三维斑点追踪成像评价脑利钠肽治疗急性前壁心肌梗死的价值

目的 应用超声三维斑点追踪成像(3D-STI)技术评价重组人脑利钠肽（rhBNP）治疗急性前壁或广泛前壁心肌梗死的价值。方法 急性前壁或广泛前壁心肌梗死患者90例被随机分为3组,A组（接受急诊PCI）、B组（急诊PCI 早期rhBNP治疗）、C组（急诊PCI 后期rhBNP治疗）。分别在入院6小时内,术后1周及术后1、3、6月对患者进行常规经胸二维超声心动图和实时三维超声心动图检查,应用3D-STI技术测量左心室壁17节段长轴应变、径向应变、圆周应变以及面积应变。结果 入院6小时内各组EF、LVEDV、LVESV值无明显差异;随着随访时间延长至1周,及其后的1月、3月、6月及12月,B组及C组EF大于A组,LVEDV、LVESV值小于A组而B组与C组间无统计学差异。入院6小时内各组前降支对应节段长轴应变、径向应变、圆周应变以及面积应变无明显差异,随着随访时间延长1月、6月及12月,B组及C组长轴应变、径向应变、圆周应变以及面积应变均小于A组,而B组与C组间无统计学差异。结论rhBNP干预可以改善局部心肌的应变力,从而提高左心室机械功能,改善心肌重构;在入院6小时内或术后开始应用rhBNP在改善心脏功能、抑制心肌重构方面无明显差异。     

伊伐布雷定在心血管疾病中应用的研究进展

伊伐布雷定为特异性的 I f通道阻滞剂,通过调节窦房结的起搏,发挥特有电生理学作用,可减慢心率但不影响心肌收缩力、心内传导、心室复极等,因其不良反应少,安全性高,目前不仅被广泛应用于慢性稳定性心衰、冠心病等疾病,而且最新临床及动物试验证实,伊伐布雷定药物的应用在不断的拓展,一些临床不良反应也得到进一步证实,该文就其近年来在心血管疾病中的新的应用进展予以综述。     

扩张型心肌病的诊治进展

扩张型心肌病 (dilated cardiomyopathy,DCM) 是一种以进行性左室或者双室扩大,心肌收缩功能障碍为主要特征的原发性心肌疾病。由于发病机制目前不是十分明确,导致临床中诊断和治疗都十分困难。目前临床治疗的主要目标是减轻患者症状、改善预后,提高生存率。近年来,随着新的治疗药物和治疗策略的出现,DCM的治疗取得了很大进步。本文就DCM的发病机制、诊断和治疗的研究进展做出综述。     

单纯性冠状动脉瘤样扩张对心室复极化及左心室功能的影响 冯斯婷,郝鹏,王梅,艾辉,阙斌,聂绍平作者单位：100029首都医科大学附属北京安贞医院急诊危重症中心通讯作者：聂绍平,Email：spnie@126.com

目的：单纯性冠状动脉瘤样扩张(CAE)为无明显冠状动脉狭窄闭塞、瓣膜病或其他结构性心脏疾病存在的冠状动脉瘤样扩张,本研究比较单纯性CAE患者和冠脉正常患者心电图及超声心动图指标的差异,评价瘤样扩张所累及冠状动脉节段的数目与各指标的相关性,从而评价单纯性CAE对心室复极化及左心室功能的影响。方法：本研究连续入选2015年1月至4月就诊北京安贞医院行冠脉造影检查的患者1112名,根据单纯性CAE的定义入选CAE 组患者38名,冠脉正常对照组患者49名,对两组患者的临床基线资料、心电图Tp-Te、Tp-Te /QT和Tp-Te /QTc、超声心动图左心室舒张末期内径(LVEDD)、二尖瓣口血流E峰速度(E峰)、E/A比值等指标和冠脉造影CAE分布特点进行统计学分析。结果：CAE组LVEDD(48.21±3.22mm)较对照组(46.63±3.47mm)显著升高(P<0.01),CAE组Tp-Te间期较对照组升高(P＜0.01),Tp-Te/QT(0.26±0.07)较对照组(0.23±0.07)升高(P＜0.05),Tp-Te/QTc(0.25±0.07)也较对照组(0.18±0.03)升高(P＜0.01)。CAE组患者瘤样扩张所累及冠状动脉节段数目与LVEDD、E峰、E/A呈明显相关(P＜0.05)。结论：单纯性CAE患者Tp-Te、Tp-Te/QT、Tp-Te/QTc及LVEDD明显增加,E峰及E/A比值明显减低,且瘤样扩张所累及冠状动脉节段的数目与LVEDD具有正相关性。     

探讨心衰超声指数评价慢性心力衰竭患者的临床运用价值

目的：探讨心衰超声指数评价慢性心力衰竭患者的临床运用价值。方法：选取2013年4月—2014年4月符合诊断标准的84例慢性心力衰竭患者(观察组)按照患者的临床症状分为I、II、III、IV级,另取40例门诊体检者(对照组)。对各级慢性心力衰竭患者、门诊体检者进行心衰超声指数评分,与氨基末端脑钠肽前体(NT-ProBNP)水平、左室射血分数、左房内径、左室舒张末径、纽约心功能分级进行比较。结果：门诊体检者、心功能I、II、III、IV级的慢性心力衰竭患者的心衰超声指数分别为0、1.43±0.87、2.15±0.96、3.27±1.02、5.46±1.43,各组具有统计学差异(P<0.05);门诊体检者、心功能I、II、III、IV级的慢性心力衰竭患者的NT-ProBNP水平、左室射血分数、左房内径、左室舒张末径均具有统计学差异(P<0.05);纽约心功能分级越严重,心衰超声指数越大(P<0.05)。结论：心衰超声指数与氨基末端脑钠肽前体水平、左室射血分数、左房内径、左室舒张末径、纽约心功能分级具有相关性,心衰超声指数可用于评价与诊断慢性心力衰竭患者的心功能。     

Circulating miR-208b and miR-34a Are Associated with Left Ventricular Remodeling after Acute Myocardial Infarction

Left ventricular remodeling after acute myocardial infarction (AMI) is associated with adverse prognosis. It is becoming increasingly clear that circulating miRNAs could be promising biomarkers for various pathological processes in the heart, including myocardial infarction, myocardial remodeling and progression to heart failure. In the present study, a total of 359 consecutive patients were recruited. Plasma samples were collected on admission. Echocardiographic studies were performed during the admission and at six months follow-up after AMI. Remodeling was defined as an at least 10% increase from baseline in the left ventricular end-diastolic volume. Plasma miRNA levels were assessed for association with six months mortality or development of heart failure. Results showed that levels of plasma miR-208b and miR-34a were significantly higher in patients with remodeling than those without. Increased miRNA levels were strongly associated with increased risk of mortality or heart failure within six months for miR-208b (OR 17.91, 95% confidence interval = 2.07–98.81, p = 0.003), miR-34a (OR 4.18, 95% confidence interval = 1.36–12.83, p = 0.012) and combination of the two miRNAs (OR 18.73, 95% confidence interval = 1.96–101.23, p = 0.000). The two miRNA panels reclassified a significant proportion of patients with a net reclassification improvement of 11.7% (p = 0.025) and an integrated discrimination improvement of 7.7% (p = 0.002). These results demonstrated that circulating miR-208b and miR-34a could be useful biomarkers for predicting left ventricular remodeling after AMI, and the miRNA levels are associated with increased risk of mortality or heart failure.     

Cognitive impairments in the STOP null mouse model of schizophrenia.

Cognitive dysfunction is a primary and persisting core deficit of schizophrenia that is marginally improved by antipsychotic treatment. Adult mice that lack the stable tubule-only polypeptide (STOP) have neurochemical and behavioral abnormalities that model some features of schizophrenia. Recognition and long-term memory in the STOP null mouse were tested with the novel object recognition task and an olfactory discrimination task, respectively. Researchers examined the brains from STOP null mice to determine whether differences in task performance were associated with alterations in brain morphology. STOP null mice displayed deficits in both recognition and long-term memory. These behavioral deficits were accompanied by a massive enlargement of the cerebral ventricular system as well as by reductions in volume of cortical and diencephalic structures. In addition to deficits in recognition and long-term memory, STOP null mice displayed exaggerated neuroanatomical deficits somewhat reminiscent of those observed among individuals with schizophrenia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)