Radiology residents' on-call interpretation of chest radiographs for pneumonia

RATIONALE AND OBJECTIVES: This study is designed to assess the performance of radiology residents in interpreting emergency department chest radiographs for pneumonia and to characterize chest radiographic findings in patients for which interpretation was amended by an attending radiologist. MATERIALS AND METHODS: We retrospectively reviewed all amended reports for chest radiographs performed on emergency department patients July 2002-June 2003. Reports preliminarily interpreted by residents and amended by a board-certified staff radiologist for the presence or absence of pneumonia were identified. A panel of three experienced radiologists, blinded to reports, jointly reviewed each chest radiograph. If the panel diagnosed pneumonia, the chest radiograph was evaluated for the projection that best showed the pneumonia, its size and location, and the presence or absence of the following features: increased opacity, air bronchograms, loss of vascular markings, silhouette sign, and linear opacities. The resident's post-graduate year (PGY) training level was noted. RESULTS: One percent (134/12,600 reports) of chest radiographic reports were amended for the presence or absence of pneumonia. One hundred chest radiographs were available and comprised the series. There were 56 females and 44 males with a mean age of 45 years (range, 1-99 years). The staff radiologist diagnosed pneumonia in 79% (79/100 radiographs). The panel agreed with the staff in 77% (kappa = 0.76) and the resident in 23% (kappa = 0.43). The panel diagnosed pneumonia in 60% (60/100 radiographs) with the following chest radiographic findings: 100% (60/60), increased opacity; 37% (22/60), air bronchograms; 72% (43/60), loss of vascular markings; 40% (24/60), silhouette sign; and 20% (12/60), linear opacities. The pneumonia was right sided in 52% (31/60), left sided in 37% (22/60), and bilateral in 11% (7/60). Right-sided pneumonias were equally distributed among the three lobes, and left-sided pneumonias had a lower-lobe predominance of 77% (17/22). Seventy-five percent (45/60) of pneumonias were segmental or smaller, and 82% (49/60) of chest radiographs showing pneumonia had both posteroanterior and lateral projections. The pneumonia was conspicuous on only one projection in 43% (21/49); the posteroanterior view in 22% (11/49), and the lateral view in 20% (10/49). Eighty-one percent (81/100) of interpreting residents were PGY-3. CONCLUSION: Interpretation of chest radiographs for pneumonia by PGY-3 residents has a low error rate. Missed pneumonias often were segmental or smaller and conspicuous on only one projection.     

左卡尼汀治疗慢性充血性心力衰竭的疗效观察

目的观察左卡尼汀治疗慢性充血性心力衰竭的疗效。方法入选65例NYHA心功能分级Ⅲ～Ⅳ级的慢性充血性心力衰竭患者,随机分为左卡尼汀治疗组35例和对照组30例。左卡尼汀组在常规治疗基础上给予左卡尼汀3g/d口服,连用14d。对照组给予常规治疗。分别于治疗前及治疗14d后进行6min步行试验、NYHA心功能分级、LVEF及血清生化等指标的检查,评价两组的疗效,记录不良反应。结果治疗前后比较,两组6min步行距离、左室射血分数和NYHA心功能分级均较治疗前有明显改善（P=0.031,0.042,0.20）。两组血清BNP水平均有降低（P=0.026）。治疗后两组间比较,左卡尼汀组6min步行距离平均增加32m,对照组平均增加15m（P=0.036）;LVEF平均增加12%,对照组平均增加7%（P=0.044）;B型利钠肽水平下降61.22ng/L,而对照组下降46.18ng/L（P=0.038）;左卡尼汀组心功能改善1级以上共32例,对照组共19例（P=0.019）。所有实验对象均无肝肾功能损害及严重不良反应。结论左卡尼汀可以改善慢性左心衰竭患者的6分钟步行距离、LVEF和心功能,降低B型利钠肽水平,提高运动耐量,是一种安全、有效的药物。     

Accuracy of chest radiographs in the emergency diagnosis of heart failure

The purpose of this study was to determine the diagnostic accuracy of chest radiographic findings of heart failure (HF) in current patients presenting with dyspnea in the emergency department. In a secondary analysis of the BASEL study, initial chest radiographs of 277 patients with acute dyspnea were evaluated by two radiologists blinded to the adjudicated diagnosis (56% had the final diagnosis of HF). Predefined radiographic criteria of HF were used. Statistical analysis included receiver-operating characteristic (ROC) analysis and calculation of a logistic regression model including B-type natriuretic peptide (BNP) levels. The reader's overall impression showed the highest area under the ROC curve for the diagnosis of HF in both supine and erect patient positions (0.855 and 0.857). Among individual radiographic findings, peribronchial cuffing in the supine position (0.829) showed the highest accuracies. The lowest accuracy was found for the vascular pedicle width in the supine position (0.461). Logistic regression analysis showed no significant differences between the reader's overall impression, the radiographic model, and BNP testing. In our study, the combination of radiographic features provided valuable information and was of comparable accuracy as BNP-testing for the diagnosis of HF.     

Radiology resident interpretation of on-call CT pulmonary angiograms

RATIONALE AND OBJECTIVES: To evaluate the interpretation of computed tomographic pulmonary angiograms performed outside of regular reporting hours, comparing the initial interpretation by the radiology resident to the attending radiologist. MATERIALS AND METHODS: Records for 840 consecutive computed tomographic pulmonary angiograms (CTPA) performed outside of regular reporting hours at two tertiary referral centers from January 1, 2004-December 31, 2005 were reviewed. The preliminary interpretation by the on-call radiology resident was compared to the subsequent final report issued by a subspecialty trained chest radiologist. Studies were stratified as positive, negative, or equivocal for pulmonary embolus. Cases with discordant interpretations or negative CTPA were reviewed to determine impact on clinical outcome. Patients were followed up to 12 months after CTPA to document any subsequent thromboembolic event. RESULTS: Sixteen percent (131/840) of CTPAs were reported positive by the staff radiologist. There was agreement in 90% (752/840) of studies (P = .76, 95% confidence interval, 0.71-0.81) with 86% (114/133) agreement for studies interpreted as positive by residents, 95% (582/612) for studies interpreted as negative by residents, and 63% (60/95) for studies interpreted as equivocal by residents. Studies of optimal quality had higher interobserver agreement than studies of suboptimal quality (P < .0001). In-patient studies were more likely to be positive than emergency room patients (20% vs. 13%) (P = .004). No adverse clinical outcomes were attributed to discordant interpretations. CONCLUSIONS: Radiology residents provide a high level interpretation of on-call CTPA studies, achieving good concordance with the attending radiologists' assessment.     

依那普利联合卡维地洛治疗老年慢性心衰的临床观察

目的探讨依那普利联合卡维地洛在老年慢性心力衰竭患者治疗中的疗效、耐受性和安全性。方法选择老年充血性心力衰竭（CHF）患者130例,随机分为常规治疗组（对照组,28例）、依那普利与卡维地洛联合治疗组（观察组,42例）、依那普利治疗组31例和卡维地洛治疗组29例。4组治疗前和治疗6个月后,均使用超声心动图分别测定左心室舒张末期内径（LVEDD）、心输出量（CO）和左心室射血分数（LVEF）,进行疗效观察。结果治疗后4组LVEDD较治疗前显著减少（P〈0.05）,LVEF和CO较治疗前显著增高（P〈0.05）;治疗后观察组、LVEDD低于对照组（P〈0.05）,LVEF和CO较对照组显著增高（P〈0.05）。结论在常规治疗老年CHF患者的基础上,加用目标剂量的依那普利联合卡维地洛,对CHF患者安全有效,能明显改善心功能,提高左室射血分数。     

Usefulness of Tc-99m methoxyisobutylisonitrile scintigraphy for evaluating congestive heart failure

BACKGROUND: Evidence is accumulating that technetium 99m methoxyisobutylisonitrile (MIBI) is not retained in the impaired myocardium. The purpose of this study was to determine whether the severity of congestive heart failure (CHF) can be evaluated by use of the washout rate (WR) of MIBI. METHODS AND RESULTS: Seventeen patients with CHF and ten healthy volunteers were enrolled in this study. MIBI and iodine 123 metaiodobenzylguanidine (MIBG) scintigraphy techniques were performed, and the WR was calculated. The blood was also sampled for the measurement of levels of brain natriuretic peptide, which is a powerful predictor of the severity of CHF. The WR of MIBI was higher in CHF patients (31.2%+/-6.3%) than in healthy volunteers (25.2%+/-4.7%) (P<.05). There were positive correlations between the WR of MIBI and brain natriuretic peptide levels (r=0.723, P<.0001) and a negative correlation between the WR of MIBI and the left ventricular ejection fraction (r=-0.545, P<.01). The WR of MIBI was correlated with that of MIBG (r=0.603, P<.01). CONCLUSIONS: MIBI scintigraphy is useful in evaluating the severity of congestive heart failure.     

Projection profile analysis for identifying different views of chest radiographs

RATIONALE AND OBJECTIVES: For computerized analysis of chest images in the clinical environment, identification of frontal (posteroanterior/anteroposterior) and lateral chest radiographs is an important preprocessing step. In this study, we developed a method to distinguish frontal from lateral views of the chest radiographs based on an analysis of the projection profile. MATERIALS AND METHODS: Projection profile is obtained by projecting a chest image on to the mediolateral axis. Two indices, body symmetry index and background percentage index, are computed from the projection profile. The combination of body symmetry index and background percentage index is used to determine the view of chest radiographs. The method is evaluated on a sample of 2000 frontal and 1000 lateral chest images. RESULTS: The values of body symmetry index are found to be 1.18 +/- 0.23 and 3.07 +/- 1.42 for frontal and lateral chest images, respectively. The values of background percentage index are found to be 0.03 +/- 0.05 and 0.33 +/- 0.09 for frontal and lateral chest images, respectively. The discrimination is evaluated by linear discriminant analysis and receiver operating characteristic analysis. Area Az under the receiver operating characteristic curve with the combination of the two indices is 0.993. CONCLUSION: The method can be used as a preprocessing step for further analysis in chest radiographs.     

彩色多普勒超声对中药治疗慢性充血性心力衰竭疗效的分析

目的 :运用彩色多普勒超声技术监测中药治疗慢性充血性心力衰竭前后心功能变化的情况。方法 :选取择慢性心功能不全病人 4 0例 ,均经超声或临床确诊。随机分为中药组 2 0例与西药组 2 0例 ,分别用中药及西医正规治疗 ,观测其心功能各项参数EFFS治疗前后的变化。结果 :射血分数 (EF)及左室短轴缩短率 (FS)不论在中药组还是西药组 ,第2 / 6 / 10周的测量值都有统计学差异 ;中药组和西药组的治疗前后总测量值比较有统计学差异 ,P =0 0 10 ;EF指标的第 2 /6 / 10周的变化趋势在中药组和西药组两组间是不同的 ,差异有统计学意义 ,P =0 0 10。结论 :中药组及西药组二者均能有效改善心功能 ;但西药疗效快 ,长期疗效欠佳 ,中药疗效慢 ,但长期疗效持久稳定 ;指标EF较FS更敏感。     

氨基末端脑钠肽水平与老年血液透析合并心力衰竭死亡的相关性

 

目的 研究氨基末端脑钠肽(N terminal-pro brain nalriuretic peptide,NT-proBNP)水平与老年维持性血液透析并充血性心力衰竭死亡的相关性。方法 选择维持性血液透析并充血性心力衰竭入院患者52例,因心力衰竭死亡22例为死亡组,心力衰竭缓解30例为非死亡组,比较住院前、住院期间死亡组和非死亡组NT-proBNP水平,采用二分类Logistic回归分析影响死亡的相关因素,偏相关分析影响死亡组NT-proBNP水平的相关因素,受试者工作特征(ROC)曲线评价NT-proBNP水平对死亡的预测效能。结果 死亡组入院时NT-proBNP中位数为31 000 ng／L,与非死亡组入院时NT-proBNP中位数28 500 ng／L比较无统计学意义;死亡组住院期间NT-proBNP中位数为9200 ng／L,明显高于非死亡组NT-proBNP中位数4700 ng／L,差异有统计学意义(P＜0.01);二分类Logistic回归分析提示住院期间NT-proBNP水平为影响死亡的唯一相关因素(P＜0.01);左室EF值、透析间期体质量增加值、左室扩大为影响死亡组住院期间NT-proBNP水平相关因素(P＜0.01)。死亡组住院期间NT-proBNP的AUC值为0.962,差异有统计学意义(P＜0.05);NT-proBNP＞7650 ng／L作为界值(Cut off值)的敏感度为82.4%,特异度为84%;非死亡组住院期间NT-proBNP的AUC值为0.038,差异无统计学意义。结论 老年维持性血液透析并充血性心力衰竭住院期间高水平NT-proBNP与死亡具有相关性,可作为预测死亡的指标。

     

Predictors of improvement in left ventricular ejection fraction with carvedilol for congestive heart failure

BACKGROUND: Beta-blocker therapy has been reported to improve survival and left ventricular ejection fraction (LVEF) in the setting of congestive heart failure (CHF). The magnitude and predictors of improved LVEF are unclear. METHODS: A total of 295 patients were enrolled in the study. Inclusion criteria were LVEF <35% at baseline and symptomatic (New York Heart Association class II to IV) CHF despite treatment with at minimum an angiotensin-converting enzyme inhibitor. Carvedilol was initiated at 3.125 mg twice daily and titrated to a target dose of 25 or 50 mg twice daily, depending on the patient's weight. Paired pretreatment baseline and 9 months with treatment follow-up quantitative LVEFs (assessed by resting radionuclide ventriculograms) were obtained in 161 (55 %) of the patients. RESULTS: LVEF improved from 25% +/- 6% at baseline to 36%+/-12% at follow-up (P<.001). Mean change in LVEF (deltaLVEF) was greater for nonischemic cardiomyopathy (NICM) (+14.5+/-2 LVEF points) than ischemic cardiomyopathy (deltaLVEF +/- 7.6+/-10 EF points, P = .001). The deltaLVEF was > or =21 LVEF points in 30% of the NICM group versus 10% of the ischemic cardiomyopathy group. Conversely, the deltaLVEF was unchanged to minimally improved (< or =5 LVEF points) in 21% of the NICM group versus 52% of the ischemic cardiomyopathy group. Multivariable analysis identified NICM and recent onset of congestive heart failure as correlates of improved LVEF. CONCLUSIONS: Carvedilol significantly improved LVEF, especially in patients with NICM and those with recent onset of CHF.     

黄芪总苷对实验性猫急性心衰的治疗作用

目的：观察黄芪总苷对戊巴比妥钠引起猫急性心力衰竭的治疗作用及作用强度。方法：用3％戊巴比妥钠致猫急性心衰，以恒速静滴的方法给予黄芪总苷注射液，观察药物对左心室内压峰值（LVSP）、左心室内压最大上升率（LVdp／dtmax）及动物存活时间的影响。结果：黄芪总苷可使心衰猫LVSP及LVdp／dtrmax显著升高，且能非常显著延长动物存活时间。同时观察到黄芪总苷对猫心率无明显影响。与西地兰相比，治疗宽度和治疗指数均有明显优势。结论：黄芪总苛对戊巴比妥钠引起猫急性心力衰竭有良好的治疗作用，且毒性小，与西药相比优势明显。     

卡维地洛与美托洛尔对充血性心力衰竭的疗效和二者的成本─效果分析

目的:观察卡维地洛与美托洛尔治疗充血性心力衰竭(CHF)的远期疗效及二者的成本─效果分析.方法:选择CHF患者114例,随机分3组.A组为对照组,予以血管扩张剂、利尿剂、地高辛、血管紧张素转换酶抑制荆等常规治疗;B组为卡维地洛组,在上述常规治疗的基础上给予卡维地洛.C组在常规治疗基础上给予美托洛尔,随访6个月.用药前后分别观察左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、心衰症状等指标变化情况.结果:6个月后B组和C组LVEDD、LVESD缩小,LVEF明显提高,心衰症状明显好转.但卡维地洛组LVEF改善优于美托洛尔组:卡维地洛组的成本─效果分析低于美托洛尔组.结论:美托洛尔、卡维地洛均可逆转心室重塑,改善心脏功能.卡维地洛疗效略优于美托洛尔.     

Effectiveness of chest radiography,lung ultrasound and thoracic computed tomography in the diagnosis of congestive heart failure

Hydrostatic pulmonary edema is as an abnormal increase in extravascular water secondary to elevated pressure in the pulmonary circulation, due to congestive heart failure or intravascular volume overload. Diagnosis of hydrostatic pulmonary edema is usually based on clinical signs associated to conventional radiography findings. Interpretation of radiologic signs of cardiogenic pulmonary edema are often questionable and subject. For a bedside prompt evaluation, lung ultrasound (LUS) may assess pulmonary congestion through the evaluation of vertical reverberation artifacts, known as B-lines. These artifacts are related to multiple minimal acoustic interfaces between small water-rich structures and alveolar air, as it happens in case of thickened interlobular septa due to increase of extravascular lung water. The number, diffusion and intensity of B lines correlates with both the radiologic and invasive estimate of extravascular lung water. The integration of conventional chest radiograph with LUS can be very helpful to obtain the correct diagnosis. Computed tomography (CT) is of limited use in the work up of cardiogenic pulmonary edema, due to its high cost, little use in the emergencies and radiation exposure. However, a deep knowledge of CT signs of pulmonary edema is crucial when other similar pulmonary conditions may occasionally be in the differential diagnosis.     

Tei指数及B型钠尿肽对老年充血性心力衰竭的诊断价值

 目的 研究Tei指数及B型钠尿肽(B- type natriuretic peptide,BNP)对老年人充血性心力衰竭(congestive heart failure,CHF)的诊断、病情评估价值.方法 选择老年CHF患者83例作为研究对象,另选健康体检老年患者48例作为对照组,采用美国博适公司生产的Triage快速诊断测定仪床边检测血浆BNP浓度,并行心脏彩超测定Tei指数、左心室射血分数(LVEF)及其他心脏参数.结果 (1)老年CHF不同心功能组Tei指数和血浆BNP水平均显著高于老年对照组;且随着心功能的恶化,Tei指数和血浆BNP水平均逐渐升高,两者升高呈显著的正相关关系(r=0.47,P ＜0.01).(2) Tei指数的AUC为(0.86±0.03),BNP的AUC为(0.88±0.03),两者的AUC显著大于LVEF的AUC(0.75±0.05),差异有统计学意义(P均＜0.05),但两者之间的AUC比较,差异无统计学意义(P＞0.05).BNP的最佳截断值为425 ng/L,敏感度为87.95％,特异度为75％,Tei指数最佳截断值为0.47,敏感度为75.90％,特异度85.42％,在两者最佳截断值下,BNP的敏感度显著大于Tei指数(P均＜0.05),Tei指数的特异度显著大于BNP(P均＜0.05).结论 Tei指数与BNP有良好的相关性,Tei指数与BNP一样可作为判定老年人心力衰竭及其程度的指标,联合Tei指数和BNP有利于进一步提高慢性心力衰竭诊断的准确性.     

Doses and image quality for chest radiographs in three Nigerian hospitals

To encourage local participation in patient dose data acquisition, a mathematical method of entrance skin doses determination, developed by Harpen, has been used to determine patient doses and radiographic/technical image quality for 169 adult patients undergoing non-grid chest radiography in three Nigerian hospitals. Calculated doses were found to be about 12.5% (range 8.9-13.3%) higher than doses obtained with thermoluminescence dosemeters (TLD). This level of discrepancy was about 4% higher than the value reported in the literature. Radiographic/technical quality was rated at 53.7% while image quality obtained against a standard image according to the European guidelines was rated with an above average score (58%). Notable variation between the hospitals was observed and the need for optimization highlighted in technical areas like collimation, film processing and in patient dose reduction using better exposure techniques. This study presents patient entrance doses and image quality in hospitals where such data was not existing and could therefore be used as a basis for future studies in dose and image quality, towards the development of local and national reference parameters. The mathematical method, though highly susceptible to errors, can be employed until dose monitoring equipment become more accessible.     

Image quality of supine chest radiographs: intra-individual comparison of computed radiography and low-dose linear-slit digital radiography

The purpose of this retrospective study was to intra-individually compare the image quality of computed radiography (CR) and low-dose linear-slit digital radiography (LSDR) for supine chest radiographs. A total of 90 patients (28 female, 62 male; mean age, 55.1 years) imaged with CR and LSDR within a mean time interval of 2.8 days ± 3.0 were included in this study. Two independent readers evaluated the image quality of CR and LSDR based on modified European Guidelines for Quality Criteria for chest X-ray. The Wilcoxon test was used to analyse differences between the techniques. The overall image quality of LSDR was significantly better than the quality of CR (9.75 vs 8.16 of a maximum score of 10; p < 0.001). LSDR performed significantly better than CR for delineation of anatomical structures in the mediastinum and the retrocardiac lung (p < 0.001). CR was superior to LSDR for visually sharp delineation of the lung vessels and the thin linear structures in the lungs. We conclude that LSDR yields better image quality and may be more suitable for excluding significant pathological features of the chest in areas with high attenuation compared with CR.     

心脏再同步化治疗慢性心衰的短期疗效观察

目的 观察心脏再同步化治疗慢性心力衰竭(CHF)的短期临床疗效.方法 26例慢性心力衰竭患者行双心室再同步起搏治疗,全部患者均经冠状静脉窦植入左心室导线1根至心脏静脉,术后随访13.8±10.4(3～34)个月,观察心功能,患者活动度及夜间心率、QRS波时限,左心室收缩、舒张末内径,左室收缩、舒张末容积,左心室射血分数,左室舒张充盈时间,左室内各室壁收缩期达峰时间等.结果 26例患者中,1例于术后2个月时猝死;25例于术后3个月随访时发现心功能改善,有效率96.2%,心功能NY-HA分级,从Ⅲ-Ⅳ级改善为Ⅱ-Ⅲ级,患者活动度从0.31±0.40h/d增加至2.35±1.20h/d,夜间心率由84.8±15.7/min降低至63.4±4.5/min,心律变异性从47.3±7.1ms提高至96.4±15.1ms,QRS波从158.6±31.8ms缩短至129.5±30.2ms(P＜0.05),左心室收缩末内径、舒张末内径分别从67.6±8.2mm、77.0±9.4mm缩小至62.1±12.3mm、71.6±8.7mm(P＜0.05),左心室收缩末容积、舒张末容积分别从213±54ml、266±68ml缩小至151±62ml、212±63m1(P＜0.05),左心室射血分数从21.2%±4.5%提高至32.5%±6.4%(P＜0.05),左室舒张充盈时间从329±140ms提高至423±118ms(P＜05),左室12个节段收缩达峰时间标准差(Ts-Sd-12)从48.4±17.9ms减少至33.5±19.7ms(P＜0.05).结论 双心室再同步起搏是慢性心力衰竭治疗的有效方法.     

慢性心力衰竭与高尿酸血症关系探讨

目的探讨慢性心力衰竭（chronic heart failure,CHF）患者心功能和血尿酸（uric acid,UA）水平及左室重构程度的关系。方法 236例CHF患者,按NYHA心功能分级分为Ⅱ、Ⅲ、Ⅳ级,分为3组,分别为78、86、72例;按UA水平分为正常血尿酸组（132例）和高尿酸血症组（104例）。所有入选者入院后急诊或常规检查尿酸、肝肾功能、电解质等项目;超声心动图测定心脏左室舒张末期内径（left ventricular end diastolic diameter,LVEDd）、左室后壁厚度（left ventricular posterior wall diameter,LVPWd）,计算左室射血分数（left ventricular ejection fraction,LVEF）。结果心力衰竭患者血尿酸明显升高,发生率为44.1%,随着心功能损害的加重,高尿酸血症的发生率增加（χ2=8.46,P〈0.05）,尿酸水平增高（F=11.68,P〈0.05）;血尿酸增高者左室舒张末内径明显增大,左室射血分数显著降低,（P〈0.05）,相关分析显示LVEDd与血尿酸水平正相关（r=0.386,P〈0.01）,LVEF与血尿酸水平负相关（r=-0.324,P〈0.05）。（F=11.68,P〈0.05）。结论随着心力衰竭程度的加重,尿酸水平逐步升高。     

曲美他嗪联合培哚普利治疗慢性充血性心力衰竭疗效观察

目的观察曲美他嗪（TMZ）联合培哚普利治疗慢性充血性心力衰竭（CHF）患者的临床疗效。方法72例CHF患者随机分为研究组和对照组，均给予内科常规抗心衰治疗。对照组加服培哚普利，初始剂量2mg，每日1次，逐渐加至靶剂量4mg，每日1次；研究组在对照组的基础上接受曲美他嗪20mg／次，3次/d。治疗12周。结果治疗12周，两组心功能较治疗前有明显改善，治疗组临床总有效率为93．4％，较对照组（80．6％）显著提高（P〈0．05）；超声心动图LVEF均较治疗前有明显改善（P〈0．01或P〈0．051．但治疗组较对照组改善更为显著（P〈0．05）。治疗组LVEDD、LVESD、LADD均较治疗前改善，差异有显著性（P〈0．01或P〈0．05），而对照组无改善；两组均未发现有明显的不良反应。结论TMZ联合培哚普利治疗CHF是一种安全有效的方法。