Aside from the important role of brain natriuretic peptide (BNP) in diagnosis, and differential diagnosis of heart failure, this biological peptide has proved to be an independent surrogate marker of rehospitalization...Aside from the important role of brain natriuretic peptide (BNP) in diagnosis, and differential diagnosis of heart failure, this biological peptide has proved to be an independent surrogate marker of rehospitalization and death of the fatal disease. Several randomized clinical trials demonstrated that drugs such as beta blocker, angiotensin converting enzyme inhibitor, spiro- nolactone and amiodarone have beneficial effects in decreasing circulating BNP level during the management of chronic heart failure. The optimization of clinical decision-making appeals for a representative surrogate marker for heart failure prognosis. The serial point-of-care assessments of BNP concentration provide a therapeutic goal of clinical multi-therapy and an objective guid- ance for optimal treatment of heart failure. Nevertheless new questions and problems in this area remain to be clarified. On the basis of current research advances, this article gives an overview of BNP peptide and its property and role in the management of heart failure.展开更多
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,especi...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.展开更多
Background Renal insufficiency （RI） is significantly associated with clinical prognosis in patients with heart failure （HF）,but direct evidences on the relation between renal function and clinical outcome in patie...Background Renal insufficiency （RI） is significantly associated with clinical prognosis in patients with heart failure （HF）,but direct evidences on the relation between renal function and clinical outcome in patients receiving cardiac resynchronization therapy （CRT） are limited.The aim of the current study was to systematically evaluate the association of baseline and 6-month renal function with cardiac reverse remodeling and long-term outcome after CRT.Methods We retrospectively evaluated 190 consecutive patients who underwent CRT at Fuwai Hospital from January 2008 to April 2013.Renal function tests,echocardiographic measurement,and clinical parameters at baseline and after 6 months of CRT were performed.Primary endpoint events included all-cause mortality,cardiac transplantation,and unplanned hospitalizations for HF.Results At baseline,compared with normal renal function or mild RI （estimated glomerular filtration rate （eGFR） 〉-60 ml·min-1·1.73 m-2）,moderate-to-severe RI （eGFR 〈60 ml·min-1·1.73 m-2） exerted a negative influence on cardiac reverse remodeling parameters.At 6-month follow-up,114 （60.0%） patients were classified as responders and showed significant renal function improvement,whereas renal function deteriorated in non-responders and subsequently 41 （25.6%） patients developed worsening renal function （WRF）.During the mean follow-up of （24.3±17.1） months,both patients with baseline eGFR 〈60 ml·min^-1·1.73 m^-2 and those with WRF experienced worse event-free survival （P 〈0.01,respectively）.Conclusions：This analysis identified that baseline eGFR as well as WRF after CRT were found to be independent determinants of the combined endpoints of all-cause mortality and HF-related hospitalizations in CRT recipients.展开更多
Background Angiotensin converting enzyme （ACE） inhibitors and G-blockers （13B） have beneficial effects on left ventricular （LV） remodeling, alleviate symptoms and reduce morbidity and mortality in patients with ...Background Angiotensin converting enzyme （ACE） inhibitors and G-blockers （13B） have beneficial effects on left ventricular （LV） remodeling, alleviate symptoms and reduce morbidity and mortality in patients with chronic heart failure （CHF）. However the correlation between the d osages of ACE inhibitors, βB, and recovery of LV structure remains controversial. Clinical factors associated with recovery of normal ventricular structure in CHF patients receiving medical therapy are poorly defined. Here we aimed to identify variables associated with recovery of normal or near-normal structure in patients with CHF. Methods We recruited 231 consecutive CHF outpatients, left ventricular ejection fraction （LVEF） 〈40% and left ventricular end diastolic diameter （LVEDD） 〉55/50 mm （male/female）, who were receiving optimal pharmacotherapy between January 2001 and June 2009, and followed them until December 31,2009. They were divided into three groups according to LVEDD and whether they were still alive at final follow-up： group A, LVEDD 〈60/55 mm （male/female）; group B, LVEDD 〉60/55 mm （male/female）; and group C, those who died before final follow-up. Apart from group C, univariate analysis was performed followed by Logistic multivariate analysis to determine the predictors of recovery of LV structure. Results A total of 217 patients completed follow-up, and median follow-up time was 35 months （range 6-108）. Twenty-five patients died during that period; the all-cause mortality rate was 11.5%. Group A showed clinical characteristics as follows： the shortest duration of disease and shortest QRS width, the lowest N-terminal brain natriuretic peptide （NT-proBNP） at baseline, the highest dose of I3B usage, the highest systolic blood pressure （SBP）, diastolic blood pressure （DBP） and the lowest New York Heart Association （NYHA） classification, serum creatinine, uric acid, total bilirubin and NT-proBNP after treatment. Logistic multivariate analysis was performed according to recovery or no recovery of LV structure. Data showed that LVEF at follow-up （P=0.013）, mitral regurgitation at baseline （P=0.020）, LVEDD at baseline （P=-0.031）, and βB dosage （P=0.041） were independently associated with recovery of LV diameter. Conclusion Our study suggests that four clinical variables may predict recovery of LV structure to normal or near-normal values with optimal drug therapy alone, and may be used to discriminate between patients who should receive optimal pharmacotherapy and those who require more aggressive therapeutic interventions.展开更多
文摘Aside from the important role of brain natriuretic peptide (BNP) in diagnosis, and differential diagnosis of heart failure, this biological peptide has proved to be an independent surrogate marker of rehospitalization and death of the fatal disease. Several randomized clinical trials demonstrated that drugs such as beta blocker, angiotensin converting enzyme inhibitor, spiro- nolactone and amiodarone have beneficial effects in decreasing circulating BNP level during the management of chronic heart failure. The optimization of clinical decision-making appeals for a representative surrogate marker for heart failure prognosis. The serial point-of-care assessments of BNP concentration provide a therapeutic goal of clinical multi-therapy and an objective guid- ance for optimal treatment of heart failure. Nevertheless new questions and problems in this area remain to be clarified. On the basis of current research advances, this article gives an overview of BNP peptide and its property and role in the management of heart failure.
文摘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.
文摘Background Renal insufficiency （RI） is significantly associated with clinical prognosis in patients with heart failure （HF）,but direct evidences on the relation between renal function and clinical outcome in patients receiving cardiac resynchronization therapy （CRT） are limited.The aim of the current study was to systematically evaluate the association of baseline and 6-month renal function with cardiac reverse remodeling and long-term outcome after CRT.Methods We retrospectively evaluated 190 consecutive patients who underwent CRT at Fuwai Hospital from January 2008 to April 2013.Renal function tests,echocardiographic measurement,and clinical parameters at baseline and after 6 months of CRT were performed.Primary endpoint events included all-cause mortality,cardiac transplantation,and unplanned hospitalizations for HF.Results At baseline,compared with normal renal function or mild RI （estimated glomerular filtration rate （eGFR） 〉-60 ml·min-1·1.73 m-2）,moderate-to-severe RI （eGFR 〈60 ml·min-1·1.73 m-2） exerted a negative influence on cardiac reverse remodeling parameters.At 6-month follow-up,114 （60.0%） patients were classified as responders and showed significant renal function improvement,whereas renal function deteriorated in non-responders and subsequently 41 （25.6%） patients developed worsening renal function （WRF）.During the mean follow-up of （24.3±17.1） months,both patients with baseline eGFR 〈60 ml·min^-1·1.73 m^-2 and those with WRF experienced worse event-free survival （P 〈0.01,respectively）.Conclusions：This analysis identified that baseline eGFR as well as WRF after CRT were found to be independent determinants of the combined endpoints of all-cause mortality and HF-related hospitalizations in CRT recipients.
文摘Background Angiotensin converting enzyme （ACE） inhibitors and G-blockers （13B） have beneficial effects on left ventricular （LV） remodeling, alleviate symptoms and reduce morbidity and mortality in patients with chronic heart failure （CHF）. However the correlation between the d osages of ACE inhibitors, βB, and recovery of LV structure remains controversial. Clinical factors associated with recovery of normal ventricular structure in CHF patients receiving medical therapy are poorly defined. Here we aimed to identify variables associated with recovery of normal or near-normal structure in patients with CHF. Methods We recruited 231 consecutive CHF outpatients, left ventricular ejection fraction （LVEF） 〈40% and left ventricular end diastolic diameter （LVEDD） 〉55/50 mm （male/female）, who were receiving optimal pharmacotherapy between January 2001 and June 2009, and followed them until December 31,2009. They were divided into three groups according to LVEDD and whether they were still alive at final follow-up： group A, LVEDD 〈60/55 mm （male/female）; group B, LVEDD 〉60/55 mm （male/female）; and group C, those who died before final follow-up. Apart from group C, univariate analysis was performed followed by Logistic multivariate analysis to determine the predictors of recovery of LV structure. Results A total of 217 patients completed follow-up, and median follow-up time was 35 months （range 6-108）. Twenty-five patients died during that period; the all-cause mortality rate was 11.5%. Group A showed clinical characteristics as follows： the shortest duration of disease and shortest QRS width, the lowest N-terminal brain natriuretic peptide （NT-proBNP） at baseline, the highest dose of I3B usage, the highest systolic blood pressure （SBP）, diastolic blood pressure （DBP） and the lowest New York Heart Association （NYHA） classification, serum creatinine, uric acid, total bilirubin and NT-proBNP after treatment. Logistic multivariate analysis was performed according to recovery or no recovery of LV structure. Data showed that LVEF at follow-up （P=0.013）, mitral regurgitation at baseline （P=0.020）, LVEDD at baseline （P=-0.031）, and βB dosage （P=0.041） were independently associated with recovery of LV diameter. Conclusion Our study suggests that four clinical variables may predict recovery of LV structure to normal or near-normal values with optimal drug therapy alone, and may be used to discriminate between patients who should receive optimal pharmacotherapy and those who require more aggressive therapeutic interventions.
