(NHF组,48例),另选健康体检者20例作为对照组。化学发光法检测BNP,超声心动图检测各个参数,并计算左心室Tei值。结果DHF组Tei指数、BNP明显高于NHF组和对照组(P<0.01),NHF组Tei指数、BNP也明显高于对照组(P<0.05,P<0.01)。BNP法诊断敏感性、特异性明显好于Tei指数法,差异有统计学意义(P<0.05)。结论BNP和Tei指数均为诊断高血压早期舒张功能不全的敏感指标,且BNP法较Tei指数法更为高效、准确。     

原发性高血压患者左心室功能的临床研究

目的探讨原发性高血压患者左心室功能的临床研究。方法原发性高血压患者176例,按Ganau法分为4型:正常构型组(A组)46例、向心性重构组(B组)53例、向心性肥厚组(C组)40例、离心性肥厚组(D组)37例;正常对照组35例。超声心动图测量舒张末室间隔厚度(IVS)、左心室后壁厚度(LVPW)及左心室舒张末期内径,二尖瓣血流频谱左心室舒张早期血流峰速(E),舒张晚期血流峰速(A)值比,左心室射血分数(LVEF)及Tei指数。各组血浆脑钠肽(BNP)浓度对比分析。结果正常对照组与高血压各组比较,在年龄、性别均差异无显著性意义,C组、D组收缩压最高,左心房内径最大(P<0.05);B组、D组IVS、LVPW轻度增厚(P<0.05);高血压各组的E/A值均降低(P<0.05),LVEF值只有D组与正常对照组比较差异有显著性意义;各组Tei指数差异有显著性意义;BNP在B组、C组、D组差异有显著性意义。结论Tei指数,BNP共同评价原发性高血压患者不同左心室构型的心功能情况,对原发性高血压的治疗效果和预后有临床应用价值。     

比索洛尔与卡维地洛对原发性高血压疗效及逆转左心室肥厚的对比研究

目的对比研究富马酸比索洛尔和卡维地洛治疗原发性高血压的疗效以及逆转左心室肥厚的作用。方法将106例原发性高血压伴左心室肥厚的患者随机分为富马酸比索洛尔组(49例)和卡维地洛组(46例),于服药前及服药后3、6及12个月分别监测两组患者血压、心率,并测定左心室舒张末内径、舒张期室间隔厚度、左心室后壁厚度、左心室射血分数、心排血量、A峰速度、E峰速度及A峰与E峰比值(A/E比值)。结果两组治疗后心率比治疗前减慢,差异有统计学意义(P0.05);富马酸比索洛尔组治疗后心率低于卡维地洛组,差异有统计学意义(P0.05)。两组治疗后随访3、6、9个月的血压均比治疗前降低,差异有统计学意义(P0.05)。两组治疗前后左心室射血分数、心排血量比较,差异无统计学意义(P0.05);两组治疗后A/E比值均比治疗前明显降低。两组左心室质量指数、左心室舒张末内径、舒张期室间隔厚度、左心室后壁厚度治疗后均比治疗前降低,差异有统计学意义(P0.05);富马酸比索洛尔组治疗后上述指标比卡维地洛组低,差异有统计学意义(P0.05)。结论富马酸比索洛尔和卡维地洛在降低血压的同时,均能改善左心室舒张功能,并明显减轻左心室肥厚;富马酸比索洛尔比卡维地洛减轻左心室肥厚效果更强,并可以有效控制心率。     

靶剂量比索洛尔治疗明显改善原发性高血压伴心力衰竭患者的心脏重构与心功能

目的探讨靶剂量比索洛尔治疗对原发性高血压伴心力衰竭患者心脏重构和心功能的影响,及与血压、血管内皮生长因子(VEGF)、高敏C反应蛋白(hsCRP)的相关性。方法入选163例原发性高血压伴心力衰竭患者,根据治疗方案分为常规药物加比索洛尔(5mg,比索洛尔组,n=83)和常规药物(对照组,n=80),随访12月,观察治疗前后一般临床资料、超声心动图、放射性核素和实验室检查结果的变化。结果比索洛尔组及对照组患者治疗12月后左心室舒张末期内径(LVIDd)及左心室收缩末期内径(LVIDS)明显减少,二尖瓣返流明显减轻;左心室射血分数(LVEF)、左心室高峰充盈率(LVPFR)明显增高,而氨基末端脑钠尿肽原(NT-proBNP)明显降低;尤以比索洛尔组较甚。靶剂量比索洛尔治疗后患者收缩压、舒张压及脉压较治疗前明显降低,且VEGF及hsCRP亦明显降低。结论对原发性高血压伴心力衰竭患者,靶剂量比索洛尔治疗可以明显改善心脏重构和心功能。     

比索洛尔对老年高血压伴心功能不全病人血压及心室重塑的影响

目的探讨比索洛尔对老年高血压伴心功能不全病人血压及心室重塑的影响。方法将80例老年高血压伴心功能不全病人随机分为两组,对照组给予常规治疗;观察组在对照组治疗基础上加用比索洛尔治疗,治疗3个月后比较两组血压、超声心动图结果及血清胰岛素样生长因子1(IGF-1)、B型利钠肽(BNP)水平。结果治疗后,观察组24 h收缩压(SBP)、舒张压(DBP)及平均动脉压(MAP)均显著低于对照组(P0.05);观察组左室舒张末容量(LVEDV)、左心室质量(LVMI)、室间隔舒张末期厚度(IVST)、左室后壁舒张末期厚度(LVPWT)、左室收缩末容量(LVESV)、左室舒张早期快速充盈峰(E峰)/舒张晚期(心房收缩)充盈峰(A峰)均低于对照组,左室射血分数(LVEF)显著高于对照组(P0.05);观察组血清IGF-1、BNP水平均低于对照组(P0.05);观察组心功能分级显著优于对照组(Z=2.125,P0.05)。结论比索洛尔可提高老年高血压伴心功能不全病人的血压控制效果,改善病人心室重塑。     

比索洛尔联合曲美他嗪治疗充血性心力衰竭的临床疗效研究

目的观察比索洛尔联合曲美他嗪治疗充血性心力衰竭(CHF)的临床疗效。方法选取2013年1月—2015年1月宁乡县人民医院收治的CHF患者135例,随机分为对照组68例和观察组67例。两组患者均给予2周常规对症治疗,对照组患者在此基础上加用比索洛尔,观察组患者在此基础上加用比索洛尔联合曲美他嗪,均连续治疗16周。比较两组患者临床疗效、超声心动图检查指标及不良反应发生情况。结果共128例患者按要求完成了既定治疗,其中对照组65例,观察组63例。观察组患者临床疗效优于对照组(P0.05)。治疗前两组患者左心室射血分数(LVEF),左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)、左心室后壁厚度(LVPWT)及室间隔厚度(IVST)比较,差异无统计学意义(P0.05);治疗后,观察组患者LVEF高于对照组,LVESD、LVEDD、LVPWT、IVST低于对照组(P0.05)。两组患者不良反应发生率比较,差异无统计学意义(P0.05)。结论比索洛尔联合曲美他嗪治疗CHF的临床疗效确切,可有效改善患者心功能,逆转心室重构,且安全性较高。     

Tei指数对老年原发性高血压患者左心功能评价的临床研究

目的探讨Tei指数评价老年原发性高血压患者左心功能的价值。方法老年原发性高血压患者47例,平均年龄(75.32±6.01)岁,按Ganau分类法分为4种左室构型:正常构型组(Ⅰ组)、向心性重构组(Ⅱ组)、向心性肥厚组(Ⅲ组)、离心性肥厚组(Ⅳ组);正常对照组平均年龄(73.60±7.82)岁。超声心动图测量舒张末期室间隔、左室后壁厚度、左室舒张末期和收缩末期内径及左房内径(IVS、LVPW、LVEDd、LVEDs、LAD)、二尖瓣口血流频谱舒张早期和舒张晚期血流峰值比值(E/A)、左室射血分数(LVEF)以及左室Tei指数。结果高血压各组和对照组E/A比值均<1,各组间差异无统计学意义;高血压各组和对照组LVEF均大于>50%,各组组间差异无统计学意义;高血压各组左室Tei指数较对照组显著增大〔(0.32±0.06),(0.40±0.06),(0.48±0.06),(0.45±0.05),(0.54±0.07),P<0.05〕,高血压各组中,Ⅱ组和Ⅰ组,Ⅳ组和Ⅰ、Ⅱ、Ⅲ组左室Tei指数的组间差异有统计学意义(P<0.05);对照组中Tei指数与年龄进行相关性分析发现,左室Tei指数与年龄之间无显著相关性(r=0.048,P>0.05)。结论Tei指数是一种能够灵敏地检测出高血压患者早期左心整体功能改变的多普勒超声新方法;当老年高血压患者出现左室构型改变时,Tei指数能够反映其相应左心功能的不同程度损害。     

不同剂量比索洛尔对老年高血压病并发舒张性心力衰竭左室舒张功能的影响

目的: 观察不同剂量的比索洛尔对舒张性心力衰竭患者左室舒张功能的影响。方法: 92例高血压病并发左室舒张功能不全但左室射血分数（LVEF）>50%的患者,在氨氯地平控制血压达标（<140/90 mmHg）的基础上,按照加用比索洛尔的剂量随机分为3组:对照组（不用比索洛尔组,n=31）,低剂量组（加用比索洛尔1.25 mg,1次/d,n=30）,高剂量组（加用比索洛尔5 mg,1次/d,n=31）,平均随访观察30周。采用超声多普勒心动图评估治疗前后左室结构和功能参数的变化。结果: 3组治疗后LVEF和收缩压无明显改变,舒张压和心率在低剂量组和高剂量组下降明显（P<0.05）。加用比索洛尔治疗后,患者E峰、A峰、E/A、E峰流速积分（VTIE）、A峰流速积分（VTIA）、流速时间积分比率(E-VTI/A-VTI）有不同程度改善,高剂量组较低剂量组改善更加显著（P<0.05）。左室舒张末内径（LVEDD）、室间隔厚度（IVSD）、左室后壁厚度（PWT）、左室质量指数（LVMI)在高剂量组变化显著(P<0.05),对照组无显著改善。结论: 在氨氯地平降压达标基础上,比索洛尔能够进一步改善高血压病患者左室舒张功能,较大剂量作用更加显著。     

Relationship between Tei index of myocardial performance and left ventricular geometry in Nigerians with systemic hypertension

Introduction

Left ventricular geometry is associated with cardiovascular events and prognosis. The Tei index of myocardial performance is a combined index of systolic and diastolic dysfunction and has been shown to be a predictor of cardiovascular outcome in heart diseases. The relationship between the Tei index and left ventricular geometry has not been well studied. This study examined the association between the Tei index and left ventricular geometry among hypertensive Nigerian subjects.

Methods

We performed echocardiography on 164 hypertensives and 64 control subjects. They were grouped into four geometric patterns based on left ventricular mass and relative wall thickness. The Tei index was obtained from the summation of the isovolumic relaxation time and the isovolumic contraction time, divided by the ejection time. Statistical analysis was done using SPSS 16.0.

Results

Among the hypertensive subjects, 68 (41.4%) had concentric hypertrophy, 43 (26.2%) had concentric remodelling, 24 (14.6%) had eccentric hypertrophy, and 29 (17.7%) had normal geometry. The Tei index was significantly higher among the hypertensives with concentric hypertrophy (CH), concentric remodelling (CR) and eccentric hypertrophy (EH) compared to the hypertensives with normal geometry (0.83 ± 1.0, 0.71 ± 0.2, 0.80 ± 0.2 vs 0.61 ± 0.2, respectively). The Tei index was higher among hypertensives with CH and EH than those with CR. Stepwise regression analysis showed that the Tei index was related to ejection fraction, fractional shortening and mitral E/A ratio.

Conclusion

Among Nigerian hypertensives, LV systolic and diastolic functions (using the Tei index) were impaired in all subgroups of hypertensive patients according to their left ventricle geometry compared to the control group. This impairment was more advanced in patients with concentric and eccentric hypertrophy.     

Effect of cilnidipine on left ventricular function in hypertensive patients as assessed by tissue Doppler Tei index

Tissue Doppler Tei index is pointed to be more effective in the evaluation of global cardiac function than systolic and diastolic measurements alone in various heart diseases. This study was designed to assess the effect of cilnidipine on left ventricular function in hypertensive patients by using this index. A group of 40 hypertensives (mean age 55+/-8 years, range: 35-65) and 16 controls (mean age 52+/-9 years, range: 36-65) were included. Hypertensives were classified into non-left ventricular hypertrophy (NLVH) group (25 patients) and left ventricular hypertrophy (LVH) group (15 patients), and treated with cilnidipine for 2 months. Before and after treatment, the participants were examined by echocardiography. Tissue Doppler Tei index was calculated as diastolic time interval measured from end of late diastole to origin of early diastole (a') minus systolic Sm duration (b') divided by b', that is Tei index = (a'-b')/b'. Thirty-seven hypertensive patients finished the treatment. Tei index was significantly higher in NLVH and LVH groups than in control group, and in LVH group than in NLVH group (0.44+/-0.07 vs 0.28+/-0.06, P < 0.001; 0.51+/-0.13 vs 0.28+/-0.06, P < 0.001; 0.51+/-0.13 vs 0.44+/-0.07, P < 0.05). After treatment, Tei index was significantly decreased (0.40+/-0.11 vs 0.46+/-0.10, P < 0.0001); systolic blood pressure and diastolic blood pressure were also decreased significantly. In conclusion, Tei index is impaired in hypertensives before development of ventricular hypertrophy and impairment is more prominent in hypertrophy. Cilnidipine can improve left ventricular function. Tissue Doppler Tei index is gaining importance in evaluating LV function after drug intervention in hypertensive patients.     

芪苈强心胶囊对老年慢性心力衰竭患者N末端脑钠肽前体、左心室射血分数、Tei指数的影响

目的观察芪苈强心胶囊对老年慢性心力衰竭(chronic heart failure,CHF)患者临床疗效、N末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)、左心室射血分数(left ventricular ejection fraction,LVEF)、Tei指数的影响。 方法选择2014年6月至2015年7月在云南省第二人民医院门诊及住院部医治的170例老年CHF患者,采用数字表法随机分为2组,对照组85例,给予标准心力衰竭治疗;治疗组85例,在对照组治疗基础上加服芪苈强心胶囊(4粒,每日3次)。疗程均为3个月。观察并比较2组患者治疗前后临床疗效以及NT-proBNP水平、左心室舒张末期内径(left ventricular end-diastolic diameter,LVEDD)、LVEF、Tei指数的变化。 结果治疗3个月后,治疗组临床疗效明显优于对照组(88.1%比63.4%,P<0.05)。2组患者治疗后NT-proBNP水平下降,治疗组优于对照组(P<0.05)。2组患者LVEDD、Tei指数均降低(P<0.05),LVEF增加(P<0.05),治疗组上述指标改善均优于对照组(P<0.05)。2组均未发现明显不良反应。 结论芪苈强心胶囊能在标准心力衰竭基础上进一步降低NT-proBNP、LVEDD、Tei指数,提高LVEF,改善老年CHF患者心功能,且安全性好。     

比索洛尔对高血压病并发慢性心力衰竭患者脑钠尿肽前体的影响

目的 探讨比索洛尔对高血压病并发慢性心力衰竭（CHF）患者脑钠尿肽（BNP）前体（Pro-BNP)的影响。方法 选取我院收治的高血压病并发CHF的患者102例,随机分为试药组和对照组各51例。对照组按照高血压病并发CHF的常规治疗方案进行干预,试药组在对照组治疗方案的基础上,加用比索洛尔口服治疗。治疗3个月后对比两组患者的心功能改善情况,同时对比两组患者治疗前后的心率、血压、左室射血分数(LVEF)以及pro-BNP的变化情况。结果 试药组的显效率为49%,总有效率为96%,均显著高于对照组（分别为29%,76%,均P<0.05）;两组患者治疗后的心率、收缩压和舒张压均显著低于治疗前,而LVEF显著高于治疗前（均P<0.05）;试药组治疗后的LVEF为（44±4）%,显著高于对照组〔（35±4）%,P<0.05〕;试药组治疗后的Pro-BNP水平为（733±58） ng/L,对照组治疗后的Pro-BNP水平为（802±63） ng/L,两组患者治疗后的Pro-BNP水显著低于治疗前（均P<0.05）;试药组治疗后的Pro-BNP水平显著低于对照组（P<0.05）。结论 比索洛尔可有效降低高血压病并发CHF患者的Pro-BNP水平,提高临床疗效。     

高血压患者心力衰竭严重程度与高密度脂蛋白胆固醇水平的关系

目的探讨高血压患者心力衰竭严重程度与血清HDL-C水平的关系。方法采用随机数字表随机抽取法选择高血压患者156例,分为心力衰竭组83例和心功能正常组73例。用酶法检测血清TC、TG;用磷钨酸镁沉淀法检测血清HDL-C;根据Friedewald公式计算血清LDL-C。采用超声心动图诊断并评价心力衰竭的严重程度。结果与心功能正常组比较,心力衰竭组患者血清HDL-C水平明显降低(P<0.05);心力衰竭组患者室间隔、左心室后壁、左心室舒张末内径、左心房内径、心力衰竭超声指数和心室壁节段性运动异常比率明显升高(P<0.05),LVEF明显降低(P<0.05)。Pearson直线相关分析和偏相关分析显示,高血压患者血清HDL-C与心力衰竭超声指数呈负相关(r=-0.230,P<0.05;Υ=-0.262,P<0.05)。结论高血压患者心脏收缩和(或)舒张功能衰竭的严重程度与血清HDL-C水平密切相关。     

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。     

Prognostic value of the Tei index combining systolic and diastolic myocardial performance in patients with acute myocardial infarction treated by successful primary angioplasty

Cardiac systolic (left ventricular ejection fraction) and diastolic (mitral inflow velocity pattern and/or mitral deceleration time) function were reported as predictors of clinical outcome or left ventricular remodeling in patients with acute myocardial infarction (AMI). Recently, a new index (Doppler-derived index combining systolic and diastolic myocardial performance; Tei index) for combined systolic and diastolic ventricular function has been reported to be a useful and convenient method for evaluation of global ventricular function. We therefore investigated the usefulness of the Tei index by echocardiography for evaluation of infarct size and clinical outcome in patients with AMI treated by successful primary angioplasty. We analyzed 10 age-matched control subjects and 43 consecutive patients with first AMI treated by successful primary angioplasty. The Tei index of the AMI patients was significantly greater than that of the control subjects (0.630 ± 0.106 vs 0.375 ± 0.036, P 0.0001). Also, the Tei index showed a significant positive correlation with peak creatine kinase values and ^99mTc-tetrofosmin scores. Moreover, multiple logistic regression analysis showed that the Tei index 0.70 (P = 0.0313, odds ratio = 14.14) was the only significant explanatory factor for cardiac death or developed congestive heart failure. The Tei index combining systolic and diastolic myocardial performance reflects infarct size and might be a predictor of clinical outcome in patients with AMI treated by successful primary angioplasty.