Association between comorbid cardiomyopathy and composite endpoints of patients with congestive heart failure in the intensive care unit: a retrospective cohort study.

Background: Congestive heart failure (HF) is a common condition in the intensive care unit (ICU). Cardiomyopathy is an important etiological factor in HF. However, few studies have explored the effect of cardiomyopathy on the prognosis of HF. This study explored the association between comorbid cardiomyopathy and the outcomes of critically ill patients with congestive HF. Methods: A retrospective cohort study was performed using data extracted from Medical Information Mart for Intensive Care IV (MIMIC-IV) database. All adult patients with the first ICU admission were enrolled as participants but those diagnosed with cardiomyopathy alone were excluded. The demographics, comorbidities, vital signs, laboratory tests, scoring systems, and treatments of patients were extracted to further analyze. The composite endpoints included in-hospital mortality, cardiac arrest, and re-admission to the ICU. The association between cardiomyopathy comorbidity and the composite endpoints was assessed using propensity-score matching (PSM) and multivariable logistic regression models. Results: A total of 27,901 critically ill patients were enrolled, including 1,023 patients diagnosed with cardiomyopathy and congestive HF. The average age of the cohort was 64.37±17.36 years, and 58.13% of the patients were men. The ethnicity of patients was mainly white (64.67%). Multivariable logistic regression analyses found the risk of composite endpoints in patients with cardiomyopathy was higher than other groups [odds ratio (OR) =1.87; 95% confidence interval (CI): 1.62-2.15; P<0.001]. Compared to patients with congestive HF alone (OR =1.43; 95% CI: 1.26-1.62; P<0.001), patients with cardiomyopathy had a similar risk of in-hospital death (OR =1.35; 95% CI: 1.06-1.71; P=0.014). Moreover, the risks of cardiac arrest (OR =1.53; 95% CI: 1.01-2.34; P=0.029) and re-admission to the ICU (OR =1.74; 95% CI: 1.39-2.17; P<0.001) were both higher in patients with cardiomyopathy than other groups. After PSM, the risk of composite endpoints was still higher in patients with cardiomyopathy (OR =1.64; 95% CI: 1.33-2.02; P<0.001). The association was consistent among patients admitted to the coronary care unit (CCU) and medical ICU (MICU)/surgical ICU (SICU). Conclusions: Comorbid cardiomyopathy increased the risk of composite endpoints in patients with congestive HF admitted to the ICU. Cardiomyopathy is related to the poor outcomes of critically ill patients with congestive HF.

Dietary fiber intake and its correlation with cardiac event-free survival in patients with heart failure / 中华临床营养杂志

Objective:To investigate the daily dietary fiber intake, the main adverse cardiovascular events during follow-up and the cardiac event-free survival in patients with chronic heart failure, and to analyze the relationship between dietary fiber intake and cardiac event-free survival in this population.Methods:This study was a prospective investigation. The investigation was performed in chronic heart failure patients from three third-class hospitals in Suzhou using general information questionnaire and 3-day diet diary. Major adverse cardiovascular events within 6 months after discharge and event-free survival were obtained by telephone call and medical records.Results:The incidence of major cardiovascular adverse events in 122 patients with heart failure was 27.9% within 6 months after discharge. Their dietary fiber intake was 8.1(5.8-10.9)g/d, lower than the recommended intake. Kaplan-Meier plots and log-rank tests demonstrated that cardiac event-free survival was significantly shorter in patients with dietary fiber deficiency ( P=0.043). Patients with dietary fiber intake ≥6 g/d after discharge showed decreased risk of major adverse cardiovascular events compared to patients with dietary fiber intake<6 g/d ( HR=0.422; 95% CI=0.189-0.942; P=0.035). Conclusions:This study revealed insufficient dietary fiber intake in patients with heart failure. Insufficient dietary fiber intake was associated with higher risk of major adverse cardiovascular events and shorter cardiac event-free survival in heart failure patients within 6 months after discharge. In conclusion, patients with heart failure can increase dietary fiber intake in order to improve prognosis.

Analysis on related factors of pleural effusion caused by severe congestive heart failure / 重庆医学

Objective To understand the related influencing factors of pleural effusion caused by severe congestive heart failure to provide an idea for clinical diagnosis and treatment.Methods Three hundreds patients with severe congestive heart failure admitted to the cardiology department of this hospital from January to June 2015 were selected.The sex,age,heart failure degree,pleural effusion,type of heart disease,diabetes mellitus,atrial fibrillation,B-type pro-brain natriuretic peptide,white blood cell,neutrophil percentage,hemoglobin,blood urea nitrogen,serum albumin and hospital stay were recorded and performed the statistical analysis.Results The sex,heart failure degree,ejection fraction,B-type pro-brain natriuretic peptide,neutrophil percentage and serum albumin had statistical differences between the patients with pleural effusion caused by severe congestive heart failure and patients without pleural effusion(P＜0.05).The left atrial diastolic diameter/left ventricular end-diastolic diameter,white blood cell,hemoglobin,blood urea nitrogen,type of heart disease,diabetes,atrial fibrillation and hospitalization stay had no statistically significant differences(P＞0.05).Conclusion Pleural effusion caused by severe congestive heart failure has the correlation with the sex,heart failure degree,hypoproteinemia and neutrophil percentage.

[Expressions of SERCA2a and miR-25-3p/5p in myocardium of rats with heart failure and therapeutic effects of Xiefei Lishui recipe].

OBJECTIVE: To investigate the expressions of sarcoplasmic reticulum calcium ATPase 2a (SERCA2a) mRNA and miR-25-3p/5p in myocardium of rats with heart failure and the therapeutic effects of Xiefei Lishui recipe(Traditional Chinese Medicine). METHODS: SD rats were randomly divided into five groups:control group, model group, Traditional Chinese Medicine group(TCM group), captopril group and digoxin group(n=10). Heart failure rat model was induced by intraperitoneal injections of doxorubicin(6 injections within 2 weeks; total dose:15 mg/kg). Five weeks after the first injection, Distilled water(10 ml/(kg·d)), TCM(22 g/(kg·d)), captopril(19 mg/(kg·d)),and digoxin(32µg/(kg·d))were administrated by gastrogavage for 35 days,respectively. Myocardial expressions of SERCA2a mRNA and miR-25-3p/5p were detected;myocardial activities of SERCA2a were measured; cardiac output(CO) and left ventricular ejection fraction(LVEF) and plasma level of B-type natriuretic peptide (BNP) were measured. RESULTS: Myocardial mRNA expression of SERCA2a was significantly down-regulated in rats with heart failure which could be significantly up-regulated by TCM or captopril or digoxin,while expressions of miR-25-3p and miR-25-5p in myocardium were significantly up-regulated which could be significantly down-regulated by TCM or captopril. SERCA2a activity, CO and LVEF in rats with heart failure were decreased significantly which could be significantly increased by TCM,while plasma level of BNP was increased significantly which could be significantly decreased by TCM or captopril or digoxin. CO in rats with heart failure could be signifi-cantly increased by captopril or digoxin. CONCLUSIONS: In rats with heart failure, myocardial mRNA expression of SERCA2a was downregulated, expression of miR-25-3p and miR-25-5p in myocardium was upregulated. Xiefei Lishui recipecan upregulate myocardial mRNA expression of SERCA2a, downregulate expression of miR-25-3p and miR-25-5p in myocardium and improve cardiac function.

Continuous blood purification for patients with severe heart failure and renal failure / 中国基层医药

Objective To investigate the clinical effect of continuous blood purification therapy in patients with severe heart failure and renal failure.Methods The clinical data of 38 patients with severe heart failure and renal failure treated by continuous blood purification were analyzed retrospectively.Heart rate,mean blood pressure, APACHE II score,Boston score,blood biochemistry,blood gas analysis and cardiac function changes were compared before and after the treatment of continuous blood purification.Results After treatment 12h and 72h,patients breath-ing[(19.24 ±2.88)times/min],heart rate[(88.57 ±15.68)times/min],APACHE Ⅱ [(14.28 ±3.26)points] and the score of Boston[(6.27 ±1.25 )points]were significantly decreased compared with those before treatment [(35.68 ±5.97)time /min,(131.24 ±24.26)time /min,(26.34 ±5.96)points,(17.88 ±2.87)points],and the differences were statistically significant (t =3.13 3.45,2.12,4.11,3.67,5.68,3.44,609,all P <0.05).38 cases of severe heart failure with renal failure after continuous blood purification treatment,markedly effective in 16 cases, effective in 12 cases,ineffective in 10 cases,the total effective rate was 73.68%.Patients after continuous blood purification treatment,the SCr[(168.15 ±31.16)μmol/L],BUN [(13.13 ±3.44)mmol/L]were significantly decreased.pH[(7.41 ±0.13)],HCO3 [(25.57 ±5.11)mmol/L],PaO2 [(88.26 ±7.72)mmHg],SaO2 [(96.43 ± 3.14)%]and blood biochemistry and blood gas index decreased markedly,and the differences were statistically significant (t =4.55,3.21,2.11,3.45,673,4.21,all P <0.05).After the examination of echocardiography,stroke volume (SV)[(59.31 ±6.58)mL],cardiac output (CO)[(4.57 ±0.62)L/min]and left ventricular ejection fraction (LVEF)[(68.12 ±4.88)%]increased significantly compared with before treatment,and the differences were statistically significant (t =4.33,5.12,367,all P <0.05).Conclusion Continuous blood purification could effectively maintain the hemodynamic stability of patients,and is safe and effective in the treatment of severe heart failure with renal failure.

Progress of tolvaptan in treating heart failure / 中华老年医学杂志

Tolvaptan is a novel oral selective arginine vasopressin V2 receptor antagonist.Tolvaptan improves heart failure signs and symptoms without serious adverse events.Tolvaptan has no effect on all-cause mortality and cardiovascular death or admission rate for heart failure.But in heart failure patients with hyponatremia,tolvaptan can decrease cardiovascular death and admission rate for heart failure.

The characteristics and clinical value of dynamic electrocardiogram in the treatment of patients with congestive heart failure and atrial arrhythmia / 中国基层医药

Objective To investigate the characteristics and clinical value of dynamic electrocardiogram in the treatment of patients with congestive heart failure and atrial arrhythmia.Methods A total of 226 congestive heart failure patients were taken into this research.124 congestive heart failure and atrial arrhythmia patients were divided into OSG group,102 congestive heart failure patients were divided into CTG group.24 -hour Holter monitoring was examined in both groups with ATA including AFR,AFL,ATC and PAC by dynamic electrocardiogram made in Mei Gaoyi medical equipment company.Results The ATA was (824.6 ±108.2)times(compared with the control group, t =9.054,P =0.019)in 124cases of the OSG group,including ATC (80.4 ±25.8)cases (compared with the control group,P =0.021,t =8.934).duration time (25.4 ±9.7)s,AFL (26.8 ±7.1 )cases(compared with the control group,P =0.014,t =9.162).duration time (13.5 ±5.8)s,AFR (97.5 ±51.3)times (compared with the control group,t =9.314,P =0.009).duration time (70.1 ±18.5)s,PAC (41.9 ±14.3)cases (compared with the control group,t =8.796,P =0.026).duration time (34.8 ±11.2)s.The ATA was (102.6 ±59.3)times in 102cases of the CTG group,including ATC (69.5 ±19.4)cases,duration time(5.7 ±1.3)s,AFL(8.5 ±2.6)cases,duration time (2.6 ±0.9)s,AFR (27.6 ±12.5)times,duration time,PAC(24.8 ±10.4)cases,duration time(19.6 ±7.9)s, which was significantly different with the CTG group(t =8.796,P <0.05).Conclusion CHF patients are probable to be complicated with ATA.The DCG examination in CHF patients is conducive to improve the effect of treatment and limit chances of sudden death,which is worthy of promotion.

Clinical efficacy and safety of Shenmai and meglumine cyclic adenosine monophosphate in the treatment of chronic heart failure with / 中国基层医药

Objective To investigate the clinical curative effect and safety of Shenmai combined with meglu-mine adenosine cyclophosphate in the treatment of chronic heart failure.Methods 118 patients with chronic heart failure were selected as the research subjects.They were randomly divided into control group and observation group, 59 cases in each group.The patients in the control group received routine comprehensive treatment,the observation group was given intravenous Shenmai injection 50mL,1 /d,meglumine adenosine cyclophosphate injection 120mg, 250mL 5% glucose injection intravenous drip note,the 1 time /d,7d for a course of treatment.Two groups of patients received a total of 2 courses of treatment.Before and after treatment,left ventricular ejection fraction (LVEF)was detected by cardiac ultrasound,and the brain natriuretic peptide (BNP)level in patients was measured.The total effective rate of the two groups was analyzed.Results Before treatment,LVEF of the control group and the observa-tion group were (32.19 ±5.72)%,(32.50 ±6.01 )%.After treatment,LVEF of control group was (36.62 ± 4.13)%,LVEF indexes in the observation group was (42.09 ±5.52)%,LVEF increased significantly in the two groups,but that in the observation group was higher than that of the control group (t =-3.882,P =0.017),the difference was statistically significant.Before treatment,BNP index of the observation group and the control group were (485.16 ±206.15 )pg/mL,(489.11 ±178.96)pg/mL,after treatment,BNP level of the observation group was (159.29 ±93.62)pg/mL,BNP level in the control group was (322.36 ±156.58)pg/mL,BNP in the observation group was significantly lower than that of the control group(t =-7.443,P =0.000).24 cases in the observation group after treatment,effective in 30 cases,the total effective rate was 91.53%,which was significantly higher than 76.27% of the control group (χ2 =9.524,P =0.003).No obvious adverse reactions or allergic reaction etc.were observed in the observation group.Conclusion The therapeutic effect of combination of Shenmai injection and meglumine in the treatment of chronic heart failure is accurate,it can significantly improve cardiac function,and has high safety,and without adverse reaction reports,it is worthy of the clinical application and popularization.

Influence of erythropoietin therapy with oral iron supplementation on red blood cell distribution width in chronic heart failure patients with anemia / 中国基层医药

Objective To analyze the effect of erythropoietin therapy with oral iron supplementation on red blood cell distribution width (RDW)in chronic heart failure patients with anemia.Methods 148 patients of chronic heart failure with anemia from September 2014 to March 2015 in our hospital were included and randomly divided into two groups with the random number table,with 74 cases in each group.The control group were treated with convention-al anti heart failure therapy,the treatment group were treated with erythropoietin and oral iron supplementation on the basis of routine treatment for four weeks.RDW was tested by automatic five classification blood analyzer.The correla-tion between RDW and other detection indexes was analyzed.Results The levels of RDW in the treatment group were significantly lower than those of the control group[(13.08 ±0.792)vs (14.32 ±0.864),t =-8.974,P <0.01].Before treatment,bivariate analysis in the treatment group showed that RDW had positive correlation with NT-proBNP and high -sensitivity C -relative protein (hs -CRP)(r =0.783,P <0.01;r =0.870,P <0.01),but negative correlation with serum creatinine (Cr)and hemoglobin (r =-0.338,P <0.01;r =-0.743,P <0.01).Af-ter treatment,bivariate correlations analysis in the treatment group showed that the difference of RDW was positive correlation with the difference of NT -proBNP,high -sensitivity C -relative protein (hs -CRP)(r =0.783,P <0.01;r =0.680,P <0.01),but negative correlation with the difference of hemoglobin(r =-0.459,P <0.01),and no correlation with the others (Cr,UA,LDL,TC,TG and LVEF).Conclusion On the basis of conventional anti heart failure treatment,erythropoietin therapy with oral iron supplementation against anemia could improve heart func-tion of CHF and decrease the levels of RDW.RDW may be served as one of observing indexes of the worsening and effect judgment in chronic heart failure patients with anemia.

Analysis of chronic heart failure of coronary heart disease and ventricular arrhythmia / 中国基层医药

Objective To analyze the treatment and pathogenetic condition of chronic heart failure of coro -nary heart disease(CHD) and ventricular arrhythmia (VA).Methods 100 patients with chronic heart failure were collected to observe the treatment of chronic heart failure and pathogenetic condition of VA .Results 44 cases occured VA and 56 cases without VA in 100 patients.NT-proBNP(3 110.00 ±522.00)pg/mL of VA group was sig-nificantly higher than that (2 200.00 ±486.00)pg/mL of non-VA group(t=8.996,P (15.38%) with statistically significant(χ2 =5.853,12.532,27.375,all P<0.05).The amount(44.20 ±12.90)mg of use βreceptor blockers of amiodarone group was significantly lower than that of non -amiodarone group(44.20 ± 12.90)mg (t=5.284,P<0.05).Conclusion NT-proBNP of CHEF of CHD and VA patients will improve and amiodarone can reduce the amount of use anti -heart failure drug .

Effect of trimetazidine in treatment of ischemic cardiomyopathy heart failure and its influence on cardiac function and heart rate variability / 中国基层医药

Objective To investigate the clinical efficacy of trimetazidine in treatment of ischemic cardiomy-opathy heart failure and its influence on cardiac function and heart rate variability .Methods 160 cases of patients with ischemic cardiomyopathy heart failure were randomly divided into the two groups with 80 cases in each group .The two groups were given conventional treatment of anti heart failure ,the observation group used trimetazidine on basis of that,clinical effect and the influence on the index of heart rate variability and cardiac function of two groups were ob -served.Results The total effective rate of the observation group was 91.25%,significantly higher than 73.75% of the control group (χ2 =9.57,P<0.05);LVEDD and LVESD of the observation group after treatment were (49.88 ± 4.60)mm and (37.10 ±3.15)mm,significantly reduced than before treatment (t=7.44,7.83,all P<0.05) and the control group (t=6.60,6.85,all P<0.05); while the LVEF was (48.04 ±4.20)%,increased significantly than before treatment (t=6.51,P<0.05) and the control group (t=7.11,P<0.05);SDNN,SDANN,rMSSD and PNN50 of the observation group after treatment were (124.72 ±7.02)ms,(111.20 ±5.89)ms,(46.74 ±4.22)ms and (17.72 ±2.08)%,increased significantly than before treatment (t=7.43,7.83,7.06,8.17,all P<0.05) and the control group (t=6.66,6.90,6.15,7.21,all P<0.05).Conclusion Trimetazidine has an exact effect in treat-ment of ischemic cardiomyopathy heart failure ,which can improve heart function and heart rate variability which has an important value in clinical application .

The effects of creatine phosphate sodium on heart function and NT-proBNP in older patients combination with ischemic cardiomyopathy and intractable heart failure / 中国基层医药

Objective To observe the effects of creatine phosphate sodium on heart function and B -type natriuretic peptide in patients combination with ischemic cardiomyopathy and intractable heart failure .Methods 70 cases of coronary heart disease combined with ischemic cardiomyopathy and intractable heart failure were randomly ( with the random number table ) divided into the control group ( n=33) and the creatine phosphate sodium treatment group (n=37).The control group treated with conventional therapy (digitalis,diuretics,vasodilator,ACEI,et al) ten days;the treatment group with creatine phosphate sodium treatment on the basis of conventional therapy .The symp-tom,sign of the heart failure patients of the two groups before and after treatment were observed .NYHA cardiac func-tional grading were estimated.Echocardiography was used to detect left ventricular end -systolic diameter(LVESD), left ventricular end diastolic diameter ( LVEDD ) and left ventricular ejection fraction ( LVEF ); amino terminal pro brain natriuretic peptide (NT-proBNP) tested by laboratory of the two groups.Drug treatment for 10 days,the chan-ges of the indicators before and after treatment were observed .Results After treatment , compared with the control group[(50.63 ±4.67) mm,(61.30 ±4.58) mm].LVESD,LVEDD of the creatine phosphate sodium treatment [(47.16 ±4.30)mm,(57.92 ±4.30)mm]significantly decreased(t=5.73,4.96,all P<0.01),LVEF[(40.57 ± 4.51)%,(37.63 ±4.53)%]increased significantly(t =5.53,P<0.01).After ten days of treatment levels of NT-proBNP decreased in both two groups [(1 659.±248.18) pg/mL,1 899.3 ±205.45] than before treatment [2 043.46 ±217.04,(2 105.46 ±239.09)pg/mL](t=3.23,3.64,all P<0.05),and the decrease degree of the creatine phosphate sodium treatment group was more obvious than those of the control group (t=4.11,P<0.05). Conclusion Creatine phosphate sodium can improve the cardiac function and left ventricular ejection fraction of ischemic cardiomyopathy and intractable heart failurepatients ,enhance the clinical symptoms of patients .

The prognostic analysis of dose adjustment for beta blockers in the acute exacerbation of chronic congestive heart failure in the elderly / 中国基层医药

Objective To evaluate the effects and the prognosis of beta receptor blocker (metoprolol)dose adjustment of senile patients with chronic congestive heart failure (CHF)of acute exacerbation,and to provide reference for clinical treatment.Methods 76 cases with chronic CHF in acute exacerbation who treated with beta blockers and other reasonable treatment were randomly divided into half dose group (40 cases)and full stop group (36 cases).After adjusted for 3 months,the clinical symptoms were observed,noninvasive hemodynamic machine was used to detect cardiac index (CI),left cardiac work (LCW),cardiac output (CO)and changes of other indicators. Immunoradiometric analysis was used to detect plasma type B natriuretic peptide (BNP).Results 72h after treatment,in the half dose group,the progression of the disease in 13 cases,improved in 27 cases,in the full stop group,progression in 20 cases,improvement in 16 cases,the difference was statistically significant (χ2 =4.09,P <0.05).Before the adjustment of metoprolol,the index of the two groups had statistically significant difference(χ2 =4.52,P <0.05 ).Compared with pretreatment,the changes of NYHA classification,Co,CI,LCW of the half dose group were not obvious,and he change of NYHA of the full stop group was obvious,,III /IV the progression of the disease the number of cases increased in 5 cases and 3 cases,Co,Ci,LCW were reduced by about 25%,35% and 30%.After the adjustment of metoprolol,BNP of the half dose group was (321.8 ±97.6 )mg/L,which was significantly lower than (422.3 ±139.4)mg/L of the full stop group,the difference was statistically significant (t =3.94,P <0.05 ).Conclusion In the patients with beta blockers combined with other reasonable treatment, CHF patients with acute exacerbation of the beta blockers than the discontinuation of the prognosis,and the safety is high.

Prognostic Value of Copeptin,Big Endothelin-1 and N-Terminal Pro-Brain Natriuretic Peptide in Patients with Chronic Heart Failure / 现代检验医学杂志

Objective To investigate the prognostic factors for chronic heart failure and the prognostic ability of copeptin,big endothelin-1(Big ET-1)and N-terminal pro-brain natriuretic peptide (NT-proBNP)in patients with chronic heart failure. Methods To study 1 5 9 consecutive patients hospitalized for chronic heart failure.Serum concentration of copeptin,NT-proBNP,cTnI,CKMB and plasma Big ET-1 as well as left ventricular ejection fraction (LVEF)and NYHA classⅠtoⅣ on admission were measured.Cardiac events were found by patients to discharge after 360~490 days,prospectively.Results During a median follow-up period of 385 days,the endpoint of recurrence for cardiac events was reached in 65 patients with 159 heart failure.Multivarlate canonical correlation analysis shows the older and the higher NYHA classification as well as the lower LVEF in patients with heart failure.There were higher concentration of copeptin,Big ET-1 and NT-proBNP.On a Cox proportional hazards regression models analyses,age,copeptin,Big ET-1 and NT-proBNP were found to be the inde-pendent predictors of cardiac events.Risk ratio (RR)were 1.215,1.236,4.031 and 13.052,respectively.Logistic regression models analyses,copeptin,Big ET-1 and NT-proBNP were found independent predictors of death.Odd ratio (OR)were 4.003,2.477 and 1.235,respectively.Conclusion Measurement of copeptin,Big ET-1 and NT-proBNP in patients with chronic heart failure can help to identify patients at higher risk for cardiac events and patients for prognosis.

Influence of Ginsenoside-Rbl on Toll-like receptor of myocardial cells in rats with heart failure induced by adriamycin / 心血管康复医学杂志

Objective:To explore whether the effect relieving chronic heart failure (CHF) induced by Adriamycin of Ginsenoside-Rbl (Gs-Rbl ) is related to inhibiting Toll-like receptor (TLR ) . Methods :Adriamycin-induced CHF model rats were randomly divided into Adriamycin group (n=15) and Gs-Rb1 group (70 mg/kg d ,n=17);another 10 normal rats were regard as control group .Neonate rat cardiomyocytes were also randomly divided into control group ,Adriamycin group (1 μmol/L) and Gs-Rb1 group (1 μmol/L Adriamycin + 200 μmol/L Gs-Rbl) .After the intervention being performed ,echocardiography and expressions of TLR2/TLR4 gene and protein were assessed in all groups .Results:(1) Both studies in vivo and in vitro indicated that expressions of TLR 2 protein and mRNA in Adriamycin group were significantly higher than those of control group ,compared with Adriamycin group ,there were significant reductions in expressions of TLR2 protein [ (0.975 ± 0.022/0.564 ± 0.031) vs .(0.593 ± 0.018/0.344 ± 0.024)] and mRNA [ (0.576 ± 0.029/0.853 ± 0.043) vs .(0.349 ± 0.015/0.401 ± 0.021)] in Gs-Rbl group ,P<0.01 both ;(2) No matter study in vivo or in vitro ,expressions of TLR4 protein and mRNA in Adriamy-cin group were significantly higher than those of control group ,compared with Adriamycin group ,there were signif-icant reductions in expressions of TRL4 protein [ (0.654 ± 0.032/0.519 ± 0.013 ) vs . (0.371 ± 0.013/0.254 ± 0.027)] and mRNA [ (1.602 ± 0.013/0.838 ± 0.021) vs .(1.140 ± 0.021/0.503 ± 0.022)] in Gs-Rbl group , P<0.01 both .Conclusion:Adriamycin may trigger the process of CHF through increasing TLR 2 and TLR4. The effect of Gs-Rbl improving adriamycin-induced CHF may be related to inhibition of TLR 2 and TLR4 .

Predictive value of serum cTnI and NT-proBNP for patients with chronic stable heart failure / 心血管康复医学杂志

Objective:To explore the correlation among serum cardiac troponin I (cTnI),N terminal pro brain natri-uretic peptide (NT-proBNP)and main endpoint events of heart in patients with chronic stable heart failure.Meth-ods:The present study enrolled 95 patients with NYHA cardiac function class III~IV from Feb 2010 to Feb 2011.According to levels of cTnI and NT-proBNP,the patients were divided into cTnI negative group (n=60)and cTnI positive group (n=35);NT-proBNP negative group (n=40)and NT-proBNP positive group (n=55),all patients were followed up for two years,and the main endpoint events were cardiogenic sudden death and rehospitalization caused by acute aggravation of heart failure.Results:Compared with negative group,the hazard ratio (HR)of end-point events was 2.69 and confidence interval (CI)was 1.54~ 4.72,P = 0.002 in cTnI positive group;HR was 2.54 and CI was 1.35~4.78,P =0.003 in NT-proBNP positive group;further interclass crossover analysis found that,when patients'cTnI and NT-proBNP were both positive,the hazard ratio of cardiac endpoint events was the highest (HR=6.34,CI 2.26~17.9,P <0.001).Conclusion:In patients with chronic stable heart failure,serum elevated levels of cardiac troponin I and N terminal pro brain natriuretic peptide are important predictors reflecting prognosis of patients with heart failure.

Therapeutic effect and safety of large dosage of valsartan on chronic heart failure / 心血管康复医学杂志

Objective:To analyze the clinical therapeutic effect and safety of large dosage of valsartan on chronic heart failure (CHF).Methods:A total of 106 CHF patients hospitalized in our department were chosen and ran-domly divided into routine dose group (n=53,received routine dosage of valsartan,80mg,once/d)and large dose group (n=53,received large dosage of valsartan,80mg,twice/d)accerding to number table.Both groups received anti-heart failure treatment for six months according to the guidelines.After treatment,plasma N terminal pro brain natriuretic peptide (NT-proBNP)level was measured,left ventricular end-systolic diameter (LVESd),left ventricu-lar end-diastolic diameter (LVEDd),interventricular septal thickness (IVST)and left ventricular posterior wall thickness (LVPWT)were measured by color Doppler echocardiography,and all patients received 6min walking test. Therapeutic effect and incidence rates of adverse reactions were compared and analyzed between two groups after treatment.Results: Compared with routine dose group,there were significant reductions in NT-proBNP level [(3042.6±116.3)pmol/L vs.(2565.8±98.2)pmol/L],LVESd [(34.5±2.2)mm vs.(29.4± 2.0)mm], LVEDd [(55.1±2.9)mm vs.(50.2±2.5)mm],IVST [(12.9±1.8)mm vs.(10.7±1.2)mm]and LVPWT [(11.8±1.1)mm vs.(10.9±0.9)mm];significant rise in 6min walking distance [(271.2±24.9)m vs.(367.7 ±22.3)m]and total effective rate (43.40% vs.62.26%)in large dose group,P 0.05).Conclusion:Large dos-age of valsartan is more effective and is safe in treatment of chronic heart failure.

The influence of anti-anxiety and depression treatment on quality life and plasma B-type natriuretic peptide for chronic heart failure patients / 中国医师进修杂志

Objective To investigate the influence of anti-anxiety and depression treatment on quality life and plasma B-type natriuretic peptide (BNP) for chronic heart failure (CHF) patients.Methods Eighty-two patients with CHF were divided into control group and intervention group by random digits table method with 41 cases each.After admission,the patients were given conventional anti-heart failure treatment.The patients in intervention group received the standard therapy in combination with lorazepam,with depression plus fluoxetine,and psychological treatment.After treatment,the patients were evaluated by symptom checklist (SCL-90),determined the plasma BNP level and heart function indexes,and recorded the length of stay,number of hospitalization,and so on.Results After treatment the intervention group somatization,interpersonal barriers as well as depression,anxiety,hostility,terrorism,paranoia,psychotic and other emotions significantly alleviated,there were statistical differences compared with before treatment and after treatment of control group (P ＜ 0.05).There were no statistical differences in heart function indexes before treatment between the 2 groups (P ＞ 0.05).After treatment in control group,only the left ventricular ejection fraction was significantly higher than that before treatment,there was statistical difference (P ＜ 0.05).After treatment in intervention group compared with before treatment and after treatment in control group,the heart rate and left ventricular early diastolic and late peak velocity ratio were significantly lower [(71.0 ± 10.9) times/min vs.(82.5 ± 12.4) and (77.3 ± 10.1) times/min,1.26 ± 0.28 vs.1.38 ± 0.21 and 1.31 ± 0.33],left ventricular ejection fraction was significantly higher [(50.9 ± 6.9)％ vs.(39.2 ± 7.4)％ and (43.4 ± 7.8)％],there were statistical differences (P ＜ 0.05).The plasma BNP level was downtrend after treatment in the 2 groups,compared with the control group,after 5 d of treatment in intervention group was significant decrease,the changes was slowly after 14 d of treatment.There were statistical differences in plasma BNP level in 5,7,10 d of treatment between the 2 groups (P ＜ 0.05).The length of stay,number of hospitalization and fatality rate in intervention group were lower than those in control group [(6.0 ± 1.4)d/time vs.(10.0 ± 2.1) d/time,(1.6 ± 0.5) times/year vs.(3.2 ± 0.8) times/years,0 vs.9.8％ (4/41)],there were statistical differences (P ＜ 0.05).Conclusion Anti-anxiety and depression treatment can significantly improve cardiac function in CHF patients,shorter hospital stays,and improve quality of life.

Clinical therapeutic effect of recombinant human erythropoietin on patients with heart failure compli-cated chronic kidney disease / 心血管康复医学杂志

Objective:To observe clinical therapeutic effect of recombinant human erythropoietin (rhEPO)on pa-tients with heart failure complicated chronic kidney disease.Methods:A total of 84 patients with heart failure com-plicated renal insufficiency were selected.They were divided into routine treatment group (n=42)and rhEPO group (n=42,received rhEPO based on routine treatment)according to random number table method.Echocardiographic examination results and renal function were compared between two groups after 12-week treatment.Results:Com-pared with routine treatment group,there were significant rise in left ventricular ejection fraction [LVEF,(37.2± 10.3)% vs.(45.4 ± 11.4)%]and left ventricular fractional shortening [LVFS,(19.6 ± 4.3)% vs.(24.5 ± 3.8)%],and significant reductions in left ventricular end-diastolic diameter [LVEDd,(6.12±0.67)mm vs.(5.01 ±0.54)mm],24h urinary protein [(0.76±0.1)g vs.(0.24±0.09)g],24h urine microalbumin [(319.6±39.6) mg vs.(107.3±26.7)mg],blood urea nitrogen [(10.3±1.9)mmol/L vs.(6.2±1.5)mmol/L]and serum creati-nine [(97.2±16.8)μmol/L vs.(79.3±15.7)μmol/L]in rhEPO group,P<0.01 all.Conclusion:Recombinant human erythropoietin could significantly improve heart,renal function in patients with heart failure complicated re-nal insufficiency.

Therapeutic effect of simvastatin combined cyclic adenosine monophosphate on chronic heart failure and levels of serum-related factors / 心血管康复医学杂志

Objective:To explore the clinical therapeutic effect of simvastatin combined cyclic adenosine monophos-phate on coronary heart disease (CHD)with chronic heart failure (CHF)and levels of serum-related factors.Meth-ods:A total of 78 CHD patients with CHF hospitalized in our hospital from Jan 2011 to Jan 2012 were selected. They were randomly and equally divided into simvastatin group and combined treatment group using number table, both groups received routine treatment,simvastatin group received simvastatin in addition, while combined treat-ment group received cyclic adenosine monophosphate based on simvastatin group.Therapeutic effect,changes of cardiac function indexes and serum factor levels were compared between two groups before and after treatment.Re-sults:The total effective rate of combined treatment group (92.31%)was significantly higher than that of simvasta-tin group (71.79%),P<0.05;compared with before treatment and simvastatin after treatment,there were signifi-cant rise in left ventricular ejection fraction [LVEF,(33.54±3.34)%,(43.41±3.23)% vs.(55.21±3.45)%] and transmitral early/late diastolic peak flow velocity [E/A,(0.63±0.11),(0.70±0.15)vs.(1.01±0.21)],and significant reductions in levels of brain natriuretic peptide [BNP,(536.74±21.41)ng/ml,(117.23±11.57)ng/ml vs.(78.20±10.92)ng/ml]and C reactive protein [CRP,(24.00±2.34)mg/L,(17.01±1.09)mg/L vs.(8.28± 0.81)mg/L]in combined treatment group,P<0.05~<0.01.Conclusion:Simvastatin combined cyclic adenosine monophosphate possess significant therapeutic effect on chronic heart failure of coronary heart disease,it can signif-icantly improve cardiac function and serum factor levels in CHD patients with chronic heart failure,and possess good clinical application value.