Background Chronic heart failure（CHF）and diabetes mellitus portend high morbidity and mortality because of an interrelated pathophysiologic process.This large cohort study aimed to analyze the prevalence,clinicaI ch...Background Chronic heart failure（CHF）and diabetes mellitus portend high morbidity and mortality because of an interrelated pathophysiologic process.This large cohort study aimed to analyze the prevalence,clinicaI characteristics and long-term outcome of patients with CHF and diabetes.Methods A totaI of 1119 patients with NYHA functionaI class Ⅱ-Ⅳ and left ventricular ejection fraction（LVEF）〈45% between January 1995 and May 2009 were recruited.Clinical variables, biochemical and echocardiographic measurements were retrospectively reviewed,and composite major cardiac events （MCE） including death,headtransplantation, and refractory heart failure requiring multiple hospitalizations were recorded.Results The prevalence of CHF with diabetes was progressively increased with time （16.9% in 1995-1999;20.4% in 2000-2004,and 29.1% in 2005-2009）and age（1 8.5% in〈60 years,26.6% in 60-80 years,and 26.6% in〉80 years）.Compared with CHF patients without diabetes,those with diabetes had worse cardiac function,more abnormal biochemical changes.and higher mortality.Treatment with glucose-lowering agents significantly improved LVEF and decreased MCE.An elevated serum HbA1c level was associated with large left ventricular end-systolic diameter （P〈0.05）,decreased LVEF（P〈0.01）and reduced survival（P〈0.05）.Multivariable Logistic regression analysis revealed that after adjustment for confounding factors,NYHA functional class（OR2.65,95%CI 1.14-6.16,P=0.024）and HbA1c level≥7%（OR2.78, 95%CI 1.00-7.68,P=0.049）were independent risk factors for adverse outcomes in CHF patients with diabetes.Conclusions Prevalence of CHF with diabetes was increasing during past decades,and patients with CHF and diabetes had worse clinical profiles and prognosis.Aggressive anti-CHF and diabetes therapies are needed to improve overall outcomes for these patients.展开更多
Background Potentially lethal ventricular arrhythmias （PLVAs） occur frequently in survivors after acute myocardial infarction and are increasingly recognized in other forms of structural heart diseases.This study in...Background Potentially lethal ventricular arrhythmias （PLVAs） occur frequently in survivors after acute myocardial infarction and are increasingly recognized in other forms of structural heart diseases.This study investigated the prevalence and prognostic significance of PLVAs in patients with chronic heart failure （CHF）.Methods Data concerning demographics,etiology of heart failure,NYHA functional class,biochemical variables,electrocardiographic and echocardiographic findings,and medical treatments were collected by reviewing hospital medical records from 1080 patients with NYHA Ⅱ-Ⅳ and a left ventricular （LV） ejection fraction ≤45%.PLVAs were defined as multi-focal ventricular ectopy （〉30 beats/h on Holter monitoring）,bursts of ventricular premature beats,and nonsustained ventricular tachycardia.All-cause mortality,sudden death,and rehospitalization due to worsening heart failure,or cardiac transplantation during 5-year follow-up after discharge were recorded.Results The occurrence rate of PLVAs in CHF was 30.2%,and increased with age; 23.4% in patients 〈45 years old,27.8% in those between 45-65 years old,and 33.5% in patients 〉65 years old （P=0.033）.Patients with PLVAs had larger LV size and lower ejection fraction （both P 〈0.01） and higher all-cause mortality （P=0.014） during 5-year follow-up than those without PLVAs.Age （OR 1.041,95% Cl 1.004-1.079,P=0.03） and LV end-diastolic dimension （OR 1.068,95% Cl 1.013-1.126,P=0.015） independently predicted the occurrence of PLVAs.And PLVA was an independent factor for all-cause mortality （RR 1.702,95% Cl 1.017-2.848,P=0.031） and sudden death （RR 1.937,95% CI 1.068-3.516,P=0.030） in patients with CHF.Conclusion PLVAs are common and exert a negative impact on Iona-term clinical outcome in patients with CHF.展开更多
Background There is a paucity of studies investigating the clinical and biochemical characteristics of pain in chronic heart failure （CHF） patients. This study aimed to determine the clinical and biochemical charact...Background There is a paucity of studies investigating the clinical and biochemical characteristics of pain in chronic heart failure （CHF） patients. This study aimed to determine the clinical and biochemical characteristics and outcomes in Chinese patients with CHF and symptoms of pain. Methods Sociodemographics, serum levels of creatinine, NT-proBNP, high-sensitivity C-reactive protein （hs-CRP）, tumor necrosis factor （TNF）-α, interleukin （IL）-6 and IL-10, and two-dimensional echocardiographic left ventricular ejection fraction （LVEF） were determined in 305 patients with CHF. A questionnaire packet including the Brief Pain Inventory （BPI） and the Minnesota Living with Heart Failure Questionnaire （MLHFQ） was used to assess the degree of pain rated on a 0-10 scale and the quality of life （QOL）. A six-minute walking test was performed during routine clinic visits. Major adverse cardiac events （MACE） were recorded; including all-cause or cardiac mortality and rehospitalization because of myocardial infarction, worsening heart failure or stroke at follow-up. Results Pain occurred in 25.6% of CHF patients, and was more common when the New York Heart Association （NYHA） functional class was worse. More patients with pain were female in gender, and had more co-morbidities, lower LVEF, and shorter distance during the 6-minute walking test. Despite similar serum levels of creatinine, N-terminal prohormone of brain natriuretic peptide （NT-proBNP）, IL-6 and IL-10, the TNF-a levels were higher and MLHFQ scores were greater in CHF patients with pain. At follow-up, CHF patients with moderate to severe pain （≥4 scale） had higher rates of all-cause and cardiac mortality and rehospitalization because of myocardial infarction, worsening heart failure or stroke. Multivariate regression analysis revealed that the presence of pain was an independent risk factor for MACE and reduced QOL in CHF patients.展开更多
文摘Background Chronic heart failure（CHF）and diabetes mellitus portend high morbidity and mortality because of an interrelated pathophysiologic process.This large cohort study aimed to analyze the prevalence,clinicaI characteristics and long-term outcome of patients with CHF and diabetes.Methods A totaI of 1119 patients with NYHA functionaI class Ⅱ-Ⅳ and left ventricular ejection fraction（LVEF）〈45% between January 1995 and May 2009 were recruited.Clinical variables, biochemical and echocardiographic measurements were retrospectively reviewed,and composite major cardiac events （MCE） including death,headtransplantation, and refractory heart failure requiring multiple hospitalizations were recorded.Results The prevalence of CHF with diabetes was progressively increased with time （16.9% in 1995-1999;20.4% in 2000-2004,and 29.1% in 2005-2009）and age（1 8.5% in〈60 years,26.6% in 60-80 years,and 26.6% in〉80 years）.Compared with CHF patients without diabetes,those with diabetes had worse cardiac function,more abnormal biochemical changes.and higher mortality.Treatment with glucose-lowering agents significantly improved LVEF and decreased MCE.An elevated serum HbA1c level was associated with large left ventricular end-systolic diameter （P〈0.05）,decreased LVEF（P〈0.01）and reduced survival（P〈0.05）.Multivariable Logistic regression analysis revealed that after adjustment for confounding factors,NYHA functional class（OR2.65,95%CI 1.14-6.16,P=0.024）and HbA1c level≥7%（OR2.78, 95%CI 1.00-7.68,P=0.049）were independent risk factors for adverse outcomes in CHF patients with diabetes.Conclusions Prevalence of CHF with diabetes was increasing during past decades,and patients with CHF and diabetes had worse clinical profiles and prognosis.Aggressive anti-CHF and diabetes therapies are needed to improve overall outcomes for these patients.
文摘Background Potentially lethal ventricular arrhythmias （PLVAs） occur frequently in survivors after acute myocardial infarction and are increasingly recognized in other forms of structural heart diseases.This study investigated the prevalence and prognostic significance of PLVAs in patients with chronic heart failure （CHF）.Methods Data concerning demographics,etiology of heart failure,NYHA functional class,biochemical variables,electrocardiographic and echocardiographic findings,and medical treatments were collected by reviewing hospital medical records from 1080 patients with NYHA Ⅱ-Ⅳ and a left ventricular （LV） ejection fraction ≤45%.PLVAs were defined as multi-focal ventricular ectopy （〉30 beats/h on Holter monitoring）,bursts of ventricular premature beats,and nonsustained ventricular tachycardia.All-cause mortality,sudden death,and rehospitalization due to worsening heart failure,or cardiac transplantation during 5-year follow-up after discharge were recorded.Results The occurrence rate of PLVAs in CHF was 30.2%,and increased with age; 23.4% in patients 〈45 years old,27.8% in those between 45-65 years old,and 33.5% in patients 〉65 years old （P=0.033）.Patients with PLVAs had larger LV size and lower ejection fraction （both P 〈0.01） and higher all-cause mortality （P=0.014） during 5-year follow-up than those without PLVAs.Age （OR 1.041,95% Cl 1.004-1.079,P=0.03） and LV end-diastolic dimension （OR 1.068,95% Cl 1.013-1.126,P=0.015） independently predicted the occurrence of PLVAs.And PLVA was an independent factor for all-cause mortality （RR 1.702,95% Cl 1.017-2.848,P=0.031） and sudden death （RR 1.937,95% CI 1.068-3.516,P=0.030） in patients with CHF.Conclusion PLVAs are common and exert a negative impact on Iona-term clinical outcome in patients with CHF.
文摘Background There is a paucity of studies investigating the clinical and biochemical characteristics of pain in chronic heart failure （CHF） patients. This study aimed to determine the clinical and biochemical characteristics and outcomes in Chinese patients with CHF and symptoms of pain. Methods Sociodemographics, serum levels of creatinine, NT-proBNP, high-sensitivity C-reactive protein （hs-CRP）, tumor necrosis factor （TNF）-α, interleukin （IL）-6 and IL-10, and two-dimensional echocardiographic left ventricular ejection fraction （LVEF） were determined in 305 patients with CHF. A questionnaire packet including the Brief Pain Inventory （BPI） and the Minnesota Living with Heart Failure Questionnaire （MLHFQ） was used to assess the degree of pain rated on a 0-10 scale and the quality of life （QOL）. A six-minute walking test was performed during routine clinic visits. Major adverse cardiac events （MACE） were recorded; including all-cause or cardiac mortality and rehospitalization because of myocardial infarction, worsening heart failure or stroke at follow-up. Results Pain occurred in 25.6% of CHF patients, and was more common when the New York Heart Association （NYHA） functional class was worse. More patients with pain were female in gender, and had more co-morbidities, lower LVEF, and shorter distance during the 6-minute walking test. Despite similar serum levels of creatinine, N-terminal prohormone of brain natriuretic peptide （NT-proBNP）, IL-6 and IL-10, the TNF-a levels were higher and MLHFQ scores were greater in CHF patients with pain. At follow-up, CHF patients with moderate to severe pain （≥4 scale） had higher rates of all-cause and cardiac mortality and rehospitalization because of myocardial infarction, worsening heart failure or stroke. Multivariate regression analysis revealed that the presence of pain was an independent risk factor for MACE and reduced QOL in CHF patients.
