抑郁对急性冠状动脉综合征预后的影响

目的研究抑郁对急性冠脉综合征(ACS)预后的影响。方法将临床确诊为ACS的262例患者分为抑郁组与非抑郁组,比较两组的近期心血管事件发生率及分析抑郁与各心血管事件的关系,了解ACS并抑郁患者心率变异性(HRV)的变化和抑郁与HRV的相关性。结果ACS并抑郁患者心绞痛、急性ST段抬高心肌梗死、急性非ST段抬高心肌梗死、心力衰竭、短阵室性心动过速、心室颤动、心脏性死亡的发生率分别为40.8%,11.4%,19.4%,21.4%,13.3%,9.4%和8.2%。抑郁均为各心血管事件发生的独立预测因素。ACS并抑郁患者时域指标、高频功率均低于非抑郁组,极低频功率、低频功率高于非抑郁组。抑郁严重度指数与HRV各指标相关。结论ACS并抑郁患者心血管事件的发生率增加,抑郁为各心血管事件发生的独立预测因素。     

阿托伐他汀钙在急性冠脉综合征中应用的研究进展

急性冠脉综合征(ACS)是一组由急性心肌缺血引起的临床综合征,包括不稳定性心绞痛、急性非ST段抬高型心肌梗死(NSTEMI)、急性ST段抬高型心肌梗死(STEMI),是造成人类致死、致残的严重心血管事件;其病理基础为冠状动脉内的不稳定斑块破裂,继而血小板活化、血栓形成。研究表明,他汀类     

非ST段抬高急性冠脉综合征患者GRACE评分与冠脉病变程度的相关性

急性冠脉综合征(ACS)是冠状动脉病变导致心肌缺血急性发作而引发的一系列心血管事件。其中,非ST段抬高急性冠脉综合征(ACS)包括不稳定性心绞痛(UA)及非ST段抬高心肌梗死(NSTEMI),它是临床表现、危险层次及预后不一致的一组疾病群。研究表明ACS早期危险分层有助于指导治疗与     

aVR导联ST段抬高患者冠脉病变特点及预后评价

目的探讨心电图aVR导联ST段抬高对急性冠脉综合征患者远期预后的诊断价值。方法根据心电图有无aVR导联ST段抬高将878例急性冠脉综合征患者分为观察组和对照组。对比分析两组患者冠状动脉病变特点和一年内心血管事件发生率。结果对照组813例患者中,左主干病变10例、三支病变58例,一年内发生心血管事件21例。观察组65例患者中,左主干病60例、三支病变4例,一年内发生心血管事件9例。组间比较差异有统计学意义,p0.05。aVR导联ST段诊断左主干病变的敏感性为92.3%,特异性为98.8%,阳性预测值为85.7%。结论心电图aVR导联ST段抬高对急性冠脉综合征患者左主干病变有较好的诊断价值,并对患者心血管事件发生率具有较高的预测价值。     

高负荷量氯吡格雷对中高危非ST段抬高型急性冠脉综合征患者行PCI的疗效观察

目的 探讨行经皮冠状动脉介入治疗(PCI)前,高负荷量氯吡格雷对中高危非ST段抬高型急性冠脉综合征(ACS)患者的近期疗效和安全性.方法 选择中高危非ST段抬高型ACS患者238例,随机分为观察组120例、对照组118例.行PCI前,观察组给予高负荷量氯吡格雷600mg顿服,对照组给予常规负荷量氯吡格雷300 mg顿服;观察两组行PCI后即刻病变血管的TIMI血流和心肌灌注指标,随访其行PCI后30 d内主要心血管事件和出血并发症发生率.结果 PCI后即刻,两组冠脉造影达到TIMI血流3级的发生率比较无统计学差异(P＞0.05);与对照组比较,观察组心肌灌注TMPG 2级以上发生率高,校正TIMI计帧数小,PCI后30d内主要心血管事件发生率降低(P均＜0.05).两组30 d内出血事件发生率无统计学差异(P＞0.05).结论 高负荷量氯吡格雷可显著改善中高危非ST抬高型ACS患者的PCI后心肌灌注,减少其PCI后30 d内不良心血管事件发生,且不增加出血风险.     

非ST段抬高型急性冠脉综合征的危险分层和处理策略

急性冠脉综合征(ACS)是一组由于冠状动脉急性缺血引起的临床综合征.尽管具有共同的病理生理基础,但不同ACS患者缺血和出血风险不同,其死亡和心血管不良事件发生率也存在明显差异.及时准确地对ACS患者进行危险分层,采取及时有效的处理策略,对改善患者预后具有重要意义.我们对非ST段抬高型ACS(NSTE-ACS)的危险分层及处理策略进行阐述.     

急性心肌梗死的治疗进展

急性冠脉综合征(ACS)是近年来提出的新概念,按ST段抬高与否,分为ST段抬高及非ST段抬高的ACS.ST段抬高的ACS主要演变为Q波型急性心肌梗死(AMI),非ST段抬高的ACS主要演变为非Q波型心肌梗死和不稳定型心绞痛两大类.     

急性冠脉综合征的抗血栓治疗

急性冠状动脉综合征(ACS)为冠心痛急性发病的临床类型,其发病机理主要是因斑块破裂继发血栓形成所致.ACS临床类型包括ST段抬高急性心肌梗死(AMI)以及无ST段抬高AMI和不稳定性心绞痛(UA),后两者常被称为无ST段抬高ACS.     

血浆D二聚体水平在急性冠脉综合征、急性肺栓塞、主动脉夹层鉴别诊断中的应用价值

目的 目的检测血浆D二聚体(DD)的水平在急性冠脉综合征(ACS)、急性肺栓塞(APE)和主动脉夹层(AD)患者中的差异,探讨其在ACS、APE、AD鉴别诊断中的价值.方法 选择因胸痛住院的ACS患者437例[ACS组,其中急性ST段抬高型心肌梗死(STEMI)280例,急性非ST段抬高型心肌梗死(NSTEMI) 74例和不稳定心绞痛(UAP) 83例],APE患者51例(APE组),AD患者21例(AD组),同期行冠脉造影正常者58例(对照组),各组均检测DD并进行比较.结果 APE组和AD组血浆DD水平均明显高于ACS组和对照组(P＜0.01),ACS组与对照组比较无显著差异(P＞0.05);在ACS各亚型中,STEMI、NSTEMI患者DD水平高于UAP患者和对照组,但差异均无统计学意义(P均＞0.05).结论 DD水平的高低有助于鉴别ACS与APE、AD.     

无ST段抬高的急性冠脉综合症氟伐他汀疗效观察

目的:观察无ST段抬高的急性冠脉综合症早期应用氟伐他汀对血脂、心血管事件发生的影响。方法:40例无ST段抬高的急性冠脉综合症患者被随机分为治疗组(n=20)和对照组(n=20)。观察其治疗前、后血脂的变化,心血管事件发生情况。结果:治疗组治疗前、后血脂异常明显改善(P<0.05)对照组治疗前、后血脂无变化。与对照组相比,治疗组心血管事件的发生率明显下降(P<0.05)。结论:无ST段抬高的急性冠脉综合症早期应用氟伐他汀可在改善血脂异常的同时明显减少心血管事件的发生。     

抑郁对急性冠脉综合征患者心率变异性的影响

目的研究急性冠脉综合征(ACS)并抑郁患者心率变异性的变化。方法将临床确诊为ACS的262例患者分为抑郁组与非抑郁组,比较两组近期心血管事件的发生率并分析抑郁与各心血管事件的关系,了解ACS并抑郁患者心率变异性的变化和抑郁与心率变异性的相关性。结果ACS并抑郁患者心绞痛、急性ST段抬高心肌梗死、急性非ST段抬高心肌梗死、心力衰竭、短阵室速、室颤、心脏性死亡的发生率分别为40.8%、11.4%、19.4%、21.4%、13.3%、9.4%和8.2%。抑郁均为各心血管事件发生的独立预测因素。ACS并抑郁患者SDNN、SDANN、SDNNIDX、RMSSD、PNN50、HF均显著低于非抑郁组,VLF、LF显著高于非抑郁组。抑郁严重度指数与心率变异性各指标相关。结论ACS并抑郁患者心率变异性发生改变且抑郁与心率变异性相关。     

Effect of exercise training in patients with heart failure: a pilot study on autonomic balance assessed by heart rate variability.

BACKGROUND: Heart rate variability (HRV) is decreased in patients with congestive heart failure (CHF) and is a prognostic marker in this disease. Exercise training is now regarded as an important part of the treatment of patients with CHF, but the effect on HRV and the association between this effect and the effect on neurohormones are not well assessed. METHODS: Heart rate recording was performed in 12 patients with CHF (mean age 67+/-8 years) with CHF NYHA functional class III, before and after 12 weeks of exercise training. The association with exercise capacity and serum levels of atrial natriuretic peptide was assessed. We also evaluated the correlation between HRV and survival at follow-up 87 months later. RESULTS: At baseline there was a significant correlation between mean heart rate and work performed during max cycle test (r=0.650, P=0.022) and the HRV parameter standard deviation normal to normal (SDNN) (r=0.678, P=0.015). After exercise training there was a significant increase in work performed (30.3+/-14.2 versus 38.1+/-14.1 kJ), 6-min walk test (502+/-88 versus 552+/-59 m, P=0.006) and SDNN (117.3+/-40.7 versus 128.6+/-42.3 ms, P=0.028). At 87 months of follow-up, there was a borderline significant difference between survivors and non-survivors. Only the survivors had a significant increase in SDNN after exercise training. CONCLUSION: This pilot study demonstrates an improvement with regard to parameters for HRV after exercise training in patients with CHF. The study suggests that the positive effect of exercise training in patients with CHF involves an attenuation of the reduced HRV response, and that this improvement might have prognostic significance.     

急性冠脉综合征患者的心率减速力与心率变异性之间的关系

目的:研究急性冠脉综合征（ACS）患者心率减速力（DC）的变化及其与心率变异性（HRV）之间的关系。方法:97例ACS患者（ACS组）与99例稳定型心绞痛患者（SAP组）及98例正常人行24小时动态心电图检查，计算机自动测定DC值并进行心率变异性（HRV）分析。结果:ACS组患者中，异常DC的发生率明显高于SAP组和正常对照组；ACS组患者的DC值明显低于SAP组与正常对照组；ACS组患者的DC与HRV密切相关。结论:ACS患者的DC减弱，DC变化与HBV密切相关。     

急性冠脉综合征患者窦性心率震荡变化特点及其与心率变异性的相关性研究

目的分析急性冠脉综合征（ACS）患者窦性心率震荡（HRT）指标变化特点及其与心率变异性（HRV）的相关性。方法应用相应的分析软件对与59名健康体检者和161例确诊为ACS的患者24h动态心电图检查结果进行分析,检测HRT参数震荡初始（TO）、震荡斜率（TS）和HRV时域指标24h正常RR间期标准差（SDNN）、全程相邻窦性R—R间期之差的均方根值（rMSSD）、相邻正常RR间期差值〉50ms的心搏数占总RR间期数的百分比（PNN50）。将ACS组分为不稳定型心绞痛（UAP）组和急性心肌梗死（AMI）组,比较HRT、HRV指标和HRT异常的发生率在各组间的差异,进一步探讨ACS患者HRT和HRV指标相关性。结果与健康对照组比较,UAP组及AMI组TO明显增高,TS显著降低（均P〈0．01）;UAP组及AMI组间TO和TS无显著差异。UAP组及AMI组HRT异常率较对照组显著升高（X^2=5．385,P〈0．05;r=9．227,P=0．01）。UAP组及AMI组HRV指标SDNN、rMSSD、PNN50较对照组显著降低（均P〈0．01）,AMI组SDNN较UAP组降低（P〈0．05）,rMSSD、PNN50差异无统计学意义。ACS患者的TO与SDNN呈负相关（r=-0．26,P=0．031）,与rMSSD、PNN50不相关,TS与SDNN、PNN50、RMSSD呈正相关,其中和SDNN的相关性最强（r=0．301,P=0．047）。结论HRT可作为ACS危险分层的一项新的心电学筛选指标。ACS患者HRT、HRV变化从不同方面反映心脏迷走神经的功能受损,二者互相联系又相互独立。     

急性冠状动脉综合征患者窦性心率震荡与左心室功能的关系

目的 研究急性冠状动脉综合征(ACS)患者窦性心率震荡(HRT)现象的变化及与左心室收缩功能的关系.方法 103例ACS患者和62例健康者行24 h动态心电图检查,根据心电图检查结果计算HRT指标:震荡初始值(TO)、震荡斜率(TS)、心率变异(HRV)和全部窦性心搏RR间期的标准差(SDNN).测量左心室射血分数(LVEF)和左心室舒张末期直径(LVEDD).根据心肌酶及心电图的变化将ACS患者分为急性心肌梗死、不稳定心绞痛两个亚组.比较ACS组与对照组及ACS各亚组各变量的差异,分析HRT与LVEF及LVEDD的相关性.结果 (1)ACS组TO高于对照组(0.17±1.40)%与(-0.26±0.99)%,差异有统计学意义(P＜0.05);TS低于对照组[RR间期分别为(0.88±2.51)ms与(2.60±2.76)ms,差异有统计学意义(P＜0.01)].(2)ACS患者两亚组比较,TS、LVEF、LVEDD差异有统计学意义(均P＜0.01).(3)LVEF与TS呈正相关(r=0.21,P＜0.05);与TO负相关(r=-0.26,P＜0.05).结论 ACS患者窦性HRT减弱,提示ACS患者的心脏自主神经调节功能下降,HRT可作为一个评价左心室功能和预后的指标.

Abstract：

Objective To observe the change of sinus heart rate turbulence (HRT) and its relation to left ventricular systolic function (LVSF) in patients with acute coronary syndrome (ACS). Methods The 103 ACS patients and 62 healthy subjects were enrolled in this study, all of them received 24-hour Holter monitor. And the values of turbulence onset (TO), turbulence slope (TS)and heart rate variability (HRV) SDNN were calculated according the Holter records. The clinical information, left ventricular ejection fraction (LVEF) and left ventricular end diastolic diameter (LVEDD) were recorded. Then the ACS patients were divided into acute myocardial infarction (AMI)group and unable angina pectoris (UAP) group according to the cardiac enzymes and electrocardiogram. Results The value of TO was significantly higher in ACS group than in control group [(0.17±1.40)％ vs. (- 0.26±0.99)％, P＜0.05], and TS was significantly lower in ACS group than in control group [R-R interval:(0.88±2.51) ms vs. (2.60±2.76) ms, P＜0.01].There were significant differences in TS, LVEF and LVEDD between AMI group and UAP group (all P＜0.01), but there were no differences in HRV and TO between the two groups. TS was positively correlated with LVEF (r=0.21, P＜0.05), while TO was negatively correlated with LVEF (r=-0.26, P＜0.05) by Spearman correlation analysis. Conclusions HRT is significantly blunted in ACS patients and can evaluate cardiac autonomic function. It may be as a predictor of LVSF in ACS patients.     

老年高血压病患者运动血压和心率变异关系的初探

目的:探讨老年高血压病患者运动血压和心奉变异的关系。方法:入选血压控制良好的老年高血压病患者100例,分别给予踏车运动试验和24小时动态心电图测定心率变异(HRV)。按运动试验中最大运动量时收缩压(peakSBP)分为反应过高(A组)和反应正常(B组)2组,以运动停止6分钟后收缩压(recSBP)分为恢复慢(C组)和恢复正常(D组)2组,对比分析各组心率变异各指标的差异。结果:A组心率变异指标PNN 50,rMSSD,SDSD,SDNNI均显著高于B组(P<0.05或<0.01),多元逐步回归分析显示,peakSBP与SDNNI显著正相关(r=0.46)。C组与D组比较,心率变异各指标无统计学意义(P>0.05)。结论:老年高血压病运动血压过度升高可能与自主神经调节功能失调有关,其中SDNNI与peakSBP显著正相关,值得进一步研究。     

Effects of physical training on heart rate variability in patients on hemodialysis.

Dysfunction of the cardiac autonomic nervous system is a known complication of end-stage renal disease. The objective of the study was to mainly investigate the effects of physical training on 24-hour vagal cardiac activity in dialysis patients. Sixty chronic uremic patients (mean age 48 +/- 12 years) on maintenance hemodialysis were studied. After initial evaluation, 30 patients (group A) were randomly assigned to a 6-month exercise training program (3/week). The other 30 patients (group B) and 30 nonuremic sedentary persons (group C) remained untrained and were used as controls. Parasympathetic activity was assessed at the beginning and the end of the study noninvasively from 24-hour electrocardiographic ambulatory monitoring by calculating heart rate variability (HRV). HRV index, mean NN interval, and standard deviation NN (SDNN) were measured according to the "triangular method." At baseline HRV index, mean RR, SDNN, and aerobic capacity were significantly reduced in both hemodialysis groups compared with values in group C. Also, 40% of all patients on hemodialysis and 16% of group C had arrhythmias (Lown class >II). Moreover, hemodialysis patients with a more depressed HRV index (<25, n = 37) had a higher incidence of arrhythmias (60%) compared to those with HRV index >25 (p <0.05). Exercise training in group A significantly increased HRV index from 22 +/- 7 to 28 +/- 9 (p <0.05) and SDNN from 0.11 +/- 0.03 to 0.13 +/- 0.04 (p <0.05). Furthermore, fewer patients continued to have an HRV index <25 (by 40%) and arrhythmias (by 33%) compared with baseline data. Training was also associated with a significant improvement in fitness level, as assessed by maximal oxygen consumption (by 41%; p <0.05) and exercise testing duration (by 33%; p <0.05). There was a significant correlation in HRV index and maximal oxygen consumption. No changes were observed in the control groups between baseline and follow-up data. Results demonstrate that physical training in hemodialysis patients augments cardiac vagal activity and decreases vulnerability to arrhythmias.     

Relation between 24-h heart rate variability and blood pressure fluctuation during exercise in stroke patients.

BACKGROUND: In some stroke patients blood pressure (BP) fluctuates extensively during medical rehabilitation, so the present study investigated the influence of autonomic nervous dysfunction on the change in BP during exercise. METHODS AND RESULTS: The subjects consisted of 55 stroke inpatients (males, 29; mean age, 58.8 years old; ischemic/hemorrhagic etiology, 30/25) who were admitted to the Stroke Center within 2 weeks of their first stroke. The control group consisted of 15 age-matched healthy volunteers. The 24-h heart rate (HR) variability (HRV) and BP variability (BPV) were examined, and then the increase and recovery of BP and HR were measured during bicycle ergometer exercise at 4 METs. Components of 24-h HRV (low-frequency power (LF), high-frequency power (HF), LF/HF, and asleep-awake ratio of LF/HF (LF/HF(d-n)) were lower (p < 0.01) and BPV was greater in the stroke group (p < 0.05) than in the control group. There was a negative correlation between BP change during exercise and LF/HF or LF/HF(d-n) (r = -0.43 or r = -0.58, p < 0.01), and a greater increase in systolic BP (102 +/-9.8 mmHg, n = 7) during exercise was observed in stroke patients with lower LF/HF(d-n) (< or = 1.0). CONCLUSIONS: Lower HRV in stroke patients may relate to an increase in BP during exercise. HRV is useful for estimating the risk during medical rehabilitation.     

急性冠状动脉综合征患者心率震荡的变化与临床意义

目的观察急性冠状动脉综合征(ACS)患者窦性心率震荡(HRT)的变化以及与冠状动脉病变的相关性。方法分别选择109例确诊为ACS患者(ACS组)和69例心脏正常者(对照组),行24 h动态心电图检查,并计算震荡初始值(TO)和震荡斜率(TS)及心率变异指标。同时检测临床资料和冠状动脉造影结果。并根据心肌酶以及心电图的变化对所有ACS患者分为急性心肌梗死(AMI,AMI亚组,51例)、不稳定性心绞痛(UAP,UAP亚组,58例)。比较各组HRT的差异,并根据冠状动脉造影结果分析HRT与Gensini评分的相关性。结果与对照组比较,ACS组TO明显升高(P0.05),TS明显降低(P0.01)。与UAP亚组比较,AMI亚组患者Gensini评分升高,TS明显降低(P0.05,P0.01)。Pearson相关分析显示,冠状动脉病变程度与TO呈正相关(r=0.23,P0.05),与TS呈负相关(r=-0.46,P0.01)。结论 ACS患者HRT现象明显受损,提示ACS患者的心脏自主神经调节功能下降,并且反映冠状动脉病变程度。