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.
ObjectiveTo summarize the individualized selection of surgical treatment strategies and the key points of perioperative management for patients with heart valve disease complicated with severe chronic heart failure.MethodsThe clinical characteristics of 5 male patients with valvular heart disease complicated with severe chronic heart failure (CHF) were analyzed retrospectively from June 2017 to October 2018 in Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, with an average age of 60.21 years.ResultsFive patients were given angiotensin receptor and neprilysin inhibitor (ARNI)-based anti-heart failure treatment after admission. The operation mode of these patients was decided to be valve replacement under cardiopulmonary bypass after individualized evaluation of patients’ improving symptoms. Three patients were treated with intra-aortic balloon pump (IABP) and continuous renal replacement therapy (CRRT) early after operation to assist patients in improving cardiac function. Five patients recovered oral anti-heart failure after awakening. All patients were discharged smoothly 2 weeks after operation.ConclusionIndividualized evaluation is needed for the choice of operation timing and mode, standardized preoperative treatment for heart failure, shortening the aortic blocking time during cardiopulmonary bypass, and early application of left ventricular adjuvant drugs or instruments are all important measures to help patients recover smoothly.
Percutaneous ventricular assist device (PVAD) is a minimally invasive treatment which can replace the function of the failing heart. It provides circulatory support for patients with severe emergent cardiovascular diseases such as complex coronary artery disease, acute myocardial infarction complicated by cardiogenic shock, and acute decompensated chronic heart failure. PVAD has been developed since the rise of the Hemopump, to the prosperity of the Impella, and increasingly been used as a haemodynamic support to improve prognosis. This article will review the evolution and clinical application of PVAD.
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.
ObjectiveTo systematically review the efficacy of palliative care in heart failure patients. MethodsPubMed, EMbase, CINAHL, The Cochrane Library, VIP, CNKI, CBM and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy of palliative care in heart failure patients from inception to September 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies; then, meta-analysis was performed using RevMan 5.3 software. ResultsA total of 11 RCTs involving 912 patients were included. The results of meta-analysis showed that palliative care could improve the quality of life of patients with heart failure (KCCQ & McGill QoL: SMD=0.85, 95%CI 0.13 to 1.58, P=0.02; MLHFQ: SMD=?1.32, 95%CI ?2.10 to ?0.54, P=0.000 9), reduce the level of depression (SMD=?0.58, 95%CI ?0.87 to ?0.28, P=0.000 1) and anxiety (SMD=?0.51, 95%CI ?0.89 to ?0.13, P=0.008), improve the adverse symptoms (SMD=?1.46, 95%CI ?2.67 to ?0.24, P=0.02), reduce the readmission rate (RR=0.64, 95%CI 0.42 to 0.98, P=0.04) and the per hospitalization time (MD=?0.94, 95%CI ?1.28 to ?0.60, P<0.000 01). However, it had no obvious effect on the mortality of patients (RR=1.00, 95%CI 0.63 to 1.57, P=0.99). ConclusionCurrent evidence shows that palliative care can improve the quality of life, emotional state and adverse symptoms of patients with heart failure, and reduce the length of hospital stay and readmission rate. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusion.
Heart failure (HF) is a symptoms caused by various diseases. As the myocardial contractility and/or diastolic weakening, the cardiac output decreased, when it can not satisfy the needs of the body, a series of symptoms and signs occurs. HF is an end-stage performance of heart disease, and is also a major factor of mortality. The morbidity of heart failure increased as peoples enter the aging. Despite the continuous improvement of drug treatment,the morbidity and mortality of HF remains high. At present, nondrug treatment of heart failure get more and more attention to clinicians. Surgical methods gets more innovation.Medical intervention has been introducted new auxiliary facilities, and genetics and stem cell technology bring new hope to it’s treatment. This article reviews the HF surgery, nterventional treatment and its related gene and cell therapy and research recently.
ObjectiveTo systematically review the efficacy of MitraClip therapy in heart failure patients with mitral insufficiency. MethodsDatabases including PubMed, The Cochrane Library (Issue 11, 2014), EMbase, CBM, CNKI, VIP and WanFang Data were searched from October 2005 to October 2015 to collect before-after controlled studies about the efficacy of MitraClip therapy in heart failure patients with mitral insufficiency. Two reviewers independently screened literature, extracted data and assessed the methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.2 software. ResultsA total of 9 studies involving 782 patients were included. The results of meta-analysis showed that, compared with their conditions before treatment, patients after the MitraClip implantation had a declined NYHA class Ⅲ-Ⅳ ratio (RD=0.72, 95%CI 0.60 to 0.85, P<0.000 01), increased left ventricular ejection fraction (LVEF) (MD=-2.97，95%CI -5.06 to -0.89，P<0.005) and improved performance in 6 min walk-test (6-MWT) (MD=-88.73, 95%CI -157.16 to -20.31, P=0.01). ConclusionMitraClip therapy can, to a certain extent, improve the cardiac function of patients with heart failure and mitral insufficiency. However, further studies are needed to confirm its effects on improving the long-term survival of patients.
Heart failure with preserved ejection fraction (HFpEF) is the main type of heart failure (HF), accounting for more than half of the incidence of HF. However, the etiology, pathogenesis, treatment and prognosis of HFpEF are still not fully understood. Recommendations for HFpEF are in different chapters in the 2022 AHA/ACC/HFSA guideline for the management of heart failure. This paper interpreted the definition, stage, diagnosis, epidemiology, clinical evaluation, stage treatment, acute attack stage, comorbidity management, vulnerable population and research prospect of HFpEF, which aimed to provide the latest thinking in terms of the management of HFpEF for clinicians.
摘要:目的:探討胺碘酮治療充血性心力衰竭(CHF)心房顫動伴快速心室率的臨床療效。方法: 將106例各種原因所致的房顫伴快速心室率的CHF患者按入院順序隨機分為治療組及對照組。兩組抗CHF基礎治療相同,治療組加用靜脈負荷量胺碘酮150 mg后,再以1 000μg/min靜脈點滴維持6小時,500 μg/min靜滴18小時。同時口服胺碘酮0.2,3次/d,1周;再0.2,2次/d,1周以后以0.2,1次/d 至觀察終點,隨診為12個月。 結果: 治療組53例使用胺碘酮治療可顯著增加抗心律失常有效性,改善左室射血分數,減少心力衰竭再住院率,42例患者轉復為室性心律。 結論: 靜脈及口服胺碘酮同時應用治療充血性心力衰竭房顫是有效和安全的。Abstract: Objective: To explore the effect and safety of amiodarone in the treatment of atrial fibrillation with congestive heart failure. Methods:One hundred and six patients of AF with CHF caused by a variety of reasons were randomly divided into treatment group and control group according to hospitalized order.The two groups were treated with the same antiCHF therapy,the treatment group was treated with loaded intravenous amiodarone 150 mg;and then dripped to 1 000 μg/min for 6 hours, dripped to 500 μg/min for 18 hours. United with oral amiodarone by amiodarone tablets with 0.2 g,3 time/day a week,further 0.2 g,2 times/day a week,later 0.2 g,1 times/day to the end.The end of followup time was 12 months. Results:In treatment group,53 cases with amiodarone therapy can significantly increase the effectives of antiarrhythmic, improve the rate and heart failure rehospitalization.42/53 patients reversed to sinus rhythm. Conclusion:The results showed it is effective and safe united with intravenous amiodarone and oral amiodarone in treatment of atrial fibrillation with organic heart disease.