Partial Left Ventriculectomy (Batista Procedure) in the Treatment of Dilated Cardiomyopathy: Makati Medical Center Philippine Experience

A bstract In the Philippines patients with end-stage heart disease refractory to conventional medical and surgical treatment do not have alternative choices. More than 99% of the population cannot afford cardiac transplantation. Partial left ventriculectomy (PLV) is a surgical procedure that improves cardiac function and refractory congestive heart failure (CHF). Between October 1997 and February 1998 eight patients had PLV at the Makati Medical Center, Philippines. All patients had end-stage dilated cardiomyopathy. Six patients had an id-iopathic etiology, one was ischemic and one valvular. Seven of eight operations were done with the heart beating and all had transesophageal echo monitoring. An average of a 2-cm reduction in the left ventricle diameter was achieved and ejection fraction improved in all cases. There were no operative deaths. There were three late deaths. Two patients died of refractory CHF and ventricular arrhythmias and one patient died of massive cerebral hemorrhage with coumadin therapy. The five survivors are all doing well with no CHF. Follow-up two-dimensional echo shows stable left ventricular (LV) size and improved ejection fraction. Our initial experience shows that PLV, at least in the short-term, has beneficial effects in the treatment of end-stage dilated cardiomyopathy and might become an alternative to cardiac transplantation.     

Assessment of Regional Myocardial Function in Patients with Dilated Cardiomyopathy by Velocity Vector Imaging

Objective: To assess the left ventricular (LV) longitudinal systolic and diastolic function in patients with dilated cardiomyopathy (DCM) by syngo Velocity Vector Imaging (VVI). Methods: Digital dynamic images of 30 DCM patients and 30 healthy subjects were collected; then the longitudinal velocity, strain, and strain rate were measured in systolic early and late diastolic periods, and the time to peak systolic velocity, strain, and strain rate were measured and recorded. The parameters of the two groups were compared. Results: All of the parameters of the DCM were significantly lower than those of the normal group (P < 0.05–0.01), except that the parameter of late diastolic strain was not different between the two groups (P > 0.05). Conclusions : VVI is a novel noninvasive tool to assess quantitatively and objectively LV regional systolic and diastolic function in patients with DCM; it provides another useful modality for evaluating cardiac function.     

抗人心肌线粒体抗体在病毒性心肌炎和扩张型心肌病中的检测及其意义

目的检测病毒性心肌炎(VMC)和扩张型心肌病(DCM)患者血清中是否有抗人心肌线粒体抗体存在及其意义。 方法以人心肌线粒体作抗原,应用免疫点印迹在29例VMC(VMC组)、24例DCM(DCM组)、33例其它心脏病(OCD组)及20例健康献血者(HBD组)进行抗人心肌线粒体抗体检测,用免疫印迹方法检测其抗原分子量。 结果VMC组(12例,41.4%)DCM组(10例,41.7%)抗人心肌线粒体抗体阳性明显高于OCD组(2例,6.1%)及HBD(0%);②抗体阳性的VMC和DCM患者中有43.8%的心肌肌钙蛋白T升高,抗体阴性者为12.0%(P＜0.05)有显著性差异;③人心肌线粒体特异性抗原的分子量为30KD。 结论①在VMC和DCM患者血清中存在抗人心肌线粒体抗体,说明部分VMC及DCM与自身免疫有关,该抗体是引起心肌损伤的因素之一,对该抗体的检测可作为VMC和DCM的辅助诊断手段之一;②该抗体的特异性抗原可能为人心肌线粒体腺苷酸转位酶。     

Assessment of Left Atrial Function in Hypertrophic Cardiomyopathy and Athlete's Heart: A Left Atrial Myocardial Deformation Study

Background: Hypertrophic cardiomyopathy (HCM) is a common cause of sudden death in athletes and differentiating this condition from the nonpathological "athlete's heart" remains a challenge. The development of pathological left ventricular hypertrophy (LVH) is associated with left atrial (LA) dilatation and dysfunction. LA strain and strain rate by two-dimensional (2D) speckle tracking are novel indices of LA function and might contribute to differentiate physiological from pathological LVH among athletes with underdiagnosed HCM. Methods: We evaluated 20 patients with nonobstructive HCM, 20 highly trained athletes and 20 healthy controls matched for age, gender, and body surface area. All patients underwent a transthoracic echocardiogram with evaluation of LA strain: s-wave (LASs); and strain rate: s-wave (LASRs) and a-wave (LASRa). Results: LV mass index, LA volume index, and ejection fraction were comparable between patients with HCM and athletes. Patients with HCM had a significantly lower LASs (19 + 8% vs. 43 + 8%, P < 0.01), LASRs (0.7 + 0.2 s-1 vs. 1.6 + 0.2 s-1, P < 0.01), and LASRa (-0.8 + 0.1 s-1 vs. -1.4 + 0.3 s-1, P < 0.01) compared to athletes. Among hypertrophic subjects, independent predictors of hypertrophy related to HCM were LASs and E/é ratio. Conclusions: LA myocardial deformation is significantly impaired in patients with HCM compared to athletes and healthy controls. LA strain and strain rate assessed by 2D speckle tracking should be incorporated in the evaluation of trained athletes with LVH and LA dilatation.     

Comparison of Baroreflex Sensitivity with Age and Indices of Left Ventricular Function in Patients with Dilated Cardiomyopathy

Background: BRS is an index of autonomic innervation of the heart. Depression of the BRS after Ml is correlated with an increased risk of cardiac mortality and sudden death. However, little is known about the BRS in patients with idiopathic dilated cardiomyopathy (IDC). Methods: In a prospective study the BRS was measured in 89 patients with IDC by the noninvasive phenylephrine method. Mean age of the study population was 48 years, LVEF was 30.2 ± 9.5 %, and left ventricular enddiastolic diameter was 66.9 ± 7.6 mm. Results: BRS did not significantly differ in patients with an LVEF > 30% compared to patients with an ejection fraction 30% (6.2 ± 4.1 vs. 7.3 ± 3.6 ms/mmHg, P > 0.05). There was no difference in the BRS slope between patients with a left ventricula- end-diastolic diameter 65 mm compared to > 65 mm (6.4 ± 3.2 vs. 7.0 ± 4.4 ms/mmHg, P < 0.05) and in patients older than 50 years of age compared to younger patients (6.1 ± 3.7 vs. 7.3 ± 4.0 ms/mmHg, P < 0.05). Conclusion: BRS may be an independent parameter useful for risk stratification in patients with dilated cardiomyopathy. A.N.E. 1999;4(1):67–71     

米力农对扩张型心肌病患者肿瘤坏死因子α和左室射血分数及肺动脉收缩压的影响

目的研究米力农对扩张型心肌病(DCM)患者血清肿瘤坏死因子α(TNF-α)、心脏左室射血分数(LVEF)及肺动脉收缩压(PASP)的影响,探讨米力农治疗DCM的可行性及病理生理学机制。方法 80例DCM患者随机分为3组。对照组(30例)使用常规药物治疗;低剂量米力农组(28例)在常规药物治疗的基础上静脉使用米力农(2周内总药量≤100mg);高剂量米力农组(22例)在常规药物治疗的基础上静脉使用米力农(2周内总药量>100mg)。于研究开始及2周后用酶联免疫吸附法(ELISA)测定患者血清TNF-α水平、通过超声心动图计算患者的LVEF及PASP,并进行统计学分析。结果治疗后高剂量米力农组TNF-α水平高于低剂量米力农组和对照组,低剂量米力农组TNF-α水平高于对照组,差异有统计学意义(P<0.05);高、低剂量米力农组LVEF高于对照组,PASP低于对照组,差异有统计学意义(P<0.05)。结论米力农会增加患者TNF-α水平,同时提高患者LVEF、降低PASP。低剂量使用米力农可通过血流动力学的改善在一定程度上代偿了TNF-α水平的增高,对预后影响不大。而大剂量使用米力农后TNF-α水平会显著增加,且不能完全通过血流动力学代偿,对预后不利。     

Guiding of Percutaneous Transcoronary Septal Myocardial Ablation in Hypertrophic Obstructive Cardiomyopathy by Myocardial Contrast Echocardiography:

Percutaneous transluminal septal myocardial ablation (PTSMA) by alcohol injection into septal branches (SB) of the left coronary artery has evolved as a promising therapeutic option for selected patients with obstructive hypertrophic cardiomyopathy (HOCM). Originally, probatory balloon occlusion of the target vessel was considered to be predictive for definitive reduction of left ventricular outflow gradients (LVOTG). The need for additional information regarding the exact site and extension of the therapeutic septal infarction is demonstrated by a case report. In this patient, myocardial contrast echocardiography (MCE) was performed prior to alcohol injection and showed that the septal area corresponding to LVOTG formation was supplied by a SB originating atypically from an intermediate branch. PTSMA guided by MCE led to complete LVOTG elimination without sustained rhythm disturbances and with a minimum CK rise.     

柯萨奇B病毒性心肌炎、扩张型心肌病中病毒持续感染及中药干预的研究

目的：研究柯萨奇B病毒性心肌炎、扩张型心肌病中病毒持续感染与中药干预的相关性。方法：建立急慢性病毒性心肌炎动物模型，用定性及定量多聚酶链反应测脾脏白细胞中以及心肌匀浆中的柯萨奇B病毒核糖核酸（CVB－RNA）；对急性病毒性心肌炎及扩张型心肌病的临床病例，用定性的方法定期检测外周血白细胞中CVB－RNA，观察其病毒持续状态以及用原位PCR法检测扩张型心肌病心肌活检标本中CVB－RNA，以明确病毒持续感染与扩张型心肌病的意义；观察苦参中抗柯萨奇B病毒的有效成分（SFA）干预的临床价值。结果：18例扩张型心肌病病人有6例病人的外周血白细胞中CVB－RNA（＋），占33．3％，有的已持续3年以上，其中13例用原位PCR检测，有6例心肌细胞中CVB－RNA（＋），占46．2％，对慢性（270d)病毒性心肌炎动物模型脾脏白细胞及心肌匀浆中定量检测，结果均证明有持续感染的存在，用SFA治疗后，在心肌匀浆中CVB－RNA的清除率为92．77％，脾脏白细胞中CVB－RNA的清除率为89．04％。结论：扩张型心肌病与病毒性心肌炎有关性，扩张型心肌病与病毒持续感染有关，SFA能清除CVB－RNA达89％－92％。     

Real Time Three‐Dimensional Echocardiographic Assessment of Left Ventricular Regional Systolic Function and Dyssynchrony in Patients with Dilated Cardiomyopathy

Purpose: To evaluate left ventricular (LV) regional systolic function and dyssynchrony in patients with dilated cardiomyopathy (DCM) by real time three‐dimensional echocardiography (RT‐3DE). Methods: The study population comprised 30 normal controls (NOR) and 44 patients with DCM. We divided the left ventricle into apical, middle, and basal regions. We calculated the LV regional end‐diastolic volume (_REDV), regional end‐systolic volume (_RESV), regional ejection fraction (_REF), and standard deviation in the time to minimal systolic volume in each level segment (Tmsv‐SD) of the three regions by RT‐3DE. Results: Compared with NOR, the _REDV, _RESV, and Tmsv‐SD of DCM were significantly higher, whereas the _REF was lower (P < 0.01). In DCM, the Tmsv‐SD increased smoothly from base to apex, and the _REF gradually decreased from base to apex (P < 0. 05). Linear correlation was observed between the Tmsv‐SD of the middle region and 3D‐EF in DCM (r =?0. 6829, P < 0.01). Conclusion: RT‐3DE provides a simple and feasible approach to quantify LV regional systolic function and dyssynchrony. (ECHOCARDIOGRAPHY 2010;27:415‐420)