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。     

柳州市10408成人中高血压患病率调查

目的　了解柳州市成人中高血压患病情况 ,为人群干预作基线调查。方法　整群抽样市区常居人口 10 40 8人 ,平均年龄 3 7 4± 10 7岁。调查一般人口学指标 ,测定血压 ,体重指数 ,腰围及血液有关生化参数。结果　本组人群高血压标化患病率为 16.97% ,男 19 56% ,女 14 2 3 % ;一级高血压占 72 0 5% ,二级占 2 2 40 % ,三级占 5 55% ;高血压组中空腹血糖受损、糖尿病及血脂异常的检出率显著高于血压正常组 (P <0 0 0 1) ;超重组、肥胖组高血压患病率均显著高于BMI正常组 ,其OR值分别为 3 93、10 85;腰围增大组高血压患病率显著高于腰围正常组 ,OR值为 5 2 9。结论　柳州市成人高血压患病率已达到较高水平 ,高血压病人常伴有糖代谢及脂代谢异常 ,年龄、超重或肥胖是影响高血压患病率的重要因素。应采取干预措施以降低其危险因素和心血管病的发生率     

Heart Rate Turbulence as a Predictor of Cardiac Mortality and Arrhythmic Events in Patients with Dilated Cardiomyopathy: A Prospective Study

Background: Few studies have described the clinical usefulness of heart rate turbulence (HRT), an autonomic predictor of mortality, in stratifying patients with dilated cardiomyopathy (DCM) at risk of cardiac mortality and arrhythmic events. We prospectively assessed the utility of HRT for risk stratification in patients with ischemic or nonischemic DCM.
Methods: We enrolled 375 consecutive patients with DCM including ischemic (n = 241) and nonischemic causes (n = 134). HRT was measured using an algorithm based on routine 24-hour Holter electrocardiograms, assessing 2 parameters: turbulence onset (TO) and turbulence slope (TS). HRT was considered positive when both TO was ≥0% and TS was ≤ 2.5 ms/R-R interval. The primary endpoint was defined as cardiac mortality and the secondary endpoint as occurrence of hemodynamically stable sustained ventricular tachyarrhythmias.
Results: Of patients enrolled, 83 patients (22.1%) were not utilized for HRT assessment because there were too few ventricular premature beats, or for other reasons. Eighty-one of 292 patients (27.7%) were HRT-positive. During follow-up of 445 ± 216 days, 30 patients (10.3%) reached the primary endpoint and 17 patients, the secondary endpoint. The hazard ratio (HR) of patients with an HRT-positive outcome was 6.4 (95%CI, 3.0–14.1; P < 0.0001) for the primary endpoint and 5.1 (95%CI, 2.8–9.3; P < 0.0001) for combined endpoints. On subanalysis, HRT positivity was significantly associated in both the ischemic and nonischemic DCM patients with both the primary endpoint (HR = 4.9, P = 0.0006 and HR = 12.3, P = 0.002, respectively) and with combined endpoints.
Conclusions: HRT is a powerful risk stratification marker for cardiac mortality and arrhythmic events in patients with DCM whether ischemia is present or not.     

Influence of Orthotopic Heart Transplantation on Breathing Pattern Disorders in Patients with Dilated Cardiomyopathy

Cheyne-Stokes respiration is well-known in patients with congestive heart failure. One of the causes might be a prolonged circulation time or diminished pulmonary gas stores. Improvement of cardiac function by heart transplantation might abolish Cheyne-Stokes respiration. We examined 29 male patients (age 24 to 63 years) with polysomnographically verified Cheyne-Stokes respiration before and 3 to 9 weeks after orthotopic heart transplantation. All patients suffered from congestive heart disease. Left ventricular ejection fraction (LVEF) was between 8 and 19% We analyzed sleep stages, respiratory events, oxygen saturation, and cardiac function (echocardiography and ergometry). Before heart transplantation all patients showed periodic breathing (apnea-hypopnea index [AHI] 13.2–51.6/h). Oxygen saturation dropped to a minimum of 63% Sleep was severely disturbed. After heart transplantation LVEF was significantly higher in all patients (x_mean = 64%). Twenty-three of 29 patients showed no more evidence of periodic breathing. However, even with normalized cardiac function, 6 patients still suffered from Cheyne-Stokes respiration. Cheyne-Stokes respiration is often associated with dilated cardiomyopathy. Our results demonstrate that normalization of cardiac function improves Cheyne-Stokes respiration. Even after normalization of cardiac function, some patients suffer from Cheyne-Stokes respiration further on. We suggest that breathing control centers may be permanently damaged in these patients.     

扩张性心肌病并心力衰竭患者双室同步起搏治疗对心率变异性的影响

观察双室同步起搏对扩张性心肌病并心力衰竭 (简称心衰 )患者心功能及心率变异性 (HRV)的影响。选择1 5例扩张性心肌病并顽固心衰患者 ,置入双室起搏器 ,观察心功能、HRV及血浆丙二醛、一氧化氮、内皮素 1、血管紧张素 Ⅱ的变化。结果 :心功能NYHA分级从术前 3.32± 0 .31级提高为 2 .1 8± 0 .33级 ,左室射血分数由 0 .2 9± 0 .0 3增至 0 .36± 0 .0 3(P <0 .0 5 ) ;2 4h正常RR间期均值标准差、相邻RR间期差值均方根、相邻RR间期差值 >5 0ms占正常RR间期数的百分比、总功率、低频及高频波段功率分别由 73± 8.1ms、4 1± 8.0ms2 、5 .3%± 1 .5 %、1 0 2 4± 4 1 3ms2 、1 1 5± 35ms2 及 4 8± 1 5ms2 增至 1 0 7± 1 3ms、70± 1 1ms2 、1 1 .3%± 3.4 %、1 92 1± 4 84ms2 、1 94± 35ms2 及 91± 2 9ms2 (P均 <0 .0 1 ) ;血浆丙二醛、内皮素 1分别由 4 31± 37nmol/L、83.1± 2 1ng/L降至 32 3± 2 9nmol/L、6 7.3± 1 6ng/L ,一氧化氮由 38.1± 7.6 μmol/L增至 5 1 .3± 9.2 μmol/L(P均 <0 .0 1 ) ,血管紧张素 Ⅱ无变化 (P >0 .0 5 )。结论 :同步起搏改善扩张性心肌病心衰患者心功能及HRV。     

Prediction of the Effect of Bisoprolol in Dilated Cardiomyopathy

Survival improvement by beta-blocker treatment in patients with chronic heart failure appears to be related to the intermediate-term changes in left ventricular function. The therapeutic potential of beta blockade might be increased by early identification of patients in whom left ventricular function would deteriorate. We aimed at predicting the intermediate-term effect of bisoprolol on left ventricular systolic and diastolic function in patients with dilated cardiomyopathy. Twenty-five patients with symptomatic chronic heart failure treated with bisoprolol were investigated. As a background, tailored therapy with digitalis, diuretics and vasodilators was given. Prediction of the 6-month (intermediate-term) effect of bisoprolol was investigated, using baseline values and short-term (1-month) changes of simple, noninvasive parameters obtained at rest and during maximal exercise. Multivariate analysis resulted in reliable predictions, there was close correlation between the observed and predicted changes of left atrial filling pressure (R = 0.87) and left ventricular ejection fraction (R = 0.74). The baseline value of left ventricular ejection fraction, short-term changes of the pulse amplitude and the double product proved independent predictors of intermediate-term changes of left ventricular ejection fraction. The baseline value of mean pulmonary capillary wedge pressure, heart rate, and increase in heart rate during maximal exercise were predictors of the intermediate-term changes in mean pulmonary capillary wedge pressure. In dilated cardiomyopathy, the intermediate-term effects of bisoprolol on left ventricular ejection fraction and mean pulmonary capillary wedge pressure can be predicted reliably by simple noninvasive variables in the early treatment phase.     

参麦注射液治疗扩张型心肌病心力衰竭疗效观察

目的观察参麦注射液治疗扩张型心肌病心力衰竭的疗效。方法选择扩张型心肌病心力衰竭患者80例,分为对照组和治疗组。对照组给予常规药物治疗,治疗组在常规药物治疗基础上加用参麦注射液。结果两组治疗后较治疗前临床症状以及心脏彩超各参数(射血分数、左室内径)以及6min步行试验均有改善。治疗后两组相比差别有统计学意义(P<0.05)。结论参麦注射液可有效治疗扩张型心肌病心力衰竭,安全性较高,无明显不良反应。     

Quality of life on treatment with Metoprolol in Dilated Cardiomyopathy: Results from the MDC trial

Summary Quality of life in heart failure patients is receiving increased attention as a reflection of a treatment's potential secondary benefit of general well-being and daily functioning. The Metoprolol in Dilated Cardiomyopathy (MDC) trial was conducted as a large, multicenter trial to establish the effects of metoprolol on mortality and need for heart transplantation in patients with symptomatic idiopathic cardiomyopathy. It was found that metoprolol was well tolerated, improved symptoms and cardiac function, and prevented clinical deterioration in patients with symptomatic idiopathic dilated cardiomyopathy. Quality of life was evaluated as a secondary endpoint in 345 out of 383 randomized patients using a disease-specific questionnaire, the Quality of Life in Heart Failure Questionnaire, depicting physical activity, somatic symptoms, emotions, and life satisfaction. In a comparison of patients treated with metoprolol or placebo, patients treated with metoprolol noted a significantly more favorable response than those treated with placebo in terms of the overall treatment evaluation (p<0.05). Additionally, an analysis of the changes from baseline to 18 months, using 95% confidence intervals, revealed that patients treated with metoprolol showed a significant improvement from baseline to 18 months in life satisfaction, physical activity, and the total score, while patients treated with placebo did not change at all. The improvement in quality of life was supported by the correlations with improvement in traditional clinical parameters.     

自体骨髓移植治疗扩张型心肌病并心力衰竭的初步效果(附5例报告)

目的 观察自体骨髓移植(ABMT)治疗扩张型心肌病并心力衰竭的初步效果。方法 1)临床资料:收集自2002年1月以来的5例扩张型心肌病患者,年龄20～63岁,男性2例,女性3例,其中,心肌炎性心肌病1例,围生期心肌病1例,缺血性心肌病1例,酒精性心肌病1例。不明原因心肌病1例。伴糖尿病或糖耐量异常(IGT)2例,高血压2例,心房纤颤2例,室性心律失常1例,完全性左束支传导阻滞1例,安置人工心脏起搏器(双室起搏)1例:心功能Ⅱ～Ⅲ级(按NYHA分级标准)。2)自体骨髓移植(ABMT):于髂后上棘采集自体骨髓,左侧2例,右侧3例;经肘静脉输注自体骨髓细胞。3)应用彩色多普勒超声心动图检测患者左房内径(LAD),左室舒张末径(LVEDD),左室收缩末径(LVESD),左室射血分数(LVEF)和左室舒张功能(E/A值)。结果 1)全部病例采髓及移植均成功,移植骨髓细胞(单核细胞)数目8.03×10~8～1.70×10~9;无移植物抗宿主病(GVHD),无感染等并发症。2)ABMT术后一个月,患者心功能恢复至Ⅰ～Ⅱ级。超声检测表明,LVEF从17％～37％增加至24％～56％,LAD,LVESD均有不同程度缩小;然而,LVEDD,E/A没有显著变化:3)随访3个月～6个月,除1例因恶性室性心律失常死亡外,余均存活。结论:ABMT治疗扩张型心肌病并心力衰竭是一种安全、有效的细胞治疗,它能通过加强心肌收缩力改善患     

Electrophysiological Effects of Carvedilol Administration in Patients with Dilated Cardiomyopathy

PURPOSE: Several studies suggest the clinical efficacy of carvedilol in reducing atrial and ventricular arrhythmias in patients with left ventricular dysfunction (LVD) due to congestive heart failure (CHF) or following myocardial infarction. However, the mechanisms supporting its antiarrhythmic efficacy have been derived from experimental studies. In this prospective, placebo-controlled trial we examined the electrophysiological effects of a high oral dose of carvedilol in patients with CHF and LVD due to non-ischemic dilated cardiomyopathy. METHODS: Thirty-one patients with stable CHF underwent electrophysiological study and were randomly assigned to treatment with carvedilol or placebo. After 2 months of treatment the study was repeated. RESULTS: Carvedilol prolonged almost all conduction times. In the same group atrial and ventricular effective refractory periods were significantly prolonged, while the parameters of repolarization remained virtually unchanged. The prolongation of refractoriness was most pronounced in the atrium. The change in ventricular refractoriness was correlated with ejection fraction (r = 0.94, p < 0.01) suggesting that patients with more preserved left ventricular function responded to treatment with greater prolongation. CONCLUSION: Even after a short period of administration carvedilol has marked and diffused electrophysiological effects that would be beneficial for patients with CHF and may contribute to the positive outcome of clinical trials.     

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扩张型心肌病是一组心肌的异质性疾病,其特点是在没有异常负荷状态或没有导致心肌收缩力下降的缺血因素存在的前提下,表现为心室扩大和心肌收缩力下降。扩张型心肌病病因复杂多样,临床表现近似,诊断和鉴别诊断困难,治疗效果差异较大,预后有别。     

心脏再同步治疗晚期扩张型心肌病的临床研究

目的 探讨心脏再同步治疗（CRT）治疗扩张型心肌病（DCM）晚期慢性心力衰竭（HF）的疗效。方法DCM晚期发生慢性HF患者植入CRT。术后观察左室射血分数（LVEF）、左室舒张末内径（LVEDD）、心电图、NT—ProBNP,评估NYHA心功能分级,6min步行试验。结果所有患者均成功地植入右房-双心室三腔起搏器,并且无术后并发症。术后随访6～12个月心功能分级、LVEF、LVEDD、房室瓣反流速、NT—ProBNP水平、QRS波宽度较术前均明显改善,差异有统计学意义（P〈0．05）。结论CRT可以改善心功能,逆转左室重构,改善生活质量。     

Regional Heterogeneity of Systolic Dysfunction Is Associated with Ventricular Dyssynchrony in Patients with Idiopathic Dilated Cardiomyopathy and Narrow QRS Complex

Background: Regional heterogeneity of left ventricular (LV) contraction, known as dyssynergy, in idiopathic dilated cardiomyopathy (IDC) patients has been previously reported, but no comprehensive analysis of this abnormality has been made. The purpose of this study was to test the hypothesis that regional heterogeneity of systolic dysfunction is associated with LV dyssynchrony in IDC patients with a narrow QRS complex using novel three‐dimensional (3D) speckle‐tracking strain. Methods: We studied 54 consecutive IDC patients with ejection fraction (EF) of 34 ± 12% and QRS duration of 102 ± 13 msec (all <120 msec), and 30 age‐matched normal controls. The 3D speckle‐tracking LV dyssynchrony (LV dyssynchrony index) was quantified from all 16 LV sites to determine the standard deviation (SD) of time‐to‐peak strain. Similarly, regional heterogeneity of LV systolic function (LV dyssynergy index) was quantified from all 16 LV sites to establish the SD of peak 3D speckle‐tracking strain. Results: The LV dyssynergy and dyssynchrony indices of IDC patients were significantly larger than those of normal controls. Furthermore, IDC patients showed significantly higher Z‐scores for septum and inferior regions than for the free wall (3.34 ± 1.21 vs. 1.69 ± 1.06 and 2.79 ± 1.30 vs. 1.69 ± 1.06, respectively, P < 0.001). An important findings of multivariable analysis was that the LV dyssynergy index (β = 0.69, P < 0.001) and LVEF (β = ?0.34, P = 0.001) were independent determinants of the LV dyssynchrony index. Conclusion: 3D speckle‐tracking strain revealed that the myocardial systolic dysfunction of IDC patients with a narrow QRS complex has a marked heterogeneous regional distribution. This regional heterogeneity as well as systolic dysfunction is thought to lead to LV dyssynchrony.     

免疫吸附在扩张型心肌病中的应用现状

细胞免疫功能的异常在扩张型心肌病的发生和发展中起着重要作用。去除患者血液循环中的自身抗体可以显著改善血流动力学和患者的生活质量。免疫吸附疗法可以去除自身抗体,从而改善心功能,减轻心肌炎症。这为扩张型心肌病患者带来了新的治疗方式。     

家族性扩张型心肌病研究进展

家族性扩张型心肌病占所有扩张型心肌病的比例达20%~48%,但在国内尚未引起充分重视。现就其近年来在临床表现型、基因型及诊断和治疗方面的最新进展进行综述。     

肺动脉高压对扩张型心肌病预后的影响

目的探讨肺动脉高压对扩张型心肌病患者的预后影响。方法连续入选2016年1月—2018年12月在本院住院的扩张型心肌病患者。肺动脉高压定义为最大三尖瓣反流速度>3.0 m/s。随访患者主要终点包括全因死亡、植入型心脏复律除颤器治疗和因心力衰竭住院。结果共入选139例扩张型心肌病患者,基线平均左室射血分数为31%±5%,其中43.88%的患者合并肺动脉高压。中位随访15个月(1～33个月)期间,33. 09%的患者发生主要心血管不良事件。合并肺动脉高压患者发生主要心血管不良事件风险显著增高(HR 2.202,95%CI 1.151～4.213,P<0. 01)。结论在扩张型心肌病患者中,合并肺动脉高压的预后差。     

Beneficial Effects of Captopril and Metoprolol Treatment in Idiopathic Dilated Cardiomyopathy

Background: Abnormal autonomic nervous function (ANF), such as an enhanced sympathetic tone and an attenuated parasympathetic tone, have been shown in patients with congestive heart failure (CHF). Methods: We examined the effects of captopril and metoprolol on autonomic nervous function and ventricular arrhythmias in patients with idiopathic dilated cardiomyopathy (DCM), using 24-hour ambulatory electrocardiographic monitoring and power spectral analysis of heart rate variability. Twenty-one patients (pts) with idiopathic DCM (54 ± 15 years [mean ± SDI) were allocated to three groups: a captopril group (8 pts); a metoprolol group (7 pts); and a control group (6 pts). Power spectra were quantified in high (HF) and low frequency power (LF), and natural logarithmic values of HF (In(HF) and LF/HF (In (LF(HF]) were used as indices of parasympathetic and sympathetic nervous activities, respectively. Results: In the captopril and the metoprolol groups, there was a significant increase in In(HF) (P < 0.05), a trend of decrease in ln(LF/HF), and an improvement of ventricular arrhythmia (VA). In contrast, no significant change was found in any of In(HF), In (LF/HF), and VA in the control group. Conclusion: We conclude that both captopril and metoprolol have beneficial effects on ANF and VA, and the restored autonomic balance and the improvement of VA correlate to each other.     

The Prevalence and Prognostic Effects of Subclinical Thyroid Dysfunction in Dilated Cardiomyopathy Patients: A Single-Center Cohort Study

BackgroundSubclinical thyroid dysfunction may be a risk factor for mortality in patients with heart failure and may be associated with dilated cardiomyopathy (DCM). This was a cohort study to examine the possible association between subclinical thyroid dysfunction and all-cause mortality in DCM patients, because the current evidence on this association remains elusive.Methods and ResultsA total of 963 DCM patients were evaluated for thyroid function. Of these patients, 7.1% (n = 68) had subclinical hyperthyroidism (defined as serum thyroid-stimulating hormone [TSH] <0.35 μIU/mL), 84.7% (n = 816) had euthyroidism (TSH 0.35-5.5 μIU/mL), and 8.2% (n = 79) had subclinical hypothyroidism (TSH >5.5 μIU/mL). There was a significant difference in all-cause mortality rates between patients with euthyroidism and patients with subclinical hyper- and hypothyroidism (21%, 38.2%, and 26.6%, respectively; log-rank χ² = 13.104; P = .001) with mean follow-up of 3.5 years. After adjustment for other confounding factors at baseline, QRS duration, N-terminal pro–B-type natriuretic peptide, New York Heart Association functional class, left atrial diameter, and subclinical hyperthyroidism (hazard ratio 1.793, 95% CI 1.010–3.183; P = .046) emerged as significant predictors of all-cause mortality.ConclusionDCM patients with subclinical hyper- and hypothyroidism had higher all-cause mortality rates. However, only subclinical hyperthyroidism, not subclinical hypothyroidism, was an independent predictor for increased risk of all-cause mortality.