BACKGROUND Congenital hypothyroidism(CH)is a common condition in both preterm and term infants characterized by either thyroid gland absence or hypofunctionality.The clinical association of refractory lactic acidosis ...BACKGROUND Congenital hypothyroidism(CH)is a common condition in both preterm and term infants characterized by either thyroid gland absence or hypofunctionality.The clinical association of refractory lactic acidosis and heart failure has rarely been observed in cases of pediatric patients with CH pathology.Here,we explored the etiological relationship between CH,heart failure,and refractory lactic acidosis to reflect the importance of thyroid function screening in neonates with heart disease.CASE SUMMARY A 33-day-old extremely premature female infant presented with tachypnea,respiratory distress,recurrent infections,and abdominal distension postnatal.On admission to our facility,she had cardiomegaly,hepatomegaly,and lactic acidosis(revealed on blood gas analysis),with lactate progressively rising to 25 mmol/L.Chest radiographs showed pulmonary congestion,while echocardiography revealed cardiac enlargement,left ventricular wall thickening,and pericardial effusion.Initial management aimed at correcting acidosis and treating heart failure proved ineffective.After reassessment,thyroid function tests showed significantly decreased triiodothyronine,free triiodothyronine,thyroxine,and free thyroxine levels,with a significantly increased thyroidstimulating hormone level,confirming a CH diagnosis.Levothyroxine was administered,resulting in rapid correction of lactic acidosis and gradual improvement of thyroid function and systemic symptoms,culminating in full recovery and discharge.We also reviewed the relevant literature on thyroid and cardiac dysfunctions in order to explore their deeper association.CONCLUSION This case links CH-induced heart failure with refractory lactic acidosis,urging prompt thyroid screening in affected neonates to reduce mortality.展开更多
Background:“Qi deficiency”(a pathological state where the body’s vital energy(Qi)is insufficient or weakened,impairing physiological functions and diminishing the body’s ability to perform daily activities,defend ...Background:“Qi deficiency”(a pathological state where the body’s vital energy(Qi)is insufficient or weakened,impairing physiological functions and diminishing the body’s ability to perform daily activities,defend against illness,and maintain homeostasis)syndrome is considered a critical syndrome in traditional Chinese medicine(TCM)and is associated with poor prognosis in heart failure(HF).This study investigates the clinical,metabolic,and transcriptomic differences between heart failure patients with and without Qi deficiency syndrome.Methods:56 heart failure patients were evaluated using a Qi deficiency syndrome scale and divided into Qi deficiency syndrome(QD)and non-Qi deficiency(non-QD)groups based on the median score.Clinical characteristics,including baseline N-terminal pro-B-type natriuretic peptide(NT-proBNP),left ventricular ejection fraction(LVEF),total diuretic use during hospitalization,and 90-day rehospitalization rates,were compared between the groups.Differentially expressed genes(DEGs)and differential metabolites were identified,followed by enrichment analyses and validation using qPCR and Western blot in AC16 cardiomyocytes.Results:QD patients exhibited significantly higher NT-proBNP levels,lower LVEF,and increased 90-day rehospitalization rates.Metabolomic profiling revealed lipid metabolism disruptions,notably in linoleic acid and phospholipid pathways.Transcriptomic analysis highlighted 17 DEGs,including CISD2,a critical mitochondrial regulator,which was downregulated in QD patients.Correlation analysis identified significant associations between DEGs(e.g.,CISD2,BPGM)and lipid metabolites such as PC(16:0/P-16:0).Functional knockdown of CISD2 in AC16 cells led to upregulation of lipid oxidation enzymes ALOX15 and CYP1A2,linking CISD2 dysfunction to lipid metabolic dysregulation.Conclusion:Qi deficiency is associated with more severe heart failure symptoms,worse prognosis,and distinct metabolic and transcriptomic profiles,particularly in lipid metabolism.CISD2 emerges as a potential therapeutic target,offering new avenues for integrating molecular insights with TCM approaches to optimize HF management.展开更多
This article discusses the study by GrubićRotkvićet al on the mechanisms of action of sodium-glucose cotransporter 2 inhibitors(SGLT2i)in patients with type 2 diabetes mellitus(T2DM)and heart failure(HF).T2DM and HF a...This article discusses the study by GrubićRotkvićet al on the mechanisms of action of sodium-glucose cotransporter 2 inhibitors(SGLT2i)in patients with type 2 diabetes mellitus(T2DM)and heart failure(HF).T2DM and HF are highly comorbid,with a significantly increased prevalence of HF in patients with T2DM.SGLT2i exhibit potential in reducing hospitalization rates for HF and cardiovascular mortality through multiple mechanisms,including improving blood glucose control,promoting urinary sodium excretion,reducing sympathetic nervous system activity,lowering both preload and afterload on the heart,alleviating inflammation and oxidative stress,enhancing endothelial function,improving myocardial energy metabolism,and stabilizing cardiac ion homeostasis.Further research and clinical practice will help optimize the use of SGLT2i in HF patients.展开更多
Objectives To compare respiratory parameters of peripheral blood mononuclear cell mitochondria and iron metabolism indicators in patients with different NYHA functional classes of ischemic heart failure(HF).Methods Th...Objectives To compare respiratory parameters of peripheral blood mononuclear cell mitochondria and iron metabolism indicators in patients with different NYHA functional classes of ischemic heart failure(HF).Methods This single center, prospective, non-blinded study enrolled 20 patients with diagnosed chronic HF of ischemic genesis with reduced and mildly reduced left ventricle ejection fraction. The maximum oxygen consumption at the peak of the exercise test(VO2peak), iron metabolism parameters and respiratory activity of peripheral blood mononuclear cell mitochondria were assessed.Results Among the patients, a half of individuals were diagnosed with iron deficiency. Subgroups of patients with different HF severity did not significant differ in VO2peak(P=0.209), serum iron(P=0.468) and ferritin(P=0.235) levels. But there was a trend in increasing in these parameters with increasing NYHA HF functional class. Respiratory control coefficient(RC) in NADdependent and FAD-dependent mitochondrial oxidation were lower in patients with NYHA HF Ⅲ functional class compared to individuals with NYHA HF I functional class(P=0.028 and P=0.040, respectively). Serum iron(P=0.026), ferritin(P=0.045)levels, transferrin saturation(P=0.006) were negatively correlated with RC in NAD-dependent mitochondrial oxidation.Conclusions In aggravation of ischemic HF NYHA FC, there is a decrease in RC of PBMC mitochondria during the oxidation of NAD-dependent and FAD-dependent substrates. In the whole sample, patients with laboratory-confirmed iron deficiency accounted a half of the total number. Iron metabolism parameters had a paradoxical inverse relationship with the level of RC in PBMC mitochondria of patients with HF.展开更多
BACKGROUND Chronic heart failure(CHF)is a severe cardiovascular disease that significantly threatens human health.Depression,a common comorbidity,may substantially impact cardiac structure and function.However,the exa...BACKGROUND Chronic heart failure(CHF)is a severe cardiovascular disease that significantly threatens human health.Depression,a common comorbidity,may substantially impact cardiac structure and function.However,the exact relationship between depression and cardiac remodeling and left ventricular functional changes remains incompletely understood.This study sets out to explore,with a clinically grounded perspective,how depressive states may subtly or profoundly influence the trajectory of cardiac remodeling and the functional dynamics of the left ventricle in individuals grappling with CHF.Beyond mere observation,it also aims to untangle the underlying physiological or neurohormonal pathways that might bridge emotional distress and cardiac dysfunction.AIM To delve into how depressive symptoms might shape the progression of cardiac remodeling and impair left ventricular function among individuals living with CHF.Particular attention is given to the role of inflammatory signaling and disruptions in neuroendocrine balance as possible mediating factors.By examining these intertwined physiological and psychological processes,the study seeks to shed light on the reciprocal link between emotional distress and CHF,offering insights that may inform more precise,mechanism-based treatment strategies.METHODS In this retrospective clinical trial,248 patients diagnosed with CHF were analyzed in the tertiary treatment center between January 2018 and December 2022.According to Hamilton's Depression Scale score,participants were classified into two cohort of depression(score 17)and no significant depression characteristics(score 17).Cardiac morphology and functional parameters were assessed using a combination of hyperechocardiocardiocardiography,heart magnetic resonance,and associated blood biomarkers.RESULTS The results of this study underscore the significant effects that depression can have on both the structure and function of the heart in patients with CHF.In particular,the individuals in the cohort with depression were 42.3%±6.7%of the individuals without depression vs 51.6%±5.9%,P<0.01)In comparison,the left ventricular ejection fraction,an important measure of contractional performance,was significantly reduced,underlining the harmful physiological interaction between mood disorders and cardiac efficiency.The measurement of the left ventricular end-diastolic diameter showed a significant expansion of the ventricular envelope in the depression group(68.2±7.5 mm vs 59.6±6.3 mm,P<0.01).Inflammatory markers,including high-sensitivity C-reactive protein(hs-CRP)and tumor necrosis factor-α(TNF-α),were significantly elevated in the depressed group(hs-CRP:8.7±2.3 mg/L vs 4.5±1.6 mg/L;TNF-α:42.5±7.6 pg/mL vs 28.3±5.4 pg/mL).Both B-type natriuretic peptide(1256±345 pg/mL vs 756±234 pg/mL)and angiotensin II(86.4±15.7 ng/mL vs 62.5±12.3 ng/mL)levels were significantly higher in the depressed group.CONCLUSION Among people with CHF,the presence of depressive symptoms appears to be closely related to pronounced changes in heart structure and impaired functional abilities.It is likely that depressive states contribute to the progress of heart reform and deterioration of left stomach function,possibly due to increased inflammatory cascades and increased activation of neuroendocrine regulatory pathways.展开更多
Heart failure(HF)with preserved ejection fraction(HFpEF)has exceeded HF with reduced ejection fraction(HFrEF),becoming the most common type of HF.Unlike HFrEF,HFpEF is primarily a chronic low-grade inflammatory proces...Heart failure(HF)with preserved ejection fraction(HFpEF)has exceeded HF with reduced ejection fraction(HFrEF),becoming the most common type of HF.Unlike HFrEF,HFpEF is primarily a chronic low-grade inflammatory process closely associated with metabolic disorders.The coexistence of HFpEF and metabolic dysfunction-associated steatotic liver disease(MASLD)presents significant clinical challenges due to shared metabolic pathophysiology and complex inter-play.Management strategies for HFpEF and MASLD remain challenging.Sodium-glucose cotransporter 2 inhibitors have shown benefits in managing both conditions.Additionally,glucagon-like peptide-1 receptor agonists are being actively investigated for their potential benefits,particularly in MASLD.A comprehensive,patient-centered approach that combines metabolic and cardiova-scular care is essential for improving outcomes in patients with HFpEF and MASLD,addressing the global metabolic health challenges.展开更多
Chronic heart failure(CHF)is a complex clinical syndrome characterized byimpaired cardiac function and neurohormonal dysregulation.While CHF hastraditionally been regarded as a hemodynamic disorder,growing evidencehig...Chronic heart failure(CHF)is a complex clinical syndrome characterized byimpaired cardiac function and neurohormonal dysregulation.While CHF hastraditionally been regarded as a hemodynamic disorder,growing evidencehighlights the pivotal role of autonomic nervous system(ANS)dysfunction in itsprogression and prognosis.The ANS,comprising sympathetic and parasympatheticbranches,exerts significant control over cardiac function,including heartrate,contractility,and vascular tone.In CHF,sympathetic overactivation coupledwith parasympathetic withdrawal contributes to adverse cardiac remodeling,arrhythmogenesis,and further deterioration of cardiac performance.This minireviewsummarizes current knowledge on the role of autonomic dysfunction inCHF and heart transplantation.It focuses on how sympathetic nervous systemimbalance contributes to CHF progression and explores the impact of autonomicdysregulation on post-transplant outcomes.By synthesizing existing evidence,thereview highlights ANS modulation as a key therapeutic target for improvingcardiac function and patient prognosis in both clinical settings.展开更多
Objective:To explore the improvement effect of implementing Buzhong Yiqi Decoction combined with Xuefu Zhuyu Decoction on cardiac function and quality of life of patients during the treatment of coronary heart disease...Objective:To explore the improvement effect of implementing Buzhong Yiqi Decoction combined with Xuefu Zhuyu Decoction on cardiac function and quality of life of patients during the treatment of coronary heart disease complicated with heart failure.Methods:Eighty cases were included in the study,and they were equally divided into a control group(n=40,treated with basic western medicine)and a study group(n=40,treated with Buzhong Yiqi Decoction combined with Xuefu Zhuyu Decoction)according to random sampling grouping method.The intervention index results of the two groups were compared.Results:The improvement of cardiac function index,TCM syndrome score,and quality of life in the study group was more prominent,with a statistical value of P<0.05.Conclusion:Buzhong Yiqi Decoction combined with Xuefu Zhuyu Decoction and conventional western medicine treatment can effectively improve the cardiac function of patients with coronary heart disease complicated with heart failure and enhance their quality of life.It is worthy of clinical promotion and application.展开更多
BACKGROUND Depression is a highly prevalent and clinically significant psychiatric comorbidity in patients with heart failure(HF),exerting multidimensional effects that extend beyond emotional symptoms to influence ph...BACKGROUND Depression is a highly prevalent and clinically significant psychiatric comorbidity in patients with heart failure(HF),exerting multidimensional effects that extend beyond emotional symptoms to influence physiological outcomes and disease progression.Emerging evidence in psychocardiology highlights the bidirectional interplay between mood disorders and cardiovascular dysfunction through neuroendocrine,autonomic,and behavioral pathways.This study aims to explore the real-world effect of depression severity-measured by the Patient Health Questionnaire-9(PHQ-9)-on left ventricular systolic function and one-year cardiovascular readmission in patients with HF,providing insights into its prognostic relevance within a psychocardiological framework.AIM To investigate the impact of depression severity on medication adherence,ventricular function,and readmission in patients with HF.METHODS A total of 160 patients hospitalized for HF between January 2020 and December 2023 were included in this real-world retrospective cohort study.Depression severity was assessed by using the PHQ-9,with scores≥10 indicating moderate-to-severe depression.Cardiac function was evaluated through transthoracic echocardiography to determine left ventricular ejection fraction(LVEF).Medication adherence was assessed at three and six months postdischarge by employing the four-item Morisky Medication Adherence Scale(MMAS-4)and categorized as high(score=0),moderate(1-2),or low(3-4).Data on antidepressant or anxiolytic prescriptions and psychological interventions during hospitalization were collected.Patients were followed up for one year to capture cardiovascular-related readmissions.Kaplan-Meier analysis was employed to estimate eventfree survival,and Cox regression identified independent predictors of readmission.RESULTS Patients with moderate-to-severe depression(PHQ-9≥10)presented with significantly lower LVEF at baseline,higher N-terminal pro-B-type natriuretic peptide levels,and more severe HF symptoms than other patients.They also demonstrated poorer medication adherence postdischarge,with a higher proportion classified as low adherence on the MMAS-4 scale,and were less likely to receiveβ-blockers or angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker at discharge than other patients.At three and six months postdischarge,PHQ-9 and MMAS-4 scores were inversely correlated with LVEF,suggesting a behavioral pathway linking depression to impaired cardiac recovery.During the one-year follow-up period,30.0%of patients experienced cardiovascular-related readmissions,predominantly due to worsening HF(54.1%).In multivariable Cox regression analysis,high PHQ-9 scores,reduced LVEF,old age,elevated N-terminal pro-B-type natriuretic peptide levels,New York Heart Association class IV,and absence ofβ-blocker therapy were independently associated with readmission risk.CONCLUSION In patients with HF,depression severity independently predicts impaired ventricular function,low medication adherence,and increased one-year cardiovascular readmission.These findings highlight the psychocardiological relevance of depression screening and behavioral intervention in optimizing adherence and clinical outcomes in routine HF care.展开更多
BACKGROUND Advanced heart failure and transplant(AHFTC)teams are crucial in the management of patients in cardiogenic shock.We sought to explore the impact of AHFTC physicians on outcomes in patients receiving extraco...BACKGROUND Advanced heart failure and transplant(AHFTC)teams are crucial in the management of patients in cardiogenic shock.We sought to explore the impact of AHFTC physicians on outcomes in patients receiving extracorporeal membrane oxygenation(ECMO)support.AIM To determine whether outcomes differ in the care of ECMO patients when AHFTC physicians serve in a primary vs consultative role.METHODS We conducted a retrospective cohort study of 51 patients placed on veno-venous(VV)and veno-arterial(VA)ECMO between January 2015 and February 2023 at our institution.We compared ECMO outcomes between teams managed primarily by intensivists vs teams where AHFTC physicians played a direct role in ECMO management,including patient selection.Our primary outcome measure was survival to 30 days post hospital discharge.RESULTS For combined VA and VV ECMO patients,survival to 30 days post discharge in the AHFTC cohort was significantly higher(67%vs 30%,P=0.01),largely driven by a significantly increased 30-day post discharge survival in VA ECMO patients in the AHFTC group(64%vs 20%,P=0.05).CONCLUSION This study suggests that patients in shock requiring VA ECMO support may have improved survival 30 days after hospital discharge when an AHFTC team serves in a direct role in the selection and management of patients.Further studies are needed to validate this impact.展开更多
Lingguizhugan Decoction(LGZG)demonstrates significant efficacy in treating various cardiovascular diseases clinically,yet its precise mechanism of action remains elusive.This study aimed to elucidate the potential mec...Lingguizhugan Decoction(LGZG)demonstrates significant efficacy in treating various cardiovascular diseases clinically,yet its precise mechanism of action remains elusive.This study aimed to elucidate the potential mechanisms and effects of LGZG on isoproterenol(ISO)continuous stimulation-induced chronic heart failure(CHF)in mice,providing direct experimental evidence for further clinical applications.In vivo,continuous ISO infusion was administered to mice,and ventricular myocytes were utilized to explore LGZG's potential mechanism of action on theβ1-adrenergic receptor(β1-AR)/Gs/G protein-coupled receptor kinases(GRKs)/β-arrestin signaling deflection system in the heart.The findings reveal that LGZG significantly reduced the messenger ribonucleic acid(mRNA)expression of hypertrophy-related biomarkers[atrial natriuretic peptide(ANP)and B-type natriuretic peptide(BNP)]and improved cardiac remodeling and left ventricular diastolic function in mice with ISO-induced CHF.Furthermore,LGZG inhibited the overactivation of Gs/cyclic adenosine monophosphate(c AMP)/protein kinase A(PKA)signaling and downregulated the downstream transcriptional activity of c AMP-response element binding protein(CREB)and the expression of the coactivator CBP/P300.Notably,LGZG downregulated the expression ofβ-arrestin1 and GRK 2/3/5 while upregulating the expression ofβ1-AR andβ-arrestin2.These results suggest that LGZG inhibits Gs/c AMP/PKA signaling andβ-arrestin/GRK-mediated desensitization and internalization ofβ1-AR,potentially exerting cardioprotective effects through the synergistic regulation of theβ1-AR/Gs/GRKs/β-arrestin signaling deflection system via multiple pathways.展开更多
According to the Japanese Ministry of Health,Labour,and Welfare,14.2%of people were aged>75 years in Japan in 2018,and this number continues to rise.With population aging,the incidence of congestive heart failure(C...According to the Japanese Ministry of Health,Labour,and Welfare,14.2%of people were aged>75 years in Japan in 2018,and this number continues to rise.With population aging,the incidence of congestive heart failure(CHF)is also increasing.[1–3]Reports have shown that the presence of cognitive impairment(CI)in patients with CHF is associated with poor prognosis,[4–6]and the degree of CI is related to CHF severity.展开更多
BACKGROUND Anxiety and depression are prevalent among patients with chronic heart failure(CHF)and can adversely contribute to treatment adherence and clinical outcomes.Poor fluid restriction adherence is a widespread ...BACKGROUND Anxiety and depression are prevalent among patients with chronic heart failure(CHF)and can adversely contribute to treatment adherence and clinical outcomes.Poor fluid restriction adherence is a widespread challenge in the management of CHF.To effectively manage disease progression and alleviate symptoms,it is crucial to identify key influencing factors to facilitate the implementation of targeted interventions.AIM To investigate the status of anxiety and depression among patients with CHF and determine the factors contributing to poor fluid restriction adherence.METHODS Three hundred CHF patients seeking medical treatment at The First Hospital of Hunan University of Traditional Chinese Medicine between June 2021 and June 2023 were included in the study.Questionnaires,including the Psychosomatic Symptom Scale,Self-Rating Anxiety Scale,Self-Rating Depression Scale,and Fluid Restriction Adherence Questionnaire were administered to patients.Based on their anxiety and depression scores,patients were categorized into anxiety/depression and non-anxiety/depression groups,as well as fluid restriction adherence and fluid restriction non-adherence groups.General patient data were collected,and univariate and logistic regression analyses were conducted to determine the occurrence of depression and anxiety.Logistic regression analysis was used to identify independent factors influencing fluid restriction adherence.RESULTS Statistically significant differences in age,New York Heart Association(NYHA)grading,marital status,educational attainment,and family support were observed between depressed and non-depressed CHF patients(P<0.05).Age,NYHA grading,marital status,educational attainment,and family support were identified as factors influencing the development of depression.The anxiety and non-anxiety groups differed statistically in terms of gender,age,NYHA grading,smoking history,alcohol consumption history,monthly income,educational attainment,and family support(P<0.05).Gender,smoking,alcohol consumption,monthly income,and educational attainment affected anxiety in these patients.The fluid restriction adherence rate was 28.0%,and thirst sensation,anxiety,and depression were identified as independent influencing factors.CONCLUSION CHF patients are susceptible to anxiety and depression,with multiple associated influencing factors.Moreover,anxiety and depression are independent factors that can influence fluid restriction adherence in these patients.展开更多
OBJECTIVE To investigate possible associations between physical function assessment scales,such as Short Physical Performance Battery(SPPB)and Berg Balance Scale(BBS),with all-cause mortality in acute decompensated he...OBJECTIVE To investigate possible associations between physical function assessment scales,such as Short Physical Performance Battery(SPPB)and Berg Balance Scale(BBS),with all-cause mortality in acute decompensated heart failure(ADHF)patients.METHODS A total of 108 ADHF patients were analyzed from October 2020 to October 2022,and followed up to May 2023.The association between baseline clinical characteristics and all-cause mortality was analyzed by univariate Cox regression analysis,while for SPPB and BBS,univariate Cox regression analysis was followed by receiver operating characteristic curves,in which the area under the curve represented their predictive accuracy for all-cause mortality.Incremental predictive values for both physical function assessments were measured by calculating net reclassification index and integrated discrimination improvement scores.Optimal cutoff value for BBS was then identified using restricted cubic spline plots,and survival differences below and above that cut-off were compared using Kaplan-Meier survival curves and the log-rank test.The clinical utility of BBS was measured using decision curve analysis.RESULTS For baseline characteristics,age,female,blood urea nitrogen,as well as statins,angiotensin-converting enzyme inhibitors,angiotensin II receptor blockers,or angiotensin receptor-neprilysin inhibitors,were predictive for all-cause mortality for ADHF patients.With respect to SPPB and BBS,higher scores were associated with lower all-cause mortality rates for both assessments;similar area under the curves were measured for both(0.774 for SPPB and 0.776 for BBS).Furthermore,BBS≤36.5 was associated with significantly higher mortality,which was still applicable even adjusting for confounding factors;BBS was also found to have great clinical utility under decision curve analysis.CONCLUSIONS BBS or SPPB could be used as tools to assess physical function in ageing ADHF patients,as well as prognosticate on all-cause mortality.Moreover,prioritizing the improvement of balance capabilities of ADHF patients in cardiac rehabilitation regimens could aid in lowering mortality risk.展开更多
Objective:To analyze the burden of caregivers of CHF patients in the current environment,to explore the related burden and influencing factors of caring for patients with chronic heart failure,and to explore the impac...Objective:To analyze the burden of caregivers of CHF patients in the current environment,to explore the related burden and influencing factors of caring for patients with chronic heart failure,and to explore the impact of filial piety values on the burden of caring for patients.Methods:192 caregivers of CHF patients in the hospital were selected as the main objects of this study.The main method was convenient sampling.Through a questionnaire survey of 192 CHF patients'caregivers,a unified investigation was conducted from the aspects of patient"'s general condition,objective burden,anxiety and depression degree and relationship quality,etc.The structural equation model was constructed and adjusted by analyzing data entry and variable correlation.Finally,path analysis was used to conduct inferential research on the direct and indirect influencing factors of control burden.Results:More than half of the patients'caregivers had a caregiving burden,and the practical caregiving dimension had the highest score.The total effect values of patient-related factors,including anxiety degree,number of concomitant diseases and half-year readmission rate,were 0.36,0.31 and 0.20,respectively(P<0.05).The total effect values of filial piety,anxiety degree,average care time and understanding degree of disease directly derived from the caregivers themselves were-0.38,0.29,0.29 and-0.23,respectively(P<0.05).In addition,the influence of filial piety values on the caregiver burden was more obvious,and the direct effect value of the value was-0.41(P<0.001).Conclusion:Most caregivers of CHF patients have a certain objective burden of care,and there are many factors that affect it,among which the degree of filial piety value is the most important.This finding provides a clear goal for caregivers to develop measures to improve the caregiver burden.展开更多
Objective:In addition to dyspnea and edema,gastrointestinal discomfort is common among patients with heart failure(HF).Reduced cardiac output can lead to inadequate perfusion of the intestinal mucosa and subsequent im...Objective:In addition to dyspnea and edema,gastrointestinal discomfort is common among patients with heart failure(HF).Reduced cardiac output can lead to inadequate perfusion of the intestinal mucosa and subsequent impairment of the intestinal barrier.Levosimendan,a novel inotropic agent,binds to cardiac troponin C to enhance calcium sensitivity,activates ATP-dependent potassium channels in cardiomyocytes and vascular smooth muscle cells,exerts positive inotropic and vasodilatory effects,and reduces free radical generation,thereby improving systemic hemodynamics including intestinal circulation.However,clinical evidence regarding its protective effects on the intestinal barrier in HF patients remains limited,and the underlying mechanisms require further clarification.This study aims to investigate whether levosimendan confers protective effects on the intestinal barrier in HF patients and to explore its potential mechanisms.Methods:Network pharmacology was first used to analyze potential mechanisms of levosimendan in treating intestinal barrier dysfunction among HF patients.A total of 62 hospitalized patients with acute exacerbation of HF with reduced ejection fraction(HFrEF)were enrolled based on echocardiographic left ventricular ejection fraction.According to clinical medication regimens,patients were assigned to a conventional treatment group(n=31)or a levosimendan treatment group(n=31).The conventional treatment group received standard anti-HF therapy,while the levosimendan treatment group received levosimendan in addition to standard therapy.Enzyme-linked immunosorbent assays were used to measure plasma levels and changes in the intestinal-barrier proteins zonulin,intestinal fatty acid binding protein(I-FABP),proinflammatory cytokines[interleukin(IL)-17,IL-6,and tumor necrosis factor(TNF)-α],anti-inflammatory cytokine IL-10,and N-terminal probrain natriuretic peptide(NT-proBNP).Improvements in cardiac function and gastrointestinal symptoms were evaluated using the Kansas City Cardiomyopathy Questionnaire(KCCQ)and the Gastrointestinal Symptom Rating Scale(GSRS).Results:Network pharmacology indicated that the effects of levosimendan on intestinal barrier dysfunction in HF patients may involve inflammation-related pathways such as IL-17 and TNF.Clinically,after treatment,zonulin decreased by 32.94 ng/mL in the levosimendan treatment group versus 15.05 ng/mL in the conventional treatment group(P<0.05).I-FABP decreased by 6.97 pg/mL in the levosimendan treatment group but increased by 35.16 pg/mL in the conventional treatment group(P<0.05).IL-6,IL-17,and TNF-αdecreased by 1.11 pg/mL,1.21 pg/mL,and 2.83 pg/mL,respectively,in the levosimendan treatment group,whereas they increased by 7.68 pg/mL,0.67 pg/mL,and 2.38 pg/mL in the conventional treatment group(all P<0.05).IL-10 decreased by 24.48 pg/mL in the conventional treatment group but increased by 24.98 pg/mL in the levosimendan treatment group(P<0.05).NT-proBNP increased by 7.35 pg/mL in the conventional treatment group but decreased by 4.73 pg/mL in the levosimendan treatment group(P<0.05).KCCQ scores increased by 0.36 in the conventional treatment group and 1.86 in the levosimendan treatment group,GSRS scores decreased by 1.00 in the conventional treatment group and 2.40 in the levosimendan treatment group,respectively,but the differences were not statistically significant(both P>0.05).Conclusion:Levosimendan not only improves HF and gastrointestinal symptoms in hospitalized patients with acute exacerbation of HFrEF but also reduces plasma intestinal barrier factor levels.These effects may be associated with decreased plasma proinflammatory cytokines and increased anti-inflammatory cytokines after treatment,potentially involving IL-17 and TNF signaling pathways.展开更多
Falls remain a prevalent source of injury in daily life and underlying aetiology of falls are often complex and multi-factorial.[1,2]Older persons living with heart failure(OPLHF)are of a particular interest when disc...Falls remain a prevalent source of injury in daily life and underlying aetiology of falls are often complex and multi-factorial.[1,2]Older persons living with heart failure(OPLHF)are of a particular interest when discussing falls as multiple factors associated with heart failure(HF)aetiology and treatment are assumedly implicated in falls occurrence.A retrospective study reported a 14%increased risk of falls among OPLHF,and prospective data has shown that up to 40%of HF patients may experience a fall within a year from diagnosis.展开更多
In the past 6 years, significant breakthroughs have been achieved in the treatment of heart failure(HF), especially in drug therapy. The classification of chronic HF and the treatment methods for HF and its complicati...In the past 6 years, significant breakthroughs have been achieved in the treatment of heart failure(HF), especially in drug therapy. The classification of chronic HF and the treatment methods for HF and its complications are also constantly being updated. In order to apply these results to the diagnosis and treatment of patients with HF in China and further improve the level of diagnosis and treatment of HF in China, the HF Group of Chinese Society of Cardiology, Chinese Medical Association, Chinese College of Cardiovascular Physician, Chinese HF Association of Chinese Medical Doctor Association, and Editorial Board of Chinese Journal of Cardiology have organized an expert group and update the consensus and evidence-based treatment methods in the field of HF based on the latest clinical research findings at home and abroad, combined with the national conditions and clinical practice in China, and referring to the latest foreign HF guidelines while maintaining the basic framework of the 2018 Chinese Guidelines for Diagnosis and Treatment of HF.展开更多
Background Patients aged 85 years or older admitted for heart failure(HF)have increased enormously due to improved survival in this disease.However,few studies assess the characteristics,treatments,and prognosis of ve...Background Patients aged 85 years or older admitted for heart failure(HF)have increased enormously due to improved survival in this disease.However,few studies assess the characteristics,treatments,and prognosis of very elderly patients admitted for acute HF.Methods This study is a retrospective analysis of the EPICTER registry,that included patients admitted for acute HF in 74 Spanish hospitals.For this analysis,a total of 1887 patients were included and divided into 2 groups:85 years or older(very elderly,680 patients)and those under 85 years.Results Compared to patients<85 years,very elderly patients were more frequently women,had more hypertension and disease cerebrovascular disease,and less presence of chronic obstructive pulmonary disease(COPD),diabetes,and acute myocardial infarction.There were no differences in symptoms,except for delirium,significantly more common in very elderly patients.Management of these patients was more conservative and died more than the younger ones(41%vs.25%,P<0.001).The predictor variables of mortality in very elderly patients were the presence of COPD and peripheral arterial disease,delirium,and estimated survival of less than 6 months assessed by the physician in charge of the patient care.Conclusion Very elderly patients admitted for HF differ from younger ones in comorbidities,management,and symptoms,and have higher mortality.The presence of delirium,peripheral arterial disease,and COPD worsen the prognosis in these patients and can help to adapt the therapeutic effort and place emphasis on adequate symptom control.展开更多
Objective: To develop a best-evidence-based optimal nutrition management plan for patients with chronic heart failure, apply it in clinical practice, and evaluate its effectiveness. Methods: Use the KTA knowledge tran...Objective: To develop a best-evidence-based optimal nutrition management plan for patients with chronic heart failure, apply it in clinical practice, and evaluate its effectiveness. Methods: Use the KTA knowledge translation model to guide evidence-based practice in nutrition management, and compare the nutritional status, cardiac function status, quality of life, and quality review indicators of chronic heart failure patients before and after the application of evidence. Results: After the application of evidence, the nutritional status indicators (MNA-SF score, albumin, hemoglobin) of two groups of heart failure patients significantly increased compared to before the application of evidence, with statistically significant differences (p Conclusion: The KTA knowledge translation model provides methodological guidance for the implementation of evidence-based practice for heart failure patients. This evidence-based practice project is beneficial for improving the outcomes of malnutrition in chronic heart failure patients and is conducive to standardizing nursing pathways, thereby promoting the improvement of nursing quality.展开更多
文摘BACKGROUND Congenital hypothyroidism(CH)is a common condition in both preterm and term infants characterized by either thyroid gland absence or hypofunctionality.The clinical association of refractory lactic acidosis and heart failure has rarely been observed in cases of pediatric patients with CH pathology.Here,we explored the etiological relationship between CH,heart failure,and refractory lactic acidosis to reflect the importance of thyroid function screening in neonates with heart disease.CASE SUMMARY A 33-day-old extremely premature female infant presented with tachypnea,respiratory distress,recurrent infections,and abdominal distension postnatal.On admission to our facility,she had cardiomegaly,hepatomegaly,and lactic acidosis(revealed on blood gas analysis),with lactate progressively rising to 25 mmol/L.Chest radiographs showed pulmonary congestion,while echocardiography revealed cardiac enlargement,left ventricular wall thickening,and pericardial effusion.Initial management aimed at correcting acidosis and treating heart failure proved ineffective.After reassessment,thyroid function tests showed significantly decreased triiodothyronine,free triiodothyronine,thyroxine,and free thyroxine levels,with a significantly increased thyroidstimulating hormone level,confirming a CH diagnosis.Levothyroxine was administered,resulting in rapid correction of lactic acidosis and gradual improvement of thyroid function and systemic symptoms,culminating in full recovery and discharge.We also reviewed the relevant literature on thyroid and cardiac dysfunctions in order to explore their deeper association.CONCLUSION This case links CH-induced heart failure with refractory lactic acidosis,urging prompt thyroid screening in affected neonates to reduce mortality.
基金supported by the Sanming Project of Medicine in Shenzhen[SZZYSM202206001]National Natural Science Foundation of China[82004320 and 82374383]+3 种基金Natural Science Foundation of Guangdong Province of China[2022A1515011710 and 2022A1515010679]Shenzhen Science and Technology Innovation Committee[JCYJ20220530141407017 and JCYJ20240813153619026]2024 High-quality Development Research Project of Shenzhen Bao’an Public Hospital[YNXM2024078]and Shenzhen Bao’an Chinese Medicine Hospital Research Program[BAZYY20220702].
文摘Background:“Qi deficiency”(a pathological state where the body’s vital energy(Qi)is insufficient or weakened,impairing physiological functions and diminishing the body’s ability to perform daily activities,defend against illness,and maintain homeostasis)syndrome is considered a critical syndrome in traditional Chinese medicine(TCM)and is associated with poor prognosis in heart failure(HF).This study investigates the clinical,metabolic,and transcriptomic differences between heart failure patients with and without Qi deficiency syndrome.Methods:56 heart failure patients were evaluated using a Qi deficiency syndrome scale and divided into Qi deficiency syndrome(QD)and non-Qi deficiency(non-QD)groups based on the median score.Clinical characteristics,including baseline N-terminal pro-B-type natriuretic peptide(NT-proBNP),left ventricular ejection fraction(LVEF),total diuretic use during hospitalization,and 90-day rehospitalization rates,were compared between the groups.Differentially expressed genes(DEGs)and differential metabolites were identified,followed by enrichment analyses and validation using qPCR and Western blot in AC16 cardiomyocytes.Results:QD patients exhibited significantly higher NT-proBNP levels,lower LVEF,and increased 90-day rehospitalization rates.Metabolomic profiling revealed lipid metabolism disruptions,notably in linoleic acid and phospholipid pathways.Transcriptomic analysis highlighted 17 DEGs,including CISD2,a critical mitochondrial regulator,which was downregulated in QD patients.Correlation analysis identified significant associations between DEGs(e.g.,CISD2,BPGM)and lipid metabolites such as PC(16:0/P-16:0).Functional knockdown of CISD2 in AC16 cells led to upregulation of lipid oxidation enzymes ALOX15 and CYP1A2,linking CISD2 dysfunction to lipid metabolic dysregulation.Conclusion:Qi deficiency is associated with more severe heart failure symptoms,worse prognosis,and distinct metabolic and transcriptomic profiles,particularly in lipid metabolism.CISD2 emerges as a potential therapeutic target,offering new avenues for integrating molecular insights with TCM approaches to optimize HF management.
文摘This article discusses the study by GrubićRotkvićet al on the mechanisms of action of sodium-glucose cotransporter 2 inhibitors(SGLT2i)in patients with type 2 diabetes mellitus(T2DM)and heart failure(HF).T2DM and HF are highly comorbid,with a significantly increased prevalence of HF in patients with T2DM.SGLT2i exhibit potential in reducing hospitalization rates for HF and cardiovascular mortality through multiple mechanisms,including improving blood glucose control,promoting urinary sodium excretion,reducing sympathetic nervous system activity,lowering both preload and afterload on the heart,alleviating inflammation and oxidative stress,enhancing endothelial function,improving myocardial energy metabolism,and stabilizing cardiac ion homeostasis.Further research and clinical practice will help optimize the use of SGLT2i in HF patients.
基金supported by Russian Science Foundation,RSF 23-75-00009(part of the study corresponding to finding 1)Part of the study corresponding to finding 2 was carried out within the state assignment,FSR No.:122020300045-5(03.02.2022).
文摘Objectives To compare respiratory parameters of peripheral blood mononuclear cell mitochondria and iron metabolism indicators in patients with different NYHA functional classes of ischemic heart failure(HF).Methods This single center, prospective, non-blinded study enrolled 20 patients with diagnosed chronic HF of ischemic genesis with reduced and mildly reduced left ventricle ejection fraction. The maximum oxygen consumption at the peak of the exercise test(VO2peak), iron metabolism parameters and respiratory activity of peripheral blood mononuclear cell mitochondria were assessed.Results Among the patients, a half of individuals were diagnosed with iron deficiency. Subgroups of patients with different HF severity did not significant differ in VO2peak(P=0.209), serum iron(P=0.468) and ferritin(P=0.235) levels. But there was a trend in increasing in these parameters with increasing NYHA HF functional class. Respiratory control coefficient(RC) in NADdependent and FAD-dependent mitochondrial oxidation were lower in patients with NYHA HF Ⅲ functional class compared to individuals with NYHA HF I functional class(P=0.028 and P=0.040, respectively). Serum iron(P=0.026), ferritin(P=0.045)levels, transferrin saturation(P=0.006) were negatively correlated with RC in NAD-dependent mitochondrial oxidation.Conclusions In aggravation of ischemic HF NYHA FC, there is a decrease in RC of PBMC mitochondria during the oxidation of NAD-dependent and FAD-dependent substrates. In the whole sample, patients with laboratory-confirmed iron deficiency accounted a half of the total number. Iron metabolism parameters had a paradoxical inverse relationship with the level of RC in PBMC mitochondria of patients with HF.
文摘BACKGROUND Chronic heart failure(CHF)is a severe cardiovascular disease that significantly threatens human health.Depression,a common comorbidity,may substantially impact cardiac structure and function.However,the exact relationship between depression and cardiac remodeling and left ventricular functional changes remains incompletely understood.This study sets out to explore,with a clinically grounded perspective,how depressive states may subtly or profoundly influence the trajectory of cardiac remodeling and the functional dynamics of the left ventricle in individuals grappling with CHF.Beyond mere observation,it also aims to untangle the underlying physiological or neurohormonal pathways that might bridge emotional distress and cardiac dysfunction.AIM To delve into how depressive symptoms might shape the progression of cardiac remodeling and impair left ventricular function among individuals living with CHF.Particular attention is given to the role of inflammatory signaling and disruptions in neuroendocrine balance as possible mediating factors.By examining these intertwined physiological and psychological processes,the study seeks to shed light on the reciprocal link between emotional distress and CHF,offering insights that may inform more precise,mechanism-based treatment strategies.METHODS In this retrospective clinical trial,248 patients diagnosed with CHF were analyzed in the tertiary treatment center between January 2018 and December 2022.According to Hamilton's Depression Scale score,participants were classified into two cohort of depression(score 17)and no significant depression characteristics(score 17).Cardiac morphology and functional parameters were assessed using a combination of hyperechocardiocardiocardiography,heart magnetic resonance,and associated blood biomarkers.RESULTS The results of this study underscore the significant effects that depression can have on both the structure and function of the heart in patients with CHF.In particular,the individuals in the cohort with depression were 42.3%±6.7%of the individuals without depression vs 51.6%±5.9%,P<0.01)In comparison,the left ventricular ejection fraction,an important measure of contractional performance,was significantly reduced,underlining the harmful physiological interaction between mood disorders and cardiac efficiency.The measurement of the left ventricular end-diastolic diameter showed a significant expansion of the ventricular envelope in the depression group(68.2±7.5 mm vs 59.6±6.3 mm,P<0.01).Inflammatory markers,including high-sensitivity C-reactive protein(hs-CRP)and tumor necrosis factor-α(TNF-α),were significantly elevated in the depressed group(hs-CRP:8.7±2.3 mg/L vs 4.5±1.6 mg/L;TNF-α:42.5±7.6 pg/mL vs 28.3±5.4 pg/mL).Both B-type natriuretic peptide(1256±345 pg/mL vs 756±234 pg/mL)and angiotensin II(86.4±15.7 ng/mL vs 62.5±12.3 ng/mL)levels were significantly higher in the depressed group.CONCLUSION Among people with CHF,the presence of depressive symptoms appears to be closely related to pronounced changes in heart structure and impaired functional abilities.It is likely that depressive states contribute to the progress of heart reform and deterioration of left stomach function,possibly due to increased inflammatory cascades and increased activation of neuroendocrine regulatory pathways.
基金Supported by Wenzhou Science Technology Bureau Foundation,No.2022Y0726.
文摘Heart failure(HF)with preserved ejection fraction(HFpEF)has exceeded HF with reduced ejection fraction(HFrEF),becoming the most common type of HF.Unlike HFrEF,HFpEF is primarily a chronic low-grade inflammatory process closely associated with metabolic disorders.The coexistence of HFpEF and metabolic dysfunction-associated steatotic liver disease(MASLD)presents significant clinical challenges due to shared metabolic pathophysiology and complex inter-play.Management strategies for HFpEF and MASLD remain challenging.Sodium-glucose cotransporter 2 inhibitors have shown benefits in managing both conditions.Additionally,glucagon-like peptide-1 receptor agonists are being actively investigated for their potential benefits,particularly in MASLD.A comprehensive,patient-centered approach that combines metabolic and cardiova-scular care is essential for improving outcomes in patients with HFpEF and MASLD,addressing the global metabolic health challenges.
基金Supported by National Key Research and Development Program of China,No.2022YFC3500704Youth Talent Support Project of China Association of Acupuncture-Moxibustion,No.2024-2026ZGZJXH-QNRC005。
文摘Chronic heart failure(CHF)is a complex clinical syndrome characterized byimpaired cardiac function and neurohormonal dysregulation.While CHF hastraditionally been regarded as a hemodynamic disorder,growing evidencehighlights the pivotal role of autonomic nervous system(ANS)dysfunction in itsprogression and prognosis.The ANS,comprising sympathetic and parasympatheticbranches,exerts significant control over cardiac function,including heartrate,contractility,and vascular tone.In CHF,sympathetic overactivation coupledwith parasympathetic withdrawal contributes to adverse cardiac remodeling,arrhythmogenesis,and further deterioration of cardiac performance.This minireviewsummarizes current knowledge on the role of autonomic dysfunction inCHF and heart transplantation.It focuses on how sympathetic nervous systemimbalance contributes to CHF progression and explores the impact of autonomicdysregulation on post-transplant outcomes.By synthesizing existing evidence,thereview highlights ANS modulation as a key therapeutic target for improvingcardiac function and patient prognosis in both clinical settings.
文摘Objective:To explore the improvement effect of implementing Buzhong Yiqi Decoction combined with Xuefu Zhuyu Decoction on cardiac function and quality of life of patients during the treatment of coronary heart disease complicated with heart failure.Methods:Eighty cases were included in the study,and they were equally divided into a control group(n=40,treated with basic western medicine)and a study group(n=40,treated with Buzhong Yiqi Decoction combined with Xuefu Zhuyu Decoction)according to random sampling grouping method.The intervention index results of the two groups were compared.Results:The improvement of cardiac function index,TCM syndrome score,and quality of life in the study group was more prominent,with a statistical value of P<0.05.Conclusion:Buzhong Yiqi Decoction combined with Xuefu Zhuyu Decoction and conventional western medicine treatment can effectively improve the cardiac function of patients with coronary heart disease complicated with heart failure and enhance their quality of life.It is worthy of clinical promotion and application.
文摘BACKGROUND Depression is a highly prevalent and clinically significant psychiatric comorbidity in patients with heart failure(HF),exerting multidimensional effects that extend beyond emotional symptoms to influence physiological outcomes and disease progression.Emerging evidence in psychocardiology highlights the bidirectional interplay between mood disorders and cardiovascular dysfunction through neuroendocrine,autonomic,and behavioral pathways.This study aims to explore the real-world effect of depression severity-measured by the Patient Health Questionnaire-9(PHQ-9)-on left ventricular systolic function and one-year cardiovascular readmission in patients with HF,providing insights into its prognostic relevance within a psychocardiological framework.AIM To investigate the impact of depression severity on medication adherence,ventricular function,and readmission in patients with HF.METHODS A total of 160 patients hospitalized for HF between January 2020 and December 2023 were included in this real-world retrospective cohort study.Depression severity was assessed by using the PHQ-9,with scores≥10 indicating moderate-to-severe depression.Cardiac function was evaluated through transthoracic echocardiography to determine left ventricular ejection fraction(LVEF).Medication adherence was assessed at three and six months postdischarge by employing the four-item Morisky Medication Adherence Scale(MMAS-4)and categorized as high(score=0),moderate(1-2),or low(3-4).Data on antidepressant or anxiolytic prescriptions and psychological interventions during hospitalization were collected.Patients were followed up for one year to capture cardiovascular-related readmissions.Kaplan-Meier analysis was employed to estimate eventfree survival,and Cox regression identified independent predictors of readmission.RESULTS Patients with moderate-to-severe depression(PHQ-9≥10)presented with significantly lower LVEF at baseline,higher N-terminal pro-B-type natriuretic peptide levels,and more severe HF symptoms than other patients.They also demonstrated poorer medication adherence postdischarge,with a higher proportion classified as low adherence on the MMAS-4 scale,and were less likely to receiveβ-blockers or angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker at discharge than other patients.At three and six months postdischarge,PHQ-9 and MMAS-4 scores were inversely correlated with LVEF,suggesting a behavioral pathway linking depression to impaired cardiac recovery.During the one-year follow-up period,30.0%of patients experienced cardiovascular-related readmissions,predominantly due to worsening HF(54.1%).In multivariable Cox regression analysis,high PHQ-9 scores,reduced LVEF,old age,elevated N-terminal pro-B-type natriuretic peptide levels,New York Heart Association class IV,and absence ofβ-blocker therapy were independently associated with readmission risk.CONCLUSION In patients with HF,depression severity independently predicts impaired ventricular function,low medication adherence,and increased one-year cardiovascular readmission.These findings highlight the psychocardiological relevance of depression screening and behavioral intervention in optimizing adherence and clinical outcomes in routine HF care.
文摘BACKGROUND Advanced heart failure and transplant(AHFTC)teams are crucial in the management of patients in cardiogenic shock.We sought to explore the impact of AHFTC physicians on outcomes in patients receiving extracorporeal membrane oxygenation(ECMO)support.AIM To determine whether outcomes differ in the care of ECMO patients when AHFTC physicians serve in a primary vs consultative role.METHODS We conducted a retrospective cohort study of 51 patients placed on veno-venous(VV)and veno-arterial(VA)ECMO between January 2015 and February 2023 at our institution.We compared ECMO outcomes between teams managed primarily by intensivists vs teams where AHFTC physicians played a direct role in ECMO management,including patient selection.Our primary outcome measure was survival to 30 days post hospital discharge.RESULTS For combined VA and VV ECMO patients,survival to 30 days post discharge in the AHFTC cohort was significantly higher(67%vs 30%,P=0.01),largely driven by a significantly increased 30-day post discharge survival in VA ECMO patients in the AHFTC group(64%vs 20%,P=0.05).CONCLUSION This study suggests that patients in shock requiring VA ECMO support may have improved survival 30 days after hospital discharge when an AHFTC team serves in a direct role in the selection and management of patients.Further studies are needed to validate this impact.
基金supported by the National Natural Science Foundation of China(No.82074054)Shanghai Municipal Commission of Health and Family Planning(No.ZY(2021-2023)-0208)+2 种基金Youth Program of the National Natural Science Foundation of China(No.81903831)Shanghai Municipality:Shanghai Chenguang Program(No.19CG48)Natural Science Foundation of Shanghai(No.24ZR1465900)。
文摘Lingguizhugan Decoction(LGZG)demonstrates significant efficacy in treating various cardiovascular diseases clinically,yet its precise mechanism of action remains elusive.This study aimed to elucidate the potential mechanisms and effects of LGZG on isoproterenol(ISO)continuous stimulation-induced chronic heart failure(CHF)in mice,providing direct experimental evidence for further clinical applications.In vivo,continuous ISO infusion was administered to mice,and ventricular myocytes were utilized to explore LGZG's potential mechanism of action on theβ1-adrenergic receptor(β1-AR)/Gs/G protein-coupled receptor kinases(GRKs)/β-arrestin signaling deflection system in the heart.The findings reveal that LGZG significantly reduced the messenger ribonucleic acid(mRNA)expression of hypertrophy-related biomarkers[atrial natriuretic peptide(ANP)and B-type natriuretic peptide(BNP)]and improved cardiac remodeling and left ventricular diastolic function in mice with ISO-induced CHF.Furthermore,LGZG inhibited the overactivation of Gs/cyclic adenosine monophosphate(c AMP)/protein kinase A(PKA)signaling and downregulated the downstream transcriptional activity of c AMP-response element binding protein(CREB)and the expression of the coactivator CBP/P300.Notably,LGZG downregulated the expression ofβ-arrestin1 and GRK 2/3/5 while upregulating the expression ofβ1-AR andβ-arrestin2.These results suggest that LGZG inhibits Gs/c AMP/PKA signaling andβ-arrestin/GRK-mediated desensitization and internalization ofβ1-AR,potentially exerting cardioprotective effects through the synergistic regulation of theβ1-AR/Gs/GRKs/β-arrestin signaling deflection system via multiple pathways.
文摘According to the Japanese Ministry of Health,Labour,and Welfare,14.2%of people were aged>75 years in Japan in 2018,and this number continues to rise.With population aging,the incidence of congestive heart failure(CHF)is also increasing.[1–3]Reports have shown that the presence of cognitive impairment(CI)in patients with CHF is associated with poor prognosis,[4–6]and the degree of CI is related to CHF severity.
基金Huxiang TCM Physique Intervention Clinical Research Center,No.2023SK4061Traditional Chinese Medicine Research Project of Hunan Province,No.B2023065+4 种基金Hunan Province"14th Five-Year Plan"key specialty of TCM,No.[2023]4Hunan University of Chinese Medicine and Hospital Joint Foundation,No.2023XYLH019 and 2024XYLH365R&D Plan for Key Areas of Hunan Provincial Department of Science and Technology,No.2019SK2321Excellent Youth Program of Hunan Education Department,No.24B0346Hunan Provincial Natural Science Foundation for Young Scientists,No.2025JJ60626.
文摘BACKGROUND Anxiety and depression are prevalent among patients with chronic heart failure(CHF)and can adversely contribute to treatment adherence and clinical outcomes.Poor fluid restriction adherence is a widespread challenge in the management of CHF.To effectively manage disease progression and alleviate symptoms,it is crucial to identify key influencing factors to facilitate the implementation of targeted interventions.AIM To investigate the status of anxiety and depression among patients with CHF and determine the factors contributing to poor fluid restriction adherence.METHODS Three hundred CHF patients seeking medical treatment at The First Hospital of Hunan University of Traditional Chinese Medicine between June 2021 and June 2023 were included in the study.Questionnaires,including the Psychosomatic Symptom Scale,Self-Rating Anxiety Scale,Self-Rating Depression Scale,and Fluid Restriction Adherence Questionnaire were administered to patients.Based on their anxiety and depression scores,patients were categorized into anxiety/depression and non-anxiety/depression groups,as well as fluid restriction adherence and fluid restriction non-adherence groups.General patient data were collected,and univariate and logistic regression analyses were conducted to determine the occurrence of depression and anxiety.Logistic regression analysis was used to identify independent factors influencing fluid restriction adherence.RESULTS Statistically significant differences in age,New York Heart Association(NYHA)grading,marital status,educational attainment,and family support were observed between depressed and non-depressed CHF patients(P<0.05).Age,NYHA grading,marital status,educational attainment,and family support were identified as factors influencing the development of depression.The anxiety and non-anxiety groups differed statistically in terms of gender,age,NYHA grading,smoking history,alcohol consumption history,monthly income,educational attainment,and family support(P<0.05).Gender,smoking,alcohol consumption,monthly income,and educational attainment affected anxiety in these patients.The fluid restriction adherence rate was 28.0%,and thirst sensation,anxiety,and depression were identified as independent influencing factors.CONCLUSION CHF patients are susceptible to anxiety and depression,with multiple associated influencing factors.Moreover,anxiety and depression are independent factors that can influence fluid restriction adherence in these patients.
基金supported by the Key Research and Development Special Project of the Autonomous Region(No.2022B03023-3)the Key Supported Discipline of Health System in Shanghai(No.2023ZDFC0302)。
文摘OBJECTIVE To investigate possible associations between physical function assessment scales,such as Short Physical Performance Battery(SPPB)and Berg Balance Scale(BBS),with all-cause mortality in acute decompensated heart failure(ADHF)patients.METHODS A total of 108 ADHF patients were analyzed from October 2020 to October 2022,and followed up to May 2023.The association between baseline clinical characteristics and all-cause mortality was analyzed by univariate Cox regression analysis,while for SPPB and BBS,univariate Cox regression analysis was followed by receiver operating characteristic curves,in which the area under the curve represented their predictive accuracy for all-cause mortality.Incremental predictive values for both physical function assessments were measured by calculating net reclassification index and integrated discrimination improvement scores.Optimal cutoff value for BBS was then identified using restricted cubic spline plots,and survival differences below and above that cut-off were compared using Kaplan-Meier survival curves and the log-rank test.The clinical utility of BBS was measured using decision curve analysis.RESULTS For baseline characteristics,age,female,blood urea nitrogen,as well as statins,angiotensin-converting enzyme inhibitors,angiotensin II receptor blockers,or angiotensin receptor-neprilysin inhibitors,were predictive for all-cause mortality for ADHF patients.With respect to SPPB and BBS,higher scores were associated with lower all-cause mortality rates for both assessments;similar area under the curves were measured for both(0.774 for SPPB and 0.776 for BBS).Furthermore,BBS≤36.5 was associated with significantly higher mortality,which was still applicable even adjusting for confounding factors;BBS was also found to have great clinical utility under decision curve analysis.CONCLUSIONS BBS or SPPB could be used as tools to assess physical function in ageing ADHF patients,as well as prognosticate on all-cause mortality.Moreover,prioritizing the improvement of balance capabilities of ADHF patients in cardiac rehabilitation regimens could aid in lowering mortality risk.
文摘Objective:To analyze the burden of caregivers of CHF patients in the current environment,to explore the related burden and influencing factors of caring for patients with chronic heart failure,and to explore the impact of filial piety values on the burden of caring for patients.Methods:192 caregivers of CHF patients in the hospital were selected as the main objects of this study.The main method was convenient sampling.Through a questionnaire survey of 192 CHF patients'caregivers,a unified investigation was conducted from the aspects of patient"'s general condition,objective burden,anxiety and depression degree and relationship quality,etc.The structural equation model was constructed and adjusted by analyzing data entry and variable correlation.Finally,path analysis was used to conduct inferential research on the direct and indirect influencing factors of control burden.Results:More than half of the patients'caregivers had a caregiving burden,and the practical caregiving dimension had the highest score.The total effect values of patient-related factors,including anxiety degree,number of concomitant diseases and half-year readmission rate,were 0.36,0.31 and 0.20,respectively(P<0.05).The total effect values of filial piety,anxiety degree,average care time and understanding degree of disease directly derived from the caregivers themselves were-0.38,0.29,0.29 and-0.23,respectively(P<0.05).In addition,the influence of filial piety values on the caregiver burden was more obvious,and the direct effect value of the value was-0.41(P<0.001).Conclusion:Most caregivers of CHF patients have a certain objective burden of care,and there are many factors that affect it,among which the degree of filial piety value is the most important.This finding provides a clear goal for caregivers to develop measures to improve the caregiver burden.
基金supported by the Hunan Provincial Science and Technology Major Special Fund(2021SK1020)the Natural Science Foundation of Hunan Province(2023JJ30948)+1 种基金the Health Commission of Hunan Province(202203014687)the International Medical Exchange Cardiovascular Multidisciplinary Integrated Thinking Research Foundation(Z-2016-23-2101-20),China.
文摘Objective:In addition to dyspnea and edema,gastrointestinal discomfort is common among patients with heart failure(HF).Reduced cardiac output can lead to inadequate perfusion of the intestinal mucosa and subsequent impairment of the intestinal barrier.Levosimendan,a novel inotropic agent,binds to cardiac troponin C to enhance calcium sensitivity,activates ATP-dependent potassium channels in cardiomyocytes and vascular smooth muscle cells,exerts positive inotropic and vasodilatory effects,and reduces free radical generation,thereby improving systemic hemodynamics including intestinal circulation.However,clinical evidence regarding its protective effects on the intestinal barrier in HF patients remains limited,and the underlying mechanisms require further clarification.This study aims to investigate whether levosimendan confers protective effects on the intestinal barrier in HF patients and to explore its potential mechanisms.Methods:Network pharmacology was first used to analyze potential mechanisms of levosimendan in treating intestinal barrier dysfunction among HF patients.A total of 62 hospitalized patients with acute exacerbation of HF with reduced ejection fraction(HFrEF)were enrolled based on echocardiographic left ventricular ejection fraction.According to clinical medication regimens,patients were assigned to a conventional treatment group(n=31)or a levosimendan treatment group(n=31).The conventional treatment group received standard anti-HF therapy,while the levosimendan treatment group received levosimendan in addition to standard therapy.Enzyme-linked immunosorbent assays were used to measure plasma levels and changes in the intestinal-barrier proteins zonulin,intestinal fatty acid binding protein(I-FABP),proinflammatory cytokines[interleukin(IL)-17,IL-6,and tumor necrosis factor(TNF)-α],anti-inflammatory cytokine IL-10,and N-terminal probrain natriuretic peptide(NT-proBNP).Improvements in cardiac function and gastrointestinal symptoms were evaluated using the Kansas City Cardiomyopathy Questionnaire(KCCQ)and the Gastrointestinal Symptom Rating Scale(GSRS).Results:Network pharmacology indicated that the effects of levosimendan on intestinal barrier dysfunction in HF patients may involve inflammation-related pathways such as IL-17 and TNF.Clinically,after treatment,zonulin decreased by 32.94 ng/mL in the levosimendan treatment group versus 15.05 ng/mL in the conventional treatment group(P<0.05).I-FABP decreased by 6.97 pg/mL in the levosimendan treatment group but increased by 35.16 pg/mL in the conventional treatment group(P<0.05).IL-6,IL-17,and TNF-αdecreased by 1.11 pg/mL,1.21 pg/mL,and 2.83 pg/mL,respectively,in the levosimendan treatment group,whereas they increased by 7.68 pg/mL,0.67 pg/mL,and 2.38 pg/mL in the conventional treatment group(all P<0.05).IL-10 decreased by 24.48 pg/mL in the conventional treatment group but increased by 24.98 pg/mL in the levosimendan treatment group(P<0.05).NT-proBNP increased by 7.35 pg/mL in the conventional treatment group but decreased by 4.73 pg/mL in the levosimendan treatment group(P<0.05).KCCQ scores increased by 0.36 in the conventional treatment group and 1.86 in the levosimendan treatment group,GSRS scores decreased by 1.00 in the conventional treatment group and 2.40 in the levosimendan treatment group,respectively,but the differences were not statistically significant(both P>0.05).Conclusion:Levosimendan not only improves HF and gastrointestinal symptoms in hospitalized patients with acute exacerbation of HFrEF but also reduces plasma intestinal barrier factor levels.These effects may be associated with decreased plasma proinflammatory cytokines and increased anti-inflammatory cytokines after treatment,potentially involving IL-17 and TNF signaling pathways.
文摘Falls remain a prevalent source of injury in daily life and underlying aetiology of falls are often complex and multi-factorial.[1,2]Older persons living with heart failure(OPLHF)are of a particular interest when discussing falls as multiple factors associated with heart failure(HF)aetiology and treatment are assumedly implicated in falls occurrence.A retrospective study reported a 14%increased risk of falls among OPLHF,and prospective data has shown that up to 40%of HF patients may experience a fall within a year from diagnosis.
基金National High Level Hospital Clinical Research Funding(2022-PUMCH-B-098)CAMS Innovation Fund for Medical Sciences (2021-I2M-1-003)。
文摘In the past 6 years, significant breakthroughs have been achieved in the treatment of heart failure(HF), especially in drug therapy. The classification of chronic HF and the treatment methods for HF and its complications are also constantly being updated. In order to apply these results to the diagnosis and treatment of patients with HF in China and further improve the level of diagnosis and treatment of HF in China, the HF Group of Chinese Society of Cardiology, Chinese Medical Association, Chinese College of Cardiovascular Physician, Chinese HF Association of Chinese Medical Doctor Association, and Editorial Board of Chinese Journal of Cardiology have organized an expert group and update the consensus and evidence-based treatment methods in the field of HF based on the latest clinical research findings at home and abroad, combined with the national conditions and clinical practice in China, and referring to the latest foreign HF guidelines while maintaining the basic framework of the 2018 Chinese Guidelines for Diagnosis and Treatment of HF.
文摘Background Patients aged 85 years or older admitted for heart failure(HF)have increased enormously due to improved survival in this disease.However,few studies assess the characteristics,treatments,and prognosis of very elderly patients admitted for acute HF.Methods This study is a retrospective analysis of the EPICTER registry,that included patients admitted for acute HF in 74 Spanish hospitals.For this analysis,a total of 1887 patients were included and divided into 2 groups:85 years or older(very elderly,680 patients)and those under 85 years.Results Compared to patients<85 years,very elderly patients were more frequently women,had more hypertension and disease cerebrovascular disease,and less presence of chronic obstructive pulmonary disease(COPD),diabetes,and acute myocardial infarction.There were no differences in symptoms,except for delirium,significantly more common in very elderly patients.Management of these patients was more conservative and died more than the younger ones(41%vs.25%,P<0.001).The predictor variables of mortality in very elderly patients were the presence of COPD and peripheral arterial disease,delirium,and estimated survival of less than 6 months assessed by the physician in charge of the patient care.Conclusion Very elderly patients admitted for HF differ from younger ones in comorbidities,management,and symptoms,and have higher mortality.The presence of delirium,peripheral arterial disease,and COPD worsen the prognosis in these patients and can help to adapt the therapeutic effort and place emphasis on adequate symptom control.
文摘Objective: To develop a best-evidence-based optimal nutrition management plan for patients with chronic heart failure, apply it in clinical practice, and evaluate its effectiveness. Methods: Use the KTA knowledge translation model to guide evidence-based practice in nutrition management, and compare the nutritional status, cardiac function status, quality of life, and quality review indicators of chronic heart failure patients before and after the application of evidence. Results: After the application of evidence, the nutritional status indicators (MNA-SF score, albumin, hemoglobin) of two groups of heart failure patients significantly increased compared to before the application of evidence, with statistically significant differences (p Conclusion: The KTA knowledge translation model provides methodological guidance for the implementation of evidence-based practice for heart failure patients. This evidence-based practice project is beneficial for improving the outcomes of malnutrition in chronic heart failure patients and is conducive to standardizing nursing pathways, thereby promoting the improvement of nursing quality.
