A Case of Pediatric Heart Failure Caused by Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery: Case Report and Literature Review

A female patient aged 3 months and 10 days was admitted to the cardiology department because of symptoms of heart failure.According to the echocardiography results,the patient received a diagnosis of primary endocardial fi broelastosis and was treated withγ-globulin,prednisone,digoxin,and diuretics.Coronary computed tomographic angiography and coronary angiography were performed as there was no improvement after 2 months of treatment.Finally,the patient received a diagnosis of anomalous origin of the left coronary artery from the pulmonary artery(ALCAPA).ALCAPA is a rare congenital heart defect that can cause severe heart failure during infancy,and is easily misdiagnosed clinically.In this report,we show the process of misdiagnosis of the case and consult the relevant literature,hoping to improve the understanding and early diagnosis of ALCAPA.

Real-time Three-dimensional Echocardiographic Assessment of Left Ventricular Remodeling Index in Patients with Hypertensive Heart Disease and Coronary Artery Disease

Left ventricular remodeling index （LVRI） was assessed in patients with hypertensive heart disease （HHD） and coronary artery disease （CAD） by real-time three-dimensional echocardiography （RT3DE）. RT3DE data of 18 patients with HHD, 20 patients with CAD and 22 normal controis （NC） were acquired. Left ventricular end-diastolic volume （EDV） and left ventricular end-diastolic epicardial volume （EDVepi） were detected by RT3DE and two-dimensional echocardiography Simpson biplane method （2DE）. LVRI （left ventricular mass/EDV） was calculated and compared. The results showed that LVRI measurements detected by RT3DE and 2DE showed significant differences inter-groups （P〈0.01）. There was no significant difference in NC group （P〉0.05）, but significant difference in HHD and CAD intra-group （P〈0.05）. There was good positive correlations between LVRI detected by RT3DE and 2DE in NC and HHD groups （t=0.69, P〈0.01; r=0.68, P〈0.01）, but no significant correlation in CAD group （r=0.30, P〉0.05）. It was concluded that LVRI derived from RT3DE as a new index for evaluating left ventricular remodeling can provide more superiority to LVRI derived from 2DE.

Arterial hypertension and electrocardiographic diagnosis of left ventricular hypertension in the group of geriatric patients with coronary heart disease living in the far north

As a result of research, high prevalence of arterial hypertension has been identified in the group of patients with coronary heart disease aged 60 and older. Most often, occurring form of arterial hypertension among geriatric patients is isolated systolic arterial hypertension (ISAH). The comparison of two ethnic groups of the population has showed higher levels of systolic and diastolic blood pressure (SBP and DBP) in the group of patients of non-indigenous nationality, rather than Yakut patients. Correlation was recorded in the group of non-indigenous patients as they age. Significant increase in the level of SBP was identified in the group of senile and long-livers than in the elderly. Detection of ECG signs of LVH showed the lowest specificity of Cornell voltage criterion comparing to Sokolow-Lyon criterion with its more often occurrence. ECG-signs of left ventricle hypertrophy are significantly more often established by Sokolow-Lyon criterion for men, Cornell voltage—for women. Correlation has been found between the presence of LVH and combination of Cornell voltage criterion with both Gubner-Ungerleider and Sokolow-Lyon criteria.

Diagnosis and treatment of heart failure with preserved left ventricular ejection fraction

Nearly six million people in United States have heart failure.Fifty percent of these people have normal left ventricular(LV)systolic heart function but abnormal diastolic function due to increased LV myocardial stiffness.Most commonly,these patients are elderly women with hypertension,ischemic heart disease,atrial fibrillation,obesity,diabetes mellitus,renal disease,or obstructive lung disease.The annual mortality rate of these patients is 8%-12%per year.The diagnosis is based on the history,physical examination,laboratory data,echocardiography,and,when necessary,by cardiac catheterization.Patients with obesity,hypertension,atrial fibrillation,and volume overload require weight reduction,an exercise program,aggressive control of blood pressure and heart rate,and diuretics.Miniature devices inserted into patients for pulmonary artery pressure monitoring provide early warning of increased pulmonary pressure and congestion.If significant coronary heart disease is present,coronary revascularization should be considered.

Customized 3D-printed occluders enabling the reproduction of consistent and stable heart failure in swine models

Reproducibility of clinical output is important when investigating therapeutic efficacy in pre-clinical animal studies.Due to its physiological relevance,a swine myocardial infarction(MI)model has been widely used to evaluate the effectiveness of stem cells or tissue-engineered constructs for ischemic heart diseases.Several methods are used to induce MI in the swine model.However,it is difficult,using these approaches,to obtain a similar level of functional outcomes from a group of animals due to interpersonal variation,leading to increased experimental cost.Hence,in order to minimize human intervention,we developed an approach to use a customized occluder that has dimensional similarities with that of the coronary artery of animals in the case of the swine model.We carried out angiography to measure the diameter of the middle left anterior descending artery of each individual animal to fabricate the customized occluder using a 3D-printing system.The fabricated occluder contained a central hole smaller than that of the targeted middle left anterior descending artery to mimic an atherosclerotic coronary artery that has an approximately 20%blocked condition.Interestingly,the 3D-printed occluder can provide continuous blood flow through the central pore,indicating a high survival rate(88%)of up to 28 days post-operation.This method showed the possibility of creating consistent myocardial infarction induction as compared to the conventional representative closed-chest method(50%survival rate),thus highlighting how our method can have a profound effect on accelerating reliable experiments for developing new therapeutic approaches to ischemic heart diseases.

Treatment with neurohormonal inhibitors and prognostic outcome in pulmonary arterial hypertension with risk factors for left heart disease

BACKGROUND Despite major advances in pharmacologic treatment,patients with pulmonary arterial hypertension(PAH)still have a considerably reduced life expectancy.In this context,chronic hyperactivity of the neurohormonal axis has been shown to be detrimental in PAH,thus providing novel insights on the role of neurohormonal blockade as a potential therapeutic target.AIM To evaluate the application and prognostic effect of neurohormonal inhibitors(NEUi)in a single-center sample of patients with idiopathic PAH and risk factors for left heart disease.METHODS We analyzed data retrospectively collected from our register of right heart catheterizations performed consecutively from January 1,2005 to October 31,2018.Patients on beta-blocker,angiotensin-converting enzyme inhibitor,angiotensin receptor blocker or mineralocorticoid receptor antagonist at the time of right heart catheterization were classified as NEUi users and compared to NEUi nonrecipients.RESULTS Complete data were available for 57 PAH subjects:27 of those(47.4%)were taking at least one NEUi at the time of right heart catheterization and were compared with the remaining 36 NEUi non-recipients.NEUi users were older and had a higher cardiovascular risk profile compared to non-recipients.Additionally,NEUi non-users had a higher probability of dying during the course of follow-up than NEUi recipients(56.7%vs 25.9%,log-rank P=0.020).CONCLUSION The above data highlighted a subgroup of patients with PAH and comorbidities for left heart disease in which NEUi use has shown to be associated with improved survival.Future prospective studies are needed to identify the most appropriate therapeutic strategies in this subset population.

Correlation analysis between lung ultrasound scores and pulmonary arterial systolic pressure in patients with acute heart failure admitted to the emergency intensive care unit

Background:No convenient,inexpensive,and non-invasive screening tools exist to identify pulmonary hypertension(PH)-left heart disease(LHD)patients during the early stages of the disease course.This study investigated whether different methods of lung ultrasound(LUS)could be used for the initial investigation of PH-LHD.Methods:This was a single-center prospective observational study which was performed in the Zigong Fourth People’s Hospital.We consecutively enrolled patients with heart failure(HF)admitted to the emergency intensive care unit from January 2018 to May 2020.Transthoracic echocardiography and LUS were performed within 24 h before discharge.We used the Spearman coefficient for correlation analysis between ultrasound scores and pulmonary arterial systolic pressure(PASP).Bland-Altman plots were generated to inspect possible bias,and receiver operating characteristic(ROC)curves were calculated to assess the relationship between ultrasound scores and an intermediate and high echocardiographic probability of PH-LHD.Results:Seventy-one patients were enrolled in this study,with an overall median age of 79(interquartile range:71.5–84.0)years.Among the 71 patients,36(50.7%)cases were male,and 26(36.6%)had an intermediate and high echocardiographic probability of PH.All four LUS scores in patients with an intermediate and high probability of PH were significantly higher than in patients with a low probability of PH(P<0.05).The correlation coefficient(r)between different LUS scoring methods and PASP was moderate for the 6-zone(r=0.455,P<0.001),8-zone(r=0.385,P=0.001),12-zone(r=0.587,P<0.001),and 28-zone(r=0.535,P<0.001)methods.In Bland-Altman plots,each of the four LUS scoring methods had a good agreement with PASP(P<0.001).The 8-zone and 12-zone methods showed moderately accurate discriminative values in differentiating patients with an intermediate and high echocardiographic probability of PH(P<0.05).

Coronary collateral circulation： Effects on outcomes of acute anterior myocardial infarction after primary percutaneous coronary intervention

Background To investigate the effects of collateral coronary circulation on the outcome of the patients with anterior myocardial infarction （MI） with left anterior desending artery occlusion abruptly. Methods Data of 189 patients with acute anterior MI who had a primary percutaneous coronary intervention （PCI） in the first 12 h from the onset of symptoms between January 2004 and December 2008 were retrospective analyzed. Left anterior descending arteries （LAD） of all patients were occluded. LADs were reopened with primary PCI. According to the collateral circulation, all patients were classified to two groups： no collateral group （n = 111）, patients without angiographic collateral filling of LAD or side branches （collateral index 0） and collateral group （n = 78）, and patients with angiographic collateral filling of LAD or side branches （collateral index 1, 2 or 3）. At one year＇ s follow-up, the occurrence of death, reinfarctlon, stent thrombosis （ST）, target vessel revascularization and readmission because of heart failure were observed. Results At one year, the mortality was lower in patients with collateral circulation compared with those without collateral circulation （1% vs. 8%, P = 0.049）, whereas there Were no differences in the occurrence of reinfarction, ST, target vessel revascularization and readmission because of heart failure. The occurrence of composite of endpoint was lower in patients with collateral circulation compared with those without collateral circulation （12% vs. 26%; P = 0.014）. Conclusions Pre-exist collateral circulation may prefigure the satisfactory prognosis to the patients with acute anterior MI after primary PCI in the first 12 h of MI onset.

Ambulatory pulmonary artery pressure monitoring in advanced heart failure patients

Heart failure (HF) is an emerging epidemic associate with significant morbidity, mortality, and health care expenditure. Although there were major advances in pharmacologic and device based therapies for the management of HF, mortality of this condition remains high. Accurate monitoring of HF patients for exacerbations is very important to reduce recurrent hospitalizations and its associated complications. With the failure of clinical signs, tele-monitoring, and laboratory bio-markers to function as early markers of HF exacerbations, more sophisticated techniques were sought to accurately predict the circulatory status in HF patients in order to execute timely pharmacological intervention to reduce frequent hospitalizations. CardioMEMSTM (St. Jude Medical, Inc., Saint Paul, Minnesota) is an implantable, wireless pulmonary arterial pressure (PAP) monitoring system which transmits the patient’s continuous PAPs to the treating health care provider in the ambulatory setting. PAP-guided medical therapy modification has been shown to significantly reduce HF-related hospitalization and overall mortality. In advanced stages of HF, wireless access to hemodynamic information correlated with earlier left ventricular assist device implantation and shorter time to heart transplantation.

冠状动脉CT血管造影预测冠心病患者发生左心室重构及远期心血管不良事件的价值

目的分析冠状动脉CT血管造影预测冠心病患者发生左心室重构及远期心血管不良事件的价值。方法选取郑州大学第一附属医院2021年1月至2022年7月诊治的120例冠心病患者,随访1 a,根据左心室重构发生情况分为左心室重构组(26例)、无左心室重构组(94例),根据心血管不良事件发生情况分为发生组(24例)、未发生组(96例)。比较不同组别患者冠状动脉CT血管造影结果,分析冠状动脉CT血管造影预测冠心病患者发生左心室重构及远期心血管不良事件的价值。结果左心室重构组、无左心室重构组在冠状动脉管腔狭窄程度和高危斑块特征方面的差异有统计学意义(P<0.05)。发生组、未发生组斑块总体积、钙化斑块体积、非钙化斑块体积、病变长度、斑块负荷比较,差异有统计学意义(P<0.05)。受试者工作特征(ROC)曲线分析显示,冠状动脉CT血管造影在预测冠心病患者发生左心室重构及远期心血管不良事件中具有较高的价值。结论冠状动脉CT血管造影在预测冠心病患者发生左心室重构及远期心血管不良事件中具有较高的价值。

心房分流术研究进展及启示

虽然心力衰竭(心衰)的药物和器械治疗均取得了较大进步,但心衰患者整体仍预后较差。心衰的血流动力学异常表现为左心房压升高和肺淤血,既往研究表明降低左心房压可改善心衰患者的症状和预后,因此左心系统超负荷可能是心衰治疗的一个潜在靶点。心房分流术旨在制造一定程度稳定可控的左向右心内分流,将心衰患者失代偿的左心容量和压力负荷恢复至代偿状态,从而改善心衰症状及预后,目前全球范围内仍处于临床研究阶段,已有数据表明心房分流术可降低心衰患者静息或运动时左心房压,改善肺淤血,提高患者活动耐量和临床心功能,但尚无研究证实其可以改善心衰再入院和死亡等临床终点事件。未来的研究重点在于筛选能从心房分流术中获益的心衰患者,明确心衰病因、右心功能和肺血管阻力可逆性的评估以及依据射血分数的心衰分型可能是筛选患者的关键因素。

重度左心室功能低下患者心脏不停搏冠状动脉旁路移植术探讨

目的探讨重度左心室功能低下患者不停搏冠状动脉旁路移植术(off-pump coronary artery bypass grafting,Off-pump CABG)的可行性。方法筛选首都医科大学大兴教学医院2017年5月至2022年5月,无法介入干预或介入干预失败同时不伴有其他需外科干预的冠状动脉粥样硬化心脏病(冠心病)变患者32例,其中男28例、女4例,左心室射血分数(left ventricular ejection fraction,LVEF)<30%,年龄为(62.1±7.4)岁。术前均行心肌核素扫描,术前、术中同期预置主动脉球囊反搏。所有患者均采用体外循环湿备下非体外循环Off-pump CABG术。结果无患者死亡,32例患者心绞痛症状消失,生活质量明显改善。超声心动图3个不同时期(术前、术后10~14 d、术后1年)LVEF、左心室舒张末期内径(left ventricular end-diastolic diameter,LVEDD)、左心室收缩末期内径(left ventricular end-systolic diameter,LVESD)比较,差异有统计学意义(P<0.05)。结论充分术前准备的重度左心室功能低下患者采用Off-pump CABG术安全、有效。

重度肺动脉高压患者的左心室射血分数及NT-ProBNP与预后相关

目的探讨重度肺动脉高压(PAH)患者超声心动图测量左心功能相关参数与预后的关系。方法回顾性分析2018年10月~2021年12月于中国人民解放军北部战区总医院先心病内科住院治疗的55例第一大类PAH患者(不包括艾森曼格综合征)及慢性血栓栓塞性肺动脉高压。并依据随访中是否出现临床恶化事件分为临床恶化组(n=20)与无临床恶化组(n=35),采用单因素和多因素COX比例风险回归模型、Kaplan-Meier生存曲线分析重度PAH患者超声心动图测量左心功能参数与预后的关系。结果55例患者中有20例出现临床恶化事件,其中2例(4%)发生全因死亡,10例(18%)因PAH恶化再住院,8例(14%)治疗升级。与无临床恶化组相比,临床恶化组的右心室/左心室内径比值、右心室内径与LVEF更大(均P<0.01),每搏量指数与左心室舒张末期内径更小(均P<0.05),血清总胆红素(P<0.05)与NT-ProBNP更高(均P<0.01)。多因素Cox风险回归分析表明:LVEF[HR 1.66(1.29~2.14);P<0.01]及NT-ProBNP[HR 1.001(1.000~1.002);P<0.05]是重度PAH患者预后的独立预测因素。受试者工作特征曲线表明LVEF 71%和NT-ProBNP 724.5 pg/ml是最佳截点值,灵敏度及特异度均较高。Kaplan-Meier生存分析显示LVEF>71%者及NT-ProBNP>724.5 pg/ml的临床恶化发生率均显著升高(均P<0.01)。结论超声心动图测量LVEF及NT-ProBNP可很好预测重度PAH患者的临床恶化事件发生率。

急性心力衰竭患者早期应用无创正压通气的临床效果研究

目的探讨急性心力衰竭患者早期应用无创正压通气的临床效果。方法采用前瞻性随机对照研究,选取2021年1月至2024年1月因呼吸困难就诊的急性心力衰竭200例作为研究对象,随机数表法分为观察组和对照组,每组100例。对照组给予常规治疗方案,观察组在对照组常规治疗方案基础上,于患者急性心力衰竭发作60 min内接受无创正压通气治疗。比较2组入院时及入院24 h生命体征指标[心率、呼吸频率、平均动脉压(MAP)]、心功能及肺功能指标[动脉血氧分压(PaO_(2))、血氧饱和度(SpO_(2))、B型脑钠肽(BNP)、血乳酸、左心室射血分数(LVEF)]、临床治疗相关指标(无创正压通气时间、住院时间以及24 h内气管插管率),分析无创正压通气总时间(d)与入院到使用无创正压通气时间(min)的相关性。结果入院24 h,观察组的心率、呼吸频率、MAP以及血乳酸水平均低于对照组,PaO_(2)、SpO_(2)、LVEF均高于对照组(P<0.05);2组BNP比较差异无统计学意义(P>0.05)。观察组的无创正压通气总时间、住院时间短于对照组,24 h内气管插管率低于对照组(P<0.05)。无创正压通气时间(d)和入院到使用无创正压通气时间(min)之间有着显著的正相关性(r=0.323,P=0.010)。结论急性心力衰竭患者早期应用无创正压通气治疗,临床效果显著,能明显提高患者抢救成功率,降低患者有创机械通气应用率。

通心络胶囊治疗冠心病稳定型心绞痛气虚血瘀络阻证临床效果研究进展

冠心病在临床上是一种常见的多发疾病,主要的发病群体是中老年人,一旦发病就会严重影响患者的日常生活,增加残疾和死亡的风险。而稳定型心绞痛是冠心病中常见的一种类型,主要是由心肌血氧供应不足导致的,若是不及时予以有效治疗,就会造成心功能逐渐下降,在急性发作期间还会威胁患者的生命安全。现阶段临床治疗稳定型心绞痛大多是稳定冠状动脉粥样硬化斑块、改善肌缺血缺氧,从而减轻心肌组织的损伤,防止心功能降低。以往临床治疗大多选择常规西药干预,可是部分患者由于长期用药产生耐药性,造成临床疗效一般,故需要选择一种更加科学有效的治疗手段改善患者预后。中医认为,稳定型心绞痛的病机与气滞、血瘀有着密切关系,治疗原则为活血化瘀和行气止痛,而通心络胶囊是治疗心血管疾病常用的中药,也在冠心病稳定型心绞痛气虚血瘀络阻证的临床治疗中被广泛应用并认可。

Preferred Revascularization Strategies in Patients with Ischemic Heart Failure: A Meta-Analysis

Clinically,coronary artery bypass grafting (CABG)or percutaneous coronary intervention (PCI)is generally used to treat patients with ischemic heart failure.However, the optimal treatment strategy remains unknown.This study examined the efficacy of the two coronary revascularization strategies for severe ischemic heart failure by using a meta-analysis.Studies comparing the efficacy of CABG and PCI were obtained from PubMed,EMBASE,Google Scholar and Cochrane Central Register of Controlled Trials (CENTRAL).The quality of each eligible article was evaluated by Newcastle-Ottawa Quality Assessment Scale (NOS),and the meta-analysis was performed using Stata version 12.0 software.Eventually,12 studies involving 9248 patients (n=4872 in CABG group;n=4376 in PCI group)were subject to the meta-analysis for subsequent pooling calculation.The pooled hazard ratio (HR)[HR=0.83,95%CI (0.76,0.90),P<0.001; heterogeneity,P=0.218,I^2=22.9%]of CABG compared with that of PCI revealed a statistical superiority of CABG to PCI in terms of the long-term mortality.Furthermore, CABG showed more advantages over PCI with respect to the incidence of myocardial infarction [HR=0.51,95%CI (0.39,0.67),P<0.001;heterogeneity,P=-0.707,I^2=0%]and repeat revascularization [HR=0.40,95%CI (0.27,0.59),P<0.001;heterogeneity,P<0.001, I^2=80.1%].It was concluded that CABG appears to be more advantageous than PCI for the treatment of ischemic heart failure in the given clinical setting.

冠心病合并射血分数降低患者血运重建策略:经皮冠状动脉介入治疗和冠状动脉旁路移植术的对比研究

目的对比经皮冠状动脉介入治疗(PCI)和冠状动脉旁路移植术(CABG)治疗冠状动脉粥样硬化性心脏病(CAD)合并左心室收缩功能不全患者的血运重建效果。方法研究纳入2005年1月1日至2014年12月31日首都医科大学附属北京安贞医院905例CAD合并左心室射血分数(LVEF)降低(≤35%)的患者。对比PCI和CABG治疗后患者的短期和长期全因死亡率、因心力衰竭再入院发生率和再次血运重建率。采用倾向性评分匹配两组患者基线资料。结果与CABG组相比,PCI组患者术后30 d死亡率更低(HR 0.29,95%CI 0.09~0.88,P=0.029)。平均随访4.5年结果发现,PCI与CABG的全因死亡率(HR 1.00,95%CI 0.67~1.50,P=0.990)以及因心力衰竭再入院发生率(HR 0.81,95%CI 0.40~1.64,P=0.561)差异均无统计学意义。PCI组患者再次血运重建发生率更高(HR 14.46,95%CI 3.43~60.98,P<0.001),差异有统计学意义。与CABG比,PCI能更显著地改善患者心功能(交互作用P=0.031)。结论在CAD合并LVEF降低患者中,与CABG相比,PCI有着更低的短期死亡率,同时心功能改善更显著,但再次血运重建发生率更高。PCI与CABG的长期生存率以及因心力衰竭再入院风险相似。

Aortic implantation for anomalous origin of the left coronary artery from the pulmonary artery:A ten-year single center experience

Background At present, creation of a dual coronary system with direct aortic implantation is the preferred management for anomalous origin of left coronary artery from the pulmonary artery （ALCAPA）. However, controversy still exists over the initial management of mitral regurgitation （MR） at the time of ALCAPA repair. Methods Between March 2005 and March 2015, 52 consecutive patients （20 males and 32 females） underwent direct aortic implantation of ALCAPA. Median age at surgery was 10 months （range, 2 to 193）. Mean weight was 9.7_＋7.8 kg. In order to facilitate the analysis, description of MR was given a numeric grade： 0 = none, 1 = trivial, 2 = mild, 2.5 = mild-moderate, 3 = moderate, 3.5 = moderate-severe, and 4 = severe. Results The LV shortening fraction （LVFS） demonstrated significant improvement between presentation and discharge （32.1±10.1% vs. 28.6±9.6%, P = 0.023）, and there was also significant improvement in the mean MR grade between presentation and discharge （2.40＋1.16 vs. 2.91＋ 1.19, P = 0.001）. There were 4 hospital deaths （7.7%）. The median follow-up was 21 months （range 1.5 to 111）, 3 patients （5.8%） were lost to follow-up, 1 patient required reoperation for mitral valve replacement. Significant improvement was seen in LVFS between discharge and late follow-up （38.0±6.0% vs. 32.1±10.1%, P = 0.001）, however, the degree of MR did not dem- onstrate further change （2.29_＋1.20 vs. 2.40＋1.16, P = 0.541）. Conclusion Creation of a dual coronary system with direct aortic implantation of the left coronary artery results in complete recovery of left ventricular function. Concomitant mitral valve （MV） repair for ALCAPA patients with moderate-severe and severe MR is helpful to early MV function recovery.

The predictive value of coronary collateral circulation in patients with one or more coronary artery occlusion undergoing elective PCI

Background The coronary collateral circulation has a positive effect on the ischemic myocardium. But it is limited for patients missing the time window of total occlusion of the coronary artery elective percutaneous coronary intervention （PCI）. The effect of collateral circulation on left cardiac function has been less studied. Methods A total of 34 patients with one or more coronary artery occlusion who underwent coronary angiography and Rentrop＇ s method were divided into 2 groups： Good collateral circulation （A groups, Rentrop score 2-3, n= 19） and （B groups, Rentrop score 1-2, n=15）. The improvement of left ventricular end diastolic volume （LVEDV） and left ventricular ejection fraction （LVEF） were compared between the two groups before and after PCI. Results In good collateral circulation group, left ventricular ejection fraction （LVEF） was significantly higher after PCI（P〈O.05）. In poor collateral circulation group, left ventricular end diastolic volume index （LVEDV） was significantly increased after PCI （P〈O.05）. Conclusions Good collateral circulation has a signifi- cant protective effect on left ventricular function. PCI operation can significantly improve the prognosis of patients with good collateral circulation of coronary artery occlusion.

先天性心脏病相关肺动脉高压血清IL-32的变化与肺动脉压相关性研究

目的:探讨血清白介素⁃32(interleukin⁃32,IL⁃32)水平与先天性心脏病相关肺动脉高压(pulmonary arterial hypertension,PAH)的存在和严重程度之间的关系。方法:试验组纳入85例CHD患者,根据右心导管术测得的平均肺动脉压(mean pulmonary artery pressure,PAPm)将其分为:无PAH组(PAPm≤20 mmHg)、灰色区间组(20 mmHg<PAPm<25 mmHg)、轻度组(25 mmHg≤PAPm<35 mmHg)、中重度组(PAPm≥35 mmHg),对照组为30例健康成人。采用酶联免疫吸附试验检测各组血清IL⁃32的水平,化学发光微粒子免疫分析法用于测定实验组血浆B型脑钠肽(B⁃type natriuretic peptide,BNP)的水平。结果:中重度组、轻度组和灰色区间组的血清IL⁃32水平显著高于无PAH组及对照组,肺体循环血流量比(Qp/Qs)≥1.5的CHD患者血清IL⁃32水平显著高于Qp/Qs<1.5的CHD患者。血清IL⁃32水平与PAPm(r=0.377,P<0.05)、肺动脉收缩压(r=0.286,P<0.05)及Qp/Qs(r=0.266,P<0.05)正相关。受试者工作特征(receiver operating characteristic,ROC)曲线分析IL⁃32诊断PAH(PAPm>20 mmHg)的效能不劣于BNP,两者联合诊断具有更高的灵敏度、阳性预测值和阴性预测值。结论:血清IL⁃32可能是先天性心脏病相关肺动脉高压的潜在生物标志物。