Low night-to-night variability of sleep disordered breathing in patients with stable congestive heart failure

Sleep disordered breathing (SDB) has a high prevalence and prognostic impact in patients with chronic heart failure (CHF). Aim of this study was to investigate variability of SDB parameters in patients with stable CHF. Cardiorespiratory polygraphy was used to determine SDB in two consecutive nights in 50 CHF patients (NYHA class ≥ II, LV-EF ≤ 40%). The apnoea—hypopnoea—index (AHI) and apnoea—index (AI) were used to quantify SDB severity. Central, obstructive or mixed SDB were classified according to the majority of events. There was an excellent correlation in AHI (r = 0.948, P < 0.001) and AI (r = 0.842, P < 0.001) results of both nights. The overall number of detected apnoea and hypopnoea during the first night as compared to the maximum of both nights was 85% for the AHI and 77% for the AI. The reproducibility was dependent on SDB severity: AHI 15–29/h = 87%, AHI ≥ 30/h = 92% and AI ≥ 10/h = 83%. Classification was identical in 17 out of 19 patients with AI ≥ 10/h. In patients with stable CHF a single night of cardiorespiratory monitoring leads to representative results on severity and type of SDB. This may enhance the applicability and dissemination of cardiorespiratory polygraphy in clinical practice.     

Aquatic therapies in patients with compromised left ventricular function and heart failure

With water immersion, gravity is partly eliminated, and the water exerts a pressure on the body surface. Consequently there is a blood volume shift from the periphery to the central circulation, resulting in marked volume loading of the thorax and heart. This paper presents a selection of published literature on water immersion, balneotherapy, aqua exercises, and swimming, in patients with left ventricular dysfunction (LVD) and/or stable chronic heart failure (CHF). Based on exploratory studies, central hemodynamic and neurohumoral responses of aquatic therapies will be illustrated. Major findings are: 1. In LVD and CHF, a positive effect of therapeutic warm-water tub bathing has been observed, which is assumed to be from afterload reduction due to peripheral vasodilatation caused by the warm water. 2. In coronary patients with LVD, at low-level water cycling the heart is working more efficiently than at lowlevel cycling outside of water. 3. In patients with previous extensive myocardial infarction, upright immersion to the neck resulted in temporary pathological increases in mean pulmonary artery pressure (mPAP) and mean pulmonary capillary pressures (mPCP). 4. Additionally, during slow swimming (20-25m/min) the mPAP and/or PCP were higher than during supine cycling outside water at a 100W load. 5. In CHF patients, neck- deep immersion resulted in a decrease or no change in stroke volume. 6. Although patients are hemodynamically compromised, they usually maintain a feeling of well-being during aquatic therapy. Based on these findings, clinical indications for aquatic therapies are proposed and ideas are presented to provoke further research.     

左室舒张性心力衰竭的左心形态及舒张功能的超声评价

目的探讨左室舒张性心力衰竭(LVDHF)的左心形态及舒张功能的超声心动图特点。方法 LVDHF组60例,健康体检30例为对照组,超声心动图测量左房内径(LAD)、左室内径(LVD)、舒张期室间隔厚度(IVST)、左室后壁厚度(LVPWT)、左室射血分数(LVEF)、二尖瓣口舒张早期流速峰值(E)、肺静脉反向血流速度(Ar)、彩色M型血流传播速度(Vp)、二尖瓣瓣环舒张早晚期速度比(Ea/Aa)、E/Ea及心室收缩期与舒张期正向波峰速比(S/D)。结果与对照组比较,LVDHF组LAD、IVST、LVPWT、E/Ea及Ar均增加,Ea/Aa、Vp及S/D均减小,差异均有统计学意义(P<0.05)。结论超声心动图能正确判断左室舒张功能,是目前临床通用的诊断左室舒张性心力衰竭的最佳办法。     

Laparoscopic gastrectomy for heart failure patients with left ventricular assist devices

Left ventricular assist devices (LVADs) currently play an important role in the treatment of patients with end-stage heart failure who require a bridge to heart transplantation. As the LVAD population increases, the incidence of cancer patients with an LVAD is assumed to be increasing as well. For gastric cancer patients with an LVAD, surgery may be the only curative treatment, especially as chemotherapy is scarcely available. However, we cannot perform an upper-middle incision in these patients because of the LVAD's location and driveline. Furthermore, to reduce the risk of driveline infection, minimally invasive surgery is desirable. Therefore, laparoscopic surgery is, where possible, suitable for achieving a secure approach to the abdominal cavity. However, laparoscopic surgery for patients with LVAD requires careful consideration not only for anesthetic management, but also for the technical procedure. We ingenuously performed laparoscopic gastrectomy for a gastric cancer patient with LVAD to preserve the device and obtain a good surgical view.     

Factors influencing left ventricular diastolic function in elderly patients with chronic heart failure

The purpose of the study was to define factors influencing the diastolic left ventricular (LV) function in elderly patients with chronic heart failure (CHF). Ninety-seven I to IV functional class CHF patients aged 65 to 88 (mean age 76.6+/-5.1 yr), 61 women and 36 men, were examined. CHF was caused by coronary artery disease in 22 (22.7%) patients, by arterial hypertension in 14 (14.4%) patients, and by both in 61 (62.9%) patients. Fourteen (14.4%) patients had type 2 diabetes. Hemoglobin level lower than 130g/l in men or 120g/l in women was considered anemia. Glomerular filtration speed (GFS) was calculated using Cockcroft-Gault formula. EchoCG and Doppler EchoCG were performed in all patients. LV hypertrophy (LVH) was revealed in 90 (92%) of the patients; 52patients had concentric L VH and 38 patients had eccentric LVH. Ejection fraction was less than 45% in 17 (17.5%) patients. Isovolemic relaxation time (IVRT) was over the normal limit in 73 (75.3%) patients; the time of early diastolic flow slowing (DT) changed in different directions and was 211.2+/-55.6 msec. A type of transmitral blood flow with relaxation disorder was found in 58 (59.8%) patients, a pseudonormal type was revealed in 32 (33%), and a restrictive type was found in 7 (7.2%) of patients. The study found a reverse independent correlation between hemoglobin level and the speed of LV filling during atrial systole. An independent correlation between the degree of renal dysfunction (GFS) and disorder of LV relaxation was found: the lower GFS, the longer IVRT and DT. Thus, in addition to age and structural changes in the heart, factors that have adverse effects on diastolic filling parameters are anemia, lowered renal function, and the level of systolic and diastolic pressure.     

左心室射血分数正常的心力衰竭患者心肺运动负荷研究

目的通过心肺运动联合试验(CPET)评价左心室射血分数(LVEF)正常心力衰竭患者的运动心肺功能变化。方法本组78例心力衰竭患者分为LVEF正常组(26例)和LVEF减低组(52例)进行CPET。运动前、运动高峰和运动后分别测定心电图和血压,峰耗氧量(VO2),峰VO2/预测峰O2比值,无氧阀值(AT),分钟通气量/二氧化碳产生量(MV/VCO2)斜率。此外,对35例健康体健者进行相同项目的检测作为对照。结果与对照组相比较,两组心力衰竭患者短轴内径增大,运动心率,运动耐量,峰VO2以及与预测峰O2比值,AT和MV/VCO2斜率均有显著降低(P0.05)。运动心率与VO2存在相关性(r=0.4,P0.05)。而LVEF正常组与LVEF减低组相比,运动心率减慢和运动时间缩短现象更明显。结论 CPET有助于评价LVEF正常和减低的心力衰竭患者运动时心血管储备功能和呼吸困难程度。     

Home oxygen therapy (HOT) for patients with heart failure associated with sleep disturbed breathing

Recently, there is increasing evidence that sleep apnea may adversely affect pathophysiology and outcomes of congestive heart failure (CHF). Repetitive nocturnal apneas may worsen CHF through a number of mechanisms including the repetitive arterial oxygen desaturation, increased left ventricular afterload, or an activation of sympathetic nervous system. Although central sleep apnea (CSA) is relatively rare, prospective studies revealed that 33 to 82 % of patients with CHF have evidence of CSA and characteristic Cheyne-Stokes respiration (CSR). We assessed an efficacy of nasal O2 therapy at night using a conventional O2 concentrator in ambulatory patients with stable CHF and CSR. O2 resulted in a significant improvement of sleep together with an increase in left ventricular function and quality of life. Therefore, home oxygen therapy(HOT) can be a valuable nonpharmacological option for the treatment of patients with CHF and CSR-CSA.     

心力衰竭患者左心室非同步运动的定量组织速度成像研究

目的　探讨定量组织速度成像(QTVI)评价充血性心力衰竭(CHF)患者左心室心肌的非同步性运动及其与左心功能、QRS间期的关系。方法　正常人和CHF患者各40例,利用QTVI技术,获取标准心尖部左室长轴、两腔和四腔观,获得左心室6个壁基底段、中间段和心尖段共18个位点的多普勒速度曲线,测量各位点QRS波起始至心肌收缩期峰值速度和舒张早期峰值速度的时限(TS和TE)。计算同一节段6个壁间TS和TE的最大差值(Inter ΔTS和Inter ΔTE)、同一壁内3个节段间TS和TE的最大差值(Intra ΔTS和Intra ΔTE)及左心室18个位点间TS和TE的最大差值(Max ΔTS和Max ΔTE)。同时计算二尖瓣环6个位点收缩期峰值速度和舒张早期峰值速度的均值(MeanVs和MeanVe)及左心室射血分数(LVEF)。结果　CHF组Inter ΔTS、Inter ΔTE、Intra ΔTS、Intra ΔTE、Max ΔTS和Max ΔTE较正常组明显延长(均P<0. 05 );CHF组Max ΔTs与LVEF、MeanVs负相关(r= -0. 761, P<0. 01; r= -0. 738, P<0. 01),与QRS间期不相关; Max ΔTE与QRS间期正相关(r=0. 470,P<0. 01),与MeanVe负相关(r=-0. 656,P<0. 01)。结论　CHF患者左心室同一节段及同一壁内均存在非同步运动,且与左心功能、QRS间期关系密切。     

超声新技术评价慢性心力衰竭患者左心室功能的临床研究

目的 探讨心肌组织速度成像(TVI)和心肌应变率成像(SRI)评价心力衰竭患者左心室功能的临床价值.方法 选取慢性充血性心力衰竭(CHF)患者48例,参照纽约心脏病学会(NYHA)心功能分级标准将其分为Ⅱ、Ⅲ、Ⅳ组;并选取43例健康志愿者作为正常对照组.测量传统评价心功能的参数,包括左心室射血分数(LVEF)、心脏每搏输出量(SV)、二尖瓣口舒张早期最大血流速度与舒张晚期最大血流速度比值(E/A)、E峰减速时间(DT)、等容收缩时间(ICT)、等容舒张时间(IRT)评价心肌收缩及舒张功能.同时基于组织多普勒成像技术之上测量并比较Tei指数、等容收缩期心肌收缩加速度(IVA)、收缩期峰值应变率(PSSR)和舒张早晚期峰值应变率(PESR、PASR)等参数在心力衰竭患者的改变.结果 与对照组比较,CHF患者Ⅱ组和Ⅲ组的Tei指数逐渐增大,LVEF、IVA、PSSR、PESR逐渐减小(P＜0.05),但Ⅲ和Ⅳ组之间差异无统计学意义;E/A、SV在Ⅲ和Ⅳ组之间差异有统计学意义(P＜0.05).PSSR和IVA与心功能分级呈负相关(r＝-0.67,r＝-0.80,P＜0.01);Tei指数与心功能分级间呈正相关(r=0.73,P＜0.01).以Tei指数≥0.50为界值,诊断CHF的敏感性为87%,特异性为84%.结论 综合评价超声新技术与传统方法的各项参数将为临床准确判断心力衰竭患者的心功能状态提供可靠依据.     

Age-related underutilization of left ventricular function evaluation in older heart failure patients

BACKGROUND: Underutilization of left ventricular function (LVF) evaluation in older patients with heart failure has been well documented, but age-related variation in the use of LVF evaluation has not been. METHODS: We studied age-related variation of LVF evaluation in older Medicare-beneficiaries discharged with a diagnosis of heart failure in 1994 in Alabama. RESULTS: A total of 1,090 patients had a mean +/- SD age of 79 +/- 7.5 years; 60% were female and 18% were African American. Of these, 636 (58%) had LVF evaluation. Compared with patients aged 65 to 74 years, those 75 to 84 years of age and those aged 85 and older were less likely to receive LVF evaluation. Age of 85 years and older was also independently associated with lower odds of LTF evaluation. CONCLUSION: The overall rate of LVF evaluation was low, and performance of evaluation decreased with patient age. Left ventricular function evaluation should be performed in all patients with heart failure. Considerable opportunities exist for improving care among hospitalized Medicare beneficiaries diagnosed with heart failure.     

双通道多普勒成像技术评价心力衰竭患者左心室舒张功能

目的 探讨双通道多普勒成像技术同步测量舒张早期二尖瓣血流速度峰值与彩色M型血流传播速度比值(E/Vp)评价心力衰竭患者左心室舒张功能不全的价值。方法 随机选取心力衰竭患者60例为病例组,选性别、年龄相匹配的60名健康人为对照组,采用双通道多普勒成像技术以及常规超声分别测量二尖瓣口血流舒张早期二尖瓣血流峰值速度(E峰)、舒张晚期二尖瓣血流峰值速度(A峰),组织多普勒舒张早期二尖瓣瓣环峰值速度(Em)、二尖瓣环舒张晚期运动峰值流速(Am),以及M型血流传播速度(Vp),计算同步与非同步E/Vp、E/Em。分析:①E/Vp、E/Em与纽约心脏病学会心功能分级(NYHA分级)的相关关系;②E/Vp、E/Em与N端B型利钠肽原(NT-proBNP)的相关关系;③分析E/Vp、E/Em用于左心室舒张功能评价的可行性。结果 ①病例组同步及非同步测得E/Vp、E/Em高于对照组,差异有统计学意义(P均<0.01);②随着NYHA分级的增高,心力衰竭患者的同步E/Vp也随之增高,同步E/Vp与NT-proBNP相关性良好(r=0.77,P<0.01);③当同步E/Vp≥1.32时,诊断左心室舒张功能不全的ROC曲线下面积为0.90,敏感度为74%,特异度为96%;同步E/Em≥9.11时,诊断左心室舒张功能不全的ROC曲线下面积为0.85,敏感度为61%,特异度为92%。结论 采用双通道多普勒成像技术测量的同步E/Vp重复性好,能较准确地评估心力衰竭患者的左心室舒张功能。     

二维斑点追踪超声心动图评价心力衰竭患者左心室功能

目的应用二维斑点追踪超声心动图(STE)评价心力衰竭患者左心室功能的变化。方法收集射血分数正常的心力衰竭(HFNEF)和射血分数减低的心力衰竭(HFREF)患者各30例,正常志愿者30名作为对照组。采用实时三维超声心动图(RT-3DE)测量左心室舒张末期容积(EDV)、左心室收缩末期容积(ESV)、左心室射血分数(LVEF);应用STE技术获取左心室的轴向(C)、径向(R)及纵向(L)的应变(S)及应变率(SR)曲线,分别测量收缩期左心室峰值S及SR。结果对照组、HFNEF组及HFREF组三组间EDV及ESV递增,除HFNEF组较对照组EDV及ESV增大无统计学意义,余各两组比较差异均有统计学意义(均P<0.05);三组间LVEF递减(P均<0.05)。左心室收缩期轴向、径向及纵向的S和SR在三组间的总趋势是递减的。在应变参数中,除对照组与HFNEF组下壁CS、后壁CS,前壁RS、侧壁RS、前室间隔RS、后室间隔RS、侧壁中间段LS、室间隔心尖段LS及HFNEF组与HFREF组前壁CS、后壁CS,侧壁中间段LS、侧壁心尖段LS差异无统计学意义外,其余两组间数据差异均有统计学意义(均P<0.05);在应变率参数中,除对照组与HFNEF组下壁CSR、后壁CSR、前壁RSR、侧壁RSR、前室间隔RSR、后壁RSR、后室间隔RSR差异无统计学意义外,其余两组间数据差异均有统计学意义(均P<0.05)。除侧壁、下壁、后壁、后室间隔CSR比CS与LVEF的相关性较好外,其余各壁轴向、径向及纵向S均比SR与LVEF的相关性好。结论 STE测量心肌S及SR能有效评价心力衰竭患者左心室收缩功能,为临床提供有价值信息。     

高血压左室肥厚伴左心力衰竭患者采取心脏超声的诊断情况及准确性分析

目的:观察与分析心脏超声在高血压左室肥厚伴左心力衰竭患者在临床诊断中的效果及准确性.方法:研究对象抽取我院40例2019年10月—2020年10月期间收诊的罹患高血压左室肥厚伴左心力衰竭病患作为实验组,并抽取同期收诊40例健康体检者作为对照组.所有纳入病例均行心脏超声诊断,总结评价两组诊断结果.结果:实验组纳入病例的左...     

Treatment of heart failure with decreased left ventricular ejection fraction

Original Article Class I recommendations for treating patients with current or prior symptoms of heart failure with reduced left ventricular ejection fraction (LVEF) include using diuretics and salt restriction in individuals with fluid retention. Use angiotensin-converting enzyme (ACE) inhibitors, beta blockers, and angiotensin II receptor blockers if intolerant to ACE inhibitors because of cough or angioneurotic edema. Nonsteroidal anti-inflammatory drugs, most antiarrhythmic drugs, and calcium channel blockers should be avoided or withdrawn. Exercise training is recommended. Implant cardioverter-defibrillator (ICD) is recommended in individuals with a history of cardiac arrest, ventricular fibrillation, or hemodynamically unstable ventricular tachycardia. ICD is indicated in patients with ischemic heart disease for at least 40 d post-myocardial infarction or nonischemic cardiomyopathy, an LVEF of 30% or less, New York Heart Association (NYHA) class II or III symptoms on optimal medical therapy, and an expectation of survival of at least 1 yr. Cardiac resynchronization therapy should be used in individuals with an LVEF of 35% or below, NYHA class III or IV symptoms despite optimal therapy, and a QRS duration greater than 120 ms. An aldosterone antagonist can be added in selected patients with moderately severe to severe symptoms of heart failure who can be carefully monitored for renal function and potassium concentration (serum creatinine should be ≶2.5 mg/dL in men and ≶2.0 mg/dL in women; serum potassium should be <5.0 mEq/L).     

斑点追踪显像技术评价心力衰竭患者左室扭转不同步运动

目的 应用二维超声斑点追踪显像技术观察慢性心力衰竭患者左室运动情况.方法 选取我院心血管内科住院部确诊的收缩性心力衰竭患者35例(心衰组),依据患者心电图QRS时限,可将其分为A组(QRS时限≥120 ms)与B组(<120 ms) 两亚组,另选同期健康体检者35例为正常组.应用斑点追踪显像技术对心衰组和正常组左室心肌扭转运动进行分析,比较两组扭转达峰时间(T-Peaktw)、6节段达峰时间标准差(Rot-SD)、6节段达峰最大时间差(Rot-diff)及两亚组间的Rot-SD、Rot-diff及左室旋转达峰时间.结果 正常组与心衰组心尖部Rot-diff分别为(28±52)ms、(133±86)ms,基底部Rot-diff分别为(51±70)ms、(144±101)ms,两组比较差异有统计学意义(P <0.05);心衰组心尖部和基底部Rot-SD均明显大于正常组[ 心尖部:(58±39)ms vs.(14±27)ms,基底部:(60±40)ms vs.(22±29)ms],差异有统计学意义(P <0.05).心衰组中A组与B组Rot-SD、Rot-diff及左室旋转达峰时间比较差异均无统计学意义.结论 心力衰竭患者的心尖部与基底部心肌旋转方向多变,各节段旋转不同步,扭转效率下降;心室扭转不同步参数,即Rot-diff与Rot-SD可反映左室心肌运动同步性,有望用于指导心脏再同步化治疗;心电图QRS时限不能作为评价左室不同步运动的可靠指标.     

Respiratory sleep disorders in patients with congestive heart failure

AIM: To examine respiration in sleeping patients with congestive heart failure (CHF). MATERIAL AND METHODS: Night cardiorespiratory monitoring was made in 30 CHF patients with coronary heart disease (CHD), arterial hypertension and dilated cardiomyopathy. The control group consisted of 16 patients with obstructive sleep apnea and hypopnea (OSAH) free of CHF. RESULTS: Respiratory sleep disorders were registered in all the examinees. Moderate and severe OSAH occurred more often. CHF patients vs controls had shorter inhalation, expiration, overall duration of the respiratory cycle, higher rate of the respiratory movements. With aggravation of the respiratory disorders in sleeping CHF patients, minute ventilation, respiratory volume and mean inspiratory flow arose. In severe OSAH there was low functional residual lung capacity and high intraalveolar volume in end expiration positive pressure. The above changes may cause fatigue and weakness of the respiratory muscles and alter intracardiac hemodynamics. CONCLUSION: For CHF patients it is recommended to perform CPAP-therapy in sleep.     

Left ventricular diastolic heart failure with normal left ventricular systolic function in older persons

Underlying causes and precipitating causes of congestive heart failure (CHF) should be treated when possible. Older persons with CHF and normal left ventricular (LV) ejection fraction should have maintenance of sinus rhythm, treatment of hypertension and myocardial ischemia, slowing of the ventricular rate below 90 beats/minute, and reduction of salt overload. First-line drug treatment in the management of these persons is the use of loop diuretics combined with beta blockers as tolerated. Angiotensin-converting enzyme (ACE) inhibitors should be administered if CHF persists despite diuretics and beta blockers. If persons are unable to tolerate ACE inhibitors because of cough, rash, or altered taste sensation, angiotensin II type 1 receptor antagonists should be given. If CHF persists despite diuretics, beta blockers, and ACE inhibitors or the person is unable to tolerate beta blockers, ACE inhibitors, and angiotensin II type 1 receptor antagonists, isosorbide dinitrate plus hydralazine should be administered. Calcium channel blockers should be used if CHF persists despite administration of diuretics and the person is unable to tolerate beta blockers, ACE inhibitors, angiotensin II type 1 receptor antagonists, and isosorbide dinitrate plus hydralazine. Digoxin, beta blockers, verapamil, and diltiazem may be used to slow a rapid ventricular rate in persons with supraventricular tachyarrhythmias. Digoxin should not be used in persons with CHF in sinus rhythm with normal LV ejection fraction.