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Objective To observe the effects of sacubitril-valsartan tablets on the expressions of N terminal pro B type natriuretic peptide(NT-proBNP),troponin Ⅰ(cTnⅠ)and cardiac function in patients with chronic cardiac insufficiency.Methods Patients with chronic cardiac insufficiency who were diagnosed and treated in Beijing Friendship Hospital of Capital Medical University from November 2021 to December 2022 were selected as the study subjects,and were divided into the study group(sacubitril-valsartan tablets)and the control group(valsartan capsules)according to the random number table method.The total effective rate,cardiac function indexes[left ventricular ejection fraction(LVEF),left ventricular end systolic diameter(LVESD),left ventricular end-diastolic diameter(LEVDD)],plasma NT-proBNP,cTnⅠ,soluble growth stimulation expression gene 2 protein(sST2),angiotensin(AngⅡ)and the incidence of adverse reactions were observed in the two groups.Results A total of 100 patients with cardiac insufficiency were included in the study,with 50 in the study group and 50 in the control group.After treatment,the total effective rate of the study group was higher than that of the control group(P＜0.05).The LVEF in the study group was significantly higher than that in the control group,while the LVESD,LEVDD were significantly lower than those in the control group(P＜0.05).After treatment,the plasma of NT-proBNP,cTnⅠ,AngⅡ,and sST2 in two groups had statistical difference(P＜0.05)and the difference in the above indicators before and after treatment in two groups were statistically siginficant(P＜0.05).The differences in adverse reactions between two groups were not statistically significant(P＞0.05).Conclusion The treatment of chronic heart failure patients with sacubitril-valsartan tablets can improve heart function,prognosis,and safety.
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Objective To explore the application value of traditional Chinese medicine (TCM) symptom score in the evaluation of the prognosis of patients with acute exacerbation of chronic cardiac insufficiency and establish a mortality probability model to assess the patients' consistency between the risk of death and actual death. Methods A retrospective observational study was conducted. Three hundred and twenty patients with acute exacerbation of chronic cardiac insufficiency admitted to Zhuji Hospital of TCM from January 2015 to June 2017 were divided into survival and death groups according to 28-day prognosis. The TCM symptom score and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score were recorded on admission, then Spearman correlation analysis was used to determine the correlation between the two types of evaluating score; the differences in APACHE Ⅱ score and TCM symptom score between the two groups of patients were compared; the receiver operating characteristic curve (ROC) was drawn, and the area under ROC curve (AUC) was calculated to evaluate the values of APACHE Ⅱ score and TCM symptom score in predicting the prognosis of patients. Whether the patients being dead or not and the TCM symptom score were used to carry out the logistic regression analysis and establish the regression model, then the relationship between the risk of death and actual death was verified. Results A total of 320 patients were enrolled, of whom 279 survived and 41 died.① The APACHE Ⅱ score and TCM symptom score in the dead group were significantly higher than those in survival group [APACHE Ⅱ score: 30.0 (22.5, 33.5) vs. 14.0 (8.0, 21.0); TCM symptom score: 28 (25, 33) vs. 15 (10, 20); both P < 0.01]. ② The APACHE Ⅱ score of patients with acute exacerbation of chronic cardiac insufficiency was positively correlated with their TCM symptom score obviously (r = 0.814, P < 0.01). ③ The AUC for predicting the prognosis of patients with acute exacerbation of chronic cardiac insufficiency by APACHE Ⅱ score and TCM symptom score were 0.816 and 0.920 respectively, when the best critical value of APACHE Ⅱ score was 21, the sensitivity of predicting death in the patients was 82.9%, and specificity was 74.1%, and the 95% confidence interval (95%CI) was 0.739-0.893;when the best critical value of TCM symptom score was 25, the sensitivity of predicting death in patients was 82.7%, specificity was 91.0% and 95%CI was 0.876-0.964. ④ Whether the patient being dead or not and TCM symptom score were brought into logistic regression analysis to obtain the death risk model: ln [R/(1-R)] = -8.131+0.283×TCM symptom score, after the TCM symptom score was substituted into the death risk model, the result revealed that the death risk was consistent with the actual death situation, that is with the rising of TCM symptom score, the death risk rate increases, and the actual fatality rate also increases gradually. Conclusions The application of TCM symptom score is helpful to realize the degree of disease severity and early judgement of prognosis in patients with chronic cardiac insufficiency.
RESUMO
Objective To explore the application value of traditional Chinese medicine (TCM) symptom score in the evaluation of the prognosis of patients with acute exacerbation of chronic cardiac insufficiency and establish a mortality probability model to assess the patients' consistency between the risk of death and actual death. Methods A retrospective observational study was conducted. Three hundred and twenty patients with acute exacerbation of chronic cardiac insufficiency admitted to Zhuji Hospital of TCM from January 2015 to June 2017 were divided into survival and death groups according to 28-day prognosis. The TCM symptom score and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score were recorded on admission, then Spearman correlation analysis was used to determine the correlation between the two types of evaluating score; the differences in APACHE Ⅱ score and TCM symptom score between the two groups of patients were compared; the receiver operating characteristic curve (ROC) was drawn, and the area under ROC curve (AUC) was calculated to evaluate the values of APACHE Ⅱ score and TCM symptom score in predicting the prognosis of patients. Whether the patients being dead or not and the TCM symptom score were used to carry out the logistic regression analysis and establish the regression model, then the relationship between the risk of death and actual death was verified. Results A total of 320 patients were enrolled, of whom 279 survived and 41 died.① The APACHE Ⅱ score and TCM symptom score in the dead group were significantly higher than those in survival group [APACHE Ⅱ score: 30.0 (22.5, 33.5) vs. 14.0 (8.0, 21.0); TCM symptom score: 28 (25, 33) vs. 15 (10, 20); both P < 0.01]. ② The APACHE Ⅱ score of patients with acute exacerbation of chronic cardiac insufficiency was positively correlated with their TCM symptom score obviously (r = 0.814, P < 0.01). ③ The AUC for predicting the prognosis of patients with acute exacerbation of chronic cardiac insufficiency by APACHE Ⅱ score and TCM symptom score were 0.816 and 0.920 respectively, when the best critical value of APACHE Ⅱ score was 21, the sensitivity of predicting death in the patients was 82.9%, and specificity was 74.1%, and the 95% confidence interval (95%CI) was 0.739-0.893;when the best critical value of TCM symptom score was 25, the sensitivity of predicting death in patients was 82.7%, specificity was 91.0% and 95%CI was 0.876-0.964. ④ Whether the patient being dead or not and TCM symptom score were brought into logistic regression analysis to obtain the death risk model: ln [R/(1-R)] = -8.131+0.283×TCM symptom score, after the TCM symptom score was substituted into the death risk model, the result revealed that the death risk was consistent with the actual death situation, that is with the rising of TCM symptom score, the death risk rate increases, and the actual fatality rate also increases gradually. Conclusions The application of TCM symptom score is helpful to realize the degree of disease severity and early judgement of prognosis in patients with chronic cardiac insufficiency.
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La insuficiencia cardíaca crónica se caracteriza por presentar una importante activación neurohormonal que consiste principalmente en un aumento de la activación simpática y del sistema renina-angiotensina-aldosterona. Esta activación en un principio compensatoria, con el tiempo lleva al empeoramiento de la función ventricular y los síntomas en la insuficiencia cardíaca. El tratamiento médico debe ir dirigido a bloquear dicha activación y con ello disminuir la progresión de la enfermedad. Las estatinas, IECAS, ARA II, antagonistas de la aldosterona y los beta bloqueadores constituyen, fármacos antagonistas neurohormonales. Todos ellos han demostrado disminuir la morbimortalidad de la enfermedad...
The chronic heart failure is determined by an important neurohormonal activation that consists in the increase of the sympathetic activation and the renin-angiotensin-aldosterone system. This activation is at the beginning compensatory, but then it leads to a bigger damage of the ventricular function and chronic insufficiency symptoms. The physician must avoid this activation and diminish the progression of the disease. Statins, ACE inhibitor (angiotensin-converting-enzyme inhibitor), angiotensin receptor blockers (ARBs), aldosterone antagonists and beta blockers are the antagonist neurohormonal drugs. All of them have proven to decrease the morbimortality of the disease...