Prognostic impact of atrial fibrillation on clinical outcomes of acute coronary syndromes,heart failure and chronic kidney disease

Atrial fibrillation(AF) is the most common type of sustained arrhythmia,which is now on course to reach epidemic proportions in the elderly population. AF is a commonly encountered comorbidity in patients with cardiac and major non-cardiac diseases. Morbidity and mortality associated with AF makes it a major healthcare burden. The objective of our article is to determine the prognostic impact of AF on acute coronary syndromes,heart failure and chronic kidney disease. Multiple studies have been conducted to determine if AF has an independent role in the overall mortality of such patients. Our review suggests that AF has an independent adverse prognostic impact on the clinical outcomes of acute coronary syndromes,heart failure and chronic kidney disease.

Development of Nursing Protocol for Preventing Interruptions during Clinical Examinations and Treatments in the Early Days of Hospitalization for Acute Exacerbation of Chronic Heart Failure in Patients with Impaired Cognitive Function

The purpose of this study is to prepare a nursing protocol for preventing interruptions during clinical examinations and treatments performed in the early days of hospitalization for acute exacerbation of chronic heart failure in patients with impaired cognitive function. For the first stage of the research, we prepared a draft of the nursing protocol based on a basic survey. For the second stage, semi-structured interviews were conducted with 5 nurses specialized in chronic heart failure and 11 nurses in dementia care to ensure content validity of the draft protocol. For the third stage, we examined the possibility of clinical application of the revised version of the protocol draft prepared in the second stage of the study. For assessment items, significant points of nursing care, and specific nursing care practice in this revised version, 73 subjects (84.9%) considered effective for patients, in terms of prevention of interruptions during clinical examinations and treatments in the early days of hospitalization. All items and contents were considered useful by more than 60% of the nurses. Considering that the nurses working in the clinical setting reported 84.9% of usefulness, we concluded that this nursing protocol remained valid at a certain level. We consider that this nursing protocol will be useful especially for newly graduated/employed nurses as a procedure manual which can reduce their anxiety or stress caused by lack of knowledge or experiences.

Development of Nursing Protocol for Preventing Discontinuation of Treatments by Methods Other than Physical Restraint during Acute Exacerbation of Chronic Heart Failure in Patients with Impaired Cognitive Function

The purpose of this study is to prepare a nursing protocol for preventing discontinuation of treatments using a method other than physical restraint during acute exacerbation of chronic heart failure in patients with impaired cognitive function. For the first stage of the study, we prepared a draft of the nursing protocol based on a basic survey. For the second stage, semi-structured interviews were conducted with 5 nurses specialized in chronic heart failure and 10 nurses in dementia case to ensure content validity of the draft protocol. For the third stage, we examined the possibility of clinical application of the revised version of the protocol draft prepared in the second stage of the study. For assessment items, significant points of nursing care, and specific nursing care practice in this revised version, 154 subjects (93.9%) considered effective for patients, in terms of prevention of treatment discontinuation using a method other than physical restraint. All items and contents were considered useful by more than 60% of the nurses. Considering that the nurses working in the clinical setting reported 93.9% of usefulness, we concluded that this nursing protocol remained valid at a certain level. We also received a comment from the certified nurses that we should include the basic contents for newly graduated nurses. We consider that this nursing protocol will be also useful for newly graduated nurses to acquire knowledge. It helped to standardize nursing care in order to predict potential risks for patients with impaired cognitive function.

Effect of ivabradine in the treatment of acute exacerbation of chronic obstructive pulmonary disease with heart failure

Objective: To observe the effectiveness and safety of ivabradine in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and heart failure. Methods:Patients who were admitted to hospital with AECOPD during the period from August 2017 to July 2018. Then those both had heart failure with reduced ejection fraction(HFrEF) and a resting heart rate>70 beats/min were enrolled. A total of 86 cases were screened and completed, which were randomly divided into two groups for treatment. The control group(41 cases) received standard treatments, such as oxygen, anti-infection, anti-spasmodic, hormone, diuretic, ACEI/ARB, recombinant human brain natriuretic peptide (rhBNP), etc. The bisoprolol was given 2.5~5 mg orally once a day to control heart rate, and the test group(45 cases) was further treated with ivabradine 2.5~5 mg orally twice a day on the basis of the control group. The average heart rate, cardiac function, lung function, and 6-minute walking test were compared between the two groups. Results: After treatment, the average heart rate of the test group was lower than the control group, and the heart rate control rate(<70 beats/min%) of the test group was superior to the control group. The level of N-terminal B-type natriuretic peptide(NT-proBNP) in test group was significantly lower than that in control group. The distance of the 6-minute walking test in e test group was significantly longer than that in control group. Conclusion: Ivabradine combined with bisoprolol could help patients with AECOPD and heart failure to further reduce the heart rates, improve heart function and exercise tolerance. Moreover, the therapeutic safety was acceptable during the short term.

Development of a Nursing Protocol for Hospitalized Patients with Reduced Cognitive Function in the Process of Recovery from Acute Exacerbation of Chronic Heart Failure

The purpose of this study is to develop a nursing protocol aiming at early recovery of hospitalized patients with reduced cognitive functions in the process of recovery from acute exacerbation of chronic heart failure. At the first stage of the research, a draft nursing protocol was prepared based on a basic survey. At the second stage of research, a semi-structured interview was conducted for 4 nurses certified for chronic heart failure nursing and 11 nurses certified for dementia nursing so as to ensure content validity of the draft nursing protocol. At the third stage of the study, the possibility of clinical application of the nursing protocol revision plan proposed at the second stage of the study was examined. The nursing protocol revision plan was effective for 118 nurses (90.1%) who carried out the protocol for the target patient on assessment items, essential points of nursing care and specific nursing care. There were no items or contents for which confirmation of usefulness was less than 60%. Since 90.1% of the usefulness was confirmed by nurses working in the actual clinical setting, the authors believe that this nursing protocol was secured to a certain level. The nursing protocol developed in this study has been requested by nurses at clinical sites in the past. It is very meaningful in improving nursing for the early recovery of hospitalized patients with reduced cognitive function in the process of recovery from acute exacerbation of chronic heart failure.

The Lebanese Society of Cardiology Consensus Statement on the Use of Natriuretic Peptides for the Management of Heart Failure

Plasma concentration of Natriuretic Peptide (NP) is a valuable diagnostic tool for heart failure (HF). It can help rule out or confirm a diagnosis of HF based on symptoms, but its use is not clearly defined. NPs should be used in conjunction with physical examination and other diagnostic tests. However, it is important to note that several conditions besides the diagnosis of HF may cause NPs levels to be elevated. Additionally, there are situations when NP concentrations may be below diagnostic thresholds in [1]. This consensus statement aims to provide a straightforward diagnostic flowchart for clinicians in both the emergency department and outpatient settings to aid in diagnosing both acute and chronic HF. The diagnosis of acute HF can be ruled out with a BNP level of 100 pg/mL or NTproBNP level of 300 pg/mL, regardless of the patient’s age. To identify HF, a 3-level cut-off point based on the patient’s age is recommended. Chronic heart failure can be ruled out with a BNP level of 35 pg/mL or NTproBNP level of 125 pg/mL, regardless of thepatient’s age [1].

Risk factors for progression to acute-on-chronic liver failure during severe acute exacerbation of chronic hepatitis B virus infection

BACKGROUND Acute exacerbation in patients with chronic hepatitis B virus(HBV) infection results in different severities of liver injury. The risk factors related to progression to hepatic decompensation(HD) and acute-on-chronic liver failure(ACLF) in patients with severe acute exacerbation(SAE) of chronic HBV infection remain unknown.AIM To identify risk factors related to progression to HD and ACLF in compensated patients with SAE of chronic HBV infection.METHODS The baseline characteristics of 164 patients with SAE of chronic HBV infection were retrospectively reviewed. Independent risk factors associated with progression to HD and ACLF were identified. The predictive values of our previously established prediction model in patients with acute exacerbation(AE model) and the model for end-stage liver disease(MELD) score in predicting the development of ACLF were evaluated.RESULTS Among 164 patients with SAE, 83(50.6%) had compensated liver cirrhosis(LC),43 had progression to HD without ACLF, and 29 had progression to ACLF within 28 d after admission. Independent risk factors associated with progression to HD were LC and low alanine aminotransferase. Independent risk factors for progression to ACLF were LC, high MELD score, high aspartate aminotransferase(AST) levels, and low prothrombin activity(PTA). The area under the receiver operating characteristic of the AE model [0.844, 95%confidence interval(CI): 0.779-0.896] was significantly higher than that of MELD score(0.690, 95%CI: 0.613-0.760, P < 0.05) in predicting the development of ACLF.CONCLUSION In patients with SAE of chronic HBV infection, LC is an independent risk factor for progression to both HD and ACLF. High MELD score, high AST, and low PTA are associated with progression to ACLF. The AE model is a better predictor of ACLF development in patients with SAE than MELD score.

Chronic Liver Failure-Sequential Organ Failure Assessment is better than the Asia-Pacific Association for the Study of Liver criteria for defining acute-on-chronic liver failure and predicting outcome

AIM:To compare the utility of the Chronic Liver FailureSequential Organ Failure Assessment(CLIF-SOFA)and Asia-Pacific Association for the Study of Liver(APASL)definitions of acute-on-chronic liver failure(ACLF)in predicting short-term prognosis of patients with ACLF.METHODS:Consecutive patients of cirrhosis with acute decompensation were prospectively included.They were grouped into ACLF and no ACLF groups as per CLIF-SOFA and APASL criteria.Patients were followed up for 3 mo from inclusion or mortality whichever was earlier.Mortality at 28-d and 90-d was compared between no ACLF and ACLF groups as per both criteria.Mortality was also compared between different grades of ACLF as per CLIF-SOFA criteria.Prognostic scores like CLIF-SOFA,Acute Physiology and ChronicHealth Evaluation(APACHE)-Ⅱ,Child-Pugh and Model for End-Stage Liver Disease(MELD)scores were evaluated for their ability to predict 28-d mortality using area under receiver operating curves(AUROC).RESULTS:Of 50 patients,38 had ACLF as per CLIFSOFA and 19 as per APASL criteria.Males(86%)were predominant,alcoholic liver disease(68%)was the most common etiology of cirrhosis,sepsis(66%)was the most common cause of acute decompensation while infection(66%)was the most common precipitant of acute decompensation.The 28-d mortality in no ACLF and ACLF groups was 8.3%and 47.4%(P=0.018)as per CLIF-SOFA and 39%and 37%(P=0.895)as per APASL criteria.The 28-d mortality in patients with no ACLF(n=12),ACLF grade 1(n=11),ACLF grade 2(n=14)and ACLF grade 3(n=13)as per CLIF-SOFA criteria was 8.3%,18.2%,42.9%and76.9%(χ2 for trend,P=0.002)and 90-d mortality was 16.7%,27.3%,78.6%and 100%(χ2 for trend,P<0.0001)respectively.Patients with prior decompensation had similar 28-d and 90-d mortality(39.3%and 53.6%)as patients without prior decompensation(36.4%and 63.6%)(P=NS).AUROCs for 28-d mortality were 0.795,0.787,0.739 and 0.710 for CLIF-SOFA,APACHE-Ⅱ,Child-Pugh and MELD scores respectively.On multivariate analysis of these scores,CLIF-SOFA was the only significant independent predictor of mortality with an odds ratio 1.538(95%CI:1.078-2.194).CONCLUSION:CLIF-SOFA criteria is better than APASL criteria to classify patients into ACLF based on their prognosis.CLIF-SOFA score is the best predictor of short-term mortality.

Acute-on-chronic liver failure in a multi-ethnic Asian city:A comparison of patients identified by Asia-Pacific Association for the Study of the Liver and European Association for the Study of the Liver definitions

AIM To explore the applicability of the Asia-Pacific Association for the Study of the Liver(APASL) and European Association for the Study of the Liver(EASL) guidelines for acute-on-chronic liver failure(ACLF) in profiling patients and determining the outcome.METHODS Patients admitted to a tertiary hospital in Singapore with acute decompensation of liver disease from January 2004to July 2014 are screened for ACLF according to the APASL and EASL criteria. The patients' data(including basic demographics, information about existing chronic liver disease, information about the acute decompensation, relevant laboratory values during admission, treatment, and outcome) are retrospectively analyzed to determine the background, precipitating factors and outcome.RESULTS A total of 458 liver patients is analyzed, and 78 patients with ACLF are identified. Sixty-three patients(80.8%) meet the APASL criteria, 64 patients(82.1%) meet the EASL criteria, and 49 patients(62.8%) fulfilled both criteria. The most common causes of acute liver injury are bacterial infections(59.0%), hepatitis B flare(29.5%), and variceal bleeding(24.4%). The common aetiologies of the underlying chronic disease included hepatitis B(43.6%), alcoholic(20.5%) and cryptogenic(11.5%) liver disease. The overall mortality rate is 61.5%. Increased age, the number of organ failures(as per CLIF-SOFA score), peak creatinine, INR, and amylase levels are associated with increased mortality or the need for liver transplantation. 14.3% of patients undergo liver transplantation with a 100% 1-year survival rate. CONCLUSION Both APASL and EASL criteria have identified ACLF patients with high three-month mortality, but those who fulfill APASL criteria alone have a better survival.

Prevalence and risk factors of acute-on-chronic liver failure in a single center from Argentina

AIM To study the prevalence, characteristics, risk factors and mortality at 28 d of acute-on-chronic liver failure(ACLF).METHODS A total of 100 cirrhotic patients admitted to our hospital for more than one day were included during the period between June 2013 and December 2015. We used the European Association for the Study of the Liver-Chronic Liver Failure-Consortium diagnostic criteria for ACLF, considering it as the acute decompensation of cirrhosis associated with the presence of one or more organ failure. For the diagnosis of organic failure the Chronic Liver Failure-Sequential Organ Failure Assessment score was used. Our population was divided into patients with and without ACLF. Clinical characteristics, presence of precipitating events, potential risk factors for developing ACLF and causes of mortality were analyzed. Mortality at 28 d was evaluated.RESULTS Twenty-nine patients(29%) developed ACLF criteria. Alcoholism, detected in 58 patients(58%), was the major etiological agent of cirrhosis. Bacterial infections were recognized as a precipitating event in 41.3% of cases and gastrointestinal bleeding in 27.5%. No precipitating event was identifiable in 27.5% of patients with ACLF. Comparing patients with and without ACLF, statistically significant risk factors were: Child Pugh score 10.2 ± 2.1 vs 8.4 ± 1.6(P < 0.0001), MELD score 20.7 ± 8.5 vs 12.3 ± 4(P < 0.0001), presence of ascites 27(93%) vs 43(60.5%)(P = 0.001), leukocytosis 15300 ± 8033 per cubic millimeter vs 10770 ± 5601 per cubic millimeter(P < 0.0001), and high plasma levels of C reactive protein values 50.9 ± 46.4 mg/L vs 28.6 ± 23.4 mg/L(P < 0.0019). Mortality rate was 62%(18 patients) vs 5.6%(4 patients), respectively(P < 0.0001).CONCLUSION We observed that the ACLF is a frequent entity in this group of patients and has a significantly higher mortality rate.

Correlation of Ceruloplasmin with Biomarkers of Cardiac Remodelling and Myofibrosis in Patients with Acute Decompensated Heart Failure Referred to a Tertiary Nurse Lead Heart Failure Clinic

Background: Ceruloplasmin is an acute phase protein with plasma copper binding properties, and is a potent extracellular antioxidative enzyme. Inflammation and oxidative stress might explain the role of ceruloplasmin in the pathophysiology of heart failure. Study objective: The objective is to assess the correlation of ceruloplasmin levels with biomarkers of cardiac remodelling and myofibrosis in patients with acute decompensated heart failure. Patients and methods: Blood samples were taken and serum levels of soluble ST2, galectin-3, NT-proBNP and ceruloplasmin were analysed in 31 consecutive patients with systolic HF referred to tertiary care nurse lead heart failure clinic with acute decompensated CHF requiring i.v. diuretics. The mean patients’ age was 68 years, mean left ventricular ejection fraction (LV EF) was 29%, 66% patients had ischemic aetilogy of CHF and 33% had atrial fibrillation. Results: The mean ceruloplasmin level was 0.243 g/l, mean galectin-3 level was 1.26 ng/ml, mean sST2 level was 38.15 ng/ml, and mean NT-proBNP was 1927 pg/ml. The ceruloplasmin level correlated with NT-proBNP (r = 0.58, p < 0.05) and with sST2 (r = 0.77, p < 0.001), sST2 levels correlated significantly with NT-proBNP (r = 0.66, p < 0.01). The ceruloplasmin level did not correlate with galectin-3 concentration. Conclusion: The ceruloplasmin level correlates with the biomarkers of cardiac remodelling (NT-proBNP, sST2), but not with the biomarker of myofibrosis (galectin-3). This finding supports the hypothesis of inflammatory response in acute decompensated heart failure.

Effi cacy and Renal Tolerability of Ultrafi ltration in Acute Decompensated Heart Failure: A Meta-analysis and Systematic Review of 19 Randomized Controlled Trials

Background:Acute decompensated heart failure(ADHF)is a life-threatening and costly disease.Controversy re-mains regarding the effi cacy and renal tolerability of ultrafi ltration for treating ADHF.We therefore performed this meta-analysis to evaluate this clinical issue.Methods:A search of PubMed,EMBASE,and the Cochrane database of controlled trials was performed from in-ception to March 2021 for relevant randomized controlled trials.The quality of the included trials and outcomes was evaluated with the use of the risk of bias assessment tool and the Grading of Recommendations,Assessment,Develop-ment and Evaluation(GRADE)approach,respectively.The risk ratio and the standardized mean difference(SMD)or weighted mean difference(WMD)were computed and pooled with fi xed-effects or random-effects models.Results:This meta-analysis included 19 studies involving 1281 patients.Ultrafi ltration was superior to the control treatments for weight loss(WMD 1.24 kg,95%confi dence interval[CI]0.38-2.09 kg,P=0.004)and fl uid removal(WMD 1.55 L,95%CI 0.51-2.59 l,P=0.003)and was associated with a signifi cant increase in serum creatinine level compared with the control treatments(SMD 0.15 mg/dL,95%CI 0.00-0.30 mg/dL,P=0.04).However,no signifi cant effects were found for serum N-terminal prohormone of brain natriuretic peptide level,length of hospital stay,all-cause mortality,or all-cause rehospitalization in the ultrafi ltration group.Conclusions:The use of ultrafi ltration in patients with ADHF is superior to the use of the control treatments for weight loss and fl uid removal,but has adverse renal effects and lacks signifi cant effects on long-term prognosis,in-dicating that this approach to decongestion in ADHF patients is effi cient for fl uid management but less safe renally.

Acute kidney injury in acute-on-chronic liver failure is different from in decompensated cirrhosis

AIM To evaluate the differences in acute kidney injury(AKI) between acute-on-chronic liver failure(ACLF) and decompensated cirrhosis(DC) patients. METHODS During the period from December 2015 to July 2017, 280 patients with hepatitis B virus(HBV)-related ACLF(HBV-ACLF) and 132 patients with HBV-related DC(HBV-DC) who were admitted to our center were recruited consecutively into an observational study. Urine specimens were collected from all subjects and the levels of five urinary tubular injury biomarkers were detected,including neutrophil gelatinase-associated lipocalin(NGAL), interleukin-18(IL-18), liver-type fatty acid binding protein(L-FABP), cystatin C(CysC), and kidney injury molecule-1(KIM-1). Simultaneously, the patient demographics, occurrence and progression of AKI, and response to terlipressin therapy were recorded. All patients were followed up for 3 mo or until death after enrollment. RESULTS AKI occurred in 71 and 28 of HBV-ACLF and HBV-DC patients, respectively(25.4% vs 21.2%, P = 0.358). Among all patients, the levels of four urinary biomarkers(NGAL, CysC, L-FABP, IL-18) were significantly elevated in patients with HBV-ACLF and AKI(ACLF-AKI), compared with that in patients with HBV-DC and AKI(DC-AKI) or those without AKI. There was a higher proportion of patients with AKI progression in ACLF-AKI patients than in DC-AKI patients(49.3% vs 17.9%, P = 0.013). Fortythree patients with ACLF-AKI and 19 patients with DC-AKI were treated with terlipressin. The response rate of ACLFAKI patients was significantly lower than that of patients with DC-AKI(32.6% vs 57.9%, P = 0.018). Furthermore, patients with ACLF-AKI had the lowest 90 d survival rates among all groups(P < 0.001).CONCLUSION AKI in ACLF patients is more likely associated with structural kidney injury, and is more progressive, with a poorer response to terlipressin treatment and a worse prognosis than that in DC patients.

Acute-on-chronic liver failure：recent update

Acute on chronic liver failure（ACLF） was first described in 1995 as a clinical syndrome distinct to classic acute decompensation.Characterized by complications of decompensation,ACLF occurs on a background of chronic liver dysfunction and is associated with high rates of organ failure and significant short-term mortality estimated between45%and 90%.Despite the clinical relevance of the condition,it still remains largely undefined with continued disagreement regarding its precise etiological factors,clinical course,prognostic criteria and management pathways.It is concerning that,despite our relative lack of understanding of the condition,the burden of ACLF among cirrhotic patients remains significant with an estimated prevalence of 30.9%.This paper highlights our current understanding of ACLF,including its etiology,diagnostic and prognostic criteria and pathophysiology.It is evident that further refinement of the ACLF classification system is required in order to detect high-risk patients and improve short-term mortality rates.The field of metabolomics certainly warrants investigation to enhance diagnostic and prognostic parameters,while the use of granulocyte-colony stimulating factor is a promising future therapeutic intervention for patients with ACLF.

Bacterial infection triggers and complicates acute-on-chronic liver failure in patients with hepatitis B virus-decompensated cirrhosis: A retrospective cohort study

BACKGROUND Reports on bacterial infection(BI)in decompensated cirrhosis(DC)is mainly from alcoholic cirrhosis.The role of BI as a trigger or complication of acute-onchronic liver failure(ACLF)in patients with hepatitis B virus decompensated cirrhosis(HBV-DC)remains to be investigated.AIM To investigate the impact of BI on the outcomes of the patients with HBV-DC admitted into the hospital with or without ACLF.METHODS This retrospective study included patients with HBV-DC admitted to two tertiary centers in China.In-hospital overall survival,90-d transplant-free survival,5-year post-discharge survival,and cumulative incidence of ACLF were evaluated.Risk factors for death were analyzed considering liver transplantation as a competing event.RESULTS A total of 1281 hospitalized HBV-DC patients were included;284 had ACLF at admission.The overall prevalence of BI was 28.1%.The patients with BI had a significantly lower in-hospital survival and transplant-free 90-d survival than those without,in both the patients admitted with and without ACLF.The presence of BI significantly increased the risk of developing ACLF[subdistribution hazard ratio(sHR)=2.52,95%CI:1.75-3.61,P<0.001]in the patients without ACLF.In the patients discharged alive,those who had an episode of BI had a significantly lower 5-year transplant-free survival.BI was an independent risk factor for death in the patients admitted without ACLF(sHR=3.28,95%CI:1.93-5.57),while in ACLF admissions,the presence of pneumonia,but not other type of BI,independently increased the risk of death(sHR=1.87,95%CI:1.24-2.82).CONCLUSION BI triggers ACLF in patients with HBV-DC and significantly impairs short-term survival.HBV-DC patients should be monitored carefully for the development of BI,especially pneumonia,to avoid an adverse outcome.

Definition and classification of acute-on-chronic liver diseases

Patients with chronic liver diseases(CLDs)develop acute liver injury and/or acute decompensation under the attack of various precipitants and present with significantly elevated alanine aminotransferase and/or total bilirubin levels,liver failure,or acute decompensation of liver cirrhosis,which is called acute-on-CLD(AoCLD).AoCLD accounts for the majority of patients hospitalized in the Department of Hepatology or Infectious Diseases.AoCLD is complicated by various clinical types,the severity of the disease,and may pose a high risk of death.To date,the definition of AoCLD is still vague,and a consensus concept of the clinical classification is lacking.This review aimed to define the concept and clinical types of AoCLD based on related studies and the literature.

Effect of Angiotensin Receptor-neprilysin Inhibitor on Acute Kidney Injury in Patients With Acute Decompensated Heart Failure

Objective:The risk of acute kidney injury(AKI)is high in patients with acute decompensated heart failure(ADHF).The aim of this study is to analyze the role of urinary neutrophil gelatinase-associated lipocalin(uNGAL)in diagnosing AKI in patients with ADHF and evaluate the therapeutic effect of angiotensin receptor-neprilysin inhibitor(ARNI)on AKI.Method:Sixty patients with ADHF were enrolled at the First Affiliated Hospital of Kangda College of Nanjing Medical University from January 2020 to June 2021,and randomized into 2 groups(ARNI group:30 patients treated with tablets of sacubitril valsartan sodium;and angiotensin-converting enzyme inhibitor(ACEI)group:30 patients treated with benazepril).The uNGAL level was measured immediately after as well as 1,2,3,and 7 d after hospital admission.The serum creatinine(sCr)level and estimated glomerular filtration rate(eGFR)were measured immediately as well as 2 and 7 d after hospital admission.The urine volume,dose of loop diuretics,and duration of hospital stay(DoHS)were recorded.Result:The most valuable diagnostic metric for AKI in patients with ADHF was the uNGAL level 1 d after hospital admission,which had a sensitivity of 0.94,specificity of 0.84,and optimal cutoff of 125.62μg/L.In the presence of AKI,during the first 2 d,patients in the ARNI-AKI and ACEI-AKI groups showed an increase in the sCr level and a reduction in the eGFR level,but there was no significant difference between the 2 groups(P>0.05).After 7 d of treatment,the sCr level decreased and the eGFR level increased in both groups,with a significantly greater changes being observed in the ARNI-AKI group than in the ACEI-AKI group(P<0.05,respectively).In the absence of AKI,the difference in the sCr level and eGFR between the 2 groups was not significant.The DoHS((11.25±2.38)d vs.(14.11±2.89)d),urinary microalbumin level((22.95±6.04)mg/L vs.(31.91±2.18)mg/L),and daily dose of loop diuretics((19.03±3.04)mg/d vs.(23.62±4.46)mg/d)were significantly lower in patients with AKI in the ARNI group than in the ACEI group(P<0.05,respectively).Conclusion:In patients with ADHF,uNGAL measurement enables the diagnosis of AKI earlier than that using the sCr level by 1 to 2 d.ARNI treatment reduced the sCr level,facilitated eGFR recovery,reduced the daily dose of loop diuretics,and decreased the DoHS compared with that in patients receive ACEI treatment.

参附注射液治疗心肾阳虚型慢性心力衰竭急性加重的临床研究

目的:观察参附注射液治疗心肾阳虚型慢性心力衰竭急性加重的临床疗效。方法:选取2023年10月—2024年1月在安徽中医药大学第一附属医院住院的慢性心力衰竭急性加重病人60例,按照随机数字表法分为观察组与对照组,各30例。观察组给予参附注射液加西医常规治疗,对照组仅给予西医常规治疗,比较两组治疗前后血浆氨基末端B型钠尿肽前体(NT-proBNP)、超敏肌钙蛋白I(hs-cTnI)、6 min步行试验(6MWT)、明尼苏达州心力衰竭生活质量问卷评分(MLHFQ)、中医证候积分及纽约心脏病协会(NYHA)心功能分级。结果:与治疗前比较,两组治疗后NT-proBNP、hs-cTnI水平降低(P<0.05),两组治疗后NT-proBNP、hs-cTnI水平比较差异均无统计学意义(P>0.05);与治疗前比较,两组治疗后6MWT、MLHFQ评分均明显改善(P<0.05),观察组改善程度优于对照组(P<0.05);两组治疗后各单项中医证候积分低于治疗前(P<0.05),观察组治疗后喘促气短、倦怠乏力、畏寒肢冷及言语声低评分低于对照组(P<0.05)。观察组总有效率为96.7%,对照组为80.0%,两组比较差异有统计学意义(P<0.05)。结论:参附注射液联合西药常规治疗可改善心肾阳虚型慢性心力衰竭急性加重病人心功能,提高病人运动耐量和生活质量。

Performance measures for management of chronic heart failure patients with acute coronary syndrome in China： results from the Bridging the Gap on Coronary Heart Disease Secondary Prevention in China （BRIG） Project

Background Chronic heart failure （CHF） is a severe clinical syndrome associated with high morbidity and mortality, and with high health care expenditures. No nationwide data are currently available regarding the quality of clinical management of CHF patients in China. The aim of this study was to assess the quality of care of CHF inpatients in China. Methods The American College of Cardiology/American Heart Association Clinical Performance Measures for Adults with Chronic Heart Failure （Inpatient Measurement Set） with slight modifications was used to measure the performance status in 612 CHF patients with acute coronary syndrome （ACS） from 65 hospitals across all regions of China. Results The implementation rates of guideline recommended strategies for CHF management were low. Only 57.5% of the CHF patients received complete discharge instructions, 53.6% of the patients received evaluation of left ventricular systolic function, 62.8% received an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker at discharge, and 52.7% received a p-blocker at discharge, 56.3% of the smokers received smoking cessation counseling. The rate of warfarin utilization was only 9.7% in CHF patients with atrial fibrillation. Most patients （81.4%） did not receive all the first four treatments. There were marked differences in the quality of CHF management among patients with different characteristics. Conclusions Performance measures provide a standardized method of assessing quality of care, and can thus highlight problems in disease management in clinical practice. The quality of care for CHF patients with ACS in China needs to be improved.

重组人脑利钠肽对急性失代偿性心力衰竭的疗效及相关指标的影响探讨

目的观察重组人脑利钠肽(rhBNP)对急性失代偿性心力衰竭的疗效及相关指标的影响。方法78例急性失代偿性心力衰竭患者,根据治疗方案差异分成对照组与观察组,每组39例。对照组采取常规治疗,观察组在对照组基础上加用重组人脑利钠肽治疗。比较两组治疗前后临床症状评分、炎性介质水平、血管内皮功能、心功能指标及生存质量。结果治疗后,两组呼吸困难、下肢水肿、入睡困难、喘息不止、颈静脉怒张评分较治疗前更低,且观察组呼吸困难、下肢水肿、入睡困难、喘息不止、颈静脉怒张评分分别为(1.05±0.26)、(1.43±0.25)、(0.77±0.21)、(1.51±0.45)、(1.29±0.62)分,较对照组的(2.52±0.89)、(2.31±0.67)、(1.07±0.38)、(2.12±0.36)、(2.31±0.72)分更低(P<0.05)。治疗后,两组肿瘤坏死因子-α、白细胞介素-6、超敏C反应蛋白水平较治疗前更低,且观察组肿瘤坏死因子-α、白细胞介素-6、超敏C反应蛋白水平分别为(0.43±0.15)pg/L、(8.86±1.51)pg/ml、(8.10±1.15)mg/L,较对照组的(0.61±0.11)pg/L、(10.51±1.62)pg/ml、(10.32±1.22)mg/L更低(P<0.05)。治疗后,两组一氧化氮、内皮素-1水平较治疗前更低,且观察组一氧化氮水平(53.81±7.92)μmol/L、内皮素-1水平(40.91±2.30)ng/L较对照组的(60.46±6.42)μmol/L、(52.16±3.63)ng/L更低(P<0.05)。两组治疗后左心室射血分数、心输出量、心脏指数较治疗前更高,左心室舒张末期内径、左心室收缩末期内径较治疗前更小,且观察组左心室射血分数、心输出量、心脏指数较对照组更高,左心室舒张末期内径、左心室收缩末期内径较对照组更小(P<0.05)。两组治疗后生理、心理、社会关系、环境评分较治疗前更高,且观察组较对照组更高(P<0.05)。结论采用重组人脑利钠肽治疗急性失代偿性心力衰竭效果显著,其能够改善患者临床相关症状及血管内皮功能,有助于心功能早日恢复至健康状态。