Chronic Congestive Heart Failure Patients Research Articles

Internal jugular vein ultrasound in patients with chronic congestive heart failure

Abstract Background Bedside assessment of intravascular volume in patients with chronic congestive heart failure (CHF) is often difficult. Under- and over-diuresis are common causes of morbidity and readmissions in these patients. Purpose We hypothesized that ultrasound assessment of the internal jugular vein would be easier and more reproducible than clinically assessing jugular venous pressure (JVP). Our goal was to create a bedside test that would be simpler to learn than inferior vena cava (IVC) assessment and easier to perform in obese patients. Methods Adults with HF (n=53, 52% men, mean age 65 years, mean BMI 29.6 kg/m2, mean LVEF 44%) scheduled for right heart catheterization (RHC) had an ultrasound of their right internal jugular (RIJ) vein performed immediately prior. Cross-sectional area of RIJ was measured during normal breathing with patients at 90 and 45 degrees recumbency and was indexed by height (RIJI). JVP was also assessed clinically. Results were compared to right atrial pressure (RAP) measured by RHC. Operators were blinded to RHC results and vice versa. Results JVP was correctly assessed clinically in only 43%. RIJI at 90 and 45 degrees were significantly larger in patients with elevated RAP compared to euvolemic patients (Table). At 90 degrees, RIJI of >15 predicted a RAP of >10 mmHg with 68% sensitivity and 72% specificity. At 45 degrees, RIJI of >10 predicted a RAP of >10 mmHg with 94% sensitivity and a negative predictive value of 80% (Table). Simply being able to see the RIJ at 90 degrees (n=34) had an 82.4% positive predictive value for elevated RAP. IVC data could not be obtained on 23% of patients due to body habitus or inability to lay flat. Conclusion Ultrasonographic RIJI is more accurate than clinical assessment in patients with CHF and can be accurately performed even in obese patients. It requires only a basic linear ultrasound probe and was easily performed by clinicians at various stages of training with reproducible results. With the increased availability of bedside ultrasound in clinical practice, it is a feasible method of evaluating chronic CHF patients. Funding Acknowledgement Type of funding sources: None.

Growth differentiation factor 15 as an integrative biomarker of heart failure in patients with acute myocardial infarction

Growth differentiation factor 15 (GDF15), a stress-responsive cytokine member of the transforming growth factor-β family, is an emerging biomarker in cardiovascular (CV) diseases. GDF15 is weakly expressed in normal condition but increased in pathological situations such as inflammation, oxidative stress, and left-ventricular remodeling. Recent data suggest GDF15 as a marker in heart failure (HF). We aimed to measure the levels of GDF15 in patients admitted for an acute myocardial infarction (AMI) and HF. In our prospective study, we included all consecutive patients admitted from June 2016 to October 2017 with type 1 AMI from the ‘obseRvatoire des Infarctus de Côte d’Or’ (RICO) survey. Chronic congestive HF patients were excluded. Admission and hospital HF were diagnosed by killip class > 1. Serum levels of GDF15 were measured using a commercially available ELISA kit. Among the 219 AMI patients, median-age was at 69(58–80) y, 29% were women, 25% had diabetes and 63% were hypertensive. GDF15 levels (median = 1254 (819–2140) ng/L) were strongly correlated with age ( r = 0.558, P < 0.001), and elevated with most CV risk factors (i.e. hypertension, diabetes, hypercholesterolemia), prior CAD, chronic kidney disease ( P < 0.001 for all) and in patients with CRP > 3 mg/L ( P < 0.001). When compared with patients without HF, patients who developed HF on admission (22%) or in-hospital (6%), GDF15 was markedly higher ( Fig. 1 ). GDF15 levels were negatively correlated with LVEF ( r = -0.142, P < 0.05). Moreover, Receiving Operating Curve analysis showed that GDF15 was associated with HF (AUC = 0.69 (0.61–0.77), P < 0.001). These preliminary results suggest that GDF15 could be an integrative biomarker of HF in patient with AMI. Further studies are needed to elucidate the underlying mechanisms linking the cytokine with the development of HF and to investigate its use for patient monitoring in AMI.

The impact of weight management and related diuretic medication intervention based on body weight changes on cardiac function and re-hospitalization rate in patients with chronic congestive heart failure

Objective: To explore the impact of weight management and related medication intervention based on body weight changes on cardiac function among patients with chronic congestive heart failure (CHF). Methods: Using prospective, randomized, controlled study methods, consecutive CHF patients, who hospitalized in our department from June 2014 to June 2016 (n=350), were randomly divided into intervention group (n=175) and control group (n=175). Patients in the intervention group received weight management guidance and the post discharge diuretic drugs regimen was adjusted based on body weight changes. The control group received routine medical care post discharge. Left ventricular ejection fraction (LVEF), B type natriuretic peptide precursor (NT-proBNP), 6 minutes walk distance and NYHA classification at one day before discharge and after 6 months were compared between the two groups respectively. Results: Follow-up visit data were not available from 6 patients in the control and intervention group respectively. NYHA classification, LVEF, NT-proBNP and 6 minutes walk distance were similar between the two groups at one day before discharge (all P>0.05). After 6 months, the LVEF and 6 minutes walk distance were significantly higher while NT-proBNP level was significantly lower in the intervention group compared to the control group (all P<0.01). Meanwhile, the LVEF and 6 minutes walk distance were significantly increased, while NT-proBNP was significantly reduced at 6 months post discharge compared to one day before discharge in the intervention group (all P<0.01). The LVEF was also significantly improved (P=0.035), but the NT-proBNP and 6 minutes walk distance were similar (P were 0.328 and 0.807 respectively) at 6 months after discharge compared to one day before discharge in the control group. The NYHA classification was significantly lower in intervention group and in control group at 6 months after discharge compared to one day before discharge (Z=5.154, P<0.01 and Z=10.497, P<0.01), and the NYHA classification improved more in the intervention group than in control group at 6 months after discharge (Z=9.235, P<0.01). The re-hospitalization rate of CHF patients in intervention group was 11.83% (20/169), which was significantly lower than the control group (33.14% (56/169), χ(2)=21.99, P<0.01). At 6 months follow up, body weight remained unchanged in the intervention group, while body weight tended to be higher in the control group compared to one day before discharge. Conclusion: The weight management and diuretic drug regimen adjudgment intervention based on body weight changes can improve cardiac function and reduced re-hospitalization rate in CHF patients.

Clinical study of modified Renshen decoction plus routine western medicine on patients of chronic congestive heart failure

Objective To evaluate the effect of modified Renshen decoction plus routine western medicine on chronic congestive heart failure. Methods The selected 75 candidate patients were divided into control group with 37 patients and treatment group with 38 patients. The patients of control group received routine western medicine and treatment group received modified Renshen decoction plus routine western medicine. After 2 weeks of treatment, the effect of both group were evaluated with indictors of clinical heart function, BNP and traditional Chinese syndrome. Results There were significantly statistical difference, of total effective ratio of clinical heart function (χ2=4.343, P<0.05)between the treatment group (92.1%,35/38)and control group (73.0%, 27/37), and of total effective ratio of traditional Chinese syndrome (χ2=4.649, P<0.05) between the treatment group (94.7%, 36/38) and control group (73.0%, 27/37). The BNP levels of both group decreased significantly (P<0.05), and the significant statistical difference between two groups was also observed 1 477.1 ± 316.7 pg/ml vs. 2 256.9 ± 521.3 pg/ml; t=7.853, P<0.01). Conclusions The Modified Renshen decoction plus routine western medicine could improve chronic congestive heart failure patients' the heart function, reduce BNP and attenuate the symptoms. Key words: Heart failure; Modified Renshen decoction; Natriuretic peptide,brain; Integrated Chinese traditional and western medicine therapy

The clinical study of atorvastatin calcium in the treatment of chronic congestive heart failure

Objective To explore the clinical efficacy of atorvastatin calcium in the treatment of chronic congestive heart failure(CHF). Methods According to the order of admission with single and double, 132 CHF patients were randomly divided into control group and study group, 66 cases in each group.The control group was given routine treatment, and the study group was treated with atorvastatin calcium on the basis of routine treatment.The clinical efficacy was assessed.Before and after treatment, the serum TC level was measured, the left ventricular ejection fraction(LVEF) and heart left ventricular end diastolic diameter(LVDD), heart index(CI) were assessed by echocardiography.The adverse reactions during treatment were observed. Results The total effective rate of the study group was 92.42%, which was higher than 83.33% of the control group, the difference was statistically significant(χ2=9.35, P 0.05). Conclusion Atorvastatin calcium in the treatment of CHF patients on the basis of routine treatment has better clinical effect.It can significantly reduce TC and significantly improve cardiac function, and has high safety. Key words: Heart Failure; Atorvastatin Calcium; Cholesterol; Heart Function Tests

The SERVE-HF safety notice in clinical practice – experiences of a tertiary sleep center

BackgroundIn May 2015, the results of the SERVE-HF trial – addressing adaptive servoventilation (ASV) in chronic congestive heart failure (CHF) patients with central sleep apnea (CSA) – prompted a field safety notice. It was recommended to identify CHF patients treated with ASV and to advise the discontinuation of the treatment. We aimed to analyze the identification process and effect of ASV discontinuation on affected patients. Methods126 patients treated with ASV on May 13th, 2015 at our institution were retrospectively analyzed. Treatment decisions, effect of ASV discontinuation and clinical course were followed for a year. Patients on ASV with CHF were compared to those without CHF. ResultsThe risk criteria of the safety notice were fulfilled by 10.3% of patients (13/126). Additional echocardiographies were performed in 38%. ASV was discontinued in 93% of patients without adverse events (emergency hospitalization in n = 1). CSA reappeared immediately. Day- or nighttime symptoms were reported by 61%. Symptomatic patients were started on alternative treatments. CHF and non-CHF patients differed in cardiac function and type of SDB. CHF patients had shorter overall treatment duration. Compliance to ASV was similar in both groups with a median usage of 412 min (269; 495)/night in the CHF group and 414.5 min (347; 480) in the non-CHF group. ConclusionIdentification of patients “at risk” is feasible but outcome of discontinuation of ASV cannot be evaluated based on these data. ASV withdrawal in patients with stable chronic CHF and CSA leads to an immediate return of sleep disordered breathing. Symptomatic patients may ask for alternative treatment options.

Comparison of Indwelling Pleural Catheters to Serial Thoracentesis in Management of Refractory Pleural Effusions Secondary to Congestive Heart Failure

SESSION TITLE: Cardiovascular Disease SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM PURPOSE: Patients with chronic congestive heart failure (CHF) often present with pleural effusions causing dyspnea and worsening hypoxemia. Patients who fail medical therapy often need thoracentesis and recurrent admissions for symptom control. Use of indwelling pleural catheters (IPC) for malignant recurring effusions has been shown to improve quality of life; though there is limited data regarding its use in CHF. We evaluated management outcomes of pleural effusions secondary to CHF, refractory to optimal medical regimen; with either an IPC or serial thoracentesis METHODS: A retrospective study (January 2014 to October 2015) was conducted comparing management outcomes of all patients with refractory transudative pleural effusion secondary to CHF admitted to Northside medical center, who required an IPC, thoracentesis or both. Comparisons were made with regards to; length of hospital stay, number of readmissions related to pleural effusion, number of interventions or procedures and complications related to either method. RESULTS: We identified 24 patients (12 (50%) males and 12 (50%) females) with a mean age of 77.6 years. 8 had systolic CHF, 22 had diastolic CHF and 7 were noted to have renal dysfunction. 13 patients (54.2%) required repeated thoracentesis initially followed by IPC insertion; 10 patients (41.7%) were treated with serial thoracentesis alone and 1 patient (4.2%) had IPC inserted at presentation, following failure of outpatient management. A total of 90 interventions (with needle thoracentesis) were performed in 23 patients (average 3.91) and 25 IPCs were inserted in 14 patients. When comparing, the serial thoracentesis group to the IPC group; the mean length of hospital stay in the thoracentesis group was 17.39 days as compared to 8.36 days in the IPC group (the mean difference was 9.03 days, 95% CI, 2.36-15.71 and a P value of 0.0094). Patients requiring thoracentesis were admitted on average three times at a rate of once every 28 days in comparison to once the in the IPC group, which was mainly for IPC removal (mean difference was 1.58 admissions, 95% CI, 0.67-2.50 and p value of 0.0012). No mortality was reported from procedure in either group; however, 1 patient in each group developed pneumothorax from the procedure. 1 patient with an IPC developed empyema that required pleurodesis. Ten patients among the IPC group (71.4%) achieved successful spontaneous pleurodesis without any complications. CONCLUSIONS: Indwelling Pleural Catheters reduce the length of hospital stay and rate of readmissions when compared to serial thoracentesis, in the treatment of refractory recurrent pleural effusion secondary to CHF. Risks of infection are justified and further studies are needed to assess its utility in management of benign pleural effusions. CLINICAL IMPLICATIONS: Minimal options are available for CHF patients with recurrent pleural effusions despite optimal medical therapy. Not many patients are good candidates for surgical interventions and further research is needed to look into less invasive management strategies. Chemical pleurodesis as reported in the past had disappointing results with increased morbidity. Placement of an indwelling pleural catheter can prevent re-admissions and repeated interventions; hence improving quality of life. DISCLOSURE: The following authors have nothing to disclose: Tamer Said Ahmed, Ahmed El-Moghraby, Nafsi Tabassum No Product/Research Disclosure Information

Osteoprotegerin is associated with depletion of circulating endothelial progenitor cells and elevation in pulmonary arterial pressure in patients with systolic heart failure

Objective Osteoprotegerin (OPG) may predict progression of chronic congestive heart failure (CHF) with increased mortality and play an important role in the development of pulmonary arterial hypertension (PAH). Mounting evidence suggests that PAH developed during CHF is not solely caused by a “passive” increase from the left ventricular end-diastolic pressure, but rather a “reactive” response from contributing lung endothelial dysfunction and vascular remodelling, a pathological process that can be signifi cantly infl uenced by endothelial progenitor cells (EPCs). This study aims to examine whether circulating EPCs from patients with CHF are aff ected and if OPG could be implicated during disease progression.Methods In this study EPCs were isolated, cultured, and quantifi ed from patients of CHF with (n = 20) or without PAH (n = 40) as measured by right heart catheterization. Serum levels of OPG and N-terminal pro-brain natriuretic peptide (NT- pro BNP) were analysed and correlated with EPCs.Results A signifi cant decrease in circulating EPCs (39.3 ± 9.1 vs 67.1 ± 10.5 EPCs/×200 fi eld; P < 0.05) was found in CHF patients who developed PAH compared to those without PAH. Both OPG (551.90 ± 49.83 vs 312.29 ± 31.12 pg/ml; P < 0.05) and NT-pro BNP (2,946.50 ± 1,434.50 vs 1,328.20 ± 811.90; P < 0.05) were also signifi cantly elevated in CHF patients with PAH. Circulating level of OPG correlated inversely with EPCs (r=–0.45, P= 0.037) but positively with mPAP (r = 0.53, P= 0.011).Conclusions Our study demonstrates that OPG elevation and EPC depletion are associated with CHF patients who have developed PAH. The inverse relationship of circulating OPG with EPCs suggests a possible mechanism for OPG in the development of pulmonary vascular dysfunction, thus worsening prognosis for CHF patients.

The prognostic value of circulating microRNAs in heart failure: preliminary results from a genome-wide expression study.

Recent studies have demonstrated the potential of microRNAs (miRNA) as biomarkers in various cardiovascular disorders. The aim of the present study was to quantitatively evaluate the expression levels of miRNAs in patients with chronic congestive heart failure (CHF) in order to identify differential expression profiles as biomarkers with prognostic values. The study included 20 clinically stable [New York Heart Association (NYHA) II] and 22 decompensated (NYHA III and IV) CHF patients and 15 healthy controls. miRNA profiling was performed using a microarray method. Dysregulated miRNAs were evaluated for their biomarker potential. Microarray profiling revealed an increase in the expression of miR-21, miR-650, miR-744, miR-516-5p, miR-1292, miR-182, miR-1228, miR-595, miR-663b, miR-1296, miR-1825, miR-299-3p, miR-662 miR-122, miR-3148 and miR-518e and a decrease in the expression of miR-129-3p, miR-3155, miR-3175, miR-583, miR-568, miR-30d, miR-200a-star, miR-1979, miR-371-3p, miR-155-star and miR-502-5p in sera of CHF patients. The prognostic value of miR-182 [area under the curve (AUC) 0.695] was found to be superior to pro-brain type natriuretic peptide (NT-proBNP; AUC 0.350) and high-sensitivity C-reactive protein (hs-CRP) (AUC 0.475) by receiver operator characteristic (ROC) analysis. Cox regression analysis showed that miR-182 could predict cardiovascular mortality (P = 0.032). We demonstrated the increased expression levels of circulating miRNAs in CHF as compared with controls. Moreover, miR-182 was found to be a potential prognostic marker in CHF.

ASSA14-07-02 Comparision of metoprolol succinate sustained-release tablets and metoprolol tartrate tablets on cardiac function in patients with chronic congestive heart failure

Background To investigate the effect of Metoprolol succinate sustained-release tablets and Metoprolol tartrate tablets on cardiac in chronic congestive heart failure patients. Methods 182 patients with clinical data, who suffered with chronic congestive heart failure were collected, and 67 cases were excluded. The patients were divided into 2 groups according to the different types of dosage forms: Metoprolol succinate sustained-release tablets group and Metoprolol Tartrate Tablets group. Patients in Metoprolol Tartrate Tablets group took 25 mg-50 mg Metoprolol Tartrate Tablets every day, while patients in the other group took 23.75–95 mg metoprolol succinate sustained-release tablets every day. Average heart rate, LVDd, EF, BUN and Crea were measured. Results Compared with Metoprolol Tartrate Tablets, Metoprolol succinate sustained-release tablets decreased average heart rate in chronic congestive heart failure patients (64.0 ± 5.4 vs 69.5 ± 7.6, p Conclusions Metoprolol succinate sustained-release tablets decreased average heart rate in chronic congestive heart failure patients compared with Metoprolol Tartrate Tablets. The effect on cardiac and renal function was equal.

Use of gated myocardial perfusion imaging to assess clinical value of Xinmailong injection in chronic congestive heart failure

ObjectiveThis study used gated myocardial perfusion imaging (G-MPI) to assess the clinical value of Xinmailong injection in chronic congestive heart failure (CHF). MethodsA total of 102 CHF patients were randomly divided into the control group (n=51) and the Xinmailong group (n=51). Patients in the control group were routinely treated. Patients in the Xinmailong group were additionally treated with Xinmailong injection in addition to routine treatment. Before and 3 months after treatment, G-MPI was used to determine changes in the left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV). Fourteen days after treatment, changes in plasma brain natriuretic peptide (BNP) levels were determined. ResultsBefore treatment, there were no significant differences in LVEF, LVEDV, LVESV, and BNP levels between the two groups (all P>0.05). After treatment, LVEDV, LVESV, and BNP levels were significantly lower, and LVEF was significantly higher in the Xinmailong group than in the control group (all P<0.05). ConclusionAdditional use of Xinmailong injection in addition to routine treatment improves cardiac function of CHF patients. Because of the safety and effectiveness of Xinmailong injection, this therapy should be promoted.

To evaluate the clinical curative effect of meglumine adenosine cyclophosphate combined with perindopril on patients with chronic congestive heart failure

Objective To explore the relationship of plasma NT-proBNP level and severity of chronic congestive heart failure (CHF) and investigate the curative effect and security of meglumine adenosine cyclophosphate (MAC) combined with perindopril on patients with CHF.Methods From June 2011 to June 2013,126 inpatients with chronic congestive heart failure were randomly divided into A group (42 cases,routine therapy),B group (41 cases,routine therapy and perindopril) and C group (43 cases,routine therapy and perindopril plus MAC),all cases treated for 14 days.The left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDD) by echocardiography and plasma NT-proBNP levels were evaluated before and after 14 days therapy.Results The plasma NT-proBNP levels in NYHA Ⅱ ～ Ⅳ classes were significantly difference compared each other between any two classes (P ＜0.05) and the levels was positively correlated with NYHA cardiac function class and LVEDD (r =0.617,P ＜ 0.01 ; r =0.412,P ＜ 0.01),negatively correlated with LVEF (r =-0.372,P ＜ 0.01).After 14 days therapy,compared with A group,the LVEF and LVEDD significantly improved (P ＜ 0.05) and NT-proBNP level significantly decreased (P ＜ 0.05) in B,C groups; Compared with B group,C group had lower NT-proBNP level (P ＜ 0.05) although no further improvement in cardiac function.Conclusions The plasma NT-proBNP level is correlated closely with the severity of CHF and it is a good examination of diagnose,therapy and evaluating prognosis of CHF.Perindopril may significantly decline plasma NT-proBNP level and improve cardiac function of CHF patients,combined with MAC may further decline plasma NT-proBNP level although not further improved LVEF.Giving MAC and perindopril to patients with CHF was secure and patients tolerated it well. Key words: Melamine adenosine cyclophosphate; Perindopril; N-terminal pro-brain natriuretic peptide; Congestive heart failure

Treatments to achieve fluid balance in heart failure

Chronic heart failure is a progressive disease with persistent symptoms that limit day-to-day activities. Fluid retention and congestion contribute to the debilitating symptoms experienced by heart failure patients, impacting on their quality of life. Assessment and management of fluid intake and output are key nursing issues, and this article discusses the importance of fluid balance interventions that can aid symptom control, thus enhancing patient comfort. The underlying physiology of fluid balance in chronic congestive heart failure patients will be explored, as will the psychological factors that may enhance or impede treatment.

Kardiorenales Syndrom

The cardiorenal syndrome is an interdisciplinary challenge with increasing health economic relevance. Renal failure is a strong predictor for mortality in patients with severe congestive heart failure (CHF) and CHF is one of the fastest increasing morbidities in western countries. For successful therapy a close cooperation between cardiology und nephrology is required. Moreover, a good compliance of the patient is needed to improve symptoms and to reduce the frequency of cardiac decompensation. A broad cardiological and nephrological evaluation and consideration of optimal conservative options according to national and international guidelines are essential. However, a renal replacement therapy might be helpful in patients with refractory heart failure even if they are not dialysis-dependent. In cases of acute heart and renal failure an intensive care management might be necessary to reduce volume overload with the help of extracorporeal ultrafiltration or a dialysis modality. Nevertheless, in cases of chronic refractory CHF peritoneal dialysis should be preferred. The first analysis of the registry of the German Society of Nephrology (http://www.herz-niere.de) confirmed that there is a benefit for health-related quality of life in chronic CHF patients treated with peritoneal dialysis.

The role of brain natriuretic peptide and serum triiodothyronine in the diagnosis and prognosis of chronic heart failure

Objective The objective of this paper was to investigate the diagnostic and prognostic value of plasma B type natriuretic peptide (BNP) and serum triiodothyronine (T3) in chronic congestive heart failure (CHF).Methods 156 cases of CHF patients and 75 cases of cardiac function I patients hospitalized over the same period were utilized in this study. On admission, the patient’s BNP and T3 plasma concentrations were measured. The correlation analysis of plasma BNP and T3 in CHF patients with cardiac function classification was conducted.Results According to the NYHA grading systems, the plasma BNP levels in patients with II, III, and IV grade CHF were significantly higher than those with cardiac function I (P < 0.05); BNP levels and NYHA grading of cardiac function correlated positively. The BNP concentrations increased with CHF progression (P < 0.01). The T3 level and NYHA grading of cardiac function correlated negatively. The T3 level decreased as the degree of heart failure increased. Using CHF in combination with BNP to predict the occurrence of CHF had a sensitivity value of 90.8% with 95.5% specificity, 86.3% accuracy, and a negative predictive value of 87.7%.Conclusions Plasma BNP was more sensitive than T3 in the diagnosis of CHF. The T3 was more meaningful than the BNP in the prognosis of CHF. The BNP and T3 combination detection was more valuable in determining the severity of CHF and prognosis.

Dynamic CO2 inhalation: a novel treatment for CSR–CSA associated with CHF

Cheyne-Stokes respiration with central sleep apnea (CSR-CSA) is very common in patients with chronic congestive heart failure (CHF). A current concept of the key pathophysiological mechanism leading to CSR-CSA is a fluctuation of PaCO2 below and above the apneic threshold. A number of therapeutic approaches for CSR-CSA have been proposed-all with varying success, some of which include various modes of positive airway pressure among other strategies. However, CO2 oscillations seen in CSR-CSA have yet to be looked at as a specific therapeutic target by current treatments. Previous studies have shown that delivery of constant CO2 is efficacious in eliminating CSR-CSA by raising PaCO2, but there are serious concerns about the potential side effects, such as unwanted elevations in ventilation, work of breathing, and sympathetic nerve activity (SNA), and consequently CO2 inhalation therapy has not been recommended as a routine option for therapy. However, recent new studies into CO2 inhalation therapy have been made that may reshape its role as therapeutic. In this review, we will focus on the recent developments of administration of dynamic CO2 in the management of CSR-CSA in CHF patients.

Analysis of Metoprolol combined with Lotensin in treating elderly patients with CHF

Objective To investigate the therapeutic effects and safety of Metoprolol combined with Lotensin in treating elderly patients with chronic congestive heart failure (CHF).Methods 70 cases of elderly CHF patients were divided into the observation group and the control groups randomly,both received conventional anti-heart failure treatment.Based on this,the patients of the observation group took Metoprolol combined with Lotensin.Measured the left ventricular end-systolic volume (LVESV) and the left ventricular end-diastolic volume (LVEDV) before and after treatment,and made the clinical evaluation.Results After treatment,LVESV were significantly better in two groups(P ＜0.01),while LVESV of observation group improved more obviously than the control group(P ＜0.01).The total effective rate of the observation group was 88.57％,much higher than that of the control group(74.29％)(P ＜ 0.05).Conclusion Metoprolol combined with Lotensin can significantly improve the clinical symptoms and cardiac function of the patients with CHF. Key words: Metoprolol; Lotensin; Treatment; Elderly CHF; Cardiac function

Unrecognised ventricular dysfunction in COPD

While both chronic congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) impose a substantial disease burden and share aetiological and epidemiological associations, they have largely been studied separately. The aim of our study was to assess the prevalence and the prognostic implications of the coexistence of left ventricular dysfunction in COPD patients and airway obstruction in CHF patients. We used a prospective cohort study including stable ≥ 60-yr-old patients with echocardiographically confirmed CHF (n=201) and stable ≥ 60-yr-old patients with clinically and spirometry-confirmed COPD (n=218). All CHF patients underwent routine spirometry, and all COPD patients underwent routine echocardiographic assessment and B-type natriuretic peptide (BNP) measurement. Patients were followed for 2 yrs. The prevalence of airway obstruction among CHF patients was 37.3% and the prevalence of ventricular dysfunction among COPD patients was 17%. The presence of ventricular dysfunction in patients with COPD tended to increase the risk of mortality during follow-up (hazard ratio 2.34, 95% CI 0.99-5.54; p=0.053). The presence of airway obstruction in patients with CHF did not influence survival. CHF and COPD frequently coexist, and ventricular dysfunction worsens survival in patients with COPD. Considering the high prevalence and the prognostic implications of ventricular dysfunction, routine assessment with either BNP or echocardiogram should be considered in COPD patients.

Plasma BNP and renal failure as prognostic factors of mid-term clinical outcome in congestive heart failure patients

Risk stratification in patients suffering chronic congestive heart failure (CHF) is based on a variety of clinical and laboratory variables. Indeed, several prognostic parameters have been identified, including age, New York Heart Association (NYHA) class, renal function, comorbidity such as atrial fibrillation, diabetes mellitus and ischemic heart disease [1]. In acute decompensated heart failure (ADHF) episodes, the degree of renal dysfunction and arterial hypotension easily stratified patients with worst clinical outcome [2]. A single determination of Brain Natriuretic Peptide (BNP) plasma level represents a reliable risk stratification procedure and its increase is considered a sensitive diagnostic marker of left ventricular dysfunction [3,4] and predicted cardiovascular events in congestive heart failure (CHF) patients [5–8] and even in asymptomatic subjects [9]. The objective of this study was to analyse if renal dysfunction and plasma BNP predict mid-term clinical outcome in CHF patients discharged after an ADHF episode. This prospective cohort study, approved by the local ethics committees, included 237 patients (64.5% males, age 71) with a diagnosis of CHF after an acute decompensation episode discharged from the Heart Failure Unit fromApril 2008 up to August 2010. Death by any cause, cardiac transplantation andworsening heart failure requiring readmission to the hospital were considered cardiovascular events [events group 34 (14.3%) subjects and a no-event group 203 (85.7%) patients]. The follow-up of this study lasted 408±255 days. BNP at discharge resulted 401.3±501.7 pg/ml. During the 14-month follow-up 15 (6.3%) patients died, one (0.4%) underwent cardiac transplantation and 18 (7.6%)were readmitted for CHF (event group); in 203 (85.6%) no eventswere observed (no-event group). HigherNYHAclass (2.1±0.7 vs 1.9±0.4 p=0.01), BNP at discharge (750.2±527.3 pg/ml vs 340.7± 474.3 pg/ml, p=0.002) and impaired renal function (creatinine 1.7± 0.6 vs 1.2±0.8 mg/dl, p=0.004) were noticed in the event group. At multivariate Cox analysis only LVEF (p=0.0009), plasma creatinine (p=0.006) and BNP at discharge (p=0.001) were significantly associated with adverse mid-term outcome. The Kaplan–Meier survival curves demonstrated that adding two parameters (creatinine bor N1.5 mg/dl and BNPbor N250 pg/ml), four different survival curves were obtained (p=0.0001; log rank 21.09), inwhich the clinical weight of renal function clearly emerged (Fig. 1). From this study emerged that CHF patients discharged after an acute decompensation had a severe adverse clinical outcome (death, cardiac transplantation and hospital readmission) in 14.3% during a follow-up lasted 14 months. Elderly patients with CHF represent most of subjects (70%) admitted to hospitals for acute cardiac decompensation; the length of hospitalization lasts usuallyN2 weeks in geriatric wards and readmission is frequent [10]. Recently, the OPTIMIZE -HF study [11] included more than 30,000 CHF patients discharge from 215 hospitals, described the short length of hospitalization (4 days) but a 21.3% of rate of readmission within 30-day. The study evidenced as an early (oneweek) outpatient clinical follow-up after discharge had lower probability to be readmitted within 30-day. The first strong prognostic parameter in those patients was a plasma BNP value at discharge≥250 pg/ml (p=0.001, log rank 10.7). This data confirm previous reports [8,12] in which the pre-discharge values of BNP identified an adverse outcome (death or hospital re-admission) at 6-month follow-up. According to the practical approaches to treating CHF patients published by Maisel [13], it could be identified a ‘wet BNP’ in patients with CHF and fluid overload and a ‘dry BNP’ after optimization of therapy. In our population only the ‘dry BNP’ (at discharge) predicted cardiovascular events, because it identified the real state of neurohormonalmodulation due to the systolic, diastolic heart dysfunction and left ventricle enlargement. The second strong predictor of adverse outcomewas renal dysfunction. The presence of a chronic cardio-renal syndrome, recently classified as type 2 of the cardio-renal syndromes [14], has been reported in 63% of patients admitted for CHF [15,16]. Moreover, the ADHERE registry highlighted as the in-hospital mortality risk incredibly increased in patients with urea nitrogen≥43 mg/dl and plasma creatinine≥2.75 mg/dl [17]. In our population serum creatinine was higher in the event group (pb0.01) and alone identified (divided into three groups b1.5 mg/dl, between 1.5–2 mg/dl and finally N2 mg/dl) three different cumulative survival curves. Moreover, adding data of renal function with discharge plasma BNP, four different cumulative survival curves emerged (BNPb250 pg/ml and creatinineb1.5 mg/dl, BNPb250 pg/ml and creatinineN1.5 mg/dl, BNPN250 pg/ml and creatinineb1.5 mg/dl and finally BNPN250 pg/ml and creatinineN1.5 mg/dl), in which clearly appeared the prognostic weight of a serum creatinineN1.5 mg/dl. Therefore, this analysis identified a simple and practical combination of two markers for identifying a high-risk CHF patient at discharge for a medium-term follow-up, which should be strictly monitored and controlled in order to avoid adverse clinical outcome. The authors of themanuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology [18].

E0333 Effects of Qiliqiangxin capsule on chronic congestive heart failure in patients

ObjectiveTo study the clinical effect of Qiliqiangxin capsule on chronic congestive heart failure (CHF) in patients for two weeks.Methods64 CHF patients were randomised equally into two groups. All were treated...