血清可溶性ST2在射血分数保留心力衰竭患者中的变化及意义研究

目的:探讨血清可溶性ST2(sST2)在射血分数保留心力衰竭(HFPEF)患者中的变化及意义。方法:选取本院2016年3月-2018年3月232例心力衰竭患者为研究对象,依据患者是否具有左心室射血分数保留能力分为HFPEF组128例,射血分数下降的心力衰竭(HFREF)组104例,并以同期正常健康体检患者100例作为对照组,对比各组患者sST2、NT-proBNP水平变化及sST2与患者发生心血管事件的关系。结果:HFPEF组患者血清sST2、NT-proBNP水平明显低于同期HFREF组患者(P0.05),高于同期正常组(P0.05);随HFPEF患者心功能级别增加其sST2、NT-proBNP水平增加(P0.05)。结论:HFPEF患者sST2、NT-proBNP水平明显低于HFREF患者但高于正常患者,sST2而且对心力衰竭的严重程度具有评估作用,但敏感度不如NT-proBNP。     

左室射血分数正常心力衰竭患者6 min步行试验的临床研究

目的 通过6 min步行试验评价左室射血分数正常的心力衰竭（HFNEF）患者心肺功能变化.方法 选取慢性心功能衰竭患者71例,按左室射血分数分为HFNEF组及射血分数降低的心力衰竭（HFREF）组,并另选32名健康体检者作为对照组,对所有入选者进行6 min步行试验并测定肺通气功能及心脏彩超.结果 3组间步行距离、左心室内径及短轴缩短率差异均无统计学意义（P＞0.05）;3组间6 min步行试验前后肺功能指标变化差异有统计学意义（P＜0.05）,HFNEF组与对照组和HFREF组比较差异有统计学意义（P＜0.05）,而HFREF组与对照组比较差异无统计学意义（P＞0.05）.结论 6 min步行试验可用于HFNEF的心力衰竭患者心功能的评估,并且相对安全;HFNEF患者较HFREF患者肺功能损害更明显.     

射血分数正常的心力衰竭131例临床特点

目的探讨射血分数正常心力衰竭（HFPEF）患者的临床特点。方法分析213例心衰患者根据左室射血分数（LVEF）分为HFPEF组（LVEF≥50%）131例和对照组（LVEF〈50%）82例,HFPEF组又分为左室正常亚组和左室扩大亚组,对各组临床资料进行对比分析。结果HFPEF组患者的年龄更大,女性、高血压、肥厚性心肌病（HCM）、E/A比值〈1.0的比率均高于对照组,而心肌梗死和扩张型心肌病比率低于对照组（P〈0.01或P〈0.05）;左室正常亚组的高血压、HCM、E/A比值〈1.0的比率和LVEF均高于左室扩大亚组（P〈0.01或P〈0.05）;各组冠心病、糖尿病及房颤比率差异均无统计学意义（P〉0.05）。结论HFPEF患者在心衰中的比率较高,年龄较大、女性和高血压是其危险因素,左室正常者主要为舒张功能异常,左室扩大者可能存在收缩功能异常。     

不同类型心力衰竭患者超声心动图参数、NT-proBNP及其临床意义

目的探讨不同类型心力衰竭患者超声心动图参数、血浆N-末端脑钠肽前体(NT-proBNP)水平及其临床意义。方法选取心力衰竭患者98例根据超声心动图参数左心室射血分数(LVEF)水平分为LVEF减低型心力衰竭(HFREF)组、LVEF保留型心力衰竭(HFPEF)组和LVEF中间型心力衰竭(HFMEF)组。比较3组一般资料、血浆NT-proBNP水平和超声心动图参数左心室舒张期末内径(LVEDD)、左心房前后径(LAD)和LVEF,分析NT-proBNP水平与LVEDD、LAD、LVEF和心功能分级的相关性。结果HFREF组收缩压低于HFPEF组和HFMEF组,HFPEF组、HFMEF组和HFREF组血浆NT-proBNP和LVEDD依次增高,LVEF依次降低(P＜0.05);HFMEF组和HFREF组LAD高于HFPEF组(P＜0.05);3组心功能分级差异有显著性(P＜0.05)。各组NT-proBNP水平均与LVEDD、LAD和心功能分级呈正相关,与LVEF呈负相关(P＜0.05)。结论HFREF患者超声心动图参数与心功能分级明显相关,NT-proBNP水平比HFPEF和HFMEF患者明显更高,其对于早期判断患者心力衰竭类型和心功能具有一定指导价值。     

不同类型心力衰竭患者肺部超声参数变化及与LVEF、NT-proBNP的相关性分析

目的探讨不同类型心力衰竭(HF)患者肺部超声参数变化,并分析左室射血分数(LVEF)、血浆氨基末端B型利钠肽前体(NT-proBNP)与其相关性。方法采用病例对照组研究方式,按照LVEF分为射血分数下降型心衰(HFREF组,44例)和射血分数保留型心衰(HFPEF组,45例),患者均进行床旁肺部超声检查,比较两组肺超声指标变化,分析肺超声指标B线(彗星尾征)与患者LVEF及NT-proBNP指标的相关性。结果HFREF组的B线条数为(31.6±12.5)条,高于HFPEF组的(26.4±11.7)条,LVEF则低于HFPEF组,差异均具有统计学意义(P<0.05);HFREF组的NT-proBNP为(5.64±1.63)pg/mL,高于HFPEF组的(2.33±1.27)pg/mL,差异具有统计学意义(P<0.05);B线条数与患者的LVEF、NT-proBNP水平均呈正相关,差异均具有统计学意义(P<0.05)。结论不同类型心衰患者的肺超声影像图中B线数多于HFPEF患者,且与机体的LVEF、NT-proBNP水平有良好的相关性。     

射血分数保留的心力衰竭患者临床特点及治疗方法探讨

目的探讨射血分数正常的心力衰竭（HFNEF）患者的临床特点及治疗。方法采取抽样的方法选择我院心内科2005～2010年1240例心力衰竭患者，筛选出572例分为LVEF≥50％组及LVEF〈50％组。结果LVEF≥50％与LVEF〈50％的患者相比，HFPEF患者年龄更大，女性及高血压更多；陈旧性心梗、扩张性心肌病、房颤及急性心力衰竭比例均低于对照组，有统计学差异。结论HFPEF存在收缩功能减低，不完全等同于舒张功能下降的心力衰竭（DHF）。早期干预对延缓及阻止HFPEF的发生进展至关重要。     

射血分数降低的心衰与射血分数保留的心衰临床特征分析

目的分析射血分数降低的心衰(HFREF)与射血分数保留的心衰(HFPEF)临床特征。方法对60例心衰患者的临床资料进行回顾性分析,按照LVEF的不同,将全部患者分成射血分数降低的心衰(LVEF50%)和射血分数保留的心衰(LVEF≥50%);分析观察两组患者的临床特征。结果 60例患者中,HFREF患者共36例,HFPEF患者共24例。在年龄、性别方面,两组患者比较差异有统计学意义(P0.05);另外两组患者的EF值、LVD值、合并心律失常、合并心肌病以及NTpro BNP水平比较差异有统计学意义(P0.05)。结论射血分数保留的心衰的年龄更高;患者的性别不同,NHYA分级和分布也存在差异;射血分数降低的心衰患者LVD值、NTpro BNP水平更高;合并症对射血分数降低的心衰患者的总体影响更严重。     

射血分数保留和降低急性心衰患者应用无创呼吸机的效果分析

目的：探讨无创呼吸机 (Non-invasive ventilator, NIV) 在射血分数保留 (Heart failure with preserved ejection fraction, HFPEF) 和射血分数降低 (Heart failure with reduced ejection fraction, HFREF) 急性心衰 (Acute heart failure,AHF) 患者的应用效果。方法：选取2018年10月—2019年10月在汝州市第一人民医院住院期间应用NIV治疗的80例急性失代偿期心力衰竭患者作为研究对象,根据左室射血分数 (Left ventricular ejection fraction, LVEF) 分为 HFPEF 组和HFREF组。记录两组患者一般资料,分析两组患者血清中氨基末端B型利钠钛前体 (NT-proBNP)、高敏C反应蛋白 (hsCRP)、红细胞 (RBC)、血红蛋白 (Hb)、血尿素氮 (BUN)、肌酐 (Cr)、乳酸 (Lac)、pH值氧饱合度 (SaO₂)、二氧化碳分压 (PaCo₂     

卡维地络与多巴胺联合治疗舒张性心力衰竭临床观察

在有明显心力衰竭症状的患者中,接近一半的患者左室射血分数在正常范围。其基本病理生理改变是左室舒张功能异常,常称之为舒张性心衰。舒张性心力衰竭（DHF）是一组以具有心力衰竭的一般临床症状和体征,且E峰降低、A峰增高、E/A比率减小、左室射血分数（LVEF）正常而舒张功能异常为特征的临床综合征。因此,治疗上多以减慢心率、延长舒张时间来改善舒张功能。笔者近年来采用卡维地洛与多巴胺联合治疗舒张性心力衰竭,取得显著疗效,现分析报道如下。     

血浆NT-ProBNP对慢性心力衰竭的心功能及预后关系的临床观察

目的 探讨N-端脑钠肽前体（NT-ProBNP）与心力衰竭患者的心功能NYHA分级及左室射血分数（LVEF）的关系,研究NT-ProBNP对心力衰竭的早期诊断及治疗预后的临床价值.方法 选取97例心力衰竭的患者,心功能情况按照纽约心脏病协会（NYHA）标准分级.采取电化学发光法测定NT-ProBNP的含量.心脏彩色超声多普勒测定左室结构和左室射血分数（LVEF）,研究NT-ProBNP的变化与心功能（NYHA）分级及左室射血分数、治疗预后的关系.结果 NT-ProBNP水平与左室射血分数、6min步行试验的数值之间呈负向关,随着NYHA心功能分级的增加,NT-ProBNP的含量升高,各组间比较有着显著差异（P＜0.05）,动态监测NT-ProBNP发现,治疗“有效”组心衰的患者NT-ProBNP水平与治疗前比较明显下降,而治疗“死亡”组的心衰患者在治疗后NT-ProBNP水平与治疗前比较基线下降少,甚至升高.结论 NT-ProBNP能够反映心力衰竭的心功能状态,对心力衰竭的早期诊断、治疗检测及临床预后的评估有重要价值.     

Prevalence of heart failure and systolic ventricular dysfunction in older Australians: the Canberra Heart Study

OBJECTIVE: To estimate the prevalence of heart failure (HF) and left ventricular (LV) systolic dysfunction in a population-based sample of older Australians. DESIGN, SETTING AND PARTICIPANTS: A cross-sectional survey of 2000 randomly selected residents of Canberra, aged 60-86 years, conducted between February 2002 and June 2003. Participants were assessed by history, physical examination by a cardiologist, and echocardiography. MAIN OUTCOME MEASURES: Age- and sex-specific prevalence rates of clinical HF and LV systolic dysfunction (defined as LV ejection fraction < or = 50%). RESULTS: Of 1846 people eligible for our study, 1388 (75%) agreed to participate and 1275 completed all investigations (mean age, 69.4 years; 50% men). In the study sample, 72 subjects (5.6%; 95% CI, 4.4%-7.1%) had clinical HF that had been previously diagnosed and was confirmed by our assessment. A further 0.6% (95% CI, 0.3%-1.2%) had undiagnosed clinical HF (ie, evidence of structural heart disease and symptoms/signs of cardiac insufficiency without a previous diagnosis of clinical HF). Thus, the overall prevalence of clinical HF in the sample was 6.3% (95% CI, 5.0%-7.7%). Clinical HF increased in prevalence with advancing age (a 4.4-fold increase from the 60-64-years age group to the 80-86-years age group; P < 0.0001). Of the 75 subjects (5.9%; 95% CI, 4.7%-7.3%) with LV systolic dysfunction, 44 (59%) were in the preclinical stage of disease. CONCLUSION: Diagnosed HF cases represent the "tip of the iceberg" for the national burden of HF and LV systolic dysfunction. Clinically identifiable HF cases can remain undiagnosed, and the majority of people with LV systolic dysfunction are in a preclinical stage of the disease.     

扩张型心肌病左心功能改变的特征

采用心机械图法，测定２０２名正常人和５８例扩张型心肌病２项收缩性指标和５项舒张性指标。结果证明ＤＣＭ的心力衰竭属收缩和舒张混合型，在ＤＣＭ早期射血分数就已明显减低，其降幅与临床心功能不全的程度相一致，反映左室舒张性的多项指标与心衰症状的出现相关联，ＤＣＭ的晚期病例提示有心室“过度”顺应现象。     

Preliminary Clinical Study of Real-time Three-dimensional Echocardiographic Volume-time Curve in Evaluating Left Ventricular Diastolic Function

The volume-time curve change in patients with normal left ventricular （LV） diastolic function and diastolic dysfunction was evaluated by real-time three-dimensional echocardiography （RT3DE）. LV diastolic dysfunction was defined by E＇〈A＇ in pulse-wave tissue Doppler for inter-ventricular septal （IVS） of mitral annulus. In 24 patients with LV diastolic dysfunction, including 12 patients with delayed relaxation （delayed relaxation group） and 12 patients with pseudo-normal function （pseudo-normal group） and 24 normal volunteers （control group）, data of full-volume image were acquired by real-time three-dimensional echocardiography and subjected to volume-time curve analysis. EDV （end-diastolic volume）, ESV （end-systolic volume）, LVEF （left ventricular ejection fraction）, PER （peak ejection rate）, PFR （peak filling rate） from RT3DE were examined in the three groups. Compared to the control group, PFR （diastolic filling index of RT3DE） was significantly reduced in the delayed relaxation group and pseudo-normal group （P〈0.05）. There were no significant differences in EDV, ESV, LVEE PER （P〉0.05）. It is concluded that PFR, as a diastolic filling index of RT3DE, can reflect the early diastolic function and serve as a new non-invasive, quick and accurate tool for clinical assessment of LV diastolic function.     

M-mode echocardiographic findings in a contemporary Afro-Caribbean population referred for evaluation of congestive cardiac failure

Congestive cardiac failure is emerging as a significant public health problem around the world, including the Caribbean. Recent reports from developed countries suggest that 30 to 40% of patients with congestive cardiac failure have normal systolic function. This percentage may be even higher in non-Caucasian, non-male populations. This study was undertaken to determine the M-mode echocardiographic findings in a current, consecutive series of Afro-Caribbean patients referred for congestive cardiac failure. There were 165 patients, 51% male, mean and standard deviation (SD) age of 63 +/- 15 years, referred between May 1998 and June 2000. Echocardiographic findings included left atrial size (LA), left ventricular (LV) end systolic (ESD) and end diastolic dimension (EDD), LV posterior wall thickness (PWT) and ventricular septal thickness (VST). LV ejection fraction (EF) was derived. LA > 4 cm, PWT or VST > 13 mm and LVEF < 50% were considered abnormal. Increased LV wall thickness (LV hypertrophy) only was the most frequent finding, 68/165 (41%), consistent with possible diastolic dysfunction. If a less restrictive definition for abnormal LV wall thickness, 12 mm, is used, this finding increases to 79/165 (48%). Decreased LVEF (LV systolic dysfunction) was seen in 57/165, (35%) and was seen in significantly more men (42% versus 29%, p < 0.01). Valvular disease was seen in 13/165, 8%. Normal findings on echocardiography were found in 27/165 (16%), more commonly in women (19 versus 8, p < 0.05) and younger patients (54 years versus 65 years, p < 0.05) and in only 10% if 12 mm is used for LV wall limit. LV hypertrophy was seen in 42% of patients (61% if 12 mm is used for LV wall limit) with systolic dysfunction. Thus, congestive cardiac failure with LV hypertrophy is the most frequent finding in this Afro-Caribbean population, with LV systolic dysfunction in only 35% of patients. These findings are consistent with possible diastolic LV dysfunction due to hypertension as the primary cause of cardiac failure in the population.     

When left ventricular failure complicates chronic obstructive pulmonary disease: Hypoxia plays the major role

Introduction: As the chronic obstructive pulmonary disease (COPD) progress, is usually accompanied by involvement of the both left ventricle (LV) and right ventricle (RV), and their systolic and diastolic function. Signs and symptoms of LV failure can be difficult to distinguish from those of COPD. Objective: The study was carried out to determine the prevalence of LV systolic dysfunction in the COPD patients and to assess the possible risk factor behind such development. Material and Methods: It is a prospective study of 60 cases of COPD patients with or without cor-pulmonale attending Manipal Teaching Hospital. Results: The prevalence of LV systolic dysfunction was found to be 26.7%, and the findings directly correlate with the severity of COPD i.e., the more the severity of the lung disease more the probability for the incidence of LV systolic dysfunction. These data are in support of the hypothesis that hypoxia and the excess accumulation of toxic metabolic products like lactic acid, significant right-to-left shunting through the bronchial circulation explains the diminished LV ejection fraction in severe COPD patients. Conclusion: Routine echocardiography investigation of the severe COPD patients is required for assessing the status of LV function and to rule out the possible association of LV systolic dysfunction. Key words: Chronic obstructive pulmonary disease, Cor-pulmonale, Hypoxia, LV systolic dysfunction.     

达利全对充血性心力衰竭患者左室舒张功能的影响

目的:通过超声心动指标的监测,客观评价达利全对左室舒张功能的影响。方法:入选68例患者:缺血性心脏病38例,高血压性心脏病20例,扩张型心肌病10例,符合美国纽约心脏病学会(NYHA)心功能分级:Ⅲ级42例,Ⅳ级(无明显钠、水潴留)26例,所有患者入院后都接受心衰常规治疗(休息、限盐、应用血管紧张素转换酶抑制剂、利尿剂、强心甙、硝酸酯类等),达利全组(n=30),加用达利全,初始剂量为3.125mg/d,2次/d,2周后增至6.25mg,2次/d,以后根据耐受情况逐渐上调,每2周倍增,逐渐增加至患者最大耐受量。详细观察并记录二组患者血压、心率、心律,心衰症状及体征的变化,评价心功能的变化。分别于治疗前和治疗4个月、1年后作超声心动图检查测定EDV、ESV、A波、E波、E/A、Mass、DT,IVRT、PAPs、EF,评价心脏舒张功能。结果:①心率、血压的变化:达利全组治疗后心率比治疗前明显减慢(P<0.05),而且也较对照组控制好(P<0.05);达利全组治疗后血压虽有下降趋势,但差异无统计学意义。②超声心动图的变化:达利全组治疗4个月后A、E/A、DT、IVRT、PAPs较常规治疗组差异有统计学意义(P<0.05),达利全组治疗1年后ESV、EF、E、A、E/A、DT、IVRT、PAPs较常规治疗组差异有统计学意义(P<0.05)。③心功能的变化:两组治疗前后的心功能:H=30.6029,P<0.001。治疗前两组之间d=3.1429,P>0.05;达利全组和对照组治疗前后比较,P<0.05。结论:心衰患者包括中、重度心衰(无明显钠、水潴留)患者短期及长期应用达利全均可改善左室舒张功能,应用时间越长,获益越多。     

长轴和整体应变评估左室舒张功能不全模型

目的 探讨超声二维长轴应变和整体应变评估左室舒张功能不全的实验研究.方法 采用心导管、超声诊断仪测量实验模型的左室压力、压力最大变化速率、室壁厚度、左室射血分数等指标,运用斑点追踪测量起搏过程中长轴峰值应变、整体应变指标.方法 实验犬安置起搏器后的左室舒张末压较起搏前有逐渐增长的趋势.随着起搏时间的延长,左室腔内压力最大上升和下降速率均呈下降趋势,实验犬心肌各段的二维长轴应变和整体应变呈逐渐减低的趋势,部分终末时间段的测量值显著低于基础状态（P＜0.05）.其中二维长轴应变和整体应变与左室舒张末压和左室腔内压力最大下降速率呈正相关.结论 斑点追踪技术测量的二维长轴应变和整体应变与左室舒张功能下降呈正相关,对于早期评价左室舒张功能降低具有研究价值.     

Optimization of atrioventricular delay by surface electrocardiography during dual chamber pacing

During dual chamber pacing, both atrial and ventricular leads are routinely positioned at the right appendage and right ventricular apex. Alterations in cardiac electromechanical direction and sequence may have an impact on left atrial and ventricular contraction and filling, leading to reduction in left ventricular (LV) pumping function due to abnormal atrioventricular (AV) delay.1 To achieve adequate cardiac output and haemody- namic advantages of the heart in dual chamber pacing,2 optimal …     

2型糖尿病患者左室整体舒缩功能与HbA1c的相关性研究

【目的】应用实时三平面定量组织速度成像技术（Triplane‐QTVI）评价2型糖尿病（T2DM）患者左室功能,并探讨T2DM患者左室功能与糖化血红蛋白（HbA1c）的相关性。【方法】选取单纯T2DM患者50例（T2DM组）和正常体检者50例（对照组）,采用常规超声心动图、Triplane‐QTVI技术检测左室纵轴收缩、舒张功能;检测T2DM患者的HbA1c ,并探讨超声心动图参数与 HbA1c的相关性。【结果】两组左室射血分数（EF％）、左室短轴缩短率（FS％）、二尖瓣环收缩期均值速度（Sm ）及二尖瓣口舒张早期最大血流速率（E ）比较无统计学意义（ P ＞0．05）;T2DM组左房收缩期最大血流速率（A）、二尖瓣环舒张晚期均值速度（Am）、E／二尖瓣环舒张早期均值速度（Em）高于对照组,E／A、Em、Em／Am明显低于对照组（ P ＜0．01）。HbA1c与E／A呈线形负相关（ P ＜0．05）,与E／Em呈线形正相关（ P＜0．05）,与EF、FS、E、A、Sm、Am不相关性。【结论】Triplane‐QTVI能够准确评价T2DM患者左室纵轴收缩、舒张功能,T2DM患者左室舒张功能障碍早于收缩功能,HbA1c与左室舒张功能障碍相关。