Objective: To observe the benefit of mineralocorticoid receptor antagonist and sodium-glucose co-transport 2 inhibitor (SGLT2 inhibitor) in heart failure preserved ejection (HFpEF) in rural Tanzania. Background and Re...Objective: To observe the benefit of mineralocorticoid receptor antagonist and sodium-glucose co-transport 2 inhibitor (SGLT2 inhibitor) in heart failure preserved ejection (HFpEF) in rural Tanzania. Background and Result: The use of spironolactone and dapagliflozin was shown to be effective in improving the clinical outcome and reducing CV hospitalization rate and CV mortality in patients with heart failure preserved left ventricular ejection fraction (HFpEF). This is the case presentation of one patient with HFpEF with diastolic dysfunction grade 3, obesity grade 3, Type 2 Diabetes, and Atrial Fibrillation (permanent). In the case of a 76-year-old female after previous ineffective treatment, the initiation of Spironolactone and Dapagliflozin led to a rapid and marked improvement in the clinical conditions. Diastolic dysfunction was improved from stage III to stage I. Moreover, the initiation of spironolactone and dapagliflozin therapy avoided a referral for surgical intervention and interrupted a long series of hospitalizations for acute HF and prevented CV death. Conclusion: Based on our experience, we conclude that the treatment with spironolactone and dapagliflozin allows for better treatment optimization with a positive impact on the control of clinical outcomes and preventing CV death and CV hospitalization in HFpEF and related comorbidities in the African population, which is underrepresented in most of the trials.展开更多
目的:探讨二甲双胍恩格列净片治疗2型糖尿病(T2DM)合并射血分数保留性心力衰竭(HFpEF)患者的临床效果和安全性。方法:选取2021年10月—2022年9月保定市第一中心医院80例T2DM合并HFpEF患者,通过随机数字表法将其分为观察组(n=40)和对照组...目的:探讨二甲双胍恩格列净片治疗2型糖尿病(T2DM)合并射血分数保留性心力衰竭(HFpEF)患者的临床效果和安全性。方法:选取2021年10月—2022年9月保定市第一中心医院80例T2DM合并HFpEF患者,通过随机数字表法将其分为观察组(n=40)和对照组(n=40)。对照组给予常规药物治疗,观察组在对照组的用药基础上联合二甲双胍恩格列净片治疗。两组均接受为期6个月的连续治疗。对比两组血糖指标、心功能指标及不良反应发生情况。结果:治疗后,两组空腹血糖(FBG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(HbA1c)均较治疗前下降,且观察组均低于对照组(P<0.05)。治疗后,两组左室射血分数(LVEF)、左室舒张末径(LVEDD)、左室收缩末径(LVESD)、脑钠肽(BNP)均优于治疗前,且观察组均优于对照组(P<0.05)。观察组不良反应发生率(5.0%)低于对照组(22.5%),差异有统计学意义(P<0.05)。结论:二甲双胍恩格列净片治疗2型糖尿病合并HFpEF临床效果显著,能够使患者的血糖水平下降并提高心功能相关指标,同时安全性较高。展开更多
Heart failure with preserved ejection fraction(HFpEF)displays normal or near-normal left ventricular ejection fraction,diastolic dysfunction,cardiac hypertrophy,and poor exercise capacity.Berberine,an isoquinoline alk...Heart failure with preserved ejection fraction(HFpEF)displays normal or near-normal left ventricular ejection fraction,diastolic dysfunction,cardiac hypertrophy,and poor exercise capacity.Berberine,an isoquinoline alkaloid,possesses cardiovascular benefits.Adult male mice were assigned to chow or high-fat diet with L-NAME(“two-hit”model)for 15 weeks.Diastolic function was assessed using echocardiography and noninvasive Doppler technique.Myocardial morphology,mitochondrial ultrastructure,and cardiomyocyte mechanical properties were evaluated.Proteomics analysis,autophagic flux,and intracellular Ca^(2+)were also assessed in chow and HFpEF mice.The results show exercise intolerance and cardiac diastolic dysfunction in“two-hit”-induced HFpEF model,in which unfavorable geometric changes such as increased cell size,interstitial fibrosis,and mitochondrial swelling occurred in the myocardium.Diastolic dysfunction was indicated by the elevated E value,mitral E/A ratio,and E/e’ratio,decreased e’value and maximal velocity of re-lengthening(-dL/dt),and prolonged re-lengthening in HFpEF mice.The effects of these processes were alleviated by berberine.Moreover,berberine ameliorated autophagic flux,alleviated Drp1 mitochondrial localization,mitochondrial Ca^(2+)overload and fragmentation,and promoted intracellular Ca^(2+)reuptake into sarcoplasmic reticulum by regulating phospholamban and SERCA2a.Finally,berberine alleviated diastolic dysfunction in“two-hit”diet-induced HFpEF model possibly because of the promotion of autophagic flux,inhibition of mitochondrial fragmentation,and cytosolic Ca^(2+)overload.展开更多
Dysfunctions of calcium cycling occur in heart failure wi+reduced and preserved ejection fraction(HFrEF and HFpEF).HFrEF and HFpEF showed Ca^(2+)leakage at diastole.the compensation of Na^(+)/Ca^(2+)exchanger andthe d...Dysfunctions of calcium cycling occur in heart failure wi+reduced and preserved ejection fraction(HFrEF and HFpEF).HFrEF and HFpEF showed Ca^(2+)leakage at diastole.the compensation of Na^(+)/Ca^(2+)exchanger andthe decrease of T-tubule density reduces cytoplasmic Ca^(2+)concentration in HFrEF and impairs systolic function.In contrast,HFpEF hasthe increase of cytoplasmic Ca^(2+)concentration and diastolic dysfunctions.the decrease of mitochondrial Ca^(2+)concentration weakens myocardial contractility in HFrEF while the increased concentration retainsthe contractility in HFpEF.Here,the changes of calcium cycling in HFrEF and HFpEF are summarized andthe possibility of relevanttherapeutic targets is discussed.展开更多
文摘Objective: To observe the benefit of mineralocorticoid receptor antagonist and sodium-glucose co-transport 2 inhibitor (SGLT2 inhibitor) in heart failure preserved ejection (HFpEF) in rural Tanzania. Background and Result: The use of spironolactone and dapagliflozin was shown to be effective in improving the clinical outcome and reducing CV hospitalization rate and CV mortality in patients with heart failure preserved left ventricular ejection fraction (HFpEF). This is the case presentation of one patient with HFpEF with diastolic dysfunction grade 3, obesity grade 3, Type 2 Diabetes, and Atrial Fibrillation (permanent). In the case of a 76-year-old female after previous ineffective treatment, the initiation of Spironolactone and Dapagliflozin led to a rapid and marked improvement in the clinical conditions. Diastolic dysfunction was improved from stage III to stage I. Moreover, the initiation of spironolactone and dapagliflozin therapy avoided a referral for surgical intervention and interrupted a long series of hospitalizations for acute HF and prevented CV death. Conclusion: Based on our experience, we conclude that the treatment with spironolactone and dapagliflozin allows for better treatment optimization with a positive impact on the control of clinical outcomes and preventing CV death and CV hospitalization in HFpEF and related comorbidities in the African population, which is underrepresented in most of the trials.
文摘目的:探讨二甲双胍恩格列净片治疗2型糖尿病(T2DM)合并射血分数保留性心力衰竭(HFpEF)患者的临床效果和安全性。方法:选取2021年10月—2022年9月保定市第一中心医院80例T2DM合并HFpEF患者,通过随机数字表法将其分为观察组(n=40)和对照组(n=40)。对照组给予常规药物治疗,观察组在对照组的用药基础上联合二甲双胍恩格列净片治疗。两组均接受为期6个月的连续治疗。对比两组血糖指标、心功能指标及不良反应发生情况。结果:治疗后,两组空腹血糖(FBG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(HbA1c)均较治疗前下降,且观察组均低于对照组(P<0.05)。治疗后,两组左室射血分数(LVEF)、左室舒张末径(LVEDD)、左室收缩末径(LVESD)、脑钠肽(BNP)均优于治疗前,且观察组均优于对照组(P<0.05)。观察组不良反应发生率(5.0%)低于对照组(22.5%),差异有统计学意义(P<0.05)。结论:二甲双胍恩格列净片治疗2型糖尿病合并HFpEF临床效果显著,能够使患者的血糖水平下降并提高心功能相关指标,同时安全性较高。
基金supported in part by the National Natural Science Foundation of China(Nos.82272184 and 82130011)Shanghai Xuhui District Scientific Research Project(Nos.202104 and 202105).
文摘Heart failure with preserved ejection fraction(HFpEF)displays normal or near-normal left ventricular ejection fraction,diastolic dysfunction,cardiac hypertrophy,and poor exercise capacity.Berberine,an isoquinoline alkaloid,possesses cardiovascular benefits.Adult male mice were assigned to chow or high-fat diet with L-NAME(“two-hit”model)for 15 weeks.Diastolic function was assessed using echocardiography and noninvasive Doppler technique.Myocardial morphology,mitochondrial ultrastructure,and cardiomyocyte mechanical properties were evaluated.Proteomics analysis,autophagic flux,and intracellular Ca^(2+)were also assessed in chow and HFpEF mice.The results show exercise intolerance and cardiac diastolic dysfunction in“two-hit”-induced HFpEF model,in which unfavorable geometric changes such as increased cell size,interstitial fibrosis,and mitochondrial swelling occurred in the myocardium.Diastolic dysfunction was indicated by the elevated E value,mitral E/A ratio,and E/e’ratio,decreased e’value and maximal velocity of re-lengthening(-dL/dt),and prolonged re-lengthening in HFpEF mice.The effects of these processes were alleviated by berberine.Moreover,berberine ameliorated autophagic flux,alleviated Drp1 mitochondrial localization,mitochondrial Ca^(2+)overload and fragmentation,and promoted intracellular Ca^(2+)reuptake into sarcoplasmic reticulum by regulating phospholamban and SERCA2a.Finally,berberine alleviated diastolic dysfunction in“two-hit”diet-induced HFpEF model possibly because of the promotion of autophagic flux,inhibition of mitochondrial fragmentation,and cytosolic Ca^(2+)overload.
基金supported by the National Key Research and Development Program of China 2021YFA1000200 and 2021YFA1000203(Y.Huo)Shenzhen Science and Technology R&D Grant KQTD20180411143400981(Y.Huo).
文摘Dysfunctions of calcium cycling occur in heart failure wi+reduced and preserved ejection fraction(HFrEF and HFpEF).HFrEF and HFpEF showed Ca^(2+)leakage at diastole.the compensation of Na^(+)/Ca^(2+)exchanger andthe decrease of T-tubule density reduces cytoplasmic Ca^(2+)concentration in HFrEF and impairs systolic function.In contrast,HFpEF hasthe increase of cytoplasmic Ca^(2+)concentration and diastolic dysfunctions.the decrease of mitochondrial Ca^(2+)concentration weakens myocardial contractility in HFrEF while the increased concentration retainsthe contractility in HFpEF.Here,the changes of calcium cycling in HFrEF and HFpEF are summarized andthe possibility of relevanttherapeutic targets is discussed.
