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.

Hyperglycemia is associated with increased length of stay and total cost in patients hospitalized for congestive heart failure

Objectives: Hyperglycemia is a well-known marker of poor clinical outcomes in acute myocardial infarction and critical illness;however, its effect in congestive heart failure (CHF) is controversial. We hypothesized that persistent hyperglycemia is associated with increased length of stay (LOS) and increased total cost in patients admitted with CHF. Methods: We studied 203 consecutive patients admitted with a primary diagnosis of CHF. Patient characteristics, admission glucose, mean blood glucose (MBG) during the entire hospital stay, length of stay, total cost, and readmission rates were assessed. Persistent hyperglycemia was defined as a MBG level ≥140 mg/dl. Results:Patients with persistent hyperglycemia had longer mean LOS (8.1 vs 5.2 days, p = 0.001) and higher total hospital costs (median $8940 vs $6892, p = 0.01) independent of diabetes status. Similarly, prolonged hospital stay >7 days (38% vs 21%;p = 0.01) and total cost >$10,000/patient (46% vs 29%;p = 0.01) were seen more commonly in patients with poor glucometrics. Neither admission glucose >140 mg/ dL or diabetes status was predictive of total costs or LOS. In multivariate linear regression, only MBG ≥ 140 mg/dl was associated with increased LOS and total cost. Patients with persistent hyperglycemia also had higher 6 months all-cause readmission rates (51% vs 37%;p = 0.03). Conclusion: Persistent hyperglycemia (MBG > 140 mg/dL), but not admission glucose, was associated with increased LOS, total cost and readmission rates independent of diabetes status. Our study emphasizes the need to further examine the role of glycemic control in patients admitted with CHF.

Severity of Symptoms of Systemic Inflammatory Response Syndrome and Congestive Heart Failure Caused by Chronic Aortic Stenosis and Its Pharmacological Correction

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&reg;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&reg;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&reg;leads to the decreasing symptoms of CHF and beneficial action occurs on all the key links of SIRS.

The role of B-type natriuretic peptide in the evaluation of congestive heart failure patients in emergency department

Aim: Congestive heart failure (CHF) is a severe cardiovascular disorder seen in the Emergency Department (ED). B-type Natriuretic Peptide (BNP) is usually ordered to evaluate the CHF severity. However, it is difficult to interpret serum BNP level when different clinical entities existed. The aim of this study is to illustrate the correlation between serum BNP level and relevant clinical variables and further determine the role of serum BNP in different CHF patients. Methods: Univariate comparisons between 26 clinical variables and serum BNP level were analyzed. In order to avoid confounding factors, potential independent clinical variables were analyzed together using multivariate regression. Results: 529 CHF patients were reviewed and divided into different groups by 26 clinical variables. Serum BNP levels were found statistically significant different by univariate compareson between groups divided by 8 clinical variables that included obesity, diastolic/systolic heart failure (HF), serum blood urea nitrogen (BUN) level, serum creatinine (Cr) level, serum sodium (Na) level, patients taking loop diuretics, history of cerebrovascular accident (CVA), and history of dementia. Among all 8 clinical variables, obesity, serum BUN, Cr level, and diastolic/systolic HF had weak-to-moderate correlation effects with serum BNP level by correlation coefficient analysis. However, only obesity and dia- stolic/systolic HF were two moderately stronger clini- cal variables that can affect the serum BNP levels by multivariate regression. Analyzing CHF patients separately by obesity and diastolic/systolic HF subsets showed longer hospitalization in diastolic HF patients with relatively higher serum Cr level. In addition, poor correlation was found between serum BNP level and length of hospitalization (LOH) as well. Conclusion: High variability of serum BNP levels exists in CHF patients with weak-to-moderate correlation effects particularly on obesity and diastolic/systolic HF.It is recommended that physicians should be cautious on interpreting BNP in different CHF populations.

Effectiveness of chest radiography,lung ultrasound and thoracic computed tomography in the diagnosis of congestive heart failure

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.

Safety and predictors of adherence of a new rehabilitation program for older women with congestive heart failure

ObjectivesTo 与充血的心失败(CHF ) 为老妇人估计一个心脏的康复节目的安全并且决定有 CHF 的超过 65 岁的某些因素影响 adherence.MethodsWomen 是否出席了 physiotherapist 监督的一个锻练节目。生活的质量被纽约心协会(NYHA ) 班被明尼苏达生活与心失败问询表(MLHFQ ) 和疾病的严厉测量。题目会议被分类进出席了 90% 的那些或更多，出席了不到 90%sessions.ResultsFifty 一个题目的那些被学习。八个题目没出席任何会议。43 个参加者，出席的会议的平均百分比是 87% 。在年龄， MLHFQ 或 NYHA 班的二个组之间没有重要差别。仅仅从有的 280 参加者 attendances.ConclusionsThe 节目有一个不利事件在这张人口的坚持的高水平。班没在会话出席上影响的年龄， MLHFQ 或 NYHA。我们的数据建议这个节目为这张人口是安全的。进一步的研究被需要决定出席的另外的预言者和安全问题和长期的坚持的考试在这张人口锻练。

Serum uric acid as an index of impaired renal function in congestive heart failure

BackgroundHyperuricemia 经常是在有心失败的病人的现在。许多病理学的条件例如织物局部缺血，肾的功能缺陷，心脏的功能缺陷，新陈代谢的症候群，和煽动性的地位，可以影响尿酸(UA ) 新陈代谢。这研究是回顾地在心 failure.MethodsWe 估计他们的潜在的关系到 UA 新陈代谢估计的临床的特征， echocardiological ，肾，与充血的心失败在随机选择的成年人的一个大队在心血管的疾病和 UA 新陈代谢根据他们的参与的以前的证据选择的新陈代谢、煽动性的变量( n = 553 )。由索引聚类，那些变量用因素 analysis.ResultsIn 因素分析被探索，尿酸(SUA ) 形成了的浆液包括了浆液 creatinine (SCr ) 和血脲氮(甜面包) 的肾的功能的变量的主要的簇的部分。在有充血的心失败的病人的变量之间的 Univariate 关联系数证明为 SUA 的最强壮的关联与甜面包(r = 0.48， P &#x0003c；0.001 ) 并且 SCr (r = 0.47， P &#x0003c；0.001 ).ConclusionsThere 是在 SUA 层次和在有充血的心失败的病人的肾的功能的措施之间的一种反的关系。在 SUA 和 SCr 和甜面包层次之间的强壮的关联建议提高的 SUA 集中在心失败反映肾的功能的一个缺陷。

Deteriorated function of cutaneous microcirculation in chronic congestive heart failure

背景长期的充血的心失败是在外部 microcirculation 导致机能障碍的一个复杂条件。我们以前证明了那脉管的反应与增加年龄被减少。在这研究，我们与严重的长期的心失败检查了一组很老的病人测试脉管的功能被心失败和老化的联合进一步损害的假设。方法皮肤的前臂血流动被激光 Doppler flowmetry 测量并且在三之中比较了组：组织 1 (n = 20，吝啬的 +/- SE：85.5 +/- 4 年) ，有纽约心协会班 IV (NYHA IV ) 并且与 NT-proBNP 的心失败病人铺平 5000 ng/L；组织 2 (n = 15，吝啬的 +/- SE：76.5 +/- 2 年) ，有 NYHA II 和 NT-proBNP 2000 ng/L 的心失败病人，和组 3 (n = 10，吝啬的 +/- SE：67.6 +/- 3.0 年) ，没有心失败的临床的符号的健康控制。对醋胆素(ACh ) 的 iontophoretic 管理的血管扩张药反应，经由 endothelial 机制，和钠 nitroprusside (SNP ) 行动，经由光滑的肌肉房间机制行动，被学习。结果当时，有心失败的所有病人显著地减少了刺激(ACh， SNP 或热) 的模式的脉管的反应独立人士与健康控制相比。然而，回答没在二组心失败病人之间不同。结论皮肤的脉管的反应在心失败病人被减少并且不与条件的严厉或病人的年龄相关。

Relationship between lipidslevelsand right ventricular volume overload in congestive heart failure

在类脂化合物和冠的动脉疾病之间的 BackgroundThe 关系很好被建立了。然而，这在类脂化合物和心失败之间不是事实。讽刺地，高类脂化合物层次充分在心失败与更好的结果被联系，但是位于现象下面的机制不是理解。这研究被执行到由于静脉的拥挤减少了肠的类脂化合物吸收的假设可以导致的测试低类脂化合物 levels.MethodsWe 与充血的心失败在 442 个 unselected 病人收集了临床的特征， echocardiograph，和类脂化合物侧面的数据。在类脂化合物层次之间的关联[包括的全部的胆固醇( TCL )，高密度的脂蛋白胆固醇(高级数据链路控制)，低密度的脂蛋白胆固醇( LDL-C )，和 triglycerides ( TG )]并且正确的室结束心脏舒张的直径( RVEDD )，左室结束心脏舒张的直径( LVEDD )，正确中庭直径( RA )，左中庭直径( LA )，或左室喷射部分( LVEF )用皮尔森关联和部分关联被分析。RVEDD， LVEDD， RA，和 LA 被索引到身体表面 area.ResultsThere 是在 TCL 层次和 RVEDD 之间的显著地反的关联(r =&#x02212； 0.34， P &#x0003c；0.001 ) 并且 RA (r =&#x02212； 0.36， P &#x0003c；0.001 ) 。象 LDL-C，高级数据链路控制，和 TG 那样的另外的类脂化合物与 RVEDD 和 RA 有类似的反的关联。在好久调整以后未改变的仍然是的所有这些关联，性，吸烟地位，物理活动层次， comorbidities，和药 use.ConclusionsLipid 层次相反地与充血的心失败在病人被相关到 RVEDD；然而，因为这是观察研究，进一步的调查被需要验证我们的结果以及如果有的话识别一种原因的关系。

Extracorporeal veno-venous ultrafiltration in congestive heart failure:What’s the state of the art?A mini-review

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.

A Case Report of Isolated Left Ventricular Non-Compaction Presenting with Congestive Heart Failure and Intramural Thrombus

Isolated left ventricular non-compaction is recently described as a rare form of cardiomyopathy that is associated with a heart failure, life threatening cardiac arrhythmia and thromboembolic complications. The diagnosis is based on echocardiography demonstration of spongy myocardium. Here we report a case of 74 years old female patient diagnosed as an isolated left ventricular non-compaction with congestive heart failure, intramural thrombus and hypertension. There is no specific treatment for LVNC;therapeutic measures are directed towards the patient’s symptom (heart failure, arrhythmia and thrombotic events) and consideration of an implantable cardioverter defibrillator and cardiac transplantation.

Increased ostial pulmonary vein diameter in congestive heart failure: a multi-slice computed tomography angiography evaluation

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.

Effectiveness of Bumetanide Infusion in Treatment of Generalized Edema and Congestive Heart Failure

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&#174), bumetanide (Bumex&#174), torsemide (Demadex&#174) 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.

Relationship of Intralymphocytic Cyclic Nucleotide and Calcium Ion Changes with Cardiac Function in Congestive Heart Failure Patients Treated with Amrinone

The contents of intralymphocytic cyclic nucleotide（cAMP and cGMP）and cal-cium ions(Ca++)were determined in 20 patients with refractory congestive heart failure be-fore and after the treatment of Chinese-made amrinone,and their cardiac index was alsomcasured with the thermodilution technique.It was found that the cAMP andCa++contents were markedly elevated while the cardiac index increased under amrinonctreatment,and that both the cAMP and Cacontents were in positive correlation withthe cardiac index before and after amrinone administration.It is suggested that amrinone is likcly to exert its positive inotropic effect on themyocardium through augmenting the cAMP and Ca++contents in myocardial cells,andthat the determination of intralymphocytic cyclic nuclcotidc and Ca++might bc of signifi-canoe to assess the impairment of cardiac function and the cfficacy of a thcrapcuticagent.

Reversible congestive heart failure associated with hypocalcemia:A case report

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.

Current concept in the diagnosis,treatment and rehabilitation of patients with congestive heart failure

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.

Correlation between Serum Uric Acid Level and Left Ventricular Ejection Fraction in Patients with Congestive Heart Failure

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.

The Thinking on TCM Differential Treatment of Congestive Heart Failure

Congestive heart failure(CHF),the manifestationat the late stage of cardiovascular diseases,is a commonand critical illness.Traditional Chinese medicine showsa good therapeutic effectiveness in treatment of CHF,especially for latent heart failure,refractory heart failureand digitalis poisoning.The thinking on treatment ofCHF by traditional Chinese medicine on the basis ofclinical practice is described below.

Intervention Effect of Jianxin Decoction (健心汤) on Serum Cytokine Level of Congestive Heart Failure Patients

Objective: To investigate the intervention effect of Jianxin Decoction (健心汤, JXD) on the cytokine level in serum of patients with congestive heart failure (CHF). Methods; Sixty-six patients with CHF were randomly divided into the control group (n = 33) and the trial group (n = 33). The control group received conventional treatment, and the trial group was treated with conventional therapy plus JXD for 4 weeks. Before and after treatment, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and nitrogen monoxide (NO) in serum and cardiac function were determined. Results: After treatment, the levels of TNF-α, IL-6 and NO were significantly lower than those before treatment (P<0.05, or P<0.01) in the two groups, and the lowering degree of the indices in the trial group was more significantly reduced than that in the control group (P<0.05). And cardiac functions in both groups were improved significantly (P<0.05, or P< 0.01). Conclusion: JXD could prevent and reverse ventricular remodeling so as to ameliorate cardiac function through regulating the levels of cytokines.