慢性收缩性心力衰竭患者血清miR-129表达与心功能的关系

目的 探讨慢性收缩性心力衰竭(CSHF)患者血清微小RNA-129(miR-129)表达水平并分析其与心功能指标的关系.方法 选取2016年5月-2018年10月在武汉市第六医院收治的103例CSHF患者为观察组,依据纽约心脏病协会(NYHA)标准将其分为三组:NYHAⅡ级组(33例)、NYHAⅢ级(28例)、NYHA...     

探讨心衰超声指数评价慢性心力衰竭患者的临床运用价值

目的：探讨心衰超声指数评价慢性心力衰竭患者的临床运用价值。方法：选取2013年4月—2014年4月符合诊断标准的84例慢性心力衰竭患者(观察组)按照患者的临床症状分为I、II、III、IV级,另取40例门诊体检者(对照组)。对各级慢性心力衰竭患者、门诊体检者进行心衰超声指数评分,与氨基末端脑钠肽前体(NT-ProBNP)水平、左室射血分数、左房内径、左室舒张末径、纽约心功能分级进行比较。结果：门诊体检者、心功能I、II、III、IV级的慢性心力衰竭患者的心衰超声指数分别为0、1.43±0.87、2.15±0.96、3.27±1.02、5.46±1.43,各组具有统计学差异(P<0.05);门诊体检者、心功能I、II、III、IV级的慢性心力衰竭患者的NT-ProBNP水平、左室射血分数、左房内径、左室舒张末径均具有统计学差异(P<0.05);纽约心功能分级越严重,心衰超声指数越大(P<0.05)。结论：心衰超声指数与氨基末端脑钠肽前体水平、左室射血分数、左房内径、左室舒张末径、纽约心功能分级具有相关性,心衰超声指数可用于评价与诊断慢性心力衰竭患者的心功能。     

The heart failure revascularisation trial (HEART): rationale,design and methodology

BACKGROUND: Most patients with heart failure due to left ventricular systolic dysfunction (LVSD) secondary to coronary artery disease (CAD) have evidence of myocardium in jeopardy (reversible ischaemia and/or stunning hibernation). It is not known whether revascularisation in such cases is safe or beneficial. AIMS: To determine whether revascularisation will improve the survival of patients with LVSD and heart failure secondary to CAD and myocardium in jeopardy. METHODS: This is a randomised controlled trial comparing revascularisation or not, in addition to optimal medical therapy with ACE inhibitors, beta-blockers, aldosterone antagonists and an anti-thrombotic agent. Patients must have heart failure requiring treatment with diuretics, a left ventricular ejection fraction <35% and evidence of coronary disease. Myocardial viability and ischaemia are assessed by a broad range of techniques including stress echocardiography and nuclear imaging. All imaging tests are reviewed in core laboratories to ensure uniform reporting. Any conventional revascularisation technique is permitted. The primary outcome measure is all cause mortality. Symptoms, quality of life and health economic issues will also be explored. Assuming an annual mortality of 10% in the control group and allowing for substantial cross-over rates, a study of 800 patients followed for 5 years has 80% power with an alpha of 0.05 (two-sided) to show a 25% reduction in mortality with revascularisation. RESULTS: At the time of writing 180 patients have been screened for inclusion, 111 have consented to participate and 70 have been randomised. The results of viability testing are awaited in 22 patients. Twenty-six patients had been investigated for myocardial viability and/or by angiography prior to consent, as part of the routine practice in that cardiology department. Of 68 patients who have completed assessment only after consent, 47 (69%) were included. The principal reason for drop-out between consent and randomisation was lack of evidence of myocardial ischaemia or hibernation. CONCLUSION: The HEART trial will help to determine whether investigation of myocardial ischaemia and/or viability with a view to revascularisation should become part of the routine care of patients with heart failure due to LVSD and CAD.     

老年慢性心力衰竭患者血浆脑钠肽水平观察

目的 研究血浆脑钠肽(BNP)在老年慢性心力衰竭(CHF)患者的诊断、治疗和预后评估中的临床作用. 方法 选取2010年1月至2011年3月我科住院206例＞60岁老年CHF患者,按照纽约心脏病学会(NYHA)心功能分级分为4组,采用ELISA法测定患者血液BNP的水平,并测定左心室射血分数(LVEF).在抗心力衰竭治疗2周后或出院时复测上述指标,进行统计学分析. 结果 按NYHA心功能分级的各组患者血浆BNP的水平差异具有统计学意义,心功能越严重,年龄越大,BNP值越高,而LVEF差异仅在Ⅰ、Ⅲ、Ⅳ级心功能间有意义(P＜0.05);经抗心衰治疗后,患者心衰症状缓解,复测BNP值下降而LVEF升高,但仅BNP的变化有统计学意义. 结论 BNP值可作为较可靠的老年CHF的早期预测参考指标,也可作为判断心功能不全严重程度和疗效以及预测预后的指标,而且操作简便,易于重复.     

Cross sectional study estimating prevalence of heart failure and left ventricular systolic dysfunction in community patients at risk

OBJECTIVE—To examine a general practice population to measure the prevalence of signs and symptoms of heart failure (SSHF) and left ventricular systolic dysfunction (LVSD).
DESIGN—Cross sectional screening study in three general practices followed by echocardiography.
SETTING AND PATIENTS—All patients  50 years in two general practices and  40 years in one general practice were screened by case record reviews and questionnaires (n = 2158), to identify subjects with some evidence of heart disease. Among these, subjects were sought who had SSHF (n = 115). Of 357 subjects with evidence of heart disease, 252 were eligible for examination, and 126 underwent further cardiological assessment, including 43 with SSHF.
MAIN OUTCOME MEASURES—Prevalence of SSHF as defined by a modified Boston index, LVSD defined as an indirectly measured left ventricular ejection fraction  0.45, and numbers of subjects needing an echocardiogram to detect one case with LVSD.
RESULTS—SSHF afflicted 0.5% of quadragenarians and rose to 11.7% of octogenarians. Two thirds were handled in primary care only. At  50 years of age 6.4% had SSHF, 2.9% had LVSD, and 1.9% (95% confidence interval 1.3% to 2.5%) had both. To detect one case with LVSD in primary care, 14 patients with evidence of heart disease without SSHF and 5.5 patients with SSHF had to be examined.
CONCLUSION—SSHF is extremely prevalent in the community, especially in primary care, but more than two thirds do not have LVSD. The number of subjects with some evidence of heart disease needing an echocardiogram to detect one case of LVSD is 14.


Keywords: heart failure; left ventricular systolic dysfunction     

Epidemiology of Left Ventricular Systolic Dysfunction and Heart Failure in the Framingham Study: An Echocardiographic Study Over 3 Decades

Objectives

The purpose of this study was to describe the temporal trends in prevalence of left ventricular systolic dysfunction (LVSD) in individuals without and with heart failure (HF) in the community over a 3-decade period of observation.

Dilated versus nondilated cardiomyopathy in the elderly population treated with guideline-based medical therapy for systolic chronic heart failure

BACKGROUND: Although the process by which the left ventricular (LV) remodels in response to an injury generally leads to dilatation, in patients with heart failure (HF) the recognition of a small or mildly dilated left ventricle is not uncommon. We investigated the prevalence and the characteristics of elderly patients with traditional dilated and nondilated cardiomyopathy (CMP). We also assessed the response to the guideline-based medical therapy and the prognosis based on LV dilatation in this population. METHODS AND RESULTS: We selected 243 patients >70 years of age with HF and LV ejection fraction <40% who underwent clinical and echocardiographic evaluations at baseline and after 12 months. They were subdivided into 2 groups according to baseline LV end-diastolic volume (LVEDV) (values < or =78 mL/m(2) identified nondilated CMP). Nondilated CMP was recognized in 64 patients (26%) who showed at baseline better clinical status, less severe mitral regurgitation, and higher LV ejection fraction than those with dilated CMP. At the final evaluation, favorable changes in clinical and echocardiographic parameters could be detected in both groups. The magnitude of these variations did not differ between the groups. The risk of hospitalization for worsening HF was 2.4-fold higher in patients with nondilated than dilated CMP. Mortality was 11% and 20%, respectively (P = .06). Statistical analysis revealed a direct, approximately linear relationship between LVEDV and outcomes in this population. CONCLUSIONS: A total of 1 of 4 elderly patients with systolic HF had a nondilated left ventricle. These patients had a better clinical presentation than did counterparts with dilated left ventricles. After HF therapy is optimized, the likelihood of improvement is independent of LV size in this population, whereas the risk of death or worsening HF linearly increases with LV dilatation.     

An alternative approach to understanding the pathophysiological mechanisms of chronic heart failure

No single well established hypothesis for the mechanisms of heart failure currently exists. Those definitions that do exist are either not universally applicable or are not exclusive to heart failure. The pathogenesis of heart failure has been considered by some to be too complex to define with multiple pathophysiological processes being implicated. The many clinical and neurohumoral features of heart failure may be more dependent on the severity of the condition and its speed of onset rather than its etiology. This suggests a potential single common pathway or pathogenic mechanism in all forms of heart failure regardless of cause.This viewpoint uses the framework of myocardial mechanics and energetics to propose an alternative, simplified definition and unifying hypothesis for the pathogenesis of chronic heart failure. Chronic heart failure may be understood as follows. Cardiac output and stroke volume are determined by the tissues' requirements; the ejection fraction is determined by both myocardial shortening and degree of end-diastolic wall thickness; the end-diastolic volume is determined by the requirement to normalize stroke volume. We will argue that chronic heart failure can be viewed as a condition where the dominant compensatory mechanism is through regulation of ventricular end-diastolic volume. Consequently, in conditions where there is a fall in tissue perfusion, stroke volume and tissue perfusion are returned toward normal predominantly via this feedback mechanism.It is important for researchers, clinicians and their patients that we strive for a comprehensive, inclusive and unambiguous unifying hypothesis for pathophysiological mechanisms of heart failure.     

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.     

Incidence,determinants, and outcomes of recovered left ventricular ejection fraction (LVEF) in patients with non-ischemic systolic heart failure; a hospital-based cohort study

BackgroundThe data on incidence of recovered Left Ventricular Ejection Fraction (LVEF) and outcome in patients with non ischemic systolic heart failure is limited. We report the incidence, determinants and mortality in patients with recovered LVEF. Methods: The 369 patients with HFrEF with LVEF of less than 40% of non ischemic etiology with available follow up echocardiography study at one year were enrolled. The baseline data of clinical characteristics and treatment was recorded prospectively and were followed up annually for mean of 3.6 years (range 2 to 5 years) to record all cause death and LVEF measured echocardiographically. The recovered, partially recovered and no recovery of LVEF was defined based on increase in LVEF to 50% and more, 41% to 49% and to persistently depressed LVEF to 40% or lower respectively.ResultsThe LVEF recovered in 36.5%% of the cohort at 5 years. The rate of recovery of LVEF was slower in patients with no recovery of LVEF at one year compared to cohort with partially recovered LVEF (18% vs.53%) at five year. The Baseline LVEF was significantly associated with recovered LVEF, odd ratio (95% C.I.) 1.09(1.04, 1.14). The cumulative mortality at five years was significantly lower in cohort with recovered LVEF (18.1% vs. 57.1%).ConclusionsOne third of the patients had recovered LVEF and was significantly associated with baseline LVEF and lower mortality rate.     

神经型一氧化氮合酶在慢性心力衰竭患者血浆中的变化及其作用

目的 探讨神经型一氧化氮合酶（nNOS）在慢性心力衰竭（CHF）患者血浆中的变化及其作用。方法 入选患者为2015年11月至2016年4月就诊于延边大学附属医院的失代偿CHF患者共计234例。根据左室射血分数（LVEF）值不同分成3个组：A组（EF 20%～29%）、B组（EF 30%～49%）、C组（EF≥50%）。结果 ①三组患者血浆nNOS浓度比较,差异均有统计学意义（87.7±6.6U/L,178.0±11.5U/L和142.6±8.8U/L;P<0.05）,其中,A组患者血浆nNOS浓度明显低于B组（87.7±6.6U/L和178.0±11.5U/L;P<0.01）;C组患者血浆nNOS浓度略低于B组（178.0±11.5U/L和142.6±8.8U/L;P<0.05）;A组患者血浆nNOS浓度低于C组（87.7±6.6U/L和142.6±8.8U/L;P<0.05）。②三组患者E峰值比较,差异均有统计学意义（0.7±0.05m/s,0.9±0.03m/s和0.8±0.03m/s;P<0.05）,其中,A组患者E峰值低于B组（0.7±0.05m/s和0.9±0.03m/s;P<0.05）; C组患者E峰值略低于B组（0.8±0.03m/s 和0.9±0.03m/s;P<0.05）;A组患者E峰值略低于C组（0.7±0.05m/s和0.8±0.03m/s;P<0.05）。③用Spearman相关分析对血浆nNOS浓度与抗心衰药物之间进行分析,血浆nNOS浓度与ACEI类、ARB类、地高辛和β-blocker呈正相关。结论 心力衰竭患者增加的神经型一氧化氮合酶是通过对E峰的调节来保护心功能的。     

Does digitalis work in chronic heart failure? The end of a 200-year-old controversy

Summary Controlled trials using modern methods of assessment in well-defined groups of patients have now convincingly demonstrated that digitalis is an effective and well-tolerated drug in patients with chronic heart failure who have left ventricular systolic dysfunction. These encouraging findings concerning digitalis, however, should not be construed to suggest that the drug should be used alone in the treatment of heart failure. Digitalis cannot adequately control the fluid retention seen in most patients with chronic heart failure; diuretics should be added to maintain sodium balance. Digitalis has not been shown to prolong life in chronic heart failure; converting-enzyme inhibitors should be added to reduce morbidity and mortality. All three drugs should be used together in the management of patients with this disorder.Dr. Packer is the recipient of a Research Career Development Award (K04-HL-01229) from the National Institutes of Health, Bethesda, Maryland.