The relationship of myocarditis to dilated cardiomyopathy

Three patients with congestive cardiomyopathy are reported inwhom high neutralizing antibody titres to Coxsackie B viruseswere detected. At post-mortem examination, all three had histologicallydemonstrable chronic inflammation of the myocardium. The heartsof ten patients dying in cardiac failure due to other causesshowed no comparable inflammatory infiltration. This providesfurther evidence that Coxsackie B viral myocarditis is involvedin the pathogenesis of some cases of dilated cardiomyopathy. One patient also had pulmonary veno-occlusive disease. Thishas been reported in association with myocarditis once previouslyin an infant. A viral aetiology has been postulated. It seemslikely in this patient to have also been due to a CoxsackieB virus.     

Regional distribution of β1- and β2-adrenoceptors in the failing and nonfailing human heart

Summary Total -adrenoceptor density and ₁- and ₂-subtype distribution in right and left atria and in different ventricular regions from 14 failing and seven nonfailing human hearts have been compared. End-stage heart failure was due to idiopathic dilated cardiomyopathy (n=8) or ischaemic cardiomyopathy (n=6).In nonfailing hearts the total -adrenoceptor density was similar in the right and left atria and in all the ventricular regions studied (about 70 to 80 fmol/mg protein). The ₁:₂-adrenoceptor ratio in both nonfailing atria was similar (about 70:30%) and was significantly smaller than in the different regions of both ventricles (about 80:20%). The ₁-subtype density was similar in nonfailing atria and ventricles (about 55 fmol/mg protein). The ₂-subtype density was significantly higher in the right and left atrium (about 25 fmol/mg protein) than in both ventricles (about 15 fmol/mg protein).In patients with end-stage heart failure due to idiopathic dilated cardiomyopathy or ischaemic cardiomyopathy the total -adrenoceptor density was reduced by 50–60% in all regions. On the other hand, the ₁- and ₂-subtype distribution differed with the cause of heart failure. In patients with idiopathic dilated cardiomyopathy, the ₁-adrenoceptor density was lower in all regions, but the ₂-adrenoceptor density was not significantly reduced. In patients with ischaemic cardiomyopathy both ₁- and ₂-adrenoceptors were reduced in all regions.It is concluded that downregulation of -adrenoceptors in patients with end-stage idiopathic dilated cardiomyopathy or ischaemic cardiomyopathy occurs uniformly throughout the heart. The results support the hypothesis that changes in -adrenoceptor subtypes may be related to the cause of heart failure.     

Role of prenatal echocardiography in the study of hypertrophic cardiomyopathy in the fetus

The increased incidence of hypertrophic cardiomyopathy in children of diabetic mothers has already been demonstrated, but its prenatal diagnosis has not yet been extensively studied. The purpose of this prospective study was to evaluate the frequency, severity, and echocardiographic features of fetal hypertrophic cardiomyopathy in a population with several indications for prenatal echocardiography. From March 1987 to April 1991, 283 fetuses were submitted to comprehensive prenatal echocardiography, including M-mode measurements, cross-sectional imaging, Doppler studies, and color flow mapping. One hundred seventy-six were pregnancies complicated by previous or gestational diabetes. The diagnosis of disproportionate septal hypertrophy was made in 39 fetuses (mean septal thickness 7.12 +/- 1.6 mm), at a mean gestational age of 32 weeks. Diabetes mellitus was present in 36 of these pregnancies (92.3%). In four cases, nonimmune hydrops was detected. A systolic anterior motion of the mitral valve was present in three fetuses, but only one showed a gradient across the left ventricular outflow tract. Postnatal echocardiographic examination in 27 babies did not show false positivity. In ten cases, spontaneous regression of the septal hypertrophy was shown. There were three neonatal deaths, unrelated to the myocardial disease. We concluded that transient hypertrophic cardiomyopathy is a frequent entity, especially when associated with diabetes during gestation, being a potential cause for nonimmune hydrops. Fetal echocardiography is the method of choice for its prenatal diagnosis and should always be indicated in diabetic mothers.     

An infant with Costelio syndrome complicated with fatal hypertrophic obstructive cardiomyopathy

We report a 3-month-old girl with Costelio syndrome complicating fatal hypertrophic obstructive cardio-myopathy. She had typical findings of this syndrome, slight dyspnea and persistent wheezing. Doppler echocardiography revealed asymmetric septal hypertrophy and systolic anterior movement of the anterior mitral leaflet. There was grade 1 mitral regurgitation. Although once her heart failure had been controlled medically, she died suddenly following deterioration of her heart condition. Costelio syndrome can complicate fatal hypertrophic obstructive cardiomyopathy.     

回心草化学成分研究

目的:研究回心草的化学成分。方法:回心草95%乙醇提取物依次用石油醚、醋酸乙酯、正丁醇进行充分萃取,用硅胶柱色谱、葡聚糖凝胶柱色谱反复对醋酸乙酯部位进行成分分离、纯化,通过波谱方法鉴定结构。结果:从回心草中共分离鉴定了8个化合物,分别为胡椒碱(1),咖啡酸甲酯(2),尿嘧啶苷(3),熊果酸(4),3β-羟基-5α,8α-氧桥-6,22-二烯(5),3β-羟基-5α,8α-氧桥-6,9(11),22-三烯(6),β-谷甾醇(7),胡萝卜苷(8)。结论:化合物1-6和8为首次从该植物分离得到。     

经皮室间隔心肌化学消融治疗肥厚型梗阻性心肌病近期疗效观察

目的:评价经皮室间隔心肌化学消融(PTSMA)方法治疗的6例肥厚型梗阻性心肌病(HOCM)近期疗效观察。方法:6例肥厚型梗阻性心肌病患者,男4例,女2例;平均年龄(38.6±12)岁;病程(1~7)年,采用RAO 15°~45°体位投照下,确定靶血管后,向球囊导管中心腔内注入无水酒精,均放置临时起搏器,术中密切观察患者的心电图以及LVOTG的变化,术后所有患者均定期复查心电图及超声心动图,随访观察6个月。结果:术中消融第一间隔支者4例,消融第二间隔支者2例。术中有1例出现Ⅲ度房室传导阻滞,2例出现完全性右束支传导阻滞,均为一过性;随访观察6个月,所有患者均存活,无晕厥及心绞痛复发;经常规心电图及动态心电图观察,均无频发室早、短阵室速及其他恶性心律失常出现,复查超声心动图均提示原先肥厚的室间隔心肌变薄,搏动减弱,LVOTG下降,SAM现象消失,左室射血分数提高。结论:PTSMA治疗肥厚型梗阻性心肌病可使室间隔变薄,压力差降低,左室流出道梗阻减轻,患者术后的症状、体征以及超声心动图表现均较术前有显著改善,无严重并发症出现。这表明PTSMA是一种治疗HOCM的有效方法,其近期疗效可靠。     

螺内酯对扩张型心肌病心力衰竭的治疗作用

目的 探讨螺内酯对扩张型心肌病心力衰竭的治疗作用.方法 将119例患者按入选顺序随机分编入治疗组和对照组.对照组接受常规治疗（β受体阻滞剂＋ACEI＋地高辛＋速尿）,治疗组在对照组的基础上加安体舒通（螺内酯）（20mg BID）.结果 治疗1a后,左房、左室内经明显小于对照组,左室射血分数,左室短轴缩短率明显高于对照组.结论 螺内酯对扩张型心肌病心力衰竭有效,可改善心功能和改善心室重构,改善预后.     

Relation between myocardial response to dobutamine stress and sympathetic nerve activation in patients with idiopathic dilated cardiomyopathy: A comparison of123I-MIBG scintigraphic and echocardiographic data

It is likely that a close association exists between findings obtained by two methods: dobutamine stress echocardiography and 123I-MIBG scintigraphy. Both of these methods are associated with beta-adrenergic receptor mechanisms. This study was conducted to demonstrate the relation between myocardial response to dobutamine stress and sympathetic nerve release of norepinephrine in the failing heart. In 12 patients with heart failure due to idiopathic dilated cardiomyopathy, the myocardial effects of dobutamine stress were evaluated by low-dose dobutamine stress echocardiography: and sympathetic nerve function was evaluated by scintigraphic imaging with iodine-123 [123I] meta-iodobenzylguanidine (MIBG), an analogue of norepinephrine. Echocardiography provided quantitative assessment of wall motion and left ventricular dilation; radiotracer studies with 123I-MIBG provided quantitative assessment of the heart-to-mediastinum (H/M) uptake ratio and washout rate. Results showed that H/M correlated with baseline wall motion (r = 0.682, p = 0.0146), wall motion after dobutamine stress (r = 0.758, p = 0.0043), the change in wall motion (r = 0.667, p = 0.0178), and with left ventricular diastolic diameter (r = 0.837, p = 0.0007). In addition, the 123I-MIBG washout rate correlated with baseline wall motion (r = 0.608, p = 0.0360), wall motion after dobutamine stress (r = 0.703, p = 0.0107), and with the change in wall motion (r = 0.664, p = 0.0185). Wall motion, especially in the myocardial response to dobutamine stress, is related to sympathetic nerve activity in heart failure.     

氨基胍对糖尿病大鼠心脏功能及心肌超微结构的影响

目的 :探讨非酶糖化抑制剂 氨基胍 (amin oguanidine ,AG)对链尿佐菌素 (streptozotocin ,STZ)糖尿病大鼠心肌的保护作用 ,为糖尿病心肌病的防治提供参考。方法 :建立STZ糖尿病大鼠模型 ,随机分为对照组、糖尿病组和氨基胍治疗组 ,AG剂量为15 0mg·kg-1·d-1。 12周时测定大鼠血清果糖胺含量、心脏重量指数、左室内压最大上升和下降率 (±dp dtmax)值 ,电镜观察心肌超微结构 ,测量心肌毛细血管基底膜厚度。结果 :糖尿病组大鼠血清果糖胺含量、心脏重量指数明显增高 ,±dp dtmax降低 ;超微结构显示心肌肌原纤维排列紊乱 ,线粒体肿胀变性 ,间质胶原增生 ,微血管内皮细胞肿胀、基底膜明显增厚。氨基胍治疗组血清果糖胺含量降低、心脏重量指数明显下降、±dp dtmax 值上升 ,微血管基底膜增厚减轻 ,间质胶原减少 ,心肌细胞超微结构异常减轻。结论 :糖尿病时存在心脏功能异常、心肌肥厚和超微结构的改变 ,早期应用AG在一定程度上可阻抑糖尿病心肌病变的发展。