舒张性心力衰竭的疗效观察

目的观察舒张性心力衰竭(DHF)患者的治疗效果。方法回顾性分析我院2009年1月—2011年12月收治的DHF患者56例,给予硝酸甘油20mg+0.9%氯化钠溶液250ml,静脉滴注,1次/d;口服硝酸异山梨酯片、卡托普利片、双氢克脲噻、氨体舒通等治疗,其中2例心房纤颤患者口服胺碘酮0.2g,1次/d,维持窦性心律。结果本组所有DHF患者的平均治疗时间为20d;治疗后,DHF患者显效33例(58.93%),有效20例(35.71%),无效3例(5.76%),总有效率为94.64%。结论及早正确诊断DHF,联合治疗DHF有助于缓解心室重构,且能较好地改善心功能,提高有效率。     

养心氏片治疗舒张性心力衰竭的临床研究

目的 观察养心氏片治疗舒张性心力衰竭(DHF)的临床疗效.方法 将125例随机分为两组,对照组62例,采用西医基础治疗;治疗组63例,在西医治疗基础上加用养心氏片治疗.观察两组临床疗效、中医证候积分、再次住院率的变化.结果 治疗组总有效率为92.1%,优于对照组的80.6%(P<0.05).两组治疗后中医症状积分均有所下降.治疗组治疗后各项指标积分与治疗前比较差异均有统计学意义(P<0.05或P<0.01),与对照组治疗后相比,治疗组气促、胸闷、纳呆、口唇紫暗、舌淡胖、舌质暗、脉弱无力、脉结或代等症状积分均明显降低(P<0.05).治疗组再次住院率为15.9%低于对照组的30.6%(P<0.05).结论 养心氏片治疗DHF疗效优于西医常规治疗.     

舒张性心力衰竭与收缩性心力衰竭临床特征的比较

目的:探讨舒张性心力衰竭和收缩性心力衰竭患者临床特征的差异。方法:选择心力衰竭患者253例,其中舒张性心力衰竭118例,收缩性心力衰竭135例。登记患者的临床资料,分析各组患者临床特征的差异。所有患者均检测N末端脑钠尿肽前体(NT-proBNP)及高敏C反应蛋白(hs-CRP)。结果:舒张性心力衰竭和收缩性心力衰竭均以老年患者居多,前者以女性多见(56.8%),并发高血压病(81.4%)及心房颤动(26.3%)均高于于后者(前项P0.01,后项P0.05),并发冠心病(45.8%)少于后者(P0.01);两组NT-proBNP及hs-CRP均随着NYHA心功能分级增加而显著升高(P0.01),舒张性心力衰竭组NT-proBNP低于收缩性心力衰竭组(P0.01),但hs-CRP两组间差异无统计学意义。结论:与收缩性心力衰竭相比,舒张性心力衰竭于老年女性更多见,高血压病患病率及心房颤动发生率较高,NT-proBNP水平较低。     

舒张性心力衰竭的诊治进展

50%以上的心力衰竭为舒张性心力衰竭(dias-tolic heart failure,DHF)。DHF的比例随年龄而增加,其发病率在45岁以下人群中为46%,而85岁以上为59%;DHF的主要危险因素有长期高血压、老年、女性、肥胖、糖尿病、慢性肾病以及冠状动脉疾病〔1〕。有研究表明,DHF的住院率与收缩性心力     

舒张性心力衰竭动物模型建立的方法学研究

目的 :建立舒张性心力衰竭动物模型。方法 :应用心导管和超声心动图同步检查技术控制实验条件 ,通过缝扎冠状动脉造成心肌缺血使左室松弛、充盈功能减低、左室舒末压升高 ,而保持 L VEF≥ 4 5 %的实验状态。结果 :缺血即刻左室舒张末压从静息对照状态的 5 .3± 2 .8m m Hg（ 1mm Hg=0 .13 3 k Pa）升高到 7.1± 2 .8m m Hg（ P<0 .0 5 ） ,平均升高了 3 2 .4 %± 2 .8% ,左室松驰时间常数延长 ,左室舒张早期充盈速度减慢 ,L VEF从 5 7%± 6%减少到5 0 %± 8% （ P<0 .0 5 ）。结论 :通过控制实验条件可建立舒张性心力衰竭的动物模型     

曲美他嗪联合卡维地洛对舒张性心力衰竭的影响研究

目的观察曲美他嗪联合卡维地洛对舒张性心力衰竭心功能及运动耐量的影响。方法入选60例舒张性心力衰竭患者,随机分为两组,一组为对照组,接受卡维地洛及常规抗心力衰竭治疗,另一组为治疗组,在常规抗心力衰竭治疗基础上,予曲美他嗪联合卡维地洛,两组疗程均为12周,观察并比较两组治疗前后心功能,运动耐量,评估两组治疗的临床效果。结果治疗组在心功能,运动耐量改善方面均优于对照组,差异有统计学意义(P<0.05),结论曲美他嗪联合卡维地洛能有效提高患者心功能及运动耐量。     

早期床旁血滤治疗舒张性心力衰竭并慢性肾脏病Ⅳ期高龄患者一例

1病例资料 患者,女性,80岁。主因“呼吸困难1周,加重15h”入院。患者1周前坐位变卧位时出现呼吸困难,伴咳嗽。此后反复发作,伴颜面部及双上肢水肿,水肿部位与重力有关,持续不缓解,并出现尿量减少（约400ml／d）及夜间咳嗽加重,     

螺内酯在老年高血压并发舒张性心力衰竭的应用研究

目的 探讨螺内酯在老年高血压并发舒张性心力衰竭中的疗效.方法 选择2009年6月-2011年10月我院心内科住院的高血压合并舒张性心力衰竭患者64例,随机分为观察组和对照组,每组各32例.对照组给予β-受体阻滞剂、血管紧张素转化酶抑制剂、钙拮抗剂、硝酸酯类及他汀类等治疗;观察组在常规治疗基础上加用螺内酯,疗程共6个月.比较两组治疗前后6min步行试验、左房室瓣舒张早期血流最大速度E峰、舒张晚期最大速度A峰以及舒张早期和晚期充盈速度比值(E/A)变化.结果 观察组治疗后E峰、A峰、E/A以及6min步行试验均显著改善(P＜0.05),与对照组比较,差异有统计学意义(P＜0.05).结论 螺内酯可改善老年高血压并发舒张性心力衰竭患者心脏舒张功能,并逆转心室重塑.     

舒张性心力衰竭患者血浆Apelin-12水平变化

目的:探讨舒张性心力衰竭(心衰)患者血浆Apelin-12水平的变化及临床意义。方法:选择2010-01-2010-06期间在我院心内科住院的慢性心衰患者60例,舒张性心衰(A组)20例,收缩性心衰(B组)40例,后者再分为3个亚组,心功能Ⅱ级组9例,心功能Ⅲ级组20例,心功能Ⅳ级组11例。健康体检者20例为对照组。酶联免疫吸附法(ELISA)测定血浆Apelin-12水平。结果:A组和B组血浆Apelin-12水平均明显低于对照组[(1.55±0.18)ng/L,(0.91±0.15)ng/L∶(3.55±0.26)ng/L,均P<0.05],其中,A组高于B组,P<0.05。B组不同的心功能分级Apelin-12水平差异无统计学意义,P=0.126。结论:舒张性心衰患者和收缩性心衰患者,血浆Apelin-12水平均降低,与心功能分级无关。     

贫血对舒张性心力衰竭患者心功能的影响(英文)

目的:探讨舒张性心力衰竭(DHF)患者血红蛋白(Hb)含量的变化,贫血与左室功能的关系及对预后的影响。方法:176例DHF患者按照NYHA分级分为:Ⅱ级78例,Ⅲ级50例,Ⅳ级48例,分析各组Hb水平和贫血患病率。按照贫血诊断标准患者被分为贫血组(58例,占33.0%)与非贫血组(118例,占67.0),对两组患者左室舒张功能,随访期间的死亡率及再住院率进行比较分析。结果:贫血组随心功能分级(Ⅱ级~Ⅳ级)增加,Hb水平呈下降趋势[(130±6)g/L比(108±4)g/L比(96±12)g/L],而贫血的患病率逐渐增加(8.97%比36.0%比68.8%),P均<0.05。与非贫血组相比,贫血组的冠心病患者比例(55.1%比65.5%)、肌酐[(87.6±39.2)μmol/L比(113.7±59.8)μmol/L]、N末端B型利钠肽原[NT-proBNP,(578.0±136.7)pg/ml比(886.0±174.8)pg/ml]水平明显升高,舒张早期峰速减速时间明显增加[(137±15)ms比(196±13)ms],二尖瓣舒张早期/晚期峰值流速比值[E/A,(0.87±0.32)比(0.62±0.29)]明显减小(P均<0.05)。随访期间与非贫血组比较,贫血组的死亡率(9.3%比20.7%)、再住院率(18.6%比32.8%)明显上升(P均<0.05)。结论:DHF患者常伴有贫血,随着心衰严重程度的加重其贫血发病率增加,贫血可能加重心脏舒张功能不全,合并贫血的DHF患者其死亡率及再住院率增加。     

Effects of long-term renal sympathetic denervation on heart failure after myocardial infarction in rats

The purpose of the present study was to investigate the effects of long-term renal denervation (RD) on heart failure due to myocardial infarction (MI). Wistar rats were anesthetized and the bilateral renal nerves were surgically denervated 2 days before MI was induced by coronary artery ligation. Four weeks later, left ventricular (LV) function and sodium excretion were determined. In MI rats, RD improved the reduced sodium excretion. MI + RD rats revealed lower LV end-diastolic pressure and greater maximum dP/dt as compared with those of MI+ innervation (INN) rats. LV end-diastolic and end-systolic dimensions were significantly smaller and LV fractional shortening was greater in MI + RD rats than in MI + INN rats (20.9% ± 3.2% vs 14.9% ± 3.0%). In rats without MI, RD did not affect either sodium excretion or LV function and dimensions. The present results suggest that the long-term RD reduces LV filling pressure and improves LV function after MI, probably due to a restoration of impaired natriuresis. Increased renal sympathetic nerve activity might contribute to the progression of heart failure after MI. Received: June 11, 2001 / Accepted: September 22, 2001     

Atrial fibrillation impairs cardiac sympathetic response to baroreceptor unloading in congestive heart failure.

AIMS: In this study, we investigated for a potential mechanism by which atrial fibrillation (AF) might convey a worse prognosis in congestive heart failure (CHF). Specifically, we aimed to determine whether AF impaired cardiac sympathetic response to baroreceptor unloading in comparison to sinus rhythm (SR) in CHF. METHODS AND RESULTS: Eighteen CHF patients (ejection fraction 30+/-2%, age 59+/- 2 years), nine in SR and nine in AF, were enrolled. A right heart study and cardiac sympathetic tone assessment by coronary sinus catheter were performed at baseline and after 10 min of 20 degrees and 30 degrees of passive head up tilt (HUT). Filling pressures fell significantly during HUT in both SR and AF groups (AF, P=0.002; SR, P<0.001). The cardiac sympathetic response to HUT was significantly attenuated by AF compared with SR (P=0.014). In conjunction, right atrial appendages were collected from 23 cardiac surgery patients, 12 in SR and 11 in AF to investigate the presence of fibrosis. AF was associated with a significant increase in the collagen density (P=0.025). CONCLUSION: AF is associated with impaired cardiac sympathetic response to baroreceptor unloading compared with SR in CHF, possibly secondary to atrial fibrosis.     

培哚普利对充血性心力衰竭及血管内皮依赖性舒张功能的影响

目的 评估培哚普利对充血性心力衰竭的疗效及对血管内皮依赖性舒张功能的影响。方法 慢性充血性心力衰竭48例,停用血管扩张药1周,在使用强心苷及利尿药基础上,口服培哚普利2～4mg,每日1次,用药前及用药后8周分别查肝、肾功能,电解质。行超声心功能测定、血管内皮依赖性舒张功能测定及运动耐量检查。结果 培哚普利治疗后心功能明显改善38例,总有效率79%（38/48）;左心室收缩末期内径和左心室舒张末内径较前明显缩短,左心室射血分数明显增加（P〈0.05）,二尖瓣舒张早期血流最大速度和舒张早期和晚期充盈速度比值增大（P〈0.01）,6min步行试验明显好转（P〈0.01）,血管内皮依赖性舒张功能明显好转（P〈0.01）。结论 培哚普利不仅能明显改善充血性心力衰竭患者的心功能、运动耐量,而且能改善血管内皮依赖性舒张功能。     

Diagnosing diastolic heart failure

BACKGROUND: increasing evidence supports the existence of left ventricular diastolic dysfunction as an important cause of congestive heart failure, present in up to 40% of heart failure patients. AIM: to review the pathophysiology of LV diastolic dysfunction and diastolic heart failure and the currently available methods to diagnose these disorders. RESULTS: for diagnosing LV diastolic dysfunction, invasive hemodynamic measurements are the gold standard. Additional exercise testing with assessment of LV volumes and pressures may be of help in detecting exercise-induced elevation of filling pressures because of diastolic dysfunction. However, echocardiography is obtained more easily, and will remain the most often used method for diagnosing diastolic heart failure in the coming years. MRI may provide noninvasive determination of LV three-dimensional motion during diastole, but data on correlation of MRI data with clinical findings are scant, and possibilities for widespread application are limited at this moment. CONCLUSIONS: in the forthcoming years, optimal diagnostic and therapeutic strategies for patients with primary diastolic heart failure have to be developed. Therefore, future heart failure trials should incorporate patients with diastolic heart failure, describing precise details of LV systolic and diastolic function in their study populations.     

卡维地洛治疗舒张性心力衰竭临床观察

目的评价卡维地洛对舒张性心力衰竭的临床疗效和安全性。方法将53例舒张性心力衰竭患者随机分为治疗组27例及对照组26例,全部给予抗舒张性心力衰竭的常规治疗,治疗组加用卡维地洛5～40mg/d,疗程6个月。疗程结束后,对比两组患者治疗前、后临床症状和左心室超声收缩及舒张功能指标改善情况。结果治疗组总有效率及左心室舒张功能指标的改善均优于对照组(P<0.05、0.01)。治疗过程中,两组均发生部分轻度不良反应,无一例停药。结论应用卡维地洛可明显改善左室舒张功能,且安全、有效。     

The prevalence of left ventricular diastolic filling abnormalities in patients with suspected heart failure

AIMS: It is reported that one third of patients with heart failurehave normal left ventricular systolic function, and may or maynot have left ventricular diastolic dysfunction. We sought todefine the prevalence of left ventricular diastolic fillingabnormalities in a large unselected group of patients, unlikethe diagnosis by exclusion in the small highly selected groupsof patients studied previously. METHODS AND RESULT: Patients were referred by general practitioners to an open-accessechocardiography service for assessment of possible heart failure.Echocardiography included a Doppler study of transmitral flowat the tips of the mitral leaflets and calculation of an E/Aratio. Of 534 patients referred and assessed, 371 patients hadnormal systolic function and a measurable E/A ratio. These werecompared with age-adjusted reference ranges to give 9 abovethe reference range and 19 below. This is only 10 more thanwould be expected if our patients were normal. In the same groupof patients we found 96 cases of left ventricular systolic dysfunction,or 52 amongst the 423 with a measurable E/A ratio. CONCLUSIONS: Either left ventricular diastolic filling abnormalities arevery much less common than previously supposed or the E/A ratiois almost useless for their detection.     

The clinical quandary of left and right ventricular diastolic dysfunction and diastolic heart failure

Summary

Diastolic heart failure is a common clinical entity that is indistinguishable from systolic heart failure without direct evaluation of left ventricular function. Diastolic heart failure is a clinical diagnosis in patients with signs and symptoms of heart failure but with preserved left ventricular function and normal ejection fraction, and is often seen in patients with a long-standing history of hypertension or infiltrative cardiac diseases. In contrast, diastolic dysfunction represents a mechanical malfunction of the relaxation of the left ventricular chamber that is primarily diagnosed by two-dimensional transthoracic echocardiography and usually does not present clinically as heart failure. The abnormal relaxation is usually separated in different degrees, based on the severity of reduction in passive compliance and active myocardial relaxation. The question whether diastolic dysfunction ultimately will lead to diastolic heart failure is critically reviewed, based on data from the literature. Treatment recommendations for diastolic heart failure are primarily targeted at risk reduction and symptom relief. Currently, few data only are reported on diastolic dysfunction and its progression to systolic heart failure.     

舒张性心衰和收缩性心衰临床比较(英文)

目的:回顾性分析心衰患者的资料,了解舒张性心衰和收缩性心衰临床特点、费用、疗效等的异同,提高对二者的认识。方法:选择福建医科大学附属协和医院心内科住院的807例心衰患者,根据左室射血分数(LVEF)水平分为两组:LVEF>45%者为舒张性心衰(DHF)组,LVEF≤45%者为收缩性心衰(SHF)组,然后每个组根据NYHA心功能分级分为Ⅱ、Ⅲ、Ⅳ3组。比较两组的临床资料。结果:结构比:DHF和SHF分别占81.3%及18.7%。心功能:相对DHF组,SHF组的NYHAⅢ、Ⅳ级(23.5%,9.6%比47.7%,21.9%),E/A显著增大[(0.74±0.31)比(1.26±0.56)]。临床特点:DHF组女性比例较SHF组显著增大;心脏增大,心律失常比例显著增大,冠心病、肺炎、慢性肾功能不全的比例显著上升,高血压病比例、入院收缩压水平则显著较低,以上P均<0.001;SHF组平均住院时间明显延长[(12.9±8.1)d比(14.5±11.6)d,P<0.05],住院费用[12323(8530～33815)元比19554(9186～49927)元,P<0.05]、住院期间死亡率(0.5%比3.3%,P<0.01)显著较高。结论:舒张性心衰在心衰中占的比例很大,收缩性心衰的心衰更重,心脏损害更重,住院天数更长,住院费用更多、住院期间死亡率更高。