Effect of PTCA and stenting on left ventricular diastolic function in patients with CHD

Objective The aim of this study was to determine the effect of successful coronary revascularisation on left ventricular diastolic function.Methods We consecutively studied the diastolic function by Doppler echocardiography in 125 patients with one vessel disease before and 48 hours after selective coronary angioplasty. The following parameters of left ventricular diastolic function were evaluated: peak early (VE, m/s) and peak late diastolic (VA, m/s) flow velocity, E/A ratio, acceleration time (AT, ms), deceleration time (DT, ms) and isovolumetric relaxation time (IVRT, ms). Ejection fraction (EF; %) was determined and used to characterise systolic left ventricular function. Results All of the patients were initially successful treated with coronary angioplasty (residual stenosis <40% ). In 98 patients( 78.4% ) stents were used to improve an inadequate result after coronary angioplasty. Both patient groups (27 patients with coronary angioplasty and 98 patients with combined coronary angioplasty and stent implantation) showed no relevant differences concerning sex, age, atherosclerotic risk factors, exercise capacity and results of exercise electrocardiography. All patients who underwent stent implantation showed an early improvement of left ventricular diastolic function 48 hours after revascularisation. Surprisingly there was no significant short term improvement (48 hours) of diastolic function in patients with initially successful angioplasty.Conclusions We suppose that stent implantation might normalize coronary blood flow faster than that of coronary balloon angioplasty.

Left ventricular regional and global diastolic function assessed using Quantitative Tissue velocity Imaging in patients with hypertrophic cardiomyopathy

Objectives The study was performed to assess the left ventricular (LV) regional and global diastolic function、left ventricular wall motion features in patients with Hypertrophic cardiomyopathy by Quantitative Tissue Velocity Imaging (QTVI). Methods 42 patients with hypertrophic cardiomyopathy and 36 age-matched normal subjects underwent QTVI study. Off-line LV regional muscular tissue velocity Imaging along LV apical long-axis view were obtained. Regional diastolic function was assessed in using peak tissue velocities of LV regional muscular tissue during early diastole (Ve)and LA contraction (Va), Ve/Va ratio, derived from Tissue Velocity Imaging. Global diastolic function was reflected by isovolumic relaxation time(IRT) and mitral valve peak flow velocity ( E/A ) calculated with pulsed wave doppler. The end-diastolic interventricular septal thickness (ⅣSt) was measured by conventional 2 - dimension echocardiography. Results ① Ve、 Va、 Ve/Va in the segments of hypertrophic interventricular septum (IVS) reduced wlhile E/A ratio significantly reduced and IRT markedly prolonged in HCM patients than in normal subjects。 ② Ve、 Ve/Va were significant reduced in the segments of hypertrophic interventricular septum compared with other LV segments in HCM patients . ③ There was a correlation between Ve/Va and E/A in HCM patients with abnormal E/A ratio (r = 0. 70). ④ There was a negative correlation between Ve/Va and ⅣSt in non -obstruction HCM patients (B group , r = -0.61 ) Conclusions QTVI offers a newer method in clinical practice which has a higher sensibility and accuracy in evaluating the LV regional and global diastolic function in HCM patients .

Effect of amlodipine combined with telmisartan or compound amiloride on plasma ET-1 concentration and left ventricular diastolic function of essential hypertension patients with left ventricular hypertrophy

Objective： To observe the effect of different combination antihypertensive therapies on plasma endothelin-1 （ET-1） concentration and left ventricular diastolic function of essential hypertension patients with left ventricular hypertrophy （LVH） Methods： A total of 111 patients with essential hypertension were selected, including 60 cases （34 males, 26 females） aged （60.7±5.6） years with simple hypertension, and 51 cases （28 males, 23 females） aged （61.8±7.0） years with essential hypertension complicated with LVH. Essential hypertension patients with LVH were randomly divided into the group of amlodipine （2.5 mg/d） combined with telmisartan （40 mg/d, n=26） and the group of amlodipine （2.5 mg/d） combined with amiloride （half tablet/d, n=25）,and the treatment lasted for 1 year. Echocardiography was performed before and after the treatment. Left ventricular mass index （LVMI）, left ventricular isovolumic relaxation time （IVRT） and other indicators were detected, and plasma ET-1 concentrations were measured for comparative analysis. And 56 patients （31 males, 25 females） aged （59.3±6.7） years with normal blood pressure in the same period in our hospital were selected as the normal control group. Results： The general clinical characteristics were similar between hypertensive LVH group, simple hypertensive group and normal healthy control group. Plasma ET-1 concentrations, LVMI and IVRT of hypertensive LVH group were significantly higher than those of normal control group and simple hypertension group, and the difference was statistically significant. The patients＇ baseline blood pressure, ET-1, LVMI, interventricular septal thickness （IVST）, left ventricular posterior wall thickness （LVPWT）, left ventricular end-diastolic diameter （LVEDd） and other clinical parameters showed no significant difference （P〉0.05） between the group of amlodipine combined with telmisartan and the group of amlodipine combined with amiloride. It was found that compared with that before treatment, blood pressure could be effectively controlled （P〈0.05）, and LVMI, IVST, LVPWT and IVRT （P〈0.05） were all lowered, and ET-1 （P〈0.01） was significantly reduced after 1 year of antihypertensive therapy in both the group of amlodipine combined with telmisartan and the group of amlodipine combined with amiloride. The group of amlodipine combined with telmisartan was better in lowering blood pressure and reducing LVMI, IVST, LVPWT, IVRT and ET-1 than the group of amlodipine combined with amiloride （P〈0.05）. Conelus｜on： Amlodipine-based combination antthypertensive therapy could reverse LVH and improve left ventricular diastolic function partly by lowering blood pressure and ET-1, and the effect of amlodipine combined with telmisartan was superior to that ofamlodipine combined with amiloride

Preliminary Clinical Study of Real-time Three-dimensional Echo-cardiographic Volume-time Curve in Evaluating Left Ventricular Diastolic Function

The volume-time curve change in patients with normal left ventricular （LV） diastolic function and diastolic dysfunction was evaluated by real-time three-dimensional echocardiography （RT3DE）. LV diastolic dysfunction was defined by E＇〈A＇ in pulse-wave tissue Doppler for inter-ventricular septal （IVS） of mitral annulus. In 24 patients with LV diastolic dysfunction, including 12 patients with delayed relaxation （delayed relaxation group） and 12 patients with pseudo-normal function （pseudo-normal group） and 24 normal volunteers （control group）, data of full-volume image were acquired by real-time three-dimensional echocardiography and subjected to volume-time curve analysis. EDV （end-diastolic volume）, ESV （end-systolic volume）, LVEF （left ventricular ejection fraction）, PER （peak ejection rate）, PFR （peak filling rate） from RT3DE were examined in the three groups. Compared to the control group, PFR （diastolic filling index of RT3DE） was significantly reduced in the delayed relaxation group and pseudo-normal group （P〈0.05）. There were no significant differences in EDV, ESV, LVEE PER （P〉0.05）. It is concluded that PFR, as a diastolic filling index of RT3DE, can reflect the early diastolic function and serve as a new non-invasive, quick and accurate tool for clinical assessment of LV diastolic function.

ASSESSMENT OF DIASTOLIC FUNCTION IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY BY DOPPLER TISSUE IMAGING

To determine the clinical application of pulsed Doppler tissue imaging in assessing the left ventricular diasto-lic function and in discriminating between normal subjects and patients with hypertrophic cardiomyopathy with various stages of diastolic dysfunction. Methods We measured the peak diastolic velocities of mitral annulus in 81 patients with hypertrophic cardiomyopathy with various stages of diastolic dysfunction and 50 normal volunteers by Doppler tissue imaging using the apical window at 2-ch-amber and long apical views, respectively. The myocardial velocities were determined with use of variance F statistical analysis. Results Early diastolic myocardial velocities of mitral annulus were higher in normal subjects than in patients with hy-pertrophic cardiomyopathy with either delayed relaxation, pseudonormal filling, or restrictive filling. However, peak myocar-dial velocities of mitral annulus during atrial contraction were similar in normal subjects and patients with hypertrophic cardiomyopathy. Conclusion Doppler tissue imaging can directly reflect upon left diastolic ventricular function. Early phase of diastole was the best discriminator between control subjects and patients with hypertrophic cardiomyopathy.

Do Continuous Flow LVADS Improve Diastolic Dysfunction?

Background: Ventricular assist devices are now used as a bridge to recovery/decision/transplant or as destination therapy in end-stage heart failure. Continued improvements in technology and pump design have made implantation an easier process with reduced operative risks and pump-related adverse events. Considering the beneficial effects of these devices in the clinical setting, it seemed logical to address the long-term effect of the continuous flow pumps on diastolic dysfunction. Methods: This study addresses the effect of HeartMate IITM(HMII) support for 284+/-97 days on echocardiographic parameters of diastolic function. Data from fifteen patients was retrospectively studied status post left ventricular assist device (LVAD) implantation. The data at approximately 1-year post implantation was compared with that obtained prior to implantation. Statistical analyses were performed using the Microsoft Excel Program/MSExcel Stats. Echocardiographic measurements were carried out in accordance with the American Society of Echocardiography guidelines. Results: Of all the echocardiographic parameters assessed only E/Ea and calculated left atrial pressure (LAP) showed a statistically significant decrease. Two parameters that showed a trend towards significance are Ea (septal) and global functional index (p = 0.05). Conclusions: Continuous Flow LVAD support appears to improve diastolic dysfunction. This study has limitations in that we used a single type of continuous flow device (HeartMate IITM) and was conducted as a retrospective analysis. Further studies with larger populations and longer support are required to validate this finding.

The relation of flow-mediated vasodilatation and diastolic function in uncomplicated Type 2 diabetic patients

Objectives: To evaluate the association of diastolic function of the left ventricle with flowme-diated dilatation (FMD) in uncomplicated Type 2 diabetes mellitus patients. Methods: Eighty-two uncomplicated Type 2 diabetic patients were examined by pulse and tissue Doppler echocardiography and FMD of brachial artery. The patients were divided into 2 groups according to the size of the left ventricular relaxation parameter—E’. Results: The average age of the patients was 61 ± 6 years. FMD was 5.0 ± 1.8% in 41 patients with E’ from 3 to 7.4 cm/s (mean 6 cm/s) comparing to 5.1 ± 1.9% (p = 0.96) in 41 patients with E’ from 7.5 to 10.9 cm/s (mean 8.9 cm/s). E/E’ was 11.2 ± 2.3 in the group with lower E’ and 9.1 ± 1.6 in the group with higher E’ (p 0.001). Linear negative correlation was found between E/E’ and FMD for the patients with E’ from 3 to 7.4 cm/s (R2 = 0.131;p = 0.025) but not for the group of patients with the higher E’. The significant association between FMD and E/E’ was confirmed by multivariate analysis ((Rc)2 = 0.233;p 0.05). Conclusion: FMD has no impact on the left ventricular relaxation. However FMD is negatively associated with E/E’ in Type 2 diabetic patients who have low E’ as a sign of an impaired early relaxation.

Assessment of Left Ventricular Mechanical Function in Cardiac Syndrome X: Speckle Tracking Imaging Study

Objective: Early detection of LV mechanical abnormalities in patients with cardiac syndrome X (CSX) by speckle tracking echocardiography (STE). Background: Cardiac syndrome X is a triad of angina pectoris, positive stress test for myocardial ischemia and angiographically free coronary arteries. Two dimensional speckle tracking?echocardiography (2D-STE) provides a more sensitive method for evaluation of global and segmental LV function than conventional two dimensional echocardiographic parameters. Subjects and Methods: Seventy patients proved to have CSX and 20 healthy control volunteers were included with a mean age of 49.43 ± 5.92 vs. 49.40 ±6.27 years respectively with no difference regarding sex for both patients and controls. Patients with hypertension, diabetes mellitus, valvular heart disease, cardiomyopathies, inflammatory diseases, myocarditis and arrhythmias were excluded. All included individuals were subjected to complete conventional echocardiographic assessment and left ventricular global and segmental mechanical function was assessed using 2D based strain and strain rate (longitudinal, radial and circumferential) imaging. Results: There was no statistically significant difference in LV conventional echo parameters between patients and controls. However, global mean longitudinal strain was significantly lower in patients than controls (-15.05 ± 3.28 vs. -20.22 ± 2.49;p 0.001). For radial and circumferential strain stain, there was no significant changes between patients vs. controls (29.75 ± 18.26 vs. 28.09 ± 15.48;p = 0.74) and (-19.88 ± 8.63 vs. -21.93 ± 5.69;p 0.05) respectively. Conclusion: In spite of normal conventional echo parameters among patients and controls, LV longitudinal strain and strain rate by 2D speckle tracking imaging were lower in the patients denoting subclinical left ventricular mechanical dysfunction in patients with CSX.

左心房容积指数与左心房前后径评价左心室舒张功能的一致性

目的探讨左心房容积指数(LAVI)与左心房前后径(LAAP)的关系以及二者评价左心室舒张功能的一致性。方法选取我院2018年7月至2019年12月进行超声心动图检查患者315例,其中健康者68例(21.6%),高血压患者98例(31.1%),冠状动脉粥样硬化性心脏病患者97例(30.8%),扩张型心肌病患者32例(10.2%),肺源性心脏病患者11例(3.5%),先天性心脏病患者9例(2.9%)。收集患者临床一般资料,超声心动图检测患者各项心脏指标,包括LAAP、左心房容积(LAV)、二尖瓣舒张早期峰值血流速度(MV E)、二尖瓣舒张晚期峰值血流速度(MV A)、二尖瓣环室间隔部位舒张早期峰值速度(Septal e’)、二尖瓣环侧壁部位舒张早期峰值速度(Lateral e’)、三尖瓣反流峰速(TR)、左心室射血分数(LVEF)等。根据LVEF分为LVEF正常组(LVEF≥53%,n=264)和LVEF减低组(LVEF<53%,n=51),采用独立样本t检验比较2组左心室舒张功能指标的差异。采用Pearson或Spearman相关分析LAVI与LAAP的相关性;采用Kappa检验分析LAAP和LAVI评价左心室舒张功能的一致性。结果与LVEF正常组比较,LVEF减低组患者LAAP、LAV、LAVI、E/e’及TR显著增大(均P<0.001),而Septal e’及Lateral e’显著减小(均P<0.001)。LAAP和LAVI水平呈正相关(r=0.74,P<0.001)。LAAP和LAVI评价左心室舒张功能是否减低及分级的一致性均较强(均P<0.001)。结论LAAP与LAVI水平呈正相关;LAAP与LAVI评价左心室舒张功能是否减低和分级时一致性均较强。LVEF减低时,LAAP与LAVI相关性更高,LAAP与LAVI评价左心室舒张功能分级的一致性更强。因此,对于LVEF减低患者,当无法获得LAVI指标时,可用LAAP替代LAVI进行评估。

高血压患者短期血压变异与左室舒张功能的相关性分析

目的探讨原发性高血压患者血压变异与左室舒张功能的关系。方法对2021年10月至2022年1月我院门诊138例初诊原发性高血压患者的临床资料进行回顾性分析,根据超声心动图测量平均E/e′结果分两组(舒张功能正常组E/e′<14、舒张功能降低组E/e′≥14),比较两组间24 h动态血压指标结果(血压变异以血压变异系数、平均收缩压及舒张压标准差表示),分析左室舒张功能与血压变异指标及临床生化指标的相关性。结果左室舒张功能降低组患者的24 h收缩压变异系数(24hSBPCV)、24 h收缩压标准差(24hSBPSD)、24 h舒张压变异系数(24hDBPCV)、日间收缩压变异系数(dSBPCV)、日间舒张压变异系数(dDBPCV)、日间收缩压标准差(dSBPSD)、24 h收缩压平均水平(24hSBP)、夜间收缩压平均水平(nSBP)均高于舒张功能正常组,24hDBP、dDBP及nDBP低于舒张功能正常组,差异有统计学意义(P<0.05)。相关性分析提示:24hSBPCV、24hSBPSD、dSBPCV、dSBPSD、24hSBP、nSBP、年龄均与E/e′呈正相关(r=0.136、0.182、0.170、0.205、0.195、0.322、0.568,P=0.032、0.004、0.007、0.001、0.022、0.000、0.000);24hDBP、dDBP及nDBP均与E/e′呈负相关(r=-0.322、-0.334、-0.198,P=0.000、0.000、0.020);Logistic回归分析显示:dSBPSD及年龄是左室舒张功能的独立影响因素[OR=3.062(1.314~7.133)、1.094(1.058~1.132)]。结论原发性高血压患者短期血压变异及年龄是左室舒张功能的影响因素。

基于组织特征追踪的心脏磁共振左房应变分析在肥厚型心肌病左室舒张功能障碍评估中的价值

目的探索磁共振左心房应变(left atrial strain,LAS)在肥厚型心肌病(hypertrophic cardiomyopathy,HCM)左室舒张功能障碍(left ventricular diastolic dysfunction,LVDD)诊断中的价值。材料与方法回顾性分析2021年2月至2022年8月中国医学科学院阜外医院诊断的103例HCM住院患者的临床资料、超声心动图、心脏磁共振(cardiac magnetic resonance,CMR)基本参数、基于组织特征追踪的左室应变(left ventricular strain,LVS)及LAS参数,根据超声心动图结果将上述患者分为28例LVDD组(A组)以及75例无明显LVDD组(B组)。采用独立样本t检验、非参数检验、卡方检验等统计方法,分别比较A组与B组的临床基线资料、CMR基本参数、LVS及LAS参数,同时采用logistic回归分析筛选LVDD的独立相关因素。结果A组患者的年龄更大[中位年龄为53.0(43.2,66.8)岁]、纽约心功能分级(New York HeartAssociation,NYHA)Ⅲ~Ⅳ(60.7%)更高,出现晕厥(32.1%)、猝死家族史(32.1%)等临床症状的比例更高。与B组比较,A组左房前后径(left atrial anteroposterior diameter,LAD-AP)、左心室收缩末期容积指数(left ventricular end-systolic volume index,ESVi)、左心室质量指数(left ventricular mass index,LVMi)及左室流出道梗阻(left ventricular outflow tract obstruction,LVOTO)的比例均显著增高(P值均<0.05),被动应变(passive strain,εe)、峰值正应变率(peak positive strain rate,SRs)、峰值早期负应变率(peak early negative strain rate,SRe)及峰值晚期负应变率(peak late negative strain rate,SRa)均显著降低(P均<0.05)。多因素logistic回归分析显示LVOTO[优势比(odds ratio,OR)=4.127,95%置信区间(confidence interval,CI):1.488~11.450,P=0.006]及SRa(OR=4.672,95%CI:1.624~13.441,P=0.004)与LVDD独立相关,且SRa具有较高的诊断效能,其区分LVDD的受试者工作特征(receiver operator characteristic,ROC)曲线下面积(area under the curve,AUC)为0.717。结论磁共振LAS可反映HCM患者的LVDD。SRa对LVDD有一定的诊断效能,是一个具有潜在价值的诊断指标。

基于4D Flow CMR技术评价心肌纤维化对肥厚型心肌病患者左室舒张功能障碍的影响

目的采用四维血流(four-dimensional flow,4D Flow)心脏磁共振成像(cardiac magnetic resonance,CMR)技术对肥厚型心肌病(hypertrophic cardiomyopathy,HCM)患者是否存在左心室舒张功能障碍进行评估,探讨心肌纤维化对HCM患者左心室舒张功能的影响。材料与方法前瞻性纳入44例HCM患者,根据患者是否合并晚期钆增强(late gadolinium enhancement,LGE)分为HCM LGE(+)组(25例)和HCM LGE(-)组(19例),同期纳入31例健康对照者。三组人群进行3.0 T磁共振稳态自由进动序列及4D Flow序列扫描。采用CVI42后处理软件进行分析,包括心功能参数、二尖瓣血流速度参数。使用单因素方差分析或Mann-Whitney U检验对三组受试者临床资料及影像学参数进行比较;并对二尖瓣水平舒张早期平均血流速度(E)与舒张期整体室壁峰值厚度(global peak wall thickness,GPWT)、左心室质量(left ventricular mass,LVmass)进行相关性分析。结果HCM患者的LVmass及GPWT均大于健康对照组,且伴有心肌纤维化较不伴有心肌纤维化的HCM患者的GPWT增大更加明显[HCM LGE(+)组vs.HCM LGE(-)组vs.健康对照组];[LVmass:157.34(122.24,194.38)g vs.148.29(131.79,189.83)g vs.85.73(73.00,94.02)g;GPWT:20.04(16.76,24.99)mm vs.17.46(16.19,19.99)mm vs.9.47(8.35,10.92)mm](P<0.001);伴有心肌纤维化的HCM患者舒张早期平均血流速度峰值(E峰)低于不伴有心肌纤维化的HCM患者,且均较健康对照组低[HCM LGE(+)组vs.HCM LGE(-)组vs.健康对照组:(30.03±11.33)cm/s vs.(38.05±12.03)cm/s vs.(47.44±10.82)cm/s](P<0.001);而舒张晚期平均血流速度峰值(A峰)在三组间均无显著性差异;且伴有心肌纤维化的HCM患者较健康对照组的E/A值明显减低(1.10±0.61 vs.1.74±0.85)(P<0.05)。舒张期早期二尖瓣水平的平均血流速度与GPWT和LVmass均呈负相关(r=-0.593/r=-0.371,P<0.001/P=0.001)。结论基于4D Flow CMR不仅可以从三维角度对血流速度进行准确测量,同时能从血流动力学方面定量评估HCM患者的左室舒张功能障碍及心肌纤维化对HCM患者左心室舒张功能的影响。

妊娠期糖尿病对胎儿超声心动图肺静脉血流频谱及心脏功能的影响

目的探讨妊娠期糖尿病(GDM)对胎儿超声心动图检查肺静脉血流频谱及心脏功能的影响。方法选取我院诊断的GDM孕妇190例作为GDM组,另选取同期在我院行超声检查的健康孕妇203例作为对照组,GDM组依据不同血糖控制水平分为GDM1组(血糖控制稳定)112例和GDM2组(血糖控制不佳)78例。比较各组孕妇糖化血红蛋白(HbAlc)水平,并行超声心动图检查,比较各组孕妇宫内胎儿左心室结构相关参数。结果GDM2组空腹血糖、餐后2 h血糖和HbAlc水平、左心室厚度(LVWT)、室间隔舒张末期厚度(IVSd)、肺静脉峰值流速(PVIV)、肺静脉搏动指数(PI)均高于对照组和GDM1组,GDM1组上述指标均高于对照组,差异有统计学意义(P<0.05);GDM2组左心室短轴缩短率(LVFS)、左心室射血分数(LVEF)、A峰流速均低于对照组和GDM1组,差异有统计学意义(P<0.05);GDM1组上述指标均低于对照组,差异有统计学意义(P<0.05)。GDM1组、GDM2组HbAlc与LVWT、IVSd均呈正相关(P<0.05),与LVFS、LVEF均呈负相关(P<0.05);GDM1组、GDM2组胎儿肺静脉血流频谱A峰流速与PVIV和PI均呈负相关(P<0.05)。结论GDM对胎儿肺静脉血流频谱参数A峰流速的下降和PVIV与PI的升高提示GDM孕妇胎儿左心室舒张功能的下降。

维持性血液透析患者左心室舒张功能障碍的危险因素分析

目的 探讨维持性血液透析(maintenance hemodialysis,MHD)患者左心室舒张功能障碍(left ventricular diastolic dysfunction,LVDD)发生的危险因素。方法 采用回顾性研究,纳入北京市顺义区医院血液净化中心进行维持性血液透析的100例患者,根据多普勒超声心动图结果,记录心尖四腔切面室间隔侧二尖瓣环处舒张早期峰值速度(early diastolic flow-velocity peak,Ve)及舒张晚期峰值速度(late diastolic flow-velocity peak,Va),计算Ve与Va的比值(Ve/Va)。以Ve/Va<1作为判断左心室舒张功能障碍的标准,将患者分为LVDD组和无LVDD组;收集2组患者一般资料和生化指标,比较2组间上述各指标的差异性,并采用Logistic回归分析LVDD的危险因素结果 (1)MHD患者LVDD组糖尿病肾病(diabetic nephropathy,DN)发生率高于左心室舒张功能正常组(χ^(2)=4.332,P=0.024)。(2)与左心室舒张功能正常组相比,LVDD组收缩压、钙磷乘积、C-反应蛋白(CRP)水平显著增高(t=6.443、5.419、5.107,P=0.033、0.043、0.036),而血浆白蛋白(Alb)水平显著降低(t=6.759,P=0.008)。(3)Logistic回归分析显示:收缩压升高可能是MHD患者LVDD发生的独立危险因素(OR=1.245,95%CI:0.987~1.008,P=0.001),而血浆白蛋白是其保护性因素(OR=2.061,95%CI:0.091~1.239,P=0.037)。结论 糖尿病肾病、收缩压、营养不良、钙磷乘积升高、CRP升高与MHD患者LVDD发生有关,且收缩压升高、白蛋白降低可能是其重要的独立危险因素。需要引起临床重视。

中青年原发性高血压患者血清sSema4D、CXCL12水平与左心室舒张功能的关系

目的探讨中青年原发性高血压患者血清可溶性信号素4D(sSema4D)、CXC趋化因子配体12(CXCL12)水平与左心室舒张功能的关系。方法选取该院2020年11月至2022年11月收治的148例中青年原发性高血压患者为研究对象,并根据患者左心室舒张功能分为左心室舒张功能不全组41例和左心室舒张功能正常组107例。采用酶联免疫吸附试验检测血清sSema4D、CXCL12水平,Pearson相关性分析血清sSema4D、CXCL12水平与患者左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、舒张末期室间隔厚度(IVST)、左心室舒张末期后壁厚度(LVPWT)、左心室射血分数(LVEF)、E峰/A峰(E/A)和三尖瓣反流最大速度(TRVmax)的相关性。受试者工作特征(ROC)曲线分析血清sSema4D和CXCL12水平对中青年原发性高血压患者左心室舒张功能不全的预测价值。结果左心室舒张功能不全组和左心室舒张功能正常组舒张压和性别比较差异有统计学意义(P<0.05)。与左心室舒张功能正常组比较,左心室舒张功能不全组血清sSema4D、CXCL12水平明显升高,差异有统计学意义(P<0.05)。与左心室舒张功能正常组比较,左心室舒张功能不全组IVST和LVPWT明显升高,E/A明显降低,差异有统计学意义(P<0.05)。Pearson相关性分析显示,血清sSema4D和CXCL12水平均与LVEDD、IVST、LVPWT呈正相关(P<0.05),与E/A呈负相关(P<0.05)。ROC曲线分析显示,血清sSema4D、CXCL12联合预测中青年原发性高血压患者左心室舒张功能不全的曲线下面积(AUC)为0.894(95%CI:0.833~0.939),显著大于sSema4D单独预测中青年原发性高血压患者左心室舒张功能不全的AUC(Z=3.142,P=0.002)和CXCL12单独预测中青年原发性高血压患者左心室舒张功能不全的AUC(Z=3.268,P=0.001)。结论血清sSema4D和CXCL12水平与中青年原发性高血压患者左心室舒张功能有关。

血压节律与水平和左心室舒张功能的相关性分析

目的 探讨原发性高血压患者的血压昼夜节律、不同血压水平与左室舒张功能之间的关系。方法 纳入解放军总医院第一医学中心心内科2022年1月~2023年4月收治的678例原发性高血压住院患者,所有患者均接受动态血压监测(ambulatory blood pressure monitoring, ABPM)和超声心动图检查。根据血压昼夜节律分为杓型血压组(n=46)、非杓型组(n=451)、反杓型组(n=181)。采用左房容积指数(left atrial volume index, LAVI)、二尖瓣口舒张早期血流峰值速度/二尖瓣环处侧壁和间隔舒张早期速度的平均值(E/e′)、二尖瓣环处侧壁和间隔舒张早期速度的平均值(e′)评估3组患者左室舒张功能。采用方差分析和多元线性回归分析诊室血压、24 h收缩压平均值(24 h-mSBP)、24 h舒张压平均值(24 h-mDBP)、日间收缩压平均值(D-mSBP)、日间舒张压平均值(D-mDBP)、夜间收缩压平均值(N-mSBP)、夜间舒张压平均值(N-mDBP)、24 h收缩压变异性(24-SBPV)、24 h舒张压变异性(24-DBPV)、日间收缩压变异性(D-SBPV),日间舒张压变异性(D-DBPV),夜间收缩压变异性(N-SBPV),夜间舒张压变异性(N-DBPV)与左室舒张功能之间的关系。结果 反杓型血压组的LAVI明显高于杓型血压组,差异有统计学意义(P<0.05)。多元线性回归的结果显示,24 h-SBP、D-mSBP和N-mSBP与LAVI独立相关(B=0.06,P<0.05);24 h-mSBP、D-mSBP、N-mSBP、诊室收缩压、24-SBPV、24-DBPV、D-SBPV和D-DBPV与E/e′独立相关(B=0.03、0.03、0.02、0.01、0.09、0.10、0.05、0.07,P<0.05);24 h-mSBP、24 h-mDBP、N-mDBP和诊室舒张压与e′独立相关(B=-0.01、-0.02、-0.02、-0.01,P<0.05)。结论 反杓型血压节律和收缩压平均值(mSBP)与左房扩大相关。mSBP及诊室收缩压均与左室舒张功能相关,且mSBP与左室舒张功能的相关性强于诊室血压。ABPM可用于早期识别高血压患者中左房扩大和左心室舒张功能障碍的高风险人群。

慢性心力衰竭患者心肌能量代谢变化与心脏收缩功能及左心室重构的相关性

目的分析慢性心力衰竭患者心肌能量代谢(MEE)变化与心脏收缩功能及左心室重构的相关性。方法回顾性选取2021年3月至2022年12月南平市第一医院收治的100例慢性心力衰竭患者作为观察组,选取同期来本院进行体检的85名健康体检者作为对照组。比较两组研究对象的左心室收缩末圆周室壁应力(cESS)、MEE、血清游离脂肪酸(FFA)、血清糖类抗原125(CA125)、左心室舒张末期内径(LVEDd)、左心室收缩末期内径(LVESd)、左心室质量指数(LVMI)、左心室射血分数(LVEF)、每搏输出量、短轴缩短率及射血时间水平;采用Pearson相关分析,分析慢性心力衰竭患者心肌能量代谢变化与心脏收缩功能及左心室重构的相关性。结果观察组患者cESS、MEE、FFA及CA125水平分别为(194.35±30.25)kdyne/cm^(2)、(128.37±23.69)cal/min、(850.41±150.35)μmol/L、(68.54±5.33)kU/L,均高于对照组[(79.44±50.69)kdyne/cm^(2)、(68.57±12.97)cal/min、(227.31±40.57)μmol/L、(17.25±2.70)kU/L],差异均有统计学意义(P<0.05)。观察组患者LVEDd、LVESd、LVMI分别为(71.58±12.45)mm、(67.55±12.74)mm、(140.33±25.64)g/m^(2),均高于对照组[(42.05±8.46)mm、(41.39±8.16)mm、(77.59±13.58)g/m^(2)],LVEF、每搏输出量、短轴缩短率及射血时间分别为(38.49±7.64)%、(48.69±12.46)mL、(18.53±2.14)%、(181.31±18.49)ms,均低于对照组[(68.14±12.18)%、(68.67±15.04)mL、(36.05±2.34)%、(320.45±20.14)ms],差异均有统计学意义(P<0.05)。经过Pearson相关分析,cESS、MEE、FFA均与LVEDd、LVESd、LVMI、CA125呈正相关(P<0.05),cESS、MEE、FFA均与LVEF、每搏输出量、短轴缩短率、射血时间呈负相关(P<0.05)。结论慢性心力衰竭患者MEE、心脏收缩功能及左心室重构均发生异常,且MEE与心脏收缩功能、左心室重构密切相关。

滋阴潜阳汤配合耳穴按压对高血压患者左心室舒张功能的影响

目的:观察滋阴潜阳汤配合耳穴按压对高血压患者左心室舒张功能的影响。方法:将90例高血压患者根据随机数字表法分为常规组和研究组,每组各45例。常规组给予耳穴按压治疗,研究组在常规组治疗的基础上联合滋阴潜阳汤治疗。监测两组患者治疗前后24 h血压变化情况,比较两组患者不良反应发生率及治疗前后主动脉内径(aorta,AO)、左心室射血分数(left ventricular ejection fraction,LVEF)、E峰、A峰、E/A、凝血因子Ⅷ、抗凝血酶Ⅲ、组织型纤溶酶原激活物(tissue-type plasminogenactivator,t-PA)等指标变化情况。结果:两组患者治疗后各项血压指标低于本组治疗前,且治疗后研究组低于常规组(P<0.05)。两组患者治疗后AO、LVEF、E峰、A峰及E/A高于本组治疗前,且治疗后研究组高于常规组(P<0.05)。两组患者治疗后凝血因子Ⅷ、抗凝血酶Ⅲ及t-PA等各项凝血纤溶系统指标高于本组治疗前,且治疗后研究组高于常规组(P<0.05)。研究组不良反应发生率低于常规组(P<0.05)。结论:滋阴潜阳汤配合耳穴按压治疗高血压疗效确切,可降低患者血压水平,改善凝血纤溶系统指标及左心室舒张功能,且不良反应较少。

颈动脉内中膜厚度与亚临床左心室收缩功能的关系

目的:在江苏丹阳社区人群中探讨颈动脉内中膜厚度(carotid intima-media thickness,c IMT)与亚临床左心室功能的关系。方法:研究对象为2021年在江苏省丹阳市车站社区招募的受试者。使用GE Vivid E90超声仪测量分析c IMT;二维斑点追踪技术采集左心室整体纵向应变(left ventricular global longitudinal strain,LVGLS)作为评估亚临床收缩功能的指标,二尖瓣口血流频谱和组织多普勒成像采集e’和E/e’比值作为评估亚临床舒张功能的指标。结果:研究共计纳入561例,年龄(58.2±11.7)岁,其中女339例(60.4%)。首先使用三分位法将cIMT作为分类变量分析,在单因素分析中,除了左心室射血分数外,LVGLS,E/A和e’均随着cIMT三分位数从低到高下降,而E/e’比值随着cIMT三分位数从低到高增加(均P_(trend)≤0.002)。然而,进一步进行多因素校正分析后,只有LVGLS仍随着c IMT三分位数从低到高下降(P<0.05)。进一步将c IMT自然对数转换后进行连续变量分析,结果与分类变量分析结果类似,仅有LVGLS与cIMT显著负相关(r=-0.087,P=0.041);并且在回归分析中也发现了类似的结果(β=-1.12,P=0.041)。结论:在江苏丹阳社区人群中,cIMT增厚与GLS减低独立相关。

左室射血分数正常的心力衰竭患者左心形态和左室舒张功能与心功能分级的相关性

目的分析左室射血分数(LVEF)正常的心力衰竭患者左心形态,左室舒张功能与心功能分级的相关性。方法回顾性选取2021年1月—2022年7月电子科技大学医学院附属绵阳医院收治的40例LVEF正常的心力衰竭患者作为观察组,同期选取50例健康体检者作为对照组。观察组患者根据纽约心脏病学会心功能分级标准又分为Ⅱ级组(14例)、Ⅲ级组(19例)、Ⅳ级组(7例)。比较各组3个心动周期的左心房内径(LAD)、左心室舒张末期内径(LVDD)、室间隔厚度(IVST)、左心室收缩末期内径(LVDs)。利用多普勒成像程序测定二尖瓣环侧壁部舒张早期峰速度(Elat)、二尖瓣环间隔部舒张早期峰速度(Esep)、E峰减速时间(DT),检测舒张晚期A峰速度、二尖瓣E峰速度、二尖瓣环舒张早期运动峰速度(Ea)并计算E/A、E/Ea。采用Spearman相关性检验分析LVEF正常的心力衰竭患者左心形态、左室舒张功能与心功能分级的相关性。结果观察组LAD、LVDD和LVDs均长于对照组,IVST厚于对照组,差异有统计学意义(P<0.05)。观察组Elat、Esep均快于对照组,DT短于对照组,E/A、E/Ea均高于对照组,差异有统计学意义(P<0.05)。三组LAD、LVDD、IVST、LVDs比较,差异有统计学意义(P<0.05)。Ⅲ级组、Ⅳ级组LAD、LVDD和LVDs均长于Ⅱ级组,IVST厚于Ⅱ级组,差异有统计学意义(P<0.05)。Ⅳ级组LAD、LVDD和LVDs均长于Ⅲ级组,IVST厚于Ⅲ级组,差异有统计学意义(P<0.05)。三组Elat、Esep、DT、E/A、E/Ea比较,差异有统计学意义(P<0.05)。Ⅲ级组、Ⅳ级组Elat、Esep均快于Ⅱ级组,DT短于Ⅱ级组,E/A、E/Ea均高于Ⅱ级组,差异有统计学意义(P<0.05)。Ⅳ级组Elat、Esep均快于Ⅲ级组,DT短于Ⅲ级组,E/A、E/Ea均高于Ⅲ级组,差异有统计学意义(P<0.05)。LAD、LVDD、IVST、LVDs与LVEF正常的心力衰竭患者心功能分级呈明显正相关关系(r=0.712、0.656、0.689、0.693,P<0.001),Elat、Esep、E/A、E/Ea与LVEF正常的心力衰竭患者心功能分级呈明显正相关关系(r=0.698、0.701、0.675、0.639,P<0.001),DT与LVEF正常的心力衰竭患者心功能分级呈明显负相关关系(r=-0.712,P<0.001)。结论LVEF正常的心力衰竭患者左心形态、左室舒张功能与心功能分级呈显著相关关系。