慢性心力衰竭患者氨基末端B型钠尿肽与心肌肌钙蛋白Ⅰ水平分析

目的了解氨基末端B型钠尿肽（NT-proBNP）在慢性心力衰竭（CHF）患者中的水平变化以及与心肌肌钙蛋白I（cTnI）之间的关系。方法将166例CHF患者心功能按美国纽约心脏病协会（NYHA）分级方案分为Ⅰ～Ⅳ级（Ⅰ级15例、Ⅱ级57例、Ⅲ级54例、Ⅳ级40例）,同时测定166例CHF患者和45名正常对照者血清cTnI及NT-proBNP水平并作比较,分析NT-proBNP与cTnI及患者年龄之间的相关关系。结果 CHF组以及NYHA分级各组患者的血清NT-proBNP、cTnI水平均高于正常对照组（P〈0.01）;且随着NYHA分级的提升,NT-proBNP、cTnI水平也随之增高（P〈0.01）,超过正常参考范围的例数也随之增多。CHF组NT-proBNP与cTnI、年龄呈正相关（r分别为0.664、0.217,P均〈0.01）。结论 NT-proBNP是诊断CHF较好的心肌标志物,能反映CHF病情的严重程度。cTnI有随着NT-proBNP升高而增高的趋势。     

慢性心力衰竭患者血清尿酸、N末端B型利钠肽原、血管形成抑制素-2与左心室射血分数的相关性

目的探讨慢性心力衰竭(CHF)患者血清尿酸(UA)、N末端B型利钠肽原(NT-proBNP)、血管形成抑制素-2(VS-2)水平与左心室射血分数(LVEF)的相关性。方法将160例CHF患者根据纽约心脏病协会(NYHA)心功能分级标准分为Ⅰ级组、Ⅱ级组、Ⅲ级组、Ⅳ级组,每组40例。比较4组血清UA、NT-proBNP、VS-2、LVEF水平,分析血清UA、NT-proBNP、VS-2水平与LVEF的相关性。结果Ⅰ级组、Ⅱ级组、Ⅲ级组、Ⅳ级组血清NT-proBNP、UA水平呈上升趋势,VS-2、LVEF水平呈下降趋势,差异均有统计学意义(P 0.05)。相关性分析显示,患者血清VS-2与LVEF呈显著正相关(r=0.664,P=0.001),血清NT-proBNP、UA水平与LVEF呈显著负相关(r=-0.645、-0.518,P=0.002、0.005)。结论血清UA、NT-proBNP、VS-2水平可有效反映CHF患者心功能和疾病进展状况,且与LVEF具有显著相关性。     

NT—proBNP在急性心肌梗死所致心力衰竭患者中的检测价值

目的探宄血浆氨基末端脑钠素前体（NT-proBNP）水平与急性心肌梗死所致心力衰竭患者的心功能之间的关系,以及影响NT—proBNP水平的主要因素。方法选取沫阳县中心医院114例急性心肌梗死所致心力衰竭患者,按心功能NYHA分级系统分为NYHAⅠ、Ⅱ、Ⅲ、Ⅳ级4组,检测4组患者NT—proBNP水平。测量4组患者的左心室射血分数（LVEF）、左心室舒张末期内径（LVEDD）,记录患者年龄、性别、收缩压、舒张压、NYHA分级、LVEF、LVEDD、有无糖尿病史、高血压史、冠心病史、房颤史。结果4组NT-proBNP水平分别是：Ⅳ组（2016．3土423．10）pg／mL、HI组（1542．1±326．32）pg／mL、Ⅱ组（1123．4±241.36）pg／mL、Ⅰ组（785．3±112．30）pg／mL,两两比较差异均有统计学意义,并且心功能分级增加,NT-proBNP水平升高。LVEF与LVEDD4组之间的数据两两相比差异均有统计学意义,并且心功能分级增加,LVEF逐渐减少,LVEDD逐渐升高。患者性别、糖尿病史、高血压史、冠心病与患者NT-proBNP水平无关,与年龄、房颤史、LVEDD、NYHA分级、收缩压、舒张压呈正相关,与LVEF呈负相关。结论NT—proBNP对急性心肌梗死所致心力衰竭患者具有很好的诊断价值。     

氨基末端B型脑钠肽前体在心力衰竭诊断中作用

目的探讨氨基末端B型脑钠肽前体（N-terminal pro-brain natiuretic peptide,NT-proBNP）水平在心力衰竭诊断及分级诊断中的意义。方法心力衰竭患者120例,按NYHA心功能分级分为Ⅰ、Ⅱ、Ⅲ、Ⅳ级组各30例,同期60例体检健康者为对照组,检测各组血清NT-proBNP水平,并进行比较。结果 NYHA心功能分级Ⅰ、Ⅱ、Ⅲ、Ⅳ级组NT-proBNP水平分别为（398.3±54.3）、（1 259.0±380.6）、（3 401.0±655.5）、（15 802.0±6 577.6）ng/L,均高于对照组（（116.6±50.7）ng/L）（P〈0.01）,组间比较差异均有统计学意义（P〈0.05）。结论血清NT-proBNP水平可有效反映心功能状况,可用于心力衰竭的诊断和分级诊断。     

N-末端B型利钠肽原在老年慢性心力衰竭诊断中的应用

目的 探讨N-末端B型利钠肽原(NT-proBNP)水平与老年慢性心力衰竭的关系及其临床意义.方法 采用电化学发光免疫法检测129例老年患者,根据临床病史、症状、体征、客观检查作出诊断,并按美国纽约心脏病学会(NYHA)分级方案将心功能分为4级.比较非心衰和心衰老年患者NT-proBNP水平并进行对照分析.结果 血清NT-proBNP水平均呈偏态分布.不同性别、同一性别、不同年龄的体检健康者血清NT-proBNP水平差异有统计学意义(P＜0.05);心衰组血清NT-proBNP水平明显高于非心衰疾病对照组和健康对照组,差异均有统计学意义(P<0.05).各级心衰组右心室射血分数(LVEF)与NT-proBNP呈负相关(P<0.05);以900、1 800 pg/mL为临界值,LVEF以50%为临界值,其诊断心衰的灵敏度分别为87.7%和46.8%.结论 NT-proBNP检测结果可靠,检测水平与NYHA分级及LVEF有良好的相关性,NT-proBNP检测比LVEF更灵敏.     

血清NT-proBNP测定在心力衰竭患者中的应用价值

目的探讨心力衰竭（HF）患者血清氨基末端B型钠尿肽原（NT-proBNP）水平变化的临床意义。方法采用双向侧流免疫法检测107例HF患者、30例健康对照者血清NT-proBNP水平及28例HF患者经常规抗HF治疗第3天、第7天、第15天时的血清NT-proBNP水平并进行统计分析。结果 HF组心功能Ⅰ~Ⅳ级[按美国纽约心脏协会（NYHA）分级]患者的血清NT-proBNP水平分别为（308.31±39.64）、（510.57±92.58）、（2 297.81±290.12）、（5 630.85±393.87）ng/L,均明显高于健康对照组（〈200 ng/L）,且血清NT-proBNP水平随着HF程度加重呈指数增加[相关系数（r）=0.76,P〈0.01]。HF患者治疗3 d后血清NT-ProBNP的水平开始明显降低（P〈0.01）,第7天、第15天血清NT-ProBNP水平继续下降,且与患者心功能的改善相对应。治疗后3个时间点与治疗前比较,血清NT-proBNP水平下降幅度与NYHAⅢ~Ⅳ级患者分级下降例数呈正相关（r值分别为0.41、0.53、0.77,P〈0.01）。结论血清NT-proBNP水平是反映心功能状态的客观指标。检测血清NT-proBNP水平对HF的诊断、严重程度和疗效评价有重要价值。     

血清Copeptin与老年慢性心力衰竭患者病情严重程度关系及对预后预测作用

目的探讨血清Copeptin与老年慢性心力衰竭(chronic heart failure, CHF)患者病情严重程度关系及对预后预测作用。方法选取符合纳入及排除标准的老年CHF 198例作为观察组,另选取同期健康体检者198例作为对照组。观察比较观察组和对照组以及不同NYHA心功能分级老年CHF患者血清Copeptin、N-末端脑利钠肽前体(N-terminal pro brain natriuretic peptide, NT-proBNP)水平及左室射血分数(left ventricular ejection fractions, LVEF),应用受试者工作特征(ROC)曲线分析血清Copeptin和NT-proBNP预测老年CHF患者预后不良的价值,采用多因素Cox回归分析对老年CHF患者预后影响因素进行分析。结果观察组血清Copeptin及NT-proBNP水平高于对照组,LVEF低于对照组,差异有统计学意义(P0.01)。不同NYHA心功能分级老年CHF患者血清Copeptin、NT-proBNP水平及LVEF总体比较差异有统计学意义(P0.01)。老年CHF NYHA心功能Ⅱ级患者血清Copeptin和NT-proBNP水平低于NYHA心功能Ⅲ级和Ⅳ患者,LVEF高于NYHA心功能Ⅲ级和Ⅳ级患者;NYHA心功能Ⅲ级患者血清Copeptin水平低于NYHA心功能Ⅳ患者,LVEF高于NYHA心功能Ⅳ级患者,差异均有统计学意义(P0.01)。ROC曲线分析结果显示,血清Copeptin和NT-proBNP联合预测老年CHF患者预后不良的曲线下面积(AUC)高于血清Copeptin和NT-proBNP单独预测老年CHF患者预后不良的AUC,差异有统计学意义(P0.01)。多因素Cox回归分析结果显示,年龄≥70岁、LVEF45%及血清Copeptin≥22.50 pmol/L、NT-proBNP≥4350 ng/L是老年CHF患者预后不良的独立危险因素(P0.01)。结论血清Copeptin水平可反映老年CHF患者病情严重程度,可用于预测其近期预后,据血清Copeptin水平对老年CHF患者进行危险分层,有助于实现个体化干预,改善患者预后。     

慢性心衰患者血清脑利钠肽前体水平与心功能的相关性分析

目的 探讨慢性心衰患者血清脑利钠肽前体(NT-proBNP)水平与不同NYHA心功能分级、左室射血分数(LVEF)、左室舒张期末内径(LVEDd)的相关性.方法 42例心力衰竭住院患者,使用酶联免疫法测定其血清NT-proBNP水平,超声心动图测定LVEF及LVEDd,分析患者NT-proBNP水平与不同心功能分级及上述指标的相关性.结果 (1)不同NYHA心功能分级组患者血清NT-proBNP水平(pg/ml)差异有统计学意义[Ⅰ级:162.5(128.0,633.0),Ⅱ级:1 202.5(587.0,2350.0),Ⅲ级:3 374.0(2 169.0,4 442.0),Ⅳ:10 403.5(7 241.0,17 697.0),P<0.05～<0.01],其水平与心功能分级呈正相关(r=0.797,P<0.000 1);(2)NT-proBNP与LVEF呈负相关(r=-0.438,P<0.000 1);(3)NT-proBNP与LVEDd呈正相关(r=0.437,P<0.000 1).结论 NT-proBNP测定是临床诊断心力衰竭的有效辅助方法之一,总体上可反映心力衰竭的严重程度.     

血清NT-proBNP、Galectin-3水平检测在慢性心力衰竭患者心功能分级中的应用

目的探究血清半乳糖凝集素-3(Galectin-3)、N端B型脑钠肽前体(NT-proBNP)水平检测在慢性心力衰竭患者心功能分级中的应用价值。方法选取2014年5月-2018年4月我院150例慢性心力衰竭患者作为观察组,美国纽约心脏病协会(NYHA)心功能分级:Ⅰ级27例,Ⅱ级38例,Ⅲ级52例,Ⅳ级33例;另选取我院同期体检健康者50例作为对照组。两组均抽取4 ml空腹肘静脉血,离心留取血清,以酶联免疫吸附试验测定血清Galectin-3水平,电化学发光免疫法测定血清NT-proBNP水平。对比两组血清Galectin-3、NT-proBNP水平及观察组不同心功能分级患者血清Galectin-3、NT-proBNP水平,并分析血清Galectin-3、NT-proBNP水平与慢性心力衰竭患者心功能分级相关性。结果观察组血清Galectin-3、NT-proBNP水平均较对照组高(P0.05)。对于观察组心功能不同分级的血清Galectin-3、NT-proBNP水平,NYHA分级Ⅳ级患者较Ⅲ级高(P0.05),Ⅲ级患者较Ⅱ级高(P0.05),Ⅱ级患者较Ⅰ级高(P0.05)。血清Galectin-3、NT-proBNP水平与慢性心力衰竭患者心功能分级呈正相关关系(P0.05)。结论随心功能分级增加,血清Galectin-3、NT-proBNP水平随之升高,该结果为慢性心力衰竭的诊断和治疗提供有力依据,具有较高应用价值。     

血浆NT-proBNP水平在心房纤颤合并心衰诊断中的研究分析

目的观察血浆B型脑钠利尿肽前体N端脑利钠肽（NT-proBNP）水平与超声心动图检测LVEF值在心房纤颤以及心房纤颤合并心衰时的不同,以判断NT-proBNP在心房纤颤合并心衰时的诊断价值。方法对90例心房纤颤的患者,依据临床症状将其分为左室功能正常者（A组）33例,左室功能不正常者（B组）共57例,B组再分亚组,其中（B1组）为NYHAⅠ级28例,（B2组）为NYHAⅡ~Ⅳ级29例,进行血浆NT-proBNP测定及超声心动图LVEF的检测。结果 A组血浆NT-proBNP（75.1±8.9）pg/mL。B1组（323.3±11.2）pg/mL,B2组（835.3±9.2）pg/mL,组间两两比较差异均有统计学意义（P〈0.01）;超声心动图检测,A组LVEF值（56.4±6.9）%,B1组LVEF值（44.2±8.4）%,B2组LVEF值（35.3±6.3）%,组间两两比较差异均有统计学意义（P〈0.05）。结论以血浆NT-proBNP作为诊断心房纤颤合并心衰的指标,特异性更高,简单快速,效果与其准确性与心脏超声心动图有同等重要的价值,但较其更为敏感。     

Health-related quality of life consequences of implantable cardioverter defibrillators: results from MADIT II

BACKGROUND: Implantable cardioverter defibrillators (ICDs) improve survival and extend lives of patients with severe heart disease. OBJECTIVE: We sought to evaluate the impact of ICDs on health-related quality of life (HRQOL) during the first 3 years after implantation. SUBJECTS: A total of 1089 patients from the Multicenter Automatic Defibrillator Implantation Trial II (MADIT II) were randomized to an ICD or medical treatment only. MEASURES: Health Utility Index (HUI3) at baseline, 3, 12, 24, and 36 months following randomization; survival data. RESEARCH DESIGN: We constructed mean profiles of HRQOL for living patients, estimated overall quality-adjusted life years (QALYs), separately by treatment arm, and calculated cumulative QALY gains/losses as the difference between the areas under the treatment specific HRQOL profiles. Multivariate fixed effect regression models were developed to impute the missing HRQOL data using baseline patient characteristics (age, gender, treatment, HUI3 score, diabetes, diuretics use, and NYHA class). Bootstrapped standard errors were calculated for the estimated differences in HRQOL gains/losses between treatment arms. Similarly, we performed subgroup analyses (by gender, age, and baseline NYHA class, blood urine nitrogen, ejection fraction, and QRS). RESULTS: There were no differences in QALYs loss for living patients by treatment group (-0.037, P = 0.64) or in overall QALYs loss by treatment group (0.043, P = 0.37) over 3 years. In subgroup analysis, female subjects demonstrated a trend towards greater survival benefit (0.298, P = 0.07) and overall QALYs (0.261, P = 0.14). CONCLUSIONS: Adverse effects of the ICD on HRQOL together with lower HRQOL among survivors may offset the 3-year survival benefits of ICDs.     

Activities of daily living for old persons in primary health care with chronic heart failure

Chronic heart failure (CHF) is a common condition among Europe's aging population. Findings indicate that CHF patients must make significant changes in many aspects of daily life. Previous studies of older primary health-care participants and their activities of daily living (ADL)-ability are rare. The aim of this study was to describe ADL-ability in older people with CHF syndrome. The factors considered were dependence on others, perceived strain, quality of performance, and the association between The New York Heart Association classification (NYHA) and ADL-ability. The participants, recruited from a primary health-care centre, had symptoms indicating CHF and were diagnosed by a cardiologist. Forty persons over 65 years (mean age 81), participated in the study and self-reported co-morbidity was frequent. The Assessment of Motor and Process Skills (AMPS) and the Staircase of ADL were used to describe ADL-ability. Most participants were independent with respect to personal activities of daily living (PADL), and 75% were dependent in one or more instrumental activities of daily living (IADL), usually shopping. Most participants perceived strain, and only three could perform all ADL without strain. Age had a significant impact on ADL performance (motor measures: OR 7.11, CI 1.19-42.32, p = 0.031 and process measures: OR 8.49, CI 1.86-38.79, p = 0.006). However, participants showed lower ADL motor and process ability in AMPS compared with well persons of the same age. Participants in NYHA III/IV (adjusted for age), had significantly increased effort (under motor cut-off) when performing ADL-tasks (OR: 15.5, CI 2.40-100.1, p = 0.004) compared to those in NYHA I/II. Older persons in primary health care with CHF exhibit a high amount of dependence, perceived strain and increased effort during performance of ADL. There is an association between NYHA class III/IV and a decreased ADL-ability (AMPS motor ability) even when adjusted for age.     

Is the Ability index superior to the NYHA classification for assessing heart failure?

BACKGROUND: Heart failure (HF) is a major problem in the long-term follow-up of adolescents and adults with congenital heart disease (ACHD) after cardiac surgery. The functional status of ACHD may be assessed in terms of the NYHA classification or the Ability index (ABILITY). OBJECTIVE: The purpose of our study was to examine which of the two classification systems is more closely related to objectively defined HF. METHODS : NT-pro brain natriuretic peptide (N-BNP) and maximal oxygen uptake (VO(2max)) were measured in 360 consecutive ACHD patients. HF was defined as an elevated N-BNP level > or =100 pg/ml combined with a reduced VO(2max) < or =25 ml/kg/min. RESULTS: There were no significant differences between the NYHA and ABILITY in grading HF in these patients. In both classifications, the risk of HF increases continuously over the classes and grades from odds ratio (OR) 1 in NYHA I/ABILITY 1 to an OR=3.4 in NYHA II/ ABILITY 2 up to 11.6 or 5.4 (ns) in NYHA III/ABILITY 3. Thus in the highest scores HF is found in 70-77% of the patients. The fact that in NYHA class I and ABILITY grade 1, 15% and 19% of the patients exhibited HF according to the measured indices underscores the discrepancy between subjective and objective assessment of the individual patients condition. CONCLUSION: The NYHA classification and the Ability index take different approaches to the patients with congenital heart defects but are equally suitable for the judgement of HF in post surgical ACHD.     

Comparison of the efficacy of two surgical alternatives for cardiac resynchronization therapy: trans-apical versus epicardial left ventricular pacing

Background: Epicardial pacing lead implantation is the currently preferred surgical alternative for left ventricular (LV) lead placement. For endocardial LV pacing, we developed a fundamentally new surgical method. The trans‐apical lead implantation is a minimally invasive technique that provides access to any LV segments. The aim of this prospective randomized study was to compare the outcome of patients undergoing either trans‐apical endocardial or epicardial LV pacing. Methods: In group I, 11 end‐stage heart failure (HF) patients (mean age 59.7 ± 7.9 years) underwent trans‐apical LV lead implantation. Epicardial LV leads were implanted in 12 end‐stage HF patients (group II; mean age 62.8 ± 7.3 years). Medical therapy was optimized in all patients. The following parameters were compared during an 18‐month follow‐up period: LV ejection fraction (LVEF), LV end‐diastolic diameter (LVEDD), LV end‐systolic diameter, and New York Heart Association (NYHA) functional class. Results: Nine out of 11 patients responded favorably to the treatment in group I (LVEF 39.7 ± 12.5 vs 26.0 ± 7.8%, P < 0.01; LVEDD 70.4 ± 13.6 mm vs 73.7 ± 10.5 mm, P = 0.002; NYHA class 2.2 ± 0.4 vs 3.5 ± 0.4, P < 0.01) and eight out of 12 in group II (LVEF 31.5 ± 11.5 vs 26.4 ± 8.9%, P = < 0.001; NYHA class 2.7 ± 0.4 vs 3.6 ± 0.4, P < 0.05). During the follow‐up period, one patient died in group I and three in group II. There was one intraoperative LV lead dislocation in group I and one early postoperative dislocation in each group. None of the patients developed thromboembolic complications. Conclusions: Our data suggest that trans‐apical endocardial LV lead implantation is an alternative to epicardial LV pacing. PACE 2012; 35:124–130)     

Projecting the Long-term Clinical Value of Mavacamten for the Treatment of Obstructive Hypertrophic Cardiomyopathy in the United States: An Assessment of Net Health Benefit

PurposeThe aim of the study was to project the long-term net health benefits of mavacamten for the treatment of symptomatic obstructive hypertrophic cardiomyopathy (HCM) in the United States.MethodsA Markov model with 4 mutually exclusive health states (New York Heart Association [NYHA] functional classes I, II, and III/IV and death) was developed to project the life-years (LYs) and quality-adjusted life-years (QALYs) over a lifetime horizon for patients with symptomatic obstructive HCM receiving mavacamten with or without β-blocker (BB) or calcium channel blocker (CCB) monotherapy or placebo with or without BB or CCB monotherapy. The model simulated a patient cohort with a starting age of 59 years and 41% women. Transition probabilities across NYHA functional classes were estimated using data from the Phase III Clinical Study to Evaluate Mavacamten (MYK-461) in Adults With Symptomatic Obstructive Hypertrophic Cardiomyopathy (EXPLORER-HCM) and the EXPLORER long-term extension (EXPLORER-LTE) cohort from the Long-term Safety Extension Study of Mavacamten in Adults who Have Completed MAVERICK-HCM or EXPLORER-HCM (MAVA-LTE) trial and were extrapolated after week 30. The mortality risks of NYHA functional class I were assumed to be the age- and sex-specific mortality risks of the US general population. The mortality risks for NYHA class II and III/IV were estimated using those for class I in conjunction with the relative mortality risks derived using patients with obstructive HCM from a large real-world registry. Health state utilities for each treatment were estimated from EXPLORER-HCM. Both LYs and QALYs were aggregated over a lifetime for each treatment arm, discounted at 3% annually, and compared between the 2 arms. Sensitivity analyses were conducted to evaluate the robustness of the model findings.FindingsOver a lifetime, treatment with mavacamten with or without BB or CCB monotherapy was associated with 3.67 incremental LYs compared with placebo with or without BB or CCB monotherapy (13.00 vs 9.33 LYs). Compared with individuals in the placebo group, patients in the mavacamten group were projected to spend 6.17 additional LYs in NYHA functional class I and 0.04 and 2.46 fewer LYs in NYHA functional classes II and III/IV, respectively. With utilities incorporated, mavacamten with or without BB or CCB monotherapy was associated with 4.17 additional QALYs compared with placebo with or without BB or CCB monotherapy (11.74 vs 7.57 QALYs). In the sensitivity analyses, incremental benefits ranged from 1.55 to 6.21 LYs and from 2.48 to 6.19 QALYs across the scenarios.ImplicationsThis model projected substantial net health benefits associated with mavacamten for symptomatic obstructive HCM owing to improved patient survival and quality of life. The projected QALY gain underscored the likely long-term clinical value of mavacamten in symptomatic obstructive HCM.     

Assessment of quality of life and activities of daily living in Turkish patients with heart failure

Heart failure is an entire clinical syndrome affecting many aspects of life, rather than merely a usual disease. This cross-sectional study was designed to assess heart failure patients' quality of life and activities of daily living (ADL). Seventy-five patients who applied to the cardiology department were included in the study. The data were obtained using the left ventricular dysfunction scale (LVD-36) and ADL scale. A statistically significant relationship was found between LVD-36 and ADL scores and New York Heart Association (NYHA) functional class, previous hospitalization, daily medication, age and education (P < 0.05). It was found that LVD-36 and ADL scores increase as the level of education increases and as the NYHA functional class, previous hospitalization, number of drugs taken daily and age decrease. The study found a statistically significantly negative relationship between quality of life and ADL (P < 0.05). In patients with heart failure, age, NYHA functional class, number of drugs taken daily independently affected the ADL scores. Additionally, in these patients, education, NYHA functional class, number of drugs taken daily and previous hospitalizations independently affected the quality of life. As the functional situation deteriorates and becomes severe, individual care, training, social support and consultation services for the patient and their family should be increased.     

The benefits of biventricular pacing in heart failure patients with narrow QRS, NYHA class II and right ventricular pacing

OBJECTIVE: To identify subgroups of heart failure patients who might benefit from biventricular pacing. BACKGROUND: Cardiac resynchronization therapy (CRT) improves the quality of life, New York Heart Association (NYHA) functional class, and exercise capacity and decreases hospitalizations for heart failure for patients who have severe heart failure and a wide QRS. It is unclear if other populations of heart failure patients would benefit from CRT. METHODS: One hundred forty-four consecutive heart failure patients who underwent CRT and completed 3 months of follow-up were reviewed. Demographic, echocardiographic, electrocardiographic, and clinical outcome data were analyzed to assess the relationship of functional class and QRS duration before device implantation to postimplant outcomes. RESULTS: There were 20, 88, and 36 patients in NYHA functional class II, III, and IV, respectively. Thirty-four patients had right ventricular pacing and another 29 patients had a QRS duration < or = 150 ms. Patients who were in NYHA functional class II at baseline had significant improvement in left ventricular ejection fraction and indices of left ventricular remodeling after CRT. Similar significant findings were seen in the subgroup with right ventricular pacing at baseline after CRT. However, in the subgroup with a narrow QRS duration, there were no significant changes in the indices of left ventricular remodeling or in the NYHA functional class and there was a significant increase in the QRS duration. For the study cohort as a whole, an improvement in NYHA functional class after CRT correlated with a significant decrease in adverse clinical outcomes. CONCLUSIONS: Heart failure patients who were in NYHA functional class II and those with right ventricular pacing appeared to benefit from CRT.     

Response of sympathetic nervous system activity to exercise in patients with congestive heart failure

To investigate the serial sympathetic nervous system response to exercise, plasma norepinephrine (NE) and epinephrine (E) concentrations were measured at rest, during each stage of treadmill exercise, and immediately and 5 minutes after exercise in 68 congestive heart failure (CHF) patients (NYHA functional class I 24, II 25, III 19) and 30 normal subjects. Circulatory responses of NYHA class II patients increased at early stages of exercise. Systolic blood pressure and double product at peak exercise were significantly lower in NYHA class III patients. Plasma NE response of NYHA class I patients was similar to that of normal subjects. However, plasma NE at rest, and during and after exercise were significantly higher in NYHA classes II and III patients than in normal subjects and NYHA class I patients (peak NE (pg ml-1); Normals: 547 +/- 37, I: 535 +/- 53, II: 867 +/- 87, III: 1033 +/- 157). There was no significant difference in plasma E levels among the four groups. NE response to exercise was augmented according to the severity of heart failure, which suggested compensatory activation of sympathetic nervous system activity. Circulatory responses were reduced in NYHA class III patients despite the exaggerated compensatory activation of the sympathetic nervous system. Blunted circulatory responses to increased NE concentration in NYHA class III patients might relate to a decreased cardiac responsiveness to sympathetic activity in severe CHF patients.     

The clinical significance of a urinary B-type natriuretic peptide assay for the diagnosis of heart failure

BackgroundThe purpose of this study was to investigate the applicability of urinary B-type natriuretic peptide (BNP) levels to the diagnosis and prognosis of heart failure (HF) by comparing urinary and plasma BNP levels.MethodsUrinary and plasma BNP levels of 160 patients with HF classifiable into NYHA stages I, II, III, or IV, and 30 healthy control subjects were measured using the microparticle enzyme immunoassay (MEIA). The heart function of each patient was examined by ultrasonic cardiogram and classified according to the NYHA standard.ResultsThe levels of urinary and plasma BNP among patients in the HF group were significantly higher than those in the control group. Urinary BNP levels were correlated with plasma BNP levels and NYHA grades of HF and were negatively correlated with LVEF. According to the Cox model multivariate regression analyses on age, gender, heart function class, LVEF, and urinary BNP among patients with post-treatment cardiac events, age and the urinary BNP level were predictors for the independent post-treatment cardiac events.ConclusionsMeasurement of urinary BNP is applicable in clinical diagnosis and prognosis of HF; it provides similar accuracy to plasma BNP in the detection of HF, and it has the advantage of being a noninvasive test.     

Symptoms in heart failure correlate poorly with objective haemodynamic parameters

Introduction: Even though heart failure (HF) is a very common condition, surprisingly little is known regarding association between patient’s symptoms and objective data. The purpose of this study was to evaluate for any correlations between haemodynamic, echocardiographic and laboratory data of presenting symptoms in HF patients. Methods: This study is a retrospective analysis of the limited access dataset from the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial provided by the National Heart, Lung and Blood Institute. Symptoms including dyspnoea, orthopnoea, fatigue and gastrointestinal (GI) discomfort were graded by their severity from minimal (0) to maximal (3) on admission, at discharge, at 3 months and at 6 months from the admission. Results of Minnesota Living with Heart Failure (MLHF) score and assigned New York Heart Association (NYHA) functional class were available at the same time points. Results: A total of 433 patients with decompensated HF and decreased systolic function (ejection fraction < 30%) were included in this trial. Orthopnoea, dyspnoea and fatigue had weak correlation with invasive pulmonary artery systolic and diastolic pressure and negative correlation with serum creatinine, albumin, sodium, total bilirubin, haemoglobin and haematocrit; fatigue showed positive correlation to pulmonary artery pressures. Abdominal discomfort had no correlation to symptoms. There was no correlation of symptoms, NYHA class, or MLHF scores with age, gender, peak VO₂ on cardiopulmonary stress test, body mass index, either right or left ventricular systolic function, B‐type natriuretic peptide, cardiac output or cardiac index, troponin level, velocity of tricuspid regurgitation and multiple other factors predicting morbidity and mortality in HF. Conclusion: Overall, the correlation between symptoms and objective parameters was weak. Because of low magnitude of relationship between symptoms to objective parameters, it was concluded that there are likely other factors determining the perception of symptoms in HF patients.