Prognosis investigation in patients with chronic heart failure and pericardial effusion

Background  Researchers still do not reach the consensus on the incidence, characters and the prognostic value of pericardial effusion (PE) in patients with chronic heart failure (CHF). This study is to investigate the incidence, characters and the prognostic value of pericardial effusion (PE) in patients with CHF.

Methods  One thousand one hundred and eighty-nine patients, with a diagnosis of CHF consecutively admitted to three centers, were enrolled. M-mode echocardiography was used to determine the presence or absence of PE and to semi-quantify it. The 118 patients with PE and 472 without PE were followed up. The relationship between the PE and other parameters and the prognostic value of PE for CHF were analyzed by univariate and multivariate analyses.

Results  After following up, 550 patients were analyzed, of which 226 were dead. The incidence of PE was 9.92%. Moderate PE was the most common which account 90.68% (107/118). The 6.78% of the patients (8/118) had small while only 2.54% (3/118) had large one. The systolic blood pressure (OR=1.04, 95% CI (1.01–1.07), P=0.08), left ventricular ejection fraction (LVEF) (OR=1.09, 95% CI (1.02–1.15), P=0.06), and main pulmonary artery diameter (MPAD) (OR=1.51, 95% CI (1.24–1.85), P <0.001) were the independent predictors of PE. The glomerular filtration rate (GFR) (OR=1.013, 95% CI (1.005–1.026), P=0.02), systolic blood pressure (OR=1.02, 95% CI (1.00–1.03), P=0.015), LVEF (OR=1.08, 95% CI (1.04–1.12), P <0.001) and diabetes mellitus (OR=3.53, 95% CI (1.99–6.44), P <0.001) were determined as the independent predictors of CHF prognosis.

Conclusions  The PE is not uncommon in CHF patients and most PE are small to moderate. PE is not related to the etiology of CHF while is strongly connected with higher systolic blood pressure, low LVEF and large MPAD. PE dose not increase the risk of death in patients with CHF.

     

Risk of cardiovascular disease and all-cause mortality among diabetic patients prescribed rosiglitazone or pioglitazone: a meta-analysis of retrospective cohort studies

Background  The difference of cardiovascular effects between rosiglitazone and pioglitazone treatment for diabetic patients has not been thoroughly studied. We performed a meta-analysis to compare the risk of cardiovascular adverse effects in patients with type 2 diabetes treated with rosiglitazone compared to pioglitazone.

Methods  The Cochrane Library, PubMed, and Embase were searched to identify retrospective cohort studies assessing cardiovascular outcomes with rosiglitazone and pioglitazone. Meta-analysis of retrospective cohort studies was conducted using RevMan 5.0 software to calculate risk ratios.

Results  Of the 74 references identified, eight studies involving 945 286 patients fit the inclusion criteria for the analysis. The results of meta-analyses showed that, compared with pioglitazone, rosiglitazone therapy significantly increased the risk of myocardial infarction (risk ratios (RR) 1.17, 95% confidence interval (CI) 1.04–1.32; P=0.01), the risk of heart failure (RR 1.18, 95% CI 1.02–1.36; P=0.03), and total mortality (RR 1.13, 95% CI 1.08–1.20; P <0.000 01).

Conclusion  Compared with pioglitazone, rosiglitazone was associated with an increased risk of myocardial infarction, heart failure, and all-cause mortality in diabetic patients.

     

Relationship of left heart size and left ventricular mass with exercise capacity in chronic heart failure

Background  Impaired exercise capacity is one of the most common clinical manifestations in patients with chronic heart failure (CHF). The severity of reduced exercise capacity is an indicator of disease prognosis. The aim of the current study was to investigate the association between left heart size and mass with exercise capacity.

Methods  A total of 74 patients were enrolled in the study, with 37 having congestive heart failure (left ventricular ejection fraction (LVEF) <0.45) and the other 37 with coronary heart disease (by coronary angiography) serving as the control group (LVEF >0.55). Echocardiography and cardiopulmonary exercise test were performed. The multiply linear regression model was used to evaluate the association between echocardiogrphic indices and exercise capacities.

Results  The study showed that left ventricular end diastolic / systolic diameter (LVEDD/LVESD), left atrial diameter (LAD) and left ventricular mass index (LVMI) were significantly enlarged in patients with chronic heart failure compared with controls (P <0.01). The VO₂AT, Peak VO₂, Load AT, and Load Peak in chronic heart failure patients were also significantly reduced compared with controls (P <0.05), VE/VCO₂ slope was increased in patients with chronic heart failure (P <0.01). Multivariate linear regression analysis indicated that the patients’ exercise capacity was significantly associated with the left heart size and mass, however, the direction and/or strength of the associations sometimes varied in chronic heart failure patients and controls. Load AT correlated negatively with LVEDD in chronic heart failure patients (P=0.012), while Load AT correlated positively with LVEDD in control patients (P=0.006). VE/VCO₂ slope correlated positively with LAD (B=0.477, P <0.0001) in chronic heart failure patients, while the VE/VCO₂ slope correlated negatively with LAD in control patients (P=0.009).

Conclusion  The study indicates that the size of LVEDD and LAD are important determinants of exercise capacity in patients with CHF, which may be helpful to identify exercise tolerance for routine monitoring of systolic heart failure.

     

Variants of tumor necrosis factor-induced protein 3 gene are associated with left ventricular hypertrophy in hypertensive patients

Background  Tumor necrosis factor-induced protein 3 (TNFAIP3) gene has been shown important in cardiac remodeling. The aim of the present study was to investigate whether the variants of TNFAIP3 gene are associated with left ventricular hypertrophy (LVH) in hypertensive patients.

Methods  Four representatives of all the other single nucleotide polymorphisms (SNPs) in TNFAIP3 gene were tested for association with hypertrophy in two independent hypertensive populations (n=2120 and n=324).

Results  We found that only the tag SNP (rs5029939) was consistently lower in the hypertensives with cardiac hypertrophy than in those without cardiac hypertrophy in the two study populations, indicating a protective effect on LVH (odds ratio (OR) (95% confidence interval (CI))0.58 (0.358–0.863), P=0.035; OR (95% CI)=0.477 (0.225–0.815), P <0.05, respectively). Multiple regression analyses confirmed that the patients with G allele of rs5029939 had less thickness in inter-ventricular septum, left ventricular posterior wall, relative wall thickness and left ventricular mass index than did those with CC allele in the hypertensive patients in both study populations (all P <0.01).

Conclusion  These findings indicate that the SNP (rs5029939) in the TNFAIP3 gene may serve as a novel protective genetic marker for the development of LVH in patients with hypertension.

     

Long-term effects of bone marrow-derived cells transplantation in patients with acute myocardial infarction: a meta-analysis

Background  The long-term effects of bone marrow-derived cells (BMC) transplantation in patients with acute myocardial infarction (AMI) have not been established. The present meta-analysis of randomized controlled trials with follow-up ³2 years was performed to investigate the long-term effects of BMC therapy in patients after AMI.

Methods  Specific terms were used to conduct a systematic literature search of MEDLINE, EMBASE, the Cochrane Library and the Cochrane Central Register of Controlled Trials, and the China Biological Medicine Disk database from their inception to March 2012. A standardized protocol was used to extract information, and random effect model was used to analyze all data except major adverse events.

Results  Five trials comprising 510 patients were included. Compared with controls, BMC therapy significantly improved left ventricular ejection fraction (LVEF) (4.18%, 95% CI: 2.02% to 6.35%, P=0.0002), while mildly but not significantly reduced left ventricular end-systolic volume (–4.47 ml, 95% CI: –10.92 to 1.99, P=0.17) and left ventricular end-diastolic volume (–2.29 ml, 95% CI: –9.96 to 5.39, P =0.56). Subgroup analysis revealed that significant improvement of LVEF induced by BMC therapy could be observed in patients with baseline LVEF £42%, but disappeared in those with baseline LVEF >42%. There were trends in favor of BMC therapy for most major clinical adverse events, though most differences were not significant.

Conclusions  Intracoronary BMC infusion in patients with AMI seems to be safe and may further improve LVEF on top of standard therapy; especially the beneficial effects could last for long term. The findings need to be validated in the future.

     

Incidence and predictors of definite stent thrombosis after coronary stent implantation

Background  Coronary stents are widely used in percutaneous coronary intervention (PCI) procedures. We aimed to explore the incidence, predictors and characteristics of stent thrombosis (ST) after coronary stent implantation in routine clinical practice.

Methods  From data of 18 063 consecutive patients who underwent successful stent implantation in Shenyang Northern Hospital from 2004 to 2010, we identified patients with definite ST (n=140) and control patients (n=280) matched on age, diagnosis, sex, current antiplatelet medication and stent type. The incidence, predictors and characteristics of ST after coronary stent implantation were investigated.

Results  The incidence of angiographically confirmed ST was 0.78% (140/18 063). The time distribution of ST was acute in 43 (30.7%), subacute in 50 (35.7%), and late in 47 (33.6%) patients. Binary Logistic regression analysis identified the angiotensin-converting enzyme inhibitor (ACEI) (odds ratio (OR)=0.472, 95% CI: 0.276–0.807, P=0.006) and heparin (OR=0.477, 95% CI: 0.278–0.819, P=0.007) were associated with an reduced risk of cumulative ST. Stent length (OR=1.042, 95% CI: 1.026–1.058, P <0.001), serum creatinine total (OR=1.020, 95% CI: 1.004–1.035, P=0.04), cholesterol (OR=1.267, 95% CI: 1.021–1.573, P=0.032), glucose (OR=1.086, 95% CI: 1.002–1.176, P=0.044), and platelet aggregation (OR=1.113, 95% CI: 1.075–1.154, P <0.001) were associated with an increased risk of cumulative ST.

Conclusion ST is associated with longer stent length and higher level of total cholesterol, glucose and platelet aggregation.

     

Serum uric acid levels correlate with atrial fibrillation in patients with chronic systolic heart failure

Background  Studies have shown that increased levels of serum uric acid (SUA) are associated with atrial fibrillation (AF). However, less is known about the prognostic value of SUA levels for AF in patients with chronic heart failure (CHF). The aim of the study was to examine the prognostic value of SUA levels for AF in patients with CHF.

Methods  Sixteen thousand six hundred and eighty-one patients diagnosed with CHF from 12 hospitals were analyzed. Patients were categorized into AF group and non-AF group, death group, and survival group according to the results of the patients’ medical records and follow-up. Univariate and multivariate Cox proportional hazards analyses were performed to examine the risk of AF. The sensitivity and specificity of SUA level in predicting the prognosis were examined by multivariate Cox models and receiver operating characteristic (ROC) curves.

Results  The results of univariate predictors in overall patients showed that the higher SUA level was associated with AF. SUA level (HR, 1.084; 95% CI, 1.017–1.144; P <0.001), diuretics (HR, 1.549; 95% CI, 1.246–1.854; P <0.001), and New York Heart Association (NYHA) (HR, 1.237; 95% CI, 1.168–1.306; P <0.001) function class were the independent risk factors for AF. The sensitivity and specificity of the models were 29.6% and 83.8% respectively for predicting AF. When SUA level was added to these models, it remained significant (Wald c², 1494.88; P <0.001 for AF); 58.8% (95% CI, 57.7%–60.0%) of the observed results were concordant with the separate model.

Conclusion  Higher SUA level is associated strongly with AF in patients with CHF. SUA level can increase the sensitivity and specificity in predicting AF.

     

A meta-analysis of carotid endarterectomy versus stenting in the treatment of symptomatic carotid stenosis

Background  Carotid stenosis is one of the common reasons for patients with ischemic stroke, and the two invasive options carotid endarterectomy (CEA) and carotid artery stenting (CAS) are the most popular treatments. But the relative efficacy and safety of the methods are not clear.

Methods  About 521 articles related to CAS and CEA for carotid stenosis published in 1995–2011 were retrieved from MEDLINE, Cochrane Library (CL), and China National Knowledge Infrastructure (CNKI) China Journal Full-Test database. Of them, eight articles were chosen. Meta-analysis was used to assess the relative risks.

Results  The eight studies included 3873 patients with symptomatic carotid artery stenosis, including 1941 cases in the carotid stent angioplasty group, and 1932 cases in the carotid endarterectomy group. Fixed effect model analysis showed that within 30 days of incidence of all types of strokes, surgery was significantly highly preferred in CAS patients (CAS group) than the CEA patients (CEA group), and the difference was statistically significant (relative ratio (RR)=1.80, 95% confidence interval (CI): 1.380–2.401, P <0.0001). But the incidence of death in the two groups is not showed and is not statistically significant after 30 days (RR=1.52, 95% CI: 0.82–2.82, P=0.18). The rate of cranial nerve injury in the CAS group is lower than the CEA group (RR=0.14, 95% CI: 0.05–0.43, P=0.0005). The incidence of CAS patients with myocardial infarction is lower than the CEA group after 30 days, but statistically meaningless (RR=0.22, 95% CI: 0.05–1.02, P=0.05). The stroke or death in CAS patients were higher than the CEA group after 1 year of treatment (RR=2.58, 95% CI: 1.03–6.48, P=0.04).

Conclusions  Compared to CAS, carotid endarterectomy is still the preferred treatment methodology of symptomatic carotid artery stenosis. Future meta-analyses should then be performed in long-term follow-up to support this treatment recommendation.

     

Impact of depressed left ventricular function on outcomes in patients with three-vessel coronary disease undergoing percutaneous coronary intervention

Background  Patients with multivessel coronary artery disease and depressed left ventricular ejection fraction (LVEF) represent a high risk group of patients for coronary revascularization. There are limited data on percutaneous coronary intervention treatment in this population.  

Methods  Among a cohort of 4335 patients with three-vessel disease with or without left main disease undergoing percutaneous coronary intervention, 191 patients had LVEF <40% (low ejection fraction (EF)) and 4144 patients had LVEF ≥40%. In-hospital and long-term outcomes were examined according to LVEF.

Results  The estimated two-year rates of major adverse cardiac events, cardiac death, and myocardial infarction were significantly higher in the low EF group (19.64% vs. 8.73%, Log-rank test: P <0.01; 10.30% vs. 1.33%, Log-rank test: P <0.01, and 10.32% vs. 2.28%, Log-rank test: P <0.01 respectively), but there was no difference in the rates of target vessel revascularization (6.18% vs. 6.11%, Log-rank test: P=0.96). Using the Cox proportional hazard models, LVEF <40% was a significant risk factor for cardiac death, myocardial infarction, and major adverse cardiac events (OR (95% CI): 4.779 (2.369–9.637), 2.673 (1.353–5.282), and 1.827 (1.187–2.813) respectively), but was not a statistically significant risk factor for target vessel revascularization (OR (95% CI): 1.094 (0.558–2.147)).

Conclusion  Among patients undergoing percutaneous coronary intervention for multivessel coronary artery disease, left ventricular dysfunction remains associated with further risk of cardiac death in-hospital and during long-term follow-up.

     

Prognostic factors associated with rebleeding in cirrhotic inpatients complicated with esophageal variceal bleeding

Background  Esophageal variceal bleeding is a frequent and severe complication in patients with cirrhosis. The aim of this study was to identify prognostic factors of esophageal variceal rebleeding in cirrhotic inpatients. 

Methods  Consecutive cirrhotic patients who were admitted to Changhai Hospital because of esophageal variceal bleeding were retrospectively analyzed. To assess the independent factors for recurrent hemorrhage after esophageal variceal bleeding, medical assessment was completed at the time of their initial hospital admission, including documentation of clinical, biochemical, and treatment methods that might contribute to variceal rebleeding. Univariate and multivariate analyses were retrospectively performed.

Results  Totally 186 patients (35.8%) were assigned to a rebleeding group and the other 334 patients (64.2%) to a non-rebleeding group. Multivariate stepwise regression analysis showed that four variables were positively correlated with rebleeding: Child-pugh grade B (OR=2.664, 95% CI 1.680–4.223) (compared with Child-pugh grade A), total bilirubin (Tbil) (OR=1.0006, 95% CI 1.002–1.0107), creatinine (OR=1.008, 95% CI 1.002–1.015) and the cumulative volume of blood transfusion (OR=1.519, 95% CI 1.345–1.716). The presence of ascites (OR=0.270, 95% CI 0.136–0.536) and prophylactic antibiotics (OR=0.504, 95% CI 0.325–0.780) were negatively correlated with rebleeding of the cirrhotic inpatients. According to standardized coefficient, the importance of rebleeding predictors ranked from the most to the least was as follows: the cumulative volume of blood transfusion, Child-pugh grade B, Tbil and creatinine.

Conclusion  Rebleeding in cirrhotic inpatients was associated with more blood transfusions, Child-pugh grade B, higher Tbil and creatinine.

     

Factors influencing recovery of left ventricular structure in patients with chronic heart failure

Background  Angiotensin converting enzyme (ACE) inhibitors and β-blockers (βB) 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 βB 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.

     

Prevalence, clinical characteristics and outcome in patients with chronic heart failure and diabetes

Background Chronic heart failure（CHF）and diabetes mellitus portend high morbidity and mortality because of an interrelated pathophysiologic process.This large cohort study aimed to analyze the prevalence,clinicaI characteristics and long-term outcome of patients with CHF and diabetes.Methods A totaI of 1119 patients with NYHA functionaI class Ⅱ-Ⅳ and left ventricular ejection fraction（LVEF）〈45% between January 1995 and May 2009 were recruited.Clinical variables, biochemical and echocardiographic measurements were retrospectively reviewed,and composite major cardiac events （MCE） including death,headtransplantation, and refractory heart failure requiring multiple hospitalizations were recorded.Results The prevalence of CHF with diabetes was progressively increased with time （16.9% in 1995-1999;20.4% in 2000-2004,and 29.1% in 2005-2009）and age（1 8.5% in〈60 years,26.6% in 60-80 years,and 26.6% in〉80 years）.Compared with CHF patients without diabetes,those with diabetes had worse cardiac function,more abnormal biochemical changes.and higher mortality.Treatment with glucose-lowering agents significantly improved LVEF and decreased MCE.An elevated serum HbA1c level was associated with large left ventricular end-systolic diameter （P〈0.05）,decreased LVEF（P〈0.01）and reduced survival（P〈0.05）.Multivariable Logistic regression analysis revealed that after adjustment for confounding factors,NYHA functional class（OR2.65,95%CI 1.14-6.16,P=0.024）and HbA1c level≥7%（OR2.78, 95%CI 1.00-7.68,P=0.049）were independent risk factors for adverse outcomes in CHF patients with diabetes.Conclusions Prevalence of CHF with diabetes was increasing during past decades,and patients with CHF and diabetes had worse clinical profiles and prognosis.Aggressive anti-CHF and diabetes therapies are needed to improve overall outcomes for these patients.     

促红细胞生成素在慢性心功能不全合并贫血患者中的保护作用的meta分析

目的探讨促红细胞生成素(erythropoietin, EPO)对于慢性心动能不全(chronic heart failure, CHF)合并贫血患者的临床疗效及其安全性。方法 检索Embase、Medline至2013年7月为止的针对EPO与CHF进行临床疗效评估的相关文献。选择比较EPO与安慰剂或空白对照在CHF合并贫血患者的治疗效果的所有随机临床研究。结果总共有750例CHF合并贫血的患者接受EPO治疗3个月至1年并跟踪随访,这些患者包含在9个随机对照研究中。EPO的治疗可以显著降低CHF患者的住院周期(RR=0.47, CI: 0.32~0.70;P=0.0002)。CHF患者使用EPO治疗后虽不能降低其死亡风险 (RR=0.68, CI: 0.38~1.19;P=0.18),但也没有出现死亡率的升高。此外,CHF合并贫血的患者使用EPO治疗后可以显著改善血红蛋白(Hb),红细胞压积(HCT),脑利钠肽(BNP),运动能力,肾功能,心功能(NYHA)和左心室射血分数(LEVF)。结论 在CHF患者中,EPO治疗后有益作用明显,并没有出现死亡率的升高或更多不良事件的发生。这些结果支持在CHF合并贫血的患者中使用EPO进行治疗。     

不同血运重建方式对冠心病合并非重度左心功能不全患者预后的影响

目的 比较经皮冠状动脉介入治疗(PCI)和冠状动脉旁路移植术(CABG)对冠心病合并非重度左心功能不全患者预后的影响.方法 选择2011年1月至2013年1月在首都医科大学宣武医院住院的冠心病合并非重度慢性心力衰竭行血运重建患者412例为研究对象,根据血运重建方式分为PCI组268例和CABG组144例.随访截止至2016年1月,随访主要终点事件为全因病死率,次要终点事件为非致死性心肌梗死、再次血运重建及主要不良心血管事件(MACE)发生率,比较PCI组与CABG组长期预后的差别.结果 随访时间5(3,6)年,其中PCI组失访28例(10.4％),CABG组失访17例(11.8％).住院期间总MACE、死亡、非致死性心肌梗死、靶血管血运重建(TVR)发生率两组间比较,差异无统计学意义(P＞0.05);心功能变化比较,PCI组有效比例高于CABG组,无效比例PCI组低于CABG组(P＜0.05).随访期间,PCI组累积全因病死率低于CABG组(7.8％vs.19.4％,P＜0.05),总MACE发生率低于CABG组(38.1％vs.43.8％,P＜0.05);PCI组累积非致死性心肌梗死发生率、累积TVR率与CABG组的差异无统计学意义(P＞0.05).Cox模型多因素分析矫正后,PCI组总MACE发生率(HR=1.357,95％CI 1.105～1.729),全因病死率(HR=0.426,95％CI 0.121 ～ 0.753)仍低于CABG组(P＜0.05);TVR率、非致死性心肌梗死的差异无统计学意义(P＞0.05).结论 冠心病合并非重度心功能不全患者行PCI安全有效,与CABG组相比心功能改善更明显,可降低全因病死率和MACE.     

促甲状腺激素对冠心病患者行经皮冠状动脉介入术预后的影响

目的 研究正常范围内不同浓度梯度的促甲状腺激素(thyroid-stimulating hormone,TSH)对冠心病患者行经皮冠状动脉介入术(percutaneous coronary interventions,PCI)预后的影响及其临床意义.方法 回顾性纳入1 002例行PCI且TSH处于正常范围内(0.30 ～4.20 μIU/mL)的冠心病患者,将受试者分为3组:TSH正常低值组(0.30 ～ 1.60 μIU/mL,387例)、TSH正常中值组(1.61 ～2.90 μIU/mL,413例)、TSH正常高值组(2.91 ～4.20 μIU/mL,202例),随访时间1年,终点事件是全因死亡,并统计出血事件和再入院事件.结果 正常低值组全因死亡事件6例,全因死亡率1.55％;正常中值组全因死亡事件8例,全因死亡率1.94％;正常高值组全因死亡事件10例,全因死亡率4.95％;各组之间比较差异有统计学意义(P＜0.05).正常低值组再出血事件13例,再出血率3.36％;正常中值组再出血事件14例,再出血率3.39％;正常高值组再出血事件16例,再出血率7.92％;各组之间比较差异有统计学意义(P＜0.05).正常低值组再入院事件38例,再入院率9.82％;正常中值组再入院事件27例,再入院率6.54％;正常高值组再入院事件15例,再入院率7.43％;各组之间比较差异无统计学意义(P＞0.05).Logistic回归分析显示正常高值的TSH(OR=1.48)是PCI术后全因死亡的危险因素,同时正常高值的TSH(OR=1.47)是PCI术后出血的危险因素.生存分析也进一步证明正常高值的TSH是PCI术后全因死亡的危险因素(P＜0.05).结论 TSH水平越高,全因死亡事件、再出血事件的发生率越高;正常高值的TSH是经皮冠状动脉介入治疗的全因死亡和出血事件的危险因素.     

PCI术前应用IABP辅助治疗对于急性心肌梗死患者临床疗效的系统评价

目的 评价行经皮冠脉介入治疗(PCI)之前应用主动脉球囊反搏(IABP)辅助治疗对于急性心肌梗死(AMI)患者的近远期临床疗效.方法 通过检索PubMed、The Cochrane library、Medline、Embase、CBM、中国知网期刊数据库(CNKI)、万方、维普等数据库,获取自2000年1月到2015年10月所有发表的有关急性心肌梗死患者在行PCI之前应用IABP辅助治疗的临床随机对照试验的相关文献,按照纳入和排除标准提取文献数据,采用Review Manager5.3软件进行荟萃分析,采用漏斗图检验发表偏倚.结果 共纳入7项研究,样本量1107例,行PCI之前应用IABP不能改善AMI患者30 d及6个月的全因死亡率(RR 0.74,95％ CI 0.40-1.36,P＞0.05;RR 0.77,95％ CI 0.40-1.48,P＞0.05);不能增加术后TIMI血流3级的人数(RR 1.03,95％ CI0.90-1.18,P＞0.05);但可减少30 d内的主要不良心血管事件(MACE)发生率,差异有显著性意义(RR 0.42,95％ CI 0.29-0.62,P＜0.05),出血事件发生率无显著增加(RR 2.11,95％ CI 0.95-4.70,P＞0.05).亚组分析结果显示:早期运用IABP不能有效降低AMI合并心源性休克患者的全因死亡率(RR 0.97,95％ CI 0.52-1.82,P＞0.05),但可以减少不合并心源性休克患者的全因死亡率(RR 0.40,95％CI 0.18-0.85,P＜0.05).结论 对于急性心肌梗死患者在行PCI术前应用IABP可以显著减少MACE事件的发生,但不能显著降低术后30d、6个月的死亡率.     

正常甲状腺病态综合征对慢性心力衰竭患者远期预后的影响研究

背景　甲状腺激素的代谢异常参与了慢性心力衰竭（CHF）的病理过程,而目前国内对伴正常甲状腺病态综合征（ESS）的CHF患者的远期预后研究甚少。目的　探讨ESS对CHF患者远期预后的影响。方法　选取2017年1月-2019年6月于复旦大学附属中山医院吴淞医院心内科住院的CHF患者304例。将三碘甲状腺原氨酸（T3）<1.01 nmol/L和/或游离三碘甲状腺原氨酸（FT3）<3.28 nmol/L的患者纳入ESS组,T3为1.01~2.48 nmol/L及FT3为3.28~6.47 nmol/L的患者纳入甲功正常组。比较两组患者一般资料及实验室检查指标。出院后对所有患者进行随访,随访截至2020年6月,观察主要终点是全因死亡（包括因心力衰竭死亡和非心源性死亡）,次要终点是因心力衰竭再入院。依据患者存活情况将患者分为存活组与全因死亡组,再将全因死亡组分为心力衰竭死亡亚组和非心源性死亡亚组。比较存活组与全因死亡组、存活组与心力衰竭死亡亚组和非心源性死亡亚组甲状腺激素〔T3、FT3、甲状腺素（T4）、游离甲状腺素（FT4）、促甲状腺激素（TSH）〕、B型脑钠肽（BNP）、左心室射血分数（LVEF）。比较ESS组和甲功正常组患者心力衰竭再入院率、心力衰竭死亡率、全因死亡率,并绘制生存分析曲线;采用Cox回归分析探究CHF患者发生心力衰竭死亡、全因死亡的影响因素。结果　CHF患者中ESS组164例,甲功正常组140例。两组患者美国纽约心脏病协会（NYHA）分级比较,差异有统计学意义（P<0.05）;ESS组患者T3、FT3、FT4、TSH、ALB、Hb水平及LVEF低于甲功正常组,BNP、C反应蛋白（CRP）、肌酐水平高于甲功正常组（P<0.05）。中位随访时间25.7（14.2）月,发现全因死亡46例（因心力衰竭死亡32例、非心源性死亡14例）,存活258例（出现至少1次因心力衰竭再入院115例）。全因死亡组及心力衰竭死亡亚组患者T3、FT3水平及LVEF低于存活组,BNP水平高于存活组（P<0.05）。ESS组患者心力衰竭再入院率、心力衰竭死亡率、全因死亡率高于甲功正常组（P<0.05）。经Kaplan-Meier法分析结果显示：ESS组心力衰竭死亡率、全因死亡率均高于甲功正常组（P<0.016）。Cox回归分析结果显示,年龄〔HR=1.056,95%CI（1.009,1.105）〕、FT3〔HR=0.564,95%CI（0.325,0.976）〕、Hb〔HR=0.955,95%CI（0.932,0.980）〕、LVEF〔HR=0.980,95%CI（0.961,1.000）〕是CHF患者发生心力衰竭死亡的影响因素（P<0.05）;年龄〔HR=1.055,95%CI（1.019,1.093）〕、Hb〔HR=0.964,95%CI（0.944,0.984）〕、LVEF〔HR=0.979,95%CI（0.963,0.994）〕是CHF患者发生全因死亡的影响因素（P<0.05）。结论　CHF伴ESS患者肾功能、肝功能情况较差,且心力衰竭死亡率、全因死亡率高于单纯CHF患者,远期预后较差,而T3、FT3可以反映CHF患者病情严重程度及预后情况。     

血清胱抑素C在慢性心力衰竭患者心功能评价中的应用

目的：探讨血清胱抑素C（CysC）水平的变化对慢性心力衰竭（CHF）患者临床心功能变化评价的临床意义。方法：选取CHF组80例,健康体检正常者（对照组）30名。心力衰竭程度按纽约心脏病协会心功能分级法,采用免疫比浊法测定各组血清CysC水平,并采用超声心动图测定左心室射血分数及左心室舒张末内径评价患者左心室功能,同时记录住院期间及出院6个月内患者的病死率和因CHF再次发作住院率。结果：CHF组患者血清CysC水平显著高于对照组（P〈0．01）,且随着心功能分级的增高,血清CysC水平也逐渐升高（P〈0．01）。患者血清CysC水平与左心室舒张末内径呈正相关关系（P〈0．05）,与左心室射血分数呈负相关关系（P〈0．05）。高、低血清CysC组中患者住院期间病死率差异无统计学意义（P〉0．05）,高血清CysC组出院6个月病死率及因心力衰竭再住院率均升高（P〈0．05）。结论：CysC对于评价CHF患者临床心功能变化及评估预后具有一定意义。     

Long-term prognostic value of analysis of sympathetic drive by myocardial 123I-metaiodobenzylganidine scintigraphy in chronic heart failure

Background The over increase of sympathetic drive in chronic heart failure （CHF） is with main responsibility for the deterioration and mortality of the disease.Myocardial 123I-metaiodobenzylganidine （MIBG） scintigraphy is a non-invasive convenient method to assess sympathetic dysfunction in patients with CHF.The aim of the study was to detect if sympathetic antidrive analysed through myocardial MIBG scintigraphy plays a crucial role in long-term prognosis in CHF.Methods Sixty-four enrolled patients underwent myocardial MIBG scintigraphy, and their plasma concentration of brain natriuretic peptide （BNP）, myocardial contractile reserve （MCR）, rest left ventricular ejection fraction （rest LVEF）and New York Heart Association （NYHA） function class were assessed.They were separated into groups according to median of above parameters.Endpoint was cardiac death and it was recorded in each group during average 54 months＇ follow-up.Results At the end of follow-up, group with lower ratio of heart/mediastinum （H/M） had more death events （P=0.001）,and its BNP level was higher and MCR level was lower （P=0.003 and 0.001, respectively）; but its rest LVEF and NYHA function class were not significantly different.H/M, MCR and BNP correlated closely with death （P=0.000, 0.000 and 0.001, respectively）.Among the three indicators the death risk ratio （RR） of H/M was 4.66, more than MCR and BNP （1.88 and 2.56, respectively）.However, rest LVEF and NYHA function class did not correlate with death （P=0.652 and 0.384, respectively）.The group with lower H/M and MCR, higher BNP had much more death than that with higher H/M and MCR, lower BNP, the RR being 12.8.Conclusions Myocardial MIBG scintigraphy is a long-term prognostic marker in CHF.BNP, MCR are also excellent predictors of long-term prognosis in CHF, but not stronger than myocardial MIBG scintigraphy.If the three indicators were joined together, the prediction would become most powerful.Rest LVEF and NYHA have no significance in long-term prediction of CHF.