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1.
Article in Chinese | WPRIM | ID: wpr-1027175

ABSTRACT

Objective:To evaluate the value of the ratio of tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP) in evaluating right ventricular function of patients with hypertrophic cardiomyopathy (HCM) and heart failure with preserved ejection fraction (HFpEF).Methods:A total of 74 patients with HCM and HFpEF and 22 healthy individuals who visited the First Affiliated Hospital of Zhengzhou University from January 2021 to January 2023 were included in this study. The HCM patients with HFpEF were divided into three groups based on the tertiles of the TAPSE/PASP (low group: <0.280 0 mm/mmHg; middle group: 0.280 0-0.476 2 mm/mmHg; high group: >0.476 2 mm/mmHg). Conventional echocardiographic parameters were collected, and two-dimensional speckle tracking technology was used to obtain right ventricular strain parameters. The differences in parameters among the groups were compared, and the correlations between TAPSE/PASP and clinical parameters and right ventricular function parameters were analyzed.Results:The results of difference analysis showed that there were significant differences in 6-minute walking test, New York Heart Association grade (NYHA grade), incidence of atrial fibrillation, left atrial area (LAA), left ventricular global longitudinal strain (LVGLS), TAPSE, PASP, right ventricular fractional area change (RVFAC), right ventricular global longitudinal strain (RVGLS), right ventricular free wall strain (RVFWST) and cardiac magnetic resonance right ventricular ejection fraction (CMR-RVEF) among the three groups. The results of correlation analysis and multiple linear regression analysis showed that the TAPSE/PASP was positively correlated with 6-minute walking distance, RVFAC, tricuspid annulus peak systolic velocity (RV s′), and CMR-RVEF ( r=0.449, 0.284, 0.358, 0.577; all P<0.05). It was negatively correlated with N-terminal pro-brain natriuretic peptide (NT-proBNP), NYHA grade, LAA, mitral early diastolic peak velocity / mitral annulus early diastolic peak velocity (LV E/e′), LVGLS, RVGLS, RVFWST and tricuspid early diastolic peak velocity / tricuspid annulus early diastolic peak velocity (RV E/e′) (r/ rs=-0.336, -0.349, -0.468, -0.452, -0.444, -0.339, -0.405, -0.320; all P<0.05). The LAA and CMR-RVEF correlated independently with TAPSE/PASP(all P<0.05). Conclusions:The TAPSE/PASP can provide an early, simple, rapid, and convenient evaluation of right ventricular function in patients with HCM and HFpEF, so as to guide clinical treatment and monitoring disease progression.

2.
Article in Chinese | WPRIM | ID: wpr-1036233

ABSTRACT

ObjectiveTo observe the clinical efficacy and safety of Tinglu Yixin prescription in the treatment of patients with heart failure with preserved ejection fraction (HFpEF) combined with diabetes (syndromes of Qi and Yin deficiency and water retention and blood stasis) from taste-based compatibility and descending adverse Qi with bitter and pungent medicinals. MethodA total of 108 HFpEF patients with diabetes (syndromes of Qi and Yin deficiency and water retention and blood stasis) treated in the Nanjing Integrated Traditional Chinese and Western Medicine Hospital Affiliated to Nanjing University of Chinese Medicine from May 2022 to March 2023 were enrolled in this study and randomized into an observation group (54 patients) and a control group (54 patients). Both groups received conventional Western medicine treatment according to the guide recommendations for chronic heart failure and diabetes, and the observation group additionally received Tinglu Yixin prescription. The treatment course for both groups was 12 weeks. The New York Heart Association (NYHA) grading of cardiac function, left ventricular end diastolic diameter (LVEDD), left atrium diameter (LAD), the ratio of early diastolic maximum mitral flow velocity (E) to early diastolic mitral annular motion velocity (e') (E/e'), N-terminal pro-B-type natriuretic peptide (NT-proBNP), hemoglobin A1c (HbA1c), 6-minute walking test (6MWT), Minnesota Living with Heart Failure Questionnaire, traditional Chinese medicine (TCM) syndrome scores, and safety indicators were determined before and after treatment. ResultFinally, 104 patients were included for analysis, including 52 patients in the observation group and 52 patients in the control group. After treatment, 35 and 47 patients in the control and observation groups showed improved cardiac function, which indicated the total response rates of 67.3% and 90.4%, respectively. The total response rate regarding the cardiac function in the observation group was higher than that in the control group (χ2=2.754, P<0.05). The observation group outperformed the control group in reducing LVEDD and LAD (P<0.05), decreasing the E/e' ratio (P<0.05), lowering the NT-proBNP and HbA1c levels (P<0.05), and recovering the 6MWT and Minnesota quality of life score TCM syndrome scores (P<0.05). None of the safety indicators in the two groups showed abnormal values before and after treatment, and no serious adverse reaction was observed. ConclusionTinglu Yixin prescription can improve the heart function, exercise tolerance, and quality of life, lower the HbA1c level, and alleviate the TCM syndrome in the patients with HFpEF combined with diabetes (syndrome of qi and yin deficiency and water stagnation and blood stasis).

3.
Article in Chinese | WPRIM | ID: wpr-1005107

ABSTRACT

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.

4.
Article in Chinese | WPRIM | ID: wpr-1019969

ABSTRACT

Objective To investigate the expression level and clinical significance of WW domain-containing E3 ubiquitin protein ligase 1(WWP1)and nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3)in patients with heart failure with preserved ejection fraction(HFpEF).Methods A total of 153 patients with HFpEF admitted to Fengfeng General Hospital of North China Medical and Health Group from January 2021 to September 2022 were collected as the observation group.According to the New York Heart Association(NYHA)cardiac function grading of patients,they were grouped into cardiac function grading Ⅰ~Ⅱ group(n=64)and cardiac function grading Ⅲ~Ⅳ group(n=89),while 148 healthy volunteers were collected as the control group.The correlation between serum WWP1 and NLRP3 levels and cardiac function indexes of patients was explored by Pearson analysis.The diagnostic value of serum WWP1 and NLRP3 levels on the severity of heart failure in HFpEF patients was analyzed by the receiver operating characteristic(ROC)curve.Results Compared with the control group,the expression levels of WWP1(1.68±0.35 vs 1.04±0.19)and NLRP3(6.72±1.26 ng/ml vs 4.57±0.84 ng/ml)in the observation group were significantly increased,and the differences were statistically significant(t=19.623,17.359,all P<0.05).Compared with grade Ⅰ to Ⅱ groups,WWP1(1.87±0.39 vs 1.42±0.32)and NLRP3(7.53±1.40 ng/ml vs 5.59±1.18 ng/ml)expression levels in grade Ⅲ to Ⅳ groups were significantly increased and the differences were statistically significant(t=7.744,9.017,all P<0.05).The differences of heart rate,left atrial diameter(LAD),left ventricular end-diastolic diameter(LVEDD),left ventricular end-diastolic diameter(LVEDD),left atrial diameter(LAD),left ventricular end-diastolic diameter(LVEDD),left ventricular end-diastolic posterior wall thickness(LVPWT),left ventricular ejection fraction(LVPWT),left ventricular ejection fraction(LVEF),peak mitral early diastolic velocity(E)/peak late diastolic velocity(A)and the incidence of atrial fibrillation between the cardiac function grade Ⅰ to Ⅱ groups and the grade Ⅲ to Ⅳ groups were significant(t/χ2=2.757~7.069,all P<0.05).Serum WWP1 level in HFpEF patients was positively correlated with LAD,LVEDD and LVPWT(r=0.547,0.471,0.536,all P<0.05),and negatively correlated with LVEF and E/A(r=-0.485,-0.417,all P<0.05).Serum NLRP3 level was positively correlated with LAD,LVEDD and LVPWT(r=0.534,0.494,0.520,all P<0.05),and negatively correlated with LVEF and E/A(r=-0.462,-0.523,all P<0.05).ROC results showed that the area under the curve(AUC)of serum WWP1 and NLRP3 levels alone for diagnosing the severity of heart failure in HFpEF patients was 0.825 and 0.855,respectively,and the AUC(0.924)diagnosed by the combination of the two was significantly greater than that diagnosed by the serum WWP1 alone and the AUC diagnosed by the NLRP3 alone(Z=3.600,P<0.001;Z=3.053,P=0.002).Conclusion The levels of serum WWP1 and NLRP3 were increased in patients with HFpEF,which were closely related to the cardiac function of patients.Serum WWP1 and NLRP3 have certain diagnostic value for the severity of heart failure in patients with HFpEF.

5.
Article in Chinese | WPRIM | ID: wpr-973751

ABSTRACT

ObjectiveTo observe the effect of Jiawei Shenqi Yixin prescription on cardiovascular risk factors in the patients with heart failure with preserved ejection fraction and insulin resistance. MethodFrom January 2021 to January 2022, a total of 82 patients with heart failure with preserved ejection fraction were enrolled in the ward of the First Affiliated Hospital of Heilongjiang University of Chinese Medicine. The patients were randomly assigned into two groups ( 41 cases) and received the same basic treatment. The observation group was additionally treated with Jiawei Shenqi Yixin prescription for 8 weeks. The clinical efficacy, traditional Chinese medicine (TCM) efficacy, cardiac function indexes [NT-probrain natriuretic peptide (NT-proBNP) and 6-min walking test (6MWT)], echocardiographic parameters [left atrial volume index (LAVI), left ventricular mass index (LVMI), peak early diastolic to peak late diastolic mitral flow velocity (E/A) ratio], insulin resistance-related indexes [fasting insulin (FINS), fasting plasma glucose (FPG), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), homeostatic model assessment of insulin resistance (HOMA-IR), triglyceride-glucose index (TYG), and triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio], inflammatory cytokines [tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), adiponectin (ADP), and C-reactive protein (CRP)], vascular endothelial function indicators [nitric oxide (NO), endothelial nitric oxide synthase (eNOS), inducible nitric oxide synthase (iNOS), and endothelin-1 (ET-1)], and the safety of treatment were determined. In addition, Pearson correlation analysis was performed to analyze the correlations of insulin resistance, inflammatory cytokines, and vascular endothelial factors with the mitigation of heart failure. ResultIn terms of clinical efficacy, the therapy of the observation group was significantly effective in 26 patients, effective in 12 patients, ineffective in 3 patients, with the total effective rate of 92.68%, the therapy of the control group was significantly effective in 14 patients, effective in 12 patients, and ineffective in 15 patients, with the total effective rate of 63.41%. The clinical total effective rate of the observation group was higher than that of the control group (χ2=11.6, P<0.05). In terms of TCM efficacy, the therapy of the observation group was significantly effective in 26 patients, effective in 11 patients, and ineffective in 4 patients, with the total effective rate of 90.24%; the therapy of the control group was significantly effective in 9 patients, effective in 13 patients, and ineffective in 19 patients, with the total effective rate of 53.66%. The TCM total effective rate of the observation group was higher than that of the control group (χ2=8.19, P<0.05). Compared with those before treatment, the levels of NT-proBNP, LAVI, LVMI, FPG, FINS, HOMA-IR, TYG, TG/HDL-C, TNF-α, IL-6, CRP, ET-1, and iNOS in two groups declined after treatment (P<0.05), while the levels of 6MWT, E/A, ADP, NO, and eNOS elevated (P<0.05). After treatment, the observation group had lower levels of NT-proBNP, LAVI, LVMI, FPG, FINS, HOMA-IR, TYG, TG/HDL-C, TNF-α, CRP, and ET-1 (P<0.05) and higher levels of 6MWT, E/A, ADP, and NO than the control group (P<0.05). In addition, the increase in 6MWT after treatment was positively correlated with the increase in NO and the decrease in ET-1. The decrease in LVMI after treatment was positively correlated with the increase in NO and the decrease in FINS. The increase in left ventricular ejection fraction after treatment was positively correlated with the decreases in TNF-α and TYG (P<0.05). Adverse reactions were observed in neither group. ConclusionJiawei Shenqi Yixin prescription can significantly mitigate the symptoms, reduce inflammation, and improve vascular endothelial function in the patients with heart failure with preserved ejection fraction and insulin resistance, being safe without causing adverse reactions.

6.
Article in Chinese | WPRIM | ID: wpr-992813

ABSTRACT

Objective:To evaluate the left ventricular diastolic function and pulmonary congestion in patients with acute myocardial infarction (AMI) with preserved left ventricular ejection fraction (LVEF) by cardiopulmonary ultrasound (CPUS), and to explore the value of CPUS in predicting the occurrence of heart failure with preserved ejection fraction (HFpEF) in AMI patients with preserved LVEF during hospitalization.Methods:A total of eighty-four patients with AMI with preserved LVEF (≥50%) who received optimal emergency reperfusion therapy on admission at Beijing Chaoyang Hospital Affiliated to Capital Medical University from August 2021 to March 2022 were enrolled. All patients completed comprehensive cardiopulmonary ultrasonography within 12 hours after reperfusion therapy and LVEF, left atrial maximum volume(LAV), peak flow velocity of tricuspid valve regurgitation (V TR), peak flow velocity of mitral valve in early diastole (E), peak velocity of mitral valve annulus on septal side and left ventricular lateral side in early diastole and other conventional echocardiography parameters were obtained, and then the left atrial volume index (LAVI), the mean peak velocity of the mitral valve annulus on the septal side and left ventricular lateral side in early diastole (e′) and E/e′ were calculated; lung ultrasound parameters(the number of B lines) were obtained; the left ventricular global long-axis strain (GLS) was obtained using speckle tracking imaging (STE). The predictive power of CPUS parameters for HFpEF during hospitalization in AMI patients with preserved LVEF were analyzed. Results:①The incidence of HFpEF during hospitalization was 40.4% (34/84). ②The number of B lines and LAVI were independently correlated with the occurrence of HFpEF during hospitalization( P<0.05). ③The ROC curve analysis showed that the area under the curve (AUC) of the number of B lines and LAVI for predicting the occurrence of HFpEF during hospitalization were 0.766 and 0.690, respectively. The number of B lines combined with LAVI had the best predictive performance in predicting the occurrence of HFpEF during hospitalization, with the largest AUC of 0.903, which was significantly better than the number of B lines and LAVI ( P<0.05). Conclusions:The number of B lines combined with LAVI can effectively predict the occurrence of HFpEF during hospitalization in AMI patients with preserved LVEF, which is helpful to further improve the clinical management of AMI patients at risk of HFpEF.

7.
Article in Chinese | WPRIM | ID: wpr-1014583

ABSTRACT

Sodium calcium exchanger (NCX) is encoded by the SCL8 family genes and belongs to the cation/Ca

8.
Article in Chinese | WPRIM | ID: wpr-1014589

ABSTRACT

AIM: To study the mechanism of Ginseng Yixin granules (QSYXG) in treating ejection fraction preserved heart failure (HFpEF) based on network pharmacology. METHODS: Effective chemical composition information of QSYXG particles was collected through TCMSP database; DisGeNET, GeneCards, OMIM database for obtaining HFpEF related targets; Metascape GO and KEGG enrichment analysis of the intersection targets of HFpEF; STRING Construction and analysis of the database PPI network; Cytoscape3.7.2 Software construction network diagram; Docking of the major active components to the core target with the AutoDock Vina software molecules, the results were visualized and analyzed with pymol. RESULTS: A total of 66 components and corresponding targets were obtained, HFpEF corresponds to 1 931 targets, The intersection of 127 targets, the main active ingredients are quercetin, kaempferol, β-sitosterol, etc.; TNF, AKT1, IL-6, P53 and JUN as the core targets, Good docking of the key components with the core targets; Mainly involving the positive regulation of gene expression, signal transduction, negative regulation of apoptotic process, positive regulation of cell proliferation and senescence, hypoxia response, negative regulation of gene expression, inflammatory response and so on, PI3K-Akt, AGE-RAG, MAPK, TNF, IL-17, and HIF-1 are the main associated signaling pathways. CONCLUSION: QSYXG may treat HFpEF by activating targets of TNF, AKT1, IL-6, P53, JUN, and regulating apoptotic process, cell proliferation, hypoxia response, and inflammatory response.

9.
Article in Chinese | WPRIM | ID: wpr-988176

ABSTRACT

ObjectiveTo explore the material basis and molecular mechanism of Linggui Qihua prescription (LGQH) against myocardial fibrosis in heart failure with preserved ejection fraction (HFpEF). MethodLiquid chromatography-mass spectrometry (LC-MS) was used to qualitatively analyze the active components of LGQH. AutoDock software was employed for molecular docking between the active components of LGQH and target proteins including α-smooth muscle actin (α-SMA), type Ⅰ collagen (ColⅠ), type Ⅲ collagen (ColⅢ), matrix metalloproteinase-9 (MMP-9), and tissue inhibitor of metalloproteinase-1 (TIMP-1). In vivo experiments were conducted on 40 spontaneously hypertensive rats (SHRs) aged 4 weeks, which were divided into an HFpEF group, an Entresto group (0.018 g·kg-1), and low- and high-dose LGQH groups (3.87, 7.74 g·kg-1). A high-fat, high-salt, and high-sugar diet was administered for 16 weeks along with intraperitoneal injection of streptozotocin solution for 8 weeks to establish an HFpEF model in rats. The blank group consisted of 10 Wistar Kyoto (WKY) rats and 10 SHRs. After successful modeling, the WKY, SHR, and HFpEF groups were given equal volumes of normal saline, while the other three groups received predetermined interventions. Daily oral gavage was performed for 6 weeks. After intervention, echocardiography was conducted to measure left ventricular (LV) anterior wall thickness (LVAWd), LV posterior wall thickness (LVPWd), LV internal diameter at end-diastole (LVIDd), LV ejection fraction (LVEF), isovolumic relaxation time (IVRT), early diastolic peak velocity of mitral valve inflow (E), and early diastolic mitral annular velocity (e'). The E/e' ratio was calculated. Enzyme-linked immunosorbent assay (ELISA) was used to detect serum atrial natriuretic peptide (ANP), B-type natriuretic peptide (BNP), and galectin-3 (Gal-3). Myocardial fibrosis was observed through Masson staining of pathological sections, and collagen volume fraction (CVF) and perivascular fibrosis ratio (PFR) were calculated. Real-time polymerase chain reaction (PCR) and Western blot were employed to detect LV myocardial mRNA and protein expression of α-SMA, ColⅠ, ColⅢ, MMP-9, and TIMP-1. ResultLC-MS identified 13 active components in LGQH. Molecular docking indicated stable binding of the 13 compounds with five target proteins. In vivo experiments showed that compared with the blank group, the HFpEF group had significantly increased LVAWd, LVPWd, LVIDd, IVRT, E/e', ANP, BNP, Gal-3, CVF, and PFR. LV myocardial α-SMA, ColⅠ, and ColⅢ mRNA and protein expression was significantly upregulated, while MMP-9/TIMP-1 mRNA and protein ratios were significantly downregulated (P<0.05, P<0.01). Compared with the HFpEF group, LGQH might dose-dependently reduce LVAWd, LVPWd, LVIDd, IVRT, E/e', ANP, BNP, Gal-3, CVF, and PFR, downregulated myocardial α-SMA, ColⅠ, ColⅢ mRNA expression, α-SMA, and ColⅠ protein expression, and upregulated MMP-9/TIMP-1 mRNA and protein expression (P<0.05, P<0.01). ConclusionLGQH contains multiple active components and may inhibit myocardial fibrosis in HFpEF rats. It may further alleviate LV hypertrophy, dilation, and diastolic dysfunction, making it an effective Chinese medicinal prescription for treating HFpEF.

10.
Zhongguo yi xue ke xue yuan xue bao ; Zhongguo yi xue ke xue yuan xue bao;(6): 264-272, 2023.
Article in Chinese | WPRIM | ID: wpr-981262

ABSTRACT

Objective To investigate the cardiac structural and functional characteristics in the patients with heart failure with preserved ejection fraction (HFpEF) and type 2 diabetes mellitus (T2DM),and predict the factors influencing the characteristics. Methods A total of 783 HFpEF patients diagnosed in the Department of Geriatric Cardiology,the First Hospital of Lanzhou University from April 2009 to December 2020 were enrolled in this study.Echocardiography and tissue Doppler technique were employed to evaluate cardiac structure and function.According to the occurrence of T2DM,the patients were assigned into a HFpEF+T2DM group (n=332) and a HFpEF group (n=451).Propensity score matching (PSM)(in a 1∶1 ratio) was adopted to minimize confounding effect.According to urinary albumin excretion rate (UAER),the HFpEF+T2DM group was further divided into three subgroups with UAER<20 μg/min,of 20-200 μg/min,and>200 μg/min,respectively.The comorbidities,symptoms and signs,and cardiac structure and function were compared among the groups to clarify the features of diabetes related HFpEF.Multivariate linear regression was conducted to probe the relationship of systolic blood pressure,blood glucose,glycosylated hemoglobin,and UARE with cardiac structural and functional impairment. Results The HFpEF+T2DM group had higher prevalence of hypertension (P=0.001) and coronary heart disease (P=0.036),younger age (P=0.020),and larger body mass index (P=0.005) than the HFpEF group,with the median diabetic course of 10 (3,17) years.After PSM,the prevalence of hypertension and coronary heart disease,body mass index,and age had no significant differences between the two groups(all P>0.05).In addition,the HFpEF+T2DM group had higher interventricular septal thickness (P=0.015),left ventricular posterior wall thickness (P=0.040),and left ventricular mass (P=0.012) and lower early diastole velocity of mitral annular septum (P=0.030) and lateral wall (P=0.011) than the HFpEF group.Compared with the HFpEF group,the HFpEF+T2DM group showed increased ratio of early diastolic mitral filling velocity to early diastolic mitral annular velocity (E/e') (P=0.036).Glycosylated hemoglobin was correlated with left ventricular mass (P=0.011),and the natural logarithm of UAER with interventricular septal thickness (P=0.004),left ventricular posterior wall thickness (P=0.006),left ventricular mass (P<0.001),and E/e' ratio (P=0.049). Conclusion The patients with both T2DM and HFpEF have thicker left ventricular wall,larger left ventricular mass,more advanced left ventricular remodeling,severer impaired left ventricular diastolic function,and higher left ventricular filling pressure than the HFpEF patients without T2DM.Elevated blood glucose and diabetic microvascular diseases might play a role in the development of the detrimental structural and functional changes of the heart.


Subject(s)
Humans , Aged , Heart Failure/diagnosis , Diabetes Mellitus, Type 2 , Stroke Volume , Glycated Hemoglobin , Blood Glucose , Propensity Score , Ventricular Function, Left , Hypertension
11.
Zhongguo Zhong Yao Za Zhi ; (24): 4747-4760, 2023.
Article in Chinese | WPRIM | ID: wpr-1008642

ABSTRACT

In this study, untargeted metabolomics was conducted using the liquid chromatography-tandem mass spectrometry(LC-MS/MS) technique to analyze the potential biomarkers in the plasma of mice with heart failure with preserved ejection fraction(HFpEF) induced by a high-fat diet(HFD) and nitric oxide synthase inhibitor(Nω-nitro-L-arginine methyl ester hydrochloride, L-NAME) and explore the pharmacological effects and mechanism of Jiming Powder in improving HFpEF. Male C57BL/6N mice aged eight weeks were randomly assigned to a control group, a model group, an empagliflozin(10 mg·kg~(-1)·d~(-1)) group, and high-and low-dose Jiming Powder(14.3 and 7.15 g·kg~(-1)·d~(-1)) groups. Mice in the control group were fed on a low-fat diet, and mice in the model group and groups with drug intervention were fed on a high-fat diet. All mice had free access to water, with water in the model group and Jiming Powder groups being supplemented with L-NAME(0.5 g·L~(-1)). Drugs were administered on the first day of modeling, and 15 weeks later, blood pressure and cardiac function of the mice in each group were measured. Heart tissues were collected for hematoxylin-eosin(HE) staining to observe pathological changes and Masson's staining to observe myocardial collagen deposition. Untargeted metabolomics analysis was performed on the plasma collected from mice in each group, and metabolic pathway analysis was conducted using MetaboAnalyst 5.0. The results showed that the blood pressure was significantly lower and the myocardial concentric hypertrophy and left ventricular diastolic dysfunction were significantly improved in both the high-dose and low-dose Jiming Powder groups as compared with those in the model group. HE and Masson staining showed that both high-dose and low-dose Jiming Powder significantly alleviated myocardial fibrosis. In the metabolomics experiment, 23 potential biomarkers were identified and eight strongly correlated metabolic pathways were enriched, including linoleic acid metabolism, histidine metabolism, alpha-linolenic acid metabolism, glycerophospholipid metabolism, purine metabolism, porphyrin and chlorophyll metabolism, arachidonic acid metabolism, and pyrimidine metabolism. The study confirmed the pharmacological effects of Jiming Powder in lowering blood pressure and ameliorating HFpEF and revealed the mechanism of Jiming Powder using the metabolomics technique, providing experimental evidence for the clinical application of Jiming Powder in treating HFpEF and a new perspective for advancing and developing TCM therapy for HFpEF.


Subject(s)
Male , Mice , Animals , Heart Failure/metabolism , Powders , Stroke Volume/physiology , Chromatography, Liquid , NG-Nitroarginine Methyl Ester/therapeutic use , Mice, Inbred C57BL , Tandem Mass Spectrometry , Metabolomics , Biomarkers , Water
12.
Journal of Medical Research ; (12): 154-158,169, 2023.
Article in Chinese | WPRIM | ID: wpr-1023557

ABSTRACT

Objective To explore the clinical efficacy of sacubitril/valsartan(SV)in the treatment of maintenance hemodialysis(MHD)with heart failure with preserved ejection fraction(HFpEF).Methods A total of 90 patients with MHD combined with HFpEF admitted to the Second People′s Hospital Affiliated of Hefei to Bengbu Medical College from January to December 2021,they were divided into control group and treatment group according to the random number method,with 45 cases in each group.Patients in the control group tookangiotensin-converting enzyme inhibitor/angiotensin Ⅱ receptor blocker(ACEI/ARB)conventional drugs orally;patients in the treatment group took ARNI orally,the initial dose was 50mg,twice a day,followed by an increase to 100mg twice a day,after 2 weeks.After 3 months of treatment,the relevant indicators of cardiac function,including left ventricular ejection fraction(LVEF),left ventricu-lar end-diastolic dimension(LVEDD),left ventricular end-systolic dimension(LVESD),pulmonary artery pressure(PAP),N-ter-minal pro-B-type natriuretic peptide(NT-pro BNP),6-minutes walk test(6MWT),blood pressure level,serum potassium and the incidence of adverse events before and after treatment were collected and compared.Results After 3months of treatment,there were no significant differences in the clinical data,cardiac function index,cardiac function grade,6MWT,blood pressure level and serum potassi-um between the control group and the treatment group before treatment(P<0.05);after 3months of treatment,the levels of LVEF,LVEDD,LVESD,PAP,NT-pro BNP,6MWT,and blood pressure were all improved significantly compared with the baseline in both groups(P<0.05),and there was no significant difference of serum potassium before and after treatment in the two groups(P>0.05);after treatment,LVEF and 6MWT in the treatment group were higher than those in the control group,the LVEDD,LVESD,PAP,NT-pro BNP and blood pressure were lower than in the control group(P<0.05).There were significant differences in LVEF,LVEDD,LVESD,NT-pro BNP,6MWT,systolic blood pressure and diastolic blood pressure between the two groups before and after treatment(P<0.05).Conclusion The clinical efficacy of SV in MHD patients with HFpEF is certain,and can significantly improve cardiac function,increase the NYHK grade,improve blood pressure levels and exercise tolerance,reduce rehospitalization rates.

13.
Chin. j. integr. med ; Chin. j. integr. med;(12): 847-854, 2022.
Article in English | WPRIM | ID: wpr-939796

ABSTRACT

OBJECTIVE@#To summarize the medication rules of Chinese herbs to treat heart failure with preserved ejection fraction (HFPEF) based on data mining and to provide references for clinical utilization.@*METHODS@#The China National Knowledge Infrastructure (CNKI), Wanfang database (Wanfang), VIP database (VIP), Chinese Biomedical Literature (CBM), PubMed, Embase, and Cochrane Library databases were searched from inception to October 2021 to identify relevant literature on treating HFPEF with Chinese herbs. Microsoft Excel 2019 was used to set up a database, and then, association rule analysis and hierarchical cluster analysis were performed by using apriori algorithm and hclust function respectively in R-Studio (Version 4.0.3).@*RESULTS@#A total of 182 qualified papers were included, involving a total of 92 prescriptions, 130 Chinese herbs, and 872 individual herbs prescribed, with an average of 9.5 herbs per prescription. The six most frequently prescribed herbs were Astragali Radix (Huangqi), Salviae Miltiorrhizae Radix Et Rhizoma (Danshen), Poria (Fuling), Glycyrrhizae Radix Et Rhizoma (Gancao), Cinnamomi Ramulus (Guizhi), and Ginseng Radix Et Rhizoma (Renshen). There were 35 herbs used more than 5 times, involving 11 efficacy categories. The top three categories were deficiency-tonifying herbs, blood-activating and stasis-removing herbs, and dampness-draining diuretic herbs. The most commonly used herbs were mainly warm and sweet. The primary meridian tropisms were Lung Meridian, Heart Meridian and Spleen Meridian. Association rule analysis yielded 26 association rules, such as Astragali Radix (Huangqi) & Salviae Miltiorrhizae Radix Et Rhizoma (Danshen), Poria (Fuling), Cinnamomi Ramulus (Guizhi) & Atractylodis Macrocephalae Rhizoma (Baizhu). Hierarchical cluster analysis yielded four herb classes, and their functions were mainly qi-replenishing and yang-warming, blood-activating and diuresis-inducing.@*CONCLUSIONS@#HFPEF is the syndrome of root vacuity and tip repletion, and its core pathogenesis is "deficiency", "stasis", and "water", with "deficiency" being the most principal, which is closely related to Xin (heart), Fei (Lung), and Pi (Spleen). The treatment of this disease occurs by improving qi, warming yang, activating blood and inducing diuresis. Astragali Radix (Huangqi) with Salviae Miltiorrhizae Radix Et Rhizoma (Danshen) is the basic combination of herbs applied.


Subject(s)
Humans , Data Mining , Drugs, Chinese Herbal/pharmacology , Heart Failure/drug therapy , Medicine, Chinese Traditional , Salvia miltiorrhiza , Stroke Volume
14.
Article in Japanese | WPRIM | ID: wpr-924584

ABSTRACT

We present the case of 83-year-old male patient. He was under observation as an outpatient with mild to moderate aortic stenosis and regurgitation since 75 years old. He underwent surgery because of repeated hospitalization by heart failure due to progressive aortic valve stenosis and regurgitation, mitral valve stenosis and regurgitation, and tricuspid regurgitation. Elective aortic valve replacement, mitral valve replacement and tricuspid valve repair was performed. Even though his condition after surgery was stable, suddenly feature like low output syndrome appeared on day 6, and led to a mortality on day 8 after operation. Ejection fraction was kept above 50 percent before and after surgery, which indicated to Heart Failure with preserved Ejection Fraction (HFpEF). After autopsy examination, by immunohistochemical staining identified transthyretin, we demonstrated previously undiagnosed transthyretin-related cardiac amyloidosis (TTR-CA).

15.
Zhongnan Daxue xuebao. Yixue ban ; (12): 1733-1739, 2022.
Article in English | WPRIM | ID: wpr-971358

ABSTRACT

Heart failure with preserved ejection fraction (HFpEF) is a syndrome with highly heterogeneous clinical symptoms, and its incidence has been increasing in recent years. Compared with heart failure with reduced ejection fraction (HFrEF), HFpEF has a worse prognosis. Traditional therapies targeting the internal mechanisms of the heart show limited or inefficacy on HFpEF, and new therapeutic targets for HFpEF are expected to be found by focusing on the extracardiac mechanisms. Recent studies have shown that cardiopulmonary pathophysiological interaction exacerbates the progression of HFpEF. Hypertension, systemic vascular injury, and inflammatory response lead to coronary microvascular dysfunction, myocardial hypertrophy, and coronary microvascular remodeling. Acute kidney injury affects myocardial energy production, induces oxidative stress and catabolism of myocardial protein, which leads to myocardial dysfunction. Liver fibrosis mediates heart injury by abnormal protein deposition and inflammatory factors production. Skeletal muscle interacts with the sympathetic nervous system by metabolic signals. It also produces muscle factors, jointly affecting cardiac function. Metabolic syndrome, gut microbiota dysbiosis, immune system diseases, and iron deficiency promote the occurrence and development of HFpEF through metabolic changes, oxidative stress, and inflammatory responses. Therefore, the research on the extracardiac mechanisms of HFpEF has certain implications for model construction, mechanism research, and treatment strategy formulation.


Subject(s)
Humans , Heart Failure/diagnosis , Stroke Volume/physiology , Myocardium/metabolism , Cardiomyopathies/metabolism , Hypertension , Ventricular Function, Left
16.
Article in Chinese | WPRIM | ID: wpr-910127

ABSTRACT

Objective:To assess the changes of left ventricular systolic function and global myocardial work in heart failure with preserved ejection fraction (HFpEF) patients by speckle tracking layer-specific strain combined with myocardial work technique and explore the diagnostic value of each parameter for HFpEF.Methods:From December 2019 to December 2020, 38 HFpEF patients (HFpEF group) and 38 healthy individuals with age- and sex-matched (control group) were enrolled consecutively in the Fourth Affiliated Hospital of Harbin Medical University. Conventional ultrasound parameters were collected. Layer-specific strain and myocardial work techniques were used to obtain the global longitudinal strain (GLS) of the left ventricular endocardium, mid-myocardium, and epicardium (GLSendo, GLSmid, GLSepi), global myocardial work index (GWI), global myocardial work efficiency (GWE), global constructive work (GCW), and global wasted work (GWW). The absolute difference of GLS(ΔGLS) between endocardium and epicardium were calculate.All parameters were analyzed statistically. ROC curves were plotted to compare the effectiveness of layer-specific strain and myocardial work parameters in predicting left ventricular systolic function impairment in HFpEF patients.Results:①Left atrial diameter, interventricular septum at end-diastole, left ventricular posterior wall at end-diastole, relative wall thickness, left ventricular mass index, and average early diastolic peak velocity (E)/early diastolic tissue velocity (e′) in HFpEF group were significantly higher compared with control subjects, while late diastolic peak velocity (A), E/A, and e′ were significantly lower (all P<0.05); E, left ventricular end-diastolic diameter, left ventricular end-diastolic volume, left ventricular end-systolic volume, fraction shortening, and left ventricular ejection fraction were not different between HFpEF and control groups (all P>0.05). ②The global longitudinal strain of the left ventricule was highest in the endocardium and lowest in the epicardium. ③Compared with control subjects, HFpEF patients demonstrated significantly decreased GLSendo, GLSmid, GLSepi, ΔGLS, GWI, GWE, GCW and increased GWW (all P<0.01). ④The ROC results showed that the area under the curve of ΔGLS and GWE for predicting left ventricular contractile function impairment in HFpEF group, was 0.884 and 0.882, respectively; The cutoff values were -5.8% and 95%; The sensitivity were 84.2% and 71.1%, and the specificity was 84.2% and 89.5%, respectively. ⑤The ROC curve of combining the two technologies showed that the maximum area under the curve of the ΔGLS in tandem with GWE was 0.944, the sensitivity was 81.6%, and the specificity was 97.4%. Conclusions:Both speckle tracking layer-specific strain and myocardial work techniques can sensitively detect left ventricular myocardial function impairment in HFpEF patients at an early stage. ΔGLS and GWE are more reliable indexes for predicting left ventricular systolic function damage in HFpEF patients. Combining the two techniques can improve the diagnostic performance in HFpEF patients.

17.
Chinese Journal of Ultrasonography ; (12): 1081-1087, 2021.
Article in Chinese | WPRIM | ID: wpr-932366

ABSTRACT

Objective:To evaluate the pathological features of a heart failure with preserved ejection fraction(HFpEF) model, which is established by spontaneously hypertensive rats (SHR) through high-fat diet and diabetic factors.Methods:Twenty specific pathogen-free grade(SPF grade) and 14-week-old SHR rats were randomly divided into SHR group (normal diet) and HFpEF group [high-fat diet combined with intraperitoneal injection of streptozotocin (STZ, 25 mg/kg) were used to create a diabetic complex model] with 10 rats in each group. Ten SPF and 14-week-old WKY rats with the same genetic background were set as blank control group (WKY group). All rats were fed for 8 weeks. Echocardiography was performed to measure cardiac parameters: peak velocity of early diastolic mitral inflow(E), peak velocity of late diastolic mitral inflow(A), and the early diastolic mitral annulus e′ in the same cardiac cycle, left atrial ejection fraction (LAEF), left ventricular ejection fraction (LVEF), left atrial diameter, right atrial diameter and interventricular septal thickness(IVST). Serological testing included glucose (GLU) and glycosylated serum protein (GSP); Enzyme-linked immunoassay (ELISA) testing included insulin (INS), glucagon (PG), C-peptide (CP), leptin (LEP), atrial natriuretic peptide (ANP) and B-type brain natriuretic peptide (BNP). The rat heart tissue was stained with HE, and the morphological changes of atrial/ventricular tissue were observed under an optical microscope.Results:The pathological characteristics of HFpEF was established in SHR rats fed with high fat and diabetes. Echocardiography showed that compared with the WKY group, the values of E, E/A and E/e′ in the HFpEF group were significantly increased (all P<0.01), and e′and LAEF were significantly reduced (all P<0.01). In the HFpEF group, the anteroposterior and tranverse dimensions of the left atrium and the long-axis dimension of the right atrium increased to varying degrees (all P<0.05), and the IVST was also significantly increased ( P<0.01). At the same time, atrial wall was thickened obviously, myocardial cells were disordered, and myocardial fibers were broken. Compared with the WKY group, the levels of serum markers ANP and BNP in HFpEF group were significantly increased (all P<0.01), and the levels of serum insulin-related indicators INS, PG, CP, LEP, GSP, and GLU increased to varying degrees (all P<0.01). Conclusions:The composite model established by SHR rats through high-fat diet and diabetic factors can simulate the Doppler echocardiographic changes and pathological features of HFpEF, as well as abnormal changes in serum related markers and insulin indicators.

18.
Rev. bras. pesqui. méd. biol ; Braz. j. med. biol. res;53(7): e9646, 2020. graf
Article in English | LILACS, ColecionaSUS | ID: biblio-1132528

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 , Prognosis
19.
Indian Heart J ; 2019 May; 71(3): 242-248
Article | IMSEAR | ID: sea-191696

ABSTRACT

Background India has one of the largest population of heart failure (HF) patients in the world; yet only limited information is available about HF in India. Methods This observational study was performed at Medanta- The Medicity, a large, tertiary-care institute in the National Capital Region of India. Records of HF patients with reduced left ventricular ejection fraction (LVEF) registered at Medanta HF clinic during the period early 2014 to mid-2017 were reviewed. Disease characteristics and one-year mortality details were collected. Results Mean age of the subjects (n = 5590) was 59.1 ± 11.8 years with 83.0% males. Mean LVEF was 30.0 ± 6.6%. Coronary artery disease (CAD) was the dominant cause of HF, accounting for 77.8% of the total population. Most patients received guideline-directed medical therapy with a beta blocker being prescribed to 81.8% subjects. The one-year all-cause mortality was 17.6%. On multivariate analysis, age, usage of loop diuretics and ivabradine, and serum creatinine were independently associated with one-year mortality, whereas rheumatic etiology had an inverse association. Conclusions This represents the largest single-center data of HF patients reported so far and the largest study describing clinical outcomes from HF patients in India. Our patients were younger, had high proportion of CAD, and there was higher usage of beta-blockers. Despite this, the one-year mortality was substantial. Given the enormous magnitude of HF burden in India and the paucity of information on this subject, these findings should be of help in identifying key problem areas and potential solutions for management of HF in India.

20.
Chin. j. integr. med ; Chin. j. integr. med;(12): 770-777, 2019.
Article in English | WPRIM | ID: wpr-777117

ABSTRACT

OBJECTIVE@#To evaluate the effectiveness and safety of oral Chinese herbal medicine (OCHM) for heart failure with preserved ejection fraction (HFpEF).@*METHODS@#PubMed, Excerpta Medica Database (EMBASE), Cochrane Library, Chinese Biological Medicine Database (CBM), Wanfang Database, Chongqing VIP Information (VIP) and China National Knowledge Infrastructure (CNKI) were searched for appropriate articles from respective inceptions until June 3, 2018. Randomized controlled trials (RCTs) investigating the effectiveness of OCHM for the patients with HFpEF were eligible. Quality assessment was performed by employing the Cochrane Risk of Bias assessment tool. Papers were independently reviewed by two reviewers and analyzed using Cochrane software Revman 5.3. Dichotomous data were analyzed by relative risk (RR) with a 95% confidence interval (CI), while continuous variables were analyzed by using mean difference (MD) with 95% CI for effect size.@*RESULTS@#A total of 16 RCTs involving 1,320 participants were identified. Fourteen of the trials used conventional Western medicine (CWM) as the control, the control of 1 trial was no treatment, and another was placebo. Three of the trials served Chinese patent medicine (CPM) as interventions, and other OCHM were Chinese medicine decoctions (CMDs). Only limited evidence showed experimental group with OCHM may get better effect on brain natriuretic peptide (BNP: MD -37.29, 95% CI -53.08 to -21.50, P<0.00001) or N terminal pro B type natriuretic peptide (NT-proBNP: MD -236.04, 95% CI -356.83 to -115.25, P=0.0001), Minnesota Living with Heart Failure questionnaire (MLHFQ, MD -9.94, 95% CI -16.77 to -3.11, P=0.004), but the results had high heterogeneities. With concerns on 12 of 16 trials, the meta-analysis found that the adjuvant therapy of OCHM might be more effective in increasing overall response rate (RR 1.17, 95% CI 1.11 to 1.24, P<0.00001), when compared with CWM alone. Subgroup meta-analysis between CPMs and CMDs showed that the two CPMs may have more therapeutic effect on MLHFQ, but not on NT-proBNP, and CMD came to the opposite conclusion. No significant differences were found between experimental groups and control groups on 6-min walk test (6MWT). Adverse events, such as more defecation, weakness, cardiopalmus, edema, cough and hypotension, were mild in all groups and disappeared after the easement of pharmacological intervention.@*CONCLUSIONS@#Due to the insufficient quality of trials that were analyzed, it is not appropriate to confirm or deny the potency of OCHMs in treating HFpEF at the present time. More rigorously designed RCTs focusing on primary endpoints with long-term follow-up are warranted to validate the effect of OCHMs for patients with HFpEF.

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