达利全对心力衰竭患者心功能及sFas的影响

目的　观察达利全 (卡维地洛 )对慢性充血性心力衰竭 (CHF)患者的心功能及血清可溶性Fas(sFas)水平的影响。方法　 72例CHF患者随机分成达利全组和治疗对照组 ,于治疗前、后查超声心动图 (UCG)的左室射血分数 (LVEF)、左室收缩末内径 (LVDd)、左室舒张末内径 (LVDs)、血清sFas。 10例心功能正常者为血清sFas正常对照组。结果　治疗 4个月后两组LVEF升高、LVDd和LVDs均缩小 ,血清sFas水平降低 ,但达利全组明显优于对照组 P<0 .0 1。结论　达利全能改善CHF患者心功能和心室重构。     

心力衰竭患者脑钠肽、C反应蛋白与心功能的关系

目的：探讨心力衰竭患者脑钠肽、C反应蛋白（CRP）、心功能分级与心功能之间的相互关系。方法：将51例心力衰竭患者与15例健康对照者抽血测定血浆B型脑钠肽（BNP）及血清CRP浓度。同时用彩色多普勒超声心动图仪测定左室射血分数（LVEF）、左室舒张末期内径（LVDD）。心力衰竭组根据美国纽约心脏病（NYHA）心功能分级标准分为Ⅱ、Ⅲ、Ⅳ级组。结果：心力衰竭各组BNP、CRP、LVDD均较对照组显著增高，而LVEF明显降低（P值均小于0．01）；BNP和cRP随着心功能分级的增加而显著增加（P〈0．05）；线性回归分析示BNP与LVEF（r=-0．897。P〈0．01）、LVDD（r=0．740。P〈0．01）、心功能分级（r=0．793，P〈0．01）均有显著的相关性，而CRP只与心功能分级（r=0．397。P=0．02）相关，与LVEF（r=0．197，P=0．083）、LVDD（r=0．389，P=0．065）无关。结论：心力衰竭患者血浆BNP和血清CRP随着心力衰竭程度的加重而相应升高，BNP与左心功能状态有良好的相关性．而CRP则没有这种相关性。     

实时三维超声心动图与二维超声心动图、核素、磁共振检查评价老年人左心功能的相关性比较

目的：评价实时三维超声心动图（real-time three-dimensional echocardiography。RT-3DE）测量的老年人左心功能参数与二维超声心动图（2DE）、核素、磁共振等无创性影像学检查的准确性和可行性的比较。方法：年龄≥75岁的老年病人23例，应用实时三雏超声成像系统测量左室容积及射血分数。将测量结果与2DE、多门电路平衡法^99mTc-RBC心肌血池显像及电影磁共振（cine-MRI）心功能检查结果进行相关性比较。结果：23例患者RT-3DE所测的左心功能与2DE测量结果之间的相关性好[左心室射血分数（LVEF）的相关系数r=0．81，P〈0．01；舒张未期容量（EDV）的相关系数r=0．51．P〈0．05：收缩末期容量（ESV）的相关系数r=0．62，P〈0．01]；RT-3DE所测的左心功能与cine-MRI测量结果相关性好（LVEF、EDV及ESV的相关系数分别为r=0．81，r=0．70和r=0．74。P〈0．01）；2DE所测LVEF及ESV与cine-MRI测量结果相关性好（LVEF相关系数r=0．69，P〈0．01，ESV相关系数r=0．54，P〈0．01），二者间EDV相关性欠佳（r=0．39，P〉0．05）：相比2DE-RT-3DE与eine．MRI测量结果相关性更好；RT-3DE所测的LVEF与核素心肌血池显像测量结果间的相关性（r=0．64，P〈0．01）较2DE与核素检查结果相关性好（r=0．53，P=0．01）。结论：RT-3DE技术能够准确进行老年人左心功能定量测定。在老年人心血管疾病的定性和定量诊断方面具有广阔的临床应用前景。     

超声心动图联合64层螺旋CT评价左室收缩功能

目的比较超声心动图(UCG)和多层螺旋CT(MSCT)对左室射血分数(LVEF)的评估。方法对74例临床怀疑冠心病的患者进行超声心动图和64层螺旋CT检查,前者使用M型超声心动图Teichholz校正公式法测量LVEF,后者经过心功能分析软件处理,根据Simpson公式自动测定左室收缩末期容积、舒张末期容积,通过多层累积计算而得出LVEF。将两种检查所测得的结果进行比较。结果UCG与MSCT所测LVEF值(%)差异有显著性(P<0.01),并具有很好的相关性(r=0.888,P<0.01),MSCT所测的LVEF稍低于UCG。根据Bland-Altman方法,UCG与MSCT测定LVEF的差值为-0.0549±0.0284,一致性范围为-0.1117～0.0019。结论MSCT与UCG测量LVEF存在一定差异,但是两种检查对于左室收缩功能的评价均具有临床应用价值。     

慢性心衰患者血清脑利钠肽前体水平与心功能的相关性分析

目的 探讨慢性心衰患者血清脑利钠肽前体(NT-proBNP)水平与不同NYHA心功能分级、左室射血分数(LVEF)、左室舒张期末内径(LVEDd)的相关性.方法 42例心力衰竭住院患者,使用酶联免疫法测定其血清NT-proBNP水平,超声心动图测定LVEF及LVEDd,分析患者NT-proBNP水平与不同心功能分级及上述指标的相关性.结果 (1)不同NYHA心功能分级组患者血清NT-proBNP水平(pg/ml)差异有统计学意义[Ⅰ级:162.5(128.0,633.0),Ⅱ级:1 202.5(587.0,2350.0),Ⅲ级:3 374.0(2 169.0,4 442.0),Ⅳ:10 403.5(7 241.0,17 697.0),P<0.05～<0.01],其水平与心功能分级呈正相关(r=0.797,P<0.000 1);(2)NT-proBNP与LVEF呈负相关(r=-0.438,P<0.000 1);(3)NT-proBNP与LVEDd呈正相关(r=0.437,P<0.000 1).结论 NT-proBNP测定是临床诊断心力衰竭的有效辅助方法之一,总体上可反映心力衰竭的严重程度.     

超声心动图技术在小儿川崎病中的应用价值

目的:探讨超声心动图技术(UCG)在小儿川崎病中的应用价值。方法:选取2017年8月至2019年8月期间就诊于本院的小儿KD患者80例,按冠状动脉受累情况进行分组,无冠状动脉损害者38例,为对照组;并发冠状动脉损害者42例,为研究组,对比两组患者的心动图检查结果。结果:观察对照组及研究组患者的声像图特征,所有冠状动脉均清晰可见,对照组患儿均未发现冠状动脉受损,且心功能正常。而研究组患儿中27例伴CAE,伴左房扩大4例,左室扩大1例,LVEF降低1例;并发冠状动脉瘤15例,动脉瘤内径为3.5~17.0mm,伴左房扩大5例,左室扩大2例,LVEF降低3例;经对比发现有冠状动脉损害组与无冠状动脉损害组心功能改变发生率比较有统计学差异(P<0.05)。CAL严重程度与年龄呈负相关性(r=-0.342,p=0.027),年龄越小越容易发生损伤并且损伤程度越重。结论:超声心动图技术作为小儿川崎病的一种诊断方式,有助于患儿冠状动脉早期病变的发现,获得确切诊断效果,将其用于小儿KD的诊断,具备可靠性。     

超声心动图评价儿童心内膜弹力纤维增生症

目的：探讨心内膜弹力纤维增生症(EFE)患儿治疗前、后的心功能状态及评价治疗效果。方法：对10例临床恢复或好转的心电图及胸片结果与超声心动图检测的左心功能进行比较；初、复诊各以10例健康儿作为对照组。结果：治疗前左室舒张末内径(LVDd)、左室射血分数(LVEF)、左室射血前期(LVPKP)、E峰间隔分开(ESPP)均明显异常；治疗后症状明显好转，9／10例心功能指数LVEF、缩短分数(FS)达正常范围．但与正常对照比较仍有LVEF、FS偏低，EP5S、LVPEP升高，左室收缩期壁应力(ESWS)降低。LVDd增大。结论：EFE临床恢复标准不能仅依赖临床症状、心电图及胸片恢复或好转，更需根据其左心功能、LVDd的测量作综合评价。     

104例伴或不伴休克的心功能不全患者B型脑钠肽与心功能关系的分析

【目的】探讨伴或不伴休克的心功能不全患者血浆B型脑钠肽（BNP）与心功能的关系。【方法】选取3年住院心力衰竭患者104例,分为休克组、非休克组和死亡组、非死亡组。测定血清BNP水平;同时均行心脏超声测定其左室舒张末内径（LVDd）、左室射血分数（LVEF）。比较各组BNP水平以及BNP与LVEF、LVDd的相关性。【结果】休克组较非休克组BNP水平显著升高,有统计学差异（P〈0．05）,BNP与年龄呈正相关性（r=0．392,P〈0．05）;与LvDd呈正相关（r=0．349,P〈0．05）;与LvEF呈负相关（r=-0．586,P〈0．05）。死亡组与非死亡组相比,BNP显著升高,差别有统计学意义（P〈0．05）,LVDd、LvEF差别亦有统计学意义（P〈0．05）。【结论]BNP水平可作为判断心力衰竭患者的心功能不全程度及预后的指标。     

曲美他嗪对缺血性心脏病心力衰竭患者心室重塑和心功能的影响

【目的】探讨曲美他嗪 (trimetazidine,TMZ)对缺血性心脏病心力衰竭患者心室重塑和心功能的影响。【方法】缺血性心脏病心力衰竭患者 78例 ,左室射血分数≤ 4 0 % ,心功能 (NYHA)Ⅱ～Ⅳ级 ,常规治疗基础上随机分为TMZ组 (n =4 0 ) )和对照组 (n =38)。治疗 6个月 ,观察曲美他嗪对心室重塑和心功能的影响。【结果】经过 6个月治疗 ,TMZ治疗组症状和心功能改善 ,与对照组比较左室收缩末容积下降 [(15 9.2±4 6 .7)mlvs (179.8± 4 8.5 )ml,P <0 .0 5 ],左室收缩末内径减小 [(32 .7± 4 .1)mmvs (39.5± 3.9)mm ,P <0 .0 5 ],左室射血分数显著提高 [(48.6± 9.5 ) %vs (35 .2± 8.7) % ,P <0 .0 1];与基线比较左室舒张末容积下降 (P <0 .0 5 ) ,左室舒张末内径减小 (P <0 .0 5 ) ,但两组间无统计学差异。【结论】在心力衰竭标准治疗基础上 ,应用TMZ能显著改善缺血性心脏病心力衰竭患者心室重塑和心功能。     

心力衰竭患者彩色多普勒超声心动图与B型脑钠肽及心功能分级的相关性

目的探讨心力衰竭患者彩色多普勒超声心动图与B型脑钠肽(BNP)及心功能分级的相关性。方法回顾性选取2017年8月至2019年9月首都医科大学附属北京友谊医院收治的心力衰竭患者90例,将急性心力衰竭患者设为观察组,慢性心力衰竭患者设为对照组,每组各45例。两组心力衰竭患者均进行彩色多普勒超声检查及血清BNP检查。统计分析两组患者心脏彩色多普勒超声心动图结果、BNP水平及心功能分级,并分析超声心动图与BNP水平及心功能分级的相关性。结果观察组患者的左心室射血分数(LVEF)、左心房舒张末期内径(LAD)、二尖瓣舒张早期血流速度峰值(E)和肺动脉瓣舒张早期血流速度峰值(A)、E/A分别为(36. 79±2. 01)%、(41. 09±2. 11) cm、(44. 53±3. 65) cm/s、(62. 23±1. 35) cm/s、(0. 51±0. 06),对照组分别为(41. 25±2. 79)%、(40. 78±2. 05) cm、(61. 15±4. 59)cm/s、(72. 62±0. 68) cm/s、(0. 49±0. 23)。观察组患者的的LVEF、E均低于对照组,差异具有统计学意义(P 0. 05);观察组患者的BNP水平及心功能分级分别为(1 286. 49±35. 82) mg/L、(3. 65±0. 32)级,对照组分别为(289. 63±25. 78) mg/L、(3. 09±0. 12)级。观察组患者的B型脑钠肽水平及心功能分级均高于对照组,差异具有统计学意义(P0. 05)。Pearson相关性分析显示,心力衰竭患者LVEF与BNP水平(r=-0. 646,P=0. 032 0. 05)、心功能分级(r=-0. 738,P=0. 025 0. 05)均呈负相关。结论心力衰竭患者的LVEF与B型脑钠肽水平、心功能分级均呈负相关,加强多普勒超声检查和检测B型脑钠肽水平的动态变化能预测心力衰竭发生。     

Entrainment of Ventricular Tachycardia in Arrhythmogenic Right Ventricular Tachycardia

In two patients with arrhythrnogenic right ventricular dysplasia (ARVDJ, sustained ventricular tachycardia (VT) was induced by programmed stimulations during serial drug testings. One patient had five and the other had two VT morphologies, and the sites of origin were determined by endocardial catheter mappings. When overdrive pacing was performed, constant fusion in the QflS complex was observed in the two patients. Constant fusion of a different degree was also observed at different paced cycle lengths. Both patients had dilated right ventricles and wall-motion abnormality, and the diagnosis of ARVD was further confirmed by the specimen resected at the site of origin of VT. Therefore, VT in ARVD can be entrained and reentry is the most likely mechanism of such VT.     

Unipolar Ventricular Electrogram in the Diagnosis of Right Ventricular Ischemic Injury

Unipolar ventricular electrograms were recorded in the right ventricular apical area in five patients with clinical, hemodynamic features of the right ventricular infarction. The intracavitary potential exhibited a downward displacement of the ST segment (1.5 mV). This significant negative current of injury in the ventricular electrogram is consistent with ischemic injury of the free right ventricular wall in the area subtended by the intracavitary exploring electrode. We suggest that ventricular electrographic recordings be performed in patients who present with acute inferior wall infarction requiring temporary electrode catheter pacing for serious AV conduction disturbances. The presence of a significant downward ST segment displacement (1.5 mV) provides further support and an electrical criterion for right ventricular ischemic injury.     

Amiodarone in the Management of Patients with Ventricular Tachycardia and Ventricular Fibrillation

Fifty-eight patients with symptomatic ventricular tachycardia (VT) or ventricular fibrillation (VF) were treated with amiodarone. All had clinical episodes of VT/VF or inducible VT during electropharmacologic testing despite treatment with maximumtolerated doses of conventional antiarrhythmic agents. Chronic treatment with amiodarone was begun at a dose of 800–1000 mg per day. Thirty-two patients were also treated with a previously ineffective conventional agent. Thirty patients underwent programmed ventricular stimulation after 2.6 ± 1.7 months (mean ± S. D.) of treatment with amiodarone at a mean daily dose of 588 ± 155 mg. VT was induced in 25 patients (sustained in 20, nonsustained in five). Seventeen patients had a recurrence of VT or VF after 0.5–9 months of treatment with amiodarone (fatal in seven, non-fatal in 10). Forty-one patients (71%) had no recurrence of symptomatic VT or VF while being treated with amiodarone (mean follow-up period, 17.1 ± 12.4 months). Among the 25 patients who had inducible VT with programmed ventricular stimulation while being treated with amiodarone, 19 patients (76%) have had no recurrence of symptomatic VT or VF overa follow-up period of 21.5 ± 7.3 months. Ambulatory electrocardiographic recordings obtained after one week of treatment with amiodarone were not helpful in predicting clinical response. Twenty-two patients (38%) developed ataxia and/or an intention tremor which improved with a decrease in the amiodarone dose. Amiodarone, either by itself or in combination with conventional antiarrhythmic drugs, has a significant therapeutic effect in high risk patients with refractory VT. The finding of inducible VT during electropharmacologic testing in patients taking amiodarone does not preclude a favorable clinical response. Neurologic toxicity is common in patients treated with 600–800 mg per day of amiodarone.     

频发性室性期前收缩患者室速心动过速发生的影响因素分析

[目的]探讨频发性室性期前收缩(VPB)患者室性心动过速(室速)发生的影响因素.[方法]选择2012年6月至2014年6月本院心内科收治的247例诊断为频发VPB的患者,根据其是否发生室速将其分为室速组(n=73)和非室速组(n=174).记录所有患者临床资料、化验结果、心脏彩超结果等.对可能影响频发VPB中室速发生的危险因素行单因素及多因素Logistic回归分析.[结果]频发VPB的患者室速发生率为29.6％(73/247);两组患者年龄、男性发病率、LVEF、LVEDD比较,差异均具有统计学意义(均P＜0.05).Logistic多因素回归分析显示,LVEF、LVEDD均为影响频发VPB患者室速发生的危险因素(均P＜0.05).[结论]LVEF、LVEDD为频发VPB患者室速发生的危险因素.     

Ventricular Pacing Induced Ventricular Tachycardia in Patients with Implantable Cardioverter Defibrillators

Appropriately timed noncompetitive ventricular pacing potentially may initiate ventricular tachycardia in patients prone to these arrhythmias. The combination of bradycardia pacing and stored electrograms in a currently available cardioverter defibrillator provides an opportunity to evaluate the occurrence of such pacing induced ventricular tachycardia. During a surveillance period of 18.7 ± 11.4 months, stored electrograms documented 302 episodes of ventricular tachycardia in 77 patients. Five patients (6.5%) demonstrated 25 episodes (1–16 per patient) of ventricular tachycardia that were immediately preceded by an appropriately paced ventricular beat (8.3% of all episodes of ventricular tachycardia). All five patients had prior myocardial infarctions and a history of monomorphic ventricular tachycardia occurring both spontaneously and in response to programmed electrical stimulation. Antitachycardia pacing terminated pacing induced ventricular tachycardia in 22 episodes; in one episode antitachycardia pacing accelerated ventricular tachycardia. In two cases shock therapy was aborted for nonsustained ventricular tachycardia. We conclude that, in selected postinfarction patients with recurrent sustained monomorphic ventricular tachycardia treated with implantable cardioverter defibrillators, appropriately timed ventricular pacing may induce ventricular tachycardia.     

Ventricular Pacing in Children

Ventricular pacing in children. Ventricular pacing was performed in forty-one children ranging from one day to twenty years of age (median age = 10). Weight of the recipient at implant ranged from 2 kg. to 86 kg. Indications included presyncope, syncope, dyspnea on exertion, congestive heart failure, postoperative infra-Hisian heart block, and inadequate cardiac rate during pharmacotherapy. Four patients died during follow-up, but no deaths were attributable to pacemaker management. In contrast, 66% of the patients required more than one pacemaker related-operative procedure, and 43% of leads implanted failed by 48 hours. Indications for permanent cardiac pacing in this population at this time are symptomatic congenital AV block, symptomatic sinus node disease, and AV block in the postoperative period. Technological developments which might reduce complications seen in this population and electrophysiologic techniques which may better define indications for pacing in children are also reviewed.     

Two Cases of Ventricular Parasystole Associated with Ventricular Tachycardia

In two patients, ventricular pamsystole (VP) was associated with ventricular tachycardia (VT), and in one patient, catheter ablation was successful. In patient 1, with dilated cardiomyopathy, VP led to VT, which converted to ventricular fibrillation. In patient 2, VP led to symptomatic nonsustained polymorphic VT. The origin of parasystolic focus was determined byendocardial mapping, and a radiofrequency current was delivered to patient 2. Both VP and VT disappeared immediately, and no recurrence has been observed during a follow-up of 8 months. Catheter ablation to the parasystolic focus was effective and a relationship between VP and VT was strongly suggested.     

Ventricular Tachycardia in Neonates

Infant VT can be a devastating arrhythmia, with high mortality for those presenting with myocarditis, long QT syndrome, or cardiovascular collapse with rapid VT due to tumors. While management of these patients can be challenging and discouraging, other infants with wide QRS rhythms tend to follow a more benign course. These latter patients have accelerated idio-pathic ventricular rhythm or aberrant forms of infant supraventricular tachycardia. Distinguishing these forms of wide QRS tachycardia from the more lethal forms is paramount to institution of appropriate therapies.     

Aberrant Ventricular Conduction Resembling Ventricular Premature Beats

Patients who complain of gaseous indigestion may be more sensitive to an underlying intestinal motor abnormality than are others with similar dysfunctbn. Modifications in living and eating habits are basic steps that can be taken to relieve the problem; drugs that alter intestinal activity or responses may be effective.     

Ventricular Activation Onset-Triggered Left Ventricular Pacing:

Ventricular activation onset-triggered (VAOT) left ventricular pacing modalities synchronize left ventricular paced activation with existing intrinsic ventricular activation, in patients with complete LBBB and adequate rate. The purpose of this study was to evaluate the safety and feasibility of VAOT pacing with one left ventricular pacing lead, during temporary pacing in the postoperative period following open heart surgery. VAOT pacing was studied in five patients with LBBB and two patients with previously implanted right ventricular pacemakers. The VAOT pacing system used was assembled by modifying the function of existing equipment and its programming is described in detail. Comparative ECGs are reported, documenting the changes in ventricular activation produced by VAOT pacing. Stability of surface ECG acquisition was found to be essential to the success of temporary VAOT pacing and inappropriate pacing due to ECG instability is described. Patients were studied at rest and none experienced congestive heart failure. In the comparison of cardiac output, with and without VAOT pacing, no significant differences were found in LBBB patients or those with right ventricular pacemakers. In the comparison of arterial pressure, with and without VAOT pacing, no significant differences were found in six patients, however, in one LBBB patient with intrinsic predominant ventricular trigeminy, VAOT pacing was observed to have an antiarrhythmic effect resulting in suppression of ventricular ectopy and stabilization of arterial pressure. All patients survived VAOT pacing and the postoperative period without complications requiring additional intervention or treatment. (PACE 2004; 27[Pt. I]:730–739)