缬沙坦对维持性血液透析患者心脏功能和结构的影响

目的:探讨缬沙坦对维持性血液透析(maintenance hemodialysis,MHD)患者心脏功能和结构的影响。方法:100例MHD患者,随机分为治疗组(50例)与对照组(50例),对照组仅予基础治疗,治疗组加予口服缬沙坦治疗,总疗程为6个月。观察治疗前后超声心动图指标变化。结果:与治疗前及对照组同期比较,治疗组心脏结构指标左房收缩末期内径(LAD)、左室舒张末期内径(LVDD)、室间隔厚度(IVST)、左室后壁厚度(LVPWT)、左房内径指数(LAI)、左室重量指数(LVMI)及相对室壁厚度(RWT)有所降低,心脏功能指标:左室射血分数(LVEF),左室短轴缩短率(FS),二尖瓣口舒张早期和晚期最大血流速度比(E/A)值有所提高,差异均有统计学意义(P<0.05)。对照组超声心动图各项指标与治疗前相比变化不明显(P>0.05)。结论:缬沙坦能延缓或逆转左心室肥厚,明显改善左室舒张功能,有助于改善MHD患者心脏重构,改善心脏功能,从而延缓慢性肾功能衰竭尿毒症期患者的左心室重塑,降低心血管疾病的发生率和死亡率。缬沙坦对MHD患者心血管疾病并发症的预防和治疗及提高MHD患者生存率有一定临床指导意义。     

常规血液透析和维持性血液透析对尿毒症患者心脏结构 及功能影响的对比研究

目的：采用超声联合心电图比较常规血液透析和维持性血液透析对尿毒症患者心脏结构及功能影响。方法：选取2014 年2 月至2014 年11 月我院收治的尿毒症患者110 例,将其随机分为实验组和对照组,每组各55例。对照组予常规血液透析,实验组 予维持性血液透析,采用碳酸氢盐透析液,透析液流量500-600 mL/min,每周透析2-3 次,每次透析4h。治疗后,通过超声心动图 测定室间隔厚度、左心室壁厚度、左心室舒张末内径、射血分数,采用心电图Q-T离散度分析Q-T离散度。结果：①治疗后,与对照 组相比较,实验组患者EF、FS 均显著降低,差异具有统计学意义(P＜0.05),LVDd、LVDs、LVMI、LVH 值均明显升高,差异具有统 计学意义(P＜0.05)。②治疗后,维持性血液透析患者的心电图Q-T 离散度与对照组相比较,差异有统计学意义(P＜0.05)。结论：维 持性血液透析较常规血液透析能够更有效地改善尿毒症患者的心脏结构及功能。     

高通量血液透析对糖尿病肾病血液透析患者心脏功能及结构的影响及预后的影响因素分析

摘要 目的：探讨高通量血液透析对糖尿病肾病（DN）血液透析患者心脏功能及结构的影响,并分析预后的影响因素。方法：选取2017年5月~2018年11月期间我院收治的DN血液透析患者（n=172）,上述DN血液透析患者中普通透析治疗者60例（普通透析组）、高通量血液透析治疗者112例（高通量透析组）。普通透析组采用低通量透析治疗,高通量透析组采用高通量透析治疗,比较两组患者心脏功能及结构以及预后情况,采用单因素、多因素Logistic回归分析预后的影响因素。结果：高通量透析组治疗6个月后左心房内径（LAD）、左心室舒张末内径（LVDd）、左心室心肌重量指数（LVMI）低于治疗前和普通透析组（P<0.05）,高通量透析组治疗6个月后左心室射血分数( LVEF )高于治疗前和普通透析组（P<0.05）。高通量透析组的生存率高于普通透析组（P<0.05）。存活组年龄、上机前舒张压、上机前收缩压、血磷、全段甲状旁腺激素（iPTH）均低于死亡组（P<0.05）,存活组透析频率、白蛋白、血红蛋白均高于死亡组（P<0.05）,两组性别、血钙比较无差异（P>0.05）。多因素Logistic回归分析结果显示,上机前舒张压高、上机前收缩压高、血磷高、iPTH高、透析频率少、白蛋白低、血红蛋白低均是DN血液透析患者死亡的危险因素（P<0.05）。结论：高通量血液透析能减轻DN患者血液透析所引起的心脏功能及结构损伤,改善患者预后。影响DN血液透析患者预后的因素较多,其中上机前舒张压、上机前收缩压、血磷、iPTH越高,白蛋白、血红蛋白越低,透析频率越少,患者的死亡风险越大。     

Cardiac Function and Outcome in Patients with Cardio-Embolic Stroke

Background

The relationship between whole spectrum of Ejection fraction (EF) and cardioembolic stroke (CES) outcome has not been fully described yet. Notably, it remains unclear whether borderline EF (41∼49%) is related with poor outcome after CES. We sought to evaluate whether lower ejection fraction and borderline EF could predict the outcome in patients with CES.

Method and Results

We evaluated the relationship between EF and functional outcome in 437 consecutive patients with CES. EF was introduced as continuous and categorical (EF≤40%, EF 41∼49%, EF≥50%) variable. Patients with CES and the subgroup with AF were evaluated separately. Poor short-term outcome (modified Rankin Score≥3at discharge or death within 90 days after stroke onset) and long-term mortality were evaluated. A total of 165 patients (37.8%) had poor short-term outcomes. EF tends to be lower in patients with poor short-term outcome (56.8±11.0 vs. 54.8±12.0, p-value 0.086). Overall cumulative death was136 (31.1%) in all CES patients and 106 (31.7%) in the AF subgroup. In a multivariable model adjusted for possible covariates, the hazard ratio for mortality significantly decreased by 3% for every 1% increase in ejection fraction in CES patients and 2% for every 1% increase in the AF subgroup. Reduced EF (EF≤40%) showed higher mortality (HR 2.61), and those with borderline EF (41∼49%) had a tendency of higher mortality (HR 1.65, p-value 0.067)compared with those with normal EF.

Conclusion

We found a strong association between lower EF and CES outcome. Echocardiographic evaluation helps to better determine the prognosis in CES patients, even in subgroup of patients with AF.     

Circulating MiR-133a as a Biomarker Predicts Cardiac Hypertrophy in Chronic Hemodialysis Patients

Background

MicroRNAs (miRNAs) are small ribonucleotides regulating gene expression. MicroRNAs are present in the blood in a remarkably stable form and have emerged as potential diagnostic markers in patients with cardiovascular disease. Our study aimed to assess circulating miR-133a levels in MHD patients and the relation of miR-133a to cardiac hypertrophy.

Methods

We profiled miRNAs using RNA isolated from the plasma of participants. The results were validated in 64 MHD patients and 18 healthy controls.

Results

Levels of plasma miR-133a decreased in MHD patients with LVH compared with those in healthy controls. Plasma miR-133a concentrations were negatively correlated with LVMI and IVS. After single hemodialytic treatment, plasma miR-133a levels remained unchanged. Cardiac Troponin I and T were not associated with LVMI and IVS.

Conclusions

Our observations supplied the possibility that circulating miR-133a could be a surrogate biomarker of cardiac hypertrophy in MHD patients.     

Association of Systemic Collagen Type IV Formation with Survival among Patients Undergoing Hemodialysis

Objective

The 7S domain of collagen type IV (P4NP_7S) assessed in plasma represents systemic collagen type IV formation. The objective of the study was to investigate the association of systemic collagen type IV formation with survival among patients undergoing hemodialysis.

Methods

We performed an observational cohort study of 371 hemodialysis patients. Plasma P4NP_7S was analyzed using a specific enzyme-linked immunosorbent assay detecting the amino-terminal propeptide of type IV procollagen. Association between categories of plasma P4NP_7S concentrations and survival was initially assessed by Kaplan-Meier analysis, then in an adjusted Cox model.

Results

For hemodialysis patients in the highest category of systemic collagen type IV formation, i.e. plasma P4NP_7S concentrations more than 775 pg/L, an increased risk for death was observed (highest P4NP_7S category vs all other categories, hazard ratio, 1.934; 95% confidence interval, 1.139 to 3.285). Survival analysis showed an increased risk of death in the highest P4NP_7S category compared to the other categories (Chi square 6.903; P = 0.032). Median survival was only 105 days in the highest P4NP_7S category whereas it was 629 days in the medium category, and 905 days in the lowest category. Multivariable-adjusted Cox regression showed increased odds for death with higher age and higher P4NP_7S categories. Systemic collagen type IV formation was associated with plasma concentrations of the collagen IV degradation product C4M (Spearman r = 0.764; P<0.0001) confirming extracellular matrix turnover.

Conclusion

Among hemodialysis patients elevated systemic collagen type IV formation suggesting accelerating systemic fibrosis was associated with increased risk of death.     

Accumulation of Mitochondrial DNA Mutations Disrupts Cardiac Progenitor Cell Function and Reduces Survival

Transfer of cardiac progenitor cells (CPCs) improves cardiac function in heart failure patients. However, CPC function is reduced with age, limiting their regenerative potential. Aging is associated with numerous changes in cells including accumulation of mitochondrial DNA (mtDNA) mutations, but it is unknown how this impacts CPC function. Here, we demonstrate that acquisition of mtDNA mutations disrupts mitochondrial function, enhances mitophagy, and reduces the replicative and regenerative capacities of the CPCs. We show that activation of differentiation in CPCs is associated with expansion of the mitochondrial network and increased mitochondrial oxidative phosphorylation. Interestingly, mutant CPCs are deficient in mitochondrial respiration and rely on glycolysis for energy. In response to differentiation, these cells fail to activate mitochondrial respiration. This inability to meet the increased energy demand leads to activation of cell death. These findings demonstrate the consequences of accumulating mtDNA mutations and the importance of mtDNA integrity in CPC homeostasis and regenerative potential.     

Genetic Polymorphisms in Endothelin-1 as Predictors for Long-Term Survival and the Cardiac Index in Patients Undergoing On-Pump Cardiac Surgery

Genetic variants within the endothelin-1 gene (EDN1) have been associated with several cardiovascular diseases and may act as genetic prognostic markers. Here, we explored the overall relevance of EDN1 polymorphisms for long-term survival in patients undergoing on-pump cardiac surgery. A prospectively collected cohort of 455 Caucasian patients who underwent cardiac surgery with cardiopulmonary bypass was followed up for 5 years. The obtained genotypes and inferred haplotypes were analyzed for their associations with the five-year mortality rate (primary endpoint). The EDN1 T-1370G and K198N genotype distributions did not deviate from Hardy–Weinberg equilibrium and the major allele frequencies were 83% and 77%, respectively. The cardiovascular risk factors were equally distributed in terms of the different genotypes and haplotypes associated with the two polymorphisms. The five-year mortality rate did not differ among the different EDN1 T-1370G and K198N genotypes and haplotypes. Haplotype analysis revealed that carriers of the G-T (compound EDN1 T-1370G G/K198N T) haplotype had a higher cardiac index than did non-carriers (p = 0.0008); however, this difference did not reach significance after adjusting for multiple testing. The results indicate that common variations in EDN1 do not act as prognostic markers for long-term survival in patients undergoing on-pump cardiac surgery.     

透析充分性、微炎症、营养状态对血液透析患者生存质量及长期生存率的影响

目的:探讨透析充分性、微炎症、营养状态对血液透析患者生存质量及长期生存率的影响。方法:随机选择我院血液透析中心维持透析每周3次,治疗6月以上的患者89例,观察并评估其入组时、入组后第3、6、12、18、24月的生存质量(KDTA、SF-36)、营养状况(MQSGA、MAMC)、微炎症(hCRP、IL-6)及透析充分性(iPTH、Kt/V、β2-MG),并分析透析充分性、营养状况、微炎症与生存质量、生存率的相关性。结果:89例患者有9例死亡,死亡率为10.1%;iPHT、MQSGA与KDTA、SF-36呈负相关(P0.05),Kt/V与KDTA、SF-36呈正相关(P0.05),β2-MG、胆固醇与KDTA、SF-36无明显相关(P0.05);hCRP、IL-6分别与KDTA、SF-36呈负相关(P0.05);HGS与KDTA呈正相关(P0.05),与SF-36无明显相关(P0.05),ALB、MAMC与KDTA、SF-36呈正相关(P0.05);Kt/V、MQSGA、IL-6、iPTH均与KDAT及SF-36存回归关系(P0.05);Cox回归模型发现Kt/V、ALB及开始透析年龄是导致血透患者死亡的危险因素(P0.05)。结论:透析充分性、微炎症及营养状况均影响透析患者的生存质量及长期生存率;iPTH、Kt/V、MQSGA、IL-6是其生存质量的独立影响因素,Kt/V、ALB及开始透析年龄是血透患者的死亡独立危险因素。     

Low Potassium Dialysate as a Protective Factor of Sudden Cardiac Death in Hemodialysis Patients with Hyperkalemia

AimHyperkalemia increases the risk of sudden cardiac death (SCD) in hemodialysis patients. Our objective was to determine the association between administering low potassium dialysate to hyperkalemic hemodialysis patients and SCD.MethodsWe conducted a retrospective cohort study with patients undergoing maintenance hemodialysis from May 1, 2006, through December 31, 2013. The dialysate composition was adjusted over time according to monthly laboratory results. A 1.0 mEq/L potassium dialysate was applied in patients with predialysis hyperkalemia (>5.5 mEq/L) and was included as a time-dependent confounding factor. The clinical characteristics of enrolled patients, the incidence and timing of SCD and risk factors for all-cause mortality and SCD were analyzed.ResultsThere were 312 patients on maintenance hemodialysis during the study period. One hundred and fifty-seven patients had been dialyzed against a 1.0 mEq/L potassium dialysate at least once. The rates of all-cause mortality and SCD were 48.17 and 20.74 per 1000 patient-years, respectively. A 1.12-fold increase in the risk of SCD in the 24-hour period starting with the hemodialysis procedure and a 1.36-fold increase in the 24 hours preceding a weekly cycle were found (p = 0.017). Multivariate Cox proportional hazards models showed that age, diabetes mellitus and predialysis hyperkalemia (>5.0 mEq/L) were significant predictors of all-cause mortality and SCD. Exposure to 1.0 mEq/L potassium dialysate, Kt/V, and serum albumin were independent protective factors against all-cause mortality. Only exposure to 1.0 mEq/L potassium dialysate significantly prevented SCD (hazard ratio = 0.33, 95% CI = 0.13–0.85).ConclusionsUsing low potassium dialysate in hyperkalemic hemodialysis patients may prevent SCD.     

轻度低氧血症的慢性阻塞性肺疾病患者的心脏结构及功能的早期变化

目的:评估正常动脉血氧分压和无右心室衰竭迹象的慢性阻塞性肺疾病(COPD)患者心脏结构和功能.方法:25个COPD稳定期的患者(FEV1,1.23±0.52 L/s;PaO2,82±10 mm Hg),26个与研究对象年龄匹配的受试者作为对照组.以超声多普勒超声心动图测定右心室(RV)和左心室(LV)的结构与功能及检肺动脉压(PAP).结果:COPD组与对照组右心室舒张期末直径为19±3mm,23±2mm,(P＜0.01),三尖瓣口舒张期血流速度比值为1.2±0.9,1.5±0.4(P＜0.05);右心室壁舒张末期厚度为4±0.9,3±0.8,(P＜0.05);右心室射血分数56±12,60±11(P＞0.05).COPD组与对照组左心室舒张期直径为48.0±5.5,46.2±3.4(P＞0.05);二尖瓣口舒张期血流速度比值:1.2±0.4,1.5±0.9左心室后壁厚度为10.0±0.8,10.3±0.7(P＞0.05);EF斜率55.5±11.7,54.5±12.1(P＞0.05);左室舒张早期最大充盈速率分数为2.83±0.43,2.81±0.45 (P＞0.05);左心室射血分数53±7,62±14(P＞0.05);COPD组与对照组均不伴有肺动脉高压.结论:心肌肥厚是COPD患者右心室压力超负荷最早迹象,这些心脏的适应性变化不改变左右心室的收缩功能.     

高通量与低通量血液透析对糖尿病肾病透析患者氧化应激、细胞免疫功能和微炎症状态的影响

目的:比较高通量与低通量血液透析对糖尿病肾病透析患者氧化应激、细胞免疫功能和微炎症状态的影响。方法:选择2011年1月~2017年1月在我院进行诊治的糖尿病肾病透析患者60例,随机分为对照组与观察组,每组各30例。对照组采用低通量血液透析治疗,观察组采用高通量血液透析治疗,两组每次血液透析的时间、透析液流速以及透析液成分均完全相同。比较两组血液透析前后的血清丙二醛、过氧化物歧化酶以及谷胱甘肽过氧化物酶等氧化应激指标,CD~+4、CD~+3、CD~+8以及CD~+4/CD~+8等细胞免疫功能指标,高敏C反应蛋白、白介素-6以及肿瘤坏死因子等微炎症状态指标。结果:治疗后,观察组血清过氧化物歧化酶、谷胱甘肽过氧化物酶、高敏C反应蛋白、白介素-6以及肿瘤坏死因子水平均明显低于对照组(P0.05),血清丙二醛、CD~+4、CD~+3以及CD~+4/CD~+8水平均明显高于对照组(P0.05)。结论:糖尿病肾病血液透析患者体内普遍存在不同程度的微炎症状态以及氧化应激状态,长期采用低通量血液透析会加重体内的炎性反应和氧化应激水平,而高通量血液透析能缓解炎性反应和氧化应激,并且有效改善患者的细胞免疫功能。     

左西孟旦对急性心衰患者心功能及cTnT, hs-CRP, NT-proBNP水平影响

目的:观察左西孟旦对急性心力衰竭患者心功能及cTnT、hs-CRP、NT-proBNP水平影响。方法:选取在我院就诊的327例急性心力衰竭患者,按照治疗方式不同,分为观察组(常规治疗+左西孟旦)164例和对照组(常规治疗)163例,对比两组用药前及用药后24 h的左心射血分数(LVEF)、每搏输出量(SV)、肌钙蛋白T(cTnT)、超敏C反应蛋白(hs-CRP)和氨基末端B型利钠肽前体(NT-proBNP)水平。结果:治疗前,两组LVEF和SV比较,差异无统计学意义(P0.05)。治疗后观察组LVEF和SV均显著高于治疗前(P0.05);对照组LVEF显著高于治疗前(P0.05),SV与治疗前比较,差异无统计学意义(P0.05)。治疗后观察组LVEF和SV均显著高于对照组(P0.05)。治疗前两组cTnT、hs-CRP、NT-proBNP水平比较,差异无统计学意义(P0.05)。治疗后两组cTnT、hs-CRP、NT-proBNP水平均显著低于治疗前(P0.05)。治疗后观察组cTnT、hs-CRP、NT-proBNP水平显著低于对照组(P0.05)。两组不良反应比较差异无统计学意义(P0.05)。结论:左西孟旦治疗急性心力衰竭可明显增加心肌收缩力,抑制心肌重塑,减轻炎症反应,改善患者预后。     

不同透析模式对维持性血透患者残余肾功能、血脂及大中分子毒素的影响

目的:探讨不同透析模式对维持性血透患者残余肾功能、血脂及大中分子毒素的影响。方法:选取2013年3月-2014年3月期间于我院进行维持性血液透析的患者64例,采用随机数字表法随机分为研究组和对照组各32例。研究组采用高通量维持性血液透析,对照组患者采用低通量维持性血液透析。观察并比较两组患者治疗前、治疗3个月、6个月及9个月后内生肌酐清除率(Ccr)、血脂及大中分子毒素。结果:治疗后3个月、6个月、9个月两组Ccr水平较治疗前依次降低,且研究组各个时间点的Ccr均低于对照组(均P0.05)。治疗后两组患者TC、TG和LDL-C水平均显著降低,HDL-C显著上升,治疗后6个月、9个月各指标改善程度均显著优于治疗后3个月,且研究组变化更显著,差异有统计学意义(均P0.05)。治疗后两组患者血清磷、β2微球蛋白和甲状旁腺激素水平均显著降低,治疗后6个月、9个月各指标水平均显著低于治疗后3个月,且研究组明显低于对照组,两组比较差异均有统计学意义(均P0.05)。结论:高通量维持性血液透析的方式可有效清除体内的血脂和大中分子毒素,对残余肾功能影响较小。     

The Post-Resuscitative Urinalysis Associate the Survival of Patients with Non-Traumatic Out-of-Hospital Cardiac Arrest

Objective

To analyze whether urine output and urinalysis results are predictive of survival and neurologic outcomes in patients with non-traumatic out-of-hospital cardiac arrest (OHCA).

Methods

Information was obtained from 1,340 patients with non-traumatic OHCA who had achieved a sustained return of spontaneous circulation (ROSC). Factors that were associated with survival in the post-resuscitative period were evaluated. The association between urine output and fluid challenge in the early resuscitative period was analyzed and compared between the survivors and the non-survivors. The results of the initial urinalysis, including the presence of proteinuria and other findings, were used to evaluate the severity of vascular protein leakage and survival. The association between proteinuria and the neurologic outcomes of the survivors was also analyzed. The clinical features of capillary leakage were examined during the post-resuscitative period.

Results

Of the 1,340 patients, 312 survived. A greater urine output was associated with a higher chance of survival. The initial urine output increased in proportion to the amount of fluid that was administered during early resuscitation in the emergency department for the survivors but not for the non-survivors (p<0.05). In the initial urinalysis, proteinuria was strongly associated with survival, and severe proteinuria indicated significantly poorer neurologic outcomes (p<0.05 for both comparisons). Proteinuria was associated with a risk of developing signs of capillary leakage, including body mass index gain and pitting edema (both p<0.001).

Conclusion

The severity of proteinuria during the early post-resuscitative period was predictive of survival.     

卡维地洛对慢性心力衰竭患者神经内分泌及心功能的影响

目的:观察卡维地洛对慢性心力衰竭患者神经内分泌及心功能的影响.方法:60例慢性心力衰竭患者随机分为对照组(n=30)和卡维地洛组(n=30).对照组给予洋地黄、利尿剂、血管紧张素转化酶抑制剂等常规治疗;卡维地洛组在给予常规治疗的基础上加用卡维地洛,从小剂量(3.125mg,1次/天)逐渐加至靶剂量(12.5mg,2次/天或3次/天)治疗6个月.治疗前及治疗6个月后放射免疫法测定血浆血管紧张素Ⅱ(Ang Ⅱ)及内皮素-1(ET-1)水平,超声心动图检测心功能.结果:两组治疗后较治疗前Ang Ⅱ及ET-1水平显著降低,卡维地洛组改善更明显(P＜0.01);两组左房内径、左室舒张末期内径(LVEDD)和左室收缩末期内径(LVESD)明显缩短(P＜0.01),左室射血分数(LVEF)显著增高(P＜0.01).结论:卡维地洛抑制心衰患者的神经内分泌激活,逆转心室重塑,改善心功能.     

螺内酯对充血性心衰患者心功能和血浆脑钠肽的影响

目的:观察螺内酯治疗充血性心力衰竭患者前后心功能和脑钠肽的变化及临床意义.方法:选取2008-2010年沈阳军区总医院心内科门诊的充血性心力衰竭患者70例,随机分为螺内酯治疗组和对照组,对照组采用常规内科治疗.螺内酯治疗组在常规内科治疗的基础上加用螺内酯治疗.结果:两组治疗前左室收缩末期容积(LVESV),左心室射血分数(LVEF),血浆BNP水平比较无差异(P＞0.05),治疗后两组LVESV,血浆BNP明显下降,LVEF水平明显升高(P＜0.05).螺内酯治疗组临床疗效高于对照组(P＜0.05).结论:螺内酯可以改善充血性心力衰竭患者的心脏功能.     

老年心力衰竭患者BNP、LVEDD、LVEF水平与心脏功能的关系

摘要 目的：探究老年心力衰竭患者的脑利钠肽（Brain natriuretic peptide,BNP）、左室舒张末径（Left ventricular end diastolic diameter,LVEDD）、左室射血分数（Left ventricular ejection fraction,LVEF）水平与心脏功能的关系。方法：选择2019年3月-2020年12月于我院接受治疗的150例老年心力衰竭患者,按照其BNP水平将其分为A（BNP水平<94 pg/mL,43例）、B（BNP水平94~349.9 pg/mL,40例）、C（BNP水平350~988.9 pg/mL,44例）、D（BNP水平≥989 pg/mL,23例）4组,对比4组患者LVEDD、LVEF水平、血同型半胱氨酸（Homocysteine,HCY）水平,对比4组患者不同心功能分级比率,对比4组患者随访2个月心脏不良事件发生率,最后分析BNP、LVEDD和LVEF与心力衰竭患者心功能分级相关性。结果：A、B、C、D四组患者LVEDD、HCY呈递增趋势,LVEF呈递减趋势,C、D两组患者的LVEDD、HCY水平明显高于A、B两组（P<0.05）,C、D两组LVEF水平明显低于A、B两组患者（P<0.05）;A、B、C、D四组患者心功能分级逐渐加重,A组患者I级70例,II级27例,B组患者II级60例,III级29例,C组III级68例,IV级20例,D组III级3例,IV级43例,各组间对比心功能分级差异具有统计学意义（P<0.05）;A、B、C、D四组患者心脏不良事件发生率分别为4.12 %、11.24 %、26.14 %,43.48 %,不良事件发生率逐渐升高,差异具有统计学意义（P＜0.05）;BNP、LVEDD与心功能分级呈正相关（r=0.878、0.564,P<0.05）,LVEF与心功能分级呈负相关（r=0.781,P<0.05）。结论：BNP、LVEDD与LVEF指标可以作为心力衰竭评估指标,能够对心力衰竭患者心脏功能及预后进行评估。