坎地沙坦联合地高辛治疗慢性心力衰竭对患者血清CT-1、NT-proBNP和β-EP水平的影响

目的探究坎地沙坦联合地高辛治疗慢性心力衰竭对患者血清心肌营养素-1(CT-1)、N末端B型利钠肽前体(NT-proBNP)和β-内啡肽(β-EP)水平的影响。方法选取2016年6月至2018年6月该院收治的慢性心力衰竭患者100例作为研究对象,随机分为对照组和治疗组,每组各50例。对照组口服地高辛,治疗组在此基础上另口服坎地沙坦。观察两组患者心功能指标变化和临床疗效。采用实时荧光定量聚合酶链反应和酶联免疫吸附试验分别检测患者治疗前后血清CT-1、NT-proBNP和β-EP的转录水平和蛋白水平。Pearson相关性系数分析血清CT-1、NT-proBNP和β-EP水平与心功能相关指标的相关性。结果与对照组比较,治疗组患者NT-proBNP和β-EP的mRNA水平均明显下降,CT-1的mRNA水平明显上升,差异均有统计学意义(P<0.05)。治疗组患者血清中CT-1的蛋白水平明显上升,而NT-proBNP和β-EP的蛋白水平明显下降,差异均有统计学意义(P<0.05)。血清CT-1水平与左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)均呈正相关(P<0.05);血清NT-proBNP水平与LVEDD、左心室收缩末期容积(LVESV)、LVESD均呈正相关(P<0.05);血清β-EP水平与LVEF、LVESV均呈正相关(P<0.05)。结论坎地沙坦联合地高辛治疗慢性心力衰竭有较好的临床疗效,能降低患者NT-proBNP和β-EP水平,提升CT-1水平,具有一定的临床应用推广价值。     

运动康复训练在老年慢性心力衰竭治疗中的作用

目的探讨运动康复训练在老年慢性心力衰竭(CHF)患者治疗中的作用。方法选取老年CHF患者93例,随机分为研究组46例与对照组47例。2组均采用常规治疗与护理,研究组在此基础上开展运动康复训练,观察2组心功能改善情况,比较干预前后心功能指标[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)、左心房内径(LAD)、心肌质量指数(LVMI)及舒张早期峰值血流速度与舒张晚期峰值血流速度比(E/A)]及明尼苏达心力衰竭生活质量调查表(MLHFQ)评分。结果研究组总有效率为82. 6%,显著高于对照组的66. 0%(P 0. 05);干预后,2组LVEF、E/A较干预前显著升高,LVESD、LVEDD、LAD及LVMI则显著降低,且研究组各指标变化幅度均显著大于对照组(P 0. 05);干预后,2组MLHFQ评分均显著低于干预前,且研究组评分显著低于对照组(P 0. 05)。结论在常规治疗与护理的基础上对老年CHF患者开展运动康复训练,有助于患者心功能及生活质量的改善。     

注射用磷酸肌酸钠联合常规抗心力衰竭方案对慢性心力衰竭患者心功能及血清BNP水平的影响

目的探讨注射用磷酸肌酸钠联合常规抗心力衰竭方案对慢性心力衰竭患者心功能及血清B型利钠肽(BNP)水平的影响。方法选取2016年3月至2018年3月慢性心力衰竭患者82例,根据随机数表法分为对照组与研究组,每组41例。对照组给予常规抗心力衰竭方案治疗,观察组采用注射用磷酸肌酸钠联合常规抗心力衰竭方案治疗。观察统计两组疗效、治疗前后两组血清BNP水平、嗜铬粒蛋白A(CgA)、心功能指标[左心室舒张末内径(LVEDD)、每搏输出量(SV)、左心室收缩末内径(LVESD)及左心室射血体积分数(LVEF)]改善情况。结果治疗后4周,观察组治疗总有效率(87.80%)高于对照组(68.29%),差异有统计学意义(P0.05);治疗后4周,两组LVEDD、LVEF、SV、LVESD等心功能指标均较治疗前明显改善,且观察组LVEF、SV大于对照组,LVEDD、LVESD小于对照组,差异有统计学意义(P0.05);治疗后4周,两组血清BNP较治疗前明显降低,且观察组血清BNP低于对照组(P0.05)。结论常规抗心力衰竭方案基础上联合注射用磷酸肌酸钠治疗慢性心力衰竭能进一步调节患者血清BNP水平,改善患者心功能,促进患者病情转归。     

心肌梗死后射血分数下降患者应用沙库巴曲缬沙坦钠治疗的临床疗效评估

目的 探讨沙库巴曲缬沙坦钠治疗心肌梗死后射血分数下降的临床疗效。方法 选取2021年2月至2022年2月我院心内科收治的心肌梗死后射血分数下降患者96例，采用抽签法随机分为观察组和对照组各48例。两组患者在入院后均常规给予抗血小板药物、调脂药、β受体阻滞剂降压等对症处理，对照组加用卡托普利治疗，观察组则加用沙库巴曲缬沙坦钠治疗。对比两组治疗前后的射血分数（LVEF）、左心室收缩末期内径（LVESD）、左心室舒张末期内径（LVEDD），对比两组的临床疗效，对比两组血浆N末端B型脑钠肽前体(NT-proBNP)、超敏C-反应蛋白(hs-CRP)，对比两组生存质量(MLHFQ）评分和住院时间。结果 治疗前，两组患者LVEF、LVESD及LVEDD比较，差异无统计学意义（P>0.05）；治疗后，两组LVEF均高于治疗前，LVESD及LVEDD低于治疗前，且观察组LVEF均高于对照组，LVESD及LVEDD低于对照组，差异有统计学意义（P<0.05）。观察组治疗总有效率为93.75%，高于对照组的79.17%，差异有统计学意义（P<0.05）。治疗前，两组NT-proBNP、h...     

氯吡格雷联合曲美他嗪对缺血性心肌病患者血浆NT-proBNP水平及心功能的影响

目的观察氯吡格雷联合曲美他嗪对缺血性心肌病(ICM)患者血浆NT-proBNP水平及心功能的影响。方法选择2017年1月至2018年5月82例ICM患者作为研究对象,依据治疗方案分为对照组与观察组,每组41例。对照组予以综合治疗,观察组在对照组基础上口服氯吡格雷+曲美他嗪。比较两组N末端脑钠肽前体(NT-proBNP)水平与心功能指标[左心室收缩末期内径(LVESD)、左室射血分数(LVEF)、每搏输出量(SV)与左心室舒张末期内径(LVEDD)]。结果观察组NT-proBNP、LVESD、LVEDD值低于对照组,LVEF及SV值高于对照组,差异有统计学意义(P0.05)。结论针对ICM患者,应用氯吡格雷联合曲美他嗪治疗可降低NT-proBNP水平,促进心功能改善,利于健康恢复。     

伊伐布雷定治疗急性心肌梗死合并心力衰竭的疗效

目的 探讨伊伐布雷定治疗急性心肌梗死(AMI)合并心力衰竭患者的效果及对N末端脑钠肽元(NT-pro BNP)水平及心率(HR)的影响。方法 将郑州市第二人民医院2018年3月至2019年3月采用常规治疗的40例AMI合并心力衰竭患者纳入对照组,将郑州市第二人民医院2019年4月至2020年4月采用常规治疗+伊伐布雷定治疗的40例AMI合并心力衰竭患者纳入观察组。对比两组患者治疗前与治疗3个月后心功能指标[HR、左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)、左室射血分数(LVEF)]、NT-pro BNP水平。结果 治疗3个月后,两组HR、LVEDD、LVESD相比治疗前均较低,LVEF相比治疗前均较高,且观察组HR、LVEDD、LVESD更低,LVEF更高,差异有统计学意义(P 0. 05);治疗3个月后,两组NT-pro BNP水平均较治疗前低,且观察组更低,差异有统计学意义(P 0. 05)。结论 伊伐布雷定治疗AMI合并心力衰竭患者效果显著,有助于降低NT-proBNP水平及HR,提高心功能。     

达格列净治疗慢性心力衰竭伴射血分数降低患者的疗效分析

目的 观察达格列净治疗慢性心力衰竭伴射血分数降低患者中的临床效果。方法 选择2021年4月至10月我院收治的48例慢性心力衰竭伴射血分数降低患者,以随机数字表法分为观察组和对照组各24例。对照组采用基础治疗,观察组于对照组基础上给予达格列净治疗。比较两组空腹血糖(FPG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbAlc)、左心射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、每搏输出量(SV)、N末端B型利钠肽原(NT-proBNP)、6分钟步行距离(6MWD)、不良反应发生率。结果 治疗后,两组HbA1C、FPG、2 hPG水平均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05)。治疗后,两组LVEF、SV水平高于治疗前,且观察组高于对照组,两组LVEDD、LVESD低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05)。治疗后,两组6MWD水平大于治疗前,且观察组大于对照组,两组NT-proBNP水平低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05)。两组不良反应发生率分别为8.33%、4.17%,差异无统计学意义(P>0.05)。结论 达格列净治疗慢性心力衰竭伴射血分数降低患者,可降低血糖水平,对心功能恢复及心肌损伤减轻有着促进作用,且不会增加不良反应发生率,值得临床重视。     

医护一体化救治模式对慢性心力衰竭患者预后的影响

目的:探讨医护一体化救治模式对慢性心力衰竭(心衰)患者预后的影响。方法:将收治的66例慢性心衰患者采用随机数字表法分为对照组和观察组各33例,对照组采取常规护理模式,观察组在常规护理基础上实施医护一体化救治模式;分别于入院时、出院时、出院6个月后测定两组心功能分级[美国纽约心脏学会(NYHN)心功能分级]、6 min步行距离、超声心动图指标包括[左心室舒张末期内经(LVEDD)、左心室收缩末期内径(LVESD)、左心室射血分数(LVEF)]、NT-proBNP值及生活质量[采用明尼苏达心力衰竭生活质量问卷(MLHFQ)]。结果:出院时、出院6个月后,观察组NYHA心功能分级均明显优于对照组(P0.05),6 min步行距离明显长于对照组(P0.05),LVESD、LVEDD低于对照组(P0.05),LVEF高于对照组(P0.05),NT-proBNP值、MLHFQ评分低于对照组(P0.05)。结论:医护一体化救治模式可有效改善慢性心衰患者心功能及运动能力,降低血清NT-proBNP值,提升患者生活质量,值得临床推广。     

伊伐布雷定对慢性心力衰竭患者心脏功能及血清重组人半乳糖凝集素3、可溶性人基质裂解素2、N末端B型脑钠肽前体水平的影响

目的研究伊伐布雷定对慢性心力衰竭患者心脏功能及血清重组人半乳糖凝集素3(Galectin-3)、可溶性人基质裂解素2(sST2)以及N末端B型脑钠肽前体(NT-proBNP)水平的影响。方法选择94例慢性心力衰竭患者按随机数字表法均分为两组,各47例。对照组患者给予常规治疗,观察组患者加用伊伐布雷定,连续治疗3个月。比较治疗前后心率、心室射血分数(LVEF)、左心室收缩末期及舒张末期内径(LVESD、LVEDD),检测治疗前后血清NT-proBNP、sST2、Galectin-3水平,并比较治疗总有效率与不良事件发生率。结果(1)观察组治疗总有效率显著高于对照组(P<0.05);(2)治疗前两组心率及心脏功能指标差异无统计学意义(P>0.05),治疗后观察组LVESD、LVEDD、心率低于对照组,LVEF高于对照组(P<0.05);治疗前两组血清指标水平差异无统计学意义(P>0.05),治疗后观察组血清Galectin-3、NT-proBNP水平低于对照组,sST2水平显著高于对照组(P<0.05);两组不良事件发生率差异无统计学意义(P>0.05)。结论伊伐布雷定能显著改善慢性心力衰竭患者心率以及心脏功能,能调节纤溶系统功能,控制心肌重塑,并提高心肌细胞功能。     

曲美他嗪治疗冠心病慢性心力衰竭的临床研究

选取2012年1月~2014年3月我院收治的的冠心病慢性心力衰竭患者180例,随机分为观察组和对照组,各90例。对照组给予常规药物治疗,观察组在对照组的基础上给予曲美他嗪治疗。比较两组患者临床疗效和以多普勒超声(Simpgon法)测定的治疗前后左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)、左室射血分数(LVEF)及6 min步行距离(6WMT)。结果观察组临床疗效明显优于对照组(P<0.05);两组患者治疗后LVESD、LVEDD明显缩小及LVEF、6WMT明显增加,与治疗前比较差异均具有统计学意义(P<0.05),其中观察组改善程度明显优于对照组(P<0.05)。曲美他嗪治疗冠心病慢性心力衰竭临床效果显著,可有效提高患者的心功能,值得临床推广应用。     

Atrioventricular Block Occurring Late After Heart Transplantation: Presentation of Three Cases and Literature Review

Sinus node dysfunction is a well-known occurrence following orthotopic heart transplantation, but atrioventricular block is rarely described. We compare the incidence and clinical presentation of atrioventricular block and sin us node dysfunction among the first 200 consecutive patients receiving heart transplantation at the University of Utah. Two of 200 patients (1%) required pacemaker implantation for symptomatic atrioventricular block compared to 13 of 200 (6.5%) who required pacemaker for symptomatic sinus node dysfunction. Of the patients with atrioventricular block, one had intermittent Mobitz II second-degree atrioventricular block and one had high grade atrioventricular block without ventricular escape. The most striking difference between the patients with atrioventricular block and those with sinus node dysfunction was the interval between transplantation and pacemaker implantation; time to pacemaker implantation in the atrioventricular block patients was 955 and 810 days compared to a median time of 26 days for sinus node dysfunction patients (P = 0.037). The patients requiring permanent pacemaker implantation were similar to those not requiring pacemaker implantation with respect to age, sex, ischemic time, and donor age. None of the patients requiring permanent pacemaker implantation was on amiodarone therapy within 2 months of transplant.     

经皮穿刺钢丝钩状电极紧急心脏起搏32例临床分析

目的：观察心跳骤停时紧急起搏的临床疗效及安全性。方法：回顾性分析采用本院研制的单极钢丝钩状起搏电极经皮紧急起搏32例心跳骤停患者的临床资料。结果：心脏停跳后穿刺,均能在30s内起搏。院内心跳骤停患者均起搏成功。结论：经皮穿刺钢丝钩状电极紧急心脏起搏起效迅速,操作安全,对其它复苏措施影响小。     

Biomaterials in myocardial tissue engineering

Cardiovascular disease is the leading cause of death in the developed world, and as such there is a pressing need for treatment options. Cardiac tissue engineering emerged from the need to develop alternative sources and methods of replacing tissue damaged by cardiovascular diseases, as the ultimate treatment option for many who suffer from end‐stage heart failure is a heart transplant. In this review we focus on biomaterial approaches to augmenting injured or impaired myocardium, with specific emphasis on: the design criteria for these biomaterials; the types of scaffolds – composed of natural or synthetic biomaterials or decellularized extracellular matrix – that have been used to develop cardiac patches and tissue models; methods to vascularize scaffolds and engineered tissue; and finally, injectable biomaterials (hydrogels) designed for endogenous repair, exogenous repair or as bulking agents to maintain ventricular geometry post‐infarct. The challenges facing the field and obstacles that must be overcome to develop truly clinically viable cardiac therapies are also discussed. Copyright © 2014 John Wiley & Sons, Ltd.     

Echocardiography-based selection of quiescent heart phases: implications for cardiac imaging.

OBJECTIVE: We compared the potential effectiveness of echocardiography with electrocardiography (ECG) for the selection of phases within the cardiac cycle during which there is relatively little motion. Determination of such phases may be important for triggering other modalities such as computed tomography and magnetic resonance imaging. METHODS: In a preliminary study in 2 volunteers, simultaneous ECG and cardiac echocardiographic data were obtained and analyzed. Various phases of the echocardiographic data were cross-correlated from beat to beat. Time point pairs from different cardiac cycles with correlation of 0.8 were selected. RESULTS: Beat-to-beat correlation values peaked at around 80% of the R-R' interval near the cardiac apex and around 30% of the R-R' interval near the cardiac base for 1 subject. For the other subject, the correlation values peaked at around 75% of the R-R' interval near the cardiac apex. CONCLUSIONS: The cardiac cycle phase having maximum spatial cross-correlation for the longest period varied from subject to subject and also on the portion of the heart that was being imaged. Echocardiography may be superior to ECG in determining points in the cardiac cycle when the heart is relatively stationary and can potentially provide more optimal triggering information for cardiac computed tomography or magnetic resonance imaging.     

Cardiac power output and its response to exercise in athletes and non‐athletes

Cardiac power output (CPO) is an integrative measure of overall cardiac function as it accounts for both, flow‐ and pressure‐generating capacities of the heart. The purpose of the present study was twofold: (i) to assess cardiac power output and its response to exercise in athletes and non‐athletes and (ii) to determine the relationship between cardiac power output and reserve and selected measures of cardiac function and structure. Twenty male athletes and 32 age‐ and gender‐matched healthy sedentary controls participated in this study. CPO was calculated as the product of cardiac output and mean arterial pressure, expressed in watts. Measures of hemodynamic status, cardiac structure and pumping capability were assessed by echocardiography. CPO was assessed at rest and after peak bicycle exercise. At rest, the two groups had similar values of cardiac power output (1·08 ± 0·2 W versus 1·1 ± 0·24 W, P>0·05), but the athletes demonstrated lower systolic blood pressure (109·5 ± 6·2 mmHg versus 117·2 ± 8·2 mmHg, P<0·05) and thicker posterior wall of the left ventricle (9·8 ± 1 mm versus 9 ± 1·1 mm, P<0·05). Peak CPO was higher in athletes (5·87 ± 0·75 W versus 5·4 ± 0·69 W, P<0·05) as was cardiac reserve (4·92 ± 0·66 W versus 4·26 ± 0·61 W, P<0·05), respectively. Peak exercise CPO and reserve were only moderately correlated with end‐diastolic volume (r = 0·54; r = 0·46, P<0·05) and end‐diastolic left ventricular internal diameter (r = 0·48; r = 0·42, P<0·05), respectively. Athletes demonstrated greater maximal cardiac pumping capability and reserve than non‐athletes. The study provides new evidence that resting measures of cardiac structure and function need to be considered with caution in interpretation of maximal cardiac performance.     

Effect of transvenous cardiac resynchronization therapy device implantation on cardiac troponin I release

BACKGROUND: Pacemaker and implantable cardioverter defibrillator (ICD) implantation increases cardiac troponin I (cTnI) levels which indicates myocardial injury. During implantation of a cardiac resynchronization therapy (CRT) device, balloon inflation for coronary sinus (CS) venogram, cannulation of CS side branch, and electrode advancement may interfere with CS drainage and, hence, may decrease the washout of toxic metabolites from the heart. Thus, CRT implantation may further increase cTnI levels. In this study, we investigated the effects of CRT implantation on cTnI release. METHODS: We included 10 patients (mean age = 57 +/- 15 years) in whom a successful transvenous CRT system was implanted (CRT group). Twenty patients (mean age = 65 +/- 10 years) who underwent a transvenous pacemaker or ICD implantation were included as the control group. Blood samples for cTnI were drawn at baseline and at six, 12, 18, and 24 hours thereafter. RESULTS: Baseline median cTnI levels were similar in CRT and control groups (0.03 ng/mL vs 0.02 ng/mL, respectively; P = 0.1). Postoperative cTnI levels during 24 hours were significantly higher in the CRT group (P < 0.05) by two-way repeated measures of analysis of variance. Post hoc analysis revealed that cTnI levels were higher at the 6th, 12th, 18th, and 24th hours compared to baseline levels (P < 0.001, P < 0.001, P < 0.01, and P < 0.01, respectively). There was a significant difference in the area under the curves (AUCs) of cTnI measurements (1.79 hr.ng/mL in the CRT group and 0.78 hr.ng/mL in the control group, P < 0.05). CONCLUSION: Postoperative cTnI levels were higher after CRT implantation than simple pacemaker/ICD implantation. This may be due to CS manipulation during CRT implantation.     

Ventricular pacemaker lead in the left hemithorax: Mechanisms and evidence‐based management of a late‐onset hazardous complication

Late‐onset migration of pacing leads in the left hemithorax is a rare but potentially life‐threatening complication. Radiological examinations are required to detect any involvement of either left ventricle or lung parenchyma, prompting immediate surgical extraction in this setting. Identification of high‐risk patients is mandatory to prevent this complex iatrogenic complication.     

A rare case of an intramyocardial mesothelial inclusion cyst

A symptomatic intramyocardial cyst, whilst a rare occurrence, is most effectively investigated using Magnetic Resonance Imaging. Furthermore, following diagnosis it can be effectively treated using a surgical approach.     

Primary cardiac angiosarcoma directly invading the right lung: An autopsy report

We presented a difficult‐to‐diagnose case of cardiac angiosarcoma. The patient presented pericardial effusion, but cytology of the effusion was negative. Because cytological detection of angiosarcoma cells is difficult, a possibility of malignancy should not be excluded with negative cytological examination. Biopsy of cardiac mass is the best way for diagnosis.     

Electrical stimulation of cardiac adipose tissue‐derived progenitor cells modulates cell phenotype and genetic machinery

A major challenge of cardiac tissue engineering is directing cells to establish the physiological structure and function of the myocardium being replaced. Our aim was to examine the effect of electrical stimulation on the cardiodifferentiation potential of cardiac adipose tissue‐derived progenitor cells (cardiac ATDPCs). Three different electrical stimulation protocols were tested; the selected protocol consisted of 2 ms monophasic square‐wave pulses of 50 mV/cm at 1 Hz over 14 days. Cardiac and subcutaneous ATDPCs were grown on biocompatible patterned surfaces. Cardiomyogenic differentiation was examined by real‐time PCR and immunocytofluorescence. In cardiac ATDPCs, MEF2A and GATA‐4 were significantly upregulated at day 14 after stimulation, while subcutaneous ATDPCs only exhibited increased Cx43 expression. In response to electrical stimulation, cardiac ATDPCs elongated, and both cardiac and subcutaneous ATDPCs became aligned following the linear surface pattern of the construct. Cardiac ATDPC length increased by 11.3%, while subcutaneous ATDPC length diminished by 11.2% (p = 0.013 and p = 0.030 vs unstimulated controls, respectively). Compared to controls, electrostimulated cells became aligned better to the patterned surfaces when the pattern was perpendicular to the electric field (89.71 ± 28.47º for cardiac ATDPCs and 92.15 ± 15.21º for subcutaneous ATDPCs). Electrical stimulation of cardiac ATDPCs caused changes in cell phenotype and genetic machinery, making them more suitable for cardiac regeneration approaches. Thus, it seems advisable to use electrical cell training before delivery as a cell suspension or within engineered tissue. Copyright © 2013 John Wiley & Sons, Ltd.