充血性心力衰竭患者血钠水平与其神经内分泌激素水平、运动耐量及再住院率的关系

目的:探讨充血性心力衰竭患者低钠水平对其相关神经内分泌激素水平、运动耐量的影响,并通过观察比较再入院率,明确低钠水平对心衰患者康复和预后的作用。方法:选择2004年2月—2005年4月我院心内科确诊为充血性心力衰竭、NYHAⅡ—Ⅳ级的住院患者,共106例,包括56例充血性心力衰竭伴低钠血症患者和50例正常血钠的慢性心力衰竭患者,用放射免疫法、心脏超声同时测定106例慢性心力衰竭患者血浆NE、ALD、AngⅡ水平和LVEF。结果:低钠水平的充血性心力衰竭患者血浆NE、ALD、AngⅡ水平均较正常血钠组显著升高,NE(0.92±0.24ng/mlvs0.48±0.15ng/ml,t=3.865,P<0.01),ALD(264.05±42.85ng/Lvs154.56±39.34ng/L,t=2.521,P<0.05),AngⅡ(251.35±70.06ng/Lvs106.08±30.15ng/L,t=3.275,P<0.01)。低钠水平与血浆NE、ALD、AngⅡ水平呈显著负相关(r=-0.33,P<0.05;r=-0.69,P<0.01)。低钠水平组的心衰患者6min步行距离明显短于正常血钠组298.45±26.35mvs390.25±29.65m,P<0.05。6个月内因心衰的再入院率明显高于正常血钠组(χ2=117.96,P<0.05)。结论:低钠水平可能促进充血性心力衰竭患者神经内分泌激素激活水平,明显减低其运动耐量,增加再入院率,影响心衰患者的康复和预后。

中药针剂治疗充血性心力衰竭的近况

中药针剂配合常规西医治疗能明显提高充血性心力衰竭的疗效,且毒副作用少、耐受性好。通过对相关文献的查阅,综述了近年来中药针剂治疗充血性心力衰竭的概况。

240例充血性心力衰竭患者阶梯疗法的临床分析

本文对我院十年240例住院充血性心衰患者实施阶梯疗法方案情况进行回顾性探讨。结果表明:第一阶梯疗法常用于风心病心衰患者;占近半数的心衰患者采用第二阶梯疗法。第三阶梯疗法的有效率分别高于第一、第二和第五阶梯疗法(P <0.05),低于第四阶梯疗法,但无统计学差异(P >0.05)。心衰程度的加重与阶梯疗法的升级几乎成正比。

心脏再同步化治疗在心力衰竭中应用机制研究进展

心脏再同步化治疗(CRT)是借助起搏技术模拟生理循环状态使严重的房室传导阻滞或心室内传导障碍患者恢复原有的心脏收缩同步状态。多项大规模临床试验证实CRT能改善心脏功能、提高生活质量;使心力衰竭(简称心衰)住院率减少,全因死亡率下降。其可能是通过纠正收缩协调、拮抗神经内分泌激活,逆转左室重塑、心力衰竭相关基因的逆转等方面发挥作用的。

血浆IL-1β、IL-6水平与CHF患者临床病理参数关系

目的:观察充血性心力衰竭(CHF)患者血浆白介素1β(IL-1β)、白介素6(IL-6)水平变化与疾病发展的关系。方法:采用酶联免疫吸附法分别检测50例CHF患者血浆IL-1βI、L-6水平,并与临床病理资料进行对比分析。结果:IL-1β在LVEF≤50%表达水平明显高于LVEF>50%组、E/A≤1组明显高于E/A>1、冠脉病变Ⅲ、Ⅳ型明显高于冠脉病变Ⅰ、Ⅱ型组,在不同年龄分组、NYHA分组和血脂分组中无明显差别;IL-6在LVEF≤50%表达水平明显高于LVEF>50%组、E/A≤1组明显高于E/A>1、冠脉病变Ⅲ、Ⅳ型明显高于冠脉病变Ⅰ、Ⅱ型组,血脂异常组明显高于正常组。结论:检测CHF患者血浆IL-1βI、L-6的变化可以评估疗效及预后。

SERUM CONCENTRATIONS OF HYALURONIC ACID, PROCOLLAGEN TYPE III NH_2-TERMINAL PEPTIDE, AND LAMININ IN PATIENTS WITH CHRONIC CONGESTIVE HEART FAILURE

Objective To explore the role of serum fibrotic indices including hyaluronic acid （HA）, procollagen type Ⅲ NH2-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 E [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, PCMP, 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.

Left univentricular pacing for cardiac resynchronization therapy using rate-adaptive atrioventricular delay

Objective To evaluate left univentricular （LUV） pacing for cardiac resynchronization therapy （CRT） using a rate-adaptive atrioven- tricular delay （RAAVD） algorithm to track physiological atrioventricular delay （AVD）. Methods A total of 72 patients with congestive heart failure （CHF） were randomized to RAAVD LUV pacing versus standard biventricular （BiV） pacing in a 1 ： 1 ratio. Echocardiography was used to optimize AVD for both groups. The effects of sequential BiV pacing and LUV pacing with optimized A-V （right atrio-LV） delay using an RAAVD algorithm were compared. The standard deviation （SD） of the S/R ratio in lead VI at five heart rate （HR） segments （Rs/R-SD5）, defined as the ＂tracking index,＂ was used to evaluate the accuracy of the RAAVD algorithm for tracking physiological AVD. Results TheQRS complex duration （132 ± 9.8 vs. 138± 10ms, P 〈 0.05）, the time required for optimization （21 ±5 vs. 50±8min, P〈 0.001）, the mitral regurgitant area （1.9 ± 1.1 vs. 2.5 ± 1.3 em2, P 〈 0.05）, the interventricular mechanical delay time （60.7 ± 13.3 ms vs. 68.3 ± 14.2 ms, P 〈 0.05）, and the average annual cost （13,200 ± 1000 vs. 21,600 ± 2000 RMB, P 〈 0.001） in the RAAVD LUV pacing group were significantly less than those in the standard BiV pacing group. The aortic valve velocity-time integral in the RAAVD LUV pacing group was greater than that in the standard BiV pacing group （22.7 ± 2.2 vs. 21.4 ± 2.1 cm, P 〈 0.05）. The Rs/R-SD5 was 4.08 ± 1.91 in the RAAVD LUV pacing group, and was significantly negatively correlated with improved left ventricular ejection fraction （LVEF） （ALVEF, Pearson＇s r = -0.427, P = 0.009）, and positively correlated with New York Heart Association class （Spearman＇s r - 0.348, P 0.037）. Conclusions RAAVD LUV pacing is as effective as standard BiV pacing, can be more physiological than standard BiV pacing, and can de- crease the average annual cost of CRT.

Review:Cell therapy in congestive heart failure

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 asymmetrically 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 differentiation into cardiac tissue. So far, basic studies by using potential sources such as BMCs and CSCs to treat animat CHF have shown improved ventricular remodelling and heart function. Recently, however, a few of randomized, double-blind, placebo-controlled clinical trials demonstrated mixed results in heart failure with BMC therapy during acute myocardial infarction.

Hyperphosphatemia after sodium phosphate laxatives in low risk patients:Prospective study

AIM:To establish the frequency of hyperphosphate-mia following the administration of sodium phosphate laxatives in low-risk patients. METHODS:One hundred consecutive ASAⅠ-Ⅱindividuals aged 35-74 years,who were undergoing colonic cleansing with oral sodium phosphate(OSP) before colonoscopy were recruited for this prospective study.Exclusion criteria:congestive heart failure, chronic kidney disease,diabetes,liver cirrhosis,intestinal obstruction,decreased bowel motility,increased bowel permeability,and hyperparathyroidism.The day before colonoscopy,all the participants entered a 24-h period of diet that consisted of 4 L of clear fluids with sugar or honey and 90 mL(60 g)of OSP in two 45-mL doses,5 h apart.Serum phosphate was measured before and after the administration of the laxative. RESULTS:The main demographic data(mean±SD) were:age,58.9±8.4 years;height,163.8±8.6 cm; weight,71±13 kg;body mass index,26±4;women, 66%.Serum phosphate increased from 3.74±0.56 to 5.58±1.1 mg/dL,which surpassed the normal value (2.5-4.5 mg/dL)in 87%of the patients.The highest serum phosphate was 9.6 mg/dL.Urea and creatinine remained within normal limits.Post-treatment OSP se-rum phosphate concentration correlated inversely with glomerular filtration rate(P<0.007,R 2=0.0755),total body water(P<0.001,R 2=0.156)and weight(P< 0.013,R 2=0.0635). CONCLUSION:In low-risk,well-hydrated patients, the standard dose of OSP-laxative-induced hyperphos-phatemia is related to body weight.

The association between orthostatic hypertension and all-cause mortality in hospitalized elderly persons

Background Little is known about the prevalence oforthostatic hypertension （OHT） and its effect on long-term mortality in the eld- erly. We evaluated the prevalence of OHT and its effect on mortality in hospitalized elderly patients. Methods Out of 1852 patients admit- ted between 31/12/1999 and 31/12/2000 to an acute geriatric ward, 474 patients （48% males） with a mean age of 81.5 ±6.8 years were en- rolled in this study. Blood pressure （BP） was measured three times during the day in a supine and standing position. Patients with at least one increase in systolic or diastolic BP levels upon standing were diagnosed with OHT. Medical history, physical examination and laboratory parameters were retrieved from the medical records. Mortality data until 18th June 2014 were retrieved from the computerized system of the Ministry of the Interior. Results Four hundred and seven patients （86%） were diagnosed with OHT. Those without OHT had a lowerbody mass index and were more likely males, smokers, had a higher rate of Parkinson＇s disease and less congestive heart failure compared with those with OHT. Patients with OHT had a better survival rate than those without OHT （P = 0.024）. Hazard ratios （HRs） for mortality in those with OHT adjusted to age and multiple risk factors were： 0.67 [95% confidence interval （CI）： 0.51-0.87] and 0.73 （95% CI： 0.55-0.97）, respectively; a similar tendency was noticed in a sensitivity analysis by gender. Conclusion Hospitalized elderly patients with OHT had a better survival rate than those without OHT.

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

Objectives To assess the safety of a cardiac rehabilitation program for older women with Congestive Heart Failure （CHF） and determine if certain factors influence adherence. Methods Women over the age of 65 with CHF attended an exercise program supervised by a physiotherapist. Quality of life was measured by the Minnesota Living with Heart Failure Questionnaire （MLHFQ） and severity of disease by the New York Heart Association （NYHA） Class. Subjects were classified into those who attended 90% or more of the sessions and those who attended less than 90% of the sessions. Results Fifty-one subjects were studied. Eight subjects did not attend any sessions. Of the 43 attendees, the average percentage of sessions attended was 87%. There were no significant differences between the two groups in age, MLHFQ or NYHA Class. There was only one adverse event out of 280 participant attendances. Conclusions The program had a high level of adherence in this population. Age, MLHFQ or NYHA Class did not impact on session attendance. Our data suggests this program is safe for this population. Further research is needed to determine other predictors of attendance and the examination of safety issues and long-term adherence to exercise in this population.

Sleep-disordered breathing is associated with depletion of circulating endothelial progenitor cells and elevation in pulmonary arterial pressure in patients with decompensated systolic heart failure

Background Sleep-disordered breathing （SDB） is known to occur frequently in and may predict worsening progression of patients with congestive heart failure （CHF）. SDB is also known to play an important role in the development of idiopathic pulmonary arterial hyper- tension （PAH） via inducing endothelial dysfunction and vascular remodeling, a pathological process that can be significantly influenced by factors such as osteoprotegerin （OPG） and endothelial progenitor cells （EPCs）. The objective of this study is to determine if CHF with SDB is associated with changes in OPG, EPCs, and PAIl. Methods EPCs were isolated, cultured, and quantified from CHF patients with SDB （n = 52）, or without SDB （n - 68）. OPG and N-terminal pro-brain natriuretic peptide （NT-proBNP） from each group was analyzed and cor- related with EPCs and the mean pulmonary artery pressure （mPAP） measured by right heart catheterization. Results A significant decrease in circulating EPCs （29.30 ± 9.01 vs. 45.17 ± 10.51 EPCs/x 200 field; P 〈 0.05） was found in CHF patients with SDB compared to those without SDB. Both OPG （789.83 ±89.38 vs. 551.29 ± 42.12 pg/mL; P 〈 0.05） and NT-proBNP （5946.50 ± 1434.50 vs. 3028.60 ± 811.90 ng/mL; P 〈 0.05） were also significantly elevated in SDB CHF patients who also had significantly elevated mPAP （50.2 ± 9.5 vs. 36.4 ± 4.1 mm Hg; P 〈 0.05）. EPC numbers correlated inversely with the episodes of apnea and hypopnea per hour （RDI, r = -0.45, P = 0.037） and blood level of OPG （r =-0.53, P = 0.011）. Although NT-proBNP was also increased significantly in patients with SDB, it had no correlation with either EPCs or RD1. Conclusions SDBdue to hypoxemia from decompensated CHF is associated with （1） OPG elevation, （2） EPC depletion, and （3） mPAP elevation. The inverse relationship of circulating OPG with EPCs suggests a likely mechanism for hypoxemia and OPG in the development of pulmonary vascular dysfunction via depleting EPCs, thus worsening prognosis of CHF.

Anticoagulation in elderly patients at high risk of atrial fibrillation without documented arrhythmias

Recent studies have suggested that patients with high CHA2DS2VASc-score [Congestive Heart failure, hyperten- sion, Age ≥ 75 years （doubled）, Diabetes, Stroke （doubled）, Vascular disease, Age 65-74 years, Sex category （female sex）] thromboembolic complications occurred irrespective of the presence of atrial fibrillation （AF） and anticoagulant therapy may be initiated irrespective of documented AF.

Anabolic steroid-induced cardiomyopathy underlying acute liver failure in a young bodybuilder

Heart failure may lead to subclinical circulatory disturbances and remain an unrecognized cause of ischemic liver injury. We present the case of a previously healthy 40-year-old bodybuilder, referred to our Intensive-Care Unit of Hepatology for treatment of severe acute liver failure, with the suspicion of toxic hepatitis associated with anabolic steroid abuse. Despite the absence of symptoms and signs of congestive heart failure at admission, an anabolic steroid-induced dilated cardiomyopathy with a large thrombus in both ventricles was found to be the underlying cause of the liver injury. Treatment for the initially unrecognized heart failure rapidly restored liver function to normal. To our knowledge, this is the f irst reported case of severe acute liver failure due to an unrecognized anabolic steroid-induced cardiomyopathy. Awareness of this unique presentation will allow for prompt treatment of this potentially fatal cause of liver failure.

CARDIAC RISK STRATIFICATION IN PATIENTS WITH CONGESTIVE HEART FAILURE:A CATECHOLAMINES-β-ADRENOCEPTOR-cAMP PATHWAY

Objective To investigate the stratification risk of catecholamines-β-adrenoceptor (β-AR)-cAMP pathway for cardiogenic death events in patients with congestive heart failure (CHF). Methods A total of 83 identified CHF patients with a baseline and follow-up plasma levels of norepinephrine (NE) and epinephrine (E), lymphocytes β-AR density (Bmax), and intralymphocyte cAMP content in peripheral blood were followed up. Major cardiogenic death events were registered. Results The period between the initial entry and the last follow-up measurement were 51±16 months, the total duration of clinical follow-up after the last measurement were 14±8 months. During follow-up, 39 patients died of cardiogenic (sudden death 17 patients, worsening heart failure 22 patients). Persistence of high NE, E, and cAMP from baseline to follow-up were confirmed as risk predicting factors of cardiovascular events. Persistence NE above 4.0 nmol/L, E above 3.5 nmol/L, and the intralymphocyte cAMP content above 3.5 pmd·mg-1·pro-1 from baseline to follow-up were significant adverse prognostic predictors. The major cardiogenic death events rates per 100 patients-years were 1.33 and 4.82 in patients with NE below and above 4.0 nmol/L (HR: 2.91; 95% CI: 1.08-7.33; P = 0.015); were 1.42 and 4.36 in the patients with E levels below and above 3.5 nmol/L (HR: 2.64; 95% CI: 1.02-6.41; P = 0.019); were 1.81 and 4.67 in the patients with the intralymphocyte cAMP content below and above 3.5 pmd·mg-1·pro-1 (HR: 2.79; 95% CI: 1.04-6.83; P = 0.017), but difference was not significant between the β-AR density below and above median. Conclusions Persistent increase in circulating catecholamines and intralymphocyte cAMP content may increase the long-term mortality in CHF patients.

Relationship of the plasma urotensin Ⅱ with proadrenomedullin N-terminal 20 peptide in patients with congestive heart failure

Objective: To understand the role of urotensin Ⅱ(UⅡ) and proadrenomedullin N-terminal 20 peptide (PAMP), a fragment of proadrenomedullin (proADM) possessing biological activity, in the pathophysiological process of congestive heart failure (CHF) by observing the variation of their plasma levels and exploring their interrelations. Methods: Plasma UⅡ and PAMP levels were measured by radioimmunoassay in 52 patients with CHF and 14 healthy subjects. Left ventricular ejection fraction (LVEF) and the ratio of E/A were determined by echocardiography. Results: The plasma UⅡ level was significantly lower in patients with CHF than the healthy subjects (1.5±1.0 pg/ml vs 4.3±1.2 pg/ml, P<0.05), while plasma PAMP level was significantly higher in the former group (30.6±5.8 pg/ml vs 21.0±6.6 pg/ml P<0.05). The levels of UⅡ and PAMP were parallel with the severity of CHF, and significant correlation of plasma levels of UⅡ with LVEF (r=0.530, P=0.000) and the ratio of E/A (r=0.618, P=0.000) was noted. LVEF and ratio of E/A were found to be inversely correlated with plasma PAMP levels in the patients (r=-0.568, P=0.000; r=-0.350, P=0.004). Also found was the significant correlation between plasma UⅡ and PAMP levels (r=-0.528, P=0.000). The treatment of the patients resulted in increased plasma UⅡ levels and lowered PAMP levels. Conclusion: The variations of plasma levels of UⅡ and PAMP are parallel with the severity of CHF, suggesting their cooperative actions in the pathophysiology of CHF.

Effects of 6-minute walk test on the QT dispersion in patients with congestive heart failure

Objective: To investigate the clinical value of QT dispersion (QTd) and the effects of 6-minute walk test (6-MWT) mimicking the patients' daily activities on QTd in patients with congestive heart failure (CHF).Methods: Twenty-eight CHF patients and 22 normal subjects participated these study, who all completed 6-MWT without developing severe arrhythmias.Before and after 6-MWT, standardized 12-lead surface ECGs were obtained to measure QTd and corrected QTd (QTcd).Results: Both before and after 6-MWT, the QTd and QTcd in CHF patients were longer than those in the controls (P<0.001), and QTd and QTcd after 6-MWT were significantly shorter than those before 6-MWT in CHF patients (P=0.007, and 0.018).There was no significant difference in the measurement in the control group.Conclusion: QTd and QTcd are longer in CHF patients than in normal subjects.Moderate exercise may improve the inhomogeneity of ventricular repolarization dispersion in CHF patients.

Cardiovascular effects of hemoglobin response in patients receiving epoetin alfa and oral iron in heart failure with a preserved ejection fraction

Background Previous data from a recently conducted prospective, single blind randomized clinical trial among community dwelling older patients with heart failure with a preserved ejection fraction （HFPEF） and anemia randomized to treatment with epoetin alfa （erythro-poiesis-stimulating agents, ESA） vs. placebo did not demonstrate significant benefits of therapy regarding left ventricular （LV） structure, functional capacity, or quality of life （QOL）. However, several patients randomized to the treatment arm were non-responders with a subop-timal increase in hemoglobin. All patients in the trial also received oral ferrous gluconate, which could have contributed to increases in he-moglobin observed in those receiving placebo. Accordingly, we performed an analysis separating patients into responders vs. non-responders in order to determine if measured improvement in anemia would have any effect on clinical endpoints. Methods A total of 56 patients （age 77 ± 11 years, 68%female） were recruited who had anemia defined as a hemoglobin of≤12 g/dL （average, 10.4 ± 1 g/dL） with HFPEF defined as having NHANES-CHF （National Health And Nutrition Examination Survey：Congestive Heart Failure） criteria score of≥3 and an ejection fraction of＆gt;40%（average EF=63%±15%）. Patients were randomly allocated to receive either ESA and ferrous gluconate or ferrous gluconate only. In this analysis, a responder was defined as a patient with an increase of 1 g/dL in the first 4 weeks of the trial. Re-sults Nineteen subjects were classified as responders compared to 33 non-responders. While the average hemoglobin increased signifi-cantly at the end of 6 months for responders （1.8 ± 0.3 vs. 0.8 ± 0.2 g/dL, P = 0.004）, 50% of the subjects assigned to ESA were non-responders. Left ventricular function including ejection fraction （P=0.32） and end diastolic volume （P=0.59） was unchanged in res-ponders compared to non-responders. Responders also showed no significant improvements in New York Heart Association （NYHA） class, Six Minute Walk Test （6 MWT） and peak VO2. Though QOL improved significantly within each group, there was no difference between the two. Conclusions A significant hemoglobin response to anemia treatment with ESA and oral iron does not lead to differences in LV re-modeling, functional status, or QOL. Additionally, a significant percent of older adults with HFPEF and anemia do not respond to ESA ther-apy. Given the results of this small trial, it appears as though using objective improvements in anemia as a marker in older adult subjects with HFPEF does not have significant clinical utility.

Relationship of calcineurin expression between T-lymphocyte and myocardium in patients with heart failure

Objective Congestive heart failure （CHF） is the final common pathway of various heart diseases.Calcineurin,a calcium/calmodulindependent phosphatase consisting of a catalytic subanit A （CnA） and a regulatory calcium-binding subunit B （CnB）,is activated in heart failure.This study aimed to investigate the relationship between mRNA level of calcineurin in circulating T-lymphocyte and that in myocardium in patients with CHF. Methods A total of 38 patients with CHF （aged from 29 to 62 years） were included in this study.The mRNA levels of alpha-and beta-isoform of CnA in left ventricular anterior papillary muscle and peripheral lymphocytes were determined by semi-quantitative reverse transcription polymerase chain reaction.Pearson linear correlation analysis was performed,and difference was considered statistically significant at a P value 〈0.05. Results Calcineurin mRNA levels in lymphocytes were positively correlated with those in myocardium （for CnA-alpha mRNA,r=0.820;for CnA-beta mRNA,r=0.875;both P〈0.01）.CnA-beta mRNA levels in both circulating lymphocytes and myocardium increased significantly with increasing NYHA class （r=0.877 for peripheral blood and r=0.805 for cardiac muscle;both P〈0.01）. Conclusions The mRNA level of CnA-beta in circulating lymphocytes is positively correlated with that in myocardium and is a promising marker for the severity of cardiac dysfunction in patients with CHF.