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Objective@#To study the related factors of heart failure in patients with non-valvular atrial fibrillation.@*Methods@#Eighty patients with non-valvular atrial fibrillation were selected from the First People′s Hospital of Wucheng District of Jinhua City from August 2015 to April 2019. Patients with atrial fibrillation were divided into non-heart failure group (56 patients) and heart failure group (24 patients) according to the presence or absence of heart failure. The general characteristics of the two groups were compared with univariate analysis and Logistic analysis.@*Results@#There was no significant difference in average age, sex, body mass index, hypertension, hypercholesterolemia, diabetes mellitus, coronary heart disease, stroke, hemoglobin, white blood cell and red blood cell volume between the two groups (P>0.05). There were significant differences in the classification of atrial fibrillation, red blood cell distribution width (RDW) and serum creatinine (P<0.05).Multivariate Logistic regression analysis showed that RDW and serum creatinine were independent predictors of heart failure in patients with non-valvular atrial fibrillation (OR=3.08 and 1.03, P<0.05). The probability of heart failure in persistent atrial fibrillation, long-term persistent atrial fibrillation or permanent atrial fibrillation was 3.87 and 4.10 times higher than that of paroxysmal atrial fibrillation (P<0.05). Receptor operation character (ROC) curve analysis showed that the maximum Youden index of RDW was 14.00%, and the sensitivity and specificity for predicting heart failure were 55.7% and 87.7%, respectively.@*Conclusions@#Classification of atrial fibrillation, RDW and serum creatinine may be independent predictors of heart failure in patients with non-valvular atrial fibrillation. RDW>14.00% has certain value in predicting heart failure in patients with non-valvular atrial fibrillation.
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Objective To study the related factors of heart failure in patients with non-valvular atrial fibrillation.Methods Eighty patients with non-valvular atrial fibrillation were selected from the First People's Hospital of Wucheng District of Jinhua City from August 2015 to April 2019.Patients with atrial fibrillation were divided into non-heart failure group (56 patients) and heart failure group (24patients) according to the presence or absence of heart failure.The general characteristics of the two groups were compared with univariate analysis and Logistic analysis.Results There was no significant difference in average age,sex,body mass index,hypertension,hypercholesterolemia,diabetes mellitus,coronary heart disease,stroke,hemoglobin,white blood cell and red blood cell volume between the two groups (P ＞ 0.05).There were significant differences in the classification of atrial fibrillation,red blood cell distribution width (RDW) and serum creatinine (P ＜ 0.05).Multivariate Logistic regression analysis showed that RDW and serum creatinine were independent predictors of heart failure in patients with nonvalvular atrial fibrillation (OR =3.08 and 1.03,P ＜ 0.05).The probability of heart failure in persistent atrial fibrillation,long-term persistent atrial fibrillation or permanent atrial fibrillation was 3.87 and 4.10times higher than that of paroxysmal atrial fibrillation (P ＜ 0.05).Receptor operation character (ROC)curve analysis showed that the maximum Youden index of RDW was 14.00％,and the sensitivity and specificity for predicting heart failure were 55.7％ and 87.7％,respectively.Conclusions Classification of atrial fibrillation,RDW and serum creatinine may be independent predictors of heart failure in patients with non-valvular atrial fibrillation.RDW ＞ 14.00％ has certain value in predicting heart failure in patients with non-valvular atrial fibrillation.
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Objective To observe the effect of metoprolol combined with trimetazidine on coronary heart disease with chronic congestive heart failure ,and its effects on myocardial structure ,plasma brain natriuretic peptide (BNP) and matrix metalloproteinase－9 (MMP－9).Methods From January 2016 to November 2017,160 coronary heart disease patients with chronic congestive heart failure in the First Peopleˊs Hospital of Wenling were randomly divided into treatment group (78 cases)and control group (77 cases)through random number table method.The control group was given conventional anti－heart failure treatment.The treatment group was treated with metoprolol and trimetazidine. After 3 months of treatment,left ventricular end－diastolic volume (LVEDV), left ventricular end －systolic volume (LVESV),LVEF,BNP and changes in MMP －9 were compared.Results The total effective rate of the treatment group was 90.36%,which was significantly higher than 77.92%of the control group (χ2 ＝5.024,P＜0.05).There were no statistically significant differences in LVESV and LVEDV between the two groups before and after treatment (t＝0.07,P＝0.47;t＝0.75,P＝0.22;t＝0.90,P＝0.18;t＝1.24,P＝0.10).Compared with before treatment ,the LVEF change in the control group had no statistically significant difference ( P＞0.05),the LVEF of the treatment group was increased [(41.38 ±9.26)% vs.(46.31 ±10.8)%] ( t ＝－3.15,P＝0.001).After treatment,the LVESV between the treatment group and control group had statistically significant difference [(124.54 ±16.57) mL vs.(106.36 ±16.44)mL](t＝7.16,P＜0.05).The BNP level was decreased in the treatment group after treatment [(4 036.39 ±696.24)ng／L vs.(3 621.78 ±732.57) ng／L] ( t＝3.73,P＜0.05),while the BNP level had no statistically significant change in the control group ( t＝1.47,P＝0.07).the MMP－9 level in the treatment group was lower than that before treatment [(396.21 ±97.56)ng／mL vs.(345.11 ±86.25)ng／mL](t＝3.57,P＜0.05), while the MMP－9 level in the control group had no statistically significant change (t＝1.06,P＝0.15).The MMP－9 and BNP levels decreased more significantly in the treatment group than those in the control group (t＝3.73,3.57,all P＜0.05).Conclusion Metoprolol combined with trimetazidine in the treatment of patients with chronic heart failure can significantly alleviate clinical symptoms ,reduce the expression level of MMP －9,and is safe for clinical use. Therefore,it is recommended use in clinical.
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Objective@#To observe the effect of metoprolol combined with trimetazidine on coronary heart disease with chronic congestive heart failure, and its effects on myocardial structure, plasma brain natriuretic peptide (BNP) and matrix metalloproteinase-9 (MMP-9).@*Methods@#From January 2016 to November 2017, 160 coronary heart disease patients with chronic congestive heart failure in the First People's Hospital of Wenling were randomly divided into treatment group (78 cases)and control group (77 cases)through random number table method.The control group was given conventional anti-heart failure treatment.The treatment group was treated with metoprolol and trimetazidine.After 3 months of treatment, left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume(LVESV), LVEF, BNP and changes in MMP-9 were compared.@*Results@#The total effective rate of the treatment group was 90.36%, which was significantly higher than 77.92% of the control group (χ2=5.024, P<0.05). There were no statistically significant differences in LVESV and LVEDV between the two groups before and after treatment (t=0.07, P=0.47; t=0.75, P=0.22; t=0.90, P=0.18; t=1.24, P=0.10). Compared with before treatment, the LVEF change in the control group had no statistically significant difference(P>0.05), the LVEF of the treatment group was increased[(41.38±9.26)% vs.(46.31±10.8)%] (t=-3.15, P=0.001). After treatment, the LVESV between the treatment group and control group had statistically significant difference[(124.54±16.57)mL vs.(106.36±16.44)mL](t=7.16, P<0.05). The BNP level was decreased in the treatment group after treatment[(4 036.39±696.24)ng/L vs.(3 621.78±732.57)ng/L] (t=3.73, P<0.05), while the BNP level had no statistically significant change in the control group (t=1.47, P=0.07). the MMP-9 level in the treatment group was lower than that before treatment[(396.21±97.56)ng/mL vs.(345.11±86.25)ng/mL](t=3.57, P<0.05), while the MMP-9 level in the control group had no statistically significant change (t=1.06, P=0.15). The MMP-9 and BNP levels decreased more significantly in the treatment group than those in the control group (t=3.73, 3.57, all P<0.05).@*Conclusion@#Metoprolol combined with trimetazidine in the treatment of patients with chronic heart failure can significantly alleviate clinical symptoms, reduce the expression level of MMP-9, and is safe for clinical use.Therefore, it is recommended use in clinical.
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Previous studies have shown that the patients with long-term cancer often have complications such as heart failure. However, the recent studies have shown a heightened risk of incident malignancy in the patients with preexisting heart failure as compared with the normal; there are significant differences even after excluding common pathogenic factors such as obesity. This phenomenon suggests that heart failure may be a carcinogenic condition. Some researchers believe that the systemic pathological processes, such as inflammation and oxidative stress, may promote both heart failure and cancer, leading to the occurrence of these two diseases intersecting. Another hypothesis is that the active neurohormonal system caused by heart failure can directly affect the occurrence, development and prognosis of tumors. When the heart failure occurs, the activities of sympathetic nervous system (SNS) and renin-angiotensin-aldosterone system (RAAS) in the neurohormone system are greatly enhanced. The activation of SNS and RAAS is closely related to the tumor proliferation and angiogenesis, which may be an important way for heart failure to cause tumors. This paradigm is supported by both experimental researches and clinical investigations. On the one hand, tumor growth and metastatic spreading increase following the activation of SNS or RAAS invivo. On the other hand, the results of clinical observation have shown that the use of neurohormonal inhibitors, especially RAAS blockers, is associated with more favorable cancer outcomes. Exploring the relationship between heart failure and tumorigenesis, and then elucidating the key regulatory mechanisms of heart failure acting on tumors is now becoming a hot topic worldwide. This may provide a new basis for the clinical treatments of both heart failure and tumors.
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The paper was to systematically evaluate the clinical efficacy of supplemented Zhenwu decoction for treating congestive heart-failure. Three foreign language databases including the Cochrane Library, PubMed, EMbase and four Chinese databases including CBM, CNKI, VIP and Wanfang Database were retrieved from their establishment to July 2016 for all randomized control trials(RCTs) on supplemented Zhenwu decoction in treatment of congestive heart-failure. The references in the included RCTs were also traced. Literature selection and information extraction was completed and screened by two independent reviewers, and Meta-analysis was performed by using RevMan 5.3 software. Totally 13 clinical RCTs were included in this study, involving 982 patients. Meta-analysis results showed that as compared with western medicine alone, the total effective rate of heart function could be improved by applying supplemented Zhenwu decoction based on the western medicine[RR=1.16, 95%CI (1.10, 1.22)], with increased ejection fraction[MD=7.12, 95%CI= (3.98,10.27)], increased cardiac activity index[MD=6.92, 95%CI (5.21, 8.62)], increased stroke volume [MD=11.18, 95%CI (6.04, 16.33)], and increased heart index[MD=0.50, 95%CI (-0.29, 1.30)]. Supplemented Zhenwu decoction combined with routine treatment could improve the clinical symptoms of congestive heart-failure. However, due to the low quality in methodology and reports as well as small sample size of included RCTs in this study, more randomized double-blind trials with a large sample size are still required to verify the efficiency of supplemented Zhenwu decoction for treating congestive heart-failure.
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Objective:To explore the effect of gingko flavonoids on the content of SOD and MDA and cardiac function in the rats with heart failure. Methods:Totally 40 male Sprague-Dawley rats were randomly divided into 5 groups by random number table meth-od, namely the blank group, the model group, low-dose gingko flavonoids group, high-dose gingko flavonoids group and metoprolol group. Except the blank group, all the other groups were subcutaneously injected 300 mg·kg-1 isopropyl adrenaline for two days to make the heart failure model. After that, metoprolol group was given metoprolol 20 mg·kg-1 ·d-1 , the ginkgo flavonoids group was given 250 or 500 mg·kg-1 ·d-1 ginkgo flavonoids extract, the other groups were given physiological saline with the same volume, and the treatment course was 8 weeks. After the treatment, cardiac function indices ( IVST, LVPWT, LVEDD, LVESD and LVEF) , SOD and MDA levels in cardiac muscle tissue and the pathological integral, and myocardial pathologic morphology characteristics were deter-mined. Results:LVEDD and LVESD of the two ginkgo flavonoids groups and metoprolol group were obviously improved compared with those of the model group, while LVEF, IVST and LVPWT were significantly decreased (P<0. 05), showing that the cardiac function was improved after the treatment. The levels of SOD were raised, while MDA and the pathological integral were decreased significantly in the two ginkgo flavonoids groups compared with those of the model group (P<0. 05), with a dose-dependant relationship. Conclu-sion:Ginkgo flavonoids have certain protective effect in heart failure rats, and the mechanism may be related to reducing the level of lipid peroxidation and improving the body antioxidant enzyme activity.
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A necessidade de aplicação e registro do Processo de Enfermagem em unidade hospitalar motivou a realização do presente estudo que tem como objetivo identificar os diagnósticos de enfermagem mais prevalentes nos pacientes internados na unidade coronariana de um hospital universitário com Insuficiência Cardíaca (IC). Trata-se de uma pesquisa transversal e descritiva realizada por meio de uma análise documental retrospectiva. Os diagnósticos de enfermagem foram elaborados a partir de evidências clínicas levantadas dos registros médicos e de enfermagem contidos nos prontuários. A formulação da declaração diagnóstica foi feita com a utilização da linguagem de Classificação Internacional para a Prática de Enfermagem - CIPE® versão 2. Os diagnósticos de enfermagem identificados foram: Baixo débito cardíaco, Troca gasosa prejudicada, Risco para infecção, Volume de líquido aumentado e Ventilação prejudicada. Estes diagnósticos estão intimamente relacionados à fisiopatologia da doença e contemplam as necessidades biológicas do indivíduo; no entanto os registros contidos nos prontuários revelaram-se insuficientes para abranger a totalidade das necessidades sabidamente afetadas e apresentadas pelos pacientes.
The need forapplicationand registrationof nursing processathospitalmotivated thepresent studythataimed to identifynursing diagnosesmore prevalent inpatients withheart failure (HF)admitted to thecoronary care unitof auniversity hospital. This isa cross-sectional, descriptivestudy usingaretrospectivedocumentary analysis. The nursing diagnosesweremade fromclinical evidenceofmedical and nursingrecordscontainedin the patient's records. Toformulate thediagnosticstatementwere used thelanguageof the International ClassificationforNursing Practice-ICNP®Version 2. The nursing diagnosesidentified were:Low cardiac output, Gas exchangeimpaired, Risk of infection, Increased liquid volume andVentilation impaired. These diagnosticsare closely relatedto thepathophysiologyof the diseaseandinclude theindividual's biological needs, howeverthe recordscontainedin the patient recordswere insufficienttocover allknownaffectedneeds presented by patients.
La necesidad de laaplicación y registro delProceso de Enfermeríaen el hospitalmotivóel presente estudio quetuvo como objetivo identificarlos diagnósticos de enfermeríamásfrecuentesen los pacientescon insuficienciacardíaca (IC), ingresados enla unidad coronariade un hospitaluniversitario.Se trata deun estudio transversal, descriptivo, realizadamediante un análisisdocumentalretrospectivo.Los diagnósticos de enfermeríafueron hechos deevidencia clínica deregistros médicosy de enfermeríaidentificados que figuran en losregistros médicos.Para formular ladeclaración de diagnósticose utilizó ellenguajede la ClasificaciónInternacional para la Prácticade Enfermería -CIPE® Versión2.Los diagnósticosde enfermería identificadosfueron:Bajo gasto cardíaco, Deterioro del intercambio gaseoso, Riesgo de infección, El aumento de volumen de líquido eDeterioro de laventilación. Estos diagnósticosestán estrechamente relacionados conlafisiopatología de la enfermedade incluyenlas necesidades biológicas dela persona, sin embargolosregistros contenidos enlas historias clínicasno fueron suficientes paracubrirtodaslas necesidades conocidamente afectadas y presentadaspor los pacientes.
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Cross-Sectional Studies , Heart Failure , Nursing Diagnosis , Nursing ProcessABSTRACT
Objective: To evaluate the effects of a nutritional intervention focused on the improvement of clinical status and the prognosis of heart failure patients. Methods: A 12-mo randomized controlled study in 203 heart failure (HF) patients assigned to intervention (IG, n=84) or control group (CG, n=119). Patients in the IG received a sodium (2000 to 2400 mg/d) and fluid (<1500 ml/d) restricted diet. CG received general nutritional recommendations. Body composition, clinical status, hospitalization and time of survival were evaluated. Results: At the end of follow-up, urinary sodium excretion decreased 16,4 percent in the IG vs. an 8,8 percent increase in the CG (p<0,05). Extra cellular water decreased 1,4 percent in the IG vs. a 1¡2 percent increase in the CG (p=0,03). In addition, decrease percentage of fatigue was significant and higher in the IG that in the CG, and a significant increase in the ejection fraction for the IG vs. CG (49,6 percent vs. 5,0 percent, p=0,001), among systolic HF patients was found. Amount of hospitalizations and time of survival tended to be better in the IG. Conclusion: A nutritional intervention with restriction of sodium and fluid was proved to be beneficial since had positive effects in clinical status in HF patients.
Objetivo: Evaluar el efecto de una intervención nutricional sobre el estado clínico y el pronóstico de pacientes con insuficiencia cardiaca (IC). Métodos: Doscientos tres pacientes con IC fueron aleatorizados al grupo con intervención (GI, n=84) o al control (GC, n=119) y seguidos por 12 meses. El GI recibió una dieta con restricción de sodio (2000 a 2400 mg/d) y líquidos (<1500 ml/d) y el GC recomendaciones nutricionales generales. Se evaluó la composición corporal, el estado clínico, hospitalizaciones y sobrevida. Resultados: Al término del seguimiento, la excreción urinaria de sodio disminuyó 16,4 por ciento en el GI vs. un aumento de 8,8 por ciento en el GC (p<0,05). El agua extracellular disminuyó 1,4 por ciento en el GI vs. 1,2 por ciento de aumento en el GC (p=0,03). Asimismo, el porcentaje de reducción de fatiga fue significativo para el GI, no así para el GC; también se observó, entre los pacientes con IC sistólica, un aumento significativamente mayor en la fracción de expulsión para el GI vs. CG (49,6 por ciento vs. 5,0 por ciento, p=0,001). El número de hospitalizaciones y el tiempo de sobrevida tuvieron una tendencia a ser mejor en el GI. Conclusión: Una intervención nutricional con restricción de sodio y líquidos mostró tener un impacto favorable en el estado clínico de pacientes con IC.
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Humans , Diet, Sodium-Restricted , Cardiovascular Diseases/diet therapy , Cardiovascular Diseases/metabolism , Cardiovascular Diseases/prevention & control , Drinking/physiologyABSTRACT
Background: Diabetes mellitus is an important risk factor for cardiovascular complications among patients on hemodialysis. However, the incidence of these complications among non diabetic patients on hemodialysis is not well known. Aim: To assess the incidence of cardiovascular complications in non diabetic patients on hemodialysis. Patients and methods: Seventy five non diabetic patients aged 55.6 ± 17 years (48 males), receiving hemodialysis three times a week were evaluated with laboratory tests, echocardiogram anda carotid ultrasound. In 26 patients, interleukin 6, tumor necrosis factor alpha, and intercellular adhesión molecule (ICAM-1) were also measured. Patients were followed during two years. Results: The mean lapse of dialysis therapy was 6.5 ±5 years. The main cause of renal failure was hypertension. Sixty two percent had systolic hypertension, 86 percent had concentric left ventricular hypertrophy, 43 percent had atrial dilatation and 60 percent had calcifications in the thoracic aorta. Compared with normal controls, patients had higher levels of interleukin 6, tumor necrosis factor alpha and ICAM-1. Carotid media thickness was also higher and increased in the two years of follow up. No correlations were found between ventricular hypertrophy and dialysis lapse, packed red cell volume, calcium phosphorus product, parathormone levels or median arterial pressure. No cardiovascular events were recorded during the follow up period. Conclusions: Non diabetic patients on chronic hemodialysis have a high frequency of ventricular hypertrophy, carotid media thickening, aortic calcifications and an increase in proinflammatory cytokines.