肌钙蛋白T与急性失代偿心力衰竭患者容量负荷的关系探讨

目的 分析肌钙蛋白T(cTnT)与急性失代偿心力衰竭(ADHF)患者容量负荷的关系。方法 记录一般资料并测定cTnT水平、NT-proBNP、血清清蛋白、血红蛋白、红细胞比容等容量性指标水平。结果 3组清蛋白、血红蛋白、红细胞比容比较,观察组<对照组<健康组,cTnT、NT-proBNP水平比较,观察组>对照组>健康组(P<0.05)。cTnT与清蛋白、血红蛋白、红细胞比容均呈负相关,与NT-proBNP呈正相关(P<0.05)。cTnT水平对心脏容量负荷预测的ROC曲线面积为0.867,具有良好的预测价值。结论 ADHF患者血清cTnT水平明显升高,是心脏容量超负荷的危险因素,可能是判断ADHF预后的潜在标志物。     

心脏肌钙蛋白Ⅰ测定在急性心力衰竭诊治中的意义

心脏肌钙蛋白Ⅰ(cTnI)是心脏特异性结构蛋白,伴随心肌细胞的损伤而释放入血,可用来检测心肌损伤.作者检测了急性心力衰竭或慢性心力衰竭急性加重情况下的cTnI水平,现报告如下.     

心脏肌钙蛋白I测定在急性心力衰竭诊治中的意义

心脏肌钙蛋白Ⅰ (cTnI)是心脏特异性结构蛋白 ,伴随心肌细胞的损伤而释放入血 ,可用来检测心肌损伤。作者检测了急性心力衰竭或慢性心力衰竭急性加重情况下的cTnI水平 ,现报告如下。1　临床资料2 0 0 2年 5月～ 2 0 0 3年 4月本院收治的急性心力衰竭或慢性心力衰竭急性加重的住院患者2 9例。男 1 6例 ,女 1 3例 ,年龄 5 0～ 85岁 ,平均( 62 8± 1 6 2 )岁。其中冠心病 1 1例 ,高血压性心脏病 8例 ,扩张型心肌病 4例 ,风湿心脏病 6例。2 9例患者均排除急性心肌梗死、不稳定心绞痛及急性心肌炎。对照组 :选取同期住院但无心脏病的患者 2 0…     

心肌肌钙蛋白T在心力衰竭患者中的水平及意义

【目的】探讨心力衰竭患者心肌肌钙蛋白T(cTnT)的水平及意义。【方法】用电化学发光法测定72例不同原因所致的心力衰竭患者与同期 4 0例健康体检者和 4 2例急性心肌梗死患者的血清cTnT含量 ,并比较不同心功能分级的cTnT水平。【结果】心功能Ⅱ级组与健康对照组相比 ,血清cTnT浓度无明显差异 ;心功能Ⅲ级组较Ⅱ级组升高 ,但两组间无统计学差异 ;心功能Ⅳ级组较Ⅱ、Ⅲ级组明显升高 (P <0 .0 5 ) ,但较AMI组明显降低 (P <0 .0 1)。【结论】血清cTnT水平对判断心功能障碍的严重程度有一定价值。     

急性心力衰竭肌钙蛋白I定量检测的意义

目的;探讨心肌钙蛋白Ｉ定量测定在监测心力衰竭患者病情进展方面的应用价值。方法：采用微粒子化学发光法定量检测血ＣＴｎＩ。结果：３７例确诊为心力衰竭,心功能Ⅳ级患者比２６例非心血管病对照组患者ＣＴｎＩ明显升高（Ｐ〈０．００１）,而两组同时检测的磷酸肌酸激酶同工酶（ＣＫ－ＭＢ）浓度无明显差异（Ｐ＝０．９２）,心衰组的ＣＴｎＩ浓度随病情好转而降至正常范围,病情恶化患者ＣＴｎＩ持纽不降或继续上升,结论：血Ｃ     

急性心力衰竭肌钙蛋白Ⅰ定量检测的意义

目的：探讨心肌钙蛋白Ⅰ（ＣＴｎＩ）定量测定在监测心力衰竭患者病情进展方面的应用价值。方法：采用微粒子化学发光法定量检测血ＣＴｎＩ。结果：３７例确诊为心力衰竭、心功能Ⅳ级患者比２６例非心血管病对照组患者ＣＴｎＩ明显升高（Ｐ＜０００１）,而两组同时检测的磷酸肌酸激酶同工酶（ＣＫ－ＭＢ）浓度无明显差异（Ｐ＝０９２）。心衰组的ＣＴｎＩ浓度随病情好转而降至正常范围,病情恶化患者ＣＴｎＩ持续不降或继续上升。结论：血ＣＴｎＩ定量测定对心衰病情监测及预后估计有一定应用价值。     

心力衰竭心肌肌钙蛋白T动态变化及预后价值

目的：探讨充血性心力衰竭（CHF）患者cTNT的动态变化及对预后判断的临床意义。方法：检测89例不同病因、不同心功能分级的心力衰竭患者及42例正常对照组cTNT、及LVEF变化,并进行治疗前后对比观察并随访。结果：不同病因、不同心功能分级心力衰竭患者cTNT及LVEF与对照组比较均有统计学差异（P〈0.01）,cTNT水平越低预后越好。结论：联合检测血清cTnT对于判断CHF患者病情严重程度及预后具有重要的临床意义。     

急性失代偿性心力衰竭治疗进展

急性失代偿性心力衰竭(ADHF)约占急性心衰的65%,是急性心衰最常见的表现形式,其死亡率达30%～60%[1].本文就ADHF治疗方面取得的进展作一综述.     

肌钙蛋白T在急性心肌梗死中的诊断意义

目的:探讨血清肌钙蛋白T(cTnT)的动态变化对急性心肌梗死(AMI)的诊断意义。方法:对60例AMI患者进行动态观察血清cTnT变化,同时测定肌酸激酶同工酶(CK-MB)进行对比。结果:AMI患者胸痛4h内cTnT阳性率高于CK-MB(P<0.05),12～24h两者无显著差异(P>0.05),48h后两者存在显著差异(P<0.01)。结论:cTnT定性检测对AMI诊断具有早期、特异性高、时间窗长的特点,是诊断AMI较理想的方法之一。     

心肌肌钙蛋白I检测在婴幼儿心力衰竭中的临床意义

目的：探讨心肌肌钙蛋白（cTnI）检测在婴幼儿心力衰竭中的应用价值。方法：对38例心力衰竭患儿与26例无心肌损伤及心脏病同期住院患儿进行cTnI及肌酸激酶同功酶（CK—MB）检测，同时比较心力衰竭患儿病情稳定前后cTnI及CK—MB的变化。结果：心衰组血清cTnI浓度显著增高（P〈0.01），而CK—MB无明显差异；心衰组病情稳定前后比较cTnI浓度有显著差异（P〈0．01），而CK—MB无显著性差异。结论：cTnI在评价心肌损伤方面，其敏感性及特异性均优于CK—MB，可在亚细胞水平上为诊断心衰提供一项生化指标；cTnI的动态变化有助于判断心衰的病情演变。     

Role of tolvaptan in acute decompensated heart failure

Acute decompensated heart failure accounts for more than 1 million hospitalizations in the USA every year. Currently, the most common treatment for symptom relief is the use of loop diuretics, despite recent concerns for potential adverse effects. With the growing understanding of the role of neurohormonal dysregulation in the pathophysiology of heart failure, there has been increasing interest in novel pharmacologic therapies targeting specific neurohormonal axes. Serum arginine vasopressin is a potent vasoconstrictor, as well as an antidiuretic, and serum concentrations are upregulated in heart failure. Tolvaptan, a vasopressin receptor antagonist, has been shown to improve diuresis and symptom relief without adversely affecting renal function, and may be a promising novel therapeutic agent in the growing population of patients with heart failure.     

Bedside ultrasound of the lung for the monitoring of acute decompensated heart failure

Purposes

Multiple artifacts B lines (B+) at transthoracic lung ultrasound have been proposed as a sonographic sign of pulmonary congestion. Our aim is to assess B+ clearance after medical treatment in acute decompensated heart failure (ADHF) and to compare the usefulness of sonography with other traditional tools in monitoring resolution of pulmonary congestion.

Methods

Eighty-one patients with a diagnosis of ADHF were submitted to lung ultrasound and chest radiography at admission, and 70 of them underwent the same procedures as control group after 4.2 ± 1.7 days of medical treatment. The ultrasound examination was performed with 11 scans on as many anterolateral thoracic areas (6 on the right side and 5 on the left side). Then, we calculated a sonographic score counting the B+ scans and compared it with radiologic score for extravascular lung water, clinical, and plasma brain natriuretic peptide improvement.

Main Results

All patients showed B+ pattern at admission and significant clearing after treatment, with median number of 8 positive scans (range, 3-9 scans) vs 0 (range, 0-7 scans) (P < .05). Our sonographic score showed positive linear correlation with radiologic score (r = 0.62; P < .05), clinical score (r = 0.87; P < .01), and brain natriuretic peptide levels (r = 0.44; P < .05). Δ Sonographic score correlated with Δ clinical (r = 0.55; P < .05) and radiologic (r = 0.28; P < .05) scores.

Conclusions

B line pattern mostly clears after adequate medical treatment of ADHF and represents an easy-to-use alternative bedside diagnostic tool for clinically monitoring pulmonary congestion in patients with ADHF.     

Management of acute decompensated heart failure

Heart failure, a debilitating complex clinical syndrome, affects nearly 5 million people in the United States and presents a heavy socioeconomic burden. Neurohormonal abnormalities contribute to the pathophysiology of heart failure. Acute decompensated heart failure (ADHF) has emerged as a major health problem associated with poor prognosis, increased costs related to care, reduced quality of life, and frequent readmissions. Symptoms of ADHF are primarily related to congestion and/or low perfusion states. The use of biomakers such as B-natriuretic peptides is useful in distinguishing between cardiac and noncardiac causes of symptoms. Treatment for ADHF begins with identification and treatment of precipitating factors for acute decompensation. Initial goal of therapy is focused on symptom management followed by interventions that delay disease progression, reduce readmission, and prolong survival.     

Cardiorenal syndrome in acute decompensated heart failure

Cardiorenal syndrome (CRS) commonly occurs during treatment of acute decompensated heart failure (ADHF) and is associated with poor clinical outcome. The pathophysiology of CRS entails a complex interaction between hemodynamic alterations, including reduced renal perfusion, increased venous pressure and activation of multiple neurohormonal systems. Attempts to effectively treat congestion while preserving renal function in ADHF are often met with limited clinical success and often require therapeutic decisions that reflect a compromise between potential benefits and harm. At present, there is no evidence-based intervention specifically targeted at renal function. Recent Phase III randomized trials, using novel agents in patients with ADHF, have largely failed to demonstrate any benefits of therapy on renal and clinical outcomes. Early diagnosis of CRS using novel markers of tubular injury may allow for timely interventions and attenuate progression. Future studies are needed to further elucidate the pathophysiology of this complex syndrome and identify new potential targets for effective evidence-based treatments.     

Guidelines for acute decompensated heart failure treatment

OBJECTIVE: To describe the development of guidelines for the treatment of acute decompensated heart failure (ADHF) in the emergency department/observation unit (ED-OU) setting for hospitals that are part of a group purchasing organization (GPO). DATA SOURCES: A MEDLINE search (1966-March 2003) using the following search terms: cardiotonic agents; diuretic; dobutamine; heart failure, congestive; milrinone; natriuretic peptide, brain; nesiritide; nitroglycerin; vasodilator agents, was conducted. STUDY SELECTION AND DATA EXTRACTION: Relevant articles in the English language were identified. All randomized studies and meta-analyses for each category of drugs were included. DATA SYNTHESIS: A group consensus method was used to develop guidelines. An expert panel reviewed and revised the guidelines. The final guidelines were approved June 1, 2003, and are described here. They are organized based upon a patient's symptomatology at the time the diagnosis of ADHF is made. Patients with evidence of volume overload require intravenous diuretics and/or intravenous vasodilators to alleviate the symptoms of ADHF. Patients with signs and symptoms of low cardiac output require inotropic support to manage their ADHF. A timeline for diagnosis, treatment, reassessment, and disposition is provided and encourages an early, aggressive approach to treating patients with ADHF. CONCLUSIONS: Hospitalization for ADHF is common and costly. Consensus guidelines for the treatment of ADHF did not previously exist, resulting in inconsistent and inefficient treatment. Consequently, hospitals struggling with the treatment of ADHF may find these guidelines and the process by which they were developed useful.     

Extracorporeal ultrafiltration therapy for acute decompensated heart failure

Congestion is the most common reason for hospitalization of patients with acute decompensated heart failure (ADHF) and adversely impacts their outcomes. Extracorporeal ultrafiltration (UF) therapy has re-emerged as an effective strategy for decongestion in this setting. This article is intended to discuss key concepts in UF and its technique, provide a brief historical view of UF application for decongestion in ADHF, review the hemodynamic and neurohormonal effects of UF and their positive effects on the pathophysiology of ADHF, discuss the findings of the landmark trials in this field, and explain key findings of these studies as well as the apparent discrepancies in their findings. In a separate section we discuss the intricacies of renal dysfunction in ADHF as it plays a very important role in understanding the current evidence and designing futures clinical trials of UF in ADHF. In the end, the authors provide their perspective on the future role of UF in management of patients with ADHF and congestion.