米力农治疗充血性心力衰竭疗效观察及其对血浆NT-pro-BNP的影响

目的观察米力农对充血性心力衰竭患者心功能及血浆脑利钠肽水平的影响。方法76例充血性心力衰竭患者随机分为研究组（36例）和对照组（40例）,两组患者均给予常规抗心力衰竭的治疗,根据病情选用利尿剂、血管紧张素转化酶抑制剂、B受体阻滞剂、螺内酯药物等,必要时应用洋地黄等正性肌力药物。研究组在常规治疗基础上加用米力农静滴,疗程为10d。观察两组治疗前后心功能改善情况：心脏指数（CI）、心输出量（CO）、左室射血分数（LVEF）和血浆NT—pro—BNP水平。结果治疗10d后,研究组与治疗前及对照组相比CI、CO和LVEF均明显增加。而NT—pro—BNP明显降低;差异有统计学意义（P〈O．01及P〈O．05）。结论米力农对充血性心力衰竭疗效较好,可提高CO、CI和IJVEF,降低血浆NT—pro—BNP水平。     

曲美他嗪对慢性心力衰竭患者心功能及心率变异性的影响

目的探讨曲美他嗪对慢性心力衰竭（CHF）患者心功能及心率变异性（HRV）的影响。方法将60例CHF患者随机分为治疗组和对照组,每组30例,对照组给予常规治疗,治疗组在常规治疗的基础上加用曲美他嗪治疗6个月,观察两组患者治疗前后NYHA分级、左心室舒张末期内径（LVEDd）、左心室射血分数（LVEF）、N末端原脑利钠肽（NT-pro-BNP）及6min步行距离（6-MWD）的变化,采用12导联同步1-IOLTER检测系统检查,测定HRV时域指标（SDNN、SDANNindex MSDD、PNN50）。结果6个月后,治疗组患者的心功能明显改善,LVEDd及NT—pro—BNP与对照组相比明显降低,LVEF及6-MWD与对照组相比明显增加,HRV参数明显好转。结论曲美他嗪可以改善CHF患者的心功能及HRV。     

充血性心力衰竭患者血浆内皮素水平变化及药物干预的临床研究

 目的观察福辛普利对充血性心力衰竭(Congestive heart failure,CHF)患者血浆内皮素(Endothelin,ET)水平及心功能变化的影响,并探讨其相关机制.方法采用放射免疫法检测福辛普利组及常规治疗对照组患者治疗前和治疗12周后血浆ET水平,同时间点采用超声心动图检测左室射血分数(Left ventricular ejection fraction,LVEF)和二尖瓣血流最大流速E峰和A峰比值(E/A),并以38例健康体检者作为正常对照组.结果 CHF患者ET水平显著高于对照组,福辛普利治疗12周后,CHF患者的ET水平显著降低,LVEF、E/A值显著提高.结论 CHF患者ET水平增高可作为判断CHF病情的指标之一;福辛普利可降低CHF患者的ET水平,改善CHF患者的心脏功能.     

放射性核素显像在心力衰竭中的应用

放射性核素显像在测定心室功能,评价心力衰竭的严重程度,了解心肌血流灌注、心肌活力及心脏交感神经功能,鉴别心力衰竭的病因,判断预后,指导临床治疗和评估疗效等多方面都有重要的临床价值。     

高活性心钠素治疗重度充血性心力衰竭及超氧化物岐化酶的研究

 目的 观察高活性心钠素(haANP)治疗充血性心力衰竭(CHF)的疗效及心钠素(ANP)与超氧化物岐化酶(SOD)的关系。方法选择符合CHF诊断标准的连续住院患者110例,随机分为haANP治疗观察组79例,给予haANP 300 μg加入5％葡萄糖250ml中静滴;常规治疗对照31例,疗程均为14d。观察治疗疗效及治疗前后心率、心胸比、血压、左心室舒张末内径(LVDd)、左心室射血分数(LVEF),检测治疗前后SOD和ANP水平。结果观察组总有效率81％,与对照组51.6％比较有显著性差异(P＜0.01),观察组治疗后心率、血压、心胸比、SOD、LVDd均明显下降(p＜0.05、P＜0.01),LVEF增加(P＜0.01)。结论haANP治疗CHF疗效显著,SOD与病情缓解有关,CHF患者血中ANP与SOD之间相关。     

Correlation of radiographic cardiothoracic ratio with cardiac function in patients with acute congestive heart failure

Objective: Plain film radiographs are routinely used as a part of the emergency department evaluation of patients with acute congestive heart failure. Determination of the cardiothoracic ratio (CT ratio) may provide insight into the severity and mechanism of the cardiac dysfunction. This study was designed to correlate the determined CT ratio with measures of systolic and diastolic function in patients with decompensated congestive heart failure (CHF). Methods: The CT ratio was retrospectively calculated from the routine upright anteroposterior plain film radiographs obtained during the evaluation of patients with acute CHF. Likewise, values for the diastolic time intervals such as isovolumic relaxation times and filling times (measures of diastolic dysfunction, IVRT, FT) and the Heather Index (a measure of systolic contractility, HI) were obtained from the tracings obtained by impedance cardiography (IC). These functional measures were then independently correlated with the CT ratio by multiple regression analysis. The degree of left ventricular hypertrophy (LVH) as determined by EKG voltage was also correlated to cardiac function measures for comparison. Results: In 45 patients there was no significant correlation (P < 0.05) of the measured IVRT and FT with the corresponding CT ratio. The HI was also significantly inversely correlated with the CT ratio (r = –0.36, P < 0.05). By comparison, the degree of LVH was not significantly related to the measures of systolic function but was highly correlated to the IVRT. Conclusion: CT ratios determined from plain film radiographs appear to correlate well with measures of cardiac systolic function and may be useful in determining the severity and mechanism of CHF in the acute setting.     

Large animal models of congestive heart failure: A critical step in translating basic observations into clinical applications

Congestive heart failure (CHF) is a clinical syndrome in which pathophysiologic underpinnings include left ventricular (LV) dysfunction, remodeling, and increased neurohormonal activation. Accordingly, large animal constructs must be developed that mimic this disease process in order to define new pharmacologic and surgical treatment strategies. Multiple large animal species have been used for these purposes. For instance, canine coronary artery microembolization has been used to generate ischemia-induced LV dilation and dysfunction. Sheep have been subjected to total acute coronary artery occlusion to evaluate ischemia-induced mitral valve insufficiency. Rapid ventricular pacing has been used in both dogs and pigs to reproduce the characteristics of dilated cardiomyopathy. Each model is associated with advantages and disadvantages. Therefore findings derived from the study of large animal models of LV failure must be carefully evaluated. With proper interpretation, important insights into the pathogenesis of CHF may be realized. Furthermore, these models may be used in conjunction with imaging modalities such as magnetic resonance imaging, single photon emission computed tomography, and positron emission tomography to elucidate the identification of cellular and extracellular alterations associated with LV failure. Thus large animal models of CHF are critical components in the effort to translate basic observations into beneficial clinical applications.     

缬沙坦对慢性心力衰竭患者脑钠肽和心室重构的影响

 目的观察慢性心力衰竭患者缬沙坦治疗前后血浆脑钠肽的变化,探讨缬沙坦对心室重构的影响.方法55例慢性心力衰竭患者,随机分为缬沙坦治疗组(n=25)和常规治疗组(对照组,n=30),缬沙坦组除常规抗心衰治疗外加用缬沙坦40～80mg/d,在治疗前、治疗后2周、治疗后1个月、治疗后3个月不同时间采静脉血测定BNP值,治疗前和治疗后3个月超声心动图测定心功能和心室重构指标.结果缬沙坦组和对照组治疗后血浆BNP水平较治疗前均有下降,但缬沙坦组下降得更明显,两组比较差异有统计学意义(P＜0.01);治疗后3个月时,左室射血分数、左室收缩末内径、左室舒张末内径两组之间差异无统计学意义,但左室后壁厚度、室间隔厚度和左室重量指数缬沙坦组显著低于对照组(P＜0.05).结论缬沙坦可显著抑制心衰患者BNP的分泌和心室重构,改善心功能.     

Tei指数预测慢性心力衰竭病人运动耐量的价值

目的　测量慢性心力衰竭病人的Tei指数 ,分析Tei指数与 6分钟步行距离的关系。方法　慢性心力衰竭住院病人 70例 ,行超声心动图检查 ,所有病人进行 6分钟步行试验 ,分析 6分钟步行距离与超声心动图各参数的相关性。结果　平均Tei指数随NYHA分级的增加而增加 ,单因素相关分析显示Tei指数与E/A比值呈正相关 ,与左室晚期充盈的A峰速度、E峰减速时间DT及左室射血分数呈负相关。Tei指数与心率、血压、年龄无相关性。与单纯反映左室收缩舒张功能的指标相比 ,Tei指数与 6分钟步行距离之间有更强的相关性 (r=- 0 .5 80 ,P <0 0 0 1)。多因素逐步回归分析显示Tei指数与A峰速度为预测心力衰竭病人 6分钟步行距离的独立因素。结论　左室舒张功能异常比左室收缩功能异常对慢性心力衰竭病人运动耐量的影响更明显。Tei指数反映整体的心肌功能 ,对于评价左室收缩功能不全病人的心肺运动耐量是一个很有价值、简便、易重复的指标     

Mediastinal lymphadenopathy in congestive heart failure: a sequential CT evaluation with clinical and echocardiographic correlations

The aim of this study was to evaluate the frequency and evolution after treatment of mediastinal lymphadenopathy associated with congestive left heart failure on CT scans in correlation with clinical and echocardiographic findings. Thirty-one consecutive patients with subacute left heart failure underwent a clinical evaluation using the NYHA classification, a CT examination, and transthoracic echocardiography at the time of initial presentation (T1). After initiation of medical treatment (T2), follow-up CT scans were systematically obtained together with a clinical evaluation. At T1, all patients showed severe (type III: n=12, 39%; type IV: n=12, 39%) to moderate (type I, n=1, 3%; type II, n=6, 19%) dyspnea with a mean ejection fraction of 39% (range 22–74%). On initial CT scans, enlarged mediastinal lymph nodes were seen in 13 patients (42%) with blurred contours in 5 patients (16%) and hazy mediastinal fat in 1 patient (3%). Significant decrease in the size of lymphadenopathy was observed between T1 and T2 (T1, n=13, 42% vs T2, n=10, 32%; p<0.05) with a concurrent decrease in the severity of dyspnea (grade III–IV dyspnea at T1, n=24, 78% vs grade I–II dyspnea at T2, n=26, 83.5%). Patients with enlarged lymph nodes at T1 showed: (a) a significantly lower ejection fraction at echocardiography than those without lymphadenopathy (mean±SD value: 34±12.9 vs 43±13.8%; p=0.04); (b) a significantly larger diameter of the right superior pulmonary vein (mean±SD value: 17±2.75 vs 14±3.9 mm; p=0.04); and (c) a higher frequency of abnormal peribronchovascular thickening (n=5 vs n=1; p=0.06). Mediastinal lymphadenopathy associated with subacute left heart failure was observed in 13 patients (42%), showing regression after initiation of treatment in 8 of 13 patients (62%).     

缬沙坦联合美托洛尔治疗充血性心力衰竭的疗效观察

目的 :观察缬沙坦联合美托洛尔治疗慢性充血性心力衰竭 (CHF)的临床疗效。方法 :96例CHF患者随机分为 :A组 (n =4 6 )给予洋地黄及利尿剂等常规治疗 ,B组 (n =5 0 )在常规治疗的基础上口服缬沙坦 (4 0～ 16 0mg·d-1)和美托洛尔 (12 .5～ 10 0mg·d-1) ,疗程均为 6个月。结果 :治疗后B组患者心功能改善、血压下降、心率减慢、心胸比缩小 ,左室舒张末期内径 (LVDd)及左房内径 (LAd)均明显减小 ,左室射血分数 (LVEF)增加 (P <0 .0 5 ) ,明显优于A组 ;且副作用少、患者耐受性好。结论 :缬沙坦联合美托洛尔治疗CHF疗效肯定、副作用少 ,值得临床推广。     

Ventilation imaging of the lung: Comparison of hyperpolarized helium-3 MR imaging with Xe-133 scintigraphy

RATIONALE AND OBJECTIVES: To compare hyperpolarized helium-3 (HHe) magnetic resonance imaging (MRI) of the lung with standard Xe-133 lung ventilation scintigraphy. MATERIALS AND METHODS: We performed a retrospective review of 15 subjects who underwent HHe MRI and Xe-133 lung ventilation imaging. Coronal MRI sections were acquired after a single inhalation of HHe gas, and standard posterior planar lung ventilation scintigraphy was performed during continuous breathing of Xe-133 gas. The first breath scintigram of each patient was compared with a composite MR image composed of the sum of the individual MR images and with the individual helium-3 MR images. Ventilation defects on the two imaging modalities were compared for size, conspicuity, and concordance in presence and location. Assessment was done separately for each of four lung quadrants. RESULTS: Comparing the composite HHe MR images with Xe-133 scintigraphy, ventilation defect size, conspicuity and concordance were the same in 67% (40/60), 63% (38/60), and 62% (37/60) quadrants, respectively. Comparing the individual HHe MR image sections with the Xe-133 ventilation scan, there was concordance between the ventilation defects in 27% (16/60) of quadrants. More defects were identified on the individual HHe MR images in 62% (37/60) of quadrants. CONCLUSION: There was good agreement between composite HHe MR image and first breath Xe-133 scintigraphic images, supporting the widely held assumption that HHe MRI likely depicts first breath lung ventilation.     

门冬氨酸钾镁治疗充血性心力衰竭40例临床疗效观察

目的：探讨慢性充血性心力衰竭时应用门冬氨酸钾镁改善心功能的临床疗效．方法：81例心衰病人分两组，治疗组40例在常规抗心衰的基础上酌情加滴门冬氨酸钾镁7～10天，41例对照组予常规抗心衰治疗。结果：治疗组总有效率97．50％，对照组总有效率78．05％。两组总有效率之间差异显著（P＜0．05）。结论：门冬氨酸钾镁能改善心肌代谢，缩短纠正心衰的时间。     

阿托伐他汀对冠心病心力衰竭患者血管内皮功能的影响

目的 研究阿托伐他汀(立普妥)对冠心病(CHD)合并充血性心力衰竭(CHF)患者血浆中一氧化氮(NO)、降钙素基因相关肽(CGRP)和内皮素(ET)的影响.方法 将68例CHD并CHF患者分为2组,常规用药对照组(地高辛、氢氧噻嗪、硝酸异山梨酯)34例,常规用药加阿托伐他汀联用组34例,并设正常人组34例.N0测定用Greiss法,放射性免疫法测定治疗前后血中CGRP和ET的水平.结果 CHD并CHF患者中NO和CGRP水平明显低于正常人组(P<0.01),ET显著高于正常人组(P<0.01),治疗后均显著改善(P<0.01),且以常规用药加阿托伐他汀组改善更为显著,与常规组治疗后比较差异有统计学意义(P<0.05).结论 常规用药加阿托伐他汀能显著改善CHD合并CHF患者的NO、CGRP和ET的代谢失衡.     

心脏再同步治疗对慢性心力衰竭患者的近期疗效观察

目的:观察心脏再同步起搏治疗对慢性心力衰竭的临床疗效.方法:31例慢性心力衰竭合并室内传导阻滞患者行心脏再同步起搏治疗,全部患者成功经冠状静脉植入左心室导线,分别于3月和6月随访,观察QRS波宽度,左心室收缩、舒张末内径,左心室射血分数.结果:心脏再同步治疗后患者QRS时限由术前的(160±32) ms减少到术后的(118±21 )ms,P＜0.05.术后的第3月和第6月,患者LVEDD由术前(74.5±14.1 )mm减少到(66.2±9.5)mm、(64.3±11.2) mm,P＜0.01;患者LVESD由术前(65.2±10.2)mm减少到(57.3±9.2)mm、(56.2±10.9)mm,P＜0.01;LVEF由术前的(0.24±0.09)增加到(0.36±0.11)、(0.38±0.14),P＜0.01.结论:心脏再同步化治疗是慢性心力衰竭治疗的有效方法.     

Clinical value of lung uptake of iodine-123 metaiodobenzylguanidine (MIBG), a myocardial sympathetic nerve imaging agent, in patients with chronic heart failure

This study investigated the clinical value of I-123 MIBG pulmonary accumulation and washout in patients with chronic heart failure (CHF). Nineteen patients with CHF and 15 normal volunteers (NL) were included. The uptake ratio of heart to mediastinum (H/M), that of lung fields to mediastinum (L/M), and washout rate (WR) of the heart and lung fields were calculated in anterior planar images and compared with results of echocardiography and cardiac catheterization. In the CHF group, the lung uptake in delayed images increased and lung WR was decreased, suggesting pulmonary endothelial lesions. Furthermore, there was a negative correlation between right and left lung WR and pulmonary arterial diastolic pressure (PA(D)) and pulmonary arterial systolic pressure (PA(s)) in the CHF group. Since the WR of MIBG reflected PA, it may be used as an index of severity of cardiac dysfunction.     

Predictors of improvement in left ventricular ejection fraction with carvedilol for congestive heart failure

BACKGROUND: Beta-blocker therapy has been reported to improve survival and left ventricular ejection fraction (LVEF) in the setting of congestive heart failure (CHF). The magnitude and predictors of improved LVEF are unclear. METHODS: A total of 295 patients were enrolled in the study. Inclusion criteria were LVEF <35% at baseline and symptomatic (New York Heart Association class II to IV) CHF despite treatment with at minimum an angiotensin-converting enzyme inhibitor. Carvedilol was initiated at 3.125 mg twice daily and titrated to a target dose of 25 or 50 mg twice daily, depending on the patient's weight. Paired pretreatment baseline and 9 months with treatment follow-up quantitative LVEFs (assessed by resting radionuclide ventriculograms) were obtained in 161 (55 %) of the patients. RESULTS: LVEF improved from 25% +/- 6% at baseline to 36%+/-12% at follow-up (P<.001). Mean change in LVEF (deltaLVEF) was greater for nonischemic cardiomyopathy (NICM) (+14.5+/-2 LVEF points) than ischemic cardiomyopathy (deltaLVEF +/- 7.6+/-10 EF points, P = .001). The deltaLVEF was > or =21 LVEF points in 30% of the NICM group versus 10% of the ischemic cardiomyopathy group. Conversely, the deltaLVEF was unchanged to minimally improved (< or =5 LVEF points) in 21% of the NICM group versus 52% of the ischemic cardiomyopathy group. Multivariable analysis identified NICM and recent onset of congestive heart failure as correlates of improved LVEF. CONCLUSIONS: Carvedilol significantly improved LVEF, especially in patients with NICM and those with recent onset of CHF.     

依那普利联合卡维地洛治疗老年慢性心衰的临床观察

目的探讨依那普利联合卡维地洛在老年慢性心力衰竭患者治疗中的疗效、耐受性和安全性。方法选择老年充血性心力衰竭（CHF）患者130例,随机分为常规治疗组（对照组,28例）、依那普利与卡维地洛联合治疗组（观察组,42例）、依那普利治疗组31例和卡维地洛治疗组29例。4组治疗前和治疗6个月后,均使用超声心动图分别测定左心室舒张末期内径（LVEDD）、心输出量（CO）和左心室射血分数（LVEF）,进行疗效观察。结果治疗后4组LVEDD较治疗前显著减少（P〈0.05）,LVEF和CO较治疗前显著增高（P〈0.05）;治疗后观察组、LVEDD低于对照组（P〈0.05）,LVEF和CO较对照组显著增高（P〈0.05）。结论在常规治疗老年CHF患者的基础上,加用目标剂量的依那普利联合卡维地洛,对CHF患者安全有效,能明显改善心功能,提高左室射血分数。     

Quantitative MRI measurement of lung density must account for the change in T with lung inflation

Purpose

To evaluate lung water density at three different levels of lung inflation in normal lungs using a fast gradient echo sequence developed for rapid imaging.

Materials and Methods

Ten healthy volunteers were imaged with a fast gradient echo sequence that collects 12 images alternating between two closely spaced echoes in a single 9‐s breathhold. Data were fit to a single exponential to determine lung water density and T. Data were evaluated in a single imaging slice at total lung capacity (TLC), functional residual capacity (FRC), and residual volume (RV). Analysis of variance for repeated measures was used to statistically evaluate changes in T and lung water density across lung volumes, imaging plane, and spatial locations in the lung.

Results

In normal subjects (n = 10), T (and [lung density/water density]) was 1.2 ± 0.1 msec (0.10 ± 0.02), 1.8 ± 0.2 ms (0.25 ± 0.04), and 2.0 ± 0.2 msec (0.27 ± 0.03) at TLC, FRC, and RV, respectively. Results also show that there is a considerable intersubject variability in the values of T.

Conclusion

Data show that T in the lung is very short, and varies considerably with lung volume. Thus, if quantitative assessment of lung density within a breathhold is to be measured accurately, then it is necessary to also determine T. J. Magn. Reson. Imaging 2009. © 2009 Wiley‐Liss, Inc.     

法舒地尔对老年慢性充血性心衰患者心功能及脑钠肽的影响

目的探讨Rho激酶(ROCK)抑制剂法舒地尔对老年慢性充血性心力衰竭(CHF)患者心功能及脑钠肽(BNP)水平的影响。方法将120例NYHA心功能Ⅲ～Ⅳ级的老年患者分为两组:(1)对照组60例给予常规抗心衰治疗(强心剂、利尿剂、β-受体阻滞剂及ACEI/ARB等);(2)治疗组60例在对照组常规抗心衰治疗基础上加用法舒地尔静脉滴注,两组患者均治疗14 d,观察治疗前、后6 min步行距离、左室射血分数(LVEF)及血浆BNP水平的变化。结果治疗14 d后,同常规抗心衰治疗组相比,加用法舒地尔组患者临床有效率、6min步行距离及LVEF明显提高,BNP显著降低(P<0.05)。结论法舒地尔结合常规抗心衰治疗能够明显改善老年CHF患者的临床症状及心功能指标,疗效优于单纯常规药物治疗。