心衰患者心源性猝死的一级预防

心衰患者SCD平均发生率约40％。 本文综述SCD发生率、原因、高危病人的识别及药物治疗对SCD的影响。并且概述ICD在SCD一级预防中的重要性。     

Sudden Cardiac Death: The Larger Problem… the Larger Genome

This perspective considers progress in understanding how genetic influences modulate susceptibility to lethal ventricular arrhythmias in cardiac patients and the population at large, as opposed to those with rare inherited arrhythmic conditions, such as the Long-QT and Brugada syndromes. It addresses largely unresolved issues, such as how important these effects may be and what we know of underlying mediators and pathways. Attention is given to newly revealed mechanisms of genomic function and the problem of identifying new susceptibility genes and targets useful in developing improved strategies for sudden death prevention.     

心力衰竭患者心源性猝死的预警和治疗策略

重点探讨心力衰竭患者发生心源性猝死的预测方法和治疗策略,旨在为心源性猝死的预防及治疗提供客观依据。     

慢性心力衰竭患者猝死预防的无创指标进展

慢性心力衰竭患者中,猝死的风险增加与心室重构和电重构等因素有关,如何通过无创性方法甄别猝死高危患者成为研究热点之一。现有研究指标较多,但研究价值各异,部分指标如射血分数、脑钠肽、T波峰一末间期、T波电交替、心率减速力、高敏c反应蛋白和综合量表显示出较高的预测价值和临床意义。深入认识这些指标在慢性心力衰竭中的变化规律和干扰因素,有利于心源性猝死的预防和心力衰竭的治疗,提高患者的生活质量。     

T波电交替预测心力衰竭病人心源性猝死价值的新分歧

有半数的心力衰竭病AN致命性室性心律失常事件死于心源性猝死。T波电交替是公认的预测心源性猝死的重要指标。早在许多年前就发现T波电交替与心源性猝死有关,近年来新建了频域和时域测量方法。跨室壁复极离散度异常增大是T波电交替的机制。最近研究发布的用微伏级T波电交替进行心肌梗死后危险性分层的初步结果否定心肌梗死后左室射血分数〈30％的病人发生致死性快速室性心律失常的价值。但体内除颤器置入前T波电交替的对心源性猝死一级预防试验和非缺血性心肌病心力衰竭T波电交替的预测价值试验则强有力地支持T波电交替能预测心律失常。     

Risk of Sudden Cardiac Death in Chronic Kidney Disease

The review discusses the epidemiology and the possible underlying mechanisms of sudden cardiac death (SCD) in chronic kidney disease (CKD), and highlights the unmet clinical need for noninvasive risk stratification strategies in these patients. Although renal dysfunction shares common risk factors and often coexists with atherosclerotic cardiovascular disease, the presence of renal impairment increases the risk of arrhythmic complications to an extent that cannot be explained by the severity of the atherosclerotic process. Renal impairment is an independent risk factor for SCD from the early stages of CKD; the risk increases as renal function declines and reaches very high levels in patients with end‐stage renal disease on dialysis. Autonomic imbalance, uremic cardiomyopathy, and electrolyte disturbances likely play a role in increasing the arrhythmic risk and can be potential targets for treatment. Cardioverter defibrillator treatment could be offered as lifesaving treatment in selected patients, although selection strategies for this treatment mode are presently problematic in dialyzed patients. The review also examines the current experience with risk stratification tools in renal patients and suggests that noninvasive electrophysiological testing during dialysis may be of clinical value as it provides the necessary standardized environment for reproducible measurements for risk stratification purposes.     

Clinical Outcomes in Patients With Isolated Left Ventricular Noncompaction and Heart Failure

BackgroundWe prospectively evaluated long-term clinical outcomes of patients diagnosed with isolated left ventricular noncompaction (ILVNC) and heart failure from a sub-Saharan African population.Methods and ResultsPatients in this single-center study were followed at a tertiary care institution. Clinical follow-up was performed with the use of protocol-driven echocardiographic screening for ventricular thrombus every 4 months. Warfarin was maintained or initiated only if thrombus was detected with the use of echocardiography. Fifty-five patients were followed for 16.7 ± 5.9 (range 12–33) months. All individuals had left ventricular (LV) ejection fraction <50% (mean 29.6 ± 11.8%). Of the 55 patients, 7 (12.7%) died, and sudden cardiac death was the cause in 5 (71.4%). There were no differences in baseline clinical, echocardiographic, or electrocardiographic characteristics between survivors and nonsurvivors. Recurrent heart failure developed in 12 patients (21.8%); 1 patient developed a ventricular arrhythmia. No thromboembolic or major bleeding complications occurred in the 16 patients on warfarin; 1 episode of thromboembolism occurred in the 39 patients not on warfarin. Mean survival probability at 33 months was 0.64.ConclusionsSudden cardiac death was the most common cause of death in patients with ILVNC and heart failure. Recurrent heart failure occurred in 21.8% of patients. Development of LV thrombus and cardioembolism is uncommon in this population.     

HE4 Serum Levels Are Associated with Heart Failure Severity in Patients With Chronic Heart Failure

Background

The novel biomarker human epididymis protein 4 (HE4) shows prognostic value in acute heart failure (HF) patients. We measured HE4 levels in patients with chronic heart failure (CHF) and correlated them to HF severity, kidney function, and HF biomarkers, and determined its predictive value.

Effect of Losartan on the Cardiac and Renal Function in Patients With Chronic Heart Failure

Objectives To explore the effect of losartan on cardiac and renal function in patients with chronic heart failure (CHF). Methods Sixty-five patients with CHF were divided into two groups using a randomized, control and single blind method: losartan group (n=30) and convention group (n=35), with a treatment course of 8 weeks for both groups. The concentrations of cystatin C (cys C) in serum, microamount albumin (MA) in urine were measured by immunoturbidimetry. The concentration of aquaporin-2(AQP-2)was determined by enzyme-linked-immunosorbent assay (ELISA) and the heart contractile function was measured by echocardiography before and after treatment respectively. Results Comparing with routine treatment group, left ventricular end-diastolic dimension (LVEDd) decreased significantly, while left ventricular ejection fraction(LVEF)and left ventricular fractional shortening (LVFS) increased significantly in losartan group. The levels of cys C in serum and MA, AQP-2 in urine were significantly lower in losartan group than in routine treatment group. Conclusion Losartan can improve cardiac and renal function in patients with CHF.     

麝香通心滴丸对慢性心力衰竭病人心功能的影响

目的观察麝香通心滴丸对慢性心力衰竭(CHF)病人心功能的影响。方法将121例CHF病人随机分为治疗组(61例)和对照组(60例),治疗组给予常规药物及麝香通心滴丸治疗8周,对照组给予常规药物治疗。评估6 min步行试验距离(6MWT),监测血浆氨基末端脑钠肽前体(NT-proBNP)、左心室舒张末内径(LVEDD)及左室射血分数(LVEF);常规实验室检查及心电图评估麝香通心滴丸的安全性。结果与治疗前比较,两组治疗后6MWT和LVEF明显增加,血浆NT-proBNP及LVEDD明显降低(P<0.05或P<0.01);与对照组比较,治疗组治疗后6MWT、LVEF明显增加,血浆NT-proBNP明显下降(P<0.05)。结论麝香通心滴丸能明显改善CHF病人的心功能,治疗期间未见明显不良反应。     

Characteristics of the Circadian Rhythm of Heart Rate Variability in Patients with Sudden Cardiac Death after Myocardial Infarction

Background: Sudden cardiac death (SCD) after myocardial infarction, most commonly caused by ventricular fibrillation, is closely associated with autonomic nervous tone. However, the mechanism of SCD and its association with autonomic nervous tone and the circadian rhythm of this tone remain obscure. We examined the characteristics of autonomic nervous tone in patients with SCD using heart rate variability (HRV) analysis. Methods: HRV was analyzed by spectral and nonspectral methods in 46 postinfarction patients, including 6 patients who experienced SCD (SCD[+]) and 40 survivors (SCD[—]). The circadian rhythm of HRV was assessed by a nonlinear least squares method combined with the maximum entropy method (MEM) using data from 24-hour ambulatory ECGs. The mean follow-up period was 27 ± 12 months. Results: Midline estimating statistic of rhythm and the amplitude of the high frequency (HF) component in the SCD(+) group were lower than those in the SCD(—) group, and differences of the circadian rhythm of the HF component between the SCD(+) group and the SCD(—) group were observed. Conclusions: A decreased HF component indicating diminished parasympathetic nervous activity was the strongest independent predictor of SCD. These results suggest that postinfarction patients whose parasympathetic nervous activity is low and whose circadian changes are small may be susceptible to SCD.     

Thickness and an Altered miRNA Expression in the Epicardial Adipose Tissue Is Associated With Coronary Heart Disease in Sudden Death Victims

Introduction and objectives

An increased epicardial adipose tissue (EAT) thickness has become a new risk factor for coronary heart disease (CHD). We aimed to study the role of EAT dysfunction as a CHD marker by focusing on its thickness and microRNA (miRNA) expression profile, and the potential factors possibly influencing them.

曲美他嗪对慢性心力衰竭病人心功能、脑钠肽和心肌肌钙蛋白Ⅰ的影响

目的观察曲美他嗪对慢性心力衰竭（CHF）病人心功能、脑钠肽（BNP）和心肌肌钙蛋白Ⅰ（cTnⅠ）的影响。方法60例病情稳定的CHF病人。随机分为治疗组及对照组。每组30例。对照组病人采用心力衰竭常规药物治疗，治疗组在对照组治疗的基础上加用曲美他嗪20mg，每日3次。两组均连续治疗4周。观察治疗前后两组NYHA分级、心功能、BNP和cTnⅠ等指标的变化。结果与治疗前相比，两组治疗后NYHA分级及心功能均得到显著改善，血浆BNP及cTnⅠ水平显著降低（P〈0．05或P〈0．01）；与对照组治疗后相比，曲美他嗪组显著缩小病人左室舒张末内径（LVEDD，P〈0．05），显著减小左室质量指数（LVMI，P〈0．05），显著增加左室射血分数（LVEF。P〈0．05）；血浆BNP（P〈0．05）和cTnⅠ（P〈0．01）显著降低。结论曲美他嗪能降低血浆BNP及cTnⅠ水平，改善CHF病人的心功能。