Retinopathy and risk of congestive heart failure

Context  Congestive heart failure (CHF) affects a substantial proportion of adults including those without preexisting coronary heart disease. The pathogenesis of CHF is uncertain, but microvascular disease has been hypothesized as a possible factor. Objective  To determine the relationship of retinopathy, a marker of systemic microvascular disease, to risk of CHF. Design, Setting, and Participants  Population-based, prospective 7-year cohort study in 4 US communities using the Atherosclerosis Risk in Communities Study database. Participants (n = 11 612, aged 49 to 73 years) had retinal photographs taken between 1993 and 1995. The photographs were graded according to a standardized protocol for the presence of retinopathy (eg, microaneurysms, retinal hemorrhages, soft exudates), arteriovenous nicking, focal arteriolar narrowing, and generalized arteriolar narrowing. Main Outcome Measures  Association between retinopathy and incident CHF, identified from hospitalization and death records. Results  The 7-year cumulative incidence of CHF was 5.4% (492 events). Participants with retinopathy had a higher incidence of CHF compared with those without retinopathy (15.1% vs 4.8%, P<.001). After controlling for age, sex, race, preexisting coronary heart disease, mean arterial blood pressure, diabetes, glucose level, cholesterol level, smoking, body mass index, and study site, the presence of retinopathy was associated with a 2-fold higher risk of CHF (relative risk, 1.96; 95% confidence interval, 1.51-2.54). Among participants without preexisting coronary heart disease, diabetes, or hypertension, retinopathy was associated with a 3-fold higher risk of CHF (relative risk, 2.98; 95% confidence interval, 1.50-5.92). Conclusions  Retinopathy is an independent predictor of CHF, even in persons without preexisting coronary heart disease, diabetes, or hypertension. This suggests that microvascular disease may play an important role in the development of heart failure in the general population. Some asymptomatic persons with retinopathy on an ophthalmologic examination may benefit from further assessment of CHF risk.      

急性心肌梗死患者血清肌酸激酶同工酶高峰与充血性心力衰竭的关系

目的：了解急性心肌梗死（AMI）患血清肌酸激酶同工酶MB（CK－MB）高峰与充血性心力衰竭（下称“心衰”）的关系。方法：对34例AMI患采用免疫抑制法制定系列血清CK－MB,并观察其并发心衰的情况。结果：AMI并发心衰患9例（心衰组,其中约40％在24h后并发心衰）,AMI无心衰患25例（无心衰组）两组血清CK－MB高峰时间均在24h内,但心衰组血清CK－MB峰值比无心衰组明显增高（P＜0．01）。结论：测定血清CK－MB峰值有助于预测AMI并发心衰。     

急性心肌梗死合并心功能不全患者的相关危险因素分析

目的 研究与急性心肌梗死(Acute myocardial infarction,AMI)患者心功能不全相关的危险因素,进而预测疾病发展进程.方法 选取2014年1月-2015年6月于武汉大学人民医院就诊的130例AMI合并心功能不全患者作为心功能不全组;选择同期110例未合并心功能不全的AMI患者作为非心功能不全组.两组实验对象的一般临床特征和AMI标志物如肌酸激酶同工酶(Creatine kinase isoenzyme,CK-MB)、肌红蛋白(Myoglobin,MYO)、肌钙蛋白Ⅰ(Cardiac tro-ponin Ⅰ,cTnI)和血浆氨基末端脑钠肽前体(N-terminal pro-B-type natriuretic peptide,NT-proBNP)水平,采用SPSS19.0统计学软件进行分析.采用单因素和多因素Logistic回归分析AMI患者发生心功能不全的相关危险因素.结果 心功能不全组患者的年龄、合并高血压和(或)糖尿病的发生率、CK-MB、NT-proBNP和Glu水平均高于非心功能不全组,差异均有统计学意义(P＜0.05);单因素Logistic回归分析显示,患者的年龄、CK-MB、Glu水平、高血压和糖尿病均与AMI患者心功能不全的发生相关;多因素Logistic回归分析显示,Glu升高是AMI患者并发心功能不全的独立危险因素(OR=1.141,95％CI:1.004-1.297,P=0.043).结论 AMI患者合并心功能不全的发生率较高,且受多种临床因素影响,Glu水平升高是AMI患者发生心功能不全的危险因素.     

充血性心力衰竭患者血浆肾上腺髓质素水平观察

为研究充血性心力衰竭（ＣＨＦ）患者在不同心功能状态下及治疗前后血浆肾上腺髓质素（ＡＭ）含量，同时分析血浆ＡＭ含量与内皮素（ＥＴ）和血管紧张素Ⅱ（ＡｎｇⅡ）含量之间的关系。用放射免疫法测定了５１例ＣＨＦ患者和３０例健康对照组的血浆ＡＭ、ＥＴ和ＡｎｇⅡ含量。结果显示：①ＣＨＦ组不同程度心功能患者血浆ＡＭ、ＥＴ、ＡｎｇⅡ含量均较对照组明显增高（Ｐ＜０００１），且血浆ＡＭ、ＥＴ、ＡｎｇⅡ含量随心功能级别增高而升高。②心功能改善后，血浆ＡＭ、ＥＴ及ＡｎｇⅡ含量较治疗前显著下降（Ｐ＜０００１），但仍高于对照组（Ｐ＜００１）。③ＣＨＦ患者治疗前后血浆ＡＭ与ＥＴ、ＡｎｇⅡ含量均呈显著正相关。结果提示：血浆ＡＭ升高可能与ＥＴ和ＡｎｇⅡ含量升高有关，血浆ＡＭ含量不仅可反映心力衰竭严重程度，还可作为ＣＨＦ疗效的一项观察指标     

Insulin resistance and risk of congestive heart failure

Context  Diabetes and obesity are established risk factors for congestive heart failure (CHF) and are both associated with insulin resistance. Objective  To explore if insulin resistance may predict CHF and may provide the link between obesity and CHF. Design, Setting, and Participants  The Uppsala Longitudinal Study of Adult Men, a prospective, community-based, observational cohort in Uppsala, Sweden. We investigated 1187 elderly (70 years) men free from CHF and valvular disease at baseline between 1990 and 1995, with follow-up until the end of 2002. Variables reflecting insulin sensitivity (including euglycemic insulin clamp glucose disposal rate) and obesity were analyzed together with established risk factors (prior myocardial infarction, hypertension, diabetes, electrocardiographic left ventricular hypertrophy, smoking, and serum cholesterol level) as predictors of subsequent incidence of CHF, using Cox proportional hazards analyses. Main Outcome Measure  First hospitalization for heart failure. Results  One hundred four men developed CHF during a median follow-up of 8.9 (range, 0.01-11.4) years. In multivariable Cox proportional hazards models adjusted for established risk factors for CHF, increased risk of CHF was associated with a 1-SD increase in the 2-hour glucose value of an oral glucose tolerance test (hazard ratio [HR], 1.44; 95% confidence interval [CI], 1.08-1.93), fasting serum proinsulin level (HR, 1.29; 95% CI, 1.02-1.64), body mass index (HR, 1.35; 95% CI, 1.11-1.65), and waist circumference (HR, 1.36; 95% CI, 1.10-1.69), whereas a 1-SD increase in clamp glucose disposal rate decreased the risk (HR, 0.66; 95% CI, 0.51-0.86). When adding clamp glucose disposal rate to these models as a covariate, the obesity variables were no longer significant predictors of subsequent CHF. Conclusions  Insulin resistance predicted CHF incidence independently of established risk factors including diabetes in our large community-based sample of elderly men. The previously described association between obesity and subsequent CHF may be mediated largely by insulin resistance.      

左心室成形术结合骨骼肌成肌细胞移植治疗心肌梗死后心力衰竭

目的:探讨左心室成形术结合骨骼肌成肌细胞移植对心肌梗死后充血性心力衰竭的治疗作用.方法:48只心梗后4周的大鼠随机分为4组,组Ⅰ(n=10)在梗死区两侧边缘注射PBS;组Ⅱ(n=11)注射骨骼肌成肌细胞;组Ⅲ(n=13)行左心室成形术,同时注射PBS;组Ⅳ(n=14)行左心室成形术同时注射骨骼肌成肌细胞.分别在术后第1、2、3、4周超声随访心功能.结果:左室舒张末期内径(EDD)与收缩末期内径(ESD)值在组Ⅲ和组Ⅳ于术后1周时明显减小,然后有逐渐增大的趋势,到第4周时,组Ⅲ与组Ⅰ、Ⅱ已没有显著差别,而组Ⅳ仍小于其他3组,差异有非常显著意义(P<0.01);反映左室收缩功能的EF值在组Ⅲ、组Ⅳ于术后1周时达到最高,然后逐渐降低,到第4周时,组Ⅳ的EF大于组Ⅰ、Ⅱ、Ⅲ,差异有显著意义(P<0.01).结论:在左心室成形术的同时进行骨骼肌成肌细胞移植,可以加强手术的疗效,延缓心室的再次扩大和心功能的再次恶化.     

Vascular alpha 1D-adrenoceptor function is maintained during congestive heart failure after myocardial infarction in the rat

BACKGROUND: During congestive heart failure, desensitization of beta-adrenoceptors is related to a lower adrenergic responsiveness in the heart; little is known about alpha 1-adrenoceptors in the vasculature under this condition. We evaluated alpha 1D-adrenoceptor response in aorta and carotid arteries in a model of congestive heart failure (CHF) post-myocardial infarction. METHODS: Noradrenaline-elicited contraction was determined in endothelium-denuded arterial rings from young (10-week-old) Wistar rats in the absence and presence of the alpha 1D-adrenoceptor antagonist BMY 7378 (8-(2-(4-(2-methoxyphenyl)-1-piperazinyl) ethyl)-8-azaspiro(4,5)decane-7,9-dione dihydrochloride) in sham-operated rats and in rats that developed CHF 4 weeks or 7 months after myocardial infarction. RESULTS: In the thoracic aorta, BMY 7378 displaced noradrenaline effect to the right with pA2 values of: sham, 8.58 +/- 0.12; CHF, 8.36 +/- 0.13, and sham, 8.56 +/- 0.10; CHF, 7.99 +/- 0.13 at 4 weeks and 7 months after myocardial infarction, respectively. While in carotid arteries, the pA2 values were: sham, 8.43 +/- 0.19; CHF, 8.81 +/- 0.19, and sham, 8.35 +/- 0.18; CHF, 8.29 +/- 0.08 at 4 weeks and 7 months after myocardial infarction, respectively. When adult (7-month-old) rats were subjected to myocardial infarction, CHF was not installed and pA2 values were similar and high in both sham and infarcted rats. CONCLUSIONS: These results indicate that alpha 1D-adrenoceptors remained as the main receptors involved in contraction in aorta and carotid arteries, irrespective of CHF duration.     

心肌梗塞愈后心力衰竭大鼠心肌AE3 mRNA表达及其意义

目的 观察心梗愈后心力衰竭大鼠心肌ＡＥ３ ｍＲＮＡ及其蛋白表达的变化,探讨其在心力衰竭中的病理生理意义。方法 结扎大鼠冠状动脉,造成心梗愈后心力衰竭模型,应用原位杂交及免疫组化技术,检测心肌ＡＥ３ ｍＲＮＡ及其蛋白表达。结果 心衰组心肌ＡＥ３ｍＲＮＡ及其蛋白表达显著增加,其ＩＯＤ值明显高于假手术组和正常对照组（Ｐ〈０．０１）。结论 心力衰竭时心肌ＡＥ３ ｍＲＮＡ及其蛋白表达显著增加是一种代偿反应,     

老年人充血性心力衰竭的甲状腺激素变化

目的 旨在探讨老年人充血性心力衰竭（ＡＣＨＦ）的甲状腺功能变化。方法 本实验收集了６０例ＡＣＨＦ病例,正常老年人３０例。分治疗前,治疗后及正常组３组对照。分别测定血浆三碘甲状腺原氨酸（Ｔ３）,甲状腺素（Ｔ４）,游离三碘甲状腺原氨酸（ＦＴ３）,游离甲状腺素（ＦＴ４）,促甲状腺素（ＴＳＨ）。结果 老年ＣＨＦ治疗前血浆Ｔ３,ＦＴ３低于治疗后（Ｐ〈０．０１）,显著低于正常对照组（Ｐ〈０．０１）,老年ＡＣＨＦ治疗前血浆Ｔ４,ＦＴ４明显低于治疗后（Ｐ〈０．０５）及正常组（Ｐ〈０．０５）,老年ＣＨＦ治疗前ＴＳＨ低于治疗后及正常组（Ｐ〈０．０５）。老年ＣＨＦ治疗后Ｔ３,ＦＴ３,ＴＳＨ低于正常对照组（Ｐ〈０．０５）,而Ｔ４,ＦＴ４不显示明显相关性（Ｐ〉０．０５）。结果还显示血浆Ｔ３,ＦＴ３,Ｔ４,ＦＴ４,ＴＳＨ下降与心衰程度呈正     

Plasma adiponectin levels and risk of myocardial infarction in men

Context  Adiponectin, a recently discovered adipocyte-derived peptide, is involved in the regulation of insulin sensitivity and lipid oxidation and, purportedly, in the development of atherosclerosis and coronary heart disease in humans. Objective  To assess prospectively whether plasma adiponectin concentrations are associated with risk of myocardial infarction (MI). Design, Setting, and Participants  Nested case-control study among 18 225 male participants of the Health Professionals Follow-up Study aged 40 to 75 years who were free of diagnosed cardiovascular disease at the time of blood draw (1993-1995). During 6 years of follow-up through January 31, 2000, 266 men subsequently developed nonfatal MI or fatal coronary heart disease. Using risk set sampling, controls were selected in a 2:1 ratio matched for age, date of blood draw, and smoking status (n = 532). Main Outcome Measure  Incidence of nonfatal MI and fatal coronary heart disease by adiponectin level. Results  After adjustment for matched variables, participants in the highest compared with the lowest quintile of adiponectin levels had a significantly decreased risk of MI (relative risk [RR], 0.39; 95% confidence interval [CI], 0.23-0.64; P for trend <.001). Additional adjustment for family history of MI, body mass index, alcohol consumption, physical activity, and history of diabetes and hypertension did not substantively affect this relationship (RR, 0.41; 95% CI, 0.24-0.70; P for trend <.001). Further adjustment for hemoglobin A_1c or C-reactive protein levels also had little impact, but additional adjustment for low- and high-density lipoprotein cholesterol levels modestly attenuated this association (RR, 0.56; 95% CI, 0.32-0.99; P for trend = .02). Conclusions  High plasma adiponectin concentrations are associated with lower risk of MI in men. This relationship can be only partly explained by differences in blood lipids and is independent of inflammation and glycemic status.      

Diurnal blood pressure pattern and risk of congestive heart failure

Context  High blood pressure is the most important risk factor for congestive heart failure (CHF) at a population level, but the relationship of an altered diurnal blood pressure pattern to risk of subsequent CHF is unknown. Objectives  To explore 24-hour ambulatory blood pressure characteristics as predictors of CHF incidence and to investigate whether altered diurnal blood pressure patterns confer any additional risk information beyond that provided by conventional office blood pressure measurements. Design, Setting, and Participants  Prospective, community-based, observational cohort in Uppsala, Sweden, including 951 elderly men free of CHF, valvular disease, and left ventricular hypertrophy at baseline between 1990 and 1995, followed up until the end of 2002. Twenty-four-hour ambulatory blood pressure monitoring was performed at baseline, and the blood pressure variables were analyzed as predictors of subsequent CHF. Main Outcome Measure  First hospitalization for CHF. Results  Seventy men developed heart failure during follow-up, with an incidence rate of 8.6 per 1000 person-years at risk. In multivariable Cox proportional hazards models adjusted for antihypertensive treatment and established risk factors for CHF (myocardial infarction, diabetes, smoking, body mass index, and serum cholesterol level), a 1-SD (9–mm Hg) increase in nighttime ambulatory diastolic blood pressure (hazard ratio [HR], 1.26; 95% confidence interval [CI], 1.02-1.55) and the presence of "nondipping" blood pressure (night-day ambulatory blood pressure ratio 1; HR, 2.29; 95% CI, 1.16-4.52) were associated with an increased risk of CHF. After adjusting for office-measured systolic and diastolic blood pressures, nondipping blood pressure remained a significant predictor of CHF (HR, 2.21; 95% CI, 1.12-4.36 vs normal night-day pattern). Nighttime ambulatory diastolic blood pressure and nondipping blood pressure were also significant predictors of CHF after exclusion of all participants who had an acute myocardial infarction before baseline or during follow-up. Conclusions  Nighttime blood pressure appears to convey additional risk information about CHF beyond office-measured blood pressure and other established risk factors for CHF. The clinical value of this association remains to be established in future studies.      

比索洛尔改善充血性心衰心功能及心肌重塑的疗效观察

目的　观察比索洛尔 (bisoprolol)对充血性心衰心功能及心肌重塑的临床疗效 .方法　 2 12例患者随机分为比索洛尔组和常规药物组 ,比索洛尔剂量起始量 0 .6 2 5 mg～1.2 5 0 mg,1次· d- 1 ,逐渐增加至最大剂量为 2 .5 mg～ 5 .0mg,1次· d- 1 .观察心功能、临床疗效、左室舒张末内径(L VEDD)、左室收缩末内径 (L VESD)、射血分数 (EF)、舒张早期 E峰流速 /舒张晚期 A峰流速 (VE/ VA) .结果　比索洛尔组与常规药物组比较 ,比索洛尔治疗 3m o后有效者(87.7% )高于常规药物组 (6 6 .0 % ) ,P <0 .0 5 ;冠心病(87.9% )和扩张型心肌病心衰 (91.9% )疗效明显好于常规药物组 (分别为 6 6 .7% ,6 7.4 % ) ;治疗 6 mo后重度心衰者疗效(90 .0 % )明显好于常规药物组 (6 5 .4 % ,P <0 .0 5 ) .治疗后比索洛尔组 L VESD[(44 .8± 3.9) m m vs(48.8± 4 .6 ) mm],EF[(40 .7± 7.5 ) % vs (35 .7± 5 .2 ) % ]优于常规药物组 (P<0 .0 1) ;L VEDD,VE/ VA也较治疗前有明显改善 .结论　比索洛尔改善充血性心力衰竭临床症状 ,促进心脏收缩、舒张功能恢复 ,部分逆转心肌重塑 .     

Early and chronic captopril or Losartan therapy reduces infarct size and avoids congestive heart failure after myocardial infarction in rats

BACKGROUND: Angiotensin converting enzyme (ACE) inhibitors and angiotensin II AT1-receptor antagonists prolong survival in experimental postischemic heart failure (CHF) in rats. The aim of this study was to investigate whether potential beneficial effects of early and long-term therapy with low doses of captopril or losartan occur in hemodynamics and heart morphometry, as well as in infarct size during establishment of CHF after myocardial infarction. METHODS: Male Wistar rats were subjected to myocardial infarction by left coronary ligation. Subsequently, 24 h after surgery captopril (2.5 mg/kg/day/28 days) or losartan (3 mg/kg/day/28 days) was administered by mini-osmotic pump release. Hemodynamics, infarct size, and heart morphometry were measured in sham, untreated, and treated operated rats. RESULTS: Morphometric and hemodynamic parameters were modified after myocardial infarction indicating hypertrophy of the heart and CHF establishment; however, either captopril or losartan partially avoided hypertrophy. Captopril reverted hemodynamics to sham values, while losartan induced further decrease in systolic blood pressure. Both drugs were able to drastically reduce infarct size produced by myocardial infarction. CONCLUSIONS: Data show that early and chronic therapy with low doses of captopril or losartan prevent CHF establishment, probably by limiting extension of infarcted area after coronary occlusion, and suggest AT1 receptor pathway involvement in this pathology.