目的 探究射频消融联合左心耳封堵一站式治疗心房颤动的效果,并比较一站式术后空窗期内服用华法林、利伐沙班、达比加群酯抗栓的有效性与安全性.方法 纳入2019年6月—2020年10月就诊于我院并行射频消融联合左心耳封堵一站式手术的心房颤动患者150例,随机分为3组,分别在术后空窗期(3个月)内服用华法林、利伐沙班、达比加群酯进行抗栓治疗,观察3组患者在空窗期内出血性事件、缺血性事件及器械相关血栓形成的发生率,并比较左心耳封堵的效果.结果 围手术期,3组患者心包积液或局部出血的发生率比较差异无显著性(P>0.05),且均未发生围手术期死亡、卒中/短暂性脑缺血发作(TIA)、系统性栓塞、器械栓塞及大出血事件.在(13.33±3.20)个月的随访中,3组患者均未发生死亡、卒中/TIA、系统性栓塞、器械相关血栓形成;3组患者之间系统性出血或局部出血发生率比较差异无显著性(P>0.05).术后3个月随访时,3组患者封堵器周围残余分流例数及残余分流大小比较差异无显著性(P>0.05).结论 射频消融联合左心耳封堵一站式治疗心房颤动安全有效,术后空窗期内服用华法林、利伐沙班或达比加群酯也均安全、有效.

目的 探讨外周动脉斑块(颈动脉分叉处、股动脉斑块)与冠状动脉(冠脉)粥样硬化严重程度的相关性,分析外周斑块对严重冠状动脉粥样硬化性心脏病(冠心病)的临床预测价值.方法 纳入149例患者,依据颈部超声所示病变等级评分将患者分为5组,基于冠脉造影检查结果(CAG)计算患者冠脉钙化积分(Gensini积分、Leaman积分),比较各组间冠脉钙化积分差异;同时对有无股动脉斑块受试对象的冠脉钙化积分进行差异比较.用接受者操作特征曲线(ROC)对颈动脉分叉斑块、股动脉斑块及联合两者对严重冠心病进行预测效能分析,对结果的灵敏度、特异性及其曲线下面积(AUC)进行比较.结果 对于颈动脉分叉处及股动脉处斑块形成程度不同的患者,其冠脉钙化积分大小均存在显著差异(P均<0.0001).颈动脉分叉处斑块性质更严重时或存在股动脉斑块时,冠脉钙化程度往往更严重.ROC曲线分析颈部分叉斑块、股动脉斑块对严重冠心病预测的AUC分别是0.7394,0.6826;联合两者可提高AUC至0.7686.基于颈动脉分叉处斑块,预测冠心病严重性的灵敏度89.19％,特异度58.70％;基于股动脉斑块斑块,灵敏度81.08％,特异度55.43％;若两种因素同时考虑则灵敏度93.33％,特异度60.38％.结论 外周动脉斑块与冠脉粥样硬化严重程度存在相关性,颈动脉、股动脉血管超声可作为一个简单的非侵入性操作来评估冠脉粥样硬化的严重程度,颈动脉分叉斑块相较股动脉斑块对严重冠脉粥样硬化预测价值更高,联合两者,增加CAG术前筛查严重冠心病的可靠性.

Objective:To summarize the clinical characteristics of heart failure patients with recovered ejection fraction (HFrecEF) and identify variables capable of predicting left ventricular ejection fraction (LVEF) recovery.Methods:This case control study included patients with heart failure, who admitted to Department of Cardiology of Beijing Hospital from January 1, 2009 to December 31, 2017. The patients were divided into 3 groups based on the baseline LVEF and changes of LVEF: heart failure with reduced ejection fraction (HFrEF, baseline LVEF≤40%, follow-up LVEF≤40% or follow-up LVEF>40% but LVEF increase<10% from baseline), HFrecEF(baseline LVEF≤40%, follow-up LVEF>40% and increase≥10% from baseline), and heart failure with preserved ejection fraction (HFpEF, baseline LVEF>40%). Clinical data were collected and endpoint events (all-cause death, cardiovascular death and sudden death) were recorded. The Log-rank test was used to evaluate the differences of terminal events in different groups, and Kaplan-Meier survival analysis was performed. Logistic regression equation was used to identify prognostic factors of HFrecEF.Results:A total of 310 patients with heart failure were included. There were 91(29.4%) HFrEF patients, 38(12.3%) HFrecEF patients and 181(58.4%) HFpEF patients. Compared with HFrEF patients and HFpEF patients, HFrecEF patients were featured by younger age, more likely to be female, higher systolic blood pressure, diastolic blood pressure and resting heart rate (all P<0.05). Dilated cardiomyopathies were more common, while old myocardial infarctions were less common in HFrecEF (both P<0.05). During a median follow-up of 36.7(18.0, 63.9) months, Kaplan-Meier survival analysis found that HFrecEF patients had the lowest all-cause mortality (Log-rank P=0.047, HFrecEF vs. HFpEF P=0.017, HFrecEF vs. HFrEF P=0.016, and HFpEF vs. HFrEF P=0.782).The cardiovascular mortality ranged from low to high was in HFrecEF patients, HFpEF patients, and HFrEF patients (Log-rank P<0.001, HFrecEF vs. HFpEF P=0.029, HFrecEF vs. HFrEF P<0.001, HFrEF vs. HFpEF P=0.005). Sudden death rate was similar among the three groups (Log-rank P=0.520). Logistic regression analysis showed that left ventricular end-diastolic diameter (LVEDD)≤55 mm ( OR=5.922, 95% CI 1.685-20.812, P=0.006), higher diastolic blood pressure ( OR=1.058, 95% CI 1.017-1.100, P=0.005), faster resting heart rate ( OR=1.042, 95% CI 1.006-1.080, P=0.024), absence of old myocardial infarction ( OR=5.343, 95% CI 1.731-16.488, P=0.004) were independent prognostic factors of LVEF recovery after clinical treatment. Conclusions:Patients with HFrecEF are associated with a better prognosis as compared to patients with HFrEF and HFpEF. LVEDD≤55 mm, higher diastolic blood pressure, faster heart rate,and absence of old myocardial infarction are independent prognostic factors of LVEF recovery after clinical treatment.

Objective:To explore value of pulsed wave (PW) and tissue synchronization imaging (TSI) evaluate cardi-ac systolic synchronization in patients with ischemic cardiomyopathy (ICM) .Methods:A total of 50 ICM patients were enrolled as ICM group and 35 healthy volunteers without organic heart disease were regarded as healthy control group ,PW was used to measure mitral diastolic blood flow duration/RR interval (LVFT/RR) to evaluate synchroni-zation of left atrial and left ventricular synchronization ;interventricular mechanical delay (IVMD) was measured to evaluate left and right ventricular synchronization ;TSI software was used to measure mitral annular mean systolic peak velocity (LV-Sm) ,systolic time to peak (Ts) and Ts standard deviation (Ts-SD) of all segments in order to e-valuate left ventricular systolic synchronization .Results:Compared with healthy control group ,there were signifi-cant reductions in LVFT/RR [ (44.74 ± 1.58)% vs .(41.08 ± 4.65)% ] and LV-Sm [ (9.72 ± 0.53) ms vs .(4.09 ± 1.06) ms] ,and significant rise in IVMD [ (15.51 ± 5.52) ms vs .(41.96 ± 4.20) ms] and Ts-SD [ (16.47 ± 4.16) ms vs .(34.13 ± 11.68) ms] in ICM group , P<0.01 all;Ts of anterior wall ,inferior wall et .6 positions were significantly longer ,and its synchronization significantly reduced , P<0. 05 all ,percentages of the most de-layed systolic part of left ventricle were no significant differences between two groups (P> 0.05) .Conclusion:Compared with healthy control group ,left ventricular total systolic function ,left atrial&ventricular ,left&right ventricular synchronization and systolic synchronization within left ventricular significantly reduce in ICM patients .

目的：分析采用替罗非班治疗急性心梗冠脉介入术后C反应蛋白的变化情况，并分析其后期影响。方法：从某院接收的急性心梗并采用急诊冠脉介入手术的患者中抽取42例，将所有病例随机分为两组，对照组和治疗组，对照组采用常规性的抗心梗治疗方法；治疗组采用常规疗法的基础上，还增加了替罗非班治疗法，剂量控制400ml，每h注射12ml。治疗后观察两组病人血清中的C反应蛋白的含量，然后来判定病人心肌的受损状况。结果：通过一个月的治疗，治疗组中的C反应蛋白从原来的9.3±0.8mg/L降低到了5.4±0.9mg/L，而对照组的C反应蛋白从原来的9.5±0.7mg/L降低到了9.0±0.8mg/L，两组都存在C反应蛋白降低，但对照组变化较小，没有统计学意义（P＞0.05），两组之间的治疗效果存在较大差异（P＜0.01）。结论：在心肌梗死患者采用急诊介入术治疗后，采用替罗非班可以有效地降低C反应蛋白的含量，从而减少对心肌的损伤，改善患者的预后状况。

目的 探讨牙龈卟啉单胞菌慢性感染对SD大鼠颈动脉结构及其粥样斑块影响.方法 将80只10周龄SD大鼠随机分为对照组和牙龈炎组,通过牙颈部丝线结扎并局部接种牙龈卟啉单胞菌的方法建立牙龈炎动物模型,分别在实验第1天(T0)、第1个月(T1)、第3个月(T2)、第6个月(T3)分批处死SD大鼠,取颈动脉,苏木精-伊红(HE)染色进行病理学观察,计算颈动脉横断面内膜与中膜面积的比值(I/M);采用巢式聚合酶链反应(PCR)法检测动脉壁及血液中牙龈卟啉单胞菌16S rDNA.结果 T0、T1时牙龈炎组与对照组I/M值比较差异无显著性(P＞0.05),T2、T3时牙龈炎组I/M值大于对照组(F=38.02,q =8.26、10.32,P＜0.01).T1、T2、T3时牙龈炎组血液中检出牙龈卟啉单胞菌16S rDNA,T2、T3时在颈动脉斑块中检测到牙龈卟啉单胞菌16S rDNA.对照组各时期动脉粥样硬化斑块及血液中均未检测到牙龈卟啉单胞菌16S rDNA.结论 牙龈卟啉单胞菌慢性感染可加快颈动脉内膜粥样斑块的发展.

The study aimed to investigate the effects of ivabradine on the levels of hypoxia-inducible factor-1alpha(HIF-1α) and VEGF in serum of rabbit with acute myocardial infarction(AMI).Methods AMI model was established by ligating the left anterior descending branch of the coronary artery in New Zealand white rabbits.Twenty five rabbits were randomly divided into 4 groups:sham-operated(S),myocardial-infarction(M) with bisoprolol treatment(M+B) and ivabradine-treated(I+M).The medical treatment began immediately after infarction and continued for 3 weeks.Serum of each rabbit was obtained at the following time points(24 h before the operation,24 h,3 d,1 week,2 weeks and 3 weeks after the operation).ELISA was used to measure the levels of HIF-1α and VEGF of each sample.ECG and heart rates(before and after treatment) were analyzed.Results Baseline heart rate showed no significant differences between the 3 infarcted groups(M,M+B,M+I).Three weeks later the heart rates were significantly lower in group M + B and group M+I than in group M.However,there was no statistic difference between the two drug-treated groups(P=0.848).The levels of HIF-1α and VEGF in groups M,M+B and M+I) increased significantly compared with group S(P<0.01).The productions of HIF-1α and VEGF were lower in group M+B and group M+I compared with group M(P<0.01).There was no statistical difference between the group M + B and group M + I(P>0.05),and the correlative analysis revealed that the production of HIF-1α was positively correlated with that of VEGF(r=0.732,P<0.01).Conclusion Ivabradine can reduce heart rate and meanwhile decrease the serum levels of HIF-1α and VEGF after AMI.

Objective:To explore influence of rosuvastatin on N terminal pro brain natriuretic peptide(NT-proBNP)and cardiac remodeling in patients with sick sinus syndrome(SSS)after dual-chamber pacemaker implanta-tion.Methods:A total of 44patients,who admitted in department of cardiology of affiliated hospital of medical college of Qingdao University because of SSS and received dual-chamber pacemaker(DDD) implantation from Jan 2011 to Jun 2011,were selected and randomly and equally divided into rosuvastatin group(received rosuvastatin 10mg/d at night based on routine treatment after surgery) and routine treatment group(received routine treatment without rosuvastatin).NT-proBNP level,left atrial diameter(LAD),left ventricular ejection fraction(LVEF),left ventricular end-diastolic dimension(LVEDd) and left ventricular end-systolic dimension(LVESd) were measured in both groups before,and 12months after surgery.Results:Compared with before surgery,there were improvement trend in above indexes after six month in routine treatment group;compared with before treatment,there were significant decrease in NT-proBNP,LAD,LVESd and LVEDd in rosuvastatin group after six months,P<0.05all.Compared with before surgery,all indexes significantly improved in two groups(P<0.05all) after 12 months;compared with routine treatment group,there were significant decrease in NT-proBNP level [(341.51±373) pg/ml vs.(257.09±173) pg/ml ] and LAD [(3.96±0.84) cm vs.(3.67±0.40) cm ] in rosuvastatin group(P<0.05 all).Conclusion:Rosuvastatin can reverse cardiac remodeling and improve cardiac function to some extent in patients with sick sinus syndrome after dual-chamber pacemaker implantation.

目的探讨肢体缺血后处理(I-post)对急性心肌梗死(AMI)患者行急症介入治疗的心肌保护作用。方法选择行急症介入治疗的初发AMI患者80例,随机分为两组各40例。A组于冠脉造影术后,常规行冠脉支架植入术;B组于冠脉造影术后,采用股动脉加压器压迫对侧股动脉5 min、松开5 min,反复3次,然后松开股动脉加压器行直接冠脉介入治疗(PCI),术中观察慢血流/无复流的发生率。两组手术前后均检测血清丙二醛(MDA)、N端前脑钠素(NT-proBNP)、CRP及左室舒张末期内径(LVDd)、左室射血分数(LVEF),术后24 h行血清CK-MB检测。结果两组术中慢血流/无复流发生率无统计学差异(P>0.05);术后24 h,B组血清MDA、NT-proBNP、CRP和CK-MB峰值均低于A组(P均<0.05);术后6个月,B组LVDd低于A组,LVEF高于A组(P均<0.05)。结论肢体I-post能明显减轻AMI患者行急症介入治疗引起的再灌注损伤,改善心功能。

目的:应用应变率成像(SRI)技术评价右室流出道起搏对于三度房室传导阻滞患者左心房功能的影响.方法:分别于双腔起搏器植入术前、术后1个月和术后3个月应用SRI技术对20例三度房室传导阻滞患者左心房功能进行评价.结果:与术前比较,术后1月左心房收缩期前容积[ (30.17±2.92)ml比(27.66±3.25) ml]、最大容积[ (47.00±2.94)ml比(44.25±3.15)m1]、最小容积[(18.27±3.02) ml比(16.14±2.54) ml]明显减小(P均＜0.05),心室收缩期左心房峰值应变率(SRs)[(3.82±0.28) s-1比(3.58±0.32)s-1]降低,心室舒张晚期左心房峰值应变率[Sra,(-2.49±0.29)s-1比(-2.72±0.31)s-1]和心室舒张早期左心房峰值应变率[Sre,(-3.11±0.28)s-1比(-3.32±0.27)s-1]升高,术后3月,上述指标变化更为显著(P＜0.01);术后3月主动排空分数[ (25.78±9.00)％比(49.39±9.33)％]和被动排空分数[(35.77±5.40)％比(41.46±7.44)％]、左室射血分数[ (62.85±3.27)％比(65.75±2.87)％]明显升高(P＜0.05～＜0.01);与术前相比,术后3个月左室射血分数的变化率与Sra的变化率呈显著的正相关(r=0.522,P＜0.05).结论:双腔起搏器植入术后可影响三度房室传导阻滞患者的左心房的功能,表现为管道和辅泵功能增加,储器功能下降.

Objective:To investigate influence of different atrioventricular delay(AVD) pacing on left atrial function in patients with dual chamber pacemaker implanted.Methods:A total of 40 patients with dual chamber pacemaker implanted were selected and divided into normal diastolic function group(n=20) and diastolic dysfunction group(n=20).Real-time tri-plane strain rate imaging was used to measure left atrial mean systolic peak strain rate(SRs),mean early diastolic peak strain rate(SRe) and mean late diastolic peak strain rate(SRa) under different AVDs in two groups.Results:In normal diastolic function group,influence of different AVD pacing on left atrial function was no significance(P>0.05).In diastolic dysfunction group:① When AVD increased from 80ms to 250ms,SRa increased correspondingly and reached top at 200ms AVD,then it started to decrease gradually.When AVD was 150ms and 200ms,the SRa and left atrial ejection fraction(LAEF) were significantly higher than those at 80ms,100ms and 250ms;② When AVD was 80ms and 250ms,SRs increased and SRe decreased;SRs at 200ms was significantly lower than that of AVD at 80ms [(3.02±0.56) s-1 vs.(3.27±0.62) s-1,P<0.05].Conclusion:Different atrioventricular delay has no significant effect on left atrial function in patients with normal diastolic function,but moderate prolongation of atrioventricular delay is good for left atrial function and improves hemodynamic in patients with pure diastolic dysfunction.

Objective To investigate the effect of different AV delays on left atrial function in DDD pacemaker implanted patients with diastolic dysfunction.Methods Seventy-six patients with DDD pacemaker were enrolled into the study.Patients were divided into two goups:one with normal cardiac function and the other with diastolic dysfunction.Left atrial ejection fraction (LAEF)and cardiac output (CO) were measured using echocardiography.Mean systolic peak strain rate(SR-s),mean early diastolic peak strain rate( SR-e )and mean late diastolic peak strain rate(SR-a) were measured using real-time triplane strain rate imaging.The results were compared between different AV delays.Results The group of diastolic dysfunction:①)When AV delay increased from 80 to 200 ms,LAEF 、SR-a and CO gradually increased.When AV delay increased to 200 ms,LAEF,CO,SR-a were reached to the highest level.Further increase in AV delay to 250 ms resulted in decreased SR-a,LAEF and CO.②Compared with 200 ms AV delay,SR-s increased significantly at 80 ms AV delay(P＜0.05).While in the group of normal cardiac function,insignificant changes in LAEF、SR-s、SR-e and SR-a were detected by setting AV delay.Conclusion Setting of AV delay has significant effect on the left atrial function in patients with diastolic dysfunction,and moderate prolongation of AV delay has a favorable effect.

Objective:To evaluate influence of right ventricular outflow tract pacing on left atrial function in patients with complete atrioventricular block(CAVB) by strain rate imaging(SRI).Methods:SRI was used to evaluate left atrial function of 20 CAVB patients before,one and three months after implantation of dual chamber pacemaker.Results:Compared with before operation,after one month,there were significant decrease in pre-systolic volume [ LAVp(30.17±2.92) ml vs.(27.66±3.25) ml],maximum volume,minimum volume of left atrium(P<0.05 all) and ventricular systolic peak strain rate of left atrium(SRs) [(3.82±0.28)s-1 vs.(3.58±0.32) s-1],and significant increase in ventricular late-diastolic left atrial peak strain rate and ventricular early-diastolic left atrial peak strain rate,and changes of above indicators were more significant after three months(P<0.01);after three months,there were significant increase in left atrial active ejection fraction [(25.78±9.00)% vs.(49.39±9.33)%],left atrial passive ejection fraction [(35.77±5.40)% vs.(41.46±7.44)%] and left ventricular ejection fraction,P<0.05～<0.01;Compared with before operation,LVEF change was positively correlated with that of SRa(r=0.522,P<0.05) after three months.Conclusion:Implantation of dual chamber pacemaker can affect left atrial function in patients with complete atrioventricular block,presented as significant increase in conduit and pumping function and significant decrease in storage function.

Objective To study whether the reperfusion injury salvage kinase (RISK) pathway take part in cardioprotection of superior mesenteric artery ischemic postconditioning on rabbit cardiac ischemia-reperfusion model in vivo. Methods The rabbits were randomly divided into the following group (eight in each group): Ischemia-reperfusion (IR); superior mesenteric artery ischemic postconditioning (MI-PostC); ischemic preconditioning (IPC)+ MI-PostC; drug intervention (DI) + MI-PostC. When the experiment completed,the heart in each group was harvested and dyed with NBT (nitroblue tetrazolium), the infarct size determined. The tissue structures were observed microscopically. Myocardium Akt and eNOS were tested by Western-blot methods. Results Infarct size was significantly less in the MI-PostC and IPC+MI-PostC groups than that of the other groups (F=4.72,q=3.69-4.20,P<0.05), but there were no differences between this two groups.However, in DI +MI-PostC groups, LY294002 abrogated the myocardium infarct size reduction in MI-PostC group (q=4.18,P<0.05). The quantity of Akt and eNOS in myocardium was higher in MI-PostC than in the other groups (F=276.34,31.8;q=9.02-29.82;P<0.01). Similarly,in DI +MI-PostC group, LY294002 abolished this protective effect in MI-PostC group. Conclusion When reperfusion is done for the ischemic myocardium, superior mesenteric artery ischemic postconditioning can not produce supernumerary protection on the base of ischemic preconditioning. RISK pathway takes part in cardioprotection of superior mesenteric artery ischemic postconditioning.