Congestive heart failure is a disease in which initially compensatory changes in cardiac , vascular, and renal functions become detrimental over time. The changes are mediated by a large number of neurohormones and cy...Congestive heart failure is a disease in which initially compensatory changes in cardiac , vascular, and renal functions become detrimental over time. The changes are mediated by a large number of neurohormones and cytokines. Counter-regulatory hormones also play a role, but are generally insufficient to offset the adverse effects of the neurohormones or progression of the disease. Symptoms of heart failure occurs in the 'presence of systolic dysfunction, usually documented by a decrease in ejection fraction, or can present with impaired diastolic function occasionally labeled as heart failure with preserved systolic function of the left ventricle. Heart failure and its treatment represent a medical problem of significant importance because of the high mortality associated with it despite the current therapy , which has substantial evidence of reduction in mortality and morbidity. Prevention or slowing of the progressive deterioration in function of the heart and other organs involved through utilizing new agents that affect more or different neurohormonal pathways may be beneficial and forms the focus of heart failure research and drug development. However , the multiplicity of hormonal effects mandate the use of complex therapy in the management of congestive heart failure(CHF). The new agents in addition to the conventional therapy used in the management of heart failure are; Human B-type nalriuretic peptide (in the treatment of decompensated CHF) , endothelin receptor antagonists, calcium sensitizers, neutral endopeptidase (NEP) and vasopeptidase inhibitors, vasopressin antagonists and cytokine inhibitors.展开更多
Cardiac resynchronization therapy(CRT)reduces heart failure(HF)hospitaliz-ations and all-cause mortality in patients with HF with reduced ejection fraction with left bundle branch(LBB)block.Biventricular pacing(BVP)is...Cardiac resynchronization therapy(CRT)reduces heart failure(HF)hospitaliz-ations and all-cause mortality in patients with HF with reduced ejection fraction with left bundle branch(LBB)block.Biventricular pacing(BVP)is considered the gold standard for achieving CRT;however,approximately 30%–40%of patients do not respond to BVP-CRT.Recent studies have demonstrated that LBB pacing(LBBP)produces remarkable results in CRT.In this meta-analysis,LBBP-CRT showed better outcomes than conventional BVP-CRT,including greater QRS duration reduction and left ventricular ejection fraction improvement,along with consistently lower pacing thresholds on follow-up.Additionally,there was a grea-ter reduction in New York Heart Association class and brain natriuretic peptide levels.This study contributes to the growing body of encouraging data on LBBP-CRT from recent years.With ongoing technological advancements and increasing operator expertise,the day may not be far when LBBP-CRT becomes the standard of care rather than the exception.展开更多
目的探讨V1导联P波终末电势(P wave terminal force in lead V1,PtfV1)在心功能不全患者中的临床应用价值。方法 110例心功能不全患者及100例正常对照组纳入研究。测量、计算、记录所有入选者的体表心电图PtfV1数值,超声心动图左室射血...目的探讨V1导联P波终末电势(P wave terminal force in lead V1,PtfV1)在心功能不全患者中的临床应用价值。方法 110例心功能不全患者及100例正常对照组纳入研究。测量、计算、记录所有入选者的体表心电图PtfV1数值,超声心动图左室射血分数(LVEF)以及性别、年龄、民族等相关临床指标。按照纽约心功能分级(NYHA)将病例组分为轻症组(NYHAⅠ~Ⅱ)及重症组(NYHAⅢ~Ⅳ)。按照LEVF下降程度将病历组分为LEVF轻度下降组(LVEF 40%~50%)及中重度下降组LVEF<40%。分别比较心功能不全患者与正常人,NYHA分级严重程度不同的患者之间相较,LEVF下降程度不同的患者之间相较,PtfV1数值的差异。并分析PtfV1与传统评价心功能严重程度的指标LVEF之间的相关性。结果 1心功能不全患者与对照组相较,PtfV1数值明显下降(p<0.05);2NYHA分级重症心功能不全患者较轻症患者的PtfV1数值明显下降(p<0.05);3LVEF中重度降低患者与轻度降低的患者相较,Ptfv1数值明显下降(p<0.05);4PtfV1与LVEF呈显著正相关,相关系数r=0.77,p<0.01。结论 V1导联P波终末电势(PtfV1)可作为评价心功能不全患者病情严重程度的一项临床心电学指标。展开更多
文摘Congestive heart failure is a disease in which initially compensatory changes in cardiac , vascular, and renal functions become detrimental over time. The changes are mediated by a large number of neurohormones and cytokines. Counter-regulatory hormones also play a role, but are generally insufficient to offset the adverse effects of the neurohormones or progression of the disease. Symptoms of heart failure occurs in the 'presence of systolic dysfunction, usually documented by a decrease in ejection fraction, or can present with impaired diastolic function occasionally labeled as heart failure with preserved systolic function of the left ventricle. Heart failure and its treatment represent a medical problem of significant importance because of the high mortality associated with it despite the current therapy , which has substantial evidence of reduction in mortality and morbidity. Prevention or slowing of the progressive deterioration in function of the heart and other organs involved through utilizing new agents that affect more or different neurohormonal pathways may be beneficial and forms the focus of heart failure research and drug development. However , the multiplicity of hormonal effects mandate the use of complex therapy in the management of congestive heart failure(CHF). The new agents in addition to the conventional therapy used in the management of heart failure are; Human B-type nalriuretic peptide (in the treatment of decompensated CHF) , endothelin receptor antagonists, calcium sensitizers, neutral endopeptidase (NEP) and vasopeptidase inhibitors, vasopressin antagonists and cytokine inhibitors.
文摘Cardiac resynchronization therapy(CRT)reduces heart failure(HF)hospitaliz-ations and all-cause mortality in patients with HF with reduced ejection fraction with left bundle branch(LBB)block.Biventricular pacing(BVP)is considered the gold standard for achieving CRT;however,approximately 30%–40%of patients do not respond to BVP-CRT.Recent studies have demonstrated that LBB pacing(LBBP)produces remarkable results in CRT.In this meta-analysis,LBBP-CRT showed better outcomes than conventional BVP-CRT,including greater QRS duration reduction and left ventricular ejection fraction improvement,along with consistently lower pacing thresholds on follow-up.Additionally,there was a grea-ter reduction in New York Heart Association class and brain natriuretic peptide levels.This study contributes to the growing body of encouraging data on LBBP-CRT from recent years.With ongoing technological advancements and increasing operator expertise,the day may not be far when LBBP-CRT becomes the standard of care rather than the exception.
文摘目的探讨V1导联P波终末电势(P wave terminal force in lead V1,PtfV1)在心功能不全患者中的临床应用价值。方法 110例心功能不全患者及100例正常对照组纳入研究。测量、计算、记录所有入选者的体表心电图PtfV1数值,超声心动图左室射血分数(LVEF)以及性别、年龄、民族等相关临床指标。按照纽约心功能分级(NYHA)将病例组分为轻症组(NYHAⅠ~Ⅱ)及重症组(NYHAⅢ~Ⅳ)。按照LEVF下降程度将病历组分为LEVF轻度下降组(LVEF 40%~50%)及中重度下降组LVEF<40%。分别比较心功能不全患者与正常人,NYHA分级严重程度不同的患者之间相较,LEVF下降程度不同的患者之间相较,PtfV1数值的差异。并分析PtfV1与传统评价心功能严重程度的指标LVEF之间的相关性。结果 1心功能不全患者与对照组相较,PtfV1数值明显下降(p<0.05);2NYHA分级重症心功能不全患者较轻症患者的PtfV1数值明显下降(p<0.05);3LVEF中重度降低患者与轻度降低的患者相较,Ptfv1数值明显下降(p<0.05);4PtfV1与LVEF呈显著正相关,相关系数r=0.77,p<0.01。结论 V1导联P波终末电势(PtfV1)可作为评价心功能不全患者病情严重程度的一项临床心电学指标。
