老年退行性钙化性心脏瓣膜病的临床分析

老年退行性钙化性心脏瓣膜病,简称老年瓣膜病。我国目前已进入老龄化社会,老年瓣膜病越来越多见,其并发症较多,危害严重,预后较差。现将我院1997年1月-2003年1月经超声心动图(UCG)确诊的46例患者资料进行临床分析。     

老年钙化性心脏瓣膜病的发病机制

老年钙化性心脏瓣膜病亦称老年心脏钙化综合征。近年来因检测手段的进展,本病检出率逐渐增多,它是威胁老年人健康的一种常见心血管病。目前对其钙化发生机制进行了大量研究并取得一些成果,本文拟对此作一综述。     

老年钙化性心瓣膜病的病理学研究

老年钙化性心瓣膜病是老年人最常见的瓣膜疾病,1904年Ｍｏｎｃｈｋｅｂｅｒｙ首先发现人在自然衰老的过程中会出现退行性变,导致钙化性主动脉瓣狭窄,1910年Ｄｅｗｉｔｓｋｙ首次描述了二尖瓣环钙化。随着人类寿命的延长,本病的发病率随年龄增长而升高,Ｌｉｎｄｒｏｏｓ等在75～76岁、80～81岁、85～86岁3个年龄组随机抽取501人进行超声心动图检查,发现不同程度主动脉瓣钙化发生率是53%,临床钙化性主动脉狭窄的发病率是29%。Ｓｔｅｗａｒｔ等对≥65岁老年人5102例进行心血管健康研究显示,主动脉硬化发生率是26%,主动脉狭窄为2%;在≥75岁的人…     

老年钙化性心脏瓣膜病

老年钙化性心脏瓣膜病，又称老年退行性心脏瓣膜病，是一种与增龄相关的退行性变。自1901年Dewitek首先报告36例非炎症性二尖瓣环钙化以来，人们逐步对此病有了认识，现就此介绍如下。     

老年钙化性心脏瓣膜病

老年钙化性心脏瓣膜病是老年人特有的心脏瓣膜病 ,其病理变化为瓣膜结缔组织退行性变、纤维化、增厚及钙化 ,从而引起瓣膜及其支架的功能异常。主要有钙化性主动脉瓣狭窄及关闭不全 ,二尖瓣环及二尖瓣钙化 ,以及两个瓣膜同时存在的联合瓣膜钙化等类型。当本病同时合并传导系统、乳头肌及冠状动脉的钙化时称为老年心脏钙化综合征。该病的发生率较高 ,但由于其临床症状不典型 ,且常被高血压、冠心病及其他心脏病的症状所掩盖 ,故长期以来未被关注 ,直到近年才逐步为人们所重视。本病在所有的老年心脏瓣膜病中约占 2 5 %。在老年非风湿性心脏瓣…     

老年钙化性心脏瓣膜病临床研究

研究老年钙化性心脏瓣膜病的发病机制和临床特征，用日本产ＥＵＢ－５５５型彩色多普勒血流显像仪超声探查，同期进行常规Ｘ线、心电图及动态心电图监测。与同期收治的无瓣膜钙化的冠心病患者进行临床对比研究，结果：钙化组在心脏扩大、心前区杂音、心律失常、充血性心力衰竭，以及脑血管病变和猝死的发生率明显高于冠心组Ｐ＜０．０１。老年钙化性心脏瓣膜病可导致血液动力学障碍，加重心功能损害，成为老年人充血性心力衰竭、心律失常、猝死的重要原因之一。     

老年钙化性心瓣膜病的病因学研究

老年钙化性心瓣膜病(senile carcific valve disease,SCVD)又称老年退行性心瓣膜病,是老年人最常见的瓣膜疾病。它是在正常瓣膜基础上,随年龄增长,瓣膜产生老化、退行性变和钙质沉积所致,使单个或多个瓣膜发生狭窄和(或)关闭不全,导致血液向前流动障碍和(或)反流〔1〕。过去几十年里,关于其病因学的观点经历了重大转变。目前对于老年钙化性心瓣膜病的病因有多种不同的观点,本文从血流动力学说、骨化学说、慢性炎症学说、5-羟色胺学说等几方面对其病因学的研究进展作一综述。1流行病学及危险因素随着人类寿命的延长,SCVD的发病率随年龄增…     

老年退行性心瓣膜病的临床研究

老年退行性心瓣膜病 (SDHVD)因其临床表现缺乏特异性 ,诊断主要依靠心脏超声 ,致许多病人漏诊、误诊。现将我们收治的 5 2例SDHVD患者超声心动图资料分析报告如下。1　资料与方法1 1　一般资料　 1994年 7月至 2 0 0 1年 7月经超声心动图诊断的SDHVD门诊和住院患者 5 2例 ,男 3 0例 ,女 2 2例 ,年龄 60～ 88岁 ,平均 (68± 5 2 )岁。心功能 (NYHA分级 ) :I级 18例 ,II级 2 0例 ,III级 12例 ,IV级 2例。临床症状 :夜间阵发性呼吸困难 2 0例 ,劳力性气短 2 3例 ,胸闷 18例 ,心前区疼痛 5例 ,头晕、乏力 10例 ,晕厥 3例。高血压史 …     

老年钙化性心脏瓣膜病临床分析

目的探讨老年钙化性心脏瓣膜病（CVHD）患者的临床特点。方法230例60岁以上经超声心动图诊断CVHD患者,回顾性分析了临床表现、超声心动图和其他辅助检查资料。结果CVHD常伴发高血压病、冠心病、糖尿病等疾病。受累瓣膜以主动脉瓣最常见,二尖瓣次之。无冠瓣钙化多于左、右冠瓣,瓣膜反流多于狭窄,二尖瓣钙化女性多于男性。常见心脏功能受损为左心舒张功减低（82.3%）、左房增大（37.1%）和左室增大（18.5%）。心律失常主要为期前收缩（41.7%）、心房颤动（20.4%）、房室传导阻滞（16.1%）。胸部X线检查71.7%有主动脉弓钙化;生化检查62.6%有血脂异常。结论CVHD临床表现和实验室检查具有一定特点,而主动脉弓钙化有助于诊断,但确诊仍需借助超声心动图。     

老年退行性心脏瓣膜病与心律失常的临床分析

目的 评价ＭＡ方案治疗老年急性髓细胞白血病（ＡＭＬ）及观察老年ＡＭＬ治疗中应用Ｇ－ＣＳＦ的临床效果。方法 ＭＡ方案治疗老年ＡＭＬ３６例,２１例化疗中联合应用Ｇ－ＣＳＦ,其余１５例未用Ｇ－ＣＳＦ作为对照。结果 ①ＭＡ方案治疗３６例老年ＡＭＬＣＲ率４１．７％,总有效率７５．０％。②化疗中联合应用Ｇ－ＣＳＦ可缩短外周血白细胞减少和粒细胞缺乏的天数,化疗后白细胞恢复及应用抗生素的天春诱导相关死亡率明显低     

老年退行性心脏瓣膜病与心律失常的临床分析

目的探讨和进一步提高对老年人心律失常发生原因的认识。方法分析１０７例经彩色多普勒超声心动仪检查而确诊为老年退行性心脏瓣膜病患者心律失常发生情况,全部患者首先根据病史、系统体格检查、心电图、２４ｈ动态心电图、超声心动图、实验室检查资料完全排除了风湿性心脏瓣膜病、先天性心脏瓣膜病、感染性心内膜炎及其他继发性心脏瓣膜病。结果其心律失常的发生率为７６．６％,其中室上性心律失常占５２．４％,室性心律失常占１３．４％,房性心律失常并室性心律失常占９．８％,各种类型传导阻滞占２４．３％。结论老年人心律失常的发生与心肌的退行性变以及病变心肌的扩张、钙化涉及传导系统有关。     

Doppler echocardiography versus cardiac catheterization in the evaluation of valvular heart disease: Do we have a gold standard?

Definitive evaluation of valvular heart disease is traditionally accomplished by cardiac catheterization. Recent advances in Doppler echocardiography allow noninvasive assessment of valvular heart disease with a high degree of accuracy compared to the cardiac catheterization gold standard. Doppler echocardiography may occasionally yield erroneous results due to technical difficulties in the performance of the study. A number of patient related and echo-machine related factors may also affect the Doppler measurements independent of the severity of the lesion. Thus, a discrepancy between Doppler and catheterization data is generally considered to be a failure of Doppler methods. However, catheterization data may also be flawed due to errors in the measurement of pressure and cardiac output, as well as the known shortcomings of qualitative angiography. The Gorlin equation itself suffers from several limitations, including the substitution of pressure gradient for velocity in the basic hydrodynamic equation, and the use of a constant which may not be appropriate in all circumstances. Therefore, when Doppler echocardiography and cardiac catheterization yield discordant results, both studies should be carefully reviewed and correlated with other clinical data in order to elucidate the sources of the discrepancy and ascertain the actual severity of the valvular lesion.     

Dynamic arm exercise during cardiac catheterization in the assessment of stenotic valvular disease

Assessment of hemodynamic responses during some form of exertion or stress during cardiac catheterization is useful among patients suspected of having valvular stenosis who demonstrate normal or borderline valve gradients at rest. Leg raising exercise and drug administration are commonly used for this purpose, but each has inherent limitations. To evaluate the usefulness of dynamic arm raising exercise as a means of altering hemodynamics during cardiac catheterization, 23 such patients were studied. Measurements obtained during arm raising exercise were compared with those at rest. Heart rate rose by 34 +/- 4 beats/min (p less than 0.001), while cardiac output increased by 1.4 +/- 0.2 l/min (p less than 0.001). Stroke volume decreased slightly, although left ventricular filling pressures and pulmonary capillary wedge pressures rose in nearly all subjects. The change in valvular gradients was variable. These data were compared with those obtained in 11 similar patients receiving either dopamine or isoproterenol as an intervention. The changes in heart rate and cardiac output from the resting state were similar between the groups, with fewer side effects occurring during arm exercise. Dynamic arm exercise is a safe and effective maneuver which can be performed during cardiac catheterization in patients undergoing diagnostic evaluation of stenotic valvular disease.     

Report: Association of coronary artery disease and valvular heart disease in chile

This study analyzes the prevalence of coronary artery disease (CAD) among patients with rheumatic valvular heart disease (VHD) in Chile. Coronary angiography was performed in all patients referred to cardiac catheterization with VHD who were over age 50 years and who had angina or ECG signs of ischemia. A total of 100 patients entered the study. Significant CAD (greater than 50% obstruction) was found in 14% of the cases: 7% in patients with mitral valve disease (MVD), 18% in aortic valve disease (AVD), and 21% in combined mitral and aortic valve disease (MAVD). Angina was present in 14% of the patients with MVD, 63% with AVD, and 53% with MAVD. Only 57% of patients with CAD had angina pectoris; 20% with angina had CAD. Hemodynamic parameters and left ventricular ejection fraction were not correlated with the presence or absence of CAD. We conclude that in patients with valvular heart disease, the incidence of CAD is lower in Chile than previously reported in the English literature. We confirmed the fact that angina is often not associated with CAD, and that CAD is often present in the absence of angina.     

Non-invasive preoperative assessment of chronic valvular heart disease by Doppler ultrasound

Between February 1986 and June 1987,306 consecutive patientswere included in a programme of non-invasive preoperative assessmentof valvular heart disease using M-mode and cross-sectional echocardiographyand Doppler ultrasound. In 285 cases (93%), echocardiographyprovided all the necessary preoperative information. Coronaryangiography was performed in 74 patients because of angina andin 55 because of their age. Invasive investigation was neededin 21 cases because of discrepancies between clinical data andecho-Doppler results. The results were definitely misleadingin six patients, mainly due to erroneous assessment of valvularregurgitation. One hundred and ninety one patients underwentvalve surgery (179 evaluated exclusively by echocardiography,79 with coronary angiography as the sole invasive procedure).No discrepancies were observed between echo-Doppler diagnosisand macroscopic evaluation of valvular heart disease at surgery.Operative mortality (3.6%) was not significantly different fromthat observed during the preceeding period when preoperativecatheterisation was performed (3.3%). It is concluded that echo-Dopplertechniques are perfectly satisfactory for the preoperative assessmentof patients with valvular heart disease. Cardiac catheterisationis only infrequently required, although coronary angiographyremains mandatory in a selected group of these patients.     

SIRT1基因启动子DNA甲基化在老年钙化性心脏瓣膜病中的临床意义研究

[摘 要] 目的 探讨沉默信息调节因子1（SIRT1）基因启动子区域DNA甲基化修饰变化与老年钙化性心脏瓣膜病的相关性。方法 选取我院 2020年2月 ~ 2021年1月就诊的老年钙化性心脏瓣膜病患者60例,另纳入同期体检的健康老年40例作为对照。甲基化特异性PCR检测SIRT1基因启动子区域甲基化率,荧光定量PCR检测SIRT1 mRNA表达,ELISA检测SIRT1蛋白和NF-κB蛋白表达。结果 观察组SIRT1基因启动子区域甲基化率为63.3%（38/60）,显著高于对照组的37.5%（15/40）（P<0.01）。甲基化组SIRT1 mRNA的2-△△Ct值为0.22±0.05,显著低于非甲基化组的0.36±0.07（P<0.01）,甲基化组SIRT1 蛋白表达水平为82.34±11.56 μmol/L,显著低于非甲基化组的143.24±18.73 μmol/L（P<0.01）,甲基化组NF-κB蛋白表达水平为126.48±17.32 μmol/L,显著高于非甲基化组的41.53±7.26 μmol/L（P<0.01）。老年钙化性心脏瓣膜病SIRT1 mRNA与NF-κB蛋白表达呈显著负相关（P<0.05）,SIRT1蛋白表达与NF-κB蛋白表达呈显著负相关（P<0.05）。结论 老年钙化性心脏瓣膜病患者SIRT1基因启动子区域高甲基化变化,导致SIRT1表达减低,激活炎症反应,可能参与其致病过程。     

Magnetic resonance imaging in valvular heart disease

Magnetic resonance techniques can be employed to depict valvular abnormalities but are especially helpful in quantifying regurgitant or stenotic lesions which cannot be quantitatively assessed by other noninvasive techniques. Gradient echo techniques and phase velocity mapping are the most important magnetic resonance pulse sequences employed for these purposes. Valvular regurgitation can be quantitated by measuring the area of signal void on conventional gradient-echo images, by calculating stroke volume differences from k-space segmented gradient echo images, by measuring the proximal convergence zone from velocity encoded images or by comparing stroke volumes of the ventricles from velocity measurements. In contrast to this variety of possibilities in regurgitant lesions, stenotic lesions can only be quantitated by using velocity mapping techniques. Magnetic resonance spectroscopy can be used to assess myocardial metabolism in chronic valvular lesions. However, this tool needs further development and more clinical data before its use can be recommended to assess the necessity and optimal timing of surgical intervention.     

风湿性心瓣膜病患者心功能量化的初步评估

目的：探讨风湿性二尖瓣狭窄患者术前心功能储备的评估方法。方法：随机抽取2011年1月～12月100名风湿性二尖瓣狭窄的住院患者（患者组,n=100）和100名无心血管病史的同期在院陪护的患者家属（正常对照组,n=100）,采用心音监测仪分别于静息状态和完成规定运动量后即刻采集心音,进行心率、D／S比值以及S1／s2比值的对照研究。结果：患者组100名风心病患者静息状态下心率、D／S比值和运动后即刻SI／$2比值与正常对照组存在着显著的差异（均P〈0．05）。结论：心音监测法有可能为临床心功能储备提供一种量化的标准。