缬沙坦降血压和逆转左心室肥厚的作用观察

目的 观察缬沙坦降压疗效及对原发性高血压(EH)左心室肥厚(LVH)的逆转作用。方法 入选患者服用缬沙坦80—160mg，晨服一次，治疗12周，用携带式动态血压监测仪监测血压，用超声心动图测定患者的左心室结构及功能改变。结果 缬沙坦使24小时血压稳定下降，室间隔厚度、左心室后壁厚度、左心室舒张末内径、左室心肌重量指数均较治疗前显著改善(P＜0．01)。结论 缬沙坦能有效治疗高血压，有逆转左心室肥厚，改善左心室舒张功能。     

缬沙坦联合贝那普利逆转老年性高血压伴左心室肥厚的疗效观察

目的：观察缬沙坦联合贝那普利逆转老年性高血压及左心室肥厚的疗效。方法：选择老年性高血压（年龄≥60岁）及经超声心动图证实有左室肥厚患者59例,给予缬沙坦联合贝那普利口服治疗,6个月为1个疗程,监测血压并行超声心动图复查左室舒张末期内径（LVDd）、舒张末期室间隔厚度（IVSd）、左室后壁厚度（LVPWd）及计算左室重量指数（LVMI）,评估疗效。结果：老年性高血压患者收缩压及舒张压均明显降低,超声心动图复查IVSd、LVPWd及LVMI均明显改善,与治疗前相比差异均有统计学意义（P〈0.05）。结论：缬沙坦联合贝那普利可以有效地降低老年性高血压及改善左心室肥厚。     

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.     

心电图与超声心动图在原发性高血压左心室肥厚诊断中的应用价值对比

目的探讨心电图（ECG）与超声心动图（UCG）在原发性高血压左心室肥厚（LVH）诊断中的应用价值。方法回顾性分析了2007年7月～2012年7月入住我院的200例原发性高血压患者的ECG与UCG的资料,对其进行统计学分析。结果 ECG检出LVH49例（24.5%）,UCG检出LVH 146例（73.0%）,二者检出率存在显著性差异（P〈0.01）。其中Ⅰ级高血压28例,ECG与UCG检出LVH比率分别为7.14%（2/28）、32.14%（9/28）;Ⅱ级高血压69例,ECG与UCG检出LVH比率分别为13.04%（9/69）、62.32%（43/69）;Ⅲ级高血压103例,ECG与UCG检出LVH比率分别为36.89%（38/103）、91.26%（94/103）。结论 ECG与UCG在原发性高血压左心室肥厚检测中存在互补关系,应综合性地运用两种方法才能提高原发性高血压LVH的检出率,从而降低原发性高血压患者的致残率及病死率。     

The Natural History of Left Ventricular Geometry in the Community: Clinical Correlates and Prognostic Significance of Change in LV Geometric Pattern

ObjectivesThis study sought to evaluate pattern and clinical correlates of change in left ventricular (LV) geometry over a 4-year period in the community; it also assessed whether the pattern of change in LV geometry over 4 years predicts incident cardiovascular disease (CVD), including myocardial infarction, heart failure, and cardiovascular death, during an additional subsequent follow-up period.BackgroundIt is unclear how LV geometric patterns change over time and whether changes in LV geometry have prognostic significance.MethodsThis study evaluated 4,492 observations (2,604 unique Framingham Heart Study participants attending consecutive examinations) to categorize LV geometry at baseline and after 4 years. Four groups were defined on the basis of the sex-specific distributions of left ventricular mass (LVM) and relative wall thickness (RWT) (normal: LVM and RWT <80th percentile; concentric remodeling: LVM <80th percentile but RWT ≥80th percentile; eccentric hypertrophy: LVM ≥80th percentile but RWT <80th percentile; and concentric hypertrophy: LVM and RWT ≥80th percentile).ResultsAt baseline, 2,874 of 4,492 observations (64%) had normal LVM and RWT. Participants with normal geometry or concentric remodeling progressed infrequently (4% to 8%) to eccentric or concentric hypertrophy. Change from eccentric to concentric hypertrophy was uncommon (8%). Among participants with concentric hypertrophy, 19% developed eccentric hypertrophy within the 4-year period. Among participants with abnormal LV geometry at baseline, a significant proportion (29% to 53%) reverted to normal geometry within 4 years. Higher blood pressure, greater body mass index (BMI), advancing age, and male sex were key correlates of developing an abnormal geometry. Development of an abnormal LV geometric pattern over 4 years was associated with increased CVD risk (140 events) during a subsequent median follow-up of 12 years (adjusted-hazards ratio: 1.59; 95% confidence interval: 1.04 to 2.43).ConclusionsThe longitudinal observations in the community suggest that dynamic changes in LV geometric pattern over time are common. Higher blood pressure and greater BMI are modifiable factors associated with the development of abnormal LV geometry, and such progression portends an adverse prognosis.     

Echocardiography for Hypertrophic Cardiomyopathy

Hypertrophic cardiomyopathy (HCM) is a genetic cardiomyopathy. The prevalence of phenotypic expression, in the absence of another systemic or cardiac disease causing increased left ventricular (LV) wall thickness, is estimated to be 1:500. The frequency of clinical presentation is far less, highlighting the need for a non-invasive diagnostic imaging tool. Echocardiography is readily available and allows for structural characterization and hemodynamic assessment of the hypertrophic heart and to screen patients at-risk for HCM, such as first degree relatives of affected individuals, and differentiate HCM from the athletic heart. Echocardiography can also be used to assess for anatomic abnormalities of the mitral valve apparatus that may exacerbate LV outflow track obstruction and to further risk stratify patients during exercise. Finally, echocardiography plays an integral role in guiding alcohol septal ablation procedures.     

The Global Burden of Aortic Stenosis

Degenerative, calcific valvular aortic stenosis (AS), caused by an active process of atherosclerosis, calcification and ossification, is the most common cause of AS in industrialized nations. The prevalence of calcific AS is age-dependent, and thus is expected to increase due to demographic aging of the global population. It is well recognized that severe AS carries a poor prognosis if left untreated. Despite this recognition, many patients are inappropriately denied surgery because of perceived risk. This article will examine the etiology, prevalence, and current trends in the treatment of degenerative AS focusing on indications for surgical aortic valve replacement.     

The effect of enzyme replacement therapy on clinical outcomes in female patients with Fabry disease – A systematic literature review by a European panel of experts

BackgroundHeterozygous females with Fabry disease have a wide range of clinical phenotypes depending on the nature of their mutation and their X-chromosome inactivation pattern; it is therefore important to examine outcomes of enzyme replacement therapy (ERT) in the female patient population specifically. This paper presents the findings of a systematic literature review of treatment outcomes with ERT in adult female patients.MethodsA comprehensive systematic literature review was conducted through January 2017 to retrieve published papers with original data on ERT in the treatment of Fabry disease. The review included all original articles that presented ERT outcomes data on patients with Fabry disease, irrespective of the study type.ResultsClinical evidence for the efficacy of ERT in female patients was available from 67 publications including six clinical trial publications, and indicates significant reductions in plasma and urine globotriaosylceramide (GL-3) accumulation (in female patients with elevated pre-treatment levels) and improvements in cardiac parameters and quality of life (QoL). To date, data are insufficient to conclude on the effects of ERT on the nervous system, gastrointestinal manifestations, and pain in female patients with Fabry disease.ConclusionsThis review of available literature data demonstrates that ERT in adult female patients with Fabry disease has a beneficial effect on GL-3 levels and cardiac outcomes. The current evidence also suggests that ERT may improve QoL in this patient population, though further studies are needed to examine these results.