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Objective:To evaluate nutritional status in elderly patients with chronic heart failure and to investigate its association with unplanned readmission.Methods:From July 2020 to August 2021, 220 elderly patients hospitalized for chronic heart failure in Qilu Hospital of Shandong University were enrolled in a prospective cohort study. Basic information, laboratory tests and other data of the patients were collected. Nutritional status of the patients was assessed by geriatric nutritional risk index and the patients were divided into groups. Data were analyzed by R4.1.1 and SPSS26.0, survival curves were drawn by Kaplan-Meier method, and the relationship between nutritional status and unplanned readmission in elderly patients with chronic heart failure was analyzed by univariate and multivariate Cox regression.Results:Among 220 elderly patients with chronic heart failure, 59.5%(131/220) were in normal nutrition. There were 40.5%(89/220) in the malnutrition, including 26.8%(59/220) in the mild malnutrition and 13.6%(30/220) in the moderate and severe malnutrition. During the follow-up period of 3 months, 25.9% (57/220) had unplanned readmission. Kaplan-Meier survival curve showed that the incidence of unplanned readmissions was higher in the moderate and severe malnutrition than in the normal and mild malnutrition, and the difference among them was statistically significant ( P<0.05). Multivariate Cox regression analysis showed that moderate and severe malnutrition was an independent predictor of unplanned readmission in elderly patients with chronic heart failure ( HR=2.064, 95% CI 1.029-4.138, P<0.05). Conclusions:The prevalence of malnutrition in elderly patients with chronic heart failure is high. Moderate and severe malnutrition is an independent predictor of unplanned readmission in elderly patients with chronic heart failure. The geriatric nutritional risk index is an effective screening tool and can provide a reference for clinical evaluation of nutritional risk in patients.
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Objective To observe the changes of serum heart-type fatty acid-binding protein (h-FABP) and brain natriuretic peptide (BNP) for assessing the clinical values in children with chronic heart failure (CHF).Methods A total of 50 patients with CHF,including 22 endocardial fibroelastosis (EFE) cases and 28 dilated cardiomyopathy (DCM) cases,were enrolled.Thirty healthy children were enrolled as controls.The concentrations of serum h-FABP and BNP were measured by enzyme-linked immunosorbent assay (ELISA),and the left ventricular end-systolic diameter (LVESD),left ventricular end-diastolic diameter (LVEDD),left ventricular ejection fraction (LVEF),left ventricular fractional shortening (LVFS),and cardiac index (CI) were measured by echocardiography.Results The concentrations of serum h-FABP and BNP in patients with CHF were significantly higher than those in control group (22.68 ±4.18 ng/mL vs.6.31 ± 1.72 ng/mL;565.52±179.64 pg/mLvs.31.22±9.83 pg/mL,all,P ＜ 0.01),and h-FABP and BNP were positively correlated with the degree of heart failure (all,P ＜0.01),and they were both higher in group EFE and DCM than those in control group (all,P＜0.01),but there was no statistically significant difference between the two groups (P ＞ 0.05).The h-FABP concentration in CHF patients was positively correlated with BNP ((r =0.782,P ＜0.01).The h-FABP concentration in CHF patients was positively correlated with LVESD,LVEDD (r =0.626,O.662,respectively;all,P＜0.01),and negatively correlated with LVEF,LVFS,and CI (r =-0.652,-0.636,-0.709,respectively;all,P ＜ 0.01).The BNP concentration was also positively correlated with LVESD,LVEDD (r =0.733,0.689,respectively;all,P ＜0.01),and negatively correlated with LVEF,LVFS,and CI (r=-0.745,-0.612,-0.791,respectively;all,P＜0.01).Conclusions Serum concentrations of h-FABP and BNP can be used as biomarkers to evaluate the severity of chronic heart failure.
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Objective To determine the influence of depression on C reactive protein in patients with chronic ischemic heart failure (CIHF).Methods 73 patients with CIHF were divided into CIHF without depression group(n=49) and CIHF with depression group (n=24) according to the standard sore of the self-rating depression scale.C reactive protein(CRP)and other clinical characteristics were detected.The geometric means of CRP between two groups were compared,and stepwise multiple linear regression analysis was used to confirm the independent correlation factors of CRP.Results (1) The geometric means of CRP in CIHF without depression group and CIHF with depression group were (1.38± 1.29)mg/L and (1.78±1.53) mg/L respectively.No statistically significant difference was found between two groups(P=0.276).(2) Stepwise multiple linear regression analysis showed that aspirin inversely related with CRP(β=-1.070,P=0.004),but brain natriuretic peptide (BNP)positively related with CRP(β=0.426,P=0.001).Conclusion Depression has no additional effect on CRP in patients with CIHF.
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Abstrsct:Objective To analyze the correlation of hyponatremia with chronic heart failure (CHF) and the prognostic analysis of CHF. Methods Patients with CHF (n=507) and healthy adult (n=212) were included in this study. The general data of the two groups were analysed. The index which was statistically significant was indicated as independent variables. Multivariate logistic analysis was used to analysis the correlation between serum sodium and CHF. The relationship between serum sodium and the prognosis of CHF include mortality and rate of readmission were included in follow-up study. The prognostic correlation of serum sodium with BNP (brain natriuretic peptide), heart failure with preserved ejection fraction (HFpEF, LVEF≥0.45) and heart failure with reduced ejection fraction (HFrEF, LVEF0.05) while other indicators like age, hemoglobin, serum sodium presents statistical significance (P 0.05);While for patients with HFpEF, the mortality and the readmission rates were both significantly different (P<0.05). Conclusion Serum sodium is the protective factor in CHF, the patients with hypona?tremia have higher readmission rate and death rate in HFpEF background.
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Objective To investigate the relationship among electrocardiogram QRS complex duration,left ventricular ejection fraction( LVEF),N-terminal pro-brain natriuretic peptide( NT-proBNP)and their relation to New York Heart Association (NYHA)functional classification in patients with chronic heart failure(CHF),and observe the intervention effects of Shenfu injection(SFI)on patients with CHF. Methods A total of 72 CHF patients were randomly assigned to treatment group(36 cases)and control group(36 cases). Patients in the control group received standard care,and those in the treatment group received standard care plus 1. 0 mL·kg-1 ·d-1 of SFI in 5% glucose for two weeks. Before and after the treatments,the electrocardiogram QRS complex duration,LVEF,NT-proBNP were measured and NYHA functional classification was evaluated. Results Electrocardiogram QRS complex duration was negatively correlated with LVEF and was positively correlated with NT-proBNP and NYHA functional classification( P〈0. 05 ). After the treatment,the proportion of patients with NYHA classⅠ-Ⅱsignificantly increased and classⅢ-Ⅳsignificantly decreased in both groups. The treatment group was superior to the control group in reinstating cardiac function( P〈0. 05 ). After the treatment,electrocardiogram QRS complex duration and the levels of NT-proBNP were significantly descended and LVEF were significantly ascended in both groups(P〈0. 05). The level of NT-proBNP in the treatment group was significantly lower than in the control group(P〈0. 05),but electrocardiogram QRS complex duration and LVEF did not show significant difference. The prior-and post-treatment difference in electrocardiogram QRS complex duration and LVEF was more obvious in the treatment group than in the control(P〈0. 05). Conclusion The extension of electrocardiogram QRS complex duration is correlated with plasma NT-proBNP elevation and cardiac dysfunction,which can be used as a reference for disease progression or medication efficacy. SFI is effective on CHF of the yang-qi deficiency type.
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10.3969/j.issn.1008-9691.2013.03.016
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Objective To investigate the effect of olmesartan medoxomil on renal oxidative stress in mice with chronic heart failure. Methods C57 mice were divided into sham operation group(SHAM group),chronic heart failure group(CHF group)and olmesartan medoxomil treatment group(OLM group).Experimental CHF model was established by coronary artery ligation,in which OLM group fed with a daily dose of 10 mg/kg.The heart rate,blood pressure,cardiac function,Scr,BUN,and plasma and kidney angiotensin(Ang)Ⅱ were measured.Real-time PCR was used to examine renal gp91phox,p22phox and NOX4 expression.AZAN and DHE staining was used to detect renal pathological change after 12 weeks. Results Compared with SHAM group,left ventricular-end diastolic dimension (LVDd)and left ventricular end-systolic dimension(LVDs)were significantly increased(P<0.05),while fractional shortening(FS)and ejection fraction(EF)were significantly decreased in CHF and OLM groups (P<0.05).Compared with SHAM group,systolic blood pressure,Scr,BUN,and AZAN and DHE staining positive area were significantly increased in CHF group(P<0.05),while above indexes were significantly lower in OLM group as compared to CHF group(P<0.05).Compared with SHAM group,plasma and kidney Ang Ⅱ levels,gp91phox,p22phox and NOX4 expression were increased in CHF group(P<0.05),while above indexes were significantly lower in OLM group as compared to CHF group (P<0.05).Conclusions Chronic heart failure can activate intrarenal NADPH oxidase resulting in renal injury.Olmesartan medoxomil can protect kidney by inhibiting the effect of Ang Ⅱ-induced oxidative stress.
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Objective To explore the clinical significance of heart rate turbulence (HRT) in patients with chronic heart failure(CHF).Methods Thirty CHF patients(CHF group) and 28 non-organic heart disease persons (control group) were examined by 24 hours dynamic electrocardiogram (DCG).According to the NYHA grading of the cardiac function,CHF group were divided into low-degree heart failure (LdHF) sub-group (NYHA Ⅰ -Ⅱ,16 cases) and high-degree heart failure (HdHF) sub-group (NYHA Ⅲ-Ⅳ,14 cases).In CHF group,ischemic heart disease (IHD) patients were 18 cases and non-ischemic heart disease (NIHD) patients were 12 cases.Two indexes of HRT including turbulence onset (TO) and turbulence slope (TS) were measured and analyzed.Results The TO value in CHF group [(0.43 ±0.83)%] was significantly higher than that in control group [( - 1.49 ± 1.00)%] (P ＜0.05),and the TS value in CHF group[( 2.67 ± 0.66) ms/RRI] was significantly lower than that in control group [( 8.52 ± 2.09)ms/RRI] (P ＜0.05).The TO value in the HdHF sub-group [(0.79 ± 0.67)%] was significantly higher than that in LdHF sub-group[(0.12 ± 0.86)%] (P = 0.026),and the TS value in the HdHF sub-group [(2.88 ±0.79) ms/RRI] was significantly higher than that in LdHF sub-group [(2.40 ± 0.35) ms/RRI] (P= 0.045).The TO and TS values had no significant difference between the IHD and the NIHD patients (P＞0.05).In CHF group,53.3%(16/30) patients' TO and TS values were both abnormal (TO ≥ 0,TS ≤ 2.5 ms/RRI),and 40.0% (12/30) patients had only TO or TS value abnormal,93.3% (28/30) patients had abnormal HRT.Conclusion The phenomenon of HRT in the patients with CHF obviously decrease,and the HRT can be used to evaluate the severity of heart failure and predict the prognosis of the heart failure.
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Objective To study the effect of cardiac troponin T(cTnT)on the prognosis of chronic heart failure in the elderly patients.Methods Serum level of cTnT,and serum activities of creatine kinase (CK)and creatine kinase-MB(CK-MB)were measured in 60 elderly patients of chronic heart failure with varied classes of cardiac function.Cardiac events,including malignant cardiac arrhythemia,repeated or aggravated heart failure or cardiac death,in patients with increased cTnT during hospitalization were compared to those without it.Results Serum level averaged(89.1?13.6)mmol/L for CK and(7.9? 1.4)mmol/L for CK-MB in 20 patients with Class Ⅱ cardiac function by New York Heart Association (NYHA)classification and without increased cTnT,(88.2?13.4)mmol/L for CK and(7.5?1.8) mmol/L for CK-MB in 19 patients with Class Ⅲ cardiac function and four of them with increased cTnT,and (93.3?14.2)mmol/L for CK and(8.1?1.6)mmol/L for CK-MB in 21 patients with Class Ⅳ cardiac function and 14 of them with increased cTnT.Malignant cardiac arrhythemia occurred in six,repeated heart failure in eight,and death in three of 18 patients with increased cTnT,and one,two and one in 22 patients without increased cTnT,respectively.Incidence of cardiac events was higher in patients with increased cTnT than those without it(P
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Objective To establish the relationship of serum TNF-? and IL-6 contents with myocardial cell apoptosis in the chronic heart failure (CHF)rats,and to explore the therapeutic mechanism of Anxin Granules (AXG)in treating CHF.Methods Fifty female SD rats were randomly divided into five groups:normal control group (A),model group (B),captopril group(C),low-dosage AXG group (D)and high-dosage AXG group (E).CHF models were established by intraperitoneal injection of small-dose of adriamycin,once per week for continuous 6 weeks.Meanwhile,group C was given captopril injection (6.25mgkg-1d-1),and groups D and E received gastric gavage of low-dosage AXG (0.8 gkg-1d-1)and high-dosage AXG (1.6gkg-1d-1)respectively.After 6 weeks of modeling,serum levels of TNF-? and IL-6 of different groups were tested by ELISA,the apoptosis of myocardial cells was tested by TUNEL,and then the apoptosis index(AI)was counted.Results Serum levels of TNF-? and IL-6 were increased in the model group (P