Efficacy and Safety of Nalbuphine for Post-operative Analgesia ：a Meta-analysis / 中国药房

OBJECTIVE： To evaluate the efficacy and safety of nalbuphine for postoperative analgesia systematically， and to provide evidence-based reference in clinic. METHODS： Retrieved from Embase， Medline， PubMed， CNKI， VIP and Wanfang database， RCTs about nalbuphine hydrochloride （trial group） vs. other analgesics （control group） for postoperative analgesia were collected. After literature screening， data extraction and literature quality evaluation with modified Jadad scale， Meta-analysis was performed by using Rev Man 5.3 statistical software. RESULTS： A total of 10 RCTs were included， involving 796 patients. Results of Meta-analysis showed that there was no statistical significance in satisfaction rate of analgesia [OR＝1.11，95％CI（0.70，1.74），P＝0.66]， the incidence of nausea [OR＝1.20，95％CI（0.79，1.83），P＝0.39]， vomiting [OR＝1.02，95％CI（0.69，1.50），P＝0.92] or narcolepsy [OR＝1.32，95％CI（0.47，3.76），P＝0.06] between 2 groups. The incidence of pruritus [OR＝0.29，95％CI（0.14，0.58），P＝0.000 6]， respiratory depression [OR＝0.21，95％CI（0.08，0.58），P＝0.003] and uroschesis [OR＝0.05，95％CI（0.01，0.37），P＝0.004] in trial group were significantly lower than control group. CONCLUSIONS： Nalbuphine has better efficacy and safety for postoperative analgesia.

Chemical constituents from Euphorbia helioscopia / 中草药

Objective: To investigate the chemical constituents from Euphorbia helioscopia. Methods: The compounds were isolated and purified using macroporous resin, silica gel colimu, ODS, MCI gel and Sephadex LH-20, and their structures were elucidated on the basis of spectral data and physicochemical properties. Results: Sixteen compounds were isolated from 95% ethyl alcohol extract from the whole arial of E. helioscopia and identified as four terpenoides: helioscopinolide E (1), ent-kaurane-3-oxo-16β-17-diol (2), oleanolic acid (3), betulinic acid (4); six phenolics: benzoic acid (5), ethyl gallate (6), 3, 3', 4, 4'-tetrahydroxy diphenyl (7), brevifolin (8), 6-hydroxy-7, 8-methylenedioxy coumarin (9), 3, 3'-di-O-methylellagic acid (10); and five phenolics: apigenin (11), chrysoeriol (12), hyperin (13), naringenin-7-O-β-D-glucoside (14), cannabisci-trin (15), and 3β-hydroxy-cholesta-5-ene (16). Conclusion: Compounds 7-10 and 12 are isolated from this genus for the first time. Compounds 2-5 and 14-15 are isolated from this plant for the first time.

Method of bubble under water capsulorhexis in small incision used in mature cataract operation / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To observe application of underwater bubble method capsulorhexis overmature period to improve the small incision cataract surgery, so as to explore the clinical value of the surgical method. ● METHODS: From Jul. 2012 to Mar. 2016 at the grassroots of blindness 58 people fail in the 66 eyes overmature period of cataract were randomly divided into underwent capsulorhexis by underwater bubble method to improve the small incision cataract surgery group ( 36 eyes of 30 cases ) and conventional viscoelastic agent underwent capsulorhexis small incision cataract surgery group (30 eyes of 28 cases). ● RESULTS: A total of 66 eyes in success rate of continuous circular capsulorhexis: 92% ( 33/36 eyes ) of underwater bubble method, method of viscoelastic agent only 40% ( 12/30 eyes ) . Two groups of cases of postoperative corneal endothelial cell density are compared with preoperative significantly reduced, no significant statistical difference between the two groups(P>0. 05). ● CONCLUSION: Underwater bubble method capsulorhexis difficult to overmature period of cataract surgery capsulorhexis solution is a better way.

Prognostic value of right ventricular end-diastolic diameter in patients with chronic systolic heart failure / 中华老年医学杂志

Objective To investigate the prognostic value of right ventricular end-diastolic diameter (RVDD) in patients with chronic systolic heart failure (CHF).Methods A retrospective study was conducted with clinical data of inpatients from 12 third-grade class-A hospitals of Hubei Province between 2000 to 2010,followed up by phone calls.Based on RVDD,patients diagnosed with chronic systolic CHF were divided into four groups:＞38 mm,31-38 mm,25-30 mm and ＜25 mm groups;based on prognosis,patients were divided into the death group and the survival group.Of the death group,patients were further divided into the heart failure death subgroup and the sudden cardiac death subgroup.Single-factor and multi-factor Cox survival analyses were conducted to analyze the relationships between RVDD and mortality,including all-cause mortality,CHF mortality and sudden cardiac death (SCD).Results A total of 16681 patients were enrolled in this study.They were followed up for 1-4 years,during which 6453 died.Multivariate Cox survival analysis showed that the mortality risk for patients with RVDD between 25-30 mm,between 31-38 mm,and ＞38 mm groups was 1.87,2.41,3.95 times that for patients with RVDD＜25 mm,respectively (95％CI:1.64-2.13,2.06-2.80,3.61-4.32,all P＜0.01).The risk of sudden cardiac death for patients with RVDD＞38mm was 3.82 times that for patients with RVDD＜25 mm (95％CI:2.27-5.94,P＜0.01).The areas under the ROC curve for death by the best prediction model alone and RVDD combined with the best respectively.RVDD increased the areas under the ROC curve for all cause mortality,CHF mortality and sudden cardiac death.The best prediction model combined with RVDD could discriminate between total mortality,heart failure mortality and sudden cardiac death for patients with different causes of death in multivariate analysis.Conclusions RVDD has a predictive value in the prognosis of patients with chronic systolic heart failure.RVDD increases the sensitivity and specificity of the best prediction model for total mortality prediction in patients with chronic systolic heart failure.RVDD increases the sensitivity and specificity of the best prediction model to discriminate between all-cause mortality,heart failure mortality and sudden cardiac death in patients with different causes of death.RVDD＞38 mm can serve as an indicator for the assessment of sudden cardiac death in CHF patients.

Effect of temperature on hospital admission among patients with chronic systolic heart failure / 中华流行病学杂志

<p><b>OBJECTIVE</b>To investigate the effect of temperature on hospital admission among patients with chronic systolic heart failure (CSHF).</p><p><b>METHODS</b>Data regarding in-hospital patients with CSHF were gathered from 12 hospitals in Hubei province, between 2000 and 2010. Patients with a history of congenital heart disease and the history of cancer from this series, were excluded. Chi-square (χ(2)) tests and t tests were used for descriptive analysis. Univariate and multivariate logistic regression methods were performed to determinate the risk of hospital admission of every month to compare with the previous one. We used 2-tailed 95% confidence interval (CI), and tests with P < 0.01 to consider the significant levels, statistically. We also used the SPSS 13.0 for Windows, release 15, 2006 (SPSS Inc, Chicago, Ill) for data analyses.</p><p><b>RESULTS</b>(1) 48 964 patients were enrolled in the present study. The numbers of admission increased 18.71%, 13.84%, -21.90%, -34.62%, -21.97%, -3.81%, -2.04%, 10.13%, -17.13%, -0.85%, 21.54% and 42.70% from January to December when compared to the average number of admission. (2) The odds ratios (ORs) (95% CI, P values) of hospital admission in January, February and December were 1.09 (0.96 - 1.23, 0.54), 0.98 (0.84 - 1.10, 0.46) and 0.96 (0.84 - 1.08, 0.59), respectively in females which did not show any significant differences when compared to the number in August. However the ratios were 0.61 (0.54 - 0.69, < 0.01), 0.80 (0.68 - 0.92, < 0.01) and 0.73 (0.64 - 0.83, < 0.01), respectively, in males that showed significant differences when, compared to the figures in August. (3) The OR of admission increased more when temperature got lower for patients with coronary artery disease, hypertension heart disease or rheumatic heart disease, but not with dilated cardiomyopathy. (4) The OR of admission showed a different impact on patients with different occupation, along with the change of temperature. Low or high temperature did not seem to have different effects on the OR of admission in patients who were free-lanced or unemployed.</p><p><b>CONCLUSION</b>Temperature seemed to have significant effects on the risk of admission, which related to gender, etiology or occupation.</p>

Effect of anxiety and depression on the recurrence of persistent atrial fibrillation after circumferential pulmonary vein ablation / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The effects of anxiety and depression on the recurrence of persistent atrial fibrillation (AF) after circumferential pulmonary vein ablation (CPVA) are not clear. Whether CPVA can alleviate the anxiety and depression symptoms of persistent AF patients is unknown.</p><p><b>METHODS</b>One hundred and sixty-four patients with persistent AF, of which 43 treated with CPVA (CPVA group) and 103 treated with anti-arrhythmics drugs (medicine group), were enrolled. The Zung Self-Rating Anxiety Scale (SAS), and Zung Self-Rating Depression Scale (SDS) were assessed before and 12 months after treatment in all patients.</p><p><b>RESULTS</b>The scores of SAS (40.33 ± 7.90 vs. 49.76 ± 9.52, P < 0.01) and SDS (42.33 ± 8.73 vs. 48.17 ± 8.77, P < 0.01) decreased 12 months after CPVA. Over 12 months follow-up, AF relapsed in 17 patients in CPVA group. Compared with the data in the recurrent group (17 patients), the scores of SAS and SDS were significantly lower in the non-recurrent group (26 patients) at baseline. The results of multivariate Logistic regression analysis showed normal scores of SAS and SDS were the independent risk factors of AF recurrence after CPVA.</p><p><b>CONCLUSIONS</b>Anxiety and depression increase the recurrence risk of persistent AF after CPVA. CPVA can ameliorate the anxiety and depression symptoms in patients with persistent AF.</p>

Serum uric acid levels correlate with atrial fibrillation in patients with chronic systolic heart failure / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Studies have shown that increased levels of serum uric acid (SUA) are associated with atrial fibrillation (AF). However, less is known about the prognostic value of SUA levels for AF in patients with chronic heart failure (CHF). The aim of the study was to examine the prognostic value of SUA levels for AF in patients with CHF.</p><p><b>METHODS</b>Sixteen thousand six hundred and eighty-one patients diagnosed with CHF from 12 hospitals were analyzed. Patients were categorized into AF group and non-AF group, death group, and survival group according to the results of the patients' medical records and follow-up. Univariate and multivariate Cox proportional hazards analyses were performed to examine the risk of AF. The sensitivity and specificity of SUA level in predicting the prognosis were examined by multivariate Cox models and receiver operating characteristic (ROC) curves.</p><p><b>RESULTS</b>The results of univariate predictors in overall patients showed that the higher SUA level was associated with AF. SUA level (HR, 1.084; 95%CI, 1.017 - 1.144; P < 0.001), diuretics (HR, 1.549; 95%CI, 1.246 - 1.854; P < 0.001), and New York Heart Association (NYHA) (HR, 1.237; 95%CI, 1.168 - 1.306; P < 0.001) function class were the independent risk factors for AF. The sensitivity and specificity of the models were 29.6% and 83.8% respectively for predicting AF. When SUA level was added to these models, it remained significant (Wald c(2), 1494.88; P < 0.001 for AF); 58.8% (95%CI, 57.7% - 60.0%) of the observed results were concordant with the separate model.</p><p><b>CONCLUSION</b>Higher SUA level is associated strongly with AF in patients with CHF. SUA level can increase the sensitivity and specificity in predicting AF.</p>

Activating protein kinase C enhances ventricular action potential duration restitution and increase arrhythmia susceptibility in Langendorff-perfused rabbit hearts / 中华心血管病杂志

<p><b>OBJECTIVE</b>To determine effects of activating protein kinase C (PKC) on ventricular action potential duration restitution (APDR) and Burst stimulus induced arrhythmia in Langendorff-perfused rabbit hearts.</p><p><b>METHODS</b>Male rabbits were equally divided into three groups randomly: control group (Tyrode's solution perfusion), PKC agonist phorbol-12-myristate-13-acetate (PMA, 100 nmol/L) group and PKC inhibitor bisindolylmaleimide (BIM, 500 nmol/L) group. Thirty minutes after perfusion, the monophasic action potential (MAP) and effective refractory period (ERP) were determined in right basal ventricle (RB), right apex (RA), left basal ventricle (LB) and left apex (LA) of all the animals, and APDR curve was drawn. Burst stimulus method was used to induce ventricular arrhythmia in perfused rabbit hearts; Real-time PCR was used to detect the mRNA expression of PKC in four different areas of ventricle.</p><p><b>RESULTS</b>Compared with the control group, the ERP, 90% of monophasic action potential duration (MAPD(90)) and ERP/MAPD(90) were significantly shortened (all P < 0.01), the max slopes (S(max)) of APDR curve were significantly steeper (RB: 1.22 ± 0.23 vs. 0.65 ± 0.19; RA: 2.99 ± 0.29 vs. 1.02 ± 0.18; LB: 1.84 ± 0.21 vs. 0.85 ± 0.12; LA: 4.02 ± 0.32 vs.1.12 ± 0.23, all P < 0.01) and the incidences of ventricular arrhythmia were significantly increased in the PMA group. All parameters were similar between the BIM group and the control group (all P > 0.05).</p><p><b>CONCLUSION</b>Activating PKC could enhance the max slopes of APDR curve at various ventricular areas and subsequently increase arrhythmia susceptibility in Langendorff-perfused rabbit hearts.</p>

Cardiac electrophysiological differences between Kunming and C57BL6/J mice / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the alterations of cardiac electrophysiological properties and substantial mechanism and find the stable arrhythmia mouse model in Kunming (KM) and C57BL6/J (C57) mice.</p><p><b>METHODS</b>Electrocardiogram recordings were used to analyze the QT interval in vivo, and mono- phasic action potential of right and left ventricular epicardium was recorded to elicit changes of action potential duration (APD) in conventional and programmed electrical stimulation (PES). Transient outward potassium current (Ito) was recorded via whole-cell patch-clamp technique in single right and left epicardial myocytes.</p><p><b>RESULTS</b>QT interval was prolonged in KM mice relative to C57 mice (62.51±4.47 ms vs. 52.59±4.85 ms, P<0.05) The APD at 50% repolarization of the left ventricular epicardium (18.60±0.91 ms vs. 12.90±0.35 ms), and APDs at 50% (17.31±6.05 ms vs. 12.00±3.24 ms) and 70% repolarization (36.13±5.32 ms vs. 21.95±8.06 ms) of the right ventricular epicardium in KM mice were more sensitive to PES-induced ventricular tachycardia (25%, 3 of 12 hearts), and especially to Burst-induced ventricular tachycardia (50%, 6 of 12 hearts)compared with C57 mice, which were 20% (2 of 10 hearts) and 30% (3 of 10 hearts) respectively. Ito densities both in the left and right ventricular epicardial myocytes from KM mice were significantly decreased compared with C57 mice, respectively (all P<0.01).</p><p><b>CONCLUSION</b>Our data showed that KM mice with the prolonged QT interval and APD are vulnerabilities to ventricular arrhythmia, which are attributed to lower Ito densities in ventricular myocytes obtained from KM mice than that from C57 mice.</p>

Prognosis investigation in patients with chronic heart failure and pericardial effusion / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Researchers still do not reach the consensus on the incidence, characters and the prognostic value of pericardial effusion (PE) in patients with chronic heart failure (CHF). This study is to investigate the incidence, characters and the prognostic value of pericardial effusion (PE) in patients with CHF.</p><p><b>METHODS</b>One thousand one hundred and eighty-nine patients, with a diagnosis of CHF consecutively admitted to three centers, were enrolled. M-mode echocardiography was used to determine the presence or absence of PE and to semi-quantify it. The 118 patients with PE and 472 without PE were followed up. The relationship between the PE and other parameters and the prognostic value of PE for CHF were analyzed by univariate and multivariate analyses.</p><p><b>RESULTS</b>After following up, 550 patients were analyzed, of which 226 were dead. The incidence of PE was 9.92%. Moderate PE was the most common which account 90.68% (107/118). The 6.78% of the patients (8/118) had small while only 2.54% (3/118) had large one. The systolic blood pressure (OR=1.04, 95%CI (1.01-1.07), P=0.08), left ventricular ejection fraction (LVEF) (OR=1.09, 95%CI (1.02-1.15), P=0.06), and main pulmonary artery diameter (MPAD) (OR=1.51, 95%CI (1.24-1.85), P<0.001) were the independent predictors of PE. The glomerular filtration rate (GFR) (OR=1.013, 95%CI (1.005-1.026), P=0.02), systolic blood pressure (OR=1.02, 95%CI (1.00-1.03), P=0.015), LVEF (OR=1.08, 95%CI (1.04-1.12), P<0.001) and diabetes mellitus (OR=3.53, 95%CI (1.99-6.44), P<0.001) were determined as the independent predictors of CHF prognosis.</p><p><b>CONCLUSIONS</b>The PE is not uncommon in CHF patients and most PE are small to moderate. PE is not related to the etiology of CHF while is strongly connected with higher systolic blood pressure, low LVEF and large MPAD. PE dose not increase the risk of death in patients with CHF.</p>

Investigation on the prevalence and related factors of medicinal therapy in patients with chronic svstolic heart failure / 中华流行病学杂志

Objective To investigate the prevalence and related factors of medicinal therapy in patients with chronic systolic heart failure (CSHF).Methods Data on in-hospital patients with CSHF were studied from 12 hospitals in Hubei province,in 2000 and 2010.Differences on gender and age were calculated and Multivariate Cox regression analysis was performed to determinate the independent risk factors of all-cause mortality.Results (1) 16 681 patients were enrolled in this study.Among which,6453 died during the 5.82 ± 1.63 years of follow-up.The annual medical expenditure was larger in the survival group than in the dead ones (3.19 ± 0.65 vs.3.32 ± 0.57,P＜0.01).(2)The prevalence of Angiotensin Ⅱ receptor blocker increased along with age which accounted as 7.73％,7.35％,12.26％,14.29％,17.19％,19.87％ and 20.49％,respectively,in the ＜30,30-39,40-49,50-59,60-69,70-79 and ≥80-year groups.The distribution of digitalis,diuretics,β-receptor blocker,Angiorensin- converting enzyke inhibitors showed inversed U shape.(3)The annual medical expenditure increased as patients got older,with age groups ＜30,30-39,40-49,50-59,60-69 and 70-79 years old as 2.96 ± 0.70,3.09 ± 0.62,3.15 ± 0.58,3.30 ± 0.59 and 3.25 ±0.58,respectively (P＜0.01).It reduced to the same level as in the 50-59 year-old group.The distribution of annual medical expenditure showed similar pattern in males.However,the trends were only found in patients at 50-59,60-69,70-79 and ≥80 years-old groups in female.Conclusion More attention should be paid to medicinal therapy in patients with CSHF.Medicinal therapy shifted with age and gender,of which females had more adverse trend than in males.

Impact of red cell distribution width on outcome of 16 681 patients with chronic systolic heart failure / 中华心血管病杂志

<p><b>OBJECTIVE</b>To determinate the prognostic value of red cell distribution width (RDW) and the relationships between RDW and clinical characteristics in patients with chronic heart failure (CHF).</p><p><b>METHODS</b>A total of 16 681 in-hospital patients with chronic systolic HF and LVEF < 50% from 12 hospitals in Hubei province, China were enrolled. All patients were followed up with telephone call. Patients were divided into RDW ≤ 13.2% (n = 3981), 13.3% - 14.1% (n = 3996), 14.2% - 14.8% (n = 4319) and ≥ 14.9% (n = 4385) groups. Multivariate Cox regression analysis was performed to determine whether RDW is an independent risk factor of all-cause mortality in overall patients, patients with various etiologies. Multivariate Cox proportional hazard analysis was performed to determine the risk of all-cause mortality among various RDW groups.</p><p><b>RESULTS</b>(1) Compared with RDW ≤ 13.2% group, adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of all-cause mortality for RDW 13.3% - 14.1%, 14.2% - 14.8% and ≥ 14.9% were 0.892 (95%CI 0.818 - 0.973, P = 0.01), 0.859 (95%CI 0.793 - 0.931, P < 0.01) and 1.034 (95%CI 0.961 - 1.111, P = 0.373) respectively. (2) Compared with MCV normal group, the adjusted HRs of MCV elevation and MCV decline groups were 1.351 (95%CI 1.063 - 1.718, P < 0.01) and 1.316 (95%CI 1.034 - 1.675, P < 0.01), respectively. (3) Compared to patients with rheumatic heart diseases, the adjusted HR for all-cause mortality in patients with coronary heart disease, dilated cardiomyopathy and hypertensive heart disease with RDW > 16% were 1.437 (95%CI 1.141 - 1.810, P < 0.01), 1.651 (95%CI 1.276 - 2.138, P < 0.01) and 1.276 (95%CI 1.004 - 1.621, P < 0.01), respectively. (4) The RDW is independently correlated with BMI (r = -0.345, P < 0.01), diastolic blood pressure (r = -0.321, P < 0.01), albumin (r = -0.411, P < 0.01), blood urine nitrogen (r = 0.476, P < 0.01), right ventricular end-diastolic diameter (r = 0.383, P < 0.01), LVEF (r = -0.463, P < 0.01) and heart rate (r = 0.379, P < 0.01).</p><p><b>CONCLUSIONS</b>There is a J shape relationship between all-cause mortality and RDW. The elevation or decline of MCV with increased RDW is linked with increased all-cause mortality in CHF patients.</p>

Action potential duration restitution and the potential association with ventricular arrhythmia in Langendorff-perfused chronic heart failure rabbit hearts / 中华心血管病杂志

<p><b>OBJECTIVE</b>To observe the action potential duration restitution (APDR) change and potential association with ventricular arrhythmia (VA) in Langendorff-perfused chronic heart failure rabbit hearts.</p><p><b>METHODS</b>Male rabbits were randomly divided into two groups: control (CTL, n=15) group and chronic heart failure (CHF, n=15) group. CHF was induced by injecting isoproterenol (300 µg×kg(-1) ×d(-1)) for 14 days. Four weeks later, cardiac function and structure change of both groups were assessed by echocardiography. In the whole Langendorff-perfused hearts, the monophasic action potential (MAP) and the effective refractory period (ERP) were recorded from left anterior basal ventricle, left anterior free wall, left anterior apex and left posterior basal ventricle, left posterior free wall and left posterior apex, the APD curves were also constructed in both groups; at the six sites of every isolated heart, the programmed electrical stimulation and burst pacing were used to induce action potential duration (APD) alternans and VA, respectively.</p><p><b>RESULTS</b>Left ventricular ejection was reduced and end-dimension was enlarged in rabbits of CHF group. Compared with the same sites of CTL group, the 90% of MAP duration (MAPD90), the ERP, the max slope (Smax) of APDR curves, the pacing cycle length of inducing the APD alternans and the VAs were significantly increased (all P<0.05) in CHF group; the spatial dispersions of MAPD90, ERP and Smax of APDR curves in CHF group were also greater than in CTL group (all P<0.05).</p><p><b>CONCLUSION</b>The ventricular APD alternans might be linked with occurrence of the VA in CHF rabbits. Increase of the Smax from APDR curves and the spatial dispersions of Smax in this CHF model might facilitate the development of ventricular arrhythmia.</p>

Effect of right ventricular end-diastolic diameter on prognosis of patients with chronic heart failure / 中国综合临床

Objective To determine the prognostic value of fight ventricular end-diastollc diameter (RVDD)in patients with chronic heart failure(CHF).Methods The clinical data of the in-hospital patients diagnosed as CHF were analyzed retrospectively.Telephone follow-up was carried out for all participants.The patients were divided into the survival group and death groups according to their clinical outcomes.The relationship between RVDD and death was evaluated by independent t-test and multivariate Logistic regression analysis.Results 1552 in-hospital patients were enrolled into the study.The mean age was 64.62 ± 10.45 years old,with 879(56.64％)male.After 3 years' follow-up,439(28.29％)patients died.Comparison of baseline data showed that gender,age,SBP,NYHA classification,the serum level of creatinine,LVEF,LVDD and RVDD were significantly different between the two groups(P ＜ 0.01);Multivariable logistic analysis showed that RVDD(OR=1.11,95％ CI:1.07-1.14,P ＜0.01),age(OR =1.03,95％ CI:1.02-1.05,P ＜0.01),creatinine(OR =1.02,95 ％ CI:1.01-1.04,P ＜ 0.01),LVEF(OR =0.93,95 ％ CI:0.92-0.97,P ＜ 0.01),LVDD(OR =1.13,95％ CI:1.09-1.17,P ＜0.01)and NYHA classification(OR =1.17,95％ CI:1.12-1.24,P ＜ 0.01)were independent predicting factors for the death of CHF patients.The power of RVDD to predict mortality was examined by ROC curves.The area under the curve was 0.805(95％ CI:0.798-0.812,P ＜ 0.01).Conclusion RVDD increases the risk of death in patients with CHF.RVDD is a significant independent predictor for death among patients with CHF.

The prognostic value of etiology in patients with chronic systolic heart failure / 中华流行病学杂志

Objective To determinate the prognostic value of etiology in patients with chronic systolic heart failure (CSHF).Methods Data of in-hospital patients with CSHF were investigated between 2000 and 2010 from 12 hospitals in Hubei province.All patients were followed up through telephone calls.Univariate and multivariate Cox proportional hazards analyses were then used to explore the differences in the all-cause mortality,heart failure (HF) mortality and sudden cardiac death (SCD) among patients caused by different etiologies.Kaplan-Meier curve were then constructed and Univariate and multivariate Cox regression analyses were used to select demographic and clinical variables in predicting the all-cause mortality,HF mortality and SCD in CSHF patients.Multivariate logistic models and ROC curve were developed with or without the cinfirmed etiology to assess the incremental additive information related to different etiologies.Results (1)Over the median 3 (2-4) years follow-up program,6453 (38.69％) patients died,including 5505 (33.00％) due to HF prognosis and 717 (4.30％) died of SCD.All-cause mortality rates accounted for 34.50％,54.30％,41.48％ and 15.76％,with HF mortality rates as 30.11％,44.95％,36.25％ and 13.10％.SCDs accounted 8.46％,8.45％,9.84％ and 1.05％ in patients with CHD,DCM,HHD and RHD,respectively.(2) Compared with RHD patients,the adjusted HRs for all-cause mortality were 1.554 (1.240 to 1.947;P＜0.001),1.405(1.119 to 1.764;P=0.003) and 1.315(1.147 to 1.467;P=0.005) while the adjusted HRs and 95％CIs for HF mortality were 1.458( 1.213-1.751 ;P＜0.001 ),1.763( 1.448-2.147;P＜0.001 ) and 1.281 ( 1.067-1.537; P=0.008),in patients with CHD,DCM and HHD,respectively.There were no significant differences in CHD (HR 3.345; 95％ CI,1.291 to 8.666; P=0.013 ) or HHD (HR 2.062; 95％CI,0.794 to 5.352; P=0.137 ),while only DCM ( HR 4.764; 95％CI,1.799 to 12.618;P=0.002) remained significant in SCD despite of the multivariate adjustment.(3) Etiology increased the sensitivity and specificity of predicting models for all-cause mortality(AUC 0.839,95％CI,0.832to 0.845 vs.0.776,95％CI,0.768 to 0.784) and HF mortality(AUC 0.814,95％CI,0.806 to 0.822 vs.0.796,95％CI,0.788 to 0.804) but not with SCD (AUC 0.777,95％CI,0.749 to 0.809 vs.0.747,95％CI,0.727 to 0.766).Conclusion CSHF due to CHD,DCM and HHD carried a worse prognosis than that of RHD.Different etiologies provided significant incremental prognostic information beyond readily available clinical variables for all-cause mortality and HF mortality.

Characteristics of in-hospital patients with chronic heart failure in Hubei province from 2000 to 2010 / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the current status of chronic heart failure (CHF) in Hubei province and analyze the epidemiology of CHF including the general condition, etiology and pharmacological therapy.</p><p><b>METHODS</b>Data of in-hospital patients with CHF were investigated between 2000 and 2010 from 12 hospitals in Hubei Province.</p><p><b>INCLUSION CRITERIA</b>over 18 years of age, organic heart disease and with the symptom of HF including dyspnea and fatigue. Patients with a history of myocardial infarction in the prior 12 months, congenital heart disease, pericardial disease and the history of cancer were excluded.</p><p><b>RESULTS</b>(1) A total of 12 450 patients were enrolled (7166 male, 57.56%). The average age was (62.0 ± 14.5) years. Patients in the scale of age ≥ 80, 70 - 79, 60 - 69, 50 - 59, 40 - 49 and < 40 was 9.53% (1187/12 450), 30.80% (3835/12 450), 23.45% (2920/12 450), 18.81% (2342/12 450), 10.73% (1336/12 450) and 6.67% (830/12 450), respectively (P < 0.01). The NYHA class I, II, III and IV was 0.60%, 23.20%, 50.31% and 26.50%, respectively. (2) The age of patients was significant reduced from 2000 - 2003, 2004 - 2006 to 2007 - 2010 [(66.4 ± 14.1) years, (64.9 ± 14.4) years and (64.2 ± 14.8) years, P < 0.01]. (3) The major causes of CHF were hypertension (31.54%), coronary heart disease (28.24%), dilated cardiomyopathy (26.57%) and rheumatic valvular heart disease (17.49%). The most frequent etiology for CHF was rheumatic valvular heart disease in patients aged less than 40 years old, dilated cardiomyopathy in patients aged 40 - 49 and 50 - 59 years and hypertension in patients aged 60-69, 70-79 and ≥ 80 years. (4) Drug use was as follows: Digitalis (47.49%), diuretics (68.75%), ACEI (50.66%), β-blocker (44.06%) and aldosterone antagonist (53.08%). Use of digitalis (Wald χ(2) = 903.41, P < 0.01;r = 0.271, P < 0.01), diuretics (Wald χ(2) = 818.05, P < 0.01; r = 0.249, P < 0.01), aldosterone antagonists (Wald χ(2) = 76.92, P < 0.01; r = 0.091, P < 0.01) increased while the β-blocker (Wald χ(2) = 160.65, P < 0.01; r = -0.117, P < 0.01) declined in proportion to NYHA class increase.</p><p><b>CONCLUSIONS</b>The age of in-hospital patients with CHF declined in the previous 10 years. The primary etiology was hypertension for aged CHF in-hospital patients with CHF. There was big gap between guideline recommended standard therapy and current drug use for in-hospital patients with CHF in Hubei province.</p>

Impact of hematocrit on prognosis of patients with acute myocardial infarction / 中国综合临床

Objective To examine the relationship between hematocrit and risk of long term mortality among patients with acute myocardial infarction. Methods A total of 274 patients with acute myocardial infarction were recruited and divided into two groups by death after long term follow-up, the relationship between hematocrit and mortality was evaluated through the methods of independent t-test,chi-square test and multivariate regression analysis. Results The mean age was 69. 79 ± 7.45 years, with 73. 0% of male. The average of followup was 44. 4± 10. 7 months, with mortality of 38.7% . Comparison of baseline data showed that NYHA classification, smoking history, hemoglobin, hematocrit, mean red cell volume, glomerular filtration rate, ejection fraction,left ventricular diastolic diameter and right ventricular diameter was significantly different between the two groups( Ps ＜ 0. 05), Multivariable logistic analysis showed that hematocrit ,glomerular filtration rate, ejection fraction and smoking history were independently predicted factors, with OR of 0. 904 (95% CI: 0. 832 - 0. 982,P =0. 016) ,0. 983 (95% CI: 0. 969 -0. 996,P =0. 014) ,0. 932 (95% CI: 0. 887 -0. 979,P =0. 005) and 3. 230 (95% CI: 1.468 - 7. 106, P = 0. 004), respectively. The power of hematocrit to predict mortality was examined by ROC curves, the area under the curve was 0. 669(P ＜ 0. 001,95% CI: 0. 603 - 0. 736) Conclusion Hematocrit is a significant independent predictor for long term death among patients with acute myocardial infarction.