Left bundle branch pacing vs biventricular pacing in heart failure patients with left bundle branch block:A systematic review and meta-analysis

BACKGROUND Left bundle branch pacing(LBBP)is a novel pacing modality of cardiac resynchronization therapy(CRT)that achieves more physiologic native ventricular activation than biventricular pacing(BiVP).AIM To explore the validity of electromechanical resynchronization,clinical and echocardiographic response of LBBP-CRT.METHODS Systematic review and Meta-analysis were conducted in accordance with the standard guidelines as mentioned in detail in the methodology section.RESULTS In our analysis,the success rate of LBBP-CRT was determined to be 91.1%.LBBP CRT significantly shortened QRS duration,with significant improvement in echocardiographic parameters,including left ventricular ejection fraction,left ventricular end-diastolic diameter and left ventricular end-systolic diameter in comparison with BiVP-CRT.CONCLUSION A significant reduction in New York Heart Association class and B-type natriuretic peptide levels was also observed in the LBBP-CRT group vs BiVP-CRT group.Lastly,the LBBP-CRT cohort had a reduced pacing threshold at follow-up as compared to BiVP-CRT.

Heart failure with preserved ejection fraction: A distinct heart failure phenotype?

The present work discusses the serious confusion resulting from the arbitrary nomenclature of heart failure with preserved ejection fraction(HFpEF),the presumed underlying pathophysiology,and the supposed features.A consequence of this misconception is that HFpEF trials have recruited patients with entirely different characteristics rendering the extrapolation of the results of one study to the other infeasible and dramatically affecting diagnosis and treatment.

CLINICAL RESEARCH ON THE EFFECT OF ACUPUNCTURE ON THE LEFT VENTRICULAR CONTRACTION FUNCTION IN SYMPTOMLESS CARDIAC FAILURE PATIENTS

Objective: To observe the effect of acupuncture therapy on the function of myocardial contraction in symptomless cardiac failure patients.Methods: A total of 60 cases of symptomless cardiac insufficiency inpatients were randomly divided into medication and acupuncture groups, with 30 cases in each group. For patients of acupuncture group, Neiguan (PC 6), Ximen (PC 4), Tanzhong (CV 17), Xinshu (BL 15), Jueyinshu (BL 14) and Geshu (BL 17) were punctured, twice daily, with 30 days being a therapeutic course. In medication group, patients were asked to take Capoten 25 mg (t.i.d.). The left ventricular ejection fraction (LVEF) and its fractional shortening (FS) of the minor axis were used as the indexes for assessing the therapeutic effect and detected by using a color ultrasonic Doppler apparatus. Results: After one course of treatment, of the each 30 cases of acupuncture and medication groups, 13 (43.3%) and 16 (53.3%) had marked improvement, 16 (53.3%) and 14 (46.7%) had improvement, and 1 (3.3%) and 0 had no any effect respectively. No significant difference was found between two groups in the therapeutic effect. It shows acupuncture therapy can improve myocardial contraction function. Conclusion: Acupuncture has a similar effect in enhancing the systolic function of the myocardium.

Clinical characteristics and prognosis of heart failure with normal left ventricular ejection fraction in elderly patients

Background The term heart failure with normal ejection fraction （HFNEF） is often used to describe the syndrome of heart failure with normal ejection fraction. Based on the previous studies, HFNEF has a significant morbidity and mortality and is associated with a similar prognosis to heart failure with reduced ejection fraction （HFREF）. The present study aimed to investigate the clinical characteristics and prognosis of HFNEF in elderly patients. Methods Consecutive elderly patients （〉60 years old） hospitalized for the first episode of heart failure （HF） in Beijing Hospital from January 2003 to December 2009 were retrospectively recruited. Three hundred and ten patients with HF were eligible for our study. As recently recommended, a cut-off value of 50% was used to distinguish HFNEF （LVEF〉50%） from HFREF （LVEF〈50%）. Data were retrospectively obtained from hospital records and databases. Follow-up data were obtained by telephone and from hospital records. For every eligible patient, the clinical characteristics and prognosis were collected and compared between the HFNEF and HFREF groups. Results Patients with HFNEF accounted for 54.5% of all cases of elderly patients with HF. Compared with HFREF, the elderly patients with HFNEF had a higher proportion of females （62.1% vs. 32.6%, P 〈0.001）, higher body mass index （BMI） （（24.9±4.7） vs. （23.5±4.0） kg/m2, P=0.011）, higher systolic blood pressure at admission （（141.5±22.6） vs. （134.3±18.6） mmHg, P=0.002）, but lower hemoglobin levels （（118.3±22.7） vs. （125.8±23.8） g/L, P=0.005）. The incidence of coronary heart disease （43.2% vs. 65.2%, P 〈0.001） and myocardial infarction （16.6% vs. 46.1%, P 〈0.001） were significantly lower in elderly patients with HFNEF than in those with HFREF （P 〈0.001）. With a mean follow-up of 33.5 （0.5-93） months, 120 patients （38.7%） died, including 94 （30.3%） cardiac deaths. The HFNEF group had fewer deaths than the HFREF group at the end of the first follow-up （46/169 （27.2%） vs. 58/141 （41.1%）） and at the end of the second follow-up （56/169 （33.1%） vs. 64/141 （45.4%））. Kaplan-Meier survival analysis showed a significantly higher survival rate in elderly patients with HFNEF than those with HFREF （P=0.021 for total mortality and P 〈0.001 for cardiac mortality）. Multiple Logistic regression analysis showed that LVEF 〈50% was an independent risk factor for death in elderly patients with HF. Conclusions More than half of elderly patients with HF have a normal LVEF. The prognosis of the elderly patients with HFNEF is poor, though slightly better than the elderly patients with HFREF.

Preferred Revascularization Strategies in Patients with Ischemic Heart Failure: A Meta-Analysis

Clinically,coronary artery bypass grafting (CABG)or percutaneous coronary intervention (PCI)is generally used to treat patients with ischemic heart failure.However, the optimal treatment strategy remains unknown.This study examined the efficacy of the two coronary revascularization strategies for severe ischemic heart failure by using a meta-analysis.Studies comparing the efficacy of CABG and PCI were obtained from PubMed,EMBASE,Google Scholar and Cochrane Central Register of Controlled Trials (CENTRAL).The quality of each eligible article was evaluated by Newcastle-Ottawa Quality Assessment Scale (NOS),and the meta-analysis was performed using Stata version 12.0 software.Eventually,12 studies involving 9248 patients (n=4872 in CABG group;n=4376 in PCI group)were subject to the meta-analysis for subsequent pooling calculation.The pooled hazard ratio (HR)[HR=0.83,95%CI (0.76,0.90),P<0.001; heterogeneity,P=0.218,I^2=22.9%]of CABG compared with that of PCI revealed a statistical superiority of CABG to PCI in terms of the long-term mortality.Furthermore, CABG showed more advantages over PCI with respect to the incidence of myocardial infarction [HR=0.51,95%CI (0.39,0.67),P<0.001;heterogeneity,P=-0.707,I^2=0%]and repeat revascularization [HR=0.40,95%CI (0.27,0.59),P<0.001;heterogeneity,P<0.001, I^2=80.1%].It was concluded that CABG appears to be more advantageous than PCI for the treatment of ischemic heart failure in the given clinical setting.

Left Ventricular Dysfunction: The Perspective of Echocardiography in Ghana

Introduction: Ghana is one of the fastest growing economies in sub-Saharan Africa which is expected to undergo a significant epidemiologic transition because of industrialisation and economic development. Having transitioned from low to middle income status recently, this study investigated the epidemiology of left ventricular dysfunction (LVD) in patients who were referred for echocardiography. Material and Methods: We conducted a retrospective cross-sectional study on an out-patient population who were referred to the Precise Specialist Clinic in Kumasi, Ghana for echocardiography, from January 2016 to December 2018. Descriptive statistical analyses were performed and the results summarised in the proportions, tables and pie charts. Categorical variables and proportions were compared using Fisher’s exact test and test of proportions respectively. P-value Results: The results show that 61% of the out-patient population referred for echocardiography between 2016 and 2018 had LVD at a mean age of 59 years. In this LVD population, Heart Failure with preserved ejection fraction (HFpEF) and Heart Failure with reduced ejection fraction (HFrEF) accounted for 73% and 27% respectively. The majority of patients with HFrEF also had left ventricular diastolic dysfunction, mitral regurgitation and tricuspid regurgitation.Conclusion: This study shows that, HFpEF was seen in over 70% of patients with LVD, and it occurred at a relatively younger age. Efforts should be made for prevention, early detection and control of conditions such as hypertension, diabetes and obesity which have been shown to be associated with HFpEF.

Changes of Plasma Levels of Brain Natriuretic Peptide in Patients with Chronic Heart Failure

To investigate the changes of plasma brain natriuretic peptide （BNF） levels inpatients with chronic heart failure （CHF）. Methods Plasma BNP concentrations in patients with CHF （n=56） and in normal controls （n=60） were measured with specific radioimmunoassay. Left ventricular ejection fraction in patients with chronic heart failure was measured with 99mTc gated cardiac blood pool scintigraphy. Results The results showed that Plasma BNP concentrations in patients with CHF were significantly higher than normal controls （223±79 ng/L vs 40±15 ng/L, P 〈 0.01）. Plasma BNP concentrations had a significant negative correlation with left ventricular ejection fractions（r=-0.68, P 〈 0.01 ）. Conclusions These results indicates that Plasma BNP levels are increased in patients with CHF, and they markedly increased according to the severity of heart failure classified by NYHA classifi- cation. The plasma BNP levels may be a biochemical parameter for evaluating the left ventricular function.

Left bundle branch area pacing:A new era of cardiac resynchronization therapy?

The recent systematic review and meta-analysis provided a comprehensive focus on the current state of cardiac resynchronization therapy(CRT).The authors determined the feasibility of physiological left bundle branch area pacing(LBBAP)in patients indicated for CRT through a careful analysis of trials.They found that LBBAP was associated with significant reductions in QRS duration,New York Heart Association functional class,B-type natriuretic peptide levels,and pacing thresholds as well as improvements in echocardiographic parameters compared to biventricular pacing.

Left atrial diameter and atrial fibrillation,but not elevated NT-proBNP,predict the development of pulmonary hypertension in patients with HFpEF

Background The determinants of pulmonary hypertension(PH)due to heart failure with preserved ejection fraction(HFpEF)have been poorly investigated in patients with cardiovascular diseases(CVD).Methods From July 12017 to March 312019,a total of 149 consecutive HFp EF patients hospitalized with CVD were enrolled in this prospective cross-sectional study.A systolic pulmonary artery pressure(PASP)>35 mm Hg estimated by echocardiography was defined as PH-HFp EF.Logistic regression was performed to establish predictors of PH in HFpEF patients.Results Overall,the mean age of participants was 72±11 years,and 74(49.7%)patients were females.A total of 59(39.6%)patients were diagnosed with PH-HFpEF by echocardiography.The left atrial diameter(LAD)was related to the ratio of the transmitral flow velocities/mitral annulus tissue velocities in early diastole(E/E’)and the left ventricular diameter in systole(LVDs).N-Terminal pro B-type natriuretic peptide(NT-proBNP)was not found to be associated with LAD and impaired diastolic or systolic function of the left ventricle.Multivariable logistic regression showed that atrial fibrillation(AF)increased the risk of PH-HFpEF incidence 3.46-fold with a 95%confidence interval(CI)of 1.44–8.32,P=0.005.Meanwhile,LAD≥45 mm resulted in a 3.43-fold increased risk,95%CI:1.51–7.75,P=0.003.However,the significance levels of NT-proBNP,age and LVEF were underpowered in the regression model.Two variables,AF and LAD≥45 mm,predicted the PH-HFpEF incidence(C-statistic=0.773,95%CI:0.695–0.852,P<0.001).Conclusions Two parameters associated with electrical and anatomical remodelling of the left atrium were related to the incidence of PH in HFpEF patients with CVD.

实时三维超声心动图Heart Model模式定量评价左室容量及左室射血分数

目的探讨三维超声心动图全自动左心定量技术(three-dimensional echocardiography Heart Model,3D-HM)在左室收缩功能评估中的应用价值。方法选取我院2018年1月~2019年5月健康体检的正常成年人58例,男24例,女34例。均采用常规M型超声、双平面辛普森法、二维心功能定量(2DQ)、三维自动化心功能定量(3DQA)、3D-HM分别测量左室舒张末期容积(LVEDV)、收缩末期容积(LVESV)、射血分数(LVEF),对比分析3D-HM与其他方法测量的差异性和相关性。结果ESV:3D-HM组较M型超声、Bi-plane、X-plane、2DQ、3DQA组ESV值偏高,差异具有显著统计学意义(P<0.01);EDV:3D-HM组较Bi-plane、X-plane、2DQ、3DQA组EDV值偏高,差异具有显著统计学意义(P<0.01),较M型超声组EDV值差异无统计学意义(P>0.05);EF:3D-HM组较M型超声、Bi-plane、2DQ组EF值偏低,差异具有显著统计学意义(P<0.01),较X-plane、3DQA组EF值差异无统计学意义(P>0.05)。相关性分析:ESV:3D-HM组与M型超声、Bi-plane、2DQ、X-plane、3DQA组ESV值呈正相关关系(P<0.05);EDV:3D-HM组与M型超声、Bi-plane、X-plane、2DQ、3DQA组EDV值呈正相关关系(P<0.05);EF:3D-HM组与M型超声、Bi-plane、2DQ、3DQA组EF值呈正相关(P<0.05),与X-plane组EF值无直线相关关系。结论3D-HM可以准确、快速量化左室容量及射血分数,在左心收缩功能评价中具有较高的临床价值。

Heart‘omicsin’AGEing (HOMAGE):design,research objectives and characteristics of the common database

Heart failure is common in older people and its prevalence is increasing.The Heart ＇omics＇ in AGEing（HOMAGE） project aims to provide a biomarker approach that will improve the early diagnosis of heart failure.A large clinical database,based on（1） prospective population studies or（2） cross-sectional,prospective studies or randomized controlled trials（RCTs） of patients at risk for or with overt cardiovascular disease will be constructed to determine most promising ＇omics＇-based biomarkers to identify the risk of developing heart failure and/or comorbidities.Population studies,patient cohorts and RCTs are eligible for inclusion in the common database,if they received ethical approval to obtain and share data and have baseline information on cardiovascular risk factors.Currently,the HOMAGE database includes 43,065 subjects,from 20 studies in eight European countries,including healthy subjects from three population studies in France,Belgium and Italy（n = 7,124）,patients with heart failure（n = 4,312） from four cohorts in the UK,Spain and Switzerland and patients at high risk for cardiovascular disease（n = 31,629） in 13 cohorts.It is anticipated that more partners will join the consortium and enlarge the pooled data.This large merged database will be a useful resource with which to identify candidate biomarkers that play a role in the mechanism underlying the onset and progression of heart failure.

Comparative breakthrough: Umbilical cord mesenchymal stem cells vs bone marrow mesenchymal stem cells in heart failure treatment

In this article,we evaluate the comparative efficacy and safety of mesenchymal stem cells(MSCs)derived from bone marrow(BM-MSCs)and umbilical cord(UC-MSCs)in the treatment of heart failure and myocardial infarction.MSCs have gained importance as living bio drug due to their regenerative potential,with BM-MSCs being the most extensively studied.However,UC-MSCs offer unique advantages,such as noninvasive collection and fewer ethical concerns.This systematic review and meta-analysis summarizes data from 13 randomized controlled trials,which included a total of 693 patients.Their study shows that UC-MSCs significantly improved left ventricular ejection fraction by 5.08%at 6 months and 2.78%at 12 months compared with controls,while BM-MSCs showed no significant effect.Neither cell type showed significant changes in 6-minute walk distance.In addition,UC-MSCs and BM-MSCs had comparable safety profiles,with no significant differences in major adverse cardiac events,except for a lower rehospitalization rate observed with BM-MSCs.These results position UC-MSCs as a promising alternative in MSC-based therapies for cardiac disease,offering potential improvements in cardiac function while maintaining a favorable safety profile.Future research should focus on optimizing adminis-tration protocols and further exploring the long-term benefits and mechanisms of UC-MSCs in cardiac repair.

The Prevalence and Short-Term Outcomes of Ventricular Dyssynchrony after Right Ventricular Pacing

Objective: Long-term right ventricular pacing has been associated with an increased risk of heart failure and cardiomyopathy. The pathophysiology of cardiomyopathy associated with right ventricular pacing remains unclear. We aim to evaluate the burden and short-term outcomes of ventricular dyssynchrony after immediate permanent pacemaker implantation. Materials and Methods: This prospective cohort study examined consecutive patients who had permanent pacemaker implantation at Vajira Hospital in 2019. Left ventricular systolic function, specifically left ventricular ejection fraction (LVEF) and echocardiographic ventricular dyssynchrony parameters were assessed. The endpoints included the prevalence of ventricular dyssynchrony, new-onset cardiomyopathy, heart failure, and death. The correlation between QRS complex duration, the burden of ventricular pacing, and echocardiographic ventricular dyssynchrony was measured. Results: Thirty-six consecutive patients underwent pacemaker implantation. The prevalence of mechanical ventricular dyssynchrony was 22.2% using the interventricular conduction delay method, 41.7% using LV pre-ejection period method, and 11.1% using the septal posterior wall motion abnormality method. Electrical ventricular dyssynchrony was 86.1% and new-onset cardiomyopathy was 17.1% after 3 months of permanent pacemaker implantation. The right ventricular pacing of more than 20% was significantly associated with cardiomyopathy (p < 0.022) and heart failure (log-rank, p = 0.049) within 3 months. But heart failure was not associated with mechanical ventricular dyssynchrony parameters (log-rank, p = 0.610;hazard ratio [HR], 1.53;95% confidence interval [CI], 0.29 - 7.96;p = 0.613 for IVMD and log-rank, p = 0.398;HR, 0.04;95% CI, 0.01 - 3316.7 for SPWMD). Conclusion: Mechanical and electrical ventricular dyssynchrony are common findings in right ventricular pacing. High-burden right ventricular pacing after 3 months of permanent pacemaker implantation is often associated with cardiomyopathy and heart failure, but mechanical and electrical ventricular dyssynchrony does not predict a short-term decline in left ventricular systolic function and heart failure.

A Brief Review of a Common Clinical Question: Intravenous Diltiazem or Metoprolol for Atrial Fibrillation with Rapid Ventricular Response?

Two classes of rate controlling medications—beta blockers (BBs) and non- dihydropyridine calcium channel blockers (CCBs)—are given to patients who present with atrial fibrillation (AF) with rapid ventricular response (RVR). Both are Class I recommendations from the American Heart Association (AHA), American College of Cardiology (ACC), and Heart Rhythm Society (HRS) for the management of AF with RVR. Multiple studies support the view that diltiazem is more effective than metoprolol, even though data from the AFFIRM trial suggests BBs are more frequently used. CCBs are generally avoided in AF with RVR patients who have concomitant heart failure with reduced ejection fraction (HFrEF) for concern of triggering decompensation. However, some recent studies indicate this idea may be unfounded. The aim of this article is to compare the efficacy of diltiazem and metoprolol for rate control in AF with RVR and examine the use of diltiazem in patients with both AF with RVR and HFrEF.

Effect of Different Styles of Coronary Heart Disease and Its Risk Factors on Cardiac Remodeling and Dysfunction

Objectives To evaluate the effect of different styles of coronary heart disease （CHD）, different regions of acute myocardial infarction （AMI）, its risk factors and branches of coronary stenosis on left ventricular remodeling and dysfunction by applying echocardiography. Methods 251 patients with CHD and 96 patients without CHD （NoCHD） were verified by selective coronary angiography. CHD patients were divided into stable angina pectoris （SAP） 26, unstable angina pectoris（UAP） 53, acute myocardial infarction （AMI） 140 and old myocardial infarction （OMI） 30 based on clinical situation, cTnT, cardiac enzyme and ECG. AMI patients were further divided into subgroups including acute anterior myocardial infarct （Aa,n = 53）, acute inferior myocardial infarction （Ai, n=54） and Aa＋Ai （n=33） based on ECG. Cardiac parameters： end-diastolic interventricular septum thickness（IVSd）, end-diastolic left ventricular internal diameter （LVd）, left ventricular mass （LM）, end-diastolic left ventricular volume （EDV）, end-systolic left ventricular volume （ESV） and left ventricular ejection fraction（LVEF） were measured by ACUSON 128XP/10 echocardiography. Multiples linear regression analyses were performed to test statistical associations between LVEF and the involved branches of coronary stenosis, blood pressure, lipids, glucose and etc after onset of myocardial infarction. Results EDV and ESV were increased and LVEF decreased on patients with AMI,OMI and UAP （P〈0.05-0.0001）. LM was mainly increased in patients with OMI （P〈0.01） and LVd was mainly enlarged in patients with AMI. EF was significantly decreased and EDV, ESV, LM and LVd were remarkably increased in AMI patients with Aa and Aa＋Ai. With the multiple linear regression analyses by SPSS software, we found that LVEF was negatively correlated to the involved branches of coronary stenosis as well as to systolic blood pressure after onset of myocardial infarction while there was no significant correlation between LVEF and other factors. LVEF was significantly decreased, and LVd and LM increased in AMI patients with antecedent hypertension, compared to patients without hypertension （P〈0.001）. Conclusions Effects of different styles of CHD and different regions of AMI on left ventricular remodeling and cardiac function are different. Myocardial infarction, especially Aa and Aa＋Ai, is one of the most important causes of left ventricular remodeling and cardiac dysfunction. Multiple vessel stenosis and systolic blood pressure at the onset of myocardial infarction reduce LVEF in AMI patients. Antecedent hypertension may accelerate the effect of AMI on cardiac remodeling and dysfunction. Therefore primary and secondary preventions of CHD are critical for protecting heart from remodeling and dysfunction.

β受体阻滞剂应用于小儿充血性心力衰竭的系统评价与Meta分析

目的 系统评价β受体阻滞剂对小儿充血性心力衰竭患者的疗效,为临床用药提供证据。方法 从PubMed、Embase、the Cochrane Library及CNKI、万方、维普数据库中检索相关前后对照试验与随机对照试验,检索时限自建库起至2023年10月31日。结局指标有左心室射血分数(LVEF)、左心室短轴缩短率(LVFS)、左心室舒张末期内径(LVDD)、左心室收缩末期内径(LVSD)、N端B型脑钠肽(NT-proBNP)、心率、血压及心功能改善情况。结果 共纳入20项符合标准的研究,包含1 068例患儿,包括扩张型心肌病、心内膜弹力纤维增生。Meta分析显示,在常规心力衰竭药物治疗的基础上,使用β受体阻滞剂(琥珀酸美托洛尔、比索洛尔及卡维地洛),对改善患儿LVEF[MD=13.06,95%CI(11.67,14.45),P <0.001]、LVFS [MD=6.96,95%CI(6.54,7.37),P <0.001]、LVDD [MD=-6.43,95%CI(-7.58,-5.28),P <0.001]和LVSD [MD=-8.30,95%CI(-8.83,-7.76),P <0.001]效果显著;也可改善患儿血压、心率、NT-proBNP和心功能。结论 在常规心力衰竭药物治疗的基础上使用β受体阻滞剂的联合方案可提高小儿充血性心力衰竭患者的心功能及改善心力衰竭症状,推荐将β受体阻滞剂积极应用于该类患儿的常规治疗方案中。

二参真武汤联合美托洛尔治疗左心室射血分数保留型心力衰竭患者的疗效及对其心功能和神经内分泌因子的影响

目的探究二参真武汤联合美托洛尔治疗左心室射血分数保留型心力衰竭(Heart failure with preserved ejection fraction,HFpEF)患者的疗效及对其心功能和神经内分泌因子的影响。方法选取2021年6月-2023年6月期间就诊于安徽省中西医结合医院心血管内科的HFpEF患者92例,依据简单随机数字表法分为对照组和研究组,每组各46例。两组患者均给予常规治疗,对照组在常规干预基础上口服美托洛尔,研究组在对照组基础上联合二参真武汤,两组患者均治疗4周。观察比较两组患者临床疗效、不良反应发生情况,治疗前后中医证候积分、心功能[左心室射血分数(Left ventricular ejection fractions,LVEF)、左心室收缩末内径(Left ventricular end systolic diameter,LVESD)、左心室舒张末内径(Left ventricular end diastolic diameter,LVEDD)、左心室等容舒张时间(Isovolumic relaxation time,IVRT)]、神经内分泌因子指标[醛固酮(Aldosterone,ALD)、血管紧张素Ⅱ(AngiotensinⅡ,AngⅡ)、去甲肾上腺素(Noradrenaline,NE)]水平、中性粒细胞明胶酶相关脂质运载蛋白(Neutrophil gelatinase-associated lipocalin,NGAL)、生长分化因子-15(Growth differentiation factor-15,GDF-15)水平。结果治疗后研究组治疗总有效率93.48%(43/46)明显高于对照组78.26%(36/46),差异有统计学意义(P<0.05)。治疗后两组患者胸胁作痛、心悸、气短喘息、浮肿与唇甲青紫、面色晦暗、畏寒肢冷分值均较治疗前降低,差异有统计学意义(P<0.05);且研究组中医证候积分明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者LVEF水平均较治疗前升高,LVESD、LVEDD、IVRT水平均较治疗前降低,差异有统计学意义(P<0.05);且研究组LVEF水平明显高于对照组,LVESD、LVEDD、IVRT水平均明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者血清ALD、AngⅡ、NE水平均较治疗前降低,差异有统计学意义(P<0.05);且研究组神经内分泌因子水平明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者血清NGAL、GDF-15水平均较治疗前降低,差异有统计学意义(P<0.05);且研究组血清NGAL、GDF-15水平均明显低于对照组,差异有统计学意义(P<0.05)。治疗期间,研究组不良反应发生率4.35%(2/46)与对照组8.70%(4/46)比较,差异无统计学意义(P>0.05)。结论联合二参真武汤及美托洛尔治疗HFpEF,可缓解患者临床症状,调节ALD、AngⅡ、NE及NGAL、GDF-15水平,改善心功能,提升整体治疗效果,且具有安全性。

沙库巴曲缬沙坦对射血分数保留的心力衰竭患者右心结构及功能的影响分析

目的探讨沙库巴曲缬沙坦对射血分数保留的心力衰竭(HFpEF)患者右心结构及功能的影响。方法选取2020年8月至2022年6月于安徽医科大学附属合肥医院心内科门诊收治的120例HFpEF患者,根据随机数字表法分为观察组和对照组各60例,观察组应用沙库巴曲缬沙坦(50 mg,bid)治疗,对照组应用缬沙坦(50 mg,bid)治疗,比较观察组和对照组患者治疗后右心收缩功能、舒张功能指标的变化。结果治疗后,两组心肌做功指数(Tei index,Tei指数)较治疗前下降(P<0.05),右室面积变化分数(RVFAC)、三尖瓣环平面收缩期位移(TAPSE)、三尖瓣环侧壁收缩期峰流速(TAPSV)均较治疗前升高,其中观察组Tei指数较对照组下降,而RVFAC、TAPSE、TAPSV均较对照组升高(P<0.05)。同时肺动脉平均压(mPAP)、右心房容积指数(RAVI)、舒张期室间隔厚度(IVST)在缬沙坦或沙库巴曲缬沙坦治疗后均下降(P<0.05),右侧房室瓣环处心肌舒张早期峰值流速(Ve)/舒张晚期峰值流速(Va)较治疗前升高,其中观察组mPAP、RAVI、IVST均较对照组下降,Ve/Va较对照组升高(P<0.05)。结论沙库巴曲缬沙坦能有效改善HFpEF患者右心收缩及舒张功能,可通过降低炎症因子以及纤维化相关因子水平改善心室重构。

心音频谱图在二尖瓣反流患者左心室功能监测中的作用

目的探求使用可穿戴设备获取心音频谱图,观察不同程度二尖瓣反流(MR)患者心音频谱特征在左心室功能监测中的作用。方法入选2020年6月至2021年5月因心血管疾病入住上海交通大学医学院附属瑞金医院的102例MR患者,根据心脏超声MR反流束面积/左心房面积比值超过20%将其分为轻度MR组72例和中度及以上MR组30例。基于心音频谱图对心音持续时间、最大声强、最大心音振幅进行分析,并与心脏超声测定的左心室射血分数(LVEF)进行相关性分析。结果心音频谱图第一心音持续时间与收缩期持续时间比值(S11-S12/S11-S21)与LVEF呈线性负相关(r=-0.535,P<0.01),S11-S12/S11-S21用于判定LVEF降低(LVEF<50%)曲线下面积为0.840(95%CI=0.756~0.924,P<0.01),截断值是55.50%,敏感度78.6%,特异度83.3%。结论心音频谱图提示,MR患者心脏收缩期第一心音持续时间占比与LVEF呈负相关性,在二尖瓣病患的心功能居家监测中存在潜在的应用价值。

射血分数保留型心力衰竭患者心率变异性与左心室僵硬度的相关性

目的筛选反映射血分数保留型心力衰竭(heart failure with preserved ejection fraction,HFpEF)患者左心室僵硬度的敏感心率变异性(heart rate variability,HRV)指标,并评价其对HFpEF患者的预后评估价值。方法选取150例左心室射血分数(LVEF)正常的患者,行24 h动态心电图及常规超声心动图检查。将入选患者分成正常对照组(68例)和HFpEF组(82例)。采用受试者工作特征曲线分析,筛选HRV指标中能反映HFpEF患者左心室僵硬度的敏感指标,并对主要终点事件进行随访。结果在HRV指标中,SDANN预测HFpEF的曲线下面积最大,达0.68(P<0.01),cut-off值90 ms。SDANN与左心室舒张期室壁应变呈负相关;SDANN越高,左心室僵硬度就越高。根据SDANN的cut-off值,HFpEF患者被分为高SDANN组(cut-off值≥90 ms,44例)和低SDANN组(cut-off值<90 ms,38例)。低SDANN组左心室僵硬度较低。生存曲线分析显示,高SDANN组的主要不良心脏事件发生率和全因死亡率较低SDANN组显著升高(P<0.05)。结论SDANN可作为HFpEF患者临床诊断及预后评估的敏感指标。