扩张型心肌病合并高血压的心功能及预后分析

目的探讨扩张型心肌病合并高血压患者的心功能及预后。方法选取2005—2010年我院收治的扩张型心肌病患者50例,根据患者病史中是否合并高血压将其分为合并高血压组27例和未合并高血压组23例。比较两组患者预后及心动图检查结果。结果两组患者病死率比较,差异无统计学意义(P0.05)。合并高血压组患者室间隔厚度、左心室射血分数低于未合并高血压组,左心室后壁厚度及左心室心肌质量高于未合并高血压组,出院时美国纽约心脏病协会心功能分级(NYHA分级)改善程度优于未合并高血压组(P0.05)。结论扩张型心肌病合并高血压患者室间隔厚度减小,左心室射血分数降低,心脏收缩功能增强,左心室心肌质量增大,但是运用血压水平作为排除高血压所引发心脏损害的手段具有一定的局限性。     

老年高血压患者昼夜血压、心率变异与左心室肥厚的关系

目的　探讨老年高血压伴左心室肥厚患者昼夜血压变化与自主神经损害的关系。方法　选择伴左心室肥厚的老年高血压患者75例,不伴左心室肥厚的老年高血压患者80例进行动态血压、动态心电图、心率变异等监测,分析昼夜血压变化、血压负荷、血压类型及心率变异功率频谱指标。结果　(1 )左心室肥厚组2 4hSBP、2 4hPP、SBP负荷值尤其夜间SBP负荷值均较非左心室肥厚组偏高,两组差异显著;而DBP及DBP负荷值,两组差异无显著性。(2 )左心室肥厚组以非杓型血压为主;而非左心室肥厚组以杓型血压为主。(3 )两组HRV功率频谱改变比较,左心室肥厚组HRV昼夜节律性减弱甚至消失;而非左心室肥厚组HRV呈昼夜节律变化。结论　高血压左心室肥厚者自主神经损害明显,在高血压治疗中应注意尽可能减少血压负荷,恢复血压昼夜节律,改善心率变异,减少及防治并发症。     

难治性高血压左心室肥厚与交感神经兴奋性关系的临床研究

目的:探讨难治性高血压患者左心室肥厚(LVH)与交感神经兴奋性之间的关系。方法:选取2014年1月至2015年6月就诊的200例难治性高血压患者,超声心动图测量室间隔厚度、左心室后壁厚度、左心室心肌质量、左心室质量指数等LVH相关指标,根据心脏超声结果分为不伴LVH组(不伴有LVH的难治性高血压患者,n=90)和LVH组(伴有LVH的难治性高血压患者,n=110)。根据24 h动态心电图结果计算平均心率、心率变异性时域指标和心率变异三角指数等交感神经兴奋性相关指标,比较两组平均心率和心率变异性。结果:与不伴LVH组相比,LVH组超声心动图LVH相关指标和平均心率均明显升高(P均0.05),心率变异性时域指标和心率变异三角指数明显降低(P均0.05)。结论:难治性高血压患者中,伴有左心室肥厚者交感神经兴奋性增强。     

心脏再同步治疗AV、VV间期优化对缺血性与扩张性心肌病的疗效比较

目的比较AV、VV间期优化的心脏再同步治疗(CRT)对缺血性与扩张性心肌病患者的疗效。方法 2例缺血性心肌病与24例扩张性心肌病患者因心力衰竭植入CRT的患者分别于术后1 w及6个月行超声心动图以及组织多普勒,测定左心室舒张末期直径(LVED)、射血分数(LVEF)、舒张期二尖瓣反流速度时间积分(VTImr)、主动脉瓣射血时间速度积分(VTIa)、右心室侧壁与左心室壁收缩达峰时间差及间隔对左心室后壁的运动延迟时间差(SPWMD)。植入术后1 w在超声指导下行AV、VV间期优化。结果 AV、VV间期优化后随访6个月,缺血性心肌病组与扩张性心肌病组比较:LVED(P=0.48)及LVEF(P=0.88)均无差异;VTIa(P=0.55)及VTImr(P=0.98)均无差别;右心室侧壁与左心室壁收缩达峰时间差(P=0.49)及SPWMD(P=0.15)均无差异。结论缺血性心肌病组与扩张性心肌病对AV、VV间期优化的CRT均反应良好,两者无明显差异。     

伴有二尖瓣返流的扩张性心肌病患者并发左心室血栓少但存活率低

扩张性心肌病患者高发左心室血栓,血管栓塞的并发率也较高(3%～4%)。本实验的目的是确定伴有二尖瓣回流(MR)的扩张性心肌病患者是否发生左心室血栓的倾向较低并估价MR对扩张性心肌病患者存活率的影响。对象和方法:采用彩色二维脉冲多普勒超声心动图技术对91例(女性13例,男性78例)扩张性心肌病患者进行分析,检测和定量MR,记录收缩期和舒张期的最大血流速度并检查是否存在左心室血栓。统计学分析表明伴有MR的患者组(A组:66.1±16.0岁)与无MR的患者组(B组:64.3±14.0岁)相比年龄差异不显著。结果:57%患者伴有MR,40%有左心室血栓,但并存者只占8%(P<0.0001)。与B组(26%)相比,A组充血     

老年高血压患者运动性高血压的临床分析

目的探讨老年高血压患者运动血压异常升高与颈动脉内膜和心脏改变的关系。方法应用血压监测仪监测运动平板时的运动血压及24小时动态血压,采用彩色超声诊断仪检查颈动脉内膜、舒张末期左心房内径(LAd)、左心室内径(LVIDd)、左室后壁厚度(LVPWT)、室间隔厚度(IVST)等指标,比较运动血压异常升高的老年高血压患者和运动血压正常的老年高血压患者的差别。结果运动血压异常升高组与运动血压正常组在平均血压控制方面无明显的差异,在颈动脉内膜厚度、左心房内径、及左心室重量均有显著差异,在左室后壁厚度、室间隔厚度、左心室内径无显著性差异。结论运动血压异常升高与血管内膜及心脏损害存在着密切的关系。在控制好高血压患者的静息血压的同时,还应关注高血压患者的运动血压异常反应情况。     

高血压患者内皮功能相关分子与颈动脉硬化的相关性

目的通过测定高血压患者血浆血栓调节蛋白、细胞间粘附分子1和P选择素浓度及颈动脉内膜中膜厚度,旨在探讨高血压患者内皮功能异常在动脉硬化发生中的作用。方法选择原发性高血压患者43例,正常血压者19例,采用酶联免疫吸附法测定血浆血栓调节蛋白、细胞间粘附分子1和P选择素浓度,采用彩色超声系统测定颈动脉内膜中膜厚度。高血压患者按照颈动脉内膜中膜厚度大小又分为颈动脉内膜中膜厚度<0.9 mm组(高血压无颈动脉硬化组)、颈动脉内膜中膜厚度≥0.9 mm组(高血压伴颈动脉硬化组)。结果高血压组颈动脉内膜中膜厚度、血浆血栓调节蛋白、细胞间粘附分子1和P选择素水平显著高于对照组(P<0.05);高血压伴颈动脉硬化组血浆血栓调节蛋白、细胞间粘附分子1和P选择素水平显著高于高血压无颈动脉硬化组(P<0.05);血浆血栓调节蛋白、细胞间粘附分子1和P选择素水平与颈动脉内膜中膜厚度呈正相关。结论高血压患者伴有内皮功能损害,且内皮功能损害与动脉硬化程度相关。     

伊贝沙坦对老年原发性高血压患者血压昼夜节律与左心室肥厚的影响

目的 :探讨伊贝沙坦对老年原发性高血压患者的血压昼夜节律及左心室肥厚 (LVH)的影响。　　方法 :选择 93例年龄≥ 60岁的老年原发性高血压患者 ,通过 2 4小时动态血压监测了解其血压昼夜节律变化 ,通过超声心动图观察左心室内径、室间隔和左心室后壁厚度 ,并测算左心室重量指数。选择血压昼夜节律消失的 5 4例患者随机分为伊贝沙坦治疗组 (伊贝沙坦组 ) 3 0例 ,吲达帕胺对照组 (吲达帕胺组 ) 2 4例。治疗 12周后两组患者再次接受动态血压监测和超声心动图检查 ,对比治疗前后血压昼夜节律及左心室参数的变化。　　结果 :93例老年原发性高血压患者中合并左心室肥厚者 5 3例 ,其中血压昼夜节律消失者为 42例 (79 2 % ) ;40例无LVH患者中昼夜节律消失者为 12例 (3 0 0 % ) ,合并LVH者中血压昼夜节律消失者显著多于无LVH者 (P <0 0 0 5 ) ,有极显著性差异 ;5 4例血压昼夜节律消失者治疗 12周后昼夜节律恢复者伊贝沙坦组 2 2例 (2 2 /3 0 ) ,吲达帕胺组 9例 (9/2 4) ,两组比较有极显著性差异 (P <0 0 1) ;伊贝沙坦组高血压合并LVH者治疗后室间隔、左心室后壁厚度无显著性改变 ,但左心室重量指数与治疗前及吲达帕胺组比较均有下降 (P均 <0 0 5 ) ,均有显著性差异。　　结论 :在血压昼夜节律消失的老年原发     

缺血性心肌病伴高血压患者心电图表现及临床意义

<正>缺血性心肌病(ICM)是指由于冠状动脉粥样硬化所致心肌长期供血不足引起的心肌弥漫性纤维化,以心力衰竭、血栓栓塞或猝死为临床特点。研究认为高血压左心室肥厚(HLVH)是心血管疾病及猝死发生的独立危险因子〔1〕。通过对ICM是否伴有高血压患者动态心电图(AECG)、动态血压监测(ABPM)、超生心动图检查差异进行分析,以利于预防或减少心脏不良事件的发生。     

经皮肾穿刺活检诊断淀粉样变性患者超声心动图特点及其预后分析

目的 通过分析经皮肾穿刺活检明确诊断为淀粉样变性肾病伴心脏受累患者的临床及超声心动图特点,为心肌淀粉样变性患者的早期诊断提供帮助。方法 共纳入经皮肾穿刺活检确诊的淀粉样变性肾病患者45例,收集患者行肾穿刺活检时的临床资料(年龄、性别、血压等)、超声心动图指标(室间隔厚度、左心室舒张期末内径、左心室射血分数等),对比心脏受累与未受累者指标差异及预后。结果 超声心动图指标分析显示,心脏受累组较未受累组室间隔厚度、左心室后壁厚度增加,差异具有统计学意义(P＜0.05)。心脏受累组中位生存期15月,较心脏未受累组明显下降,差异具有统计学意义(P＜0.05)。结论 经皮肾穿刺活检诊断淀粉样变性患者超声心动图提示室间隔厚度及左心室后壁厚度增加,且室间隔厚度≥10 mm,可作为判断是否合并心肌淀粉样变性的早期依据。     

不同类型心肌病伴慢性收缩性心力衰竭患者冠脉灌注压的临床分析

目的:探讨扩张型心肌病（DCM）和缺血性心肌病(ICM)的冠脉灌注压的特点及临床价值。方法: 应用连续多普勒超声心动图（CWDE）测量40例DCM伴轻度主动脉瓣反流患者和40例ICM伴轻度主动脉瓣反流患者冠状动脉灌注压。结果: 两组在心脏结构、心功能和冠状动脉灌注压等方面均无统计学差异。结论: 伴慢性收缩性心力衰竭的DCM和ICM患者冠状动脉灌注压无显著差异。     

Clinical assessment of left ventricular systolic function by force-length and stress-shortening relationships

Left ventricular (LV) systolic function was assessed in patients with hypertensive heart disease (HHD, n = 30), hypertrophic cardiomyopathy (HCM, n = 27), dilated cardiomyopathy (DCM, n = 25), volume overload heart (VOH, n = 31) and normal subjects (NS, n = 32) in the two-dimensional framework of force-length (end-systolic stress-end-systolic volume index) and stress-shortening (mid-systolic stress-ejection fraction). Quadratic discriminant analysis revealed that the ellipses of confidence of HHD and normal subjects were in the same place with regard to both force-length and stress-shortening, while all other groups were well-discriminated. Three subgroups of patients, those with DCM with mild heart failure and those with VOH (with and without heart failure), were easily distinguishable on the basis of stress-shortening, but not on the basis of force-length measurements. It is concluded that LV systolic function and afterload are maintained within the normal range under pressure and volume overload until symptoms of heart failure appear via the mechanism of compensatory hypertrophy. Stress-shortening appears to be a more useful parameter than force-length for the analysis of LV systolic function in clinical practice.     

Clinical outcome and reversibility of systolic dysfunction in patients with dilated cardiomyopathy due to hypertension and chronic heart failure

INTRODUCTION AND OBJECTIVES: There is little information on the clinical and functional course of patients with heart failure secondary to dilated cardiomyopathy due to hypertension. The objectives of our study were to assess the clinical and functional course of these patients, and to identify possible predictors of prognosis. PATIENTS AND METHOD: We evaluated a series of 49 patients with this condition diagnosed in our hospital from 1994 to 2003. Mean age was 63(11) years, and 40% were women. Left ventricular ejection fraction was 30.1(4.8)%. Follow-up was 45(23) months (median, 41 months). RESULTS: Four-year survival was 0.84, the 4-year rate of hospitalization due to heart failure was 0.12, and likelihood of readmission-free survival was 0.80 at 4 years. Left ventricular ejection fraction increased from 30.1(4.8)% to 57.6(13.5)% (P< .001). An unfavorable clinical and functional outcome at 4 years (death, readmission for heart failure or persistence of dilated cardiomyopathy) was recorded in only in 40% of the patients. Multivariate analysis with the Cox model showed appropriate control of blood pressure to be the only independent predictor of a favorable clinical outcome (absence of death or readmission for heart failure) (hazard ratio = 4.58; 95% CI, 1.32-9.83; P=.032). CONCLUSIONS: The course of patients with severe dilated cardiomyopathy due to hypertension was favorable in 60% of cases. Adequate control of blood pressure was the only independent predictor of a favorable clinical outcome.     

扩张型心肌病患者高血压患病率的初步调查

目的观察扩张型心肌病患者高血压患病率及其并发高血压的主要危险因素。方法随机选取扩张型心肌病患者362例及401例同年龄的普通居民(对照组),统计各组高血压患病率并作组间比较;根据患者有无合并高血压,将扩张型心肌病患者分成高血压亚组与非高血压亚组,比较两亚组患者与血压相关的临床资料有无差异。结果扩张型心肌病患者高血压患病率明显高于对照组(32.9%比21.7%,P<0.01);扩张型心肌病两亚组患者的年龄、性别、职业、左心室射血分数等因素差异无显著性(P>0.05),但高血压亚组患者的心率及高血压家族史百分率均明显高于非高血压亚组(P<0.05或P<0.01)。结论扩张型心肌病患者的高血压患病率高,交感神经系统兴奋性升高及高血压遗传因素可能是其并发高血压的主要危险因子。     

Preliminary Survey on the Prevalence Rate of Hypertension in Patients with Dilated Cardiomyopathy

Objectives To investigate the prevalence of hypertension and its primary risk factors in patients with dilated cardiomyopathy (DCM). Methods Three hundred and sixty-two patients with DCM(DCM group)and 401 age-matched residents (control group) were enrolled randomly in the study, the hypertensive prevalence rate were calculated respectively in the two groups and were compared with each other; the patients in the DCM group were divided into two subgroups (hypertension subgroup and non-hypertension subgroup) according to whether the patients have hypertension; the clinical data related to blood pressure was compared between the two subgroups. Results The prevalence of hypertension in DCM group was significantly higher than that in the control group (32.8% vs. 20.1%, P<0.01); There were no significant differences on the age, gender, occupation and left ventricular ejection fraction (LVEF) between the two subgroups, but the mean heart rate and the percentage of patients who had family history of hypertension were significantly higher in the hypertension subgroup than that in the non-hypertension subgroup (P<0.05 and P<0.01). Conclusions The prevalence of hypertension in patients with DCM was high; The increased activity of sympathetic nervous system and the hypertensive genetic factor may be the main risk factors of hypertension in patients with DCM.     

Mildly dilated congestive cardiomyopathy

Five patients with only mildly dilated ventricles but other features typical of congestive cardiomyopathy underwent cardiac transplantation for class IV NYHA heart failure. The findings of clinical studies, cardiac catheterization, endomyocardial biopsy, and pathologic examination of the removed hearts in this group with mildly dilated congestive cardiomyopathy (MDCM) were compared with similar data in four patients with idiopathic restrictive cardiomyopathy (IRCM) and in 10 patients with typical dilated congestive cardiomyopathy (DCM). In comparison with the other groups, patients with MDCM had a higher incidence of familial cardiomyopathy (p = .02) and a shorter symptomatic period than patients with IRCM (p less than .02). Patients with both MDCM and DCM had globular hearts (with predominant left ventricular dilatation), congestive hemodynamics and poor left ventricular contractility (ejection fraction 12% to 19%), and high incidence of ventricular thrombi. Patients with IRCM showed normal ventricular size, marked atrial dilatation, restrictive hemodynamics, mild-to-moderate decrease in left ventricular contractility (ejection fraction 29% to 55%), and absence of ventricular thrombi. Cardiac index, ventricular wall thickness, and light microscopic findings were similar in the three groups of patients. Electron microscopy showed no myofibrillar loss in patients with IRCM but mild (partial) or moderate-to-severe (almost total) myofibrillar loss in those with MDCM and DCM, respectively. We conclude that end-stage congestive cardiomyopathy may occur without significant ventricular dilatation and patients with MDCM have heart sizes intermediate between those found in IRCM and DCM but their clinical, hemodynamic, and pathologic findings are virtually identical to those of patients with typical DCM.     

Effect of pimobendan in patients with chronic heart failure

OBJECTIVE:

To assess the effects of a calcium sensitizer, pimobendan, in patients with mild to moderate chronic heart failure.

PATIENTS AND METHODS:

Pimobendan was administered at a dose of 2.5 mg/day for 12 months to 34 patients with chronic heart failure (New York Heart Association functional class IIm to III) after treatment with diuretics and angiotensin-converting enzyme inhibitors. The etiologies of heart failure were dilated cardiomyopathy (DCM), old myocardial infarction (OMI) and other heart disease (Others). The effects of pimobendan were assessed by echocardiography, blood pool scintigraphy, Holter monitoring, ¹²³I-meta-iodobenzylguanidine (MIBG) imaging and ¹²³I-β-methyl-p-iodophenyl-pentadecanoic acid (BMIPP) imaging.

RESULTS:

Pimobendan produced improvement of symptoms in the majority of patients. Improvement was more common in the DCM group than in the OMI group. Left ventricular internal diameter measured by echocardiography was significantly decreased. Left ventricular ejection fraction was significantly increased in the DCM and Others groups. The heart to mediastinum ratio on MIBG imaging was significantly increased in the DCM and Others groups, and the heart to mediastinum ratio on BMIPP imaging was significantly increased in the DCM group.

CONCLUSIONS:

Pimobendan is effective in patients with chronic heart failure but is less effective in patients with OMI than in patients with DCM or other heart diseases.     

Increased right ventricular wall thickness in left ventricular pressure overload: echocardiographic determination of hypertrophic response of the "nonstressed" ventricle

Left ventricular hypertrophy in left ventricular pressure overload occurs in response to excessive work load imposed on the left ventricle by increased impedance to ejection. Right ventricular hypertrophy may occur in patients with these findings, but has been considered to be secondary to pulmonary hypertension. To determine the frequency of right ventricular hypertrophy and its relation to increased left ventricular wall thickness in patients with left ventricular pressure overload, right ventricular wall thickness was measured using M-mode echocardiography with two-dimensional echocardiographic guidance in 65 patients with left ventricular pressure overload; 49 patients had essential hypertension and 16 had aortic valve stenosis. These measurements were compared with data from 13 patients with "thin-walled" dilated cardiomyopathy and 20 normal subjects. Average right ventricular wall thickness in hypertensive patients (7 +/- 2 mm) and patients with aortic stenosis (6 +/- 2 mm) was significantly greater than that in normal subjects (4 +/- 1 mm) and patients with dilated cardiomyopathy (4 +/- 1 mm) who had normal left ventricular wall thickness, even though left ventricular mass was increased in all patient groups. Increased right ventricular wall thickness was present in 40 (80%) of 49 patients with hypertension and 10 (63%) of 16 patients with aortic stenosis. The magnitude of increase in right ventricular wall thickness was linearly correlated (r = 0.76, p less than 0.005) with left ventricular wall thickness, but was not associated with pulmonary hypertension. It is concluded that increased right ventricular wall thickness is common in patients with left ventricular pressure overload, is directly related to increases in left ventricular wall thickness, and is independent of right ventricular hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)     

美托洛尔治疗扩张型心肌病及高血压对左心室重构的影响

目的观察扩张型心肌病患者对β受体阻断药的耐受性及治疗后左心室重构与高血压的关系。方法扩张型心肌病26例，高血压组12例，血压正常组14例。在常规治疗基础上开始口服美托洛尔6．25mg／d，逐渐加大剂量直至目标剂量250mg／d或最大耐受量，然后维持此剂量并随访1年。所有患者均于治疗前及治疗后1年采用超声心动图检测其左心室舒张末期内径（left ventricular end-diastolic dimension，LVEDd）、左心房舒张末期内径（left atrial end-diastolic dimension，LAEDd）及左心室射血分数（left ventricular ejection fraction，LVEF）。结果高血压组患者对美托洛尔的平均耐受量明显高于血压正常组患者（P〈0.05）；治疗前，两组患者LVEDd、LAEDd及LVEF组间差异无统计学意义（P〉0．05）；美托洛尔治疗1年后，两组患者LVEDd、LAED的及LVEF均有明显改善，但高血压组LVEDd明显小于血压正常组患者，而LVEF明显高于血压正常组（P〈0.05）。结论伴发高血压的扩张型心肌病患者对美托洛尔的耐受性较好，治疗后改善左心室重构更显著。     

Familial dilated cardiomyopathy in patients transplanted for idiopathic dilated cardiomyopathy

OBJECTIVE: To evaluate the prevalence, clinical features, and pattern of inheritance of familial dilated cardiomyopathy (DCM) in heart transplant patients. PATIENTS AND METHOD: Patients with idiopathic DCM who had undergone heart transplantation were invited to participate. Patients with alcohol abuse were excluded. A clinical evaluation, 12-lead ECG, echocardiogram, blood tests, and DNA extraction were performed in patients and relatives. Familial DCM was defined as the presence of at least one relative with idiopathic DCM. Possible familial DCM was considered when at least one relative had left ventricular enlargement (LVE) (> 112% predicted LVEDD). RESULTS: One hundred and ninety-nine relatives of 43 families were studied. DCM was familial in 11 probands (25.6%) and possibly familial in 11 (25.6%). Fifteen relatives had DCM (7.5%), 26 (13.1%) LVE, and 5 (2.5%) hypertrophic cardiomyopathy. The pattern of inheritance was autosomal dominant in most families. Five probands (3 with familial DCM) had antecedents of consanguinity and possible recessive inheritance. Six probands (14%, 1 with familial DCM) had relatives with conduction system defects. Creatine kinase was moderately increased in 9 relatives (4.5%), 3 of them with LVE. Fifteen patients had at least moderate alcohol intake. Three of them had familial DCM (relatives without alcohol abuse) and 6 had possible familial DCM. CONCLUSIONS: The prevalence of familial DCM is high in patients who undergo heart transplant. Left ventricular enlargement, conduction system abnormalities, and elevated creatine kinase may be early markers of familial disease. Hypertrophic cardiomyopathy is present in some relatives of patients with idiopathic DCM. Familial DCM is present in patients with a previous diagnosis of alcoholic DCM.