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在急性给予β阻断剂后的恢复阶段观察心室壁运动异常增强了多巴酚丁胺负荷超声心动图的灵敏性

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世界核心医学期刊文摘（心脏病学分册） 2006年第6期2卷 32-33页

作者： Karagiannis S.E. bax j.j. Elhendy A. D. Poldermans 姜朝晖 Department of Cardiology Erasmus MC Rotterdam Netherlands Dr.

Dobutamine stress echocardiography(DSE) has a modest sensitivity for detecting single- vessel coronary artery disease(CAD). This study assessed the additional diagnostic value of new or worsening wall motion abnormalities during recovery after acute administration of β blockers. The study population consisted of 200 patients(mean 59± 11 years of age, 144 men), who underwent DSE. Images were acquired at rest, low dose, peak dose, and during recovery. Patients received intravenous metoprolol(1 to 5 mg/min). The dose was adjusted to achieve a recovery heart rate within a 10% range of heart rate at rest. Coronary angiography was performed within 2 months. Inducible new wall motion abnormalities were observed in 168 patients(84% ) at peak stress. An additional 14 patients(7% )developed new or worsening wall motion abnormalities during recovery. CAD was detected in 182 patients(86 had single- vessel CAD). Sensitivity, specificity, and accuracy of DSE were 88% , 65% , and 73% at peak stress and 97% , 65% , and 74% during recovery. Sensitivity was particularly higher during recovery than during peak stress in patients with single- vessel CAD(98% vs 81% , p< 0.001). In conclusion, assessment of wall motion abnormalities during the recovery phase after acute β blockade improves sensitivity of DSE, particularly in patients with single- vessel CAD.

关键词：多巴酚丁胺负荷超声心动图室壁运动异常 β阻断剂灵敏性恢复阶段急性单支血管病变 AD患者冠状动脉疾病冠状动脉造影

接受腹主动脉瘤或下肢旁路手术治疗的患者中血浆N末端B型利钠肽前体与术后心脏事件的关系

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世界核心医学期刊文摘（心脏病学分册） 2006年第11期2卷 36-37页

作者： Feringa H.H.H. bax j.j. Elhendy A. D. Poldermans 黄浙勇 Department of Anesthesiology Erasmus Medical College University Medical Center Rotterdam Netherlands Dr.

Postoperative cardiac events are related to myocardial ischemia and reduced left ventricular function. The utility of N-terminal pro-B-type natriuretic peptide(NT-pro-BNP) for preoperative cardiac risk evaluation has not been evaluated. The objective of this study was to assess whether plasma NT-pro-BNP predicts postoperative cardiac events in patients who undergo major vascular surgery in addition to clinical and dobutamine stress echocardiographic data. One hundred seventy consecutive patients scheduled for major noncardiac vascular surgery were prospectively evaluated by dobutamine stress echocardiographic andNT-pro-BNP measurements. Multivariable logistic regression analysis was performed to evaluate the predictors of cardiac death and nonfatal myocardial infarction during a follow-up of 30-days. Receiver-operating characteristic analysis was performed to determine the optimal cut-off value of NT-pro-BNP to predict outcome. Patients’mean age was 59±13 years, and 71%were men. The median NT-pro-BNP level was 110 pg/ml(interquartile range 42 to 389). Cardiac events occurred in 2 of 144 patients(1.4%) with NT-pro-BNPjusted odds ratio 52, 95%confidence interval 11 to 256, pjustment for cardiac risk factors and dobutamine stress echocardiographic results, NT-pro-BNP remained significantly associated with cardiac events(adjusted odds ratio 17, 95%confidence interval 3 to 106, p=0.002). In conclusion, in patients scheduled for major vascular surgery, elevated plasma NT-pro-BNP levels are independently associated with an increased risk for postoperative cardiac events. Further studies in a larger number of patients are required to confirm these findings.

关键词： B型利钠肽腹主动脉瘤心脏事件旁路手术负荷超声心动图多巴酚丁胺心脏性死亡非致死性左室功

窦性节律与慢性房颤患者对心脏再同步化治疗反应的比较

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世界核心医学期刊文摘（心脏病学分册） 2005年第7期1卷 54-55页

作者： Molhoek S.G. bax j.j. Bleeker G.B. 刘文秀 Dr. Department of Cardiology Leiden University Medical Center Albinusdreef 2 2333 ZA Leiden Netherlands

Cardiac resynchronization therapy(CRT) is a new therapeutic option for patients who have drug-refractory end-stage heart failure. Much information has been obtained from patients who have sinus rhythm, but the use of CRT in patients who have chronic atrial fibrillation(AF) has not been studied extensively. Accordingly, we evaluated the clinical response and long-term survival rate of CRT in patients who had heart failure and chronic AF, and the results were compared with those in patients who had sinus rhythm and who underwent CRT. Sixty patients who had end-stage heart failure(30 had sinus rhythm and 30 had chronic AF), New York Heart Association classes III to IV, left ventricular ejection fraction120 ms, and a left bundle branch block received a biventricular pacemaker. New York Heart Association class, Minnesota Quality of Life score, and 6-minutew-alking distance were evaluated at baseline and after 6 months of CRT. Longterm follow-up was ≤2 years. New York Heart Association class, Minnesota Quality of Life score, and 6-minute walking distance improved significantly in the 2 groups after 6 months of CRT. The number of nonresponders was greater among patients who had ***, the long-term survival rate was comparable between patients who had sinus rhythm and those who had AF. Patients who had AF demonstrated comparable benefit from CRT as those who had sinus rhythm.

关键词：慢性房颤心脏再同步化窦性节律左束支传导阻滞心脏协会射血分数窦性心律心功能双心室长期生存率

血管外科患者接受大剂量β受体阻断剂及严格心率控制治疗可减少心肌缺血及肌钙蛋白T释放

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世界核心医学期刊文摘（心脏病学分册） 2007年第1期3卷 25-26页

作者： Feringa H.H.H. bax j.j. Boersma E. D. Poldermans 罗亮 Erasmus Medical Center University of Rotterdam Dr. Molewaterplein 40 3015 GD Rotterdam NetherlandsDr.

背景:尽管围术期使用了β受体阻断剂,但不良心脏事件仍时常发生。本研究旨在探讨使用较大剂量的β受体阻断剂以及严格心率控制与减少围术期心肌缺血、肌钙蛋白T释放及改善长期预后之间是否存在相互联系。方法和结果:在此观察性队列研究... 详细信息

背景:尽管围术期使用了β受体阻断剂,但不良心脏事件仍时常发生。本研究旨在探讨使用较大剂量的β受体阻断剂以及严格心率控制与减少围术期心肌缺血、肌钙蛋白T释放及改善长期预后之间是否存在相互联系。方法和结果:在此观察性队列研究中,272例血管外科患者接受心脏危险因素及β受体阻断剂使用情况的术前筛查。β受体阻断剂使用情况采用最大推荐治疗剂量的百分比来表示。

关键词： β受体阻断剂血管外科肌钙蛋白心率控制不良心脏事件队列研究观察性全因死亡导联心电图心

心脏保护性药物治疗与外周动脉疾病患者生存率改善相关

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世界核心医学期刊文摘（心脏病学分册） 2006年第8期2卷 59-60页

作者： Feringa H.H.H. Van Waning V.H. bax j.j. D. Poldermans 孙凯 Erasmus Medical Center University of Rotterdam Dr. Molewaterplein 40 3015 GD Rotterdam NetherlandsDr.

OBjECTIVES: We sought to investigate the effect of cardiac medication on long-term mortality in patients with peripheral arterial disease(PAD). BACKGROUND: Peripheral arterial disease is associated with increased cardiovascular morbidity and mortality. Treatment guidelines recommend aggressive management of risk factors and lifestyle modifications. However, the potential benefit of cardiac medication in patients with PAD remains ill defined. METHODS: In this prospective observational cohort study, 2,420 consecutive patients(age, 64± 11 years, 72% men) with PAD(ankle-brachial index ≤ 0.90) were screened for clinical risk factors and cardiac medication. Follow-up end point was death from any cause. Propensity scores for statins, beta-blockers, aspirin, angiotensin- converting enzyme(ACE) inhibitors, calcium channel blockers, diuretics, nitrates, coumarins, and digoxin were calculated. Cox regression models were used to analyze the relation between cardiac medication and long-term mortality. RESULTS: Medical history included diabetes mellitus in 436 patients(18% ), hypercholesterolemia in 581(24% ), smoking in 837(35% ), hypertension in 1,162(48% ), coronary artery disease in 1,065(44% ), and a history of heart failure in 214(9% ). Mean ankle-brachial index was 0.58(± 0.18). During a median follow-up of eight years, 1,067 patients(44% ) died. After adjustment for risk factors and propensity scores, statins(hazard ratio [HR] 0.46, 95% confidence interval [CI] 0.36 to 0.58), beta-blockers(HR 0.68, 95% CI 0.58 to 0.80), aspirins(HR 0.72, 95% CI 0.61 to 0.84), and ACE inhibitors(HR 0.80, 95% CI 0.69 to 0.94)were significantly associated with a reduced risk of long-term mortality. CONCLUSIONS: On the basis of this observational longitudinal study, statins, beta-blockers, aspirins, and ACE inhibitors are associated with a reduction in long-term mortality in patients with PAD.

关键词：外周动脉疾病药物治疗疾病患者心脏生存率保护性 β受体阻断剂 Cox回归模型分析 ACE抑制剂远期死亡率

用16层CT与二维超声心动图测定左室容积和射血分数的比较

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世界核心医学期刊文摘（心脏病学分册） 2007年第7期3卷 51-51页

作者： Schuijf j.D. bax j.j. jukema j.W. 刘少伟 Department of Cardiology Leiden University Medical Center Albinusdreef 2 2333 ZA Leiden Netherlands

背景：最近几年，多层计算机断层扫描（MSCT）作为冠心病的无创性评估方法，进展十分迅速。同时，虽然左室（LV）功能尚不是MSCT的一项常规检查内容，但是也可利用MSCT进行测定。鉴于此，本研究拟在一组大样本患者中用二维超声心动图来... 详细信息

背景：最近几年，多层计算机断层扫描（MSCT）作为冠心病的无创性评估方法，进展十分迅速。同时，虽然左室（LV）功能尚不是MSCT的一项常规检查内容，但是也可利用MSCT进行测定。鉴于此，本研究拟在一组大样本患者中用二维超声心动图来验证MSCT测定LV功能的准确性。方法：研究纳入70例患者（57例男性，13例女性），进行16层MSCT后对LV整体功能进行回顾性分析。用二维超声心动图作为参照标准，评价所测定的这些指标。结果：就LV容积而言，线性回归分析显示，舒张期末容积（EDV）（r=0．97）和收缩期末容积（ESV）（r=0．98）均与超声心动图结果具有极好的相关性。

关键词：二维超声心动图左室容积 MSCT 测定射血分数计算机断层扫描线性回归分析评估方法

比较无创性冠状动脉影像技术中MRI和多层CT诊断性能的荟萃分析

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世界核心医学期刊文摘（心脏病学分册） 2006年第6期2卷 16-16页

作者： Schuijf j.D. bax j.j. Shaw L.j. 宁宁 Department Cardiology Leiden University Medical Center Albinusdreef 2 2333 ZA Leiden Netherlands Dr.

Background: Magnetic resonance imaging(MRI) and multislice computed tomography(MSCT) have emerged as potential noninvasive coronary imaging techniques. The objective of the present study was to clarify the current accuracy of both modalities in the detection of significant coronary artery lesions(compared to conventional angiography as the gold standard)by means of a comprehensive meta- analysis of the presently available literature. Methods: A total of 51 studies on the detection of significant coronary artery stenoses(≥ 50% diameter stenosis) and comparing results with conventional angiography were identified by means of a MEDLINE search. Weighted sensitivities, specificities, and predictive values, all with 95% CIs, as well as summary odds ratios, were calculated for both techniques. In addition, the relationship between diagnostic specificity and disease prevalence was determined using metaregression analysis. Results: A comparison of sensitivities and specificities revealed significantly higher values for MSCT(weighted average 85% [95% CI 86% - 88% ] and 95% [95% CI 95% ]) as compared with MRI(weighted average 72% , 95% CI 69% - 75% and 87% , 95% CI 86% - 88% ). A significantly higher odds ratio(16.9- fold) for the presence of significant stenosis was observed for MSCT as compared with MRI(6.4- fold)(P< .0001). Linear regression analysis revealed a better specificity for MSCT versus MRI in lower disease prevalence populations(P=.056). Conclusion: Meta- analysis of the available studies with MRI and MSCT for noninvasive coronary angiography indicates that MSCT has currently a significantly higher accuracy to detect or exclude significant coronary artery disease.

关键词：冠状动脉造影荟萃分析多层CT 影像技术诊断性 MRI 无创性 MEDLINE 术中冠状动脉病变

自体骨髓单核细胞注射对顽固性心绞痛伴慢性心肌缺血患者的持久作用:12个月的随访结果

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世界核心医学期刊文摘（心脏病学分册） 2007年第2期3卷 29-29页

作者： Beeres S.L.M.A. bax j.j. Dibbets-Schneider P. 苏畅 Department of Cardiology Leiden University Medical Center Leiden Netherlands.Dr.

背景:细胞疗法最近被引入对顽固性心绞痛患者的治疗。由于大多数试验随访时间较短,细胞疗法的长期疗效仍为未知。方法:25例顽固性心绞痛患者(年龄64±10岁,21例男性)在Tc-99m tetrofosmin单光子发射计算机断层扫描(SPECT)所示心肌缺血... 详细信息

背景:细胞疗法最近被引入对顽固性心绞痛患者的治疗。由于大多数试验随访时间较短,细胞疗法的长期疗效仍为未知。方法:25例顽固性心绞痛患者(年龄64±10岁,21例男性)在Tc-99m tetrofosmin单光子发射计算机断层扫描(SPECT)所示心肌缺血区域注入总量为84±29×106骨髓源性单核细胞。分别在基线时和3个月、6个月、12个月时评估心绞痛症状和生活质量。

关键词：自体骨髓缺血区域慢性心肌缺血室壁运动细胞疗法生活质量左室功能射血分数髓细胞门控

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胸内阻抗监测预测失代偿性心力衰竭

世界核心医学期刊文摘（心脏病学分册） 2007年第7期3卷 25-25页

作者： Ypenburg C. bax j.j. van der Wall E.E. 杜媛 Department of Cardiology Leiden University Medical Center Leiden Netherlands Dr.

InSync Sentry双心室植入式心脏复律除颤器中引入了胸内阻抗测定，可以用来早期确定继发于左心力衰竭（HF）的肺水肿。当阻抗指数增加超过预先设定的水平60Q·d时，可以激发一种可闻的报警（OptiVol警报）。本研究拟观察OptiVol警报的... 详细信息

InSync Sentry双心室植入式心脏复律除颤器中引入了胸内阻抗测定，可以用来早期确定继发于左心力衰竭（HF）的肺水肿。当阻抗指数增加超过预先设定的水平60Q·d时，可以激发一种可闻的报警（OptiVol警报）。本研究拟观察OptiVol警报的临床价值及其对失代偿性HF的预测作用。连续115例接受InSyncSentry双心室植入式心脏复律除颤器的患者（NYHA分级2．8±0．5，左室射血分数26％±8％）入选研究。当出现OptiVol警报时，评估当时的血流动力学状态。

关键词：失代偿性心力衰竭阻抗监测预测作用植入式心脏复律除颤器胸内血流动力学状态 InSync NYHA分级