老年房颤患者血浆apelin水平及与N端B型利钠肽前体和左房内径的关系

目的探讨老年房颤患者血浆apelin的表达水平及其与N端B型利钠肽前体(NT-pro BNP)、左房内径(LAD)的关系。方法 122例老年房颤患者,其中53例为阵发性房颤(阵发组),36例为持续性房颤(持续组),33例为永久性房颤(永久组),并于同期随机选取40例非房颤患者为对照组,采用酶联免疫吸附法(ELISA)检测血浆apelin和NT-pro BNP水平,心脏多普勒超声诊断仪测定LAD、左心室射血分数(LVEF),并分析apelin与NT-pro BNP、LAD的关系。结果阵发组、持续组、永久组血浆apelin水平低于对照组,持续组、永久组血浆apelin水平低于阵发组,永久组血浆apelin水平低于持续组(P<0.05);阵发组、持续组、永久组NT-pro BNP、LAD高于对照组,持续组、永久组NT-pro BNP、LAD高于阵发组,永久组NTpro BNP、LAD高于持续组(P<0.05)。经Pearson积矩相关分析,老年房颤患者血浆apelin与NT-pro BNP、LAD均呈负相关关系(r=-0.675、-0.772,P<0.05)。结论老年房颤患者血浆apelin水平降低,并且apelin通过抗纤维化作用而参与心肌重构,进而参与房颤的发生及维持过程。     

不同病因房颤患者血浆脂联素与B型利钠肽前体及心功能的关系

目的探讨不同病因房颤患者血浆脂联素(APN)水平及其与B型利钠肽前体(NT-proBNP)、左室射血分数(LVEF)的关系。方法将74例房颤患者根据病因分为肺心病合并房颤组(CPD组)25例、冠心病合并房颤组(CHD组)23例、高血压合并房颤组(EH组)26例。检测各组血浆APN、NT-proBNP水平,经胸彩色心脏超声多普勒检测LVEF。结果 CPD组APN较CHD组和EH组明显升高(P均<0.05),CHD组与EH组比较无统计学差异;三组NT-proBNP及LVEF比较均无统计学差异。相关分析表明,血浆APN与NT-proBNP呈正相关(r=0.21,P<0.05),与LVEF呈负相关(r=-0.22,P<0.05),NT-proBNP与LVEF呈负相关(r=-0.34,P<0.05)。结论房颤合并肺心病患者的血浆APN水平明显升高,提示血浆APN可能与患者发生心力衰竭的基础病因有关,也可能与肺组织纤维化有关。     

血浆N端B型利钠肽原对前壁与非前壁ST段抬高心肌梗死患者左室收缩功能的预测价值

目的探讨血浆N端B型利钠肽原（NT—proBNP）对急性前壁及非前壁sT段抬高型心肌梗死（STEMI）患者左室射血分数（LVEF）的早期预测价值。方法193例行急诊经皮冠状动脉介入术的STEMI患者,在人院时测量血浆NT—pmBNP水平,并将之以第三四分位数为界分组,分别评价NT—proBNP水平对前壁及非前壁STEMI患者发病6个月后经超声心动图测量的LVEF的预测价值。结果非前壁STEMI患者中NT—proBNP≥310pg／ml组较NT—proBNP〈310pg／ml组的LVEF低[（41±12）％比（54±7）％]（P〈0．05）。多元线性回归分析发现,NT—proBNP≥310pg／ml是非前壁STEMI患者LVEF降低的独立预测因子（β=-6．3,P=0．02）。结论在行急诊经皮冠状动脉介入术的非前壁STEMI患者中,入院NT—proBNP≥310pg／ml是6个月时LVEF降低的独立预测因子。入院时测定血浆NT—proBNP可能有助于对急性非前壁STEMI患者进行早期危险分层。     

慢性心力衰竭患者血浆和肽素的水平及意义

目的探讨和肽素(copeptin)与慢性心力衰竭(CHF)的关系。方法选择CHF患者108例为CHF组,健康体检者30例作为对照组。所有入选人员均行超声心动图检查,并测定血中copeptin、氨基末端脑钠肽前体(NT-proBNP)浓度。结果 (1)CHF患者血浆copeptin、NT-proBNP浓度显著高于对照组,且CHF患者心功能Ⅲ级+Ⅳ级组copeptin、NT-proBNP水平显著高于Ⅰ+Ⅱ级组(均P<0.05)。(2)CHF患者血浆copeptin、NT-proBNP浓度在不同射血分数组差异有统计学意义(P<0.05),且随射血分数的降低而增加。(3)copeptin分别与肌酐、NT-proBNP呈显著正相关(P<0.01),与左室射血分数(LVEF)呈负相关(P<0.01)。结论 CHF患者血浆copeptin水平显著升高,检测CHF患者血浆中copepein水平变化对CHF患者诊断及病情严重程度评估具有一定的临床价值。     

B型利钠肽在评估慢性房颤患者左心房血栓形成的价值

目的:探讨B型利钠肽(BNP)在评估慢性房颤患者左心房血栓形成中的临床价值. 方法:对65例慢性房颤患者实施经食管超声检查,根据有无左心房血栓分组,检测并比较患者的BNP及其他临床资料. 结果:左房血栓组的血浆BNP水平高于无左房血栓组(93.27±22.13) ng/L对(54.19±19.04) ng/L.多变量回归分析表明,高血浆BNP水平是慢性房颤患者发生左房血栓的独立预测指标(OR=1.01,95％CI:1.00～1.15,P ＝ 0.04). 结论:血浆BNP水平可作为预测慢性房颤患者左房血栓的指标.     

不同剂量艾司洛尔对老年冠心病患者BNP和NT-proBNP水平的影响

目的比较术中使用不同剂量的艾司洛尔对老年患者B型利钠肽(BNP)和N端脑钠肽前体(NT-pro BNP)的影响。方法将210例冠心病患者随机分为3组,A组(对照组)术中持续缓慢泵注生理盐水;B组术中持续泵注艾司洛尔50μg·kg-1·min-1;C组术中持续泵注艾司洛尔250μg·kg-1·min-1。记录并比较不同组间患者T0、T1、T2时的收缩压(SBP)、舒张压(DBP)和血氧饱和度(SpO2)的变化。分别于T0、T1、T2、T3、T4时间点采集桡动脉血,测定血浆BNP及NT-proBNP水平。结果三组患者血流动力学参数差异无统计学意义(P>0.05)。A组、B组之间T0、T1、T2和T3 4个时间点血浆BNP和NT-proBNP表达水平无显著差异(P>0.05);而C组T0、T1两个时间点血浆BNP和NT-proBNP表达水平与A、B两组无差异,但T2和T3两个时间点血浆BNP和NT-proBNP表达水平显著低于A、B两组。结论对于手术的冠心病老年患者,术中以250μg·kg-1·min-1速度持续泵注艾司洛尔可降低患者术后血浆BNP和NT-proBNP的表达,降低并发症发生率。     

老年慢性心力衰竭患者血浆脑钠肽水平观察

目的 研究血浆脑钠肽(BNP)在老年慢性心力衰竭(CHF)患者的诊断、治疗和预后评估中的临床作用. 方法 选取2010年1月至2011年3月我科住院206例＞60岁老年CHF患者,按照纽约心脏病学会(NYHA)心功能分级分为4组,采用ELISA法测定患者血液BNP的水平,并测定左心室射血分数(LVEF).在抗心力衰竭治疗2周后或出院时复测上述指标,进行统计学分析. 结果 按NYHA心功能分级的各组患者血浆BNP的水平差异具有统计学意义,心功能越严重,年龄越大,BNP值越高,而LVEF差异仅在Ⅰ、Ⅲ、Ⅳ级心功能间有意义(P＜0.05);经抗心衰治疗后,患者心衰症状缓解,复测BNP值下降而LVEF升高,但仅BNP的变化有统计学意义. 结论 BNP值可作为较可靠的老年CHF的早期预测参考指标,也可作为判断心功能不全严重程度和疗效以及预测预后的指标,而且操作简便,易于重复.     

血浆N末端B型利钠肽原水平对急诊呼吸困难病人的应用价值

目的分析并评价血浆N末端B型利钠肽原(NT-proBNP)含量对急诊呼吸困难病人鉴别的应用价值。方法将我院急诊科自2012年3月至2013年11月期间收治的194例受检者分为心源性呼吸困难组110例与肺源性呼吸困难组84例。对两组患者的血浆NT-proBNP水平进行检测并检查心脏超声,对比分析两组患者的血浆NT-proBNP水平与左室射血分数;对心源性呼吸困难患者的血浆NT-proBNP水平与左室射血分数之间的相关性进行分析。结果心源性呼吸困难组患者的血浆NT-proBNP含量显著高于肺源性呼吸困难组患者(t=21.093,P=0.001),具有统计学意义;心源性呼吸困难组患者的LVEF水平显著低于肺源性呼吸困难组(t=18.093,P=0.001),具有统计学意义。心源性呼吸困难组患者的血浆NT-proBNP水平与LVEF之间呈负相关关系(r=-0.59,P0.01)。结论血浆NT-proBNP水平在急性呼吸困难患者的诊断方面具有重要的应用价值。     

心功能不全患者肾小球滤过率及血浆NT-proBNP水平的变化及意义

<正>国内外研究发现,心功能不全患者常伴有肾功能的改变〔1〕,为了解心功能不全患者肾功能的改变,本文对心功能不全患者体内肾小球滤过率(GFR)和血浆N-末端脑利钠肽前体(NT-pro BNP)水平进行分析,对临床心功能患者的诊治和预后提供依据。1资料和方法1.1一般资料随机选取我院2012年6月至2014年7月住院治疗的心功能不全患者90例,入选标准:病因分别为肥厚性     

儿茶酚抑素与STEMI患者心功能的相关性研究

【目的】：探讨血浆儿茶酚抑素（catestatin,CST）与ST段抬高型心肌梗死（ST segment elevation myocardial infarction,STEMI）患者心功能的相关性。【方法】：入选STEMI患者130例,同期入选健康人群40例作为对照组。采用ELISA法检测血浆CST浓度。采用Killip心功能分级对STEMI组进行心功能分级,超声心动图检测左室射血分数（left ventricular ejection fraction,LVEF）、荧光免疫定量分析法检测氨基末端B型脑利钠肽前体（N-terminal fragment of pro-brain sodium peptides,NT-proBNP）水平。通过Spearman秩相关分析CST与NT-proBNP的关系,利用受试者工作特征曲线（receiver operating characteristic curve,ROC曲线）评价CST对STEMI患者发生心力衰竭的预测价值。【结果】：1.根据Killip心功能分级法将STEMI患者分为四组：Killip心功能I级,Killip心功能II级,Killip心功能III级,Killip心功能IV级。不同组患者的年龄、性别、BMI、吸烟、高血压史、糖尿病史、TC、TG、LDL组间差异无统计学意义（P>0.05）。2.STEMI组血浆CST浓度水平高于正常人群（2.2±0.8 vs. 0.21±0.05 ng/ml,P＜0.001）。3.不同Killip心功能分级患者的LVEF、NT-proBNP、CST组间差异有统计学意义。4.Spearman相关分析研究显示CST与NT-proBNP有正相关性（r=0.302,P=0.048）。5.ROC曲线分析提示CST与NT-proBNP对STEMI患者发生心衰的预测价值,面积分别为0.742（P=0.01）、0.992（P＜0.001）。【结论】：STEMI患者血浆CST浓度水平明显高于正常人群。血浆CST浓度对STEMI患者并发心力衰竭有一定预测价值。     

P波离散度对脑卒中患者并发阵发性房颤及预后的预测价值

目的 探讨P波离散度对脑卒中患者发生阵发性房颤及预后的预测价值.方法 选择72例脑卒中患者,根据有无阵发性房颤分为A组（伴有阵发性房颤）36例和B组（不伴有阵发性房颤）36例,两组患者均行12导联心电图及彩色多普勒超声心动图,24h动态心电图检测,分别测量心电图P波最大时限（Pmax）、P波最小时限（Pmin）,计算P波离散度（Pd）、左心房内径（LAD）、左心室射血分数（LVEF）,并进行比较.结果 两组间P波最大时限（Pmax）、P波离散度（Pd）、左心房内径（LAD）、左心室射血分数（LVEF）、频发房早、短阵房速比较,差异有统计学意义（P＜0.05）.结论 P波离散度是预测脑卒中患者并发阵发性房颤的可靠指标,对预后观测有一定意义.     

改良左房折叠术在风湿性心脏病并发心房纤颤的临床应用

目的探讨改良左房折叠术治疗心房纤颤（房颤）的有效性。方法：210例风湿性心脏病并发房颤的患者[所有患者均因个人原因未选择瓣膜置换术中行射频消融术,各组患者术前年龄、左房内径（LAD）差异无统计学意义],在行瓣膜置换（单瓣115例,双瓣95例）的同时随机分为3组：改良组（71例,即瓣膜置换的同时行改良左房折叠术）、常规A组（对照组1,68例）和常规B组（对照组2,71例）行常规左房折叠术,术后测量患者LAD、左室射血分数（LVEF）值,观察改良左房折叠术治疗房颤的有效性。结果：术前、术后相同心脏超声平面显示改良组术后LAD显著减小,且改良组房颤转复率1月高达31％,明显高于常规A组（12％）和B组（7％）。术后12个月随访发现,改良组房颤转复率为18％,与常规A组（6％）和常规B组（4％）相比有统计学意义（P〈0．05）。结论：在行瓣膜置换术的同时,改良左房折叠术作为附加术式在一定程度上可有助于转复患者房颤心律为窦性心律。     

Preserved left ventricular ejection fraction following atrioventricular junction ablation and pacing for atrial fibrillation

Introduction: Right ventricular apical (RVA) pacing creates ventricular dyssynchrony and may compromise left ventricular ejection fraction (LVEF). The impact of RVA pacing in patients who have undergone atrioventricular junction (AVJ) ablation for atrial fibrillation (AF) is unclear. We sought to determine whether RVA pacing after AVJ ablation for patients with AF compromises LVEF in the short- or long-term.
Methods/Results: We studied 286 patients with AF who underwent AVJ ablation and RVA pacing at our institution between 1990 and 2002. Patients were stratified into a short-term follow-up group (LVEF reassessed by echocardiography within a year after AVJ ablation, n = 134) and a long-term group (LVEF reassessed after a year, n = 152). Among all 286 patients (mean follow-up 20 months), we observed no change in mean LVEF after AVJ ablation and RVA pacing (48% before vs. 48% after, P = 0.42). Short-term follow-up patients had a statistically significant improvement in mean LVEF (46% before vs. 49% after, P = 0.03), whereas there was no statistically significant change in mean LVEF in long-term follow-up patients (49% before vs. 48% after, P = 0.37). Only 9% of short-term patients, 15% of long-term patients, and 1% of patients with baseline LVEF ≤ 40% experienced ≥10% absolute decrease in LVEF. Baseline LVEF > 40% was a multivariate predictor of LVEF decline.
Conclusions: RVA pacing after AVJ ablation does not compromise LVEF in the short- or long-term for the vast majority of patients. Better predictors are needed to help us select patients for biventricular pacing after AVJ ablation.     

替米沙坦预防高血压并阵发性房颤患者房颤复发的效果及机制

目的探讨替米沙坦预防高血压病并阵发性房颤患者房颤复发的效果及其作用机制。方法将186例高血压并阵发性房颤患者随机分为观察组91例和对照组95例,两组均口服胺碘酮,在此基础上观察组同时口服替米沙坦20-80 mg/d,均连续治疗6个月;两组血压控制不理想者均联用钙离子拮抗剂、β受体阻滞剂与利尿剂,但对照组停用和避免使用血管紧张素转换酶抑制剂和血管紧张素受体拮抗剂。随访6个月分别观察两组血压变化,房颤复发例数、发作次数、首次复发时间及左室舒张末内径（LVEDD）、左房内径（LAD）变化。结果两者治疗前后血压变化无显著差异;观察组6个月末房颤复发例数与次数均显著低于对照组、首次复发时间明显长于对照组;观察组6个月末LVEDD、LAD均显著小于对照组（P〈0.05）。结论替米沙坦可预防高血压病并阵发性房颤患者房颤复发,机制主要是抑制心房重构。     

老年心房颤动患者左心房内径及其电活动变化的临床研究

目的探讨老年心房颤动(房颤)患者左心房内径、电活动变化及其意义。方法142例老年非瓣膜性房颤患者(房颤组)进行彩色多普勒超声心动图仪及三导心电图仪检查,测定左心房内径(LAD)、左心室舒张期末内径、左心室后壁厚度、室间隔厚度、左心室射血分数(LVEF)及房颤的检出。采用食管调搏的方法测定左心房电生理特性,以400ms起搏周长(PCL)对左心房进行S1S2扫描,测定基础状态左心房有效不应期(LAERP);以3种不同起搏周长(400、500、600ms)对左心房进行S1S2扫描,观察LAERP频率适应性。150例健康体检者为正常对照组。结果房颤组患者LAD较正常对照组显著增加,其中左心房扩大(LAD>32mm)者占95.07%,且持续性房颤患者LAD较阵发性房颤患者显著增加。左心室肥厚患者LAD较无左心室肥厚患者显著扩大,左心房扩大与心功能降低有关,其中左心房显著扩大者(LAD≥40mm)其LVEF、每搏输出量下降最明显。房颤组患者LAERP较正常对照组显著缩短,LAERP频率适应性较正常对照组减退。结论LAD扩大及其电重构与房颤发生密切相关,LAD扩大与左心室肥厚及心功能减退有关。     

Left ventricular diastolic dysfunction in patients with so-called lone atrial fibrillation

Lone atrial fibrillation (AF) is defined by the absence of identifiable causes of AF, but its hemodynamics have not been investigated. Twenty-eight patients with lone AF were compared with 14 control patients referred for Wolff-Parkinson-White ablation. Transthoracic and transesophageal echocardiography were performed to rule out structural heart disease, followed by transseptally performed complete hemodynamic evaluation of the left heart systolic and diastolic function. There was no evidence of diastolic dysfunction according to echocardiographic criteria in AF and control patients. There was no difference in echocardiographic measurements, except for a significantly higher inferosuperior left atrial dimension seen in the four-chamber apical view in AF patients (51+/-10 vs 40+/-6 mm, P = 0.03). Hemodynamic evaluation showed that end-diastolic left ventricular pressure and the nadir of the left atrial Y descent were significantly higher in lone AF patients versus controls: 13+/-5 versus 8+/-3 mmHg (P = 0.001) and 6.7+/-3 versus 4.6+/-2.7 mmHg (P = 0.05). Our results demonstrated the presence of diastolic left heart dysfunction in patients with so-called lone AF.     

Prognostic significance of atrial fibrillation is a function of left ventricular ejection fraction

BACKGROUND: Atrial fibrillation (AF) has been reported to be associated with decreased survival in population-based studies. Its prognostic importance in end-stage heart failure is not clear. METHODS AND RESULTS: We investigated the prognostic implications of AF as function of left ventricular (LV) ejection fraction (EF) in 8,931 consecutive patients undergoing echocardiography at our medical center between 1990 and 1999. Patient characteristics were: age 66 +/- 13 years, EF 51 +/- 15, AF in 1,203 patients. There were 1,911 deaths over a mean follow up of 913 days. The prevalence of AF was 11% in patients with normal left ventricular ejection fraction (LVEF) (EF >/= 55%, n = 5, 130), and 18% each in those with mild (EF 41-54%, n = 1209), moderate (EF 26-40%, n = 1183) and severe reductions in left ventricular ejection fraction (LVEF) (EF /= 450, raising a possibility of enhanced susceptibility of these patients. CONCLUSIONS: The effect of AF on mortality diminishes with worsening LV function and is absent in those with severe LV dysfunction. Susceptibility of patients with QT prolongation to AF mortality warrants further attention.     

Effect of pacing the right ventricular mid-septum tract in patients with permanent atrial fibrillation and low ejection fraction

Introduction: Permanent right ventricular (RV) pacing leads have been traditionally implanted in the right ventricular apex (RVA). Nowadays, some deleterious effects of RVA pacing have been recognized. The aim of this study was to evaluate the effect of different sites of RV pacing in patients with permanent atrial fibrillation (AF) and low ejection fraction (LEF) needing a pacemaker (PM) implantation.
Methods: Two hundred seventy-three patients with permanent AF and EF <30% underwent a one-chamber rate responsive (VVIR) PM implant procedure. Patients were divided into two groups: Group A, including 113 patients with the pacing lead tip placed in the RV mid-septum, and Group B of 120 patients with the pacing lead tip placed at the apex of RV. All patients had clinical and Echo control after 1, 3, 6, 12, and 18 months after PM implantation to assess New York Heart Association (NYHA) class and EF.
Results: After 18 months, NYHA class changed in Group A from 2.9 ± 0.4 at implant to 1.7 ± 0.3 at 18 months (P = 0.01), and in Group B from 3.0 ± 0.5 at implant to 3.3 ± 0.6 at 18 months (P = n.s.). EF increased in Group A: 28 ± 2% at implant, 33 ± 1% at 18 months (P = 0.0125), while no significant changes were observed in Group B: at implant 27 ± 2%, 26 ± 2% at 18 months (P = n.s.).
Conclusion: The present study suggests that more physiological pacing from the RV sept can improve EF and quality of life (QoL) in patients with permanent AF and low EF needing a PM.