Analysis of the Treatment Strategy of Heart Failure with Preserved Ejection Fraction Based on ZHANG Boli's Theory of “Damp-turbidity and Phlegm-rheum Type of Diseases” / 中医杂志

Professor ZHANG Boli believed that the core pathogenesis of heart failure with preserved ejection fraction （HFpEF） is weak pulse at yang and wiry pulse at yin. By referring to the theory of “damp-turbidity and phlegm-rheum type of diseases”， he proposed that yin pathogens of damp-turbidity and phlegm-rheum may damage yang qi in each stage of HFpEF， thus aggravating the trend of weak pulse at yang and wiry pulse at yin， which played an important role in the deterioration of HFpEF. Therefore， Professor ZHANG Boli advocated that importance should be attached to the elimination of yin pathogen and the protection of yang qi during the various stages of HFpEF in order to delay the aggravation of weak pulse at yang and wiry pulse at yin； he put forward the idea of staged treatment that “yin pathogen should be dispelled and yang qi should be demonstrated”； and he formulated the treatment strategy of treating the disease as early as possible， eliminating pathogens and protecting yang， interrupting the disease trend， using warm-like medicinals， and activating blood circulation， to enrich the theoretical system of traditional Chinese medicine in the treatment of HFpEF.

Berberine alleviates myocardial diastolic dysfunction by modulating Drp1-mediated mitochondrial fission and Ca2+ homeostasis in a murine model of HFpEF / 医学前沿

Heart failure with preserved ejection fraction (HFpEF) displays normal or near-normal left ventricular ejection fraction, diastolic dysfunction, cardiac hypertrophy, and poor exercise capacity. Berberine, an isoquinoline alkaloid, possesses cardiovascular benefits. Adult male mice were assigned to chow or high-fat diet with L-NAME ("two-hit" model) for 15 weeks. Diastolic function was assessed using echocardiography and noninvasive Doppler technique. Myocardial morphology, mitochondrial ultrastructure, and cardiomyocyte mechanical properties were evaluated. Proteomics analysis, autophagic flux, and intracellular Ca2+ were also assessed in chow and HFpEF mice. The results show exercise intolerance and cardiac diastolic dysfunction in "two-hit"-induced HFpEF model, in which unfavorable geometric changes such as increased cell size, interstitial fibrosis, and mitochondrial swelling occurred in the myocardium. Diastolic dysfunction was indicated by the elevated E value, mitral E/A ratio, and E/e' ratio, decreased e' value and maximal velocity of re-lengthening (-dL/dt), and prolonged re-lengthening in HFpEF mice. The effects of these processes were alleviated by berberine. Moreover, berberine ameliorated autophagic flux, alleviated Drp1 mitochondrial localization, mitochondrial Ca2+ overload and fragmentation, and promoted intracellular Ca2+ reuptake into sarcoplasmic reticulum by regulating phospholamban and SERCA2a. Finally, berberine alleviated diastolic dysfunction in "two-hit" diet-induced HFpEF model possibly because of the promotion of autophagic flux, inhibition of mitochondrial fragmentation, and cytosolic Ca2+ overload.

Correlation of serum ST2 levels with severity of diastolic dysfunction on echocardiography and findings on cardiac MRI in patients with heart failure with preserved ejection fraction

Objective: The aim of the present study was to find a correlation of serum Suppression of tumorigenicity 2 (ST2) levels with severity of diastolic dysfunction on echocardiography and cardiac magnetic resonance imaging (CMRI) in heart failure with preserved ejection fraction (HFpEF) patients. Methods: Fifty patients aged _x0001_18 years fulfilling diagnostic criteria for HFpEF were included. ST2 levels, 2D echocardiography and CMRI were performed. Left ventricular ejection fraction, E/A, Septal E/E’, left atrial volume index (LAVI), tricuspid regurgitation (TR), assessment of diastolic dysfunction, T1 mapping in milliseconds and late gadolinium enhancement (LGE) in percentage were noted. The primary outcome measure was to study correlation of ST2 levels with severity of diastolic dysfunction, whereas the secondary outcome measures were to study correlation of ST2 levels with native T1 mapping and LGE on CMRI. Results: ST2 levels showed statistically significant and positive correlation with E/E’ (r ¼ 0.837), peak TR velocity (r ¼ 0.373), LAVI (r ¼ 0.74), E/A (r ¼ 0.420), and T1 values in milliseconds (r ¼ 0.619). There was no statistically significant correlation between ST2 level and LGE in % (r ¼ 0.145). The median ST2 levels in patients with E/E’ > 14 and E/E’ 14 were 110.8 and 36.1 respectively (p-value < 0.05). The mean ST2 levels were significantly higher in patients who had diastolic dysfunction grade III (126.4) and New York Heart Association class IV (133.3). Conclusions: Evaluation of ST2 adds important information to support the diagnosis of left ventricular diastolic dysfunction in patients with HFpEF

Heart failure with preserved ejection fraction: an update on pathophysiology, diagnosis, treatment, and prognosis

Heart failure (HF) with preserved ejection fraction (HFpEF) is a clinical syndrome in which patients have symptoms and signs of HF with normal or near-normal left ventricular ejection fraction (LVEF ≥50%). Roughly half of all patients with HF worldwide have an LVEF ≥50% and nearly half have an LVEF <50%. Thanks to the increased scientific attention about the condition and improved characterization and diagnostic tools, the incidence of HF with reduced ejection fraction (HFrEF) dropped while that of HFpEF has increased by 45%. HFpEF has no single guideline for diagnosis or treatment, the patient population is heterogeneously and inconsistently described, and longitudinal studies are lacking. To better understand and overcome the disease, in this review, we updated the latest knowledge of HFpEF pathophysiology, introduced the existing promising diagnostic methods and treatments, and summarized its prognosis by reviewing the most recent cohort studies.

Clinical characteristics of patients with preserved ejection fraction and reduced heart failure / 中国基层医药

Objective To compare the clinical characteristics of heart failure patients with preserved ejection fraction (HFPEF) and reduced ejection fraction (HFREF).Methods A total of 171 patients with heart failure from September 2015 to November 2017 in the Second Hospital of Shanxi Medical University were retrospectively analyzed . According to left ventricular ejection fraction (EF),the patients were divided into two groups : HEPEF [EF≥45%, 84 cases,mean age (64.8 ±2.2)years old,33 males and 51 females] and HFREF (EF＜45%,87 cases,mean age (74.6 ±1.5) years old,including 61 males and 26 females).The clinical data of the two groups including general information,underlying etiology,biochemical indicators,echocardiography results,medication in detail were recorded. Results Among the 171 patients, there were 69 patients with coronary heart disease , 44 patients with dilated cardiomyopathy,21 patients with hypertensive heart disease ,10 patients with pulmonary heart disease ,15 patients with rheumatic heart disease,7 patients with degenerative valvular disease ,2 patients with congenital heart disease ,2 cases of heart failure caused by atrial fibrillation ,1 case of viral myocarditis .The patients in the HFPEF group were older [(74.6 ±1.5)years old vs.(64.8 ±2.2) years old,t＝3.598,P＝0.015],more women(60.7%vs.29.9%,χ2＝16.410,P＝0.000),lower body weight [(62.7 ±13.4) kg vs.(68.6 ±14.9) kg,t ＝－2.395,P＝0.018],less likely to have renal insufficiency(36.7%vs.53.6%,χ2＝4.670,P＝0.041),and more likely to have hypertension (54.8%vs.37.9%,χ2＝4.871,P＝0.032) and atrial fibrillation(47.6% vs.13.8%,χ2＝23.107,P＝0.000). The HFPEF group had higher admission systolic blood pressure than the HFREF group [(131.2 ±22.2)mmHg vs. (124.1 ±24.9)mmHg,t＝2.058,P＝0.041].The BNP value[(874.2 ±912.3) pg/mL vs.(835.2 ±1 490.4)pg/mL,t＝－5.011,P＝0.000],hemoglobin value[(125.5 ±24.3)g/L vs.(134.7 ±23.9)g/L,t＝－2.460,P＝0.015] in the HFPEF group were lower than those in the HFREF group .The ESR in the HFPEF group was faster than that in HFREF group[(28.0 ±25.6)mm/h vs.(16.9 ±14.9)mm/h,t＝2.486,P＝0.017].The HFPEF group had smaller left ventricular size than the HFREF group [(50.9 ±6.4)mm vs.(67.3 ±8.5)mm,t＝－11.303,P＝0.000].RAS blockers (52.4% vs.86.2%,χ2＝23.107,P ＝0.000),spironolactone (72.6% vs.88.5%,χ2＝6.926,P ＝0.011),β－blockers (57.1% vs.75.9%,χ2＝6.739,P ＝0.015),statin (38.1% vs.54%,χ2＝4.362,P＝0.046) were used more in the HFREF group,while calcium channel blockers (38.1%vs.13.8%,χ2＝13.208,P＝0.000) and warfarin (16.7%vs.5.7%,χ2＝5.159,P＝0.129) were used more in the HFPEF group.Conclusion Different clinical characteristics were found in patients with HFPEF and HFREF ..Different types of heart failure need different treatment and prevention programs .

Coronary artery lesions in different types of heart failure with ischemic heart disease / 实用医学杂志

Objective To compare the degree of coronary lesions in different types of heart failure with ischemic heart disease. Methods This retrospective analysis include 282 cases diagnosed as heart failure with ischemic heart disease in Zhengzhou People′s Hospital from January 2015 to May 2016. Based on LVEF and the level of BNP and NT-proBNP examination results ,282 cases were divided into HFmrEF(89 cases),HFrEF(109 cases) and HFpEF (84 cases). The clinical basic data ,cardiac color Doppler ultrasound and the difference of coronary artery lesions were compared. Results (1) HFpEF,HFmrEF and HFrEF groups gensini score were 30.45 ± 33.18,62.12 ± 41.25,86.72 ± 38.80. The differences are significant(P < 0.05). Pairwise comparison showed significant difference.(2)HFpEF,HFmrEF and HFrEF groups SYNTAX score were 11.77 ± 8.39,19.08 ± 8.39,26.41 ± 10.31. Compared with HFpEF group,the SYNTAX score of other groups are higher(P < 0.05). (3)The duration of disease ,LVEDD ,LVESD ,LVMI ,the number of vascular lesions was significantly higher in HFrEF group than those in other groups. (4) Multivariate correlation analysis suggested that SYNTAX scores were related to cardiac function classification,BNP,NT-proBNP and LVEF. Gensini integral is related to cardiac function classification ,BNP and NT-proBNP. Conclusions With the severity and complexity of coronary artery disease,the degree of heart failure is more serious. The complexity and severity of coronary artery disease is an important factor in heart failure in patients with ischemic heart disease.

Coronary artery lesions in different types of heart failure with ischemic heart disease / 实用医学杂志

Objective To compare the degree of coronary lesions in different types of heart failure with ischemic heart disease. Methods This retrospective analysis include 282 cases diagnosed as heart failure with ischemic heart disease in Zhengzhou People′s Hospital from January 2015 to May 2016. Based on LVEF and the level of BNP and NT-proBNP examination results ,282 cases were divided into HFmrEF(89 cases),HFrEF(109 cases) and HFpEF (84 cases). The clinical basic data ,cardiac color Doppler ultrasound and the difference of coronary artery lesions were compared. Results (1) HFpEF,HFmrEF and HFrEF groups gensini score were 30.45 ± 33.18,62.12 ± 41.25,86.72 ± 38.80. The differences are significant(P < 0.05). Pairwise comparison showed significant difference.(2)HFpEF,HFmrEF and HFrEF groups SYNTAX score were 11.77 ± 8.39,19.08 ± 8.39,26.41 ± 10.31. Compared with HFpEF group,the SYNTAX score of other groups are higher(P < 0.05). (3)The duration of disease ,LVEDD ,LVESD ,LVMI ,the number of vascular lesions was significantly higher in HFrEF group than those in other groups. (4) Multivariate correlation analysis suggested that SYNTAX scores were related to cardiac function classification,BNP,NT-proBNP and LVEF. Gensini integral is related to cardiac function classification ,BNP and NT-proBNP. Conclusions With the severity and complexity of coronary artery disease,the degree of heart failure is more serious. The complexity and severity of coronary artery disease is an important factor in heart failure in patients with ischemic heart disease.