Chronic Heart Failure Group Research Articles

Ginsenoside Rg1 treats chronic heart failure by downregulating ERK1/2 protein phosphorylation.

In this study, we investigated the potential therapeutic mechanism of ginsenoside Rg1 (GRg1) in chronic heart failure (CHF), focusing on its regulation of ERK1/2 protein phosphorylation. H9c2 cardiomyocytes and SD rats were divided into the control group, CHF (ADR) group, and CHF+ginsenoside Rg1 group using an isolated cardiomyocyte model and an in vivo CHF rat model induced by adriamycin (ADR). Cell viability, proliferation, apoptosis, and the expression of relevant proteins were measured to assess the effects of GRg1. The results showed that treatment with GRg1 increased cell activity and proliferation, while significantly reducing levels of inflammatory and apoptotic factors compared to the CHF (ADR) group. Moreover, the CHF+ginsenoside Rg1 group exhibited higher levels of Bcl-2 mRNA and protein expression, as well as lower levels of Caspase3 and Bax mRNA and protein expression, compared to the CHF (ADR) group. Notably, the CHF+ginsenoside Rg1 group displayed decreased serum NT-proBNP levels and heart weight/body weight (HW/BW) index. Furthermore, the electrocardiogram of rats in the CHF+ginsenoside Rg1 group resembled that of rats in the control group. Overall, our findings suggested that GRg1 alleviated CHF by inhibiting ERK1/2 protein phosphorylation, thereby inhibiting apoptosis, enhancing cell activity and proliferation, and reducing cardiac inflammatory responses.

Enhancing Comprehensive Assessments in Chronic Heart Failure Caused by Ischemic Heart Disease: The Diagnostic Utility of Holter ECG Parameters.

Background and Objectives: Chronic heart failure (CHF) caused by ischemic heart disease (IHD) is the leading cause of death worldwide and presents significant health challenges. Effective management of IHD requires prevention, early detection, and treatment to improve patient outcomes. This study aims to expand the diagnostic utility of various 24 h Holter ECG parameters, such as T-wave alternans (TWA), late ventricular potentials (LVPs), and heart rate variability (HRV) in patients with CHF caused by IHD. Additionally, we seek to explore the association between these parameters and other comorbid conditions affecting the prognosis of CHF patients. Materials and Methods: We conducted a prospective case-control study with 150 patients divided into two subgroups: 100 patients with CHF caused by IHD, and 50 patients in the control group. Data included medical history, physical examination, laboratory tests, echocardiography, and 24 h Holter monitoring. Results: Our comparative analysis demonstrated that both TWA and LVPs were significantly higher in patients with CHF compared to the control group (p < 0.01), indicating increased myocardial electrical vulnerability in CHF patients. Both time and frequency-domain HRV parameters were significantly lower in the CHF group. However, the ratio of NN50 to the total count of NN intervals (PNN50) showed a borderline significance (p = 0.06). While the low-frequency (LF) domain was significantly lower in CHF patients, the high-frequency (HF) domain did not differ significantly between groups. Acceleration and deceleration capacities were also significantly altered in CHF patients. Categorizing CHF patients by left ventricular ejection fraction (LVEF) revealed that the mean of the 5-min normal-to-normal intervals over the complete recording (SDNN Index) was significantly higher in patients with LVEF ≥ 50% compared to those with CHF with reduced EF and CHF with mildly reduced EF (p < 0.001), whereas the other HRV parameters showed no significant differences among the groups. Conclusions: Holter ECG parameters can become a reliable tool in the assessment of patients with CHF. The integration of multiple Holter ECG parameters, such as TWA, LVPs, and HRV, can significantly enhance the diagnostic assessment of CHF caused by IHD. This comprehensive approach allows for a more nuanced understanding of the patient's condition and potential outcomes.

#472 Cardiorenal relations in patients with chronic heart failure

Abstract Background and Aims To study the functional state of the kidneys and cardiorenal relationships in patients with chronic heart failure, depending on the representation of components of metabolic syndrome Method To achieve the objectives, 227 male patients with chronic heart failure (CHF) of ischemic origin of functional class II-III according to NYHA, aged 40-60 years with a history of myocardial infarction of 6 months, were examined up to 5 years. Depending on the presence of MS components, 3 groups of patients were identified: group I (n=80), patients without MS (CHF FC II—42, CHF FC III—38 patients); Group II (n=77) patients with various combinations of dyslipidemia (HDL-C &amp;lt;1.03 mmol/l; LDL-C &amp;gt;3.0 mmol/l) with abdominal obesity (AO), hypertension and hypertriglyceridemia (HTG) (CHF FC II—40, CHF FC III—37 patients); Group III (n=75) patients with various combinations of dyslipoproteinemia (DLP) and type 2 diabetes mellitus (DM2) with AO, hypertension and hypertriglyceridemia (CHF) (CHF FC II—36, CHF FC III—39 patients). When diagnosing MS, the International Diabetes Federation diagnostic criteria for MS were used (IDF, 2009). The study of the functional state of the kidneys included determination of the level of serum creatinine, urinary albumin excretion (determination of microalbuminuria (MAU ≥300 mg/l) in a single morning urine using indicator strips (Biosensor AN, Russia), glomerular filtration rate (GFR), calculated by the formula GFR EPI, which takes into account race, sex, age, serum creatinine. To calculate GFR using the CKD-EPI formula, you can use special applications for mobile devices (QxMDCalculator). Results When studying the parameters of the functional state of the kidneys in patients with group 1 CHF, 20 patients (25%) out of 80 were diagnosed with MAU. Serum creatinine clearance in this group was 89.0 ± 8.49 μmol/L, and the GFR level was 88.58 ± 8.36 ml/min. With the development of MS in group II patients, 41 out of 77 patients had MAU (53.2%). A decrease in GFR by 19.3% (P&amp;lt;0.01) was also found with an increase in serum creatinine levels by 22.7% (P&amp;lt;0.01), in contrast to the data from group I of the study. Further analysis of the parameters of renal function in CHF group III revealed a significant decrease in GFR (by 29.8%; P&amp;lt;0.001) with a significant increase in blood creatinine levels (by 31.8%; P&amp;lt;0.001) in relation to the data of group I. Also in group III of patients with CHF and MS (+DM2), microalbuminuria was detected in 47 patients (74.6%) out of 75. When comparing indicators of renal function between study groups II and III, there was a significant difference in the level of blood creatinine clearance and glomerular filtration rate by 21.3% and 20.1% (P&amp;lt;0.005), respectively. According to the classification of CKD, in group I of patients with CHF, stage I CKD was detected in 39.3%, in group II in 28.6% and in group III in 19.4%. CKD stage II was detected in group I in 46.4%, in group II in 50% of patients. 46.9% had CKD stage II of the disease in group III of the study. Also, in group II, 21.4% and group III, 43.7% were diagnosed with stage III CKD. V In group I, 35% had a high risk, 53.6% had a moderate and 14.3% had a low combined risk of developing cardiovascular complications in cardiorenal syndrome. Conclusion Thus, MS in patients with CHF aggravates renal dysfunction, which developed as one of the main pathogenetic links of CHF. It has been established that as MS progresses (addition of type 2 diabetes to other components of MS), the phenomena of functional renal failure increase. Violation of the functional state of the kidneys, the severity and nature of this dysfunction depends on the presence and nature of the representation of MS components.

Canagliflozin combined with aerobic exercise protects against chronic heart failure in rats

To determine the efficacy and potential protective mechanism of canagliflozin combined with aerobic exercise in treating chronic heart failure (CHF). Isoproterenol was injected into rats to create CHF models. The rats were then subsequently divided into saline, canagliflozin (3mg/kg/d), aerobic exercise training, and canagliflozin combined with aerobic exercise training. Compared to the CHF group, the canagliflozin combined with the aerobic exercise group had superior ventricular remodeling and cardiac function. In rats treated with canagliflozin combined with aerobic exercise, the expression of cytochrome P450 (CYP) 4A3, CYP4A8, COL1A1, COL3A1, and FN1 was reduced, while the expression of CYP26B1, ALDH1A2, and CYP1A1 increased significantly. Additionally, canagliflozin combined with aerobic exercise decreased the phosphorylation of AKT and ERK1/2. Canagliflozin combined with aerobic exercise has a positive effect on the development of CHF via the regulation of retinol metabolism and the AKT/ERK signaling pathway.

Epidemiological and clinical analysis of exposure-related factors in non-melanoma skin cancer: A retrospective cohort study

BackgroundThe incidence of non-melanoma skin cancers (NMSCs) increased over last decades, probably due to environmental concerns or to the increase of frail patients with age related comorbidities. Currently, the relationship of increasing global skin cancer rates with increased ultraviolet radiations (UVRs) resulting from stratospheric ozone depletion, global warming, and air pollution from fossil-fuel combustion. AimsWe conducted a retrospective epidemiological study including 546 NMSC patients managed at the Dermatology Unit of the Tor Vergata Hospital to highlight different trends of sun exposure or different comorbidities. MethodsDescriptive and inferential statistical analyses were performed to evidence differences between continous variable and Spearman rank test for dicotomical variables. Charlson Comorbidity Index was calculated to obtain the 10-years survival rate in order to identify the mean comorbidity burden of our patients. ResultsConsidering patients with comorbidities (73.81%), actinic keratoses (AKs) was the most frequent lesion. In patients with a history of previous melanoma, basal cell carcinoma (BCC) was predominant (ANOVA test, p < 0.05) with a statistically significant correlation (rho = 0.453; p < 0.01). Squamous cell carcinoma (SCC) showed a higher rate in arterial hypertension patients, followed by the chronic heart failure and hematologic neoplasms (60%, 29.7% and 32.1%, respectively) groups. Men were more affected than women, representing 61.54% of patients. Chronic sun exposure is directly correlated with SCC rho = 0.561; p < 0.01), whereas BCC correlated with a history of sunburns (rho = 0.312; p < 0.05). ConclusionsHistory of photo-exposition had an important role on NMSC development especially for work or recreational reasons. Sex, age, and presence of comorbidities influenced different NMSC types. BCC was more frequent in younger patients, associated with melanoma and sunburns. The presence of SCC is associated with older patients and the hypertension group. AKs were diagnosed predominantly in oldest men, with a chronic sun-exposure history, and hematologic neoplasms group.

Correlation between SUA and prognosis in CHF patients after revascularization.

To explore the correlation between serum uric acid (SUA) and prognosis in patients with chronic heart failure (CHF) after revascularization. A total of 126 patients with CHF undergoing revascularization [coronary artery intervention (PCI) or coronary artery bypass grafting (CABG)] in the hospital were enrolled as CHF group between December 2021 and October 2022, while 126 healthy controls during the same period were enrolled as healthy control group. The levels of SUA, inflammatory factors and cardiac function in the two groups were detected. The correlation between SUA level and inflammatory factors, cardiac function levels was analyzed. All patients in CHF group were followed up for 6 months to observe prognosis. The differences in the above indexes among patients with different prognosis were compared. The risk factors of prognosis were analyzed by multivariate Logistic regression analysis, and their predictive value for prognosis was evaluated by ROC curves analysis.

Immunological and biochemical markers of adverse disease outcomes in COVID-19 and chronic heart failure

The purpose of this study was to study immunological and biochemical markers of unfavorable outcome during coronavirus infection in patients with chronic heart failure. Materials and methods. The retrospective study included 136 patients with COVID-19, 46 of whom had chronic heart failure (CHF). All of them underwent a study of C-reactive protein (CRP) of interleukin-6 (IL-6) with assessment of the level of increase in markers (IgM, IgG to SARS-CoV-2) with an assessment of the outcome of the disease. Of these, 70 were men (24 with CHF), 66 women (22 with CHF). Median age of patients with COVID-19 48 (39; 56) years, patients with COVID-19 and CHF 58 (52; 62) years Research results. In patients with COVID-19+CHF (group 1) hospitalized, there was a less pronounced increase in IgM to SARS-CoV-2, higher IgG to SARS-CoV-2 both initially and after 8-10 days, a parallel increase in both CRP and IL-6 unlike patients with only COVID-19 without CHF (group 2). Statistically significant differences in IgM levels to SARS-CoV-2 were revealed in patients of groups 1 and 2 with a favorable outcome. The level of CRP and IL-6 in deceased patients was higher and did not tend to decrease; the changes were more pronounced in group 1. Thus, a simultaneous increase in CRP and IL-6 in patients with COVID-19 and CHF is an unfavorable prognostic parameter for patient survival. Prolongation of antibody titers, both IgM and IgG, can be considered as markers of antibody-dependent increase in infection.

Abstract 13344: Differential Impact of Self-Care Behaviour on Mortality Between Patients With Stable and Recent Worsening Chronic Heart Failure

Backgrounds: Although self-care is crucial to maintain health and recommended in the guidelines in patients with chronic heart failure (CHF), its prognostic significance is controversial. We hypothesized that self-care is more effective in vulnerable patients with recent hospitalization due to worsening HF (WHF). The aim of this study was to investigate the prognostic significance of self-care behaviour on mortality between patients with stable and recent worsening CHF. Methods: We prospectively examined consecutive 1,873 CHF patients from a Japanese multicenter registry and assessed the European Heart Failure Self-care Behaviour Scale (EHFScBS) at enrollment. The patients were divided into inpatient due to WHF (WHF group) and outpatient stable CHF (stable CHF group). The optimal EHFScBS was defined as more than 70 based on previous reports. The primary outcome was all-cause death. Results: Of studied patients (1,102 male, mean age 72 ± 13 years), 625 (33%) and 1,165 (67%) were classified into WHF and stable CHF groups, respectively. During a median follow-up period of 427 (IQR 273 - 642) days, the primary outcome occurred in 50 patients. In stable CHF group, there was no significant difference on primary outcome between optimal and suboptimal EHFScBS (P = 0.65) (Figure A). On the other hand, patients with suboptimal EHFScBS showed a higher incidence of death than those with optimal score in WHF group (P = 0.01) (Figure B). In WHF group, Cox regressions showed that the EHFScBS score was independently associated with mortality (HR 0.51, 95% CI 0.26-0.99) adjusted for significant covariates including hemoglobin, estimated glomerular filtration rate, serum sodium, log NT-proBNP, and the Meta-Analysis Global Group in Chronic Heart Failure risk score. Conclusions: In patients with recent worsening, not stable CHF, the EHFScBS was associated with subsequent mortality, indicating that the self-care education might be more effective for patients with recent worsening CHF.

The association between erector spinae muscle content and chronic heart failure and its severity.

Previous studies have shown a significant reduction in skeletal muscle content in patients with chronic heart failure (CHF). The present study focused on the erector spinae muscle (ESM) to determine whether ESM content is associated with the development and severity of CHF. A total of 652 patients were included in this trial for the study. According to the diagnostic criteria of CHF, 652 patients were divided into two groups, namely, the control group (268 patients) and the CHF group (384 patients). Meanwhile, to assess whether the ESM is associated with the severity of CHF, patients in the CHF group were divided into two groups according to left ventricular ejection fraction (LVEF) values: heart failure with preserved ejection fraction (HFpEF, LVEF ≥50%, 256 patients) and heart failure with reduced ejection fraction (HFrEF, LVEF ≤40%, 68 patients). Receiver operating curve analysis was performed to assess whether ESM content could predict CHF and determine its severity. Compared with the control group, the patients in the CHF group were older, the prevalence of coronary heart disease (CHD) and atrial fibrillation was higher, the colour ultrasound results showed that LVEF decreased significantly, and the left ventricular end-diastolic internal diameter and left ventricular end-systolic internal diameter increased significantly. Besides, patients in the CHF group had significantly lower ESM content, and ESM is an independent predictor of heart failure, with an odds ratio of 0.713 (CHF group vs. control group, 95% confidence interval 0.626-0.811, P<0.001). Compared with the HFpEF group, the HFrEF group has a lower prevalence of CHD, LVEF decreased significantly, the left ventricular end-diastolic internal diameter and left ventricular end-systolic internal diameter increased significantly, also patients in the HFrEF group had significantly lower ESM content compared with patients in the HFpEF group, and ESM is an independent predictor of the severity of heart failure, with an odds ratio of 0.514 (HFrEF group vs. HFpEF group, 95% confidence interval (0.418-0.633, P<0.05). The results of receiver operating curve analysis showed that the sensitivity and specificity of ESM content for the diagnosis of CHF were 65.6% and 71.6%, respectively, while the sensitivity and specificity of ESM content for predicting the severity of CHF were 47.1% and 89.1%, respectively. The ESM is of great value in predicting the onset and severity of CHF.

Resting pulmonary function and artery pressure and cardiopulmonary exercise testing in chronic heart failure patients in Taiwan − a prospective observational cross-sectional study comparing healthy subjects and interstitial lung disease patients

Background Restrictive ventilatory defects and elevated pulmonary artery pressure (PAP) are common in patients with chronic heart failure (CHF) and those with interstitial lung disease (ILD). However, as oxyhemoglobin desaturation seldom occurs in stable CHF patients at peak exercise, we hypothesized that the pathophysiology may be different between them. This study aimed to investigate: (1) PAP and lung function at rest, (2) pulmonary gas exchange (PGX) and breathing patterns at peak exercise, (3) mechanisms of dyspnea at peak exercise in patients with CHF compared to healthy subjects and ILD patients. Methods We consecutively enrolled 83 participants (27 with CHF, 23 with ILD, and 33 healthy controls). The CHF and ILD groups had similar functional status. Lung function and cardiopulmonary exercise tests with Borg Dyspnea Score were performed. PAP was estimated using echocardiography. Resting lung function, PAP and peak exercise data in the CHF group were compared to the healthy and ILD groups. Correlation analysis was performed to elucidate the mechanisms of dyspnea in the CHF and ILD groups. Results Compared to the healthy group, the CHF group had normal lung function, PAP at rest, and normal dyspnea score and PGX at peak exercise, whereas the ILD group had abnormal values compared to the CHF group. Dyspnea score was positively correlated with pressure gradient, lung expansion capabilities, and expiratory tidal flow in the CHF group (all p < 0.05), but inversely correlated with inspiratory time-related variables in the ILD group (all p < 0.05). Conclusion Normal lung function and PAP at rest, and dyspnea scores and PGX at peak exercise indicated that pulmonary hypertension and fibrosis were insignificant in the patients with CHF. The factors affecting dyspnea at peak exercise were different between the CHF and ILD groups. As the sample size in this study was small, large-scale studies are warranted to confirm our findings.

POLYMORPHISM OF GENES RESPONSIBLE FOR NEUROHUMORAL MECHANISMS OF DEVELOPMENT OF CHRONIC HEART FAILURE WITH PRESERVED EJECTION FRACTION IN PERSONS WITH TYPE 2 DIABETES MELLITUS

The search for genetic markers of chronic heart failure (CHF), comorbid with type II diabetes mellitus, is an urgent task. The study aim was to identify genetic polymorphisms associated with impaired neurohumoral regulation in patients with CHF with preserved and low ejection fraction and type II diabetes mellitus. Material and methods. Polymorphisms of genes responsible for neurohumoral mechanisms of CHF development were studied in 167 patients (69.9±10.1 years) with type II diabetes mellitus, hypertension, CHF with preserved or low ejection fraction, and healthy volunteers. Results and discussion. The angiotensin gene, angiotensin-converting enzyme, angiotensin 1 and 2 receptors polymorphisms are not involved in the CHF formation in patients with type II diabetes mellitus. In the control group, rs1403543 GA polymorphism was found in 90.48% of the examined, in patients with CHF with preserved ejection fraction and type II diabetes mellitus, GA and AA variants were found in 20% of cases, in the CHF group with a low ejection fraction AA polymorphism was found in 53.85% of the examined. It is possible they do not participate in the formation of CHF in patients with type II diabetes mellitus, or have a protective effect. The gene GNB: 825 C &gt; T rs5443 polymorphism was detected from 53.33 to 61.9% of the examined in all groups. rs1799998 polymorphism is not associated with the development of CHF. The rs2070744 polymorphism is associated with the development of CHF with a preserved ejection fraction, but not CHF with a low ejection fraction, in patients with type II diabetes mellitus. The gene NOS3: 894 G &gt; T rs1799983 in heterozygous and homozygous variants polymorphism was more common in patients with CHF with preserved ejection fraction (statistically insignificant). Conclusions. CHF with a preserved ejection fraction and CHF with a low ejection fraction in patients with type II diabetes mellitus are associated with different polymorphisms and have different pathogenesis. The gene AGTR2 polymorphism rs1403543 in patients with type II diabetes mellitus and CHF with preserved ejection fraction occurs less frequently than in the control group. The gene GNB polymorphism rs5443 in patients with CHF with a preserved ejection fraction and CHF with a low ejection fraction occurs much less frequently than in the control group. The gene NOS3 polymorphism rs2070744 in patients with CHF with a preserved ejection fraction occurs significantly more often than in the control group and in patients with CHF with a low ejection fraction.

Quantitative evaluation of gastrocnemius medialis mass in patients with chronic heart failure by gray-scale ultrasound and shear wave elastography.

To assess the usefulness of gray-scale ultrasound (US) and shear wave elastography (SWE) in assessing the condition of the skeletal muscles in patients with chronic heart failure (CHF). We prospectively compared 20 patients with clinically diagnosed CHF and a control population of 20 normal volunteers. The gastrocnemius medialis (GM) of each individual in the rest and the contraction position was assessed using gray-scale US and SWE. The quantitative US parameters including the fascicle length (FL), pinnation angle (PA), echo intensity (EI), and Young's modulus of the muscle were measured. In the CHF group compared with the control group, in the rest position, there was a significant difference in EI, PA, and FL of the GM (P < 0.001), but no statistically significant difference in Young's modulus values (P > 0.05); however, in the contraction position, all parameters were statistically different between the two groups (P < 0.001). In the different subgroups of the CHF group grouped according to New York Heart Association staging (NYHA) or left ventricular ejection fraction (LVEF), there were no significant differences in ultrasound parameters in the rest position. However, during the contraction of GM, the smaller the FL and Young's modulus, the larger the PA and EI with the increase of NYHA grade or the decrease of LVEF (P < 0.001). The gray-scale US and SWE can provide an objective assessment of skeletal muscle status for CHF patients and are expected to be used to guide their early rehabilitation training and improve their prognosis.

ВЛИЯНИЕ САРКОПЕНИИ НА ТЕЧЕНИЕ И ПРОГНОЗ У ПАЦИЕНТОВ С ХРОНИЧЕСКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТЬЮ

Purpose of the study: to evaluate and compare the main anthropometric, echocardiographic parameters and survival between a group of patients with chronic heart failure (CHF) and sarcopenia and a group of patients with CHF without sarcopenia. Materials and methods: 69 patients with chronic heart failure were examined, who were divided into two groups during the examination. The main group (n=36) is represented by patients with chronic heart failure (CHF) and sarcopenia. Patients with CHF without sarcopenia (n=33) were studied as a control group. The study was conducted on the basis of the Department and Clinic of Hospital Therapy of the Military Medical Academy named after S.M. Kirov. (St. Petersburg). The indicators were re-evaluated after 12 months. Evaluation of indicators in dynamics after 12 months was carried out taking into account the withdrawn patients. Results and Discussion: During the study, a statistically significant intergroup difference was demonstrated. Thus, patients in the CHF and sarcopenia group significantly differ in lower anthropometric parameters such as height, weight, muscle mass and strength compared to the control group. At the same time, analyzing the indicators of the morphofunctional state of the heart according to echocardiography data, it was demonstrated that there was a statistical decrease in the ejection fraction in dynamics after 12 months in the main group compared to the control group. However, no differences were found at baseline. Survival of patients in the CHF group without sarcopenia is higher than in the group of patients with CHF and sarcopenia. There were no intergroup differences in the causes of death. Conclusion: As a result of the assessment and intergroup comparison, data were obtained indicating a statistically significant effect of sarcopenia on such anthropometric indicators as height, weight, muscle mass and strength. In addition, in the main group there was a statistically significant decrease in the ejection fraction in dynamics after 12 months compared with the control group. The survival rate of patients with CHF and sarcopenia is lower than in the group of patients with CHF without sarcopenia.

Alteration of the gut microbiota and metabolite phenylacetylglutamine in patients with severe chronic heart failure.

Chronic Heart Failure (CHF) is the end result of nearly all cardiovascular disease and is the leading cause of deaths worldwide. Studies have demonstrated that intestinal flora has a close relationship with the development of Cardiovascular Disease (CVD) and plays a vital role in the disease evolution process. Phenylacetylglutamine (PAGln) a metabolite of the intestinal flora, is one of the common chronic kidney disease toxins. Its concentrations in plasma were higher in patients with major adverse cardiovascular events (MACE) however, its variation in patients with various degrees of CHF has rarely been reported. Therefore, we collected stool and plasma samples from 22 healthy controls, 29 patients with NYHA Class III and 29 patients with NYHA Class IV CHF (NYHA stands for New York Heart Association) from the Department of Cardiology of Shanghai Fengxian District Central Hospital. Next, we analyzed these samples by performing bacterial 16S ribosomal RNA gene sequencing and liquid chromatography tandem mass spectrometry. The result shows: The Chao 1 index was significantly lower in both NYHA class III and NYHA class IV than it was in the control group. The beta diversity was substantially dissimilar across the three groups. The linear discriminant analysis effect size analysis (LEfSe) showed that the bacterial species with the largest differences were Lachnospiraceae in control group, Enterobacteriaceae in NYHA class III, and Escherichia in NYHA class IV. The concentration of PAGln was significantly different between CHF and control groups and increased with the severity of heart failure. Finally, the correlation analysis represented that Parabacteroides and Bacteroides were negatively correlated to brain natriuretic peptide (BNP) and PAGln; Romboutsia and Blautia adversely associated with PAGln; Klebsiella was positively interrelated with BNP; Escherichia-Shigella was positively correlated with PAGln and BNP; Alistipes was contrasted with BNP; and Parabacteroides was negatively correlated with the left ventricular end-diastolic diameter (LVEDD). This study presented that the intestinal flora and its metabolite PAGln were altered with different grades of CHF and illustrated the effects of the gut flora and its metabolite on CHF.

The association between chronic heart failure and frailty index: A study based on the National Health and Nutrition Examination Survey from 1999 to 2018.

This study aims to explore the association between the frailty index and chronic heart failure (CHF). We collected data from the National Health and Nutrition Examination Survey (NHANES) (1998-2018) database to assess the association between CHF and frailty. Demographic, inquiry, laboratory examinations, and characteristics were gathered to compare CHF and non-CHF groups. Multiple logistic regression analysis was performed to explore the relationship between frailty and CHF. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence interval (CI) for mortality from all causes and cardiovascular disease (CVD). A total of 16,175 participants with cardiac and cerebrovascular disease were categorized into CHF (n = 1,125) and non-CHF (n = 15,050) groups. In patients with CHF, the prevalence of frailty, pre-frailty, and non-frailty were 66.31, 30.93, and 2.75%, respectively. In multiple logistic regression, patients with CHF who were male (OR = 0.63, 95% CI: 3.11-5.22), whose annual family income was over $20,000 (OR = 0.52, 95% CI: 0.37-0.72, p < 0.001), or with normal hemoglobin level (OR = 0.77, 95% CI: 0.68-0.88, P < 0.001) had a lower likelihood of frailty. CHF patients with hypertension (OR = 3.60, 95% CI: 2.17-5.99, P < 0.0001), coronary heart disease (OR = 1.76, 95% CI: 1.10-2.84, P = 0.02), diabetes mellitus (OR = 1.89, 95% CI: 1.28-2.78, P < 0.001), and stroke (OR = 2.52, 95% CI: 1.53-4.15, P < 0.001) tended to be frail. Survival analysis suggested that pre-frailty and frailty were related to poor all-cause deaths (HR = 1.48, 95% CI: 1.36-1.66; HR = 2.77, 95% CI: 2.40-3.18) and CVD mortality (HR = 1.58, 95% CI: 1.26-1.97; HR = 2.55, 95% CI: 2.02-3.21). CHF patients with frailty were strongly connected with all-cause death (HR = 2.14, 95% CI: 1.27-3.62). Frailty was positively associated with CHF. Patients with CHF who were male, whose annual family income was over $20,000, or with normal hemoglobin level were negatively correlated to frailty. For patients with cardiac and cerebrovascular disease as well as CHF, frailty was strongly connected with all-cause death.

NESFATIN-1 ACTIVITY IN THE BLOOD SERUM IN PATIENTS WITH CHRONIC HEART FAILURE OF ISCHEMIC ORIGIN AGAINST THE BACKGROUND OF TYPE 2 DIABETES MELLITUS AND OBESITY.

The aim: To study the nesfatin-1 activity in the blood serum of patients with chronic heart failure (CHF) of ischemic origin against the background of such metabolic disorders as type 2 diabetes mellitus (T2DM) and obesity. Materials and methods: 154 patients with CHF were examined, and divided into 4 groups, according to the presence of metabolic disorders. Group 1 included patients with CHF on the background of coronary heart disease (CHD) and T2DM and obesity (n=42). The second group consisted of patients with heart failure on the background of CHD with concomitant T2DM (n=46), the third group - with concomitant obesity (n=36), the fourth group was formed from patients with signs of heart failure of ischemic origin without metabolic disorders (n=30). The control group (CG) included 30 practically healthy persons of comparable age. Results: The mean level of serum nesfatin-1 was 1.64±0.27 ng/mL in the СHF group, 0.342±0.19 ng/mL in the CHF + T2DM + obesity group, 1.06±0.36 ng/ mL in the obese + CHF group, 0.96±0.27 ng/mL in the CHF + T2DM group and 2.98±0.38 ng/mL in the CG. Significant correlation was found between the serum nesfatin-1 level and BMI (r=-0.34, p<0.05), HOMA (r=-0.54, p<0.05), insulin (r=-0.41, p<0.05). No significant correlation was found between the serum nesfatin-1 level and blood glucose level (r=0.13, p=0.65). Conclusions: Thus, nesfatin-1 may play a significant role in the pathogenesis of both weight-related abnormalities and type 2 diabetes mellitus in patients with chronic heart failure of ischemic origin.

Levels of Galectin-3 in Chronic Heart Failure: A Case-Control Study.

IntroductionHeart failure (HF) is a progressive clinical syndrome resulting from various cardiac disorders. Galectin-3 promotes adverse cardiac remodeling leading to chronic heart failure (CHF).AimTo estimate the levels of galectin-3 in chronic heart failure (CHF) patients and controls and to determine the association between galectin-3 levels with age, gender, and left ventricular ejection fraction (LVEF).Materials and methodsThe levels of plasma galectin-3 were estimated in CHF patients from January 2013 to October 2013 at Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu. The study was a case-control study. A total of 55 CHF patients were recruited as cases, and 55 controls were enrolled for the study. Participants' profiles were documented, and 5 mL of blood sample was collected. Galectin-3 levels in plasma were estimated by using an enzyme-linked immunosorbent assay (ELISA). Data were analyzed using SPSS 25.0 version. Mean, SD, and percentages were used to compare the characteristics of the two groups. The student's t-test was used to compare galectin-3 levels between CHF patients and the controls. ANOVA was employed to compare galectin-3 levels in the different age groups, gender, and LVEF. The receiver operating characteristic (ROC) curve was plotted for plasma galectin-3 in CHF.ResultsIn the present study, the mean age of CHF patients was 55.9±8.1 years and 54.1±9.4 years for controls. Males constituted 63.6% (n=35) and females were 36.4% (n=20) in the CHF group while 67.3% (n=37) were males and 32.7% (n=18) were females in the control group. The mean and SD for plasma galectin-3 was 9.95±2.8 ng/mL among CHF patients, while it was 4.08±1.3 ng/mL among controls (p<0.0001). As the age increased, levels of plasma galectin-3 increased in CHF patients and controls (p<0.00001). However, there was no statistical significance (p >0.05) for levels of galectin-3 among males and females in both groups. There was a highly significant difference in galectin-3 levels among cases and controls when classified into sub-groups based on their LVEF (p<0.0001). At the cut-off level of 8 ng/mL, plasma galectin-3 had a sensitivity of 92% and specificity of 71% in predicting CHF.ConclusionGalectin-3 helps in identifying CHF due to maladaptive remodeling of the heart. The present study concludes that estimating the plasma levels of galectin-3 is useful in diagnosing CHF.

A co-morbid patient of a phthisiologist, pulmonologist and cardiologist: focus on quality of life

The objective: to assess the impact of tuberculosis (TB), chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) on the quality of life (QOL) and the need to manage each disease to improve the physical and mental components of QOL.Subjects and Methods. A simple prospective study included 80 patients, men – 53.9%, women – 46.1% who were divided into 3 groups: Group 1 – COPD (n = 35), median age [Me (25.0; 75.0 )] 56.0 (54.0; 60.0) years old, Group 2 – COPD + TB (n = 25), 58.0 (56.0; 59.0) years old, Group 3 – COPD + TB + CHF with preserved ejection fraction (n = 20), 60.0 (57.0; 64.0) years old. QOL was assessed using the SF-36 questionnaire. There were no statistically signifcant differences between the compared groups in terms of COPD severity and TB forms.Results. Low QOL indices were observed in TB + COPD + CHF Group assessed by all scores especially for physical (30 points) and social functioning (35 points) and general health (35 points). After 3 months of therapy aimed to manage all pathological conditions, a positive trend in QOL was achieved in TB + COPD + CHF Group in terms of physical and mental health scores.Conclusion. QOL in co-morbid patients is determined not only by the quality and severity of individual nosologies but also by their number. Comprehensive therapy improves the general subjective state of the patient that helps to improve adherence to drug therapy thereby increasing the chance of recovery.

Effect of Chronic Heart Failure Complicated with Type 2 Diabetes Mellitus on Cognitive Function in the Elderly.

Objective To explore the effect of chronic heart failure complicated with type 2 diabetes mellitus on cognitive function in the elderly. Methods 600 patients with chronic heart failure were selected from January 2018 to January 2021. All patients were divided into observation group (A) and control group (B). A was chronic heart failure complicated with type 2 diabetes mellitus group. B was chronic heart failure group. The clinical effects of the two groups were observed. Results Compared with the clinical indexes during and after operation, there were differences in operation time, postoperative recovery time, and treatment cost between A and B, but the difference is not significant (all P > 0.05). LVEF cardiac function index score, LVEF score of A compared with B, the difference was statistically significant (P < 0.05). The MMSE score and MoCA score of the two groups were compared. Before operation, the MMSE score and MoCA score of A were lower than those of B, and the difference was statistically significant (P < 0.05). After operation, the MMSE score and MoCA score in B were significantly higher than those in B, but the increasing trend of MMSE score and MoCA score in B was significantly higher than that in A (P < 0.05). Comparison of HAMA score and HAMD score: before operation, the HAMA score and HAMD score were higher in A, but the difference is not significant (P > 0.05). After operation, the scores of HAMA and HAMD in A and B decreased significantly, but the difference is not significant (P > 0.05). Multivariate analysis showed that the fasting blood glucose and glycosylated hemoglobin were the risk factors of cognitive impairment. Conclusion Type 2 diabetes mellitus in elderly patients with chronic heart failure will further aggravate cognitive impairment, and type 2 diabetes is an important independent risk factor affecting cognitive function, which accelerates cognitive impairment and significantly reduces the executive ability of elderly patients with chronic heart failure, resulting in a significant decline in patients' ability to understand and apply information.

Cheyne-Stokes Breathing as a Predictive Indicator of Heart Failure in Patients With Obstructive Sleep Apnea; A Retrospective Case Control Study Using Continuous Positive Airway Pressure Remote Monitoring Data.

ObjectiveWe conducted a retrospective case control study to examine whether remote monitoring of Cheyne-Stokes breathing (CSB) was useful for predicting the onset of heart failure (HF) in patients with obstructive sleep apnea (OSA) on continuous positive airway pressure (CPAP).MethodsAmong patients with OSA treated at our hospital, 33 patients with HF that occurred between July 2014 and May 2021 [11 patients with acute HF (AHF); 22 patients with chronic HF (CHF) exacerbation] were included in the HF group. Of the 618 stable patients, 149 patients with a 30-days average CSB rate (CSB%) ≧1% were included in the non-HF control group. The chronologic change of CSB% were compared among the AHF, CHF and Control groups. Furthermore, of the 149 patients in the non-HF control group, 44 patients were matched for CSB%, body mass index, and sex in a ratio of 1:2 to 22 patients with CHF. The average cycle length (CL) of CSB was compared among three groups: CHF in stable period (CHF-stable group), CHF in exacerbation period (CHF-exacerbation group), and control group. In addition, according to the status of HF, receiver operating characteristic (ROC) curves were generated to determine the optimal cut-off points for variation of CSB% and CL.ResultsChronological change in CSB% among the three groups was significantly different. Standard deviation of CSB% (SD CSB%) before onset HF was significantly higher in both the AHF and CHF groups than in the control group. The CL of CSB was significantly longer in the CHF group than in the control group and was longer during the exacerbation period than during the stable period. The optimal cut-off value of CL that could differentiate patients with and without the onset of HF was 68.9 s.ConclusionThe HF group demonstrated greater CSB variations and longer CL than the non-HF control group. Furthermore, the CL was longer during the exacerbation period of HF even in the same patient. These results suggest that remote monitoring of CPAP device data for CSB variations and CL might allow early prediction of the onset and exacerbation of HF.