Association of Sex With Cardiovascular Outcomes in Heart Failure Patients With Obstructive or Central Sleep Apnea.

BACKGROUND: This study investigated the association of sex with cardiovascular outcomes in a prospective cohort of patients with heart failure (HF) with obstructive sleep apnea or central sleep apnea. METHODS AND RESULTS: Patients were screened for sleep apnea on admission using multichannel cardiopulmonary monitoring from May 2015 to July 2018. The primary outcome was a composite of cardiovascular death or unplanned hospitalization for worsening HF. Ultimately, 453 patients with HF with obstructive sleep apnea or central sleep apnea were included; 71 (15.7%) and 382 (84.3%) were women and men, respectively. During a median follow-up of 2.33 years, 248 (54.7%) patients experienced the primary outcome. In the overall population, after adjusting for potential confounders, women had an increased risk of the primary outcome (66.2% versus 52.6%; hazard ratio [HR], 1.47 [95% CI, 1.05-2.04]; P=0.024) and HF rehospitalization (62.0% versus 46.6%; HR, 1.55 [95% CI, 1.10-2.19]; P=0.013) compared with men but a comparable risk of cardiovascular death (21.1% versus 23.3%; HR, 0.78 [95% CI, 0.44-1.37]; P=0.383). Likewise, in patients with HF with obstructive sleep apnea, women had a higher risk of the primary outcome (81.8% versus 46.3%, HR, 2.37 [95% CI, 1.28-4.38]; P=0.006) and HF rehospitalization (81.8% versus 44.7%, HR, 2.46 [95% CI, 1.32-4.56], P=0.004). However, in patients with HF with central sleep apnea, there was no statistically significant difference between women and men. CONCLUSIONS: In hospitalized patients with HF, female sex was associated with an increased risk of the primary outcome and HF rehospitalization, especially in those with obstructive sleep apnea. Screening for sleep apnea should be emphasized to improve the prognosis. REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02664818.

Prediction of effluent total nitrogen and energy consumption in wastewater treatment plants: Bayesian optimization machine learning methods.

The control of effluent total nitrogen (TN) and total energy consumption (TEC) is a key issue in managing wastewater treatment plants. In this study, effluent TN and TEC predictive models were established by selecting influent water quality and process control indicators as input features. The prediction performance of machine learning methods under different random seeds was explored, the moving average method was used for data amplification, and the Bayesian algorithm was used for hyperparameter optimization. The results showed that compared with the traditional hyperparameter optimization method for effluent TN prediction, the coefficient of determination (R2) increased by 0.092 and 0.067, reaching 0.725, and the root mean square error (RMSE) decreased by 0.262 and 0.215 mg/L, reaching 1.673 mg/L, respectively, after Bayesian optimization and data amplification. During TEC prediction, R2 increased by 0.068 and 0.042, reaching 0.884, and the RMSE decreased by 232.444 and 197.065 kWh, reaching 1305.829 kWh, respectively.

Association of hypoxic burden metrics with cardiovascular outcomes in heart failure and sleep-disordered breathing.

AIMS: Heart failure (HF) and sleep-disordered breathing (SDB) frequently coexist. We aimed to compare the prognostic value of different nocturnal hypoxic burden metrics in hospitalized HF patients. METHODS AND RESULTS: HF patients underwent polygraphy screening for SDB in this prospective cohort. Hypoxic burden metrics assessed using pulse oximetry included time < 90% oxygen saturation (T90), proportion of total recording time < 90% oxygen saturation (TRT90), oxygen desaturation index (ODI), and mean oxygen saturation (meanSO2 ). The prespecified endpoints were the composite of cardiovascular death or admission for worsening HF. This study included 764 hospitalized HF patients, 16.5% and 36.6% of whom had obstructive and central sleep apnoea, respectively. With a median follow-up time of 2.2 years, endpoint events occurred in 410 (53.7%) patients. In univariate and multivariate analyses, T90, TRT90, and meanSO2 were substantially associated with the composite outcome, whereas ODI was not. After multivariate Cox model adjustment, patients with 5.0 ≤ T90 ≤ 52.0 min [hazard ratio (HR) 1.32, 95% confidence interval (CI): 1.02-1.71, P = 0.034] or T90 > 52.0 min (HR 1.56, 95% CI: 1.21-2.02, P = 0.001) had a greater risk of the composite outcome than those with T90 < 5.0 min. The TRT90 and T90 results were similar. Compared with meanSO2  > 95%, meanSO2  < 93% (HR 1.47, 95% CI: 1.16-1.88, P = 0.002) was correlated with adverse outcomes. CONCLUSIONS: The hypoxic burden metrics T90, TRT90, and meanSO2 , but not ODI, were independent predictors of cardiovascular death or readmission for worsening HF. Indicators of duration and severity, not just the frequency of nocturnal hypoxaemia, should be valued and considered for intervention to improve outcomes in HF patients.

Prevalence, clinical characteristics, and predictors of sleep disordered breathing in hospitalized heart failure patients.

BACKGROUND: Heart failure (HF) is often comorbid with sleep disordered breathing (SDB). This prospective study investigated the prevalence, clinical characteristics, and predictors of SDB in hospitalized HF patients. METHODS: Sleep studies were performed on hospitalized HF patients from January 2015 to February 2019. SDB was categorized as no/mild SDB, obstructive sleep apnea (OSA), and central sleep apnea (CSA). RESULTS: The study included 1069 hospitalized HF patients. The prevalence rates of OSA and CSA were 16.6% and 36.9%, respectively. Patients with OSA or CSA were more likely to be male and have a higher body mass index (BMI) and more comorbidities. Multivariate logistic regression analysis showed that male sex (odds ratio [OR] = 1.803, 95% confidence interval  [CI] = 1.099-2.958), BMI (per 5 kg/m2 increase: OR = 2.270, 95% CI = 1.852-2.783), hypertension (OR = 2.719, 95% CI = 1.817-4.070), diabetes (OR = 1.477, 95% CI = 1.020-2.139), and left ventricular ejection fraction (LVEF) (per 5% increase, OR = 1.126, 95% CI = 1.053-1.204) were independent predictors of OSA. Male sex (OR = 1.699, 95% CI = 1.085-1.271), age (per 10 years, OR = 1.235, 95% CI = 1.118-1.363), heart rate (per 10 bpm, OR = 1.174, 95% CI = 1.099-2.958), LVEF (per 5% increase, OR = 0.882, 95% CI = 0.835-0.932), NT-proBNP (lnNT-proBNP, OR = 1.234, 95% CI = 1.089-1.398) and hypocapnia (OR = 1.455, 95% CI = 1.105-1.915) were independent predictors of CSA. The areas under the receiver operating characteristic curves were 0.794 (95% CI = 0.758-0.830) and 0.673 (95% CI = 0.640-0.706), respectively. CONCLUSIONS: More than half of hospitalized HF patients had OSA or CSA, and CSA was the predominant type. OSA and CSA predictors differ. The clinical characteristics of HF patients can help make preliminary predictions for SDB patients.

Prediction of all-cause mortality with malnutrition assessed by nutritional screening and assessment tools in patients with heart failure：a systematic review.

BACKGROUND AND AIMS: In the absence of a gold standard or scientific consensus regarding the nutritional evaluation of heart failure (HF) patients, this study aimed to summarize and systematically evaluate the prognostic value of nutritional screening and assessment tools used for all-cause mortality in HF patients. METHODS AND RESULTS: Relevant studies were retrieved from major databases (PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), WanFang Data, and China Biology Medicine disc (CMB)) and searched from the earliest available date until July 2021. If three or more studies used the same tool, meta-analysis using RevMan 5.3 was performed. This systematic review was registered at PROSPERO (number CRD42021275575). A total of 36 articles involving 25,141 HF patients were included for qualitative analysis and 31 studies for quantitative analysis. Meta-analysis of these studies indicated, poor nutritional status evaluated by using 5 nutritional screening tools (Prognostic Nutritional Index (PNI), Geriatric Nutritional Risk Index (GNRI), Controlling Nutritional Status Score (CONUT), Nutritional Risk Index (NRI), and Short Form Mini Nutritional Assessment (MNA-SF)) or 2 nutritional assessment tools (the Mini Nutritional Assessment (MNA) and Generated Subjective Global Assessment (SGA)) predicted all-cause mortality in HF patients. Of all tools analyzed, MNA had the maximum HR for mortality [HR = 2.62, 95%CI 1.11-6.20, P = 0.03] and MNA-SF [HR = 1.94, 95%CI 1.40-2.70, P＜0.001] was the best nutritional screening tools. CONCLUSION: Poor nutritional status predicted all-cause mortality in HF patients. MNA may be the best nutritional assessment tool, and MNA-SF is most recommended for HF patient nutritional screening. The application value of MNA, especially in patients with reduced left ventricular ejection fraction (LVEF), needs to be further confirmed. The clinical application value of Mini-Nutrition Assessment Special for Heart Failure (MNA-HF) and Global Leadership Initiative on Malnutrition (GLIM) in HF patients needs to be confirmed.

Prognostic value of sleep apnea and nocturnal hypoxemia in patients with decompensated heart failure.

BACKGROUND: Nocturnal hypoxemia is an important factor underlying the impact of sleep apnea on heart failure. It remains unclear whether nocturnal hypoxemia has a greater prognostic value in acute decompensated heart failure (ADHF) compared with the frequency of sleep apnea. HYPOTHESIS: Nocturnal hypoxemia might be better than the frequency of sleep apnea in predicting the outcomes in ADHF. METHODS: Sleep studies were prospectively performed during an ADHF hospitalization from January 2015 to December 2017. Sleep apnea was defined as the apnea-hypopnea index (AHI) ≥15/h. The severity of nocturnal hypoxemia was determined by the percentage of time with saturation below 90% (T90%). The endpoint was the first event of all-cause death, heart transplantation, implantation of left ventricular assist device, unplanned hospitalization for worsening heart failure, acute coronary syndrome, significant arrhythmias, or stroke. RESULTS: Of 382 patients, 189 (49.5%) had sleep apnea. The endpoint incidence did not differ between AHI categories (≥15/h vs <15/h: 52.4% vs 44.6%, log rank P = .353), but did between T90% categories (≥3.6% vs <3.6%: 54.5% vs 42.4%, log rank P = .023). Multivariate Cox regression analysis showed that T90% was independently associated with the endpoint (hazard ratio [HR] 1.008, 95% confidence interval [CI] 1.001-1.016, P = .033), whereas AHI was not; the risk of the endpoint increased by 40.8% in patients with T90% ≥3.6% (HR 1.408, 95%CI 1.030-1.925, P = .032). CONCLUSION: Nocturnal hypoxemia had a greater prognostic value in ADHF than the frequency of sleep apnea.

[Fast Start-up and Performance of the CANON Process Based on a SBAF Systemand Evolution Properties of Microorganisms].

The CANON process has the disadvantages of long start-up periods and unstable operation. In the SBAF system, under strictly controlled conditions of dissolved oxygen (DO) and temperature, a CANON process is started up in 51 days and is operated stably for 278 days using a new method of independent research and development. The results show that the maximum and average ARR are 98.9% and 95.1%, respectively. The maximum and average TNR are 85.9% and 75.1%, respectively. Furthermore, a small quantity of nitratenitrogen exists in this system. The microbial structure features of the sludge are analyzed by 16S rDNA macro high-throughput genome sequencing. It is verified that Proteobacteria is the main microorganism in the AOB, and Planctomycete Candidatus Brocadia is the main microorganism in the AnAOB. Both of them collaborate on total nitrogen removal in the CANON process.

[Fast Start-up of SBAF System Assisted CANON Process and the Microbial Analysis].

Long period start-up is one of the main restraining factors of the single-stage completely autotrophic nitrogen removal over nitrite (CANON) process.This study investigated the fast start-up of the CANON process initiated by a submerged biological aerated filter (SBAF) method.With conventional activated sludge from the secondary sedimentation tank of municipal waste water treatment plants as the seed sludge,the CANON process was successfully started up after the acclimation of sludge microorganisms for 48 days under the experimental conditions of (30±2)℃,organic carbon free and controlled dissolved oxygen (stage Ⅰ:0.3-0.5mg·L-1;stage Ⅱ-Ⅳ:0.1-0.2mg·L-1),with the maximum removal rates of ammonia nitrogen and total nitrogen achieved at 99.9% and 86.5%,respectively.The population structure characteristics of microorganisms in the system were studied using high-throughput sequencing of 16S rDNA amplicon.The results demonstrated that the two dominant microbial strains in the system were Proteobacteria and Planctomycetes,accounting for 26.6% and 17.8%,respectively.The major contributors of nitrogen removal were Nitrosomonas in ß-Proteobacteria and Candidatus brocadia in Brocadiae.Through the above experiments,it was revealed that the investigated SBAF based CANON possesses had the advantages of fast start-up,efficient biological nitrogen removal and stable operation process.

[Enhanced Treatment of Printing and Dyeing Wastewater Using H2O2-Biochemical Method].

The traditional biochemical treatment of printing and dyeing wastewater has limited efficiency. This study investigated whether H2O2 could strengthen the biological ability of the hydrolytic acidification/biological contact oxidation process (A/O), which effectively treats the printing and dyeing wastewater. After biofilm formation and the biochemical system startup and operation by H2O2, the system was successfully started and steadily operated when H2O2was added into reactor A with the H2O2 voluve fraction of 3 mL·L-1, doses of 100.0 mL, the flow velocity of 0.67 mL·min-1, and dosing frequency of once a day. The experimental results showed that the average removal efficiencies of COD, ammonia nitrogen, PVA, and color of printing and dyeing wastewater were 89.8%, 96.7%, 87.4%, and 92.1%, respectively. The microorganism community structures of reactor A and reactor O in this system were analyzed by high-throughput sequencing of 16S rDNA amplicon. The results demonstrated that the three dominant microbial strains in reactor A were Proteobacteria, Bacteroidetes, and Verrucomicrobia, and in reactor O were Planctomycetes, Proteobacteria, and Acidobacteria.

[Plasma amino-terminal pro-brain natriuretic peptide level and affecting factors in a community-based healthy Chinese population].

OBJECTIVE: To investigate the plasma level of amino-terminal pro-brain natriuretic peptide (NT-proBNP) and related influencing factors in a community-based healthy population in Beijing area. METHODS: We measured plasma NT-proBNP level by fluoroimmunoassay between March 2012 and July 2012 from 1 034 healthy subjects (including 486 men and 548 women). Empiric method was used to determine the reference value and influencing factors were analyzed. RESULTS: Age and gender are important factors affecting the level of NT-proBNP in healthy subjects. NT-proBNP plasma level is significantly higher in women than in men within each age strata below 75 years old, i.e. < 45, 45-54, 55-64 and 65-74 years old (P = 0.005, 0.001, 0.001, 0.011 respectively), but NT-proBNP plasma level is similar between male and female older than 75 years (P = 0.504). NT-proBNP level also increases with age irrespective of gender. Body mass index (BMI) is another independent influencing factor of NT-proBNP (P < 0.001), while estimated glomerular filtration rate is not influencing factor. The reference range of NT-proBNP is < 133 ng/L for men and < 289 ng/L for women aged < 55 years old, < 185 ng/L for men and < 333 ng/L for women aged between 55 and 64 years old, and < 465 ng/L for men and < 378 ng/L for women aged ≥ 75 years old. CONCLUSION: The major influencing factors of NT-proBNP level in the healthy population are age, gender and BMI. It essential to establish normal reference range of NT-proBNP according to these factors for Chinese population.

The utility of galectin-3 for predicting cause-specific death in hospitalized patients with heart failure.

OBJECTIVES: Galectin-3 has been shown to be involved in the process of cardiac fibrosis and to predict adverse events in heart failure (HF), but the association of galectin-3 with cause-specific death has not been well established. The purpose of this study was to investigate the prognostic value of baseline galectin-3 for all-cause, cardiovascular (CV), and in-hospital death in patients with HF. METHODS AND RESULTS: From March 2009 to April 2013, we consecutively measured galectin-3 in a large cohort of 1,440 hospitalized patients with HF. Cox proportional hazards regression, discrimination, and reclassification analyses were used to evaluate the association between galectin-3 and death. During a median follow-up of 582 days, 283 deaths were identified, of which 64 were patients who died during hospitalization. Compared with the lowest galectin-3 tertile, the highest 2 tertiles were significantly associated with all-cause, CV, and progressive HF death, but not significant for sudden and in-hospital death when analyzed by multivariable Cox regression. The utility of combining galectin-3 and N-terminal pro-B-type natriuretic peptide was assessed by dichotomizing these 2 biomarkers according to their median values. The highest risk of death due to all-cause, CV, and progressive HF was observed when both biomarkers were elevated after adjustment for established risk factors. Addition of galectin-3 to the prediction model for all-cause and CV death significantly improved discrimination and reclassification. CONCLUSIONS: Galectin-3 independently predicted death and added additional prognostic value beyond established risk factors in hospitalized patients with HF. The utility of galectin-3 alone as a risk predictor was not strong enough to assess sudden or in-hospital death.

[Predict value of soluble ST2 on one-year mortality for hospitalized patients with chronic heart failure].

OBJECTIVE: To explore the predict value of plasma soluble ST2 (sST2) on one-year mortality for hospitalized patients with chronic heart failure (HF). METHODS: A total of 1 244 consecutive hospitalized patients admitted to Heart Failure Center Fuwai Hospital between March 2009 and July 2012 and with HF as their primary diagnosis were included. Plasma sST2 was measured in all patients and patients were followed up for 1 year, and the primary endpoint was defined as all-cause death. RESULTS: There were 193 deaths during follow up. sST2 concentrations at admission were positively correlated with NT-proBNP, NYHA functional class and heart rate, and negatively correlated with left ventricular ejection fraction, blood sodium, total cholesterol and glomerular filtration rate at admission. sST2 concentrations were significantly higher in non-survivors compared with survivors (P < 0.001). Multivariable Cox regression analyses showed that sST2 independently predicted 1-year mortality (per 1 log unit, hazard ratio 1.87, 95% confidence interval: 1.56 to 2.25, P < 0.001). In receiver operating characteristic analyses, the area under the curve for ST2 was 0.776 which was similar to that of N-terminal pro-B-type natriuretic peptide (NT-proBNP) (AUC = 0.775). The prognostic value was improved when combining these two biomarkers together (AUC = 0.813). CONCLUSIONS: sST2 concentration at admission is correlated with clinical and biochemical indexes and associated with 1-year mortality for hospitalized patients with HF.

[Cognitive function and factors related to cognitive function in hospitalized patients with chronic heart failure].

OBJECTIVE: To explore the cognitive function status and potential influence factors on cognitive function in hospitalized patients with chronic heart failure. METHODS: Using a cross-sectional research design, CHF patients (n = 267, mean age (63.8 ± 9.4) years) were recruited from two care units-Heart Failure Care Unit and Intensive Care Unit of our hospital. Cognitive function status was evaluated by the Montreal Cognitive Assessment (MoCA) screen test. RESULTS: Based on the MoCA score, 37.8% (101/267) patients suffered from cognitive impairment (score<26), especially on the three specific cognitive functions-memory, langue and executive capability. Multifactorial analysis showed that after controlling for other factors, there was a downward trend on cognitive function with aging (OR = 1.09, 95%CI:1.05-1.14) while higher left ventricular ejection fraction (LVEF) was related to better cognitive function (OR = 0.97, 95%CI:0.95-0.99); patients who took medicine regularly also had better cognitive function (OR = 3.71, 95%CI:1.40-10.91); cognitive function was better in patients with high level of social support compared those with low social support (OR = 0.92, 95%CI:0.88-0.96). CONCLUSIONS: Incidence of cognitive impairment is high in hospitalized patients with chronic heart failure. Age, LVEF, whether taking medication regularly and social support are factors related to cognitive function in CHF patients.

The prognostic value of plasma soluble ST2 in hospitalized Chinese patients with heart failure.

BACKGROUND: sST2 has been shown to be a risk predictor in heart failure (HF). Our aim was to explore the characteristics and prognostic value of soluble ST2 (sST2) in hospitalized Chinese patients with HF. METHODS AND RESULTS: We consecutively enrolled 1528 hospitalized patients with HF. Receiver operating characteristic (ROC) and multivariable Cox proportional hazards analysis were used to assess the prognostic values of sST2. Adverse events were defined as all-cause death and cardiac transplantation. During a median follow-up of 19.1 months, 325 patients experienced adverse events. Compared with patients free of events, sST2 concentrations were significantly higher in patients with events (P<0.001). Univariable and multivariable Cox regression analyses showed sST2 concentrations were significantly associated with adverse events (per 1 log unit, adjusted hazard ratio 1.52, 95% confidence interval: 1.30 to 1.78, P<0.001). An sST2 concentration in the highest quartiles (>55.6 ng/mL) independently predicted events in comparison to the lowest quartile (≤25.2 ng/mL) when adjusted by multivariable model. In ROC analysis, the area under the curve for sST2 was not different from that for NT-proBNP in short and longer term. Over time, sST2 also improved discrimination and reclassification of risk beyond NT-proBNP. CONCLUSIONS: sST2 is a strong independent risk predictor in Chinese patients hospitalized with HF and can significantly provide additional prognostic value to NT-proBNP in risk prediction.

[Clinical experience of supplying sodium chloride for the treatment of patients with severe heart failure].

OBJECTIVE: To observe the effect and safety of supplying sodium chloride in the treatment of patients with severe heart failure. METHODS: Consecutive 51 hospitalized patients with severe heart failure and cardiac edema were included in this study. Normal diet (6 g NaCl/d) was supplied to all patients. On the basis of controlling fluid intake and treating related etiological factors as well as standard medications including furosemide for severe heart failure, patients with mild hyponatremia (serum sodium level 130 - 134 mmol/L) ate additional salted vegetables, patients with moderate hyponatremia (serum sodium level 125 - 129 mmol/L) and severe hyponatremia (serum sodium level < 125 mmol/L) ate additional salted vegetables and were received additionally intravenous 3%NaCl hypertonic saline infusion (10 ml/h) until reaching normal serum sodium level. RESULTS: On admission, 37.25% (19/51) patients had hyponatremia. During the first two weeks hospitalization period, 88.24% (45/51) patients were treated with intravenous diuretics and total incidence of hyponatremia was 64.71% (33/51), mild hyponatremia was 50.98% (26/51), middle and severe hyponatremia was 13.73% (7/51); among them, hyponatremia lasted less than 3 d in 57.58% (19/33) patients and ≥ 3 d in 42.42% (14/33) patients. Heart failure exacerbation and hypernatremia were not observed in patients receiving additional sodium chloride therapy. Hospitalization time was similar among patients with different blood natrium levels [average (16 ± 12) d]. Fifty out of 51 (98%) patients discharged from the hospital with improved heart failure symptoms and signs. CONCLUSION: Supplying additional sodium chloride could rapid correct hyponatremia in heart failure patients with or without intravenous diuretics therapy which might contribute to a favorable prognosis in hospitalized heart failure patients.