ObjectiveTo analyze factors affecting the recovery of postoperative left ventricular function in patients with valvular disease combined with heart failure with reduced ejection fraction [HFrEF, left ventricular ejection fraction (LVEF)<40%].MethodsThe clinical data of 98 patients with valvular disease combined with HFrEF who underwent surgeries in our hospital from January 2011 to June 2018 were retrospectively analyzed, including 75 males and 23 females aged 9-78 (55.3±11.9) years.ResultsA total of 15 patients were dead after the operation, including 4 deaths within 3 months and 11 mid-long-term deaths after the operation. Ninety-one patients were followed up for more than 6 months (10 months to 8.6 years). The postoperative cardiac function (NYHA) of 91 patients was classⅠ-Ⅱ, the LVEF of 18 (19.8%) patients increased more than 10%, that of 47 (51.6%) patients maintained at the preoperative level, and that of 26 (28.6%) patients decreased. Postoperative LVEF was more prone to recover in HFrEF patients with sinus rhythm before operation (P=0.038), valvular disease mainly in aortic valve (P=0.026), obvious reduction of left ventricular end diastolic diameter in early postoperative period (P=0.017), and higher systolic pulmonary artery pressure (SPAP) before operation (P=0.018). The risk factors for postoperative LVEF deterioration included large left atrium before operation (P=0.014), smaller left ventricle end systolic diameter before operation (P=0.003), and fast heart rate after operation (P=0.019). ConclusionMitral valve prolapse patients with obviously increased left ventricular diameter should receive operation as soon as possible. HFrEF patients with aortic valve disease should receive operation positively. The operation efficacy is satisfactory in the HFrEF patients with high SPAP.
The fundamental reason why the organic lesions of chronic heart failure are difficult to reverse is ventricular remodeling. Myocardial fibrosis (MF) is an important pathological basis of ventricular remodeling. Its development process involves complex biological mechanisms and neuroendocrine system. Extracellular signal-regulated kinase (ERK) pathway is a classic pathway for the treatment of tumors. It is found that the inhibition of the ERK pathway can also slow down the progressive aggravation of MF. Therefore, exploring the mechanism of ERK pathway in MF may provide a new idea for the prevention and treatment of chronic heart failure. In this paper, the mechanism of ERK pathway in the occurrence and development of MF and its inhibition drugs were described, in order to provide evidence for the prevention and treatment of MF in chronic heart failure based on this pathway.
ObjectiveTo systematically review the efficacy and safety of angiotensin-converting enzyme inhibitor (ACEI) and/or angiotensin receptor blocker (ARB) in the treatment of patients with diastolic heart failure (DHF). MethodsPubMed, EMbase, The Cochrane Library (Issue 11, 2014), CNKI, WanFang Data, VIP and CBM were electronically searched from inception to November 2014 for randomized controlled trials (RCTs) of ACEI/ARB for DHF patients. References of included studies were also retrieved. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.2 software. ResultsA total of 22 RCTs involving 9 557 patients were included. The results of meta-analysis indicated that, compared with the control group, the ACEI/ARB group had significant improvements in exercise capacity (6-minute walk distance:SMD=0.02, 95% CI 0.05 to 0.38, P=0.01; Exercise time:MD=40.58, 95% CI 14.06 to 67.10, P=0.003) and diastolic function (E/A ratio:MD=0.20, 95% CI 0.09 to 0.31, P=0.000 4; E/E' ratio:MD=-1.69, 95% CI -2.11 to -1.27, P<0.000 01). In addition, compared with the control treatment, ACEI/ARB could significantly decrease the serum BNP level (SMD=-0.44, 95% CI -0.72 to -0.16, P=0.002) and NT-proBNP level (SMD=-0.68, 95% CI -1.24 to -0.12, P=0.02). ConclusionCurrent evidence shows that ACEI/ARB can improve the exercise capacity and diastolic function, and reduce the levels of serum BNP and NT-proBNP in DHF patients. Due to the limited quality of the included studies and discrepancies in the diagnostic criteria of DHF, more high-quality studies are needed to verify the above conclusion.
Objective To explore the effect of motivational interviewing (MI) on medication compliance and self-management behaviors of patients with chronic heart failure (CHF). Methods Between April 2013 and May 2015, 200 cases of CHF were randomly divided into control group (n=98) and MI group (n=102). Patients in the control group received routine nursing measures only. On the basis of routine nursing measures, patients in the MI group received MI program throughout the whole process inside and outside the hospital. The main contents of MI were medication compliance and self-management, to find the existing problems in patients’ daily living and make solutions with the patients. At the time of admission and 6 months after discharge, the Compliance Scale for Drug Treatment of Hypertension and the Self-management Scale for Patients with Heart Failure were conducted to asses the medication compliance and self-management behaviors of the two groups. Results Six months after discharge, the compliance level in the MI group was improved than that on admission with a significant difference (P<0.05), while the medication compliance in the control group was not improved significantly compared with that on admission (P>0.05). In the aspect of self-management, there was no significant difference in the control group between 6 months after discharge and on admission time (P>0.05); while the scores of diet management, drug management, symptom management, and psychological and social adjustment in the MI group (12.9±2.5, 16.1±2.8, 17.3±3.1, 17.0±2.4, respectively) were higer than those on admission (9.9±1.9, 13.3±2.7, 13.7±2.6, 12.8±2.2, respectively), with statistically significant differences (P<0.05). Conclusion MI can prompt CHF patients to improve medication compliance and the ability of self-management, and adopt a more healthy lifestyle.
ObjectiveTo explore the predictive value of myocardial vitality in the improvement of cardiac function after coronary artery bypass grafting (CABG) in patients with ischemic heart failure.MethodsFrom December 8, 2015 to November 12, 2018, 46 patients with ischemic heart failure who underwent CABG operation alone were collected retrospectively. There were 41 males and 5 females with an average age of 60.4±8.0 years. The myocardial vitality and number of different types of myocardium were measured. The clinical data of patients in the left ventricular ejection fraction (LVEF) improvement group (≥5%) and non-improvement group (<5%) were compared and analyzed. The correlation between each index and LVEF improvement was analyzed by logistic multivariate regression analysis, and the boundary value of hibernating myocardium between LVEF improvement and non-improvement was obtained by receiver operating characteristic (ROC) curve.ResultsThere were significant differences in the number of hibernating myocardium (15.0%±12.3% vs. 4.3%±4.5%, P=0.000), the number of normal myocardium (74.7%±13.7% vs. 82.4%±8.6%, P=0.027), and cardiac function classification (NYHA) development (−0.7±0.7 vs. −0.3±0.5, P=0.047) between the two groups, but there was no significant difference in other indexes between the two groups (P>0.05). Logistic regression analysis showed that the number of hibernating myocardium was an independent factor affecting the improvement of LVEF after CABG in patients with ischemic heart failure (OR=1.366, 95%CI 1.033-1.807, P=0.029). The ROC curve showed that the threshold value, sensitivity and specificity of hibernating myocardium were 15.0%, 43.8% and 100.0%, respectively.ConclusionThe percentage of hibernating myocardium to left ventricular wall area ≥15.0% can accurately predict the improvement of LVEF in patients with ischemic heart failure after CABG. Preoperative myocardial vitality assessment has important diagnostic value in predicting the improvement of cardiac function in patients with ischemic heart failure after simple CABG.
ObjectivesTo systematically assess the efficacy and safety of nitrates for patients with chronic heart failure. MethodWe searched PubMed, EMbase, Web of Science, The Cochrane Library (Issue 1, 2016), CBM, CNKI, VIP, and WanFang Data to collect randomized controlled trials (RCTs) and cross-over studies about nitrates in the treatment of heart failure from inception to January 4th 2016. Two reviewers independently screened literature, extracted data and evaluated the risk of bias of included studies. Then, meta-analysis was performed by RevMan 5.3 software. ResultsTen trials were included involving 414 patients (195 patients in the nitrates group and 219 patients in the control group). The results of meta-analysis showed that, compared with the control group, the nitrates group could reduce arterial blood pressure (MD=-1.91, 95%CI -3.66 to -0.16, P=0.03), pulmonary wedge pressure vessels (PCWP) (MD=-2.00, 95%CI -3.84 to -0.15, P=0.03), increase cardiac index (CI) (MD=0.25, 95%CI 0.09 to 0.42, P=0.003), treadmill exercise time (MD=70.14, 95%CI 55.22 to 85.05, P < 0.000 01); but easily emerge side effects (OR=5.21, 95%CI 2.60 to 10.41, P < 0.000 01). ConclusionCurrent evidence indicates that nitrates treatment could improve the hemodynamic effect, enhance cardiac output and increase exercise tolerance in patients with heart failure.
Objective To investigate the 30-day mortality risk factors in elderly patients (≥70 years) with heart failure with reduced ejection fraction (HFrEF) after isolated coronary artery bypass grafting (CABG) and to construct a nomogram for predicting mortality risk. Methods A retrospective analysis of elderly HFrEF patients undergoing isolated CABG at Tianjin Chest Hospital from 2010 to 2024. Simple random sampling in R was used to divide the dataset into training and validation sets in a 7 : 3 ratio. The training set was further divided into survivors and non-survivors. Univariate logistic regression was performed to identify differences between groups, followed by multivariate logistic stepwise regression to select independent risk factors for death and to establish a death-risk nomogram, which underwent internal validation. The predictive value of the nomogram was assessed by plotting receiver operating characteristic (ROC) curves, calibration curves, and decision-curve analyses for both the training and validation sets. ResultsA total of 656 patients were included. The training set consisted of 458 patients (survivors 418, deaths 40); the validation set consisted of 198 patients (survivors 180, deaths 18). In the training cohort, univariate analysis showed significant differences between survivors and deaths for creatinine (Cr) level, brain natriuretic peptide (BNP), maximum Cr, intra-aortic balloon pump (IABP) use, assisted ventilation, reintubation, hyperlactatemia, low cardiac output syndrome, and renal failure (P<0.05). After multivariable logistic regression with stepwise selection, five independent risk factors were identified: IABP use (OR=3.391, 95%CI 1.065–11.044, P=0.038), reintubation (OR=15.991, 95%CI 4.269–67.394, P<0.001), hyperlactatemia (OR=8.171, 95%CI 2.057–46.089, P=0.007), Cr (OR=4.330, 95%CI 0.997–6.022, P=0.024), and BNP (OR=1.603, 95%CI 1.000–2.000, P=0.010). Accordingly, a nomogram predicting mortality risk was constructed. The ROC and calibration analyses indicated good predictive value: training set AUC was 0.898 (95%CI 0.831–0.966); validation set AUC 0.912 (95%CI 0.805–1.000). Calibration and decision-curve analyses showed good agreement and clinical utility. Conclusion The nomogram incorporating IABP use, reintubation, hyperlactatemia, creatinine, and BNP provides good predictive value for 30-day mortality after CABG in elderly patients with HFrEF and demonstrates potential clinical utility.
Objective To explore the effect of long non-coding RNA H19 (lncRNA H19) on chronic heart failure (CHF) rats and its possible mechanism. Methods CHF (SD male rats, with a weight of 300±10 g, 10 weeks old) rat model was established by abdominal aortic coarctation. The 84 rats successfully modeled were randomly divided into a model group, a si-NC group [transfected lncRNA H19 small interfering RNA (siRNA) negative control], a si-H19 group (transfected lncRNA H19 siRNA), a si-miR-NC group [transfected microRNA-214 (miR-214) siRNA negative control], a si-miR-214 group (transfected miR-214 siRNA), a si-H19+si-miR-NC group (co-transfected lncRNA H19 siRNA and miR-214 siRNA negative control), and a si-H19+si-miR-214 group (co-transfected lncRNA H19 siRNA and miR-214 siRNA), 12 rats in each group. Another 12 rats were set up in a sham operation group (rats were only threaded without ligation, and the other operations were the same as the model group). After 4 weeks of intervention, the cardiac function, serum myocardial injury markers, heart failure markers, inflammatory related factors, apoptosis related factors and myocardial histopathological changes were compared. The expressions of lncRNA H19 and miR-214 in myocardial tissue were detected by real-time fluorescence quantitative PCR, and the targeting relationship between lncRNA H19 and miR-214 was detected by double luciferase reporter gene. Results Compared with those in the sham operation group, the myocardium of rats in the model group was severely damaged and a large number of inflammatory cells infiltrated; the lncRNA H19, cardiac function indexes (left ventricular end systolic diameter, left ventricular end diastolic diameter), serum myocardial injury markers (creatine kinase MB, cardiac troponin I), heart failure markers (brain natriuretic peptide, N-terminal pro brain natriuretic peptide), inflammatory related factors (interleukin-1β, interleukin-18, tumor necrosis factor-α, interleukin-6), cardiomyocyte apoptosis rate, apoptosis related proteins [B lymphocytoma-2 (Bcl-2), Bcl-2 related X protein (Bax), cysteinyl aspartate specific proteinase-1 (Caspase-1)] in the myocardial tissue of the model group were significantly increased (P<0.05); miR-214 of myocardial tissue, cardiac function indexes (left ventricular ejection fraction, left ventricular fractional shortening) and Bcl-2/Bax ratio were significantly decreased (P<0.05). Compared with the model group, silencing lncRNA H19 could significantly improve the cardiac function and the changes of the above indexes in CHF rats, and reduce myocardial injury (P<0.05); down-regulation of miR-214 could significantly reverse the protective effect of si-H19 on myocardial injury in CHF rats (P<0.05). Conclusion Silencing lncRNA H19 can up-regulate the expression of miR-214, inhibit the expression of Caspase-1, inhibit the apoptosis and inflammatory reaction of cardiomyocytes, and alleviate myocardial injury in rats with CHF.
ObjectiveTo systematically review the efficacy of irbesartan combined with metoprolol plus conventional treatment compared with single drug (irbesartan, metoprolol) plus conventional treatment or conventional treatment for elderly patients with severe heart failure.MethodsPubMed, The Cochrane Library, Web of Science, CNKI, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) on irbesartan combined with metoprolol in the treatment of elderly patients with severe heart failure from January 2009 to September 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Network meta-analysis was then performed using gemtc package of R software.ResultsA total of 58 RCTs involving 5 064 patients were included. The results of meta-analysis showed that the efficiency, left ventricular ejection fraction (LVEF) and brain natriuretic peptide (BNP) of combination group were significantly superior to single drug group.ConclusionsThe current evidence shows that under the premise of conventional treatment, the combination of irbesartan and metoprolol is more effective than irbesartan or metoprolol alone in the treatment of elderly patients with severe heart failure. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
Objective To evaluate the efficacy of recombinant human brain natriuretic peptide (rhBNP) on Chinese patients with congestive heart failure by meta analysis. Methods Both foreign language databases including PubMed, EMbase, The Cochrane Library (Issue 3, 2009) and Chinese databases involving CBM, VIP and CJFD were searched to identify randomized controlled trials (RCTs) that reported the effect of rhBNP on the heart function (left ventricular ejection fraction (LVEF) and the recent level of improvement in cardiac function) and its side effects of Chinese patients with congestive heart failure. Two reviewers assessed the quality of each trial and extracted data independently. The Cochrane Collaboration’s RevMan 4.2.8 software was used for statistical analysis. Results Nineteen RCTs were included, all of which came from internal. The methodological quality of the included studies was good. The baseline data of each trial were comparable. The results of meta-analyses showed: (1) the improvement of LVEF was higher in the rhBNP group than that in the blank control group (WMD=7.22, 95%CI 3.15 to 11.291, P=0.000 5). The level of improvement in cardiac function was better in the rhBNP group than those in the blank control group (OR=5.48, 95%CI 1.61 to 18.65, P=0.007), the nitroglycerin group (OR=3.60, 95%CI 2.02 to 6.41, Plt;0.000 1), and the sodium nitroprusside group (OR=3.21, 95%CI 0.12 to 85.20, P=0.49). The incidence of side effects was lower in the rhBNP group than that in the nitroglycerin group (OR=0.23, 95%CI 0.11 to 0.47, Plt;0.000 1), and the sodium nitroprusside group (OR=0.30, 95%CI 0.11 to 0.82, P=0.02). Moreover, the results of sensitivity analysis were also consistent with the above findings. Conclusion Recombinant human brain natriuretic peptide can effectively improve the hemodynamics and cardiac function level of Chinese population of patients with heart failure. The treatment doses are safe and tolerant, so it is recommended to clinical use.