ABSTRACT
【Objective】 To observe the clinical effect of combination therapy of sacubitril valsartan and dapagliflozin in heart failure with reduced ejection fraction (HFrEF) and non-diabetes patients. 【Methods】 This study involved 96 patients with HFrEF and non-diabetes. The patients were randomly divided into control group (50 cases) and observation group (46 cases). On the basis of routine treatment, the control group was treated with sacubitril valsartan, while the observation group was treated with sacubitril valsartan and dapagliflozin. After 1-month and 6-month treatment, we monitored blood pressure, N-terminal pro brain natriuretic peptide (NT-proBNP), high sensitivity troponin T (cTnT), fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDd), left atrial diameter (LAD), left ventricular posterior wall thickness (LVPW), Minnesota soda heart failure life quality score (MLHFQ), the incidence of rehospitalization and death, and major adverse cardiovascular events (MACE) in the two groups. 【Results】 After 6 months, systolic blood pressure, cTnT, NT-proBNP, LVEDd, LVPW, and LAD of the observation group were significantly decreased compared with the control group (P0.05). 【Conclusion】 The combination treatment of sacubitril valsartan and dapagliflozin on HFrEF and non-diabetes patients can significantly improve cardiac function, inhibit myocardial remodeling, reduce the incidence of MACE, and improve the prognosis.
ABSTRACT
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.
Subject(s)
Humans , Stroke Volume/physiology , Ventricular Function, Left/physiology , Heart Failure/diagnosis , Heart Failure/physiopathology , Heart Failure/therapy , PrognosisABSTRACT
Objectives Cardiac resynchronization therapy (CRT) has significantly improved management of patients with heart failure with reduced ejection fraction (HFrEF). A significant number of patients have a dramatic response and have been termed “super-responders”. The characteristics of this subset of patients in Indian and Asian population have not been well studied. In this study, we sought to assess the prevalence and clinical characteristics of this cohort of patients. Methods This was a retrospective study involving patients undergoing CRT. Changes in ejection fraction and LVESV at the end of one year of follow-up following device implantation were assessed, and patients were stratified into non-responders, responders, and super-responders. Responders had a 15–29% decrease in LVESV while super-responders had a >30% decrease in LVESV. Results Of the 74 patients who had undergone CRT-P/CRT-D implantation, 16 patients did not have echocardiograms at the end of one year of follow-up and were excluded from the analysis. Thus, 58 patients were enrolled for analysis. We identified 16 patients (27.6%) to be super-responders, 26 patients (44.8%) to be responders, and 16 patients (27.6%) to be non-responders. Factors associated with a super-response were a diagnosis of dilated cardiomyopathy as against ischemic cardiomyopathy (93.7% vs 6.3%; p – 0.01), prior right ventricular (RV) apical pacing (25% vs 2.4%; p – 0.02) and absence of a prior history of myocardial infarction (MI) (0% vs 33.3%; p – 0.02). Conclusion In our study, 27.6% of patients were super-responders, and a diagnosis of dilated cardiomyopathy, absence of a prior history of MI and prior RV apical pacing predicted a super-response to CRT.
ABSTRACT
Objective To investigate the nutritional status of patients with heart failure and its effect on all-cause mortality.Methods A total of 351 patients with chronic heart failure,who were consecutively admitted to the East Hospital of Shanghai from March 2013 to November 2015,were put into the heart failure with reduced left ventricular ejection fraction (HFrEF) group.They were compared to 222 controls who were admitted during the same period for preclinical heart failure.After a median follow-up time of 606 days,108 patients of the HFrEF group died,compared to 11 of the controls.Logistic regression was used to analyze correlations of all-cause mortality with the patients' body mass index (BMI),serum albumin and other factors.Results Compared to the controls,patients with chronic heart failure had lower BMI [(22.71±3.95) kg/m2 vs.(24.23±3.66) kg/m2,t=4.331,P=0.000],total cholesterol [(3.81±0.99) mmol/L vs.(4.03±0.96) mmol/L,t=2.638,P=0.009],albumin [(38.18±5.03) g/Lvs.(40.18±6.12) g/L,t=3.874,P=0.000] and prealbumin [(187.67±61.83) mg/L vs.(211.94±65.44) mg/L,t=3.937,P=0.000].Within the HFrEF group,patients with lower BMI had higher mortality (36.0％ vs.22.4％,P=0.008).Logistic regression suggested BMI,age were independent predictors of all-cause death.Conclusions Patients with chronic heart failure had high incidence of malnutrition,and those with BMI＜22 kg/m2 had higher risk of mortality.Serum albumin and BMI not only reflected nutritional status of the patients but had significant implications on prognosis.
ABSTRACT
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 .
ABSTRACT
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.
ABSTRACT
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.