B-type Natriuretic Peptide(BNP) is activated in patients with severe, symptomatic aortic stenosis(AS), but the prognostic value of BNP in this setting has not been extensively studied. This study aimed to assess the p...B-type Natriuretic Peptide(BNP) is activated in patients with severe, symptomatic aortic stenosis(AS), but the prognostic value of BNP in this setting has not been extensively studied. This study aimed to assess the prognostic value of the BNP level in symptomatic and asymptomatic patients with severe AS. Seventy consecutive patients referred to our echocardiography laboratory for severe AS with preserved left ventricular function were prospectively enrolled(40 men, median age 74 years [62-82]; aortic valve area 0.7 cm2[0.6-0.8]; transaortic gradient 48 mmHg[38-60], and left ventricular fractional shortening 38%[32-43]). C-terminal BNP serum level at enrolment was evaluated against baseline functional and echocardiographic parameters as well as clinical outcome. BNP level was elevated in the presence of symptoms and increased with NYHA functional class. BNP serum level >66 pg/ml detected symptomatic patients with a sensitivity, specificity and accuracy of 84%, 82%and 84%, respectively. In symptomatic and asymptomatic patients, BNP level was a strong independent predictor for cardiovascular death by multivariable analysis adjusted to age and NYHA functional class. BNP serum level allows to differentiate symptomatic from asymptomatic patients with severe AS. BNP is an independent predictor of outcome in these patients and may be helpful for risk stratification.展开更多
Background -Right ventricular outflow tract obstruction(RVOTO) is a common problem after repair of congenital heart disease. Percutaneous pulmonary valve implantation(PPVI) can treat this condition without consequent ...Background -Right ventricular outflow tract obstruction(RVOTO) is a common problem after repair of congenital heart disease. Percutaneous pulmonary valve implantation(PPVI) can treat this condition without consequent pulmonary regurgitation or cardiopulmonary bypass. Our aim was to investigate the clinical and physiological response to relieving RVOTO. Methods and Results -We studied 18 patients who underwent PPVI for RVOTO(72%male, median age 20 years) from a total of 93 who had this procedure for various indications. All had a right ventricular outflow tract(RVOT)gradient >50 mm Hg on echocardiography without important pulmonary regurgitation(less than mild or regurgitant fraction< 10%on magnetic resonance imaging[MRI]). Cardiopulmonary exercise testing, tissue Doppler echocardiography, and MRI were performed before and within 50 days of PPVI. PPVI reduced RVOT gradient(51.4 to 21.7 mm Hg, P< 0.001)and right ventricular systolic pressure(72.8 to 47.3 mm Hg, P< 0.001) at catheterization. Symptoms and aerobic(25.7 to 28.9 mL·kg-1.min-1, P=0.002) and anaerobic(14.4 to 16.2 mL·kg-1.min-1, P=0.002) exercise capacity improved. Myocardial systolic velocity improved acutely(tricuspid 4.8 to 5.3 cm/s, P=0.05; mitral 4.7 to 5.5 cm/s, P=0.01), whereas isovolumic acceleration was unchanged. The tricuspid annular velocity was not maintained on intermediate follow-up. Right ventricular end-diastolic volume(99.9 to 89.7 mL/m2, P< 0.001) fell, whereas effective stroke volume(43.7 to 48.3mL/m2, P=0.06) and ejection fraction(48.0%to 56.8%, P=0.01) increased. Left ventricular end-diastolic volume(72.5 to 77.4 mL/m2, P=0.145), stroke volume(45.3 to 50.6 mL/m2, P=0.02), and ejection fraction(62.6%to 65.8%, P=0.03) increased. Conclusions -PPVI relieves RVOTO, which leads to an early improvement in biventricular performance. Furthermore, it reduces symptoms and improves exercise tolerance. These findings have important implications for the management of this increasingly common condition.展开更多
肥厚性心肌病(HCM)患者左室流出道和左心室之间存在收缩期压力阶差。然而,与主动脉瓣狭窄患者不同,这种压阶差的血液动力学梗阻并不是主要的。在同一患者中,其压力阶差时有变化,与预后无甚关联。HCM的病理生理改变在于舒张期充盈障碍。...肥厚性心肌病(HCM)患者左室流出道和左心室之间存在收缩期压力阶差。然而,与主动脉瓣狭窄患者不同,这种压阶差的血液动力学梗阻并不是主要的。在同一患者中,其压力阶差时有变化,与预后无甚关联。HCM的病理生理改变在于舒张期充盈障碍。为了进一步探讨HCM心室收缩期的血液动力学变化,和颈挠动脉压力波的改变,从1980.8～1987.1,观察了18例HCM患者。用CA—1颈动脉压力换能器及MX-3c型脉象仪换能器分别观察颈、挠动脉反映“梗阻”的动脉压力波“尖峰—园顶”(spike and dome)状变化。所得结果与9例老年性主动脉瓣钙化性狭窄(AS)的动脉压力波变化对照,分析结果报道如下:展开更多
目的:探讨室间隔减容治疗即室间隔部分切除术和经皮室间隔心肌消融术治疗肥厚型梗阻性心肌病(HOCM)患者的中远期效果。方法:回顾性选择2010年1月1日至2016年12月31日在首都医科大学附属北京安贞医院进行室间隔部分切除(手术组125例)或...目的:探讨室间隔减容治疗即室间隔部分切除术和经皮室间隔心肌消融术治疗肥厚型梗阻性心肌病(HOCM)患者的中远期效果。方法:回顾性选择2010年1月1日至2016年12月31日在首都医科大学附属北京安贞医院进行室间隔部分切除(手术组125例)或经皮室间隔心肌消融(介入组41例)的HOCM患者,并在手术前、术后对入组患者进行随访,中位随访时间为386天(136～1 617天),获取患者术前及术后半年以上的超声心动图指标评价室间隔厚度及左心室流出道压差变化。结果:手术组患者125例,年龄中位数48岁,男性70例(56.0%);介入组患者41例,年龄中位数50岁,男性28例(68.3%)。两组患者临床资料比较差异无统计学意义(P>0.05)。中位随访386天,失访26例患者(15.6%),手术组和介入组分别失访18例和8例。与术前相比,术后手术组室间隔厚度(16.0 mm vs 21.0 mm,P<0.05)、左心室流出道压差(8 mmHg vs 73 mmHg,1 mmHg=0.133 kPa,P<0.05)均下降;介入组室间隔厚度(15.0 mm vs 20.0 mm,P<0.05)、左心室流出道压差(11 mmHg vs 66 mmHg,P<0.05)均下降,以手术组残余压差更低(P<0.05)。随访过程中手术组1例患者死亡,两组均有1例患者手术前后左心室流出道压差无明显改善。结论:两种室间隔减容治疗均可有效降低远期左心室流出道梗阻的情况,室间隔切除术患者术后残余左心室流出道压差更低。展开更多
文摘目的：探讨超声心动图在肥厚型心肌病（hypertrophic cardiomyopathy,HCM）左室流出道压力阶差测量中的诊断价值。方法：以自身对比的方法,分析2009年1月～2012年12月共24例临床诊断HCM拟行室间隔心肌消融术患者超声测量与有创测量二种方法测量出的左室流出道压力阶差,并探讨二者的一致性。结果：左室流出道压力阶差的超声测量和左心室造影时有创测量结果比较,差别有统计学意义（47.2±15.9 vs 41.5±12.1 mmHg,P〈0.05）。24例患者超声诊断13例有梗阻,而有创测量仅9例有梗组,差异有统计学意义（P〈0.05）,但两种检查具有较好的一致性（Kappa=0.824,P〈0.01）。结论：超声心动图测量HCM左室流出道压力阶差与有创测量虽有一定差异,但一致性较好,是一种无创、操作简单的诊断HCM梗阻程度检查方法,可用于室间隔心肌消融术筛查病例。
文摘B-type Natriuretic Peptide(BNP) is activated in patients with severe, symptomatic aortic stenosis(AS), but the prognostic value of BNP in this setting has not been extensively studied. This study aimed to assess the prognostic value of the BNP level in symptomatic and asymptomatic patients with severe AS. Seventy consecutive patients referred to our echocardiography laboratory for severe AS with preserved left ventricular function were prospectively enrolled(40 men, median age 74 years [62-82]; aortic valve area 0.7 cm2[0.6-0.8]; transaortic gradient 48 mmHg[38-60], and left ventricular fractional shortening 38%[32-43]). C-terminal BNP serum level at enrolment was evaluated against baseline functional and echocardiographic parameters as well as clinical outcome. BNP level was elevated in the presence of symptoms and increased with NYHA functional class. BNP serum level >66 pg/ml detected symptomatic patients with a sensitivity, specificity and accuracy of 84%, 82%and 84%, respectively. In symptomatic and asymptomatic patients, BNP level was a strong independent predictor for cardiovascular death by multivariable analysis adjusted to age and NYHA functional class. BNP serum level allows to differentiate symptomatic from asymptomatic patients with severe AS. BNP is an independent predictor of outcome in these patients and may be helpful for risk stratification.
文摘Background -Right ventricular outflow tract obstruction(RVOTO) is a common problem after repair of congenital heart disease. Percutaneous pulmonary valve implantation(PPVI) can treat this condition without consequent pulmonary regurgitation or cardiopulmonary bypass. Our aim was to investigate the clinical and physiological response to relieving RVOTO. Methods and Results -We studied 18 patients who underwent PPVI for RVOTO(72%male, median age 20 years) from a total of 93 who had this procedure for various indications. All had a right ventricular outflow tract(RVOT)gradient >50 mm Hg on echocardiography without important pulmonary regurgitation(less than mild or regurgitant fraction< 10%on magnetic resonance imaging[MRI]). Cardiopulmonary exercise testing, tissue Doppler echocardiography, and MRI were performed before and within 50 days of PPVI. PPVI reduced RVOT gradient(51.4 to 21.7 mm Hg, P< 0.001)and right ventricular systolic pressure(72.8 to 47.3 mm Hg, P< 0.001) at catheterization. Symptoms and aerobic(25.7 to 28.9 mL·kg-1.min-1, P=0.002) and anaerobic(14.4 to 16.2 mL·kg-1.min-1, P=0.002) exercise capacity improved. Myocardial systolic velocity improved acutely(tricuspid 4.8 to 5.3 cm/s, P=0.05; mitral 4.7 to 5.5 cm/s, P=0.01), whereas isovolumic acceleration was unchanged. The tricuspid annular velocity was not maintained on intermediate follow-up. Right ventricular end-diastolic volume(99.9 to 89.7 mL/m2, P< 0.001) fell, whereas effective stroke volume(43.7 to 48.3mL/m2, P=0.06) and ejection fraction(48.0%to 56.8%, P=0.01) increased. Left ventricular end-diastolic volume(72.5 to 77.4 mL/m2, P=0.145), stroke volume(45.3 to 50.6 mL/m2, P=0.02), and ejection fraction(62.6%to 65.8%, P=0.03) increased. Conclusions -PPVI relieves RVOTO, which leads to an early improvement in biventricular performance. Furthermore, it reduces symptoms and improves exercise tolerance. These findings have important implications for the management of this increasingly common condition.
文摘肥厚性心肌病(HCM)患者左室流出道和左心室之间存在收缩期压力阶差。然而,与主动脉瓣狭窄患者不同,这种压阶差的血液动力学梗阻并不是主要的。在同一患者中,其压力阶差时有变化,与预后无甚关联。HCM的病理生理改变在于舒张期充盈障碍。为了进一步探讨HCM心室收缩期的血液动力学变化,和颈挠动脉压力波的改变,从1980.8～1987.1,观察了18例HCM患者。用CA—1颈动脉压力换能器及MX-3c型脉象仪换能器分别观察颈、挠动脉反映“梗阻”的动脉压力波“尖峰—园顶”(spike and dome)状变化。所得结果与9例老年性主动脉瓣钙化性狭窄(AS)的动脉压力波变化对照,分析结果报道如下:
文摘目的:探讨室间隔减容治疗即室间隔部分切除术和经皮室间隔心肌消融术治疗肥厚型梗阻性心肌病(HOCM)患者的中远期效果。方法:回顾性选择2010年1月1日至2016年12月31日在首都医科大学附属北京安贞医院进行室间隔部分切除(手术组125例)或经皮室间隔心肌消融(介入组41例)的HOCM患者,并在手术前、术后对入组患者进行随访,中位随访时间为386天(136～1 617天),获取患者术前及术后半年以上的超声心动图指标评价室间隔厚度及左心室流出道压差变化。结果:手术组患者125例,年龄中位数48岁,男性70例(56.0%);介入组患者41例,年龄中位数50岁,男性28例(68.3%)。两组患者临床资料比较差异无统计学意义(P>0.05)。中位随访386天,失访26例患者(15.6%),手术组和介入组分别失访18例和8例。与术前相比,术后手术组室间隔厚度(16.0 mm vs 21.0 mm,P<0.05)、左心室流出道压差(8 mmHg vs 73 mmHg,1 mmHg=0.133 kPa,P<0.05)均下降;介入组室间隔厚度(15.0 mm vs 20.0 mm,P<0.05)、左心室流出道压差(11 mmHg vs 66 mmHg,P<0.05)均下降,以手术组残余压差更低(P<0.05)。随访过程中手术组1例患者死亡,两组均有1例患者手术前后左心室流出道压差无明显改善。结论:两种室间隔减容治疗均可有效降低远期左心室流出道梗阻的情况,室间隔切除术患者术后残余左心室流出道压差更低。
