Echocardiographic Evaluation of Cardiac Dyssynchrony in Patients with Congestive Heart Failure

The present study investigated the application of echocardiography to evaluation of cardiac dyssynchrony in patients with congestive heart failure（CHF）. A total of 348 consecutive CHF patients who were admitted for cardiac resynchronization（CRT） and presented with low ejection fraction（EF） and wide QRS duration were enrolled in this study, along with 388 healthy individuals. Dyssynchrony was assessed based on filling time ratio（FT/RR）, left ventricular pre-ejection delay（PED）, interventricular mechanical delay（IVMD）, longitudinal opposing wall delay（LOWD） and radial septal to posterior wall delay（RSPWD）. Response to CRT was defined as a ≥15% increase in EF. The results showed that FT/RR was decreased while PED, IVMD, LOWD and RSPWD were increased in the CHF group compared with the control group（P〈0.01）. In the CHF group, FT/RR was negatively correlated with the QRS duration, LV end-diastolic diameter（LVESd）, LV end-diastolic volume（LVEDV） and LV end-systolic volume（LVESV）（P〈0.01）, but positively with the LVEF（P〈0.01）. Additionally, PED, IVMD, LOWD and RSPWD were positively correlated with the QRS duration, LVESd, LVEDV and LVESV（P〈0.01）, but negatively with the LVEF（P〈0.01）. The CHF group was divided into three subgroups according to the varying degrees of LVEF. FT/RR decreased successively from the LVEF-1 group to the LVEF-2 group to the LVEF-3 group, while the PED, IVMD, LOWD and RSPWD successively increased in the same order（P〈0.01）. The CHF group was divided into three subgroups according to the varying degrees of QRS duration, and FT/RR decreased successively in a sequence from the QRS-1 group to the QRS-2 group to the QRS-3 group, while the PED, IVMD, LOWD and RSPWD successively increased in the same order（P〈0.01）. Speckle tracking radial dyssynchrony ≥130 ms was predictive of an EF response in patients in QRS-1 group（78% sensitivity, 83% specificity）, those in QRS-2 group（83% sensitivity, 77% specificity） and in QRS-3 group（89% sensitivity, 79% specificity）. In conclusion, echocardiography is a convenient and sensitive method for evaluating cardiac dyssynchrony in patients with CHF.

Improved Cardiac Contractility of Human Recombinant Growth Hormone on the Congestive Heart Failure of Pig

The enhanced cardiac contractility effect of human recombinant growth hormone (hr-GH) on the congestive heart failure (CHF) was studied on the pig. To build a pig model of congestive heart failure, a temporary artificial cardiac pacemaker was implanted in the pig’s body and paced at 220 beats to 240 beats per minute for 1 week. After the model of congestive heart failure was successfully set up, the frequency of the pacemaker was changed to 150 beats to 180 beats per minute to maintain the CHF model stable. Pigs were divided into three groups: The hr-GH group in which 0.5 mg/kg per day of hr-GH was administrated intramuscularly for 15 days, the injection control group in which an equal amount of physiological saline was injected intramuscularly, and a normal control group. The left ventricular diastolic end pressure was (10.60±2.41) mmHg in the hr-GH group, but (19.00±3.81) mmHg in the saline control group (P<0.01); Cardiac output was (1.86±0.13) L/min in the hr-GH group, but (1.56±0.18) L/min in the saline control group (P<0.05); Peripheral vascular resistance was (56.88±7.51) mmHg·(L/min) -1 in the hr-GH group, whereas (70.30±11.59) mmHg·(L/min) -1 in the saline control group (P<0.05); +dp/dt max was (2900±316.23) and (2280±286.36) in the hr-HG group and the saline control group respectively (P<0.05). The results show that hr-GH enhances myocardial contractility of CHF, and the CHF model built by a temporary artificial cardiac pacemaker at a high rate of stimulation is reasonable and applicable.

Intervention Effect of Jianxin Decoction (健心汤) on Serum Cytokine Level of Congestive Heart Failure Patients

Objective: To investigate the intervention effect of Jianxin Decoction (健心汤, JXD) on the cytokine level in serum of patients with congestive heart failure (CHF). Methods; Sixty-six patients with CHF were randomly divided into the control group (n = 33) and the trial group (n = 33). The control group received conventional treatment, and the trial group was treated with conventional therapy plus JXD for 4 weeks. Before and after treatment, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and nitrogen monoxide (NO) in serum and cardiac function were determined. Results: After treatment, the levels of TNF-α, IL-6 and NO were significantly lower than those before treatment (P<0.05, or P<0.01) in the two groups, and the lowering degree of the indices in the trial group was more significantly reduced than that in the control group (P<0.05). And cardiac functions in both groups were improved significantly (P<0.05, or P< 0.01). Conclusion: JXD could prevent and reverse ventricular remodeling so as to ameliorate cardiac function through regulating the levels of cytokines.

BUN/Cr、cTnⅠ、NT-proBNP在不同严重程度的急性左心衰竭患者中的诊断价值

目的:评估血尿素氮/肌酐比(blood urea nitrogen/creatinine ratio,BUN/Cr)、心肌肌钙蛋白Ⅰ(cardiac troponinⅠ,cTnⅠ)和N末端B型利钠肽原(NT-proBNP)在诊断急性左心衰竭患者的严重程度方面的有效性。方法:选取连云港市第二人民医院检验科2023年1月—2024年2月接收的122份急性左心衰竭患者的血清样本作为研究样本,根据急性生理学及慢性健康状况评分Ⅱ(APACHEⅡ)将患者分为轻症组(APACHEⅡ评分≤20分,45例)、重症组(APACHEⅡ评分21~30分,42例)及极重症组(APACHEⅡ评分≥31分,35例)。比较三组患者的血清BUN/Cr、cTnⅠ及NT-proBNP水平,采用Spearman分析评估血清BUN/Cr、cTnⅠ及NT-proBNP水平与急性左心衰竭患者严重程度的相关性,并构建受试者操作特征(ROC)曲线分析血清BUN/Cr、cTnⅠ及NT-proBNP水平对极重症急性左心衰竭患者的诊断价值。结果:极重症组的血清BUN/Cr、cTnⅠ及NT-proBNP水平均高于重症组、轻症组,且重症组均高于轻症组,差异均有统计学意义(P<0.05);相关性分析结果显示,血清BUN/Cr、cTnⅠ及NT-proBNP水平与急性左心衰竭患者的严重程度呈正相关(P<0.05);ROC曲线分析结果显示,血清BUN/Cr、cTnⅠ及NT-proBNP联合检测的敏感度、特异度分别为94.3%、90.8%,ROC曲线下面积(AUC)为0.969,优于单独检测。结论:在急性左心衰竭患者中,血清BUN/Cr、cTnⅠ及NT-proBNP的水平与疾病严重程度相关,联合检测可以有效诊断急性左心衰竭患者的疾病严重程度,具有较高的敏感度和特异度。

Study on the effect and mechanism of the dysfunction of CD4^+ T cells in the disease process of chronic cardiac failure

Objective: To study the effect and mechanism of the dysfunction of CD4+ T cells in the disease process of chronic cardiac failure (CHF).Methods:According to different group technologies, 100 CHF patients were divided into the following groups: ischemia group and non-ischemia group, heart function Ⅰ-Ⅱ group and heart function Ⅲ-Ⅳ group, event group and non-event group, and 50 healthy volunteers were included in the control group. Realtime PCR was used to detect transcription factors T-bet and GATA-3 of Th1 and Th2; flow cytometry was applied to determine the ratio of Th17 and Treg cells; ELISA was employed to test cytokines IFN-γ, IL-4, IL-17 and IL-10 of peripheral blood Th1, Th2, Th17 and Treg cells, respectively; ultrasonic cardiogram was used to exploit to LVEF and LVEDd; and electrochemilu minescene immunoassay was used to examine plasma BNP. The differences of all indexes of all groups were analyzed and the correlation between CD4 T cells and clinical indexes was analyzed by Pearson correlation analysis. Results: As compared to the control group, the transcription factors T-bet and GATA-3 of Th1 and Th2, the ratio of cytokines Th17 and IFN-γ, cytokines IL-17, T-bet/GATA-3, IFN-γ/IL-4, Th17 cells/Treg cells, IL-17/IL-10 of the ischemia group and non-ischemia group, heart functionⅠ-Ⅱgroup and heart function Ⅲ-Ⅳ group, event group and non-event group were all increased significantly, while their transcription factor GATA-3 of Th2, cytokines IL4, Treg cells ratio, cytokines IL10 were decreased obviously. The differences showed statistical significance (P < 0.05). The increase or decrease of the partial CD4+ T cells of the ischemia group, heart function Ⅲ-Ⅳ group and event group was more distinctly. The results of Pearson correlation analysis showed that IFN-γ and IL-17 were significantly positively correlated with LVEDd and BNP, IL-4 and IL-10 were also significantly positively correlated with LVEF, but correlated negatively with BNP, and IL-17 was negatively correlative with LVEF. Conclusions: There was a correlation between CHF and the dysfunction of CD4+ T cells showing immune activation phenomenons of deviations from the Th1/Th2 balance towards Th1 and from the Th17/Treg balance towards Th17, which was also related to the types, severity and prognosis of the disease.

Myocardial Protection with Beta Blocker Treatment in Infants with Heart Failure Due to Congenital Heart Defects and Duchenne Muscular Dystrophy

Our first intention to treat infants’ heart failure with beta blockers was to improve the clinical condition as shown in our prospective randomized trial. We only use non-selective beta blockers in these infants, carvedilol in those with left ventricular dysfunction and propranolol in those with congenital heart disease without ventricular dysfunction. Despite a significant improvement of Ross’s heart failure score, we could not convince most colleagues within the last 25 years if the concept of neurohumoral activation in heart failure is not well-established pediatric cardiology. Recently, Honghai Liu et al. published that cardiomyocyte cytokinesis failure was increased in congenital heart disease. Inactivation of the beta adreno receptors genes and administration of the beta-blocker propranolol increased cardiomyocyte division in neonatal mice, which increased the number of cardiomyocytes (endowment) and conferred benefit after myocardial infarction in adults. We currently realize that propranolol in infants with congenital heart disease not only decrease highly elevated NT-Pro-BNP values but also decrease cardiac troponin T values that may indicate myocardial injury due to neurohumoral activation. We reproduce this observation, primarily seen in infants with congenital heart disease, in an infant with Duchenne muscular dystrophy. These observations were in good accordance with current data from H. Liu et al., who showed that treatment with non-selective beta blockers early after birth might rescue cytokinesis defects and prevent heart dysfunction in adulthood in a mouse model.

cTnI、CTGF、AngⅡ和miR-21在老年性慢性心力衰竭肺部感染中的诊断价值

目的探讨心肌肌钙蛋白I(cTnI)、结缔组织生长因子(CTGF)、血管紧张素Ⅱ(AngⅡ)和微小核糖核酸-21(miR-21)在老年性慢性心力衰竭肺部感染中的诊断价值。方法选取郑州市金水区总医院2022年1月至2023年8月收治的70例老年性慢性心衰肺部感染患者作为合并感染组,同期70例老年单纯心衰患者作为单纯心衰组,以及同期70例老年健康体检者作为对照组。比较三组研究对象临床指标及cTnI、CTGF、AngⅡ、miR-21水平,比较合并感染组不同心功能分级cTnI、CTGF、AngⅡ、miR-21水平,分析老年性慢性心衰肺部感染与cTnI、CTGF、AngⅡ、miR-21相关性。结果合并感染组血清cTnI、CTGF、AngⅡ、miR-21均高于单纯心衰组和对照组,单纯心衰组高于对照组,差异有统计学意义(P<0.05);合并感染组心功能Ⅳ级患者血清cTnI、CTGF、AngⅡ、miR-21高于Ⅲ级和Ⅱ级,Ⅲ级高于Ⅱ级,差异有统计学意义(P<0.05);血清cTnI、CTGF、AngⅡ、miR-21均为老年性慢性心衰肺部感染的独立危险因素(P<0.05);Pearson相关性分析显示,老年性慢性心衰肺部感染与血清cTnI、CTGF、AngⅡ、miR-21水平呈正相关关系(r=0.566、0.543、0.555、0.582,P<0.05)。结论老年性慢性心力衰竭肺部感染患者多伴有血清cTnI、CTGF、AngⅡ、miR-21升高,cTnI、CTGF、AngⅡ、miR-21与老年性慢性心衰肺部感染存在相关性。

MTWA技术联合血清miR-130a对心脏再同步化治疗后CHF患者室性心律失常的预测价值

目的探讨微伏级T波电交替(MTWA)技术联合血清微小RNA-130a(miR-130a)对心脏再同步化治疗(CRT)后慢性心力衰竭(CHF)患者室性心律失常的预测价值。方法前瞻性选取2021年3月至2022年1月郑州大学第一附属医院收治的130例经CRT治疗的CHF患者,均于CRT前、CRT 6个月后进行MTWA检查和血清miR-130a检测。所有患者均随访12个月,失访7例,根据随访期间是否发生室性心律失常分为发生组26例和未发生组97例,比较两组患者CRT前和CRT 6个月后的MTWA参数、血清miR-130a水平;采用Spearman相关系数法分析MTWA参数、血清miR-130a与CHF患者室性心律失常的相关性;采用受试者工作特征(ROC)曲线及曲线下面积(AUC)分析MTWA、血清miR-130a预测CHF患者室性心律失常的价值。结果CRT前、CRT 6个月后发生组V1导联MTWA_(max)、V1导联8:00 am MTWA、V5导联MTWA_(max)、V5导联8:00 am MTWA、miR-130a均高于未发生组,差异均有统计学意义(P<0.05);Spearman相关系数法分析结果显示,CRT前、CRT 6个月后V1导联MTWA_(max)、V1导联8:00 am MTWA、V5导联MTWA_(max)、V5导联8:00 am MTWA及miR-130a均与CHF患者室性心律失常发生呈正相关(P<0.05);ROC曲线分析结果显示,CRT前、CRT 6个月后V1导联MTWA_(max)、V1导联8:00 am MTWA、V5导联MTWA_(max)、V5导联8:00 am MTWA及血清miR-130a联合预测的AUC分别为0.912、0.933(P<0.05)。结论MTWA参数、血清miR-130a与CHF患者室性心律失常存在一定线性关系,CRT治疗前后MTWA参数和血清miR-130a联合预测CHF患者发生室性心律失常具有一定的价值。

Left univentricular pacing for cardiac resynchronization therapy using rate-adaptive atrioventricular delay

Objective To evaluate left univentricular （LUV） pacing for cardiac resynchronization therapy （CRT） using a rate-adaptive atrioven- tricular delay （RAAVD） algorithm to track physiological atrioventricular delay （AVD）. Methods A total of 72 patients with congestive heart failure （CHF） were randomized to RAAVD LUV pacing versus standard biventricular （BiV） pacing in a 1 ： 1 ratio. Echocardiography was used to optimize AVD for both groups. The effects of sequential BiV pacing and LUV pacing with optimized A-V （right atrio-LV） delay using an RAAVD algorithm were compared. The standard deviation （SD） of the S/R ratio in lead VI at five heart rate （HR） segments （Rs/R-SD5）, defined as the ＂tracking index,＂ was used to evaluate the accuracy of the RAAVD algorithm for tracking physiological AVD. Results TheQRS complex duration （132 ± 9.8 vs. 138± 10ms, P 〈 0.05）, the time required for optimization （21 ±5 vs. 50±8min, P〈 0.001）, the mitral regurgitant area （1.9 ± 1.1 vs. 2.5 ± 1.3 em2, P 〈 0.05）, the interventricular mechanical delay time （60.7 ± 13.3 ms vs. 68.3 ± 14.2 ms, P 〈 0.05）, and the average annual cost （13,200 ± 1000 vs. 21,600 ± 2000 RMB, P 〈 0.001） in the RAAVD LUV pacing group were significantly less than those in the standard BiV pacing group. The aortic valve velocity-time integral in the RAAVD LUV pacing group was greater than that in the standard BiV pacing group （22.7 ± 2.2 vs. 21.4 ± 2.1 cm, P 〈 0.05）. The Rs/R-SD5 was 4.08 ± 1.91 in the RAAVD LUV pacing group, and was significantly negatively correlated with improved left ventricular ejection fraction （LVEF） （ALVEF, Pearson＇s r = -0.427, P = 0.009）, and positively correlated with New York Heart Association class （Spearman＇s r - 0.348, P 0.037）. Conclusions RAAVD LUV pacing is as effective as standard BiV pacing, can be more physiological than standard BiV pacing, and can de- crease the average annual cost of CRT.

Clinical significance of serum cardiac troponin T in patients with congestive heart failure

Objective To determine whether the level of serum cardiac troponin T (cTnT) was increased in patients with congestive heart failure (CHF). Methods This study consisted of 265 patients with CHF and 75 healthy people. Serum cTnT was measured by electrochemiluminescence immunoassay using an Elecsys 1010 automatic analyzer. Results cTnT concentration was 0.181±0.536 ng/mL in CHF patients and 0.003±0.001 ng/mL in controls (P<0.001). Patients were categorized according to the levels of heart function and left ventricular ejection fraction (LVEF). In the first group consisting of 105 patients with LVEF≤35%, cTnT was 0.311±0.221 ng/mL. In the second group of 106 patients with LVEF>35%, cTnT was 0.07±0.0 5ng/mL (P<0.01). In patients with NYHA class Ⅰ, Ⅱ, Ⅲ and Ⅳ, cTnT values were 0.062±0.022 ng/mL, 0.113±0.121 mg/mL, 0.191±0.231 mg/ml and 0.384±0.211 mg/mL, respectively (class Ⅰ vs class Ⅱ P>0.05, class Ⅱ vs class Ⅲ P<0.01, class Ⅲ vs class Ⅳ P<0.01). A negative correlation was observed between serum cTnT concentration and LVEF in 265 patients with CHF (r=-0.493, P<0.001).Conclusions This study shows that the level of serum cTnT is increased in patients with CHF and that the increased level indicates the severity of CHF.

Health Promotion in Cardiac Rehabilitation Patients through the Use of a High-Intensity Interval Training Protocol

According to the American Heart Association’s (AHA) recent statistical update, over 2150 Americans die each day from cardiovascular disease (CVD), which equals approximately 1 death every 40 seconds;many of which were under the age of 65 years old [1]. In 2009, 386,324 people, 1 in 6 Americans, died as a result of coronary artery disease (CAD) alone [1]. They also estimate 150,000 people have “silent” heart attacks each year [1]. Even though the number of cardiovascular disease deaths has declined in the last 10 years, they still accounted for 32.3% of American deaths [1]. As a result, the AHA updated their 2020 goals to improve the nation’s cardiovascular health by 20% [1]. One of these methods is through the use of cardiac rehabilitation. Cardiac rehabilitation (CR) is a health promotion strategy to help return cardiac patients to their previous level of functioning, increase health, decrease comorbidities and promote education and lifestyle change. For select patients, another alternative exercise plan may exist to gain even better results. High intensity interval training (HIIT) has shown positive training results for athletes and many studies show that it may also be an effective exercise modality for many cardiac patients instead of the traditional circuit training method. This article will review current literature on the effects of HIIT on CR patients as well as a sample HIIT protocol for instituting this treatment with appropriate patients.

婴儿心脏术后肌钙蛋白T水平对机械通气时间延长的影响

目的探讨肌钙蛋白T对婴儿心脏术后机械通气时间延长的影响。方法回顾性选取2019年1月至4月在南方医科大学附属广东省人民医院心外科行体外循环下心内直视术的192例先天性心脏病婴儿,按术后即刻肌钙蛋白T水平分为肌钙蛋白T高值组(3798.0~10000.0 ng/L)、中值组(1827.0~3709.0 ng/L)和低值组(316.2~1801.0 ng/L),各64例。低值组中,女28例,男36例,日龄203.00(129.75,274.50)d;中值组中,女30例,男34例,日龄118.00(76.50,173.75)d;高值组中,女24例,男40例,日龄168.50(78.00,219.25)d。采用方差分析、秩和检验、χ^(2)检验进行统计分析,通过单因素和多因素logistic回归模型分析术后肌钙蛋白T水平与术后机械通气时间延长的相关性,通过单因素和多因素线性回归模型分析术后肌钙蛋白T水平与重症监护停留时间及术后住院天数的相关性。结果术前日龄越小、手术体外循环时间越长、主动脉阻断时间越长,术后肌钙蛋白T水平越高(均P<0.05)。在校正了性别、日龄、胎龄、术前血红蛋白、术前血清肌酐、体外循环时间、主动脉阻断时间、先天性心脏病手术风险调整评分(RACHS-1)等因素后,多因素回归模型发现,肌钙蛋白T水平升高是机械通气时间延长的独立危险因素[OR=1.2(1.1,1.3),P<0.001]。结论肌钙蛋白T水平升高与婴儿先天性心脏病术后机械通气时间延长有关。

Cardiac resynchronization therapy in acute pulmonary edema: A case report

We are reporting a case of 71-year old lady with a dual chamber demand pacemaker,who developed acute pulmonary edema due to an acute left ventricular(LV)dysfunction and worsening in mitral valve regurgitation after atrioventricular nodal ablation for uncontrolled atrial fibrillation.This was attributed to right ventricular apical pacing leading to LV dyssynchronization.Patient dramatically improved within 12-24 h after upgrading her single chamber pacemaker to biventricular pacing.Our case demonstrates that biventricular pacing can be an effective modality of treatment of acute congestive heart failure.In particular,it can be used when it is secondary to LV dysfunction and severe mitral regurgitation attributed to significant dyssynchrony created by right ventricular pacing in patients with atrioventricular nodal ablation for chronic atrial fibrillation.

24 h动态心电图联合cTnT、CK-MB在评价胸部恶性肿瘤患者放射性心脏损伤中的应用价值

目的探讨24 h动态心电图联合肌钙蛋白T(cTnT)、磷酸激酶同工酶MB(CK-MB)在评价胸部恶性肿瘤患者放疗诱发放射性心脏损伤(RIHD)中的应用价值。方法选取2018~2022年于海南医学院附属海南医院接受放疗的116例胸部恶性肿瘤患者,分别于不同时间(放疗前、放疗结束、放疗结束后3个月)行常规心电图、24 h动态心电图、心脏彩超、cTnT、CK-MB检查。根据是否出现RIHD将患者分成RIHD组(41例)和非RIHD组(75例)。比较两组患者放疗前、放疗结束时、放疗结束后3个月的cTnT、CK-MB水平,以及24 h动态心电图、常规心电图、心脏彩超、cTnT、CK-MB单项检测及24 h动态心电图、cTnT、CK-MB三者联合检测对胸部恶性肿瘤患者RIHD的评估价值。结果放疗前,RIHD组与非RIHD组的cTnT[(0.185±0.028)μg/L vs.(0.193±0.025)μg/L]、CK-MB[(19.21±4.07)U/L vs.(18.55±3.52)U/L]水平比较,差异均无统计学意义(t=1.579、1.913,P>0.05)。不同时间(放疗前、放疗结束时、放疗结束3个月)的cTnT、CK-MB水平比较,差异均有统计学意义(F=932.30、293.93,P<0.05)。LSD-t检验结果显示,放疗结束时、放疗结束后3个月,两组患者的cTnT、CK-MB水平均较放疗前升高,且RIHD组患者的cTnT、CK-MB水平均高于非RIHD组患者,差异均有统计学意义(P<0.05)。放疗结束后3个月,常规心电图检查与临床综合诊断结果的一致性较差(Kappa=0.306,P<0.05);24 h动态心电图检查、心脏彩超检查、cTnT、CK-MB单项检测具有中等一致性(Kappa=0.401、0.437、0.541、0.418,P<0.05);24 h动态心电图、cTnT、CK-MB联合检测的一致性最好(Kappa=0.796,P<0.05)。不同检测方法(24 h动态心电图、cTnT、CK-MB)联合评估的灵敏度、特异度、一致性、阳性预测值、阴性预测值均最高,即联合检测的真实性、可靠性、预测值均高于单项检测。结论24 h动态心电图联合cTnT、CK-MB评价胸部恶性肿瘤患者放疗诱发RIHD的真实性、可靠性、预测值均较高,可操作性强,患者可接受性强,临床推广性强。

替格瑞洛联合曲美他嗪治疗冠心病的疗效及对血清hs-cTnT、D二聚体水平的影响

目的探讨替格瑞洛联合曲美他嗪治疗冠心病(CHD)的疗效及对血清高敏心肌肌钙蛋白T(hs-cTnT)、D二聚体(D-D)水平的影响。方法选择2022年8月至2024年2月成都市第三人民医院收治的CHD患者108例为研究对象,按照随机数字表法分为对照组(给予替格瑞洛治疗,n=54)和试验组(给予替格瑞洛联合曲美他嗪治疗,n=54)。对比两组治疗前(T_(0))、治疗4周后(T_(1))的心功能、心肌损伤标志物、氧化应激因子、炎性因子、血凝标志物、临床疗效及不良反应。结果与T_(0)时点比较,两组T_(1)时点左心室射血分数(LVEF)、谷胱甘肽过氧化物酶(GSH-Px)、超氧化物歧化酶(SOD)水平均升高,且试验组明显高于对照组(P<0.05)。与T_(0)时点比较,两组T_(1)时点左室舒张末径(LVEDD)、左室收缩末径(LVESD)、血清心肌肌钙蛋白Ⅰ(cTnⅠ)、N末端B型利钠肽原(NT-proBNP)、hs-cTnT、血清肌酸激酶同工酶(CK-MB)、丙二醛(MDA)、超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子α(TNF-α)、血清纤维蛋白原(FIB)、D-D水平均降低,且试验组明显低于对照组(P<0.05)。试验组总有效率高于对照组(P<0.05),两组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论CHD患者应用替格瑞洛联合曲美他嗪治疗,可调节血清hs-cTnT及D-D水平,抑制炎性因子产生,调控氧化应激反应,减轻心肌损伤程度,改善心功能,增加冠脉血流,进一步提高临床治疗效果。

血清BNP、hs-CRP、UA与cTnT联合检测对心力衰竭的诊断价值研究

目的分析血清B型钠尿肽(BNP)、超敏C反应蛋白(hs-CRP)、尿酸(UA)、心肌肌钙蛋白T(cTnT)联合检测对心力衰竭(HF)的诊断价值。方法回顾性分析103例HF患者的资料并将其作为研究组,另回顾性分析体检的98例健康者的资料并将其作为对照组。两组研究对象均接受血清BNP、hs-CRP、UA与cTnT检测。比较两组研究对象血清BNP、hs-CRP、UA与cTnT水平;比较美国纽约心脏病学会(NYHA)分级Ⅰ~Ⅱ级、Ⅲ~Ⅳ级HF患者的血清BNP、hs-CRP、UA与cTnT水平;比较单独血清BNP、hs-CRP、UA、cTnT检测与四项指标联合检测对HF的检出率。结果研究组血清BNP、hs-CRP、UA、cTnT分别为(290.95±45.68)pg/ml、(5.12±1.02)mg/L、(432.26±30.58)μmol/L、(17.03±3.52)pg/ml,均高于对照组的(47.56±15.00)pg/ml、(1.36±0.46)mg/L、(285.65±35.44)μmol/L、(6.45±2.02)pg/ml(P<0.05)。NYHA分级Ⅲ~Ⅳ级HF患者血清BNP、hs-CRP、UA、cTnT分别为(336.52±50.66)pg/ml、(6.02±0.98)mg/L、(460.46±40.49)μmol/L、(19.56±3.00)pg/ml,均高于Ⅰ~Ⅱ级患者的(236.65±45.88)pg/ml、(4.05±1.00)mg/L、(398.65±35.45)μmol/L、(14.02±3.02)pg/ml(P<0.05)。血清四项指标联合检测对HF的检出率88.35%高于单独血清BNP、hs-CRP、UA、cTnT检测的72.82%、67.96%、60.19%、56.31%(P<0.05)。结论血清BNP、hs-CRP、UA与c TnT水平联合检测可以有效提高HF的检出率,具有临床应用价值。

老年慢性心衰患者血清cTnI、CK-MB水平与心电图QRS波的相关性研究

目的:分析老年慢性心力衰竭(CHF)患者血清心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶MB(CK-MB)与心电图QRS波的相关性。方法:选取2020年9月至2023年10月六安市中医院接收的100例老年CHF患者,将其纳入观察组,另选同期于本院进行体检的100名老年健康者纳入健康对照组。所有受检者均接受血清cTnI、CK-MB检查及心电图检查,比较两组受检者的QRS波时限、血清cTnI、CK-MB水平。100例观察组患者再根据心电图QRS波时限是否异常分为两个亚组,即QRS异常组(52例,QRS波时限≥120 ms)和QRS正常组(48例,QRS波时限<120 ms);比较两个亚组患者一般资料,血清cTnI、CK-MB水平;分析老年CHF患者血清c Tn I、CK-MB水平与心电图QRS波的相关性。结果:与健康对照组比较,观察组血清c Tn I(1.912±0.401 vs. 0.861±0.173)μg/L、CK-MB(23.272±4.801 vs. 10.573±2.332)U/L水平更高,QRS波时限更长(126.761±17.452 vs. 104.475±13.351)μg/L,两组比较差异有统计学意义(t=24.159、23.802、10.145,P<0.05)。观察组患者经心电图检查发现,有52例患者出现心电图QRS波时限异常,QRS波时限平均为(141.641±12.581)ms;48例患者心电图QRS波时限正常,QRS波时限平均为(110.652±10.751)ms。QRS波时限异常组患者的血清c Tn I、CK-MB水平均高于QRS正常组患者,差异有统计学意义(t=7.534、10.362,P<0.05);经一般线性双变量Pearson检验结果显示,c Tn I、CK-MB两项血清指标与QRS波时限均呈正相关(r=0.395、0.453,P<0.05)。经logistic回归分析结果显示,血清c Tn I、CK-MB水平与心电图QRS波时限有关,过表达可能是心电图QRS波时限异常的风险因子(OR=4.444、1.445,P<0.05)。结论:老年CHF患者血清c Tn I、CK-MB水平异常升高,二者过表达与心电图QRS波时限异常有关,可能是QRS波时限异常的风险因子。

Signaling Pathways Involved in Cardiac Hypertrophy

Cardiac hypertrophy is the heart＇s response to a variety of extrinsic and intrinsic stimuli that impose increased biomechanical stress. Traditionally, it has been considered a beneficial mechanism; however, sustained hypertrophy has been associated with a significant increase in the risk of cardiovascular disease and mortality. Delineating intracellular signaling pathways involved in the different aspects of cardiac hypertrophy will permit future improvements in potential targets for therapeutic intervention. Generally, there are two types of cardiac hypertrophies, adaptive hypertrophy, including eutrophy （normal growth） and physiological hypertrophy （growth induced by conditioning）, and maladaptive hypertrophy, physical including pathologic or reactive hypertrophy （growth induced by pathologic stimuli） and hypertrophic growth caused by genetic mutations affecting sarcomeric or cytoskeletal proteins. Accumulating observations from animal models and human patients have identified a number of intracellular signaling pathways that characterized as important transducers of the hypertrophic response, including calcineurin/nuclear factor of activated Tcells, phosphoinositide 3-kinases/Akt （PI3Ks/Akt）, G protein-coupled receptors, small G proteins, MAPK, PKCs, Gp130/STAT3, Na＋/H＋ exchanger, peroxisome proliferator-activated receptors, myocyte enhancer factor 2/histone deacetylases, and many others. Furthermore, recent evidence suggests that adaptive cardiac hypertrophy is regulated in large part by the growth hormone/insulin-like growth factors axis via signaling through the PI3K/Akt pathway. In contrast, pathological or reactive hypertrophy is triggered by autocrine and paracrine neurohormonal factors released during biomechanical stress that signal through the Gq/phosphorlipase C pathway, leading to an increase in cytosolic calcium and activation of PKC.

The Role of Bedside Troponin T Test for Identification of High Risk Patients With Acute Chest Pain

Objectives Evaluation of patients with acute chest pain when they admitted is time-consuming. We prospectively investigated the role of bedside troponin T test for predicting the risk of death and acute heart failure of patients with acute chest pain.Methods and Results 502 consecutive patients with chest pain for less than 24 hours were determined by troponin T test at bedside and quantitative troponin I test in lab. For bedside troponin T tests, there were 160 patients in positive and 323 in negative. During 30 days of followed-up. Myocardial infarction evolved in 139 patients among 160 patients in positive troponin T test, only 7 patients in negative one. Acute heart failure occurred in 51 patients among the positive group, but 37 occurred it at negative group. The odds ratio of acute heart failure of positive group vs. negative group was 3.6. Patients died 39 in positive group, 15 in negative group, the all-cause death odds ratio of positive group vs. negative group was 6.7; 31 patients died with cardiac event in positive group, 5 in negative group only. Conclusions Bedside Troponin T test is a powerful and independent predictor of death and acute heart failure for patients with acute chest pain.

注射用重组人脑利钠肽联合左西孟旦治疗心力衰竭的效果及对MMP-2、cTnI的影响

目的:探析注射用重组人脑利钠肽(新活素)联合左西孟旦治疗心力衰竭的效果及对基质金属蛋白酶2(MMP-2)、心肌肌钙蛋白I(cTnI)的影响。方法:选取2021年2月-2023年7月黑龙江远东心脑血管医院收治的90例心力衰竭患者作为研究对象。根据住院号随机抽取的方式将其划分为对照组和治疗组,各45例。对照组给予左西孟旦治疗,治疗组在对照组基础上给予新活素治疗。比较两组临床疗效,治疗前后心功能指标、相关实验室指标。结果:治疗组治疗总有效率为93.33%,高于对照组的77.78%,差异有统计学意义(P<0.05)。治疗后,治疗组N末端脑钠肽前体(NT-proBNP)、左室舒张末期内径(LVEDD)水平均低于对照组,左室舒张早期/晚期峰值速率比值(E/A)、左室射血分数(LVEF)水平均高于对照组,差异有统计学意义(P<0.05)。治疗后,治疗组MMP-2、cTnI水平均低于对照组,差异有统计学意义(P<0.05)。结论:对心力衰竭患者应用新活素与左西孟旦联合给药的方案可获得确切的效果,能有效地减轻心肌损伤,较好地改善心脏的功能。