Chronic mitral regurgitation and Doppler estimation of left ventricular filling pressures in patients with heart failure.

Previous studies relating Doppler parameters and pulmonary capillary wedge pressures (PCWP) typically exclude patients with severe mitral regurgitation (MR). We evaluated the effects of varying degrees of chronic MR on the Doppler estimation of PCWP. PCWP and mitral Doppler profiles were obtained in 88 patients (mean age 55 +/- 8 years) with severe left ventricular (LV) dysfunction (mean ejection fraction 23% +/- 5%). Patients were classified by severity of MR. Patients with severe MR had greater left atrial areas, LV end-diastolic volumes, and mean PCWPs and lower ejection fractions (each P <.01). In patients with mild MR, multiple echocardiographic parameters correlated with PCWP; however, with worsening MR, only deceleration time strongly related to PCWP. From stepwise multivariate analysis, deceleration time was the best independent predictor of PCWP overall, and it was the only predictor in patients with moderate or severe MR. Doppler-derived early mitral deceleration time reliably predicts PCWP in patients with severe LV dysfunction irrespective of degree of MR.     

Electrocardiographic left ventricular hypertrophy Cornell product is a feasible predictor of cardiac prognosis in patients with chronic heart failure

Background

Left ventricular hypertrophy (LVH) is an independent risk factor for cardiovascular disease and is associated with heart failure development. The Cornell product is an easily measured electrocardiographic parameter for assessing LVH. However, it is undetermined whether the Cornell product can predict the cardiac prognosis of chronic heart failure (CHF) patients.

Methods and results

We performed standard 12-lead electrocardiography and calculated the Cornell product in 432 consecutive CHF patients. LV geometry was assessed as normal, concentric remodeling, concentric or eccentric hypertrophy. The Cornell product was significantly higher in patients with eccentric hypertrophy, and increased with advancing New York Heart Association functional class. During a median follow-up of 660 days, there were 121 cardiac events including 36 cardiac deaths and 85 re-hospitalizations for worsening heart failure. Multivariate Cox proportional hazard analysis showed that the Cornell product was an independent predictor of cardiac events in CHF patients. Patients in the highest quartile of Cornell product had a higher prevalence of LV eccentric hypertrophy (22, 29, 33 and 67 % for quartiles one through four). Kaplan–Meier analysis demonstrated that the highest quartile of Cornell product was associated with the greatest risk among CHF patients.

Conclusion

The Cornell product is associated with LV eccentric hypertrophy and can be used to predict future cardiac events in CHF patients.     

Restrictive left ventricular diastolic filling identifies patients with heart failure after acute myocardial infarction.

Left ventricular diastolic filling was characterized by transmitral pulsed-wave Doppler velocities in 62 patients with acute myocardial infarction, and diastolic filling variables were correlated with the presence of clinical heart failure. At the time of admission, 47 patients were free of heart failure and 15 patients were in Killip class II to IV. In the latter group of patients with heart failure, peak velocity of late filling wave caused by atrial contraction (A) was lower (0.48 versus 0.59 m/sec, p < 0.05), ratio of peak velocity of early rapid filling wave to peak velocity of late filling wave caused by atrial contraction (E/A) was higher (1.5 versus 1.1, p < 0.01), and deceleration time (136 versus 196 msec, p = 0.0001) was shorter when compared with the patients not in heart failure after acute myocardial infarction. Multivariate analysis showed that the deceleration time was a powerful independent predictor of presence of heart failure after controlling for systolic functional variables. Therefore, diastolic filling variables can complement systolic functional variables in the identification of the patients with postinfarction left ventricular failure.     

高血压左室肥厚伴左心力衰竭患者采取心脏超声的诊断情况及准确性分析

目的:观察与分析心脏超声在高血压左室肥厚伴左心力衰竭患者在临床诊断中的效果及准确性.方法:研究对象抽取我院40例2019年10月—2020年10月期间收诊的罹患高血压左室肥厚伴左心力衰竭病患作为实验组,并抽取同期收诊40例健康体检者作为对照组.所有纳入病例均行心脏超声诊断,总结评价两组诊断结果.结果:实验组纳入病例的左...     

普伐他汀治疗高血压伴左室肥厚舒张功能不全的疗效

目的观察普伐他汀对高血压伴左室肥厚舒张功能不全的疗效。方法选择高血压伴左室肥厚舒张功能不全的患者86例,随机分成普伐他汀组和对照组,每组43例,普伐他汀组在标准降压的基础上加用普伐他汀20 mg,每天1次。观察治疗前后心脏结构和舒张功能的变化。结果治疗6个月后,在普伐他汀组中,室间隔舒张末期厚度（IVSD）、左室后壁舒张末期厚度（LVPWD）明显变薄,E峰与A峰的比值（E/A）明显升高（P〈0.05）。与对照组比较,IVSD、LVPWD明显变薄,E/A明显升高（P〈0.05）。结论普伐他汀能有效减轻左心室肥厚,明显改善舒张功能。     

Candesartan: from left ventricular hypertrophy to heart failure, a global approach

Cardiovascular disease is a continuum, starting with risk factors resulting from physiological changes and extending to vascular pathology associated with adverse clinical outcomes. The overactivation of the renin-angiotensin-aldosterone system has been related to the development and worsening of risk factors associated with cardiovascular diseases such as hypertension and heart failure. Treatment at each stage along the continuum may prevent, or at least delay, the next one, and so it is crucial to initiate therapy as early as possible in such patients so as to provide optimal care. Candesartan, a long-acting angiotensin receptor antagonist, has been shown to be an effective, and well-tolerated therapy, in both the early and late phases of cardiovascular disease (prehypertension, hypertension, left ventricular hypertrophy and heart failure). This article reviews the data supporting the use of candesartan in cardiovascular medicine, with a focus on left ventricular hypertrophy and ultimately heart failure. Particular emphasis is given to the Candesartan in Heart Failure Assessment of Reduction in Mortality and Morbidity (CHARM) program, which has shown a positive impact of candesartan in patients with chronic heart failure in terms of reducing the incidence of cardiovascular deaths and chronic heart failure hospitalizations.     

The ST-segment-dependent indices of patients with left ventricular hypertrophy and coronary failure]

As many as 40 men suffering from essential hypertension (EH) and left ventricular hypertrophy (LVH) or hypertrophic cardiomyopathy (HCMP) were examined. All the patients exercised on a treadmill according to the Cornell protocol taking into consideration the ST/HR slope and the ST/HR index, underwent echocardiography with measurements of the left ventricular mass (LVM), and coronary ventriculography. Coronary insufficiency was revealed in all the patients. Of these, 11 patients suffered from it due to associated EH and coronary heart disease (CHD), 31 had relative coronary insufficiency in the presence of associated EH and LVH phenomena with no stenosis of coronary vessels, and 7 patients showed up relative coronary insufficiency in the presence of HCMP. The ST/HR slope and the ST/HR index correlated well with the LVM and the asymmetry index of the left ventricle but in patients with associated relative coronary insufficiency and EH. In patients with associated EH and CHD, the ST-dependent parameters correlated well neither with the degree of atherosclerosis spreading nor with the LVM. This may indicate that both factors influence the gravity of coronary insufficiency at a time. In case a patient suffering from associated EH and coronary insufficiency phenomena has the ST/HR slope greater than or equal to greater than or equal to 4.5 microV/stroke/min and/or the ST/HR index greater than or equal to greater than or equal to 2.5 microV/stroke/min, it is more likely that myocardial ischemia is provoked by concomitant atherosclerosis of coronary arteries (sensitivity 28%, specificity 71%).     

Candesartan: from left ventricular hypertrophy to heart failure,a global approach

Cardiovascular disease is a continuum, starting with risk factors resulting from physiological changes and extending to vascular pathology associated with adverse clinical outcomes. The overactivation of the renin–angiotensin–aldosterone system has been related to the development and worsening of risk factors associated with cardiovascular diseases such as hypertension and heart failure. Treatment at each stage along the continuum may prevent, or at least delay, the next one, and so it is crucial to initiate therapy as early as possible in such patients so as to provide optimal care. Candesartan, a long-acting angiotensin receptor antagonist, has been shown to be an effective, and well-tolerated therapy, in both the early and late phases of cardiovascular disease (prehypertension, hypertension, left ventricular hypertrophy and heart failure). This article reviews the data supporting the use of candesartan in cardiovascular medicine, with a focus on left ventricular hypertrophy and ultimately heart failure. Particular emphasis is given to the Candesartan in Heart Failure Assessment of Reduction in Mortality and Morbidity (CHARM) program, which has shown a positive impact of candesartan in patients with chronic heart failure in terms of reducing the incidence of cardiovascular deaths and chronic heart failure hospitalizations.     

心脏超声在高血压左心室肥厚伴左心力衰竭患者中的诊断价值

目的探讨心脏超声在高血压左心室肥厚伴左心力衰竭患者中的诊断价值。方法选择2017年2月至2019年2月我院收治的50例高血压左心室肥厚伴左心力衰竭患者为研究组,另选取同期来院接受常规体检的健康自愿者50例为对照组。两组均接受心脏超声检查。比较两组的心脏功能指标、心脏变异率指标以及研究组不同心功能分级患者的心脏功能指标。结果研究组的左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、二尖瓣舒张期最大血流速度与二尖瓣环舒张早期最大运动速度的比值(E/Ea)均高于对照组,左室射血分数(LVEF)低于对照组(P<0.05)。研究组的全部窦性心搏R-R间期的标准差(SDNN)、相邻R-R间期差值均方根(RMSSD)、相邻窦性R-R间期差值50 ms所占百分比(PNN50)均低于对照组(P<0.05)。随着心功能分级水平的升高,患者的LVEDD、LVESD、E/Ea均升高,而LVEF降低,不同心功能分级患者间比较,差异有统计学意义(P<0.05);心功能Ⅱ、Ⅲ级患者的LVEDD、LVESD、E/Ea均高于心功能Ⅰ级患者,LVEF均低于心功能Ⅰ级患者(P<0.05)。结论结合高血压左心室肥厚伴左心力衰竭患者的疾病特点,应用心脏超声检查方法有助于临床诊断病情,评估患者心功能状态,从而为临床治疗方案的制定提供有效参考依据,值得临床推广应用。     

血清尿酸水平与慢性心力衰竭患者左心室充盈压的相关性研究

目的探讨血清尿酸(UA)水平与收缩性心力衰竭患者左心室充盈压的关系。方法分别采用酶法和Swan-Ganz导管测定150例心功能Ⅱ-Ⅳ级的收缩性心力衰竭患者的血清尿酸水平和肺毛细血管楔嵌压(PC-WP),同时采用超声心动图检测左心室射血分数(LVEF)、二尖瓣瓣尖水平的E峰和A峰最大速度比值(E/A)。结果随着心功能分级程度的增加,患者的血清UA水平和PCWP依次增加,而LVEF和E/A值依次降低,差异均有统计学意义(P<0.01)。收缩性心力衰竭患者的血清UA水平与PCWP(r=0.416,P<0.01)呈显著正相关,而与LVEF(r=-0.508,P<0.01)和E/A(r=-0.205,P<0.01)呈显著负相关。出现肺部啰音、水肿和阵发性夜间呼吸困难等临床症状的患者的血清UA水平明显高于未出现者,差异均有统计学意义(P<0.01或<0.05)。结论血清UA水平与收缩性心力衰竭患者的左心室充盈压和临床症状密切相关,可用于评估收缩性心力衰竭患者左心室充盈压水平和病情严重程度。     

脉压与冠心病患者左室功能及左室肥厚的关系

目的：比较分析合并与未合并糖尿病、高血压冠心病患者脉压与心功能指标及左室肥厚的关系.方法：[1]选择2001-01/12上海交通大学附属第一人民医院心内科住院冠心病患者105例,男70例,女35例.其中仅合并高血压者29例（合并高血压组）,同时合并高血压及糖尿病者27例（合并高血压及糖尿病组）,合并糖尿病者32例（合并糖尿病组）,无高血压及糖尿病者（无高血压及糖尿病组）17例.患者均知情同意.[2]在行冠状动脉造影术过程中测定主动脉内收缩压、舒张压,计算脉压值.超声心动描记法为M型模式下测定舒张末期左室腔直径、左室后壁厚度及室间隔厚度及左室射血分数.根据公式：左室质量=1.04[（室间隔厚度＋舒张末期左室腔直径＋左室后壁厚度）3-舒张末期左室腔直径3]-13.6计算左室质量.根据公式：相对室壁厚度=（室间隔厚度＋左室后壁厚度）/舒张末期左室腔直径计算相对室壁厚度.[3]分别以脉压、左室质量、左室射血分数及相对室壁厚度为变量,以年龄、性别、伴有高血压、伴有糖尿病、同时伴有高血压及糖尿病为控制变量,进行偏相关分析.组间分析采用方差分析.结果：冠心病105例均进入结果分析.[1]各组脉压无明显差别.合并高血压及糖尿病组左室质量、相对室壁厚度大于其他3组（P＜0.05）,心功能指标左室射血分数明显低于其他3组（P＜0.05）.[2]各组脉压均与左室质量呈显著正相关（r=0.35～0.47,P＜0.05～0.01）.合并高血压组、合并高血压及糖尿病组脉压与左室射血分数呈显著正相关（r=0.33,0.41,P＜0.05）.合并高血压及糖尿病组脉压与相对室壁厚度呈显著正相关（r=0.51,P＜0.01）.结论：脉压是一独立于高血压之外的,与左室肥厚有关的独立指标;同时合并高血压及糖尿病,为影响冠心病患者左室肥厚,左室收缩功能的重要因素.     

脉压与冠心病患者左室功能及左室肥厚的关系

目的:比较分析合并与未合并糖尿病、高血压冠心病患者脉压与心功能指标及左室肥厚的关系。方法:①选择2001-01/12上海交通大学附属第一人民医院心内科住院冠心病患者105例,男70例,女35例。其中仅合并高血压者29例(合并高血压组),同时合并高血压及糖尿病者27例(合并高血压及糖尿病组),合并糖尿病者32例(合并糖尿病组),无高血压及糖尿病者(无高血压及糖尿病组)17例。患者均知情同意。②在行冠状动脉造影术过程中测定主动脉内收缩压、舒张压,计算脉压值。超声心动描记法为M型模式下测定舒张末期左室腔直径、左室后壁厚度及室间隔厚度及左室射血分数。根据公式:左室质量=1.04[(室间隔厚度+舒张末期左室腔直径+左室后壁厚度)3-舒张末期左室腔直径3]-13.6计算左室质量。根据公式:相对室壁厚度=(室间隔厚度+左室后壁厚度)/舒张末期左室腔直径计算相对室壁厚度。③分别以脉压、左室质量、左室射血分数及相对室壁厚度为变量,以年龄、性别、伴有高血压、伴有糖尿病、同时伴有高血压及糖尿病为控制变量,进行偏相关分析。组间分析采用方差分析。结果:冠心病105例均进入结果分析。①各组脉压无明显差别。合并高血压及糖尿病组左室质量、相对室壁厚度大于其他3组(P<0.05),心功能指标左室射血分数明显低于其他3组(P<0.05)。②各组脉压均与左室质量呈显著正相关(r=0.35～0.47,P<0.05～0.01)。合并高血压组、合并高血压及糖尿病组脉压与左室射血分数呈显著正相关(r=0.33,0.41P<0.05)。合并高血压及糖尿病组脉压与相对室壁厚度呈显著正相关(r=0.51,P<0.01)。结论:脉压是一独立于高血压之外的,与左室肥厚有关的独立指标;同时合并高血压及糖尿病,为影响冠心病患者左室肥厚,左室收缩功能的重要因素。     

Mechanisms and management of hypertensive heart disease: from left ventricular hypertrophy to heart failure

Hypertensive heart disease (HHD) is a spectrum of abnormalities that represents the accumulation of a lifetime of functional and structural adaptations to increased blood pressure load. Left ventricular hypertrophy (LVH), increasing vascular and ventricular stiffness,and diastolic dysfunction are prominent intermediate features of this syndrome that operate in parallel with ischemic heart disease and ultimately cause heart failure (HF) if inadequately treated.Outcomes in HHD and HF are improved by antihypertensive drugs at any stage of the condition. This review describes an integrated model of the natural history, pathogenesis, and drug treatment of hypertensive heart disease that is consistent with the recommendations of the Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, including an important modification to the HF guideline published by the American College of Cardiology and the American Heart Association that includes LVH and diastolic dysfunction as treatable conditions within the HHD-HF continuum.     

鹿角方改善充血性心力衰竭患者左心室肥厚程度的效应

背景：左心室肥厚是充血性心力衰竭发生发展的主要环节，作为心血管疾病的独立危险因子已形成共识，如何逆转或减轻左心室肥厚对于改善心功能防治充血性心力衰竭具有重要的临床价值。 目的：观察鹿角方对充血性心力衰竭患者左心室肥厚程度的影响。 设计：以充血性心力衰竭患者为观察对象的随机对照观察。 单位：上海中医药大学附属曙光医院心血管内科。 对象：选择1996-01／1998-12上海中医药大学附属曙光医院心血管内科病房及专科门诊的充血性心力衰竭患者20例，纳入标准：①符合Framinham心衰诊断标准。②纽约心脏病学会心功能Ⅲ级以上。③病史3个月以上。④接受适量的利尿剂或扩血管药物（血管紧张素转换酶抑制剂（ACEI）除外）作基础治疗。⑤胸部X射线片及超声心动图有左心室扩大的证据。所有患者均对治疗项目知情同意。 方法：将所有患者抽签法随机分为鹿角方组和地高辛组，每组10例。①给予鹿角方组患者口服上海曙光医院按既定工艺研制的鹿角方口服液35mL，2次／d，3个月为1疗程。地高辛组患者同时口服杭州民生药厂生产的地高辛片（0．25mg／片，批号970757）。0．125—0.25mg，1次／d，3个月为1疗程。①治疗后分别观察两组患者纽约心脏病学会心功能分级。②超声心动图检查分别测量患者舒张期室间隔厚度、舒张期左室后壁厚度。根据Devereux公式计算左心室心肌重量，并用体表面积矫正计算左心室重量指数。参考Devereux标准判断左心室肥厚程度。③对两组患者血浆血管紧张素Ⅱ放免测定。 主要观察指标：两组患者纽约心脏病学会心功能分级、超声心动图（室间隔厚度、左心室后壁厚度、左心室重量指数、左心室肥厚程度）及血浆血管紧张素Ⅱ水平。 结果：纳入患者20例，全部进入结果分析。①鹿角方组患者治疗后纽约心脏病学会心功能分级Ⅰ，Ⅱ，Ⅲ，Ⅳ级分别为2，5，3，0例，与治疗前相比差异明显（0，0，7，3例，P〈0．05），地高辛组患者治疗后Ⅰ，Ⅱ，Ⅲ，Ⅳ级分别为2，4，4，0例，与治疗前相比差异明显（0，0，7，3例，P〈0．05）。②鹿角方组患者治疗后室间隔厚度明显低于治疗前[（11.20&;#177;0．42），（12．10&;#177;0．32）mm，P〈0．01]，左心室后壁厚度明显低于治疗前[（10．60&;#177;0．84），（11．40&;#177;1．10）mm，P〈0．01]，左心室重量指数明显低于治疗前[（139.4&;#177;12．4），（155．3&;#177;15.4）g／m^2，P〈0．01]，地高辛组患者以上指标与治疗前无明显差异（P〉0．05）。鹿角方组患者治疗后左心室基本正常、轻、中、重度肥厚分别为2，6，2，0例，明显少于治疗前（0，3，4，3例，P〈0．01），地高辛组未见明显变化（P〉0．05）；③鹿角方组患者治疗后血浆血管紧张素Ⅱ水平明显低于治疗前[（97．7&;#177;19．5），（144．0&;#177;18．5）ng／L，P〈0．01]，地高辛组与治疗前无明显差异（P〉0．05）。 结论：鹿角方具有逆转或减轻充血性心力衰竭患者左室肥厚程度的作用。     

鹿角方改善充血性心力衰竭患者左心室肥厚程度的效应

背景:左心室肥厚是充血性心力衰竭发生发展的主要环节,作为心血管疾病的独立危险因子已形成共识,如何逆转或减轻左心室肥厚对于改善心功能防治充血性心力衰竭具有重要的临床价值。目的:观察鹿角方对充血性心力衰竭患者左心室肥厚程度的影响。设计:以充血性心力衰竭患者为观察对象的随机对照观察。单位:上海中医药大学附属曙光医院心血管内科。对象:选择1996-01/1998-12上海中医药大学附属曙光医院心血管内科病房及专科门诊的充血性心力衰竭患者20例,纳入标准:①符合Framinham心衰诊断标准。②纽约心脏病学会心功能Ⅲ级以上。③病史3个月以上。④接受适量的利尿剂或扩血管药物(血管紧张素转换酶抑制剂(ACEI)除外)作基础治疗。⑤胸部X射线片及超声心动图有左心室扩大的证据。所有患者均对治疗项目知情同意。方法:将所有患者抽签法随机分为鹿角方组和地高辛组,每组10例。①给予鹿角方组患者口服上海曙光医院按既定工艺研制的鹿角方口服液35mL,2次/d,3个月为1疗程。地高辛组患者同时口服杭州民生药厂生产的地高辛片(0.25mg/片,批号970757),0.125～0.25mg,1次/d,3个月为1疗程。①治疗后分别观察两组患者纽约心脏病学会心功能分级。②超声心动图检查分别测量患者舒张期室间隔厚度、舒张期左室后壁厚度。根据Devereux公式计算左心室心肌重量,并用体表面积矫正计算左心室重量指数。参考Devereux标准判断左心室肥厚程度。③对两组患者血浆血管紧张素Ⅱ放免测定。主要观察指标:两组患者纽约心脏病学会心功能分级、超声心动图(室间隔厚度、左心室后壁厚度、左心室重量指数、左心室肥厚程度)及血浆血管紧张素Ⅱ水平。结果:纳入患者20例,全部进入结果分析。①鹿角方组患者治疗后纽约心脏病学会心功能分级Ⅰ,Ⅱ,Ⅲ,Ⅳ级分别为2,5,3,0例,与治疗前相比差异明显(0,0,7,3例,P<0.05),地高辛组患者治疗后Ⅰ,Ⅱ,Ⅲ,Ⅳ级分别为2,4,4,0例,与治疗前相比差异明显(0,0,7,3例,P<0.05)。②鹿角方组患者治疗后室间隔厚度明显低于治疗前[(11.20±0.42),(12.10±0.32)mm,P<0.01],左心室后壁厚度明显低于治疗前[(10.60±0.84),(11.40±1.10)mm,P<0.01],左心室重量指数明显低于治疗前[(139.4±12.4),(155.3±15.4)g/m2,P<0.01],地高辛组患者以上指标与治疗前无明显差异(P>0.05)。鹿角方组患者治疗后左心室基本正常、轻、中、重度肥厚分别为2,6,2,0例,明显少于治疗前(0,3,4,3例,P<0.01),地高辛组未见明显变化(P>0.05);③鹿角方组患者治疗后血浆血管紧张素Ⅱ水平明显低于治疗前[(97.7±19.5),(144.0±18.5)ng/L,P<0.01],地高辛组与治疗前无明显差异(P>0.05)。结论:鹿角方具有逆转或减轻充血性心力衰竭患者左室肥厚程度的作用。     

脉压与冠心病患者左室肥厚的关系探讨

目的 探讨冠心病患者左室肥厚与脉压的关系.方法 将本院收治的96例冠心病患者根据脉压大小分为3组:A组30例,脉压≤45 mmHg;B组35例,55 mmHg≥脉压＞45 mmHg;C组31例,脉压＞55 mmHg.采用彩色超声心脏诊断仪测定舒张期室间隔厚度(IVST)、左室后壁厚度(PWT)、左室舒张末期内径(LVD...     

T wave alternans as a risk predictor in patients with cardiomyopathy and mild-to-moderate heart failure

The analysis of t wave alternans (TWA) was introduced to identify patients with an increased risk of ventricular tachyarrhythmias. The inducibility of ventricular tachyarrhythmias and the spontaneous arrhythmic events are correlated with a positive TWA in patients with a reduced left ventricular ejection fraction and survived myocardial infarction. In contrast, this study is the first to investigate the correlation of a survived sudden cardiac death and TWA in patients without coronary heart disease and only slightly decreased left ventricular function. Sixty patients were included in the study. The TWA analysis was performed using the Cambridge Heart system (CH2000). Patients were sitting on a bicycle ergometer and exercised with a gradual increase of workload to maintain a heart rate of at least 105 beats/min. The exercise test was stopped after recording 254 consecutive low noise level heart beats. The electrocardiographic signals were digitally processed using a spectral analysis method. The magnitude of TWA was measured at a frequency of 0.5 cycles/beat. A TWA was defined as positive if the ratio between TWA and noise level was > 3.0 and the amplitude of the TWA was > 1.8 microV. Twelve (20%) of the included 60 patients showed a positive TWA. The sensitivity concerning a previous arrhythmic event amounted to 65%, the specificity up to 98%, respectively. The alternans ratio was significantly higher in patients with a previous event (30.3 +/- 53.2 vs 2.9 +/- 5.9, P < 0.001) and cumulative alternans voltage (4.67 +/- 3.55 vs 1.75 +/- 1.88 microV, P < 0.001). In 19 patients, invasively investigated by an electrophysiological study, a significant correlation between inducibility of tachyarrhythmias and a positive TWA result was found (Spearman R = 0.51, P = 0.01). In conclusion, the TWA analysis seems to identify patients with nonischemic cardiomyopathy who are at an increased risk of ventricular tachyarrhythmias.     

老年收缩期高血压左室肥厚与心力衰竭临床研究

目的 探讨老年收缩期高血压左室肥厚与心力衰竭的关系。方法 对30例老年收缩期高血压伴左室肥厚(HLVH)患者及30例老年单纯收缩期高血压患者分别进行超声心动图检查并分析其心功能情况。结果 研究组LVDD的LAD、IVST、LVPWT显著增加(P＜0．01)，两组LVID无显著性差异(P＞0．05)，但LVSHF的LVID比对照组显著扩大(P＜0．01)；LVSHF的LVEF、CI与对照组比较有显著性差异(P＜0．05)。研究组的E峰、E／A、DC与对照组比较显著减低．A峰、IRT显著增高。结论 老年收缩期高血压左室肥厚与心衰密切相关，积极改善左心室重塑有助于延缓心衰的发生。     

Serum cardiac troponin T in patients hospitalized with heart failure is associated with left ventricular hypertrophy and systolic dysfunction

BACKGROUND: Cardiac troponin T (cTnT) is a highly sensitive and specific marker of acute myocardial infarction. Serum cTnT is also slightly elevated in patients with severe heart failure and is associated with left ventricular hypertrophy (LVH) in patients treated with haemodialysis. In this study serum cTnT concentrations and echocardiographic findings were investigated in heart failure patients without acute coronary syndrome. cTnT was also compared with other cardiac markers and plasma levels of brain natriuretic peptide (BNP). METHODS: Twenty-six patients hospitalized with heart failure were included in the study. Echocardiographic measurements and blood sampling were carried out 12-36 h after admission. Serum cTnT (3rd generation assay), cardiac troponin I (cTnI), creatine kinase MB (CKMB) and CK were measured. Plasma BNP was analysed using the Shionoria assay. LVH was defined as left ventricular mass index (LVMI) > 125 g/m for males and > 110 g/m for females. Left ventricular systolic function was estimated from the mitral annulus motion (AV-mean LV). RESULTS: Median cTnT was 0.012 (< 0.010-0.032) microg/L. Sixty-two percent of the patients (16 of 26) had elevated serum cTnT >or= 0.010 micro/L. cTnT was positively correlated with CKMB (rho = 0.40, p = 0.04) and BNP (rho = 0.43, p = 0.03), but not with cTnI and CK. A negative correlation was found between cTnT and AV-mean LV (rho = -0.58, p = 0.007), and there was a positive correlation between cTnT and LVMI (rho = 0.44, p = 0.03). No other analyte was correlated to LVMI. CONCLUSIONS: Serum cTnT but not cTnI was associated with left ventricular dysfunction and LVH in patients hospitalized with heart failure. This explains why cTnT tends to be slightly elevated in patients with heart failure without symptoms of acute myocardial ischaemia.     

Serum cardiac troponin T in patients hospitalized with heart failure is associated with left ventricular hypertrophy and systolic dysfunction

Background: Cardiac troponin T (cTnT) is a highly sensitive and specific marker of acute myocardial infarction. Serum cTnT is also slightly elevated in patients with severe heart failure and is associated with left ventricular hypertrophy (LVH) in patients treated with haemodialysis. In this study serum cTnT concentrations and echocardiographic findings were investigated in heart failure patients without acute coronary syndrome. cTnT was also compared with other cardiac markers and plasma levels of brain natriuretic peptide (BNP). Methods: Twenty-six patients hospitalized with heart failure were included in the study. Echocardiographic measurements and blood sampling were carried out 12-36?h after admission. Serum cTnT (3rd generation assay), cardiac troponin I (cTnI), creatine kinase MB (CKMB) and CK were measured. Plasma BNP was analysed using the Shionoria assay. LVH was defined as left ventricular mass index (LVMI)&;gt;125?g/m&;lt;formula&;gt;²&;lt;/formula&;gt; for males and&;gt;110?g/m&;lt;formula&;gt;²&;lt;/formula&;gt; for females. Left ventricular systolic function was estimated from the mitral annulus motion (AV-mean LV). Results: Median cTnT was 0.012 (&;lt;0.010-0.032)?μg/L. Sixty-two percent of the patients (16 of 26) had elevated serum cTnT≥0.010?μg/L. cTnT was positively correlated with CKMB (ρ=0.40, p=0.04) and BNP (ρ=0.43, p=0.03), but not with cTnI and CK. A negative correlation was found between cTnT and AV-mean LV (ρ=?0.58, p=0.007), and there was a positive correlation between cTnT and LVMI (ρ=0.44, p=0.03). No other analyte was correlated to LVMI. Conclusions: Serum cTnT but not cTnI was associated with left ventricular dysfunction and LVH in patients hospitalized with heart failure. This explains why cTnT tends to be slightly elevated in patients with heart failure without symptoms of acute myocardial ischaemia.