Factors influencing recovery of left ventricular structure in patients with chronic heart failure

Background  Angiotensin converting enzyme (ACE) inhibitors and β-blockers (βB) have beneficial effects on left ventricular (LV) remodeling, alleviate symptoms and reduce morbidity and mortality in patients with chronic heart failure (CHF). However the correlation between the d osages of ACE inhibitors, βB, and recovery of LV structure remains controversial. Clinical factors associated with recovery of normal ventricular structure in CHF patients receiving medical therapy are poorly defined. Here we aimed to identify variables associated with recovery of normal or near-normal structure in patients with CHF.

Methods  We recruited 231 consecutive CHF outpatients, left ventricular ejection fraction (LVEF) ≤40% and left ventricular end diastolic diameter (LVEDD) >55/50 mm (male/female), who were receiving optimal pharmacotherapy between January 2001 and June 2009, and followed them until December 31, 2009. They were divided into three groups according to LVEDD and whether they were still alive at final follow-up: group A, LVEDD ≤60/55 mm (male/female); group B, LVEDD >60/55 mm (male/female); and group C, those who died before final follow-up. Apart from group C, univariate analysis was performed followed by Logistic multivariate analysis to determine the predictors of recovery of LV structure.

Results  A total of 217 patients completed follow-up, and median follow-up time was 35 months (range 6–108). Twenty-five patients died during that period; the all-cause mortality rate was 11.5%. Group A showed clinical characteristics as follows: the shortest duration of disease and shortest QRS width, the lowest N-terminal brain natriuretic peptide (NT-proBNP) at baseline, the highest dose of βB usage, the highest systolic blood pressure (SBP), diastolic blood pressure (DBP) and the lowest New York Heart Association (NYHA) classification, serum creatinine, uric acid, total bilirubin and NT-proBNP after treatment. Logistic multivariate analysis was performed according to recovery or no recovery of LV structure. Data showed that LVEF at follow-up (P=0.013), mitral regurgitation at baseline (P=0.020), LVEDD at baseline (P=0.031), and βB dosage (P=0.041) were independently associated with recovery of LV diameter.

Conclusion  Our study suggests that four clinical variables may predict recovery of LV structure to normal or near-normal values with optimal drug therapy alone, and may be used to discriminate between patients who should receive optimal pharmacotherapy and those who require more aggressive therapeutic interventions.

     

促红细胞生成素在慢性心功能不全合并贫血患者中的保护作用的meta分析

目的探讨促红细胞生成素(erythropoietin, EPO)对于慢性心动能不全(chronic heart failure, CHF)合并贫血患者的临床疗效及其安全性。方法 检索Embase、Medline至2013年7月为止的针对EPO与CHF进行临床疗效评估的相关文献。选择比较EPO与安慰剂或空白对照在CHF合并贫血患者的治疗效果的所有随机临床研究。结果总共有750例CHF合并贫血的患者接受EPO治疗3个月至1年并跟踪随访,这些患者包含在9个随机对照研究中。EPO的治疗可以显著降低CHF患者的住院周期(RR=0.47, CI: 0.32~0.70;P=0.0002)。CHF患者使用EPO治疗后虽不能降低其死亡风险 (RR=0.68, CI: 0.38~1.19;P=0.18),但也没有出现死亡率的升高。此外,CHF合并贫血的患者使用EPO治疗后可以显著改善血红蛋白(Hb),红细胞压积(HCT),脑利钠肽(BNP),运动能力,肾功能,心功能(NYHA)和左心室射血分数(LEVF)。结论 在CHF患者中,EPO治疗后有益作用明显,并没有出现死亡率的升高或更多不良事件的发生。这些结果支持在CHF合并贫血的患者中使用EPO进行治疗。     

Prevalence, clinical characteristics and outcome in patients with chronic heart failure and diabetes

Background Chronic heart failure（CHF）and diabetes mellitus portend high morbidity and mortality because of an interrelated pathophysiologic process.This large cohort study aimed to analyze the prevalence,clinicaI characteristics and long-term outcome of patients with CHF and diabetes.Methods A totaI of 1119 patients with NYHA functionaI class Ⅱ-Ⅳ and left ventricular ejection fraction（LVEF）〈45% between January 1995 and May 2009 were recruited.Clinical variables, biochemical and echocardiographic measurements were retrospectively reviewed,and composite major cardiac events （MCE） including death,headtransplantation, and refractory heart failure requiring multiple hospitalizations were recorded.Results The prevalence of CHF with diabetes was progressively increased with time （16.9% in 1995-1999;20.4% in 2000-2004,and 29.1% in 2005-2009）and age（1 8.5% in〈60 years,26.6% in 60-80 years,and 26.6% in〉80 years）.Compared with CHF patients without diabetes,those with diabetes had worse cardiac function,more abnormal biochemical changes.and higher mortality.Treatment with glucose-lowering agents significantly improved LVEF and decreased MCE.An elevated serum HbA1c level was associated with large left ventricular end-systolic diameter （P〈0.05）,decreased LVEF（P〈0.01）and reduced survival（P〈0.05）.Multivariable Logistic regression analysis revealed that after adjustment for confounding factors,NYHA functional class（OR2.65,95%CI 1.14-6.16,P=0.024）and HbA1c level≥7%（OR2.78, 95%CI 1.00-7.68,P=0.049）were independent risk factors for adverse outcomes in CHF patients with diabetes.Conclusions Prevalence of CHF with diabetes was increasing during past decades,and patients with CHF and diabetes had worse clinical profiles and prognosis.Aggressive anti-CHF and diabetes therapies are needed to improve overall outcomes for these patients.     

不同血运重建方式对冠心病合并非重度左心功能不全患者预后的影响

目的 比较经皮冠状动脉介入治疗(PCI)和冠状动脉旁路移植术(CABG)对冠心病合并非重度左心功能不全患者预后的影响.方法 选择2011年1月至2013年1月在首都医科大学宣武医院住院的冠心病合并非重度慢性心力衰竭行血运重建患者412例为研究对象,根据血运重建方式分为PCI组268例和CABG组144例.随访截止至2016年1月,随访主要终点事件为全因病死率,次要终点事件为非致死性心肌梗死、再次血运重建及主要不良心血管事件(MACE)发生率,比较PCI组与CABG组长期预后的差别.结果 随访时间5(3,6)年,其中PCI组失访28例(10.4％),CABG组失访17例(11.8％).住院期间总MACE、死亡、非致死性心肌梗死、靶血管血运重建(TVR)发生率两组间比较,差异无统计学意义(P＞0.05);心功能变化比较,PCI组有效比例高于CABG组,无效比例PCI组低于CABG组(P＜0.05).随访期间,PCI组累积全因病死率低于CABG组(7.8％vs.19.4％,P＜0.05),总MACE发生率低于CABG组(38.1％vs.43.8％,P＜0.05);PCI组累积非致死性心肌梗死发生率、累积TVR率与CABG组的差异无统计学意义(P＞0.05).Cox模型多因素分析矫正后,PCI组总MACE发生率(HR=1.357,95％CI 1.105～1.729),全因病死率(HR=0.426,95％CI 0.121 ～ 0.753)仍低于CABG组(P＜0.05);TVR率、非致死性心肌梗死的差异无统计学意义(P＞0.05).结论 冠心病合并非重度心功能不全患者行PCI安全有效,与CABG组相比心功能改善更明显,可降低全因病死率和MACE.     

促甲状腺激素对冠心病患者行经皮冠状动脉介入术预后的影响

目的 研究正常范围内不同浓度梯度的促甲状腺激素(thyroid-stimulating hormone,TSH)对冠心病患者行经皮冠状动脉介入术(percutaneous coronary interventions,PCI)预后的影响及其临床意义.方法 回顾性纳入1 002例行PCI且TSH处于正常范围内(0.30 ～4.20 μIU/mL)的冠心病患者,将受试者分为3组:TSH正常低值组(0.30 ～ 1.60 μIU/mL,387例)、TSH正常中值组(1.61 ～2.90 μIU/mL,413例)、TSH正常高值组(2.91 ～4.20 μIU/mL,202例),随访时间1年,终点事件是全因死亡,并统计出血事件和再入院事件.结果 正常低值组全因死亡事件6例,全因死亡率1.55％;正常中值组全因死亡事件8例,全因死亡率1.94％;正常高值组全因死亡事件10例,全因死亡率4.95％;各组之间比较差异有统计学意义(P＜0.05).正常低值组再出血事件13例,再出血率3.36％;正常中值组再出血事件14例,再出血率3.39％;正常高值组再出血事件16例,再出血率7.92％;各组之间比较差异有统计学意义(P＜0.05).正常低值组再入院事件38例,再入院率9.82％;正常中值组再入院事件27例,再入院率6.54％;正常高值组再入院事件15例,再入院率7.43％;各组之间比较差异无统计学意义(P＞0.05).Logistic回归分析显示正常高值的TSH(OR=1.48)是PCI术后全因死亡的危险因素,同时正常高值的TSH(OR=1.47)是PCI术后出血的危险因素.生存分析也进一步证明正常高值的TSH是PCI术后全因死亡的危险因素(P＜0.05).结论 TSH水平越高,全因死亡事件、再出血事件的发生率越高;正常高值的TSH是经皮冠状动脉介入治疗的全因死亡和出血事件的危险因素.     

Prognosis investigation in patients with chronic heart failure and pericardial effusion

Background  Researchers still do not reach the consensus on the incidence, characters and the prognostic value of pericardial effusion (PE) in patients with chronic heart failure (CHF). This study is to investigate the incidence, characters and the prognostic value of pericardial effusion (PE) in patients with CHF.

Methods  One thousand one hundred and eighty-nine patients, with a diagnosis of CHF consecutively admitted to three centers, were enrolled. M-mode echocardiography was used to determine the presence or absence of PE and to semi-quantify it. The 118 patients with PE and 472 without PE were followed up. The relationship between the PE and other parameters and the prognostic value of PE for CHF were analyzed by univariate and multivariate analyses.

Results  After following up, 550 patients were analyzed, of which 226 were dead. The incidence of PE was 9.92%. Moderate PE was the most common which account 90.68% (107/118). The 6.78% of the patients (8/118) had small while only 2.54% (3/118) had large one. The systolic blood pressure (OR=1.04, 95% CI (1.01–1.07), P=0.08), left ventricular ejection fraction (LVEF) (OR=1.09, 95% CI (1.02–1.15), P=0.06), and main pulmonary artery diameter (MPAD) (OR=1.51, 95% CI (1.24–1.85), P <0.001) were the independent predictors of PE. The glomerular filtration rate (GFR) (OR=1.013, 95% CI (1.005–1.026), P=0.02), systolic blood pressure (OR=1.02, 95% CI (1.00–1.03), P=0.015), LVEF (OR=1.08, 95% CI (1.04–1.12), P <0.001) and diabetes mellitus (OR=3.53, 95% CI (1.99–6.44), P <0.001) were determined as the independent predictors of CHF prognosis.

Conclusions  The PE is not uncommon in CHF patients and most PE are small to moderate. PE is not related to the etiology of CHF while is strongly connected with higher systolic blood pressure, low LVEF and large MPAD. PE dose not increase the risk of death in patients with CHF.

     

正常甲状腺病态综合征对慢性心力衰竭患者远期预后的影响研究

背景　甲状腺激素的代谢异常参与了慢性心力衰竭（CHF）的病理过程,而目前国内对伴正常甲状腺病态综合征（ESS）的CHF患者的远期预后研究甚少。目的　探讨ESS对CHF患者远期预后的影响。方法　选取2017年1月-2019年6月于复旦大学附属中山医院吴淞医院心内科住院的CHF患者304例。将三碘甲状腺原氨酸（T3）<1.01 nmol/L和/或游离三碘甲状腺原氨酸（FT3）<3.28 nmol/L的患者纳入ESS组,T3为1.01~2.48 nmol/L及FT3为3.28~6.47 nmol/L的患者纳入甲功正常组。比较两组患者一般资料及实验室检查指标。出院后对所有患者进行随访,随访截至2020年6月,观察主要终点是全因死亡（包括因心力衰竭死亡和非心源性死亡）,次要终点是因心力衰竭再入院。依据患者存活情况将患者分为存活组与全因死亡组,再将全因死亡组分为心力衰竭死亡亚组和非心源性死亡亚组。比较存活组与全因死亡组、存活组与心力衰竭死亡亚组和非心源性死亡亚组甲状腺激素〔T3、FT3、甲状腺素（T4）、游离甲状腺素（FT4）、促甲状腺激素（TSH）〕、B型脑钠肽（BNP）、左心室射血分数（LVEF）。比较ESS组和甲功正常组患者心力衰竭再入院率、心力衰竭死亡率、全因死亡率,并绘制生存分析曲线;采用Cox回归分析探究CHF患者发生心力衰竭死亡、全因死亡的影响因素。结果　CHF患者中ESS组164例,甲功正常组140例。两组患者美国纽约心脏病协会（NYHA）分级比较,差异有统计学意义（P<0.05）;ESS组患者T3、FT3、FT4、TSH、ALB、Hb水平及LVEF低于甲功正常组,BNP、C反应蛋白（CRP）、肌酐水平高于甲功正常组（P<0.05）。中位随访时间25.7（14.2）月,发现全因死亡46例（因心力衰竭死亡32例、非心源性死亡14例）,存活258例（出现至少1次因心力衰竭再入院115例）。全因死亡组及心力衰竭死亡亚组患者T3、FT3水平及LVEF低于存活组,BNP水平高于存活组（P<0.05）。ESS组患者心力衰竭再入院率、心力衰竭死亡率、全因死亡率高于甲功正常组（P<0.05）。经Kaplan-Meier法分析结果显示：ESS组心力衰竭死亡率、全因死亡率均高于甲功正常组（P<0.016）。Cox回归分析结果显示,年龄〔HR=1.056,95%CI（1.009,1.105）〕、FT3〔HR=0.564,95%CI（0.325,0.976）〕、Hb〔HR=0.955,95%CI（0.932,0.980）〕、LVEF〔HR=0.980,95%CI（0.961,1.000）〕是CHF患者发生心力衰竭死亡的影响因素（P<0.05）;年龄〔HR=1.055,95%CI（1.019,1.093）〕、Hb〔HR=0.964,95%CI（0.944,0.984）〕、LVEF〔HR=0.979,95%CI（0.963,0.994）〕是CHF患者发生全因死亡的影响因素（P<0.05）。结论　CHF伴ESS患者肾功能、肝功能情况较差,且心力衰竭死亡率、全因死亡率高于单纯CHF患者,远期预后较差,而T3、FT3可以反映CHF患者病情严重程度及预后情况。     

PCI术前应用IABP辅助治疗对于急性心肌梗死患者临床疗效的系统评价

目的 评价行经皮冠脉介入治疗(PCI)之前应用主动脉球囊反搏(IABP)辅助治疗对于急性心肌梗死(AMI)患者的近远期临床疗效.方法 通过检索PubMed、The Cochrane library、Medline、Embase、CBM、中国知网期刊数据库(CNKI)、万方、维普等数据库,获取自2000年1月到2015年10月所有发表的有关急性心肌梗死患者在行PCI之前应用IABP辅助治疗的临床随机对照试验的相关文献,按照纳入和排除标准提取文献数据,采用Review Manager5.3软件进行荟萃分析,采用漏斗图检验发表偏倚.结果 共纳入7项研究,样本量1107例,行PCI之前应用IABP不能改善AMI患者30 d及6个月的全因死亡率(RR 0.74,95％ CI 0.40-1.36,P＞0.05;RR 0.77,95％ CI 0.40-1.48,P＞0.05);不能增加术后TIMI血流3级的人数(RR 1.03,95％ CI0.90-1.18,P＞0.05);但可减少30 d内的主要不良心血管事件(MACE)发生率,差异有显著性意义(RR 0.42,95％ CI 0.29-0.62,P＜0.05),出血事件发生率无显著增加(RR 2.11,95％ CI 0.95-4.70,P＞0.05).亚组分析结果显示:早期运用IABP不能有效降低AMI合并心源性休克患者的全因死亡率(RR 0.97,95％ CI 0.52-1.82,P＞0.05),但可以减少不合并心源性休克患者的全因死亡率(RR 0.40,95％CI 0.18-0.85,P＜0.05).结论 对于急性心肌梗死患者在行PCI术前应用IABP可以显著减少MACE事件的发生,但不能显著降低术后30d、6个月的死亡率.     

血清胱抑素C在慢性心力衰竭患者心功能评价中的应用

目的：探讨血清胱抑素C（CysC）水平的变化对慢性心力衰竭（CHF）患者临床心功能变化评价的临床意义。方法：选取CHF组80例,健康体检正常者（对照组）30名。心力衰竭程度按纽约心脏病协会心功能分级法,采用免疫比浊法测定各组血清CysC水平,并采用超声心动图测定左心室射血分数及左心室舒张末内径评价患者左心室功能,同时记录住院期间及出院6个月内患者的病死率和因CHF再次发作住院率。结果：CHF组患者血清CysC水平显著高于对照组（P〈0．01）,且随着心功能分级的增高,血清CysC水平也逐渐升高（P〈0．01）。患者血清CysC水平与左心室舒张末内径呈正相关关系（P〈0．05）,与左心室射血分数呈负相关关系（P〈0．05）。高、低血清CysC组中患者住院期间病死率差异无统计学意义（P〉0．05）,高血清CysC组出院6个月病死率及因心力衰竭再住院率均升高（P〈0．05）。结论：CysC对于评价CHF患者临床心功能变化及评估预后具有一定意义。     

Long-term prognostic value of analysis of sympathetic drive by myocardial 123I-metaiodobenzylganidine scintigraphy in chronic heart failure

Background The over increase of sympathetic drive in chronic heart failure （CHF） is with main responsibility for the deterioration and mortality of the disease.Myocardial 123I-metaiodobenzylganidine （MIBG） scintigraphy is a non-invasive convenient method to assess sympathetic dysfunction in patients with CHF.The aim of the study was to detect if sympathetic antidrive analysed through myocardial MIBG scintigraphy plays a crucial role in long-term prognosis in CHF.Methods Sixty-four enrolled patients underwent myocardial MIBG scintigraphy, and their plasma concentration of brain natriuretic peptide （BNP）, myocardial contractile reserve （MCR）, rest left ventricular ejection fraction （rest LVEF）and New York Heart Association （NYHA） function class were assessed.They were separated into groups according to median of above parameters.Endpoint was cardiac death and it was recorded in each group during average 54 months＇ follow-up.Results At the end of follow-up, group with lower ratio of heart/mediastinum （H/M） had more death events （P=0.001）,and its BNP level was higher and MCR level was lower （P=0.003 and 0.001, respectively）; but its rest LVEF and NYHA function class were not significantly different.H/M, MCR and BNP correlated closely with death （P=0.000, 0.000 and 0.001, respectively）.Among the three indicators the death risk ratio （RR） of H/M was 4.66, more than MCR and BNP （1.88 and 2.56, respectively）.However, rest LVEF and NYHA function class did not correlate with death （P=0.652 and 0.384, respectively）.The group with lower H/M and MCR, higher BNP had much more death than that with higher H/M and MCR, lower BNP, the RR being 12.8.Conclusions Myocardial MIBG scintigraphy is a long-term prognostic marker in CHF.BNP, MCR are also excellent predictors of long-term prognosis in CHF, but not stronger than myocardial MIBG scintigraphy.If the three indicators were joined together, the prediction would become most powerful.Rest LVEF and NYHA have no significance in long-term prediction of CHF.     

Surgery for left ventricular aneurysm after myocardial infarction: techniques selection and results assessment

Background  The most appropriate surgical approach for patients with post-infarction left ventricular (LV) aneurysm remains undetermined. We compared the efficacy of the linear versus patch repair techniques, and investigated the mid-term changes of LV geometry and cardiac function, for repair of LV aneurysms.

Methods  We reviewed the records of 194 patients who had surgery for a post-infarction LV aneurysm between 1998 and 2010. Short-term and mid-term outcomes, including complications, cardiac function and mortality, were assessed. LV end-diastolic and systolic dimensions (LVEDD and LVESD), LV end-diastolic and end-systolic volume indexes (LVEDVI and LVESVI) and LV ejection fraction (LVEF) were measured on pre-operative and follow-up echocardiography.

Results  Overall in-hospital mortality was 4.12%, and major morbidity showed no significant differences between the two groups. Multivariate analysis identified preoperative left ventricular end diastolic pressure >20 mmHg, low cardiac output and aortic clamping time >2 hours as risk factors for early mortality. Follow-up revealed that LVEF improved from 37% pre-operation to 45% 12 months post-operation in the patch group (P=0.008), and from 44% pre-operation to 40% 12 months postoperation in the linear group (P=0.032). In contrast, the LVEDVI and LVESVI in the linear group were significantly reduced immediately after the operation, and increased again at follow-up. However, in the patch group, the LVEDVI and LVESVI were significantly reduced at follow-up. And there were significant differences in the correct value changes of LVEF and left ventricular remodeling between linear repair and patch groups.

Conclusions  Persistent reduction of LV dimensions after the patch repair procedure seems to be a procedure-related problem. The choice of the technique should be tailored on an individual basis and surgeon’s preference. The patch remodeling technique results in a better LVEF improvement, further significant reductions in LV dimensions and volumes than does the linear repair technique. The results suggest that LV patch remodeling is a better surgical choice for patients with post-infarction LV aneurysm.

     

Risk factors and risk index of cardiac events in pregnant women with heart disease

Background  Pregnant women with heart disease are at high risk. Studies of risk factors of these patients are of great significance to improve maternal and fetal outcomes. In this paper, we try to discuss the main risk factors of cardiac events in pregnant women with heart disease and to establish a risk assessment system.

Methods  A retrospective analysis was carried out for pregnancies in 1741 women with heart disease who delivered in Shanghai Obstetrical Cardiology Intensive Care Center between January 1993 and September 2010. A Logistic regression model was used to identify independent risk factors of cardiac events and calculate the risk index in pregnant women with heart disease.

Results  The composition of heart disease in pregnant women was arrhythmia (n=662, 38.00%), congenital heart disease (CHD; n=529, 30.40%), cardiomyopathy (n=327, 18.80%), rheumatic heart disease (RHD; n=151, 8.70%), and cardiopathy induced by pre-eclampsia (n=53, 3.00%). Main cardiac events were heart failure (n=110, 6.32%), symptomatic arrhythmia needing medication (n=43, 2.47%), cardiac arrest (n=2, 0.11%), syncope (n=3, 0.17%), and maternal death (n=10, 0.57%). Six independent risk factors to predict cardiac events in pregnant women with heart disease were cardiac events before pregnancy (heart failure, severe arrhythmia, cardiac shock, etc., P=0.000), New York Heart Association (NYHA) class >II (P=0.000), oxygen saturation <90% (P=0.018), pulmonary artery hypertention (PAH) >50 mmHg (P=0.025), cyanotic heart disease without surgical correction (P=0.015), and reduced left ventricular systolic function (ejection fraction <40%, P=0.003). Every risk factor was calculated as 1 score. The incidence of cardiac events in patients with scores 0, 1, 2, 3, and ≥4 was 2.10%, 31.61%, 61.25%, 68.97%, and 100.00% respectively.

Conclusions  Pregnancy with heart disease could lead to undesirable pregnancy outcomes. The risk of cardiac events in pregnant women with heart disease could be assessed by risk index.

     

慢性充血性心力衰竭患者心功能与血清尿酸水平相关性研究

目的研究慢性充血性心力衰竭(CHF)患者心功能与血清尿酸水平的相关性。方法选取2010年1月至2011年12月在北京顺义区医院住院的CHF患者212例(按美国纽约心脏病协会心功能分级为Ⅱ、Ⅲ、Ⅳ级)与同期在该院体检的126例健康者(对照组)的血清尿酸、左心室舒张末期内径(LVEDd)、左心室射血分数(LVEF)指标进行分析研究。结果 CHF患者的血清尿酸水平显著高于对照组(P<0.01),随CHF心功能分级的增加,血清尿酸水平显著增加(P<0.01);LVEF与血清尿酸水平呈负相关(r=-0.685,P<0.01);LVEDd与血清尿酸水平呈正相关(r=0.552,P<0.01)。结论 CHF患者的心功能与血清尿酸水平呈显著相关,CHF程度越重,血清尿酸水平越高。     

慢性心力衰竭患者血清转化生长因子-β_1和结缔组织生长因子水平与心功能关系

目的观察慢性心力衰竭(CHF)患者血清转化生长因子-β1(TGF-β1)和结缔组织生长因子(CTGF)的变化及与心功能相关性。方法收集105例CHF患者为CHF组,以68例健康查体者为健康对照组。检测血清TGF-β_1、CTGF水平及左心室射血分数(LVEF)、左心室质量指数(LVMI)变化,进行相关分析。结果 CHF患者血清TGF-β_1、CTGF均显著高于健康对照组(P均<0.01);TGF-β_1、CTGF升高与心力衰竭严重程度相平行;TGF-β_1、CTGF均与LVEF呈负相关(r=-0.638,P<0.01;r=-0.743,P<0.01),与LVMI(r=0.630,P<0.01;r=0.748,P<0.01)、心功能分级(r=0.647,P<0.01;r=0.753,P<0.01)呈正相关。结论血清TGF-β_1、CTGF共同参与了CHF的病理生理过程;血清CTGF水平可作为诊断及判断心力衰竭严重程度的生物学指标。     

慢性心力衰竭患者血浆N末端脑钠肽前体和血清胱抑素C的水平及意义

目的分析慢性心力衰竭（心衰）患者血浆N末端脑钠肽前体（NT-proBNP）、血清胱抑素C（CysC）水平及心功能与肾功能的相互关系,进一步探讨CysC在心衰患者早期肾脏损害的诊断价值。方法检测162例慢性心衰患者（心衰组）、150例健康体检者（对照组）的血浆NT—proBNP、CysC水平,同时查血清尿素氮、肌酐及超声心动图,用简化的肾病饮食改良方程计算肾小球滤过率（eGFR）。结果心衰组NT．proBNP、CysC、血肌酐、尿素氮水平及左室舒张末期内径均高于对照组,而左室射血分数、eGFR低于对照组（P〈0．05或〈0．01）,合并肾功能异常的比例明显高于对照组（P〈0．01）。心衰组心功能NYHA分级Ⅱ、Ⅲ、Ⅳ级各组NT—proBNP、CysC水平均高于对照组,左室射血分数低于对照组;NYHA分级各组间两两比较NT—proBNP、CysC差异均有统计学意义（P〈0．05）。NT—proBNP、CysC水平与左室射血分数呈负相关（r=-0．36,P〈0．01;r=-0．39,P〈0．01）;CysC、NT-proBNP呈显著正相关（r=0．87,P〈0．01）。Logistic回归分析示,NT—proBNP、CysC水平升高是慢性心衰患者住院期间死亡的危险因素。结论慢性心衰患者更易合并肾功能异常,主要表现为肾小球滤过功能受损;心衰程度愈重,肾功能损害愈明显;NT-proBNP、CysC可作为评价慢性心衰患者病情加重的指标,CysC可用于慢性心衰患者早期肾脏损害诊断。     

不同QRS时限心力衰竭患者左心室收缩不同步的实时三维斑点追踪成像研究

目的 应用实时三维斑点追踪成像（RT-3 DSTI）技术分析QRS时限增宽及正常的慢性心力衰竭（CHF）患者左心室收缩不同步性.方法 研究对象包括CHF患者61例（其中31例QRS＜ 120ms为CHF1组,30例QRS≥120ms为CHF2组）和正常对照组53例.分别进行RT-3 DSTI分析,测量经心动周期标化的左心室16节段心内膜面积、径向、圆周及纵向应变达峰时间标准差（Tsas-SD％、Tsrs-SD％、Tscs-SD％及Tsls-SD％）,分别计算左心室16节段中任意两节段心内膜面积、径向、圆周及纵向应变达峰时间的最大差值（Tsas-diff、Tsrs-diff、Tscs-diff、Tsls-diff）.结果 与对照组相比,CHF1和CHF2组的Tsas-SD％、Tsrs-SD％、Tscs-SD％、Tsls-SD％及Tsas-diff、Tsrs-diff、Tscs-diff、Tsls-diff均增大,其中除CHF1组的Tsls-diff外,其余各项指标的测值与对照组比较均有统计学差异（P＜0.01）.与CHF1组相比,CHF2组的心内膜面积、径向、圆周及纵向应变不同步指标均增大,差异均有统计学意义（P＜0.05）.结论 QRS时限正常的慢性心力衰竭患者也存在左心肌收缩不同步,但程度轻于QRS时限增宽的心力衰竭患者.RT-3DSTI为临床准确评价心力衰竭患者心肌收缩不同步提供了一种新的有效方法.     

B-型钠尿肽在慢性充血性心力衰竭诊疗中的临床应用

目的研究慢性充血性心力衰竭患者血浆B-型钠尿肽水平的变化及其与心功能状态、心脏结构的关系,探讨其用于慢性充血性心力衰竭诊断价值。方法按美国NYHA心功能分级标准,随机抽取心功能Ⅱ级、Ⅲ级、Ⅳ级内科住院患者共96例,先测定血浆BNP的含量,待慢性充血性心力衰竭患者经治疗症状缓解后同法测上述指标,并进行数据分析;心脏彩色多普勒超声诊断仪测量左室结构和功能。结果不同心功能分级患者的血浆BNP水平差异具统计学意义,经抗心衰治疗后,患者心衰症状缓解,BNP含量下降,BNP的变化有统计学意义。血浆BNP水平和LVEF呈负相关（γ=-0．37,P〈0．05）,与左室舒张末期内径（LVEDD）呈正相关（γ=0．36,P〈0．05）。结论血浆BNP水平和心脏结构相关,是慢性充血性心力衰竭诊断、治疗疗效评价的敏感指标。     

慢性心衰抗凝干预对心电图、凝血功能的影响

目的研究慢性心衰(CHF)抗凝干预对心电图、凝血功能的影响,记录1年随访观察结果。方法选取我院2012年4月至2014年10月心内科收治的76例CHF患者,随机分为2组。其中对照组38例按照CHF治疗指南给予抗心衰常规治疗,主要包括利尿剂、血管紧张素转换酶抑制剂或血管紧张素受体拮抗剂等,观察组38例在对照组基础上口服抗凝药物华法林维持治疗。分别于治疗3个月后、治疗6个月后动态观察如下指标:1两组临床疗效;2超声心电图心功能指标[左心室舒张末内径(LVEDD)、左室射血分数(LVEF)]变化;3凝血功能相关指标[血浆组织因子(TF)活性、组织因子途径抑制物(TFPI)活性、D二聚体水平]。随访1年观察两组死亡率和再入院率。结果 1两组治疗3个月总有效率无显著差异(P0.05),治疗6个月观察组总有效率94.74%较对照组78.95%高,差异显著(P0.05);2两组治疗3个月、治疗6个月LVEDD相较无显著差异(P0.05),但观察组LVEF治疗3个月(42.8±4.5)%、治疗6个月(44.3±5.1)%分别较对照组(39.1±5.2)%、(40.6±5.3)%高,差异显著(P0.05);3观察组治疗3个月、6个月TF活性、D二聚体水平分别较对照组低,治疗6个月TF活性较对照组低,均差异显著(P0.05);4随访1年结果显示两组死亡率无显著差异(P0.05),但观察组因心力衰竭、出血事件等再入院率21.05%较对照组44.44%低(P0.05)。结论 CHF患者常规治疗基础上给予抗凝干预有助于提高临床疗效,心电图动态观察显示心功能恢复效果明显,血液高凝状态得到显著改善,有利于降低再入院率。     

早期他汀药物治疗与非缺血性扩张性心肌病患者病死率关系的研究

目的 探讨早期脂溶性他汀药物(阿托伐他汀和辛伐他汀)治疗与非缺血性扩张性心肌病患者病死率的关系.方法 本研究为单中心回顾性研究,入选了2002年1月至2008年12月在北京安贞医院住院治疗的非缺血性扩张性心肌病患者315例,比较患者初次入院期间应用他汀药物组(辛伐他汀20 mg/d或阿托伐他汀10～20 mg/d)和未应用他汀药物治疗组随访全因病死率,中位随访时间为45.1个月.结果 他汀组58例,未用他汀组257例,单因素分析,应用他汀组随访病死率为17.2%,显著低于未应用他汀治疗组37.4%(P=0.003);心功能NYHA Ⅲ～Ⅳ患者中,他汀组的病死率为17.2%,非他汀组病死率高达47.4%,两组差异有统计学意义(P=0.003);心功能NYHA Ⅰ～Ⅱ级患者中,两组随访病死率差异无统计学意义.多因素分析,在校正了年龄、性别、高血压史、糖尿病史、当前吸烟、血脂、左室射血分数、NYHA心功能分级及是否使用血管紧张素转换酶抑制剂(ACEI)、β受体阻滞剂、醛固酮、其他利尿剂、地高辛和钙离子拮抗剂,总研究人群中他汀组的死亡相对危险度(RR)为0.352(95% CI0.135～0.920,P=0.033),心功能NYHA Ⅲ～Ⅳ患者中他汀组的死亡RR为0.250(95% CI 0.081～0.778,P=0.017).结论 早期阿托伐他汀或辛伐他汀药物治疗与非缺血性扩张性心肌病患者的病死率降低密切相关,特别是中重度心功能不全患者的病死率降低,而这种相关是独立于他汀药物的降脂作用及ACEI、β受体阻滞剂等目前心衰治疗基石作用的.     

SERUM CONCENTRATIONS OF HYALURONIC ACID, PROCOLLAGEN TYPE Ⅲ NH2-TERMINAL PEPTIDE, AND LAMININ IN PATIENTS WITH CHRONIC CONGESTIVE HEART FAILURE

OBJECTIVE: To explore the role of serum fibrotic indices including hyaluronic acid (HA), procollagen type III NH2 -terminal peptide (PCIIIP), and laminin (LN) in assessing the severity of myocardial fibrosis in chronic congestive heart failure (CHF). METHODS: Serum levels of HA, PCIIIP, and LN in 39 patients with CHF [14 with New York Heart Association (NYHA) functional class II, 21 with class III, 4 with class IV] and in 46 patients with NYHA functional class I were assessed by radioimmunoassay. RESULTS: The serum concentrations of HA, PCIIIP, and LN were 359.75 +/- 84.59 microg/L, 77.88 +/- 24.67 microg/L, 86.73 +/- 23.90 microg/L in CHF group, and 211.60 +/- 54. 80 microg/L, 64.82 +/- 23.99 microg/L, 82.26 +/- 23.98 microg/L in NYHA functional class I group, respectively. The HA level was significantly higher in CHF patients as compared with NYHA functional class I group (P < 0.05). However, no difference was found in the levels of PCIIIP and LN between CHF group and NYHA functional class I group. The serum HA concentration was negatively correlated with left ventricular ejection fraction (r = - 0.71, P < 0.05). CONCLUSION: Serum HA level may act as an indicator for myocardial fibrosis.