急性心肌梗死患者室壁运动及心功能损害与发病-超声检查时间的关系

目的 探索急性心肌梗死患者室壁运动及心功能损害与发病-超声检查时间的关系.方法 收集初发急性心肌梗死患者219例,均已排除陈旧性心肌梗死、早期心肌再梗死、严重的瓣膜性心脏病、先天性心脏病、心肌病等影响室壁运动及心功能的疾病.所有患者均在予冠状动脉介入干预前行经胸超声心动图检查,采用二维超声等方法测量或（和）计算左心室舒张末期内径（left ventricular diameters in diastasis,LVDd）、收缩末期内径（left ventricular diameters in systole,LVDs）、左心室射血分数（left ventricular ejection fraction,LVEF）、室壁运动计分指数（wall motion index,WMI）及运动正常节段（fragments with normal wall motion,FM）百分比等参数,并精确记录发病-超声检查时间.结果 WMI、LVDd、LVDs、LVEF、FM百分比与发病-超声检查时间的相关关系均有统计学意义（P＜0.05）,相关系数分别为0.167,0.235,0.258,-0.196,-0.144.在WMI的多重线性回归分析结果显示,变量FM百分比、LVEF、左回旋支和（或）右冠状动脉进入方程（R2=0.878,justed R2=0.876）,偏回归系数分别为-1.103,-0.030,-0.001.结论 对于未予冠状动脉介入干预的急性心肌梗死患者,其室壁运动及心功能均随发病-超声检查时间的增加而减弱.     

Resting heart rate and cardiac function in dilated cardiomyopathy

We hypothesized that, within the normal range of resting heart rate, heart rate and left ventricular ejection fraction would be inversely correlated and heart rate and left ventricular filling would be correlated in patients with dilated cardiomyopathy and not correlated in patients with normal cardiac function. At rest, heart rate, left ventricular ejection fraction, and three measures of diastolic filling (time to peak filling rate, peak filling rate, and first half filling fraction) were recorded using radionuclide ventriculography in subjects with no cardiac disease, patients with idiopathic dilated cardiomyopathy, and patients with dilated cardiomyopathy associated with ischemic heart disease. Heart rate had significant inverse correlations with left ventricular ejection fraction (r=-0.55, P=0.0007) and time to peak filling rate (r=-0.47, P=0.005) and a positive correlation with peak filling rate (r=0.73, P<0.0001) in patients with idiopathic dilated cardiomyopathy; heart rate was correlated only weakly with these measures in the absence of cardiac disease and essentially was not correlated in dilated cardiomyopathy due to ischemic heart disease. The change in resting heart rate with left ventricular ejection fraction and time to peak filling rate were significantly (P<0.05) different between patients with no cardiac disease and those with idiopathic dilated cardiomyopathy. Thus, resting heart rate correlated significantly with left ventricular ejection fraction and diastolic filling in patients with idiopathic dilated cardiomyopathy.     

Left ventricular volume and mass: Comparative study of two-dimensional echocardiography and ultrafast computed tomography

This study was undertaken to define the accuracy of two-dimensional echocardiography in the determination of left ventricular end-diastolic and end-systolic volumes, stroke volume, ejection fraction, and mass when compared to ultrafast cine computed tomography in the same 56 patients. Single-plane and biplane modified Simpson's rule, single-plane and biplane ellipsoidal formula, bullet formula (biplane only), and biapical Simpson's rule methods were utilized. Linear regression analysis showed the strongest correlation with the modified biplane Simpson's rule (mean r = 0.897). In valvular heart disease (n = 12) and dilated cardiomyopathy (n = 6), the mean correlation coefficients for all methods were high (r = 0.894 and 0.911, respectively). The mean correlation coefficient for all methods in patients with prior myocardial infarction (n = 25) was relatively poor (r = 0.643). Intraobserver and interobserver variabilities for all methods were low (r = 0.980 and 0.965, respectively). It is concluded that calculations of left ventricular volumes and mass by two-dimensional echocardiography are accurate and reproducible in patients with a global effect on the left ventricle and were less acceptable in patients with segmental (ischemic) left ventricular involvement. The best measurement technique is a modified biplane Simpson's rule.     

Progression of left ventricular enlargement in patients with hypertrophic cardiomyopathy: Incidence and prognostic value–K. Hina ef al.: Ventricular enlargement in HCM

A total of 51 patients with hypertrophic cardiomyopathy (HCM) were followed for at least 3 years (mean follow-up period 6.5 years) by serial M-mode and two-dimensional echocardiography. An increase of the left ventricular diastolic dimension (LVDd) to ≥ 55 mm with a decrease in the left ventricular ejection fraction (LVEF) to < 55% was observed in eight (15.7%) patients (progressive disease group). In five of these eight patients, the LVDd was ≥ 60 mm and the LVEF was < 40%. Ventricular enlargement was closely related to mortality and death due to congestive heart failure occurred in three of these patients. No deaths occurred among the 37 patients without significant progression of ventricular enlargement (nonprogressive group). The annual changes of LVEF and LVDd in the progressive disease group were larger than in the nonprogressive group (LVEF – 0.18 ± 1.45 vs. – 2.46 ± 1.47 %/year; LVDd 0.22 ± 0.81 vs. 1.43 ± 0.77 mm/year). An increment in LVDs occurred earlier than the enlargement of the LVDd. Therefore, close attention to the LVDs seems to be important to detect early left ventricular morphological changes in HCM. In summary, this study indicates that HCM patients include a subgroup with symptoms resembling dilated cardiomyopathy, in whom the left ventricle enlarges with hypofunction and in whom there is high mortality due to congestive heart failure.     

Extent of myocardial viability predicts response to biventricular pacing in ischemic cardiomyopathy

BACKGROUND: The clinical response to biventricular pacing is unpredictable, especially in patients with ischemic cardiomyopathy. OBJECTIVES: The purpose of this study was to prospectively examine the relationship between the extent of myocardial viability and the response to cardiac resynchronization therapy. METHODS: Twenty-one patients with ischemic left ventricular (LV) dysfunction (left ventricular ejection fraction [LVEF] 21 +/- 5%), New York Heart Association (NYHA) functional class III-IV, and QRS >120 ms received biventricular devices. Myocardial viability was assessed by myocardial contrast echocardiography, and a perfusion score index (PSI) was calculated from summed segmental perfusion scores. LV performance was assessed by echocardiography on the day after implantation and at 6 months. RESULTS: PSI was closely correlated with acute improvement in LVEF (P = .003, r = 0.65), stroke volume (P = .02, r = 0.54), and end-systolic volume (P = .05, r = -0.49). PSI also correlated with early diastolic LV relaxation (E', P < .05, r = 0.50) and global myocardial performance or Tei index (P = .003, r = 0.63). By multiple linear regression analysis, PSI provided incremental predictive value to the degree of dyssynchrony, measured by tissue Doppler imaging, for predicting improvement in LVEF. At 6 months, PSI remained positively correlated with improvement in ventricular performance and with reduction in LV end-diastolic dimension (P = .003, r = -0.68). PSI also influenced the clinical variables of NYHA class, 6-minute walk distance, quality-of-life score, and number of hospitalizations for heart failure. CONCLUSION: In patients with ischemic cardiomyopathy, the extent of myocardial viability predicts acute and long-term improvement in LV performance, exercise tolerance, and reduction in LV end-diastolic dimension with biventricular pacing.     

等容舒张期左室心肌松弛性测定的新方法

在７８例接受左右心导管检查的患者中，对等容舒张期（ＩＶＲ）左室压力曲线的下降形式进行了数学分析，并应用简化的指数曲线方程测量了ＩＶＲ左室松弛时间常数（Ｔ）。结果显示，所有患者ＩＶＲ左室瞬时压的对数值与时间呈高度直线相关（ｒ＝０．９３７～０．９９８），理论与实测Ｔ值亦高度相关（ｒ＝０．９６８～０．９８８），表明ＩＶＲ左室压力呈指数曲线下降。本文方法为Ｔ值测量提供了简便可靠的新途径。     

Assessment of myocardial perfusion and fatty acid metabolism in a patient with Churg-Strauss syndrome associated with eosinophilic heart disease.

Churg-Strauss syndrome is characterized by asthma, eosinophilia and systemic necrotizing vasculitis; cardiac involvement (ie, eosinophilic heart disease) is the major cause of morbidity and mortality, although there are no reports of an association between left ventricular dysfunction because of eosinophilic heart disease and myocardial blood flow or myocardial fatty acid metabolism. A patient presented with Churg-Strauss syndrome associated with eosinophilic heart disease that had progressed to dilated cardiomyopathy. Coronary angiography, thallium-201 ((201)Tl) and iodine-123 beta-methyl-iodophenyl pentadecanoic acid ((123)I BMIPP) myocardial single photon emission computed tomography (SPECT) were performed to evaluate left ventricular dysfunction. Although coronary angiography was normal and (201)Tl SPECT showed no apparent image defect, (123)I BMIPP SPECT showed diffuse decreased accumulation, excepting the apex. The left ventricular dysfunction in patients with eosinophilic heart disease is associated with impaired myocardial fatty acid metabolism rather than with impaired myocardial blood flow.     

扩张型心肌病心肌病变对心脏再同步化治疗的影响

目的采用前瞻性自身对照研究的方法,应用双核素同时采集法单光子发射计算机断层（SPECT）显像评价扩张型心肌病（DCM）心肌病变的程度与心脏再同步化治疗（CRT）效果之间的关系。方法13例DCM心力衰竭患者成功植入CRT,并于术前及术后半年行SPECT检查,半定量分析方法评价手术前、后左室心肌灌注、代谢变化情况。结果术后左室缺血区、坏死区质量百分比均较术前明显降低[（18．2±12．7）％vs（31．8±15．4）％,P〈0．05;（22．3±14．9）％VS（36．4±14．3）％,P〈0．051。术前坏死区质量百分比、总心肌灌注评分之和（F值）与CRT超声应答呈负相关（r=-0．578,P〈O．05;r=-0．619,P〈0．05）。心肌灌注0分的节段数（N。）与CRT临床症状好转呈正相关（r=0．81,P〈0．05）。术前Nn与术后左室收缩功能改善、左室逆转重塑呈正相关（r=-0．655,P〈0．05;r=0．719,P〈0．05）。结论术前心肌细胞坏死程度越大,CRT疗效越差;CRT治疗可使心肌局部血流灌注改善,部分心肌细胞代谢增强,心肌坏死程度较术前减轻。     

Iodine-123 meta-iodobenzylguanidine scintigraphy: a noninvasive method to demonstrate myocardial adrenergic nervous system disintegrity in patients with idiopathic dilated cardiomyopathy

Iodine-123 (I-123) meta-iodobenzylguanidine (MIBG) imaging was performed in 31 patients. Three patients were without cardiac disease and 28 had idiopathic dilated cardiomyopathy with various degrees of left ventricular dysfunction. The qualitatively assessed myocardial I-123 MIBG scintigrams and the myocardial versus mediastinal I-123 MIBG uptake ratio were related to I-123 MIBG activity and norepinephrine concentration determined from endomyocardial biopsy samples taken from the right side of the interventricular septum. Scintigrams and the MIBG uptake ratio were also related to plasma catecholamine concentrations, left ventricular ejection fraction and New York Heart Association functional class. Patients with distinct myocardial I-123 MIBG uptake (score 1) had a normal ejection fraction (58 +/- 16%). Patients with diffusely reduced uptake or scintigraphic defects (score 2) had a significantly lower ejection fraction (38 +/- 9%, p less than 0.05), whereas patients with shadowy or no visible myocardial uptake (score 3) had the lowest ejection fraction (23 +/- 6%, p less than 0.002 versus patients with score 2). The scintigraphically determined I-123 MIBG activity in the septal region correlated significantly with I-123 MIBG activity from the endomyocardial biopsy samples (r = 0.78, p less than 0.001, n = 9). The myocardial versus mediastinal I-123 MIBG activity ratio was significantly related to myocardial norepinephrine concentration (r = 0.63, n = 28) and to left ventricular ejection fraction (r = 0.74, n = 31). These data suggest that myocardial I-123 MIBG scintigraphy is a useful noninvasive method for the assessment of myocardial adrenergic nervous system disintegrity in patients with idiopathic dilated cardiomyopathy.     

钙网蛋白及基质金属蛋白酶在扩张型心肌病发病机制中的作用

目的 探讨扩张型心肌病与钙网蛋白（Calreticulin）、基质金属蛋白酶（MMPs）家族成员MMP-2和MMP-9之间的关系,为扩张型心肌病的预防和治疗提供理论论据.方法 试验分两组：扩张型心肌病组和对照组.分别收集14例扩张型心肌病患者及14例对照组全血及临床资料（年龄,性别,左房、右房、左室、右室舒张末期内径及左室射血分数等）,提取血浆,通过蛋白免疫印迹法（western blotting）测定血浆钙网蛋白的表达水平,通过明胶酶谱法（Gelatin-PAGE）检测各标本血浆中MMP-2和MMP-9活性.结果 ①扩张型心肌病组与对照组比较,两组间左房、左室舒张末期内径、左室射血分数和MMP-9活性的差异有统计学意义.②在扩张型心肌病组中,MMP-9活性与左室射血分数呈负相关（r＝-0.590,P＜0.05）,与左室舒张末径呈正相关（非正态分布等级相关：r＝0.396,P＜0.05）,但与左房、右房、右室舒张末径和室间隔厚度均无相关关系.对照组中,MMP-9与左房、右房、左室、右室舒张末径和室间隔厚度均无相关关系.③两组比较,MMP-2活性差异无统计学意义,与左房、右房、左室、右室舒张末径,左室射血分数和室间隔厚度之间均无相关关系.④钙网蛋白在扩张型心肌病组的表达升高,但与对照组相比,两者间的表达水平差异无统计学意义（P＞0.05）.结论 ①MMP-9在扩张型心肌病患者左室重构中起重要作用,MMP-9的活性可作为评估心功能情况的参考指标之一.②钙网蛋白在扩张型心肌病病理过程中未直接参与其疾病发展,但未排除通过其他途径作用于该病理过程.     

The radionuclide diagnosis of dilated cardiomyopathy: a new approach to assessing myocardial perfusion function by 201Tl scintigraphic data at rest and during the performance of the dipyridamole test]

A method for quantitative determination of the percentage of left ventricular myocardial 201Tl isotope uptake at rest and during dipyridamole test was first used in patients with dilated cardiomyopathy and coronary heart disease complicated by circulatory insufficiency or chronic myocarditis. This method makes it possible to judge the level of myocardial blood flow and perfusion reserve in these diseases. The most common differences were found between patients with coronary heart disease and those with chronic myocarditis. The patients with chronic myocarditis exhibited the greatest sizes of perfusion defects, highest values of 201Tl uptake at rest and a lower myocardial perfusion reserve during dipyridamole test. In response to exercise, most patients with chronic myocarditis had diminished perfusion defects, whereas those with coronary heart disease displayed increased defects. The myocardial perfusion was varied in patients with dilated cardiomyopathy. Some patients had a scintigraphic pattern close to that in patients with chronic myocarditis and others had a pattern identical to that in patients with coronary heart disease.     

扩张型心肌病的心肌组织细胞凋亡的研究

目的：研究扩张型心肌病（DCM）的心肌细胞凋亡及其与心功能的关系。方法：DCM组21例,其心肌组织14例来自右室心内膜心肌活检（EMB）亚组,7例来自死后尸检（尸检组）;对照组为5例死于非心血管疾病的尸检心肌组织。用原位细胞凋亡检测心肌组织凋亡细胞,计算凋亡指数（AI）。结果（1）DCM组的AI明显高于正常组（P＜0．01）,EMB亚组的AI明显低于尸检亚组（P＜0．01,但明显高于对照组（P＜0．01）。（2）DCM组中,心胸比（HTR）＜0．6、左室舒张末期内（LVDd)＜65mm和左室射血分数（LVEF）≥40％的患者AI均分别明显于低于HTR≥0．6、LVDd ≥65mm和LVEF＜40％的患者（P值均＜0．01）,但仍分别显著高于对照组（P值均＜0．01）。结论：DCM存在明显心肌细胞凋亡并随心功能恶化而程度加重,提示凋亡是DCM的心肌细胞丢失和心功能不全的重要机制。     

Myocardial creatine concentration in various nonischemic heart diseases assessed by 1H magnetic resonance spectroscopy.

BACKGROUND: Previous (31)P magnetic resonance spectroscopy (MRS) studies demonstrated that the myocardial phosphocreatine-to-ATP ratio offered important information concerning the degree of dysfunction and prognosis in patients with cardiomyopathy. In the present study, we investigated total creatine (CR) levels in various diseased hearts using 1H MRS. METHODS AND RESULTS: Fourteen patients with the following conditions were examined: cardiac amyloidosis (n = 2); hypertensive heart disease (4); valvular disease (2); hypertrophic cardiomyopathy (2); dilated cardiomyopathy (2); restrictive cardiomyopathy (1); and post-operative atrial septal defect (1). Myocardial CR was measured using 1H MRS with point-resolved spectroscopy localization. Overall, myocardial CR levels in diseased hearts were significantly lower than those in the control group [16.5+/-6.0 (n = 14) vs 27.1+/-3.2 micromol/g (n = 10), p < 0.001]. There was a positive correlation between myocardial CR and left ventricular ejection fraction (42.9+/-13.8%, range 19.5-69.1%) despite the different mechanisms of cardiac dysfunction (r = 0.60, p < 0.05). Myocardial CR levels in patients who were hospitalized due to heart failure within 1 year were significantly lower than those in other patients [11.3+/-1.0 (n = 4) vs 18.6+/-5.9 micromol/g (n = 10), p < 0.05]. CONCLUSIONS: Noninvasive measurement of myocardial CR using 1H MRS may be valuable in the assessment of disease severity and prediction of clinical course in various forms of heart disease.     

Myocardial imaging with 123I-BMIPP in patients with congestive heart failure

First, we studied the diagnostic utility of myocardial imaging with 123I-BMIPP (BMIPP), a 3-methyl-branched fatty acid analog, in patients with various types of cardiomyopathy and left ventricular dysfunction (ejection fraction below 40%) by comparing with myocardial flow tracer imaging. The incidence of a dissociation between myocardial BMIPP and 201Tl distributions (BMIPP< 201Tl) as a marker of metabolic abnormality in viable tissue varied considerably among various heart diseases. Patients with ischemic cardiomyopathy and the dilated form of hypertrophic cardiomyopathy had a higher incidence while those with idiopathic dilated, alcoholic and hypertensive cardiomyopathy had a lower incidence. These results suggest that the marked difference between ischemic and idiopathic dilated cardiomyopathies may contribute to the differential diagnosis between these two diseases which are main basic abnormalities in congestive heart failure. Second, we investigated the relationship between myocardial BMIPP uptake and ventricular stress in patients with right ventricular pressure overload due to pulmonary hypertension. Myocardial BMIPP uptake in the right ventricle estimated by referring to uptake in the left ventricle showed a significant correlation with mean pulmonary artery pressure (mPAP) and no significant difference with myocardial 99mTc-sestamibi uptake in the 15–81mmHg mPAP range. These results suggest that myocardial utilization of free fatty acid may be preserved in the presence of higher ventricular wall stress.     

自体骨髓单个核细胞移植治疗扩张型心肌病的临床研究

目的研究自体骨髓单个核细胞(ABMMNCs)经冠状动脉(冠脉)移植对扩张型心肌病(DCM)患者心功能的影响及其安全性。方法16例扩张型心肌病患者,按患者的意愿分成两组移植组(n=10)在药物治疗的同时,通过冠脉转运将ABMMNCs移植入心肌组织内;对照组(n=6)只进行相关的药物治疗;两组在术前和术后6个月分别行超声心动图及动态心电图检查。结果超声心动图检查显示移植组的左心室射血分数(LVEF)较术前明显增高,左心室舒张末期内径(LVDd)、左心室收缩末期内径(LVSd)较术前明显降低,左心房内径(LAD)也较术前明显降低。而对照组的LVEF,LVDd及LVSd虽然较6个月前有所改善,但差异无统计学意义(P>0.05)。术中及术后随访6~12个月均无恶性心律失常和其他合并症发生。结论ABMMNCs经冠脉移植,可以治疗扩张型心肌病,改善心脏功能,而且较为安全。     

扩张性心肌病患者左室射血分数与胆固醇水平的相关性

目的 目的 分析扩张性心肌病（DCM）患者左室射血分数(LVEF)与血清总胆固醇（TC）的关系。方法 选取住院DCM患者123例，分为LVEF>40％组（34例）和 LVEF≤40％组（89例）。入院后收集患者一般情况及测定血液生化，以超声心动图检查患者的心脏功能及结构，并进行比较。结果 LVEF>40%组与LVEF≤40%患者比较:LVEF>40%组年龄小于LVEF≤40%组(P<0.05)；LVEF>40%组TC显著高于LVEF≤40%组(P<0.05)。TC与LVEF呈正相关（r=0.287,P<0.01）。结论 DCM患者LVEF与TC有相关性。     

Left ventricular end-systolic wall stress is a potent prognostic variable in patients with dilated cardiomyopathy

Dilated cardiomyopathy is an important cause of morbidity and mortality among patients with heart failure. Left ventricular dilation is viewed as a compensatory response to maintain stroke volume, and left ventricular dilation is directly related to the increase of wall stress. However, only a few studies have examined whether wall stress can be a prognostic variable in patients with dilated cardiomyopathy. This study was designed to elucidate whether left ventricular systolic wall stress was related to the prognosis in patients with dilated cardiomyopathy. Twenty-five normal control subjects and 68 patients with dilated cardiomyopathy participated in this study. Hemodynamic parameters and left ventricular systolic wall stress were determined using echocardiography. In addition, the extent score determined by thallium-201 myocardial scintigraphy was measured as an index of cumulative loss of myocardium. During the 53-month follow-up period, 13 patients died of cardiac events. In a stepwise multivariable analysis, end-systolic wall stress and fractional shortening were significant predictors of survival. The extent score was markedly greater in the patients who died than in alive patients. There was a significant correlation between end-systolic wall stress and extent score (r=0.501, p=0.0001). Left ventricular end-systolic wall stress is an important predictor of mortality in patients with dilated cardiomyopathy.     

Relation of myocardial histomorphometric features and left ventricular contractile reserve assessed by high-dose dobutamine stress echocardiography in patients with idiopathic dilated cardiomyopathy

BACKGROUND: This study was designed to determine the relationship between histomorphometric features and contractile reserve assessed by high-dose dobutamine stress echocardiography in patients with idiopathic dilated cardiomyopathy. METHODS: Twenty-four consecutive patients (21 men, aged 43.4+/-8.7 years) with idiopathic dilated cardiomyopathy underwent dobutamine stress echocardiography. Wall motion score index, ejection fraction, cardiac power output and end-systolic pressure/volume ratio were used as indices of left ventricular contractility. Left ventricular endomyocardial biopsy specimens (3-5 per patient) were routinely processed and stained with Masson trichrome, interstitial fibrosis and myocyte diameter were calculated quantitatively. RESULTS: Myocyte diameter and interstitial fibrosis showed strongest correlation with change in wall motion score index (r=-0.667, p<0.001, and r=-0.567, p=0.004, respectively), followed by change in ejection fraction (r=-0.603, p=0.002, and r=-0.467, p=0.021, respectively). Interstitial fibrosis showed no correlation with change of cardiac power output and end-systolic pressure/volume ratio, whereas myocyte diameter was associated with change of both indices (r=-0.565, p=0.004, and r=-0.455, p=0.025). CONCLUSIONS: Contractile reserve elicited by high-dose dobutamine is strongly related to the degree of histological disruption in patients with idiopathic dilated cardiomyopathy.     

Increased myocardial expression of osteopontin in patients with advanced heart failure

The expression of the adhesion protein osteopontin (OP) is associated with cardiac hypertrophy and is significantly increased after transition to heart failure in experimental animal models. We, therefore, hypothesized that OP could be upregulated in heart failure in humans. In the present study, we investigated the expression of OP in myocardial biopsies obtained from patients with heart failure due to dilated cardiomyopathy (mean LVEF=30.3+/-4.4%, mean+/-S.D., n=10, group A) compared to patients with a normal left-ventricular ejection fraction (mean LVEF=61+/-11.2%, n=9; group B). Myocardial immunoreactivity for OP was examined using two different antibodies against OP. The expression of cardiac myocyte OP was significantly upregulated in group A in comparison to group B (P<0.0001). Both groups also displayed OP immunoreactivity in non-myocytes, including vascular smooth muscle cells and cardiac fibroblasts (P=not significant). Statistical analysis revealed a significant correlation of increased OP immunoreactivity in cardiac myocytes of patients with impaired left ventricular function, assessed by hemodynamic data (LVEF, RVEF, LVESVI, LVEDVI and LVEDP, R=-0.828, -0.671, 0.751, 0.685 and 0.461, respectively; all P<0.05). Furthermore, OP expression correlated with cardiac myocyte hypertrophy (mean diameter 21.0+/-1.8 microm in group A and 16.6+/-2.1 microm in group B; P<0.0001). In conclusion, the present study indicates, that factors and/or mechanisms involved in heart failure in patients with dilated cardiomyopathy, lead to induction of OP expression in humans.     

Evaluation of methods of measurement and estimation of left ventricular function after acute myocardial infarction

Using multiple gated cardiac blood pool imaging and single-plane ventriculography from cardiac catheterization, 2 independent measures of left ventricular (LV) ejection fraction (EF) were determined in each of 21 patients. Patients were seen 2 to 6 weeks after their first acute myocardial infarction and were free of electrocardiographic evidence of conduction abnormalities and left or right ventricular hypertrophy. Differences between the 2 measures of LVEF were examined and then compared with the extent of myocardial necrosis estimated from the standard 12-lead electrocardiogram using the complete 54-criteria/32-point Selvester QRS scoring system. Regression analysis yielded an r value of 0.81 (SEE = 8.05) for the overall relation between the 2 measures of LVEF. Correlation coefficients of -0.70, -0.66 and -0.72 were obtained for the relations of radionuclide LVEF, catheterization LVEF and the mean of these 2 determinations, respectively, compared with QRS score. A QRS score 4 or less achieved 100% specificity and that of 8 or less 100% sensitivity for predicting an LVEF greater than 40%. Thus, the Selvester QRS scoring system may be of value in identifying patients with or without markedly impaired LVEF. This risk stratification may be important in reaching optimal postinfarction therapeutic decisions.