• 【CT图像整合到电解剖标测系统对房颤导管消融临床结果的影响。】 复制标题 收藏 收藏
    DOI:10.1111/j.1540-8167.2006.00594.x 复制DOI
    作者列表:Kistler PM,Rajappan K,Jahngir M,Earley MJ,Harris S,Abrams D,Gupta D,Liew R,Ellis S,Sporton SC,Schilling RJ
    BACKGROUND & AIMS: BACKGROUND:A detailed appreciation of left atrial/pulmonary vein (LA/PV) anatomy may be important in improving the safety and success of catheter ablation (CA) for atrial fibrillation (AF). OBJECTIVES:The aim of this nonrandomized study was to determine the impact of computerized tomography (CT) image integration into a 3-dimensional (3D) mapping system on the clinical outcome of patients undergoing CA for AF. METHODS:Ninety-four patients (age: 56 +/- 10 years) with AF (paroxysmal 46, persistent 48) underwent wide encirclement of ipsilateral PV pairs using irrigated radiofrequency ablation with the endpoint of electrical isolation. Ablation was guided by 3D mapping alone (electroanatomic 24, noncontact 23) in 47 (3DM group) patients and by CT image integration (Cartomerge) in 47 (CT group). In persistent AF, a combination of linear ablation and targeted ablation of complex fractionated electrograms was also performed. RESULTS:Successful PV electrical isolation did not differ between the two groups. A significant reduction in fluoroscopy times was demonstrated in the CT group (49 +/- 27 minutes vs 3DM group 62 +/- 26 minutes, P = 0.03). Arrhythmia recurrence was reduced in the CT group (32% vs 51% in the 3DM group, P < 0.01). In 30 symptomatic patients (12 CT and 18 3DM), repeat procedures for AF (13 in 3DM and 5 CT, P < or = 0.10) and AT (5 in 3DM and 7 CT, P = NS) were performed. Overall success on 7-day monitor off antiarrhythmic drugs was achieved in 60% in the 3DM group when compared with 83% in the CT group (P < 0.05) at a follow-up of 25 +/- 5 weeks. CONCLUSION:CA for AF guided by CT integration was associated with reduced fluoroscopy times, arrhythmia recurrence, and increased restoration of sinus rhythm. Improved visualization of complex LA geometries might improve the safety and success of CA for AF.
    背景与目标:
  • 【阵发性心房颤动患者CHADS2评分与抗心律失常药物治疗疗效的关系.】 复制标题 收藏 收藏
    DOI:10.1253/circj.cj-12-0854 复制DOI
    作者列表:Komatsu T,Sato Y,Ozawa M,Kunugita F,Ueda H,Tachibana H,Morino Y,Nakamura M
    BACKGROUND & AIMS: BACKGROUND:The Cardiac failure, Hypertension, Age, Diabetes, Stroke [Doubled] (CHADS(2)) score is a useful scheme for risk stratification of thromboembolism patients, but there is little information about its usefulness for the evaluation of antiarrhythmic drug (AAD) therapy. METHODS AND RESULTS:This study included 459 paroxysmal atrial fibrillation (AF) patients (309 men, mean age 66 ± 12 years, mean follow-up 50 ± 35 months) and prophylactic efficacy was analyzed on the basis of CHADS(2) score. (1) Survival rates free from AF recurrence at 1, 6, 12 and 24 months were, respectively, 89%, 74%, 63% and 47% in score-0 group (n=152); 92%, 68%, 59% and 48% in score-1 group (n=158); 86%, 64%, 56% and 46% in score-2 group (n=84); 81%, 65%, 51% and 35% in score-3 group (n=43); and 68%, 50%, 36% and 18% in ≥ score-4 group (n=22) (P<0.05; score-0, score-1 or score-2 vs. ≥ score-4 group). (2) Survival rates free from progression to chronic AF at 12, 36, 60 and 90 months were, respectively, 95%, 93%, 91% and 89% in score-0 group; 97%, 91%, 89% and 88% in score-1 group; 96%, 93%, 88% and 83% in score-2 group; 91%, 74%, 67% and 60% in score-3 group; and 91%, 82%, 68% and 55% in ≥ score-4 group (P<0.01; score-0, score-1 or score-2 vs. ≥ score-4 group). (3) In multivariate logistic regression analysis adjusted for potentially confounding variables, CHADS(2) score was associated with AF recurrence (odds ratio [OR] 1.45, 95% confidence interval [CI] 1.16-1.81, P<0.001), and progression to chronic AF during AAD therapy (OR 1.64, 95% CI 1.04-2.69, P<0.001). CONCLUSIONS:When using a rhythm control strategy, the CHADS(2) score is a useful scheme for predicting the outcome of AAD treatment of patients with paroxysmal AF.  
    背景与目标:
  • 【来自右室流出道的良性室性早搏复合物触发了2型LQTS患者的多形性室性心动过速。】 复制标题 收藏 收藏
    DOI:10.2169/internalmedicine.51.8565 复制DOI
    作者列表:Sato A,Chinushi M,Sonoda K,Abe A,Izumi D,Furushima H
    BACKGROUND & AIMS: :A 57-year-old woman showed frequent premature ventricular complexes (PVCs) originating from the right ventricular outflow tract (RVOT), and some of the PVCs triggered polymorphic ventricular tachycardia (PVT). Structural heart diseases were ruled out by conventional cardiac examinations. Radiofrequency catheter ablation was successful in eliminating the PVCs and subsequent PVT. However, epinephrine infusion unmasked her prolonged QT interval, and a genetic analysis revealed a KCNH2 mutation (R694H) as the cause of latent type-2 long QT syndrome (LQTS). This case suggests that latent LQTS may work as an arrhythmogenic substrate of PVT triggered by a benign form of RVOT-PVCs in patients with a structurally normal heart.
    背景与目标: : 一名57岁的女性表现出频繁的源自右心室流出道 (RVOT) 的室性早搏 (pvc),其中一些pvc触发了多形性室性心动过速 (PVT)。常规心脏检查排除了结构性心脏病。射频导管消融成功消除了pvc和随后的PVT。然而,肾上腺素输注揭示了她延长的QT间期,基因分析显示KCNH2突变 (R694H) 是潜伏性2型长QT综合征 (LQTS) 的原因。这种情况表明,在结构正常的心脏患者中,潜在的LQTS可能是由良性形式的rvot-pvc触发的PVT的致心律失常底物。
  • 【维生素d减少左心室肥厚和慢性肾脏疾病患者的左心房体积。】 复制标题 收藏 收藏
    DOI:10.1016/j.ahj.2012.09.018 复制DOI
    作者列表:
    BACKGROUND & AIMS: BACKGROUND:Left atrial enlargement, a sensitive integrator of left ventricular diastolic function, is associated with increased cardiovascular morbidity and mortality. Vitamin D is linked to lower cardiovascular morbidity, possibly modifying cardiac structure and function; however, firm evidence is lacking. We assessed the effect of an activated vitamin D analog on left atrial volume index (LAVi) in a post hoc analysis of the PRIMO trial (clinicaltrials.gov: NCT00497146). METHODS AND RESULTS:One hundred ninety-six patients with chronic kidney disease (estimated glomerular filtration rate 15-60 mL/min per 1.73 m(2)), mild to moderate left ventricular hypertrophy, and preserved ejection fraction were randomly assigned to 2 μg of oral paricalcitol or matching placebo for 48 weeks. Two-dimensional echocardiography was obtained at baseline and at 24 and 48 weeks after initiation of therapy. Over the study period, there was a significant decrease in LAVi (-2.79 mL/m(2), 95% CI -4.00 to -1.59 mL/m(2)) in the paricalcitol group compared with the placebo group (-0.70 mL/m(2) [95% CI -1.93 to 0.53 mL/m(2)], P = .002). Paricalcitol also attenuated the rise in levels of brain natriuretic peptide (10.8% in paricalcitol vs 21.3% in placebo, P = .02). For the entire population, the change in brain natriuretic peptide correlated with change in LAVi (r = 0.17, P = .03). CONCLUSIONS:Forty-eight weeks of therapy with an active vitamin D analog reduces LAVi and attenuates the rise of BNP. In a population where only few therapies alter cardiovascular related morbidity and mortality, these post hoc results warrant further confirmation.
    背景与目标:
  • 【心房颤动患者异位活动的细胞和分子相关性。】 复制标题 收藏 收藏
    DOI:10.1093/europace/eus282 复制DOI
    作者列表:Voigt N,Dobrev D
    BACKGROUND & AIMS: :Atrial fibrillation (AF) is the most frequent arrhythmia and is associated with increased morbidity and mortality. Current drugs for AF treatment have limited efficacy and a substantial risk of proarrhythmic side effects, making novel drug development critical. Emerging evidence suggests that abnormal intracellular calcium (Ca(2+)) signalling is a key contributor to ectopic (triggered) electrical activity in human AF. Accordingly, atrial Ca(2+)-handling abnormalities underlying ectopic activity may constitute novel mechanism-based therapeutic approaches to treat AF. This article reviews the recent evidence for a role of cellular ectopic activity in human AF pathophysiology, discusses the molecular mechanisms underlying triggered activity in human atrial myocytes, and considers their relevance to the design of novel therapeutic options.
    背景与目标: 心房颤动 (AF) 是最常见的心律失常,与发病率和死亡率增加有关。目前用于房颤治疗的药物疗效有限,并且存在严重的心律失常副作用风险,因此新药开发至关重要。新兴证据表明,异常的细胞内钙 (Ca(2)) 信号传导是人类AF异位 (触发) 电活动的关键因素。因此,异位活动潜在的心房Ca(2) 处理异常可能构成治疗AF的新的基于机制的治疗方法。本文回顾了细胞异位活性在人类AF病理生理学中的作用的最新证据,讨论了人类心房肌细胞触发活性的分子机制,并考虑了它们与新型治疗方案设计的相关性。
  • 【成功的导管消融降低了CHA2DS2-VASc风险评分为1及以上的房颤患者发生心血管事件的风险。】 复制标题 收藏 收藏
    DOI:10.1093/europace/eus336 复制DOI
    作者列表:Lin YJ,Chao TF,Tsao HM,Chang SL,Lo LW,Chiang CE,Hu YF,Hsu PF,Chuang SY,Li CH,Chung FP,Chen YY,Wu TJ,Hsieh MH,Chen SA
    BACKGROUND & AIMS: AIMS:It is not known if successful catheter ablation for atrial fibrillation (AF) improves the patient's long-term cardiovascular outcomes. This study investigated the long-term outcomes and mortality of AF patients at high risk who received antiarrhythmic medication and catheter ablation. METHODS AND RESULTS:The propensity scores for AF were calculated for each patient and were used to assemble a cohort of 174 AF patients with ablation who were compared with an equal number of AF patients without ablation. Composite cardiovascular end points (major adverse cardiovascular event, MACE), including mortality and vascular events in the medically treated patients representing the control group (group 1), were compared with those in the ablation-treated patients (group 2). The rates of the total mortality (2.95% vs. 0.74% per year; P < 0.01), cardiovascular death (1.77% vs. 0% per year; P = 0.001), and ischaemic stroke/transient ischaemic attack (2.21% vs. 0.59% per year; P = 0.02) were higher in group 1 than group 2, respectively. A multivariate Cox regression analysis of the MACE scores showed that a higher CHA2DS2-VASc score [hazard ratio (HR) = 1.309 per increment of score, 95% confidence interval (CI) = 1.06-1.617; P = 0.01] and the performance of the ablation procedure (HR = 0.225, CI = 0.076-0.671; P = 0.007) were independent predictors of a MACE. In patients who received catheter ablation, recurrence of any atrial arrhythmia was a predictor of vascular events and total mortality (P < 0.05). CONCLUSION:In AF patients with CHA2DS2-VASc score ≥1, catheter ablation of AF reduced the risk of the total/cardiovascular mortality and total vascular events. Atrial fibrillation recurrence predicts long-term cardiovascular outcomes, as well as the CHA2DS2-VASc score.
    背景与目标:
  • 【经导管治疗儿童膜周室间隔缺损,继发孔型房间隔缺损和动脉导管未闭。】 复制标题 收藏 收藏
    DOI:10.2459/01.JCM.0000247327.88030.12 复制DOI
    作者列表:Butera G,Piazza L,Hijazi Z,Chessa M,Carminati M
    BACKGROUND & AIMS: :A 4-year-old child with patent ductus arteriosus, perimembranous ventricular septal defect and ostium secundum atrial septal defect was successfully treated with the use of a simultaneous transcatheter for all of the anomalies present. The patent ductus arteriosus was closed first by using a coil, then the perimembranous ventricular septal defect was closed by using a 10-mm Amplatzer eccentric device. Finally, a 10-mm Amplatzer atrial septal defect device was implanted to treat the atrial septal defect.
    背景与目标: : 一名4岁的动脉导管未闭,膜周性室间隔缺损和继发孔房间隔缺损的儿童,已成功使用同时经导管治疗所有存在的异常。首先使用线圈闭合动脉导管未闭,然后使用10mm Amplatzer偏心装置闭合膜周室间隔缺损。最后,植入了10mm Amplatzer房间隔缺损装置来治疗房间隔缺损。
  • 【扩张型心肌病的左心室多普勒充盈模式: 与血流动力学和左心房功能的关系。】 复制标题 收藏 收藏
    DOI:10.1016/s0894-7317(97)70005-1 复制DOI
    作者列表:Ito T,Suwa M,Otake Y,Moriguchi A,Hirota Y,Kawamura K
    BACKGROUND & AIMS: :This study attempted to examine the relation of left ventricular filling patterns to hemodynamic status and left atrial function in dilated cardiomyopathy. Transesophageal echocardiography and cardiac catheterization were performed in 41 patients with dilated cardiomyopathy (six with an ischemic origin). Transmitral, left atrial appendage, and pulmonary venous flow velocities were recorded with the pulsed Doppler method. Left atrial systolic function was assessed by the peak velocity of the left atrial appendage emptying wave and pulmonary venous flow reversal during atrial systole. Patients were classified into three groups according to their left ventricular filling patterns. Group 1 showed an abnormal relaxation pattern (E wave/A wave ratio <1, n = 17), group 2 had a normal or pseudonormal pattern (1 < or = E/A < 2, n = 11), and group 3 had a restrictive pattern (E/A > or = 2, n = 13). No differences were found among the groups with regard to age, gender, heart rate, and M-mode echocardiographic indices of left ventricular function. Compared with patients in group 1, those in groups 2 and 3 had more symptoms (New York Heart Association functional class III or IV) and had higher left ventricular filling pressures. The sensitivity of an E/A ratio > or = 1 for predicting a pulmonary capillary wedge pressure > or = 15 mm Hg was 75% and the specificity was 94%. Despite a similar increase of filling pressures, group 3 patients had a lower left atrial appendage emptying velocity, pulmonary venous flow reversal velocity, and mitral A velocity than did group 2 patients. The sensitivity and specificity of an E/A ratio > or = 22 for detecting left atrial dysfunction (left atrial appendage emptying velocity < or = 40 cm/sec) was 85% and 86%, respectively. In conclusion, among patients with dilated cardiomyopathy, those who had a restrictive or pseudonormal filling pattern were in a higher functional class and had higher filling pressures. Further studies are needed to determine the therapeutic and prognostic significance of left atrial dysfunction, which was common in patients with a restrictive pattern.
    背景与目标: : 本研究试图研究扩张型心肌病中左心室充盈模式与血流动力学状态和左心房功能的关系。对41例扩张型心肌病患者 (6例为缺血性起源) 进行了经食管超声心动图和心导管检查。用脉冲多普勒法记录传播,左心耳和肺静脉血流速度。通过心房收缩期间左心耳排空波的峰值速度和肺静脉血流逆转来评估左心房收缩功能。根据患者的左心室充盈方式将其分为三组。第1组显示异常弛豫模式 (E波/A波比 <1,n = 17),第2组显示正常或伪正常模式 (1 <或 = E/a <2,n = 11),第3组具有限制性模式 (E/a> 或 = 2,n = 13)。在年龄,性别,心率和左心室功能的M型超声心动图指标方面,各组之间没有发现差异。与第1组患者相比,第2组和第3组患者的症状更多 (纽约心脏协会功能III或IV级),左心室充盈压力更高。75% 了E/A比值> 或 = 1对预测肺毛细血管楔压> 或 = 15毫米Hg的敏感性,并94% 了特异性。尽管充盈压力增加相似,但第3组患者的左心耳排空速度,肺静脉血流逆转速度和二尖瓣a速度均低于第2组患者。E/A比值> 或 = 22检测左心房功能障碍 (左心耳排空速度 <或 = 40厘米/秒) 的敏感性和特异性分别为85% 和86%。总之,在扩张型心肌病患者中,具有限制性或假性正常填充模式的患者处于较高的功能级别,并且具有较高的填充压力。需要进一步的研究来确定左心房功能障碍的治疗和预后意义,这在限制性模式的患者中很常见。
  • 【平均血小板体积,用于预测二尖瓣反流和左心耳血栓形成的严重程度。】 复制标题 收藏 收藏
    DOI:10.1097/MBC.0b013e328364c453 复制DOI
    作者列表:Ulu SM,Ozkeçeci G,Akci O,Ahsen A,Altug A,Demir K,Acartürk G
    BACKGROUND & AIMS: :The incidence of thromboembolism is higher in mitral regurgitation. Mean platelet volume (MPV), which is calculated automatically in the complete blood count tests, indicates platelet production, function and activation. Elevated MPV levels in cardiovascular diseases and some heart valve diseases have been shown before. We aimed to investigate the relationship between MPV and mitral regurgitation, and to evaluate the MPV levels according to the presence of atrial fibrillation or left atrial appendage thrombus in patients with mitral regurgitation for the first time. The study included 57 patients who had undergone transthoracic and transesophageal echocardiography for the classic symptoms and diagnosed with primary (organic) mitral regurgitation. The control group was composed of 46 age, sex and BMI-matched healthy individuals who had undergone transthoracic echocardiography and obtained normal findings. Echocardiographic evaluation was performed according to the recommendations of the American Echocardiography Society. Mean MPV values in patients with mitral regurgitation were significantly higher than the control group (P < 0.001). MPV levels and the thrombus risk were correlated with the severity of the disease. When the patients with mitral regurgitation were classified according to the presence of atrial fibrillation and left atrial appendage thrombus, patients with atrial fibrillation had higher MPV levels compared to patients with normal sinus rhythm (P < 0.001). In addition, highest MPV levels were found in patients with both atrial fibrillation and thrombosis (P < 0.001). In conclusion, measurement of MPV may be considered as a quick and reliable guide in the assessment of mitral regurgitation and thrombus, without any cost or any advanced expensive technology.
    背景与目标: : 二尖瓣反流中血栓栓塞的发生率较高。在整个血液计数测试中自动计算的平均血小板体积 (MPV) 表示血小板的产生,功能和激活。以前已显示心血管疾病和某些心脏瓣膜疾病中的MPV水平升高。本研究旨在探讨MPV与二尖瓣反流的关系,并根据首次发生二尖瓣反流的患者是否存在心房颤动或左心耳血栓来评估MPV水平。该研究包括57例经胸和经食管超声心动图检查经典症状并被诊断为原发性 (器质性) 二尖瓣反流的患者。对照组由46名年龄,性别和BMI相匹配的健康人组成,他们接受了经胸超声心动图检查并获得了正常的发现。根据美国超声心动图学会的建议进行超声心动图评估。二尖瓣反流患者的平均MPV值明显高于对照组 (p  <  0.001)。MPV水平和血栓风险与疾病的严重程度相关。根据是否存在心房颤动和左心耳血栓对二尖瓣关闭不全患者进行分类时,心房颤动患者的MPV水平高于窦性心律正常患者 (p  <  0.001)。此外,房颤和血栓形成患者的MPV水平最高 (p  <  0.001)。总之,MPV的测量可以被认为是评估二尖瓣反流和血栓的快速可靠的指南,而无需任何成本或任何先进的昂贵技术。
  • 【心房缺损的双伞闭合。初步临床应用。】 复制标题 收藏 收藏
    DOI:10.1161/01.cir.82.3.751 复制DOI
    作者列表:Rome JJ,Keane JF,Perry SB,Spevak PJ,Lock JE
    BACKGROUND & AIMS: :Forty patients were catheterized for closure of atrial septal defects with the Rashkind patent ductus arteriosus umbrella device, a modified Rashkind umbrella device, and the newly designed Lock Clamshell Occluder. Patients weighed 8 kg or more (a requirement for transvenous access with the 11F delivery sheath) and had defects suitable for closure based on two-dimensional echocardiography. The new device was at least 1.6 times the diameter of the atrial septal defect as determined by balloon sizing at catheterization. Patients were followed up by telephone, clinical examination, and echocardiography at 6 months. We attempted closure in 34 patients, with atrial septal defects ranging in diameter from 3 to 22 mm; device sizes ranged from 17 to 33 mm. Initial device position immediately after release was correct in all patients. A cerebral embolus occurred in one elderly patient before device placement--the patient died 1 week later. Two instances of early device embolization occurred, and devices were retrieved by catheter without complication. Follow-up of 31 patients discharged with devices in place, for a total of 31 patient-years, has yielded no umbrella-related complications. Adequate imaging studies in 19 patients 6.5 months after device placement revealed no atrial shunt in 12; residual flow through separate, previously unrecognized atrial septal defects occurred in two; and small residual leaks (less than 3 mm) around devices were present in five patients. This initial success indicates that double-umbrella closure of atrial septal defects will aid in the treatment of intracardiac defects.
    背景与目标: : 用Rashkind动脉导管未闭伞装置,改良的Rashkind伞装置和新设计的锁翻盖封堵器对40例患者进行了房间隔缺损的导管插入术。患者体重8千克或更多 (需要通过11F递送鞘的静脉通路),并且具有适合基于二维超声心动图闭合的缺陷。根据导管插入时的球囊大小确定,新装置的直径至少是房间隔缺损直径的1.6倍。6个月时,对患者进行电话、临床检查和超声心动图随访。我们尝试对34例房间隔缺损的患者进行封堵,其直径范围为3至22毫米; 设备尺寸范围为17至33毫米。在所有患者中,释放后立即的初始设备位置正确。一名老年患者在设备放置前发生了脑栓塞-该患者在1周后死亡。发生了两次早期器械栓塞,并且通过导管取回了器械,没有并发症。对31例使用设备出院的患者进行了随访,共31个患者年,没有产生与伞相关的并发症。设备放置后6.5个月对19名患者进行了充分的影像学研究,发现12名患者没有心房分流; 两名患者发生了通过单独的,以前未识别的房间隔缺损的残留血流; 五名患者存在设备周围的小残留泄漏 (小于3毫米)。最初的成功表明,房间隔缺损的双伞闭合将有助于治疗心内缺损。
  • 【OPC-2009对豚鼠离体气管,右心房和左心房制剂的 β-肾上腺素受体刺激特性。】 复制标题 收藏 收藏
    DOI:10.1111/j.1476-5381.1977.tb07543.x 复制DOI
    作者列表:Yabuuchi Y
    BACKGROUND & AIMS: :1. The beta-adrenoceptor stimulant properties of 5-(1-hydroxy-2-isopropylaminobutyl)-8-hydroxy-carbostyril hydrochloride hemihydrate (OPC-2009) were compared with those of isoprenaline and salbutamol on guinea-pig isolated tissues. 2. In producing tracheal relaxation, OPC-2009 was approximately 7 times more potent and salbutamol 5 times less potent than isoprenaline. Both compounds were less potent than isoprenaline in increasing either the rate of beating of isolated right atria or the contractile force of left atria, OPC-2009 being 4 and 127 times and salbutamol being 100 and 700 times less potent on the respective preparations. 3. Selectivity calculated from EC50 ratio indicates that OPC-2009 was approximately 26 times and salbutamol approximately 21 times more selective than isoprenaline for tracheal smooth muscle as compared to right atrial muscle, whereas OPC-2009 was approximately 850 times and salbutamol 140 times more selective than isoprenaline for tracheal smooth muscle as compared to left atria. 4. The responses to OPC-2009 on trachea and right atria were not altered by treatment of animals with reserpine 24 h previously. Propranolol was a competitive antagonist of OPC-2009 on these tissues. 5. OPC-2009 at high concentrations competitively antagonized the positive chronotropic and inotropic responses to isoprenaline, indicating that OPC-2009 like salbutamol, may be classified as a partial agonist. 6. The results indicate that the action of OPC-2009 is more selective for tracheal smooth muscle than cardiac muscle and are interpreted in the light of subdivisions of beta-adrenoceptors.
    背景与目标: : 1。比较了5-(1-羟基-2-异丙基氨基丁基)-8-羟基-卡百利酯盐酸盐半水合物 (OPC-2009) 与异丙肾上腺素和沙丁胺醇在豚鼠分离组织上的 β-肾上腺素受体刺激性能。2.在产生气管松弛时,OPC-2009的效力约为异丙肾上腺素的7倍,沙丁胺醇的效力约为异丙肾上腺素的5倍。两种化合物在增加分离的右心房的跳动速率或左心房的收缩力方面均不如异丙肾上腺素,OPC-2009在相应制剂上的效力为4倍和127倍,沙丁胺醇的效力为100和700倍。3.根据EC50比率计算的选择性表明,与右心房肌相比,气管平滑肌的OPC-2009约为26倍,沙丁胺醇约为21倍,而与左心房相比,气管平滑肌的OPC-2009约为850倍,沙丁胺醇约为140倍。4.对气管和右心房OPC-2009的反应没有通过24 h前用利血平治疗动物而改变。普萘洛尔是这些组织上OPC-2009的竞争性拮抗剂。5.高浓度OPC-2009竞争性拮抗异丙肾上腺素的正变时性和正性肌力反应,表明沙丁胺醇等OPC-2009可被归类为部分激动剂。6.结果表明,OPC-2009的作用对气管平滑肌比心肌更具选择性,并根据 β-肾上腺素受体的细分进行解释。
  • 【达比加群酯在希腊房颤管理中的经济评估。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Andrikopoulos GK,Fragoulakis V,Maniadakis N
    BACKGROUND & AIMS: INTRODUCTION:The objective of the present study was to evaluate, from an economic perspective, dabigatran etexilate in comparison to existing pharmaceutical therapeutic options available for the protection of moderate-to-high risk patients with non-valvular atrial fibrillation from cardioembolic risk. METHODS:An existing Markov model was adapted to the Greek setting to reflect the natural course of the disease and the management of patients with different therapies. The model predicts health and economic outcomes and the implications for the social security system during the course of a patient's lifetime. The data for the population of the model were derived from the international literature and local economic databases. RESULTS:The incremental cost per quality-adjusted life year (QALY) of dabigatran 150 mg twice daily relative to the other therapies varied from €5547 to €11,762 and that of dabigatran 110 mg twice daily from €7398 to €16,437. The incremental cost per QALY of dabigatran 150 mg relative to aspirin, the least costly option, was €11,762 and relative to warfarin and acenocoumarol, the local standards of care, it was €11,400 and €11,224 respectively, well below the local thresholds of acceptance. CONCLUSION:Dabigatran etexilate may represent a cost-effective option for the prevention of thromboembolic events in AF patients at moderate-to-high risk of stroke or systemic embolism.
    背景与目标:
  • 【优化快速室性心动过速的植入式心脏复律除颤器治疗: 充电期间的抗心动过速起搏治疗。】 复制标题 收藏 收藏
    DOI:10.1016/j.hrthm.2007.03.008 复制DOI
    作者列表:Schoels W,Steinhaus D,Johnson WB,O'hara G,Schwab JO,Jenniskens I,Degroot PJ,Tang F,Helmling E,EnTrust Clinical Study Investigators.
    BACKGROUND & AIMS: BACKGROUND:Previous studies in implantable cardioverter-defibrillator (ICD) patients demonstrated the efficacy and safety of antitachycardia pacing (ATP) for rapid ventricular tachycardias (VT). To prevent shock delay in case of ATP failure, a new feature (ATP during charging) was developed to deliver ATP for rapid VT while charging for shock. OBJECTIVE:The purpose of this study was to determine the efficacy and safety of this new feature. METHODS:In a prospective, nonrandomized trial, patients with standard ICD indication received an EnTrust ICD. VT and ventricular fibrillation (VF) episodes were reviewed for appropriate detection, ATP success, rhythm acceleration, and related symptoms. RESULTS:In 421 implanted patients, 116 VF episodes occurred in 37 patients. Eighty-four (72%) episodes received ATP during or before charging. ATP prevented a shock in 58 (69%) of 84 episodes in 15 patients. ATP stopped significantly more monomorphic (77%) than polymorphic VTs (44%, P = .05). Five (6%) episodes accelerated after ATP but were terminated by the backup shock(s). No symptoms were related to ATP during charging. In four patients, 38 charges were saved by delivering ATP before charging. Of 98 induced VF episodes, 28% were successfully terminated by ATP versus 69% for spontaneous episodes (P <.01). CONCLUSION:Most VTs detected in the VF zone can be painlessly terminated by ATP delivered during charging, with a low risk of acceleration or symptoms. ATP before charging allows delivery of two ATP attempts before shock in the same time that would otherwise be required to deliver only one ATP plus a shock. It also offers potential battery energy savings.
    背景与目标:
  • 【阵发性房颤患者的超声心动图特征。】 复制标题 收藏 收藏
    DOI:10.1007/s10554-007-9247-3 复制DOI
    作者列表:Colkesen Y,Acil T,Demircan S,Sezgin AT,Ozin B,Muderrisoglu H
    BACKGROUND & AIMS: BACKGROUND:There are several risk factors for the initiation of paroxysmal atrial fibrillation (PAF) and the underlying mechanisms are multifactorial. Our study aims to explore the echocardiographic parameters that can identify in patients with PAF compared to normal subjects. METHODS:Eighty consecutive patients who were with PAF detected by 24-h Holter monitoring (HM) were assigned in our study. The control group (n = 80) consisted individuals with no PAF on HM. Indication for HM was palpitations at rest. All patients underwent routine echocardiographic evaluation. Patients with aortic and mitral stenosis, hyperthyroidism, and hypothyroidism were excluded from the study. Comprehensive clinical data were collected. RESULTS:Mean age of the patients with PAF was 63 +/- 11 years and of those 42% were male subjects. There was no difference in the prevalence of hypertension in both groups. Mean left ventricular ejection fraction (LVEF) was 57 +/- 15% in PAF group and 64 +/- 2% in control subjects (p < 0.001). Mean values of left atrial (LA) diameter for PAF and control groups were 3.7 +/- 0.6 cm vs. 3.1 +/- 0.4 cm (p < 0.001), respectively. Patients with PAF had more severe valve insufficiency, higher values of mean pulmonary artery systolic pressures (PAP) (29 +/- 10 mmHg vs. 25 +/- 2 mmHg, respectively; p = 0.001) and deteriorated MV inflow velocities (E:A ratio 0.9 +/- 0.4 vs. 1.1 +/- 0.3, respectively; p = 0.008) when compared to control group. In multivariate logistic regression analysis, LA diameter predicted the development of PAF after adjusted for age and gender. CONCLUSION:Our results indicate that LA diameter predicts the development of PAF.
    背景与目标:
  • 【食管起搏在评估室上性心动过速中的价值。】 复制标题 收藏 收藏
    DOI:10.1016/0002-9149(90)90296-d 复制DOI
    作者列表:Brembilla-Perrot B,Spatz F,Khaldi E,Terrier de la Chaise A,Le Van D,Pernot C
    BACKGROUND & AIMS: :Esophageal stimulation was performed in 40 patients who had spontaneous paroxysmal supraventricular tachycardias (SVTs). The purpose of this study was to look for the most sensitive stimulation protocol and criteria that would help to define the mechanism of reentry. In 20 patients (group I) atrial pacing up to second-degree atrioventricular block was performed under control conditions and isoproterenol, and SVT was induced in 14 patients (70%), 11 in the control state and 3 while receiving isoproterenol. In 20 patients (group II) atrial pacing and programmed atrial stimulation using 1 and 2 extrastimuli delivered at 2 cycle lengths (600 and 500 ms) was performed in the control state and while receiving isoproterenol. SVT was induced in all patients, in 13 patients in the control state and in 7 while receiving isoproterenol. Programmed stimulation always induced SVT and was the only method capable of tachycardia induction in 14 patients. The mechanism of SVT could be established in 91%. The measurement of the ventriculoatrial interval was the most useful sign to define the site of reentry. Occurrence of a bundle branch block helped to delineate the mechanism in 4 patients. When a positive P wave in V1 preceded the esophageal atrial electrocardiogram, it suggested that there was reentry through a left-sided accessory atrioventricular connection in 6 patients. SVT could always be induced by programmed atrial stimulation in the control state and under isoproterenol. The location of the P wave in V1 compared to the ventriculogram and the esophageal electrocardiogram helped to define the mechanism of tachycardia.
    背景与目标: : 对40例自发性阵发性室上性心动过速 (SVTs) 的患者进行了食管刺激。这项研究的目的是寻找最敏感的刺激方案和标准,以帮助定义折返的机制。在20例患者 (I组) 中,在控制条件和异丙肾上腺素下进行心房起搏至二度房室传导阻滞,并在14例患者 (70% 例) 中诱导SVT,在控制状态下11例,在接受异丙肾上腺素的同时诱导3例。在20例患者 (II组) 中,在对照状态下并接受异丙肾上腺素时,使用以2个周期长度 (600和500 ms) 递送的1个和2个外刺激进行心房起搏和程序化心房刺激。在接受异丙肾上腺素的所有患者中,在控制状态下的13例患者和在接受异丙肾上腺素的7例患者中诱导了SVT。程序性刺激总是引起SVT,并且是14例患者中唯一能够诱导心动过速的方法。SVT的机制可以在91% 中建立。测量心室间隔是定义折返部位的最有用标志。束支阻滞的发生有助于描述4例患者的机制。当在食管心房心电图之前出现V1阳性P波时,提示6例患者通过左侧副房室连接折返。在控制状态和异丙肾上腺素下,总是可以通过程序性心房刺激诱导SVT。与心室图和食管心电图相比,V1中P波的位置有助于确定心动过速的机制。

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