Effects of Home Telemonitoring Interventions on Patients With Chronic Heart Failure: An Overview of Systematic Reviews

BackgroundGrowing interest on the effects of home telemonitoring on patients with chronic heart failure (HF) has led to a rise in the number of systematic reviews addressing the same or very similar research questions with a concomitant increase in discordant findings. Differences in the scope, methods of analysis, and methodological quality of systematic reviews can cause great confusion and make it difficult for policy makers and clinicians to access and interpret the available evidence and for researchers to know where knowledge gaps in the extant literature exist.ObjectiveThis overview aims to collect, appraise, and synthesize existing evidence from multiple systematic reviews on the effectiveness of home telemonitoring interventions for patients with chronic heart failure (HF) to inform policy makers, practitioners, and researchers.MethodsA comprehensive literature search was performed on MEDLINE, EMBASE, CINAHL, and the Cochrane Library to identify all relevant, peer-reviewed systematic reviews published between January 1996 and December 2013. Reviews were searched and screened using explicit keywords and inclusion criteria. Standardized forms were used to extract data and the methodological quality of included reviews was appraised using the AMSTAR (assessing methodological quality of systematic reviews) instrument. Summary of findings tables were constructed for all primary outcomes of interest, and quality of evidence was graded by outcome using the GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) system. Post-hoc analysis and subgroup meta-analyses were conducted to gain further insights into the various types of home telemonitoring technologies included in the systematic reviews and the impact of these technologies on clinical outcomes.ResultsA total of 15 reviews published between 2003 and 2013 were selected for meta-level synthesis. Evidence from high-quality reviews with meta-analysis indicated that taken collectively, home telemonitoring interventions reduce the relative risk of all-cause mortality (0.60 to 0.85) and heart failure-related hospitalizations (0.64 to 0.86) compared with usual care. Absolute risk reductions ranged from 1.4%-6.5% and 3.7%-8.2%, respectively. Improvements in HF-related hospitalizations appeared to be more pronounced in patients with stable HF: hazard ratio (HR) 0.70 (95% credible interval [Crl] 0.34-1.5]). Risk reductions in mortality and all-cause hospitalizations appeared to be greater in patients who had been recently discharged (≤28 days) from an acute care setting after a recent HF exacerbation: HR 0.62 (95% CrI 0.42-0.89) and HR 0.67 (95% CrI 0.42-0.97), respectively. However, quality of evidence for these outcomes ranged from moderate to low suggesting that further research is very likely to have an important impact on our confidence in the observed estimates of effect and may change these estimates. The post-hoc analysis identified five main types of non-invasive telemonitoring technologies included in the systematic reviews: (1) video-consultation, with or without transmission of vital signs, (2) mobile telemonitoring, (3) automated device-based telemonitoring, (4) interactive voice response, and (5) Web-based telemonitoring. Of these, only automated device-based telemonitoring and mobile telemonitoring were effective in reducing the risk of all-cause mortality and HF-related hospitalizations. More research data are required for interactive voice response systems, video-consultation, and Web-based telemonitoring to provide robust conclusions about their effectiveness.ConclusionsFuture research should focus on understanding the process by which home telemonitoring works in terms of improving outcomes, identify optimal strategies and the duration of follow-up for which it confers benefits, and further investigate whether there is differential effectiveness between chronic HF patient groups and types of home telemonitoring technologies.     

A Mobile Health Intervention Supporting Heart Failure Patients and Their Informal Caregivers: A Randomized Comparative Effectiveness Trial

Background

Mobile health (mHealth) interventions may improve heart failure (HF) self-care, but standard models do not address informal caregivers’ needs for information about the patient’s status or how the caregiver can help.

Objective

We evaluated mHealth support for caregivers of HF patients over and above the impact of a standard mHealth approach.

Methods

We identified 331 HF patients from Department of Veterans Affairs outpatient clinics. All patients identified a “CarePartner” outside their household. Patients randomized to “standard mHealth” (n=165) received 12 months of weekly interactive voice response (IVR) calls including questions about their health and self-management. Based on patients’ responses, they received tailored self-management advice, and their clinical team received structured fax alerts regarding serious health concerns. Patients randomized to “mHealth+CP” (n=166) received an identical intervention, but with automated emails sent to their CarePartner after each IVR call, including feedback about the patient’s status and suggestions for how the CarePartner could support disease care. Self-care and symptoms were measured via 6- and 12-month telephone surveys with a research associate. Self-care and symptom data also were collected through the weekly IVR assessments.

Results

Participants were on average 67.8 years of age, 99% were male (329/331), 77% where white (255/331), and 59% were married (195/331). During 15,709 call-weeks of attempted IVR assessments, patients completed 90% of their calls with no difference in completion rates between arms. At both endpoints, composite quality of life scores were similar across arms. However, more mHealth+CP patients reported taking medications as prescribed at 6 months (8.8% more, 95% CI 1.2-16.5, P=.02) and 12 months (13.8% more, CI 3.7-23.8, P<.01), and 10.2% more mHealth+CP patients reported talking with their CarePartner at least twice per week at the 6-month follow-up (P=.048). mHealth+CP patients were less likely to report negative emotions during those interactions at both endpoints (both P<.05), were consistently more likely to report taking medications as prescribed during weekly IVR assessments, and also were less likely to report breathing problems or weight gains (all P<.05). Among patients with more depressive symptoms at enrollment, those randomized to mHealth+CP were more likely than standard mHealth patients to report excellent or very good general health during weekly IVR calls.

Conclusions

Compared to a relatively intensive model of IVR monitoring, self-management assistance, and clinician alerts, a model including automated feedback to an informal caregiver outside the household improved HF patients’ medication adherence and caregiver communication. mHealth+CP may also decrease patients’ risk of HF exacerbations related to shortness of breath and sudden weight gains. mHealth+CP may improve quality of life among patients with greater depressive symptoms. Weekly health and self-care monitoring via mHealth tools may identify intervention effects in mHealth trials that go undetected using typical, infrequent retrospective surveys.

Trial Registration

ClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT00555360","term_id":"NCT00555360"}}NCT00555360; https://clinicaltrials.gov/ct2/show/{"type":"clinical-trial","attrs":{"text":"NCT00555360","term_id":"NCT00555360"}}NCT00555360 (Archived by WebCite at http://www.webcitation.org/6Z4Tsk78B).     

Use of Home Telemonitoring to Support Multidisciplinary Care of Heart Failure Patients in Finland: Randomized Controlled Trial

BackgroundHeart failure (HF) patients suffer from frequent and repeated hospitalizations, causing a substantial economic burden on society. Hospitalizations can be reduced considerably by better compliance with self-care. Home telemonitoring has the potential to boost patients’ compliance with self-care, although the results are still contradictory.ObjectiveA randomized controlled trial was conducted in order to study whether the multidisciplinary care of heart failure patients promoted with telemonitoring leads to decreased HF-related hospitalization.MethodsHF patients were eligible whose left ventricular ejection fraction was lower than 35%, NYHA functional class ≥2, and who needed regular follow-up. Patients in the telemonitoring group (n=47) measured their body weight, blood pressure, and pulse and answered symptom-related questions on a weekly basis, reporting their values to the heart failure nurse using a mobile phone app. The heart failure nurse followed the status of patients weekly and if necessary contacted the patient. The primary outcome was the number of HF-related hospital days. Control patients (n=47) received multidisciplinary treatment according to standard practices. Patients’ clinical status, use of health care resources, adherence, and user experience from the patients’ and the health care professionals’ perspective were studied.ResultsAdherence, calculated as a proportion of weekly submitted self-measurements, was close to 90%. No difference was found in the number of HF-related hospital days (incidence rate ratio [IRR]=0.812, P=.351), which was the primary outcome. The intervention group used more health care resources: they paid an increased number of visits to the nurse (IRR=1.73, P<.001), spent more time at the nurse reception (mean difference of 48.7 minutes, P<.001), and there was a greater number of telephone contacts between the nurse and intervention patients (IRR=3.82, P<.001 for nurse-induced contacts and IRR=1.63, P=.049 for patient-induced contacts). There were no statistically significant differences in patients’ clinical health status or in their self-care behavior. The technology received excellent feedback from the patient and professional side with a high adherence rate throughout the study.ConclusionsHome telemonitoring did not reduce the number of patients’ HF-related hospital days and did not improve the patients’ clinical condition. Patients in the telemonitoring group contacted the Cardiology Outpatient Clinic more frequently, and on this way increased the use of health care resources.

Trial Registration

Clinicaltrials.gov {"type":"clinical-trial","attrs":{"text":"NCT01759368","term_id":"NCT01759368"}}NCT01759368; http://clinicaltrials.gov/show/{"type":"clinical-trial","attrs":{"text":"NCT01759368","term_id":"NCT01759368"}}NCT01759368 (Archived by WebCite at http://www.webcitation.org/6UFxiCk8Z).     

Depressed Systemic Arterial Compliance is Associated with the Severity of Heart Failure Symptoms in Moderate-to-Severe Aortic Stenosis: a Cross-Sectional Retrospective Study

Background: Patients with aortic stenosis (AS) may develop heart failure even in the absence of severe valve stenosis. Our aim was to assess the contribution of systemic arterial properties and the global left ventricular afterload to graded heart failure symptoms in AS.Methods: We retrospectively reviewed medical records of 157 consecutive subjects (mean age, 71±10 years; 79 women and 78 men) hospitalized owing to moderate-to-severe degenerative AS. Exclusion criteria included more than mild aortic insufficiency or disease of another valve, atrial fibrillation, coronary artery disease, severe respiratory disease or anemia. Heart failure symptoms were graded by NYHA class at admission. Systemic arterial compliance (SAC) and valvulo-arterial impedance (Zva) were derived from routine echocardiography and blood pressure.Results: Sixty-one patients were asymptomatic, 49 presented mild (NYHA II) and 47 moderate-to-severe (NYHA III-IV) heart failure symptoms. Mild symptoms were associated with lower SAC and transvalvular gradients, while more severe exercise intolerance coincided with older age, lower systolic blood pressure, smaller aortic valve area and depressed ejection fraction. By multiple ordinal logistic regression, the severity of heart failure symptoms was related to older age, depressed ejection fraction and lower SAC. Each decrease in SAC by 0.1 ml/m² per mmHg was associated with an increased adjusted odds ratio (OR) of a patient being in one higher category of heart failure symptoms graded as no symptoms, mild exercise intolerance and advanced exercise intolerance (OR: 1.16 [95% CI, 1.01-1.35], P=0.045).Conclusions: Depressed SAC may enhance exercise intolerance irrespective of stenosis severity or left ventricular systolic function in moderate-to-severe AS. This finding supports the importance of non-valvular factors for symptomatic status in AS.     

血浆白细胞介素-18水平在慢性心力衰竭患者中的应用价值

目的 探讨白细胞介素-18(interleukin-18,IL-18)水平在慢性心力衰竭(CHF)诊断中的应用价值.方法 选取2014年1月至2015年6月就诊的97例CHF患者为研究对象,依据美国纽约心脏病学会(NYHA)心脏功能分级标准,分为Ⅱ级(31例)、Ⅲ级(30例)和Ⅳ级(36例),并选择35例同期体检的健康人群为对照组.空腹采集肘静脉血,应用酶联免疫法检测IL-18水平.结果 CHF各组患者血浆IL-18水平与对照组比较,差异有统计学意义(P＜0.05).随着病情的进展,血浆IL-18水平呈显著升高趋势(P＜0.05).结论 IL-18用于评价慢性心力衰竭有一定的临床价值.     

Nek6在心力衰竭家兔心脏中的表达增加

目的：通过刺破主动脉瓣造成反流加重心脏前负荷联合缩窄腹主动脉加重心脏后负荷制作心力衰竭模型,研究Nek6在心力衰竭家兔心脏的心肌细胞中含量表达的改变,初步探讨Nek6在心力衰竭发生发展中的作用。方法将日本大耳白兔分为心衰组和对照组各10只,通过刺破主动脉瓣及缩窄腹主动脉两次手术制作心衰组模型,对照组仅行假手术。2月后使用超声检测心脏各腔室大小及室壁厚度,并计算射血分数;处死家兔后,计算心脏重量与身体重量比值,使用HE染色分析比较心肌细胞面积,使用PSR染色分析比较基质胶原含量,使用Nek6免疫组化染色分析Nek6蛋白含量变化。结果与对照组相比,心衰组家兔左室收缩末期内径及舒张末期内径均增加,射血分数降低,身心比增加,细胞明显增大,胶原增多, Nek6蛋白含量增加。结论 Nek6在心力衰竭家兔心脏的心肌细胞中表达明显上升。     

心音特征在慢性心力衰竭分型辅助诊断中的应用研究

提取心音时域和时频域特征,比较分析射血分数降低型心衰(HFrEF)和射血分数保留型心衰(HFpEF)患者各特征之间的关系。共采集了72列HFrEF患者和172列HFpEF患者20分钟的心音数据,提取第一心音与第二心音时限之比(TS1/TS2)、第一心音与第二心音幅值之比(S1/S2)、舒张期时限与收缩期时限之比的总体标准差(SDDS)、S1间期总体标准差(SDSSI)等4个时域特征。S变换分析其时频域特性,提取第一心音能量与第二心音能量之比(ES1/ES2),低频能量分数(EF-LF)、高频能量分数(EF-HF)、收缩期低频能量分数(EF-SLF)和高频能量分数(EF-SHF)、舒张期低频能量分数(EF-DLF)和高频能量分数(EF-DHF)7个时频域特征,分别进行统计学分析和聚类分析。TS1/TS2、S1/S2、SDDS、SDSSI、ES1/ES2、EF-SLF、EF-DLF在两组间均有统计学差异(P＜0.05);EF-LF、EF-HF、EF-SHF、EF-DHF无统计学意义(P＞0.05)。选择其中4个相对独立的特征值进行聚类分析,区分HFrEF组和HFpEF组的灵敏性和特异性分别为93.06%和84.88%。提取的心音特征反映了两组信号的差异性,为心音信号在慢性心力衰竭分型辅助诊断中的应用提供了理论依据。     

DKK3基因在心力衰竭家兔心脏中的表达改变研究

目的：通过增加家兔心脏前后负荷制作心衰模型,研究DKK3（ dickkopf 3）基因在心衰家兔心脏中表达改变,初步探讨DKK3在心力衰竭家兔中的作用。方法取20只日本大耳白兔随机分为对照组和心衰组。心衰组家兔通过刺破家兔主动脉瓣造成反流,2周后缩窄腹主动脉;对照组仅行假手术。2月后测量心脏结构及功能,行HE和PSR染色评价家兔心肌细胞大小及胶原重构,免疫组化检测DKK3的改变。结果与对照组相比,心衰组家兔射血分数显著下降,心脏重量增加,心肌细胞增大,胶原增多, DKK3含量明显减少。结论在心力衰竭时, DKK3表达降低,加深了心脏重构的程度。     

益气温阳中药治疗慢性舒张性心力衰竭的疗效观察

目的 了解益气温阳为主的中药治疗慢性舒张性心衰的临床疗效。方法 收集2015年10月~2017年7月在天津市和平区中医医院就诊患者,随机分为对照组与治疗组,每组50例。对照组采用单纯西医治疗,治疗组在此基础上加用益气温阳类中药加减治疗。收集治疗前和治疗后超声心动、NYHA分级、E/A值、BNP值、心律失常患者数、6 min步行试验结果、心衰生活质量评分、中医临床疗效。结果 治疗后两组6 min步行试验、心力衰竭生活质量评分、中医临床疗效方面均优于治疗前,治疗组治疗后6 min步行试验、心力衰竭生活质量评分、中医临床疗效分别为（355.52±65.03）s、（67.02±8.91）分、61.22%,优于对照组的（388.51±66.32）s、（63.14±9.33）、33.33%,差异有统计学意义（P＜0.05）;左室大小、左室射血分数等方面比较,差异统计学意义（P＞0.05）。结论 益气温阳类中药治疗慢性舒张性心衰可以协助改善患者生活质量,提高运动耐力,提高疗效。     

小剂量阿替洛尔治疗心衰的疗效观察

采用自身对比法对阿替洛尔治疗16例心衰患疗效进行观察。其中缺血性心肌病11例，扩张型心肌病5例。心功能Ⅱ、Ⅲ、IV级分别为4例、8例和4例。在强心、利尿、血管扩张剂基础上加用阿普洛尔6．25mg／次，每日2次，3天后剂量加倍。心功能Ⅱ、Ⅲ息用药后显效5例，有效7例。用l药后收缩压和好张压下降，心率减慢，心功能改善由用药前3±0，75级降至1．93±1．34级，射血分数增加。阿替洛尔对缺血性心肌病和扩张型心肌病心功能Ⅱ、Ⅲ级息有治疗作用。     

慢性心力衰竭患者窦性心率震荡的临床意义

目的探讨慢性充血性心力衰竭（CHF）患者窦性心率震荡（HRT）与心功能程度的关系。方法慢性心衰患者（CHF组）85例,全部病例按纽约心脏病协会（NYHA）心功能分级,分为轻度CHF组（心功能Ⅱ级）45例和重度CHF组（心功能Ⅲ～Ⅳ级）40例。另选同期心功能正常的42例作为对照组。所有入选者均接受24h动态心电图检查,分别计算窦性心率震荡的初始值（TO）、震荡斜率（TS）,并进行统计学分析。结果3组的TO均值比较,重度CHF组与对照组比较差异有统计学意义（P〈0．01）;轻度CHF组与对照组比较差异有统计学意义（P〈0．05）;3组间的鸭均值组间两两比较差异均有统计学意义（P〈0．01）。结论伴随CHF患者程度加重,HRT现象明显变钝减弱．其变化可能与自主神经的变化有关。     

Catheter Ablation Compared with Medical Therapy for Atrial Fibrillation with Heart Failure: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Background: The optimal strategy for patients with coexisting atrial fibrillation (AF) and heart failure (HF) was not settled. Our purpose was to conduct a systematic review and meta-analysis of randomized controlled trials to evaluate the effect of catheter ablation compared with medical therapy for AF on mortality, HF hospitalization, left ventricular (LV) function, and quality of life among patients with HF and AF.Materials and Methods: We searched Pubmed (1966 to September 20, 2019), EMBASE (1966 to September 20, 2019), the Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov for randomized controlled trials with a comparison of catheter ablation for AF with medical therapy among patients with coexisting AF and HF. Risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI) was used as a measure of the effect of catheter ablation versus medical therapy on endpoints. Our final analysis included 6 randomized control trials with 775 patients.Results: Pooled results from the random-effects model showed that compared with medical therapy for AF, catheter ablation was associated with reduced all-cause mortality (RR 0.52, 95%Cl, 0.35 to 0.76) and HF hospitalization (RR 0.56, 95%Cl, 0.44 to 0.71), as well as increased LV ejection fraction (LVEF), distance walked in six minutes, and improvements in quality of life.Conclusions: This updated meta-analysis showed that compared to medical therapy, catheter ablation for AF was associated with significant benefits in several key clinical and biomarker endpoints, including reductions in all-cause mortality and HF hospitalization.     

心率变异性多参数分析的BP网络用于心衰诊断的研究

人工神经网络是由大量并行工作的神经元组成的智能仿生模型,它在模式识别领域已经展示出了广阔的应用前景。鉴于单一心率变异性(HRV)指标所表达出来的信息具有片面性,很难用一个单一的指标来完全分类充盈性心衰(CHF)患者和健康人的不足。本研究提出联合HRV信号分析的时域、频域、非线性方法,选取多个指标作为诊断CHF的特征参数,以BP神经网络为分类器实现对充盈性心衰的诊断。经过10 000次的训练、验证与仿真测试,该网络模型对于全样本集的识别正确率最优高达99.14%,平均可达86.97%。结果表明:联合线性(时域、频域)以及非线性分析方法可以更全面地揭示心脏的动力学特征,从而提高充盈性心衰的诊断正确率。     

美托洛尔在慢性充血性心力衰竭的临床应用

目的 研究美托洛尔治疗慢性充血性心力衰竭（CHF）的临床疗效及安全性。方法 60例CHF患者随机分为2组，对照组：采用常规治疗方法（ACEI／ARb、利尿剂、地戈辛）；治疗组：在对照组治疗的基础上，加用美托洛尔，治疗15周。治疗前后检查超声心动图，并行6分钟步行试验。结果 治疗组显示心功能明显改善（P〈0．01），左心室射血分数明显增加（P〈0．05），6分钟步行距离明显增加（P〈0．01）。结论 美托洛尔在常规治疗CHF的基础上，对CHF患者安全有效，可作为CHF的常规治疗。     

心室肌细胞电生理-力学复合模型在心力衰竭中的仿真研究

目的:研究心力衰竭情况下快速收缩心肌和慢速收缩心肌力学特性的变化及其对心脏电生理的影响。方法:基于心衰心肌生理实验数据建立心室肌细胞电生理-力学复合模型,仿真对比正常和心衰肌细胞内钙离子浓度的变化,进而研究其对细胞收缩力学特性的影响。结果:仿真显示与正常细胞相比,心衰肌细胞电生理特性的变化导致细胞内钙离子浓度降低。进而与肌钙蛋白的钙结合亚单位(TnC)结合的钙离子比正常时大大减小,直接导致细胞收缩力减小。结论:心衰时心室肌细胞的收缩力减小,肌细胞中正常的电力学反馈作用减弱,增大了心室壁细胞动作电位的透壁梯度,从而可能诱发心律失常。仿真结果与文献报道的实验发现一致,将来在组织和器官层次上的心脏建模工作可以整合单细胞的电力学模型,有助于深入研究心力衰竭的病理机制。     

Perceptions and experiences of heart failure patients and clinicians on the use of mobile phone-based telemonitoring

Background

Previous trials of heart failure telemonitoring systems have produced inconsistent findings, largely due to diverse interventions and study designs.

Objectives

The objectives of this study are (1) to provide in-depth insight into the effects of telemonitoring on self-care and clinical management, and (2) to determine the features that enable successful heart failure telemonitoring.

Methods

Semi-structured interviews were conducted with 22 heart failure patients attending a heart function clinic who had used a mobile phone-based telemonitoring system for 6 months. The telemonitoring system required the patients to take daily weight and blood pressure readings, weekly single-lead ECGs, and to answer daily symptom questions on a mobile phone. Instructions were sent to the patient’s mobile phone based on their physiological values. Alerts were also sent to a cardiologist’s mobile phone, as required. All clinicians involved in the study were also interviewed post-trial (N = 5). The interviews were recorded, transcribed, and then analyzed using a conventional content analysis approach.

Results

The telemonitoring system improved patient self-care by instructing the patients in real-time how to appropriately modify their lifestyle behaviors. Patients felt more aware of their heart failure condition, less anxiety, and more empowered. Many were willing to partially fund the use of the system. The clinicians were able to manage their patients’ heart failure conditions more effectively, because they had physiological data reported to them frequently to help in their decision-making (eg, for medication titration) and were alerted at the earliest sign of decompensation. Essential characteristics of the telemonitoring system that contributed to improved heart failure management included immediate self-care and clinical feedback (ie, teachable moments), how the system was easy and quick to use, and how the patients and clinicians perceived tangible benefits from telemonitoring. Some clinical concerns included ongoing costs of the telemonitoring system and increased clinical workload. A few patients did not want to be watched long-term while some were concerned they might become dependent on the system.

Conclusions

The success of a telemonitoring system is highly dependent on its features and design. The essential system characteristics identified in this study should be considered when developing telemonitoring solutions.

Key Words

     

慢性心衰时心肌细胞的形态学特点

为探讨升主动脉缩窄慢性心衰大鼠左、右心室心肌细胞形态学特点 ,利用游离心肌细胞技术 ,对心衰大鼠左、右心室心肌细胞进行常规 HE染色及电镜 ( TEM,SEM)观察。结果发现心衰时左、右心室心肌细胞的长度、宽度及面积都显著增加 ;右心室心肌细胞成比例肥大 ,心肌细胞超微结构改变不显著 ,而左心室心肌细胞超微结构改变明显。在心衰组及对照组左心室心肌中有两条毛细血管压迹的细胞。本研究分析了上述改变与心衰间的关系     

慢性心力衰竭患者血清肾上腺髓质素测定及其临床意义

目的 :探讨慢性心力衰竭患者血清肾上腺髓质素变化及其临床意义。方法 :用放射免疫分析法测定了 76例慢性心力衰竭 (CHF)患者和 30例非慢性心力衰竭患者的肾上腺髓质素 (ADM)水平 ,并进行对照统计分析。结果 :CHF组血清ADM水平显著高于对照组 (p <0 0 1 ) ,Ⅰ、Ⅱ、Ⅲ度心力衰竭组间无显著差异 (p >0 0 5 ) ,住院期间死亡组显著低于好转组 (p <0 0 5 )。结论 :CHF患者血清ADM水平显著高于对照组 ,尤以死亡组更明显     

Immunological Aspects of the Statins＇ Function in Patients with Heart Failure： A Report from the Annual Conference of ESC Heart Failure 2005

The annual meeting of the Heart Failure Association of ESC in Lisbon, in June 2005, was exceptionally successful. There were many very interesting presentations and workshops with the unique rifle： Statins in heart failureCholesterol-lowering is not the only goal. Heart failure （HF） is a progressive disease with coronary artery disease （CAD） as the most often underlying etiology. Treatment to prevent progression of heart failure has been targeted to reverse the consequences of HF and to a less extent the cause - the atherosclerotic plaque itself. On the average 50% of patients with heart failure are treated with lipid intervention. Lipid-lowering treatment with statins clearly reduces morbidity and mortality of patients with documented CAD. Since the prevalent etiology of heart failure is CAD, its prevention may reduce heart failure progression. However, recent studies suggest that pleiotropic effects of statins are more important than the influence related to their cholesterol lowering mechanism. Furthermore it is suggested that low levels of circulating lipoproteins and cholesterol may be independent predictors of impaired outcome in patients with heart failure. There are some possible explanations for this finding. High levels of cholesterol can be beneficial to heart failure patients; cholesterol-rich serum lipoproteins are able to modulate inflammatory immune function because they bind and detoxify bacterial lipopolysaccharide, a very strong stimulator of the release of proinflammatory cytokines that promote heart failure progression and death. So current recommendations strongly emphasize that the aim of treatment of HF is not to lower cholesterol. Cellular ＆ Molecular Immunology. 2005;2（6）：433-437.     

一种便携式多普勒胎心检测系统的设计及实现

本研究设计并实现了一款便携式,全数字,用于围产期胎儿心率检测的多普勒胎心系统,其采用对超声回波加窗,数字相乘等方法获取频移信号,并可对特定组织深度进行运动检测。该系统由CPLD超声激励及采集电路、MCU及外围电路和系统软件三部分组成。与两款商用胎心仪相比,本系统准确度较高,能够稳定可靠的对胎心进行检测。