螺内酯对慢性心力衰竭患者血浆脑钠肽水平及心功能的影响

目的:探讨螺内酯对慢性心力衰竭(CHF)患者血浆脑钠肽(BNP)水平和心功能的影响。方法:64例CHF患者被随机分为常规对照组(32例)和螺内酯组(32例),两组均给予常规治疗,螺内酯组另加螺内酯20mg,2次/d,观察期3个月,测定治疗前、后左心室舒张末内径(LVEDd)、左心室射血分数(LVEF)、血浆BNP浓度的变化。结果:治疗3个月后,螺内酯组总有效率(90.6%)明显高于常规治疗组(81.3%,P0.05);两组治疗后BNP、LVEDd较治疗前有显著下降,LVEF较治疗前显著升高(P均0.01),螺内酯组血浆BNP浓度由(839±67)ng/L降至(359±51)ng/L(P0.01),LVEDd由(66.01±3.7)mm降至(59.1±2.4)mm(P0.05),LVEF由(36±1.2)%升至(49±5.9)%(P0.01),且明显优于常规对照组(P0.05)。结论:在常规心衰治疗的基础上加用螺内酯能明显改善心功能,显著降低血浆脑钠肽水平。     

螺内酯对慢性心力衰竭患者胶原代谢和心功能的影响

目的观察螺内酯对慢性心力衰竭(CHF)患者心肌细胞外基质及心功能的影响。方法将84例CHF患者随机分为常规组(40例)和螺内酯组(44例)(螺内酯40mg/d)。测定两组治疗前及治疗后3、6个月血清Ⅲ型前胶原(PCⅢ)、Ⅳ型胶原(CⅣ)、透明质酸(HA)及醛固酮(Aldo)水平;同时超声心动图测定左心室功能参数。结果①两组患者治疗后细胞外基质含量下降,螺内酯组PCⅢ及CⅣ低于常规组(P<0.05,P<0.01)。②两组血清Aldo3个月后均下降(P<0.05),6个月时回升至治疗前水平,螺内酯组高于常规组(P<0.05)。③两组左室射血分数(LVEF)及VE/VA升高,以螺内酯组明显(P<0.05)。④血清PCⅢ、CⅣ、HA与LVEF呈负相关(P<0.05)。结论螺内酯可抑制心肌细胞外基质重塑,改善心功能。     

大剂量螺内酯对老年慢性心力衰竭患者心功能和血浆脑钠肽的影响

目的 观察大剂量螺内酯对老年慢性心力衰竭(CHF)患者心功能和血浆脑钠肽(BNP)的影响.方法 选取纽约心脏病协会(NYHA)心功能分级Ⅲ～Ⅳ级的老年CHF患者68例,随机分为试验组和对照组各34例,两组在常规治疗基础上分别给予螺内酯20 mg/d和60mg/d,治疗6个月后评价患者的心功能和检测BNP.结果 试验组血浆BNP浓度由(921.4±284.5)ng/L降低为(316.4±193.3)ng/L(t=14.722,P=0.000);对照组血浆BNP浓度由(904.3±274.0)ng/L降低为(481.3±202.5)ng/L(t=9.271,P=0.000);治疗后两组比较差异均有统计学意义(t=4.280,P=0.011).两组患者治疗前后左室射血分数(LVEF)均改善[试验组(32.2±4.7)％与(45.1±6.2)％,t=6.820,P=0.004;对照组(31.8±5.1)％与(38.3±5.7)％,t=5.283,P=0.008],治疗后两组比较差异也有统计学意义(t=3.844,P=0.017).两组患者治疗前后左室舒张末期内径(LVEDD)缩小[试验组(58.6±4.4) mm与(45.7±4.4)mm,t=5.822,P=0.006;对照组(59.1±5.2) mm与(52.4+4.8) mm,t=3.018,P=0.024],治疗后两组比较差异也有统计学意义(t=3.393,P=0.020).两组治疗前后NYHA心功能分级有明显好转(x2=5.527,P=0.009;x2=4.180,P=0.013).治疗后两组比较差异有统计学意义(x2=3.273,P=0.022).观察组和对照组不良反应发生率分别为11.76％和8.82％(x2=1.063,P=0.116).结论 在常规用药基础上采用大剂量螺内酯可以明显改善CHF患者的心功能,降低BNP水平,可能更适合老年重症CHF患者.     

螺内酯对老年人轻度心力衰竭心肌纤维化和心功能的影响

目的:探讨螺内酯对老年人轻度心力衰竭心肌纤维化和心功能的影响。方法:选择老年轻度心力衰竭患者(NYHA心功能分级为Ⅰ～Ⅱ级)67例为观察组,再随机分为常规治疗组(33例)和螺内酯组(34例);另健康对照组20例,治疗前和治疗3个月时采用放射免疫法测定血清Ⅲ型前胶原氨基半端肽(PⅢNP)和血浆脑钠肽(BNP)浓度,并应用心脏彩超测定心功能变化。结果:观察组血清PⅢNP和血浆BNP浓度均高于对照组(P<0.01);3个月后与治疗前比较:螺内酯组血PⅢNP和BNP均明显下降(P<0.01);且较常规治疗组亦明显下降(P<0.05,<0.01)。结论:在老年人轻度心力衰竭患者小剂量螺内酯治疗可以起到抗心肌纤维化、改善心功能的作用。     

Effective sleep apnoea treatment improves cardiac function in patients with chronic heart failure

Background

Sleep disordered breathing (SDB) is highly prevalent in patients with chronic heart failure (CHF) and is associated with adverse effects on cardiac geometry and function. Continuous positive airway pressure (CPAP) has been proved an effective treatment modality for obstructive sleep apnoea (OSA), whereas adaptive servoventilation (ASV) is more effective in patients with central sleep apnoea (CSA). The impact of selection of therapy and effective apnoea alleviation on cardiac performance and reverse left ventricular remodelling (r-LVR) has not yet been evaluated.

Methods

Eighty five patients with stable CHF were screened for SDB and underwent polysomnography and treatment according to the type of SDB. Clinical evaluation and a comprehensive echocardiographic study was performed before initiation of therapy and after six months of effective treatment (ventilator use > 5 h/day with AHI < 5 events/h).

Results

Seventeen compliant patients under effective treatment were included in the analysis (8 OSA under Autoset CPAP and 9 CSA under ASV). In both groups, a significant improvement in all measured, conventional and TDI LV systolic indexes was recorded, including LVEF (32% ± 6% vs. 27% ± 6%, p < 0.001). A decrease in LV end-systolic volume (189 ± 94 ml vs. 211 ± 88 ml, p = 0.015, difference > 10%) was indicative of r-LVR. Furthermore, RV systolic parameters were also increased (TAPSE, p < 0.001; systolic TDI wave from lateral tricuspid annular aspect, p = 0.001), whereas right heart dimensions and areas were diminished, indicating better pulmonary haemodynamics. Moreover, a significant improvement in patients' clinical status, as evaluated by New York Heart Association Class was also documented at the end of six months follow-up.

Conclusions

Effective alleviation of SDB in CHF patients is associated with significant improvements in LV and RV systolic function and r-LVR. Longitudinal studies are needed to evaluate effects on morbidity and mortality.     

Adaptive servoventilation improves cardiac function in patients with chronic heart failure and Cheyne-Stokes respiration

BACKGROUND AND AIMS: Sleep disordered breathing (SDB), especially Cheyne-Stokes respiration (CSR) is common in patients with chronic heart failure (CHF). Adaptive servoventilation (ASV) was recently introduced to treat CSR in CHF. The aim of this study was to investigate the effects of ASV on CSR and CHF parameters. METHODS: In 29 male patients (63.9+/-9 years, NYHA> or =II, left ventricular ejection fraction [LV-EF]< or =40%), cardiorespiratory polygraphy, cardiopulmonary exercise (CPX) testing, and echocardiography were performed and concentrations of NT-proBNP determined before and after 5.8+/-3.5 months (median 5.7 months) of ASV (AutoSet CS2, ResMed) treatment. All patients also received guideline-driven CHF therapy. RESULTS: Apnoea-hypopnoea-index was reduced from 37.4+/-9.4/h to 3.9+/-4.1/h (p<0.001). Workload during CPX testing increased from 81+/-26 to 100+/-31 W (p=0.005), oxygen uptake (VO2) at the anaerobic threshold from 12.6+/-3 to 15.3+/-4 ml/kg/min (p=0.01) and predicted peak VO2 from 58+/-12% to 69+/-17% (p=0.007). LV-EF increased from 28.2+/-7% to 35.2+/-11% (p=0.001), and NT-proBNP levels decreased significantly (2285+/-2192 pg/ml to 1061+/-1293 pg/ml, p=0.01). CONCLUSIONS: In selected patients with CHF and CSR, addition of ASV to standard heart failure therapy is able to improve SDB, CPX test results, LV-EF and NT-proBNP concentrations.     

小剂量螺内酯辅助治疗高龄冠心病合并慢性心力衰竭临床疗效观察

目的观察小剂量螺内酯辅助治疗高龄冠心病(CAD)合并慢性心力衰竭(CHF)的临床效果。 方法将2016年9月至2017年6月郸城县人民医院收治的84例CAD合并CHF患者纳入研究,按照随机数表法将其分为A、B两组,各42例。A组患者接受常规治疗,B组患者在常规治疗的基础上接受小剂量螺内酯辅助治疗。比较两组患者治疗总有效率,治疗前后LVEF、NT－proBNP水平,不良反应发生率。 结果B组患者治疗总有效率(95.24%)高于A组(78.57%),差异有统计学意义(P<0.05)。B组患者治疗后LVEF水平高于A组(P<0.05),NT－proBNP水平低于A组(P<0.05)。A组不良反应发生率为9.52%,B组不良反应发生率为11.90%,组间差异无统计学意义(P>0.05)。 结论小剂量螺内酯辅助治疗CAD合并CHF临床效果较好,可有效改善患者心功能,且小剂量用药不会增加用药风险,可在临床推广。     

Troglitazone improves cardiac function in patients with congestive heart failure

Troglitazone increased cardiac output and stroke volume, as a result of decreased peripheral resistance, in diabetic patients with normal cardiac function. The cardiovascular effects of troglitazone in patients with heart failure are unknown. The aim of the study was to evaluate the cardiovascular effects of troglitazone in patients with heart failure.Blood pressure and echocardiographic findings were evaluated before and 1, 2, 3 and 4 hours after a single dose of troglitazone (400 mg) or placebo, in eight type II diabetic patients with congestive heart failure. The plasma catecholamines and coefficient of variance of RR intervals (CVRR) were also measured.Neither heart rate nor blood pressure changed after the administration of troglitazone. Left ventricular (LV) end-diastolic dimension did not change either, however, the LV end-systolic dimension significantly decreased compared with its baseline value and with that of the placebo group. On the other hand, the % fractional shortening and the E/A ratio increased significantly after troglitazone. The LV end-diastolic volume did not change, whereas the LV end-systolic volume significantly decreased. The stroke volume and the LV ejection fraction significantly increased compared with its baseline value and with that of the placebo group. The peripheral vascular resistance did not change after the administration of troglitazone, whereas plasma catecholamines significantly decreased, and CVRR remained unchanged in both groups.These hemodynamic changes suggest that a single oral dose of troglitazone induced inotropy without activation of the sympathetic nervous system.     

Levosimendan improves renal function in patients with advanced chronic heart failure awaiting cardiac transplantation

BackgroundLong-term impact of levosimendan on renal function remains undefined. Prospectively, we evaluated effects of levosimendan on renal function in patients with advanced chronic heart failure awaiting cardiac transplantation.Methods and ResultsOf 40 patients, 20 were randomized to receive levosimendan (10-minute bolus 12 μg/kg, followed by 0.1 μg/kg/min for 24 hours; LS Group), and 20 received no levosimendan (Controls). The groups did not differ in age, heart failure etiology, left ventricular ejection fraction, and plasma brain natriuretic peptide. Patients were followed for 3 months. At baseline, the groups did not differ in serum creatinine (1.92 ± 0.13 mg/dL in LS Group versus 1.91 ± 0.12 mg/dL in Controls, P = .81) and creatinine clearance (43.7 ± 2.9 mL/min versus 43.9 ± 2.8 mL/min, P = .84). At 3 months, we found a decrease in serum creatinine and an increase in creatinine clearance in LS Group, but not in Controls, leading to a significant intergroup difference in serum creatinine (1.60 ± 0.26 mg/dL in LS Group versus 1.90 ± 0.14 mg/dL in Controls, P = .005) and creatinine clearance (53.6 ± 8.6 mL/min versus 44.0 ± 3.3 mL/min, P = .005). An improvement in creatinine ≥0.5 mg/dL occurred in 50% patients from LS Group compared with 10% of Controls (P = .005).ConclusionsLevosimendan improves long-term renal function in advanced chronic heart failure patients awaiting cardiac transplantation.     

咪达普利和安体舒通干预心肌纤维化大鼠血管紧张素Ⅱ的产生

目的：探讨慢性心力衰竭大鼠心肌纤维化进程中肾素—血管紧张素—醛固酮系统(RAAS)的变化及血管紧张素转化酶抑制剂(ACEI)和安体舒通(SPI)干预对心肌纤维化大鼠AngⅡ产生途径的影响。方法：制作腹主动脉缩窄大鼠心肌纤维化模型,随机分为①模型判断组,②ACEI 组,③SPI 组,④两药合用组,⑤不用药组,另设⑥假手术组。术后4周以心重/体重、心肌胶原含量判断模型成功．然后灌胃予以ACEI(0.9mg/kg·d)、SPI(1.8 mg/kg ·d)及二药合用(ACEI 0.45 mg/kg·d SPI 0.9 mg/kg·d)8周,对比各组间心重指数、心肌胶原含量、血浆及心肌血管紧张素Ⅱ(AngⅡ)和醛固酮(ALD)含量及心肌血管紧张素转化酶(ACE)和糜酶样活力。结果：腹主动脉缩窄4周后,心肌纤维化大鼠模型心重／体重、心肌胶原含量与血浆、心肌 AngⅡ和 ALD 水平升高。予以 ACEI 和 SPI 治疗后,上述指标有所改善(P＜0.05～＜0.01)．且联合用药,心肌 ACE 和糜酶样活力降低(P＜0.05)。结论：咪达普利和安体舒通均能减轻心肌纤维化,但二者联用优于单独应用。     

Repeated sauna treatment improves vascular endothelial and cardiac function in patients with chronic heart failure

OBJECTIVES: The purpose of this study was to determine the mechanism by which 60 degrees C sauna treatment improves cardiac function in patients with chronic heart failure (CHF). BACKGROUND: We have previously reported that repeated 60 degrees C sauna treatment improves hemodynamic data and clinical symptoms in patients with CHF. We hypothesized that the sauna restores endothelial function and then improves cardiac function. METHODS: Twenty patients (62 plus minus 15 years) in New York Heart Association (NYHA) functional class II or III CHF were treated in a dry sauna at 60 degrees C for 15 min and then kept on bed rest with a blanket for 30 min, daily for two weeks. Ten patients with CHF, matched for age, gender and NYHA functional class, were placed on a bed in a temperature-controlled (24 degrees C) room for 45 min as the nontreated group. Using high-resolution ultrasound, we measured the diameter of the brachial artery at rest and during reactive hyperemia (percent flow-mediated dilation, %FMD: endothelium-dependent dilation), as well as after sublingual administration of nitroglycerin (%NTG: endothelium-independent dilation). Cardiac function was evaluated by measuring the concentrations of plasma brain natriuretic peptide (BNP). RESULTS: Clinical symptoms were improved in 17 of 20 patients after two weeks of sauna therapy. The %FMD after two-week sauna treatment significantly increased from the baseline value, whereas the %NTG-induced dilation did not. Concentrations of BNP after the two-week sauna treatment decreased significantly. In addition, there was a significant correlation between the change in %FMD and the percent improvement in BNP concentrations in the sauna-treated group. In contrast, none of the variables changed at the two-week interval in the nontreated group. CONCLUSIONS: Repeated sauna treatment improves vascular endothelial function, resulting in an improvement in cardiac function and clinical symptoms.     

慢性心力衰竭患者血红蛋白水平与心肾功能的相关性

目的:探讨慢性心力衰竭(CHF)患者血红蛋白(Hb)水平与其心功能、肾功能的关系。方法:150例CHF男性患者按照心功能分为三组:NYHA II级组44例、III级组49例,IV级组57例,并随机抽选30例健康体检患者为健康对照组,分析各组心功能指标[左室舒张末期内径(LVEDd),左室射血分数(LVEF),N末端脑利钠肽前体(NT-proBNP)],肾功能指标[血清肌酐(SCr),肾小球率过滤(GFR)],血液学指标[Hb,红细胞(RBC),血红细胞比容(HCT)];根据CHF患者贫血情况分为贫血组(61例)和非贫血组(89例),并对两组上述指标进行比较。结果:CHF各组贫血发生率均明显高于健康对照组,且随着心衰等级的增加而明显升高(P<0.05);与健康对照组比较,CHF各组心功能各项指标(LVEDd,LVEF,NT-proBNP),肾功能指标(SCr,GFR),血液学指标(Hb,RBC,HCT)均有明显恶化,且随着心衰等级增加而明显加重(P均<0.05);与CHF非贫血组比较,CHF贫血组SCr[(89.78±44.79)mmol/L比(78.79±45.02)mmol/L]、GFR[(86.13±25.42)ml.min-1(1.73m)-1比(67.99±32.12)ml.min-1(1.73m)-1]、LVEF[(55.79±11.34)%比(45.65±12.03)%]水平明显降低,LVEDd[(49.89±8.93)mm比(56.45±11.23)mm]明显增大,NT-proBNP[(945.27±1249.76)pg/ml比(3884.23±2790.42)pg/ml]水平明显升高(P<0.05);线性相关分析显示Hb与LVEDd、NT-proBNP呈负相关(r=-0.346,-0.547,P均<0.05),与LVEF、GFR呈正相关(r=0.453,0.338;P均<0.05)。结论:慢性心力衰竭患者血红蛋白下降会显著降低心、肾功能。     

Appropriateness and complications of the use of spironolactone in patients treated in a heart failure clinic

Objectives

The widespread use of spironolactone in patients with congestive heart failure (CHF) has resulted in side effects and complications. We analyzed a cohort of patients treated by a dedicated CHF team, in order to examine the tolerability and safety of spironolactone in clinical practice.

Methods

We retrospectively evaluated data on 157 patients who were followed by the Heart Failure clinic of whom 100 patients on maximal treatment (all on β blockers, 99% on ACE inhibitors) received spironolactone. The complications following spironolactone use were defined as: hyperkalemia with serum K 5.2 mEq/l; creatinine 2.0 mg/dl; hyponatremia with serum Na 135 mEq/l, hypotension and side effects such as gynecomastia and abdominal pain.

Results

At 1 year follow-up 6 patients developed hyperkalemia (range 5.3-5.9), 4 of them had K > 5.5 mEq/l. Two patients developed hyponatremia. Six patients stopped spironolactone for: 1-gynecomastia, 2-worsening renal failure and hyperkalemia, 2-hyperkalemia (5.9 mEq/l) and 1 for bradycardia. There was an increase in mean creatinine level at 1 year (1.12 ± 0.35 vs. 1.21 ± 0.38 mg/dl, p = 0.02), however, no significant changes were found in GFR (99.9 ± 33.5 vs. 65.7 ± 27.7 ml min^− 1 1.73 m^− 2, p = ns) and potassium (4.5 ± 0.4 vs. 4.6 ± 0.5 mEq/l, p = ns). We found improvement of GFR by > 10% in 19 patients and worsening by > 10% in 38 patients. No patient was hospitalized or required urgent treatment for spironolactone-related side effects.

Conclusions

In patients with CHF on optimal therapy with ACE inhibitors and β blockers appropriate spironolactone use and close follow-up by a dedicated HF team can minimize the risk for adverse events and complications.     

螺内酯对老年舒张性心力衰竭患者血清Ⅰ型前胶原羧基端肽水平的影响

目的观察老年舒张性心力衰竭患者使用螺内酯治疗前后血清Ⅰ型前胶原羧基端肽(PICP)水平的变化,探讨螺内酯减轻心肌纤维化、改善心脏舒张功能的可能机制。方法选择舒张性心力衰竭患者37例,随机分为常规治疗组及螺内酯(20 mg/d)治疗组,随访6个月,测定治疗前后血清PICP水平,并通过超声心动图观察治疗前后左心房、左心室大小、左心室壁厚度、左心室射血分数及舒张早期和晚期充盈速度(E、A)及其比值(E/A)。结果两组治疗后血清PICP水平与治疗前相比均明显下降(P<0.05),且螺内酯组低于常规治疗组(P<0.05)。两组治疗后E/A比值与治疗前相比均增高(P<0.05),且螺内酯组高于常规治疗组(P<0.05)。结论螺内酯通过降低Ⅰ型胶原的合成可能可以减轻心肌纤维化,改善心脏舒张功能。     

步行训练对老年慢性心力衰竭患者心脏功能康复的影响

目的:观察步行训练方式对老年慢性心力衰竭患者心功能康复的效果和安全性。方法:295例Ⅱ～Ⅲ级慢性心功能不全的老年患者随机被分为康复组(152例)和对照组(143例),康复组在药物治疗基础上进行步行训练,对照组只进行药物治疗。经过6个月的随访,对比两组治疗前、后的血压、静息心率、6min步行距离、心脏超声的左室射血分数(LVEF)和左室舒张末期内径(LVEDd)等的变化情况。结果:运动训练前不同组间一般情况、血压、静息心率、6min步行距离和左室功能无明显差异(P0.05);运动训练6个月后各组死亡情况没有差别;步行运动训练组总再次住院率(20.4%∶33.6%)和因心血管疾病再次住院率(11.8%∶22.8%)明显低于对照组(P均0.05);与运动训练前及对照组治疗后比较,康复组治疗后静息心率明显下降[(72.1±15.7)次/min,(74.3±16.8)次/min∶(66.8±12.4)次/min],6min步行距离[(284.9±104.7)m,(296.1±134.5)m∶(328.6±124.2)m]和LVEF[(33.4±9.7)%,(30.4±9.6)%∶(35.9±10.9)%]均明显增加(P均0.01);血压和LVEDd无明显变化(P0.05)。结论:一定强度的步行训练对老年慢性充血性心力衰竭患者心脏功能的康复是安全和有效的。     

老年慢性心力衰竭患者N末端钠尿肽前体和心率变异性与心功能的相关性

目的探讨老年慢性心力衰竭(CHF)患者N末端钠尿肽前体(NT-proBNP)水平和心率变异性与心功能的相关性。方法选择82例老年CHF患者(CHF组),按照心功能分级(NYHA)又分为:NYHAⅡ级22例,NYHAⅢ级34例,NYHAⅣ级26例;另选择同期健康体检者60例为对照组。用电化学法测2组NT-proBNP水平,超声心动图测定左心室舒张末内径(LVEDD)和LVEF,用24h动态心电图分析2组的心率变异性时域指标。结果与对照组比较,CHF组的NT-proBNP水平及LVEDD显著升高(P<0.01),随NYHA的增高而逐渐升高(P<0.01),LVEF显著降低(P<0.01)。与对照组比较,CHF组的心率变异性各指标均显著降低(P<0.01),随NYHA的增高而逐渐降低(P<0.01),心率变异性各指标均与NYHA呈负相关(P<0.01)。结论老年CHF患者存在自主神经功能受损和失衡,NT-proBNP水平和心率变异性检测能客观定量地反映老年CHF患者心功能状态。     

螺内酯治疗高血压病并左心室舒张功能不全的观察

目的:观察螺内酯对高血压病合并无症状性左心室舒张功能不全的影响.方法:选择高血压病合并无症状性左心室舒张功能不全患者共126例,随机分为常规治疗组(68例)和螺内酯组(58例).两组患者均按常规综合治疗,而螺内酯组在此基础上加用螺内酯片治疗.治疗前后观察患者血压、心率的变化,以彩色多普勒超声仪检测E峰(EV)、A峰(A...     

充血性心衰患者尿Na+/K+比值和螺内酯应用的关系

目的：探讨尿Na^ /K^ 比值作为应用醋固酮拮抗剂螺内酯指标的可行性。方法：检测41例心功能Ⅲ-Ⅳ级病人的尿Na^ /K^ 比值，按比值的不同（＜1．0或＞1．0）分两组，比较两组的治疗效果。结果：应用螺内酯后尿Na^ /K^ ＜1．0受益大。结论：尿Na^ /K^ ＜1．0，可以作为使用螺内酯治疗心力衰竭的指标。     

慢性心力衰竭患者心功能恢复的相关因素研究

目的:分析影响慢性心力衰竭(CHF)患者心功能恢复的相关因素。方法:连续入选232例诊断为CHF并至少随访1年的患者,记录患者临床和生化资料,并定期行超声心动图检测。Logistic回归分析评估影响CHF患者心功能恢复的相关因素。结果:232例患者中56例患者心功能恢复,176例患者心功能未恢复。扩张型心肌病患者较缺血性心肌病患者心功能更易恢复(P0.05),围生期心肌病患者预后良好。与体质量正常或过轻患者相比,体质量指数(BMI)较高的CHF患者心功能更易恢复(P0.05)。心功能恢复患者基础心率偏快,β受体阻滞剂耐受剂量较大,药物治疗后心率下降较明显(P均0.001)。Logistic回归分析显示,患者心功能恢复与CHF病因(OR=1.322,95%CI:1.256~1.392,P=0.04)和β受体阻滞剂剂量(OR=2.483,95%CI:2.359~2.614,P0.001)相关。结论:CHF病因和β受体阻滞剂剂量与CHF患者心功能恢复相关,BMI及基础心率较高患者心功能易于恢复。     

A machine learning-derived echocardiographic algorithm identifies people at risk of heart failure with distinct cardiac structure,function, and response to spironolactone: Findings from the HOMAGE trial

Aim

An echocardiographic algorithm derived by machine learning (e′VM) characterizes pre-clinical individuals with different cardiac structure and function, biomarkers, and long-term risk of heart failure (HF). Our aim was the external validation of the e′VM algorithm and to explore whether it may identify subgroups who benefit from spironolactone.

Methods and results

The HOMAGE (Heart OMics in AGEing) trial enrolled participants at high risk of developing HF randomly assigned to spironolactone or placebo over 9 months. The e′VM algorithm was applied to 416 participants (mean age 74 ± 7 years, 25% women) with available echocardiographic variables (i.e. e′ mean, left ventricular end-diastolic volume and mass indexed by body surface area [LVMi]). The effects of spironolactone on changes in echocardiographic and biomarker variables were assessed across e′VM phenotypes. A majority (>80%) had either a ‘diastolic changes’ (D), or ‘diastolic changes with structural remodelling’ (D/S) phenotype. The D/S phenotype had the highest LVMi, left atrial volume, E/e', natriuretic peptide and troponin levels (all p < 0.05). Spironolactone significantly reduced E/e' and B-type natriuretic peptide (BNP) levels in the D/S phenotype (p < 0.01), but not in other phenotypes (p > 0.10; p_interaction <0.05 for both). These interactions were not observed when considering guideline-recommended echocardiographic structural and functional abnormalities. The magnitude of effects of spironolactone on LVMi, left atrial volume and a type I collagen marker was numerically higher in the D/S phenotype than the D phenotype but the interaction test did not reach significance.

Conclusions

In the HOMAGE trial, the e′VM algorithm identified echocardiographic phenotypes with distinct responses to spironolactone as assessed by changes in E/e' and BNP.