血清尿酸、超敏C 反应蛋白与老年永久性房颤的关系

目的:探讨血清尿酸(UA)、超敏C反应蛋白(hs-CRP)、左心房内径(LAD)与老年永久性房颤的相关性。方法:选取2012年8月至2015年9月于首都医科大学宣武医院综合科住院的老年永久性房颤患者78例作为房颤组,选取同期住院窦性心律且无房颤病史的老年患者72例作为对照组,记录各组一般资料及超声心动图、尿酸、hs-CRP水平等,进行比较及相关性分析。结果:1与对照组相比,房颤组血清UA及hs CRP水平、左心房内径大小明显增高(P0.05),2以房颤是否发生为因变量,多因素logistic回归分析显示血清尿酸(OR=2.016,P=0.004)、左房内径(OR=4.180,P=0.001)和hs-CRP(OR=2.846,P=0.002)是老年永久性房颤发生的独立危险因素。3房颤组患者血清尿酸与hs-CRP水平呈正相关(r=0.28,P0.05),尿酸与左心房内径大小呈轻度正相关(r=0.12,P0.05)。结论:血清尿酸、hs-CRP、左房内径是老年永久性房颤发生的独立危险因素;尿酸参与的炎症反应和结构重构可能参与老年永久性房颤的发生。     

房颤不同时期结构重构的血清学变化

目的:探讨转化生长因子-β1(TGF-β1)、基质金属蛋白酶-9(MMP-9)、金属蛋白酶组织抑制因子-1(TIMP-1)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、白介素-10(IL-10)与阵发性或持续性房颤结构重构的关系。方法:入选患者分为3组,其中持续性房颤组30例、阵发性房颤组45例,以及32例阵发性室上速(包括预激综合征)作为对照组,通过ELISA方法检测上述患者左房血清的TGF-β1、MMP-9、TIMP-1、TNF-α、IL-6、IL-10水平,超声测量左心房长径。分析上述细胞因子水平与阵发性房颤或持续性房颤的关系。结果:阵发性房颤组与对照组相比,左房内径增大、TGF-β1、TNF-α升高(P0.05),IL-10、TIMP-1降低(P0.05),MMP-9无统计学差异。持续性房颤组与对照组相比,TGF-β1无统计学差异(P0.05),MMP-9、TNF-α、IL-6均升高(P0.05),IL-10、TIMP-1降低(P0.05);阵发性房颤组TGF-β1高于持续性房颤组(P0.05),持续性房颤组左房内径及MMP-9高于阵发性房颤组(P0.05)。结论:阵发性房颤患者左房扩大,已出现结构重构,结构重构的血清学变化以TGF-β1升高为主;持续性房颤患者结构重构血清学变化以MMP-9、IL-6升高为主。     

老年高血压心室肥厚并心房颤动患者血浆脑钠肽水平的变化及意义

目的探讨老年高血压左室肥厚合并持续性心房颤动与血浆B型脑钠肽(BNP)水平的关系。方法选择2011年1月~2012年12月我院住院及门诊的老年高血压患者106例,对其中48例有持续性心房颤动的老年高血压左室肥厚患者(A组)的血浆BNP水平、左室间隔厚度(IVS)、左房内径(LAD)和左室射血分数(LVEF)进行检测,并与其中30例无房颤病史的高血压心室肥厚(B组)患者及28例单纯高血压(C组)患者进行比较。结果在3组患者左房内径无差异的情况下,合并房颤老年高血压患者血浆BNP水平显著高于无房颤病史者,且随左室肥厚程度加重而升高。结论高血压左室肥厚合并持续性房颤患者的BNP水平明显升高。BNP水平可作为预测高血压左室肥厚患者房颤发生的危险因素。     

慢性心力衰竭合并心房颤动发病的相关机制研究

目的:慢性心力衰竭(Chronic Heart Failure,CHF)是心血管系统常见的疾病,威胁患者的生存周期及生活质量。本研究针对慢性心力衰竭合并房颤的临床特征,进一步探讨其发病机制,为临床治疗提供依据。方法:将80例慢性心力衰竭患者平均分为两组,心律正常的为窦性心律组,伴有心房颤动的作为房颤组。观察并比较两组的左心室射血分数(LVEF)和二尖瓣口舒张期流速(E/A)等心脏功能指标。结果:房颤组左心室射血分数(LVEF)为(0.42±0.08);二尖瓣口舒张期流速(E/A)为(0.65±0.22);左心房内径(LAD)为(53.4±8.2)mm。窦律组左心室射血分数(LVEF)为(0.45±0.09);二尖瓣口舒张期流速(E/A)为(0.72±0.17);左心房内径(LAD)为(46.7±7.9)mm。房颤组患者的LVEF和E/A值均低于窦律组,而LAD则明显高于窦律组,差异具有统计学意义(P0.05)。房颤组醛固酮、血管紧张素(AngII)、脑钠肽(BNP)及超敏C反应蛋白(hs-CRP)均高于窦律组,差异具有统计学意义(P0.05)。结论:慢性心力衰竭合并房颤的发病与患者体内神经内分泌体液系统水平和心脏结构功能有关,具体发病机制需进一步深入研究。     

急性心肌梗死患者新发心房颤动的危险因素及血清氨基末端脑钠尿肽前体、尿酸的预测价值分析

摘要 目的：探讨影响急性心肌梗死患者新发心房颤动的危险因素以及血清氨基末端脑钠尿肽前体（NT-proBNP）、尿酸（UA）对急性心肌梗死患者新发心房颤动的预测价值。方法：选择2019年10月至2021年5月在徐州医科大学附属医院接受诊治的急性心肌梗死患者110例,根据患者住院期间是否新发心房颤动分为房颤组（患者住院期间新发心房颤动,n=30）和无房颤组（患者住院期间未新发心房颤动,n=80）。另选择50例同期在徐州医科大学附属医院体检的健康者作为健康对照组,比较房颤组、无房颤组、健康对照组三组研究对象血清NT-proBNP、UA水平差异。收集患者各项临床资料,多因素Logistic回归分析影响急性心肌梗死患者新发心房颤动的危险因素。采用受试者工作特征（ROC）曲线分析血清NT-proBNP、UA单独以及联合检测对急性心肌梗死患者新发心房颤动的预测价值。结果：房颤组患者血清NT-proBNP、UA水平均明显高于健康对照组和无房颤组,且无房颤组高于健康对照组（P<0.05）。多因素Logistic回归分析显示,高NT-proBNP以及UA水平、高龄、左房增大、合并糖尿病、Killip心功能分级≥Ⅱ级是影响急性心肌梗死患者新发心房颤动的危险因素（P<0.05）。血清UA、NT-proBNP单独及联合预测急性心肌梗死患者新发心房颤动的曲线下面积（AUC）分别为0.730、0.737、0.840。结论：血清NT-proBNP、UA水平对急性心肌梗死患者新发心房颤动的发生具有一定预测价值,且两者联合应用的预测价值最高,除高NT-proBNP以及UA水平外,高龄、左房增大、合并糖尿病、Killip心功能分级≥Ⅱ级亦是新发心房颤动的危险因素。     

超声心动图对高血压心室肥厚患者左心功能的评价及意义

目的:本研究利用超声心动图检测高血压心室肥厚患者左心房结构,探讨当左心结构发生变化时心脏功能所受到的影响,为高血压及其并发症的临床诊断提供检测及诊断参考。方法:选取2011年5月-2013年1月在我院接受检查的高血压心室肥厚患者76例作为观察组,另选取同期经体检的健康人群60例为健康对照组,利用超声心动图观察左心功能和结构,比较两组研究对象的左心房内径(LAD)、心肌质量(LVMM)、舒张末容积(LVEDV)、收缩末容积(LVESV)、左心室射血分数(LVEF)及二尖瓣口舒张末期流速比值(E/A)。结果:两组间心室收缩功能无显著性差异(P0.05);高血压组LAD高于对照组,LVEF及E/A低于对照组,差异具有统计学意义(P0.05);高血压Ⅰ期、Ⅱ期、Ⅲ期患者间比较,左房内径随血压的升高逐渐递增,而左心室射血分数和二尖瓣口舒张期流速比值则逐渐递减,差异具有统计学意义(P0.05)。结论:超声心动图可以直观的显示高血压心室肥厚患者左心功能及血流动力学的变化,对临床诊断具有积极的意义。     

心房颤动患者血清脑钠肽水平变化的临床研究

目的：探讨患者心房颤动（房颤,AF）发作时对血清脑钠肽水平的影响。方法：选择阵发性房颤组、持续性房颤组、对照组（窦性心律）患者各30例,观察各组血清脑钠肽水平;并对阵发性房颤组中心室率≤100 beats/min与心室率〉100 beats/min的患者进行亚组分析;观察阵发性房颤组复律后24 h和30 d血清脑钠肽水平。结果：阵发性房颤组和持续性房颤组血清脑钠肽水平明显高于对照组（P〈0.01）,房颤复律后血清脑钠肽水平很快下降。结论：血清脑钠肽水平在房颤发作时明显升高,血清脑钠肽水平的升高与房颤的发作有关。     

不同剂量阿托伐他汀对冠心病患者心功能、血脂及血清TNF-α、ANF水平的影响

目的:探讨不同剂量阿托伐他汀对冠心病患者心功能、血脂及血清肿瘤坏死因子-α(TNF-α)、心钠素(ANF)水平的影响。方法:选取2016年1月到2017年1月在我院接受治疗的冠心病患者86例,根据随机数字表法将患者分为观察组和对照组,各43例,对照组给予10 mg剂量的阿托伐他汀进行治疗,观察组给予20 mg剂量的阿托伐他汀进行治疗,两组均治疗6个月。比较两组患者治疗前后的左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)、左心房前后径(LAD)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、TNF-α、ANF水平。对所有患者进行1年的随访,比较患者出现心肌梗死、心律失常、心源性死亡等心血管事件的情况。结果:治疗后两组的LVEDD、LAD、TC、TG、LDL-C、TNF-α、ANF均显著降低,LVEF、HDL-C显著升高(P0.05),治疗后观察组的LVEDD、LAD、TC、TG、LDL-C、TNF-α、ANF低于对照组,LVEF高于对照组(P0.05)。两组的心血管事件发生率比较无统计学差异(P0.05)。结论:两种剂量的阿托伐他汀均能有效的改善冠心病患者的心功能和血脂,降低患者体内的炎症反应,但20 mg剂量的阿托伐他汀效果更佳。     

慢性心力衰竭合并心房颤动发病的相关机制研究

目的：慢性心力衰竭（Chronic Heart Failure,CHF）是心血管系统常见的疾病,威胁患者的生存周期及生活质量。本研究针对慢性心力衰竭合并房颤的临床特征,进一步探讨其发病机制,为临床治疗提供依据。方法：将80例慢性心力衰竭患者平均分为两组,心律正常的为窦性心律组,伴有心房颤动的作为房颤组。观察并比较两组的左心室射血分数（LVEF）和二尖瓣1：7舒张期流速（E／A）等心脏功能指标。结果：房颤组左心室射血分数（LVEF）为（0．42±0．08）;二尖瓣口舒张期流速（E／A）为（0．65±0．22）;左心房内径（LAD）为（53．4±8．2）min。窦律组左心室射血分数（LVEF）为（0．45±0．09）;二尖瓣口舒张期流速（E／A）为（0．72±0．17）;左心房内径（LAD）为（46．7±7．9）min。房颤组患者的LVEF和E／A值均低于窦律组,而LAD则明显高于窦律组,差异具有统计学意义（P〈0．05）。房颤组醛固酮、血管紧张素（AngII）、脑钠）]k（BNP）TZ超敏c反应蛋白（hs-CRP）均高于窦律组,差异具有统计学意义（P〈0．05）。结论：慢性心力衰竭合并房颤的发病与患者体内神经内分泌体液系统水平和心脏结构功能有关,具体发病机制需进一步深入研究。     

2 型糖尿病合并高血压患者发生心房颤动的相关因素分析

目的:探讨2型糖尿病合并高血压住院患者发生心房颤动的相关因素。方法:选取我院收治的2型糖尿病合并高血压发生心房颤动的患者112例为研究对象(房颤组,n=112例),同期选取与房颤组年龄及性别相匹配的未发生房颤的2型糖尿病合并高血压患者150例为对照组(n=150例),比较两组患者的一般临床资料、实验室检查指标等的差异,用Logistic回归方程分析患者并发房颤的相关因素。结果:与对照组比较,房颤组患者收缩压(SBP)较高,高血压比例高、服用ACEI/ARB类药物偏低(P0.05)、左室射血分数(LVEF)偏低(P0.05)、左房内径(LAD)长(P0.05)、甘油三酯(TC)、低密度脂蛋白胆固醇(LDL-C)、糖化血红蛋白(HbA1c)、血肌酐(Scr)、B型脑钠肽(BNP)、高敏C反应蛋白(hs-CRP)、尿酸均较高(P0.05);多因素Logistic回归方程分析提示:LAD、HbA1c、BNP、hs-CRP、尿酸是患者并发房颤的独立危险因素(P0.05),而服用ACEI/ARB类药物为保护性因素。结论:LAD、HbA1c、BNP、hs-CRP、尿酸均可能是2型糖尿病合并高血压患者发生心房颤动的独立危险因素。     

Navx-guided Cryoablation of Atrial Tachycardia Inside the Left Atrial Appendage

Radiofrequency ablation procedures inside the left atrial appendage (LAA) are likely to involve dangerous complications because of a high thrombogenic effect. Cryoablation procedures are supposed to be safer. We describe two cases of successful cryoablation procedures. Two NavX-guided cryoablations of permanent focal atrial arrhythmias arising from the LAA were performed. Left atrial reconstruction and mapping allowed the zone of the earliest atrial potential to be recorded; the entire course of the ablation catheter was monitored. The arrhythmias were successfully ablated; no thrombotic complications were observed.     

Atrial fibrillation in the elderly

Atrial fibrillation (AF) is prevalent in the elderly (affecting 5% of persons aged >or= 65 years and around 10% of those aged >or= 80 years old) and is associated with stroke, heart failure and poor quality of life. The symptoms of AF are palpitations, fatigue, reduced exercise capacity, dyspnea or dizziness. AF is associated with comorbidity, mainly hypertension in outpatients, and ischaemic heart disease and heart failure in hospitalized patients. Two therapeutic strategies are available to treat arrhythmia: rhythm control or frequency control. In many elderly patients with AF, frequency control is an effective option, particularly when there is heart failure, contraindications to antiarrhythmic agents or when cardioversion is not indicated. Anticoagulation is the main measure to reduce stroke risk. If anticoagulation is not appropriate for a patient, antiaggregants can be used, but the benefit is clearly lower than that provided by anticoagulation.     

Atrial natriuretic peptide in the sheep

To study atrial natriuretic peptide (ANP) physiology in the chronically catheterized pregnant sheep model we developed a heterologous radioimmunoassay for ovine ANP using an antiserum raised against 1-28 human ANP. This antiserum (Tor I) is specific for the aminoterminus of the human ANP molecule and shows little cross reaction with any carboxyterminus ANP fragments. Ovine ANP immunoreactivity was characterized using this antiserum and a commercially available carboxyterminus ANP antiserum obtained from Peninsula Laboratories. Each antiserum detected 2 peaks of immunoreactivity in ovine atrial extracts chromatographed on a Biogel P-10 column. The minor peak migrated at a position close to 125I-human ANP whereas the major peak represented a larger molecular weight species of ANP. Examination of gel filtration eluates of ovine plasma extracts showed one immunoreactive ANP peak using the Tor I assay system and 2 peaks with the Peninsula Laboratories assay. Plasma immunoreactive ANP levels were determined in 9 sheep using both radioimmunoassay systems. Mean (+/- SEM) levels were similar using the Peninsula Laboratories and the Tor I assay systems (57 +/- 8 pg/ml versus 43 +/- 4 pg/ml, P greater than 0.05). Using the Tor I antiserum, fetal plasma immunoreactive ANP levels were found to be significantly higher than maternal levels (188 +/- 17 versus 48 +/- 8 pg/ml, P less than 0.01) whereas pregnant and nonpregnant adult sheep had similar plasma immunoreactive ANP levels (48 +/- 8 versus 43 +/- 4 pg/ml, P greater than 0.05). Disappearance curves of synthetic human ANP from the plasma of maternal and fetal sheep were assessed using both immunoassay systems and found to be similar.     

The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation

Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting an estimated 6 million people in the United States ¹. Since AF affects primarily elderly people, its prevalence increases parallel with age. As such, it is expected that 15.9 million Americans will be affected by the year 2050 ². Ischemic stroke occurs in 5% of non-anticoagulated AF patients each year. Current treatments for AF include rate control, rhythm control and prevention of stroke ³.The American College of Cardiology, American Heart Association, and European Society of Cardiology currently recommended rate control as the first course of therapy for AF ³. Rate control is achieved by administration of pharmacological agents, such as β-blockers, that lower the heart rate until it reaches a less symptomatic state ³. Rhythm control aims to return the heart to its normal sinus rhythm and is typically achieved through administration of antiarrhythmic drugs such as amiodarone, electrical cardioversion or ablation therapy. Rhythm control methods, however, have not been demonstrated to be superior to rate-control methods ^4-6. In fact, certain antiarrhythmic drugs have been shown to be associated with higher hospitalization rates, serious adverse effects ³, or even increases in mortality in patients with structural heart defects ⁷. Thus, treatment with antiarrhythmics is more often used when rate-control drugs are ineffective or contraindicated. Rate-control and antiarrhythmic agents relieve the symptoms of AF, including palpitations, shortness of breath, and fatigue ⁸, but don''t reliably prevent thromboembolic events ⁶.Treatment with the anticoagulant drug warfarin significantly reduces the rate of stroke or embolism ^9,10. However, because of problems associated with its use, fewer than 50% of patients are treated with it. The therapeutic dose is affected by drug, dietary, and metabolic interactions, and thus requires detailed monitoring. In addition, warfarin has the potential to cause severe, sometimes lethal, bleeding ². As an alternative, aspirin is commonly prescribed. While aspirin is typically well tolerated, it is far less effective at preventing stroke ¹⁰. Other alternatives to warfarin, such as dabigatran ¹¹ or rivaroxaban ¹² demonstrate non-inferiority to warfarin with respect to thromboembolic events (in fact, dabigatran given as a high dose of 150 mg twice a day has shown superiority). While these drugs have the advantage of eliminating dietary concerns and eliminating the need for regular blood monitoring, major bleeding and associated complications, while somewhat less so than with warfarin, remain an issue ^13-15.Since 90% of AF-associated strokes result from emboli that arise from the left atrial appendage (LAA) ², one alternative approach to warfarin therapy has been to exclude the LAA using an implanted device to trap blood clots before they exit. Here, we demonstrate a procedure for implanting the WATCHMAN Left Atrial Appendage Closure Device. A transseptal cannula is inserted through the femoral vein, and under fluoroscopic guidance, inter-atrial septum is crossed. Once access to the left atrium has been achieved, a guidewire is placed in the upper pulmonary vein and the WATCHMAN Access Sheath and dilator are advanced over the wire into the left atrium. The guidewire is removed, and the access sheath is carefully advanced into the distal portion of the LAA over a pigtail catheter. The WATCHMAN Delivery System is prepped, inserted into the access sheath, and slowly advanced. The WATCHMAN device is then deployed into the LAA. The device release criteria are confirmed via fluoroscopy and transesophageal echocardiography (TEE) and the device is released.