血浆脑钠肽联合左心室射血分数对心力衰竭患者预后的评估价值

目的:评价血浆脑钠肽(BNP)水平和左心室射血分数(LVEF)对心力衰竭患者预后的评估价值。方法:对100例心力衰竭患者进行随访,临床终点为心源性死亡,并对其年龄、性别、病因、NYHA分级、左心室射血分数、血浆BNP、心房利钠肽(ANP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)浓度进行单变量和多变量Cox比例风险回归分析,采用Kaplan-Meier生存分析法计算死亡率和累积生存率。结果:83例患者在平均311天的随访中发生心源性死亡15例,17例失访。单因素Cox回归分析显示性别、左心室射血分数和BNP是心源性死亡的预测因素,患者的年龄、病因、NYHA分级、ANP、IL-6和TNF-α与生存率不相关。多因素Cox回归分析显示,仅BNP(风险比值0．834,95％可信区问为0．762～0．932)和左心室射血分数(风险比值1．001, 95％可信区间1．000～1．002)是心力衰竭患者心源性死亡的独立预测因素。联合BNP和左心室射血分数对心力衰竭患者进行危险度划分,结果发现高危患者的心源性死亡发生率显著高于低危患者和中危患者(P<0．05),中危患者的心源性死亡发生率显著高于低危患者(P<0．05),Kaplan-meier生存曲线也显示不同危险分层的心力衰竭患者心源性死亡的发生率均有显著差异(P<0．05)。结论:血浆BNP水平和左心室射血分数是影响心力衰竭患者预后的独立预测因素。联合BNP和左心室射血分数对心力衰竭患者进行危险度划分可以更好地评估心力衰竭患者的危险程度,更准确地判断预后。     

左心室射血分数正常的心力衰竭

<正>近年来,左心室射血分数(left ventricularej ection fraction,LVEF)正常的心力衰竭(心衰)得到了心血管专业医生越来越多的重视,特别是近来研究发现其高发病率及和收缩性心衰相比毫不逊色的住院率、病死率使其成为了临床工作的重点之一。各家对此认知不同。     

疏血通注射液对冠心病合并射血分数正常的心力衰竭疗效影响

目的评价疏血通注射液对冠心病合并射血分数正常的心力衰竭(HF-NEF)的治疗效果及其对心衰标志物脑钠肽(BNP)水平的影响。方法选取冠心病合并射血分数正常的心力衰竭患者300例,心功能分级Ⅲ级或Ⅳ级(NYHA分级)。随机分为两组,观察两组临床症状评分、心功能分级评估、监测BNP水平,心脏彩超测定左心室射血分数(LVEF)及左心室舒张末期内径(LVEDd)。两组均给予标准抗心衰治疗,治疗组在标准抗心衰治疗基础上静脉滴注疏血通注射液。在接受治疗10d后,观察两组临床总疗效和治疗前后临床症状评分、心功能分级评估,两组重新检测BNP、LVEF、LVEDd,并观察其不良反应情况。结果两组治疗后均能改善气短、胸闷、心悸、神疲倦怠乏力、四肢浮肿、纳呆、尿少、口唇紫暗等症状评分,且治疗组在改善气短、胸闷、倦怠乏力、口唇紫暗等症状方面优于对照组(P0.05)。心功能疗效比较,治疗组总有效率优于对照组(P0.01)。心脏彩超测定LVEF及LVEDd,治疗前与治疗后无统计学意义(P0.05),治疗组与对照组无统计学意义(P0.05);BNP两组均有明显下降(P0.05),治疗组下降较对照组显著(P0.05)。结论疏血通对冠心病合并射血分数正常的心力衰竭疗效肯定,且在常规治疗效果基础上进一步降低患者血浆BNP水平,缩短病程,可作为射血分数正常的心力衰竭治疗药物。     

心力衰竭患者心房纤颤与血浆脑钠肽水平的相关性研究

目的探讨心力衰竭患者心房纤颤(房颤)与血脑钠肽(BNP)水平的关系。方法 90例符合入选标准的心力衰竭住院患者按是否存在房颤分为:房颤组(n=50)和对照组(n=40),对两组患者的血BNP水平进行测定。结果不同级别心功能合并房颤组患者血浆BNP水平均高于窦性心律组(P0.05)。结论心力衰竭合并房颤患者BNP水平比窦性心律患者高。     

射血分数保留的心力衰竭患者心房利钠肽前体A基因多态性与5年全因死亡的关系

目的 探讨心房利钠肽前体A(NPPA)基因多态性与射血分数保留的心力衰竭（HFpEF）患者5年全因死亡的关系。方法 选择2013年1月至2016年1月杭州市第九人民医院收治的HFpEF患者233例,随访5年死亡31例（死亡组）,存活202例（存活组）。比较两组患者一般资料、NPPA基因多态性。采用Cox回归分析5年全因死亡的相关影响因素,比较不同基因型患者氨基末端脑钠肽前体（NT-proBNP）水平。结果 死亡组纽约心脏病协会（NYHA）心功能分级Ⅳ级、慢性阻塞性肺疾病（COPD）、心房颤动、慢性肾功能不全占比及NT-proBNP水平高于存活组,差异均有统计学意义（均P<0.05）。NPPA基因扩增结果显示,rs5063、rs5065位点均存在基因多态性。死亡组NPPA基因rs5063位点AA基因型、A等位基因占比高于存活组,差异均有统计学意义（均P<0.05）。NYHA心功能分级、COPD、心房颤动、慢性肾功能不全、NT-proBNP、rs5063位点AA基因型均为HFpEF患者5年全因死亡的影响因素（均P<0.05）。NPPA基因rs5063与rs5065位点AG...     

射血分数正常的心力衰竭患者临床特点分析

目的:探讨国人射血分数正常的心力衰竭(HFPEF)患者的临床特点及治疗状况.方法:对我院2007年10月至2008年5月收治的心力衰竭(NYHA Ⅲ-Ⅳ级)患者中EF≥50%和EF<50%的患者的临床资料进行对照分析.结果:494例心力衰竭患者中左室收缩功能正常(EF≥50%)者327例(66.2%).与EF<50%的患者相比,HFPEF患者年龄更大(69.0∶60.6)岁,女性(51.7∶35.3)%、高血压(70.3∶34.1)%与贫血患者(22.0∶9.0)%更多;左室相对室壁厚度更大(0.47∶0.30);接受钙拮抗剂治疗者(47.7∶6.0)%较多,而应用利尿剂(43.7∶ 88.6)%与β受体阻滞剂(42.2∶60.5)%者较少.虽然HFPEF患者血浆脑钠肽明显低于EF<50%患者,但住院期间2组的死亡率差异无统计学意义(1.8∶2.4)%.结论:收缩功能正常在中度以上的国人心力衰竭患者中颇为常见,住院期间死亡率与EF降低的心力衰竭患者相近.     

阵发性心房纤颤转复前后脑钠肽和心功能变化研究

目的探讨阵发性心房纤颤患者转复前后脑钠肽浓度和心功能的变化。方法分析32例阵发性心房纤颤患者转复前后氨基末端脑钠肽前体（N-terminal pro-brain natiruretic peptide,NT-BNP）浓度、左室舒张末期容积（LVEDV）、左室收缩末期容积（LVESV）、左室射血分数（LVEF）的变化。结果转复后NT-BNP水平明显降低,与转复前比较差异有显著意义。转复后LVEDV、LVEF增加,与转复前比较差异有显著意义。转复后LVESV无明显变化。结论 LVEF〉50%的阵发性心房纤颤患者心房纤颤发作时心功能下降,成功转复为窦性心律后心脏功能得到改善。     

射血分数保留心力衰竭患者与高尿酸血症的相关研究

目的探讨射血分数保留心力衰竭患者与高尿酸血症的相关性。方法选取射血分数保留心力衰竭患者285例,非心力衰竭组218例,观察各组血液指标及超声心动图指标。结果分别按照N-末端B型脑钠肽前体(NT-pro BNP)值及血尿酸(UA)值分组后,比较差异具有统计学意义(χ2=6.59,P0.05)。Pearson相关分析结果显示:NT-pro BNP与血尿素氮(BUN)(r=0.25,P0.01)、肌酐(Scr)(r=0.24,P0.01)、UA(r=0.11,P0.05)等指标呈正相关。二元Logistic回归检验结果显示:尿酸对射血分数保留心力衰竭的OR为1.93(95%CI:1.16~3.21,P0.05)。结论心力衰竭组患者高尿酸血症比例高于非心力衰竭组,UA水平与NT-pro BNP呈正相关,高尿酸血症是射血分数保留心力衰竭患者的独立危险因素。     

左心室重量指数和血浆N末端脑钠肽前体在老年左心室射血分数正常的心力衰竭患者诊断中的价值

目的老年探讨左心室重量指数(LVMI)和血浆N末端脑钠肽前体(NT-BNP)对老年左室射血分数正常的心力衰竭(HFNEF)患者的诊断价值。方法选择70岁以上HFNEF患者、左室射血分数降低的心力衰竭(HFREF)患者和健康者各110例作为研究对象,将其分别分为HFNEF组、HFREF组和对照组,观察三组患者LVMI和血浆NT-BNP水平,分析LVMI和血浆NT-BNP对老年HFNEF的诊断价值,老年HFNEF患者LVMI和血浆NT-BNP水平的相关性以及老年HFNEF患者LVMI和血浆NT-BNP与心功能分级的关系。结果 HFNEF组患者的LVMI和血浆NT-BNP高于对照组,低于HFREF组(均P0.05)。LVMI诊断老年男性HFNEF患者的ROC曲线下面积为0.909,以147 g/m~2为界限诊断HFNEF的敏感度为0.21,特异度为0.95;LVMI诊断老年女性HFNEF患者的ROC曲线下面积为0.879,以122 g/m~2为界限诊断HFNEF的敏感度为0.51,特异度为0.98。血浆NT-BNP诊断老年HFNEF患者的ROC曲线下面积为0.971,以125 pg/ml为界限诊断HFNEF的灵敏度为0.92,特异度为0.79。血浆NTBNP和LVMI的相关性为r=0.498,P=0.000。心功能Ⅱ级患者的LVMI和血浆NT-BNP低于心功能Ⅲ级和心功能Ⅳ级者(P0.05),心功能Ⅲ级患者的LVMI和血浆NT-BNP低于心功能Ⅳ级(P0.05)。结论老年HFNEF患者LVMI和血浆NT-BNP水平升高,其升高程度和心功能的严重程度相关,LVMI诊断老年HFNEF具有较高的特异度,但敏感度不高,血浆NT-BNP诊断老年HFNEF灵敏度较高,NT-BNP和血浆NT-BNP联合检测对老年HFNEF具有一定的诊断价值。     

有关左心室射血分数正常的心力衰竭

心力衰竭发病率高,5年存活率与恶性肿瘤相仿,正在成为21世纪最重要的心血管疾病之一.由于超声心动图技术的发展和普及,1984年有学者首次报道1组左心室收缩功能正常的充血性心力衰竭患者.     

Empagliflozin in heart failure with preserved ejection fraction with and without atrial fibrillation

Aims

Atrial fibrillation/flutter (AF) is common in heart failure (HF) with preserved left ventricular ejection fraction (LVEF) and associated with worse outcomes. Empagliflozin reduces cardiovascular death or HF hospitalizations and slows estimated glomerular filtration rate (eGFR) decline in patients with HF and LVEF >40%. We aimed to assess the efficacy and safety of empagliflozin in improving outcomes in patients with HF and LVEF >40% with and without AF.

Methods and results

In this pre-defined secondary analysis of EMPEROR-Preserved, we compared the effects of empagliflozin versus placebo on the primary and secondary endpoints and safety outcomes, stratified by baseline AF, defined as AF reported in any electrocardiogram before empagliflozin initiation or in medical history. Among 5988 patients randomized, 3135 (52%) had baseline AF; these patients were older, with worse functional class, more previous HF hospitalizations and higher natriuretic peptides compared to those without AF (all p < 0.001). After a median of 26 months, empagliflozin reduced cardiovascular death or HF hospitalization compared to placebo to a similar extent in patients with and without AF (hazard ratio [HR] 0.78 [95% confidence interval 0.66–0.93] vs. 0.78 [0.64–0.95], interaction p = 0.96). Empagliflozin also reduced total HF hospitalizations (HR 0.73 [0.57–0.94] vs. 0.72 [0.54–0.95], interaction p = 0.94) and annual eGFR decline (difference = 1.368 vs. 1.372 ml/min/1.73 m²/year, interaction p = 0.99) consistently in patients with and without AF. There was no increase in serious adverse events with empagliflozin versus placebo in patients with and without AF.

Conclusions

In patients with HF and ejection fraction >40%, empagliflozin reduced the risk of serious HF events and slowed the eGFR decline regardless of baseline AF.     

Effect of atrial fibrillation on long-term survival in patients hospitalised for heart failure with preserved ejection fraction

BACKGROUND: The prognostic importance of atrial fibrillation (AF) in heart failure (HF) is not clearly established. Studies conducted in systolic HF have led to discordant results. AIMS: To evaluate the relation between AF and long-term survival in patients with heart failure and preserved ejection fraction (HFPEF). METHODS AND RESULTS: We prospectively included 368 consecutive patients hospitalised for a first episode of HFPEF during 2000 and compared the 5-year outcome of patients according to the presence or absence of AF on the baseline electrocardiogram. Propensity scores were used to reduce imbalance in baseline characteristics. Baseline AF was observed in 36% (n=132) of the study population. Patients with AF were older and more often had hypertensive heart disease. On univariate analysis, baseline AF was associated with an increased risk of 5-year overall mortality (HR=1.36; 95%CI 1.03-1.79; p=0.03). After adjustment for covariates, baseline AF was no longer a predictor of reduced survival. The risk of adjusted cardiovascular death in patients with and without AF was comparable. In the propensity-matched patients, AF was not related to a poorer outcome (HR=1.08; 95%CI 0.78-1.51; p=0.63). CONCLUSION: In patients hospitalised for HFPEF, AF is frequent and associated with an excess mortality mainly related to the advanced age of these patients. After adjustment for covariates, baseline AF is not an independent predictor of long-term mortality.     

Heart failure with preserved ejection fraction: uncertainties and dilemmas

Many uncertainties surround the syndrome of heart failure with preserved ejection fraction (HFpEF), which was the topic reviewed in an Expert Meeting at the University of Ferrara. This concluded that the absence of clear diagnostic clinical criteria was the major barrier to progress. There was general agreement that symptoms or signs of heart failure, normal LVEF despite an elevated plasma concentration of natriuretic peptides, and signs of abnormal LV relaxation, LV filling, LV hypertrophy, or left atrial enlargement, or diastolic dysfunction supported the diagnosis. However, HFpEF, like all heart failure syndromes, is heterogeneous in aetiology and pathophysiology, rather than being a single disease. HFpEF may account for about half of all patients with heart failure. The classical risk factors for developing HFpEF include age and co‐morbidities, notably hypertension, atrial fibrillation, and the metabolic syndrome. When complicated by increasing congestion requiring hospital admission, the prognosis is poor; 30% or more of patients will die within 1 year (nearly two‐thirds die from cardiovascular causes). Patients with chronic stable symptoms have a much better prognosis. Despite many clinical trials, there is no solid evidence that any treatment alters the natural history of HFpEF. Several treatments have shown promising early results and are now being tested in substantial randomized clinical trials. Further basic research is required to better characterize the disease and accelerate progress. Our review highlights the many difficulties encountered in performing randomized clinical trials in HFpEF, often due to difficulties in characterizing HFpEF itself.     

Obesity and heart failure with preserved ejection fraction: A growing problem

Heart Failure with Preserved Ejection Fraction (HFpEF) is increasing in prevalence due to the aging of the United States population as well as the current obesity epidemic. While obesity is very common in patients with HFpEF, obesity may represent a specific phenotype of HFpEF characterized by unique hemodynamics and structural abnormalities. Obesity induces a systemic inflammatory response that may contribute to myocardial fibrosis and endothelial dysfunction. The most obese patients continue to be excluded from HFpEF clinical trials, and thus ongoing research is needed to determine the role of pharmacologic and interventional approaches in this growing population.     

Role of global longitudinal strain in assessment of left ventricular systolic function in patients with heart failure with preserved ejection fraction

Objectives

To detect systolic dysfunction in heart failure with preserved ejection fraction (HFpEF) patients by using global longitudinal strain (GLS).

胱抑素C评估左心室射血分数保留的心力衰竭患者预后的价值

目的探讨胱抑素C(Cys C)评估左心室射血分数保留的心力衰竭患者预后的价值。方法选取2012年06月至2012年12月自贡市第一人民医院心内科住院的急性心力衰竭或慢性心力衰竭(心衰)急性加重的心衰患者215例,其中男性107例,女性108例,年龄50~91岁。检测患者血肌酐、血尿素氮、血红蛋白、脑钠肽(BNP)和C-反应蛋白(CRP)水平,计算肾小球滤过率(e GFR)。记录住院期间以及出院后400 d内I级终点事件及全因死亡。所有患者按Cys C水平分为四组,A组(1.10 mg/L)54例,B组(1.10~1.47mg/L)54例,C组(1.48~1.88 mg/L)54例,D组(1.88 mg/L)53例。结果与A组比较,C组和D组肾功能不全比例、BNP、血尿素氮水平、I级终点事件发生率和全因死亡率升高,e GFR下降,差异具有统计学意义(P均0.01)。与B组比较,C组和D组肾功能不全比例、BNP、血尿素氮水平升高,e GFR下降,差异具有统计学意义(P均0.01)。随着血清Cys C升高,血肌酐呈上升趋势,差异具有统计学意义(P均0.01)。血清Cys C和血肌酐呈显著正相关(r=0.717,P0.01),和e GFR呈明显负相关(r=-0.778,P0.01),与BNP呈显著正相关(r=0.530,P0.01)和心功能NYHA分级也有较强的相关性(r=0.504,P0.01),与CRP呈正相关(r=0.303,P0.01)。使用Kaplan-Meier生存曲线对四组的I级终点事件发生率和死亡率进行分析,随着血清Cys C的升高,HFPEF患者的I级终点事件发生率和死亡率均逐渐升高(P均0.01)当血清Cys C的诊断界值为1.54 mg/L的时候,ROC曲线下面积达到最大值,敏感性和特异性分别为72.97%和85.58%。使用ROC曲线评价BNP、血尿素氮、血肌酐、CRP对患者I级终点事件的预测价值,面积均小于血清Cys C(ROC曲线下面积分别为:0.7186、0.7143、0.7489、0.6138,P均0.001)。结论 Cys C评估左心室射血分数保留的心力衰竭患者预后具有一定的临床价值。