Impact of vericiguat on heart failure with reduced ejection fraction:a review

Introduction:Heart failure is a major public health issue with a prevalence of about 26 million people worldwide.Reduced nitric oxide availability,lower soluble guanylate cyclase(sGC)activity,and decreased cyclic guanosine monophosphate(cGMP)production are the causes of HF's development.Vericiguat prescribed under the brand name Verquvo was approved by U.S.Food and Drug Administration(FDA)in January 2021.It is a novel agent and the first sGC stimulator which helps to treat patients suffering from heart failure with reduced ejection fraction(HFrEF).Objective:The mechanism of action(cGMP pathway)of vericiguat,its clinical trials,its use in the treatment of heart failure,and its possible future aspects in therapeutic recommendations are all covered in this review.It will also raise awareness amongst healthcare professionals about the pharmacokinetic and pharmacodynamic parameters,dosing,administration,and drug-related problems of this new drug.Methods:Various databases for drug review were used in this review like PubMed,Medline,Google scholar,Drug bank,U.s.FDA,Medscape,and European society of cardiology guidelines.A total of 58 articles were screened out of which 39 articles were included in this review.Results:This review discusses vericiguat's mechanism of action(cGMP pathway),clinical studies,application in the treatment of heart failure,and potential future considerations in therapeutic recommendations.It will also educate healthcare professionals about the new drug's pharmacokinetics and pharmacodynamics,dose,administration,and drug-related problems.Conclusion:After hospitalization for HFrEF,the 5-year survival rate is just 25%,and disease morbidity and death are stil significant.As adjunctive therapy for individuals with heart failure and a low ejection fraction,vericiguat has a moderate level of effectiveness.Vericiguat's efficacy as an adjunct therapy to different drugs used to cure HF has to be further investigated.Vericiguat's safety and dosage in patients who have severe renal or hepatic illness need to be studied further.

Therapies for patients with coexisting heart failure with reduced ejection fraction and non-alcoholic fatty liver disease

Heart failure with reduced ejection fraction(HFrEF)and nonalcoholic fatty liver disease(NAFLD)are two common comorbidities that share similar pathophysiological mechanisms.There is a growing interest in the potential of targeted therapies to improve outcomes in patients with coexisting HFrEF and NAFLD.This manuscript reviews current and potential therapies for patients with coexisting HFrEF and NAFLD.Pharmacological therapies,including angiotensinconverting enzyme inhibitors/angiotensin receptor blockers,mineralocorticoids receptor antagonist,and sodium-glucose cotransporter-2 inhibitors,have been shown to reduce fibrosis and fat deposits in the liver.However,there are currently no data showing the beneficial effects of sacubitril/valsartan,ivabradine,hydralazine,isosorbide nitrates,digoxin,or beta blockers on NAFLD in patients with HFrEF.This study highlights the importance of considering HFrEF and NAFLD when developing treatment plans for patients with these comorbidities.Further research is needed in patients with coexisting HFrEF and NAFLD,with an emphasis on novel therapies and the importance of a multidisciplinary approach for managing these complex comorbidities.

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

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

Diagnostic and prognostic value of circulating micro RNAs in heart failure with preserved and reduced ejection fraction

micro RNAs(mi RNAs) are powerful regulators of posttranscriptional gene expression and play an important role in pathophysiological processes. Circulating mi RNAs can be quantified in body liquids and are promising biomarkers in numerous diseases. In cardiovascular disease mi RNAs have been proven to be reliable diagnostic biomarkers for different disease entities. In cardiac fibrosis(CF) and heart failure(HF) dysregulated circulating mi RNAs have been identified,indicating their promising applicability as diagnostic biomarkers. Some mi RNAs were successfully tested in risk stratification of HF implementing their potential use as prognostic biomarkers. In this respect mi RNAs might soon be implemented in diagnostic clinical routine. In the young field of mi RNA based research advances have been made in identifying mi RNAs as potential targets for the treatment of experimental CF and HF. Promising study results suggest their potential future application as therapeutic agents in treatment of cardiovascular disease. This article summarizes the current state of the various aspects of mi RNA research in the field of CF and HF with reduced ejection fraction as well as preserved ejection fraction. The review provides an overview of the application of circulating mi RNAs as biomarkers in CF and HF and current approaches to therapeutically utilize mi RNAs in this field of cardiovascular disease.

Dapagliflozin in Heart Failure with Reduced Ejection Fraction:A Real-World Study

Aims:We aimed to observe the improvements in cardiac function indexes and the occurrence of adverse events in patients with heart failure with reduced ejection fraction(HFrEF)after dapagliflozin administration in a real-world setting.Methods:We retrospectively included 201 patients with HFrEF who were treated at a tertiary hospital in Zhengzhou and started to take dapagliflozin(10 mg/d)from March 2020 to June 2021.Their New York Heart Association(NYHA)functional class,cardiac ultrasound indexes,laboratory indexes,and vital signs between baseline and the last follow-up visit were compared,and their adverse events during the follow-up period were recorded.Results:The follow-up period was 173(67–210)days.The cardiac function indexes of patients at follow-up,com-pared with baseline,indicated significant improvement(proportion of NYHA functional class I and II:40.8%vs.56.2%;left ventricular ejection fraction:28.4±5.3%vs.34.7±5.9%;left ventricular end-diastolic diameter:70.1±6.4 mm vs.64.7±5.6 mm;N-terminal pro-B-type natriuretic peptide:5421.9±2864.4 pg/mL vs.2842.8±1703.4 pg/mL at baseline vs.at follow-up;all P<0.05).The rates of hypotension,deterioration of renal function,and genital infection during the follow-up period were 6.5%,4.0%,and 3.5%,respectively.Conclusions:We believe that dapagliflozin is safe and effective in patients with HFrEF in the real world.

Heterogeneity in cardiorenal protection by Sodium glucose cotransporter 2 inhibitors in heart failure across the ejection fraction strata:Systematic review and meta-analysis

BACKGROUND Gliflozins or Sodium glucose cotransporter 2 inhibitors(SGLT2i)are relatively novel antidiabetic medications that have recently been shown to represent favorable effects on patients’cardiorenal outcomes.However,there is shortage of data on potential disparities in this therapeutic effect across different patient subpopulations.AIM To investigate differential effects of SGLT2i on the cardiorenal outcomes of heart failure patients across left ventricular ejection fraction(LVEF)levels.METHODS Literature was searched systematically for the large randomized double-blind controlled trials with long enough follow up periods reporting cardiovascular and renal outcomes in their patients regarding heart failure status and LVEF levels.Data were then meta-analyzed after stratification of the pooled data across the LVEF strata and New York Heart Associations(NYHA)classifications for heart failure using Stata software version 17.0.RESULTS The literature search returned 13 Large clinical trials and 13 post hoc analysis reports.Meta-analysis of the effects of gliflozins on the primary composite outcome showed no significant difference in efficacy across the heart failure subtypes,but higher efficacy were detected in patient groups at lower NYHA classifications(I2=46%,P=0.02).Meta-analyses across the LVEF stratums revealed that a baseline LVEF lower than 30%was associated with enhanced improvement in the primary composite outcome compared to patients with higher LVEF levels at the borderline statistical significance(HR:0.70,95%CI:0.60 to 0.79 vs 0.81,95%CI:0.75 to 0.87;respectively,P=0.06).Composite renal outcome was improved significantly higher in patients with no heart failure than in heart failure patients with preserved ejection fraction(HFpEF)(HR:0.60,95%CI:0.49 to 0.72 vs 0.94,95%CI:0.74 to 1.13;P=0.04).Acute renal injury occurred significantly less frequently in heart failure patients with reduced ejection fraction who received gliflozins than in HFpEF(HR:0.67,95%CI:51 to 0.82 vs 0.94,95%CI:0.82 to 1.06;P=0.01).Volume depletion was consistently increased in response to SGLT2i in all the subgroups.CONCLUSION Heart failure patients with lower LVEF and lower NYHA sub-classifications were found to be generally more likely to benefit from therapy with gliflozins.Further research are required to identify patient subgroups representing the highest benefits or adverse events in response to SGLT2i.

Air pollution and heart failure: Relationship with the ejection fraction

AIM: To study whether the concentrations of particulate matter in ambient air are associated with hospitaladmission due to heart failure in patients with heart failure with preserved ejection fraction and reduced ejection fraction. METHODS: We studied 353 consecutive patients admitted into a tertiary care hospital with a diagnosis of heart failure. Patients with ejection fraction of ≥ 45% were classified as having heart failure with preserved ejection fraction and those with an ejection fraction of < 45% were classified as having heart failure with reduced ejection fraction. We determined the average concentrations of different sizes of particulate matter (< 10, < 2.5, and < 1 μm) and the concentrations of gaseous pollutants (carbon monoxide, sulphur dioxide, nitrogen dioxide and ozone) from 1 d up to 7 d prior to admission. RESULTS: The heart failure with preserved ejection fraction population was exposed to higher nitrogen dioxide concentrations compared to the heart failure with reduced ejection fraction population (12.95 ± 8.22 μg/m 3 vs 4.50 ± 2.34 μg/m 3 , P < 0.0001). Multivariate analysis showed that nitrogen dioxide was a significant predictor of heart failure with preserved ejection fraction (odds ratio ranging from (1.403, 95%CI: 1.003-2.007, P = 0.04) to (1.669, 95%CI: 1.043-2.671, P = 0.03). CONCLUSION: This study demonstrates that shortterm nitrogen dioxide exposure is independently associated with admission in the heart failure with preserved ejection fraction population.

Association of frailty with in-hospital outcomes in elderly patients with heart failure

BACKGROUND Frailty is prevalent in elderly patients with cardiovascular diseases.However,the association between frailty and in-hospital outcomes for elderly patients with heart failure and reduced ejection(HFrEF)remains unknown.AIM To evaluate the predictive efficacy of frailty,compared with pre-frailty,for adverse events in these patients.METHODS Elderly patients(≥60 years)with HFrEF were assessed.Frailty was evaluated with the Fried phenotype criteria,and physical performance was evaluated based on handgrip strength and the short physical performance battery(SPPB).The composite incidence of adverse events,including all-cause death,multiple organ failure,cardiac shock,and malignant arrhythmia,during hospitalization was recorded.RESULTS Overall,252 elderly individuals with HFrEF[mean age:69.4±6.7 years,male:169(67.0%)]were included.One hundred and thirty-five(53.6%)patients were frail and 93(36.9%)were pre-frail.Frail patients were older,more likely to be female,to have a lower blood pressure,and to present with left ventricular thrombosis(P all<0.05).Frail patients with HFrEF had a higher incidence of in-hospital mortality(11.9%vs 4.3%,P=0.048).Multivariate analyses showed that female gender(OR=0.422),aging(OR=1.090),poor cardiac functional class(OR=2.167),frailty(OR=2.379),and lower handgrip strength(OR=1.106)were independent predictors of in-hospital adverse events(P all<0.05).CONCLUSION Frailty may be associated with poor in-hospital outcomes for elderly patients with HFrEF.The influence of frailty on long-term prognosis in these patients deserves further investigation.

The Effect of Sacubitril/Valsartan in a Dialysis Patient with Severe Heart Failure*

Heart failure (HF) is a major comorbidity in patients with end-stage renal disease (ESRD). The pathogenesis of HF in patients on renal replacement therapy represents the confluence of several traditional and nontraditional vascular risk factors, unique to the milieu of chronic kidney disease and the dialysis modality [1]. The purpose of this report is to describe the efficacy and safety of sacubitril/valsartan for an ESRD patient on hemodialysis therapy conmbined with heart failure with reduced ejection fraction (HFrEF). A 35-year-old woman was undergoing hemodialysis due to ESRD and suffering from heart failure with reduced ejection fraction. Because of worsening heart failure and hypertension, she was prescribed with sacubitril/valsartan at a dose of 50 mg twice a day, spironolactone at a dose of 20 mg three times a day and metoprolol at a dose of 23.75 mg once daily. There was a symptomatic improvement with the heart failure and reduction in NT-proBNP level, accompanied by a decrease of blood pressure after using sacubitric/valsartan. In conclusion, it is safe and effective to take sacubitril/valsartan in this hemodialysis patient with severe heart failure.

Digoxin and Heart Failure:Are We Clear Yet?

The Digoxin Investigation Group trial has multiple flaws in the trial design for the fi ndings to be universally applicable.Digoxin in low serum concentrations(0.5-0.9ng/mL)has been shown to decrease mortality in heart failure patients.Multiple trials in different patient populations also show benefit of digoxin in heart failure patients,including women,elderly patients,renal disease patients,and patients with heart failure with preserved ejection fraction.Retrospective observational data linking digoxin use for treatment of atrial fi brillation to increased mortality is not seen in subgroups of randomized controlled trials or population registries.Digoxin remains a useful drug in the toolbox of physicians dealing with heart failure patients.

A Brief Review of a Common Clinical Question: Intravenous Diltiazem or Metoprolol for Atrial Fibrillation with Rapid Ventricular Response?

Two classes of rate controlling medications—beta blockers (BBs) and non- dihydropyridine calcium channel blockers (CCBs)—are given to patients who present with atrial fibrillation (AF) with rapid ventricular response (RVR). Both are Class I recommendations from the American Heart Association (AHA), American College of Cardiology (ACC), and Heart Rhythm Society (HRS) for the management of AF with RVR. Multiple studies support the view that diltiazem is more effective than metoprolol, even though data from the AFFIRM trial suggests BBs are more frequently used. CCBs are generally avoided in AF with RVR patients who have concomitant heart failure with reduced ejection fraction (HFrEF) for concern of triggering decompensation. However, some recent studies indicate this idea may be unfounded. The aim of this article is to compare the efficacy of diltiazem and metoprolol for rate control in AF with RVR and examine the use of diltiazem in patients with both AF with RVR and HFrEF.

心脏收缩力调节器用于心力衰竭的机制和临床研究

心脏收缩力调节器(CCM)作为救治慢性射血分数降低的心力衰竭(HFrEF)的新型植入性电子治疗装置,因可增强心室肌收缩力、改善患者症状体征和心功能指标甚至远期预后,已迅速成为心血管领域倍受关注的热点。本文综述了CCM治疗HFrEF的机制和临床研究,并根据其机制和信号传递算法对其在射血分数保留的心力衰竭(HFpEF)、心脏再同步化治疗(CRT)反应不佳、合并心房颤动的HFrEF患者中的疗效进一步分析和展望,以期推动CCM可以满足更多、不同临床情况的心力衰竭患者的需求。

沙库巴曲缬沙坦对老年射血分数降低心力衰竭患者心脏功能和结构的影响

目的:观察老年射血分数降低型心力衰竭(heart failure with reduced ejection fraction,HFr EF)患者使用沙库巴曲缬沙坦后第3个月的心脏功能及结构的变化。方法:连续性纳入2020年1月至2022年5月,于北京安贞医院住院的173例使用沙库巴曲缬沙坦的老年HFr EF患者,其中男性131例(75.7%),平均年龄为(69.5±7.2)岁。对纳入患者采用超声心动图进行随访。主要观察终点是出院后第3个月的心脏功能及结构的变化,包括LVEF、LVEDD、LVESD、LAD、室间隔厚度、左心室后壁厚度、左心室质量指数。结果:相比于入院时的心功能,使用沙库巴曲缬沙坦第3个月的LVEF明显提高(45.9%vs.37.5%,P<0.01),而LVEDD(56.5 vs.60.2mm,P<0.01)、LVESD(42.5vs.47.6mm,P<0.01)、LAD(49.1 vs.53.0mm,P=0.01)、左心室质量指数(111.3 vs.125.5g/m^(2),P<0.01)均明显降低。在亚组分析中,男性和NHYAⅡ~Ⅲ亚组的患者心脏功能和结构改善更为显著(均P<0.05)。结论:沙库巴曲缬沙坦能够改善老年HFr EF患者的心脏功能和结构。

参芪平律方联合体外反搏治疗射血分数降低心力衰竭的临床研究

目的观察参芪平律方联合体外反搏治疗射血分数降低心力衰竭(EFrHF)患者的临床疗效。方法选取2022年2月—2023年6月在河北医科大学第一医院治疗的60例EFrHF气虚血瘀证患者,随机分为对照组和试验组各30例。2组均给予西医标准化治疗,在此基础上,对照组患者给予体外反搏治疗4周,试验组患者给予体外反搏联合参芪平律方口服4周。观察2组治疗前后气虚血瘀证评分、心功能指标[左室射血分数(LVEF)、左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)、血浆氨基末端脑钠肽前体(NT-proBNP)]、生活质量[6 min步行距离(6MWT)]的变化。结果与治疗前比较,治疗4周后2组患者气虚血瘀证评分均明显降低,心功能指标均明显改善,6MWT均明显延长,且试验组患者上述指标改善情况均明显优于对照组,差异均有统计学意义(P均<0.05)。结论参芪平律方联合体外反搏治疗能够显著减轻EFrHF气虚血瘀证患者临床症状,改善心功能,提高生活质量。

麝香保心丸联合达格列净对老年射血分数降低性心力衰竭患者心功能及预后的影响

目的:分析麝香保心丸+达格列净治疗老年射血分数降低性心力衰竭(heart failure with reduced ejection fraction,HFrEF)患者的临床价值。方法:选取赣南医学院第一附属医院2022年1月—2023年8月收治的60例老年HFrEF患者为研究对象,以随机数字表法将60例患者划分至观察组、对照组,每组30例。对照组采用达格列净治疗,观察组采用麝香保心丸+达格列净治疗。均治疗2个月。对比两组中医症候积分、不良反应、超声心动图检查结果、心功能及生活质量。结果:治疗后,观察组中医症候积分(身寒肢冷、气短乏力、动则气喘、心悸)均低于对照组,差异均有统计学意义(P<0.05)。两组不良反应比较,差异无统计学意义(P>0.05)。治疗后,观察组超声心动图检查结果[肺动脉搏动指数(pulmonary artery pulsitility index,PAPi)]高于对照组,差异有统计学意义(P<0.05)。治疗后,观察组左心室舒张末期内径(left ventricular end diastolic diameter,LVEDD)、左心室收缩末期内径(left ventricular end systolic diameter,LVESD)均低于对照组,左心室射血分数(left ventricular ejection fraction,LVEF)、每搏输出量(stroke volume,SV)均高于对照组,差异均有统计学意义(P<0.05)。治疗后,观察组明尼苏达心力衰竭生活质量调查表(Minnesota living with heart failure questionnaire,MLHFQ)各维度评分均低于对照组,差异均有统计学意义(P<0.05)。结论:予以老年HFrEF患者麝香保心丸+达格列净治疗效果显著,可改善患者临床症状与心功能,提升生活质量,保障用药安全性,促进预后。

维立西呱联合重组人脑利钠肽治疗HFrEF伴心房颤动的临床效果研究

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

伊伐布雷定联合沙库巴曲缬沙坦治疗低血压状态下HFrEF患者的效果观察

目的 观察伊伐布雷定联合沙库巴曲缬沙坦治疗低血压状态下射血分数降低的心力衰竭(HFrEF)患者的效果。方法 118例低血压状态下HFrEF患者,随机分为观察组(60例)和对照组(58例)。对照组患者口服沙库巴曲缬沙坦治疗,观察组患者在对照组基础上加用伊伐布雷定治疗。比较两组患者的心功能指标[心率、左心射血分数(LVEF)、N末端脑钠肽前体(NT-proBNP)、6 min步行距离(6MWT)],炎症因子[白细胞介素-1(IL-1)、白细胞介素-6(IL-6)]水平,生活质量评分,低血压发生情况。结果 观察组心率、LVEF、NT-pro BNP、6MWT分别为(57.36±11.24)次/min、(46.32±5.67)%、(1137.68±462.35)ng/L、(586.32±48.76)m,对照组分别为(64.28±10.62)次/min、(42.62±5.18)%、(1628.64±473.54)ng/L、(506.37±46.82)m。治疗后,观察组患者的心率、NT-proBNP水平比对照组明显更低,同时LVEF比对照组明显更高, 6MWT比对照组明显更长,差异有统计学意义(P<0.05)。观察组IL-1、IL-6分别为(101.26±12.58)、(89.26±7.32)pg/ml,对照组分别为(106.53±13.54)、(101.65±8.05)pg/ml,观察组患者的IL-1、IL-6水平比对照组显著低,差异有统计学意义(P<0.05)。观察组患者情感功能、社会功能、身体功能、认知功能、角色功能方面的生活质量评分分别为(62.56±6.23)、(52.21±4.62)、(52.16±7.26)、(58.69±5.01)、(50.28±8.06)分,均明显高于对照组的(42.62±5.16)、(43.52±5.06)、(46.58±7.02)、(46.32±4.98)、(41.32±7.85)分,差异有统计学意义(P<0.05)。观察组患者发生低血压5例(8.33%),显著少于对照组的18例(31.03%),差异有统计学意义(P<0.05)。结论 伊伐布雷定联合沙库巴曲缬沙坦治疗低血压状态下HFrEF患者,可以显著减轻患者的心力衰竭症状,减少炎性损害,并且增加患者的日常活动水平,而且比较安全可靠,可以在临床推广使用。

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

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

射血分数降低慢性心衰患者实施沙库巴曲缬沙坦治疗的效果分析

目的 评价射血分数降低慢性心力衰竭(心衰)患者应用沙库巴曲缬沙坦治疗的临床效果。方法 选择70例射血分数降低慢性心衰患者,按随机数字表法分为对照组和观察组,各35例。对照组患者采取常规西医对症支持治疗,观察组患者在对照组基础上配合沙库巴曲缬沙坦治疗。比较两组患者的临床疗效、不良反应发生情况及治疗前后心功能指标[左室射血分数(LVEF)、左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)]、炎症因子[肿瘤坏死因子-α(TNF-α)、核因子-κB(NF-κB)]水平。结果 观察组总有效率94.29%高于对照组的74.29%(P<0.05)。观察组与对照组不良反应发生率接近(P>0.05)。治疗前,两组患者LVEF、LVESD、LVEDD接近(P>0.05);治疗后,两组LVEF、LVESD、LVEDD较治疗前改善,观察组患者LVESD(38.65±3.05)mm、LVEDD(50.22±5.02)mm低于对照组的(44.08±3.10)、(56.22±5.30)mm, LVEF(46.46±4.02)%高于对照组的(40.60±3.50)%(P<0.05)。治疗前,两组患者TNF-α、NF-κB水平接近(P>0.05);治疗后,两组患者TNF-α、NF-κB较治疗前改善,观察组患者TNF-α(10.20±2.02)ng/L、NF-κB(24.28±2.26)pg/ml低于对照组的(12.95±2.20)ng/L、(30.15±2.70)pg/ml(P<0.05)。结论 对射血分数降低慢性心衰患者进行沙库巴曲缬沙坦治疗后效果明显,可促进患者心功能与炎症因子水平改善,且用药安全性高。

The role of device therapy in heart failure with reduced ejection fraction(HFrEF) : a narrative review

Heart failure has gained increasing notice due to its high prevalence and mortality rate. The management for heart failure has been emphasized on the role of device therapy. Implantable cardioverter defibrillator(ICD) and cardiac resynchronization therapy(CRT) were given strong recommendation for heart failure with reduced ejection fraction(HFrEF), considering their effectiveness on preventing sudden cardiac death(SCD), improving cardiac function and benefiting survival. In this review, we explained the underlying mechanisms of disease initiation and progression in HFrEF, in order to build the connection between the pathological basis of HFrEF and the rationality of ICD and CRT on terminating ventricular arrhythmia, improving cardiac function, decreasing the rate of adverse clinical outcomes and benefiting survival. In addition, we discussed the high-quality researches with significant values on the discovery of device therapy clinical benefits, and compared the class I recommendations for device therapy in HFr EF, suggested by American Heart Association and European Society of Cardiology.