曲美他嗪对缺血性心肌病、糖尿病性心肌病心功能的影响

目的探讨曲美他嗪对缺血性心肌病、糖尿病性心肌病患者心功能的影响。方法41例心功能不全患者随机分为二组,对照组20例给予常规治疗;观察组21例在常规治疗基础上加用曲美他嗪20mg,3次/d,餐后口服。8周后应用心动超声判断治疗前后左室射血分数(LVEF),左室舒张末期内径(LVEDd),左室短轴缩短率(FS),评价心功能。结果对照组治疗前、后LVEF、LVEDd、FS分别为(0.38±0.05),(59.0±5.4),(0.19±0.04)及(0.44±0.06),(54.4±6.0),(0.24±0.08),统计学比较P值均<0.05。观察组治疗前、后LVEF、LVEDd、FS分别为(0.39±0.03),(57.5±4.6),(0.17±0.05),(0.47±0.07),(53.3±4.8),(0.27±0.09),统计学比较P值均<0.01。结论曲美他嗪通过改善心肌代谢有利于提高缺血性心肌病、糖尿病性心肌病心力衰竭患者的心功能,是安全有效的辅助用药。     

中西医结合治疗对尿毒症心肌病患者左室功能和结构的影响--附66例临床观察分析

目的考察并比较中西医结合治疗与单用中医治疗、西医治疗尿毒症心肌病的疗效.方法中西医结合治疗组23例,采用中医辨证论治、西医基础治疗及心室逆转治疗;与单纯西医治疗组23例及中医治疗组20例进行比较.三组疗程均为9个月.结果中西医结合治疗组23例,治疗前后患者左室功能及左室结构指标大多均有所改善(P＜0.05、P＜0.01、P＜0.001),疗效优于西医治疗组、中医治疗组.结论以痰瘀为主的中医辨证论治、结合西医降压等对症治疗,可在一定时期内改善尿毒症心肌病,且优于单纯中医或西医治疗.     

米力农联合参麦注射液对缺血性心肌病患者心功能指标的影响

目的观察米力农联合参麦注射液对缺血性心肌病患者心功能指标的影响。方法选取缺血性心肌病患者160例,随机分为常规组和观察组,每组各80例,常规组常规给予血管扩张剂、利尿剂、血管紧张素转换酶抑制剂或血管紧张素受体拮抗剂、β受体阻滞剂、洋地黄等药物,观察组在常规组治疗基础上加用米力农和参麦注射液,分别治疗7 d和14 d,观察两组治疗前及治疗后2周的临床疗效、血浆N端脑钠肽前体(NT-proBNP)水平、左室射血分数(LVEF)和6 min步行距离变化。结果治疗2周后,观察组总有效率明显优于常规组,观察组血浆NT-proBNP水平较常规组下降更为明显,观察组心脏超声LVEF值及6 min步行距离较常规组增加更为显著,两组比较差异有统计学意义(P<0.05)。结论米力农联合参麦注射液可明显改善缺血性心肌病患者各项心功能指标,短期疗效显著,且无明显不良反应。     

多巴胺D5受体通过抑制氧化应激对扩张型心肌病的调节作用研究

目的 探讨多巴胺D5受体是否会通过抑制氧化应激来影响扩张型心肌病(dilated cardiomyopathy)的发生发展。方法 建立心脏特异表达人多巴胺D5受体突变基因F173L(α-MHC-hD5F173L)和正常基因(α-MHC-hD5WT)转基因小鼠。用3月龄小鼠, 首先检测比较转基因小鼠心脏内ROS的产量和NOX2的表达量。然后对α-MHC-hD5F173L小鼠通过皮下给NADPH氧化酶的抑制剂罗布麻宁(Apocynin)4周, 同时给PBS作为对照组, 然后检测各项心肌病相关指标。同时构建人多巴胺D5受体突变基因(hD5F173L)和正常多巴胺D5受体基因(hD5WT)的大鼠心肌细胞(H9C2), 检测两者在基础条件下ROS产量的变化。结果 α-MHC-hD5F173L转基因小鼠的NADPH氧化酶的活性和NOX2蛋白的表达量均明显高于野生型α-MHC-hD5WT 小鼠, 罗布麻宁能显著改善α-MHC-hD5F173L转基因小鼠的心脏功能。H9C2-hD5F173L大鼠细胞系NOX2的表达量及ROS产量高于H9C2- hD5WT对照细胞。结论 多巴胺D5受体可能通过抑制氧化应激而防止扩张型心肌病的发生发展。     

Prognostic predictive value of TLR4 polymorphisms in Han Chinese population with hypertrophic cardiomyopathy

Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiac disease and is an important cause of sudden death in patients of all ages. The aim of this study was to find out whether Toll-like receptor-4 (TLR4) polymorphism is associated with HCM. To explore the association between TLR4 gene polymorphisms and HCM, 486 HCM patients and 214 healthy controls were enrolled in a case–control study of Chinese Han population. Two single nucleotide polymorphisms (SNPs) in the promoter region of TLR4 gene, ?728G > C (rs11536865) and ?2081G > A (rs10983755), were genotyped by PCR restriction fragment length polymorphism (PCR-RFLP). The associations between TLR4 SNPs and overall survival (OS) of HCM patients were analyzed by the Kaplan–Meier estimation method and Cox proportional hazards regression analysis. Serum TLR4 level was determined by ELISA. Our results showed that the C allelic frequency of ?728G > C and A allelic frequency of ?2081G > A were higher in HCM patients than those in controls (P < 0.001). The ratios of genotype frequencies for both SNPs were associated with HCM susceptibility under three genetic models (P < 0.01). Two SNPs were also associated with the OS in HCM patients (P < 0.001). The CC genotype of ?728G > C and AA genotype of ?2081G > A were associated with poor prognosis of HCM (P < 0.001). Moreover, HCM patients had a higher serum TLR4 level compared with the controls (242.6 pg/ml versus 135.7 pg/ml, P = 0.027). In addition, significant associations were observed between CC genotype of ?728G > C or AA genotype of ?2081G > A and plasma TLR4 level (P < 0.01). The results of this study indicated that TLR4 polymorphisms may be a genetic susceptibility factor for HCM in the Han Chinese population.     

Fragmented ECG as a Risk Marker in Cardiovascular Diseases

Various noninvasive tests for risk stratification of sudden cardiac death (SCD) were studied, mostly in the context of structural heart disease such as coronary artery disease (CAD), cardiomyopathy and heart failure but have low positive predictive value for SCD. Fragmented QRS complexes (fQRS) on a 12-lead ECG is a marker of depolarization abnormality. fQRS include presence of various morphologies of the QRS wave with or without a Q wave and includes the presence of an additional R wave (R’) or notching in the nadir of the R’ (fragmentation) in two contiguous leads, corresponding to a major coronary artery territory. fQRS represents conduction delay from inhomogeneous activation of the ventricles due to myocardial scar. It has a high predictive value for myocardial scar and mortality in patients CAD. fQRS also predicts arrhythmic events and mortality in patients with implantable cardioverter defibrillator. It also signifies poor prognosis in patients with nonischemic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy and Brugada syndrome. However, fQRS is a nonspecific finding and its diagnostic prognostic should only be interpreted in the presence of pertinent clinical evidence and type of myocardial involvement (structural vs. structurally normal heart).     

Cardiac manifestations of subarachnoid hemorrhage

Subarachnoid hemorrhage (SAH) is a devastating condition. It carries a high mortality rate, with 12% of patients dying before reaching the hospital. Aside from its neurological morbidities, SAH is associated with significant medical complications. Cardiac manifestations are common and can impact morbidity and mortality in SAH patients. This article will discuss the cardiac manifestations of SAH.