AIM:The purpose of this study was to investigate the value of the tissue annular motion displacement (TMAD) parameter in assessing left ventricular systolic function in patients with severe aortic stenosis (AS) and to investigate the risk factors for major adverse cardiovascular events (MACEs) in patients with severe AS with a biplane Simpson's method ejection fraction (LVEF-Simpson) ≥ 50%. METHODS:We enrolled 81 patients diagnosed with severe AS and 22 controls. Comparative analyses were performed between the groups, and longitudinal follow-up assessments tracked the incidence of MACEs. Survival analysis, utilizing Kaplan-Meier curves, was employed to determine the prognostic significance of TMAD parameters. RESULTS:TMAD parameters showed negative linear correlations with left ventricle global longitudinal strain (LVGLS). Overall, 69 patients (85.2%) underwent successful transcatheter aortic valve replacement (TAVR), which significantly improves myocardial longitudinal systolic function. MACE occurred in 12 (14.8%) AS patients during the follow-up period. CONCLUSION:TMAD parameters allowed early detection of left ventricle systolic dysfunction (LVSF) in severe AS patients with normal ejection fraction and correlated well with LVGLS, and TMADmid-A4C was a strong predictor of MACE in severe AS patients with preserved LVEF.

The objective of this study was to evaluate the efficacy of transcatheter aortic valve replacement (TAVR) via the femoral approach in patients with pure aortic regurgitation (AR), with a focus on mortality, adverse event rates, cardiac function, and clinical symptom improvement. The study utilised a single-centre experience to provide insights and offer guidance for the management of TAVR in AR patients. Patients with aortic valve pathology who underwent TAVR at the Second Affiliated Hospital of Nanchang University, from January 2018 to March 2023 were enrolled. They were classified into two groups: pure AR and aortic stenosis (AS) based on preoperative transthoracic echocardiography. We compared baseline characteristics, imaging data, surgical outcomes, and follow-up conditions between them. We focused on the safety and efficacy of TAVR in patients with AR and evaluated these results using regression analysis. The study cohort comprised 87 patients, with 21 in the AR group and 63 in the AS group. We revealed that AR patients exhibited low mortality and adverse event rates following transfemoral TAVR, with notable improvements in postoperative cardiac function and substantial symptom relief. However, the rates of paravalvular leak (PVL), permanent pacemaker (PPM) implantation, and valve-in-valve procedures were relatively elevated. While these findings suggest that TAVR may represent a viable therapeutic option for patients with AR, the elevated rates of PVL, PPM implantation, and readmission underscore the need for further investigation, with larger cohorts and extended follow-up, to more robustly evaluate the long-term safety and efficacy of this approach.

目的 探讨左心室心肌应变对乳腺癌患者行蒽环类药物化疗后发生癌症治疗相关心功能不全(CTRCD)的预测价值.资料与方法 纳入 2018 年 1 月—2019 年 10 月于南昌大学第二附属医院经蒽环类药物治疗的乳腺癌患者 216 例进行前瞻性研究,共 29 例出现无症状 CTRCD,根据无症状 CTRCD患者治疗结束后 24 个月内是否发生主要不良心脏事件(MACE)分为MACE组和无MACE组.获取二维左心室整体纵向应变(2D-LVGLS)、三维左心室整体纵向应变(3D-LVGLS)、三维左心室整体径向应变(3D-LVGRS)、三维左心室整体圆周应变(3D-LVGCS)、三维左心室整体面积应变(3D-LVGAS).采用多因素Cox比例风险模型识别用于预测后期发生MACE的独立预测因子.结果 多因素Cox回归分析发现,3D-LVGLS(HR=1.496,95%CI 1.397～1.775,P＜0.001)、2D-LVGLS(HR=1.154,95%CI 1.036～1.369,P=0.023)是无症状CTRCD患者发生MACE的独立预测因子,受试者工作特征曲线下面积分别为0.862、0.746,3D-LVGLS以-16.1%作为截断值预测发生MACE的敏感度和特异度分别为 75%和 64%.结论 超声三维斑点追踪成像评估左心室心肌应变可定量预测乳腺癌患者行蒽环类药物化疗后CTRCD的发生,为临床早期干预提供依据.

目的 分析经导管主动脉瓣置换术(TAVR)后发生中度以上瓣周漏(PVL)患者的临床特征和危险因素.方法 本单中心研究回顾性分析了2018年1月至2022年11月在南昌大学第二附属医院心血管内科接受TAVR治疗的重度主动脉瓣狭窄患者,并根据瓣膜置入后即刻经食管超声心动图测得的主动脉瓣反流束长度与瓣环周长之比,将患者分为PVL＜3/4组和PVL≥3/4组(中度以上PVL),对比两组患者的临床特征、超声心动图及主动脉根部CT扫描分析结果.采用多因素Logistic回归模型,对术后PVL≥3/4的独立危险因素进行筛选,并通过受试者工作特征(ROC)曲线分析各危险因素对PVL≥3/4的预测价值.结果 共纳入107例患者,平均年龄(71.7±7.0)岁,其中男63例(58.9％).PVL＜3/4组70例,PVL≥3/4组37例.多因素Logistic回归分析显示,相对室壁厚度的倒数(RWTd,OR 2.697,95CI 1.168～6.229,P=0.020)以及钙化体积(OR 1.001,95％CI 1.100～1.002,P=0.026)是行 TAVR 置入 Venus-A瓣膜术后发生中度以上PVL的独立危险因素.ROC曲线显示,RWTd(AUC=0.658,95％CI 0.554～0.763,P=0.007)、钙化体积(AUC=0.657,95％CI 0.554～0.759,P=0.008)均可预测TAVR术后中度以上PVL的发生.结论 中度以上PVL患者术前左心室重构较严重,且左心室射血分数在正常范围低值;RWTd以及主动脉瓣钙化体积是TAVR术后发生中度以上PVL的独立危险因素,两者对预测术后严重PVL具有一定价值.

目的 报道江西省首例心脏收缩力调节器(Cardiac Contractility Modulation,简称CCM)植入.方法 患者46岁男性,因"反复胸闷气促7月余"入院,结合心脏超声心动图以及心脏核磁共振、冠脉造影检查等,诊断"扩张性心肌病心功能III级",最优化心衰药物治疗后左室射血分数仍低至38％,且有活动后胸闷不适症状,心电图提示"窦性心律,QRS101ms",根据国际国内心衰指南,符合CCM植入指征,遂进一步行CCM植入术以改善运动耐力和生活质量,实现逆转心肌重构.结果 患者CCM植入手术过程顺利,耗时不到1小时.术后生命体征平稳,与术前相比,术后即刻超声心动图检查显示左室收缩功能显著改善,左室射血分数提升至47％,证明心脏收缩力调节器已发挥作用.术后一个月随访,复查心脏彩超提示左室收缩末径及舒张末径均较前缩小(左室射血分数48％),患者日常活动无明显胸闷等不适症状,取得良好疗效.结论 CCM植入有助于改善心衰患者运动耐力和生活质量,在慢性心衰器械治疗领域展现一定的意义和潜力.

This study aimed to investigate the clinical characteristics and major adverse cardiovascular events (MACEs) of Chinese patients with premature acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). This study was a secondary retrospective analysis involving 2114 ACS patients undergoing PCI at a single center in China. The patients were divided into two groups according to age (premature ACS group: ≤ 55 years in men, ≤ 65 years in women; nonpremature ACS group: > 55 years in men, > 65 years in women). The primary endpoint was all-cause death, and the secondary endpoint was a composite of all-cause death, nonfatal myocardial infarction, nonfatal stroke, target vessel revascularization, and recurrent angina at follow-up, defined as MACEs. The incidence of all-cause death and MACEs was significantly lower in the premature than in the nonpremature ACS group (P < 0.001). Female sex, higher triglyceride levels, and higher low-density lipoprotein cholesterol levels were identified as independent risk factors that accelerated the development of ACS, whereas higher high-density lipoprotein cholesterol levels were identified as protective factors. Furthermore, in patients with premature ACS, non-ST-elevation ACS, cardiac insufficiency, multivessel disease, and left main lesion were risk factors for MACEs. Younger individuals, especially females, are advised to undergo early screening for the risk factors of premature ACS. Primary prevention of dyslipidemia should be more aggressively promoted at a young age. For premature ACS patients undergoing PCI, strengthened management and regular re-examinations are necessary to avoid adverse cardiovascular events as much as possible.

经导管主动脉瓣膜置换术(TAVR)是目前治疗外科手术禁忌的主动脉瓣狭窄患者的一种重要手段[1],但由于TAVR手术操作复杂,属于复杂高危介入手术,对于射血分数低下及心功能极差,甚至并发急性心力衰竭(心衰)的患者,常规TAVR手术风险较大,体外膜肺氧合(ECMO)等机械辅助循环装置可为此类患者提供手术条件.本文通过介绍南昌大学第二附属医院心血管内科2021年7月收治的1例预防性使用ECMO辅助下行TAVR治疗极高危主动脉瓣狭窄伴冠状动脉(冠脉)阻塞高风险病例,讨论目前ECMO辅助TAVR手术的应用情况以及现存的相关问题,报告如下.

肥厚型梗阻性心肌病(HOCM)是肥厚型心肌病(HCM)中最严重的类型,约占 HCM患者总数的60％,其主要表现为不对称的左室肥厚和二尖瓣收缩期前向运动引起的左室流出道梗阻,并伴有二尖瓣关闭不全和不同程度的左室舒张收缩功能障碍[１].

目的:探讨急诊科医生应用重症超声FALLS流程在休克类型早期识别的效果及可行性.方法:选取南昌大学第二附属医院急诊科2018年5月-2020年6月期间收治的休克患者210例,在不耽误这些患者救治前提下,观察组由经过重症超声培训合格的急诊科医生按照肺部超声指导的液体管理(FALLS)流程对这210例患者实行床旁超声探查测量,同时对照组由高年资超声科医生对这210例患者按照常规超声流程探查测量,以最终的临床诊断(症状、体征、既往史及辅助检查)为金标准,对比分析两组不同超声方法诊断休克类型的诊断时间与诊断效能.结果:观察组诊断时间为平均(8.32±1.03)min,对照组诊断时间为平均(12.36±1.11)min,观察组诊断时间较对照组显著缩短,差异均有统计学意义(P＜0.05);观察组诊断休克类型的敏感度为100％,观察组诊断结果的敏感度和阳性预测值均高于对照组(100.00％vs.91.46％,21.09％vs.3.91％,均P＜0.05);进一步揭示两组的诊断效能,观察组诊断休克类型的AUC(0.851)高于对照组(0.575),差异有统计学意义(P＜0.05).结论:急诊科医生应用重症超声FALLS流程对休克患者进行检查测量,有助于快速评估和明确早期休克类型,值得临床推广应用.

目的 对比床旁超声与脉搏指示剂连续心排血量监测(PiCCO)指导脓毒性休克患者行液体复苏的效果.方法 选取2018年12月—2020年5月在南昌大学第二附属医院急诊重症监护室(ICU)诊疗的脓毒性休克患者30例,按照不同治疗方法分成超声组、PiCCO组,每组15例.超声组采用床旁超声检测左心室舒张期容积、左心室收缩期容积,并计算每搏输出量(SV);PiCCO组通过PiCCO测得SV,分析超声与PiCCO测得SV的相关性.将SV在被动直腿抬高试验期间升高值(ΔSv)≥10％定义为容量有反应性,<10％定义为容量无反应性,分别进入液体复苏阶段.以28 d病死率、住院时间、机械通气时间为主要观察指标,以治疗后6 h和12 h中心静脉压(CVP)、平均动脉压(MAP)、氧合指数、乳酸、补液量及尿量为次要观察指标,分析两种方法在指导脓毒症患者早期液体复苏上有无差异.结果 两组治疗后28 d病死率、住院时间比较,差异无统计学意义(P>0.05);超声组机械通气时间短于PiCCO组(P<0.05).床旁超声测得SV与PiCCO测得SV呈正相关(r=0.983,P=0.002).超声组与PiCCO组治疗前、治疗后6 h和12 h测量MAP、CVP、氧合指数、乳酸比较,采用重复测量设计的方差分析,结果:①不同时间点MAP、CVP、氧合指数、乳酸有差异(F=8.596、7.485、10.236和8.124,均P=0.000);②超声组与PiCCO组MAP、CVP、氧合指数、乳酸无差异(F=0.567、0.639、0.496和0.496,P=0.457、0.532、0.375和0.375);③两组MAP、CVP、氧合指数、乳酸变化趋势有差异(F=5.485、4.125、3.985和5.452,P=0.015、0.023、0.034和0.034).PiCCO组治疗后6 h和12 h补液量少于超声组,尿量多于超声组(P<0.05).超声组和PiCCO组治疗后12 h补液量、尿量多于治疗后6 h(P<0.05).结论 床旁超声与PiCCO测得SV一致性较好,两者病死率及ICU住院时间无差异,但床旁超声能减少肺水肿形成及所致机械通气时间.

Annular rupture is a rare and dreaded complication of transcatheter aortic valve replacement (TAVR) and even rarer when caused by predilatation balloon aortic valvuloplasty. This complication often presents as sudden cardiac tamponade with hypotension and requires urgent intervention. The traditional rescue strategy for patients with annular rupture is emergency surgical repair. However, the mortality rate is still high, considering that most patients who undergo TAVR are not candidates for conventional cardiac surgery. Therefore, there is a need for additional emergency treatment strategies to decrease mortality. This report describes a case of predilatation-induced annular rupture during TAVR that was successfully sealed at the rupture site by valve implantation. This case suggests that continuing with valve deployment may be a successful treatment for predilatation-induced annular rupture during TAVR.

目的 探讨miR-181b靶向调控肌肉过量蛋白-3B(muscle excess protein-3,Mex3B)的表达在动脉粥样硬化(atherosclerosis,AS)斑块的形成及其分子作用机制.方法 将雄性SD大鼠随机分成正常组、模型组、对照组和实验组.对照组和实验组分别尾静脉注射miR-181b-inhibitor-NC、miR-181b-inhibitor的混合液,正常组、模型组注射等剂量的生理盐水;注射完毕24 h后将维生素D3以600000 U/kg的剂量一次性腹腔注射进模型组、对照组、实验组大鼠体内后,每日以100 g高脂饲料喂养构建AS模型大鼠,正常组大鼠始终以等量基础饲料喂养.喂养60 d后,对大鼠进行颈动脉超声检查,测量管腔动脉后壁内膜-中层厚度(intima-media thickness of the posterior wall of the artery,IMT)和斑块面积(square,S)参数.RT-PCR检测各组miR-181b和Mex3B蛋白的mRNA的表达;Western blot检测各组Mex3B蛋白的表达水平;荧光素酶报告基因分析miR-181b和Mex3B的调控关系.结果 与正常组相比,模型组大鼠颈动脉内膜增生明显,颈动脉IMT、斑块S、miR-181b和Mex3B蛋白的mRNA和蛋白的表达明显增大,与模型组相比,实验组大鼠大鼠颈动脉内膜增生明显减小,颈动脉IMT、斑块S、miR-181b和Mex3B蛋白的mRNA和蛋白的表达明显减小,差异均具有统计意义(P<0.05).荧光素酶报告基因分析证明miR-181b与Mex3B靶向结合.结论 miR-181b通过靶向调控Mex3B的表达参与动脉粥样硬化中的炎性应激反应,抑制miR-181b的表达能明显抑制炎症反应,抑制AS中斑块的形成.

目的 探讨超声弹性成像技术评估颈动脉粥样硬化斑块稳定性的应用价值.方法 应用超声弹性成像技术对60例患者的颈总动脉粥样硬化斑块进行检测,对其进行弹性评分,并计算斑块与同水平血液弹性应变率比值(B/A比值)对照分析研究.结果 ⑴按照超声弹性成像5级评分法对斑块分级评分,低回声斑块弹性评分多为1～2分;混合回声斑块评分多为3～4分;强回声斑块评分均为5分.3组斑块分级评分差异均有统计学意义(P<0.05);⑵低回声斑块组的弹性应变率比值明显低于强回声斑块组及混合回声斑块组,差异有统计学意义(P<0.01),混合回声斑块组弹性应变率比值明显低于强回声斑块组,差异有统计学意义(P<0.05).结论 超声弹性成像技术可通过弹性评分法及弹性应变率比值反映斑块的硬度特征,应变率比值能为动脉粥样硬化斑块的稳定性进行定量评估.

目的 观察用弹性应变率比值法评价中短期稳定斑块疗效.方法 选择颈总动脉斑块患者80例,分为A、B两组, A组患者每日给予阿托伐他汀20mg,B组患者每日给予阿托伐他汀40mg,分别于治疗前及治疗后3个月、6个月进行斑块弹性应变率比值测定.同时监测血清低密度脂蛋白-胆固醇(LDL-C)、高密度脂蛋白-胆固醇(HDL-C)、高敏C反应蛋白(hs-CRP)浓度.结果 ⑴治疗3个月后A、B两组血清LDL-C、hs-CRP浓度较治疗前明显降低,差异有统计学意义(A组P＜0.05, B组P＜0.01),HDL-C较治疗前升高,A组无明显统计学差异,B组差异有统计学意义(P＜0.05),治疗6个月后两组LDL-C、hs-CRP继续下降,但与3个月相比无明显统计学差异,HDL-C与3月比无明显变化.⑵A组治疗3个月后斑块弹性应变率比值较治疗前升高,但无统计学差异,6个月后较治疗前升高有统计学差异(P＜0.05),但与3个月比无统计学差异;B组治疗3个月后斑块弹性应变率比值较治疗前明显升高,有统计学差异(P＜0.05),治疗6个月继续升高,但与3个月相比无明显统计学差异.结论 ⑴应变率比值法可对斑块的硬度进行客观评价.⑵每日阿托伐他汀40mg比20mg更快增加斑块硬度从而稳定斑块,但远期疗效相差不明显.

目的：探究在髋关节置换术中不同麻醉方式临床疗效情况，分析出3种不同的麻醉方式造成的对血流动力学安全性、稳定性的影响。方法收集需择期进行人工髋关节置换手术患者144例，随机分成3组：A组（进行持续硬膜外麻醉）、B组（进行腰麻复合硬膜外麻醉）和C组（进行全麻复合硬膜外麻醉），比较在诱导、切皮及骨水泥填充后几个时间点上患者体征变化和差异。结果 B组和C组的心率、中心静脉压和血压与A组差异明显，其中B组和C组在诱导、切皮和骨水泥填充后的心率分别为(75.93±6.05)、(77.14±7.65)、(77.98±9.15)和(73.68±5.88)、(73.12±6.35)、(77.40±6.25)，中心静脉压分别为(7.17±3.25)(7.08±3.16)(8.92±3.15)和(7.12±3.48)(7.04±3.22)(8.37±3.37)，均与A组比较差异有统计学意义(P<0.05)；B组和C组在各观察时间点比较，差异均无统计学意义。结论腰麻复合硬膜外麻醉与全麻复合硬膜外麻醉对血流动力学影响较小，可控性好。两者基本等效，均可以用于髋关节的置换手术。而此二者之间再做精细比较，如何在临床中进行选择，需在今后进一步研究证实。

Objective To explore the clinical effect of femoral nerve block under B ultrasound guidance. Methods 60 patients with knee joint surgery from June 2013 to March 2015 in our hospital were selected and randomly divided into the control group and the observation group,30 patients in each group.The control group was given blind exploration method for femoral nerve block,the observation group was given femoral nerve block under B ultrasound guidance.The analgesic effect,local anesthetic drug dosage and the incidence rate of complication was compared in two groups. Re-sults The VAS score of the observation group was lower than that in the control group,with significant difference (P<0.05).The local anesthetic drug dosage of 0.5% ropivacaine in operation process of the observation group was less than that in the control group,with significant difference (P<0.05).The incidence rate of vascular injury and nerve injury in the observation group was lower than that in the control group,with significant difference (P<0.05). Conclusion Under the guidance of B ultrasound,femoral nerve block can improve the analgesic effect of the patients with knee joint surgery,alleviate the pain of patients,reduce the incidence rate of complication,it is worthy of clinical promotion and ap-plication.

目的：探讨桥本氏甲状腺炎（HT）合并甲状腺癌的超声图像特征，以提高对其诊断的准确率。方法对54例HT伴甲状腺癌(HT组)和62例单纯性甲状腺癌(对照组)共计116个癌结节患者的术前超声图像特征进行对比分析。结果 HT组和对照组中癌结节多表现为低回声。 HT组癌结节粗钙化比例为37.0%，明显高于对照组中粗钙化比例17.7%（χ2=5.487，P=0.019）；而对照组中癌结节多为微小钙化，微钙化的比例为66.1%，明显高于HT组中微钙化的比例40.7%（χ2=7.497，P=0.006）。两组癌结节在形态、边界及血流特征方面差异无统计学意义(P＞0.05)。结论桥本氏甲状腺炎合并甲状腺癌时，超声声像图有一定的特征性表现，如发现HT结节内部存在粗大钙化及点状钙化与丰富紊乱的血流信号时，应高度怀疑恶变可能。

目的：观察喉罩麻醉和气管插管麻醉在婴儿麻醉中的临床效果。方法随机选取40例患儿，年龄6个月～1岁。ASA I～I I级，将其随机分为2组，喉罩麻醉的为X组（n=20），使用气管插管麻醉的为Y组（n=20）,观察患儿身体情况。结果2组患儿的MAP及HR变化情况比较，X组T 2和T 4较T 1时MAP明显下降，HR减慢,差异有统计学意义（P＜0.05）,Y组在T 4和T 5时段较T 2时HR明显增快，MAP增高,比较差异有统计学意义（P＜0.05）。结论喉罩麻醉比气管插管麻醉更适用于婴儿麻醉，值得推广。

Objective To assess the clinical application value of velocity vector imaging(VVI) in locating right accessory path-ways of patients with overt pre-excitation syndrome. Methods Twenty healthy volunteers were included in a control group and fif-teen patients with type B overt pre-excitation syndrome were included in a trial group. Excluding the patients with organic car-diopathy and intra-ventricular block. All were examined by VVI and patients were examined before or after RFCA. When right ventricle free wall and interventricular septum contract in the early to mid systole,we measured TV,T-SD and T-MX in apex four cavity views. We assess precise rate of VVI in locating accessory pathways compared with intracardiac electrophysiology. Results (1)In the control group,heart contraction was synchronous,magnitude and directions of velocity vector were accordant. (2)Right ventricle free wall of thirteen patients was not accordant in the early to mid systole pre-operation. VVI displayed velocity vector of regional myocardium contract in advance. Intracardiac electrophysiology proved accessory pathways derived from right ventricular free wall. Myocardium contraction,magnitude and direction of right ventricular free wall were accordant basically after performed RFCA. There were two cases can not be located by VVI,operations results demonstrate that accessory pathways derived from pos-terior interventricular septum. Conclusion VVI can locate type B overt pre-excitation syndrome exactly derived from right acces-sory pathways of right ventricular free wall ,but some derived from other accessory pathways of right ventricular needed to be inves-tigated further.

目的评价太极拳对心脏功能的影响.方法采用超声多普勒成像技术,对43例太极拳锻炼的老年人和43例未经任何规范化锻炼的老年人的心脏功能指标进行检查比较. 结果实验组与对照组比较,左室舒张末内径(LVDD)、左室收缩末内径(LVSD)未见显著差异(P＞0.05),左室射血分数(EF)、左室短轴缩短率(FS)、E/A值有非常显著增高(P＜0.01).结论长期太极拳锻炼对老年人心脏功能有保健作用.