Role of cardiac CTA in estimating left ventricular volumes and ejection fraction

Left ventricular ejection fraction(LVEF)is an impor-tant predictor of cardiac outcome and helps in makingimportant diagnostic and therapeutic decisions suchas the treatment of different types of congestive heartfailure or implantation of devices like cardiac resynchro-nization therapy-defibrillator.LVEF can be measuredby various techniques such as transthoracic echo-cardiography,contrast ventriculography,radionuclidetechniques,cardiac magnetic resonance imaging andcardiac computed tomographic angiography(CTA).Thedevelopment of cardiac CTA using multi-detector rowCT(MDCT)has seen a very rapid improvement in thetechnology for identifying coronary artery stenosis andcoronary artery disease in the last decade.During theacquisition,processing and analysis of data to studycoronary anatomy,MDCT provides a unique opportunityto measure left ventricular volumes and LVEF simulta-neously with the same data set without the need foradditional contrast or radiation exposure.The develop-ment of semi-automated and automated software to measure LVEF has now added uniformity,efficiency and reproducibility of practical value in clinical practice rather than just being a research tool.This article will address the feasibility,the accuracy and the limitations of MDCT in measuring LVEF.

Electrophysiologic testing guided risk stratification approach for sudden cardiac death beyond the left ventricular ejection fraction

Sudden cardiac death threats ischaemic and dilated cardiomyopathy patients. Anti- arrhythmic protection may be provided to these patients with implanted cardiac defibrillators(ICD), after an efficient risk stratification approach. The proposed risk stratifier of an impaired left ventricular ejection fraction has limited sensitivity meaning that a significant number of victims will remain undetectable by this risk stratification approach because they have a preserved left ventricular systolic function. Current risk stratification strategies focus on combinations of non invasive methods like T wave alternans, late potentials, heart rate turbulence, deceleration capacity and others, with invasive methods like the electrophysiologic study. In the presence of an electrically impaired substrate with formed post myocardial infarction fibrotic zones, programmed ventricular stimulation provides important prognostic information for the selection of the patients expected to benefit from an ICD implantation, while due to its high negative predictive value, patients at low risk level may also be detected. Clustering evidence from different research groups and electrophysiologic labs support an electrophysiologic testing guided risk stratification approach for sudden cardiac death.

Heart failure with preserved ejection fraction and the first law of thermodynamics

In heart failure with preserved ejection fraction,significant left ventricular diastolic abnormalities are present,despite a normal systolic ejection fraction.This article will consider whether this is consistent with the law of conservation of energy,also know as the first law of thermodynamics.

Epicardial adipose tissue in obesity with heart failure with preserved ejection fraction: Cardiovascular magnetic resonance biomarker study

BACKGROUND Obesity has become a serious public health issue,significantly elevating the risk of various complications.It is a well-established contributor to Heart failure with preserved ejection fraction(HFpEF).Evaluating HFpEF in obesity is crucial.Epicardial adipose tissue(EAT)has emerged as a valuable tool for validating prognostic biomarkers and guiding treatment targets.Hence,assessing EAT is of paramount importance.Cardiovascular magnetic resonance(CMR)imaging is acknowledged as the gold standard for analyzing cardiac function and mor-phology.We hope to use CMR to assess EAT as a bioimaging marker to evaluate HFpEF in obese patients.AIM To assess the diagnostic utility of CMR for evaluating heart failure with preserved ejection fraction[HFpEF;left ventricular(LV)ejection fraction≥50%]by measuring the epicardial adipose tissue(EAT)volumes and EAT mass in obese patients.METHODS Sixty-two obese patients were divided into two groups for a case-control study based on whether or not they had heart failure with HFpEF.The two groups were defined as HFpEF+and HFpEF-.LV geometry,global systolic function,EAT volumes and EAT mass of all subjects were obtained using cine magnetic resonance sequences.RESULTS Forty-five patients of HFpEF-group and seventeen patients of HFpEF+group were included.LV mass index(g/m2)of HFpEF+group was higher than HFpEF-group(P<0.05).In HFpEF+group,EAT volumes,EAT volume index,EAT mass,EAT mass index and the ratio of EAT/[left atrial(LA)left-right(LR)diameter]were higher compared to HFpEF-group(P<0.05).In multivariate analysis,Higher EAT/LA LR diameter ratio was associated with higher odds ratio of HFpEF.CONCLUSION EAT/LA LR diameter ratio is highly associated with HFpEF in obese patients.It is plausible that there may be utility in CMR for assessing obese patients for HFpEF using EAT/LA LR diameter ratio as a diagnostic biomarker.Further prospective studies,are needed to validate these proof-of-concept findings.

The influence of pressure injury risk on the association between left ventricular ejection fraction and all-cause mortality in patients with acute myocardial infarction 80 years or older

BACKGROUND: We aimed to investigate whether the pressure injury risk mediates the association of left ventricular ejection fraction(LVEF) with all-cause death in patients with acute myocardial infarction(AMI) aged 80 years or older.METHODS: This retrospective cohort study included 677 patients with AMI aged 80 years or older from a tertiary-level hospital. Pressure injury risk was assessed using the Braden scale at admission, and three risk groups(low/minimal, intermediate, high) were defined according to the overall score of six different variables. LVEF was measured during the index hospitalization for AMI. All-cause death after hospital discharge was the primary outcome.RESULTS: Over a median follow-up period of 1,176 d(interquartile range [IQR], 722–1,900 d), 226(33.4%) patients died. Multivariate Cox regression analysis showed that reduced LVEF was associated with an increased risk of all-cause death only in the high-risk group of pressure injury(adjusted hazard ratios [HR]=1.81, 95% confidence interval [CI]: 1.03–3.20;P=0.040), but not in the low/minimal-(adjusted HR=1.29, 95%CI: 0.80–2.11;P=0.299) or intermediate-risk groups(adjusted HR=1.14, 95%CI: 0.65–2.02;P=0.651). Significant interactions were detected between pressure injury risk and LVEF(adjusted P=0.003). The cubic spline with hazard ratio plot revealed a distinct shaped curve relation between LVEF and all-cause death among different pressure injury risk groups.CONCLUSIONS: In older patients with AMI, the risk of pressure injury mediated the association between LVEF and all-cause death. The classification of older patients for both therapy and prognosis assessment appears to be improved by the incorporation of pressure injury risk assessment into AMI care management.

Interaction between the left ventricular ejection fraction and left ventricular strain and its relationship with coronary stenosis

BACKGROUND Coronary artery stenosis(CAS)is the most common type of heart disease and the leading cause of death in both men and women globally.CAS occurs when the arteries that supply blood to the heart muscle harden and become narrower due to plaque buildup-cholesterol and other material-on their inner walls.As a result,the heart muscle cannot receive the blood or oxygen it needs.Most heart attacks happen when a blood clot suddenly cuts off the hearts'blood supply,causing permanent heart damage.AIM To analyze the relationship between the left ventricular ejection fraction(LVEF),left ventricular strain(LVS),and coronary stenosis.METHODS A total of 190 participants were enrolled in this trail.The control group comprised 93 healthy individuals,and observation group comprised 97 patients with coronary heart disease who were hospitalized between July 2020 and September 2021.Coronary lesions were assessed using the Gensini score,and the LVEF and LVS were measured using magnetic resonance imaging(MRI).The interaction between the LVEF and LVS was examined using a linear regression model.The relationship between LVEF and coronary stenosis was examined using Spearman’s correlation.RESULTS The LVEF of the observation group was lower than that of the control group.The left ventricular end-systolic volume(LVESV)and left ventricular end-diastolic volume(LVEDV)of the observation group were significantly higher than those of the control group(P<0.05).The longitudinal and circumferential strains(LS,CS)of the observation group were significantly higher than those of the control group;however,the radial strain(RS)of the observation group was significantly lower than that of the control group(P<0.05).LVS,LS,and CS were significantly negatively correlated with the LVEF,and RS was positively correlated with the LVEF.There were significant differences in the LVEF,LVESV,and LVEDV of patients with different Gensini scores;the LVEF significantly decreased and the LVESV and LVEDV increased with increasing Gensini scores(P<0.05).In the observation group,the LVEF was negatively correlated and the LVESV and LVEDV were positively correlated with coronary stenosis(P<0.05).CONCLUSION The LVEF measured using MRI is significantly linearly correlated with LVS and negatively correlated with coronary stenosis.

Correction of hypovitaminosis D improved global longitudinal strain earlier than left ventricular ejection fraction in cardiovascular older adults after orthopaedic surgery

Background Cardiovascular diseases and insufficient levels of vitamin D are risk factors for adverse surgical outcomes, and they are both commonly present among older adults undergoing orthopaedic surgery. Giving the cardiovascular effects of vitamin D, pre-operative diagnosis of hypovitaminosis D would be a valuable step for the implementation of supplementation protocols. We investigated if the nor- malization of serum 25 [OH] D could ameliorate cardiac performance of older adults suffering from cardiovascular diseases. Methods We enrolled 47 older adults scheduled for major orthopaedic surgery and suffering from hypovitaminosis D. Patients underwent 6-months cal- cifediol supplementation with a starting dose at first post-operative day of 50 ~tg/die in liquid preparation. Down-titration to 20 Ixg/die at 3-months assessment was planned. Cardiac performance was evaluated by measuring left ventricular ejection fraction （LVEF） and global longitudinal strain （GLS） during pre-operative assessments and at 1-month, 3-months, 6-months follow-ups. Results Six months of cal- cifediol supplementation were associated with a significant improvement of both LVEF （＋ 3.94%; 95% CI： -4.0789 to -0.8232; P 〈 0.01） and GLS （＋ 18.56%; Z = -5.895; P 〈 0.0001）. Conclusions Calcifediol supplementation normalized serum 25 [OH] D concentration after 1-month treatment. GLS offered better insights into myocardial contractile amelioration than LVEF, thus being useful for detecting earlier subclinical changes that may anticipate hemodynamic modifications.

Heart failure with reduced,mildly reduced,or preserved left ventricular ejection fraction:Has reasoning been lost?

Left ventricular(LV)ejection fraction(LVEF),defined as LV stroke volume divided by end-diastolic volume,has been systematically used for the diagnosis,classification,and management of heart failure(HF)over the last three decades.HF is classified as HF with reduced LVEF,HF with midrange or mildly reduced LVEF,and HF with preserved LVEF using arbitrary,continuously changing LVEF cutoffs.A prerequisite for using this LVEF-based terminology is knowledge of the LVEF normal range,which is lacking and may lead to erroneous conclusions in HF,especially at the higher end of the LVEF spectrum.

Health-related quality of life among congestive heart failure patients with preserved and reduced ejection fraction

Objective:To determine factors that affect the health-related quality of life(HRQOL)of congestive heart failure(CHF)patients with preserved and reduced ejection fraction.Methods:A cross-sectional study design was used for this study.The stratified random sampling was applied for each subgroup.HRQOL was measured with the Minnesota Living with Hear t Failure Questionnaire.The data were analyzed using chi-square,Spearman's correlation analysis,and independent t-test.Results:A number of 67 respondents participated in the recent study.The total mean scores of HRQOL were significantly different(P=0.001)between heart failure(HF)patients with reduced and preserved ejection fractions,41.07±7.54 and 54.97±4.36,respectively.It related with the physical(mean±standard deviation[SD]=10.4±2.14;t=-10.08,95%CI=-12.46 to-8.34;P-value=0.001)and psychological(mean±SD=3.5±0.5;t=-6.68,95%CI=-4.55 to-2.45;P-value=0.001)domain.Strong correlation was found between age(r=-0.898,P<0.05),NYHA functional classes(r=-0.858,P<0.01),duration of HF(r=-0.807,P<0.01),family support(r=0.927,P<0.01),and quality of life(Qo L).Conclusions:HRQOL in HF patients with reduced ejection fraction was higher than in those with preserved ejection fraction.Family suppor t is a fur ther determinant factor that has a positive correlation to the Qo L.

Effect of Angiotensin Receptor-Neprilysin Inhibitor versus Valsartan on Cardiac Status in Patients with Chronic Heart Failure with Reduced Ejection Fraction: A Randomized Clinical Trial in Rangpur Medical College Hospital, Bangladesh

Background: Heart failure with reduced ejection fraction has a significant association with considerable morbidity and mortality, but there is still inadequacy in appropriate treatment to prevent this condition. We observed the effect of angiotensin receptor neprilysin inhibitor (ARNi) with such disorder compared to valsartan. Methods: In this single-blind trial, the patients were enrolled with chronic HF aged on or above 40 years, symptomatic NYHA class II - IV, an elevated NT-proBNP above 400 pg/ml level and a reduced LVEF of 40% or less. The patients were randomly assigned 1:1 to the treatment arms either ARNi (50 mg titrated to 100 mg twice a day) or valsartan (40 mg titrated to 80 mg twice a day) and followed for a median of 88 days. The primary outcome was mode of cardiovascular death and re-hospitalization for heart failure. Changes in the level of NT-proBNP and rate of ejection fraction were also measured. Results: Cardiovascular deaths occurred 4 (8%) in the ARNi treatment arm, while 11 (22%) in the valsartan treatment arm with significant hazard ratio in the ARNi group [Hazard Ratio = 0.37;95% CI: 0.34, 0.64;p = 0.042] during a median of 88 days of follow up period and 2 (4%) of the patients from the ARNi treatment arm were hospitalized due to HF, while in the valsartan treatment arm, 10 (20%) patients were hospitalized due to HF followed by receiving treatment respectively with hazard ratio in the ARNi group [Hazard Ratio = 0.80;95% CI: 0.57, 0.92;p Conclusion: Chronic treatment with the angiotensin receptor neprilysin inhibitor (ARNi) strongly decreases the NT-proBNP as well as morbidity and mortality and increases LVEF in patients with heart failure compared to valsartan.

Assessment of left ventricular ejection fraction: comparison of two dimensional echocardiography, cardiac magnetic resonance imaging and 64-row multi-detector computed tomography

Objectives To compare left ventricular ejection fraction (LVEF) determined from 64-row multi-detector computed tomography (64-row MDCT) with those determined from two dimensional echocardiography (2D echo) and cardiac magnetic resonance imaging (CMR). Methods Thirty-two patients with coronary artery disease underwent trans-thoracic 2D echo, CMR and contrast-enhanced 64-row MDCT for assessment of LVEF within 48 hours of each other. 64-row MDCT LVEF was derived using the Syngo Circulation software; CMR LVEF was by Area Length Ejection Fraction (ALEF) and Simpson method and 2D echo LVEF by Simpson method.Results The LVEF was 49.13 ± 15.91% by 2D echo, 50.72 ± 16.55% (ALEF method) and 47.65 ± 16.58%(Simpson method) by CMR and 50.00 ± 15.93% by 64-row MDCT. LVEF measurements by 64-row MDCT correlated well with LVEF measured with CMR using either the ALEF method (Pearson correlation r = 0.94, P ＜0.01) or Simpson method (r = 0.92, P＜0.01). It also correlated well with LVEF measured using 2D echo (r = 0.80, P ＜ 0.01). Conclusion LVEF measurements by 64-row MDCT correlated well with LVEF measured by CMR and 2D echo. The correlation between 64-row MDCT and CMR was better than the correlation between 2D echo with CMR. Standard data set from a 64-row MDCT coronary study can be reliably used to calculate the LVEF.

The Impact of Obesity on the Left Ventricular Ejection Fraction Using Echocardiography

Global left ventricle chamber function in obese patients is assessed, most commonly, by means of the ejection fraction. The preferred noninvasive modality for evaluating regional wall motion and overall ventricular performance is usually color-flow Doppler transthoracic echocardiography. The aim of this study was to evaluate the relationship of left ventricular ejection fraction to body mass index (BMI) measure of obesity in obese patients by using echocardiography. A prospective cohort study was conducted in the period of July 2012 to September 2014 in the ultrasound department of the Sudan Heart Center in Khartoum-Sudan, among a group of 250 obese participants of acute myocardial infarction (AMI) (67.2% males and 32.8% females) and their ages range from 22 to 86 years;mean age of 41 ± 1.2 years. Echocardiography studies were performed using MyLab 50 XVision-Esaote echocardiography machine equipped with 2.5 MHz phased array probe. Standard Statistical Package for the Social Sciences (SPSS) was used to analyze the results. The mean BMI was 28.6 ± 5.4 kg/m2. Significant relationship is found between left ventricle ejection fraction and BMI (P < 0.001). BMI is a useful statistical tool to track the body size trends in a multicentric population in Sudan. Left ventricular ejection fraction allows ventricular function to be assessed without the need for further body size adjustment.

Clinical efficacy of dapagliflozin in the treatment of type 2 diabetes mellitus with heart failure with mildly reduced ejection fraction

Objective:To observe the clinical efficacy of dapagliflozin in the treatment of type 2 diabetes mellitus(T2DM)complicated with heart failure with mildly reduced ejection fraction(HFmrEF,40%≤LVEF<50%).Methods:A total of 84 patients with T2DM complicated with HFmrEF hospitalized in our hospital from October 2019 to October 2021 were selected,and random number table method was used to divide into the control group and the study group each 42 cases.Both groups used basal hypoglycemic and standardized anti-heart failure therapy,and the study group was treated with dapagliflozin simultaneously.Nine months later,the following indexes were compared between the two groups before and after treatment:the cardiac function indicators:N-terminal pro brain natriuretic peptide(NT-proBNP),left ventricular ejection fraction(LVEF);exercise endurance:6-minute walk distance(6MWD),NYHA cardiac function class,the score of the Minnesota living with heart failure questionnaire(MLHFQ)and the incidence of major adverse cardiovascular events(MACE).Results:Nine months later,the two groups showed decreased NT-proBNP level,increased LVEF,prolonged 6MWD,improved NYHA cardiac function grade,decreased MLHFQ score,and statistically significant differences within both groups compared with before treatment(P<0.05),after treatment significant differences were displayed between the two groups(P<0.05).Less patients had MACE events and adverse drug reactions in the study group compared with the control group.Conclusion:Dapagliflozin in the treatment of T2DM patients with HFmrEF can improve cardiac function indicators,improve exercise endurance,improve NYHA cardiac function class,improve patient's quality of life,and reduce the incidence of MACE events,with no obvious side effects.

The Clinical Association of Left Atrial Function with Left Ventricular Ejection Fraction

The left atrium (LA) has been recognized as a morphophysiological barometer of left ventricular (LV) diastolic dysfunction. Because in the myocardial ischemia cascade where LV diastolic dysfunction often precedes LV systolic dysfunction, the LA which fashions as an early marker of diastolic anomaly, could equally reflect a declining LV function and/or be a good predictor of potential sequelae. We assessed this association of LA function with reduced LV systolic function among hospitalized patients. Among patients with reduced LV ejection fraction, LA passive ejection fraction was lower (0.172 ± 0.12 vs. 0.232 ± 0.14, p = 0.013) whereas LA kinetic energy was higher (6.48 ± 6.3 vs. 4.57 ± 3.5, p = 0.005). Echocardiographic assessment of LA function, therefore, appears correlated with LVEF and could be important when risk stratifying hospitalized patients.

Machine learning algorithm using publicly available echo database for simplified“visual estimation”of left ventricular ejection fraction

BACKGROUND Left ventricular ejection fraction calculation automation typically requires complex algorithms and is dependent of optimal visualization and tracing of endocardial borders.This significantly limits usability in bedside clinical applications,where ultrasound automation is needed most.AIM To create a simple deep learning(DL)regression-type algorithm to visually estimate left ventricular(LV)ejection fraction(EF)from a public database of actual patient echo examinations and compare results to echocardiography laboratory EF calculations.METHODS A simple DL architecture previously proven to perform well on ultrasound image analysis,VGG16,was utilized as a base architecture running within a long short term memory algorithm for sequential image(video)analysis.After obtaining permission to use the Stanford EchoNet-Dynamic database,researchers randomly removed approximately 15%of the approximately 10036 echo apical 4-chamber videos for later performance testing.All database echo examinations were read as part of comprehensive echocardiography study performance and were coupled with EF,end systolic and diastolic volumes,key frames and coordinates for LV endocardial tracing in csv file.To better reflect point-of-care ultrasound(POCUS)clinical settings and time pressure,the algorithm was trained on echo video correlated with calculated ejection fraction without incorporating additional volume,measurement and coordinate data.Seventy percent of the original data was used for algorithm training and 15%for validation during training.The previously randomly separated 15%(1263 echo videos)was used for algorithm performance testing after training completion.Given the inherent variability of echo EF measurement and field standards for evaluating algorithm accuracy,mean absolute error(MAE)and root mean square error(RMSE)calculations were made on algorithm EF results compared to Echo Lab calculated EF.Bland-Atlman calculation was also performed.MAE for skilled echocardiographers has been established to range from 4%to 5%.RESULTS The DL algorithm visually estimated EF had a MAE of 8.08%(95%CI 7.60 to 8.55)suggesting good performance compared to highly skill humans.The RMSE was 11.98 and correlation of 0.348.CONCLUSION This experimental simplified DL algorithm showed promise and proved reasonably accurate at visually estimating LV EF from short real time echo video clips.Less burdensome than complex DL approaches used for EF calculation,such an approach may be more optimal for POCUS settings once improved upon by future research and development.

Effect of exercise on left and right ventricular ejection fraction and wallmotion in patients with coronary artery disease: an ultrafast computed tomography study

To measure the response of left and right ventricular ejection fraction and wall motion to exercise in eighteen patients with angiogl’aphically documented coronary artery disease (CAD) and in twenty-two patients with angiographicallynormal coronary arteries using ultrafast computed tomography(UFCT). Methods: Angiography and UFCT exercise cine studieswere performed for the evaluation of chest pain in all 40 cases, including 18 CAD patients and 22 patients with normal coronary arteries. Results: Of the 18 patients with CAD, 14(78% ) had a≥5% decrease in left ventricular ejection fraction (LVEF) duringexercise by UFCT (P< 0 .001), and 14 (78%) had an abnormal response in left ventricular wall motion during exercise, (aworsened or newly-developed reginal RV wall motion abnormality (RVWMA)) during exercise. In the 22 normal patients, onlyone had a decrease in LVEF > 5%; none had an abnormal response in LV wall motion during peak exercise or a RVWMA at restor during stress. Using a decrease of ≥5 % in LVEF or a LVWMA or RVWMA during stress as a criterion for identifying patientswith CAD, the accuracy was 88% (35/40) with LVEF, 90% (36/40) with LVWMA, and 92% (37/40) with a combination ofLVEF, LVWMA and RVWMA. The sensitivity of RVWMA alone in detecting right coronary artery disease (RCAD) was 60%(6/10) and the specificity was 78% (7/9). Conclusion: Our study suggests that exercise-UFCT appears to be a useful tool for thedetection of CAD in patients with chest pain. The abnormal response of LVEF and exercise-induced LVWMA and RVWMA as determined by UFCT were important predictors CAD. Both LVWMA and RVWMA of important value in identifying patientswith CAN from those with normal coronary arteries, as is RVWMA in defining the existence of RCAD in patients with CAD.

NT-proBNP、TSP-2、hs-CRP在非瓣膜性HFrEF患者中的表达及对短期预后的预测价值

目的探讨N端脑钠肽前体(NT-proBNP)、血小板吸附蛋白2(TSP-2)、超敏C反应蛋白(hs-CRP)在非瓣膜性射血分数降低心力衰竭(HFrEF)患者中的表达及对短期预后预测价值。方法选取2018年1月至2021年12月郑州大学第一附属医院收治的120例非瓣膜性HFrEF患者为HFrEF组,60例非瓣膜性射血分数保留心力衰竭(HFpEF)患者为HFpEF组,60例心功能正常心力衰竭(HF)患者为对照组。对比三组NT-proBNP、TSP-2、hs-CRP水平;根据心功能分级将HFrEF组患者分为心功能Ⅱ级、心功能Ⅲ级组、心功能Ⅳ级组,并对比三组NT-proBNP、TSP-2、hs-CRP水平;分析NT-proBNP、TSP-2、hs-CRP各指标之间的相关性;根据随访结果将HFrEF组患者分为预后良好组和预后不良组,并比较两组患者NT-proBNP、TSP-2、hs-CRP水平;分析影响HFrEF患者预后的多因素;分析NT-proBNP、TSP-2对HFrEF患者的短期预后预测价值。结果三组NT-proBNP、TSP-2、hs-CRP水平为:HFrEF组>HFpEF组>对照组,差异有统计学意义(P<0.05);120例非瓣膜性HFrEF患者中,心功能Ⅱ级38例(31.67%)、心功能Ⅲ级46例(38.33%)、心功能Ⅳ级36例(30.00%);三组NT-proBNP、TSP-2、hs-CRP水平为:心功能Ⅳ级组>心功能Ⅲ级组>心功能Ⅱ级组,差异有统计学意义(P<0.05);非瓣膜性HFrEF患者血清NT-proBNP与TSP-2、hs-CRP呈正相关(P<0.05);120例非瓣膜性HFrEF患者中,预后良好79例(65.83%)、预后不良41例(34.17%);患者NT-proBNP、TSP-2、hs-CRP水平为:预后不良组>预后良好组,差异有统计学意义(P<0.05);Logistic回归分析结果显示,NT-proBNP、TSP-2、hs-CRP高表达是非瓣膜性HFrEF患者预后不良的危险因素(P<0.05);NT-proBNP、TSP-2、hs-CRP单独与联合预测非瓣膜性HFrEF患者预后的AUC为0.779、0.907、0.898、0.948,联合预测的AUC高于NT-proBNP、TSP-2、hs-CRP,差异有统计学意义(P<0.05)。结论NT-proBNP、TSP-2、hs-CRP在非瓣膜性HFrEF患者中高表达,三指标联合检测能较好预测患者短期预后。

沙库巴曲缬沙坦联合达格列净治疗HFrEF患者的效果

目的:观察沙库巴曲缬沙坦联合达格列净治疗射血分数降低心力衰竭(HFrEF)患者的效果。方法:选取2021年5月—2022年5月麻城市人民医院收治的200例HFrEF患者作为研究对象,依据随机数表法将纳入患者分为联合组(n=101)和对照组(n=99)。所有患者均予以常规抗心衰治疗与干预,对照组予以沙库巴曲缬沙坦,联合组在对照组基础上予以达格列净。比较两组疗效、治疗前后心功能[左室射血分数(LVEF)、左室收缩末期内径(LVESD)及左室舒张末期内径(LVEDD)]、炎症因子[超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)及白细胞介素-6(IL-6)]、T淋巴细胞亚群(CD3^(+)、CD8^(+)、CD4^(+)/CD8^(+))、不良反应及心衰再住院率。结果:联合组总有效率95.05%,高于对照组的81.82%,差异有统计学意义(P<0.05);治疗后,两组LVEF、CD3^(+)、CD4^(+)/CD8^(+)较治疗前升高,且联合组高于对照组,两组LVESD、LVEDD、hs-CRP、TNF-α、IL-6、CD8^(+)较治疗前下降,且联合组低于对照组,差异有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05);联合组随访12个月心衰再住院率低于对照组,差异有统计学意义(P<0.05)。结论:沙库巴曲缬沙坦联合达格列净可有效提高HFrEF患者疗效、心功能,降低炎症因子水平,改善免疫功能,降低心衰再住院率,且安全性好。

维立西呱联合重组人脑利钠肽治疗HFrEF伴心房颤动的临床效果研究

目的研究维立西呱联合重组人脑利钠肽治疗射血分数降低的心力衰竭(HFrEF)伴心房颤动的临床效果。方法本研究为回顾性研究,根据治疗方案不同按1:1配对原则将2022年8月至2023年7月郑州大学第一附属医院收治的124例HFrEF伴心房颤动患者分为对照组和研究组各62例。两组患者均行常规治疗,对照组另给予重组人脑利钠肽治疗,研究组则给予维立西呱联合重组人脑利钠肽治疗,均持续治疗6个月。比较两组患者治疗6个月后的治疗效果,以及治疗前和治疗3个月、6个月后的心功能指标[左心室高峰充盈率(LVPER)、左室射血分数(LVEF)、左心室收缩末期内径(LVESD)]、心肌损伤相关指标[可溶性人基质裂解素(sST2)、N末端脑钠肽前体(NT-proBNP)、心肌肌钙蛋白Ⅰ(cTnⅠ)]、运动耐力[无氧域摄氧量(VO2AT)、峰值公斤摄氧量(VO_(2max))、最大运动负荷]、预后相关指标[半乳糖凝集素3(Gal-3)、胱抑素C(CysC)、Periostin蛋白、脂肪细胞型脂肪酸结合蛋白4(FABP4)],同时比较两组患者治疗期间的不良反应发生率和6个月内心力衰竭再入院率。结果治疗6个月后,研究组患者的临床总有效率为93.55%,明显高于对照组的80.65%,差异有统计学意义(P<0.05);治疗3个月、6个月后,研究组患者的LVPER、LVEF明显高于对照组,而LVESD明显低于对照组,差异均有统计学意义(P<0.05);治疗3个月、6个月后,研究组患者的sST2、NT-proBNP、cTnⅠ明显低于对照组,差异均有统计学意义(P<0.05);治疗3个月、6个月后,研究组患者的VO_(2)AT、VO_(2max)、最大运动负荷明显高于对照组,差异均有统计学意义(P<0.05);治疗3个月、6个月后,研究组患者的Gal-3、CysC、Periostin蛋白和FABP4明显低于对照组,差异均有统计学意义(P<0.05);6个月内研究组患者的心力衰竭再入院率为20.97%,明显低于对照组的41.94%,差异有统计学意义(P<0.05);研究组患者治疗期间的不良反应发生率为8.06%,略高于对照组的6.45%,但差异无统计学意义(P>0.05)。结论维立西呱联合重组人脑利钠肽治疗HFrEF伴心房颤动疗效确切,安全性高,可减轻心肌损伤,改善心功能,提高运动耐力,预后良好。