超声声学定量检测心肌梗死患者左心功能及其与左心室重构的关系

目的：探讨54例冠心病亚急性及陈旧性心肌梗死患者左心室重构对其心功能及心律失常的影响。方法：用超声声学定量技术检测54例患者的心功能并根据患者有无左心室腔增大分为左心室重构组（34例）及非左心室重构组（20例）,同时设正常对照组（30例）,用24小时动态心电图观察其中45例患者心律失常发生情况。结果：冠心病亚急性及陈旧性心肌梗死患者发生左心室重构时,其左心室收缩功能与舒张功能明显低下,而冠心病亚急性及陈旧性心肌梗死患者未发生左心室重构时,仅表现为左心室舒张功能低下。比较两组患者心律失常发生情况,发现左心室重构组心律失常发生率明显高于非左心室重构组,尤其以室性心律失常及传导阻滞发生率为高。结论：左心室重构对心肌梗死患者左心功能及心律失常的发生有一定影响。     

心肌缺血预适应与左心功能及并发症关系分析

目的探讨冠心病有无心绞痛时左心室功能与并发症是否具有缺血预适应的保护作用。方法连续观察186例冠心病者左室舒张功能、收缩功能以及临床并发症的变化情况。结果①89例急性心肌梗死(AMI)者中心绞痛组左心室舒张、收缩功能及心律失常、心力衰竭和病死率均比无心绞痛组少(P<0.05);②97例无AMI者中左室舒张、收缩功能指标以及各种临床并发症,心绞痛组比无心绞痛组少,无统计学差异(P>0.05)。结论①AMI前发生心绞痛可使缺血心肌产生预适应效应。②慢性持续性非梗死性的心肌缺血可减弱或阻抑缺血预适应现象的产生。     

冠心病患者左心功能的改变

目的:观察不同程度冠心病患者左心功能的变化。方法;78例冠心病患者分成稳定性心绞痛(SA)、不稳定性心绞痛(UA)、急性心肌梗死(AMI)和陈旧性心肌梗死(OMI)4组,并与30例健康成人(对照组)比较。采用无创伤自动检测仪及彩色多普勒血流显像仪测定心功能指标;心排血指数(CI),外周阻力(TPR),左室射血前期(PEP)及左室射血时间(LVET);左室收缩功能:射血分数,每搏量,心搏出量;左室舒张功能:A峰,E峰,峰值速度比值,峰值充盈,标准化充盈速度。结果:AMI和OMI组心功能明显减低(P<0.01):CI减少,TPR增高,PEP延长,LVET缩短,左室收缩功能减弱,舒张功能降低;UA和SA组心功能减低(P<0.05～<0.01);AMI和OMI组比UA和SA组心功能减低有显著差异(P<0.05)。结论;冠心病随病情加重,心功能明显恶化。     

冠心病心绞痛患者中性粒细胞氧化代谢与心律失常关系的研究

目的 了解中性粒细胞氧化代谢在冠心病心绞痛患者心律失常发病中的作用。方法 应用鲁米诺依赖的分离中性粒细胞化学发光法检测冠心病心绞痛尤其是合并心律失常者与窦性心律者中性粒细胞氧化代谢功能。结果 冠心病心绞痛合并心律失常者与窦性心律者中性粒细胞化学发光峰值、积分均高于正常对照组，冠心病心绞痛合并心律失常组中性粒细胞化学发光峰值明显高于冠心病心绞痛窦性心律组。结论 冠心病心绞痛合并心律失常者的发病与中性粒细胞氧化代谢有关。     

缬沙坦对高血压合并心房颤动发生率、左心室肥厚逆转和左心室舒张功能的影响

该文探讨缬沙坦对高血压合并心房颤动发生率、逆转左心室肥厚和左室舒张功能的影响。方法：高血压合并房颤经电转复或药物恢复窦性心律患者210例，随机分为缬沙坦组和氨氯地平组。观察两组患者1年内房颤复发率及其与高血压左室肥厚的关系；比较治疗前后心脏超声参数：左室舒张末期室间隔厚度（IVST）、左室后壁厚度（LVPWT）、左室舒张末期内径（LVEDd）、左房前后径（LADd）、左室质量指数（LVMI）和左心室舒张功能指标；随访治疗期间心脑血管事件的发生。结果：     

老年收缩期高血压左室肥厚与心肌缺血,室性心律失常和心 …

目的：探讨老年收缩期高血压左室肥厚与心肌缺血、心律失常、心衰间的相关性。方法：以动态心电图和超声心动图分别检测６８例老年收缩期高血压左室肥厚（ＨＬＶＨ）患者及３０例老年单纯收缩期高血压（ＳＨＴ）患者的心肌供血、心律和心功能。结果：ＨＬＶＨ组心肌缺血、室性早搏的发生率显著高于ＳＨＴ组;左室收缩功能障碍组ＬＶＥＦ,ＣＩ明显减低;左室舒张功能障碍组二尖瓣舒张早期流速（Ｅ峰）、Ｅ／Ａ、舒张早期减速度显著减     

老年左室舒张性心力衰竭超声心动图观察

目的评价老年左室舒张性心力衰竭超声左心形态、功能的特点。方法对核素心室造影证实的４０例左室舒张性心力衰竭（ＬＶＤＨＦ）及３０例左室收缩性心力衰竭（ＬＶＳＨＦ）进行超声心动图检查，并以２０例正常人为对照组（ＣＧ）。结果ＬＶＤＨＦ组左房内径、室间壁及左室后壁厚度增加，左室内径不大，左室舒张功能参数减低，而左室收缩功能参数正常。ＬＶＳＨＦ组左室内径明显增加，左室收缩、舒张功能参数均异常。结论老年ＬＶＤＨＦ超声心动图特点为左房内径扩大、室壁增厚、左室内径不大，左室收缩功能正常，而左室舒张功能异常。     

影响冠心病左室重塑及心功能的多种因素

目的应用超声心动图评价冠心病不同亚组和急性心肌梗死(AMI)不同部位、冠状动脉病变累及支数及其危险因素等对左室重塑和心功能的影响。方法研究对象包括冠心病患者251例,均经选择性冠状动脉造影狭窄≥75%和非冠心病患者96例。应用美国Acuson公司生产128XP/10超声仪测定心脏各项指标。观察冠心病不同亚组和AMI不同部位对左室重塑和功能的影响;分析血压、血脂、吸烟、血尿酸等危险因素和冠状动脉病变支数对AMI左室重塑和功能的影响。结果AMI、陈旧性心肌梗死和不稳定性心绞痛组患者均有不同程度地左室舒张末内径增大,左室质量增加、左室舒张末和收缩末容积增加,左室射血分数(LVEF)降低(P<005～00001)。其中,陈旧性心肌梗死以左心室质量增加为著,AMI以左室舒张末内径增大为著;在AMI中,前壁和复合部位(2个)对其影响更为显著。病变血管支数和AMI时的收缩压与LVEF值呈明显负相关,即病变血管累及越多、收缩压越高,LVEF值越低(P<005～0001)。原有高血压病的心肌梗死患者LVEF值明显降低,左室舒张末期内径和左室质量显著高于无高血压病组患者(P<0001)。结论冠心病不同亚组和心肌梗死不同部位对心脏左室重塑和功能影响不同。心肌梗死是造成左室重塑和心脏收缩功能减弱的主要原因,尤其是前壁和复合部位心肌梗死更为     

实时三维超声对心肌梗死患者左室收缩同步性和收缩功能的分析

目的:应用实时三维超声心动图(RT-3DE)评价陈旧性心肌梗死患者左室收缩同步性与收缩功能,并探讨左室收缩同步性与收缩功能的关系.方法:研究对象分为2组:正常组20例,陈旧性心肌梗死组30例,其中陈旧性前壁心肌梗死14例,均行实时三维超声心动图检查,通过脱机软件分析整体及节段容积-时间曲线,获取左室整体及节段收缩功能参数、左室收缩同步性参数,并将左室心肌分为基底段、中间段、心尖段3个水平节段进行分析.结果:心肌梗死组左室收缩末期容积(ESV)、左室舒张末期容积(EDV)显著大于正常组(P＜0.01),左室射血分数(LVEF)显著小于正常组(P＜0.001).心肌梗死组左室16节段收缩同步性参数显著大于正常组(P＜0.001),且均与LVEF呈负相关,其中Tmsv-16-SD与LVEF的相关系数r=-0.644,P＜0.01.与正常组相比,前壁心肌梗死组3个水平节段的Tmsv-sel-SD、Tmsv-sel-Dif增大(P＜0.05),REF明显减小(P＜0.05),其中心尖段Tmsv-sel-SD、Tmsv-sel-Dif与心尖段REF呈负相关(r=-0.656,-0.687,P＜0.05).结论:RT-3DE能定量评价心肌梗死患者左室收缩同步性及收缩功能,左室不同步运动可影响左室收缩功能,前壁心肌梗死患者心尖段心肌的不同步运动与其节段收缩功能减低密切相关.     

陈旧性心梗患者经QRS波时限预测室性心律失常

目的 通过分析陈旧性心肌梗死（OMI）患者病理性Q波、碎裂QRS波（fQRS）及其与室性心律失常的发生情况,探讨病理性Q波及fQRS与室性心律失常的关系.方法 对335例确诊陈旧性心肌梗死的患者进行动态心电图检查,将OMI伴fQRS波患者按照fQRS波时限分为fQRS≥110ms组（36例）、fQRS ＜110ms（156例）,并对两组间室性心律失常发生率进行对比分析;将OMI伴病理性Q波患者按照病理性Q波QRS波群时限分为QRS≥110ms组（21例）、QRS ＜110ms（75例）,并对两组间室性心律失常发生率进行对比分析.结果 OMI伴fQRS波患者fQRS≥110ms组室性心动过速发生率明显高于fQRS＜110ms （p=0.026）;OMI伴病理性Q波患者QRS≥110ms组成对室性期前收缩（p=0.045）及室性逸搏心律（p=0.026）发生率明显高于QRS＜110ms组.结论 OMI伴fQRS患者随着fQRS时限延长,发生室性心动过速的风险随之增高;OMI伴病理性Q波患者随着QRS波时限延长,发生成对室性期前收缩及室性逸搏心律的风险随之增高.     

缺血后适应对急性心肌梗死经皮冠状动脉介入治疗术中心肌的保护作用

目的 探讨心肌缺血后适应对急性心肌梗死经皮冠状动脉介入治疗术（PCI）中心肌的保护作用。方法 选择首次发生急性心肌梗死的患者105例,随机分为观察组（缺血后适应组）及对照组,均接受急诊PCI。对照组行常规PCI;观察组PCI术中设置缺血后适应方式。测定两组术前及术后肌酸激酶（CK）及肌酸激酶同工酶（CK-MB）水平;测量术后左心室舒张期末容积指数(LVEDVI)、左心室收缩期末容积指数(LVESVI)、左心室射血分数(LVEF);观察术后严重心律失常、梗死后心绞痛、住院期间病死率发生情况。结果 与对照组比较,观察组术后CK及CK-MB峰值水平明显减低;术后3个月左心室容积减小, LVEDVI ［（64±6）ml/m2 vs （67±6）ml/m2,P＜0.05］,LVESVI［（30±4）ml/m2 vs （34±4）ml/m2,P＜0.05］,LVEF升高（0.53±0.02 vs 0.50±0.03,P＜0.05）;严重心律失常、梗死后心绞痛明显减低,差异有统计学意义（P＜0.05）;住院期间病死率的差异未达到显著水平。结论 心肌缺血后适应对急性心肌梗死PCI术中心肌有保护作用。     

Verapamil-sensitive left anterior fascicular ventricular tachycardia associated with a healed myocardial infarction: changes in the delayed Purkinje potential during sinus rhythm

Uncommon association of left anterior fascicular ventricular tachycardia (VT) with a healed myocardial infarction (MI) is described. A 55-year-old man with a history of anteroseptal MI had verapamil-sensitive VT. The VT exhibited a right bundle branch block configuration and right-axis deviation. The VT exit was located at the left ventricular anterolateral wall. At the mid-anterior left ventricular septum, delayed Purkinje potentials were seen during sinus rhythm, and the optimal pace map was obtained with pace delay. During the VT, diastolic and systolic Purkinje potentials were simultaneously recorded at the same site. Ablation targeting the delayed potentials during sinus rhythm prolonged the time between QRS onset and the delayed potentials, and the VT no longer became inducible when the delayed potentials were completely eliminated. Left anterior fascicular VT develops in post-MI patients; ischemia-injured His-Purkinje system may be involved in the mechanism of the VT.     

高血压患者左室重构与心功能及心律失常关系

研究高血压患者左室重构对心律失常及心功能影响。方法应用多普勒超过心动图声学定量技术和动态心电图检测８７例高血压压患者。结论左室重构对高血压早期左室收缩功能有一定代偿作用,但随着心室重构、左室肥大,心脏功能损害更加明显,同时心室重构明显增加室性心律失常的发生。     

超声心动图声学定量技术评价心肌梗塞患者左房左室功能

应用超声心动图声学定量技术测定28例亚急性及陈旧性心肌梗塞患者的左房左室功能。结果显示：心肌梗塞总组、亚急性心肌梗塞组及陈旧性心肌梗塞组左室面积、左室容积及左房面积均显著大于正常对照组；左房、左室的面积、容积变化率、充盈率及排空率明显低于正常对照组；左室峰值充盈时间较正常对照组明显延长，左房峰值充盈时间与正常对照组相比无显著性差异。提示应用超声心动图声学定量技术可较好地反应心肌梗塞患者左房左室功能的变化。     

急性心肌梗死恢复期患者平板运动试验Q-T间期离散度的价值研究

目的 探讨急性心肌梗死恢复期患者运动试验后Q-T间期离散度（Q-Td）的变化.方法 观察51例急性心肌梗死恢复期患者（观察组）平板运动试验的Q-Td的变化,并观察运动后出现严重室性心律失常、胸痛、血压下降与Q-Td变化的关系.结果 患者峰心率时Q-Td（64.3±20.5ms）较运动前（51.2±23.5ms）增大,差异有显著统计学意义（P＜0.01）.运动中出现严重室性心律失常或明显胸痛、血压下降者15例（A亚组）与36例未出现者（B亚组）比较,运动前Q-Td差异无统计学意义（59.1±17.5ms和16.3±19.2ms,P ＞0.05）,峰心率时A亚组Q-Td（76.8±15.5ms）较B亚组（60.1±16.1ms）延长,差异有显著统计学意义（P＜0.01）.两亚组Q-Td多壁梗死均比单壁梗死延长,A亚组多壁梗死比B亚组延长,差异均有统计学意义（P ＜0.05）.结论 急性心肌梗死患者运动后Q-Td进一步增大,出现严重室性心律失常的危险性增大.平板运动试验可作为筛选急性心肌梗死高危人群的手段之一.     

心肌梗死并心功能不全患者冠状动脉介入治疗的作用

目的 :评价心肌梗死 (MI)并左心功能不全患者经皮冠状动脉介入术 (PCI)对左心收缩功能和左心室重构的作用。方法 :5 2例MI并左心功能不全患者 ,急性心肌梗死 (AMI) 30例 ,陈旧性心肌梗死 (OMI) 2 2例 ,行经皮腔内冠状动脉成形术加支架术治疗 ,术后随访 3个月 ,超声心动图测定左室舒张末内径 (LVEd)、左心房内径(LAd)、左室舒张末容积 (LVEDV)、左室收缩末容积 (LVESV)、左室射血分数 (LVEF)和左室短轴缩短率 (LVFS) ,比较治疗前后各参数的变化。结果 :PCI治疗后LVEd、LAd、LVEDV、LVESV较治疗前均明显减少 (均P <0 .0 1)、LVEF和LVFS明显增高 (P <0 .0 1) ,尤以AMI组明显 ,并且冠状动脉血运重建的时间越早 ,心功能恢复越好。结论 :MI并左心功能不全患者尽早PCI治疗可明显改善左心室收缩功能 ,部分阻抑左心室重构。     

Evaluation of hepatic venous flow patterns using a pulsed Doppler technique

Evaluation of hepatic venous flow patterns was attempted by pulsed Doppler echocardiography. Subjects were 80 patients including those with dilated cardiomyopathy, old myocardial infarction, angina pectoris, pulmonary hypertension, constrictive pericarditis, tricuspid regurgitation (TR), lone atrial fibrillation, and post-cardiac surgery. Eleven normal subjects served as controls. The mean age was 53.0 +/- 12.4 years. Most of the TR patients had atrial fibrillation. Patients with aortic regurgitation and significant mitral regurgitation were excluded. Afterload stress by angiotensin II infusion was performed in 51 subjects, mainly for those with ischemic heart disease, cardiomyopathy and the normal controls. Hepatic venous flow patterns included double-peaked flow signals toward the right atrium, and the relationship between systolic (S) and diastolic flow velocities (D) was expressed as the velocity ratio [S/(S+D)]. A reversed flow during atrial systole was expressed as an "A wave" and that between the S and D waves, as an "O wave". Systolic flow velocity was less than diastolic flow velocity in cases with atrial fibrillation and the post-surgical cases. The velocity ratio was greater than 0.5 in nearly all patients with normal sinus rhythm, and less than 0.5 in cases with atrial fibrillation and the post-surgical cases. In the former, systolic flow velocity was less than diastolic flow velocity after defibrillation, in spite of restoration of normal sinus rhythm. These findings indicate that systolic flow velocity was influenced by atrial relaxation; diastolic flow velocity, by ventricular diastolic function. The A wave was increased in cases with pulmonary hypertension and A wave velocity in the hepatic vein correlated with systolic pulmonary artery pressure. In cases with tricuspid regurgitation, reversed flows were detected during ventricular systole both in normal sinus rhythm and in atrial fibrillation. After infusions of angiotensin II the velocity ratio increased in cases with dilated cardiomyopathy and in normal controls (p less than 0.01). The hepatic venous flow pattern after infusion in the former was characterized by dominant systolic and diminished diastolic flow velocities with a consequent increase in the velocity ratio toward 1.0, while a change in the ratio was less marked in normal controls. In conclusion, analysis of the hepatic venous flow pattern by pulsed Doppler echocardiography is very useful for evaluating cardiac function. A marked increase in the velocity ratio after angiotensin II infusion suggests decreased cardiac function.     

肌浆网钙ATP酶高表达对大鼠心肌梗死的影响

目的心肌梗死后心力衰竭主要表现为肌浆网钙释放减少和舒张期细胞浆钙浓度的增加。心肌细胞的肌浆网钙ATP酶(SERCA)起重要的作用。心肌梗死后常伴有SERCA表达的下降。我们通过转基因方法增加SERCA的表达,研究其对心梗后的心肌功能、左心室重构和心律失常的作用。方法将月龄匹配的过表达37%心肌SERCA2a蛋白质的转基因大鼠(TG)和对照野生型(WT)大鼠,通过结扎左冠状动脉诱发心肌梗死。采用动态心电图和心脏超声对心梗后的心律失常和左心室功能进行测定。结果心肌梗死后24hTG的死亡率高于WT(71%对35%,P<0.001),并伴有较高的室性心律失常发生率,后者可被利多卡因所预防。1个月后TG心肌舒张功能明显较WT改善,左心室重构减少,但左室收缩功能无明显改变。结论转基因高表达SERCA2a可以改善心梗后1个月的心肌舒张功能、减少重构,但同时伴有心梗急性期死亡率和心律失常发生率的增高。     

Use of Doppler echocardiography for studying hemodynamics in paroxysmal supraventricular tachycardia

Eighteen patients in whom sustained supraventricular tachycardia paroxysms were induced by programmed transesophageal pacing were examined. Doppler echocardiography was used to study left ventricular systolic and diastolic function, as well as cardiac output and pulmonary systolic pressure during sinus rhythm and paroxysms. A profound decrease in the cardiac index during paroxysms was found in 2 patients, one of them had higher pulmonary pressure. The cardiac index increased on an average from 4.4 +/- 0.9 l/min.m-2 during sinus rhythm to 4.8 +/- 1.4 l/min.m-2 during paroxysms. The diastolic function of the left ventricle was ascertained to be one of he factors that determine cardiac index in supraventricular tachycardia paroxysms.