Development and validation of a nomogram model for all-cause mortality risk in patients with chronic heart failure and atrial fibrillation.

BACKGROUND: As the global aging process continues to accelerate, heart failure (HF) has become an important cause of increased morbidity and mortality in elderly patients. Chronic atrial fibrillation (AF) is a major risk factor for HF. Patients with HF combined with AF are more difficult to treat and have a worse prognosis. The aim of this study was to explore the risk factors for 1-year mortality in patients with HF combined with AF and to develop a risk prediction assessment model. METHODS: We recruited hospitalized patients with HF and AF who received standardized care in the Department of Cardiology at Shengjing Hospital of China Medical University from January 2013 to December 2018. The patients were randomly divided into modeling and internal validation groups using a random number generator at a 1:1 ratio. Multivariate Cox regression analysis was used to identify risk factors for all-cause mortality during a one-year follow-up period. Then, a nomogram was constructed based on the weights of each index and validated. Receiver operating characteristic curve, the area under the curve (AUC), decision curve, and calibration curve analyses for survival were used to evaluate the model's predictive and clinical validities and calibration. RESULTS: We included 3,406 patients who met the eligibility criteria; 1,703 cases each were included in the modeling and internal validation groups. Eight statistically significant predictors were identified: age, sex, New York Heart Association cardiac function class III or IV, a history of myocardial infarction, and the albumin, triglycerides, N-terminal pro-b-type natriuretic peptide, and blood urea nitrogen levels. The AUCs were 0.793 (95% confidence interval: 0.763-0.823) and 0.794 (95% confidence interval: 0.763-0.823) in the modeling and validation cohorts, respectively. CONCLUSIONS: We present a predictive model for all-cause mortality in patients with coexisting HF and AF comprising eight key factors. This model gives clinicians a simple assessment tool that may improve the clinical management of these patients.

Safety and efficacy of His-Purkinje system pacing in the treatment of patients with atrial fibrillation and heart failure: a systematic review and meta-analysis.

Aim: To evaluate the safety and efficacy of the His-Purkinje system pacing (HPCSP) in the treatment of individuals with atrial fibrillation (AF) complicated by heart failure (HF). Methods: The PubMed, Cochrane Library, Web of Science, and Embase databases were searched through September 1, 2022. The literature was initially screened based on the inclusion and exclusion criteria. The baseline characteristics of the subjects, implantation success rate, New York Heart Association (NYHA) classification, left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDd), QRS duration, pacing threshold, and impedance were extracted and summarized; statistical analysis was performed using RevMan 5.3 software. Results: In all, 22 articles were included, involving 1,445 patients. Compared to biventricular pacing (BiVP), HPCSP resulted in improved cardiac function, including increased ejection fraction (MD = 5.69, 95% CI: 0.78-10.60, P = 0.02) and decreased LVEDd (MD = -3.50, 95% CI: -7.05-0.05, P = 0.05). It was also correlated with shorter QRS duration (MD = -38.30, 95% CI: -60.71--15.88, P < 0.01) and reduced all-cause mortality and rehospitalization events (RR = 0.72, 95% CI: 0.57-0.91, P < 0.01) in patients. Left bundle branch pacing (LBBP) lowered the pacing threshold (MD = 0.47; 95% CI: 0.25-0.69; P < 0.01), and there was no statistical difference in the rate of endpoint events when comparing these two physiologic pacing modalities (RR = 1.56, 95% CI: 0.87-2.80, P = 0.14). Conclusion: The safety and efficacy of HPCSP in patients with AF and HF were verified in this meta-analysis. HPCSP can reverse cardiac remodeling and has great clinical application value. Relatively speaking, His-bundle pacing (HBP) can maintain better ventricular electro-mechanical synchronization, and the pacing parameters of LBBP are more stable. Systematic Review Registration: PROSPERO (CRD42022336109).

Knockdown of Mmu-circ-0001380 Attenuates Myocardial Ischemia/Reperfusion Injury via Modulating miR-106b-5p/Phlpp2 Axis.

Myocardial ischemia/reperfusion (MI/R) injury induces myocardial damage and dysfunction. Increasing evidence has confirmed that circular RNAs (circRNAs) play crucial roles in regulating MI/R. Mmu-circ-0001380 has identified to be highly expressed in myocardium of MI/R mouse model. However, its biological function and molecular mechanism in MI/R injury are still unclear. Here, we demonstrated that knockdown of cric-0001380 attenuated myocardial injury of MI/R mice. In vitro, silence of circ-0001380 significantly enhanced viability, and inhibited apoptosis and oxidative stress in HL-1 cells under oxygen-glucose deprivation/reoxygenation (OGD/R). Mmu-miR-106b-5p interacted with circ-0001380, and suppressed the expression of pleckstrin homology domain and leucine rich repeat protein phosphatase 2 (Phlpp2). The miR-106b-5p/Phlpp2 axis mediated the effect of circ-0001380 on OGD/R-induced apoptosis through regulating the phosphorylation of p38, and further involved in regulating the viability and oxidative stress of HL-1 cells. In conclusion, circ-0001380 downregulation relieves MI/R injury via regulating the miR-106b-5p/Phlpp2 axis. The present study indicates that mmu-circ-0001380 exacerbates the myocardial ischemia/reperfusion injury through modulating the miR-106b-5p/Phlpp2 axis in vitro and in vivo.

Influence of the physical properties of the layered oxyselenides Bi2YO4Cu2Se2 through Ni doping.

We have synthesized a series of Ni-doped layered oxyselenides Bi2YO4Cu2-xNixSe2 (0 ≤ x ≤ 0.4). The crystal structure and physical properties were studied through X-ray diffraction, and electric and thermo transport measurements. We also performed DFT calculations to study the electric structure of the designed Bi2YO4Ni2Se2, which is similar to that of KNi2Se2.

Effects of Empagliflozin on Gut Microbiota in Heart Failure with a Preserved Ejection Fraction: The Design of a Pragmatic Randomized, Open-Label Controlled Trial (EMPAGUM).

Although empagliflozin has been recommended for individuals with heart failure, its effects on heart failure with preserved ejection fraction (HFpEF) remain uncertain from a physiopathological standpoint. The metabolites produced by gut microbiota have been shown to have a crucial role in the development of heart failure. Sodium-glucose cotransporter-2 inhibitors (SGLT2) have been shown to change the make-up of the gut microbiota in rodent studies. There is mixed evidence from similar studies investigating whether or not SGLT2 can affect the microbiota in the human gut. This trial is a pragmatic, randomized, open-label controlled study with empagliflozin as an intervention. We will enroll 100 patients with HFpEF and randomly assign them to one of two groups to receive either empagliflozin or a placebo. Patients in the Empagliflozin group will be given 10 mg of the drug daily, while those in the Control group will not be given empagliflozin or any other SGLT2. The purpose of the trial is to validate the changes that occur in gut microbiota in patients with HFpEF who take empagliflozin and to investigate the function of gut microbiota and their metabolites in the process.

Triglyceride glucose index and its combination with the Get with the Guidelines-Heart Failure score in predicting the prognosis in patients with heart failure.

Background: Heart failure (HF) is associated with generalized insulin resistance (IR). Recent studies demonstrated that triglyceride glucose (TyG) is an effective alternative index of IR. However, the relationship between the TyG index and in-hospital mortality in patients with HF is unclear. In the present study, we aimed to clarify the association between the TyG index and in-hospital mortality in patients with HF. Methods: A retrospective study consisting of 4,411 patients diagnosed with HF from 2015 to 2018 was conducted. All-cause mortality during hospitalization was the primary endpoint. The association between the TyG index and in-hospital mortality was assessed using the logistic regression analysis. Results: The risk of in-hospital mortality was significantly associated with increased TyG index (OR: 1.886, 95% CI: 1.421-2.501, p < 0.001) under logistic regression with multivariable adjustment. When divided into three groups based on the TyG index, Tertile 3 demonstrated significantly higher in-hospital mortality than the other two Tertiles (OR: 2.076, 95% CI: 1.284-3.354, p = 0.001). Moreover, the TyG index improved the prediction efficiency of the Get with the Guidelines-Heart Failure (GWTG-HF) score (absolute integrated discrimination improvement = 0.006, p < 0.001; category-free net reclassification improvement = 0.075, p = 0.005). In subgroup analysis, the TyG index exhibited similar predictive performance of in-hospital mortality when groups were stratified based on type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD). Conclusion: TyG is a potential index for predicting in-hospital mortality in patients with HF, independent of T2DM or CAD status. The TyG index may be combined with the GWTG-HF score to further improve its predictive efficacy.

Value of FT3/FT4 Ratio in Prognosis of Patients With Heart Failure: A Propensity-Matched Study.

Aims: Abnormal thyroid hormone secretions can alter the manifestation and prognosis of cardiovascular disease. To assess the effect of the free triiodothyronine (FT3)/free thyroxine (FT4) ratio on the prognosis of patients with heart failure (HF), we performed a propensity-matched study on patients with well-balanced baseline characteristics. Methods: Overall, 8,887 patients with HF were divided into two groups according to the FT3/FT4 ratio. Propensity scores were calculated from each patient. A cohort comprising 2,164 pairs with high or low ratios and with 34 well-balanced baseline characteristics was then assembled. The endpoints were Cardiovascular (CV) mortality and all-cause mortality. The correlation between FT3/FT4 ratio and prognosis was assessed using matched Cox regression analyses. The mean follow-up was 3.3 years. Results: In the full pre-match cohort, 3,710 (41.7%) patients died, with 2,581 (29.0%) cases of CV mortality. In the matched-pair cohort, all-cause mortality occurred in 923 (1,238/10,000 person-years of follow-up) patients with a high ratio and 1,036 (1,484/10,000 person-years) patients with a low ratio, resulting in a matched HR of 0.841 (95% CI: 0.769-0.919; P < 0.001). For CV mortality, the result was 638 (856/10,000 person-years) and 714 (1,023/10,000 person-years) patients, respectively, resulting in a matched HR of 0.844 (95% CI: 0.759-0.940; P < 0.001). Subgroup analysis revealed that a low FT3/FT4 ratio had a greater predictive value for all-cause and CV mortality in elderly or male patients and in patients with coronary artery disease (CAD), hypertension, diabetes mellitus, HFmrEF, or HFpEF. Conclusions: A low FT3/FT4 ratio is valuable for predicting CV mortality and all-cause mortality in patients with HF.

Value of the Neutrophils/Prealbumin Ratio and Its Combination With the GWTG-HF Score in Predicting In-Hospital Mortality in Patients With Heart Failure.

Heart failure (HF) is considered to be a chronic inflammatory disease. Under malnutrition, inflammation can worsen and lead to a poor prognosis. In previous studies, neutrophils and prealbumin can be used as sensitive indicators of inflammatory and nutritional status. In the present study, we aimed to clarify the association between neutrophils/prealbumin ratio (NPR) and in-hospital mortality in patients with HF. We set up a retrospective study which was consisted of 9,687 patients who were diagnosed with HF from 2013 to 2018. NPR was analyzed by continuous variable, as well as the form of category. All-cause mortality during hospitalization was the primary end point. Under logistic regression multivariable adjustment, the risk of in-hospital mortality was significantly associated with increased NPR (odds ratio 1.064, 95% confidence interval [CI] 1.043 to 1.086, p <0.001), followed by those in the Tertile 3 group (NPR>3.13) (odds ratio 5.695, 95% CI 3.524 to 9.204, p <0.001). The C-statistic for NPR was 0.783 (95% CI 0.775 to 0.791, p <0.001). Compared with get with The Guidelines - Heart Failure (GWTG-HF) score, NPR has a better prediction efficiency under C-statistic (z = 3.695, p = 0.002). Moreover, NPR can improve the prediction efficiency of the GWTG-HF score (GWTG-HF score+NPR vs GWTG-HF score: z = 8.757, p <0.001; integrated discrimination improvement = 0.0163, p <0.001; net reclassification improvement = 0.4441, p <0.001). In conclusion, NPR was an independent prognosticator of in-hospital mortality in patients with HF. NPR has better prediction efficiency than the GWTG-HF score, and NPR can improve the prediction efficiency of the GWTG-HF score.

Prognostic impact of albumin-bilirubin score on the prediction of in-hospital mortality in patients with heart failure: a retrospective cohort study.

OBJECTIVES: Liver dysfunction is prevalent in patients with heart failure (HF) and can lead to poor prognosis. The albumin-bilirubin (ALBI) score is considered as an effective and convenient scoring system for assessing liver function. We analysed the correlation between ALBI and in-hospital mortality in patients with HF. DESIGN: A retrospective cohort study. SETTING AND PARTICIPANTS: A total of 9749 patients with HF (from January 2013 to December 2018) was enrolled and retrospectively analysed. MAIN OUTCOME MEASURES: The main outcome is in-hospital mortality. RESULTS: ALBI score was calculated using the formula (log10 bilirubin [umol/L] * 0.66) + (albumin [g/L] * -0.085), and analysed as a continuous variable as well as according to three categories. Following adjustment for multivariate analysis, patients which occurred in-hospital death was remarkably elevated in tertile 3 group (ALBI ≥2.27) (OR 1.671, 95% CI 1.228 to 2.274, p=0.001), relative to the other two groups (tertile 1: ≤2.59; tertile 2: -2.59 to -2.27). Considering ALBI score as a continuous variable, the in-hospital mortality among patients with HF increased by 8.2% for every 0.1-point increase in ALBI score (OR 1.082; 95% CI 1.052 to 1.114; p<0.001). The ALBI score for predicting in-hospital mortality under C-statistic was 0.650 (95% CI 0.641 to 0.660, p<0.001) and the cut-off value of ALBI score was -2.32 with a specificity of 0.630 and a sensitivity of 0.632. Moreover, ALBI score can enhance the predictive potential of NT-pro-BNP (NT-pro-BNP +ALBI vs NT-pro-BNP: C-statistic: z=1.990, p=0.0467; net reclassification improvement=0.4012, p<0.001; integrated discrimination improvement=0.0082, p<0.001). CONCLUSIONS: In patients with HF, the ALBI score was an independent prognosticator of in-hospital mortality. The predictive significance of NT-proBNP +ALBI score was superior to NT-proBNP, and ALBI score can enhance the predictive potential of NT-proBNP.

Risk prediction model of in-hospital mortality in heart failure with preserved ejection fraction and mid-range ejection fraction: a retrospective cohort study.

Aim: To develop and validate internally a multivariate risk model for predicting the in-hospital mortality of patients with heart failure with preserved ejection fraction (HFpEF) and heart failure with mid-range ejection fraction (HFmrEF). Methods & results: The clinical data of 8172 inpatients with HFpEF and HFmrEF was used to establish a retrospective database. These patients, among whom 307 in-hospital deaths (3.8%) occurred, were randomly assigned to derivation and verification cohort. Among the extracted data from the derivation cohort were nine variables significantly related to in-hospital mortality, which were scored 0-4, for a total score of 24, which allowed formation of a risk predictive model. The verification cohort was then used to validate the discrimination and calibration capacities of this predictive model: the area under curve equaled 0.8575 (0.8285, 0.8865) for the derivation cohort, and 0.8323 (0.7999, 0.8646) for the verification cohort. According to this risk score, we divided patients into four risk classes (low-, medium-, high- and extremely high-risk) and revealed that the risk of in-hospital mortality increased with increasing risk class with an obvious linear relationship between actual and predicted mortality (r = 0.998, p < 0.001). Conclusion: The model based on nine common clinical variables should provide an accurate prediction of in-hospital mortality and appears to be a reliable risk classification system for patients with HFpEF and HFmrEF.

Predictive Value of the Serum Cystatin C/Prealbumin Ratio in Combination With NT-proBNP Levels for Long-Term Prognosis in Chronic Heart Failure Patients: A Retrospective Cohort Study.

Aim: The present study was established to investigate the use of the serum cystatin C/prealbumin (Cys-C/PAB) ratio as a predictive factor for long-term prognosis in patients with chronic heart failure. Methods: We divided our retrospective cohort of 6,311 patients admitted to hospital due to an episode of heart failure (HF) into three groups according to the Cys-C/PAB ratio. The endpoints were cardiovascular and all-cause mortality. Median follow-up time were 3.3 years (2-8 years), during which 2,945 (46.7%) patients died. Results: The Cys-C/PAB ratio was revealed to be an independent predictor of cardiovascular mortality (HR: 1.12, 95% CI: 1.15-1.23, P < 0.01) and all-cause mortality (HR: 1.19, 95% CI: 1.13-1.24, P < 0.01) by multivariable Cox analysis. Integrated discrimination improvement (IDI) showed that the Cys-C/PAB ratio in conjunction with the level of N-terminal pro-B-type natriuretic peptide (NT-proBNP) conferred a significant improvement in predicting individual risks of cardiovascular (P = 0.023) and all-cause (P = 0.028) mortality. For those with a high Cys-C/PAB ratio in combination with a high NT-proBNP level, the long-term cardiovascular mortality risk ratio was 8.6-times higher than for those with low values, and 7.51-times for all-cause mortality. Our study also showed that Cys-C/PAB and NT-proBNP in combination displayed higher value for the prediction of cardiovascular and all-cause in-hospital mortality in patients with HF. Conclusions: The Cys-C/PAB ratio is valuable for predicting cardiovascular and all-cause mortality in patients with HF and offers additional information to that provided by NT-proBNP.

Expression profiles of long noncoding RNAs and messenger RNAs in the border zone of myocardial infarction in rats.

BACKGROUND: The participation of long noncoding RNAs (lncRNAs) in myocardial infarction has recently been noted. However, their underlying roles in the border zone of myocardial infarction remain unclear. This study uses microarrays to determine the profiles of lncRNAs and mRNAs in the border zone. METHODS: Bioinformatics methods were employed to uncover their underlying roles. Highly dysregulated lncRNAs was further validated via PCR. RESULTS: Four hundred seven lncRNAs and 752 mRNAs were upregulated, while 132 lncRNAs and 547 mRNAs were downregulated in the border zone of myocardial infarction. A circos graph was constructed to visualize the chromosomal distribution and classification of the dysregulated lncRNAs and mRNAs. The upregulated mRNAs in the border zone were most highly enriched in cytokine activity, binding, cytokine receptor binding and related processes, as ascertained through Go analysis. Pathway analysis of the upregulated mRNAs showed the most significant changes were in the TNF signaling pathway, cytokine-cytokine receptor interaction and chemokine signaling pathway and similar pathways and interactions. An lncRNA-mRNA co-expression network was established to probe into the underlying functions of the 10 most highly dysregulated lncRNAs based on their co-expressed mRNAs. In the co-expression network, we found 16 genes directly involved in myocardial infarction, including Alox5ap, Itgb2 and B4galt1. The lncRNAs AY212271, EF424788 and MRAK088538, among others, might be associated with myocardial infarction. BC166504 is probably a key lncRNA in the border zone of myocardial infarction. CONCLUSIONS: The results may have revealed some aberrantly expressed lncRNAs and mRNAs that contribute to the underlying pathophysiological mechanisms of myocardial infarction.

Recanalizing left anterior descending artery chronic total occlusion with reverse controlled antegrade and retrograde tracking technology through epicardial collateral.

During recent years, the reverse controlled antegrade and retrograde tracking (CART) technique has become the dominant retrograde wire crossing technique. When the retrograde guiding wire cannot pass the occlusive lesions or the guiding wire is difficult to kiss, the reverse CART technique can significantly shorten the operation time and greatly improve the success rate of the operation. In this case we succeeded in recanalizing a chronic total occlusion (CTO) lesion with reverse CART for a patient diagnosed with old myocardial infarction (OMI).

[The prognostic value of serum albumin for in-hospital mortality in patients with heart failure basing on propensity score matching].

OBJECTIVE: To analyze the prognostic value of serum albumin for in-hospital mortality in patients with heart failure. METHODS: A total of 2 430 consecutive heart failure patients aged at (68±14) years were enrolled in the study. Patients were divided into 2 groups according to serum albumin concentration on admission: the normoalbuminemia group (≥35 g/L) and the hypoalbuminemia group (<35 g/L). Propensity score matching was conducted to reduce confounding bias between the groups. Cox proportional-hazards regression models were used to evaluate the prognostic value of serum albumin for in-hospital mortality in patients with heart failure before and after matching. RESULTS: Compared with those in the normoalbuminemia group, subjects in the hypoalbuminemia group were older, and had higher NYHA functional status and higher in-hospital mortality. More patients were diagnosed with dilated cardiomyopathy and valvular heart disease, and fewer were with hypertension in the hypoalbuminemia group than those patients in the normoalbuminemia group. Moreover, patients in this group presented with faster heart rate and lower systolic blood pressure than those in the normoalbuminemia group. They had higher levels of direct bilirubin, alkaline phosphatase, glutamyltranspetidase, creatinine, uric acid, urea, and B-type natriuretic peptide (BNP) and lower levels of hemoglobin, total cholesterol (TC), and serum sodium compared with subjects in the normoalbuminemia group. Left ventricular ejection fractions (LVEF) of patients were lower in the hypoalbuminemia group than those of patients in the normoalbuminemia group. More patients were of long-duration and treated with spirolactone. With protensity score matching, 631 pairs of patients were successfully matched. Before matching, the in-hospital mortality in normoalbuminemia group was 1.2% and that in hypoalbuminemia group was 5.7%. The multivariate Cox regression analysis indicated that the risk for in-hospital death in patients with heart failure was 12.0% greater for each 1 g/L decrement in albumin level after adjusted for all clinical factors (HR 1.120, 95% CI 1.057-1.186; P<0.001). The same held after matching. The in-hospital mortality in normoalbuminemia group was 2.9%, and that in hypoalbuminemia group was 5.7%. The multivariate Cox regression analysis showed that the risk for in-hospital death in patients with heart failure was 11.0% greater for each 1 g/L decrement in albumin level after adjusted for all clinical factors (HR 1.110, 95% CI 1.043-1.181; P=0.001). CONCLUSIONS: Serum albuminis is an independent risk factor for in-hospital mortality in patients with heart failure. Treatment of hypoalbuminemia may lower the in-hospital mortality in patients with heart failure.