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Objective: Impairment of flow‐mediated, endothelium‐dependent vasodilatation (FMD) of the brachial artery identifies peripheral endothelial dysfunction in subjects with chronic congestive heart failure (CHF) and is associated with increased morbidity and mortality. To further elucidate the interaction of peripheral and central mechanisms in the syndrome of CHF, we examined the association between endothelial function and chronotropic incompetence, an emerging prognostic marker in CHF. Methods: Thirty subjects with stable New York Heart Association (NYHA) functional class II–III CHF were studied. A vascular ultrasound study was performed to measure brachial artery FMD. The percentage of age‐adjusted maximal predicted heart rate (MPHR) reached during cardiopulmonary exercise tolerance testing (CPETT) was used to assess the degree of chronotropic competence. All patients received ACE inhibitors and β‐adrenoceptor blockers. Results: Brachial artery FMD averaged 1.3 ± 2.4% and age‐adjusted % MPHR 74.1 ± 11.7%. FMD correlated with % MPHR among all patients (r = 0.60, P = 0.01). FMD and resting heart rate (RHR) did not significantly correlate (r = 0.13, P = 0.55). Conclusions: FMD, a measure of peripheral endothelial dysfunction, and % MPHR, a central determinant of cardiac output, are moderately correlated in heart failure patients receiving optimal medical therapy. Whether a cause‐effect relationship underlies this association remains to be investigated. (Echocardiography 2010;27:294‐299)  相似文献   

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目的探讨参附注射液对慢性左心衰竭病人左心功能的影响.方法选择6例慢性左心衰竭病人,应用SPECT观察参附注射液注射前及注射后5 min、30min、60 min对左心功能各项指标的影响.结果参附注射液注射后较注射前左室射血分数(LVEF)下降(P<0.05或0.01),以30 min时下降最明显(P<0.01).结论参附注射液在短时间内能使慢性左心衰竭病人的左心功能下降.  相似文献   

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目的探讨利喜定对慢性心力衰竭(CHF)患者血浆脑钠素(BNP)水平和心功能的影响。方法将42例CHF患者随机分为利喜定组(23例)和硝普钠(19例),2组其余抗心衰治疗相同,疗程5d。测定治疗前后心率、血压,左心室射血分数(LVEF),血浆BNP浓度的变化。结果疗程结束后,利喜定及硝普钠组与治疗前相比,心率下降,LVEF升高,血浆BNP浓度降低(P〈0.05);与硝普钠组相比,利喜定组心率及血浆BNP浓度降低更明显,差异有统计学意义(P〈0.05),但是LVEF两组间无差别,无统计学意义,利喜定组低血压等并发症明显低于硝普钠。结论利喜定和硝普钠都能改善CHF的心功能,且利喜定降低血浆BNP的疗效优于硝普钠,并且不良反应低于硝普钠。  相似文献   

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目的:探讨心室起搏依赖的心力衰竭患者应用希氏束起搏(HBP)的临床价值。方法:连续入选2017年6月至2018年6月于大连医科大学附属第一医院因心室起搏依赖(心室起搏比例高于40%)而植入永久起搏器且合并心力衰竭的患者132例。HBP成功者44例为HBP组,传统起搏组88例患者。比较两组患者治疗前后的QRS时限、NYHA心功能分级,超声心动图指标及起搏器参数的变化情况;根据基线左心室射血分数(LVEF)再将各组患者分为射血分数保留(HFpEF,LVEF≥40%)患者及射血分数降低(HFrEF,LVEF<40%)患者,再次评价两类患者中HBP和传统起搏的心功能的变化情况。结果:与术前比,HBP组患者术后(末次随访)QRS时限缩短、NYHA心功能分级改善、LVEF升高、左心室舒张末期内径(LVEDD)减小、二尖瓣反流(MR)程度减轻、左心房内径(LAD)缩小(P均<0.05);传统起搏组三尖瓣反流(TR)程度较术前加重(P<0.05),LVEF、LVEDD、MR程度、LAD均较术前无显著改善(P均>0.05)。132例患者中有HFrEF患者47例,其中HBP组20例,传统起搏组27例,HBP组HFrEF患者术后QRS时限缩短、NYHA心功能分级改善、LVEF升高、LVEDD减小、MR和TR程度均减轻、LAD缩小(P均<0.05);传统起搏组HFrEF患者QRS时限延长(P<0.05)。HFpEF患者共85例,其中HBP组24例。HBP组HFpEF患者术后NYHA心功能分级明显改善(P<0.05);而传统起搏组HFpEF患者的LVEF较术前下降、MR和TR程度均加重(P均<0.05)。结论:对于心室起搏依赖的心力衰竭患者,与传统起搏相比,HBP均能够改善患者心功能,这些临床益处在射血分数减低的患者中更为显著。  相似文献   

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目的观察参田琥珀丸治疗慢性充血性心力衰竭(CHF)的临床疗效及副反应。方法属NYHA心功能分级Ⅱ级~Ⅳ级的CHF病人100例随机分为两组,治疗组53例在常规治疗基础上,加用参田琥珀丸6g,每日3次口服;对照组47例仅用强心、利尿、扩血管、血管紧张素转换酶抑制剂(ACEI)等常规治疗,疗程为1个月。观察两组治疗前后病人的临床心功能改善情况,测定病人的左室射血分数(LVEF)和左室舒张末期内径(LVDD)。结果治疗组临床心功能改善总有效率为90.57%,优于对照组的80.85%(P<0.05)。两组治疗后LVEF,LVDD均较治疗前明显改善(P<0.05或P<0.01),但治疗组比对照组效果显著(P<0.05)。未发现明显毒副反应。结论参田琥珀丸可作为治疗CHF的重要辅助药物之一。  相似文献   

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探讨心率变异 (HRV)三角指数和平均心率 (mHR)评价慢性心力衰竭 (简称心衰 )患者心功能状态的价值。应用动态心电图分析系统和彩色超声心动图对慢性心衰患者 (36例 )及健康对照组 (36例 )进行左室射血分数(LVEF)、左室舒张末内径 (LVd)、2 4hHRV三角指数和mHR等参数测量。结果 :①心衰组与对照组比较 ,mHR ,三角指数 ,LVd ,LVEF均有显著统计学差异 ,P <0 .0 1。②心衰组中三角指数和mHR与LVEF具有相关性 (r分别为- 0 .743,- 0 .6 35 ,P <0 .0 5及 0 .0 1)。③三角指数与mHR在心衰组中具有相关性 (r=0 .2 9,P =0 .0 0 8) ,在对照组中不具有相关性 (r=0 .33,P =0 .38)。结论 :在慢性心衰患者中 ,三角指数和mHR对于评价心衰患者心功能具有一定意义  相似文献   

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To investigate the changes of plasma brain natriuretic peptide (BNP) concentrations in patients with chronic heart failure (CHF) before and after carvedilol treatment. Methods Plasma BNP concentrations of patients with CHF (n=56) before and after carvedilol treatment and of normal controls (n=60) were measured with specific radioimmunoassay. Left ventricular ejection fraction of patients with CHF before and after carvedilol was measured with 99mTc gated cardiac blood pool scintigraphy. Results The results showed that plasma BNP concentrations of patients with CHF were significantly higher than that of normal controls [(222.65±78.52) ng·L-1 vs. (38.82±15.31) ng·L-1, P<0.01]. Plasma BNP concentrations had a significant negative correlation with left ventricular ejection fractions (r=-0.68,P<0.01). After three months treatment of carvedilol, plasma BNP concentrations fell to (79.65±69.52) ng·L-1(P<0.01), left ventricular ejection fractions increase from 34.41%±4.54% to 46.51%±5.38%(P<0.01). Conclusions These results indicate that plasma BNP concentrations are increased in patients with CHF, and markedly increased according to the severity of heart failure classified by NYHA classification. Carvedilol can markedly decrease plasma BNP concentrations and improve left ventricular function in patients with CHD.  相似文献   

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Objectives To investigate the changes of plasma brain natriuretic peptide (BNP) concentrations in patients with chronic heart failure (CHF) before and after carvedilol treatment. Methods Plasma BNP concentrations of patients with CHF (n = 56) before and after carvedilol treatment and of normal controls (n = 60) were measured with specific radioimmunoassay. Left ventricular ejection fraction of patients with CHF before and after carvedilol was measured with 99mTc gated cardiac blood pool scintigraphy. Results The results showed that plasma BNP concentrations of patients with CHF were significantly higher than that of normal controls [ (222. 65 ± 78.52) ng·L^-1 vs. (38.82 ± 15.31 ) ng·L^-1 , P 〈 0. 01 1. Plasma BNP concentrations had a significant negative correlation with left ventricular ejection fractions (r=-0. 68 ,P 〈 0. 01 ). After three months treatment of carvedilol, plasma BNP concentrations fell to (79. 65 ±69.52 )ng·L^-1 (P 〈 0. 01 ), left ventricular ejection fractions increase from 34. 41% ± 4. 54% to 46. 51% ± 5.38 % (P 〈 0. 01 ). Conclusions These results indicate that plasma BNP concentrations are increased in patients with CHF, and markedly increased according to the severity of heart failure classified by NYHA classification. Carvedilol can markedly decrease plasma BNP concentrations and improve left ventricular function in patients with CHD.  相似文献   

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射血分数正常的心力衰竭   总被引:4,自引:0,他引:4  
左室射血分数在正常范围内的心力衰竭近来受到关注,现将其在病因、病理生理、组织多普勒成像及治疗策略方面的研究进展综述如下。  相似文献   

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室性期前收缩是最常见的室性心律失常,不伴有器质性心脏病的室性期前收缩,通常被认为是良性的,但近10年的研究发现,频发室性期前收缩在某些条件下可导致左室重构,甚至诱发心力衰竭症状.这些条件包括患者年龄、病程长短、室性期前收缩负荷及室性期前收缩的起源部位和室性期前收缩QRS波的宽度.诱发心力衰竭的机制可能与室性期前收缩时左右心室失同步、心肌细胞能量储备耗竭、心内膜下至心外膜下血流比失调导致心肌缺血、钙平衡失调、氧自由基损伤,以及β受体密度下调、反应性下降等多种病理生理因素有关.近来有学者提出“室性期前收缩诱发的心肌病”的概念,和心动过速性心肌病一样,也可能成为一种独立的未分类心肌病.  相似文献   

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目的探讨沙库巴曲缬沙坦(LCZ696)联合温肾活血方对缺血性心肌病心力衰竭病人生存质量及N末端-脑钠肽前体(NT-proBNP)、左室舒张末期内径(LVEDD)、左室射血分数(LVEF)的影响。方法选取2017年12月—2019年5月在重庆市中医院心内科就诊的90例缺血性心肌病心力衰竭病人,根据随机数字表法分为对照组和治疗A组、治疗B组,每组30例。对照组予基础抗心力衰竭治疗,治疗A组在对照组基础上口服沙库巴曲缬沙坦,治疗B组在治疗A组基础上加用温肾活血方治疗,3组均以治疗8周为1个疗程。比较各组治疗前后中医证候积分、美国纽约心脏病学会(NYHA)心功能分级、6 min步行试验距离和NT-proBNP、LVEF、LVEDD的变化。结果与对照组相比,治疗A组、治疗B组中医证候疗效更佳(均P<0.05),且NYHA分级提高更显著(P<0.05),NT-proBNP水平降低更明显(P<0.05),改善LVEF更为明显(均P<0.05)。治疗B组较对照组6 min步行试验距离增加(P<0.05),而治疗A组6 min步行试验距离较对照组比较差异无统计学意义(P>0.05);治疗B组在改善中医证候、改善6 min步行距离方面优于治疗A组(P<0.05)。而在改善NYHA分级、降低NT-proBNP、升高LVEF、缩小LVEDD方面治疗A组、治疗B组比较差异无统计学意义(P>0.05)。结论对缺血性心肌病心力衰竭病人在常规抗心力衰竭治疗基础上加用沙库巴曲缬沙坦可改善中医证候,提高NYHA分级,降低NT-proBNP,升高LVEF,降低LVEDD,但沙库巴曲缬沙坦在增加6 min步行距离方面与常规抗心力衰竭治疗比较改善不明显,在沙库巴曲缬沙坦基础上加用温肾活血方可明显改善病人6 min步行距离,并进一步改善中医证候。  相似文献   

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充血性心力衰竭患者血清心肌肌钙蛋白测定的临床意义   总被引:2,自引:0,他引:2  
目的探讨血清心肌肌钙蛋白I(cardic troponin I,cTnl)水平与心功能、左室射血数(LVEF)及血清肌酐(Cr)之间的关系。方法对118例CHF患者采用发光免疫方法检测血清cTnl含量,根据血清cTnl水平分为两组,同时选20名无心、脑、肾疾病住院患者为对照组。所选患者都进行心功能检查,LVEF及血清Cr测定。结果CHF患者血清cTnl含量明显高于对照组(P<0.05);心功能Ⅳ、Ⅲ、Ⅱ级患者之间血清cTnl比较有显著性差异(P<0.05);CHF组血清Cr水平明显高于对照组(P<0.05),且血清cTnl升高组血清Cr水平与血清cTnl正常组比较有极显著差异(P<0.01)。血清cTnl含量与血清Cr水平呈正相关(r=0.172,P<0.05);而血清cTnl升高组LVEF与血清cTnl正常组比较无显著差异(P>0.05);在cTnl升高组中,缺血性与非缺血性心脏病之间病因比较无显著差异(P>0.05)。结论CHF患者cTnl含量与心力衰竭的程度平行,与肾功能损害有关,但与病因及LVEF无关,可作为心力衰竭诊断、预后判断的辅助指标。  相似文献   

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左心室射血分数保留性心力衰竭(HFpEF)旧称舒张功能不全的心力衰竭或收缩功能正常的心力衰竭,是一种日益流行的健康问题,相对于LVEF降低的心力衰竭(HFrEF)而言,其特征是LVEF正常或者接近正常,但有心力衰竭的临床表现。临床上该型患者的发病率逐渐增长,且预后比HFrEF更差。本文旨在对HFpEF目前的研究进展进行综诉。  相似文献   

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目的 探讨放松疗法对老年慢性心力衰竭合并糖尿病焦虑抑郁患者应用效果.方法 选取2018年1月—2019年10月该院收治的88例慢性心力衰竭合并糖尿病患者,按随机数表法分为两组,各44例.对照组给予常规护理,观察组在对照组基础上采用放松疗法.对比两组焦虑抑郁情绪、血糖水平及心功能指标.结果 干预前两组焦虑抑郁情绪对比,差...  相似文献   

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Objective Current clinical guidelines have proposed heart failure (HF) with mid-range ejection fraction (HFmrEF), defined as a left ventricular ejection fraction (LVEF) of 40-49%, but the proportion and prognosis of patients transitioning toward HF with a reduced LVEF (LVEF <40%, HFrEF) or HF with a preserved LVEF (LVEF ≥50%, HFpEF) are not fully clear. The present study prospectively evaluated the changes in the LVEF one year after discharge and the outcomes of hospitalized patients with HFmrEF. Methods We prospectively studied 259 hospitalized patients with HFmrEF who were discharged alive at our institutions between 2015 and 2019. Among them, 202 patients with HFmrEF who underwent echocardiography at the one-year follow-up were included in this study. Patient characteristics, echocardiographic data and all-cause death were collected. Results Eighty-seven (43%) patients transitioned to HFpEF (improved group), and 35 (17%) transitioned to HFrEF (worsened group). During a median follow-up of 33 months, 27 (13%) patients died. After adjustment, patients in the worsened group had an increased risk of all-cause mortality compared with those in the improved group [hazard ratio 7.02, 95% confidence interval (CI) 1.13-43.48]. The baseline LVEF (per 1% decrease) and tricuspid annular plane systolic excursion (per 1 mm decrease) were independent predictors of the worsened LVEF category (odds ratio 2.13, 95% CI 1.25-3.63 and odds ratio 1.31, 95% CI 1.01-1.70, respectively). Conclusion Our study showed that a worsened LVEF one year after discharge was associated with a poor prognosis in hospitalized patients with HFmrEF.  相似文献   

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Heart failure results from injury to the myocardium from a variety of causes, including ischemic and nonischemic etiologies. Severe heart failure carries a 50% 5-year mortality rate and is responsible for more than one-third of cardiovascular deaths in the United States.1 Heart failure progression is accompanied by activation of neurohormonal and cytokine systems as well as a series of adaptive changes within the myocardium, collectively referred to as left ventricular remodelling. The unfavorable alterations may be categorized broadly into changes that occur in the cardiac myocytes and changes that occur in the volume and composition of the extracellular matrix.2 Since remodelling in heart failure is progressive and eventually becomes detrimental, the majority of treatment strategies are aimed at stopping or reversing this process. Although medical management, cardiac resychronization therapy, and long-term or destination mechanical circulatory support have been successful in this regard, a considerable number of patients still progress to end-stage heart failure with limited therapeutic options. For these patients, stem cell therapies are being investigated as a safe treatment strategy for decreasing cardiac remodelling on top of conventional medical and device treatment.  相似文献   

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The effects of propafenone on left ventricular function and hemodynamics are presented in this study. In one group of 13 patients who underwent electrophysiological testing and subsequent chronic oral therapy with propafenone, eight had left ventricular ejection fractions determined by nuclear study before and during therapy with the drug. Initial measurements ranged from 22% to 39% (mean 30%), while those on chronic therapy showed no statistical difference and ranged from 22% to 48% (mean 30%). In a separate dose titration study of 14 patients, left ventricular ejection fraction showed a modest but significant decrease (52%± 9% to 48%± 11%; p < 0.05). This change was more marked in patients with an initial low ejection fraction. Propafenone appears to be safe in these patients but should be administered with caution in patients with particularly low ejection fractions.  相似文献   

20.
目的观察温阳活血法对慢性心力衰竭的临床疗效。方法将100例慢性心力衰竭病人随机分为治疗组和对照组,各50例。对照组给予常规抗心力衰竭治疗(血管紧张素转换酶抑制剂或血管紧张素受体拮抗剂、β受体阻滞剂、血管扩张剂、利尿剂、强心剂等药物),治疗组在对照组治疗基础上加用温阳活血为主的温阳益气活血汤,疗程4周。观察两组治疗前后中医临床症状与体征、纽约心脏病协会(NYHA)心功能分级变化,应用彩色多普勒测定两组每搏输出量(SV)、心输出量(CO)、心脏指数(CI)、左室射血分数(LVEF)、左室短轴缩短率(FS)、左室舒张末内径(LVEDD),测定血清脑钠肽(BNP)浓度。结果治疗组总有效率94%,优于对照组的78%(P<0.05)。两组治疗后SV、CO、CI、LVEF、LVEDD、BNP较治疗前均有明显改善,但治疗组优于对照组(P<0.05)。结论温阳活血法对慢性心力衰竭具有确切的疗效,对心功能各项指标均具有明显的改善作用。  相似文献   

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