Clinical significance of incomplete tricuspid valve closure seen on two-dimensional echocardiography

Incomplete closure of the tricuspid valve without apparent cusp disease was noted on two-dimensional echocardiography in 31 patients. This abnormality was defined as a failure of the tricuspid valve leaflet tips to reach the plane of the tricuspid valve anulus by at least 1 cm in the standard apical four chamber view at the point of maximal systolic closure. This resulted in a final systolic leaflet position deeper within the right ventricular cavity than is normally seen. The finding was present in the following diagnostic subgroups: Group A, pulmonary hypertension (11 patients); Group B, rheumatic heart disease (4 patients); Group C, dilated cardiomyopathy (9 patients) and Group D, previous myocardial infarction (7 patients). Right atrial, right ventricular and tricuspid anulus measurements were made and compared with those from a group of 67 normal subjects. The results were as follows: right atrial endsystolic area = 27.2 +/- 8.6 cm2 (normal = 13.4 +/- 2.0); right ventricular end-systolic area = 25.6 +/- 8.7 cm2 (normal = 10.9 +/- 2.9); right ventricular end-diastolic area = 31.5 +/- 9.1 cm2 (normal = 20.1 +/- 4.9) and tricuspid valve anular end-systolic dimension = 4.0 +/- 0.6 cm (normal = 2.2 +/- 0.3). The differences from the normal data were all statistically significant (p less than 0.001). Incomplete closure of the tricuspid valve, although a nonspecific diagnostic finding, is primarily associated with right-sided chamber enlargement. Tricuspid regurgitation may be present. The mechanism could be related to geometric changes in valve apparatus dynamics secondary to right-sided cardiac enlargement and tricuspid valve anular dilation.(ABSTRACT TRUNCATED AT 250 WORDS)     

IMA、hs-CRP、MYO、CK-MB、hs-cTnT 联合检测在急性冠脉综合症诊断中的价值比较

目的：探讨血清中缺血个儿蛋白（IMA）、超敏 C 反应蛋白（hs-CRP）、肌红蛋白（MYO）、肌酸激酶同工酶（CK-MB）、超敏肌钙蛋白（hs-cTnT）在急性冠状动脉综合征（ACS）患者早期诊断的价值。方法测定99例健康对照组和94例 ACS 患者（其中不稳定性心绞痛40例,非 ST 段抬高的心肌梗死即非 Q 波心肌梗死20例,ST 段抬高的心肌梗死即 Q 波心肌梗死34例）中IMA、hs-CRP、MYO、CK-MB、hs-TNT 的含量。通过 ROC 曲线比较5种标志物在 ACS 早期诊断中的诊断效率、灵敏度、特异性、阴阳性预测值。结果血清中 IAM、hs-CRP、MYO、CK-MB、hs-cTnT 检测结果在病例组 UAP,NSTEMI,STEMI 3组和正常对照组间比较,差异均有统计学意义（P ＜0．05）。其中 IMA、hs-CRP、MYO、CK-MB、hs-cTnT 在 UAP 与 NSTEMI 组,UAP 与NSTEMI 组间比较,差异均有统计学意义（P ＜0．05）,NSTEMI 与 STEMI 组间比较,差异均无统计学意义（P ＞0．05）。结论在ACS 中,多个指标的联合检测能取得早期诊断的价值。     

婴幼儿轮状病毒性肠炎患儿54例血清心肌酶分析

目的通过检测并分析婴幼儿轮状病毒性肠炎与非轮状病毒感染性肠炎患儿心肌酶的水平,探讨轮状病毒感染与心肌损伤的相关性。方法 54例婴幼儿轮状病毒性肠炎的患儿作为观察组,78例轮状病毒阴性的腹泻病患儿作为对照组。两组患儿入院后抽取取空腹血清检查心肌酶[磷酸肌酸激酶(CK)及其同工酶(CK-MB)、门冬氨酸氨基转移酶(AST)]进行比较分析。两组患儿经治疗,腹泻症状消失后,将心肌酶三项均增高患儿的血清心肌酶进行治疗前后的分析比较。结果观察组中血清心肌酶三项(AST、CK-MB、CK)的水平较对照组高,差异有显著性(P0.05)。且入院时,观察组心肌酶三项均异常者有30例,占55.6%;对照组心肌酶三项均异常者有13例,占16.7%。观察组心肌酶异常者比率显著高于对照组,差异有显著性(P0.05)。治疗前,观察组心肌酶三项均异常者心肌酶水平较对照组增高,差异有显著性(P0.05);治疗后,两组心肌酶三项均异常者心肌酶水平差异无统计学意义(P0.05)。结论婴幼儿轮状病毒性肠炎较非轮状病毒性腹泻更容易导致患儿心肌的损伤,经治疗后,心肌酶可以在短时间内恢复正常。因此,在治疗婴幼儿轮状病毒性肠炎时应进行心肌酶的检测,并注意排除病毒性心肌炎。     

CK-MB、TNI、IL-6与有机磷中毒性心肌炎关系的探讨

目的探讨有机磷中毒性心肌炎患者肌钙蛋白(TNI)、肌酸激酶同工酶(CK-MB)、白介素-6(IL-6)水平的变化情况。方法选择有机磷中毒性心肌炎患者30例为研究对象,同期健康体检者30例为对照组。两组患者均空腹抽静脉血3 ml,送实验室检测患者CK-MB、TNI、IL-6水平,并进行组间比较。结果中毒组患者CK-MB、TNI、IL-6水平明显高于对照组,差异有统计学意义(P0.05);中毒患者中,由轻度到重度,CK-MB、TNI、IL-6水平逐渐升高,各亚组间比较,差异有统计学意义(P0.05)。结论 CK-MB、TNI、IL-6三者联合可有效反映有机磷中毒性心肌损害程度,临床对于CK-MB、TNI、IL-6明显升高的患者,应及时对应治疗,尽量改善患者预后情况。     

Myocardial infarct size and cardiogenic shock

The relationship between estimated infarct size and cardiogenicshock was investigated in 317 consecutively admitted patientswith acute myocardial infarction (AMI). Infarct size was estimatedin vivo by serum CK-MB in all patients, and at heart autopsyby histological and histochemical techniques in 23 patientswho died in hospital. Although patients with cardiogenic shock(n = 31) had a larger median serum CK-MB estimated infarct sizethan those without cardiogenic shock (1035 U/l v. 669 U/l, P< 0.05) there was a substantial overlap in infarct size betweenthe two groups. Heart autopsy confirmed this finding and demonstratedthat patients with small subendocardial infarcts also died fromshock, especially those with severe 2 or 3 vessel disease and/orinfarction fibrosis. Those with cardiogenic shock who survivedand those who died from shock had a similar median infarct size,and patients who died from other cardiac causes had the samemedian infarct size as those who died from shock.     

Myositis as an adverse event of immune checkpoint blockade for cancer therapy

Objectives

Immune checkpoint inhibitors (ICIs) can successfully treat cancer, but their use can be hindered by serious immune-related adverse events. We report six patients receiving ICIs who presented with de novo myositis.

Left ventricular function during systole and diastole in mitral incompetence

Left ventricular function during systole and diastole was studied in 17 young patients with mitral incompetence and sinus rhythm; 13 had established chronic mitral incompetence, 3 had prolapsing posterior leaflet syndrome and 1 had ruptured chordae tendineae. In chronic mitral incompetence and prolapsing posterior leaflet syndrome, clinical disability was related to a low forward stroke index, a large regurgitant volume and tall left atrial V wave. The defect was mechanical, and the ventricle had adapted by compensatory dilatation so that overall systolic function was normal, as measured by peak rate of rise of left ventricular pressure ($\text{dP}\text{dt}$) and ejection fraction. The dilated ventricle operated at a normal or slightly increased end-diastolic pressure, a consequence of normal resting tension (O point) and a more elastic myocardium with a low rate of change of instantaneous stiffness (m) and a flattened diastolic pressure-volume curve.In acute mitral incompetence, systolic function was normal but the sudden volume overload caused the unprepared ventricle with an almost normal modulus of elasticity and slope (m) to ascend its pressure-volume curve in diastole. End-diastolic pressure was increased.     

Pharmacokinetics of antiarrhythmic drugs.

A knowledge of the determinants of the plasma concentrations of antiarrhythmic drugs is important because variation in plasma levels is often greater than the desired therapeutic range. The basic principles of pharmacokinetics are outlined and their application to the design of dosage regimens described. These principles are illustrated in a review of the pharmacokinetics of lidocaine and its congeners, procainamide and its active metabolite (N-acetylprocainamide), quindine, disopyramide, phenytoin and propranolol, with particular emphasis of the factors that contribute to altered disposition.