Systolic time intervals in anemic children with or without congestive heart failure

Systolic time intervals (STI) were measured from simultaneous high speed recordings of electrocardiogram, phonocardiogram, and carotid artery trace in 47 children of anemia with or without congestive heart failure (CHF), and in 20 healthy normal children. Group I comprised 20 healthy controls with a mean Hb level of 13.65±0.73 gm percent, group II of 37 anemic children with a mean Hb level of 7.3±1.01 gm percent, without any evidence of CHF: Group III of 10 severely anaemic children with a mean Hb level of 2.75±0.82 gm percent with overt CHF. Electromechanical systole (QS2) pre-ejection period (PEP), left ventricular ejection time (LVET) and the ratio of PEP/LVET were studied and compared in various groups. PEP/LVET ratio was found to be 0.265±0.04, 0.363±0.07 and 0.407±0.06 in groups I, II, III cases respectively. The mean PEP/LVET ratio was significantly prolonged in groups II and III when compared with group I (p<.001). Further mean PEP/LVET ratio was significantly greater in group III subjects when compared with group II patients (p<.001). Thus it seems that LV dysfunction sets in early in cases of anemic children and as the severity of anemia increases. left ventricular dysfunction proportionately increases, ultimately resulting in congestive heart failure.     

Systolic time intervals in children with heart disease

Of the systolic time intervals, the preejection period is known to correlate well with invasively measured isometric contraction time, and increase of the quotient preejection period/left ventricular ejection time (PEP/LVET) is considered to be of a good indicator of left ventricular failure. The different systolic time intervals have been recorded from the carotid pulse curve from 40 normal children, 20 aged five and 20 aged ten years. Their PEP/LVET was 0.31 +/- 0.04. Seventy-eight children with different heart diseases were then investigated. In patients with congenital total heart block or extrasystoles, there was a negative correlation between PEP/LVET and the R-R interval, in accordance with the Frank-Starling law. In patients with ventricular septal defects PEP/LVET differentiates between small and large shunts; the increased PEP/LVET of the latter normalizes after operation. The increased PEP/RVET of children with transposition of the great arteries is an expression of the inadequacy of the right ventricle as a systemic chamber. In aortic stenosis "normalization" of a previously decreased PEP/LVET may indicate early left ventricular failure. In primary myocardial disease registration of the systolic time intervals enables us to follow the left ventricular function more closely than is possible with invasive techniques.     

Nesiritide in infants and children with congestive heart failure.

OBJECTIVES: Nesiritide (synthetic B-type natriuretic peptide) has been shown to be effective in the management of acute decompensated heart failure in adults. The role of nesiritide in pediatric heart failure has not been examined. In the present study, we reviewed our initial experience with nesiritide in children with primary heart failure or low cardiac output after heart surgery. METHODS: Nesiritide was administered in an open-label fashion to patients with heart failure who were already receiving inotropic and diuretic therapy. Between July 2003 and August 2004, 30 patients aged 5 days to 16.7 yrs (median age, 4.6 months) received nesiritide therapy. Diagnoses included single-ventricle congenital defect (n = 5), two-ventricle congenital defect (n = 13), heart transplant (n = 5), and dilated cardiomyopathy (n = 7). Sixteen patients were started on nesiritide within 2 wks of corrective or palliative heart surgery. The majority of subjects (n = 24) received an initial bolus dose. Continuous infusion dosage ranged between 0.005 and 0.02 microg.kg.min. Nesiritide was discontinued for possible side effects in two patients (arrhythmia and hypotension). Duration of therapy ranged from 1 to 24 days (median, 4 days). RESULTS: Administration of nesiritide was associated with improvement in fluid balance from positive 0.8 +/- 1.9 mL.kg.hr at baseline to negative 0.3 +/- 1.8 mL.kg.hr after 24 hrs of therapy (p = .02). There was a nonsignificant trend toward a reduction in right atrial pressure (9.2 +/- 3.9 vs. 11.2 +/- 4.1, p = .08). CONCLUSIONS: Nesiritide is well tolerated in children with heart failure and is associated with improved diuresis. Further prospective studies will be needed to compare nesiritide with other vasoactive agents and examine the cost-efficacy of this therapy.     

充血性心力衰竭与重症肺炎患儿血清脑钠素浓度变化的研究

目的：B型利钠肽即脑钠素(B-typeorbrainnatriureticpeptide,BNP)在成人充血性心力衰竭(con-gestiveheartfailure,CHF)时血浆浓度显著升高,对成人CHF有重要诊断价值,对成人急性呼吸困难有重要的鉴别诊断价值。在小儿有关BNP的研究不多,该实验旨在研究小儿CHF及肺炎时血清BNP浓度变化,探讨BNP对小儿急性呼吸困难的鉴别诊断价值;进一步探讨小儿重症肺炎是否会合并心衰,为肺炎合并心衰的诊断寻找客观指标。方法：将65例有呼吸困难症状的患儿分为3组CHF组(即心源性呼吸困难组)24例;肺炎组(即肺源性呼吸困难组)23例;临床诊断肺炎心衰组18例。对10例肺炎合并心衰患儿在病情平稳2~3d后再次收集血清。正常对照组15例。用ELISA法测血清BNP浓度。结果：CHF组血清BNP浓度显著高于临床诊断肺炎心衰组、肺炎组及正常组(P<0.01);临床诊断肺炎心衰组显著高于肺炎组(P<0.01)及正常组(P<0.01),肺炎组与正常组比较差异无显著性。BNP对心源性呼吸困难鉴别诊断的受试者作业特征曲线(receiveoperatorcharacteristic,ROCcurve)下面积是0.978(P<0.01);BNP以49pg/mL为诊断界值,对呼吸困难由CHF引起的诊断敏感度是87.5%,特异度是95.8%;临床诊断肺炎心衰的18例患儿中,BNP浓度>49pg/mL的11例,其BNP浓度为172.08±56.47pg/mL,显著高于肺炎组(P<0.01),与CHF组相比无差异;这11例中有10例治疗后复查血清BNP,其浓度为26.12±15.71pg/mL,低于治疗前(P<0.01)。另7例血清BNP浓度为20.46±11.78pg/mL,与肺炎组及正常组相比差异无显著性(均P>0.05)。结论：BNP浓度检测对小儿呼吸困难是否由CHF引起有鉴别诊断价值;小儿重症肺炎时可以合并心力衰竭;BNP检测可鉴别小儿重症肺炎是否合并心力衰竭。     

Systolic time intervals in newborn infants.

Systolic time intervals, calculated from the carotid artery pulse curve have been used for some time to assess left ventricular performance. Normal values have been established for adults and older children, but few investigations have been made on newborn infants, generally with partly contradictory results. Therefore a study has been undertaken in 29 normal newborn infants 1/2-119 hours old, and 9 infants 2-3 months old to establish normal values for different intervals. They were found to differ from those reported for adults and older children, most clearly seen in the relatively long preejection period (PEP). Statistically significant differences were found between the PEP of 20 infants below 47 hours of age and 9 infnats 2-3 months old: PEP 82 ms and 68 ms respectively. (p less than 0.01); the same is true of the quotient PEP/LVET (left ventricular ejection time), which was found to be 0.41 and 0.35 resp. (p less than 0.01). By adult standards this would mean impairment of left ventricular function. A possible explanation of this could be a difficulty for the left ventricle to cope with the systemic circulation during the first days of life even in normal newborns, a difficulty not fully compensated for even at 3 months of age.     

美托洛尔治疗小儿慢性充血性心力衰竭疗效观察

目的 探讨美托洛尔治疗小儿慢性充血性心力衰竭的疗效.方法 在常规应用强心、利尿、扩血管药物及对症治疗基础上,给予患儿加服美托洛尔,从小剂量[0.2～0.5 mg/(kg·d)]开始,4周内达最大量[2mg/(kg·d)].结果 用药3个月时,治疗组总有效率为95%,对照组为56%,两组间差异有显著性(P<0.05).治疗组心率、心胸比率较对照组明显降低,射血分数值明显升高,治疗组疗效优于对照组(P<0.05).结论 常规抗心力衰竭药物加美托洛尔可明显改善慢性充血性心力衰竭患儿心功能.     

脑利钠肽对小儿充血性心力衰竭的诊断价值

目的探讨脑利钠肽(BNP)与小儿充血性心力衰竭严重程度的相关性,并评价其对心衰的诊断价值。方法充血性心力衰竭患儿40例为心衰组,健康儿童40例为对照组,测定BNP值。结果心衰组患儿的BNP值明显高于对照组,各组BNP水平比较有统计学意义,心衰组患儿BNP值与心功能分级呈正相关,不同病因心衰患儿BNP水平比较无统计学意义。心肌病组心衰患儿BNP水平与左心室射血分数呈负相关。ROC曲线下面积为0.952,以血浆BNP水平90pg/ml为诊断界值时,具有较高的灵敏度、特异度、阴性预测值。结论BNP可为心衰的诊断、危险分级、临床治疗、预后评估提供直接的病理生理学依据。     

Fetal congestive heart failure

Fetal echocardiography is used in the diagnosis of many forms of congenital heart disease, and in the assessment of the prognosis of cardiac lesions based on their anatomy and presentation in utero. However, the presence of signs of fetal heart failure such as hydrops or valvular regurgitation makes the assessment of prognosis more difficult. A tool for this assessment is the ‘cardiovascular profile score’, which combines ultrasonic markers of fetal cardiovascular unwellness based on univariate parameters that have been correlated with perinatal mortality. This profile could become the ‘heart failure score’ and could potentially be used in much the same way as and in combination with the biophysical profile score. This article will present a straightforward method for rapid evaluation of a fetus that may have congestive heart failure.     

Intraaortic balloon pump management of refractory congestive heart failure in children

Summary From December 1975 to September 1989, nine children, ages 0.6–15.8 years (mean=8.1 years) and weighing 5–44 kg (mean=24 kg), were identified as requiring intraaortic balloon pump support. Indications included ventricular failure refractory to maximal conventional therapy, inability to wean from cardiopulmonary bypass, and myocardial ischemia. Prior to insertion of the balloon catheter, mean systolic blood pressure was 64 mmHg, one to four cardiotonic medications were being administered, mechanical ventilation was being performed in eight patients, and mean urine output was 0.4 ml/kg/min in eight. Following balloon catheter insertion, mean urine output increased to 0.9 ml/kg/min. Four patients survived following discontinuation of the balloon catheter 12–96 h (mean=59 h) after initiation. Though complications such as loss of distal lower extremity pulses, sepsis, thrombocytopenia, and abdominal distention were observed, most could be attributed to other causes. Thus, the intraaortic balloon pump is a valuable addition to conventional medical therapy in the treatment of refractory cardiogenic shock in children.Presented in part at the American Academy of Pediatrics Annual Meeting, Boston, Massachusetts, October 6, 1990.     

Circulating noradrenaline and β-adrenergic receptors in children with congestive heart failure

This study was designed to investigate changes in plasma catecholamine concentrations and the number of β-adrenoceptors (β-AR) of circulating lymphocyte in 94 noncyanotic congenital heart patients, in 43 patients with congestive heart failure, β-AR density was significantly lower ( p < 0.001) and plasma noradrenergic levels were significantly higher ( p < 0.001) compared with corresponding values in 51 patients without heart failure. A significant negative correlation between lymphocyte β-AR density and plasma noradrenergic levels was observed ( r =−0.61, p < 0.001). The degree of left-to-right shunt and pulmonary pressure was correlated directly with noradrenaline level and inversely with lymphocyte β-AR density. Both plasma noradrenaline level and lymphocyte β-AR density return to normal in children with heart failure after surgical repair. Our results support the idea that changes in noradrenaline level and lymphocyte β-adrenoceptor density occur concurrently with the presence and severity of heart failure in children.     

贝那普利治疗先天性心脏病并心力衰竭29例

目的　观察贝那普利治疗小儿先天性心脏病 (先心病 )并心力衰竭的疗效。方法　充血性心力衰竭5 8例患儿随机分为贝那普利治疗组、对照组各 2 9例 ,对照组用常规抗心衰治疗 (地高辛、利尿剂 ) ,治疗组在常规基础上加贝那普利口服 ,初始剂量 0 .1mg/ (kg·d) ,1次 /d ,3～ 5d内渐增至 0 .3～ 0 .4mg/ (kg·d) ,治疗 2周。结果　治疗组与对照组呼吸、心率、肝脏大小临床观察治疗后比较有显著差异 (P <0 .0 1) ;心功能参数射血分数(EF)、心脏指数 (CI)、短轴缩短率 (FS)明显改善。结论　贝那普利能明显改善先心病并充血性心力衰竭患儿的心功能     

Systolic and diastolic function in children with chronic renal failure

BACKGROUND: Cardiovascular complications are the most frequent cause of death in patients with end-stage renal failure (ESRF). We aimed to investigate systolic and diastolic functions in children with ESRF. METHODS: Thirty-nine children with ESRF (17 on continuous ambulatory peritoneal dialysis (CAPD), eight on hemodialysis and 14 on predialysis) were examined to assess systolic and diastolic functions by echocardiography and ultrasound Doppler. Left ventricular systolic and diastolic functions were measured both in patients and age-matched healthy controls (n = 20) and the indices of cardiac performance were compared. RESULTS: Increased left ventricular mass index (LVMI) and decreased volume/mass ratio with normal systolic left ventricular function was found in patients, as compared with controls. Left ventricular diastolic dysfunction was observed in dialysis patients. In most of these patients, left ventricular isovolumic relaxation time was prolonged, except in CAPD patients. The peak of late diastolic flow (A) velocities were increased with a reduction of the early diastolic flow velocity (E)--the E/A ratio. The E velocities were unchanged in all patients as compared with controls. Our data indicated an abnormality of myocardial relaxation in patients with ESRF. We found no relationship between E/A ratio and LVMI. Among three groups of patients, the LVMI and diastolic abnormalities were highest in the hemodialysis group indicative of poor control of hypervolemia and hypertension. CONCLUSIONS: The technique of CAPD has some advantages as a renal replacement therapy for preserving cardiac functions as compared with hemodialysis. However, it must be remembered that patients with hemodialysis have features that effects cardiac status, such as higher volume load and higher afterload (hypertension).     

Zinc and copper in congestive heart failure

In this study serum zinc (Zn) and copper (Cu) levels in children with congestive heart failure (CHF) were evaluated. The mean serum Zn levels of the patients with CHF were 92.9 +/- 18.9 micrograms/100 ml, and they showed a significant decrease when compared to controls (p less than 0.05). The mean serum Cu levels, which were 173.6 +/- 26.6 micrograms/100 ml, showed a significant increase when compared to controls (p less than 0.001). After digoxin therapy, a significant increase in Zn levels and a significant decrease in Cu levels were observed.