Clinical outcome and reversibility of systolic dysfunction in patients with dilated cardiomyopathy due to hypertension and chronic heart failure

INTRODUCTION AND OBJECTIVES: There is little information on the clinical and functional course of patients with heart failure secondary to dilated cardiomyopathy due to hypertension. The objectives of our study were to assess the clinical and functional course of these patients, and to identify possible predictors of prognosis. PATIENTS AND METHOD: We evaluated a series of 49 patients with this condition diagnosed in our hospital from 1994 to 2003. Mean age was 63(11) years, and 40% were women. Left ventricular ejection fraction was 30.1(4.8)%. Follow-up was 45(23) months (median, 41 months). RESULTS: Four-year survival was 0.84, the 4-year rate of hospitalization due to heart failure was 0.12, and likelihood of readmission-free survival was 0.80 at 4 years. Left ventricular ejection fraction increased from 30.1(4.8)% to 57.6(13.5)% (P< .001). An unfavorable clinical and functional outcome at 4 years (death, readmission for heart failure or persistence of dilated cardiomyopathy) was recorded in only in 40% of the patients. Multivariate analysis with the Cox model showed appropriate control of blood pressure to be the only independent predictor of a favorable clinical outcome (absence of death or readmission for heart failure) (hazard ratio = 4.58; 95% CI, 1.32-9.83; P=.032). CONCLUSIONS: The course of patients with severe dilated cardiomyopathy due to hypertension was favorable in 60% of cases. Adequate control of blood pressure was the only independent predictor of a favorable clinical outcome.     

Usefulness of atorvastatin in patients with heart failure due to inflammatory dilated cardiomyopathy and elevated cholesterol levels

This study evaluated the safety, tolerability, and efficacy of statin therapy in patients with heart failure secondary to inflammatory dilated cardiomyopathy and moderately elevated low-density lipoprotein cholesterol levels. Seventy-four patients were randomized to receive atorvastatin 40 mg/day or conventional treatment for heart failure. After 6 months of therapy, the predefined primary efficacy end point (an increase of >5% in the absolute left ventricular ejection fraction and > or =2 selected criteria by echocardiography and a decrease in New York Heart Association functional class) was significant in the statin-treated patients (p = 0.004). Among secondary efficacy parameters, the quality-of-life index showed a trend suggesting the benefit of statin therapy (p = 0.055). In conclusion, the results of this study demonstrate that treatment with atorvastatin in addition to standard therapy for heart failure may significantly improve clinical outcomes in this cohort of patients.     

Predicting death due to progressive heart failure in patients with mild-to-moderate chronic heart failure

OBJECTIVES: The aim of this study was to explore the value of noninvasive predictors of death/mode of death in ambulant outpatients with chronic heart failure (HF). BACKGROUND: Mortality in chronic HF remains high, with a significant number of patients dying of progressive disease. Identification of these patients is important. METHODS: We recruited 553 ambulant outpatients age 63 +/- 10 years with symptoms of chronic HF (New York Heart Association functional class, 2.3 +/- 0.5) and objective evidence of left ventricular dysfunction (ejection fraction <45%, cardiothoracic ratio >0.55, or pulmonary edema on chest radiograph). After 2,365 patient-years of follow-up, 201 patients had died, with 76 events due to progressive HF. RESULTS: Independent predictors of all-cause mortality assessed with the Cox proportional hazards model were as follows: a low standard deviation of all normal-to-normal RR intervals (SDNN); lower serum sodium and higher creatinine levels; higher cardiothoracic ratio; nonsustained ventricular tachycardia; higher left ventricular end-systolic diameter; left ventricular hypertrophy; and increasing age. Independent predictors of death specific to progressive HF were SDNN, serum sodium and creatinine levels. The hazard ratio of progressive HF death for a 10% decrease in SDNN was 1.06 (95% confidence interval [CI], 1.01 to 1.12); for a 2 mmol/l decrease in serum sodium, 1.22 (95% CI, 1.08 to 1.38); and for a 10 micromol/l increase in serum creatinine, 1.14 (95% CI, 1.09 to 1.19) (all p < 0.01). CONCLUSIONS: In ambulant outpatients with chronic HF, low serum sodium and SDNN and high serum creatinine identify patients at increased risk of death due to progressive HF.     

微小RNA对老年冠心病慢性心力衰竭合并高血压的影响

目的探讨微小RNA对老年冠心病慢性心力衰竭(CHF)合并高血压的影响。方法连续收集2017年1月~2019年1月于我院收治的原发性高血压患者520例,根据患者是否合并CHF,分为CHF组178例和对照组342例,观察2组患者微小RNA谱(微小RNA-1、-21、-23、-29、-30、-130、-133、-195、-199、-208和-320)表达的差异,用Pearson相关性分析,用多因素logistic回归分析影响因素。结果与对照组比较,CHF组患者收缩压和舒张压明显增高[(166.85±12.75)mm Hg vs(158.74±13.71)mm Hg(1 mm Hg=0.133 kPa),P=0.000、(105.73±14.83)mm Hg vs(98.47±10.75)mm Hg,P=0.000];LVEF明显降低[(41.74±5.75)%vs(57.85±6.02)%,P=0.000];且CHF组微小RNA-1、微小RNA-21、微小RNA-23、微小RNA-29、微小RNA-130、微小RNA-195、微小RNA-199相对表达量增加(P<0.05)。2组微小RNA-30、微小RNA-133、微小RNA-208、微小RNA-320相对表达量比较,均无统计学差异(P>0.05)。微小RNA-1、微小RNA-21、微小RNA-23、微小RNA-29、微小RNA-130、微小RNA-195、微小RNA-199相对表达量与LVEF呈显著负相关(P<0.01)。多因素logistics回归分析显示,微小RNA-1、微小RNA-21、微小RNA-23、微小RNA-29、微小RNA-130、微小RNA-195、微小RNA-199相对表达量增加是CHF的影响因素(P<0.05,P<0.01)。结论微小RNA-1、微小RNA-21、微小RNA-23、微小RNA-29、微小RNA-130、微小RNA-195、微小RNA-199表达量增加可能与冠心病的老年患者并发CHF有关。     

比索洛尔对高血压病并发慢性心力衰竭患者脑钠尿肽前体的影响

目的 探讨比索洛尔对高血压病并发慢性心力衰竭（CHF）患者脑钠尿肽（BNP）前体（Pro-BNP)的影响。方法 选取我院收治的高血压病并发CHF的患者102例,随机分为试药组和对照组各51例。对照组按照高血压病并发CHF的常规治疗方案进行干预,试药组在对照组治疗方案的基础上,加用比索洛尔口服治疗。治疗3个月后对比两组患者的心功能改善情况,同时对比两组患者治疗前后的心率、血压、左室射血分数(LVEF)以及pro-BNP的变化情况。结果 试药组的显效率为49%,总有效率为96%,均显著高于对照组（分别为29%,76%,均P<0.05）;两组患者治疗后的心率、收缩压和舒张压均显著低于治疗前,而LVEF显著高于治疗前（均P<0.05）;试药组治疗后的LVEF为（44±4）%,显著高于对照组〔（35±4）%,P<0.05〕;试药组治疗后的Pro-BNP水平为（733±58） ng/L,对照组治疗后的Pro-BNP水平为（802±63） ng/L,两组患者治疗后的Pro-BNP水显著低于治疗前（均P<0.05）;试药组治疗后的Pro-BNP水平显著低于对照组（P<0.05）。结论 比索洛尔可有效降低高血压病并发CHF患者的Pro-BNP水平,提高临床疗效。     

Pulmonary vascular remodeling in pulmonary hypertension due to chronic heart failure

Pulmonary hypertension (PHT) associated with chronic heart failure (CHF) is a risk factor of right ventricular failure after heart transplantation (HT). Our aim was to study pulmonary vascular changes in patients with CHF and to assess any correlation with haemodynamic data. METHODS: We studied 17 HT recipients with preoperative CHF who died shortly after HT. Preoperative haemodynamic information was obtained immediately before HT. Vascular lesions in muscular arteries were assessed by linear morphometry. Haemodynamic data were correlated with the morphologic changes. RESULTS: Mean transpulmonary gradient (TPG) was 8.9+/-4.5 mm Hg and pulmonary vascular resistance (PVR) was 2.25+/-1.34 Wu. According to the threshold for at-risk PHT (TPG>12 mm Hg or PVR>2.5 Wu), six patients had at-risk PHT. Medial thickness was 23.82+/-7.23% in patients with at-risk PHT and 17.16+/-3.24% in patients without at-risk PHT (p=0.018). CONCLUSIONS: Medial hypertrophy of muscular pulmonary arteries is more common and severe than expected in patients with CHF, even in patients without at-risk PHT. This structural change could explain why PHT, even in range of values not excluding HT, is a risk factor for right ventricular failure after HT and influences post-HT haemodynamic behaviour.     

Effect of long-term digoxin therapy on autonomic function in patients with chronic heart failure

Objectives.This study was conducted to determine the effect of long-term digoxin therapy on autonomic function in patients with mild to moderate chronic heart failure.Background.Chronic heart failure is characterized by increased sympathetic activity and decreased parasympathetic activity. Intravenous digitalis has been found to reduce sympathetic activity immediately in these patients, but whether short-term neurohormonal effects are sustained during long-term oral therapy has not been assessed.Methods.We determined sympathetic activity in 26 patients with heart failure by measuring plasma norepinephrine levels and parasympathetic activity from variables of heart period variability derived from 24-h ambulatory electrocardiographic Holter recordings obtained before and after 4 to 8 weeks of digoxin therapy.Results.After digoxin therapy, plasma norepinephrine decreased significantly from a mean ± SEM of 552 ± 80 to 390 ± 37 ng/ml. In addition, the RR interval increaed significantly from 719 ± 19 to 771 ± 20 ms. High frequency power increased from 84 ± 24 to 212 ± 72ms², and the root mean square of successive differences in RR interval increased from 203 ± 1.8 to 27.0 ± 3.4 ms, indicating a substantial increase in parasympathetic activity. Low frequency power, an index of baroreflex activity, was also significantly increased (239 ± 80 to 482 ± 144 ms²) by digoxin therapy.Conclusions.These results indicate 1) that long-term therapy with digoxin acts to ameliorate the autonomic dysfunction of patients with heart failure, and 2) that the short-term neurohormonal effects of digoxin are sustained during prolonged treatment with the drug.     

Fulminant hepatic failure due to transient circulatory failure in patients with chronic heart disease

Heart failure is a recognized, although uncommon, cause of massive liver cell necrosis, the clinical consequences of which are intermingled with those of cardiac insufficiency in most cases. We report the cases of six patients suffering from chronic heart failure in whom an episode of acute circulatory failure resulted in massive liver cell necrosis and fulminant hepatic failure. The manifestations of fulminant hepatic failure, ie, hepatic encephalology, jaundice, and marked increase in prothrombin time, developed after an interval of one to three days, after the episode of acute circulatory failure, while the patients' hemodynamic condition had returned to the previous basal status.     

Plasma myeloperoxidase levels in patients with chronic heart failure

Increased oxidative stress and endothelial dysfunction are commonly observed in patients with chronic heart failure (HF). The relation between myeloperoxidase (MPO), an inflammatory marker with mechanistic links to plaque vulnerability and abnormal ventricular remodeling, and degrees of severity in chronic HF has not been reported. Plasma MPO levels were measured in 105 normal controls (no history of HF or left ventricular dysfunction) and 102 patients with chronic systolic HF (left ventricular ejection fraction <50%), and the relations among plasma MPO levels, plasma B-type natriuretic peptide levels, and the left ventricular ejection fraction were examined. Plasma MPO levels in patients with chronic systolic HF were significantly elevated compared with those of healthy controls (1,158 +/- 2,965 vs 204 +/- 139 pM, p <0.0001). Plasma MPO levels increased in parallel with increasing New York Heart Association class (p <0.0001) and were correlated with plasma B-type natriuretic peptide levels (Spearman's r = 0.39, p <0.0001). Levels of MPO were strongly associated with the prevalence of HF (unadjusted odds ratio 30.3, 95% confidence interval 11.1 to 94.5) and remained significant when adjusted for age and B-type natriuretic peptide (odds ratio 27.7, 95% confidence interval 3.6 to 371.1). In conclusion, in a cohort of patients with chronic HF, plasma MPO levels were elevated compared with those of normal controls and were associated with worsening functional class.     

Tumour marker levels in patients with chronic heart failure

BACKGROUND: Carbohydrate Antigen 125 (CA 125), a marker for ovarian cancer has been reported to increase in relation to the severity of heart failure. OBJECTIVE: To evaluate the serum levels of CA 125 and other tumour markers, in patients with chronic heart failure. METHODS: Blood levels of CA 125 and other tumour markers were determined in 44 heart failure patients (16 males and 28 females; age 66.3+/-6.5 years) before and after optimal medical treatment. Levels were also evaluated in 30 healthy volunteers (11 males and 19 females; age 65.7+/-9.8 years). The results in the heart failure patients were grouped according to clinical status (New York Heart Association Class). The mean duration of follow-up was 3+/-1.5 months. RESULTS: The mean serum level of CA 125 was 81.9+/-91 in the patient group and 7.5+/-4.8 in control group (p<0.001). The mean CA 19-9 level in the patient group (16.8+/-16.6) was significantly higher than in the control group (4.5+/-2.6) (p<0.001). CA 125 levels increased as the New York Heart Association (NYHA) functional class increased (Class I/II: 17.7+/-22.4 U/ml; Class III: 99.6+/-92.1 U/ml; Class IV 136.4+/-102.8 U/ml; p<0.05). There were no significant differences in serum CA 125 and other tumour marker levels before and after optimisation of treatment. Significantly higher serum CA 125 levels were found in patients with pericardial effusion (p=0.002) when compared to patients without pericardial effusion. CONCLUSION: Among the tumour markers evaluated, only CA 125 seems to be specifically related to the presence and severity of heart failure and also the presence of pericardial fluid. Therefore, measurements of CA 125 serum levels might be proposed for the serial assessment of heart failure. Whether CA 125 has a specific biological role in heart failure requires further investigation.     

曲美他嗪对老年糖尿病心肌病慢性心力衰竭患者心功能的影响

目的研究曲美他嗪对老年糖尿病心肌病（diabetic cardiomyopathy,DCM）慢性心力衰竭患者心功能的影响。方法DCM慢性充血性心力衰竭患者41例,其中男21例,女20例,年龄65～75岁,平均年龄（71．3±4．7）岁,随机分为对照组和治疗组。对照组给予标准药物治疗,治疗组在标准药物治疗基础上给予曲美他嗪治疗。观察两组治疗前、治疗后1年的纽约心脏病学会（NYHA）心功能分级、左室射血分数（LVEF）、6分钟步行距离（6MWD）和血浆脑利钠肽（BNPo结果两组治疗后NYHA心功能分级、LVEF、6MWD、BNP均较治疗前有明显改善,差异有统计学意义（P〈0．05o治疗组NYHA心功能分级（2．1±0．3）,对照组（2．5±0．3）,P〈0．05差异有统计学意义。治疗组LVEF为（51．1±4．5）％,对照组LVEF为（43．1±5．5）％,P〈0．05差异有统计学意义。治疗组6MWD为（364．1±21．6）m,对照组6MWD为（280．0±22．4）m,P〈0．05差异有统计学意义。治疗组BNP为（113．0±22．4）ng／mL,对照组BNP为（221．6±26．4）ng／mL,P〈0．05差异有统计学意义。结论曲美他嗪能改善老年DCM慢性心力衰竭患者心功能。     

胆红素对老年慢性心力衰竭全因死亡风险的预测价值及其影响因素

目的:研究血清胆红素对老年心力衰竭(心衰)患者全因死亡的预测价值及其影响因素。方法:对2007-01-2014-06住院入选的345名于中国中医科学院广安门医院心内科的老年心衰患者进行随访,终点事件为全因死亡,随访周期为730天。根据ROC曲线计算与死亡率相关的胆红素切值,根据此切值将患者分为胆红素正常组(组1)和胆红素升高组(组2),比较两组患者生存率的差异以及与胆红素相关的影响因素。结果:345例完成随访284例,失访61例(失访率17.68%)。死亡82例(23.77%)。单因素分析显示,总胆红素、直接胆红素、间接胆红素升高均可增加心衰患者死亡风险。总胆红素>23.5μmol/L、直接胆红素>4.60μmol/L、间接胆红素>17.70μmol/L均为心衰患者死亡的独立预测因素。通过Spearman相关分析显示,总胆红素、直接胆红素、间接胆红素与左室射血分数、血小板计数和极低密度脂蛋白呈负相关(P<0.05)。与右室内径、NT-proBNP、尿酸呈正相关(P<0.05)。多因素Cox风险比例回归显示,在考虑到年龄、性别、肾功能、血脂等因素后,以总胆红素为代表的胆红素系统对老年心衰患者的死亡率仍有独立的预测价值[HR:1.035,(95%CI:1.009-1.061),P=0.007]。结论:胆红素与老年心衰患者死亡独立相关,总胆红素、直接胆红素、间接胆红素升高均为老年心衰患者死亡的独立预测因素。心肌重构与胆红素升高关系密切。     

Effect of elevated admission serum creatinine and its worsening on outcome in hospitalized patients with decompensated heart failure

Renal insufficiency (RI), as represented by elevated serum creatinine (>1.5 mg/dl) on admission, is common and found in almost half of patients hospitalized with decompensated heart failure. This finding is associated with prolongation of length of stay and rate of rehospitalizations after discharge and also has an independent unfavorable effect on 6-month mortality. Similarly, an increase in serum creatinine (>0.5 mg/dl) in the hospital results in a significantly longer length of stay and has an independent effect on long-term mortality.     

Loss of bone mineral in patients with cachexia due to chronic heart failure

We studied body composition and cytokine levels in 58 patients with heart failure and 16 control patients using dual-energy x-ray absorptiometry. Bone mineral content and density, and lean and fat tissue content, were reduced in cachectic compared with noncachectic patients and control subjects, with negative relations between indexes of bone composition and tumor necrosis factor and tumor necrosis factor receptor 1.     

Cardiac correlates of exercise induced pulmonary hypertension in patients with chronic heart failure due to left ventricular systolic dysfunction

BACKGROUND: Patients with chronic heart failure (CHF) due to left ventricular systolic dysfunction (LVSD) may develop pulmonary hypertension at rest and during exercise. The cardiac correlates of pulmonary hypertension have been ascertained in the resting state, but seldom during exercise in these patients. AIMS: We sought to determine the cardiac correlates of exercise induced pulmonary hypertension in patients with LVSD by monitoring the estimated pulmonary artery systolic pressure (PASP) by continuous Doppler echocardiography during semirecumbent bicycle exercise. METHODS: Eighty-five patients (mean age 57 +/- 13 years, 75% male) with CHF due to LVSD (LV ejection fraction [EF] <45%, mean LVEF 26 +/- 8%) were studied. RESULTS: Mitral effective regurgitant orifice area and E-wave were independent predictors of resting PASP. Resting PASP and exercise induced changes in PASP were unrelated (r =-0.08, P = 0.45). Decrease in LV end-systolic volume, increase in left atrial (LA) area, resting LV asynchrony, and decreased tricuspid annular plane systolic excursion (TAPSE) were independent predictors of exercise PASP. CONCLUSIONS: Resting LV asynchrony, impaired LV contractile reserve, and increase in LA dilatation correlate with the severity of exercise induced pulmonary hypertension in patients with CHF due to LVSD, while right ventricular systolic dysfunction is inversely related to the severity of exercise induced pulmonary hypertension.     

卡维地洛对老年高血压及伴有心力衰竭患者的疗效观察

目的 　探讨卡维地洛 (carvedilol)对 80岁以上老年高血压及伴有心力衰竭患者的疗效及安全性。　方法　观察了 5 1例老年高血压及 18例高血压伴有心力衰竭患者经卡维地洛治疗前后 6月的血压和心功能情况。　 结果　卡维地洛治疗后 8周的 2 4h白昼和夜间的平均收缩压 ,舒张压明显下降 ,有显著性差异 (P <0 .0 5～ 0 .0 1)。伴有心力衰竭患者 6月后左室射血分数 (EF)明显提高 ,由治疗前 0 .43± 0 .0 5上升为 0 .5 2± 0 .0 2 (P <0 .0 5 ) ,心功能改善 1级者 13例 ,改善 2级者 5例、左室壁厚度及左室质量指数 (LVMI)明显下降。　 结论　卡维地洛治疗高龄老年高血压及伴有心力衰竭患者是安全有效的 ,但要注意个体化用药。     

Effect of long-term therapy with contemporary drugs on diastolic cardiac function in patients with chronic heart failure

Bisoprolol, carvedilol, enalapril are widely used for the treatment of patients with chronic heart failure. Definite role in the treatment of these patients is also played by angiotensin-II receptor blockers. Diastolic left ventricular function is widely spread among patients with chronic heart failure and its important value for prognosis has been demonstrated. However effect of modern drugs used for the treatment of chronic heart failure has been poorly studied. We assessed effects of enalapril, its combination with bisoprolol, carvedilol, and irbesartan on parameters of diastolic function in a randomized prospective controlled study on 84 patients with NYHA class III-IV heart failure and left ventricular ejection fraction <40%. It has been shown that left ventricular dysfunction is highly prevalent in patients with chronic heart failure and that differentiated approach to the choice of a drug for the treatment of chronic heart failure requires consideration of the type of diastolic dysfunction.