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.

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.

Effect of adjuvant levosimendan therapy on neuroendocrine hormones and cytokines in elderly patients with chronic heart failure

Objective: To discuss the effect of adjuvant levosimendan therapy on neuroendocrine hormones and cytokines in elderly patients with chronic heart failure. Methods: A total of 100 elderly patients with chronic heart failure who were treated in the hospital between March 2014 and March 2017 were divided into control group and levosimendan group by random number table, each with 50 cases. Control group received clinical routine therapy for chronic heart failure, and levosimendan group received routine therapy combined with adjuvant levosimendan therapy. The differences in serum levels of RAAS indexes, thyroid hormones, myocardial damage indexes and endothelial function indexes were compared between the two groups before and after treatment. Results: At T0, there was no statistically significant difference in serum levels of RAAS indexes, thyroid hormones, myocardial damage indexes and endothelial function indexes between the two groups. At T1, serum RAAS indexes PRA, AngⅡ and ALD levels of levosimendan group were lower than those of control group;serum thyroid hormones TT3, TT4, FT3 and FT4 levels of levosimendan group were higher than those of control group;serum myocardial damage indexes cTnⅠ, H-FABP and NT-proBNP levels of levosimendan group were lower than those of control group;serum endothelial function index NO level of levosimendan group was higher than that of control group while ET-1 level was lower than that of control group. Conclusion: Adjuvant levosimendan therapy for elderly patients with chronic heart failure can effectively adjust the secretion of neuroendocrine hormones and reduce the myocardial and vascular endothelial damage.

Depression and chronic heart failure in the elderly： an intriguing relationship

Chronic heart failure and depressive disorders have a high prevalence and incidence in the elderly. Several studies have shown how depression tends to exacerbate coexisting chronic heart failure and its clinical outcomes and vice versa, especially in the elderly. The negative synergism between chronic heart failure and depression in the elderly may be approached only taking into account the multifaceted pathophysiological characteristics underlying both these conditions, such as behavioural factors, neurohormonal activation, inflammatory mediators, hypercoagulability and vascular damage. Nevertheless, the pathophysiological link between these two conditions is not well established yet. Despite the high prevalence of depression in chronic heart failure elderly patients and its negative prognostic value, it is often unrecognized especially because of shared symptoms. So the screening of mood disorders, using reliable questionnaires, is recommended in elderly patients with chronic heart failure, even if cannot substitute a diagnostic interview by mental health professionals. In this setting, treatment of depression requires a multidisciplinary approach including： psychotherapy, antidepressants, exercise training and electroconvulsive therapy. Pharmacological therapy with selective serotonin reuptake inhibitors, despite conflicting results, improves quality of life but does not guarantee better outcomes. Exercise training is effective in improving quality of life and prognosis but at the same time cardiac rehabilitation services are vastly underutilized.

High flux hemodialysis in elderly patients with chronic kidney failure

BACKGROUND Hemodialysis is an advanced blood purification technique to manage kidney failure.However,for conventional hemodialysis,the high prevalence of dyslipidemia may cause cardiovascular diseases and an increase in mortality.Moreover,toxins accumulating in the body over time may induce some complications.High flux hemodialysis can effectively improve disease indexes and clinical symptoms.AIM To investigate the efficacy of high flux hemodialysis in elderly patients with chronic kidney failure(CKF).METHODS A total of 66 elderly patients with CKF who were admitted to our hospital from October 2017 to October 2018 were included in the study.According to the therapies they received,the patients were divided into a study group and a control group with 33 patients in each group.The study group received high flux hemodialysis and the control group received conventional dialysis treatment.Kidney function,toxin levels in serum,and complications were compared in the two groups.RESULTS Before the treatment,there was no significant difference in kidney function,β2-microglobulin,or blood urea nitrogen between the two groups(P>0.05).In contrast,kidney function was better in the study group than in the control group after the treatment(P<0.05).In addition,the study group had significantly lower parathyroid hormone and serum cystatin C than the control group(P<0.05).The incidence of complications was 8.57%in the study group,which was lower than that of the control group(20.00%;P<0.05).CONCLUSION High flux hemodialysis may improve kidney function and reduce toxin levels in serum and the incidence of complications in elderly patients with CKF.

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.

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.

Renal dysfunction and anemia features in geriatric patients with chronic heart failure

Aim of the work was to study the features of renal dysfunction and anemia in the patients with chronic heart failure(CHF) and saved or disturbed left ventricular systolic function(LVSF).There were examined 47 geriatric men [mean age(64.3±0.8)] with CHR due to IHD and arterial hypertension.Evaluated the glomerular filtration rate(GFR),the presence of microalbuminuria(MAU),levels of serum creatinine,ferum,erythrocyte count.GFR lowered not only in patients with saved LVSF.Increased MAU and SK,Hb concentration lowering were evaluated in patients with LVSF disturbance.No correlation between Hb level and renal function was revealed.

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.

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.

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.

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.

血清鸢尾素联合可溶性Corin在老年慢性心力衰竭患者预后评估中的价值

目的探讨血清鸢尾素和可溶性Corin在老年慢性心力衰竭(CHF)患者预后评估中的价值。方法选取2016年3月—2019年2月中国人民解放军北部战区总医院老年CHF患者129例。收集所有患者的临床资料,并检测血常规、生化常规指标和血清鸢尾素、可溶性Corin水平,以及左心室射血分数(LVEF)。对所有患者进行随访,随访终点为全因死亡或发生主要心血管不良事件。将发生终点事件的患者纳入预后不良组,未发生终点事件的患者纳入预后良好组。采用Pearson相关分析评估各项目的相关性。采用受试者工作特征(ROC)曲线确定血清鸢尾素和可溶性Corin判断老年CHF患者发生终点事件的最佳临界值并进行分组。采用Kaplan-Meier生存曲线分析老年CHF患者的生存情况。采用Cox回归分析评估老年CHF患者预后不良的危险因素。结果不同纽约心脏病协会(NYHA)分级的老年CHF患者之间临床特征差异均无统计学意义(P>0.05)。不同性别的老年CHF患者之间鸢尾素和可溶性Corin水平差异均无统计学意义(P>0.05)。血清鸢尾素和可溶性Corin与氨基末端B型钠尿肽原(NT-pro BNP)、LVEF均无相关性(P>0.05)。预后不良组血清鸢尾素和可溶性Corin水平均低于预后良好组(P<0.05)。鸢尾素>5.7 ng·m L^(–1)组和可溶性Corin>487 pg·m L^(–1)组无终点事件生存期分别显著长于鸢尾素≤5.7 ng·m L^(–1)组和可溶性Corin≤487 pg·m L^(–1)组(P<0.01)。年龄>70岁、合并心房颤动、NYHAⅡ~Ⅲ级、合并贫血、血肌酐(SCr)升高、NT-pro BNP>1000 pg·m L^(–1)、LVEF<50%、鸢尾素≤5.7 ng·m L^(–1)、可溶性Corin≤487 pg·m L^(–1)是老年CHF患者预后不良(发生主要心血管事件和全因死亡)的独立危险因素(P<0.05)。结论血清鸢尾素和可溶性Corin对老年CHF患者发生主要心血管不良事件和全因死亡具有较好的预测价值,或可作为老年CHF患者预后评估的指标。

Effect of Integrated, Person-Centred Palliative Advanced Home and Heart Failure Care on NT-proBNP Levels: A Substudy of the PREFER Study

Objective: In 2012, we initiated a new person-centred model, integrated Palliative advanced home caRE and heart FailurE caRe (PREFER), to integrate specialised palliative home care with heart failure care. Natriuretic peptide-guided treatment is valuable for younger patients (age < 75 years), but its usefulness in palliative care is uncertain. We explored whether patients in PREFER reduced mean level of N-terminal pro B-type natriuretic peptide (NT-proBNP) more than the control group. Design: A pre-specified, exploratory substudy, analysed within the prospective, randomised PREFER study, which had an open, non-blinded design. Participants: Patients in palliative care with chronic heart failure, New York Heart Association class III-IV were randomly assigned to an intervention (n = 36;26 males, 10 females, mean age: 81.9 years) or control group (n = 36;25 males, 11 females, mean age:76.5 years). The intervention group received the PREFER intervention for 6 months. The control group received care as usual at a primary health care centre or heart failure clinic at the hospital. NT-proBNP was measured at the start and end of study. Results: Plasma levels of NT-proBNP differed significantly between groups at baseline. By the end of the study, no significant difference was found between the groups. The mean value for NT-proBNP decreased by 35% in the PREFER group but was not statistically significant (P = 0.074);NT-proBNP increased 4% in the control group. Conclusions: We found no statistically significant reductions of NT-proBNP levels neither between nor within the PREFER and the control group at the end of the study.

Improving outcomes in patients with heart failure:The contribution of cardiovascular specialist nurses

Background Heart failure(HF)is a chronic,impactful condition on individuals and healthcare systems,requiring management that goes beyond inpatient care.This study investigated the impact of cardiovascular specialist nurses on long-term health outcomes and patient satisfaction in HF outpatient care.Methods In a year-long observational study from July 2021 to July 2022,230 HF patients at our hospital were divided into an experimental group(n=115)receiving care from cardiovascular specialist nurses and a control group(n=115)managed by general nursing staff.The interventions included comprehensive care such as patient education,medication management,lifestyle guidance,symptom monitoring,and psychological support.The major adverse cardiovascular events(MACEs)and rehospitalization rates were applied as the primary endpoints.Results The experimental group demonstrated significantly fewer MACEs and lower rehospitalization rates compared to the control group(P<0.001).Higher patient satisfaction was observed in the experimental group,with 81.7%reporting high satisfaction vs.53.9%in the control group(P<0.001).Differences in incidence of myocardial infarction and death rates between the groups were not statistically significant.Conclusions The involvement of cardiovascular specialist nurses in HF outpatient care significantly enhances clinical outcomes and patient satisfaction.These nurses play a key role in bridging the transition from hospital to home care,improving adherence to treatment regimens,and reducing healthcare system burdens.

基于恐惧-回避模型的康复护理方案在老年慢性心力衰竭患者中的应用

目的减轻老年慢性心力衰竭患者康复运动恐惧心理,促进其运动康复。方法便利抽取70例心内科住院老年慢性心力衰竭患者,按入院时间分为两组各35例;两组均行常规治疗护理,同时对照组行常规康复护理,干预组构建和实施基于恐惧-回避模型的康复运动方案,持续干预至出院后1个月评价效果。结果干预后干预组心功能指标显著优于对照组(均P<0.05),心脏病运动恐惧得分、明尼苏达州心力衰竭生活质量得分显著低于对照组(均P<0.05);运动方案实施过程中未发生运动相关不良事件。结论对老年慢性心力衰竭患者实施基于恐惧-回避模型的康复运动方案能减轻患者运动恐惧心理,改善心功能,提高生活质量。

专病一体化护理联合协同护理模式对老年慢性心力衰竭患者的影响

目的:探讨专病一体化护理联合协同护理模式对老年慢性心力衰竭(CHF)患者的影响。方法:选取2022年2月1日~2023年2月28日收治的98例老年CHF患者作为研究对象,依据入院时间采用抽签法分为对照组和观察组各49例,对照组给予常规护理,观察组在此基础上实施专病一体化护理联合协同护理模式;比较两组入院时、出院时、出院3个月的积极度评分,护理前后生命质量[简明健康状况调查问卷(SF-36)]评分、睡眠质量(明尼苏达心力衰竭睡眠质量量表)评分、自我护理(欧洲心力衰竭自我护理行为量表)评分、汉密顿焦虑量表(HAMA)评分、汉密顿抑郁量表(HAMD)评分,护理满意度。结果:干预后,两组积极度评分逐渐提高(P<0.01),观察组出院时、出院3个月积极度评分高于对照组(P<0.01);护理后,两组生命质量评分高于护理前(P<0.05),且观察组高于对照组(P<0.01);护理后,两组睡眠质量、自我护理评分及HAMA、HAMD评分低于护理前(P<0.05),且观察组低于对照组(P<0.01);观察组护理满意度高于对照组(P<0.01)。结论:专病一体化护理联合协同护理模式能够有效改善CHF患者的不良情绪和积极度,提高睡眠质量和生命质量,提升护理满意度。

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.

Detection of p53 gene mutations in skeletal muscle cell of patients with chronic heart failure

Progressive deterioration of physical work capacity in congestive heart failure (CHF) is often attributed to ongoing skeletal muscle atrophy and abnormalities in muscle metabolism. The purpose of the present study was to investigate if mutations in the p53 gene thought to be a promotor of apoptosis are involved in intrinsic apoptotic abnormalities in skeletal muscle of patients (pts) with CHF. Percutaneous needle biopsy from the m. vastus lateralis were obtained from 19 pts with CHF (LV EF 25%±10%). Single strand confirmation polymorphism analysis of polymerase chain reation products (PCR SSCP analysis) was used for detection of mutations in exon 5 8 of the p53 gene in skeletal Heart Center, University Leipzig, Germany (Yu JT, Adams V, Fiehn E, Schuler G and Hambrecht R) Institut of Pathology, University Freiburg, Germany (Ye J and Riede U)muscle cells. Four of 19 muscle specimens (21%) showed mobility shifts. To characterize the nuleotide sequence alterations specimens were examined further by direct sequence analysis of PCR product. Two of four specimens showing a band shift in the SSCP analysis exhibited a mutated p53 sequence. Sequence analysis revealed that these alteratons were point mutation exon 8 (14482, G→A) and deletion in exon 5 (13143 13157). A high frequency of p53 mutations was detected in skeletal muscle cells of patients with chronic heart failure. These findings suggest a role for apoptosis in the progression of intrinsic skeletal muscle abnormalities and consequently of exercise intolerance in chronic heart failure.