黄芪注射液对慢性心力衰竭患者BNP水平的影响

目的:探究黄芪注射液对慢性心力衰竭患者外周血清B型脑利钠肽水平的影响。方法:选择2013年12月-2015年1月我院收治的慢性心力衰竭住院患者334例,按用药不同分为实验组和对照组。对照组患者采取常规药物口服治疗,实验组患者应用黄芪注射液静脉滴注。观察并比较两组患者治疗前后外周血B型脑利钠肽水平的变化情况。结果:治疗后,两组患者外周血B型脑利钠肽水平均明显下降,且实验组下降更明显,实验组Ⅰ级、Ⅱ级患者比例较对照组显著升高,差异均具有统计学意义(P0.05)。结论:黄芪注射液能够降低慢性心力衰竭患者的外周血B型脑利钠肽水平,改善其心功能,值得临床推广应用。     

Joint Impact of Clinical and Behavioral Variables on the Risk of Unplanned Readmission and Death after a Heart Failure Hospitalization

Most current methods for modeling rehospitalization events in heart failure patients make use of only clinical and medications data that is available in the electronic health records. However, information about patient-reported functional limitations, behavioral variables and socio-economic background of patients may also play an important role in predicting the risk of readmission in heart failure patients. We developed methods for predicting the risk of rehospitalization in heart failure patients using models that integrate clinical characteristics with patient-reported functional limitations, behavioral and socio-economic characteristics. Our goal was to estimate the predictive accuracy of the joint model and compare it with models that make use of clinical data alone or behavioral and socio-economic characteristics alone, using real patient data. We collected data about the occurrence of hospital readmissions from a cohort of 789 heart failure patients for whom a range of clinical and behavioral characteristics data is also available. We applied the Cox model, four different variants of the Cox proportional hazards framework as well as an alternative non-parametric approach and determined the predictive accuracy for different categories of variables. The concordance index obtained from the joint prediction model including all types of variables was significantly higher than the accuracy obtained from using only clinical factors or using only behavioral, socioeconomic background and functional limitations in patients as predictors. Collecting information on behavior, patient-reported estimates of physical limitations and frailty and socio-economic data has significant value in the predicting the risk of readmissions with regards to heart failure events and can lead to substantially more accurate events prediction models.     

急性冠脉综合征患者急诊PCI术后心力衰竭的危险因素分析及护理干预

目的:探讨急性冠脉综合征(ACS)患者行急诊直接经皮冠状动脉介入治疗(PCI)后住院期间发生心力衰竭(HF)的危险因素分析及护理干预策略。方法:选取278例在我院接受急诊PCI手术患者为研究对象,按照术后住院期间是否出现心力衰竭分为两组:心力衰竭组(n=54例)和非心力衰竭组(n=224例),比较两组患者一般临床资料、实验室检查指标及相关治疗情况的差异,用Logistic回归分析探讨影响术后心力衰竭发生的危险因素,并制定相关护理策略。结果:278例老年患者中有54例PCI术后出现心力衰竭(发生率19.4%);两组患者在年龄、高血压、糖尿病、入院收缩压(SBP)、发病至PCI时间、入院血糖、入院NT-pro BNP、肌酸激酶同工酶(CK-MB)峰值、肌酐蛋白I(c Tn I)峰值、左室射血分数(LVEF)、左室舒张末内径(LVEDd)、术后TIMI血流、使用他汀类药物、β-受体阻滞剂方面存在统计学差异(P0.05);发病至PCI时间、高血压、入院时血糖、NT-pro BNP、c Tn I峰值是术后心力衰竭发生的独立危险因素(P0.05);而术后TIMI血流、使用β-受体阻滞剂治疗是保护性因素。结论:ACS患者行急诊PCI治疗后HF的发生受到多种因素的影响,应当积极制定相关护理干预策略以降低术后HF的发生率。     

Prediction of all-cause mortality with hypoalbuminemia in patients with heart failure: a meta-analysis

Abstract

Objective: The prognostic utility of serum albumin level for mortality in heart failure patients has received considerable attention. This meta-analysis sought to examine the prognostic significance of hypoalbuminemia for prediction of all-cause mortality in patients with heart failure.

Materials and methods: Pubmed and Embase databases were systematically searched up to 10 March 2019 to identify eligible studies. Epidemiological studies reporting a multivariable-adjusted risk estimate of all-cause mortality associated with hypoalbuminemia in acute or chronic heart failure patients were included.

Results: Nine studies from 10 articles involving 16,763 heart failure patients were included in the final analysis. Hypoalbuminemia was associated with an increased in-hospital mortality (risk ratio [RR] 4.90; 95% confidence interval [CI] 2.96–8.10) and long-term all-cause mortality (RR 1.75; 95% CI 1.35–2.27) in acute heart failure patients. Chronic heart failure patients with hypoalbuminemia exhibited a 3.5-fold (95% CI 1.29–9.73) higher risk for long-term all-cause mortality.

Conclusions: Hypoalbuminemia is possibly an independent predictor of all-cause mortality in patients with acute or chronic heart failure. However, the current findings should be further confirmed in future prospective studies. Moreover, future well-designed randomized controlled trials would be required to investigate whether correcting hypoalbuminemia in heart failure patients has potential to improve survival outcome.     

Myocardial dysfunction in rheumatoid arthritis: epidemiology and pathogenesis

Data from population- and clinic-based epidemiologic studies of rheumatoid arthritis patients suggest that individuals with rheumatoid arthritis are at risk for developing clinically evident congestive heart failure. Many established risk factors for congestive heart failure are over-represented in rheumatoid arthritis and likely account for some of the increased risk observed. In particular, data from animal models of cytokine-induced congestive heart failure have implicated the same inflammatory cytokines produced in abundance by rheumatoid synovium as the driving force behind maladaptive processes in the myocardium leading to congestive heart failure. At present, however, the direct effects of inflammatory cytokines (and rheumatoid arthritis therapies) on the myocardia of rheumatoid arthritis patients are incompletely understood.     

Is severe pulmonary hypertension a contraindication for orthotopic heart transplantation? Not any more

Pulmonary hypertension (PH) unresponsive to pharmacological intervention is considered a contraindication for orthotopic heart transplantation (OHTX) due to risk of postoperative right-heart failure. In this prospective study, we describe our experience with a treatment strategy of improving severe PH in heart transplant candidates by means of ventricular assist device (VAD) implantation and subsequent OHTX. In 11 heart transplantation candidates with severe PH unresponsive to pharmacological intervention we implanted VAD with the aim of achieving PH to values acceptable for OHTX. In all patients we observed significant drop in pulmonary pressures, PVR and TPG (p < 0.001 for all) 3 months after VAD implantation to values sufficient to allow OHTX. Seven patients underwent transplantation (mean duration of support 216 days) while none of patients suffered right-side heart failure in postoperative period. Two patients died after transplantation and five patients are living in very good condition with a mean duration of 286 days after OHTX. In our opinion, severe PH is not a contraindication for orthotopic heart transplantation any more.     

BN P 的测定和临床应用的研究进展

B型利钠肽是一种具有利尿作用的内源性肽,其对早期发现心衰病人、心衰病人的分级、区分心衰及其他原因引起的呼吸困难、监测心衰治疗、提示心衰病人预后、识别有无左室功能不全及急性冠脉综合症的风险评估方面具有重要临床应用价值。本文主要介绍了B型利钠肽的测定及临床应用。     

黄芪注射液联合米力农治疗充血性心力衰竭的临床分析

目的:观察黄芪注射液联合米力农治疗充血性心力衰竭的临床疗效及安全性.方法:将76例充血性心力衰竭患者随机分成两组,其中治疗组38人,对照组38人.所有患者均采取使用利尿剂、口服血管紧张素转换酶抑制药等常规治疗,治疗组患者在常规治疗基础上采用米力农联合黄芪注射液治疗,对照组患者在常规治疗基础上采用米力农治疗,从临床疗效、心衰疗效计分、心率、心脏指数、心输出量及左心室射血分数指标进行评价.结果:治疗组的临床疗效、心衰疗效计分、心率、左心室射血分数与对照组相比,有统计学差异(P＜0.05).结论:黄芪注射液联合米力农治疗充血性心力衰竭的临床疗效优于单纯应用米力农.     

Platelet-neutrophil conjugate formation is increased in diabetic women with cardiovascular disease

 

Our aim is to summarize and discuss the recent literature linking diabetes mellitus with heart failure, and to address the issue of the optimal treatment for diabetic patients with heart failure.

The studies linking diabetes mellitus (DM) with heart failure (HF)

The prevalence of diabetes mellitus in heart failure populations is close to 20% compared with 4 to 6% in control populations. Epidemiological studies have demonstrated an increased risk of heart failure in diabetics; moreover, in diabetic populations, poor glycemic control has been associated with an increased risk of heart failure. Various mechanisms may link diabetes mellitus to heart failure: firstly, associated comorbidities such as hypertension may play a role; secondly, diabetes accelerates the development of coronary atherosclerosis; thirdly, experimental and clinical studies support the existence of a specific diabetic cardiomyopathy related to microangiopathy, metabolic factors or myocardial fibrosis. Subgroup analyses of randomized trials demonstrate that diabetes is also an important prognostic factor in heart failure. In addition, it has been suggested that the deleterious impact of diabetes may be especially marked in patients with ischemic cardiomyopathy.

Treatment of heart failure in diabetic patients

The knowledge of the diabetic status may help to define the optimal therapeutic strategy for heart failure patients. Cornerstone treatments such as ACE inhibitors or beta-blockers appear to be uniformly beneficial in diabetic and non diabetic populations. However, in ischemic cardiomyopathy, the choice of the revascularization technique may differ according to diabetic status. Finally, clinical studies are needed to determine whether improved metabolic control might favorably influence the outcome of diabetic heart failure patients.     

血小板平均体积与老年急性ST段抬高型心肌梗死患者并发心力衰竭的 相关性分析

目的:探讨血小板平均体积(MPV)与老年急性ST段抬高型心肌梗死(STEMI)患者住院期间并发心力衰竭(HF)的相关性。方法:收集我院收治的172例老年STEMI患者,按照住院期间是否发生HF分为HF组(n=55例)和非HF组(n=117例),以患者MPV四分位分四组,比较以上各组之间相关指标的差异,用Logistic回归方程分析MVP与患者HF发生的关系。结果:HF组与非HF组在吸烟、发病至入院时间、前壁梗死、血清B型脑钠肽(BNP)、肌钙蛋白I(c Tn I)、左室射血分数(LVEF)、MVP存在统计学差异(P0.05),HF组MVP水平高于非HF组(P0.05);MVP四分位分组之间的心功能指标LVEF和血清BNP、HF发生率存在统计学差异(P0.05),MVP的第四四分位组(Q4组)的HF发生率高于第一分位组及第二四分位组(Q1及Q2组);多因素Logistic回归方程分析显示高水平MPV是老年STEMI患者近期发生心力衰竭的独立危险因素(P0.05);MVP四分位分组中,从Q1组到Q4组发生HF的风险值(OR)依次增高,且Q3及Q4组的OR值具有统计学意义(P0.05)。结论:高水平MPV与老年STEMI患者住院期间HF发生密切相关,可能是其发生的独立危险因素,应当引起临床关注。     

Amphiphilic conjugates of human brain natriuretic peptide designed for oral delivery: in vitro activity screening

Congestive heart failure (CHF) is a complex syndrome involving altered neurohormonal levels and impaired cardiac and renal function. In recent years, intravenous administration of exogenous human brain-type natriuretic peptide (hBNP) has become an important therapy in treating patients with acutely decompensated CHF. However, reports during the past year suggest that hBNP could play a prominent role in the chronic treatment of CHF patients as well. We are currently developing conjugates of hBNP suitable for oral delivery to provide a patient-friendly treatment option for chronic heart failure patients. In this report, we present in vitro activity results obtained from hBNP conjugates featuring a variety of rationally designed amphiphilic oligomers. Mapping studies revealed that the hydrophobic/hydrophilic balance of the oligomer impacted the regioselectivity of conjugation. Additionally, the regiochemistry and extent of conjugation had a significant impact on activity. Many monoconjugates retained activity comparable to native peptide and are currently under evaluation in subsequent in vivo screens.     

Autoantibodies against serotoninergic 5-HT(4) receptor in patients with heart failure

Serotoninergic 5-HT(4) receptors have been detected in several tissues including the heart. An autoimmune mechanism may underline the pathogenesis of heart failure. The aim of this work was to look for autoantibodies to the 5-HT(4) receptor in patients with heart failure. We looked for the presence of autoantibodies against 5-HT(4) receptor as well as angiotensin II type (AT1), β(1)-adrenoceptor, and muscarinic M2 receptors in the sera of 176 patients with heart failure (female: n=96, male: n=80) and in 108 controls (female: n=69; male: n=39). The prevalence of 5-HT(4) receptor autoantibodies was 18.8% (n=33) in the group of patients with heart failure and 4.6% (n=5) in the control group (p<0.002). The prevalence of autoantibodies against AT1 was 1.7 (n=3), β(1)-adrenoreceptor 0.6 (n=1), and muscarinic-receptor M2 4.2 (n=5). Female patients with diabetes and heart failure had a positive trend (p=0.07) to the presence of 5-HT(4) receptor autoantibodies. In the group of female heart failure patients we found a significant correlation with the presence of coronary heart disease (p=0.05). The clinical relevance of 5-HT(4) receptor autoantibodies has to be further studied. The prevalence of 5-HT(4) receptor autoantibodies was highly significant in patients with chronic heart failure. It was also a significant correlation between these autoantibodies and the female subgroup with coronary heart disease. It is conceivable that the increased prevalence of autoantibodies against the 5-HT(4) receptor in patients with heart failure is more than just an epiphenomenon.     

超声心动图对慢性收缩性心力衰竭预后的预测价值分析

目的:探讨超声心动图对慢性收缩性心力衰竭(心衰)预后的预测价值。方法:选择2016年8月到2018年9月在南京医科大学附属脑科医院(胸科院区)医学影像二科(以我院代替)诊治的慢性收缩性心衰患者112例,均给予超声心动图检查并记录相关指标,随访患者的预后并进行相关性分析。结果:随访至今,112例患者的主要心血管不良事件(Major Adverse Cardiovascular Events,MACE)发生率为18.8%。MACE组患者的左室收缩末期容积(Left ventricular end systolic volume,LVESV)、左室舒张末期容积(Left ventricular end diastolic volume,LVEDV)值显著高于非MACE组患者(P0.05),两组患者左室收缩末期内径(Left ventricular end systolic diameter,LVDs)、左房内径(Left atrial diameter,LAD)、左心室舒张末期内径(Left ventricular end diastolic dimension,LVDd值无统计学差异(P0.05)。患者预后MACE与LVEDV、LVESV值呈显著相关性(P0.05)。LVEDV、LVESV为影响慢性收缩性心衰患者MACE的独立危险因素(P0.05)。结论:超声心动图用于慢性收缩性心衰患者可反映患者的心功能状况,且具有较高的预后预测价值。     

瑞舒伐他汀治疗慢性心力衰竭80例疗效观察

目的：评价瑞舒伐他汀治疗慢性心力衰竭的疗效。方法：选取2009年6月-2010年9月住院的心力衰竭患者80例,随机分为瑞舒伐他汀治疗组和对照组,对照组采用常规内科治疗。瑞舒伐他汀治疗组在常规内科治疗的基础上加用瑞舒伐他汀治疗。观察两组患者左心室舒张末期内径（LVEDD）,左心室射血分数（LVEF及临床疗效。结果：两组治疗前LVEDD及LVEF水平比较无差异（P〉0.05）,治疗后两组LVEDD水平明显下降,LVEF水平明显升高（P〈0.05）,瑞舒伐他汀治疗后LVEDD及LVEF水平改善均明显优于对照组（P〈0.05）。瑞舒伐他汀组临床疗效高于对照组（P〈0.05）。结论：瑞舒伐他汀可以改善慢性心力衰竭患者的心脏功能。     

Conservative Treatment of Chronic Heart Block

A study of 203 patients with chronic heart block treated with oral long-acting isoprenaline showed that 85 (42%) were maintained satisfactorily on the drug for a mean period of 18.2 months. The survival rates at one, two, and three years were 76%, 64%, and 57% respectively. In 115 patients treatment by pacing became necessary to control symptoms, and in these patients the survival rates at one, two and three years were 83%, 72%, and 60%.The two most valuable guides to patients'' response to oral isoprenaline are the response to a trial dose of intravenous isoprenaline and the type of dysrhythmia associated with their Adams-Stokes attacks. Patients with heart failure with slow ventricular rates and those with angina of effort do not respond to treatment with sympathomimetic drugs.The majority of patients with chronic heart block are elderly, and in view of the complexity of pacing systems, and the need for skilled supervision of paced patients, oral long-acting isoprenaline remains of value in the longterm management of chronic heart block, provided patients are carefully selected for this form of therapy.     

Impact of Etiology on the Outcomes in Heart Failure Patients Treated with Cardiac Resynchronization Therapy: A Meta-Analysis

Background

Cardiac resynchronization therapy (CRT) has been extensively demonstrated to benefit heart failure patients, but the role of underlying heart failure etiology in the outcomes was not consistently proven. This meta-analysis aimed to determine whether efficacy and effectiveness of CRT is affected by underlying heart failure etiology.

Methods and Results

Searches of MEDLINE, EMBASE and Cochrane databases were conducted to identify RCTs and observational studies that reported clinical and functional outcomes of CRT in ischemic cardiomyopathy (ICM) and non-ischemic cardiomyopathy (NICM) patients. Efficacy of CRT was assessed in 7 randomized controlled trials (RCTs) with 7072 patients and effectiveness of CRT was evaluated in 14 observational studies with 3463 patients In the pooled analysis of RCTs, we found that CRT decreased mortality or heart failure hospitalization by 29% in ICM patients (95% confidence interval [CI], 21% to 35%), and by 28% (95% CI, 18% to 37%) in NICM patients. No significant difference was observed between the 2 etiology groups (P = 0.55). In the pooled analysis of observational studies, however, we found that ICM patients had a 54% greater risk for mortality or HF hospitalization than NICM patients (relative risk: 1.54; 95% CI: 1.30–1.83; P<0.001). Both RCTs and observational studies demonstrated that NICM patients had greater echocardiographic improvements in the left ventricular ejection fraction and end-systolic volume, as compared with ICM patients (both P<0.001).

Conclusion

CRT might reduce mortality or heart failure hospitalization in both ICM and NICM patients similarly. The improvement of the left ventricular function and remodeling is greater in NICM patients.     

Cardiac Troponin I in Non- Acute Coronary Syndrome Patients with Chronic Kidney Disease

Objective

The aim of this study was to assess the results of troponin I (cTnI) in non- acute Coronary Syndrome (ACS) patients with chronic kidney disease (CKD). We also examined the risk factors for elevated cTnI in non-ACS patients with CKD and whether stage 5 CKD modifies the associations of elevated cTnI and the risk factors in non-ACS patients with CKD.

Methods

A retrospective study was performed. Logistic regression models were used.

Results

293 non-ACS patients with CKD were included in the current study. 43.34% non-ACS patients with CKD have an elevated cTnI level and 5.12% have an elevated cTnT level in MI range. In CKD patients without ACS and heart failure, only 26.03% (38/146) patients have an elevated cTnT level. In adjusted analyses, age, diastolic blood pressure and congestive heart failure is associated with an elevated cTnI level in non-ACS patients with CKD. Congestive heart failure is associated with an elevated cTnI level in non-ACS patients with CKD (OR 2.30, 95% CI 1.08,4.88, P=0.03). Stage 5 CKD does not modify the association of congestive heart failure and an elevated cTnI level.

Conclusion

43.34% non-ACS patients with CKD and 26.03% CKD patients without ACS and congestive heart failure have an elevated cTnI level. Congestive heart failure is associated with an elevated cTnI level in non-ACS patients with CKD. Stage 5 CKD does not modify the association of congestive heart failure and an elevated cTnI level.     

Amoxycillin-resistant streptococci in dental plaque

This investigation was undertaken to study the prevalence of amoxycillin-resistant oral streptococci in normal healthy patients and patients with a cardiac condition, susceptible to infective endocarditis. Samples of supragingival dental plaque were collected from two test groups, children with congenital heart disease and adults with a history of rheumatic fever, and two control groups comprising normal healthy children and normal healthy adults. Bacteria from these samples were grown on a medium selective for oral streptococci, as well as on the same medium containing known concentrations of amoxycillin. The results indicate that a high percentage of rheumatic heart patients and children with congenital heart disease harboured amoxycillin-resistant oral streptococci. The level of amoxycillin resistance in the plaque of adults with rheumatic heart disease was significantly greater than in that of normal adults. In view of the high percentage of patients at risk harbouring amoxycillin-resistant streptococci, it is important that the individual clinical situation be monitored. Perhaps antibiotic sensitivity tests should be performed to select an appropriate antibiotic for prophylaxis of infective endocarditis.     

Chronic xanthine oxidase inhibition prevents myofibrillar protein oxidation and preserves cardiac function in a transgenic mouse model of cardiomyopathy

Heart failure is a clinical syndrome associated with elevated levels of oxygen-derived free radicals. Xanthine oxidase activity is believed to be one source of reactive oxygen species in the failing heart. Interventions designed to reduce oxidative stress are believed to have significant therapeutic potential in heart failure. This study tested the hypothesis that xanthine oxidase activity would be elevated in a mouse model of dilated cardiomyopathy and evaluated the effect of chronic oral allopurinol, an inhibitor of xanthine oxidase, on contractility and progressive ventricular dilation in these mice. Nontransgenic and transgenic mice containing a troponin I truncation were treated with oral allopurinol from 2-4 mo of age. Myocardial xanthine oxidase activity was threefold higher in untreated transgenic mice compared with nontransgenic mice. Analyses of myofilament proteins for modification of carbonyl groups demonstrated myofibrillar protein damage in untreated transgenic mice. Treatment with allopurinol for 2 mo suppressed xanthine oxidase activity and myofibrillar protein oxidation. Allopurinol treatment also alleviated ventricular dilation and preserved shortening fraction in the transgenic animals. In addition, cardiac muscle twitch tension was preserved to 70% of nontransgenic levels in allopurinol-treated transgenic mice, a significant improvement over untreated transgenic mice. These findings indicate that chronic inhibition of xanthine oxidase can alter the progression of heart failure in dilated cardiomyopathy.