非缺血性扩张型心肌病心源性猝死的危险因素

非缺血性扩张型心肌病(NIDCM)目前被定义为左心室(LV)舒张和收缩性降低,且不能归因于负荷条件或冠状动脉灌注缺陷所致的心肌病。通过超声心动图(或磁共振成像)检测心脏收缩功能降低[左心室射血分数(LVEF)<45%]和内径增大(高于平均预测值两个标准差)就足以诊断[1]。在一般人群中,NIDCM发生率为1/2500[2],易发生终末期心力衰竭(ESHF)和恶性室性心律失常(VA)。     

心脏磁共振钆延迟强化程度与慢性心力衰竭患者预后的关系

目的:探讨心脏磁共振中钆延迟强化程度与慢性心力衰竭患者预后的关系。方法:收集2015年1月至2016年12月,就诊于首都医科大学附属北京安贞医院慢性心力衰竭患者,行心脏磁共振检查,记录钆延迟强化是否出现,钆延迟强化程度的相关变量:钆延迟强化的异常心肌容量占总的心肌容量的百分比。同时记录两组患者的基线资料、血生化指标及冠状动脉造影术情况,通过电话及门诊对患者进行定期随访,记录主要不良心血管事件,包括心源性死亡、心脏移植。结果:经过2年的随访,其中12例患者发生心源性死亡,2例患者发生心脏移植。钆延迟强化的出现在事件组与非事件组中并无明显差异。单因素及多因素Cox回归分析发现,钆延迟强化程度可能是慢性心力衰竭患者预后的独立预测因子(OR=1.049,95%CI:1.019~1.079,P0.001)。结论:钆延迟强化程度可能是慢性心力衰竭患者预后的独立预测因子。     

红细胞分布宽度对于植入式心律转复除颤器患者发生室性心律失常的预测作用

目的探讨红细胞分布宽度(RDW)对于植入式心律转复除颤器(ICD)患者发生室性心律失常(VA)的预测价值。方法回顾性分析2010年6月至2014年6月于阜外医院植入带有家庭监测功能ICD的140例患者的临床资料。研究的主要终点为ICD恰当治疗的VA,次要终点为全因死亡。分析RDW对各终点事件的预测价值。结果ROC曲线显示预测VA的RDW最佳值为13.05%。Kaplan-Meier生存曲线显示,在VA和全因死亡方面RDW≥13.05%组均明显劣于RDW13.05%组(P值分别为0.002、0.012)。多因素Cox回归显示,RDW≥13.05%是ICD患者VA (HR=1.941, 95%CI:1.204-3.127, P=0.006)及全因死亡(HR=3.257,95%CI:1.085-9.781,P=0.035)的独立危险因素。结论RDW≥13.05%提示ICD患者发生VA及全因死亡的风险增加。     

CRT后心衰改善对室性心律失常减少的预测价值

目的通过观察心脏再同步化治疗除颤器(CRT-D)术前及术后第12月左室射血分数(LVEF)的变化与术后室性心律失常(VA)的发生情况,探讨术后LVEF的变化情况与VA风险的关系。方法回顾性分析安徽省立医院2014年1月至2016年8月CRT-D患者,以是否发生室性心律失常分为病例组及对照组,比较两组基线资料及术后第12月LVEF变化与VA发生情况的关系。结果研究共纳入对象210例,平均随访18.0±4.7个月,病例组共43(20.5%)名患者记录到不同类型VA事件。多因素logistic回归分析提示缺血性心肌、ICD一级预防、△LVEF是CRT患者术后VA发生风险的独立预测因素。进一步分析提示CRT术后LVEF提升低于11%的发生VA风险大。结论心脏再同步化治疗后患者LVEF提升,VA风险下降,与LVEF提升的程度有关,提升的程度越大,VA风险越低。     

急性下壁心肌梗塞并左前分支传导阻滞的临床意义

将 70例首次发生下壁心肌梗塞 (下壁 AMI)的患者分为两组。 A组为 14例合并左前分支传导阻滞 ( LAH)者 ,B组为 56例单纯下壁 AMI者。比较两组患者住院期间心脏事件 (梗塞后心绞痛、再梗塞、充血性心力衰竭、心源性休克及死亡 )的发生率及出院前左室射血分数 ( LVEF)、室性心律失常( VA)发生率。结果显示 ,A组住院期间心脏事件发生率 ( 64.3% )明显高于 B组 ( 19.6% ) ,P<0 .0 1;出院前 LVEF[( 4 5.7± 12 .8) % ]明显低于 B组 [( 57.2± 9.6) % ],P<0 .0 1;VA发生率 ( 64.3% )明显高于B组 ( 2 5.0 % ) ,P<0 .0 5。提示下壁 AMI发生 L AH者近期预后不良 ,可能存在冠脉左前降支狭窄及多支病变     

心脏磁共振成像预测围生期心肌病患者不良心血管事件的研究

目的：探讨心脏磁共振对围生期心肌病不良心血管事件的预测价值，为早期识别高危患者提供依据。方法：回顾性纳入围生期心肌病且行增强心脏磁共振检查的患者，并进行随访。终点事件包括心源性死亡、心力衰竭再住院、心脏移植、危及生命的心律失常及肺栓塞或系统性栓塞。根据是否发生不良事件将患者分为事件组和无事件组。通过COX回归分析了解不良心血管事件的相关因素。结果：共纳入29例围生期心肌病患者，平均年龄33岁，9例患者在随访中发生不良心血管事件。两组患者的妊娠情况差异无统计学意义。有9例（31%）患者存在延迟强化（late gadolinium enhancement,LGE），事件组LGE阳性患者数量和LGE质量分数均高于无事件组。整体纵向应变（global longitudinal strain,GLS）和整体周向应变（global circumferential strain,GCS）在事件组降低更明显，GCS:[(-8.7±1.9)%vs.(-7.1±1.6)%,P=0.03];GLS:[(-7.7±2.1)%vs.(-5.9±1.4)%,P=0.02]。单因素Cox分析显示LVEF,LGE质量...     

强化抗血小板治疗对冠状动脉支架术后血小板高反应性的影响

目的 探讨强化抗血小板治疗对急性冠状动脉综合征患者冠状动脉支架术后血小板高反应性(HPR)的影响.方法 2009年3月至2011年2月在3家医院连续入选3316例置入药物洗脱支架的急性冠状动脉综合征患者,其中840例(25.3％)患者诊断为HPR.HPR定义为氯吡格雷300 mg和阿司匹林300 mg治疗24h后,20 μmol/L二磷酸腺苷诱导的血小板聚集率＞55％.HPR患者按1:2的比例随机接受标准抗血小板治疗(标准组,n=280)及强化抗血小板治疗(强化组,n=560).标准组患者服用阿司匹林300 mg/d和氯吡格雷75 mg/d.强化组患者服用阿司匹林300 mg/d和双倍剂量氯吡格雷(150 mg/d),3d后如 HPR 未改善则加用西洛他唑(50～100 mg,每天2次).观察患者的HPR改善率及发生的临床事件.结果 强化组患者治疗3d后HRP改善率为54.3％(304/560);256例HRP未改善的患者接受西洛他唑治疗3d后,强化组的HRP改善率为81.1％(454/560).术后30 d,强化组HPR改善率显著高于标准组(69.9％比55.7％,P=0.000).两组患者均未发生死亡及卒中事件.强化组发生亚急性支架血栓形成1例(0.2％),标准组未发生支架血栓形成事件(P =1.000).两组均未发生死亡和主要及次要出血事件,轻度出血发生率两组之间差异无统计学意义(强化组为4.3％,标准组为2.1％,P=0.166).结论强化抗血小板治疗可显著改善急性冠状动脉综合征患者冠状动脉支架术后的HPR,且不增加出血风险,但其临床获益还需更长时间随访研究的证实.     

磁共振延迟强化对急性心肌梗死的诊断价值

<正>该文探讨磁共振延迟强化(late gadolinium enhancement,LGE)对急性心肌梗死(acute myocardial infarction,AMI)的诊断价值。方法:纳入2016年1月至2017年7月在沈阳军区总医院治疗的AMI患者52例,对其临床及心脏磁共振资料进行回顾性分析。患者均在入院1周内行心脏磁共振检查,根据是否存在LGE,将AMI患者分为LGE阴性组(19例)和     

社区强化干预治疗方案对脑血管病患者的疗效

目的探讨社区强化干预措施治疗脑血管病的临床疗效及脑血管病防治的依据。方法选取社区及医院的急性脑梗死患者629例作为研究对象,整群随机分为强化干预组319例和非强化干预组310例。干预组给予个体化的强化干预治疗方案,非干预组仅进行常规治疗,跟踪随访2年,记录两组患者的血压、血脂、血糖控制达标情况、血清同型半胱氨酸(Hcy)水平变化、颈动脉彩超变化、服药依从性、血管事件发生率、死亡率、脑梗死再发率等指标情况。结果强化干预组在治疗干预后1、2年其脱落率、抗血小板药物停药率、降压治疗药物停药率、降压不达标率、降脂治疗药物停药率、降脂不达标率、血糖控制不达标率均明显低于非强化干预组(均P<0.05);强化干预组发生血管事件25例(7.7%),死亡4例(1.3%);非强化干预组患者1年随访时,发生血管事件52例(16.3%),死亡17例(5.3%),差异均有统计学意义(均P<0.05)。2年随访时,强化干预组发生血管事件32例(10%),死亡11例(3.5%)。非强化干预组发生血管事件87例(23.7%),死亡34例(10.5%),两组差异显著(均P<0.05)。结论社区强化干预方案降低脑血管病患者血管事件发生率、死亡率、脑梗死再发率,同时有效提高服药依从性。     

心脏磁共振钆对比剂延迟强化对扩张型心肌病患者心脏不良事件的预测价值研究

目的分析心脏磁共振钆对比剂延迟强化(LGE)对扩张型心肌病(DCM)患者心脏不良事件的预测价值。方法连续选取2011年3月—2014年1月在北京市房山区良乡医院就诊的初诊DCM患者77例,根据心脏磁共振LGE情况分为无LGE者43例(对照组)和有LGE者34例(观察组);根据LGE累及心肌节段数将有LGE患者分为0~2个心肌节段者5例、3~5个心肌节段者18例、≥6个心肌节段者11例;根据LGE透壁情况将有LGE患者分为透壁者13例和肌壁间者21例。所有患者进行门诊或电话随访,随访截至2015年10月,平均随访2.6年。记录所有患者随访期间心脏不良事件发生情况。结果两组患者性别、年龄、完全性左束支传导阻滞发生率及使用血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂(ACEI/ARB)、β-受体阻滞剂、醛固酮拮抗剂、胺碘酮、利尿剂者所占比例比较,差异均无统计学意义(P>0.05);观察组患者纽约心脏病协会(NYHA)分级劣于对照组,左心室射血分数(LVEF)低于对照组,使用地高辛者所占比例高于对照组(P<0.05)。观察组患者心力衰竭再住院率、室性心动过速(VT)/心室颤动(VF)发生率、心血管死亡率及心脏不良事件发生率均高于对照组(P<0.05)。与无LGE者相比,有LGE者心脏不良事件发生风险升高9.96倍[95%CI(7.17,13.87)]。LGE累及3~5个心肌节段和≥6个心肌节段者心力衰竭再住院率、VT/VF发生率、心血管死亡率及心脏不良事件发生率均高于0~2个心肌节段者,累及≥6个心肌节段者心力衰竭再住院率、VT/VF发生率、心血管死亡率及心脏不良事件发生率均高于3~5个心肌节段者(P<0.05)。与LGE累及0~2个心肌节段者相比,累及3~5个心肌节段者心脏不良事件发生风险升高4.45倍[95%CI(2.36,8.33)];与LGE累及3~5个心肌节段者相比,累及≥6个心肌节段者心脏不良事件发生风险升高5.24倍[95%CI(1.43,19.30)]。有无LGE透壁患者心力衰竭再住院率、VT/VF发生率及心血管死亡率比较,差异均无统计学意义(P>0.05);透壁者心脏不良事件发生率高于肌壁间者(P<0.05)。与肌壁间者相比,透壁者心脏不良事件发生风险升高6.05倍[95%CI(1.31,27.94)]。结论心脏磁共振LGE及其范围和程度可在一定程度上预测DCM患者心脏不良事件的发生。     

Myocardial scarring and recurrence of ventricular arrhythmia in patients surviving an out-of-hospital cardiac arrest

Introduction

Prediction of recurrent ventricular arrhythmia (VA) in survivors of an out-of-hospital cardiac arrest (OHCA) is important, but currently difficult. Risk of recurrence may be related to presence of myocardial scarring assessed with late gadolinium enhancement cardiac magnetic resonance (LGE-CMR). Our study aims to characterize myocardial scarring as defined by LGE-CMR in survivors of a VA-OHCA and investigate its potential role in the risk of new VA events.

Methods

Between 2015 and 2022, a total of 230 VA-OHCA patients without ST-segment elevation myocardial infarction had CMR before implantable cardioverter-defibrillator implantation for secondary prevention at Copenhagen University Hospital, Rigshospitalet, and Hospital Clínic, University of Barcelona, of which n = 170 patients had a conventional (no LGE protocol) CMR and n = 60 patients had LGE-CMR (including LGE protocol). Scar tissue including core, border zone (BZ) and BZ channels were automatically detected by specialized investigational software in patients with LGE-CMR. The primary endpoint was recurrent VA.

Results

After exclusion, n = 52 VA-OHCA patients with LGE-CMR and a mean left ventricular ejection fraction of 49 ± 16% were included, of which 18 (32%) patients reached the primary endpoint of VA. Patients with recurrent VA in exhibited greater scar mass, core mass, BZ mass, and presence of BZ channels compared with patients without recurrent VA. The presence of BZ channels identified patients with recurrent VA with 67% sensitivity and 85% specificity (area under the ROC curve (AUC) 0.76; 95% CI: 0.63–0.89; p < .001) and was the strongest predictor of the primary endpoint.

Conclusions

The presence of BZ channels was the strongest predictor of recurrent VA in patients with an out of-hospital cardiac arrest and LGE-CMR.     

腹型肥胖对心脏重构的影响

目的探讨腹部脂肪特别是腹内脂肪堆积对心脏结构和功能的影响。方法495例住院患者均在空腹状态下平脐平面行螺旋CT扫描腹部脂肪,测量腹内脂肪面积（VA）,皮下脂肪面积（SA）,计算总脂肪面积（TA）;根据VA情况分为三组;行超声心动图检查计算左室重量（LVM）、左室重量指数（LVMI）、左室射血分数（LVEF）、舒张晚期和早期最大充盈血流速度的峰值比（E／A）;分析腹部脂肪与心脏结构和功能的关系。结果（1）随着VA的增加,LVM、LVMI逐渐增加,而LVEF及E／A逐渐下降;当VAI≥75cm^2,LVM、LVMI及左室肥厚检出率显著增加（P〈0．05）;当VA≥110cm^2,LVEF显著降低（P〈0．05）。SA、TA与左室结构和功能的关系也有类似趋势。（2）腹部脂肪与心脏结构和功能的相关性：校正性别、年龄、血压后,VA、SA、TA与LVMI的相关系数分别为0．146、0．190、0．197（P值均〈0．01）,VA与LVEF的相关系数为-0．113（P〈0．05）。（3）Logistic回归分析提示VA导致LVH的OR值（1．014,P〈0．001）有统计学意义。结论腹部脂肪堆积与左室重构密切相关,腹内脂肪是左室重构的独立影响因素之一。控制肥胖特别是减少腹内脂肪对防治心功能不全有重要意义。     

Left ventricular function before and following surgical treatment of mitral valve disease.

Nineteen patients with mitral valve disease were studied before and a mean 11 months +/- 9 months following valve replacement or reconstruction, which resulted in good postoperative valve function. Biplane left ventricular angiography and pressures were utilized to determine end-diastolic volume/M. (EDV), end-systolic volume/M. (ESV), ejection fraction (EF), left ventricular mass/M. (LVM), and stroke work/M. (SW). There were 19 patients--six with mitral stenosis (MS), six with mitral stenosis and regurgitation (MS + MR), and seven with mitral regurgitation (MR). Those with MS and MS + MR preoperatively had no significant change in left ventricular end-diastolic pressure (LVEDP), EDV, ESV, LVM, or EF following surgery. Patients with MR had a significant reduction in LVEDP, EDV, SV, and SW. More importantly, the EF fell in four of these seven patients and LVM did not decrease following surgery. It is concluded that surgical treatment for MS and MS + MR had little effect on left ventricular performance. Following surgical treatment for MR, reduction in EDV is not associated with reduction in LVM, and frequently left ventricular performance deteriorates as judged by the EF.     

Long-term outcomes of patients with ventricular arrhythmias and negative programmed ventricular stimulation followed with implantable loop recorders: Impact of delayed-enhancement cardiac magnetic resonance imaging

Background

Programed ventricular stimulation (PVS) is a risk stratification tool in patients at risk for adverse arrhythmia outcomes. Patients with negative PVS may yet be at risk for adverse arrhythmia-related events, particularly in the presence of symptomatic ventricular arrhythmias (VA).

Objective

To investigate the long-term outcomes of real-world patients with symptomatic VA without indication for device therapy and negative PVS, and to examine the role of cardiac scaring on arrhythmia recurrence.

Methods

Patients with symptomatic VA, and late gadolinium enhancement cardiac magnetic resonance imaging (LGE-CMR), and negative PVS testing were included. All patients underwent placement of implantable cardiac monitors (ICM). Survival analysis was performed to investigate the impact of LGE-CMR findings on survival free from adverse arrhythmic events.

Results

Seventy-eight patients were included (age 60 ± 14 years, women n = 36 (46%), ejection fraction 57 ± 9%, cardiomyopathy n = 26 (33%), mitral valve prolapse [MVP] n = 9 (12%), positive LGE-CMR scar n = 49 (62%), history of syncope n = 23 (29%)) including patients with primarily premature ventricular contractions (n = 21) or nonsustained VA (n = 57). Patients were followed for 1.6 ± 1.5 years during which 14 patients (18%) experienced VA requiring treatment (n = 14) or syncope due to bradycardia (n = 2). Four/9 patients (44%) with MVP experienced VA (n = 3) or syncope (n = 1). Baseline characteristics between those with and without adverse events were similar (p > 0.05); however, the presence of cardiac scar on LGE-CMR was independently associated with an increased risk of adverse events (hazard ratio: 5.6 95% confidence interval: [1.2–27], p = 0.03, log-rank p = 0.03).

Conclusions

In a real-world cohort with long-term follow-up, adverse arrhythmic outcomes occurred in 18% of patients with symptomatic VA despite negative PVS, and this risk was significantly greater in patients with positive DE-CMR scar. Long term-monitoring, including the use of ICM, may be appropriate in these patients.     

胺碘酮长疗程个体化治疗室性心律失常的临床疗效和安全性

为探讨胺碘酮长疗程个体化治疗室性心律失常 (VA)的临床疗效和安全性 ,31例室性心律失常 (VA)患者给予胺碘酮个体化治疗 ,疗程 1年以上 ,观察治疗前和治疗后 1年患者室性心律失常的有效控制率、QT间期变化以及不良反应。结果 :31例患者胺碘酮的维持量为 15 5± 37mg/天 ,比推荐的用量 (2 0 0～ 40 0mg/天 )要小 ,而胺碘酮治疗室性心律失常 (VA)的有效率仍高达 90 .3% ;QT间期轻度延长 (396± 5 1msvs 438± 5 3ms ,P <0 .0 5 )。不良反应方面 ,有一例患者出现一过性FT3、FT4 升高 ;未出现扭转型室速和室颤发作 ;无肺毒性和肝肾损害等副作用。不良反应也比文献报道的非个体化治疗方案要少 (3 .2 %vs 5 %～ 15 % )。结论 :胺碘酮长疗程个体化治疗室性心律失常(VA)的临床疗效确切 ,维持用量较小 ,相关的不良反应也减少。     

原发性高血压心律失常的预测因素

目的：探讨原发性高血压（EH）心律失常的预测因素,方法：采用超声心动图和动态心电图观察EH患152例,按左室肥厚,左房增大,心肌缺血,年龄,病程分类,并比较各类与心律失常关系。结果：（1）EH左室肥厚组室性心律失常发生率高于左室正常组,尤其是Lown3级以上更为显（P＜0．01）,（2）左房增大组阵发性房速或房颤发生率高于左房正常组（P＜0．05）,（3）心肌缺血组易导致严重室性心律失常;（4）年龄大及病程长易发生室性心律失常,尤其是严重室性心律失常,结论：左室肥厚,左房增大,心肌缺血,左室舒张功能减退是EH心律失常的预测因素。     

Arterial Mechanics in Ischemic versus Nonischemic Cardiomyopathy: Clinical and Diagnostic Impact

Background: Differential diagnosis between ischemic (IDCM) and the nonischemic type (NIDCM) of cardiomyopathy constitutes a challenge in the daily medical practice. Carotid and aortic elastic properties deteriorate in patients with coronary artery disease. However, their predictive role in differentiating IDCM from NIDCM has not been addressed so far. Aim of the work: To examine carotid and aortic mechanical functions using conventional and Doppler tissue echocardiography in the distinction between IDCM and NIDCM in patients with clinically undetermined etiology. Methods: 70 patients with dilatation and diffuse impairment of the left ventricular (LV) contraction were studied. All patients underwent carotid duplex for measuring intima‐media (IMT) thickness, peak systolic velocity (PSV), and luminal diameters (LD). Aortic distensibility, strain, and aortic wall velocities (systolic (Sa), early diastolic (Ea), late diastolic (Aa) velocities, Sa_t, and Ea_t) were measured. According to coronary angiographic results, patients were categorized into IDCM (n = 36) (age 57.9 ± 9.2 years) and NIDCM groups (n = 34) (age 56.0 ± 8.3 years); they were compared to 30 age‐ and sex‐matched healthy individuals as a control group. Results: The aortic pulsatile change, aortic strain, and distensibility were significantly reduced in both patient groups in comparison to control (P < 0.001). These parameters were much impaired in patients with IDCM compared with NIDCM (P < 0.001). IDCM have more deterioration of Sa, Ea, and Aa compared with NIDCM group (7.6 ± 2.4 vs. 8.9 ± 1.58, 7.5 ± 2.8 vs. 10.6 ± 1.5, 9.0 ± 1.4 vs. 6.9 ± 2.4 cm/sec; P < 0.001), respectively. In IDCM, the variables of aortic elastic properties were correlated only to age, while in NIDCM they were correlated to hemodynamics, LV volumes, wall thickness, and mass. Both carotid diameter and IMT were significantly increased in IDCM in comparison to NIDCM and control (P < 0.001). Carotid distensibility was significantly reduced in IDCM compared with NIDCM and control (P < 0.001). However, the carotid properties strongly correlated to risk factors in IDCM and to hemodynamics and LV function in NIDCM. Using ROC curve, a cutoff value ≤4.7 (cm²/dyne/10³) for aortic distensibility, value <8 cm/sec for Sa and IMT >0.8 mm predicted IDCM with 94.4%, 72.7%, and 97.2% sensitivity and 88.2%, 85.3%, and 97.1% specificity, respectively. Conclusion: Both carotid and aortic mechanical functions are more deteriorated in ischemic compared with nonischemic dilated cardiomyopathy. Different functional and structural mechanisms might be responsible for the deterioration of arterial elastic properties in each category.     

年龄对代谢综合征患者左心室重量和功能影响的性别差异

目的:探讨年龄对代谢综合征患者左心室重量和功能的影响及性别差异.方法:185例患者分为老年组(n=95)和非老年组(n=90),分析相关临床资料及行超声心动图检查.结果:用身高、体重、病程、收缩压、舒张压、脉压进行校正后,老年组和非老年组比较,女性的左心室重量明显增加(P＜0.01),而男性的左心室重量无明显变化,女性左心室舒张功能异常的比例明显增加(P＜0.01),而男性左心室舒张功能异常的比例无显著差异;老年组男性和女性的射血分数及短轴缩短率和非老年组比较都有下降趋势,但无显著性差异(P＞0.05).结论:年龄对老年女性代谢综合征患者左心室重量和舒张功能的影响较男性显著.     

冠心病急性左心衰竭患者入院24小时内新发室性心律失常的危险因素分析薛启婷

【】 目的：对入住我院急诊科病房的冠心病急性左心衰竭(LVADHF)患者入院24小时内发生室性心律失常的危险因素进行分析。方法：回顾性分析2014年1月1日至2015年7月31日因冠心病急性左心衰竭入住我院急诊病房且入院24小时内进行持续心电监护的患者,收集这些患者的临床资料,对24小时内发生室性心律失常的危险因素进行分析。结果：研究共纳入患者121名,平均年龄73±7.31 岁,发生室性心律失常患者78名,平均年龄74.17±7.97 岁,其中男性65名(53.7%)。单因素分析结果提示左室舒张末内径(LVEDD)增加、左室射血分数(LVEF)下降、高敏C反应蛋白(hsCRP)升高、pro-BNP升高以及年龄增大是发生房性心律失常的危险因素,进一步的多因素Logsitic回归分析提示LVEF低,年龄大和pro-BNP升高是发生室性心律失常的独立危险因素。结论：较低的LVEF、高龄和pro-BNP升高是冠心病左心衰竭患者入院24小时内新发室性心律失常的独立危险因素。     

Intravascular volume dependency of left ventricular mass calculation by two-dimensional guided M-mode echocardiography

BACKGROUND: Increased left ventricular mass (LVM) is an independent risk factor for cardiovascular morbidity and mortality, and may be used for risk stratification. Two-dimensional echocardiography, the most commonly used technique for estimation of LVM, uses the third power of the left ventricular internal diameter (LVID) for the calculation. OBJECTIVES: To determine whether a decrease in intravascular volume after dialysis may cause inaccurate estimation of LVM by echocardiography. METHODS: Thirty-eight patients undergoing hemodialysis due to chronic renal failure constituted the study group (14 women [37%] and 24 men [63%], mean age +/- SD 38.7+/-10.9 years). LVID, and interventricular and posterior wall thicknesses were measured by two-dimensionally guided M-mode echocardiography. Stroke volume and cardiac output were calculated using left ventricular outflow tract diameter and the pulsed-wave Doppler time-velocity integral obtained from left ventricular outflow tract. LVM was calculated by using Devereux's formula, and was indexed for body surface area and height. All echocardiographic parameters were measured or calculated before and after dialysis (on the same day), and then compared. RESULTS: There were no significant changes in wall thickness; however, LVID, LVM, the LVM/body surface index and the LVM/height index significantly decreased after dialysis (P<0.001 for each parameter). There was a significant correlation between the change in LVID and the change in LVM (P<0.001, r=0.59). Stroke volume and cardiac output also decreased significantly after hemodialysis (P<0.001 for each parameter). CONCLUSIONS: Intravascular volume-dependent change in LVID causes inaccurate estimation of LVM, so volume status should be kept in mind, especially in serial assessment of LVM.