Neutrophil-to-lymphocyte ratio compared to N-terminal pro-brain natriuretic peptide as a prognostic marker of adverse events in elderly patients with chronic heart failure

Background The neutrophil-to-lymphocyte （N/L） ratio has been associated with poor prognosis in patients with heart failure, but it has not been compared with N-terminal pro-brain natriuretic peptide （NT-proBNP） in elderly patients with chronic heart failure （CHF）. We sought to make this comparison. Methods A total of 1355 elderly patients with CHF were analyzed. A multivariate logistic regression model was used to analyze the variables associated with atrial fibrillation （AF）. Cox regression analysis was used to assess the multivariable rela- tionship between the N/L ratio, NT-proBNP level, and subsequent major cardiovascular events （MCE）. Results In the multiple logistic regression analysis, the N/L ratio was demonstrated as a risk factor for AF in elderly patients with CHF [odds ratio （OR）： 1.079, 95% confi- dence interval （CI）： 1.027-1.134, P = 0.003]. The median follow-up period was 18 months. In a multivariable model using tertiles of both variables, the highest tertile of the N/L ratio was significantly associated with MCE [hazard ratio （HR）： 1.407, 95% CI： 1.098-1.802, P = 0.007] compared with the lowest tertile. Similarly, the highest NT-proBNP tertile was also significantly associated with MCE （HR： 1.461, 95% CI： 1.104-1.934, P- 0.008）. Conclusions In elderly patients with CHF, the N/L ratio is one of the important risk factors for AF and it is an inexpensive and readily available marker with similar independent prognostic power to NT-proBNP. The risk of MCE increases 1.407-fold when the N/L ratio is elevated to the highest tertile.

Additive Benefits of Twice Forest Bathing Trips in Elderly Patients with Chronic Heart Failure

Chronic heart failure （CHF）, a clinical syndrome resulting from the consequences of various cardiovascular diseases （CVDs）, is increasingly becoming a global cause of morbidity and mortality. We had earlier demonstrated that a 4-day forest bathing trip can provide an adjunctive therapeutic influence on patients with CHF. To further investigate the duration of the impact and the optimal frequency of forest bathing trips in patients with CHF, we recruited those subjects who had experienced the first forest bathing trip again after 4 weeks and randomly categorized them into two groups, namely, the urban control group （city） and the forest bathing group （forest）. After a second 4-day forest bathing trip, we observed a steady decline in the brain natriuretic peptide levels, a biomarker of heart failure, and an attenuated inflammatory response as well as oxidative stress. Thus, this exploratory study demonstrated the additive benefits of twice forest bathing trips in elderly patients with CHF, which could further pave the way for analyzing the effects of such interventions in CVDs.

Beta-blocker therapy in elderly patients with renal dysfunction and heart failure

OBJECTIVE To assess the role of beta-blockers(BB)in patients with chronic kidney disease(CKD)aged≥75 years.METHODS AND RESULTS From January 2008 to July 2014,we included 390 consecutive patients≥75 years of age with ejection fraction≤35%and glomerular filtration rate(GFR)≤60 m L/min per 1.73 m^2.We analyzed the relationship between treatment with BB and mortality or cardiovascular events.The mean age of our population was 82.6±4.1 years.Mean ejection fraction was 27.9%±6.5%.GFR was 60-45 m L/min per 1.73 m^2 in 50.3%of patients,45-30 m L/min per 1.73 m^2 in 37.4%,and<30 m L/min per 1.73 m^2 in 12.3%.At the conclusion of follow-up,67.4%of patients were receiving BB.The median follow-up was28.04(IR:19.41-36.67)months.During the study period,211 patients(54.1%)died and 257(65.9%)had a major cardiovascular event(death or hospitalization for heart failure).BB use was significantly associated with a reduced risk of death(HR=0.51,95%CI:0.35-0.74;P<0.001).Patients receiving BB consistently showed a reduced risk of death across the different stages of CKD:stage IIIa(GFR=30-45 m L/min per 1.73 m^2;HR=0.47,95%CI:0.26-0.86,P<0.0001),stage IIIb(GFR 30-45 m L/min per 1.73 m^2;HR=0.55,95%CI:0.26-1.06,P=0.007),and stages IV and V(GFR<30 m L/min per 1.73 m~2;HR=0.29,95%CI:0.11-0.76;P=0.047).CONCLUSIONS The use of BB in elderly patients with HFr EF and renal impairment was associated with a better prognosis.Use of BB should be encouraged when possible.

Clinical study of recombinant human brain natriuretic peptide in patients with acute myocardial infarction complicating congestive heart failure

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.

Effects of health concept model-based detailed behavioral care on mood and quality of life in elderly patients with chronic heart failure

BACKGROUND With the intensification of social aging,the susceptibility of the elderly population to diseases has attracted increasing attention,especially chronic heart failure(CHF)that accounts for a large proportion of the elderly.AIM To evaluate the application value of health concept model-based detailed behavioral care in elderly patients with CHF.METHODS This study recruited 116 elderly CHF patients admitted from October 2018 to October 2020 and grouped them according to the nursing care that they received.The elderly patients who underwent health concept model-based detailed behavioral care were included in a study group(SG;n=62),and those who underwent routine detailed behavioral nursing intervention were included as a control group(CG;n=54).Patients’negative emotions(NEs),quality of life(QoL),and nutritional status were assessed using the self-rating anxiety/depression scale(SAS/SDS),the Minnesota Living with Heart Failure Questionnaire(MLHFQ),and the Modified Quantitative Subjective Global Assessment(MQSGA)of nutrition,respectively.Differences in rehabilitation efficiency,NEs,cardiac function(CF)indexes,nutritional status,QoL,and nursing satisfaction were comparatively analyzed.RESULTS A higher response rate was recorded in the SG vs the CG after intervention(P<0.05).After care,the left ventricular ejection fraction was higher while the left ventricular end-diastolic dimension and left ventricular end systolic diameter were lower in the SG compared with the CG(P<0.05).The post-intervention SAS and SDS scores,as well as MQSGA and MLHFQ scores,were also lower in the SG(P<0.05).The SG was also superior to the CG in the overall nursing satisfaction rate(P<0.05).CONCLUSION Health concept model-based detailed behavioral care has high application value in the nursing care of elderly CHF patients,and it can not only effectively enhance rehabilitation efficiency,but also mitigate patients’NEs and improve their CF and QoL.

Precipitating factors leading to decompensation of chronic heart failure in the elderly patient in South-American community hospital

Background Exacerbations of heart failure appear frequently associated with precipitating factors not directly related to the evolution of cardiac disease. There still a paucity of data on the proportional distribution of precipitating factors specifically in elderly patients. The aim of this study was to examine prospectively the precipitating factors leading to hospitalization in elderly patients with heart failure in our community hospital. Methods We evaluate elderly patients who need admissions for decompensate heart failure. All patients were reviewed daily by the study investigators at the first 24 h and closely followed-up. Decompensation was defined as the worsening in clinical NYHA class associated with the need for an increase in medical treatment （at minimum intravenously diuretics）. Results We included 102 patients （mean age 79 ± 12 years）. Precipitating factors were identified in 88.5%. The decompensation was sudden in 35% of the cases. Noncompliance with diet was identified in 52% of the patients, lack of adherence to the prescribed medications amounted to 30%. Others precipitating factors were infections （29%）, arrhythmias （25%）, acute coronary ischemia （22%）, and uncontrolled hypertension （15%）, miscellaneous causes were detected in 18% of the cases （progression of renal disease 60%, anemia 30% and iatrogenic factors 10%）. Concomitant cause was not recognizable in 11.5%. Conclusions Large proportion heart failure hospitalizations are associated with preventable precipitating factors. Knowledge of potential precipitating factors may help to optimize treatment and provide guidance for patients with heart failure. The presence of potential precipitating factors should be routinely evaluated in patients presenting chronic heart failure.

Cardiac resynchronization therapy in the elderly heart failure patient

Ms. BP is an 83 year old white female with a long history of congestive heart failure (HF). She is now symptomatic with minimal exertion, has a left ventricular ejection fraction (LVEF) of 20%. Her CHF is due to hypertension (HTN) plus coronary artery disease (CAD) and she is on angiotensin converting enzyme inhibitor (ACEI), furosemide, digoxin,spironolactone, low dose beta blocker and nitrates. Her beta-natriuretic peptide (BNP) in clinic is 3030 pg/ml, heart rate (HR) 100, blood pressure (BP) 89/43.

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.

Prevalence of iron deficiency in patients aged 75 years or older with heart failure

Background The latest studies presented at the American Heart Association (AHA) meeting on heart failure and the update of the European Cardiology Society’s (ECS) recommendations on heart failure in 2016 recommend intravenous iron supplementation in patients with heart failure, reduced ejection fraction and iron deficiency for improves walking performance and quality of life, and reduces morbidity. In the present study, we investigated the prevalence of iron deficiency in heart failure patients aged 75 years or older, as there is currently no data on these patients. Methods We performed an observational study on hospitalized patients in Geriatric Cardiology Department. Among the 462 patients hospitalized during eight months, 176 were eligible for inclusion;22 patients was significant interference with an inflammatory syndrome (high ferritin with high C-reactive protein), and for 13 patients iron-related data were not available. For each patient included, a complete iron assessment and type of heart failure was available. Results A total of 141 patients were included, the mean age was 88 years (range: 75–101), and there were 52 (36.9%) of patients with reduced ejection fraction (EF), 37 (26.2%) with mid-range EF, and 52 (36.9%) with preserved EF. Irrespective of heart failure type, 73.8% had iron deficiency (95% CI: 65.7%–80.8%);this was found in 57.7%(95% CI: 43.2%–71.3%) of those with reduced EF, 78.4%(95% CI: 61.8%–90.2%) of those with mid-range EF, and 86.5%(95% CI: 74.2%–94.4%) of those with preserved EF (P = 0.003). Conclusion The prevalence of iron deficiency was very high in very elderly patients with heart failure, especially those with HF with mid-range EF or HF with preserved EF.

Management of chronic heart failure in the older population

Chronic heart failure （CHF） is the leading cause of hospitalization for those over the age of 65 and represents a significant clinical and economic burden. About half of hospital re-admissions are related to co-morbidities, polypharmacy and disabilities associated with CHF. Moreover, CHF also has an enormous cost in terms of poor prognosis with an average one year mortality of 33%–35%. While more than half of patients with CHF are over 75 years, most clinical trials have included younger patients with a mean age of 61 years. Inadequate data makes treatment decisions challenging for the providers. Older CHF patients are more often female, have less cardiovascular diseases and associated risk factors, but higher rates of non-cardiovascular conditions and diastolic dysfunction. The prevalence of CHF with reduced ejection fraction, ischemic heart disease, and its risk factors declines with age, whereas the prevalence of non-cardiac co-morbidities, such as chronic renal failure, dementia, anemia and malignancy increases with age. Diabetes and hypertension are among the strongest risk factors as predictors of CHF particularly among women with coronary heart disease. This review paper will focus on the specific consideration for CHF assessment in the older population. Management strategies will be reviewed, including non-pharmacologic, pharmacologic, quality care indicators, quality improvement in care transition and lastly, end-of-life issues. Palliative care should be an integral part of an interdiscipli-nary team approach for a comprehensive care plan over the whole disease trajectory. In addition, frailty contributes valuable prognostic in-sight incremental to existing risk models and assists clinicians in defining optimal care pathways for their patients.

Left ventricular assist devices as destination therapy in stage D heart failure

1 Introduction? Mechanical circulatory support (MCS) has increasingly become an important management opportunity for patients with stage D heart failure (HF) with remarkable impact on patient survival and quality of life. Early clinical trials have demonstrated improved outcomes of durable left ventricular assist device (LVAD) support compared with optimal medical management.[1] As technology advanced, continuous flow LVADs outperformed pulsatile flow devices in clinical trials and the field migrated to HeartMate (Abbott Laboratories, Abbott Park, IL) and HeartWare (Medtronic, Minneapolis, MN) devices due to their clinical superiority. Among the continuous flow devices.

Submaximal oxygen uptake kinetics, functional mobility, and physical activity in older adults with heart failure and reduced ejection fraction

Background Submaximal oxygen uptake measures are more feasible and may better predict clinical cardiac outcomes than maximal tests in older adults with heart failure （HF）. We examined relationships between maximal oxygen uptake, submaximal oxygen kinetics, fianctional mobility, and physical activity in older adults with HF and reduced ejection fraction. Methods Older adults with HF and reduced ejection fraction （n = 25, age 75 ：i： 7 years） were compared to 25 healthy ageand gender-matched controls. Assessments included a maximal treadmill test for peak oxygen uptake （VO2p^ak）, oxygen uptake kinetics at onset of and on recovery from a submaximal treadmill test, functional mobility testing [Get Up and Go （GUG）, Comfortable Gait Speed （CGS）, Unipedal Stance （US）], and self-reported physical activity （PA）. Results Compared to controls, HF had worse performance on GUG, CGS, and US, greater delays in submaximal oxygen uptake kinetics, and lower PA. In controls, VO2peak was more strongly associated with functional mobility and PA than submaximal oxygen uptake kinetics. In HF patients, submaximal oxygen uptake kinetics were similarly associated with GUG and CGS as VO2peak, but weakly associated with PA. Conclusions Based on their mobility performance, older HF patients with reduced ejection fraction are at risk for adverse functional outcomes. In this population, submaximal oxygen uptake measures may be equivalent to VO2 peak in predicting functional mobility, and in addition to being more feasible, may provide better insight into how aerobic function relates to mobility in older adults with HF.

Features and clinical nursing of heart failure in elderly patients during perioperative period

Heart failure is a common condition in elderly patients.With further population aging,incidence of heart failure is constantly increasing.When heart failure occurs in this group of patients,clinical symptoms may vary vastly,rendering difficulty for the treatment process and leading to poor efficacy and prognosis.To gain better under-standing on clinical symptoms and signs of heart failure in elderly patients,to provide prevention and treatment against heart failure for elderly patients in terms of nursing care and to improve success rate of salvage treatment as well as nurs-ing quality.Methods Retrospective analysis was performed in 141 patients with heart failure who were treated in our hospital during January 2005 and December 2009.Those aged > 60 years were assigned to elderly group while those aged < 60 years were assigned to non elderly group.These two groups were compared in terms of clinical symptoms, signs and physical and laboratory examinations.Results Clinical symptoms and signs of heart failure tended to be a-typical in elderly patients.Symptoms including cough,sputum,increased heart rate and mental disorder were frequent, and a substantial proportion of patients had pulmonary congestion and edema.Conclusions Prevention and specific nursing measures should be aggressively taken based on the features of heart failure in elderly patients.Frequency of in-spection particularly observation on atypical symptoms should be increased to provide intensive monitoring.

LYMPHOCYTIC AND ERYTHROCYTIC k^+, Na^+, Ca^(++), Mg^(++) CONTENT IN PATIENTS WITH CONGESTIVE HEART FAILURE

The content of lymphocytic and erythrocytic K -, Na- , Ca++, Mg++ changed in patients with congestive heart failure, related to clinical treatment and prognosis. The longer the course of disease, the more significant the changes, with no relation to the etiology of heart disease. The changes were partically improved after treatment of the heart failure. The content of electrolytes is not significantly different in patients in NYHA Class Ⅲ, compared to those in NYHA Class Ⅳ. The metabolic changes of electrolytes occur on the myocardial cells, skeletal muscle cells and peripheral erythrocytes in patients with congestive heart failure. However, serum electrolyte content does not reflect precisely overall electrolyte metabolism in the body. Whether similar, changes of electrolyte content occur in the peripheral lymphocytes is rarely reported. We studied the lymphocytic and erythrocytic electrolyte content in patients with congestive heart failure, to provide some reference in the clinical treatment and prognosis of congestive heart failure.

Rural congestive heart failure mortality among US elderly, 1999-2013: Identifying counties with promising outcomes and opportunities for implementation research

Objective:Describe modern trends in congestive heart failure(CHF)among elderly(>65 years of age)in the United States,to identify potentially successful rural areas.Compare CHF mortality using multiple-(MCOD)versus underlying-(UCOD)cause of death data.Methods:U.S.Centers for Disease Control and Prevention mortality files(WONDER internet site).Results:Using MCOD data,overall mortality rates/100,000 population(and 95%confidence intervals)for CHF among persons>65 years of age(1999-2013)were 482.0(481.2-482.8)for large central and large fringe metropolitan(LCLF)counties,549.6(548.6-550.7)in small and medium metropolitan(SM)counties,and 652.6(650.9-654.0)in micropolitan and non-core,non-metropolitan(MNCNM)counties.Twenty positive deviance NCNM counties(collectively including 198,581 residents>65 years of age)had an overall CHF rate of 300.9(275.0-326.9)in 2013.This was significantly lower than the LCLF rate for 2013(482.0[481.2-482.8]),and rep-resented a reduction of 47%since 1999.Overall CHF occurrence as estimated with MCOD was 3.4-fold higher than that obtained with UCOD.Conclusion:These data illustrate underestimation of CHF by UCOD data and the importance of correct death certification.Rural CHF mortality rates are higher than urban rates,but some positive deviance counties demonstrate that this is not inevitable.Further research is needed to understand the relative contribution of research innovation,medical care,and public health to rural-urban disparities and the relative success of positive deviance counties.

Respiratory and Cardiac Characteristics of ICU Patients Aged 90 Years and Older:A Report of 12 Cases

Objective To investigate the respiratory and cardiac characteristics of elderly Intensive Care Unit （ICU） patients. Methods Twelve senior ICU patients aged 90 years and older were enrolled in this study. We retrospectively collected all patients＇ clinical data through medical record review. The basic demographics, primary cause for admission, the condition of respiratory and circulatory support, as well as prognosis were recorded. Shock patients and pneumonia patients were specifically analyzed in terms of clinical manifestations, laboratory variables, echocardiography, and lung ultrasound results. Results The mean age of the included patients was 95 years with a male predominance （8 to 4, 66.7%）. Regarding the reasons for admission, 6 （50.0%） patients had respiratory failure, 1 （8.3%） patient had shock, while 5 （41.7%） patients had both respiratory failure and shock. Of the 6 patients who suffered from shock, only 1 was diagnosed with distributive shock, 5 with cardiogenic shock. Of the 5 cardiogenic shock patients, 1 was diagnosed with acute coronary syndrome. The rest 4 cardiogenic shock patients were diagnosed with Takotsubo cardiomyopathy. The patient with ST-segment elevation myocardial infarction died within 24 hours. Of the 4 Takotsubo patients, 1 died on day-6 and the other 3 patients were transferred to ward after heart function recovered in 1 to 2 weeks. Of the 10 pneumonia patients, 3 were diagnosed as community acquired pneumonia, and 7 as hospital acquired pneumonia. Only 3 patients were successfully weaned from ventilator. The others required long-term ventilation complicated with heart failure, mostly with diastolic heart failure. Lung ultrasound of 6 during spontaneous breathing trial. patients with diastolic dysfunction showed bilateral B-lines Conclusions Elderly patients in shock tend to develop Takotsubo cardiomyopathy. Diastolic heartdysfunction might be a major contributor to difficult weaning from ventilator in elderly patients. Bedside lung ultrasonography and echocardiography could help decide the actual cause of respiratory failure and shock more accurately and effectively.

Investigating the Correlation between Patient Education on Web-Based Portal Functionality and the Reduction in 30-Day Hospital Readmission Rates

Background: The growing use of web-based patient portals offers patients valuable tools for accessing health information, communicating with healthcare providers, and engaging in self-management. However, the influence of educating patients on these portals’ functionality on clinical outcomes, such as all-cause readmission rates, remains underexplored. Objective: This research proposal tested the hypothesis that educating a subset of patients with Chronic Obstructive Pulmonary Disease (COPD) and Congestive Heart Failure (CHF), on how to effectively access and utilize the functionality of web-based patient portals can reduce all-cause readmission rates. Methods: We performed a prospective, quasi-experimental study at Bon Secours St. Mary’s Hospital in Richmond, Virginia, USA;dividing participants into an intervention group, receiving education about accessing and navigating “My Chart”, the Bon Secours Web based portal, and a control group, receiving standard care. We then compared 30-day readmission rates, patient engagement, and self-management behaviors between the groups. Data was analyzed using statistical tests to assess the intervention’s impact. Results: We projected that educated patients will exhibit lower readmission rates, improved engagement, and better self-management. The results of the study showed that there was a significant decrease in 30-day readmissions in the intervention group in comparison with the control group (22.7% and 40.9%, respectively). This reduction of 18. 2% of readmissions evaluated here for a trial of meaningful clinical effect is statistically insignificant (p = 0. 184). The practical significance of the intervention is considered small-to-moderate (Cramer V = 0. 20) suggesting that the observed difference has a potential clinical importance even though the difference was not statistically significant. Conclusion: These results imply that the proposed educational intervention might have a positive impact on readmissions;nonetheless, the patient’s characteristics that make him or her capable of readmission cannot be changed and are assessed by the RoR (Risk of Readmission) score. The potential impact of the intervention may be offset, in part, by these baseline risk factors. The study’s power may be limited by sample size, potentially affecting the detection of significant differences. Future studies with larger, multi-center samples and longer follow-up periods are recommended to confirm these findings.

Follicular lymphoma with cardiac involvement in a 90-year-old patient:A case report

BACKGROUND The incidence of cardiac lymphoma is low,and it mainly occurs secondary to nonHodgkin’s lymphoma,particularly diffuse large B-cell lymphoma.Here,we report a case of follicular lymphoma with cardiac involvement and severe heart failure as the sole clinical manifestation.CASE SUMMARY A 90-year-old male patient was first admitted to our hospital due to an accidentally discovered painless mass in the right lower abdomen.A biopsy of the mass revealed a follicular lymphoma.Positron emission tomography-computed tomography confirmed mild pericardial effusion,and echocardiography showed no structural abnormalities with normal ejection fraction at the time of diagnosis.The patient refused our recommendation of chemotherapy and was re-admitted 4 mo later due to heart failure.A series of subsequent echocardiographic examinations showed thickening of the left ventricular walls and increasing pericardial effusion over the following 2 mo.His heart failure exacerbated despite all symptomatic and supportive treatments.He passed away after an episode of aspiration pneumonia.CONCLUSION The diagnosis of cardiac lymphoma is difficult as its clinical manifestations are nonspecific,and prognosis is poor.

磷酸肌酸钠改善高龄慢性心功能不全患者心功能和BNP的疗效观察

目的观察磷酸肌酸钠对高龄慢性心力衰竭(CHF)患者心功能和BNP的影响。方法老年慢性心力衰竭患者47例,治疗组25例,对照组22例。对照组给予常规抗心力衰竭治疗,治疗组在常规治疗基础上加用磷酸肌酸钠,疗程6周。根据纽约心脏协会心功能(NYHA)分级法评价两组患者治疗前后的临床心功能分级情况、左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)和左室射血分数(LVEF)的改善情况及血浆BNP水平的变化。结果治疗6周后,治疗组总有效率、心功能改善情况及血浆BNP下降水平显著高于对照组(P<0.05)。结论磷酸肌酸钠联合常规治疗心衰药物能显著改善CHF患者心功能、降低血浆BNP水平。

磷酸肌酸对慢性心力衰竭患者血浆脑钠素水平的影响

目的观察磷酸肌酸对老年慢性心力衰竭的临床疗效及其对血浆脑钠素(BNP)水平的影响。方法对40例老年慢性心力衰竭患者随机分组,各组20例。对照组给予标准抗心力衰竭治疗,治疗组在标准治疗基础上加用磷酸肌酸,8周为1个疗程。观察两组治疗前后患者的临床心功能分级情况、临床症状、左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)和左室射血分数(LVEF)的改善情况及血浆BNP水平的变化。结果治疗8周后,治疗组总有效率明显高于对照组(P<0.05),LVESD、LVEDD、LVEF及血浆BNP水平均较对照组明显降低(P均<0.05)。结论磷酸肌酸(CP)配合基础心衰药物治疗能显著降低老年慢性心衰患者BNP水平,改善左室功能。