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目的·探讨同时患有2型糖尿病（type 2 diabetes mellitus,T2DM）、高血压和心房颤动患者中,不同血糖、血压控制水平及心房颤动控制策略对于新发射血分数保留心力衰竭（heart failure with preserved ejection fraction,HFpEF）风险的影响。方法·收集2008年1月—2012年12月在上海交通大学医学院附属第九人民医院心血管内科就诊的418例同时患有T2DM、高血压和心房颤动,但无心力衰竭症状及体征的患者。观察7年随访期内,不同血糖控制水平（糖化血红蛋白：<7.0%、7.0%～8.0%、>8.0%）、不同血压控制水平[24 h收缩压：<120 mmHg（1 mmHg=0.133 kPa）、120～140 mmHg、>140 mmHg]以及心房颤动节律控制或心率控制对该人群新发HFpEF风险的影响。采用单因素和多因素Cox回归模型探索新发HFpEF的相关危险因素。结果·7年随访期内,418例患者中有67例发生HFpEF;对比糖尿病、高血压和心房颤动的不同控制水平或治疗策略,强化降糖（糖化血红蛋白<7.0%）、血压控制不佳（24 h收缩压>140 mmHg）和心房颤动心率控制的患者新发HFpEF风险最高（37.9%）,而标准降糖（糖化血红蛋白7.0%～8.0%）、强化降压（24 h收缩压<120 mmHg）和心房颤动节律控制的患者新发HFpEF风险最低（4.8%）。多因素Cox回归分析显示,心房颤动心率控制策略（HR=1.727,95%CI 1.079～2.997,P=0.036）是新发HFpEF的独立危险因素。结论·对于同时患有T2DM、高血压和心房颤动的患者,采取标准降糖、强化降压和心房颤动节律控制可能是延缓HFpEF进展的重要因素。 相似文献
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《JACC: Cardiovascular Interventions》2020,13(10):1236-1247
ObjectivesOur study reports the first-in-human experience of a novel approach for left atrial access via the coronary sinus—the percutaneous atriotomy—which is used for left atrial decompression with a dedicated left atrial (LA)–to–coronary sinus (CS) shunt.BackgroundElevated LA pressures contribute to heart failure symptoms, and targeted therapy with atrial shunt devices for LA decompression is an emerging strategy. Current devices reside in the interatrial septum, with risk for right-to-left shunting and systemic embolization. Moreover, preservation of the interatrial septum is imperative with an increasing number of left-sided transseptal transcatheter interventions.MethodsPatients with symptomatic heart failure underwent implantation in a multicenter, international compassionate experience. Clinical, anatomic, and hemodynamic parameters were assessed at baseline and follow-up. The right internal jugular vein enabled CS cannulation, followed by CS-to-LA puncture and balloon dilation of the LA wall, completing the percutaneous atriotomy. The novel shunt device was then deployed between the left atrium and CS, enabling LA decompression.ResultsPercutaneous atriotomy was attempted in 11 patients, with success in 8; of these, all shunt deployments were successful. In follow-up (median 201 days; interquartile range [IQR]: 156 to 260 days) there were no major periprocedural adverse events, New York Heart Association functional class improved to I or II in 87.5%, pulmonary capillary wedge pressure was reduced (Δ −9 mm Hg; IQR: −9.5 to −8 mm Hg), and shunting was sustained (Δ Qp/Qs 0.25; IQR: 0.19 to 0.33).ConclusionsOur study reports the first-in-human experience of a novel approach for left-sided transcatheter cardiac interventions: the percutaneous atriotomy. This approach enabled the placement of a novel LA-to-CS shunt for LA decompression. The procedure is feasible and results in clinical and hemodynamic improvements. 相似文献
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Background
Peak exercise pulmonary oxygen uptake (V?O2) is a primary marker of prognosis in heart failure (HF). The pathophysiology of impaired peak V?O2 is unclear in patients. To what extent alveolar airway function affects V?O2 during cardiopulmonary exercise testing (CPET) has not been fully elucidated. This study aimed to describe how changes in alveolar ventilation (V?A), volume (VA), and related parameters couple with exercise V?O2 in HF.Methods and Results
A total of 35 patients with HF (left ventricular ejection fraction 20 ± 6%, age 53 ± 7 y) participated in CPET with breath-to-breath measurements of ventilation and gas exchange. At rest, 20 W, and peak exercise, arterial CO2 tension was measured via radial arterial catheterization and used in alveolar equations to derive V?A and VA. Resting lung diffusion capacity for carbon monoxide (DLCO) was assessed and indexed to VA for each time point. Resting R2 between V?O2 and V?A, VA, DLCO, and DLCO/VA was 0.68, 0.18, 0.20, and 0.07, respectively (all P < .05 except DLCO/VA). 20 W R2 between V?O2 and V?A, VA, DLCO, and DLCO/VA was 0.64, 0.32, 0.07, and 0.18 (all P < .05 except DLCO). Peak exercise R2 between V?O2 and V?A, VA, DLCO, and DLCO/VA was 0.55, 0.31, 0.34, and 0.06 (all P < .05 except DLCO/VA).Conclusions
These data suggest that alveolar airway function that is not exclusively related to effects caused by localized lung diffusivity affects exercise V?O2 in moderate-to-severe HF. 相似文献88.
Ramachandran S. Vasan Vanessa Xanthakis Asya Lyass Charlotte Andersson Connie Tsao Susan Cheng Jayashri Aragam Emelia J. Benjamin Martin G. Larson 《JACC: Cardiovascular Imaging》2018,11(1):1-11
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.Background
Temporal trends in the prevalence and management of major risk factors may affect the epidemiology of HF.Methods
We compared the frequency, correlates, and prognosis of LVSD (left ventricular ejection fraction [LVEF] <50%) among Framingham Study participants without and with clinical HF in 3 decades (1985 to 1994, 1995 to 2004, and 2005 to 2014).Results
Among participants without HF (12,857 person-observations, mean age 53 years, 56% women), the prevalence of LVSD on echocardiography decreased (3.38% in 1985 to 1994 vs. 2.2% in 2005 to 2014; p < 0.0001), whereas mean LVEF increased (65% vs. 68%; p < 0.001). The elevated risk associated with LVSD (～2- to 4-fold risk of HF or death) remained unchanged over time. Among participants with new-onset HF (n = 894, mean age 75 years, 52% women), the frequency of heart failure with preserved ejection fraction (HFpEF) increased (preserved LVEF ≥50%: 41.0% in 1985 to 1994 vs. 56.17% in 2005 to 2014; p < 0.001) and heart failure with reduced ejection fraction (HFrEF) decreased (reduced LVEF <40%: 44.10% vs. 31.06%; p = 0.002), whereas heart failure with midrange LVEF remained unchanged (LVEF 40% to <50%: 14.90% vs. 12.77%; p = 0.66). Cardiovascular mortality associated with HFrEF declined across decades (hazard ratio: 0.61; 95% confidence interval: 0.39 to 0.97), but remained unchanged for heart failure with midrange LVEF and HFpEF. Approximately 47% of the observed increase in LVEF among those without HF and 75% of the rising proportion of HFpEF across decades was attributable to trends in risk factors, especially a decline in the prevalence of coronary heart disease among those with HF.Conclusions
The profile of HF in the community has changed in recent decades, with a lower prevalence of LVSD and an increased frequency of HFpEF, presumably due to concomitant risk factor trends. 相似文献89.
《The Journal for Nurse Practitioners》2019,15(1):12-18
Approximately 6.5 million Americans have heart failure, and the cost is projected to reach $70 billion annually by the year 2020. Hospital systems and providers are tasked with effectively managing this condition to prevent readmission from exacerbations. In fact, if patients are readmitted within 30 days of discharge, payers limit reimbursement for the care. Traditional clinic markers and monitoring systems have failed to reduce hospital readmission rates because these systems rely on patient symptoms, which too often present late in the decompensation process. Newer technology shows promise at identifying heart failure earlier and may reduce readmission rates. 相似文献
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