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1.
Adv Exp Med Biol ; 1232: 385-392, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31893435

RESUMO

The primo-vascular system (PVS) is a newly identified vascular tissue composed of primo-nodes (PNs) and primo-vessels (PVs). Previously, we reported erythropoietic activity in the organ-surface PVS (osPVS) tissue of rats with heart failure. In this study, we further investigated whether acute anemia could induce erythropoiesis in the PVS of rats, based on the hypothesis that erythropoiesis in osPVS tissue is due to anemia accompanying heart failure. Acute anemia was induced by an intraperitoneal injection of phenylhydrazine (PHZ). Circulating red blood cells (RBCs) and hematocrit decreased by 31.6%, whereas reticulocytes and white blood cells increased at day 3 and day 6 after PHZ treatment. All these parameters recovered to control levels at day 10. At days 3 and 6, we observed an increase in the size of the PNs (P < 0.05), the number of the osPVS tissue samples per rat (P < 0.01), and the proportion of osPVS tissue samples with red chromophore (P < 0.001), which was from the RBCs in the PVS tissue. The number of RBCs, estimated from the PN sections stained with hematoxylin and eosin, increased at day 6 in the rats with anemia (P < 0.01). All these anemia-induced changes in the osPVS tissue recovered to the control levels by day 10. Taken together, the results showed that the morphological and cytological changes in the osPVS tissue appear to be related to the erythropoietic activity induced by acute anemia in rats. This study confirmed the previous findings that the osPVS can exert erythropoietic activity in disease states accompanied by anemia, such as heart failure.


Assuntos
Anemia , Eritropoese , Anemia/complicações , Anemia/patologia , Animais , Eritrócitos/citologia , Insuficiência Cardíaca/patologia , Hematócrito , Hematoxilina/metabolismo , Ratos
2.
JAMA ; 322(23): 2288-2289, 2019 12 17.
Artigo em Inglês | MEDLINE | ID: mdl-31846001
3.
Medicine (Baltimore) ; 98(50): e18331, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852127

RESUMO

This study assessed sex differences in cardiac and motor functions, quality of life (QoL), and mental status in Chinese chronic heart failure (CHF) patients after metoprolol treatment.This single-center prospective study, conducted from February 2013 to April 2016, included CHF patients (men and women) with resting heart rate (HR) >80 beats/min using metoprolol continuous release tablets. Metoprolol-induced changes in cardiac and motor functions, QoL, and mental status at 1, 3, 6, 9, and 12 months from baseline, within and between the sexes, were analyzed. Descriptive data were represented as counts, percentages, and mean ± standard deviation. Differences at various follow-up periods were compared using repeated measures one-way analysis of variance, followed by post hoc Dunnett's multiple comparison test. Statistical significance was considered at P < .05.Compared with men, women reported significantly higher systolic blood pressure (SBP) (122.28 ±â€Š6.76 vs 125.47 ±â€Š6.67 mm Hg, P < .05) and Veterans Specific Activity Questionnaire score (8.16 ±â€Š0.98 vs 8.47 ±â€Š0.89, P = .05) at 12 months. Men reported higher Hospital Anxiety and Depression Scale scores for depression than women at 1 month (10.27 vs 8.83, P < .05) and for anxiety at 12 months (8.4 vs 7.72, P < .05). Metoprolol significantly decreased HR and Minnesota Living with Heart Failure Questionnaire score in men (64.5 ±â€Š3.13 and 53.7 ±â€Š8.00) and women (65.38 ±â€Š3.32 and 53.85 ±â€Š8.42, respectively). Ejection fraction (%, men: 50.00 ±â€Š4.45, women: 50.72 ±â€Š4.09), cardiac index (L/min/m, men: 2.70 ±â€Š0.25, women: 2.78 ±â€Š0.23), 6-minute walk test distance (m, men: 414.41 ±â€Š20.84, women: 420.34 ±â€Š20.35), and short form-8 questionnaire scores (men: 52.05 ±â€Š1.94, women: 52.19 ±â€Š2.58) increased significantly in both the sexes (P < .001 for all) at 12 months. Copenhagen Burnout Inventory score significantly increased in men (mean score 62.43, P < .05).Metoprolol treatment improves cardiac and motor functions, QoL, and anxiety scores but causes greater depression and burnout in men and women. Sex was seen to affect mental status of CHF patients the most.


Assuntos
Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/psicologia , Metoprolol/uso terapêutico , Qualidade de Vida , Fatores Sexuais , Adulto , Idoso , Ansiedade/tratamento farmacológico , Ansiedade/etiologia , Grupo com Ancestrais do Continente Asiático/psicologia , China , Doença Crônica , Depressão/tratamento farmacológico , Depressão/etiologia , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Atividade Motora/efeitos dos fármacos , Estudos Prospectivos , Inquéritos e Questionários , Resultado do Tratamento
4.
Kardiologiia ; 59(10S): 64-72, 2019 Oct 07.
Artigo em Russo | MEDLINE | ID: mdl-31876463

RESUMO

AIM: To evaluate the effect of angiotensin-neprilysin receptor inhibitors on myocardial remodeling in patients with chronic heart failure and atrial fibrillation. MATERIALS AND METHODS: We studied dynamics of the parameters of ultrasound structural and functional parameters of the left atrium and left ventricle of the heart was during 3-month therapy with sacubitryl-valsartan in a group of 15 patients with a combination of chronic heart failure due to dilated and paroxysmal paroxysmal forms of atrial fibrillation. RESULTS: Showed a statistically significant positive effect of the use of angiotensin receptors and neprilysin inhibitors on the parameters of remodeling of the left atrium (according to transthoracic and transesophageal echocardiography), left ventricle, as well as levels of natriuretic peptides ANP and NT-pro-BNP. CONCLUSION: The use of ARNI may be promising in terms of treatment and prevention of AF in patients with heart failure.


Assuntos
Fibrilação Atrial , Insuficiência Cardíaca , Aminobutiratos , Humanos , Peptídeo Natriurético Encefálico , Neprilisina , Receptores de Angiotensina , Tetrazóis
5.
JAMA ; 322(23): 2292-2302, 2019 12 17.
Artigo em Inglês | MEDLINE | ID: mdl-31846016

RESUMO

Importance: Short-term infusions of single vasodilators, usually given in a fixed dose, have not improved outcomes in patients with acute heart failure (AHF). Objective: To evaluate the effect of a strategy that emphasized early intensive and sustained vasodilation using individualized up-titrated doses of established vasodilators in patients with AHF. Design, Setting, and Participants: Randomized, open-label blinded-end-point trial enrolling 788 patients hospitalized for AHF with dyspnea, increased plasma concentrations of natriuretic peptides, systolic blood pressure of at least 100 mm Hg, and plan for treatment in a general ward in 10 tertiary and secondary hospitals in Switzerland, Bulgaria, Germany, Brazil, and Spain. Enrollment began in December 2007 and follow-up was completed in February 2019. Interventions: Patients were randomized 1:1 to a strategy of early intensive and sustained vasodilation throughout the hospitalization (n = 386) or usual care (n = 402). Early intensive and sustained vasodilation was a comprehensive pragmatic approach of maximal and sustained vasodilation combining individualized doses of sublingual and transdermal nitrates, low-dose oral hydralazine for 48 hours, and rapid up-titration of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or sacubitril-valsartan. Main Outcomes and Measures: The primary end point was a composite of all-cause mortality or rehospitalization for AHF at 180 days. Results: Among 788 patients randomized, 781 (99.1%; median age, 78 years; 36.9% women) completed the trial and were eligible for primary end point analysis. Follow-up at 180 days was completed for 779 patients (99.7%). The primary end point, a composite of all-cause mortality or rehospitalization for AHF at 180 days, occurred in 117 patients (30.6%) in the intervention group (including 55 deaths [14.4%]) and in 111 patients (27.8%) in the usual care group (including 61 deaths [15.3%]) (absolute difference for the primary end point, 2.8% [95% CI, -3.7% to 9.3%]; adjusted hazard ratio, 1.07 [95% CI, 0.83-1.39]; P = .59). The most common clinically significant adverse events with early intensive and sustained vasodilation vs usual care were hypokalemia (23% vs 25%), worsening renal function (21% vs 20%), headache (26% vs 10%), dizziness (15% vs 10%), and hypotension (8% vs 2%). Conclusions and Relevance: Among patients with AHF, a strategy of early intensive and sustained vasodilation, compared with usual care, did not significantly improve a composite outcome of all-cause mortality and AHF rehospitalization at 180 days. Trial Registration: ClinicalTrials.gov Identifier: NCT00512759.


Assuntos
Insuficiência Cardíaca/tratamento farmacológico , Vasodilatadores/administração & dosagem , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Comorbidade , Esquema de Medicação , Feminino , Insuficiência Cardíaca/mortalidade , Hospitalização , Humanos , Masculino , Readmissão do Paciente/estatística & dados numéricos , Vasodilatadores/efeitos adversos
6.
Kardiologiia ; 59(12): 84-91, 2019 Dec 11.
Artigo em Russo | MEDLINE | ID: mdl-31849315

RESUMO

Chronic heart failure (CHF) remains one of the most important problems of modern cardiology. One of the effective treatment methods is resynchronization therapy (RT). The article presents an analysis of literature data on the effectiveness of RT in improving the quality of life, reducing the number of hospitalizations and mortality in patients with heart failure with severe left ventricular systolic dysfunction and expanding QRS complex, and also discusses key methods for optimizing RT.


Assuntos
Insuficiência Cardíaca , Terapia de Ressincronização Cardíaca , Doença Crônica , Humanos , Qualidade de Vida , Disfunção Ventricular Esquerda , Remodelação Ventricular
7.
Nan Fang Yi Ke Da Xue Xue Bao ; 39(11): 1273-1279, 2019 Nov 30.
Artigo em Chinês | MEDLINE | ID: mdl-31852642

RESUMO

OBJECTIVE: To investigate the diagnostic value of plasma growth and differentiation factor-15 (GDF-15) level, GDF-15 mRNA expression in circulating mononuclear cells (MNCs), and plasma pro-B-type natriuretic peptide (NT-proBNP) level for heart failure in patients with different underlying cardiac diseases, namely dilated cardiomyopathy (DCM) and coronary artery heart disease (CAD), and assess their value in predicting the severity of heart failure and long-term cardiovascular disease (CVD) events. METHODS: Fasting venous blood samples were collected from 261 patients with DCM and 251 patients with CAD admitted in our hospital between January, 2018 and January, 2019, with 132 healthy individuals serving as the control group. The plasma level of GDF-15 was measured by enzyme-linked immunosorbent assay (ELISA), and the expression of GDF-15 mRNA in the MNCs was measured by real-time PCR. We also analyzed the expression of GDF-15 in patients with different NYHA classes, and the ROC curve was used to evaluate the predictive power of GDF-15 mRNA for CVD events. RESULTS: The plasma levels of GDF-15 and GDF-15 mRNA in the MNCs were significantly higher in patients with DCM and CAD than in the control group (P < 0.01). Plasma GDF-15 levels were significantly higher in NYHA class Ⅳ patients than in class Ⅱ and Ⅲ patients, and GDF-15 mRNA expressions in the MNCs were much higher in class Ⅲ and Ⅳ patients than class Ⅱ patients (P < 0.01). ROC curve analysis showed that for predicting CVD events, the area under the curve (AUC) was 0.73 (95% CI: 0.69-0.77, P < 0.001) for NT-proBNP alone, as compared with 0.83 (95% CI: 0.79-0.86, P < 0.001) for GDF-15 mRNA in the MNCs combined with NT-proBNP. CONCLUSIONS: Plasma GDF-15 level and GDF-15 mRNA expression level in the MNSc can both be used as biomarkers for heart failure. Plasma level of GDF-15 is more sensitive for predicting NYHA class Ⅳ patients with heart failure, while GDF-15 mRNA level in the MNCs better predicts class Ⅱ patients. The combination of NT-proBNP with GDF-15 mRNAlevel in the MNCs can more accurately predict the risk of long-term CVD events.


Assuntos
Fator 15 de Diferenciação de Crescimento/sangue , Insuficiência Cardíaca , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Biomarcadores , Doenças Cardiovasculares , Insuficiência Cardíaca/diagnóstico , Humanos , Valor Preditivo dos Testes , Prognóstico
8.
Kardiologiia ; 59(11S): 36-43, 2019 Sep 12.
Artigo em Russo | MEDLINE | ID: mdl-31884939

RESUMO

PURPOSE: To assess the quality of life (QoL) changes in patients with congestive heart failure (CHF) one year after cardiac resynchronization therapy (CRT). METHODS: The study included 82 patients (68 males and 14 females) aged from 30 to 74 (mean age 55.8±9.2 years) who underwent implantation of a biventricular cardiac pacemaker for CRT. Depending on the echocardiographic response to CPT, the patients were divided into two groups: 56 people with a positive response (responders) and 26 people with insufficient response (non-responders). The SF-36 questionnaire was used to measure QoL. The results of the questionnaire were represented as scores over the eight subscales: physical functioning (PF), role-physical functioning (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role-emotional (RE), and mental health perceptions (MH). The QoL assessment was performed before and one year after CRT. RESULTS: Patients with CHF one year following CRT had significantly higher rates of improvement in PF QoL (before CRT 46.28±26.16; one year after CRT 53.05±27.65, p=0.023). The statistical tendency towards QoL improvement was revealed: VT QoL (before CRT 47.07±20.12, after CRT 51.83±20.07, p=0.081), SF (before СРТ 61.58±25.06, after CRT 67.07±24.57, p=0.088). Group of responders one year after CRT had significantly higher rates of improvement of QoL in PF (45.2±26.0 before CRT vs 57.1±26.4 after CRT, p=0.001); in VT (46.5±20.8 vs 54.4±19.7, p=0.010) and in SF (60.9±26.4 vs 70.8±20.8, p=0.012). The statistical tendency towards QoL improvement was revealed in BP (57.5±25.1 before CRT vs 64.8±23.8 after CRT, p=0.079), in GH (45.3±16.4 vs 49.1±18.0, p=0.079) and in MH (57.7±18.9 vs 62.5±17.7, p=0.081). In the group of nonresponders the statistical tendency towards decrease in QoL was detected during one year after CRT in RE (46.2±45.3 before CRT vs 26.9±41.1 after CRT, p=0.07). No significant differences were found in paired comparisons of other QoL indicators. CONCLUSION: We revealed significant increase in PF index in patients with CHF one year following CRT. The study showed that QoL was generally improving one year following CRT in responders while a tendency towards decrease in RE was detected in non-responders.


Assuntos
Terapia de Ressincronização Cardíaca , Insuficiência Cardíaca , Adulto , Idoso , Ecocardiografia , Feminino , Insuficiência Cardíaca/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Inquéritos e Questionários , Resultado do Tratamento
9.
Kardiologiia ; 59(11S): 69-76, 2019 Sep 12.
Artigo em Russo | MEDLINE | ID: mdl-31884943

RESUMO

The aim of the present study is to determine the prognostic value of GFR reduction according to the CKD-EPI formula, taking into account blood creatinine and a formula that simultaneously takes into account creatinine and cystatin C in patients who were hospitalized for the first time due to decompensation of chronic heart failure with a preserved left ventricular ejection fraction (HFSA) observation within 24 months. MATERIALS AND METHODS: The study included 117 patients (women - 65.8%, mean age 71.6 ± 9.1 years) hospitalized due to debugging of CHF and having a preserved left ventricular ejection fraction according to echocardiography. The study was a prospective observation for 2 years after the inclusion of each patient. On the first day of hospitalization, all serum samples were taken to determine the level of cystatin C. The estimated glomerular filtration rate (eGFR) was determined using the CKD-EPI formula, taking into account blood creatinine and the combined formula, including creatinine and cystatin C. The combination was used as an end point death and re-hospitalization within two years of follow-up. To determine the effect of a decrease in eGFR on the forecast, the Kaplan-Maer method and the log-rank test were used. Differences were considered statistically significant at p<0.05. The study was approved by the local ethics committee. RESULTS: During the observation period, the mortality rate was almost 12%. At the same time, every third patient was repeatedly hospitalized within two years. In order to determine the effect of reducing GFR on reaching the end points, all patients were divided into groups with eGFR values of more or less than 45 ml/min/1.73 sq.m according to both formulas. When separating patients using the CKD-EPI formula, which includes only creatinine, the groups did not differ in terms of the frequency of reaching the combined end point, as well as its components: death and re-hospitalization. However, patients with eGFR values less than 45 ml/min/1.73 sq. M according to the combined formula data significantly more often reached the combined end point, mainly due to an increase in mortality. CONCLUSION: The data obtained suggest that adding cystatin C to the CKD-EPI formula and appropriately identifying patients with reduced eGFR has a high prognostic value for stratifying the risk of an unfavorable outcome after the first decompensation of HFSSFV.


Assuntos
Insuficiência Cardíaca , Insuficiência Renal Crônica , Idoso , Idoso de 80 Anos ou mais , Biomarcadores , Creatinina , Cistatina C , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos
10.
Zhongguo Zhong Yao Za Zhi ; 44(22): 4975-4984, 2019 Nov.
Artigo em Chinês | MEDLINE | ID: mdl-31872608

RESUMO

Databases including CNKI,Wan Fang,CBM,VIP,PubMed and Cochrane Library were searched to collect qualified researches,and the quality of articles was evaluated according to scales. Meta-analysis including subgroup analysis was performed by using Rev Man 5. 3 software and Meta-regression test was performed by using Stata 12. 0 software. All of these methods were used to systematically evaluate the safety and clinical efficacy of Qili Qiangxin Capsules in treatment of ischemic heart failure under two circumstances( with or without syndrome differentiation). A total of 22 randomized controlled trials( RCTs) involving 1 942 patients were included,with generally low quality. RESULTS: of Meta-analysis showed that as compared with the routine Western treatment alone,additional use of Qili Qiangxin Capsules could improve the clinical efficacy( RR = 1. 21,95%CI[1. 16,1. 27],P<0. 000 01) in treatment of ischemic heart failure,with its combined effect of syndrome differentiation group greater than that of non-syndrome differentiation group( P= 0. 03,I~2= 78. 9%),Meta-regression( sig = 0. 9,P = 0. 057); left ventricular ejection fraction( WMD = 7. 28,95% CI[5. 18,9. 38],P<0. 000 01),with combined effect of syndrome differentiation group greater than that of non-syndrome differentiation group( P= 0. 01,I2= 83. 2%),Meta-regression( I~2= 81. 09%,R2= 29. 08%,sig = 0. 47,P = 0. 029); 6-minute walk test( WMD = 33. 20,95%CI[24. 70,41. 70 ],P < 0. 000 01); left ventricular end diastolic diameter( WMD =-4. 61,95% CI[-5. 38,-3. 84 ],P <0. 000 01); left ventricular end diastolic volume( WMD =-34. 43,95%CI[-38. 81,-30. 05],P< 0. 000 01); and left ventricular end systolic volume( WMD =-9. 60,95% CI[-13. 16,-6. 05],P < 0. 000 01). Adverse effects were reported in 11 patients taking Qili Qiangxin Capsules and in 20 patients with routine treatment group,tolerable in both groups. None of the patients had obvious abnormality in liver and kidney function. Qili Qiangxin Capsules were effective and safe in the treatment of ischemic heart failure,which can further improve clinical efficacy as compared with routine treatment alone. Qili Qiangxin Capsules with syndrome differentiation showed more significant effects than those without syndrome differentiation,indicating better efficacy of clinical syndrome differentiation. However,these conclusions still need to be verified with more high-quality and large-sample literature.


Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Cápsulas , Humanos , Masculino , Síndrome
11.
Ther Adv Cardiovasc Dis ; 13: 1753944719894509, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31854243

RESUMO

BACKGROUND: It is known that once heart failure occurs in older patients with diabetes, the overall prognosis is extremely poor. We investigated whether early initiation of SGLT2 inhibitor therapy after admission was beneficial for diabetic patients requiring inpatient treatment for acute heart failure. METHODS: We retrospectively assessed consecutive patients with comorbid diabetes who were admitted to the Department of Cardiology in Tosei General Hospital for treatment of acute heart failure. Patients were divided into two groups: those who initiated SGLT2 inhibitor therapy (SGLT2 inhibitor group; mean age: 73 ± 9 years) and those who did not receive the inhibitors during hospitalization (conventional treatment group; mean age: 75 ± 10 years). RESULTS: No intergroup differences were observed in the distribution of either the severity or classes of heart failure on admission. Glycosylated hemoglobin levels were significantly higher in the SGLT2 inhibitor group (HbA1c: 8.1% ± 0.8%) than in the conventional treatment group (HbA1c: 7.1% ± 0.8%) (p = 0.003). After admission, patients in both groups recovered equally well, and in almost the same period of time, before discharge. The rate of diuretics use at the time of discharge in the SGLT2 inhibitor group (n = 8, 67%) was significantly lower than that in the conventional treatment group (n = 19, 100%) (p = 0.016). In particular, the dose of loop diuretics in the conventional treatment group was 34 ± 4 mg/day while that in the SGLT2 inhibitor group was significantly lower at 13 ± 5 mg/day (p = 0.008). During hospitalization, the incidence of acute kidney injury was significantly higher in the conventional treatment group (n = 11, 58%) than in the SGLT2 inhibitor group (n = 2, 16%) (p = 0.031). CONCLUSIONS: For the treatment and management of heart failure in patients with diabetes, early initiation of SGLT2 inhibitor therapy appears to be effective.


Assuntos
Glicemia/efeitos dos fármacos , Diabetes Mellitus Tipo 2/tratamento farmacológico , Insuficiência Cardíaca/tratamento farmacológico , Inibidores de Simportadores de Cloreto de Sódio e Potássio/administração & dosagem , Inibidores do Transportador 2 de Sódio-Glicose/administração & dosagem , Doença Aguda , Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Glicemia/metabolismo , Comorbidade , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Hemoglobina A Glicada/metabolismo , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Intervalo Livre de Progressão , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Inibidores de Simportadores de Cloreto de Sódio e Potássio/efeitos adversos , Inibidores do Transportador 2 de Sódio-Glicose/efeitos adversos , Fatores de Tempo
12.
Kardiologiia ; 59(11S): 18-27, 2019 Oct 21.
Artigo em Russo | MEDLINE | ID: mdl-31884937

RESUMO

The review aims to appraise the value of determining the concentrations of the new biomarker sST2 for assessing prognosis and monitoring treatment effectiveness of patients with decompensated heart failure during an episode of decompensation and during long-term follow-up after discharge from the hospital. The article analyses in detail the expedience of sST2 measurement in a patient with ADHF on admission and discharge from the hospital and the changes in the biomarker level during the period of active treatment for risk-stratification in patients, presents the optimal threshold values of sST2, which should be oriented when selecting patients with high and very high risk. The importance of subsequent monitoring of the marker concentration during long-term observation in emphasized to predict the risk of death, HF re-decompensation / HF rehospitalization. The potential benefits of choosing sST2 as the optimal marker for serial measurement during long-term follow-up, as well as evaluating the treatment effectiveness in patients with HF, compared to the "classical" variant - natriuretic peptides are shown.


Assuntos
Insuficiência Cardíaca , Biomarcadores , Humanos , Peptídeo Natriurético Encefálico , Fragmentos de Peptídeos , Prognóstico , Resultado do Tratamento
13.
Kardiologiia ; 59(10S): 4-12, 2019 Sep 17.
Artigo em Russo | MEDLINE | ID: mdl-31876457

RESUMO

AIM: Assess the diagnostic significance of markers of heart failure, to identify the features of clinical symptoms and structural and functional remodeling of the left and right heart in patients with chronic heart failure (CHF) in combination with atrial fibrillation (AF) and chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS: groups of patients were formed: group 1 - patients with COPD without cardiovascular diseases (n=28), group 2 - patients with CHF and COPD without AF (n=30), group 3 - patients with CHF and AF without COPD (n=33), group 4 (main) - patients with CHF, AF and COPD (n=29). Patients were evaluated for clinical symptoms, 6-minute walk test, echocardiographic study, determined the concentration of natriuretic peptides (NUP): N-terminal fragment of the precursor of cerebral NUP (NT-proBNP) and mid-regional pro-atrial NUP (MR-proANP). RESULTS: In patients with CHF on the background of AF and COPD, a higher score of the severity of clinical symptoms was established in comparison with the 3rd group (p<0,001). The features of heart remodeling in patients of the main group were revealed in comparison with patients with CHF and AF without COPD: lower volume indices of the left (p=0,001) and right (p=0,004) atria and values of the indexed index of the end-diastolic area of the right ventricle (RV) (p=0,007), lower contractility of the RV, the presence of RV hypertrophy. The effect of AF on the structural and functional parameters of the heart in patients with CHF, COPD and AF can be judged by comparison with patients with CHF and COPD without AF: higher values of the size of the RV (p=0,012), indexed index of the end-systolic area of the RV (p<0,001), lower systolic function of the RV on the background of higher pressure in the RV cavity (p=0,001). Defined the highest level of NT-proBNP in patients with CHF, AF and COPD in comparison with its level in patients of the 2nd group (p<0,001) and in patients 3rd groups (p=0,010). Higher levels of MR-proANP were found in patients with CHF and AF without COPD (p<0,001). CONCLUSION: In patients with CHF, AF and COPD, more pronounced clinical symptoms are caused by chronic bronchial obstruction. Pathogenetic features of left and right heart remodeling in patients with CHF on the background of AF and COPD were revealed. For the early detection of HF in patients with AF the greatest diagnostic importance is the determination of the level of MR-proANP, however, in patients with combined AF and COPD the most informative is the determination of the concentration of NT-proBNP.


Assuntos
Fibrilação Atrial , Insuficiência Cardíaca , Doença Pulmonar Obstrutiva Crônica , Fator Natriurético Atrial , Átrios do Coração , Insuficiência Cardíaca/etiologia , Humanos , Peptídeo Natriurético Encefálico , Fragmentos de Peptídeos , Doença Pulmonar Obstrutiva Crônica/complicações
14.
Kardiologiia ; 59(10S): 13-21, 2019 Sep 11.
Artigo em Russo | MEDLINE | ID: mdl-31876458

RESUMO

Actuality. The risk of death of patients with chronic heart failure (CHF) after acute decompensation of heart failure (ADHF) is directly related to the quality of the treatment of CHF after discharge from the hospital. In order to achieve the maximum effect of therapy in patients with CHF, experts in Europe and the USA recommend the creation of centers of specialized medical care for patients with CHF. Objective: to determine the risks of general, cardiovascular mortality and death from ADHF in patients with CHF during two years of observation, depending on their adherence to observation in a specialized center for the treatment of chronic heart failure (center CHF). Materials and methods. The study consistently included 942 patients with CHF after ADHF. The adherence of patients to follow up in center CHF was analyzed and 4 groups were distinguished: group 1 (n = 313) included patients who were observed continuously for two years; group 2 (n = 382) included patients who, after discharge, had never been observed in the center CHF; group 3 (n = 197) consisted of patients who were monitored at center CHF during the first year and then discontinued, and group 4 (n = 49) united patients who, when included in the study, abandoned observation, but after a year began to be constantly observed during the second year center CHF. Results. Statistically significant differences in age were registered only between groups 1 and 2 (69.6+9.9 and 71.8+11 years, respectively, р1/2=0.006). The overall mortality over the 2 years of follow-up was significantly higher in group 2 (32.4%) versus group 1 (1.2%, OR=3.8, 95% CI 2.5-5.7; p1/2<0.001 ); compared with group 3 (9.1%, OR=4.8, 95% CI 2.8-8.1; p2/3<0.001) and group 4 (8,2%, OR = 5.4, 95% CI 1.9-15.3; p2/4=0.0005). Cardiovascular mortality (CVM) for 2 years of follow-up was significantly higher in group 2 versus group 1 (8.1% and 1.3% of cases, OR=6.8, 95% CI 2.4-19.5; p1/2<0.001), as well as in comparison with group 3 (CVM 3% for 2 years, OR=2.8, 95% CI 1.1-6.8; p2/3=0.02). CVM in group 4 (6.1%) was 5 times higher in comparison with group 1 (OR=5.0, 95% CI 1.1-23.2; p1/4=0.02). The risks of death from ADHF over the 2 years of follow-up were significantly higher in group 2 (16.4%) compared with all groups: with group 1 (6.4%) OR=2.9, 95% CI 1.7-4, 9, p1/2<0.001; with group 3 (5.1%) OR=3.7, 95% CI 1.8-7.3, p2/3<0.001; and with group 4 (2%) OR=9.5, 95% CI 1.3-69.7, p2/4= 0.008. The combined endpoint (CVM and death from ADHF in 2 years of follow-up) was also significantly higher in group 2 (24.5%) compared with all compared groups: group 1 (7.7%), OR=3.9, 95% CI 2.4-6.3, p1/2<0.001; group 3 (8.1%), OR=3.7, 95% CI 2.1-6.5, p2/3<0.001; and group 4 (8.2%), OR=3.7, 95% CI 1.3-10.4; p2/4=0.01. Conclusion. Surveillance of patients with CHF after an episode of ADHF in a specialized center CHF, both for a long time (two years) and partially during the first year of observation, reduces the risk of all-cause death, CVM and death from ADHF.


Assuntos
Insuficiência Cardíaca , Doença Crônica , Europa (Continente) , Humanos , Prognóstico
15.
Wiad Lek ; 72(11 cz 2): 2228-2231, 2019.
Artigo em Polonês | MEDLINE | ID: mdl-31860842

RESUMO

Patients with chronic kidney disease (CKD) are at risk of progression to end-stage renal disease and high cardiovascular mortality. Data from other populations and animal experiments suggests that angiotensin-neprilysin inhibition may be superior to renin-angiotensin-aldosterone system inhibition in reducing the risk of cardiovascular mortality and retarding the progression of CKD. The review summarizes the existing evidence on the potential benefits of angiotensin-neprilysin inhibitor (ARNi) in CKD.


Assuntos
Insuficiência Cardíaca , Insuficiência Renal Crônica , Aminobutiratos , Antagonistas de Receptores de Angiotensina , Inibidores da Enzima Conversora de Angiotensina , Angiotensinas , Animais , Humanos , Neprilisina , Insuficiência Renal Crônica/tratamento farmacológico , Sistema Renina-Angiotensina , Tetrazóis
16.
Soins ; 64(841): 12-17, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31864504

RESUMO

Heart failure is a chronic pathology resulting in repeated hospitalisations and has a significant impact on the patient's quality of life. Therapeutic patient education (TPE) forms part of patients' global care to improve their health status. A study was carried out at Bégin military teaching hospital of hospitalised patients with heart failure to identify their educational needs and create a TPE programme which best meets their expectations.


Assuntos
Insuficiência Cardíaca/terapia , Determinação de Necessidades de Cuidados de Saúde , Educação de Pacientes como Assunto , Humanos
17.
Lancet ; 394(10211): 1816-1826, 2019 11 16.
Artigo em Inglês | MEDLINE | ID: mdl-31668726

RESUMO

BACKGROUND: Uncertainty remains about the optimal monotherapy for hypertension, with current guidelines recommending any primary agent among the first-line drug classes thiazide or thiazide-like diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, dihydropyridine calcium channel blockers, and non-dihydropyridine calcium channel blockers, in the absence of comorbid indications. Randomised trials have not further refined this choice. METHODS: We developed a comprehensive framework for real-world evidence that enables comparative effectiveness and safety evaluation across many drugs and outcomes from observational data encompassing millions of patients, while minimising inherent bias. Using this framework, we did a systematic, large-scale study under a new-user cohort design to estimate the relative risks of three primary (acute myocardial infarction, hospitalisation for heart failure, and stroke) and six secondary effectiveness and 46 safety outcomes comparing all first-line classes across a global network of six administrative claims and three electronic health record databases. The framework addressed residual confounding, publication bias, and p-hacking using large-scale propensity adjustment, a large set of control outcomes, and full disclosure of hypotheses tested. FINDINGS: Using 4·9 million patients, we generated 22 000 calibrated, propensity-score-adjusted hazard ratios (HRs) comparing all classes and outcomes across databases. Most estimates revealed no effectiveness differences between classes; however, thiazide or thiazide-like diuretics showed better primary effectiveness than angiotensin-converting enzyme inhibitors: acute myocardial infarction (HR 0·84, 95% CI 0·75-0·95), hospitalisation for heart failure (0·83, 0·74-0·95), and stroke (0·83, 0·74-0·95) risk while on initial treatment. Safety profiles also favoured thiazide or thiazide-like diuretics over angiotensin-converting enzyme inhibitors. The non-dihydropyridine calcium channel blockers were significantly inferior to the other four classes. INTERPRETATION: This comprehensive framework introduces a new way of doing observational health-care science at scale. The approach supports equivalence between drug classes for initiating monotherapy for hypertension-in keeping with current guidelines, with the exception of thiazide or thiazide-like diuretics superiority to angiotensin-converting enzyme inhibitors and the inferiority of non-dihydropyridine calcium channel blockers. FUNDING: US National Science Foundation, US National Institutes of Health, Janssen Research & Development, IQVIA, South Korean Ministry of Health & Welfare, Australian National Health and Medical Research Council.


Assuntos
Anti-Hipertensivos/uso terapêutico , Hipertensão/tratamento farmacológico , Adolescente , Adulto , Idoso , Antagonistas de Receptores de Angiotensina/efeitos adversos , Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Anti-Hipertensivos/efeitos adversos , Bloqueadores dos Canais de Cálcio/efeitos adversos , Bloqueadores dos Canais de Cálcio/uso terapêutico , Criança , Estudos de Coortes , Pesquisa Comparativa da Efetividade/métodos , Bases de Dados Factuais , Diuréticos/efeitos adversos , Diuréticos/uso terapêutico , Medicina Baseada em Evidências/métodos , Feminino , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/prevenção & controle , Humanos , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/prevenção & controle , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle , Adulto Jovem
18.
Pan Afr Med J ; 33: 251, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692700

RESUMO

Introduction: Acute Heart Failure (AHF) is a specific syndromic disorder grouping several heterogeneous clinical conditions frequently seen in the emergency department. This study aimed to describe the epidemiological, clinical, therapeutic and prognostic features of patients with AHF admitted to the emergency department. Methods: We conducted a prospective, descriptive study in the emergency department. It included all patients admitted with AHF. We studied the epidemiological, clinical, therapeutic and prognostic features of these patients. Results: The study enrolled 180 patients with AHF admitted to the emergency department. Sex ratio was 1.27. The average age of patients was 66±12 years. Eighty-two percent of patients were hypertensive and 69% were known diabetic patients. The causes of decompensation included primarily hypertensive crisis (61.7% of patients), acute coronary syndrome (24% of patients). Respiratory support was mainly provided by CPAP (Continuous Positive Airway Pressure) in 73.3% of cases. Pharmacological treatment was based on nitrate derivatives (70% of cases) and diuretic (40.5% of cases). Acute heart failure incidence at one month was 21.7% (n=39 patients) and mortality rate at 3 months was 13.3%. Conclusion: Patients with AHF treated in the emergency department mainly had hypertensive crisis. Treatment is primarily based on CPAP, vasodilators and diuretics. Recurrence rate and mortality rate were high.


Assuntos
Síndrome Coronariana Aguda/complicações , Pressão Positiva Contínua nas Vias Aéreas/métodos , Insuficiência Cardíaca/epidemiologia , Hipertensão/complicações , Síndrome Coronariana Aguda/epidemiologia , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Diuréticos/administração & dosagem , Serviço Hospitalar de Emergência , Feminino , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Nitratos/administração & dosagem , Prognóstico , Estudos Prospectivos , Recidiva , Tunísia , Adulto Jovem
20.
Zhonghua Yi Xue Za Zhi ; 99(41): 3237-3242, 2019 Nov 05.
Artigo em Chinês | MEDLINE | ID: mdl-31694119

RESUMO

Objective: To explore the clinical classification and characteristics of patients with alcoholic myocardial injury in the early and late stages, and to improve the understanding of early diagnosis of alcoholic myocardial injury. Methods: From December 2016 to December 2018, a total of 102 patients with long-term history of excessive alcohol consumption, cardiovascular symptoms and evidence of myocardial injury who were admitted to the cardiology outpatient clinic of Hangzhou First People's Hospital, the Third People's Hospital of Yuhang, Dajiangdong Hospital, the Second People's Hospital of Fuyang, and the People's Hospital of Linan were enrolled. According to diagnostic criteria of alcoholic cardiomyopathy (ACM), the patients were divided into ACM group (36 cases) and non-ACM group (66 cases). The baseline data, electrocardiogram and echocardiography characteristics of the two groups were recorded and analyzed. Results: There was no significant difference in the baseline between the two groups (P>0.05), including consumption and duration of alcohol. The left ventricular end-diastolic and right ventricular diameters in ACM group were (59±5) mm and (24±4) mm, respectively, which were significantly higher than those in non-ACM group ((51±4)mm, (22±4) mm, P<0.001 and P=0.044) . The left ventricular ejection fraction in ACM group was 41%±4%, which was significantly lower than that of non-ACM group (63%±8%, P<0.001). The incidence of biatrial enlargement in non-ACM group was 57.58%, which was significantly higher than that of ACM group (36.11%, P=0.038). The incidence of atrial fibrillation in non-ACM group was 54.55%, which was significantly higher than that of ACM group (27.78%, P=0.009). The incidence of diastolic heart failure in non-ACM group was significantly higher than that of ACM group (P=0.005). Conclusions: ACM is characterized by ventricular enlargement, decreased ejection fraction and heart failure, while non-ACM may belong to the early stage of alcoholic myocardial injury, characterized by biatrial expansion, atrial fibrillation and diastolic insufficiency. Due to the lack of understanding and no clinical diagnostic criteria, non-ACM is prone to be missed diagnosed and misdiagnosed.


Assuntos
Cardiomiopatia Alcoólica , Insuficiência Cardíaca , Ecocardiografia , Eletrocardiografia , Humanos , Função Ventricular Esquerda
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