超声心动图对冠心病及孤立性房颤心房的结构及收缩功能对比分析

摘要 目的 分析两种疾病形成的心房增大的结构及功能的不同;以及超声心动图对心房结构及功能的应用价值。方法 选取我院2016年全年住院的冠心病（Coronary heart disease,CHD）及孤立性房颤（Paroxysmal Atrial Fibrillation PAF）患者各30例,领选取健康体检者30例作为对照组（Nomal Control,NC）。分别对三组行超声心动图检查,记录三组的左、右心房左右径上下径、容积（LAV、RAV）;左、右心房主动射血分数（LAEF、RAEF）;左、右心房应变（LAS、RAS）及应变率（LASR、RASR） 结果 孤立性房颤PAF组患者左、右房左、右径上下径容积均大于冠心病CHD组及正常对照组NC,左、右心房主动射血分数、应变及应变率均小于冠心病组及对照组;而冠心病CHD组的左房前后径、上下径、左右径、容积均大于正常对照组,主动射血分数应变及应变率均小于对照组;CHD组右房上下径及左右径与正常对照组无明显差异,而最大容积大于正常对照组,右房主动射血分数与正常对照组无明显差异,而应变及应变率减小。结论 冠心病及孤立性房颤均可使患者左、右心房增大,而AF造成的心房增大更显著。超声心动图可以对两种疾病的心房结构及收缩功能做较全面的评价,而二维斑点跟踪技术应变、应变率成像对心房功能的改变更敏感。     

血府逐瘀汤治疗阵发性孤立性房颤68例

临床资料 1一般资料 2000年9月-2004年8月,笔者应用血府逐瘀汤治疗阵发性孤立性房颤患者68例,其中门诊58例,住院10例;男43例,女25例;年龄平均21～62岁;平均病史16～38个月.68例均符合以下条件:①体表及动态心电图记录有反复房颤发作.②排除冠心病、肺心病、瓣膜性心脏病、高血压心脏病、心肌病、甲状腺代谢功能亢进等器质性心脏结构异常.③经心彩超检查未发现心脏结构异常.④房颤发作频率从35d～3个月不等.⑤房颤发生后经静脉注射抗心律失常药物或洋地黄制剂可自行停止.[1]     

孤立性房颤与高血压房颤患者左心重塑对比

目的:探讨高血压伴发的房颤和孤立性房颤患者左室质量等重塑状况异同及其意义。方法:房颤和(或)原发性高血压患者,排除对心脏有影响的其他疾病,分为原发性高血压无房颤组(EH组)、原发性高血压伴房颤组(EHAF组)和孤立性房颤组(LAF组)。进行超声心动图检测左房横径、左房前后径、左房长径、左房面积、左室室间隔厚度(IVST)、左室后壁厚度(PWT)和左室舒张末期内径(EDD),计算室间隔/左室后壁厚度比值和左室质量指数(LVMI)。结果: EH组入选446 例,EHAF组78例,LAF组38例。EHAF组IVST和PWT均明显大于EH组和LAF组(p<0.05和p<0.01),EH组IVST和PWT也大于LAF组(p<0.01和p<0.05)。EHAF组左房各内径和面积均明显大于LAF组和LH组(p<0.01),后两组间无明显差异。EHAF组LVMI明显大于LAF组和LH组(p<0.01和p<0.05),LAF组和LH组间无明显差异。结论:原发性高血压伴发房颤者左室肥厚程度明显重于不伴房颤者。左房扩大、左室肥厚性重塑与孤立性房颤的关系不如与高血压房颤密切,孤立性房颤发生的危险因子不同于高血压房颤。     

应变率成像定量评价孤立性房颤患者局部左房功能的研究

目的:探讨应变率成像技术定量评估孤立性房颤患者左房局部功能的临床应用价值。材料与方法:随机选取来我院就诊的孤立性房颤患者50例,行常规超声心动图检查,在超声组织速度成像状态下获取心尖四腔、两腔、左室长轴切面动态图像,将左房间隔壁、侧壁、前壁、下壁、前间隔和后壁分别按照基底段、中间段和心尖段划分为18个节段。观察左房各壁的基底段和中间段,测量收缩期峰值应变率(SR-LAs)和舒张期应变率(SR-LAe和SR-LAa),并与40例健康人相应节段心肌比较。结果:正常对照组40例480个被研究心肌节段,470个节段的应变率-时间曲线的形态整体有一定的规律性,SR-LAs、SR-LAe和SR-LAa值随个体变化不大。孤立性房颤患者组被研究600个心肌节段,应变率-时间曲线显示523个节段失去正常形态,轮廓杂乱,波峰低小、消失甚至倒置,峰值较正常心肌节段明显降低(P0.05)。结论:用应变率成像技术能够无创的定量评价孤立性房颤所致的左房功能异常。     

电话随访在孤立性房颤患者术后早期康复中的应用及效果

目的 探讨电话随访在孤立性房颤患者术后早期康复中的应用及效果评价.方法 选择2012年3月-2013年1月上海交通大学医学院附属新华医院心胸外科孤立性房颤患者60例,按入院时间分为实验组和对照组各30例.两组患者均采用超微创外科射频消融术,对照组出院时接受常规出院指导及健康宣教,实验组另外还接受护士6个月电话随访.观察两组患者出院1、3、6个月后复发例数和发生不良反应情况.结果 实验组出院3、6个月后患者复发例数和发生不良反应例数均少于对照组,两组比较差异有统计学意义（P＜0.05）.结论 电话随访能督促患者正确服药,定期复诊,降低疾病复发率,预防并发症发生,促进患者术后早期康复.     

孤立型阵发性房颤患者的B型利钠肽水平分析

目的探讨孤立型阵发性心房颤动(房颤)与血浆B型利钠肽(BNP)之间的关系。方法对34例孤立型阵发性房颤患者(房颤组)和32例健康人(对照组)进行血浆BNP和心脏超声检查。结果房颤组左室射血分数(LVEF)和左室舒张末期内径(LVDD)与对照组比较差异无统计学意义;血浆BNP水平房颤组显著高于对照组〔(298±95)vs(47±18)pg/ml,P<0.05〕。房颤转为窦律后BNP明显下降〔(298±95)vs(134±39)pg/ml,P<0.05〕。结论孤立型阵发性房颤患者BNP水平增高,房颤转律后BNP显著下降,说明房颤可影响BNP的分泌,故临床上对于BNP升高者除心力衰竭外还应考虑房颤的因素。     

胸腔镜下单纯肺静脉隔离手术与左心房盒式消融术治疗孤立性房颤的临床价值比较

目的比较胸腔镜下单纯肺静脉隔离术(PVI)与左心房盒式消融术(Box)治疗孤立性房颤的临床价值。方法采用回顾性研究方法,选取2016年1月至2018年8月湖北省中医院收治的孤立性房颤患者80例,根据手术方法不同将患者分为PVI组和Box组,每组各40例。PVI组患者采用胸腔镜下单纯PVI术治疗,Box组患者采用双极射频消融钳完成Box术治疗。比较两组患者的术后和出院时的窦性心率转复率、早期与晚期复发率以及末次随访结果。结果术后随访1.0~2.7年,平均(1.84±0.57)年,两组随访有效率均为100%。Box组患者的术后与出院时窦性心律转复率(82.5%,72.5%)明显高于PVI组(67.5%,57.5%),差异具有统计学意义(P<0.05)。Box组患者早期复发率(12.5%)明显低于PVI组(25.0%),差异具有统计学意义(P<0.05)。Box组患者晚期复发率(7.5%)低于PVI组(17.5%),但差异无显著性(P>0.05)。末次随访结果显示,Box组患者窦性心率比率(82.5%)明显高于对PVI组(62.5%),房颤以及房扑心率比率(15.0%)明显低于PVI组(27.5%),差异具有统计学意义(P<0.05)。结论胸腔镜下Box术可有效提高孤立性房颤患者窦性心律转复率、降低早期复发率,具有较高的临床价值。     

孤立性骨浆细胞瘤与多发孤立性浆细胞瘤

孤立性骨浆细胞瘤(solitary plasmacytoma of bone,SPB)与多发孤立性浆细胞瘤(multiple solitary plasmacytoma,MSP)均为浆细胞的恶性增殖性疾病,尽管其组织病理特征一致,但两者临床特征、诊断标准和治疗方法不同。2009年国际骨髓瘤工作组提出了浆细胞瘤的诊断和处...     

Determinants of plasma NT-pro-BNP levels in patients with atrial fibrillation and preserved left ventricular ejection fraction

Objectives  The present study aimed to investigate the clinical and echocardiographic determinants of plasma NT-pro-BNP levels in patients with atrial fibrillation (AF) and preserved left ventricular ejection fraction (LVEF). Methods  NT-pro-BNP levels were measured in 45 patients with paroxysmal AF, 41 patients with permanent AF and 48 controls. Results  NT-pro-BNP levels were found significantly elevated in patients with paroxysmal (215 ± 815 pg/ml) and permanent AF (1,086 ± 835 pg/ml) in relation to control population (86.3 ± 77.9 pg/ml) (P < 0.001). According to the univariate linear regression analysis, age, hypertension, β-blocker use, left atrial diameter (LAD), LVEF and AF status (paroxysmal or permanent or both) were significantly associated with NT-pro-BNP levels (P < 0.05). In multiple linear regression analysis, LVEF (B coefficient: −53.030; CI: −95.738 to −10.322; P: 0.015) and LAD (B coefficient: 285.858; CI: 23.731–547.986; P: 0.033) were significant and independent determinants of NT-pro-BNP levels. Conclusions  Plasma NT-pro-BNP levels were significantly higher in patients with paroxysmal and permanent AF compared to those with sinus rhythm in the setting of preserved left ventricular systolic function. LVEF and LAD were independent predictors of NT-pro-BNP levels.     

体外电复律治疗房颤对植入左心耳封堵器患者的影响

目的：探讨植入左心耳封堵器的房颤患者接受体外电复律治疗的可行性和安全性。方法：选取2016年5月至2019年12月北京医院收治的经皮成功植入左心耳封堵器患者51例，其中接受体外电复律治疗7例（13.7%），观察电复律对装置的影响及相关不良事件。结果：51例患者中，接受电复律治疗的7例（13.7%）患者未发生封堵器移位或脱落，围手术期未发生严重不良事件。结论：植入左心耳封堵器的房颤患者接受体外电复律治疗是安全、可行的。     

Clinical subtypes of lone atrial fibrillation

AIMS: In the face of increasing evidence of underlying genetic heterogeneity for lone atrial fibrillation (LAF), we undertook a clinical analysis of subjects to identify the phenotypic subsets of this arrhythmia. METHODS AND RESULTS: We evaluated serial patients who presented with LAF between July 5, 2001 and December 19, 2003. Subjects underwent a standardized interview to elicit a detailed medical history, prior therapies, and precipitants of atrial fibrillation. The results of a physical exam, electrocardiogram and echocardiogram were reviewed. One hundred and eighty subjects with a mean age of 45 years (15-67 years) at the time of diagnosis were enrolled. The majority of patients originally presented with paroxysmal fibrillation (94%), and 7.8% progressed to permanent AF. Reported triggers for AF included sleeping (44%), exercise (36%), alcohol use (36%), and eating (34%). Women with LAF had distinct symptoms, triggers for episodic AF, and over one-fourth had an underlying rheumatologic condition. Several subsets of AF including familial AF (39%), exercise-induced AF (32%), and conduction system disease requiring pacemaker implantation (7%), were identified. CONCLUSIONS: Family history, exercise as a trigger of AF, and a history of a pacemaker identified subtypes of LAF.     

Different clinical courses and predictors of atrial fibrillation occurrence after transisthmic ablation in patients with preablation lone atrial flutter, coexistent atrial fibrillation, and drug induced atrial flutter

The aim of this prospective study was to compare the long-term follow-up after transisthmic ablation of patients with preablation lone atrial flutter, coexistent AF, and drug induced atrial flutter to determine if postablation AF followed a different clinical course and displayed different predictors in these groups. The study evaluated 357 patients who underwent transisthmic ablation for typical atrial flutter. These were divided into four groups according to their preablation history. Group A included patients with typical atrial flutter and without preablation AF (n=120, 33.6%). Group B included patients with preablation AF and spontaneous atrial flutter (n=132, 37.0%). Group C patients had preablation AF and atrial flutter induced by treatment with IC drugs (propafenone or flecainide) (n=63, 17.6%) Group D included patients with preablation AF and atrial flutter induced by treatment with amiodarone (n=42, 11.8%). During a mean follow-up of 15.2 double dagger 10.6 months (range 6-55 months) AF occurred more frequently in groups B (56.1%) and C (57.1%) patients than in groups A (20.8%, P <0.0001) and D (31.0%, P <0.0001) patients. The results of multivariate analysis revealed that different clinical and echocardiographical variables were correlated with postablation AF occurrence in the different groups. Patients with atrial flutter induced by amiodarone have a significantly lower risk of postablation AF than patients with spontaneous atrial flutter and AF, and those with atrial flutter induced by IC drugs. Different clinical and echocardiographical variables predict postablation AF occurrence in different subgroups of patients.     

合并房颤的高血压病患者左房内径与左室射血分数的关系研究

目的研究发生房颤的高血压病患者左房内径与左室射血分数(LVEF)的相关性。方法 56例高血压病患者,根据心电图示有无房颤或房颤病史分为2组:高血压病组和高血压病合并房颤组。应用超声心动图检测左房内径、左房容积(LAV)、左房容积指数(LAVI)、LVEF。分析LVEF与心脏超声内径关系。结果与高血压病组比较,高血压病合并房颤组左房内径、LAV及LAVI均增大,LVEF减小,差异均有统计学意义(P<0.001)。LVEF与左房内径、LAV、LAVI呈负相关(r值分别为-0.555、-0.589、-0.602,P<0.001)。结论高血压病合并房颤患者较高血压病患者左房扩大更明显,左室功能更减弱,此现象可能与左房结构重构触发左室重构有关。     

心房颤动患者血清趋化素水平与心房纤维化程度的相关性

目的 探讨心房颤动（房颤）患者血清趋化素（chemerin）水平与心房纤维化程度的相关性。方法 回顾性纳入CARTO指导的首次行导管射频消融术的阵发性或持续性房颤患者80例,根据有无低电压区将患者分为无低电压区组（n=32）和低电压区组（n=48),根据低电压区范围大小,低电压区组分为3个亚组：＞5%≤20%（n=30）、＞20%≤35%（n=12）、＞35%（n=6）,左心房低电压区范围反映心房纤维化程度;采用酶联免疫吸附法（ELISA）测定患者的血清chemerin水平。 结果 与无低电压区组相比,低电压区组的chemerin水平明显升高;＞5%≤20%、＞20%≤35%、＞35%的chemerin水平差异有统计学意义（P＜0.05）,即低电压区范围越大,chemerin水平越高;相关性分析显示血清chemerin水平与低电压区范围呈正相关（r=0.721,P＜0.01）。结论 血清chemerin水平的高低可作为一种无创性的指标来评估心房纤维化程度,有助于临床选择合适的患者和消融术式。