Balloon Venoplasty of Subclavian Vein and Brachiocephalic Junction to Enable Left Ventricular Lead Placement for Cardiac Resynchronisation Therapy

This report describes the successful implantation of a LV lead using balloon venoplasty to overcome a very tight stenosis of the right subclavian vein / brachiocephalic junction for cardiac resynchronisation therapy (CRT-P) in a patient with a right sided CRT-P system and a failed epicardial LV lead. It is important for device implanters to be familiar with interventional equipments and techniques such as balloon venoplasty to overcome difficult venous access.     

Utility of the NavX® Electroanatomic Mapping System for Permanent Pacemaker Implantation in a Pregnant Patient with Chagas Disease

Chagas disease is a highly prevalent zoonosis in Mexico, Central, and South America. Early cardiac involvement is one of the most serious complications of this disease, and conduction disturbances may occur at an early age. We describe a young pregnant woman with Chagas disease and a high degree atrioventricular block, who required implantation of a permanent dual chamber pacemaker. Using an electroanatomic navigation EnSite NavX® system the pacemaker was successfully implanted with minimal fluoroscopic exposure. This case demonstrates the safety and feasibility of using an electroanatomic navigation system to guide permanent pacemaker implantation minimizing x-ray exposure in pregnant patients.     

Effects of Age and Gender on Sleep Habits and Sleep Trouble for Aged People

The healthy 455 subjects above 60 years of age were questioned on their sleep habit inventory and the morningness-eveningness questionnaire. We analyzed the effects of age and sex on sleep habits and sleep-related trouble. Bedtimes on weekdays and weekends became earlier with aging, and women went to bed significantly later than men did. The length of sleep on weekdays slightly increased with aging, and it was longer for men than for women. The number of urinations and awakenings during nocturnal sleep and the amount of daytime napping increased with aging. The score on morningness-eveningness shifted toward the morning type with aging. In comparison with men, women had significantly longer sleep latency; and a higher percentage of subjects who reported that they sleep for only a short time, have sleep trouble, have received medical treatment for their sleep trouble, and take sleep medication. From these results, we deduced that the phase of sleep shifted forward in subjects above 60 years of age, and they showed frequent interruptions during nocturnal sleep and long daytime napping. We discussed the factor of gender difference in sleep in relation to social and cultural factors, particularly the household activities of women.     

Psychiatric disturbance as a consequence of abnormal periodic cardiac variation

Abstract

The relationship between cardiac rate variation, resting sinus rhythm heart rate in beats per minute, and mental state is reviewed. A small series of 12 psychiatric patients in whom these variables were studied both before and after appropriate psychiatric treatment is reported. Comparison with the periodicity of cardiac rate variation in a normal group of subjects showed that the setting of the biological clock governing cardiac rate variation in psychiatric patients is abnormal, and in these cases running at a slower frequency than that of mental health. Appropriate psychiatric therapy re‐sets this clock in patients responding to treatment, but fails to do so in those patients who remain unimproved. Resting mean sinus rhythm heart rate in beats per minute does not show this relationship.     

恒磁场增强心肌梗死大鼠骨髓间充质干细胞移植后心脏功能改善

目的：研究恒磁场对心肌梗死大鼠骨髓间充质干细胞（bone marrow-derived mesenchymal stem cells,BMSCs）移植后心脏功能的影响。方法：取180g,9-12周龄雄性SD大鼠骨髓,以密度梯度离心分离出单个核细胞（MNCs）,于体外培养并传代培养出骨髓间充质干细胞（MSCs）。制作大鼠心肌梗死模型,将1.5×106BMSCs注射入梗死梗死区周围,分为磁场照射＋BMSCs植入组、BMSCs植入组及空白对照组。4周后处死动物,每组5只大鼠。磁场照射组用0.4 T恒磁场置于心前区30 min,每日1次,共7天。用颈动脉插管法测定心脏功能,Masson三色染色测定梗死面积,VWF VIII染色计算血管密度。结果：与对照组相比BMSCs组以及磁场组均可以显著提高左心室收缩压（LVSP）,dp/dtmax以及-dp/dtmax,减少LVEDP（P〈0.05）。但是,磁场组与BMSCs组相比LVSP,左心室内压最大上升速率（dp/dtmax）以及左心室内压最大下降速率（-dp/dtmax）增高,左心室舒张末压（LVEDP）减少（P〈0.05）。与对照组相比BMSCs组以及磁场组均可以显著提高减少心梗面积（P〈0.05）。磁场组与BMSCs组相比心梗面积减少（P〈0.05）。与对照组相比BMSCs组以及磁场组均可以显著提高增加血管密度（P〈0.05）。磁场组与BMSCs组相比血管密度增加（P〈0.05）。结论：恒磁场具有加强移植BMSCs改善心脏功能的作用。     

非透析慢性肾脏病患者心脏功能生物标记物的临床价值比较

目的:比较非透析慢性肾脏病患者心脏功能生物标记物的临床应用价值。方法:选取122例非透析且无急性冠脉综合征(ACS)的慢性肾脏病患者(CKD),将其分为CKD1-2期组、CKD3-4期组和CKD5期组,同时选择同期确诊急性冠脉综合征的慢性肾脏病患者20例作为对照组,观察并比较各组患者室间隔厚度(IVST)、左室后壁厚度(LVPWT),检测血液中血肌酐(Scr)、尿素氮(BUN)、心型脂肪酸结合蛋白(HFABP)、心肌钙蛋白(cTnI)以及肌酸激酶同功酶(CK-MB)。结果:非ACS的CKD患者HFABP、cTnI、CK-MB水平均呈不同程度增高,且各CKD组中这三个指标的阳性率存在显著差异,其中HFABP阳性率最高(P0.05)。cTnI与e GFR、Scr及年龄无显著相关性(P0.05),但与IVST、LVPWT呈显著正相关(P0.05);CK-MB与e GFR、Scr、年龄、IVST、LVPWT均无相关性(P0.05);HFABP与e GFR呈负相关(P0.05),与Scr和BUN正相关(P0.05),与年龄、IVST、LVPWT无相关性(P0.05)。结论:在非ACS的CKD患者中,HFABP可能不是一个可靠的反映心脏功能的生物标记物,cTnI及CK-MB对于CKD患者而言是较为可靠的心脏标记物。     

Comparative Gene Expression Analysis of Mouse and Human Cardiac Maturation

Understanding how human cardiomyocytes mature is crucial to realizing stem cell-based heart regeneration, modeling adult heart diseases, and facilitating drug discovery. However, it is not feasible to analyze human samples for maturation due to inaccessibility to samples while cardiomy-ocytes mature during fetal development and childhood, as well as difficulty in avoiding variations among individuals. Using model animals such as mice can be a useful strategy;nonetheless, it is not well-understood whether and to what degree gene expression profiles during maturation are shared between humans and mice. Therefore, we performed a comparative gene expression analysis of mice and human samples. First, we examined two distinct mice microarray platforms for shared gene expression profiles, aiming to increase reliability of the analysis. We identified a set of genes display-ing progressive changes during maturation based on principal component analysis. Second, we demonstrated that the genes identified had a differential expression pattern between adult and ear-lier stages (e.g., fetus) common in mice and humans. Our findings provide a foundation for further genetic studies of cardiomyocyte maturation.     

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.     

β-arrestin 2 attenuates cardiac dysfunction in polymicrobial sepsis through gp130 and p38

Sepsis is an exaggerated systemic inflammatory response to persistent bacteria infection with high morbidity and mortality rate clinically. β-arrestin 2 modulates cell survival and cell death in different systems. However, the effect of β-arrestin 2 on sepsis-induced cardiac dysfunction is not yet known. Here, we show that β-arrestin 2 overexpression significantly enhances animal survival following cecal ligation and puncture (CLP)-induced sepsis. Importantly, overexpression of β-arrestin 2 in mice prevents CLP-induced cardiac dysfunction. Also, β-arrestin 2 overexpression dramatically attenuates CLP-induced myocardial gp130 and p38 mitogen-activated protein kinase (MAPK) phosphorylation levels following CLP. Therefore, β-arrestin 2 prevents CLP-induced cardiac dysfunction through gp130 and p38. These results suggest that modulation of β-arrestin 2 might provide a novel therapeutic approach to prevent cardiac dysfunction in patients with sepsis.     

rh-BNP联合阿托伐他汀治疗急性心梗后心衰的临床疗效及对患者血清cTn-I、Myo、CK-MB水平的影响

目的:研究重组人脑利钠肽(rh-BNP)联合阿托伐他汀治疗急性心梗后心衰的临床效果及对患者血清心肌肌钙蛋白(cardiac troponin,cTn-I)、肌红蛋白(Myoglobin,Myo)、肌酸激酶同工酶(CK-MB)水平的影响。方法:选择我院2017年2月～2019年1月收治的72例急性心梗后心衰患者,按随机数字表法分为观察组38例,对照组34例。对照组给予阿托伐他汀治疗,观察组在对照组基础上另加rh-BNP,观察和比较两组的临床疗效,治疗前后血清cTn-I、Myo、CK-MB水平的变化及治疗后不良反应的发生情况。结果:治疗后,观察组总有效率明显高于对照组(P0.05),血清cTn-I、Myo、CK-MB水平均显著低于对照组[(0.23±0.10) vs.(0.16±0.08)、(27.54±3.86) vs.(21.62±2.54)、(70.82±9.25) vs.(61.28±8.33)](P0.05)。观察组治疗后不良反情况总发生率为7.89%,明显低于对照组(26.47%,P0.05)。结论:与单用阿托伐他汀治疗相比,静脉注射rh-BNP联合阿托伐他汀治疗急性心梗后心衰可显著提高临床疗效和安全性,有效减低血清cTn-I、Myo、CK-MB水平。