老年高血压患者长时血压变异性及降压治疗对动脉僵硬度的影响

目的 探讨长时血压变异性(BPV)和降压治疗对动脉僵硬度的影响。方法 选取2017年1月至6月于山西白求恩医院进行降压治疗及管理的原发性老年高血压患者411例,用臂踝脉搏波传导速度(baPWV)和踝臂指数(ABI)作为评估动脉僵硬度的指标。采用线性回归分析血压指数及BPV与baPWV、ABI的相关性,BPV用收缩压标准差(SBP_SD)表示。采用SPSS 26.0统计软件进行数据分析。采用t检验分析降压治疗的效果以及降压治疗对动脉僵硬度的影响。结果 通过3年降压治疗,老年高血压患者平均SBP、DBP、PP、MAP均较治疗前出现明显下降,FPG、TC、TG也较前明显下降,HDL-C较前明显升高,差异均有统计学意义[(131.78±7.36)和(142.92±17.14)mmHg(1mmHg=0.133kPa),(80.22±6.31)和(81.49±10.01)mmHg,(51.57±7.81)和(61.43±14.06)mmHg,(97.41±5.57)和(101.97±10.98)mmHg,(5.30±1.67)和(5.81±1.69)mmol/L,(3.85±0.95)和(4.42±0.90)mmol/L,(1.27±0.68)和(1.79±1.13)mmol/L,(1.35±0.31)和(1.21±0.31)mmol/L;均P＜0.05];而治疗前后LDL-C的差异无统计学意义。调整混杂因素后线性回归结果显示,在老年高血压患者中SBP、PP、MAP、SBP_SD均与baPWV呈正相关(β=10.390,5.500,14.940,11.110;均P＜0.05),与ABI呈负相关(β=-0.002,-0.001,-0.002,-0.003;均P＜0.05);而DBP仅与baPWV呈正相关(β=8.690,P＜0.05),而与ABI无相关性。降压治疗后,baPWV由(1782.70±308.87)cm/s降至(1732.43±261.73)cm/s、ABI由(1.12±0.10)升至(1.14±0.08),差异均有统计学意义(均P＜0.05);其中baPWV在性别和年龄分层分析中均表现出下降趋势,与降压治疗前相比,差异均有统计学意义(均P＜0.05);而ABI在女性患者及60~70岁患者中,与降压治疗前相比,差异均有统计学意义(均P＜0.05)。降压前后SBP差值、DBP差值与baPWV差值均呈正相关(β=3.000,3.290;P＜0.05),而与ABI差值无相关性。结论 SBP_SD是动脉僵硬度的影响因素,对老年高血压患者进行降压治疗及综合管理,可以显著改善患者的baPWV值,而降压治疗对ABI的影响尚需进一步的研究去明确。     

不同肺动脉压力动脉导管未闭患者介入治疗评价

目的探讨经导管介入封堵术治疗不同肺动脉压力动脉导管未闭(PDA)患者的临床疗效,为选择手术时机提供一定的参考依据。方法回顾性分析接受介入封堵治疗的47例PDA患者的临床资料,按术前右心导管测得的肺动脉收缩压分为低压力组(25例)和高压力组(22例),术前行心脏彩色超声检查,术中、术后测肺动脉压力、行主动脉弓造影,出院后随访1个月至7年。结果所有患者PDA封堵均成功。封堵前,低压力组和高压力组肺动脉收缩压分别为(38.72±7.38)mm Hg和(73.68±23.32)mm Hg;封堵后,分别下降至(29.92±5.52)mm Hg和(54.27±17.52)mm Hg,均较封堵前明显下降(均为P<0.05),且高压力组下降更为明显。低压力组患者的总住院时间及术后住院时间较高压力组短[(5.2±1.7)d比(8.2±5.2)d,P<0.05;(2.7±1.0)d比(4.2±2.0)d,P<0.01]。随访期间两组患者的左心室重构和心功能均有一定改善,高压力组患者再入院率较高(18.18%比0,P<0.05)。结论低肺动脉压力患者心功能受损小,住院时间短,术后恢复快,且再入院率低,故应在发现PDA后及时行介入封堵术。     

黛力新联合氨氯地平治疗有明显白大衣效应的原发性高血压患者的疗效

目的 探讨黛力新联合常规抗高血压治疗对有明显白大衣效应（WCE）的原发性高血压患者的疗效。方法 选取2014年、2015年我院心内科门诊原发性高血压患者130例，先用汉密尔顿焦虑量表（HAMA）对这些患者进行评分，共有83例评分大于7分的患者入选。将入选者随机分成两组：观察组在使用常规降压药物氨氯地平的基础上加用黛力新；对照组使用氨氯地平及安慰剂。观察两组患者诊室血压值、动态血压值、WCE值、HAMA评分以及血压节律的变化。结果 ①两组治疗后诊室血压值、动态血压值分别较治疗前有明显下降（P<0.01）；治疗后两组组间比较，观察组cSBP、cDBP下降较对照组更明显［（139.19±5.24）mm Hg比（150.78±6.50）mm Hg，（87.24±4.96）mm Hg比（92.85±4.73）mm Hg，P<0.01］，观察组nSBP、nDBP较对照组也略有进一步下降［（118.14±4.68）mm Hg比（120.56±5.81）mm Hg，（73.93±3.83）mm Hg比（75.85±4.01）mm Hg，P<0.05］，而两组24 h SBP、24 h DBP、dSBP、dDBP下降程度未见统计学差异（P>0.05）。②治疗后观察组WCE SBP、WCE DBP、HAMA评分均较治疗前明显缩小［（6.81±1.85）mm Hg比（18.36±3.89）mm Hg，（3.93±1.35）mm Hg比（9.31±2.67）mm Hg，（8.52±2.72）分比（19.62±6.25）分，P<0.01］，对照组治疗前、后无明显变化（P>0.05），两组组间比较差异有统计学意义（P<0.01）。③与治疗前比较，治疗后观察组杓型血压节律的发生率明显升高（P<0.01），非杓型血压节律的发生率明显下降（P<0.01），对照组无明显变化（P>0.05），两组组间比较差异有统计学意义（P<0.05）。结论 黛力新联合常规抗高血压治疗能有效缓解有WCE的原发性高血压患者的WCE，改善血压昼夜节律。     

不同联合降压方案对高血压患者血压和脉搏波传导速度的影响

目的探讨不同药物的联合降压治疗方案对高血压患者血压和脉搏波传导速度(PWV)的影响。方法选择2008年1～9月在北京医院心内科门诊就诊的高血压患者66例,其中男性36例,女性30例,年龄50～75岁,平均(60.7±7.5)岁。将研究对象随机分为两组:一组患者采用氨氯地平+复方阿米洛利(A组)治疗,另一组患者采用氨氯地平+替米沙坦(B组)治疗。观察不同的联合降压方案对血压、心率、肱踝动脉PWV(baPWV)、血脂、血糖、肌酐和尿酸的影响。结果两种治疗方案均有良好的降压作用,A组平均收缩压和舒张压由(154.4±12.7)mm Hg和(89.1±7.4)mm Hg分别降至(127.7±11.2)mm Hg和(74.8±8.8)mm Hg(均为P<0.01);B组平均收缩压和舒张压由(155.0±12.9)mm Hg和(90.9±10.1)mm Hg分别降至(128.6±9.9)mm Hg和(77.7±9.0)mm Hg(均为P<0.01)。治疗前和治疗后及两组之间比较,治疗方案对baPWV、心率、血脂、血糖和肌酐无明显影响。B组治疗后尿酸水平由治疗前的(335.8±58.5)μmol/L上升到(361.4±51.3)μmol/L(P=0.017)。结论两种联合治疗方案均有良好的降压作用,对baPWV均无显著影响。     

高龄冠心病患者行冠状动脉介入治疗的风险及疗效评价

目的:对高龄冠心病患者实施冠状动脉介入治疗风险及疗效进行综合评价。方法:总结分析年龄≥75岁(75～91岁)的高龄冠心病患者98例,<75岁399例,分别分析经皮冠状动脉成形术(PCI)前、术中、术后情况及并发症等。结果:≥75岁组患者术前合并心血管疾病的危险因素种类较<75岁组多〔(4.5±1.75)vs.(2.2±0.68),P<0.05〕,急性冠状动脉综合征(ACS)所占比例,两组之间差异无统计学意义(18.4%vs.20.6%,P>0.05);经桡动脉入路所占比例≥75岁组为56.1%,<75岁组为66.2%,差异无统计学意义;≥75岁组PCI时间长于<75岁组〔(59.1±10.4)m vs.(53.1±11.8)m,P<0.05〕;PCI成功率(96.9%vs.99.7%,P=0.026);术后在院期间病死率、PCI相关并发症发生率,两组差异均无统计学意义,术后在院期间心绞痛再发率,差异无统计学意义(3.1%vs.2%,P>0.05)。结论:高龄冠心病患者中行PCI术,可提高老年患者的生存质量,有明显获益;并且PCI术并发症与手术风险与低年龄组无明显差异,安全性好。     

周围动脉硬化指标结合运动负荷试验预测冠状动脉狭窄程度的临床意义

目的探讨周围动脉硬化指标对早期预测冠心病及冠状动脉病变程度的临床意义。方法随机选取解放军总医院心内科住院患者56例,平板运动试验前后完成静息性及运动后即刻踝臂指数(ankle-brachial index,ABI);肱动脉踝动脉脉搏波速度(brachial ankle artery pulse wave velocity,baPWV)、上行主动脉-踝动脉脉搏波速度(haPWV)检测,同时完成冠状动脉造影检查,根据造影结果,分为无病变组9例,无意义狭窄组12例,单支病变组1 7例,双支病变组9例及3支病变组9例,对各组患者运动前后ABI、baPWV及haPWV进行统计学分析。结果静息状态下,与无病变组比较,冠状动脉病变各组ABI差异无统计学意义(P>0.05),baPWV、haPWV明显增高.差异有统计学意义(P<0.05);冠状动脉病变各组间,ABI、baPWV及haPWV值比较,差异无统计学意义(P>0.05);平板运动试验结束即刻,所有研究对象ABI均有不同程度下降,但差异无统计学意义(P>0.05);无病变组与冠状动脉病变各组baPWV、haPWV及变化值比较,差异无统计学意义(P>0.05)。结论静息baPWV、haPWV显著增高,可以预测冠状动脉存在病变,但不能预测冠状动脉病变程度。运动前后ABI及运动后baPWV、haPWV对冠状动脉病变及病变程度的预测价值均甚微。     

老年高血压患者动脉僵硬度与左心室肥厚关系

目的探讨老年高血压患者动脉僵硬度与左心室肥厚的关系。方法选择原发性老年高血压患者68例,以左心室重量指数(LVMI)作为评价左心室肥厚指标,将患者分为左心室肥厚组(32例)和非左心室肥厚组(36例)。以颈动脉-股动脉肢体动脉搏动波(cfPWV)和脉压作为评价动脉僵硬度指标,进行24 h动态血压监测、cfPWV及超声心动图检测,并进行多因素相关分析。结果左心室肥厚组较非左心室肥厚组患者cfPWV高[(14.45±1.83)m/s vs(10.89±1.94)m/s]、脉压大[(78.66±9.05)mm Hg(1 mm Hg=0.133 kPa)vs(60.39±7.74)mm Hg],两组比较,差异有统计学意义(P<0.01),logistic回归分析显示,LVMI与cfPWV、脉压呈正相关。结论动脉僵硬度增加是老年高血压患者左心室肥厚的重要危险因素。     

血压、脉压水平及高血压病程对高血压患者动脉僵硬度的影响

目的探讨血压、脉压水平及高血压病程对高血压患者动脉僵硬度的影响。方法从上海市宝山区6家社区卫生中心及本院入选1026例高血压患者,收集相关病史信息,检测其颈-股动脉(C-F)、颈-桡动脉(C-R)、颈-足背动脉(C-D)脉搏波传导速度(PWV),672例患者在随访1年后复测PWV。从血压、脉压、高血压病程3者的不同水平进行分组比较及随访前后对照分析。结果 (1)1、2、3级高血压患者的C-FPWV随血压水平的增高而增快,分别为(12.61±2.76)m/s,(14.35±3.41)m/s,(15.50±2.93)m/s(均为P<0.01)。1级高血压组较2级、3级高血压组C-FPWV差异有统计学意义(均为P<0.01)。(2)随访前后C-FPWV在1级和2级高血压组分别为(12.73±2.91)m/s和(13.39±3.25)m/s,(13.96±3.07)m/s和(14.75±4.10)m/s,差异有统计学意义,而在3级高血压组差异无统计学意义。(3)脉压<40 mm Hg,40～60 mm Hg,≥60 mm Hg 3组C-FPWV随脉压的增大而增快,分别为(11.95±2.60)m/s,(12.94±2.85)m/s,(14.89±3.22)m/s(均为P<0.01)。随访1年后3组的C-FPWV分别较前增快0.70 m/s,0.65 m/s,0.85 m/s,差异均有统计学意义。(4)高血压病程<5年、5～10年、≥10年3组C-FPWV分别为(12.77±2.75)m/s,(12.85±3.07)m/s,(13.76±3.05)m/s,3组比较差异有统计学意义(均为P<0.01),病程越长,C-FPWV越快。结论(1)C-FPWV较C-RPWV、C-DPWV更能反映动脉僵硬度的变化。(2)C-FPWV随血压、脉压水平的增高及高血压病程的延长而增快,3者均为动脉僵硬度的重要影响因素。     

老年中心动脉和肱动脉血压差值与冠状动脉病变程度的研究

目的探讨冠心病患者中心动脉-肱动脉差值及动脉弹性,评价冠心病相关危险因素。方法选取2018年3月～2020年2月于我院老年病科以冠心病不稳定性心绞痛入院完成冠状动脉造影术患者416例,根据患者症状和冠状动脉造影结果分为冠心病组276例和对照组140例,收集一般临床资料,测量空腹血糖、糖化血红蛋白(HbA1C)、N末端B型钠尿肽前体(NT-proBNP)、尿酸等。采用超声心动图检查左心室质量指数(LVMI)。多功能血管病变检测仪测定踝肱指数(ABI)、肱踝脉搏波传导速度(baPWV)。冠状动脉造影术检查中心动脉收缩压,计算中心动脉与肱动脉收缩压血压差值(ΔSBP)等,应用Gensini积分法评价冠状动脉病变程度。用多因素logistic回归分析。结果冠心病组脂肪肝、高血压、高尿酸血症、糖尿病、血管内斑块、血压差值10 mm Hg(1 mm Hg=0.133 kPa)比例、空腹血糖、HbA1C、NT-proBNP、尿酸、中心动脉收缩压、中心动脉脉压差、LVMI、Gensini积分、baPWV高于对照组(P0.01),△SBP、ABI明显低于对照组(P0.01)。多因素logistic回归分析显示,血压差值10 mm Hg、baPWV、LVMI、血管内斑块(颈部/下肢)及高尿酸血症为冠心病危险因素(95%CI:5.095～27.963,P=0.000;95%CI:10.629～256.285,P=0.001;95%CI:1.042～1.088,P=0.000;95%CI:2.996～21.376,P=0.000;95%CI:2.825～35.634,P=0.004)。结论老年冠心病患者存在心室重构,动脉弹性、中心动脉-肱动脉血压差值10 mm Hg可能为冠心病的危险因素。     

肥厚型梗阻性心肌病经皮经腔间隔心肌消融术与室间隔心肌切除术疗效比较

目的应用超声心动图比较肥厚型梗阻性心肌病患者经皮经腔间隔心肌消融术与室间隔心肌切除术的疗效。方法分别于经皮经腔间隔心肌消融术及室间隔心肌切除术前、后测量肥厚型梗阻性心肌病患者左室流出道压差,比较术前及术后压差。结果肥厚型梗阻性心肌病患者在进行经皮经腔间隔心肌消融术与室间隔心肌切除术后,左室流出道压差均较术前明显减低。经皮经腔间隔心肌消融术肥厚型心肌病患者术前左室流出道压差(99±19)mm Hg(1 mm Hg=0.133 kPa),术后降至(36±20) mm Hg(P<0.05)。进行室间隔心肌切除术肥厚型心肌病患者术前左室流出道压差(117±32) mm Hg,术后降至(28±17) mm Hg(P<0.05)。经皮经腔间隔心肌消融术与室间隔心肌切除术患者术后左室流出道压差差异无统计学意义[(36±20)mm Hg比(28±17)mm Hg]。结论经皮经腔间隔心肌消融术可以明显减低肥厚型梗阻性心肌病患者左室流出道压差,且与室间隔心肌切除术疗效相似。     

Influence of left ventricular hypertrophy on left ventricular function during dynamic exercise in the presence or absence of coronary artery disease

Objectives. We investigated the influence of left ventricular hypertrophy in the presence or absence of coronary artery disease on hemodynamic characteristics during exercise in subjects without previous myocardial infarction.Background. Left ventricular hypertrophy has been found to increase the vulnerability of the myocardium to the development of ischemia. However, the independent influences of left ventricular hypertrophy and coronary artery disease have not been assessed in humans.Methods. Symptom-limited supine leg exercise tests were performed by 78 patients. They were classified into the following subgroups: no coronary artery disease or left ventricular hypertrophy (group I, n = 30), left ventricular hypertrophy only (group II, n = 12), coronary artery disease only (group III, n = 20) and both left ventricular hypertrophy and coronary artery disease (group IV, n = 16). Mean left ventricular mass index was 105, 158, 109 and 159 g/m²in groups I to IV, respectively.Results. Pulmonary artery wedge pressure increased from 6 ± 3 (mean ± SD) mm Hg at rest to 10 ± 5 mm Hg at peak exercise in group I, from 8 ± 2 to 18 ± 8 mm Hg in group II (p < 0.05 vs. group I), from 6 ± 3 to 23 ± 6 mm Hg in group III (p < 0.01 vs. group I) and from 8 ± 4 to 30 ± 7 mm Hg in group IV (p < 0.01 vs. group I; p < 0.01 vs. group II; p < 0.05 vs. group III). Multiple regression analysis showed that the number of diseased coronary vessels and left ventricular mass index were independent predictors of peak pulmonary artery wedge pressure (F = 59.2 and 19.1, respectively; multiple correlation coefficient r = 0.74, p < 0.0001).Conclusions. Left ventricular hypertrophy and coronary artery disease independently increased left ventricular filling pressure during supine leg exercise. Severe left ventricular dysfunction was induced by exercise when both conditions were present.     

Cardiac effects of prolonged and intense exercise training in patients with coronary artery disease

The effects of intense and prolonged exercise training on the heart were studied with echocardiography in eight men with coronary artery disease with a mean age ( ±standard error of the mean) of 52 ± 3 years. Training consisted of endurance exercise 3 times/week at 50 to 60 percent of the measured maximal oxygen uptake for 3 months followed by exercise 4 to 5 days/week at 70 to 80 percent of maximal oxygen uptake for 9 months. Maximal oxygen uptake capacity increased by 42 percent (26 ± 1 versus 37 ± 2 ml/kg per min; p < 0.001). Heart rate at rest and sub-maximal heart rate and systolic blood pressure at a given work rate were significantly lower after training. Systolic blood pressure at the time of maximal exercise increased (145 ± 9 before versus 166 ± 8 mm Hg after training; probability [p] < 0.01). Left ventricular end-diastolic diameter was increased after 12 months of training (from 47 ± 1 to 51 ± 1 mm; p < 0.01). Left ventricular fractional shortening and mean velocity of circumferential shortening decreased progressively in response to graded isometric handgrip exercise before training but not after training. At comparable levels of blood pressure during static exercise, mean velocity of circumferential shortening was significantly higher after training (0.76 ± 0.04 versus 0.98 ± 0.07 diameter/sec, p < 0.01). No improvement in echocardiographic or exercise variables was observed over a 12 month period in another group of five patients who did not exercise. Thus the data suggest that prolonged and vigorous exercise training in selected patients with coronary artery disease can elicit cardiac adaptations.     

Arm-crank ergometry: a new method for the evaluation of coronary artery disease

We have developed an electrocardiographic stress test to evaluate coronary heart disease using an arm-crank device (modified bicycle ergometer) in patients unable to perform leg exercise. With an initial work load of 200 kg-m/min at 40 revolutions/min for 3 minutes, followed by 100 kg-m/min increments every 3 minutes to a maximum of 700 kg-m/min at the same speed, a linear relation between the increase in heart rate and work load was observed. Twenty-one patients underwent both conventional treadmill exercise (modified Bruce protocol) and arm-crank exercise on separate days. Peak heart rate was slightly slower with arm-crank exercise (81 ± 4 [standard error] vs. 85 ± 3 percent of maximal predicted heart rate for age, P < 0.02) but peak systolic blood pressure and heart rate-systolic blood pressure product (double product) did not differ significantly (157 ± 7 vs. 154 ± 6 mm Hg, P > 0.5) and (22.0 ± 1.2 vs. 22.5 ± 1.2 × 10³, P > 0.1). Ten patients with documented coronary artery disease, including 7 with angina pectoris, had an ischemie S-T segment response (0.08 second depression greater than 1 mm) by both methods and 10 patients (7 with previous myocardial infarction and 3 with normal coronary arteriograms) had negative results by both techniques. One patient with normal coronary arteriograms had a negative arm-crank test and a positive treadmill test. In 26 patients unable to perform leg exercise the mean peak heart rate, systolic blood pressure and double product with arm-crank exercise were not significantly different (P > 0.05) from those achieved by the ambulatory patients (73.2 ± 1.9 vs. 81.0 ± 4.0 percent, 167 ± 8 vs. 157 ± 7 mm Hg and 22.4 ± 1.2 vs. 22.0 ± 1.4 × 10³, respectively). Six of 26 patients unable to perform leg exercise had a positive arm-crank test. Four of these six patients had angina pectoris and three had a previous myocardial infarction. We conclude that arm-crank exercise is comparable to treadmill exercise and is a reliable alternative method for the evaluation of suspected coronary artery disease in patients unable to perform leg exercise.     

Effects of aliskiren-based therapy on ambulatory blood pressure profile, central hemodynamics, and arterial stiffness in nondiabetic mild to moderate hypertensive patients

J Clin Hypertens (Greenwich). 2012;00:000–000. ©2012 Wiley Periodicals, Inc. Aliskiren is a direct renin inhibitor that exerts its effect at the rate‐limiting step of the renin‐angiotensin system. This study was performed to examine the beneficial effects of aliskiren‐based antihypertensive therapy on the ambulatory blood pressure (BP) profile, central hemodybamics, and arterial stiffness in untreated Japanese patients with mild to moderate hypertension. Twenty‐one Japanese nondiabetic patients with untreated mild to moderate essential hypertension were initially given aliskiren once daily at 150 mg, and the dose was titrated up to 300 mg as needed. After 12 weeks of aliskiren‐based therapy, the clinic, ambulatory, and central BP values as well as brachial‐ankle pulse wave velocity (baPWV) were all significantly decreased compared with baseline (clinic systolic BP, 151±11 mm Hg vs 132±11 mm Hg; clinic diastolic BP, 91±13 mm Hg vs 82±9 mm Hg; 24‐hour systolic BP, 144±12 mm Hg vs 133±11 mm Hg; 24‐hour diastolic BP, 88±8 mm Hg vs 81±9 mm Hg; central BP, 162±16 mm Hg vs 148±14 mm Hg; baPWV, 1625±245 cm/s vs 1495±199 cm/s; P<.05). These results show that aliskiren, as a first‐line regimen, improves the ambulatory BP profile and may have protective vascular effects in Japanese nondiabetic patients with untreated mild to moderate essential hypertension.     

Improvement of left ventricular function after percutaneous transluminal coronary angioplasty

Cardiac function and left ventricular dynamics were measured in seven consecutive patients 1 day before and 6 months after percutaneous transluminal balloon angioplasty of subtotal proximal stenosis of the left anterior descending coronary artery. Before angioplasty all patients had obvious left ventricular dysfunction during exercise and to a smaller degree during isoproterenol infusion; the condition of all patients was greatly improved 6 months after angioplasty. After angioplasty, left ventricular end-diastolic pressure was normal at rest and decreased from a mean (± standard error of the mean) of 33.8 ± 1.6 to 19.2 ± 0.5 mm Hg on exercise. Left ventricular ejection fraction, measured by a gated blood pooling technique with technetium-99m, improved on exercise from 46 ± 5.0 percent to 69 ± 1.0 percent. Cardiac output and stroke volume index increased significantly with exercise after angioplasty. The peak negative rate of pressure reduction in the left ventricle (dP/dt/min), an index of left ventricular relaxation, was highly abnormal on exercise before (2,307 ± 260 mm Hg/s) and increased to the normal range (3,154 ± 200 mm Hg/s) after angioplasty. The improvement in left ventricular function after transluminal angioplasty in these cases of proximal left anterior descending coronary arterial stenosis is extremely encouraging.     

Simultaneous Improvement in Aortic Distensibility and Coronary Flow Velocity Reserve after Successful Coronary Interventions

Objective: Deteriorations in coronary flow velocity reserve (CFR) and aortic distensibility have been demonstrated in coronary artery disease. The objective of the present study was a simultaneous echocardiographic evaluation of the CFR and aortic distensibility indices before and after successful percutaneous coronary interventions (PCI) in patients with left anterior descending coronary artery (LAD) disease. Methods: The study population, comprising 12 patients (4 women and 8 men) with significant proximal LAD stenosis, were compared with matched controls. Transesophageal echocardiography (TEE) was carried out to evaluate the CFR and aortic distensibility indices (the aortic elastic modulus E(p) and Young's circumferential static elastic modulus E(s)) before and after PCI to the LAD. The subjects underwent TEE on average 8 ± 11 days before PCI and 25 ± 6 weeks after PCI. Results: An improvement in CFR was demonstrated in patients with LAD stenosis after successful PCI (1.71 ± 0.36 vs. 2.08 ± 0.28, P < 0.05), which paralleled the decreases in E(p) (936 ± 544 mmHg vs. 567 ± 184 mmHg, P < 0.05) and E(s) (10,207 ± 6,295 mmHg vs. 5,831 ± 2,010 mmHg, P < 0.05) during the follow‐up. Conclusion: The aortic distensibility improves in parallel with the increase in CFR in patients with LAD stenosis after successful PCI. (Echocardiography 2010;27:311‐316)     

血压与冠状动脉造影病变的关系

目的研究血压与冠状动脉病变的关系。方法选择可疑冠心病患者540例,根据冠状动脉有无病变分为病变组和无病变组;根据冠状动脉病变的范围分为单支血管病变组、双支血管病变组和三支血管病变组。所有患者入院后测量血压,并对每一个患者进行高血压、吸烟和糖尿病病史的调查,测定血脂水平。采用Judkins法进行冠状动脉造影。结果病变组高血压病程(5.85±8.87年)、收缩压(133±29 mm Hg)、舒张压(83±13 mm Hg)、脉压(51±17 mm Hg)及平均压(100±14 mm Hg)均明显高于无病变组(分别为1.78±4.27年、125±21 mm Hg、80±13mm Hg4、8±15 mm Hg和97±15 mm Hg)(P<0.05)。三支血管病变组高血压病程、收缩压和脉压水平(分别为7.42±10.10年、137±21 mm Hg和54±17 mm Hg)均高于单支血管病变组(分别为4.51±7.21年、132±19 mm Hg和49±16 mm Hg)和双支血管病变组(分别为5.76±8.79年1、34±23 mm Hg和52±17 mm Hg)(P<0.05)。随着高血压病程增加、收缩压、脉压及平均压水平的增高,冠状动脉病变狭窄程度逐渐增大;经多因素回归分析高血压病程(OR值=0.139,P<0.05)、年龄(OR值=1.045,P<0.05)等因素是冠心病发生独立的危险因素。结论随着年龄增大和高血压病程增加,患冠心病的机会增加,并且收缩压和脉压的升高对冠状动脉的危害性较大。     

高血压伴冠心病患者冠状动脉狭窄与周围动脉功能关系的研究

目的分析冠状动脉的病变支数及狭窄程度与周围动脉弹性功能的关系。方法对88例高血压病患者与41例无高血压病临床怀疑冠心病的患者,在冠状动脉造影前后采用美国FDA批准的PULSEMETRIC动脉功能测定仪通过测定肱动脉脉搏图计算出反应血管弹性的参数,包括系统血管顺应性（SVC）、系统血管阻力（SVR）、肱动脉顺应性（BAC）及肱动脉阻力（BAR）,分析高血压伴及不伴冠状动脉病变者的动脉弹性的特点。结果（1）高血压组严重冠状动脉病变（冠状动脉病变〉12支以上）发生率[64．7％（57／88）]高于血压正常组[27．1％（11／41）,P〈0．05）;（2）高血压组的SVC[（0．85±0．10）ml／mmHg（1mmHg=0．133kPa）]、BAC[（0．047±0．011）ml／mmHg]明显低于非高血压组[SVC（1．17±0．11）ml／mmHg,BAC（0．063±0．010）ml／mmHg,均P〈0．05],高血压组的脉压则明显高于非高血压组[（78±20）mmHg比（47±19）ml／mmHg,P〈0．01];（3）高血压组内,动脉弹性有随冠状动脉病变加重而下降的趋势,而动脉弹性功能参数在不同的性别存在不同的变化;（4）当血压水平达到2～3级,SVC有随冠状动脉病变程度加重而降低的趋势。结论在高血压病患者中,无创方法测得的动脉功能参数在一定程度上可以反映其冠状动脉病变程度。     

替米沙坦对高血压患者脉搏波速度的影响

目的探讨替米沙坦对高血压患者脉搏波速度的影响。方法测量健康体检首次确诊的高血压患者（30例）与正常对照组（30名）的血压、血糖、血脂和脉搏波速度;替米沙坦治疗12周后重复测量上述指标,前后对比分析脉搏波速度的变化。结果高血压患者的收缩压[（154．3±9．1）mmHg]、舒张压[（103．1±6．9）mmHg]和脉搏波速度[（1989．6＋198．7）cm／s]显著高于正常对照组[（118．5±13．6）mmHg、（68．3±8．9）mmHg和（1226．3±172．6）cm／s]（P〈0．05）;总胆固醇（4．98±0．68）mmol／L]、低密度脂蛋白胆固醇[（3．12±0．58）mmol／L]和血糖[（5．02±0．45）mmol／L]与对照组[（4．87±0．26）mmol／L、（3．09±0．69）mmol／L和（4．98±0．97）mmol／L]相比,差异无统计学意义（P〉0．05）。替米沙坦治疗12周后,高血压患者与对照组相比,收缩压[（154．3±9．1）mmHg比（121．6±10．4）mmHg]、舒张压[（103．1±6．9）mmHg比（68．3±7．5）mmHg]和脉搏波速度[（1989．6＋198．7）cm／s比（1412．5±181．7）cm／s）]显著下降（P〈0．05）。结论替米沙坦可以降低高血压患者的脉搏波速度,改善动脉顺应性。     

单侧椎动脉闭塞患者的血流动力学变化

目的 通过颈动脉彩色多普勒血流成像和经颅多普勒超声联合检测评价单侧椎动脉闭塞后健侧椎动脉、基底动脉的血流动力学变化与后循环缺血发生的关系.方法 选择经DSA证实的单侧椎动脉闭塞患者96例,根据MRI结果分为后循环缺血患者(有症状组,n=50)和无后循环缺血患者(无症状组,n=46),采用颈动脉彩色多普勒血流成像和经颅多普勒超声联合检查健侧椎动脉颅外段管径、健侧椎动脉颅内段和基底动脉收缩期峰值流速及舒张末期流速. 结果有症状组经DSA证实存在颈深动脉、颈升动脉及颈外动脉分支等吻合支代偿者11例(占22.0%),无症状组存在吻合支代偿者12例(占26.1%),两组间吻合支建立的比率无显著性差异(P>0.05);无症状组健侧椎动脉管径(3.54±0.47 mm)明显大于有症状组(3.25±0.45 mm,P<0.01);无症状组健侧椎动脉颅内段收缩期峰值流速和舒张末期流速明显高于有症状组 (87.09±35.47 cm/s和35.85±18.03 cm/s比70.60±31.04 cm/s和27.32±11.75 cm/s,P<0.05);无症状组基底动脉收缩期峰值流速和舒张末期流速也明显高于有症状组 (89.54±35.56 cm/s和37.35±19.34 cm/s比72.98±25.95 cm/s和29.52±11.56 cm/s,P<0.05). 结论单侧椎动脉闭塞后健侧椎动脉的管径、收缩期峰值流速、舒张末期流速与基底动脉的收缩期峰值流速、舒张末期流速血流参数的异常与后循环缺血症状的发生具有密切相关性.