心率减速力及连续心率减速力对冠心病心脏性猝死的预警价值

目的：通过心率减速力（DC）及连续心率减速力（DRs）检测技术对老年冠心病患者进行风险分层,探讨其对心脏性猝死的预警价值。方法：随机选择经冠状动脉造影（CAG）确诊为冠心病（CHD）的患者218例作为观察组,其中隐匿性CHD 55例,急性心肌梗死（AMI）56例,心绞痛（AP）53例,缺血性心力衰竭（IHF）54例。同期选取在本院进行健康体检者55例（对照组）,对各组患者行24 h动态心电图检查,应用软件系统分析并计算出DC值及DRs值进行统计分析。结果：CHD各亚组（AMI组、AP组、IHF组、隐匿性CHD组）的DC值及DRs值均明显降低,与正常组比较,差异有统计学意义（P < 0.01）;DC值与DRs值所提示CAD各亚组的危险分级明显高于正常组,差异有统计学意义（P < 0.01）;冠状动脉造影显示冠脉病变数量越多范围越大,病情越重,这与DC、DRs所提示CHD各亚组的危险分级相一致。结论：心率减速力和连续心率减速力能够测定分析迷走神经功能,对冠心病患者进行危险分级,对高危人群有较高的预警价值,可作为预警冠心病患者发生心脏性猝死的敏感指标。     

急性心肌梗死患者心电图碎裂QRS波与左心室收缩功能、心率变异性及心脏事件的关系研究

目的:探讨急性心肌梗死患者心电图碎裂QRS(f QRS)波与左心室收缩功能、心率变异性及心脏事件的关系。方法:收集2018年1月～2020年1月期间于本院进行治疗的急性心肌梗死患者124例,对患者行心电图检查,根据患者心电图是否出现f QRS波分成f QRS组(59例)和无f QRS组(65例),采用多普勒超声诊断仪对两组患者的左心室收缩功能进行检测对比,并对两组患者进行24h动态心电图检查,对两组患者的心率变异性指标进行统计对比。对两组患者进行为期3个月的随访观察,统计对比两组患者随访期间心脏事件的发生率。结果:f QRS组患者的左室射血分数(LVEF)低于无f QRS组,左心室舒张末期容积(LVEDV)、左心室舒张末期内径(LVEDD)均高于无f QRS组(P0.05)。f QRS组患者总标准差(SDNN)、两个相邻RR间期互差(PNN50)、差值均方根(RMSSD)均低于无f QRS组(P0.05)。随访期间f QRS组患者的心脏事件发生率为35.59%(21/59),高于无f QRS组患者的13.85%(9/65)(P0.05)。结论:伴有心电图f QRS波急性心肌梗死患者的左心室收缩功能降低,心率变异性指标降低,且心脏不良事件发生率增加,心电图f QRS波在一定程度上可作为急性心肌梗死患者心功能、心率变异性及心脏事件发生的监测手段。     

心源性猝死心电预测和综合防治研究进展

随着社会老龄化的进一步加剧,冠心痛、高血压、心肌病、恶性心律失常的发病率也成为导致人群中猝死率上升的重要诱发因素.对猝死发病机制的研究中,室性心动过速和室颤往往是导致病人发生猝死的最主要的终末事件.在这篇文章中我们通过12导联心电图(ECG)的心电学预测因子的研究,揭示心电学预测因子在预防心源性猝死中的临床应用价值.另一方面,如何能提高预防猝死的预测因子的敏感性和特异性,发现新的更有临床应用价值的心电学预测因子,更好的防治猝死对社会人群的危害,成为临床研究中不断探寻的答案.最后,我们将近年来对心源性猝死的防治措施及未来的发展方向做一简要的综述.     

36 例心源性猝死尸检的临床病理学研究*

目的:分析心源性猝死的临床病理学特征,为心源性猝死的诊断和预防提供理论依据。方法:收集36例心源性猝死病例的尸检解剖资料,进行病理组织学检查。结果:36例心源性猝死者中,冠心病21例,占心源性猝死者总数的58.33%;心律失常性右心室心肌病猝死者3例,占心源性猝死者总数的8.33%。结论:科学系统的尸检可以明确猝死原因,为医疗纠纷鉴定提供可靠依据,同时,对提高医疗质量,早期诊断、治疗心血管系统疾病和减少猝死发生起有重要作用。     

心脏性猝死者心肌HO-1 和VEGF 的表达及意义

目的:探讨血红素加氧酶-1(hemeoxygenase-1,HO-1)、血管内皮生长因子(vascularendothelial growthfactor,VEGF)在心脏性猝死病人心室肌细胞中的表达及其意义.方法:运用免疫组织化学方法和Simple PCI图像分析系统观察33例心脏性猝死组和18例非心脏性猝死对照组尸检心肌组织中HO-1、VEGF蛋白的表达情况.结果:心脏性猝死组心肌组织HO-1(155.090±8.957)和VEGF蛋白表达(121.020±10.927)均显著高于非心脏性猝死对照组(116.200±6.355、84.207±4.402,均p<0.05).结论:HO-1和VEGF蛋白在心脏性猝死者心肌组织表达增强,可能与心脏性猝死有一定关系.

Abstract：

Objective: To investigate expression of the heine oxygenaso-1 (HO-I )and vascular endothelial growth factor (VEGF)in the left ventricle in patients with sudden cardiac death (SCD). Methods: Immunohistoehernistry and Simple PCI image analysis system were used to detect the expressions of riO-1 and VEGF in 33 eases of SCD and 18 eases of non SCD (control group). Results: The expressions of HO-1( 155.090± 8.957) and VEGF(121.020± 10.927) in the myoeardium of patients in SCD group were significantly higher than those in control group (116.200± 6.355, 84.207± 4.402 ,all p<0.05). Conclusions: The high expression of HO-1 and VEGF may be related with the sudden cardiac death to some extent.     

Sudden death and its predictors in myocardial infarction survivors in an Indian population

ObjectiveThis study was conducted to assess the incidence of sudden cardiac death (SCD) in post myocardial infarction patients and to determine the predictive value of various risk markers in identifying cardiac mortality and SCD.MethodsLeft ventricular function, arrhythmias on Holter and microvolt T wave alternans (MTWA) were assessed in patients with prior myocardial infarction and ejection fraction ≤ 40%. The primary outcome was a composite of cardiac death and resuscitated cardiac arrest during follow up. Secondary outcomes included total mortality and SCD.ResultsFifty-eight patients were included in the study. Eight patients (15.5%) died during a mean follow-up of 22.3 ± 6.6 months. Seven of them (12.1%) had SCD. Among the various risk markers studied, left ventricular ejection fraction (LVEF) ≤ 30% (Hazard ratio 5.6, 95% CI 1.39 to 23) and non-sustained ventricular tachycardia (NSVT) in holter (5.7, 95% CI 1.14 to 29) were significantly associated with the primary outcome in multivariate analysis. Other measures, including QRS width, heart rate variability, heart rate turbulence and MTWA showed no association.ConclusionsAmong patients with prior myocardial infarction and reduced left ventricular function, the rate of cardiac death was substantial, with most of these being sudden cardiac death. Both LVEF ≤30% and NSVT were associated with cardiac death whereas only LVEF predicted SCD. Other parameters did not appear useful for prediction of events in these patients. These findings have implications for decision making for the use of implantable cardioverter defibrillators for primary prevention in these patients.     

除颤时间与心脏性猝死除颤复苏成功率的相关性分析

目的:研究除颤时间与心脏性猝死患者除颤复苏成功率的相关性。方法:选取2015年2月至2017年6月于我院接受除颤复苏治疗的心脏性猝死患者120例为研究对象。分析除颤时间与除颤复苏成功以及心功能舒张早期充盈峰速度(E峰)、左室射血分数(LVEF)、左心室舒张末期内径(LVEDD)以及E/舒张晚期充盈峰速度(A)水平的相关性。结果:电除颤时间2 min患者的复苏成功率为60.00%(21/35),显著高于电除颤时间2~5 min、5~10 min以及10 min患者的34.21%(13/38)、11.11%(3/27)、0.00%(0/20),而电除颤时间2~5 min患者的复苏成功率又显著高于电除颤时间5~10 min患者,差异均有统计学意义(均P0.05)。电除颤时间2 min、2~5 min、5~10 min以及10 min患者的E峰、LVEF、LVEDD以及E/A水平呈逐渐下降趋势,差异均有统计学意义(均P0.05)。Pearson相关性分析结果显示心脏性猝死患者除颤时间与除颤复苏成功率、E峰、LVEF、LVEDD以及E/A均呈负相关关系(r=-0.593,P=0.000;r=-0.476,P=0.001;r=-0.523,P=0.000;r=-0.502,P=0.000;r=-0.469,P=0.001)。结论:除颤时间与心脏性猝死患者除颤复苏成功率呈负相关关系,即除颤时间越早,患者复苏成功率越高。     

心脏性猝死者心肌HO-1和VEGF的表达及意义

目的：探讨血红素加氧酶-1（heme oxygenase-1,HO-1）、血管内皮生长因子（vascular endothelial growth factor,VEGF）在心脏性猝死病人心室肌细胞中的表达及其意义。方法：运用免疫组织化学方法和Simple PCI图像分析系统观察33例心脏性猝死组和18例非心脏性猝死对照组尸检心肌组织中HO-1、VEGF蛋白的表达情况。结果：心脏性猝死组心肌组织HO-1（155.090±8.957）和VEGF蛋白表达（121.020±10.927）均显著高于非心脏性猝死对照组（116.200±6.355、84.207±4.402,均p〈0.05）。结论：HO-1和VEGF蛋白在心脏性猝死者心肌组织表达增强,可能与心脏性猝死有一定关系。     

Synaptic Neurochemistry of Human Striatum During Development: Changes in Sudden Infant Death Syndrome

Abstract: There is evidence of abnormalities in the brain-stem monoamine-containing neurons in infants with sudden infant death syndrome (SIDS). By taking advantage of the rich innervation of the human basal ganglia by monoam-inergic afferents from cell bodies in the brainstem, we studied the synaptic chemistry of catecholamine and associated neurons of the putamen obtained postmortem from 14 SIDS infants, eight age-matched control infants, and older control subjects of various ages. We found significantly lower concentrations of dopamine and higher homovanillic acid/DA ratios in samples from SIDS infants compared with age-matched control infants. Noradrenaline and 5-hydroxytryptamine were lower in SIDS compared with control subjects, but the difference did not reach statistical significance. There was no clear evidence that dihydroxyphe-nylacetic acid and 5-hydroxyindoleacetic acid were altered. Immunoblot analysis of striatal tissue showed that samples from infants with SIDS, which exhibited lower DA, also had lower tyrosine hydroxylase protein. Other transmitter-specific neuronal markers were also assessed, including enzymes associated with cholinergic and GABA-containing neurons. We found significantly decreased choline acetyltransferase activities. However, GABA, glutamate, or somatostatin concentrations or monoamine oxidase activities were unchanged in SIDS. We also noted age-dependent changes in brain weights and some synaptic markers by comparing the age-matched infants with older control subjects. Analysis of variance revealed that homovanillic acid, dihydroxyphenylacetic acid, and monoamine oxidase B activities were increased with age. DA and choline acetyltransferase were also found to be positively correlated in putamen. Our findings suggest developmental changes in some transmitter-specific neurons in SIDS that may result from apneic episodes or chronic hypoxia induced before death.     

Postmortem mRNA Expression Patterns in Left Ventricular Myocardial Tissues and Their Implications for Forensic Diagnosis of Sudden Cardiac Death

Sudden cardiac death (SCD), which is primarily caused by lethal heart disorders resulting in structural and arrhythmogenic abnormalities, is one of the prevalent modes of death in most developed countries. Myocardial ischemia, mainly due to coronary artery disease, is the most common type of heart disease leading to SCD. However, postmortem diagnosis of SCD is frequently complicated by obscure histological evidence. Here, we show that certain mRNA species, namely those encoding hemoglobin A1/2 and B (Hba1/2 and Hbb, respectively) as well as pyruvate dehydrogenase kinase 4 (Pdk4), exhibit distinct postmortem expression patterns in the left ventricular free wall of SCD subjects when compared with their expression patterns in the corresponding tissues from control subjects with non-cardiac causes of death. Hba1/2 and Hbb mRNA expression levels were higher in ischemic SCD cases with acute myocardial infarction or ischemic heart disease without recent infarction, and even in cardiac death subjects without apparent pathological signs of heart injuries, than control subjects. By contrast, Pdk4 mRNA was expressed at lower levels in SCD subjects. In conclusion, we found that altered myocardial Hba1/2, Hbb, and Pdk4 mRNA expression patterns can be employed as molecular signatures of fatal cardiac dysfunction to forensically implicate SCD as the primary cause of death.     

QRS、QT、QTc及LVEF预测心源性猝死的价值分析

摘要 目的：探讨QRS时限值（QRS）、QT间期延长（QT）、QTc间期（QTc）及左室射血分数（LVEF）预测心源性猝死的价值分析。方法：选择2018年1月至2019年12月川北医学院附属医院心血管内科治疗的356例心源性猝死患者进行研究,设为病例组,并选择同期体检的健康人200例作为对照组,分析QRS、QT、QTc及LVEF水平变化情况及其预测价值。结果：病例组QRS、QTc水平显著高于对照组,QT、LVEF水平显著低于对照组,差异显著（P＜0.05）;轻度QRS、QTc显著低于中度、重度患者,QT、LVEF水平显著高于中度、重度患者;中度患者QRS、QTc显著低于重度患者,QT、LVEF水平显著高于重度患者,差异显著（P＜0.05）;ROC结果显示,QRS预测心源性猝死的AUC为0.989,灵敏度△为84.59%,特异度为87.68%,截断值为115.59ms;QT预测心源性猝死的AUC为0.944,灵敏度85.12%,特异度为88.45%,截断值为21.69ms;QTc预测心源性猝死的AUC为0.984,灵敏度为86.05%,特异度为88.61%,截断值为416.39ms,LVEF预测心源性猝死的AUC为0.997,灵敏度87.15%,特异度为89.05%,截断值为45.63%,（P＜0.05）。结论：QRS、QT、QTc及LVEF在心源性猝死患者中检查,可显著提高心源性猝死临床诊断效能。     

猪心脏移植中供体急性脑死亡模型的初步研究

目的建立猪心脏移植供体的急性脑死亡模型,观察急性脑死亡前及后1、5、10 min时的血流动力学和血浆中儿茶酚胺释放的变化并进行初步探讨。方法采用30~40 kg的猪8只,急性脑死亡前为对照组,急性脑死亡后为实验组。测定脑死亡前基础水平及脑死亡后1、5、10 min时血流动力学改变和血浆中儿茶酚胺释放的变化,并对二者的变化进行初步探讨。结果急性脑死亡后1 min时血流动力学及儿茶酚胺水平改变最明显,心率增加了88%,收缩压升高了132%,心排量增加了80%,肾上腺素(E)和去甲肾上腺素(NE)分别升高240%和241%,多巴胺(DA)没有明显增加。随后二者均持续下降,至10 min时已降至基础水平以下。血流动力学改变的程度及时间分布与儿茶酚胺中的肾上腺素和去甲肾上腺素一致。结论急性脑死亡可造成机体血流动力学及血浆儿茶酚胺水平的剧烈改变,血中儿茶酚胺含量升高是造成急性脑死亡后血流动力学改变的原因,其中E和NE与血流动力学改变直接相关。