Soluble ST2 is associated with disease severity in arrhythmogenic right ventricular cardiomyopathy

Purpose: Diagnostic and prognostic evaluation remains challenging in arrhythmogenic right ventricular cardiomyopathy (ARVC). We measured plasma concentration of soluble ST2 (sST2) and assessed its association with right ventricular (RV) function and ventricular arrhythmias in patients with ARVC.

Methods: We included patients with ARVC and genotype positive relatives. Soluble ST2 was determined by ELISA. We assessed myocardial function by echocardiography including strain by speckle tracking technique.

Results: We included 44 subjects (age 41?±?15 years, 21 (48%) female). Soluble ST2 was associated with RV global strain (r?=?0.44; p?=?0.008), as well as with left ventricular (LV) function. Plasma levels of sST2 were higher in patients with ventricular arrhythmias than in patients without ventricular arrhythmias (35?±?13?ng/mL vs. 26?±?7?ng/mL, p?=?0.009). The association between sST2 and ventricular arrhythmias remained significant even after adjusting for RV function (Wald?=?5.2; p?=?0.02).

Conclusions: Soluble ST2 is associated with RV and LV function in patients with ARVC. Soluble ST2 may aid in the determination of disease severity in ARVC.     

颈动脉瞬时波强无创评价高血压不同构型左心室功能的研究

目的:探讨瞬时波强(WI)评价高血压不同构型心室功能的价值.方法:测量105例高血压组和98例对照组颈总动脉WI,左心室结构和功能指标.结果:①从对照组,高血压正常构型组,向心性重构组,向心性肥厚组到离心性肥厚组:其血压水平,左室舒张末内径,重量指数递增;中层短轴缩率递减;左室射血分数在向心性肥厚组增大,离心性肥厚组减...     

超声心动图评价左室舒张性心力衰竭患者左心形态及舒张功能的应用价值

目的:研究超声心动图对左室舒张性心力衰竭(LVDHF)患者左心形态及舒张功能的评估价值。方法:选择2014年3月至2016年3月我院收治的LVDHF患者78例记为观察组,另选择同期健康志愿者80例记为对照组,两组受试者均进行血压、心率检查,并利用超声心动图技术检测两组受试者的心脏相关指标。结果:观察组的舒张压(DBP)、收缩压(SBP)、心率(HR)、左房内径(LAD)、室间隔厚度(IVST)、左室后壁厚度(LVPWT)、综合指标(E/Ea)及反向血流速度(Ar)水平均明显高于对照组,而早、晚期的运动速度比(Ea/Aa)、血流传播速度(Vp)及峰速比(S/D)水平明显低于对照组,差异均有统计学意义(P0.05)。结论:超声心动图能准确地反应LVDHF患者的左心形态以及舒张功能,可在临床进行推广。     

地奥心血康对冠心病患者左心功能和血液流变学影响

冠心病患者170例,其中90例(男性60例,女性30例,年龄64±7a)采用地奥心血康200mg po.tid为治疗组;另80例(男性54例,女性26例,年龄63±8a)采用复方丹参3片tid为对照组,疗程均为2月。治疗组的左心功能和血流变学指标改善明显优于对照组(P<0.05—0.01)     

Effects of Aged Garlic Extract on Left Ventricular Diastolic Function and Fibrosis in a Rat Hypertension Model

Daily consumption of garlic is known to lower the risk of hypertension and ischemic heart disease. In this study, we examined whether aged garlic extract (AGE) prevents hypertension and the progression of compensated left ventricular (LV) hypertrophy in Dahl salt-sensitive (DS) rats. DS rats were randomly divided into three groups: those fed an 8% NaCl diet until 18 weeks of age (8% NaCl group), those additionally treated with AGE (8% NaCl + AGE group), and control rats maintained on a diet containing 0.3% NaCl until 18 weeks of age (0.3% NaCl group). AGE was administered orally by gastric gavage once a day until 18 weeks of age. LV mass was significantly higher in the 8% NaCl + AGE group than in the 0.3% NaCl group at 18 weeks of age, but significantly lower in the 8% NaCl + AGE group than in the 8% NaCl group. No significant differences were observed in systolic blood pressure (SBP) between the 8% NaCl and 8% NaCl + AGE groups at 12 and 18 weeks of age. LV end-diastolic pressure and pressure half-time at 12 and 18 weeks of age were significantly lower in the 8% NaCl + AGE group compared with the 8% NaCl group. AGE significantly reduced LV interstitial fibrosis at 12 and 18 weeks of age. Chronic AGE intake attenuated LV diastolic dysfunction and fibrosis without significantly decreasing SBP in hypertensive DS rats.     

高原人体左心室舒张功能和顺应性的改变

应用同步描记心电图、心音图、颈动脉搏动图和心尖搏动图以测定高原人体的左心室舒张功能和顺应性。在4个不同海拔高度进行实验,即76m(海平对照)、2161m、3270m和4179m,每一高度40名健康男性青年,高原3组世居、移居各20名。结果显示:随着海拔增高,主动舒张时间指数(TRTI)有减小趋势,RF波相对振幅(F/H)逐渐降低,A波相对振幅(A/D)则渐趋增大,3270m以上增大明显(p<0.05),舒张振幅时间指数(DATI)逐渐降低,3270m以上差异极显著(p<0.001)。高原世居与移居者相比,在海拔4179m出现明显差别,移居组TRTI、DATI、F/H较低而A/D较高(D<0.05)。测定射血前期与左室射血时间比值(PEP/LVET)、射血分数(EF)及左室周径纤维平均缩短速度(mVcf)3项指标作对照,显示在此高度左室收缩功能仍能保持。高原慢性心肌缺氧可能是导致左室舒张功能和顺应性轻度降低的原因。     

超声检测左心室舒张功能的临床意义——85例超声检测结果与冠状动脉造影的对照分析

目的超声心动图检测左心室舒张功能与冠状动脉造影对照分析,探讨超声诊断的临床意义。方法85例临床疑诊冠心病超声检查左心室二尖瓣口舒张早、晚期血流充盈速度E、A两峰峰值,计算E/A比值,其结果分为舒张功能正常和降低两组。全部病人均与冠状动脉造影结果对照分析。结果超声检测左心室舒张功能与冠脉造影均正常24例,均异常53例,共77例,符合率90.59%,不符合8例,占9.41%;本文依据冠脉造影提出超声检测左心室舒张功能正常值;并发现冠心病早期舒张功能降低,且随年龄与病程长短不同。结论超声检测左心室舒张功能的改变与冠脉造影符合率高,舒张功能于冠心病早期可降低,随病程长短不同,为临床对冠心病诊治和预防提供有价值的信息。     

The influence of right ventricular stimulation on acute response to cardiac resynchronisation therapy

Background

The contribution of right ventricular (RV) stimulation to cardiac resynchronisation therapy (CRT) remains controversial. RV stimulation might be associated with adverse haemodynamic effects, dependent on intrinsic right bundle branch conduction, presence of scar, RV function and other factors which may partly explain non-response to CRT. This study investigates to what degree RV stimulation modulates response to biventricular (BiV) stimulation in CRT candidates and which baseline factors, assessed by cardiac magnetic resonance imaging, determine this modulation.

Methods and results

Forty-one patients (24 (59 %) males, 67 ± 10 years, QRS 153 ± 22 ms, 21 (51 %) ischaemic cardiomyopathy, left ventricular (LV) ejection fraction 25 ± 7 %), who successfully underwent temporary stimulation with pacing leads in the RV apex (RV_apex) and left ventricular posterolateral (PL) wall were included. Stroke work, assessed by a conductance catheter, was used to assess acute haemodynamic response during baseline conditions and RV_apex, PL (LV) and PL+RV_apex (BiV) stimulation.Compared with baseline, stroke work improved similarly during LV and BiV stimulation (∆+ 51 ± 42 % and ∆+ 48 ± 47 %, both p < 0.001), but individual response showed substantial differences between LV and BiV stimulation. Multivariate analysis revealed that RV ejection fraction (β = 1.01, p = 0.02) was an independent predictor for stroke work response during LV stimulation, but not for BiV stimulation. Other parameters, including atrioventricular delay and scar presence and localisation, did not predict stroke work response in CRT.

Conclusion

The haemodynamic effect of addition of RV_apex stimulation to LV stimulation differs widely among patients receiving CRT. Poor RV function is associated with poor response to LV but not BiV stimulation.

Electronic supplementary material

The online version of this article (doi:10.1007/s12471-015-0770-x) contains supplementary material, which is available to authorized users.     

实验恒河猴超声心动图的初步研究

分别采用二维、脉冲多普勒及M型超声心动图Teichholtz公式对1 0只健康成年实验恒河猴(Macacamulatta)的心脏结构、心脏血流动力学及左室收缩功能进行测定,并比较不同性别间各参数的差异,以建立正常健康成年恒河猴超声心动图相关生理学参数的基础正常值。结果表明,健康成年实验恒河猴超声心动图各项生理指标类似于人类新生儿的指标,雌、雄组间比较除室间隔舒张末期厚度有统计学差异外(P <0 0 5 ) ,其余指标均无统计学差异(P >0 0 5 )。     

大鼠心肌梗死模型的建立及梗死后心电生理和左室功能的变化

目的建立具有稳定性高,重复性强,存活时间长的大鼠心肌梗死模型,探讨采用心电图（ECG）和心脏超声心动图（UCG）监测心梗后心电生理和左室功能变化的可行性。方法Wistar大鼠经10%水合氯醛麻醉后,气管切开插管及连通呼吸机,开胸后结扎冠状动脉左前降支。于手术后4、8和12周行ECG检测和UCG检查,术后12周取出心脏行病理检查。结果采用本法建立大鼠心肌梗死模型,术后72h内大鼠存活率为83.3%,术后12周以上大鼠存活率为73.3%。术后48、和12周ECG监测示心梗后PR间期,QRS时限,QT间期和QTc间期均较假手术组延长,同期行UCG监测示心梗后左室舒张末期内径和左室收缩末期内径显著增加,左室射血分数值和左室短轴缩短率值显著降低,12周后组织病理HE染色符合慢性心肌梗死的病理改变。结论本技术操作简单、创伤轻、成功率高,术后采用ECG和UCG可有效监测心梗后不同时期心电变化和左室功能变化。     

高原与平原肺心病右室功能改变的比较研究

目的：检测不同海拔高度肺心病患者右心室肥厚和血清ET水平变化的相关性．方法：肺心病患者高原组和平原组,采用彩色多普勒超声心动图对右心室前壁厚度、右室流出道宽度等指标进行测量比较．血清ET-1含量利用放射免疫技术进行测定。结果：高原组肺动脉瓣a消失、右室前壁增厚和左右肺动脉宽度出现频率显著高于平原组（P〈0．01）;右室流出道增宽、室间隔增宽率高原组高于平原组（P〈0．05）;平均肺动脉压也高于平原组（P〈0．05）;另外,高原组血清ET-1含量也显著高于平原组,并与肺动脉压存在一定的正相关。结论：高原肺心病右心病变较平原组严重,可能与其有更重的低氧血症及ET-1合成增多有关。     

彩色多普勒超声定量评价冠心病患者左心房、左心室功能的诊断意义

目的:评价超声二维斑点追踪显像技术(2D-STI)对冠心病(CAD)患者左心房、左心室功能的临床应用价值。方法:选取2015年12月至2016年12月因CAD在我院住院就诊患者30例作为实验组,另选取同期健康体检者30例为对照组,采用彩色多普勒超声仪应用2D-STI测量左心室各节段心内膜下心肌、中层心肌、心外膜下心肌纵向应变(TLSendo,TLSmid,TLSepi),左室心内膜下心肌、中层心肌、心外膜下心肌整体纵向应变(GLSendo,GLSmid,GLSepi),左心室收缩期左心房应变率(SRs),左心室舒张早期左心房峰值应变率(SRe)和左心室舒张晚期左心房应变率(SRa),并计算其平均值(m SRs,m SRe,m SRa)。比较两组之间的数据。结果:实验组TLSendo为(21.45±9.02)%,TLSepi为(15.22±5.12)%,低于对照组的(26.55±7.59)%、(18.79±3.77)%,差异有统计学意义(P0.05)。实验组GLSendo为(21.07±3.12)%,GLSmid为(18.11±2.57)%,GLSepi为(15.79±3.11)%,均低于对照组的(23.55±2.59)%、(20.82±2.04)%、(18.07±2.00)%,差异有统计学意义(P0.05)。实验组m SRs和m SRe分别为(3.41±0.68)、(-3.09±0.82),低于对照组的(4.55±0.69)、(-3.67±1.30);实验组m SRa为(-4.47±1.33),高于对照组的(-3.52±1.44),差异均有统计学意义(P0.05)。同一检查者两次测量结果的相关系数为r=0.935,P0.05;不同检查者的测量结果相关系数为r=0.931,P0.05。结论:2D-STI可以定量评价CAD的左心功能,其表现主要为左室各层心肌收缩功能降低,左心房储备功能降低。     

中长跑运动的心血管效应

本研究通过利用彩色多普勒超声心动图对２４例专业中长跑运动员的心脏形态、血液动力学改变及收缩舒张功能参数进行了观察,并与２０例从未参加过正规训练的同龄案牍工作者对照组进行了对比研究,结果显示：中长跑运动员的舒张末期左室内径（ＬＶＤｄ）、左室舒张末容量（ＬＶＥＤＶ）、收缩末容量（ＬＶＥＳＶ）、每搏量（ＳＶ）、左室心肌重量（ＬＶＭ）及左室心肌重量指数（ＬＶＭＩ）均高于对照组（Ｐ＜０．０１）;舒张早期峰值血流速度（ＰＦＶＥｃｍ／ｓ）高于对照组（Ｐ＜０．０１）;舒张晚期峰值血流速度（ＰＦＶＡｃｍ／ｓ）,Ｅ峰面积（Ｅａｒｅａｍ）,舒张早期峰值血流速度与舒张晚期峰值血流速度比（ＰＦＶＥ／ＰＦＶＡ）也高于对照组（Ｐ＜０．０５）。而出现三尖辩肺动脉返流的比例也明显高于对照组（Ｐ＜０．０１）。认为：中长跑运动员不仅心脏形态大小及收缩功能有显著改变,而且在舒张功能也有明显变化     

慢性缺氧对两种不同敏感性大鼠肺动脉压和右心功能的影响

将国外引进繁殖的“缺氧敏感大鼠”(Hilltop SD)和国内常用的实验大鼠(Wistar)同时放在模拟5000米高度的低压舱内进行慢性缺氧,(分平原对照和缺氧4、10、20、30、40天六组),发现HT大鼠的肺动脉压升高程度明显大于W大鼠。在缺氧20天以内,随着肺动脉压的升高,两种大鼠右室心肌收缩性能指标[ dp/dt_(max),( dp/dt_(max)(/RVSP)和舒张性能指标[-dp/dt_(max),(-dp/dt_(max)/RVSP]相应增加。但HT大鼠的心脏代偿功能比W大鼠好。缺氧30天以后,上述心肌性能指标均有下降趋势。关于HT大鼠与W大鼠对缺氧敏感性的差异原因尚待进一步研究。     

Progression of heart failure: A role for interstitial fibrosis

Progressive deterioration of left ventricular (LV) function is a characteristic feature of the heart failure (HF) state. The mechanism or mechanisms responsible for this hemodynamic deterioration are not known but may be related to progressive intrinsic dysfunction, degeneration and loss of viable cardiocytes. In the present study, we tested the hypothesis that accumulation of collagen in the cardiac interstitium (reactive interstitial fibrosis, RIF), known to occur in HF, results in reduced capillary density (CD=capillary/fiber ratio) and increased oxygen diffusion distance (ODD) which can lead to hypoxia and dysfunction of the collagen encircled myocyte. Studies were performed in LV tissue obtained from 10 dogs with chronic HF (LV ejection fraction 26±1%) produced by multiple sequential intracoronary, microembolizations. In each dog, CD and ODD were evaluated in LV regions that manifested severe RIF (volume fraction 16±2%) and in LV regions of little or no RIF (volume fraction 4±1%). In regions of severe RIF, CD was significantly decreased compared to regions of no RIF (0.92±0.02 vs. 1.05±0.03) (P<0.03). Similarly, ODD was significantly increased in regions of severe RIF compared to regions of no RIF (15.3±0.4 vs. 12.2±0.3 m) (P<0.001). These data suggest that in dogs with chronic HF, constituent myocytes of LV regions which manifest severe RIF may be subjected to chronic hypoxia; a condition that can adversely impact the function and viability of the collagen encircled cardiocyte.     

Irisin promotes cardiac progenitor cell-induced myocardial repair and functional improvement in infarcted heart

Irisin, a newly identified hormone and cardiokine, is critical for modulating body metabolism. New evidence indicates that irisin protects the heart against myocardial ischemic injury. However, whether irisin enhances cardiac progenitor cell (CPC)-induced cardiac repair remains unknown. This study examines the effect of irisin on CPC-induced cardiac repair when these cells are introduced into the infarcted myocardium. Nkx2.5⁺ CPC stable cells were isolated from mouse embryonic stem cells. Nkx2.5 ⁺ CPCs (0.5 × 10 ⁶) were reintroduced into the infarcted myocardium using PEGlylated fibrin delivery. The mouse myocardial infarction model was created by permanent ligation of the left anterior descending (LAD) artery. Nkx2.5 ⁺ CPCs were pretreated with irisin at a concentration of 5 ng/ml in vitro for 24 hr before transplantation. Myocardial functions were evaluated by echocardiographic measurement. Eight weeks after engraftment, Nkx2.5 ⁺ CPCs improved ventricular function as evident by an increase in ejection fraction and fractional shortening. These findings are concomitant with the suppression of cardiac hypertrophy and attenuation of myocardial interstitial fibrosis. Transplantation of Nkx2.5 ⁺ CPCs promoted cardiac regeneration and neovascularization, which were increased with the pretreatment of Nkx2.5 ⁺ CPCs with irisin. Furthermore, irisin treatment promoted myocyte proliferation as indicated by proliferative markers Ki67 and phosphorylated histone 3 and decreased apoptosis. Additionally, irisin resulted in a marked reduction of histone deacetylase 4 and increased p38 acetylation in cultured CPCs. These results indicate that irisin promoted Nkx2.5 ⁺ CPC-induced cardiac regeneration and functional improvement and that irisin serves as a novel therapeutic approach for stem cells in cardiac repair.     

肱动脉内皮依赖性舒张功能鉴别左室舒张功能假性正常化的价值

目的:研究冠心病患者左室舒张功能假性正常化与肱动脉内皮依赖性舒张功能的关系。方法:将75例行选择性冠状动脉造影的患者按冠状动脉病变程度分为单/双支病变组和三支病变组两组,选取48例健康志愿者作为对照组。检测左室舒张功能指标二尖瓣口血流频谱E峰、A峰、E/A比值,同时观察休息时肱动脉反应性充血后内径变化率。结果:单/双支病变组(第一组)E峰、E/A比值下降,肱动脉反应性充血后内径变化率低于正常对照组(P<0.05);三支病变组(第二组)E峰、E/A值无明显改变,肱动脉反应性充血后内径变化率明显低于对照组(P<0.01)。结论:肱动脉内皮依赖性舒张功能可作为鉴别冠心病左室舒张功能假性正常的指标。     

肺静脉多普勒血流图评价肥厚型心肌病左室舒张功能

为评价肺静脉多普勒血流频谱检测左室舒张功能的价值,我们对２３例正常人和２２例肥厚型心肌病患者进行了研究,结果发现,肥厚型心肌病二尖瓣血流频谱异常者肺静血流谱也能表现异常;在肥厚范围局限的心肌病患者,即使二尖瓣血流频谱正常,肺静脉血流频民可表现异常,特别是ＡＲ峰持续时间和Ｓ波减速时间更有诊断意义,因此用肺静脉血流频率谱评价左室舒张功能不仅交二尖瓣血流图敏感,而且可识别二尖瓣血流图假性正常化,深入研究     

心脏彩超评估高血压左心室肥厚伴左心衰竭患者心功能的临床价值及与NYHA分级的关系研究

目的:探讨心脏彩超评估高血压左心室肥厚(LVH)伴左心衰竭患者心功能的临床价值,分析其超声指标与美国纽约心脏病协会(NYHA)分级的相关性。方法:选择2017年5月至2018年5月我院收治的127例高血压LVH伴左心衰竭患者为观察组,根据NYHA分级将其分为NYHAⅡ级组(41例)、Ⅲ级组(47例)、Ⅳ级组(39例),另选择100例体检的健康志愿者为对照组。所有受试者均接受心脏彩超获得相关参数[左心房内径(LAD)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心室短轴缩短率(LVFS)、左心室后壁厚度(LVPWT)、室间隔厚度(IVST)、左心室射血分数(LVEF)、左心室舒张早期充盈峰最大充盈速度/舒张晚期充盈峰最大峰值速度(E/A)比值、Tei指数],分析心脏彩超相关参数与NYHA分级之间相关性。结果:观察组患者LAD、LVEDD、LVESD、LVPWT、IVST、Tei指数高于对照组(P0.05),LVFS、LVEF、E/A比值低于对照组(P0.05)。Tei指数随着NYHA分级增高而增高(P0.05),LVFS、LVEF、E/A比值随着NYHA分级增高而降低(P0.05)。Spearman秩相关分析结果显示,Tei指数与NYHA分级呈正相关(rs=0.398,P0.05),LVFS、LVEF、E/A比值与NYHA分级呈负相关(rs=-0.285,-0.442,-0.305,P0.05)。结论:高血压LVH伴左心衰竭患者发生明显左室肥厚和左心功能降低,心脏彩超可准确评估高血压LVH伴左心衰竭患者的心功能和病情严重程度,且部分心脏彩超相关参数与NYHA分级相关。     

衰弱对老年射血分数保留的心力衰竭患者左室舒张功能、认知功能和跌倒风险的影响

摘要 目的：观察衰弱对老年射血分数保留的心力衰竭（HFpEF）患者左室舒张功能、认知功能和跌倒风险的影响。方法：选择2021年1月至 2022年11月期间西安交通大学第一附属医院收治的176例老年HFpEF患者。根据衰弱情况将患者分为非衰弱组（n=92）、衰弱前期组（n=48）、衰弱组（n=36）。对比三组左室舒张功能[左心室射血分数（LVEF）、二尖瓣Ｅ峰血流速度（E）/二尖瓣Ａ峰血流速度（A）、左室收缩末期内径（LVESD）、E/二尖瓣环间隔侧和侧壁侧平均组织多普勒速度（e''）、左室舒张末期内径（LVEDD）]、认知功能[简易智能精神状态检查量表（MMSE）、蒙特利尔认知评估量表（MoCA）]、跌倒风险[汉化的预防老年人意外、死亡、伤害工具（STEADI）评分]以及心脏不良事件总发生率。结果：三组LVEF、LVEDD、LVESD、E/A组间对比未见统计学差异（P>0.05）。衰弱组、衰弱前期组的E/e''高于非衰弱组，且衰弱组高于衰弱前期组（P<0.05）。衰弱组、衰弱前期组的MMSE、MoCA评分低于非衰弱组，且衰弱组低于衰弱前期组（P<0.05）。衰弱组、衰弱前期组的跌倒风险评分高于非衰弱组，且衰弱组高于衰弱前期组（P<0.05）。衰弱组、衰弱前期组的心脏不良事件总发生率高于非衰弱组，且衰弱组高于衰弱前期组（P<0.05）。结论：衰弱可在一定程度上影响老年HFpEF患者左室舒张功能，降低患者的认知功能，增加跌倒风险和心脏不良事件总发生率。