Impact of heart failure and left ventricular function on long-term survival--report of a community-based cohort study in Taiwan

BACKGROUND: There is little community-based information on heart failure (HF) prognosis in ethnic Chinese populations, in whom there is a low prevalence of coronary heart disease. AIMS: To study the impact of HF and left ventricular function on long-term all-cause mortality. METHODS AND RESULTS: This community-based prospective cohort study included 2660 subjects (1215 men, 1445 women, mean age 54.4+/-11.9 years) over a 10 year follow-up period. The prevalence of HF was 5.5%. Hypertension was the most common factor related to HF. The five and ten year all-cause mortality was higher in the HF/preserved LVEF group (14.1% and 24.4%) and the HF/impaired LVEF group (29.2% and 48.2%) than in the HF-free group (6.0% and 14.6%, p<0.0001 for both). In multivariable Cox analyses, controlling for sex, LV mass, atrial fibrillation, hypertension, coronary heart disease, HF/preserved LVEF and HF/impaired LVEF were important predictors of all-cause mortality (p=0.007). CONCLUSIONS: Hypertension is a major heart failure related disease. HF and LV systolic dysfunction are associated with a significant increase in all-cause mortality in an ethnic Chinese population.     

Clinical outcome of patients with heart failure and preserved left ventricular function

Background

Patients with heart failure have a poor prognosis. However, it has been presumed that patients with heart failure and preserved left ventricular function (LVF) may have a more benign prognosis.

Objectives

We evaluated the clinical outcome of patients with heart failure and preserved LVF compared with patients with reduced function and the factors affecting prognosis.

Methods

We prospectively evaluated 289 consecutive patients hospitalized with a definite clinical diagnosis of heart failure based on typical symptoms and signs. They were divided into 2 subsets based on echocardiographic LVF. Patients were followed clinically for a period of 1 year.

Results

Echocardiography showed that more than one third (36%) of the patients had preserved systolic LVF. These patients were more likely to be older and female and have less ischemic heart disease. The survival at 1 year in this group was poor and not significantly different from patients with reduced LVF (75% vs 71%, respectively). The adjusted survival by Cox regression analysis was not significantly different (P = .25). However, patients with preserved LVF had fewer rehospitalizations for heart failure (25% vs 35%, P < .05). Predictors of mortality in the whole group by multivariate analysis were age, diabetes, chronic renal failure, atrial fibrillation, residence in a nursing home, and serum sodium ≤ 135 mEq/L.

Conclusion

The prognosis of patients with clinical heart failure with or without preserved LVF is poor. Better treatment modalities are needed in both subsets.     

充血性心力衰竭患者血清甲状腺激素和心功能的变化

测定56例充血性心力衰竭患者甲状腺激素水平的变化，发现三碘甲状腺原氨酸明显低于正常，反三碘甲状腺原氨酸显著升高。心力衰竭（心衰）程度越重，变化越明显。提示甲状腺激素变化对心衰患者心功能损害程度、治疗和预后具有一定意义。     

Effect of intravenous iron replacement on recurrent heart failure hospitalizations and cardiovascular mortality in patients with heart failure and iron deficiency: A Bayesian meta-analysis

Aims

Iron deficiency is common in patients with heart failure (HF) and reduced ejection fraction (HFrEF) and is associated with a poor prognosis. Whether intravenous iron replacement improves recurrent HF hospitalizations and cardiovascular mortality of these patients is uncertain although several trials were conducted. Moreover, none of the trials were powered to assess the effect of intravenous iron in clinically important subgroups. Therefore, we conducted a Bayesian analysis to derive precise estimates of the effect of intravenous iron replacement on recurrent HF hospitalizations and cardiovascular mortality in iron-deficient HFrEF patients using consistent subgroup definitions across trials.

Methods and results

Individual participant data were used from the FAIR-HF (n = 459), CONFIRM-HF (n = 304) and AFFIRM-AHF (n = 1108) trials. These data were re-analysed following as closely as possible the approach taken in the analyses of IRONMAN (n = 1137), for which study level data were used. Definitions of outcomes and subgroups from the FAIR-HF, CONFIRM-HF and AFFIRM-AHF were matched with those used in IRONMAN. The primary endpoint was recurrent HF hospitalizations and cardiovascular mortality. The analysis of recurrent events was based on rate ratios (RR) derived from the Lin-Wei-Yang-Ying model, and the data were pooled using Bayesian random-effects meta-analysis. Compared with placebo, intravenous iron significantly reduced the rates of recurrent HF hospitalizations and cardiovascular mortality (RR 0.73, 95% credible interval [CI] 0.48–0.99; between-trial heterogeneity tau = 0.16). The pooled treatment effects did not provide evidence for any differential effects for subgroups based on sex (ratio of rate ratios [RRR] 1.49 [95% CI 0.95–2.37], age <69.4 vs. ≥69.4 years) (RRR 0.68 [0.40–1.15]), ischaemic versus non-ischaemic aetiology of HF (RRR 0.73 [0.42–1.33]), transferrin saturation <20% vs. ≥20% (RRR 0.75 [0.40–1.34]), estimated glomerular filtration rate ≤60 versus >60 ml/min/1.73 m² (RRR 0.97 [0.56–1.68]), haemoglobin <11.8 versus ≥11.8 (RRR 0.95 [0.53–1.60]), ferritin <35 versus ≥35 μg/L (RRR 1.26 [0.72–2.48]) and New York Heart Association class II versus III/IV (RRR 0.91 [0.54–1.56]).

Conclusions

Treatment of iron-deficient HFrEF patients with intravenous iron – namely with ferric carboxymaltose or ferric derisomaltose – results in significant reduction in recurrent HF hospitalizations and cardiovascular mortality. Results were nominally consistent across the subgroups studied, but for several of these subgroups uncertainty remains present.     

妊娠合并心力衰竭孕妇分娩方式及妊娠结局分析

目的探讨妊娠合并心力衰竭孕妇的分娩方式及其对妊娠结局的影响。 方法选取2017年1月至2018年1月胶州市人民医院收治的100例妊娠合并心力衰竭孕妇作为研究对象,评估其心功能分级,并统计所有孕妇分娩方式(阴道分娩和剖宫产)与不良妊娠结局(新生儿窒息、足月低体质量、早产、围生儿死亡)发生率。 结果100例孕妇中,心功能NYHA分级Ⅰ级10例、Ⅱ级49例、Ⅲ级29例、Ⅳ级12例。Ⅰ＋Ⅱ级孕妇阴道分娩率为52.54%(31/59),Ⅲ＋Ⅳ级孕妇阴道分娩率为26.83%(11/41),差异有统计学意义(P<0.05)。Ⅰ＋Ⅱ级孕妇新生儿窒息、足月低体质量、早产、围生儿死亡发生率均低于对照组,差异有统计学意义(均P<0.05)。 结论妊娠合并心力衰竭孕妇心功能状态可对分娩方式及妊娠结局产生显著影响,且心功能分级越高,剖宫产率与不良妊娠结局发生风险越高。     

卡维地洛治疗充血性心力衰竭的临床研究

目的:探讨卡维地洛对充血性心力衰竭(CHF)患者心功能的影响。方法:45例CHF患者被随机分成2组.对照组(B组)用利尿剂、强心甙、硝酸酯类等药进行治疗,治疗组(A组)在B组治疗基础上加用卡维地洛,起始剂量3.125mg,2次/d,每2周加量1倍,至最大剂量25mg,2次/d。结果:治疗16周后,两组的心功能分级均有明显改善.与对照组比较,治疗组LVEF增加更加显著(P<0.05)。结论:卡维地洛对CHF有较好的疗效。     

Prevalence and prognostic importance of malnutrition,as assessed by four different scoring systems,in elder patients with heart failure

Background and aimsThe lack of standard diagnostic criteria in elder patients with heart failure (HF) makes it challenging to diagnose and manage malnutrition. We aimed to explore the prevalence of malnutrition, its associations and prognostic significance among elder patients with HF using four different nutritional scoring systems.Methods and resultsConsecutively presenting patients aged ⩾65 years, diagnosed with HF, and admitted to HF care unit of Fuwai Hospital CAMS&PUMC (Beijing, China) were assessed for nutritional indices. In total, 1371 patients were enrolled (59.4% men; mean age 72 years; median NT-proBNP 2343 ng/L). Using scores for the prognostic nutritional index (PNI) ≤38, controlling nutritional status (CONUT) score >4, geriatric nutritional risk index (GNRI) ≤91, and triglycerides, total cholesterol, and body weight index (TCBI) ≤1109, 10.4%, 18.3%, 9.2%, and 50.0% of patients had moderate or severe malnutrition, respectively. There was a strong association between worse scores and lower body mass index, more severe symptoms, atrial fibrillation, and anemia. The mortality over a median follow-up of 962 days (interquartile range (IQR): 903–1029 days) was 28.3% (n = 388). For those with moderate or severe condition, 1-year mortality was 35.2% for PNI, 28.3% for CONUT, 28.0% for GNRI, and 19.1% for TCBI. Malnutrition, defined by any of the included indices, showed added prognostic value when incorporated into a model and included preexisting prognostic factors (C-statistic: 0.711). However, defining malnutrition by the CONUT score yielded the most significant improvement in the prognostic predictive value (C-statistic: 0.721; p < 0.001).ConclusionMalnutrition is prevalent among elder patients with HF and confers increased mortality risk. Among the nutritional scores studied, the CONUT score was most effective in predicting the mortality risk.Clinical trial registrationURL: ClinicalTrials.gov; Unique Identifier: NCT02664818.     

免疫球蛋白对心梗后心衰大鼠心功能及非梗死区胶原的影响

目的 研究免疫球蛋白对心肌梗死后心衰大鼠心功能的影响及非梗死区胶原的抑制作用.方法 将结扎左冠状动脉前降支并饲养6 w的24只存活雌性Wistar大鼠,分为假手术组、模型组及免疫球蛋白组,每组8只.连续腹腔注射给药4 w后测定大鼠血流动力学参数,Masson染色观察非梗死区心肌胶原的沉积.结果 免疫球蛋白能明显升高左心室内压最大上升和最大下降速率(+dp/dtmax及-dp/dtmax),能明显升高左心室收缩压(LVSP),降低左心室舒张末压(LVEDP)(P＜0.05或P<0.01),但对心率(HR)、收缩压(SBP)、舒张压(DBP)无明显影响(P>0.05).Masson染色可见非梗死区心肌胶原沉积明显减轻.结论 免疫球蛋白对梗死后心衰大鼠非梗死区心肌间质胶原重构有显著的抑制作用,其作用机制与减轻胶原沉积有关.     

Trends in hospitalization and mortality for heart failure in Spain, 1980-1993

AIMS: To describe, for the first time, trends in hospitalization andmortality rates for congestive heart failure in Spain duringthe period 1980–1993. METHODS AND RESULTS: Data on primary diagnosis of congestive heart failure were takenfrom the National Hospital Morbidity Survey and the NationalVital Statistics. The number of hospital admissions for congestiveheart failure rose by 71% (from 42 965 in 1980 to 73 448 in1993) and hospitalization rates for congestive heart failureincreased by 47% (from 348 per 100 000 in 1980 to 511 per 100000 in 1993). The rise in hospitalizations was limited to personsaged 65 years, and proved greater among women. Congestive heartfailure was the leading cause of hospitalization in personsaged 65 years, accounting for 5% of all hospital admissionsin this age group. Age-adjusted congestive heart failure mortalitydeclined by 23%. The decline affected all age groups, with thesole exception of the 80-year group in which mortality rose.Nevertheless, congestive heart failure remained the third leadingcause of cardiovascular death. CONCLUSION: Congestive heart failure represents a significant hospital anddemographic burden for the Spanish population. The hospitalburden increased substantially in the period 1980–1993,and will continue to do so in future with the growth of theelderly population.     

Central and peripheral testosterone effects in men with heart failure: An approach for cardiovascular research

Heart failure (HF) is a syndrome recognized as a health problem worldwide. Despite advances in treatment, patients with HF still have increased morbidity and mortality. Testosterone is one of the most researched hormones in the course of HF. Growing interest regarding the effect of testosterone, on a variety of body systems, has increased the knowledge about its mechanisms of action. The terms central and peripheral effects are used to distinguish the effects of testosterone on cardiac and extracardiac structures. Central effects include influences on cardiomyocytes and electrophysiology. Peripheral effects include influences on blood vessels, baroreceptor reactivity, skeletal muscles and erythropoesis. Current knowledge about peripheral effects of testosterone may explain much about beneficiary effects in the pathophysiology of HF syndrome. However, central, i.e., cardiac effects of testosterone are to be further explored.     

云南思茅地区10年间心力衰竭住院病死率比较分析

目的 :探讨云南思茅地区近 10年来心力衰竭 (心衰 )的治疗概况。方法 :对我院 1987～ 1989年 136例和 1997～ 1999年 2 0 0例心衰患者的资料作比较 ,以了解云南思茅地区 10年间该病的自然病情和诊治学的改变。结果 :与 1987～ 1989年组比较 ,1997～ 1999年组患者的基本临床资料除高血压心脏病心衰率增加外 (P <0 .0 5 ) ,其他无任何改变。由于血管紧张素转换酶抑制剂 (ACEI)等药物的应用 ,使心衰平均住院病死率由 45 .5 9%降至 18.0 0 % ,有统计学意义 (P<0 .0 5 )。但心衰猝死率居高不下。结论 :近 10年来 ,由于 ACEI,β受体阻滞剂的应用 ,使心衰住院病死率明显下降 ,但猝死率无改变。