New York Heart Association Grade Research Articles

Initial Clinical Experience with Implantation of a New Left Ventricular Assist Device HeartCon

Objective: Heart failure is a major health problem worldwide. We report the initial experience of a new left ventricular assist device (LVAD) Heartcon—a centrifugal pump of magnetic-fluid suspension rotor integrated with the pump and machine. From September 2020 to March 2023, HeartCon was implanted in a total of 78 cases throughout China, 27 were implanted in TEDA International Cardiovascular Hospital. Methods: The patient data collected from the medical record included patient demographics, surgical and cardiopulmonary bypass (CPB) data, doses of transfused red blood cells, mechanical ventilation time (h), intensive care unit (ICU) stay time (d), and cardiac function indices assessed by echocardiography, 6-minute walk tests, and N-terminal pro brain natriuretic peptide (NT proBNP) values. Results: All patients were in New York Heart Association (NYHA) grade IV before surgery and 21 had a dilated cardiomyopathy. All patients survived the surgery. One patient underwent heart transplantation 10 months after the implantation. Eight patients reported adverse event events. The duration of mechanical ventilation after operation was 37.8 ± 52.0 h. The incidence of hemorrhagic stroke was 7.4% and the incidence of mediastinal infection was 7.4%. At 90 day followup, 25 patients were in NYHA grade I and the other 2 patients were in grade II. Conclusion: We conclude that HeartCon implantation is a safe and useful LVAD for treatment of end-stage heart failure. It provides a shorter duration of mechanical ventilation time, and a lower incidence of hemorrhagic stroke and mediastinal infection.

Assessment value of the modified early warning score for long-term prognosis of older patients with chronic heart failure.

The aim of the study was to explore the assessment value of the modified early warning score (MEWS) for the long-term prognosis of older patients with chronic heart failure (CHF). A total of 180 CHF patients, treated from January 2016 to January 2018, were divided into a grade I group (n = 28), a grade II group (n = 37), a grade III group (n = 68) and a grade IV group (n = 47) according to the New York Heart Association (NYHA) functional classification. The MEWS was compared on admission and discharge. Based on the clinical outcomes during follow up, the patients were divided into a non-survival group (n = 48) and a survival group (n = 132). Their general clinical data and the MEWS were compared. The predictive values of the MEWS, troponin I (cTnI) and B-type natriuretic (BNP) peptide for long-term prognosis were assessed using receiver operator characteristic (ROC) curves. The MEWS on patient discharge was significantly lower than that on admission, and it increased with increasing NYHA grade (p < 0.05). The MEWS in the non-survival group was significantly higher than that in the survival group. Different clinical outcomes were positively correlated with NYHA grade, MEWS, six-minute walking distance and left ventricular ejection fraction (r = 0.368, r = 0.471, r = 0.387, r = 0.423, p < 0.05), and negatively correlated with cTnI and BNP (r = -0.411, r = -0.425). The area under the ROC curve of the MEWS was 0.852, indicating higher accuracy. The optimal cut-off value, sensitivity and specificity of the MEWS for determining prognosis were 5.6, 0.854 and 0.797 points, respectively. The MEWS rose with increasing NYHA grade and reflected the severity of CHF in older patients, which has higher predictive value for long-term prognosis.

Coronary Heart Disease, Cognitive Impairment and Patient‐Physician‐Communication: Data from the MenDis‐CHD study

AbstractBackgroundCoronary heart disease (CHD) and dementia often co‐occur in the aging population. In addition, CHD seems to increase the risk for subsequent cognitive decline, which may in turn negatively affect the prognosis of CHD. Current CHD guidelines therefore recommend appropriate diagnosis and management of comorbid cognitive impairment. Here, we present the progression and characteristics of cognitive impairment in a group of patients with CHD and their perception of care in the patient‐physician‐relationship.MethodFor the MenDis‐CHD study, n = 364 patients with CHD were recruited from cardiologic hospital departments, rehabilitation clinics and cardiologist practices in Cologne, Germany. Medical records were used to assess severity of CHD and comorbidities. The New York Heart Association (NYHA) Functional Classification was applied for estimation of heart failure‐related symptom severity. Each patient was screened for cognitive impairment (DemTect) and depressive or anxiety symptoms (HADS questionnaire) as well as for subjective cognitive deficits. Patients were asked whether cognitive impairment was discussed with the treating physician. A follow‐up was carried out after M = 3.19 [2.2‐4.2] years in n = 118 patients. We compared patients whose cognition declined based on DemTect score to those who remained stable using t‐tests/Mann‐Whitney‐U‐tests and X²‐tests.ResultAt baseline, 10.2% of patients were screened positive for cognitive impairment, while 18.4% reported subjective cognitive deficits. Patients with a decline in cognition between study visits were significantly older (M = 67.9 vs. M = 63.1, t(115) = ‐2.7, p = .009) and showed more depressive symptoms (M = 5.0 vs. M = 3.8, t(115) = ‐2.1, p = .039). They also had more severe NYHA grades (M = 2.1 vs. M = 1.7, U(102) = 2044.5, p = .011) and a concomitant cerebrovascular diagnosis was more frequent compared to patients who did not decline (20.0% vs. 4.1%, X²(1) = 5.2, p = .048). Out of those who experienced either subjective or objective impairment at baseline (n = 88), 38.6% indicated that cognitive symptoms had previously been addressed during visits with their primary attending physician and 9.1% had been actively approached by their physician in this regard.ConclusionA relevant proportion of CHD patients displayed cognitive symptoms at baseline with progression at follow‐up. Conversations about cognitive symptoms with the physician occurred only in a minority. Our data supports the importance of raising awareness about the link between CHD and cognitive impairment in physicians.

Conduction system pacing for ventricular pacing requirement is feasible and effective on patients with hypertrophic cardiomyopathy and cardiac dysfunction

ObjectiveWe aimed to evaluate the feasibility and safety of his-bundle pacing (HBP) and left bundle branch pacing (LBBP) in patients with hypertrophic cardiomyopathy (HCM) and heart failure (HF). MethodsPatients with HF and interventricular septal thickness (IVST) ≥ 13 mm resulted from HCM, who accepted conduction system pacing (CSP) with a percentage of ventricular pacing > 40% from May 2018 to April 2022 were consecutively enrolled in our center. LBBP was preferred and HBP was the alternative therapy unless IVST ≥ 16 mm or LBBP failed, whereas LBBP would be the alternative therapy if HBP failed in patients with IVST ≥ 16 mm. All patients were followed up for at least one year. Data including clinical, echocardiographic parameters and electrocardiogram measurements, were collected and evaluated in patients with and without left ventricular ejection fraction (LVEF) < 50%. ResultsA total of 27 patients (65.93 ± 9.09 years old) were enrolled and only 3 patients failed in CSP (11.11%) via LBBP (6/13) and HBP (18/21) procedures. LVEF (P = 0.521), left ventricular end-diastolic diameter (LVEDD) (P = 0.816), and QRS duration (P = 0.928) did not worsen after CSP, and left atrial diameter (LAD) (49.58 ± 8.99 mm vs.47.04 ± 9.82 mm, P = 0.045) tended to improve slightly after 19.19 ± 7.71 months follow-up. Of note, LVEF (39.22%±7.51% vs. 45.22%±9.59%, P = 0.015), LVEDD (52.11 ± 10.10 mm vs. 48.33 ± 9.07 mm, P = 0.037), LAD (50.33 ± 8.93 mm vs. 46.11 ± 5.97 mm, P = 0.013) and New York Heart Association (NYHA) grade (2.67 ± 0.5 vs. 1.38 ± 1.02, P = 0.029) improved in 9 patients with LVEF < 50%, whereas LVEF (P = 0.372), LVEDD (P = 0.665), LAD (P = 0.093) and NYHA grade (P = 0.452) did not deteriorate in patients with preserved ejection fraction. ConclusionCSP was safe and feasible in patients with HCM and cardiac dysfunction, and did not worsen cardiac performance especially in patients with LVEF < 50%. HBP might be an effective alternative to LBBP in patients with significantly thickened interventricular septum.

Prognostic value of N-terminal Brain Natriuretic Peptide (NT-proBNP) in Risk Assessment of Adverse Cardiovascular Events in Patients with Atrial Fibrillation and Heart Failure with Reduced Left Ventricular Systolic Function

According to Russian epidemiological studies, the incidence of chronic heart failure (HF) in the general population is approximately 7%, increasing from 0.3% in the group aged 2029 years to 70% in patients aged 90 years [1]. In the general population, the incidence of atrial fibrillation (AF) ranges from 1% to 2%, which increases with age, that is, from 0.5% at the age of 4050 years to 5%15% at the age of 80 years [2]. HF and AF aggravate significantly each others course and mutually increase the risk of adverse outcomes [3, 4]. Moreover, the incidence of AF in patients with HF increases with increasing New York Heart Association (NYHA) grade; that is, among patients with HF of NYHA grade I, the incidence of AF is 5%, whereas among patients with HF NYHA grade IV, the AF incidence in 50% [5].&#x0D; Chronic HF is a syndrome with complex pathophysiology, which is characterized by the activation of neurohumoral systems, namely, the reninangiotensinaldosterone system (RAAS), sympathetic nervous system (SNS), and insufficient activity of the natriuretic peptide (NUP) system. In the early stage of HF, i.e. asymptomatic dysfunction of the left ventricle, the activation of the SNS and RAAS plays a compensatory role aimed at maintaining cardiac output and circulatory homeostasis [6]. Moreover, the NUP system has a counter-regulatory function in relation to the RAAS and SNS, and with prolonged and excessive activation of the SNS and RAAS or with insufficient NUP system activity, imbalance occurs and HF progresses [7].&#x0D; The brain natriuretic peptide (BNP) and biologically inactive N-terminal fragment of BNP (NT-proBNP) are the most studied and significant in clinical practice representatives of the NUP system. BNP and NT-proBNP are secreted by cardiomyocytes of the left ventricular (LV) myocardium in response to an increase in the mechanical load and stress of the LV myocardium. NT-proBNP is widely used as a test to rule out HF in patients with dyspnea. The NUP level also correlates with the severity and prognosis in patients with an established diagnosis of HF, and studies have reported that the NUP level acts as a criterion for treatment efficiency in patients with HF [8]. NT-proBNP is a biomarker not only for HF but also for several other conditions, such as acute coronary syndrome and myocardial infarction (MI), because it is associated with an increased risk of death from all causes, regardless of age, stable effort angina grade, myocardial infarction history, and LV ejection fraction (LVEF) [9].&#x0D; NT-proBNP levels can be influenced by several additional factors such as age, obesity, or glomerular filtration rate. The prognostic value of NT-proBNP is relevant in comorbid patients with AF associated HF because AF can increase NT-proBNP levels independently [10]. Given that NUP secretion depends on intracardiac hemodynamics, the NT-proBNP levels may also depend on the approach to managing AF. Tachycardia is associated with high NT-proBNP levels [11].&#x0D; The rhythm control approach has advantages over the heart rate control approach in patients with HF and LVEF 50% to reduce mortality and the number of unplanned hospitalizations due to HF progression [12].&#x0D; To date, the prognostic significance of NT-proBNP levels in relation to the risk of adverse events in patients with HF and reduced LV systolic function associated with AF, depending on the approach of AF management, remains unresolved.&#x0D; This study aimed to assess the predictive value of NT-proBNP in relation to the development of adverse cardiovascular events in patients with permanent or persistent AF associated with HF and LVEF 50%.

Clinical Course of Suspected Diagnosis of Pulmonary Tumor Thrombotic Microangiopathy: A 10-Year Experience of Rapid Progressive Right Ventricular Failure Syndrome in Advanced Cancer Patients.

Several cases involving severe right ventricular (RV) failure in advanced cancer patients have been found to be pulmonary tumor thrombotic microangiopathies (PTTMs). This study aimed to discover the nature of rapid RV failure syndrome with a suspected diagnosis of PTTM for better diagnosis, treatment, and prognosis prediction in clinical practice. From 2011 to 2021, all patients with clinically suspected PTTM were derived from the one tertiary cancer hospital with more than 2000 in-hospital bed. A total of 28 cases of clinically suspected PTTM with one biopsy confirmed case were included. The most common cancer types were breast (9/28, 32%) and the most common tissue type was adenocarcinoma (22/26, 85%). The time interval from dyspnea New York Heart Association (NYHA) Grade 2, 3, 4 to death, thrombocytopenia to death, desaturation to death, admission to death, RV failure to death, cardiogenic shock to death were 33.5 days, 14.5 days, 7.4 days, 6.4 days, 6.1 days, 6.0 days, 3.8 days and 1.2 days, respectively. The NYHA Grade 4 to death time was 7 days longer in those who received chemotherapy (7.1 days vs. 13.8 days, p value=0.030). However, anticoagulation, vasopressors or intensive care could not change clinical course. Rapid RV failure syndrome with a suspected diagnosis of PTTM showed a rapid progressive course from symptom onset to death. Although chemotherapy was effective, increased life survival was negligible, and treatments other than chemotherapy did not help to improve the patient's prognosis.

Correlation between Glycated Haemoglobin Level, Cardiac Function, and Prognosis in Patients with Diabetes Mellitus Combined with Myocardial Infarction.

Objective This study was to investigate the correlation between glycated haemoglobin (HbA1c) level, cardiac function, and prognosis in patients with diabetes mellitus combined with myocardial infarction. Methods Ninety-three patients with type 2 diabetes mellitus combined with acute myocardial infarction who were hospitalized and treated in our hospital from January 2021 to June 2021 were recruited for prospective analysis and equally divided into group A (HbA1c < 6.5%), group B (6.5% ≤ HbA1c ≤ 8.5%), and group C (HbA1c > 8.5%) using the random number table method, with 31 patients in each group. General data of patients were collected on admission and blood glucose and cardiac function indexes were measured; the incidence of myocardial infarction and death during the follow-up period was recorded at 6 months after discharge. Results There was a significant difference in blood glucose (FBG) and HbA1c levels at fasting between the three groups (P < 0.05). There were statistically significant differences in plasma levels of N-terminal probrain natriuretic peptide (NT-proBNP) and uric acid (UA), left ventricular end diastolic diameter (LVEDD), left ventricular end systolic volume (LVESV), left ventricular ejection fraction (LVEF), and cardiac function classification of the New York Heart Association (NYHA) among the three groups (P < 0.05). By statistical analysis, the HbA1c level was positively correlated with FBG, NT-proBNP, UA, LVEDD, LVESD, and NYHA grades but negatively correlated with LVEF (P < 0.05). The incidence rate of myocardial infarction and mortality was significantly higher in group C than in groups A and B (P < 0.05). Conclusion HbA1c level in patients with diabetes mellitus combined with myocardial infarction is closely related to the degree of cardiac function damage. Glycated haemoglobin levels are associated with the development of cardiac insufficiency in patients with acute myocardial infarction; glycated haemoglobin is also an independent predictor of major adverse cardiovascular events. Reasonable and effective blood glucose control is of great significance to the prognosis of patients.

Pericardiectomy for Constrictive Tuberculous Pericarditis: A Systematic Review and Meta-analysis on the Etiology, Patients' Characteristics, and the Outcomes.

Tuberculosis (TB) is the most common etiology of constrictive pericarditis in the developing world. In this study, we collected currently available data to evaluate the outcomes following pericardiectomy in patients with constrictive tuberculous pericarditis. We retrieved electrical databases, including PubMed and PubMed Central, from 1985 AD and onwards. We included articles that had more than 80% TB as the etiology and articles with mixed etiologies. Pooled analysis was done in Review Manager (RevMan) version 5.2 (The Nordic Cochrane Centre, Copenhagen). and Stata Statistical Software, Release 16 ( StataCorp LLC, College Station, TX). We compared the mortality in patients after pericardiectomy due to TB with other etiologies. In-hospital mortality versus one-year mortality was analyzed in studies with constrictive pericarditis of mixed etiologies. We also compared pre-operative New York Heart Association (NYHA) grade to post-operative NYHA grade one year after pericardiectomy. We calculated the pooled mean of postoperative hospital stay, postoperative intensive care unit (ICU) stay, and in-hospital mortality.A total of 12 articles and 859 patients were included in the final analysis. Pericardiectomy was performed mostly on middle-aged men with or without previous comorbidity. Total pericardiectomy was the preferred surgical procedure performed on a mean of 93% of patients. The pooled analysis shows a significant decrease in all-cause mortality in patients with TB as compared to other etiologies (pooled risk ratios (RR) 0.34 CI [0.12,1.01] I2 = 61%) and a lower but insignificant in-hospital mortality in comparison to one-year mortality in studies with mixed etiologies (RR 0.59 [0.11,3.11] I2= 61%). There was a significant improvement in the NYHA grade of the patients one year following pericardiectomy (RR 8.04, CI [5.20,12.45], I2= 0%). The mean postoperative hospital stay and the postoperative ICU stay were calculated and reported in terms of days. The mean postoperative hospital stays in studies with more than 80% of TB cases is 13.34 (10.21, 16.47) with a mean standard deviation of 4.46 (2.87, 6.05). The mean postoperative ICU stay is 1.93 (1.47, 2.39), with a mean standard deviation of 3.26 (2.51, 4.00), and the mean in-hospital mortality is 0.07 (0.02, 0.12). Similarly, the mean postoperative hospital stay in studies with mixed etiologies is 19.40 (11.93, 26.87) with a mean standard deviation of 8.26 (4.21, 12.52). The mean postoperative ICU stay is 3.52 (1.93, 5.10) with a mean standard deviation of 2.34 (1.36, 3.32). The mean in-hospital mortality is 0.06 (0.04, 0.08). There is significant heterogeneity along with a number of methodological concerns, and therefore, generalization of the data should be done with caution, and a randomized controlled trial in the future may be beneficial.

Risk factors and management of pulmonary infection in elderly patients with heart failure: A retrospective analysis.

Pulmonary infection is common in patients with heart failure, yet the risk factors remain unclear. We aimed to evaluate the clinical characteristics and risk factors of pulmonary infection in elderly patients with heart failure, to provide reference to the prevention of pulmonary infection.This study was a retrospective study design. We included elderly heart failure patient admitted to our hospital from April 1, 2018 to August 31, 2020. The characteristics and clinical data of pulmonary infection and no infection patients were assessed. Logistic regression analyses were conducted to identify the risk factors of pulmonary infections in patients with heart failure.A total of 201 patients were included. The incidence of pulmonary infection in patients with heart failure was 23.88%. There were significant differences in the age, diabetes, New York Heart Association (NYHA) grade, left ventricular ejection fraction (LVEF), C-reactive protein (CRP) between infection and no infection group (all P < .05), and there were not differences in the sex, body mass index, alcohol drinking, smoking, hypertension, hyperlipidemia, length of hospital stay between 2 groups (all P > .05). Logistic regression analyses indicated that age ≥70 years, diabetes, NYHA grade III, LVEF ≤55%, and CRP ≥10 mg/L were the independent risk factors of pulmonary infections in patients with heart failure (all P < .05). Pseudomonas aeruginosa (34.48%), Staphylococcus aureus (19.57%), and Klebsiella pneumoniae (15.22%) were the most common 3 pathogens in patients with pulmonary infection.Heart failure patients with age ≥70 years, diabetes, NYHA grade III, LVEF ≤55%, and CRP ≥10 mg/L have higher risks of pulmonary infections, preventive measures targeted on those risk factors are needed to reduce pulmonary infections.

The Association between Nutritional Status and In-Hospital Mortality among Patients with Heart Failure-A Result of the Retrospective Nutritional Status Heart Study 2 (NSHS2).

Background: A nutritional status is related to the prognosis and length of hospitalisation of patients with heart failure (HF). This study aims to assess the effect of nutritional status on in-hospital mortality in patients with heart failure. Methods: We conducted a retrospective study and analysis of medical records of 1056 patients admitted to the cardiology department of the University Clinical Hospital in Wroclaw (Poland). Results: A total of 1056 individuals were included in the analysis. A total of 5.5% of patients died during an in-hospital stay. It was found that in the sample group, 25% of patients who died had a BMI (body mass index) within the normal range, 6% were underweight, 47% were overweight, and 22% were obese. Our results show that non-survivors have a significantly higher nutrition risk screening (NRS) ≥3 (21% vs. 3%; p < 0.001); NYHA (New York Heart Association) grade 4 (70% vs. 24%; p < 0.001). The risk of death was lower in obese patients (HR = 0.51; p = 0.028) and those with LDL (low-density lipoprotein) levels from 116 to <190 mg/dL (HR = 0.10; p = 0.009, compared to those with LDL <55 mg/dL). The risk of death was higher in those with NRS (nutritional risk score) score ≥3 (HR = 2.31; p = 0.014), HFmrEF fraction (HR = 4.69; p < 0.001), and LDL levels > 190 mg/dL (HR = 3.20; p = 0.038). Conclusion: The malnutrition status correlates with an increased risk of death during hospitalisation. Higher TC (total cholesterol) level were related to a lower risk of death, which may indicate the “lipid paradox”. Higher BMI results were related to a lower risk of death, which may indicate the “obesity paradox”.

Changes of Serum Ficolin-3 and C5b-9 in Patients with Heart Failure.

Objectives:To investigate the correlation of serum ficolin-3 and C5b-9 with cardiac function and NT-proBNP in patients with heart failure.Methods:Sixty patients with heart failure admitted to the Baoding First Central Hospital from May 2019 to May 2020 were selected and divided into three groups according to the classification of New York Heart Association (NYHA). Patients with NYHA grade II, III, and IV were included into group A, B, and C, respectively. Among the population undergoing physical examination at the same time, 20 cases with no significant difference in age and gender from the experimental group were selected as the control group (Group-N), and their clinical data were recorded. The serum levels of ficolin-3, C5b-9 and NT-proBNP in each group were detected and compared.Results:The serum concentrations of ficolin-3 and C5b-9 in Group N were significantly different from those in Group A, B and C (p<0.05), the difference between Group C and Group A and B was statistically significant (p<0.05), there was no significant difference between group A and B (p>0.05). The correlation analysis between serum ficolin-3 and NT-proBNP showed that serum ficolin-3 was negatively correlated with NT-proBNP (r=-0.606, p<0.0001), while the correlation analysis between serum C5b-9 and NT-proBNP showed that serum C5b-9 was positively correlated with NT-proBNP (r=0.499, p<0.0001). According to the etiology of heart failure, patients with heart failure were divided into coronary heart disease (25 cases), dilated cardiomyopathy (15 cases) and others (20 cases). The differences of ficolin-3 and C5b-9 among patients were compared, and there was no statistical difference (p<0.05).Conclusion:Ficolin-3 was inversely associated with the severity of heart failure, while C5b-9 was positively associated with the severity of cardiac impairment. Both of them have nothing to do with the etiology of heart failure.

Risk factors of early mortality after surgical treatment for infective endocarditis.

To explore the basic clinical characteristics and relevant factors affecting the early postoperative prognosis in patients with infective endocarditis (IE). A total of 702 patients with IE, who underwent surgery in Xiangya Hospital, Central South University from January 1981 to June 2019, were studied and the data were collected through the paper records and the hospital information system. The patients from January 1981 to June 2010 served as an early group (n=224), and other patients from July 2010 to June 2019 served as a recent group (n=478). Independent risk factors for early postoperative death were determined by logistic regression analysis. The mean age of the 702 patients was 36.7±16.1 years, and the male accounted for 68.1%. Preoperative stroke occurred in 71 patients (10.1%), and dialysis was done in 14 patients (2%) preoperatively. Streptococcus were the pathogenic bacteria in 172 patients, accounting for 59.5% of all positive blood culture results. In the early group, the percentage of IE combined with congenital heart disease was significantly higher than that in the recent group [77 patients (34.4%) in the early group vs 22 patients (4.6%) in the recent group; P<0.05]. Postoperative stroke occurred in 15 patients (2.1%), while 59 patients (7%) required new dialysis postoperatively because of renal insufficiency. Twenty-nine patient died in the post-operation, with 4.1% in 30-day mortality. Logistic regression analysis revealed that the high preoperative New York Heart Association (NYHA) grade of cardiac function (OR=3.22, 95% CI 1.50-6.88; P<0.01), postoperative stroke (OR=5.75, 95% CI 1.22-27.07; P<0.05), postoperative dialysis (OR=15.53, 95% CI 3.50-68.82; P<0.01), perivalvular abscess (OR=13.19, 95% CI 3.83-45.42; P<0.01) and multivalve involvement (OR=3.57, 95% CI 1.24-10.30; P<0.05) were the independent risk factors for early mortality. Streptococcus is the most common pathogenic bacteria in the patients with IE. Surgery for IE can obtain a satisfactory early outcomes. High preoperative NYHA grade of cardiac function, postoperative stroke, postoperative dialysis, perivalvular abscess and multivalve involvement are the independent risk factors for early mortality.

Relationship between fasting serum C-peptide level and heart function in patients with or without diabetes mellitus and chronic heart failure

Objective To evaluate the relationships between admission fasting serum C-peptide concentration and cardiac function status in chronic heart failure (CHF) patients with or without diabetes. Methods From July 2017 to December 2018, 262 CHF patients with or without diabetes in the Department of Cardiology of Pudong hospital in Shanghai were analyzed.Their cardiac function was classified as New York Heart Association (NYHA) grade Ⅱ to Ⅳ, and they were divided into diabetes group (80 cases) and non diabetes group (182 cases). At the same time, 62 subjects without diabetes and heart disease were randomly selected as the control group.To analyze the relationship between fasting serum C-peptide level and cardiac function in diabetic and nondiabetic CHF patients. Results (1)The fasting plasma glucose and serum C-peptide concentrations of diabetes group paitents were(8.7±2.9) mmol/L and(0.78±0.67) nmol/L respectively, the nondiabetes group paitents were(5.8±1.67) mmol/L and(0.56±0.61)nmol/L respectively, the control group were(5.1±0.69) mmol/L and(0.16±0.12)nmol/L respectively.The difference in the three groups was statistically significant(all P 0.05). (2) In all patients with heart failure, diabetes mellitus and non diabetes heart failure, the levels of serum C-peptide were (1.05±0.85), (1.17±0.82), (0.99±0.86) nmol/L in NYHA Ⅳ group, and (0.53±0.22), (0.52±0.20), (0.54±0.23) nmol/L in NYHA Ⅲ group, and (0.32±0.09), (0.32±0.11), (0.31±0.09) nmol/L in NYHA Ⅱ group.After adjustment of age, gender, smoking, insulin secretion and hypoglycemic drugs, body mass index, blood pressure, total bilirubin (TBIL), alanine aminotransferase (ALT), creatinine, blood glucose, blood lipid, white blood cell count (WBC) and hemoglobin level by covariance analysis, all patients with heart failure The level of serum C-peptide in NYHA Ⅳ group was significantly higher than that in Ⅲ group (all P 0.05) (3) Using multiple linear regression analysis, the adjustment factors included age, gender, smoking, BMI, blood pressure, TBIL, alt, creatinine, blood glucose, blood lipid, WBC and hemoglobin levels.The results showed that the serum C-peptide level was positively correlated with pro-BNP in all patients with heart failure, diabetes and non diabetes heart failure (β: 0.006, 95%CI -0.016-0.028 , P=0.007; β: 0.117, 95%CI-0.042-0.277 , P=0.006; β: 0.411, 95%CI-0.149-0.971 , P=0.023), negatively correlated with LVEF(β: -0.122, 95%CI-0.285-0.041, P=0.004; β: -0.008, 95%CI-0.032-0.016, P=0.010; β: -0.065, 95%CI-0.139-0.011, P=0.036). Conclusion The level of fasting serum C-peptide was significantly increased in patients with CHF and non-diabetic patients, and was related to the severity of heart failure. Key words: Chronic heart failure; Diabetes mellitus; Serum C-peptide; N-terminal B-type natriuretic peptide; Cardiac function

The effectiveness and safety of precision cardiac anesthesia in patients undergoing cardiac surgery

Objective To investigate the effectiveness and safety of precision cardiac anesthesia. Methods A total of eighty subjects[New York Heart Association(NYHA) grades Ⅰ-Ⅳ] undergoing selective cardiac surgery were enrolled. They were randomly divided into two groups (n=40): a precision cardiac anesthesia group (group P) and a conventional cardiac anesthesia group (group C). Group P was primarily administrated with a low-dose of sufentanil, in combination with target - controlled infusion to accurately adjust the blood concentration of anesthetics as well as bispectral index to monitor anesthesia depth. The aim of this protocol of precision cardiac anesthesia was to achieve the rationalization of anesthetic use. The timing of tracheal extubation following cardiac surgery was determined by pre- and intra-operative individual general condition in group P. Routine dosage sufentanil was traditionally administrated in group C, and patients were transferred to intensive care unit (ICU) with tracheal intubation after surgery. All patients′ data were recorded including baseline characteristics, intraoperative sufentanil dosage, cases with cardiopulmonary bypass(CPB), operation time, lowest temperature, duration of mechanical ventilation, poor events, ICU length of stay, post - operative hospitalization stay and cost of hospital care. Results The total amount of sufentanil used intra-operatively was significantly less in group P than that in group C (P<0.05). The number of patients developing pneumonia after surgery in group C was revealed to be significantly greater than that in group P (P<0.05). Compared to group C, patients in group P had significantly decreased length of mechanical ventilation, ICU stay and post - operative hospital stay (P<0.05). Both total hospital expenditure and medical examination fee were significantly less in group P (P<0.05). Conclusions Precision cardiac anesthesia is of effectiveness and safety in adults undergoing cardiac surgery. It can reduce ICU and post-operative hospitalization stay. It is beneficial to cut the cost of health care, so as to improve efficiency of medical resources. Key words: Cardiac surgery; Precision cardiac anesthesia; Fast track

The impact of left ventricular ejection fraction on heart failure patients with pulmonary hypertension

BackgroundThe most common cause of pulmonary hypertension (PH) in developed countries is left heart disease (LHD, group 2 PH). The development of PH in heart failure (HF) patients is indicative of worse outcomes. ObjectiveThe aim of this study was to evaluate the long term outcomes of HF patients with PH in a national long-term registry. MethodsStudy included 9 cardiology centers across Israel between 01/2013–01/2015, with a 12-month clinical follow-up and 24-month mortality follow-up. Patients were age ≥18 years old with HF and pre-inclusion PH due to left heart disease determined by echocardiography [estimated systolic pulmonary arterial pressure (SPAP) ≥ 50 mmHg]. Patients were categorized into 3 groups: HF with reduced (HFrEF < 40%), mid-range (HFmrEF 40–49%), and preserved (HFpEF ≥ 50%) ejection fraction. ResultsThe registry included 372 patients, with high prevalence of cardiovascular risk factors. Median HF duration was 4 years and 65% were in severe HF New York Heart Association (NYHA) classification ≥3. Mean systolic pulmonary artery pressure (SPAP) was 62 ± 11 mmHg. During 2-years of follow-up, 54 patients (15%) died. Univariable predictors of mortality included NYHA grade 3–4, chronic renal failure, and SPAP ≥ 65 mmHg. Severe PH was associated with mortality in HFpEF, but not HFmrEF or HFrEF, and remained significant after multivariable adjustment with an adjusted hazard ratio of 2.99, (95%CI 1.29–6.91, p = 0.010). ConclusionsThe combination of HFpEF with severe PH was independently associated with increased mortality. Currently, HFpEF patients are included with group 2 PH patients. Defining HFpEF with severe PH as a sub-class may be more appropriate, as these patients are at increased risk and deserve special consideration.

The clinical application value of the plasma copeptin level in the assessment of heart failure with reduced left ventricular ejection fraction: A cross-sectional study.

This study aimed to evaluate the clinical applicability of the plasma copeptin level to assess heart failure with reduced left ventricular ejection fraction (HFrEF).One hundred thirty-one patients with HFrEF, 127 patients with heart failure with preserved left ventricular ejection fraction (HFpEF), and 119 healthy candidates were involved. The basic data and examination results of patients were collected. The heart function of the patients with HFrEF and HFpEF were graded on the basis of the criteria of New York Heart Association (NYHA) classification. The plasma copeptin and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were tested using enzyme-linked immunosorbent assays (ELISAs).The copeptin and NT-proBNP levels were higher in the HFrEF group than in the HFpEF group. The copeptin and NT-proBNP values increased as the NYHA grade increased in the patients with HFrEF. However, for the patients with HFpEF, the copeptin levels did not change markedly as the NYHA grade increased. The copeptin levels were positively correlated with the NT-proBNP levels in the patients with HFrEF; however, there was no correlation between the copeptin and NT-proBNP values in the patients with HFpEF.Copeptin is involved in the process of progression in patients with HFrEF and the copeptin values might be useful for HFrEF prediction and assessment in the clinic.

Correlation between Histone Deacetylase 9 and Regulatory T Cell in Patients with Chronic Heart Failure.

Heart failure (HF) is the end stage of various kinds of cardiovascular diseases and leads to a high mortality worldwide. Numerous studies have demonstrated that frequencies of CD4+CD25+Foxp3+ regulatory T cells (Tregs) are reduced in HF patients and properly expanding Tregs attenuates HF progression. Histone deacetylase (HDAC) 9 has been revealed to contribute to several cardiovascular and cerebrovascular diseases. Plenty of studies showed that HDAC9 negatively regulated the number and function of Tregs. Thus, we aim to investigate the expression of HDAC 9 in patients with chronic heart failure (CHF) and the relationship among HDAC9, Tregs and CHF. Our research showed a reduced number of Tregs and an increased expression of HDAC9 mRNA in CHF patients. Patients with CHF were divided into two groups by heart function grade of New York Heart Association (NYHA), we found that the HDAC9 mRNA expression level in NYHA grade II-III group were lower than that in NYHA grade IV group. More importantly, the correlation study suggested that the expression of HDAC9 mRNA was negatively correlated to Tregs frequency and left ventricular ejection fraction (LVEF), whereas positively correlated to larger left ventricular end-diastolic dimension (LVEDD) and B-type natriuretic peptide (BNP) in patients with CHF. The correlation studies also showed a positive correlation between HDAC9 and the severity of CHF. Our research suggests that HDAC9 may be a new indicator for assessing CHF and it may offer a new direction for research of CHF.

Relevance of B-Lines on Lung Ultrasound in Volume Overload and Pulmonary Congestion: Clinical Correlations and Outcomes in Patients on Hemodialysis

Background: Volume overload in patients on hemodialysis (HD) is an independent risk factor for cardiovascular mortality. B-lines detected on lung ultrasound (BLUS) assess extravascular lung water. This raises interest in its utility for assessing volume status and cardiovascular outcomes. Methods: End-stage renal disease patients on HD at the Island Rehab Center being older than 18 years were screened. Patients achieving their dry weight (DW) had a lung ultrasound in a supine position. Scores were classified as mild (0-14), moderate (15-30), and severe (>30) for pulmonary congestion. Patients with more than 60 were further classified as very severe. Patients were followed for cardiac events and death. Results: 81 patients were recruited. 58 were males, with a mean age of 59.7 years. 44 had New York Heart Association (NYHA) class 1, 24 had class 2, and 13 had class 3. In univariate analysis, NYHA class was associated with B-line classes (<0.001) and diastolic dysfunction (0.002). In multivariate analysis, NYHA grade strongly correlated with B-line classification (0.01) but not with heart function (0.95). 71 subjects were followed for a mean duration of 1.19 years. 9 patients died and 20 had an incident cardiac event. A Kaplan-Meier survival analysis demonstrated an interval decrease in survival times in all-cause mortality and cardiac events with increased BLUS scores (p = 0.0049). Multivariate Cox regression analysis showed the independent predictive value of BLUS class for mortality and cardiac events with a heart rate of 2.98 and 7.98 in severe and very severe classes, respectively, compared to patients in the mild class (p = 0.025 and 0.013). Conclusion: At DW, BLUS is an independent risk factor for death and cardiovascular events in patients on HD.

Assessment of ventricular systolic synchrony and ventricular function with gated myocardial perfusion imaging in patients with chronic heart failure

Objective To retrospectively analyze the cardiac systolic synchrony and cardiac function in patients with chronic heart failure (CHF) by gated SPECT myocardial perfusion imaging (GSMPI). Methods (1) From January 2010 to February 2015, 123 cases including 82 CHF patients (57 males, 25 females, age (59.5±11.0) years) and 41 healthy people (control group; 27 males, 14 females, age (33.8±5.2) years) were enrolled in this retrospective study. According to the New York Heart Association (NYHA) classification, the CHF patients were classified into grade Ⅰ-Ⅳ groups. The systolic synchrony and cardiac functional parameters including PHB, PSD, LVEF, EDV, summed rest scores (SRS) were acquired by Emory Cardiac Toolbox software. Differences of PHB, PSD and LVEF were compared between the CHF group and the control group using two-sample t test. The difference among the four CHF groups was compared by one-way analysis of variance. The difference of some clinical factors was compared between the two groups with and without damage of systolic synchrony. The relationship between the cardiac synchrony and myocardial perfusion was analyzed by Pearson correlation analysis. Results There was no obvious difference of PHB and PSD between the grade Ⅰ CHF patients and the control group (t=-1.502 and -0.448, both P>0.05), while LVEF was significant different (t=10.419, P<0.05). Significant difference of PHB, PSD and LVEF existed between the grade Ⅱ-Ⅳ CHF patients and the control group (t values: from -27.250 to 32.723, all P<0.05). There were significant differences of PHB, PSD and LVEF among the 4 CHF groups (F=118.05, 4.13 and 154.37; all P<0.05). The differences of LVEF, EDV and SRS were significant between the patients with and without damage of systolic synchrony (t=9.57, 10.85, 18.87, all P<0.05). The ratios of damage in systolic synchrony in grade Ⅰ-Ⅳ CHF patients were 8.7% (2/23), 60.0%(12/20), 15/18 and 100% (21/21), respectively. PHB and PSD were both positively correlated with SRS (r=0.808 and 0.773, both P<0.05). Conclusions The damage of systolic synchrony are getting severer from patients with NYHA grade Ⅱ to patients with NYHA grade Ⅳ. The damage could be accompanied by the heart failure progression. Diabetes mellitus, LVEF, EDV, ESV, and SRS are related to the damage. The myocardial perfusion damage is positively correlated with the damage of cardiac systolic synchrony. GSMPI is useful to early diagnosis and treatment of heart failure. Key words: Heart failure; Myocardial contraction; Ventricular function; Myocardial perfusion imaging; Tomography, single-photon, emission-computed; Technetium Tc 99m sestamibi

Relationship between anesthetic factor and intestinal injury in patients undergoing cardiac surgery with cardiopulmonary bypass: a comparison of propofol- versus sevoflurane-based anesthesia

Objective To investigate the relationship between anesthetic factors and intestinal injury in the patients undergoing elective cardiac surgery with cardiopulmonary bypass (CPB). Methods Ninety American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of both sexes, aged 18-64 yr, with New York Heart Association grade Ⅱ or Ⅲ, undergoing elective cardiac surgery with CPB, were divided into 2 groups(n=45 each) using a random number table: propofol-based anesthesia group (group P) and sevoflurane-based anesthesia group (group S). CPB was established routinely after anesthesia induction.Before induction (T0), immediately after aortic unclamping (T1), at 30 min after aortic unclamping (T2) and at 2 h after discontinuation of CPB (T3), blood samples were collected from the radial artery for determination of the plasma endotoxin, D-lactic acid, diamine oxidase (DAO) and intestinal fatty acid-binding protein (I-FABP) concentrations (by enzyme-linked immunosorbent assay) and plasma interleukin-6 (IL-6), IL-8 and tumor necrosis factor-alpha (TNF-α) concentrations (using radio-immunity method). Results Compared with the baseline at T0, the concentrations of plasma endotoxin, D-lactic acid, DAO, TNF-α, IL-6, IL-8 and I-FABP were significantly increased at T1-T3 in both groups (P<0.05). Compared with group P, the concentrations of plasma endotoxin, D-lactic acid, DAO, TNF-α, IL-6, IL-8 and I-FABP were significantly decreased at T1-T3 in group S(P<0.05). Conclusion Anesthetic factors are related to intestinal injury in patients undergoing cardiac surgery with CPB.Compared with propofol-based anesthesia, sevoflurane-based anesthesia is helpful in reducing the inflammatory response and in decreasing the degree of intestinal injury and is more suitable for the cardiac surgery with CPB. Key words: Anesthesia, general; Propofol; Cardiopulmonary bypass; Intestinal mucosa; Wounds and injuries; Sevoflurane