组织多普勒成像评价扩张型心肌病患者主动脉弹性的研究

目的应用组织多普勒成像(tissue Doppler imaging,TDI)技术测量扩张型心肌病(dilated cardiomyopathy,DCM)患者升主动脉近端壁运动速度,探讨TDI技术评价主动脉弹性变化的应用价值。方法选取DCM患者33例,正常志愿者30例。所有受试者肱动脉测量血压后,连接心电图,M型超声分别测量升主动脉瓣上3cm处收缩期和舒张期内径,利用公式计算主动脉膨胀性(D)和僵硬度(β);转入组织速度成像(tissue velocity imaging,TVI)模式,在组织-速度曲线上测量升主动脉同处前壁的运动速度(Sao,Eao,Aao)、加速前时间、扩张加速度。结果DCM组与对照组比较升主动脉前壁S波运动速度(4.40±0.69)cm/s vs(6.45±1.29)cm/s(P<0.01)降低,僵硬度指数(3.38±0.72)vs(1.83±0.47)(P<0.05)增高,膨胀度(0.70±0.18)cm2/dynes vs(1.24±0.32)cm2/dynes(P<0.01)降低,差异均有统计学意义。DCM组升主动脉前壁S波速度和僵硬度呈明显负相关(r=-0.68,P<0.01),与膨胀性呈正相关(r=0.39,P<0.05);对照组升主动脉前壁S波速度和僵硬度呈明显负相关(r=-0.69,P<0.01),与膨胀性呈明显正相关(r=0.60,P<0.01)。结论DCM患者主动脉弹性功能受损;利用TDI技术直接测量主动脉壁的运动速度可以评价主动脉的弹性特征。TDI技术评价大动脉弹性具有直接、简单、误差相对较少等优点。     

二维斑点追踪成像评价胸主动脉腔内修复术后升主动脉纵向应变

目的 观察胸主动脉腔内修复术(TEVAR)后升主动脉纵向应变(LS)变化。方法 回顾性分析82例以TEVAR作为一线治疗的胸主动脉疾病患者,根据术前升主动脉收缩末期内径(AoS)≥35 mm或<35 mm分为A组(n=37)及B组(n=45),以20名健康人作为对照组。比较组间基本资料差异,测量A、B组术前、术后及对照组AoS和舒张末期内径(AoD),计算升主动脉应变(Aortic Strain)及动脉硬化指数β。以二维斑点追踪成像(2D-STE)获取升主动脉前、后壁LS(LS-AW/PW),将其均值记为平均LS(LS_mean)。采用偏相关分析评价各指标间相关性。结果 A组收缩压(SBP)、脉压(PP)均高于对照组(P均<0.05);B组PP高于对照组(P<0.05);A组PP及吸烟史比例均高于B组(P均<0.05)。3组间AoD、AoS、Aortic Strain及β差异均有统计学意义(P均<0.05)。A组及B组LS-AW、LS_mean均较对照组降低(P均<0.05);A组LS-PW较对照组降低(P&l...     

Alternans of blood pressure and heart rate in dilated cardiomyopathy

Impaired myocardial performance is known to be associated with electrical and mechanical beat-to-beat alternans phenomena. The alternans in blood pressure and heart rate and their interdependency in idiopathic dilated cardiomyopathy (IDC) were studied. The arterial blood pressure and the electrocardiograph (ECG) were continuously recorded in 22 patients suffering from IDC (age 49 +/- 13 years, ejection fraction 0.33 +/- 0.13, left ventricular diameter of 67 +/- 8 mm) and in 21 healthy controls (age 52 +/- 15 years). The beat-to-beat variations of the interbeat intervals (IBI) and of the blood pressure amplitudes (AMP) were measured. An alternans beat was defined as a beat preceded and followed by beats that had higher or lower values in the respective modality. The percentages of singular and repetitive alternans patterns, and the interdependency of the alternans patterns in AMP and IBI were assessed. The study found significantly more singular and repetitive alternans patterns in the IDC group compared to the control group both in the analysis of AMP and IBI (singular alternans in IBI: 55 +/- 11 vs 47 +/- 7%, P < 0.01; singular alternans in AMP: 61 +/- 15 vs 45 +/- 6%, P < 0.01; triple alternans in IBI: 29 +/- 18 vs 16 +/- 9%, P < 0.01; triple alternans in AMP: 34 +/- 24 vs 12 +/- 7%, P < 0.01). The amplitudes of the AMP alternans patterns were higher in IDC compared to controls (9 +/- 7 vs 4 +/- 2% of AMP, P = 0.01) whereas they did not differ in IBI. The correlation analysis revealed a significant interdependency of the alternans pattern in IBI and AMP in 18 of 22 IDC patients and in 12 of 21 controls (r = 0.50 +/- 0.21 [IDC]; r = 0.26 +/- 0.05 [controls]). The slope of the linear regression (delta AMP vs delta IBI) was steeper in the IDC group compared to the control group (62 +/- 50 vs 20 +/- 22 mmHg/s, P < 0.01). The percentages of alternans patterns appearing in IBI and AMP were positively correlated to the left ventricular diameter (r = 0.70 in the IBI, and r = 0.30 in the AMP). The blood pressure amplitude and the heart rate did not differ between the two groups. Patients suffering from IDC have a higher prevalence, stability, amplitude, and interdependency of alternans patterns in IBI and AMP compared to the control group. The amount of alternans patterns indicates the stage of disease. The alternans analysis may have impact on the functional assessment of patients suffering from heart failure.     

神经阻滞疗法治疗扩张型心肌病的临床观察

目的：探讨神经阻滞疗法对扩张型心肌病的疗效。方法：32例扩张型心肌病随机分为两组，每组16例。治疗组用常规治疗心力衰竭的方案加神经阻滞疗法，连用2周，对照组单用常规治疗心力衰竭的方案治疗2周。结果：治疗组显效率63％，总有效率94％，对照组显效率25％，总有效率56％，两组对比，总有效率有显著差异(P＜0．025)。治疗组在编小左室内径和提高左室射血分数方面明显优于对照组。结论：神经阻滞疗法是治疗扩张型心肌病的有效方法。     

Ventricular fibrillation in two cases with dilated cardiomyopathy and mechanical alternans

Clinical implication of mechanical alternans is yet unclear. It may suggest the risk for sudden death in patients with chronic heart failure. Two cases with dilated cardiomyopathy showed mechanical alternans during diagnostic cardiac catheterization. They suddenly died due to ventricular fibrillation before the induction of beta-blocker therapy. Patients with mechanical alternans should be treated under intense monitoring until the induction of beta-blocker therapy.     

A case with coarctation of the aorta accompanied by coronary ectasia and dilatation of the ascending aorta

Coarctation of the aorta is one of the congenital heart diseases diagnosed primarily in childhood and early adolescence. A 67-year-old female was admitted to the hospital with chest pain. Angiography revealed a coarctation of the aorta, coronary ectasia and dilatation of the ascending aorta. This case attracted our attention because the first diagnosis was made at such an advanced age and coarctation was accompanied by coronary ectasia and dilatation of the ascending aorta. Therefore, we decided to report the case.     

靶剂量开搏通、倍他乐克在扩张型心肌病合并充血性心力衰竭治疗中的疗效评价

目的：评价靶剂量开搏通和倍他乐克治疗扩张型心肌病合并充血性心力衰竭的疗效和安全性。方法：选择75例扩张型心肌病合并充血性心力衰竭患者，分为三组，每组25例，分别予以靶剂量开搏通、倍他乐克、开搏通联合倍他乐克治疗，观察治疗前与治疗后6～12个月、24-36个月的疗效。结果：每组治疗后6～12个月、24-36个月较治疗前均有疗效差异。但三组间疗效差异无统计学意义（P〉0．05）。结论：开搏通、倍他乐克、开搏通联合倍他乐克能明显改善扩张型心肌病充血性心力衰竭患者的心功能，安全有效。     

Amplified effects of d,l-sotalol in canine dilated cardiomyopathy

Despite the presence of well-described cardiac repolarization abnormalities in heart failure, d,l-sotalol effects on cardiac repolarization have not been evaluated in animal models of CHF. The authors hypothesized that the d,l-sotalol effects on cardiac repolarization are altered in canine dilated cardiomyopathy when compared to controls. Effects of d,l-sotalol were compared in seven dogs with tachycardia induced cardiomyopathy (CHF) and six control animals. In an open-chest model, contact monophasic action potential recordings were obtained from RV and LV endocardium/epicardium during and after two doses of d,l-sotalol (1 mg/kg and 3 mg/kg, each over 20 minutes). Effects of d,l-sotalol on action potential duration at 90% repolarization (APD90) were examined at pacing cycle lengths of 300-1,000 ms. Plasma d,l-sotalol levels were measured at baseline, 10, and 40 minutes following each dose. Prolongation of APD90 by d,l-sotalol, was significantly exaggerated in CHF animals versus controls (P < 0.05, ANOVA). These differences were magnified at slow heart rates (P < 0.05, ANOVA). There were no significant differences in plasma d,l-sotalol levels between the two groups. Effects of d,l-sotalol on cardiac repolarization are exaggerated in CHF without significant alterations in plasma drug levels. While using d,l-sotalol in heart failure, independent additional effects due to ventricular electrical remodeling may be a consideration.     

间隔q波在老年慢性心力衰竭患者预后中的意义

目的　探讨间隔 q波在老年慢性心力衰竭 (chronicheartfailure ,CHF)患者预后中的意义。 方法　 10 2例心功能 (NYHA分级 )Ⅱ Ⅳ级和左室射血分数 <4 5 %的老年慢性心力衰竭患者纳入研究。根据标准 12导联心电图(ECG)在I,aVL ,V5,V6导联上有或无间隔 q波分组。平均随访 4年 ,研究终点为病死率。 结果　 10 2例CHF患者中有间隔 q波 37例 ;无间隔 q波 6 5例。总病死率39.2 % (n =4 0 )。无间隔 q波组CHF患者病死率5 2 .3% (n =34) ;有间隔 q波组CHF患者中有病死率16 .2 % (n =6 )。无间隔 q波组CHF患者病死率显著高于有间隔 q波组 (χ2 =12 .885 ,P <0 .0 0 1)。Cox多变量分析无间隔q波是预测老年CHF患者病死率的指标 (P =0 .0 0 3,危险率 2 .8,95 %CI 1.2 16～ 5 .6 84 )。结论　标准 12导联ECG无间隔 q波是CHF患者不良预后独立的预测指标 ,提示心脏结构性病变和心肌纤维化。     

Three-dimensional cross-sectional velocity distribution in the ascending aorta in cardiac patients

Summary. Knowledge of the distribution of velocities across the ascending aorta is important for measurements of cardiac output; for understanding the function of normal and diseased valves and for the evaluation of prosthetic valves. The aim of this study was to investigate, in detail, the spatial distribution of axial velocities in the human ascending aorta, covering a nearly complete cross-section of the lumen in a time continuous modus. During open-heart surgery, blood velocities in the ascending aorta were mapped in 10 patients. All patients had aortic valves with no significant clinical evidence of disease. Pulsed Doppler ultrasound technique was used to measure blood velocity using an intraluminal probe with a 1 mm, 10 MHz crystal connected to a position-sensitive device. The distribution of blood velocity in the aorta 6–8 cm above the valve was characterized by a skewed and irregular peak systolic flow, with maximum velocity posteriorly. There was a positive correlation (n=0.854, P < 0.002) between the maximum skewness slope and the stroke volume. Significant retrograde flow was recorded in all patients in the left posterior part of aorta in late systole and early diastole. The rotation of the point of maximal velocity was anticlockwise in six patients, clockwise in three and alternating in one. The present study shows that there is a considerable individual variation in the velocity distribution in the ascending aorta, with no plane symmetric features, and that large sampling volumes are required for reliable estimates of mean velocity.     

Anomalous origin of one pulmonary artery from the ascending aorta (hemitruncus) in a premature infant: A case report and literature review

Anomalous origin of one pulmonary artery from the aorta (AOPA) is a rare congenital anomaly. Here, we report the case of a premature infant with a delayed diagnosis of AOPA who died before surgical repair could be attempted, and we review the literature regarding the diagnosis and surgical approaches in premature infants with AOPA. © 2013 Wiley Periodicals, Inc. J Clin Ultrasound 42 :367–370, 2014     

主动脉夹层病人行升主动脉及全弓置换和远端支架系统植入术的手术配合

[目的]总结主动脉夹层病人行升主动脉及全弓置换和远端支架系统植入术的手术配合措施。[方法]对7例主动脉夹层病人行升主动脉及全弓置换和远端支架系统植入术,同时加强手术配合。[结果]本组病人均顺利手术,术后恢复良好,痊愈出院。[结论]加强手术配合是保证主动脉夹层病人手术成功的关键。     

The effect of a repeated immunoadsorption in patients with dilated cardiomyopathy after recurrence of severe heart failure symptoms

Background : In patients suffering from dilated cardiomyopathy (DCM), immunoadsorption with subsequent IgG substitution (IA/IgG) leads to an acute and prolonged improvement of hemodynamics and heart failure symptoms. However, some patients receiving IA/IgG experience recurrence of heart failure after an initial benefit. The aim of this study was to investigate whether a second IA/IgG treatment episode improves left ventricular systolic function and further mitigates heart failure symptoms in these patients. Methods : We retrospectively analyzed 15 DCM patients who experienced a significant improvement of LVEF (≥ 5% absolute or ≥ 20% relative) and heart failure symptoms (≥ 1 NYHA functional class) but a subsequent deterioration (decline in LVEF ≥ 5% absolute or ≥ 20% relative and NYHA worsening ≥1 class) after the first IA/IgG. These patients underwent a second IA/IgG treatment 41.7 ± 27.4 months after the first cycle. Follow up data were acquired 3–6 months after both IA/IgG treatments. Results : The first IA/IgG induced an improvement of LVEF from 33 ± 6.4% to 43.2 ± 7.9% (P < 0.001) and of mean NYHA functional class from 2.9 ± 0.26 to 1.8 ± 0.56 (P < 0.001). The second treatment was associated with a significant improvement in LVEF (from 29.7 ± 4.6% to 34.9 ± 8.3%, P = 0.013) and NYHA functional class (2.87 ± 0.64 to 2.33 ± 0.72; P = 0.02). This improvement was less pronounced compared to the first treatment with respect to both, LVEF (P = 0.09) and NYHA improvement (P = 0.04). Conclusion: In DCM patients, who experience a significant improvement of LVEF and heart failure symptoms after IA/IgG but a subsequent relapse during follow up, repeated IA/IgG may be considered. J. Clin. Apheresis 30:217–223, 2015. © 2014 Wiley Periodicals, Inc.     

Energetics and function of the failing human heart with dilated or hypertrophic cardiomyopathy

BACKGROUND: Impaired energy metabolism in the failing human heart could be an important mechanism of functional deterioration. The purpose of this study was to assess the changes of myocardial energy metabolism in the human heart at end-stage heart failure. MATERIALS AND METHODS: The left ventricular myocardium of patients undergoing heart transplantation due to dilated (DCM, n = 14) or hypertrophic cardiomyopathy (HCM, n = 5) and non-diseased donor heart samples (n = 4) were analysed for citrate synthase (CS), enzymes of the glycolytic pathway as well as concentrations of phosphocreatine (PCr), creatine (Cr), adenine and guanine nucleotides. RESULTS: Total creatine levels (phosphocreatine + creatine) were significantly decreased (P < 0.05) in both groups of diseased hearts (3.87 +/- 0.57 in DCM, 5.09 +/- 1.23 in HCM compared with control 10. 7 +/- 3.5 micromol g-1 wet weight). There was a trend for higher guanine nucleotide content in failing hearts, but no significant differences were observed in total adenine nucleotides and total NAD content. CS was markedly reduced (P < 0.05) in both groups of diseased hearts: in the DCM to 13.8 +/- 1.3 micromol min-1 g-1 wet weight, and in HCM to 11.9 +/- 2.4 compared with the control 29.2 +/- 2.2. Glycolytic enzymes were decreased compared with the control, and this decrease was greater in DCM than in HCM. Echocardiographic indices of contractility were considerably better in hypertrophic cardiomyopathy. CONCLUSION: Despite the different mechanisms of cardiac failure and the differences in contractility of the heart we have observed, metabolic changes are very similar in hypertrophic and dilated cardiomyopathy. Depletion of the creatine pool suggests an alteration in the intracellular energy reserves and transfer, whereas the decrease in citrate synthase activity suggests reduced oxidative capacity in both dilated and hypertrophic cardiomyopathy.     

Morphology of the ascending aorta: a study on 114 Chinese patients

Purpose: This study aimed to investigate the morphological characteristics of ascending aortic dissection in detail.Materials and Methods: The ascending aorta was morphologically assessed in a consecutive series of patients between January 2009 and October 2014. A new assessment and evaluation method was used to describe 114 patients with ascending aortic dissection.Results: A large difference was found in the degree of curvature between the ascending aorta with and without dissection. The shape of the former was straighter and steeper (control group R, 47.46 ± 6.40 mm; experimental group R, 59.70 ± 10.27 mm, P < 0.001). In the case of aortic dissection involving the valves, the proximal edge of the first entry was obviously close to the aortic sinus. The orientation of the entries was mainly around the 10 o’clock and 1–2 o’clock positions, and most of their shapes were fusiform (111; 70.02%). The distance of the distal extending dissection was associated with cases involving the branch arteries (involving three branches 441.40 ± 101.13 mm vs 159.85 ± 131.86 mm in others, P < 0.001).Conclusion: The morphological features of the ascending aorta after dissection and the correlations among dissections, entries, and related factors were found.     

心脏磁共振在扩张型心肌病危险分层及预后评估中的应用进展

扩张型心肌病(dilated cardiomyopathy,DCM)是一类以左心室扩张和左心室收缩功能障碍为主要特征的心脏病,可最终引起心力衰竭、心律失常和猝死,也是目前心脏移植的最主要病因.准确评估DCM患者心脏受累程度,对疾病进行危险分层,识别需密切随访及强化治疗的高危患者尤为重要.心脏磁共振(cardiovasc...     

Prognostic value of heart rate variability and ventricular arrhythmias during 13-year follow-up in patients with mild to moderate heart failure

Background  In contrast to patients with moderate to severe chronic heart failure (CHF), data regarding long-term outcome in patients with mild CHF are scarce. We examined the place of Holter monitoring to study the prognostic value of ventricular arrhythmias and heart rate variability (HRV) in patients with mild to moderate CHF during long-term follow-up. Methods  We studied 90 patients with mild to moderate CHF and NYHA class II who had been enrolled in the Dutch Ibopamine Multicenter Trial. At baseline their mean age was 60.5 ± 8.0 years, left ventricular ejection fraction (LVEF) was 0.29 ± 0.09, and 85% were males. At the start of the study, patients were only using diuretics, while digoxin, and particularly ACE inhibitors and β-blockers were initiated later. Univariate and multivariate proportional hazard analyses were performed. Results  At baseline 80% of patients were in NYHA class II, and 20% were in class III; their mean age was 60 years, mean LVEF was 0.29, and 85% were men. During a follow-up of 13 years, 47 patients (53%) died. Cardiovascular (CV) death occurred in 39 patients, of which 28 were sudden cardiac death (SCD). For both CV death and SCD, LVEF <30% and ventricular premature beats/h (>20) were independent risk markers. Of the HRV parameters, total power (>2,500 ms²) was an important risk marker for CV death, but not for SCD. Conclusion  The present 13-year follow-up study in 90 patients with mild to moderate CHF showed that ventricular premature beats and HRV may have important value in predicting outcome.