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...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.展开更多
Heart failure(HF)is a major public health problem with a prevalence of 1%-2%in developed countries.The underlying pathophysiology of HF is complex and as a clinical syndrome is characterized by various symptoms and si...Heart failure(HF)is a major public health problem with a prevalence of 1%-2%in developed countries.The underlying pathophysiology of HF is complex and as a clinical syndrome is characterized by various symptoms and signs.HF is classified according to left ventricular ejection fraction(LVEF)and falls into three groups:LVEF≥50%-HF with preserved ejection fraction(HFpEF),LVEF<40%-HF with reduced ejection fraction(HFrEF),LVEF 40%-49%-HF with mid-range ejection fraction.Diagnosing HF is primarily a clinical approach and it is based on anamnesis,physical examination,echocardiogram,radiological findings of the heart and lungs and laboratory tests,including a specific markers of HF-brain natriuretic peptide or N-terminal pro-B-type natriuretic peptide as well as other diagnostic tests in order to elucidate possible etiologies.Updated diagnostic algorithms for HFpEF have been recommended(H2FPEF,HFA-PEFF).New therapeutic options improve clinical outcomes as well as functional status in patients with HFrEF(e.g.,sodium-glucose cotransporter-2-SGLT2 inhibitors)and such progress in treatment of HFrEF patients resulted in new working definition of the term“HF with recovered left ventricular ejection fraction”.In line with rapid development of HF treatment,cardiac rehabilitation becomes an increasingly important part of overall approach to patients with chronic HF for it has been proven that exercise training can relieve symptoms,improve exercise capacity and quality of life as well as reduce disability and hospitalization rates.We gave an overview of latest insights in HF diagnosis and treatment with special emphasize on the important role of cardiac rehabilitation in such patients.展开更多
Hospitalizations for heart failure exceed 1 million per year in both the United States and Europe and more than 90%are due to symptoms and signs of fluid overload.Rates of rehospitalizations or emergency department vi...Hospitalizations for heart failure exceed 1 million per year in both the United States and Europe and more than 90%are due to symptoms and signs of fluid overload.Rates of rehospitalizations or emergency department visit at 60 days are remarkable regardless of whether loop diuretics were administered at low vs high doses or by bolus injection vs continuous infusion.Ultrafiltration(UF)has been considered a promising alternative to stepped diuretic therapy and it consists in the mechanical,adjustable removal of iso-tonic plasma water across a semipermeable membrane with the application of hydrostatic pressure gradient generated by a pump.Fluid removal with ultrafiltration presents several advantages such as elimination of higher amount of sodium with less neurohormonal activation.However,the conflicting results from UF studies highlight that patient selection and fluid removal targets are not completely understood.The best way to assess fluid status and therefore establish the fluid removal target is also still a matter of debate.Herein,we provide an up-to-date systematic review about the role of ultrafiltration among patients with fluid overload and its gaps in daily practice.展开更多
Objectives To observe the efficacy and safety of recombinant human brain natriuretic peptide(rh-BNP) on patients with acute myocardial infarction complicating congestive heart failure.Methods 40 patients with acute my...Objectives To observe the efficacy and safety of recombinant human brain natriuretic peptide(rh-BNP) on patients with acute myocardial infarction complicating congestive heart failure.Methods 40 patients with acute myocardial infarction complicated by congestive heart failure were randomly divided into control group and treatment group of 20 cases.The control group,15 cases of acute anterior myocardial infarction,5 cases of acute inferior wall myocardial infarction, 15 males and 5 females,aged 55-70 years,mean age 58±12 years;treated 16 cases of acute anterior myocardial infarction,4 cases of acute myocardial infarction,16 males and 4 females,aged 56-70 years,mean age 59±11 years;two groups of age,gender,severity of disease and vascular lesions no significant difference and comparable(P】0.05).Conventional group were given aspirin,clopidogrel, statins,Inotropic,diuretic and vasodilator therapy.In the con- ventional treatment group based on the use of recombinant human brain natriuretic peptide(new bios,Tibet Pharmaceutical Co.,Ltd.Chengdu Nuodikang biopharmaceutical production, usage:1.5μg/Kg intravenous injection(impact), then 0.0075μg-0.01μg/(kg·min)infusion rate).Continuous medication 72 h.The clinical symptoms observed for 3 days in patients before treatment and after treatment,heart rate,blood pressure and left ventricular ejection fraction (LVEF) and tumor necrosis factor(TNF-α),brain natriuretic peptide(BNP) levels were measured.Results In control group,8 cases markedly effect,5 cases effect and 7 cases no effect,the total effective rate was 65%;In treatment group,13 cases markedly effect,6 cases effect and 1 cases no effect,the total effective rate was 95%,compared with two groups P New bios treatment group significantly increased cardiac index(CI) in patients with heart failure and left ventricular ejection fraction(LVEF) than the control group(all P【0.05),further reduce the levels of tumor necrosis (TNF-α) and brain natriuretic peptide(BNP).Conclusions rh-BNP can improve symptoms and heart function,reduced plasma tumor necrosis factor(TNF-α) and BNP levels of acute myocardial infarction patients with congestive heart failure,the treatment safe and reliable.As small sample size observed,larger sample to be accumulated to further evaluate its efficacy and safety.展开更多
BACKGROUND Hypoparathyroidism is a rare disease that may occur due to primary or secondary etiologies.The estimated incidence in the United States is 24–37/100000 personyears.Congestive heart failure associated with ...BACKGROUND Hypoparathyroidism is a rare disease that may occur due to primary or secondary etiologies.The estimated incidence in the United States is 24–37/100000 personyears.Congestive heart failure associated with hypocalcemia due to hypoparathyroidism is an even rarer presentation.CASE SUMMARY Here,we present a 64-year-old woman with congestive heart failure following hypocalcemia.The patient was transferred to our emergency department with complaints of rapidly progressive dyspnea,shortness of breath and heaviness of the chest for 4 d.She had a history of undergoing thyroidectomy and partial tracheotomy 2 years prior due to a malignant thyroid tumor.Muscle spasms had been present 1 year ago,and cataracts were treated with intraocular lens replacement in both eyes.Most tests were within normal ranges,except serum calcium at 1.33 mmol/L(2.20–2.65 mmol/L),ionized calcium at 0.69 mmol/L(1.15–1.29 mmol/L),and parathyroid hormone at<1.0 pg/mL(12–88 pg/mL).Echocardiography revealed an ejection fraction of 28.48%.Cardiac function was quickly reversed by restoring the serum calcium concentration.Significant improvements were noted with an ejection fraction of up to 48.50%at follow-up.CONCLUSION For patients with potential hypocalcemia,monitoring calcium levels and dealing with hypocalcemia in time to avoid serious complications are important.展开更多
BACKGROUND Polyneuropathy,organomegaly,endocrinopathy,M-protein,and skin changes(POEMS)syndrome is a rare paraneoplastic syndrome caused by a plasma cell proliferative disorder.The syndrome is characterized by elevate...BACKGROUND Polyneuropathy,organomegaly,endocrinopathy,M-protein,and skin changes(POEMS)syndrome is a rare paraneoplastic syndrome caused by a plasma cell proliferative disorder.The syndrome is characterized by elevated plasma cells,platelets,and vascular endothelial growth factor levels.Although heart disease rarely occurs in POEMS syndrome,the death rate increases sharply after heart failure.We report a patient who initially presented with an endocrine disease and developed congestive heart failure related to POEMS syndrome 9 years later.CASE SUMMARY A 23-year-old woman with no history of menstruation and a 9-year history of type I diabetes reported feeling breathless after activities.She could not lie down and rest at night.Three months prior,she experienced pain and increased tension in her left thigh accompanied by tenderness and edema in both lower extremities.The chief complaint upon hospital admission was that blood sugar has increased for more than 9 years,pain in the left thigh,and edema in both legs for more than 2 mo.After a multisystem evaluation,she was diagnosed with POEMS syndrome.Her echocardiogram showed left ventricular dilation with systolic dysfunction,and the left ventricular ejection fraction was only 38%with severely elevated brain natriuretic peptide.She received a combination of dexamethasone and thalidomide for 1 mo,but her symptoms did not improve.Therefore,we added a two-per-week bortezomib injection.After 2 wk,the patient’s heart function had improved significantly.CONCLUSION This case provides information about the treatment of POEMS syndrome with complications and highlights the challenges of developing a standardized treatment.展开更多
The apoptosis and the expression of p53, bcl-2 and Bax in myocytes of chronic rapid ventricular pacing-induced congestive heart failure (CHF) in rabbits were investigated. The CHF rabbit model (P, n=7) was established...The apoptosis and the expression of p53, bcl-2 and Bax in myocytes of chronic rapid ventricular pacing-induced congestive heart failure (CHF) in rabbits were investigated. The CHF rabbit model (P, n=7) was established by chronic rapid ventricular pacing for 3 weeks. By using TUNEL technique the apoptosis in the myocytes in the rabbit model was studied and the expression of p53, bcl-2 and Bax in myocytes was detected by using immunohistochemical method. Sham-operated (C, n=9) group served as control group. The results showed that there were about 4033± 884.56 apoptotic cells/10 6 myocytes in P group, but no apoptotic cells were found in C group. Myocytes positive for p53 immunoreactivity (18.86±8.48 vs 5.06±0.87, P<0.01) and positive for Bax immunoreactivity (7.15±1.91 vs 0.43±0.09, P<0.01) were increased in P group as compared with those in C group, while the myocytes positive for bcl-2 immunoreactivity (7.08±1.05 vs 14.97±4.47, P<0.01) and the ratio of bcl-2/Bax were decreased in P group as compared with those in C group. Apoptosis was involved in the development of CHF induced by continuously rapid ventricular pacing in rabbit. The expression of p53 and Bax was increased, while the expression of bcl-2 was inhibited. These might play an important role in the acceleration of the apoptosis.展开更多
Fluorescence polarization immunoassay was used to study the chronopharmacokirietics of digoxin in 10 patients with congestive heart failure (CHF) who also served as self-controls. Our results showed that the serum dig...Fluorescence polarization immunoassay was used to study the chronopharmacokirietics of digoxin in 10 patients with congestive heart failure (CHF) who also served as self-controls. Our results showed that the serum digoxin concentration reached peak value 1h after taking digoxin at 7: 00 a. m.,but the serum digoxin concentration reached the peak value 2 h after taking digoxin at 4: 00 p. m.. The average serum digoxin concentration area under curve was greater and the best maintainable time of serum concentration within 24 h after taking digoxin at 4 p. m. longer than those at 7: 00 a. m.. The heart rates were obviously lower and the cardiac function was significantly improved in 4:00 p. m.group.展开更多
Background: One of the risk factors of congestive heart failure that still under investigations is hyperuricemia. It’s still debatable whether it’s an independent risk factor or it’s just a consequence of other dis...Background: One of the risk factors of congestive heart failure that still under investigations is hyperuricemia. It’s still debatable whether it’s an independent risk factor or it’s just a consequence of other disorders associated with cardiovascular diseases like hypertension, diabetes and dyslipidemia. Objective: The aim of our study is to elucidate whether in patients with heart failure serum uric acid level correlates with left ventricular ejection fraction supporting the possibility that the detection of progressive hyperuricemia in these patients may be an indicator of deteriorating cardiac function. Methods: We conducted a prospective study that included 124 studied patients and 26 apparently healthy persons at Coronary care unit and Internal Medicine Department at Sohag University Hospitals. Studied populations were classified into;* Group “I”: newly diagnosed heart failure, * Group “II”: decompensated heart failure on regular treatment, * Group “III”: decompensated heart failure but stopped their treatment from three months, Group “IV”: control group, healthy and age-matched subjects. We studied the association between left ventricular ejection fraction, the severity of congestive heart failure and the serum uric acid levels and the well-known conventional risk factors. Results: The main finding was the significantly higher mean serum uric acid levels in patients with congestive heart failure versus apparently healthy persons with “P value = 0.02”. When we adjusted the serum uric acid with other significant risk factors in the univariate analysis which were age, gender and smoking, serum uric acid was an independent risk factor “P value = 0.04”. There was a significant correlation between serum uric acid level and the severity of congestive heart failure “P value 0.35”. High rates of serum uric acid levels were recorded in patients with reduced ejection fraction. A uric acid level of 8.45 mg/dl was found to be the most appropriate cut-off point with the sensitivity 62% and the specificity 78.5%. Conclusion: Higher serum uric acid levels are significantly correlated with the severity of congestive heart failure and left ventricular ejection fraction. Serum uric acid is an independent risk factor for congestive heart failure.展开更多
Objective To explore the role of serum fibrotic indices including hyaluronic acid (HA), procollagen type III NH_ 2-terminal peptide (PCIIIP), and laminin (LN) in assessing the severity of myocardial fibrosis in chroni...Objective To explore the role of serum fibrotic indices including hyaluronic acid (HA), procollagen type III NH_ 2-terminal peptide (PCIIIP), and laminin (LN) in assessing the severity of myocardial fibrosis in chronic congestive heart failure (CHF).Methods Serum levels of HA, PCIIIP, and LN in 39 patients with CHF[14 with New York Heart Association (NYHA) functional class II, 21 with class III, 4 with class IV]and in 46 patients with NYHA functional class I were assessed by radioimmunoassay.Results The serum concentrations of HA, PCIIIP, and LN were 359.75±84.59 μg/L, 77.88±24.67 μg/L, 86.73±23.90 μg/L in CHF group, and 211.60±54.80 μg/L, 64.82±23.99 μg/L, 82.26±23.98 μg/L in NYHA functional class I group, respectively. The HA level was significantly higher in CHF patients as compared with NYHA functional class I group (P<0.05). However, no difference was found in the levels of PCIIIP and LN between CHF group and NYHA functional class I group. The serum HA concentration was negatively correlated with left ventricular ejection fraction (r=-0.71, P<0.05).Conclusion Serum HA level may act as an indicator for myocardial fibrosis.展开更多
Background and Objectives The relationship between left atrial (LA) size and congestive heart failure (CHF) is well recognized;however, there is little information on the association of pulmonary vein (PV) diameter an...Background and Objectives The relationship between left atrial (LA) size and congestive heart failure (CHF) is well recognized;however, there is little information on the association of pulmonary vein (PV) diameter and CHF.The purpose of this study was to investigate the changes of PV and LA sizes in CHF patients by multislice computed tomography (MSCT) angiography using a new 64-slice scanner. Methods and Results We assessed diameters of PVs ostium and LA by 64-slice MSCT with three-dimensional reconstruction in 25 CHF patients and in 26 age- and sex-matched non-CHF controls. Compared with controls, CHF patients showed significant greater diameters of left superior pulmonary vein (LSPV) and right inferior pulmonary vein (RIPV) in both anteriorposterior(AP) and superior-inferior (SI) directions (P<0.01), significant dilation of right superior pulmonary vein (RSPV) in AP direction (P<0.05), as well as significant increase of LA transverse, AP, and SI diameters (P<0.01). Conclusion Significant dilation of PVs with simultaneous LA enlargement was demonstrated in CHF patients. This anatomic and geometric changes may participate in the perpetuation of AF.展开更多
Congestive heart failure (CHF) has emerged as a major worldwide epidemic and its main causes seem to be the aging of the population and the survival of patients with post-myocardial infarction. Cardiomyocyte dropout (...Congestive heart failure (CHF) has emerged as a major worldwide epidemic and its main causes seem to be the aging of the population and the survival of patients with post-myocardial infarction. Cardiomyocyte dropout (necrosis and apoptosis) plays a critical role in the progress of CHF; thus treatment of CHF by exogenous cell implantation will be a promising medical approach. In the acute phase of cardiac damage cardiac stem cells (CSCs) within the heart divide symmetrically and/or asym-metrically in response to the change of heart homeostasis, and at the same time homing of bone marrow stem cells (BMCs) to injured area is thought to occur, which not only reconstitutes CSC population to normal levels but also repairs the heart by dif-ferentiation into cardiac tissue. So far, basic studies by using potential sources such as BMCs and CSCs to treat animal CHF have shown improved ventricular remodelling and heart function. Recently, however, a few of randomized, double-blind, pla-cebo-controlled clinical trials demonstrated mixed results in heart failure with BMC therapy during acute myocardial infarction.展开更多
Generalized edema (anasarca) is common in nephrotic syndrome which rarely produces shortness of breath. Increased shortness of breath associated with rapid weight gain and generalized edema signify congestive heart fa...Generalized edema (anasarca) is common in nephrotic syndrome which rarely produces shortness of breath. Increased shortness of breath associated with rapid weight gain and generalized edema signify congestive heart failure (CHF). Loop diuretics consisting of furosemide (Lasix®), bumetanide (Bumex®), torsemide (Demadex®) or ethacrynic acid (Edecrin) are effective diuretics to treat anasarca. However, efficacy varies depending on the renal function. Loop diuretic given orally or by intravenous boluses produce good urine output but overall response in reducing edema or shortness of breath as in CHF is less than optimum. Although literature information is very limited, continuous bumetanide infusion for 72 to 96 hours is found to be very effective in producing subjective relief of shortness of breath as well as objective improvement such as reduction in brain natriuretic peptide in CHF and improved kidney function, so that diuresis is sustained even after discontinuation of the infusion. Decrease in kidney function and electrolytes and acid-base imbalance are common but they are reversible with prompt replacement therapy. They pose no threat to life.展开更多
Systemic inflammatory response syndrome (SIRS) is one of the key accompanied states that worsens severity of congestive heart failure (CHF) and leads refractory CHF to conventional therapy. We investigated whether the...Systemic inflammatory response syndrome (SIRS) is one of the key accompanied states that worsens severity of congestive heart failure (CHF) and leads refractory CHF to conventional therapy. We investigated whether the cessation of the symptoms and signs of SIRS prevents the progression of the CHF caused by chronic aortic stenosis in rabbits. 8 weeks after induced CHF by left descending coronary artery stenosis, all animals were randomly assigned into 3 groups: control (CG)—without therapy (infusion of 0.9% NaCl);main I— receive mg/kg of Adenocin®dissolved in water for injection i.v., once daily and main II—animals receive 0.25 mg/kg enalapril i.m, furosemide 1.0 mg/kg i.v. (bolus) and pimobendan 0.1 mg/kg i.v. once daily. All animals were euthanized after 14 days of the beginning of treatment. Long-term aortic stenosis leads to a simultaneously developing of CHF, diagnosed by developing cardiac hypertrophy, increased level of BNP and myocardial oedema and SIRS, confirmed by increasing markers and symptoms of endotoxemia, tissue dysoxia and decreasing reserve ability of intrinsic defense systems. Restoration of myocardium redox-potential and level of NAD under treatment with Adenocin®leads unlike combined treatment with enalapril, furosemide and pimobendan to restoration, the regulatory pathways of TNF-α synthesis, cessation of the hypoxic/ischemic, lysosomal dysfunction and free radical-induced damage in myocardium and symptoms of CHF. Potential important link between cellular metabolism (hypoxia/ischemia), endotoxemia and disturbances in intrinsic defense system is the level of redox-potentail, NAD/NADH in myocardium. Influence of oxidized form of NAD-containing positive inotropic drug Adenocin®leads to the decreasing symptoms of CHF and beneficial action occurs on all the key links of SIRS.展开更多
Hydrostatic pulmonary edema is as an abnormal in-crease in extravascular water secondary to elevatedpressure in the pulmonary circulation, due to conges-tive heart failure or intravascular volume overload.Diagnosis of...Hydrostatic pulmonary edema is as an abnormal in-crease in extravascular water secondary to elevatedpressure in the pulmonary circulation, due to conges-tive heart failure or intravascular volume overload.Diagnosis of hydrostatic pulmonary edema is usuallybased on clinical signs associated to conventional ra-diography findings. Interpretation of radiologic signsof cardiogenic pulmonary edema are often question-able and subject. For a bedside prompt evaluation,lung ultrasound(LUS) may assess pulmonary conges-tion through the evaluation of vertical reverberationartifacts, known as B-lines. These artifacts are relatedto multiple minimal acoustic interfaces between smallwater-rich structures and alveolar air, as it happens incase of thickened interlobular septa due to increase of extravascular lung water. The number, diffusion and in-tensity of B lines correlates with both the radiologic andinvasive estimate of extravascular lung water. The inte-gration of conventional chest radiograph with LUS canbe very helpful to obtain the correct diagnosis. Com-puted tomography(CT) is of limited use in the work upof cardiogenic pulmonary edema, due to its high cost,little use in the emergencies and radiation exposure.However, a deep knowledge of CT signs of pulmonaryedema is crucial when other similar pulmonary condi-tions may occasionally be in the differential diagnosis.展开更多
The present study investigated the application of echocardiography to evaluation of cardiac dyssynchrony in patients with congestive heart failure(CHF). A total of 348 consecutive CHF patients who were admitted for ca...The present study investigated the application of echocardiography to evaluation of cardiac dyssynchrony in patients with congestive heart failure(CHF). A total of 348 consecutive CHF patients who were admitted for cardiac resynchronization(CRT) and presented with low ejection fraction(EF) and wide QRS duration were enrolled in this study, along with 388 healthy individuals. Dyssynchrony was assessed based on filling time ratio(FT/RR), left ventricular pre-ejection delay(PED), interventricular mechanical delay(IVMD), longitudinal opposing wall delay(LOWD) and radial septal to posterior wall delay(RSPWD). Response to CRT was defined as a ≥15% increase in EF. The results showed that FT/RR was decreased while PED, IVMD, LOWD and RSPWD were increased in the CHF group compared with the control group(P<0.01). In the CHF group, FT/RR was negatively correlated with the QRS duration, LV end-diastolic diameter(LVESd), LV end-diastolic volume(LVEDV) and LV end-systolic volume(LVESV)(P<0.01), but positively with the LVEF(P<0.01). Additionally, PED, IVMD, LOWD and RSPWD were positively correlated with the QRS duration, LVESd, LVEDV and LVESV(P<0.01), but negatively with the LVEF(P<0.01). The CHF group was divided into three subgroups according to the varying degrees of LVEF. FT/RR decreased successively from the LVEF-1 group to the LVEF-2 group to the LVEF-3 group, while the PED, IVMD, LOWD and RSPWD successively increased in the same order(P<0.01). The CHF group was divided into three subgroups according to the varying degrees of QRS duration, and FT/RR decreased successively in a sequence from the QRS-1 group to the QRS-2 group to the QRS-3 group, while the PED, IVMD, LOWD and RSPWD successively increased in the same order(P<0.01). Speckle tracking radial dyssynchrony ≥130 ms was predictive of an EF response in patients in QRS-1 group(78% sensitivity, 83% specificity), those in QRS-2 group(83% sensitivity, 77% specificity) and in QRS-3 group(89% sensitivity, 79% specificity). In conclusion, echocardiography is a convenient and sensitive method for evaluating cardiac dyssynchrony in patients with CHF.展开更多
文摘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.
文摘Heart failure(HF)is a major public health problem with a prevalence of 1%-2%in developed countries.The underlying pathophysiology of HF is complex and as a clinical syndrome is characterized by various symptoms and signs.HF is classified according to left ventricular ejection fraction(LVEF)and falls into three groups:LVEF≥50%-HF with preserved ejection fraction(HFpEF),LVEF<40%-HF with reduced ejection fraction(HFrEF),LVEF 40%-49%-HF with mid-range ejection fraction.Diagnosing HF is primarily a clinical approach and it is based on anamnesis,physical examination,echocardiogram,radiological findings of the heart and lungs and laboratory tests,including a specific markers of HF-brain natriuretic peptide or N-terminal pro-B-type natriuretic peptide as well as other diagnostic tests in order to elucidate possible etiologies.Updated diagnostic algorithms for HFpEF have been recommended(H2FPEF,HFA-PEFF).New therapeutic options improve clinical outcomes as well as functional status in patients with HFrEF(e.g.,sodium-glucose cotransporter-2-SGLT2 inhibitors)and such progress in treatment of HFrEF patients resulted in new working definition of the term“HF with recovered left ventricular ejection fraction”.In line with rapid development of HF treatment,cardiac rehabilitation becomes an increasingly important part of overall approach to patients with chronic HF for it has been proven that exercise training can relieve symptoms,improve exercise capacity and quality of life as well as reduce disability and hospitalization rates.We gave an overview of latest insights in HF diagnosis and treatment with special emphasize on the important role of cardiac rehabilitation in such patients.
文摘Hospitalizations for heart failure exceed 1 million per year in both the United States and Europe and more than 90%are due to symptoms and signs of fluid overload.Rates of rehospitalizations or emergency department visit at 60 days are remarkable regardless of whether loop diuretics were administered at low vs high doses or by bolus injection vs continuous infusion.Ultrafiltration(UF)has been considered a promising alternative to stepped diuretic therapy and it consists in the mechanical,adjustable removal of iso-tonic plasma water across a semipermeable membrane with the application of hydrostatic pressure gradient generated by a pump.Fluid removal with ultrafiltration presents several advantages such as elimination of higher amount of sodium with less neurohormonal activation.However,the conflicting results from UF studies highlight that patient selection and fluid removal targets are not completely understood.The best way to assess fluid status and therefore establish the fluid removal target is also still a matter of debate.Herein,we provide an up-to-date systematic review about the role of ultrafiltration among patients with fluid overload and its gaps in daily practice.
文摘Objectives To observe the efficacy and safety of recombinant human brain natriuretic peptide(rh-BNP) on patients with acute myocardial infarction complicating congestive heart failure.Methods 40 patients with acute myocardial infarction complicated by congestive heart failure were randomly divided into control group and treatment group of 20 cases.The control group,15 cases of acute anterior myocardial infarction,5 cases of acute inferior wall myocardial infarction, 15 males and 5 females,aged 55-70 years,mean age 58±12 years;treated 16 cases of acute anterior myocardial infarction,4 cases of acute myocardial infarction,16 males and 4 females,aged 56-70 years,mean age 59±11 years;two groups of age,gender,severity of disease and vascular lesions no significant difference and comparable(P】0.05).Conventional group were given aspirin,clopidogrel, statins,Inotropic,diuretic and vasodilator therapy.In the con- ventional treatment group based on the use of recombinant human brain natriuretic peptide(new bios,Tibet Pharmaceutical Co.,Ltd.Chengdu Nuodikang biopharmaceutical production, usage:1.5μg/Kg intravenous injection(impact), then 0.0075μg-0.01μg/(kg·min)infusion rate).Continuous medication 72 h.The clinical symptoms observed for 3 days in patients before treatment and after treatment,heart rate,blood pressure and left ventricular ejection fraction (LVEF) and tumor necrosis factor(TNF-α),brain natriuretic peptide(BNP) levels were measured.Results In control group,8 cases markedly effect,5 cases effect and 7 cases no effect,the total effective rate was 65%;In treatment group,13 cases markedly effect,6 cases effect and 1 cases no effect,the total effective rate was 95%,compared with two groups P New bios treatment group significantly increased cardiac index(CI) in patients with heart failure and left ventricular ejection fraction(LVEF) than the control group(all P【0.05),further reduce the levels of tumor necrosis (TNF-α) and brain natriuretic peptide(BNP).Conclusions rh-BNP can improve symptoms and heart function,reduced plasma tumor necrosis factor(TNF-α) and BNP levels of acute myocardial infarction patients with congestive heart failure,the treatment safe and reliable.As small sample size observed,larger sample to be accumulated to further evaluate its efficacy and safety.
基金National Key R&D Program of Chi na,No.2018YFF0301103.
文摘BACKGROUND Hypoparathyroidism is a rare disease that may occur due to primary or secondary etiologies.The estimated incidence in the United States is 24–37/100000 personyears.Congestive heart failure associated with hypocalcemia due to hypoparathyroidism is an even rarer presentation.CASE SUMMARY Here,we present a 64-year-old woman with congestive heart failure following hypocalcemia.The patient was transferred to our emergency department with complaints of rapidly progressive dyspnea,shortness of breath and heaviness of the chest for 4 d.She had a history of undergoing thyroidectomy and partial tracheotomy 2 years prior due to a malignant thyroid tumor.Muscle spasms had been present 1 year ago,and cataracts were treated with intraocular lens replacement in both eyes.Most tests were within normal ranges,except serum calcium at 1.33 mmol/L(2.20–2.65 mmol/L),ionized calcium at 0.69 mmol/L(1.15–1.29 mmol/L),and parathyroid hormone at<1.0 pg/mL(12–88 pg/mL).Echocardiography revealed an ejection fraction of 28.48%.Cardiac function was quickly reversed by restoring the serum calcium concentration.Significant improvements were noted with an ejection fraction of up to 48.50%at follow-up.CONCLUSION For patients with potential hypocalcemia,monitoring calcium levels and dealing with hypocalcemia in time to avoid serious complications are important.
文摘BACKGROUND Polyneuropathy,organomegaly,endocrinopathy,M-protein,and skin changes(POEMS)syndrome is a rare paraneoplastic syndrome caused by a plasma cell proliferative disorder.The syndrome is characterized by elevated plasma cells,platelets,and vascular endothelial growth factor levels.Although heart disease rarely occurs in POEMS syndrome,the death rate increases sharply after heart failure.We report a patient who initially presented with an endocrine disease and developed congestive heart failure related to POEMS syndrome 9 years later.CASE SUMMARY A 23-year-old woman with no history of menstruation and a 9-year history of type I diabetes reported feeling breathless after activities.She could not lie down and rest at night.Three months prior,she experienced pain and increased tension in her left thigh accompanied by tenderness and edema in both lower extremities.The chief complaint upon hospital admission was that blood sugar has increased for more than 9 years,pain in the left thigh,and edema in both legs for more than 2 mo.After a multisystem evaluation,she was diagnosed with POEMS syndrome.Her echocardiogram showed left ventricular dilation with systolic dysfunction,and the left ventricular ejection fraction was only 38%with severely elevated brain natriuretic peptide.She received a combination of dexamethasone and thalidomide for 1 mo,but her symptoms did not improve.Therefore,we added a two-per-week bortezomib injection.After 2 wk,the patient’s heart function had improved significantly.CONCLUSION This case provides information about the treatment of POEMS syndrome with complications and highlights the challenges of developing a standardized treatment.
文摘The apoptosis and the expression of p53, bcl-2 and Bax in myocytes of chronic rapid ventricular pacing-induced congestive heart failure (CHF) in rabbits were investigated. The CHF rabbit model (P, n=7) was established by chronic rapid ventricular pacing for 3 weeks. By using TUNEL technique the apoptosis in the myocytes in the rabbit model was studied and the expression of p53, bcl-2 and Bax in myocytes was detected by using immunohistochemical method. Sham-operated (C, n=9) group served as control group. The results showed that there were about 4033± 884.56 apoptotic cells/10 6 myocytes in P group, but no apoptotic cells were found in C group. Myocytes positive for p53 immunoreactivity (18.86±8.48 vs 5.06±0.87, P<0.01) and positive for Bax immunoreactivity (7.15±1.91 vs 0.43±0.09, P<0.01) were increased in P group as compared with those in C group, while the myocytes positive for bcl-2 immunoreactivity (7.08±1.05 vs 14.97±4.47, P<0.01) and the ratio of bcl-2/Bax were decreased in P group as compared with those in C group. Apoptosis was involved in the development of CHF induced by continuously rapid ventricular pacing in rabbit. The expression of p53 and Bax was increased, while the expression of bcl-2 was inhibited. These might play an important role in the acceleration of the apoptosis.
文摘Fluorescence polarization immunoassay was used to study the chronopharmacokirietics of digoxin in 10 patients with congestive heart failure (CHF) who also served as self-controls. Our results showed that the serum digoxin concentration reached peak value 1h after taking digoxin at 7: 00 a. m.,but the serum digoxin concentration reached the peak value 2 h after taking digoxin at 4: 00 p. m.. The average serum digoxin concentration area under curve was greater and the best maintainable time of serum concentration within 24 h after taking digoxin at 4 p. m. longer than those at 7: 00 a. m.. The heart rates were obviously lower and the cardiac function was significantly improved in 4:00 p. m.group.
文摘Background: One of the risk factors of congestive heart failure that still under investigations is hyperuricemia. It’s still debatable whether it’s an independent risk factor or it’s just a consequence of other disorders associated with cardiovascular diseases like hypertension, diabetes and dyslipidemia. Objective: The aim of our study is to elucidate whether in patients with heart failure serum uric acid level correlates with left ventricular ejection fraction supporting the possibility that the detection of progressive hyperuricemia in these patients may be an indicator of deteriorating cardiac function. Methods: We conducted a prospective study that included 124 studied patients and 26 apparently healthy persons at Coronary care unit and Internal Medicine Department at Sohag University Hospitals. Studied populations were classified into;* Group “I”: newly diagnosed heart failure, * Group “II”: decompensated heart failure on regular treatment, * Group “III”: decompensated heart failure but stopped their treatment from three months, Group “IV”: control group, healthy and age-matched subjects. We studied the association between left ventricular ejection fraction, the severity of congestive heart failure and the serum uric acid levels and the well-known conventional risk factors. Results: The main finding was the significantly higher mean serum uric acid levels in patients with congestive heart failure versus apparently healthy persons with “P value = 0.02”. When we adjusted the serum uric acid with other significant risk factors in the univariate analysis which were age, gender and smoking, serum uric acid was an independent risk factor “P value = 0.04”. There was a significant correlation between serum uric acid level and the severity of congestive heart failure “P value 0.35”. High rates of serum uric acid levels were recorded in patients with reduced ejection fraction. A uric acid level of 8.45 mg/dl was found to be the most appropriate cut-off point with the sensitivity 62% and the specificity 78.5%. Conclusion: Higher serum uric acid levels are significantly correlated with the severity of congestive heart failure and left ventricular ejection fraction. Serum uric acid is an independent risk factor for congestive heart failure.
文摘Objective To explore the role of serum fibrotic indices including hyaluronic acid (HA), procollagen type III NH_ 2-terminal peptide (PCIIIP), and laminin (LN) in assessing the severity of myocardial fibrosis in chronic congestive heart failure (CHF).Methods Serum levels of HA, PCIIIP, and LN in 39 patients with CHF[14 with New York Heart Association (NYHA) functional class II, 21 with class III, 4 with class IV]and in 46 patients with NYHA functional class I were assessed by radioimmunoassay.Results The serum concentrations of HA, PCIIIP, and LN were 359.75±84.59 μg/L, 77.88±24.67 μg/L, 86.73±23.90 μg/L in CHF group, and 211.60±54.80 μg/L, 64.82±23.99 μg/L, 82.26±23.98 μg/L in NYHA functional class I group, respectively. The HA level was significantly higher in CHF patients as compared with NYHA functional class I group (P<0.05). However, no difference was found in the levels of PCIIIP and LN between CHF group and NYHA functional class I group. The serum HA concentration was negatively correlated with left ventricular ejection fraction (r=-0.71, P<0.05).Conclusion Serum HA level may act as an indicator for myocardial fibrosis.
文摘Background and Objectives The relationship between left atrial (LA) size and congestive heart failure (CHF) is well recognized;however, there is little information on the association of pulmonary vein (PV) diameter and CHF.The purpose of this study was to investigate the changes of PV and LA sizes in CHF patients by multislice computed tomography (MSCT) angiography using a new 64-slice scanner. Methods and Results We assessed diameters of PVs ostium and LA by 64-slice MSCT with three-dimensional reconstruction in 25 CHF patients and in 26 age- and sex-matched non-CHF controls. Compared with controls, CHF patients showed significant greater diameters of left superior pulmonary vein (LSPV) and right inferior pulmonary vein (RIPV) in both anteriorposterior(AP) and superior-inferior (SI) directions (P<0.01), significant dilation of right superior pulmonary vein (RSPV) in AP direction (P<0.05), as well as significant increase of LA transverse, AP, and SI diameters (P<0.01). Conclusion Significant dilation of PVs with simultaneous LA enlargement was demonstrated in CHF patients. This anatomic and geometric changes may participate in the perpetuation of AF.
基金Project (No. 20060400200) supported by the Postdoctoral ScienceFoundation, China
文摘Congestive heart failure (CHF) has emerged as a major worldwide epidemic and its main causes seem to be the aging of the population and the survival of patients with post-myocardial infarction. Cardiomyocyte dropout (necrosis and apoptosis) plays a critical role in the progress of CHF; thus treatment of CHF by exogenous cell implantation will be a promising medical approach. In the acute phase of cardiac damage cardiac stem cells (CSCs) within the heart divide symmetrically and/or asym-metrically in response to the change of heart homeostasis, and at the same time homing of bone marrow stem cells (BMCs) to injured area is thought to occur, which not only reconstitutes CSC population to normal levels but also repairs the heart by dif-ferentiation into cardiac tissue. So far, basic studies by using potential sources such as BMCs and CSCs to treat animal CHF have shown improved ventricular remodelling and heart function. Recently, however, a few of randomized, double-blind, pla-cebo-controlled clinical trials demonstrated mixed results in heart failure with BMC therapy during acute myocardial infarction.
文摘Generalized edema (anasarca) is common in nephrotic syndrome which rarely produces shortness of breath. Increased shortness of breath associated with rapid weight gain and generalized edema signify congestive heart failure (CHF). Loop diuretics consisting of furosemide (Lasix®), bumetanide (Bumex®), torsemide (Demadex®) or ethacrynic acid (Edecrin) are effective diuretics to treat anasarca. However, efficacy varies depending on the renal function. Loop diuretic given orally or by intravenous boluses produce good urine output but overall response in reducing edema or shortness of breath as in CHF is less than optimum. Although literature information is very limited, continuous bumetanide infusion for 72 to 96 hours is found to be very effective in producing subjective relief of shortness of breath as well as objective improvement such as reduction in brain natriuretic peptide in CHF and improved kidney function, so that diuresis is sustained even after discontinuation of the infusion. Decrease in kidney function and electrolytes and acid-base imbalance are common but they are reversible with prompt replacement therapy. They pose no threat to life.
文摘Systemic inflammatory response syndrome (SIRS) is one of the key accompanied states that worsens severity of congestive heart failure (CHF) and leads refractory CHF to conventional therapy. We investigated whether the cessation of the symptoms and signs of SIRS prevents the progression of the CHF caused by chronic aortic stenosis in rabbits. 8 weeks after induced CHF by left descending coronary artery stenosis, all animals were randomly assigned into 3 groups: control (CG)—without therapy (infusion of 0.9% NaCl);main I— receive mg/kg of Adenocin®dissolved in water for injection i.v., once daily and main II—animals receive 0.25 mg/kg enalapril i.m, furosemide 1.0 mg/kg i.v. (bolus) and pimobendan 0.1 mg/kg i.v. once daily. All animals were euthanized after 14 days of the beginning of treatment. Long-term aortic stenosis leads to a simultaneously developing of CHF, diagnosed by developing cardiac hypertrophy, increased level of BNP and myocardial oedema and SIRS, confirmed by increasing markers and symptoms of endotoxemia, tissue dysoxia and decreasing reserve ability of intrinsic defense systems. Restoration of myocardium redox-potential and level of NAD under treatment with Adenocin®leads unlike combined treatment with enalapril, furosemide and pimobendan to restoration, the regulatory pathways of TNF-α synthesis, cessation of the hypoxic/ischemic, lysosomal dysfunction and free radical-induced damage in myocardium and symptoms of CHF. Potential important link between cellular metabolism (hypoxia/ischemia), endotoxemia and disturbances in intrinsic defense system is the level of redox-potentail, NAD/NADH in myocardium. Influence of oxidized form of NAD-containing positive inotropic drug Adenocin®leads to the decreasing symptoms of CHF and beneficial action occurs on all the key links of SIRS.
文摘Hydrostatic pulmonary edema is as an abnormal in-crease in extravascular water secondary to elevatedpressure in the pulmonary circulation, due to conges-tive heart failure or intravascular volume overload.Diagnosis of hydrostatic pulmonary edema is usuallybased on clinical signs associated to conventional ra-diography findings. Interpretation of radiologic signsof cardiogenic pulmonary edema are often question-able and subject. For a bedside prompt evaluation,lung ultrasound(LUS) may assess pulmonary conges-tion through the evaluation of vertical reverberationartifacts, known as B-lines. These artifacts are relatedto multiple minimal acoustic interfaces between smallwater-rich structures and alveolar air, as it happens incase of thickened interlobular septa due to increase of extravascular lung water. The number, diffusion and in-tensity of B lines correlates with both the radiologic andinvasive estimate of extravascular lung water. The inte-gration of conventional chest radiograph with LUS canbe very helpful to obtain the correct diagnosis. Com-puted tomography(CT) is of limited use in the work upof cardiogenic pulmonary edema, due to its high cost,little use in the emergencies and radiation exposure.However, a deep knowledge of CT signs of pulmonaryedema is crucial when other similar pulmonary condi-tions may occasionally be in the differential diagnosis.
文摘The present study investigated the application of echocardiography to evaluation of cardiac dyssynchrony in patients with congestive heart failure(CHF). A total of 348 consecutive CHF patients who were admitted for cardiac resynchronization(CRT) and presented with low ejection fraction(EF) and wide QRS duration were enrolled in this study, along with 388 healthy individuals. Dyssynchrony was assessed based on filling time ratio(FT/RR), left ventricular pre-ejection delay(PED), interventricular mechanical delay(IVMD), longitudinal opposing wall delay(LOWD) and radial septal to posterior wall delay(RSPWD). Response to CRT was defined as a ≥15% increase in EF. The results showed that FT/RR was decreased while PED, IVMD, LOWD and RSPWD were increased in the CHF group compared with the control group(P<0.01). In the CHF group, FT/RR was negatively correlated with the QRS duration, LV end-diastolic diameter(LVESd), LV end-diastolic volume(LVEDV) and LV end-systolic volume(LVESV)(P<0.01), but positively with the LVEF(P<0.01). Additionally, PED, IVMD, LOWD and RSPWD were positively correlated with the QRS duration, LVESd, LVEDV and LVESV(P<0.01), but negatively with the LVEF(P<0.01). The CHF group was divided into three subgroups according to the varying degrees of LVEF. FT/RR decreased successively from the LVEF-1 group to the LVEF-2 group to the LVEF-3 group, while the PED, IVMD, LOWD and RSPWD successively increased in the same order(P<0.01). The CHF group was divided into three subgroups according to the varying degrees of QRS duration, and FT/RR decreased successively in a sequence from the QRS-1 group to the QRS-2 group to the QRS-3 group, while the PED, IVMD, LOWD and RSPWD successively increased in the same order(P<0.01). Speckle tracking radial dyssynchrony ≥130 ms was predictive of an EF response in patients in QRS-1 group(78% sensitivity, 83% specificity), those in QRS-2 group(83% sensitivity, 77% specificity) and in QRS-3 group(89% sensitivity, 79% specificity). In conclusion, echocardiography is a convenient and sensitive method for evaluating cardiac dyssynchrony in patients with CHF.