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Objective To investigate the effect of different serum sodium levels on heart function and prognosis in very elderly patients with heart failure. Methods Totally 152 elderly patients(aged ≥ 85 years)with hyponatremia were enrolled.Based on the serum sodium level ,they were divided into mild(125 mmol/L ≤ Na+ < 135 mmol/L) ,moderate(125 mmol/L ≤ Na+ < 135 mmol/L) ,and severe hyponatremia(Na+ < 115 mmol/L)groups ,and 76 patients with normal blood sodium level(Na+ ≥ 135 mmol/L)were selected as control group. The general data ,levels of serum creatinine and N-terminal pro-brain natriuretic peptide (NTproBNP)and prognosis were compared among the above groups. Results Compared with the control group ,patients with severe hyponatremia were much older ,with more diuretics administration ,higher level of serum creatinine , lowerlevelofeGFRandleftventricularejectionfractions[(38.1±3.9)％ vs.(45.2±9.7)％ ].There were higher incidences of coronary atherosclerotic heart disease [72.4％ (n=21)vs. 56.6％ (n=43)] ,diabetes[41.4％ (n=12)vs. 23.7％ (n=18)] ,chronic renal insufficiency [22.6％ (n=8)vs. 11.8％ (n=9)] ,stroke[20.6％ (n=6)vs. 9.2％ (n=7)]in patients with severe hyponatremia compared with other groups. The severe hyponatremia group showed significantly higher levels of NTproBNP [(4823. 9 ± 588. 1 )ng/L v s. (1124. 4 ± 349. 1 )ng/L ,(1836. 2 ± 369. 3 )ng/L ,(2894. 1 ± 687. 3 )ng/L ]and higher rates of mortality [27.6％ (n=8) vs.5.3％ (n=4) ,7.6％ (n=6) ,13.6％ (n=6)]as compared to the control group ,mild and moderate hyponatremia groups. Furthermore ,length of stay in hospital were markedly longer in patients with severe hyponatremia than those with mild and moderate hyponatremia[(11.1 ± 7.1)d vs. (19.6 ± 5.7)d ,(16.1 ± 4.2)d] . Conclusions Hyponatremia is a common type of electrolyte disorder in very elderly patients with heart failure ,and severe hyponatremia may predictand increased risk of death.
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Objective To investigate the impact of hyper-homocystinemia (Hcy)on cardiac remolding in spontaneously hypertensive rat(SHR)and the protective effects of folic and vitamin B12 on the remolding.Methods The seven-week-old SHR were divided into four groups according to different diet for 20 weeks.The control group was fed a perfect compound diet without methionine,the methionine group was fed a perfect compound diet added with 2 ％ methionine,the treatment group was fed as that of methionine group,but added with vitamin B12 0.09 mg/(kg.d)and folate 4 mg/(kg.d)in the last 12 weeks,the mixture group was fed as that of methionine group in the first 8 weeks,and as that of control group.At the end of the intervention period,plasma levels of Hcy and matrix metalloprotease(MMP)-9 were measured.The blood pressure was detected by the non-invasive blood pressure sensing device.The cardiac structure and function were detected using echocardiography and invasive hemodynamic method.Picro-sirius red(PSR)staining was used to check the fibrosis in paraffin embedding ventricle section.Results Plasma levels of Hcy and MMP-9 were increased in the methionine group,while there was no significant difference in plasma levels of Hcy and MMP-9 among the treatment group,the mixture diet group and control group.Rats in methionine group had the largest heart weight among four groups,and systolic blood pressure was lower in methionine group than in the control group(P＜0.05).Compared with the other three groups,the methionine group showed that the left ventricular end-diastolic pressure(LVEDP)was increased and-dp/dt maxwas decreased.Meanwhile,LVEDP and-dp/dt m,x had no significant difference between the control group,treatment group and mixture group.The methionine group showed the most severe decrease in the left ventricular fractional shortening(LVFS)and +dp/dt While LVFS and + dp/dt max had no statistical significance between the treatment group and control groups,but the mixture group had lower LVFS and +dp/dt max values as compared with the control group(both P＜0.05).Perivascular fibrosis was increased significantly in methionine group as compared with the other three groups,while the treatment and control groups had similar perivascular fibrosis,but the mixture group had higher perivascular fibrosis than did the control group,and had similar perivascular fibrosis to the treatment group.Fibrosis deposition in myocardium mesenchymal was similar to those observed in perivascular fibrosis,but the treatment group showed a more improvement of collagen deposition as compared with the mixture group.Conclusions Hyper-homocystinemia can accelerate systolic and diastolic dysfunction through accumulating fibrosis in myocardium and perivascular wall which lead to adverse cardiac remolding.Folate and vitamin B12 have protective effects on heart function by reversing the adverse changes through decreasing Hcy level.
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Objective To explore the correlation of serum homocysteine(Hcy)levels and hypertrophy of left ventricle in very elderly hypertensive patients.Methods According to plasma Hcy levels,patients with essential hypertension (n=378) were divided into non H-type hypertension group (n=142) and H-type hypertension group (n=236). Height, weight, reg?ular medication, blood pressure, renal function, blood lipid profile and the concentration of plasma Hcy were recorded. Color Doppler ultrasonic equipment was used to determine the morphology and structure of left ventricle. The correlation between plasma Hcy and left ventricle remodeling was analyzed. Results The ratio of left ventricular hypertrophy was higher in H-type hypertension group than that in non H-type hypertension group(45.8%vs 24.6%,χ2=16.81,P<0.001). Patients in H-type hypertension group had higher systolic blood pressure, higher plasma level of Hcy and larger left ventricular posterior wall thickness(LVPWT), larger interventricular septal thickness (IVST) and increased left ventricular mass index (LVMI) compared to those in non H-type hypertension group(162.20 ± 14.97)vs(149.70 ± 5.06)mmHg,(19.76 ± 5.83)μmol/L vs (9.53±0.72)μmol/L,(9.77±2.35)vs(9.21±2.68)mm,(9.74±3.15)vs(8.51±2.42)mm,(118.64±39.38)vs(101.85±41.71)g/m2 respectively, all P<0.05). There was a positive correlation between LVMI and Hcy(r=0.381,P<0.001). Multivariable Lo?gistic regression analysis showed that hyperhomocysteinemia was an independent risk factor of LVMI. Conclusion High plasma Hcy level is an independent risk factor of LVMI, which works together with hypertension to promote left ventricular re?molding.
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Objective To investigate the pattern of antihypertensive medication prescribing in outpatients from the Second Hospital of Tianjin Medical University, and analyze the shortcoming and deficiency compared with 2010 Chinese guidelines for the management of hypertension. Methods A total of 154 262 electronic prescribing for outpatients with hy-pertension, from January-December 2012 in a Grade 3A hospital in Tianjin, were enrolled in this retrospective survey. Data of commonly used antihypertensive medication and combination therapy in patients were analyzed. The patient data collected were divided into different groups according to age, gender, high blood pressure level and the onset of the season. Results (1)The list of the drugs commonly used for treating hypertension in outpatients were calcium antagonist (52.3%), angiotensin receptor blockers (34.0%),βblockers (25.9%), angiotensin-converting enzyme inhibitors (12.1%), fixed-dose combination (11.0%) and diuretics (1.4%).(2)The fewer combination therapy was found in outpatients than that of monotherapy (43.9%vs 56.1%). Some prescriptions were not routinely recommended by the Guideline (4.6%).(3)The combination therapy used in patients with stage 3 hypertension was higher than that of patients with stage 1or stage 2 hypertension (44.5%vs 37.7%vs 37.7%, P<0.01). The rate of combination therapy was significantly higher in cardiology department than that of other clini-cal departments (P<0.01). The combination therapy tended to be used in the elderly patients than that of non-elderly pa-tients (P<0.01). The number of prescriptions was lower in summer than that of other seasons,but the rate of combination therapy was higher in summer than that of spring, autumn and winter (P<0.01). Conclusion The prescriptions of combina-tion therapy and diuretic were inadequate in outpatients with hypertension. These findings indicate the difference between clinical prescription and the guideline for the management of hypertension.
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Objective To understand the practical application of drug intervention in elderly patients with chronic heart failure (CHF) for providing evidences and data for a standard treatment. Methods The elderly CHF patients aged at least 60 years who were hospitalized from July 1973 toJuly 2007 in the Second Hospital of Tianjin Medical University and from January 1983 to December 2002 in Tianjin First Center Hospital were enrolled. The age, gender, etiology, heart function and drug therapy were retrospectively analyzed. The patients were divided into 4 groups: group 1973-,group 1980-, group 1990- and group 2000-2007. And the data were collected and analyzed by SPSS 13.0 software. Results A total of 4704 cases were enrolled, of which there were 2430 (51.7%)male and 2274 (48. 3%) female. Mean age was (71.3±-7. 1) years. The patients aged 80 years andover accounted for 12.8% (603/4704). The first three ranking causes were pulmonary heart disease,coronary heart disease and rheumatoid heart disease in group 1973- and 1980-. And those were coronary heart disease, pulmonary heart disease and rheumatoid heart disease in group 1990 and 2000-2007. The combined uses of angiotension converting enzyme inhibitors(ACEI) and β-receptor blocker,and of ACEI, β-receptor blocker and aldosterone antagonist were also increasing year by year. Patients with coronary heart disease, rheumatoid heart disease, pulmonary heart disease and dilated cardiomyopathy had a higher proportion of multiple drugs cotreatment. The differences in the frequency of all drugs use among four groups of CHF had a statistical significance (p＜0.05). The usage of ACEI combined with β-receptor blocker and aldosterone antagonist, and ACEI combined withβ-receptor blocker, diuretic and digitalis was increasing along with the heart function becoming serious. The patients with a heart function of New York Heart Association (NYHA) Ⅱ or Ⅲ class received more β-receptor blocker. And ACEI was used at most in patients with NYHA Ⅲ class. The angiotension Ⅱ receptor blockers(ARB) was used at most in NYHA Ⅲ or Ⅳ class. Conclusions Nitrate, diuretic and digitalis are the main therapeutic agents in hospitalized patients with CHF in some regions of Tianjin. ACEI, β-receptor blocker and ARB are used in a rapid increment. There are still some problems such as standardizing the heart failure treatment and prevention in the elderly.
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Objective To analyze the influence of hyponatremia on hospitalization days and hospital mortality of hospitalized patients with chronic heart failure. Methods All data were collected from 2465 patients with chronic heart failure in our hospital between January 1980 and August 2007. According to the admission serum sodium, all the patients were divided into two groups: low serum sodium group (Na+<135 mmol/L) and normal serum sodium group (Na+≥135retool/L). Clinical characteristics, therapeutic conditions and the influence of hyponatremia on prognosis were analyzed between the two groups. Results There were 618 patients in low serum sodium group among 2465 cases. Patients with hyponatremia were more likely to have lower systolic blood pressure and lower left ventricular ejection fraction. Lower admission serum sodium was related with higher concentration of serum angiotensin, aldosterone and higher activity of serum renin. Patients in low serum sodium group had significantly longer hospitalization days (Z=-4.026, P<0.01) and higher rate of hospital mortality (χ2=76.935, P<0.01) than patients in normal serum sodium group. Multivariate logistic regression indicated that lower admission serum sodium was an independent risk factor for hospitalization days (b= 0.928, P<0.01) and hospital mortality (OR=0.928, P<0.01). There was a negative correlation between admission serum sodium and hospitalization days (r=-0.132, P<0.01), and the rate of hospital mortality increased by 24.7for each 3 mmol/L decrease in admission serum sodium level. Conclusions Hyponatremia in hospitalized patients with chronic heart failure is relatively common and is associated with poorer heart function, higher activity of neural hormone and more severe prognosis. It is important to prevent hyponatremia for shortening hospitalization days and improving the prognosis of patients with chronic heart failure.