Association of CD36 gene polymorphisms with echo- and electrocardiographic parameters in patients with early onset coronary artery disease

Introduction

CD36 plays an important role in long-chain fatty acid homeostasis in skeletal muscle and the myocardium. CD36 deficiency may lead to reduced myocardial uptake of long-chain fatty acid. Therefore, different mutations of the CD36 gene may contribute to the clinical heterogeneity of cardiac hypertrophy.

Material and methods

The objective of the study was to investigate whether there is an association between the sequence changes in CD36 and echocardiographic and electrocardiographic parameters in Caucasian patients with early onset coronary artery disease. The study group comprised 100 patients. Electrocardiography and echocardiography were performed in all patients. Amplicons of exons 4 to 6 including fragments of introns were studied using the denaturing high-performance liquid chromatography technique.

Results

IVS3-6TC (rs3173798) heterozygotes had impaired left ventricle diastolic function. 573GA heterozygotes (rs5956) had higher frequency of pseudonormal left ventricular diastolic function and it was confirmed by the increase in wave A’ in the tissue Doppler. 591AT genotype was associated with borderline higher posterior wall end-diastolic thickness and lower E/A ratio. These results are consistent with electrocardiography parameters which could reflect left ventricular hypertrophy (higher R_V5(6) and R_V5(6) + S_V1(2) parameters, depressed ST segments and tendency to longer Qtc II interval) in 591AT heterozygotes.

Conclusions

Detected variant alleles of CD36 may be associated with features of left ventricular hypertrophy and impaired diastolic function.     

儿童心肌炎动态心电图监测临床价值探讨

目的：目前诊断病毒性心肌炎的标准仍是采用临床、心脏器械和实验室检查相结合的方法综合判断。该文对儿童心肌炎动态心电图(DCG)监测下心电变化特点作一回顾性分析,旨在为临床诊断、治疗及预后判断提供重要依据。方法：分析59例儿童心肌炎及41例无器质性心脏病对照组的心电图变化,测定DCG异常率、室性早搏数量、级别及分布情况、心率变异指标。 结果：心肌炎组异常DCG检出率86.4%,且部分为复合心律失常,与对照组DGC异常检出率46.3%相比,差异非常显著﹙P<0.01﹚。室早分布类型心肌炎组以均匀型（84.6%﹚及单峰型﹙64.4%﹚最常见,与对照组比较差异有显著性﹙P<0.05,P<0.01﹚。 结论： 儿童DCG监测异常、早搏分布为均匀型、早搏高峰为单峰及多峰型者或出现复合心律失常对儿童心肌炎的诊断、治疗及预后判断有一定参考价值。［中国当代儿科杂志,2007,9（3）：213-215］     

The effects of the partial beta 1-agonist xamoterol on heart rate and ventricular arrhythmias in patients with mild to moderate heart failure

A major concern with the use of oral inotropes in chronic heart failure is their propensity to exacerbate cardiac arrhythmias. In a double-blind randomized placebo-controlled crossover study of xamoterol, a novel beta 1-partial agonist, 24 h ambulatory electrocardiograms were obtained in 26 patients prior to and at the end of 13-week treatment periods. During treatment with xamoterol there was no significant change in mean hourly number of ventricular extrasystoles compared with baseline and placebo (30 +/- 17 vs 56 +/- 42 and 18 +/- 7, respectively), or in the number of patients showing complex forms (multiform VEs, pairs, ventricular tachycardia) (20/26 vs 19/26 and 19/26, respectively), or ventricular tachycardia alone (5/26 vs 4/26 and 6/26, respectively). Xamoterol therapy also stabilized heart rate variability over the 24 h period.     

Choosing the pacemaker; a rational approach to the use of modern pacemaker technology

Sophisticated pacemakers now afford greater benefit than only relief of syncope for patients with symptomatic bradyarrhythmia. For clinical reasons it is inappropriate to implant ventricular demand (VVI) pacemakers in every patient, but for both clinical and economic reasons it is also undesirable to use dual-lead or rate-responsive systems indiscriminately. However, the published guidelines for pacemaker choice and investigation are inadequate. We have analysed the clinical assessment and the investigations required in a series of 150 patients with various electrophysiological disorders, considered consecutively for pacemaker implantation using an algorithm to assist decisions. Holter electrocardiography in 77.3%, exercise testing--formal (in 9.3%) or informal (during Holter electrocardiography), electrophysiology study (EPS)--full in 15.3% and partial in 29.3%, and trial of pacing (10.7%) were all used to characterize dysfunction and to define appropriate pacing mode. 142 patients were paced--57.0% with single lead modes (12.7%) AAI, 44.3% VVI) and 43.0% dual-lead (2.8% DVI, 23.9% VDD or VAT, 16.2% DDD). Three patients received rate-responsive systems (VVIR) which, if available, would have been used in nine; four would have been suitable for AAIR and four for dual-lead responsive pacing (DVIR, DDIR or DDDR). We offer a rational approach based on published data for investigation and pacemaker choice in the management of patients with bradyarrhythmia.     

丹参多酚酸治疗心绞痛患者的临床疗效及对血小板功能的影响

目的　探讨丹参多酚酸盐治疗稳定性心绞痛的临床疗效以及对血小板功能的影响。方法　将稳定型心绞痛患者 5 6例随机分为丹参多酚酸高剂量组、低剂量组和丹参对照组 ,均治疗 14d ,观察3组的症状缓解、平板运动试验改善情况 ,以及比浊法检测的血小板聚集率、全血法流式细胞术检测的P选择素变化情况。结果　丹参多酚酸组在症状缓解、平板运动试验改善方面与丹参组相近 ,在降低血小板聚集率和P选择素方面优于丹参组。结论　丹参多酚酸能明显抑制血小板的聚集和活化 ,改善心绞痛症状及平板运动试验心电图ST T改变     

OGTT30分钟血糖升高对正常糖代谢人群心电图异常的影响

目的：探讨OGTT30分钟血糖异常升高对正常糖代谢人群中明尼苏达编码提示的心电图异常的影响。方法采用分层随机整群抽样方法，选择我省最近一次糖尿病横断面调查的糖代谢正常的人群（20-75岁）。结果：2441名有完整资料的调查对象（男39．45％）进入统计学分析。明尼苏达编码提示心电图主要异常改变人群占11．6％（男95人，女188人），多因素Logistic回归分析调整相关心血管疾病危险因素后，OGTT30分钟血糖升高（≥9．23mmol／l，第三个四分位截点）仍然和心电图异常显著相关（OR1．721（1．311-2．261），P〈0．001）。结论从早期筛查糖尿病和心血管疾病高危人群的角度出发，部分照现行糖尿病诊断标准划分为正常糖代谢的人群但负荷后30分钟血糖异常升高的人群，同样也是需要给予重视的CVD预防阶段。     

肌袖性房性心律失常的动态心电图特征分析

目的探讨肌袖性房性心律失常的动态心电图特征。方法总结8例复杂房性心律失常患者的临床和动态心电图特点。结果8例患者均有频发房性早搏，有时呈二三联律、房性过速，1例发生阵发心房扑动，均发生阵发房颤，7例发作时间为2—15min不等，1例发作时间持续十几h，诱发房颤（房扑）的房早联律间期0．20—0．28s。结论肌袖性房性心律失常的动态心电图中窦律、房早、房遇速、房扑、房颤相互转换，诱发房颤（房扑）发作的房早联律间期短，房早几乎均呈“PonT”现象。     

Longitudinal evaluation of anthracycline cardiotoxicity by signal-averaged electrocardiography in children with cancer

BACKGROUND: The aim of the present study was to investigate the detection of anthracycline cardiotoxicity by signal-averaged electrocardiography (SAE) in children with cancer. METHODS: There were 29 patients with a cumulative anthracycline (ATC) dose of 75-600 mg/m2. None of them had congestive heart failure. Patients underwent SAE just before (detection of chronic cardiotoxicity) and just after (detection of acute cardiotoxicity) ATC therapy. Echocardiography and Holter electrocardiography were performed at the same time. The rates of abnormal SAE, echocardiography, and electrocardiogram findings were calculated and compared for every 100 mg/m2 of ATC. RESULTS: The SAE showed a significantly higher detection rate for acute cardiotoxicity was at a cumulative ATC dose of less than 400 mg/m2 when compared with other methods (P < 0.05). The lowest dose at which acute cardiotoxicity was detected by SAE was 117.3 mg/m2. The detection of chronic cardiotoxicity by SAE was significantly higher at a cumulative ATC dose of 100-400 mg/m2 when compared with other methods (P < 0.05), and the lowest value showing toxicity was 373.3 mg/m2. The lowest ATC dose causing chronic cardiotoxicity was significantly lower in patients less than 2-years-old (120.0 +/- 28.3 mg/m2) than in the other age groups (P < 0.05). CONCLUSIONS: Acute and chronic ATC cardiotoxicity were detected by SAE at lower cumulative doses compared with other methods. The technique of SAE was a potentially useful method for detection of cardiotoxicity among those investigated and it provides useful information on subclinical cardiac dysfunction in patients receiving ATC therapy.     

急性前壁心肌梗死合并下壁导联ST段下移的临床意义

48例首次急性前壁心肌梗死患者中伴下壁导联ST段平均下移>1mm、持续时间>48h者,CK和CK-MB的平均峰值更高,核素检查左室射血分数<40％,左室下壁运动障碍、出现放射性稀疏或缺损区的发生率也更高(P<0.05或<0.01)。说明这类病人有下壁心肌缺血,且可能心肌坏死面积更广。     

运动试验引起的室上性早搏ST段压低的临床意义

本文通过平板运动试验与放射性核素检查结果相对照，对８６例拟诊冠心病患者在运动试验期间引起的室上性早搏ＳＴ段压低的临床意义进行了研究。认为运动试验期间引起的室上性早搏ＳＴ段压低幅度大于其前窦性心搏ＳＴ段压低的幅度，是心肌缺血的敏感标志。且二者差值的大小与冠脉病变程度呈正相关。此情况亦见于在运动试验中表现为假阴性的冠心病患者，从而增加了运动试验在检测冠心病中的敏感性。