房室间期优化对三度房室传导阻滞患者房室顺序起搏心功能的影响

目的:探讨不同房室间期(AVD)对三度房室传导阻滞(Ⅲ°AVB)患者房室顺序起搏(DDD)后心功能的影响。方法:接受DDD起搏治疗的Ⅲ°AVB患者16例,其中男女比例3∶1,平均年龄(64.50±15.96)岁。起搏器术后调整不同的AVD,应用左心导管检查测量左心室内压力上升/下降的速率(±dP/dT),评价不同AVD对Ⅲ°AVB患者DDD起搏后心功能的影响。结果:个体间最佳AVD的离散度较大(120～260 ms);不同AVD时,±dP/dT组内差异有统计学意义(P0.05),最佳AVD在160～220 ms区间的分布较集中;在160～220 ms区间的+dP/dT水平与其他区间的+dP/dT水平比较差异有统计学意义(P0.05);+dP/dT组最佳AVD与-dP/dT组最佳AVD比较差异无统计学意义(P0.05)。结论:不同的AVD对Ⅲ°AVB患者DDD起搏后心脏的收缩及舒张功能均有影响,最佳AVD能使其心脏的收缩及舒张功能达到最佳状态。     

维持性血液透析对尿毒症患者左心室收缩和舒张功能的影响及其相关因素分析

目的应用多普勒超声心动图检测维持性血液透析患者左心室收缩及舒张功能指标,并探讨相关因素对心脏功能的影响。方法根据血压、血红蛋白、每周透析时间和KT/V值将44例尿毒症患者分为透析充分组(A组,24例)和未充分透析组(B组,17例)。血液透析前后及首次超声心动检查一年后透析前测定左房内径(LAD)、左室舒张末内径(LVDd)、左室收缩末内径(LVDs)、室间隔厚度(IVST)、左室后壁厚度(LVPWT),得出左室射血分数(EF)、左室短轴缩短率(FS),测定心率(HR)。并依据上述指标判断左心室收缩及舒张功能。结果首次超声心动检查左心室舒张功能减退占59.1%,收缩功能减退占18.2%;左心室肥厚占43.2%。LAD、LVDd、LVDs、IVST、LVPWT值较对照组明显增加,FS、EF、E/A、EI/AI较对照组明显降低,单次透析前后FS、EF、E/A、EI/AI无显著变化。一年后左心室舒张功能减退占80.5%;收缩功能减退占22.0%,均同时伴有舒张功能减退。左心室肥厚占70.7%。LAD、LVDd、LVDs、IVST、LVPWT值明显增加,FS、EF、E/A、EI/AI明显降低;A、B组LAD、LVDd、LVDs、IVST、LVPWT均较对照组明显增加,B组尤为显著;B组E/A、EI/AI较A组明显下降。结论长期维持性血液透析患者首先出现左心室舒张功能障碍,进而影响收缩功能;单次血液透析后左心室收缩及舒张功能无改善;血液透析一年后左心室收缩、舒张功能明显降低,尤以舒张功能降低显著。未充分透析患者舒张功能下降更明显。     

血尿酸水平对老年2型糖尿病患者心脏结构与功能的影响

目的探讨血尿酸水平对老年2型糖尿病（T2DM）患者心脏结构及功能的影响。方法选择98例无心脏病病史的老年T2DM患者,根据血尿酸水平分为正常尿酸（A组）、高尿酸血症（B组）两组;均行彩超检测室间隔舒张末厚度（IVST）、左室后壁舒张末厚度（LVPWT）、左室舒张末内径（LVDd）、左室收缩末内径（LVDs）、左房内径（LAD）、左室射血分数（LVEF）、左室短轴缩短率（FS）、二尖瓣E峰及A峰血流速度,计算E/A比值、左室质量（LVM）及左室质量指数（LVMI）。结果与A组比较,B组LAD、LVDs、LVDd明显增大,IVST、LVPWT、LVM、LVMI明显增加,E/A比值变小,EF、FS明显降低（P〈0.01或〈0.05）。结论老年T2DM并高尿酸血症患者的心脏结构改变明显,左室收缩、舒张功能异常严重。     

维持性血液透析患者血浆NT-proBNP水平与心功能评价的相关性研究

目的探讨维持性血液透析(MHD)患者血浆N末端脑钠肽前体(NT-proBNP)水平的变化与左心室结构和功能的相关性分析,评估NT-proBNP在MHD患者心功能评价中的临床价值。方法选择在北京朝阳医院京西院区血液净化中心透析龄超过3个月的MHD患者30例,病情稳定,已排除急性心血管事件,30名健康志愿者为健康对照组。电化学法检测患者透析前NT-proBNP水平,超声心动图检测患者左心房内径(LAD)、左心室舒张末内径(LVDd)、左心室收缩末内径(LVDs)、室间隔厚度(IVST)、左心室后壁厚度(LVPWT)、左心室射血分数(LVEF)等,计算左心室心肌重量指数(LVMI),探讨NT-proBNP与MHD患者左心功能的关系。结果 MHD患者透析前血清NT-proBNP水平显著高于健康对照组,二者差异有统计学意义(P<0.01)。MHD患者血清NT-proBNP分别与LVDd、LVDs、IVST、LVMI呈正相关(P<0.05或P<0.01)、与LVEF呈负相关(P<0.01),与LAD、LVPWT无相关性。结论 MHD患者NT-proBNP水平普遍显著升高,并且与左心室功能密切相关,是一个早期诊断及评估患者心功能的重要标志物。     

Ⅲ度房室传导阻滞患者行VVI及DDD起搏后心功能及超敏C反应蛋白的比较

目的比较Ⅲ度房室传导阻滞(AVB)患者行VVI及DDD起搏后心功能、N-末端B型脑钠肽(NT-pro BNP)及超敏C反应蛋白(hs-CRP)的变化。方法选取Ⅲ度AVB患者50例,按起搏方式分组。VVI组(n=25)植入单腔起搏器,起搏模式为VVI;DDD组(n=25)植入双腔起搏器,起搏模式为DDD。随访3年,比较患者起搏参数、左房内径(LAD)、左室舒张末径(LVEDD)、左室射血分数(LVEF)、左室舒张功能(E/A)、心脏指数(CI)、每搏输出量(SV)、右室内径(RV)、hs-CRP、NT-pro BNP等指标。结果两组心室电极感知、阈值、阻抗、右室起搏比例均无差异。术后LAD、LVEDD进行性扩大,LVEF进行性下降,CI较前改善,均以VVI组较为明显;SV指标VVI组术后逐年下降,而DDD组术后1年明显增加,随后下降。术后hs-CRP、NT-pro BNP进行性升高,均以VVI组较为明显。患者hs-CRP与LVEDD、LAD、NT-pro BNP之间、NT-pro BNP与LVEDD间存在正相关关系,hs-CRP、NT-pro BNP与LVEF间存在负相关关系。结论Ⅲ度AVB患者长期VVI及DDD起搏将不同程度导致心功能恶化,VVI起搏为甚,起搏术后心功能恶化与炎症反应可能有关。     

右室心尖部起搏患者起搏QRS波时限与左室结构和功能关系探讨

目的评价起搏QRS波时限与左心结构和功能的关系。方法入选106例右室心尖起搏患者,分成左室射血分数(LVEF)<0.55的病例组(n=48)和LVEF>0.55的对照组(n=58)。通过常规体表心电图测得起搏QRS波时限,行超声心动图检查获取左房内径(LAD)、收缩末期左室内径(LVESD)、舒张末期左室内径(LVEDD)、室间隔厚度(IVST)、左室后壁厚度(LVPWT)及LVEF,评价患者的纽约心功能分级,同时检测患者的N端-B型利钠肽前体(NT-proBNP)水平,分析起搏QRS波时限与以上各指标的关系。结果①起搏QRS波时限与LVEDD(r=0.577,P<0.001)、LVESD(r=0.627,P<0.001)、LAD(r=0.241,P=0.013)、IVST(r=0.345,P<0.001)、LVP-WT(r=0.349,P<0.001)均呈正相关,与LVEF负相关(r=-0.570,P<0.001),与纽约心功能分级正相关(r=0.527,P<0.001),与NT-proBNP对数正相关(r=0.265,P=0.024)。②以起搏QRS波时限≥200ms诊断左室收缩功能不全,灵敏度和特异度分别为85.42%和70.69%。结论对于右室心尖部起搏的患者,起搏QRS波时限是一个简便而实用的初步判断心脏结构和功能的指标。     

起搏心电图问答

<正>按起搏心电图回答问题:患者因Ⅲ度房室传导阻滞植入永久起搏器(SJ Medical 5356),起搏器参数:上限跟踪频率110次/分,下限频率60次/分,PAV/SAV 200/175 ms,PVARP(心室后心房不应期)275 ms。请根据心电图分析起搏器的心房、心室电极起搏和     

老年急性呼吸困难患者N-末端脑钠肽前体位于灰色区域的临床诊断价值

目的探讨N末端脑钠肽前体(NT-proBNP)位于灰色区域对老年急性呼吸困难患者的临床诊断价值。方法选取2009年8月—2012年11月以急性呼吸困难为主要症状就诊于本院急诊及住院的患者389例,将诊断为左室射血分数保留的心力衰竭(HFPEF)所致的呼吸困难患者60例作为HFPEF组,将诊断为肺源性呼吸困难患者40例作为肺源性呼吸困难组。测定两组患者血浆NT-proBNP水平,采用超声心动图仪测定左心房内径(LAD)、左心室舒张末内径(LVDd)、室间隔舒张末厚度(IVST)、左室后壁舒张末厚度(LVPWT)、左室射血分数(LVEF),计算左心房内径指数(LADI)及左室质量指数(LVMI)。结果两组患者LADI、LVDd、LVEF及治疗前NT-proBNP比较,差异均无统计学意义(PO.05);HFPEF组患者LVMI高于肺源性呼吸困难组,治疗1周后NT-proBNP水平低于肺源性呼吸困难组(P0.05)。结论血浆NT-proBNP水平结合LVMI对NT-proBNP处于灰色区域的HFPEF的诊断有重要参考价值。     

双腔起搏房室延迟时间对心功能的影响

目的观察不同房室延迟(AVD)的双腔起搏对心脏收缩、舒张功能的影响及不同心功能状态下的优化AVD。方法测量20例心力衰竭患者及10例心功能正常者(对照组)不同房室延迟起搏的急性血流动力学效应,同时以脉冲多普勒超声心动描记术测量心脏收缩、舒张功能指标。结果心力衰竭组房室延迟在134±13、131±12、136±10ms起搏时,血流动力学指标及左心室收缩功能、右心室舒张功能指标较AVD基线穴100ms雪及250ms显著改善;140±17ms起搏时,左心室舒张功能指标较AVD基线及250ms显著改善。对照组AVD在162±14ms起搏时,血流动力学参数较AVD基线及250ms显著改善。结论优化AVD可即刻改善心力衰竭患者心脏收缩及舒张功能,优化AVD随心功能状态不同而改变。     

不同房室间期对永久起搏器患者心功能及生活质量的影响

60例置入DDD起搏器患者分为三组,每组20例。A组房室间期(AVD)=180 ms;B组AVD=250 ms;C组AVD>250 ms。术前三组Minnisota生活质量评分(QOL)、6 min步行距离测试(6-MWT)、及左室射血分数无差异,术后1年A组和C组的三项指标均较术前明显改善,并明显优于B组(P均<0.05)。A组6-MWT及QOL亦明显均优于C组(P<0.05)。结论:若把AVD程控在180 ms时,尽管是心尖部起搏也同样具有提高心功能及生存质量的作用,而且比AVD>250 ms时效果更好。     

体表心电图在双腔起搏器房室传导间期最佳化中的价值

目的:探讨置入了双腔起搏器的患者,在随访时,根据体表心电图P波宽度调节房室传导间期(AV间期)对血流动力学的影响。方法:因高度或Ⅲ度房室传导阻滞而安装美墩力SD303双腔起搏器的患者31例。测量患者体表心电图自身P波宽度,和(或)心房起搏脉冲至起搏的P波末端的宽度,在此测量值上加100ms,分别设定双腔起搏器的感知AV间期和起搏AV间期。使用多普勒超声仪,分别在出厂常规设置的AV间期和根据体表心电图优化的AV间期设定值,进行超声检查。结果:经体表心电图调整AV间期后的左室每搏量、左室舒张末期容量和左室射血分数、左室充盈时间、二尖瓣血流速度时间积分,均高于常规出厂设置的AV间期,前三者差异显著(P<0.05)。结论:根据体表心电图中P波宽度的变化来调节AV间期,不但能获得良好的血流动力学效果,且由于其简单易行,而具有广泛的临床实用价值。     

超声心动图评价双腔起搏器不同房室间期设置时心功能变化

目的采用超声心动技术评价双腔起搏器设置不同房室间期（AVD）时的急性血流动力学和心脏收缩舒张功能改变。方法36例高度或Ⅲ度房室传导阻滞安装双腔起搏器的患者,在常规设置AVD和根据体表心电图优化设置AVD的情况下分别进行超声心动图检查。结果与常规设置AVD相比,AVD优化后左室舒张末期容积、左室每搏量、左室射血分数和心排量显著增加,左室充盈时间延长,二尖瓣血流速度时间积分显著增加,Tei指数显著减小。此外,AVD优化后组织多普勒指标室间隔、左室前壁、下壁基底段收缩期峰值速度（Sm）显著增高,左、右心室壁基底段舒张晚期峰值速度（Am）显著增高,右室游离壁基底段的Sm、舒张早期峰值速度和Am均显著高于左室壁各基底段。结论双腔起搏器最佳AVD设置能改善患者的血流动力学指标和心脏功能,这些变化可用超声心动图来评价。     

Hemodynamics and echocardiograms before and after cardioversion of atrial fibrillation to normal sinus rhythm.

Hemodynamic and echocardiographic measurements were obtained in 15 patients prior to cardioversion and immediately, one, three, and five hours after cardioversion of atrial fibrillation to normal sinus rhythm. At five hours after cardioversion, there was improvement in cardiac index (P less than 0.005), in stroke index (P less than 0.005), and in stroke work index (P less than 0.025), but no significant change in heart rate, mean pulmonary capillary wedge pressure, left atrial dimemsions (LAD), left ventricular end-diastolic dimensions (LVEDD), or left ventricular end-systolic dimension (LVESD). At follow-up one week to nine months after cardioversion, 10 of the 15 patients (67 percent) remained in normal sinus rhythm. Neither the size of the left atrium, changes in hemodynamics, LAD, LVEDD, or LVESD, nor the presence or amplitude of the A-wave on the mitral valve echogram correlated with the persistence or normal sinus rhythm.     

The effect of different atrioventricular delays on left atrium and left atrial appendage function in patients with DDD pacemaker

Background: Although it has been known that optimization of atrioventricular delay (AVD) has favorable effect on the left ventricular functions in patients with DDD pacemaker, the effect of different AVDs on left atrium (LA) and left atrial appendage (LAA) functions has not been exactly evaluated. The aim of the present study was to assess the effect of different AVDs on LA and LAA functions in DDD pacemaker implanted patients with atrioventricular block. Methods: Forty‐eight patients with DDD pacemaker were enrolled into the study. Patients were divided into two groups according to the echocardiographic diastolic function: Group I (normal diastolic function) and Group II (diastolic dysfunction). LAA emptying velocity on pulsed wave Doppler and LAA late systolic wave velocity by using tissue Doppler were recorded. Patients were paced for five successive continuous pacing periods of 10 minutes duration using five selective AVDs (80–250 ms). Results: Significant effect on LA and LAA functions has not been observed by the setting of AVD in Group I. However, when the AVD was gradually shortened form 150 ms to 80 ms, LA and LAA functions gradually decreased in Group II patients. When AVD increased to 200 ms, LA and LAA functions were improved. Further increase in AVD resulted in decreased LA and LAA functions. Conclusion: Setting of AVD has not significant effect on the LA and LAA functions in patients with normal diastolic function, but moderate prolongation of AVD in physiological limits improved LA and LAA functions in DDD pacemaker implanted patients with diastolic dysfunction. (Echocardiography 2011;28:626‐632)     

Optimal Atrioventricular Delay in CRT Patients Can Be Approximated Using Surface Electrocardiography and Device Electrograms

Electrocardiographic AV Delay Adjustment . Background: Optimization of the atrioventricular (AV) delay (AVD) may result in an improvement in cardiac resynchronization therapy (CRT) outcome. Previous studies have shown positive correlation between interatrial conduction time measured invasively during the implant procedure and optimal AVD determined postimplant using Doppler echocardiography. We hypothesized that the optimal AVD can be predicted noninvasively from surface electrocardiogram (ECG). Methods: The optimal sensed (SAV) and paced (PAV) AVDs were determined for CRT patients (n = 63) by programming different AVDs (in 20 ms steps, in random sequence) and evaluating Doppler images of the mitral flow (iterative method). The time intervals between atrial sensing (As) and pacing (Ap) to the end of the P‐wave (Pend) and to the right ventricular sensing (RVs) were measured from 5 ECG leads (limb, V1, and V3) and device telemetry during sinus rhythm and atrial pacing. Results: Optimal SAV was 120 ± 30 ms and correlated with As‐Pend (R = 0.69, P < 0.0001) and As‐RVs (R = 0.45, P = 0.0003). Optimal PAV was 172 ± 38 ms and correlated with Ap‐Pend (R = 0.65, P < 0.0001) and Ap‐RVs (R = 0.60, P < 0.0001). Regression analysis suggested a simple method of AVD adjustment by pacing the ventricles 40 ms after the end of the sensed P‐wave or 30 ms after the end of the paced P‐wave but not at the expense of biventricular capture. Such a method would have resulted in significantly lower deviation from echo‐optimal AVDs compared with programming fixed values. Conclusion: A simple method of providing 30–40 ms separation between the end of the P‐wave and ventricular pacing pulse can be used to approximate echocardiographically optimal AV delays. (J Cardiovasc Electrophysiol, Vol. 21, pp. 1226‐1232, November 2010)     

Hcy对高血压患者心肌重构的影响

目的:研究同型半胱氨酸(Hcy)对高血压患者心肌重构的影响。方法:根据血浆Hcy水平,2017年1月~2017年12月于我院治疗的92例高血压患者被分为H型高血压组(46例)和非H型高血压组(46例)。测量比较两组24h平均收缩压(24h mSBP)、24h平均舒张压(24h mDBP)、左房内径(LAD)、左室后壁厚度(LVPWT)、室间隔厚度(IVST)、左室舒张末期内径(LVEDd)及LVEF。结果:两组24h mSBP、24h mDBP、LAD、LVEDd、LVEF比较均无显著差异(P均>0.05)。与非H型高血压组比较,H型高血压组LVPWT[9.80(9.38,10.73)mm比13.40(12.40,14.30)mm]、IVST[9.70(9.23,10.63)mm比13.10(12.40,14.20)mm]均显著升高(P均=0.001)。结论:与非H型高血压者比较,H型高血压患者左室后壁厚度、室间隔厚度显著增厚,可能高血浆Hcy水平加剧了高血压患者心肌重构的进展。     

超声生物显微镜VevoStrain技术定量分析正常小鼠左心室短轴应变的初步研究

目的:应用超声生物显微镜(UBM)及VevoStrain技术,探讨不同周龄正常小鼠左心室短轴心肌应变的特征。方法:对8,12及16w的健康雄性C57BL/6小鼠共24只,行常规超声心动图检查,采集胸骨旁乳头肌水平左心室短轴二维图像。常规超声心动图测量舒张末期室间隔厚度(IVST)、左心室后壁厚度(LVPWT)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心室射血分数(LVEF)、左心室内径缩短率(LVFS)。脱机分析左心室短轴的径向应变、应变率;圆周应变、应变率;应变达峰时间等指标。结果:8,12及16w LVEDD、LVESD、LVEF、FS、IVST和LVPWT比较,差异无统计学意义(P0.05);三组间左心室短轴径向应变、径向应变率、圆周应变、圆周应变率比较,差异均无统计学意义(P0.05);8,12及16w小鼠径向应变、圆周应变达峰时间基本一致,差异无统计学意义(P0.05),同一周龄小鼠左心室各壁达峰时间基本一致,差异无统计学意义(P0.05)。结论:超声生物显微镜VevoStrain技术能够无创、简便地评价正常小鼠左心室短轴心肌应变、应变率、应变达峰时间等力学参数;8~16w正常小鼠左心室心肌收缩功能处于稳定状态,在此周龄内研究其心脏病变,可以忽略年龄因素。     

Correlation between serum miR-122 and myocardial damage and ventricular function in patients with essential hypertension

BackgroundMyocardial damage and decreased ventricular function are risk factors leading to a bad prognosis in patients with essential hypertension (EH). MicroRNAs play important roles in myocardial function impairment in patients with hypertension. The purpose of our research was to investigate the correlation between serum miR-122 and myocardial damage and ventricular functions in EH patients.MethodsThe clinic data of EH patients (group A, n=60) and healthy individuals (group B, n=60) from December 2016 to December 2019 in our hospital were collected and analyzed. Serum miR-122, myocardial damage markers [B-type brain natriuretic peptide (BNP), homocysteine (Hcy), cardiac troponin T (cTnT) and creatine kinase MB isoenzyme (CK-MB)] and cardiac function indicators [ejection fraction (EF), left ventricular septal thickness (IVST), left ventricular isovolumic relaxation time (IVRT), left ventricular end-diastolic diameter (LVEDD), left ventricular posterior wall thickness (LVPWT), and left ventricular end-systolic diameter (LVESD)] were assessed in both groups. The correlation between serum miR-122 and myocardial damage markers and ventricular function indicators was analyzed.Results(I) The mean serum miR-122 concentration in group A and group B was 6.86±1.23 and 3.36±1.87 µmol/L, respectively. The serum miR-122 concentration in group A was evidently increased compared with that in group B. (II) The levels of BNP, Hcy, cTnT, and CK-MB in the peripheral blood in group A were evidently increased compared with those in group B (P<0.05). (III) EF and IVRT were evidently decreased in group A compared with that in group B (P<0.05). (IV) Serum miR-122 concentration was positively correlated with the myocardial damage markers BNP, Hcy, cTnT and CK-MB, and serum miR-122 concentration was negatively correlated with the ventricular function indicators EF and IVRT but not significantly correlated with other ventricular function indicators (IVST, LVEDD, LVPWT and LVESD).ConclusionsThe serum miR-122 concentration in EH patients was higher than that in healthy individuals, and miR-122 concentration was positively correlated with myocardial damage markers. Serum miR-122 level was negatively correlated with the ventricular function indicators EF and IVRT but was not significantly correlated with other ventricular function indicators (IVST, LVEDD, LVPWT, and LVESD).     

Determination of the optimal atrioventricular delay in DDD pacing. Comparison between echo and peak endocardial acceleration measurements.

The goal of this study was to compare two methods determining the optimal atrioventicular delay (AVD) in 19 patients implanted with the BEST-Living system for complete heart block. The definition of the optimal AVD was: the AVD with the echo method that provided the longest diastolic filling time without interruption of the A wave, and the AVD with the peak endocardial acceleration (PEA) method, corresponding to the knee of the PEA curve vs AV delay. The amplitude of the PEA was measured for every AVD programmed via an automatic scanner in steps of 60 to 300 ms (40 ms steps): in the VDD pacing mode with a low base rate, to obtain 100% sensed P waves; in DDD with a base rate = sinus rate + 20%, to obtain 100% paced P waves. Echocardiographic (Echo) measurement of the left ventricular filling time were performed in the same AV delay settings in VDD and DDD as the ones tested in the PEA method, which were manually programmed. The optimal AVDs obtained in DDD and those obtained in VDD were compared in the echo and the PEA tests by a paired Student's t-test. The optimal AVDs obtained by both Echo and by PEA were also compared by a paired Student's t-test in VDD and DDD. The r value of the correlation between the optimal AVDs obtained by Echo and those obtained by PEA was calculated. Similar values of optimal AVD were obtained with both methods. The optimal AVDs given by the Echo technique (179 +/- 25 ms in DDD and 124 +/- 18 ms in VDD) were slightly, but significantly shorter than the ones obtained with the PEA method (202 +/- 21 ms in DDD and 145 +/- 18 ms in VDD, P < 0.05). A highly significant difference between AVD VDD and AVD DDD was found with both methods (P < 0.001). The correlation between the AVDs obtained with the echo and the PEA methods was highly significant (r = 0.78, P < 0.01). Pacemaker software could be modified to determine automatically the optimal AVDs to be applied throughout the heart rate range.