中西药结合逆转高血压左心室肥厚及对左室功能的影响

目的：选择原发性高血压病1—2级合并左心室肥厚的60例患者,分为补阳还五汤合温胆汤和开博通组30例,对照组开博通组30例,治疗6个月。运用超声心动图（UCG）、测血压和临床观察等手段,观察上述治疗对临床症状改善、血压下降、左室肥厚的逆转和左室舒张功能的疗效与作用。结果：中西药疗法能有效地使血压下降,总有效率93．33％,从而有效地预防和减轻靶器官的损害;能有效地减少室间隔及左室后壁厚度,使心室腔径缩小,左室重量指数下降;随着左室肥厚的逆转,左室舒张功能明显改善,SV与CO显著增加且与LVMI的下降呈正相关;对临床症状的改善明显优于对照组。可见,通过中西药结合辨证治疗能改善与高血压病有关的各种血液动力学和神经体液调节机制,达到降压、逆转左室肥厚、改善左室功能的作用。     

左心室三维应力与左心室收缩功能的相关性研究

目的研究左心室三维应力与反映左心室收缩功能的生物力学指标——最大心肌劲度(maxEav)的相关性,以获得反映左心室收缩功能的简单且实用的生物力学指标。方法选取34例健康人为研究对象,其中男性19例,女性15例;年龄34～75岁,平均年龄49.2岁。应用超声心动图测定心脏左心室收缩末期内径和后壁厚度及射血分数;左心室收缩末期中壁长短径、室壁厚度;联合袖带肱动脉血压值计算左心室收缩末期压力。应用上述各测值计算maxEav及左心室收缩末期径线、圆周、长轴应力(σr、σθ、σm),进行相关性统计学分析。结果σr=(-62.55±0.53)N/cm2;σθ=(27.81±1.36)N/cm2;σm=(62.58±2.88)N/cm2;maxEav=(226.52±9.36)N/cm2;LVEF=(63.13±1.01)%。maxEav与σr无相关性(r=0.067,P>0.05);maxEav与σθ有极显著负相关性(r=-0.510,P<0.01);maxEav与σm有极显著正相关性(r=0.563,P<0.01)。LVEF与三向应力无相关性(P>0.05)。结论应用左心室收缩末期圆周及长轴应力两项生物力学指标评价左心室收缩功能较为简便实用且准确。     

二维超声心动图和M型超声心动图评价左心室扩大患者左心室收缩功能的对比研究

目的评价二维超声心动图（2DE）法和M型超声心动图（ME）法测量心瓣膜病中重度二尖瓣和（或）主动脉瓣反流（VR）、扩张型心肌病（DCM）和缺血性心肌病（ICM）患者左心室收缩功能相关指标的一致性及其影响因素。方法用2DE和ME同时测量100例左心室扩大患者（VR35例、DCM32例和ICM33例）的左心室舒张末期内径（LVEDD）、左心室舒张末期容积（LVEDV）和左心室射血分数（LVEF）,分别记为LVEDD2DE、LVEDDME、LVEDV2DE、LVEDVME、LVEF2DE和LVEFME。结果①患者的LVEDD2DE与LVEDDME、LVEDV2DE与LVEDVME差异有统计学意义,LVEF2DE与LVEFME差异无统计学意义,且具有良好的相关性,r=0．869;②组内比较：3组的LVEDD2DE与LVEDDME差异均有统计学意义,VR组LVEDV2DE与LVEDVME差异无统计学意义,其他两组差异有统计学意义,3组的LVEF2DE与LVEFME差异无统计学意义;③组间比较：LVEDD2DE在DCM组与ICM组之间差异有统计学意义,在VR组与ICM组之间差异也有统计学意义,LVEDDME、LVEDV2DE。和LVEDVME有相同的结果,LVEF2DE在3组间差异均有统计学意义,LVEFME在3组间差异也均有统计学意义,2DE和ME法均得到LVEDVVR≈LVEDVDCM〉LVEDVICM和LVEFDCM〈LVEFICM〈LVEFVR的一致结论;④按LVEDD2DE分为〈80mm大左心室组和≥80mm巨大左心室组,两组的LVEDV2DE与LVEDVME差异有统计学意义,LVER2DE与LVEFME各组差异无统计学意义。结论二维法和M型超声评价VR、DCM和ICM患者左心室收缩功能的指标中LVEF一致性较好．较少受左心室形状及节段性室壁运动异常的影响。2DE和ME均得出VR组与DCM组左心室增大的程度相近．但LVEF减低的程度却不同．而ICM组左心室增大的程度小于前两组。但LVEF却较VR组减低明显。     

Mild carbon monoxide poisoning impairs left ventricular diastolic function

Rationale:

Carbon monoxide (CO) poisoning is associated with direct cardiovascular toxicity. In mild CO poisoning in which cardiovascular life support is not required, the effects of CO on left and right ventricular functions are unknown in patients without cardiac failure.

Objectives:

Echocardiography was used to determine whether or not mild CO poisoning impairs ventricular function. Twenty otherwise healthy patients with CO poisoning and 20 age- and gender-matched controls were studied. Echocardiographic examinations were performed at the time of admission and 1 week after poisoning.

Results:

The impairment observed in the left and right ventricular diastolic function at the time of admission was greater than the impairment 1 week after poisoning. Mild CO poisoning did not have a significant effect on systolic function. Carboxyhemoglobin levels were positively correlated with left ventricular diastolic dysfunction, whereas the levels were not correlated with right ventricular diastolic function.

Conclusions:

In CO intoxication, the development of left and right ventricular diastolic dysfunction precedes systolic abnormality. Patients with mild CO poisoning do not manifest cardiovascular symptoms; however, it should be borne in mind that most of these patients have myocardial involvement.     

Dictionary-based monitoring of premature ventricular contractions: An ultra-low-cost point-of-care service

While cardiovascular diseases (CVDs) are prevalent across economic strata, the economically disadvantaged population is disproportionately affected due to the high cost of traditional CVD management, involving consultations, testing and monitoring at medical facilities. Accordingly, developing an ultra-low-cost alternative, affordable even to groups at the bottom of the economic pyramid, has emerged as a societal imperative. Against this backdrop, we propose an inexpensive yet accurate home-based electrocardiogram (ECG) monitoring service. Specifically, we seek to provide point-of-care monitoring of premature ventricular contractions (PVCs), high frequency of which could indicate the onset of potentially fatal arrhythmia. Note that the first-generation telecardiology system acquires the ECG, transmits it to a professional diagnostic center without processing, and nearly achieves the diagnostic accuracy of a bedside setup. In the process, such a system incurs high bandwidth cost and requires the physicians to process the entire record for diagnosis. To reduce cost, current telecardiology systems compress data before transmitting. However, the burden on physicians remains undiminished. In this context, we develop a dictionary-based algorithm that reduces not only the overall bandwidth requirement, but also the physicians workload by localizing anomalous beats. Specifically, we detect anomalous beats with high sensitivity and only those beats are then transmitted. In fact, we further compress those beats using class-specific dictionaries subject to suitable reconstruction/diagnostic fidelity. Finally, using Monte Carlo cross validation on MIT/BIH arrhythmia database, we evaluate the performance of the proposed system. In particular, with a sensitivity target of at most one undetected PVC in one hundred beats, and a percentage root mean squared difference less than 9% (a clinically acceptable level of fidelity), we achieved about 99.15% reduction in bandwidth cost, equivalent to 118-fold savings over first-generation telecardiology. In the process, the professional workload is reduced by at least 85.9% for noncritical cases. Our algorithm also outperforms known algorithms under certain measures in the telecardiological context.     

超声心动图评价高血压患者血清脂联素水平与左心室心肌质量和舒张功能的关系

目的探讨高血压患者血清脂联素水平对左心室心肌质量(LVM)及舒张功能的影响。方法入选单纯高血压患者65例(其中男性36例,女性29例;年龄34～78岁,平均年龄53.78岁)和正常对照组33例(其中男性17例,女性16例;年龄32～65岁,平均年龄52岁)。采用酶联免疫吸附分析法测定血清脂联素水平。采用超声心动图测定LVM、左心室射血分数和代表左心室舒张功能的指标E/e比值、舒张早期左心室内血流传播速度(Vp)和左心室Tei指数。结果高血压组左心室心肌质量指数显著高于正常对照组[(123.58±45.40)g/m2 vs(87.29±17.40)g/m2;P<0.05]。高血压组Vp显著低于正常对照组[(41.25±9.86)cm/s vs(56.31±8.79)cm/s,P<0.01],而E/e比值和Tei指数显著高于正常对照组(8.28±1.96 vs 7.26±1.56,0.46±0.15 vs 0.39±0.12;P<0.05)。在高血压组中血清脂联素水平与左心室心肌质量指数、E/e比值和Tei指数均呈显著负相关(r分别为-0.36、-0.56、-0.58,P<0.05),而与Vp呈显著正相关(r为0.67,P=0.023)。多元逐步回归分析表明血清脂联素水平能分别进入以Vp和Tei指数为因变量的回归方程中。结论血清脂联素水平与左心室心肌质量指数呈显著负相关,血清脂联素水平降低是导致左心室舒张功能降低的危险因素之一。     

定量组织速度成像对尿毒症血液透析患者左心室功能的再评价

目的探讨应用定量组织速度成像（QTVI）技术评价尿毒症血液透析（HD）患者左心室功能变化的应用价值。方法A组,32例尿毒症HD患者,其中男性19例,女性13例,年龄39～79岁,平均年龄54．36岁;B组,35例健康志愿者,年龄、性别与A组相匹配,为对照组。用常规超声心动图和QTVI技术对其心脏形态结构和功能进行各节段参数测定。结果A组与B组间常规超声参数比较[左心室射血分数（EF）和短轴缩短率（FS）除外]差异有统计学意义（P〈0．05）;二尖瓣环各节段QTVI参数中舒张早期峰值速度（Ve）、Ve/Va（舒张末期峰值速度）值减低,与B组比较差异有统计学意义（P〈0．05）;Va明显增高,与B组比较差异有统计学意义（P〈0．05）。收缩期峰值速度（Vs）2组间比较差异无统计学意义（P〉0．05）。结论QTVI技术可以准确评价尿毒症HD患者左心室功能的变化。     

Regional left ventricular function in the three main coronary artery territories at rest and during exercise

Summary Twenty consecutive patients (mean age 51.6 years) with persistent severe angina pectoris underwent aorto-coronary bypass surgery receiving an overall of 60 anastomosis. On an average, 9.4±1.5 months p.o. first pass radionuclide ventriculograms (18 to 24 mCi 99 m Technetium-Pertechnetate i.v.) were performed at rest and after excerise. Besides measurement of global ejection fraction (GEF), regional ejection fraction (REF) was assessed employing for the first time a new technique: each RAO-view of p.o. radionuclide left ventriculogram was subdivided into three regions according to supply of the three main coronary arteries and their branches as visualized on pre-operative coronary angiogram.GEF improved after maximum exercise in 13 cases by 8.1% points (from 50.4 to 58.5%), remained unchanged three times and decreased four times by 7.1 points (from 51.6 to 44.5%; all changesp<0.05).In completely revascularized regions (n=35) REF improved 24 times by 9.7 points (from 51.1 to 60.8%), did not differ from rest REF six times and decreased in three case by 7.3 points (from 48.6 to 41.3%; all changesp<0.05). Completely revascularized regions responded to exercise like normally perfused areas (increase 7.8 points (from 50.6 to 58.4%;n=7;p<0.05).REF deteriorated in incompletely revascularized regions (n=9) six times by 12.8 points (from 58.0 to 45.2%), remained unchanged twice and improved once by 4.5 points. Total group's REF decreased by 7.3 points (from 56.8 to 49.5%;p<0.05). Exercise REF of incompletely revascularized regions was highly significant inferior to that of completely revascularized regions (49.5 to 58.4%;p<0.01).GEF is a weighted balance of the three regional ejection fractions. The most important parameter is REF of LAD territory.     

应用组织追踪法评价妊娠高血压先兆子痫孕妇左心室收缩功能的研究

目的探讨应用组织追踪法(TT)测定左心室壁收缩期位移,以此评价妊娠高血压(PIH)先兆子痫孕妇左心室收缩功能。方法 20例PIH先兆子痫孕妇(PIH组),年龄24~36岁,平均年龄30.63岁;21例正常孕妇(对照组),年龄29~34岁,平均年龄30.14岁。获取标准心尖位左心室长轴切面、两腔切面及四腔切面,应用TT对20例PIH组和21例对照组妊娠妇女心脏不同节段即左心室侧壁、后间隔、前壁、下壁、前间隔、后壁的基底段及中间段的位移曲线,测量左心室射血分数(LVEF)、左心室心肌质量指数(LVMI)、二尖瓣口血流舒张早期峰值流速(E)、舒张末期峰值流速(A)、E/A比值、肺静脉心房收缩期反向血流充盈峰(AR),肱动脉收缩压及舒张压,对所获指标进行定量分析。结果与对照组相比,PIH组LVEF和反映左心舒张功能的E峰、肺静脉S波、D波及Ar波明显减低(P<0.05,0.05,0.01,0.01,0.01),同时二尖瓣舒张末期充盈峰(A)、LVM和LVMI则显著增加(P<0.01)。PIH组左心室前壁、前间隔、后间隔各位点的收缩期位移低于对照组(P<0.01);左心室侧壁、下壁、后壁各位点收缩期位移在两组之间比较,差异无统计学意义(P>0.05)。结论 TT可无创、敏感、客观地评价PIH先兆子痫孕妇左心室收缩功能。     

Doppler echocardiographic analysis of diastolic left ventricular function in dialysis patients and its relation to intradialytic hypotension

Summary Doppler echocardiography was used to evaluate left ventricular relaxation and filling in 20 patients on chronic maintenance hemodialysis. In comparison with 11 normal controls hemodialysed patients showed a marked prolongation of isovolumic relaxation period (83±23 ms vs 67±11 ms,P<0.01). Peak velocity of early diastolic filling was similar in both groups, but peak velocity of late ventricular filling due to atrial contraction was substantially increased in dialysis patients (66±23 cm/s vs 37±7 cm/s,P<0.01) and the ratio late to early peak velocity was significantly enlarged (0.97±0.35 vs 0.58±0.19,P<0.01). Although left ventricular mass index, as determined by Echo, was markedly increased in dialysis patients, no significant correlation was found between ventricular mass and indexes of diastolic function. When patients were divided into two groups on the basis of development of hypotension during dialysis clinical and echocardiographic characteristics were similar, although patients with dialysis hypotension (n=9) were significantly older (53±9 years) than normotensiv patients (n=11, 42±14 years,P<0.05). Indexes of diastolic function showed a great overlap between the two groups, but ratio late to early peak velocity was significantly greater in patients with intradialytic hypotension (1.13±0.35 vs 0.83±0.32,P<0.05). It is concluded that dialysis patients exhibit significant alterations of left ventricular relaxation and diastolic filling as assessed by Doppler echocardiography which might be independent of left ventricular hypertrophy. Impaired diastolic function might contribute to intradialytic hypotension.Abbreviations DEF deceleration of early diastolic flow - IVRP isovolumic relaxation period - peakA peak velocity of late left ventricular filling - peakE peak velocity of early left ventricular filling     

高血压左心功能声学定量技术与Tei指数之间的比较研究

目的研究高血压患者心功能Tei指数与声学定量（AQ）技术指标关系,找出Tei指数在高血压患者左心功能判断中的变化规律。方法将试验对象分为正常组30例和高血压组45例,其中又将高血压组依左心室情况分成非肥厚组21例和肥厚组24例;对各组进行了AQ技术指标检测及Tei指数测量。结果与正常组左心室AQ舒张功能指标相比,高血压肥厚组峰值左心房充盈率（PAFR）、左心室快速充盈分数（RFF）降低（P〈0.05）,高血压非肥厚组及肥厚组的左心房收缩充盈分数（AFF）增高,左心室快速充盈容积与左心房收缩充盈容积比值（RF/AF）降低（P〈0.05）;左心室AQ收缩功能指标显示,与对照组相比,高血压非肥厚组及肥厚组的左心室射血分数（LVEF）、峰值排空率（PER）差异无统计学意义（P〉0.05）;与正常组左心室AQ容量指标结果相比,左心室肥厚组的左心室舒张末期容积（LVEDV）、左心房收缩充盈前容积（LAOAFV）增加,左心室非肥厚组与肥厚组的左心室收缩末期容积（LVESV）增加（P〈0.05）。与正常组相比,高血压非肥厚组与高血压肥厚组左心室Tei指数、等容舒张时间（IRT）、等容收缩时间（ICT）均增高（P〈0.05）,并且高血压肥厚组Tei指数和IRT高于高血压非肥厚组（P〈0.05）;Tei指数与左心室AQ指标中的PAFR（r=0.239,P〈0.05）、LVEF（r=0.376,P〈0.05）具有相关趋势。多元逐步回归分析显示左心室质量（LVM）与Tei指数独立相关（P〈0.01）。结论同AQ技术指标相比,Tei指数有效评价高血压患者整体心功能,不仅能够反映高血压患者心功能受损,而且能够反映靶器官心脏受累的严重程度。Tei指数可用于临床预测心功能,评价预后,是值得临床广泛推广的心功能测量方法。     

Tei指数评价卡维地洛治疗充血性心力衰竭患者左心室功能的变化

目的与传统评价心功能指标比较，探讨多普勒超声左心室Tei指数在评价充血性心力衰竭患者治疗前后心功能的临床意义。方法60例充血性心力衰竭患者随机分为卡维地洛组和对照组（各30例），治疗前和治疗后3、6个月时分别用彩色多普勒超声测量左心室Tei指数、左心室射血分数（EF）、二尖瓣血流频谱舒张早期和晚期血流峰值之比（E，A）、E峰减速时间（Dn、等容舒张时间0VRT）、肺静脉血流频谱收缩波和舒张波峰值之比（S／D）及反向波（ARW）。结果两组EF在治疗后3个月及6个月逐渐增大（P＜0．01～0．05），卡维地洛组EF在治疗后6个月较对照组同期增大（P＜0．05）。两组治疗后舒张功能指标E／A先减小后增大，DT、IVRT及ARW逐渐减小，S，D逐渐增大（P＜0．01～0．05），组间差异未见有统计学意义（P＞0．05）。两组Tei指数在治疗后逐渐减低，组内比较差异均有显著统计学意义（P＜0．01），卡维地洛组减低更明显，与对照组同期比较差异有统计学意义（P＜0．01～0．05）。结论Tei指数可简便、敏感地评价心脏的整体收缩舒张功能。充血性心力衰竭患者卡维地洛治疗后左心室功能得到改善。     

左心辅助循环后心肌功能恢复的预测研究

左心辅助装置 (left ventricular assist device,L VAD)作为一种重度心衰的抢救措施及等待心脏移植阶段的过渡支持 ,近年来已取得长足进步 ,临床应用的病例数不断增加 ,抢救了许多濒死患者的生命。患者是否可以撤离 L VAD,何时撤离 L VAD,目前主要依据患者心功能的恢复情况而定。能否在用 L VAD前通过测定一些简单的、无创伤的指标来预测患者的愈后 ,该用什么指标 ,这对于临床有着重要意义 ,然而这些问题尚未弄清楚。本文就该方面研究的近况作一综述     

定量组织速度成像对阻塞性睡眠呼吸暂停综合征患者腭咽成形术前左心功能的研究

目的应用定量组织速度成像(QTVI)技术,对拟行改良腭咽成形术的阻塞性睡眠呼吸暂停综合征(OSAS)患者左心室功能的早期变化进行研究。方法 A组,35例OSAS患者,均为男性,年龄21～58岁,平均年龄41.27岁。B组33例,健康者,均为男性,年龄22～55岁,平均年龄39.57岁。B组年龄、性别、体质量指数与A组相匹配,为对照组。用常规超声心动图和QTVI新技术,对其心脏形态结构和功能进行各节段参数测定。结果 A组与B组间常规超声参数比较:主动脉根部内径(AOD)、左心室舒张末期内径(LVDd)、左心室后壁厚度(LVPWT)和二尖瓣前向血流速度舒张早期与舒张晚期的比值(E/A)差异有统计学意义(P<0.05);二尖瓣环部分节段QTVI技术参数中舒张早期峰值速度(Ve)部分节段减低、舒张晚期峰值速度(Va)部分节段增高、Ve/Va比值部分节段减低,与B组比较差异有统计学意义(P<0.05),收缩期峰值速度(Vs)二组间差异无统计学意义(P>0.05)。结论 QTVI检测的二尖瓣环运动速度在判断左心室收缩和舒张功能早期变化方面有重要价值,能早期发现OSAS患者部分指标已有增加趋势,为临床手术前、后监测左心功能变化提供参考数据。     

Effect of maintenance hemodialysis on diastolic left ventricular function in end-stage renal disease

PURPOSE:

To analyze the effect of maintenance hemodialysis on left ventricular diastolic function in patients with end‐stage renal disease.

METHODS:

Study population consisted of 42 patients with end‐stage renal disease. Before an arteriovenous fistula was surgically created, the patients were evaluated by conventional and Doppler echocardiography and Doppler tissue imaging. Then, the patients undergoing hemodialysis treatment when the arteriovenous fistula was compleated. After the first hemodialysis session (mean 76.14 ± 11.37 days) the second echocardiographic evaluations were performed.

RESULTS:

Mean age was 58 ± 13 years and 21 (%50) of the patients were female. After maintenance hemodialysis treatment; peak early (E) and peak late (A) diastolic mitral inflow velocities and E/A ratio were not significantly change however the deceleration time of E wave and left atrial diameter were significantly increased. Also there was no change in the early (Em) and late (Am) diastolic myocardial velocities and Em/Am ratios of lateral and septal walls of left ventricular. E/Em ratio was decreased insignificantly. Pulmonary vein velocities and right ventricular functions are remained almost unchanged after hemodialysis treatment.

DISCUSSION:

The acute and long‐term effect of hemodialysis on left ventricular diastolic function is unclearly. Patients with end‐stage renal disease treatment with hemodialysis via arteriovenous fistula experience a variety of hemodynamic and metabolic abnormalities that predispose to alterations in left and right ventricular functions. The present study showed that left ventricular diastolic function except left atrial diameter and right ventricular functions were not significantly change, however left ventricular systolic functions were impaired after maintenance hemodialysis treatment in patients with end‐stage renal disease.

CONCLUSION:

It has been suggested that echocardiographic parameters are useful markers for evaluation of left ventricular and right ventricular functions in patients with end‐stage renal disease. However, in patients with end‐stage renal disease treated with hemodialysis, repeated assessment of echocardiographic examinations to observe serial changes in left and right ventricular functions are not yet well established. In this study, we showed that acute changes of volume status and electrolytes and autonomic regulation by hemodialysis session did not affect left ventricular diastolic and right ventricular functions in a relatively long term.     

实时三维超声心动图与组织多普勒评价扩张型心肌病患者左心室整体收缩功能的对比研究

目的对比实时三维超声心动图(RT-3DE)与组织多普勒(TDI)评价扩张型心肌病(DCM)患者的左心室收缩功能的临床意义。方法对临床及超声心动图确诊为DCM患者33例,其中男性20例,女性13例;年龄45~69岁,平均年龄53岁;符合1996年世界卫生组织(WHO)对DCM的诊断标准,均为窦性心律,纽约心脏学会(NYHA)分级Ⅱ~Ⅳ级。健康对照组28例,其中男性16例,女性12例;年龄43~64岁,平均年龄51岁;体格检查、心电图及超声心动图证实无心血管疾病,均为窦性心律。分别行二维超声心动图(2DE)、RT-3DE及TDI扫查,测量并计算各参数,以28例健康体检者作为对照。结果 DCM患者左心室射血分数(LVEFSimpson与LVEFRT-3DE)、Sm明显减低,Tei指数增大,与对照组相比,差异均存在显著统计学意义(P<0.01)。对照组中,LVEFRT-3DE、Tei指数及Sm与LVEFSimpson有显著相关性(分别为r=0.895,P<0.01;r=0.629,P<0.05;r=-0.760,P<0.05),在DCM患者中,LVEFRT-3DE与LVEFSimpson相关性仍然显著(r=0.818,P<0.01),LVEFRT-3DE与Tei指数及Sm的相关性较对照组要明显减低(分别为r=0.487,P<0.05;r=-0.493,P<0.05)。结论 RT-3DE较Sm、Tei指数更能有效评价DCM患者左心室收缩功能,为临床提供有价值的信息。     

盐酸莫索尼定对自发性高血压大鼠左室肥厚的影响

目的:研究国产盐酸莫索尼定对自发性高血压大鼠左室肥厚时心肌纤维化和冠状动脉微血管结构的影响。方法:20周龄的雄性自发性高血压大鼠30只随机分为①Mox+SHR组;②Cap+SHR组;③SHR组, 每组10只。另设性别周龄相配的SD大鼠10只为正常对照组(NC组)。观察13周后处死动物, 获取心脏。测量左心室重/体重, 左室胶原分数, 标准化血管周胶原面积和肌间动脉中膜厚度的变化。结果:Mox+SHR组不仅左心室重/体重明显低于SHR组, 而且左室胶原分数低于SHR组(0.086±0.018vs0.046±0.015, P＜0.01), 血管外膜胶原少于SHR组(0.69±0.11vs1.34±0.29, P＜0.01), 中膜薄于SHR组。结论:盐酸莫索尼定长期抗高血压治疗能够减轻左室肥厚时的心肌纤维化和改善受损的冠脉微血管结构。     

实时三维超声心动图左心室重构指数评价冠心病患者左心室重构的研究

目的探讨实时三维超声心动图（RT-3DE）测量左心室重构指数（LVRI）评价冠心病患者左心室重构的价值。方法根据冠状动脉造影结果,将病变组分为左旋支或/和右冠支病变组（LCX/RCA组）24例,其中男性18例,女性6例,年龄38～76岁,平均年龄54.2岁;单纯左前降支病变组（LAD组）21例,其中男性16例,女性5例,年龄35～78岁,平均年龄53.5岁;包含LAD病变的双支或多支病变组（多支组）27例,其中男性20例,女性7例,年龄39～80岁,平均年龄56.2岁;正常对照组22例,其中男性17例,女性5例,年龄32～79岁,平均年龄55.2岁。行RT-3DE,应用软件自动测量左心室舒张末期容积（LVEDV）、舒张末期心外膜容积（LVEDVepi）、左心室射血分数（LVEF）;再计算左心室质量[LVM=1.05×（LVEDVepi-LVEDV）]、LVRI（LVM/LVEDV）,并采用二维超声心动图（2DE）双平面Simpson测量并计算上述各值。比较RT-3DE和2DE测量LVRI在组间的差异、组内的差异和相关性,以及LVRI与LVEDV、LVEF的相关性;并比较观察者间及观察者内两种方法测量LVRI的一致性和重复性。结果正常对照组、LCX/RCA组、LAD组、多支组两种方法测量的LVRI呈显著递减（P〈0.05或P〈0.01）。前两组两种方法间的LVRI差异无统计学意义（P〉0.05）,后两组有统计学意义（P〈0.05或P〈0.01）。相关性分析表明：①除多支组内两种方法间的LVRI无显著相关性（P〉0.05）外,余3组内均呈显著相关性（P〈0.01）;②病变组同种方法测量的LVRI与LVEDV呈显著负相关性、LVEF呈显著正相关性（P〈0.01）,但正常组内无显著相关性（P〉0.05）。RT-3DE测量的LVRI观察者间及观察者内一致性和重复性较2DE好。结论来源于RT-3DE的LVRI优于2DE,更能作为临床评价冠心病患者左心室重构的指标。     

Uncommon cause of obstruction in the left ventricular outflow tract by a metastasis of adenocarcinoma

Cardiac metastases are rare diagnoses among cardiac disorders. This case demonstrates a unique presence of an obstruction in the left ventricular outflow tract caused by the metastasis of a renal carcinoma. Adequate diagnostic and therapeutic procedures were lifesaving in this potentially fatal diagnosis.