Objectives This randomized study was designed to compare the safety and efficacy of intravenous diltiazem versus intravenous cedilanid-D （deslanoside） for ventricular rate control in patients with atrial fibrillati...Objectives This randomized study was designed to compare the safety and efficacy of intravenous diltiazem versus intravenous cedilanid-D （deslanoside） for ventricular rate control in patients with atrial fibrillation （AF）. Analysis of the effect on conduction system of these drugs was also performed. Methods Forty three patients with AF were randomly assigned to receive intravenous therapy with 0.25mg/kg diltiazem （n = 21） or 0.4rag cedilanid-D （n = 22）. If not effective at 120 minutes （〈 20% decrease in pretreatment ventricular rate or can not convert to sinus rhythm= another dose of diltiazem or 0.2mg cedilanid-D was administered. Blood pressure and electrocardiographic recordings were performed before and after 5, 10, 20, 30, 60 minutes of drug administration. Further recordings were performed at 120 minutes in noneffective patients, and at 180 minutes in patients who received second time drug administration. To evaluate the effect on conduction system of these two drugs by measuring PA, AH and HV intervals using His bundle electrogram test another nineteen sinus rhythm patients were randomized to dihiazem （n=9） and cedilanid （n= 10） group. His bundle electrogram recordings were performed before and after 5, 10, 20 and 30 minutes of drug administration. Statistical significance was assessed with the use of t test, Fisher＇s exact test, ANOVA and LSD methodology. Results At baseline and after 5, 10, 20, 30, 60 minutes of drug administration the heart rates （mean±SD） were（133±15）, （92±20）, （87±22）, （85 ±20）, （85±21）, （85 ±23）beats/minute in diltiazem group respectively and（ 140±21 ）, （ 122±24）, （118±25）, （110±26）, （112±25）, （110±28） beats/ minute in cedilanid-D group respectively. Heart rate reduction was higher in diltiazem group than cedilanid group during 5 （41±20 vs 17±14,P 〈 0.01）; 10 （46±21 vs 22±20, P〈0.01）; 20 （48±21 vs 29±22, P〈0.01 ） ; 30（48±22 vs 27±22,P〈0.01 ）and 60 minutes （48±23 vs 29±24, P〈 0.05）. Both drugs had no effect on both systolic and diastolic blood pressure （P 〉0.05） and no major side effects were noticed. Diltiazem maintained effective ventrieular rate in 20 patients, whereas eedilanid-D maintained in 15 patients within 180 minutes （95.2%vs 68.2%,P〈 0.05）. There were no statistical significance in baseline heart rate, age and weight between the two groups. Both diltiazem and cedilanid-D can increase AH interval, but have no effect on HV and PA intervals in sinus rhythm patients. Conclusions Both dihiazem and eedilanid-D decrease ventrieular heart rate, but heart rate reduction is significantly higher in diltiazem group, thus should be considered as a drug of choice for emergency control of ventrieular rate. Under clinical monitoring this dose of diltiazem seems to be safe and applicable in AF patients with congestive heart failure. Both drugs have no effect on PA and HV intervals but increase the AH interval thereby can reduce ventricular rate.展开更多
Objective To study the validation of ultrasound-based strain rate imaging in the quantitative assessment of right ventricular （RV） function in atrial septal defect （ASD）. Methods Tissue Doppler images （TDI） of R...Objective To study the validation of ultrasound-based strain rate imaging in the quantitative assessment of right ventricular （RV） function in atrial septal defect （ASD）. Methods Tissue Doppler images （TDI） of RV longitudinal and short axes were recorded from the apical 4-chamber view and the subcostal short-axis view in 18 normal controls, 28 children with ASD and 14 children after Amplazter closure of ASD respectively. Peak systolic velocities （ V）, peak systolic strain rates （SR）, peak systolic strains （S） at the basal segment, middle segment of RV lateral wall and the basal septum from the longitudinal axis, the middle segment of RV free waU from the short axis were quantitatively measured using QLAB^TM tissue velocity quantification software system respectively. Peak dp/ dt from the RV isovolumic contraction determined during the right cardiac catheterization in 28 ASD patients was used as the gold standard of RV contractility. Peak systolic indices were compared against max dp/dt by linear correlation, Results Peak systolic indices at the basal and middle segments of RV lateral wall from the longitudiual axis increased significantly in 28 ASD patients. Peak systolic indices at the basal septum also increased in patient group, but not significantly. Significant decreases in peak systolic indices at the basal and middle segments of RV lateral wall were observed after the Amplatzer closure in 14 ASD patients. There was no significant difference at the middle segment of RV free wall from the short axis between patient group and normal control. A strong correlation was found between max dp/dt and peak systolic indices at the basal and middle segments of RV lateral wal l （ P 〈 0. 05 ）. Conclusion Ultrasound-based strain rate imaging can assess quantitatively RVfunction in CHD. Peak systolic strains determined at the basal and middle segments of RV lateral wall are strong noninvasive indices of RV contractility.展开更多
Objectives To detect and compare the systolic strain rate (SR) and strain in the infarct and ischemic myocardium by strain rate imaging (SRI), in order to explore the clinical value of SRI in evaluating regional left ...Objectives To detect and compare the systolic strain rate (SR) and strain in the infarct and ischemic myocardium by strain rate imaging (SRI), in order to explore the clinical value of SRI in evaluating regional left ventricular systolic dysfunction. Methods Patients with coronary artery disease were divided into angina pectoris (11 cases) and myocardial infarction (21 cases) groups. Twenty age-matched normal subjects served as the control group. Septal, lateral, anterior, inferior, anteroseptal and posterior walls of the left ventricle were respectively scanned using color tissue Doppler imaging (TDI). Then SR and strain curves were derived from TDI for basal, middle and apical segments of each wall. SRI parameters were: Systolic SR (SRsys), systolic strain (εsys) and maximum strain (εmax). Results Compared with normal segments, SRsys, εsys and εmax decreased significantly in the infarct and ischemic segments (P<0.01). Compared with ischemic segments, SRsys, εsys and εmax decreased significantly in the infarct segments (P<0.05). Conclusions SRsys, εsys and εmax measured by SRI can be used to quantitatively analyze regional left ventricular systolic dysfunction in patients with coronary artery disease, and aid in differentiating infarct from ischemic myocardium.展开更多
目的探讨左束支区域起搏(left bundle branch area pacing,LBBaP)对房室传导阻滞(AVB)患者术后新发心房颤动(new-onset atrial fibrillation,NOAF)和心房高频事件(atrial high rate episodes,AHREs)的影响。方法回顾性纳入84例行起搏治...目的探讨左束支区域起搏(left bundle branch area pacing,LBBaP)对房室传导阻滞(AVB)患者术后新发心房颤动(new-onset atrial fibrillation,NOAF)和心房高频事件(atrial high rate episodes,AHREs)的影响。方法回顾性纳入84例行起搏治疗的三度房室传导阻滞(ⅢAVB)患者,根据心室电极位置分为LBBaP组(n=42)和右室间隔部起搏(RVSP)组(n=42)。比较两组患者术前术后QRS波时限(QRSd)、心室起搏参数,并发症、脑卒中事件和NOAF、AHREs发生率。结果(1)LBBaP组术后NOAF、AHREs发生率均低于RVSP组(P<0.05)。(2)LBBaP组的p-QRSd短于RVSP组(P<0.05)。(3)两组患者心室起搏参数、并发症及脑卒中事件发生率之间差异无统计学意义(P>0.05)。结论相对于右室起搏,LBBaP术后AHREs、NOAF的发生率较低,可改善患者预后。展开更多
目的探讨左室射血分数(left ventricular ejection fraction,LVEF)降低的扩张型心肌病(dilated cardiomyopathy,DCM)治疗后生存的影响因素。方法选取2020年6月至2023年6月于湖州市第一人民医院治疗的158例LVEF降低的DCM患者,根据生存状...目的探讨左室射血分数(left ventricular ejection fraction,LVEF)降低的扩张型心肌病(dilated cardiomyopathy,DCM)治疗后生存的影响因素。方法选取2020年6月至2023年6月于湖州市第一人民医院治疗的158例LVEF降低的DCM患者,根据生存状况将其分为死亡组(n=40)和生存组(n=118)。统计两组患者的临床资料,采用Cox比例风险回归模型分析影响LVEF降低的DCM患者治疗后生存的因素。结果死亡组患者的年龄显著大于生存组,合并高血压、纽约心脏病协会(New York Heart Association,NYHA)心功能分级Ⅳ级、室性心律失常占比、左室舒张末期内径(left ventricular end diastolic diameter,LVEDD)、左室收缩末期内径(left ventricular end systolic diameter,LVESD)、脑钠肽(brain natriuretic peptide,BNP)水平均显著高于生存组,左室整体纵向应变(global longitudinal strain,GLS)、RR间期标准差(standard deviation of RR interval,SDNN)、RR间期平均值标准差(standard deviation of the average RR interval,SDANN)、RR间期标准差平均值(the average standard deviation of RR interval,SDNNindex)、RR间期差值均方根(root mean square of RR interval difference,rMSSD)、相邻RR间期>50ms总数占总心跳数的百分比(the percentage of total number of adjacent RR intervals>50ms to total heart rate,pNN50)、舒张末期室间隔厚度(end diastolic interventricular septal thickness,IVSd)、左心室后壁舒张期厚度(left ventricular posterior wall diastolic thickness,LVPWD)、每搏输出量(stroke volume,SV)、心输出量(cardiac output,CO)均显著低于生存组(P<0.05)。Cox回归分析显示,年龄、合并高血压、NYHA心功能分级、室性心律失常、GLS、SDNN、SDANN、SDNNindex、rMSSD、pNN50、LVEDD、LVESD、BNP是影响LVEF降低的DCM患者治疗后生存率的危险因素,IVSd、LVPWD是保护因素(P<0.05)。结论LVEF降低的DCM患者死亡率较高,且受年龄、高血压、NYHA心功能分级、室性心律失常、GLS、心率变异性、LVEDD、LVESD、BNP、IVSd、LVPWD等多种因素的影响,临床应早期给予针对性干预以提高患者治疗后生存率。展开更多
文摘Objectives This randomized study was designed to compare the safety and efficacy of intravenous diltiazem versus intravenous cedilanid-D （deslanoside） for ventricular rate control in patients with atrial fibrillation （AF）. Analysis of the effect on conduction system of these drugs was also performed. Methods Forty three patients with AF were randomly assigned to receive intravenous therapy with 0.25mg/kg diltiazem （n = 21） or 0.4rag cedilanid-D （n = 22）. If not effective at 120 minutes （〈 20% decrease in pretreatment ventricular rate or can not convert to sinus rhythm= another dose of diltiazem or 0.2mg cedilanid-D was administered. Blood pressure and electrocardiographic recordings were performed before and after 5, 10, 20, 30, 60 minutes of drug administration. Further recordings were performed at 120 minutes in noneffective patients, and at 180 minutes in patients who received second time drug administration. To evaluate the effect on conduction system of these two drugs by measuring PA, AH and HV intervals using His bundle electrogram test another nineteen sinus rhythm patients were randomized to dihiazem （n=9） and cedilanid （n= 10） group. His bundle electrogram recordings were performed before and after 5, 10, 20 and 30 minutes of drug administration. Statistical significance was assessed with the use of t test, Fisher＇s exact test, ANOVA and LSD methodology. Results At baseline and after 5, 10, 20, 30, 60 minutes of drug administration the heart rates （mean±SD） were（133±15）, （92±20）, （87±22）, （85 ±20）, （85±21）, （85 ±23）beats/minute in diltiazem group respectively and（ 140±21 ）, （ 122±24）, （118±25）, （110±26）, （112±25）, （110±28） beats/ minute in cedilanid-D group respectively. Heart rate reduction was higher in diltiazem group than cedilanid group during 5 （41±20 vs 17±14,P 〈 0.01）; 10 （46±21 vs 22±20, P〈0.01）; 20 （48±21 vs 29±22, P〈0.01 ） ; 30（48±22 vs 27±22,P〈0.01 ）and 60 minutes （48±23 vs 29±24, P〈 0.05）. Both drugs had no effect on both systolic and diastolic blood pressure （P 〉0.05） and no major side effects were noticed. Diltiazem maintained effective ventrieular rate in 20 patients, whereas eedilanid-D maintained in 15 patients within 180 minutes （95.2%vs 68.2%,P〈 0.05）. There were no statistical significance in baseline heart rate, age and weight between the two groups. Both diltiazem and cedilanid-D can increase AH interval, but have no effect on HV and PA intervals in sinus rhythm patients. Conclusions Both dihiazem and eedilanid-D decrease ventrieular heart rate, but heart rate reduction is significantly higher in diltiazem group, thus should be considered as a drug of choice for emergency control of ventrieular rate. Under clinical monitoring this dose of diltiazem seems to be safe and applicable in AF patients with congestive heart failure. Both drugs have no effect on PA and HV intervals but increase the AH interval thereby can reduce ventricular rate.
文摘Objective To study the validation of ultrasound-based strain rate imaging in the quantitative assessment of right ventricular （RV） function in atrial septal defect （ASD）. Methods Tissue Doppler images （TDI） of RV longitudinal and short axes were recorded from the apical 4-chamber view and the subcostal short-axis view in 18 normal controls, 28 children with ASD and 14 children after Amplazter closure of ASD respectively. Peak systolic velocities （ V）, peak systolic strain rates （SR）, peak systolic strains （S） at the basal segment, middle segment of RV lateral wall and the basal septum from the longitudinal axis, the middle segment of RV free waU from the short axis were quantitatively measured using QLAB^TM tissue velocity quantification software system respectively. Peak dp/ dt from the RV isovolumic contraction determined during the right cardiac catheterization in 28 ASD patients was used as the gold standard of RV contractility. Peak systolic indices were compared against max dp/dt by linear correlation, Results Peak systolic indices at the basal and middle segments of RV lateral wall from the longitudiual axis increased significantly in 28 ASD patients. Peak systolic indices at the basal septum also increased in patient group, but not significantly. Significant decreases in peak systolic indices at the basal and middle segments of RV lateral wall were observed after the Amplatzer closure in 14 ASD patients. There was no significant difference at the middle segment of RV free wall from the short axis between patient group and normal control. A strong correlation was found between max dp/dt and peak systolic indices at the basal and middle segments of RV lateral wal l （ P 〈 0. 05 ）. Conclusion Ultrasound-based strain rate imaging can assess quantitatively RVfunction in CHD. Peak systolic strains determined at the basal and middle segments of RV lateral wall are strong noninvasive indices of RV contractility.
文摘Objectives To detect and compare the systolic strain rate (SR) and strain in the infarct and ischemic myocardium by strain rate imaging (SRI), in order to explore the clinical value of SRI in evaluating regional left ventricular systolic dysfunction. Methods Patients with coronary artery disease were divided into angina pectoris (11 cases) and myocardial infarction (21 cases) groups. Twenty age-matched normal subjects served as the control group. Septal, lateral, anterior, inferior, anteroseptal and posterior walls of the left ventricle were respectively scanned using color tissue Doppler imaging (TDI). Then SR and strain curves were derived from TDI for basal, middle and apical segments of each wall. SRI parameters were: Systolic SR (SRsys), systolic strain (εsys) and maximum strain (εmax). Results Compared with normal segments, SRsys, εsys and εmax decreased significantly in the infarct and ischemic segments (P<0.01). Compared with ischemic segments, SRsys, εsys and εmax decreased significantly in the infarct segments (P<0.05). Conclusions SRsys, εsys and εmax measured by SRI can be used to quantitatively analyze regional left ventricular systolic dysfunction in patients with coronary artery disease, and aid in differentiating infarct from ischemic myocardium.
文摘目的探讨左束支区域起搏(left bundle branch area pacing,LBBaP)对房室传导阻滞(AVB)患者术后新发心房颤动(new-onset atrial fibrillation,NOAF)和心房高频事件(atrial high rate episodes,AHREs)的影响。方法回顾性纳入84例行起搏治疗的三度房室传导阻滞(ⅢAVB)患者,根据心室电极位置分为LBBaP组(n=42)和右室间隔部起搏(RVSP)组(n=42)。比较两组患者术前术后QRS波时限(QRSd)、心室起搏参数,并发症、脑卒中事件和NOAF、AHREs发生率。结果(1)LBBaP组术后NOAF、AHREs发生率均低于RVSP组(P<0.05)。(2)LBBaP组的p-QRSd短于RVSP组(P<0.05)。(3)两组患者心室起搏参数、并发症及脑卒中事件发生率之间差异无统计学意义(P>0.05)。结论相对于右室起搏,LBBaP术后AHREs、NOAF的发生率较低,可改善患者预后。
文摘目的探讨左室射血分数(left ventricular ejection fraction,LVEF)降低的扩张型心肌病(dilated cardiomyopathy,DCM)治疗后生存的影响因素。方法选取2020年6月至2023年6月于湖州市第一人民医院治疗的158例LVEF降低的DCM患者,根据生存状况将其分为死亡组(n=40)和生存组(n=118)。统计两组患者的临床资料,采用Cox比例风险回归模型分析影响LVEF降低的DCM患者治疗后生存的因素。结果死亡组患者的年龄显著大于生存组,合并高血压、纽约心脏病协会(New York Heart Association,NYHA)心功能分级Ⅳ级、室性心律失常占比、左室舒张末期内径(left ventricular end diastolic diameter,LVEDD)、左室收缩末期内径(left ventricular end systolic diameter,LVESD)、脑钠肽(brain natriuretic peptide,BNP)水平均显著高于生存组,左室整体纵向应变(global longitudinal strain,GLS)、RR间期标准差(standard deviation of RR interval,SDNN)、RR间期平均值标准差(standard deviation of the average RR interval,SDANN)、RR间期标准差平均值(the average standard deviation of RR interval,SDNNindex)、RR间期差值均方根(root mean square of RR interval difference,rMSSD)、相邻RR间期>50ms总数占总心跳数的百分比(the percentage of total number of adjacent RR intervals>50ms to total heart rate,pNN50)、舒张末期室间隔厚度(end diastolic interventricular septal thickness,IVSd)、左心室后壁舒张期厚度(left ventricular posterior wall diastolic thickness,LVPWD)、每搏输出量(stroke volume,SV)、心输出量(cardiac output,CO)均显著低于生存组(P<0.05)。Cox回归分析显示,年龄、合并高血压、NYHA心功能分级、室性心律失常、GLS、SDNN、SDANN、SDNNindex、rMSSD、pNN50、LVEDD、LVESD、BNP是影响LVEF降低的DCM患者治疗后生存率的危险因素,IVSd、LVPWD是保护因素(P<0.05)。结论LVEF降低的DCM患者死亡率较高,且受年龄、高血压、NYHA心功能分级、室性心律失常、GLS、心率变异性、LVEDD、LVESD、BNP、IVSd、LVPWD等多种因素的影响,临床应早期给予针对性干预以提高患者治疗后生存率。
