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 managemen...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. CardioMEMS<sup>TM</sup> (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.展开更多
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 stiffn...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.展开更多
目的探讨慢性心力衰竭(CHF)患者心脏同步化治疗(CRT)近期及远期效果与肺动脉收缩压(PASP)的关系。方法选择行CRT的42例CHF患者,根据术前PASP水平分为高PASP组(PASP≥45 mm Hg,1 mm Hg=0.133 k Pa)(n=15)和低PASP组(PASP<45 mm Hg)(n=...目的探讨慢性心力衰竭(CHF)患者心脏同步化治疗(CRT)近期及远期效果与肺动脉收缩压(PASP)的关系。方法选择行CRT的42例CHF患者,根据术前PASP水平分为高PASP组(PASP≥45 mm Hg,1 mm Hg=0.133 k Pa)(n=15)和低PASP组(PASP<45 mm Hg)(n=27)。分别对2组患者CRT植入术前、术后6个月、1、2 a的心功能分级评估情况、PASP、左心室舒张末期内径(LVEDD)、QRS波、左心室射血分数(LVEF)、左心室短轴缩短率(FS)及血浆脑钠肽(BNP)水平进行观察比较。并对2组患者术后6个月的CRT反应率进行比较。结果 2组患者术前PASP水平比较差异无统计学意义(P>0.05);2组患者术后6个月、1、2 a的PASP水平均显著低于术前(P<0.05),2组患者术后1、2 a的PASP水平均显著低于术后6个月(P<0.05),术后2 a与术后1 a的PASP水平比较差异无统计学意义(P>0.05)。低PASP组患者术后6个月、1、2 a的PASP水平均显著低于相同时间点高PASP组(P<0.05)。2组患者术后6个月、1、2 a的心功能分级、LVEDD、QRS波、LVEF、FS及BNP水平均显著优于术前(P<0.05);术后1、2 a上述指标均优于术后6个月水平(P<0.05);术后1 a与术后2 a上述各指标比较差异均无统计学意义(P>0.05)。手术前2组患者各指标比较差异均无统计学意义(P>0.05);术后6个月、1、2 a,低PASP组患者的心功能分级、LVEF、BNP水平均显著优于低PASP组(P<0.05);LVEDD、QRS波及FS水平2组患者各时间点比较差异均无统计学意义(P>0.05)。高PASP组和低PASP组患者术后6个月CRT反应率分别为46.7%(7/15)和77.8%(21/27),低PASP组患者术后6个月的CRT反应率高于高PASP组(P<0.05)。结论 CRT植入术用于低PASP患者的近期和远期的心功能改善效果明显优于高PASP患者,且CRT反应率也显著高于高PASP患者。展开更多
目的采用右心室心肌做功（Tei）指数评价右心功能并探讨术前右心功能对心脏再同步化治疗患者临床疗效的影响。方法26例慢性心力衰竭患者分别于心脏再同步化治疗（CRT）术前及术后行超声心动图检查及心功能评估，至术后6个月时NYHA分级...目的采用右心室心肌做功（Tei）指数评价右心功能并探讨术前右心功能对心脏再同步化治疗患者临床疗效的影响。方法26例慢性心力衰竭患者分别于心脏再同步化治疗（CRT）术前及术后行超声心动图检查及心功能评估，至术后6个月时NYHA分级至少下降1级，左室收缩末期容积（LVESV）至少降低15％为CRT有反应组，作为A组，余为无反应组作为B组，统计两组患者右心室Tei指数及常规超声指标变化。结果26例心力衰竭患者A组18例，B组8例，A组术前右心Tei指数明显比B组低[（0．44±O．07）VS．（0．55±0．07），P〈0．05]，肺动脉压力（PAP）明显比B组低[（39±9）mmHgvs．（50±7）mmHg，1 mm Hg=0．133kPa，P〈0．05]。同术前比较，A组患者Tei指数明显下降[（O．44±0．07）vs．（0．39±0．08），P〈0．05]，PAP也明显降低[（39±9）mmHgVS．（35±7）mmHg，P〈0．05]；B组患者Tei指数明显增加[0．55±0．07VS．0．68±0．08，P〈0．05]，而PAP术前术后改善不明显。结论心力衰竭患者术前右心功能可影响心脏再同步化治疗效果，拟行CRT患者可常规行心脏超声评价右心功能。展开更多
文摘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. CardioMEMS<sup>TM</sup> (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.
文摘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.
文摘目的采用右心室心肌做功（Tei）指数评价右心功能并探讨术前右心功能对心脏再同步化治疗患者临床疗效的影响。方法26例慢性心力衰竭患者分别于心脏再同步化治疗（CRT）术前及术后行超声心动图检查及心功能评估，至术后6个月时NYHA分级至少下降1级，左室收缩末期容积（LVESV）至少降低15％为CRT有反应组，作为A组，余为无反应组作为B组，统计两组患者右心室Tei指数及常规超声指标变化。结果26例心力衰竭患者A组18例，B组8例，A组术前右心Tei指数明显比B组低[（0．44±O．07）VS．（0．55±0．07），P〈0．05]，肺动脉压力（PAP）明显比B组低[（39±9）mmHgvs．（50±7）mmHg，1 mm Hg=0．133kPa，P〈0．05]。同术前比较，A组患者Tei指数明显下降[（O．44±0．07）vs．（0．39±0．08），P〈0．05]，PAP也明显降低[（39±9）mmHgVS．（35±7）mmHg，P〈0．05]；B组患者Tei指数明显增加[0．55±0．07VS．0．68±0．08，P〈0．05]，而PAP术前术后改善不明显。结论心力衰竭患者术前右心功能可影响心脏再同步化治疗效果，拟行CRT患者可常规行心脏超声评价右心功能。
