An index of open-access Heart Failure content relevant to primary care
Effects of Effective Components of Yixintai on CaN and SERCA2a mRNA and Protein Expression Levels in Myocardial Tissue of a Rabbit Model of Heart Failure Due to Dilated Cardiomyopathy
LI Ya，WEI Jiaming，LI Yuying，GUO Zhihua
Chinese General Practice 2021, 24 (32): 4086-4093. DOI: 10.12114/j.issn.1007-9572.2021.01.106
Abstract
Background Dilated cardiomyopathy is a major cause of heart failure（HF）. Effective components of Yixintai（ECYXT）have proven to be very effective against HF，but the mechanism of action is not completely clear. Objective To explore the effects of the ECYXT on the protein and mRNA expression of CaN and SERCA2a in myocardial tissue of a rabbit model of HF induced by dilated cardiomyopathy. Methods The rabbit model of HF was established by injecting adriamycin into the marginal ear vein and giving propylthiouracil by gavage in January 2018. The rabbits successfully modeled were divided into HF model group〔n=17，single intragastric dose of 0.9% saline solution（10 ml/kg） per day〕，groups of low dose ECYXT 〔n=17，single intragastric dose of ECYXT solution（10 ml/kg） with a concentration of 2.1 g/kg per day〕，medium dose ECYXT〔n=17，single intragastric dose of ECYXT solution（10 ml/kg） with a concentration of 4.2 g/kg per day〕，high dose ECYXT〔n=17，single intragastric dose of ECYXT solution（10 ml/kg） with a concentration of 8.4 g/kg per day〕，and losartan potassium group〔n=16，single intragastric dose of losartan potassium suspension（10 ml/kg） with a concentration of 2.75 mg/kg〕. And other 20 rabbits were selected for comparison〔control group，single intragastric dose of 0.9% saline solution（10 ml/kg）per day〕. The intervention for all groups lasted for 4 weeks.When the experiment ended，serum atrial natriuretic peptide（ANP），brain natriuretic peptide（BNP），left ventricular ejection fraction（LVEF），left ventricular short-axis shortening（LVFS），and E/A ratio of the rabbits were measured，then the rabbits were sacrificed and cardiac muscles were obtained to observe the myocardial tissue morphology，and to measure the concentration of ［Ca2+］i in myocardial cells，the protein and mRNA expression of CaN and SERCA2a in myocardial tissue. Results HF model group showed edema and necrosis of cardiomyocytes，with shrinkage of nuclei，widening of intercellular substance，and a small amount of inflammatory cells exuded，and demonstrated disordered arrangement of myocardial fibers，with some broken. Compared with HF model group，the injury of myocardial cells in each dose group of ECYXT and losartan potassium group was alleviated in varying degrees，especially in medium and high dose groups of ECYXT，and losartan potassium group. Compared with the control group，HF model group demonstrated increased levels of serum ANP and BNP，decreased LVEF，LVFS，and E/A ratio，elevated concentration of ［Ca2+］i
in myocardial cells and protein and mRNA expression levels of CaN in myocardial tissue，as well as reduced protein and mRNA expression levels of SERCA2a in myocardial tissue（P<0.01）. Compared with HF model group，three ECYXT groups and losartan potassium group had decreased serum ANP and BNP，increased LVEF，LVFS and E/A ratio，reduced concentration of ［Ca2+］i in myocardial cells，and protein and mRNA expression levels of CaN in myocardial tissue，as well as increased protein and mRNA expression levels of SERCA2a in myocardial tissue（P<0.01）. Compared with the low dose ECYXT group，medium and high dose ECYXT groups and losartan potassium group presented decreased levels of serum ANP and BNP，increased LVEF，LVFS and E/A ratio，reduced concentration of ［Ca2+］i in myocardial cells，and protein and mRNA expression levels of CaN in myocardial tissue，as well as increased protein and mRNA expression levels of SERCA2a in myocardial tissue（P<0.01）. The above-mentioned indicators in the medium dose ECYXT group were similar to those in high dose ECYXT group and losartan potassium group（P>0.05） except that the protein and mRNA expression levels of SERCA2a in myocardial tissue were increased in the latter two groups（P<0.01）. There were no significant differences in the above-mentioned indicators between high dose ECYXT group and losartan potassium group（P>0.05）. Conclusion ECYXT could improve the protein and mRNA expression of SERCA2a in myocardial tissue，decrease the concentration of ［Ca2+］i in myocardial cells，inhibit the protein and mRNA expression of CaN in myocardial tissue，indicating that ECYXT improve heart function and HF induced by dilated cardiomyopathy in the rabbit model.
Clinical Characteristics and Comprehensive Management of Heart Failure with Improved Ejection Fraction
WANG Yucheng，CHEN Zhiwei，CHEN Ruizhen
Chinese General Practice 2021, 24 (32): 4049-4054. DOI: 10.12114/j.issn.1007-9572.2021.01.108
Abstract
Left ventricular ejection fraction （LVEF） is often used as a guideline for classification of heart failure（HF）. With the advancement of heart failure diagnosis and treatment technology，more heart failure patients have experienced improvement in LVEF. The 2021 report of multi-national heart failure societies denominates and defines heart failure with improved ejection fraction（HFimpEF），but there is still a lack of authoritative guidelines to discuss the diagnosis and treatment of HFimpEF. Therefore，this article will review the research progress of HFimpEF based on the existing research evidence，in order to discuss the clinical characteristics，diagnosis，and treatment of HFimpEF.
Efficacy and Safety of Wenyang Lishui Recipes for Heart Failure with Diuretic Resistance：a Meta-analysis
WANG Mengxi，CAO Peihua，WU Chenjie，CHEN Xiaohu
Chinese General Practice 2021, 24 (29): 3734-3741. DOI: 10.12114/j.issn.1007-9572.2021.01.001
Abstract
Background Diuretics are a cornerstone treatment for heart failure，but some patients will gradually develop reduced sensitivity to diuretics，resulting in weakened or even disappeared diuretic effect after a long-term use of them，which is clinically called diuretic resistance. Diuretic resistance is independently associated with heart failure-related mortality，which cannot be cured by western medicine，but has been proven to be partially improved by Wenyang Lishui Recipes（WLR），a type of Chinese medicine treatment. Objective To systematically evaluate the efficacy and safety of WLR in treating heart failure with diuretic resistance. Methods The authors searched the databases of PubMed，Web of Science，The Cochrane Library，EMBase，CNKI，Wanfang，VIP and CBM to screen randomized controlled trials（RCTs） comparing WLR with western medicine treatment against western medicine treatment in heart failure with diuretic resistance patients from inception to January 2020. The major primary outcome indicators included 24-hour urine collection，and left ventricular ejection fraction （LVEF）. Secondary outcome indicators included N-terminal proB-type natriuretic peptide （NT-proBNP），clinical symptom response rate，and cardiac function improvement rate. Safety indicators included serum potassium and creatinine. The “Risk of bias' tool described in Cochrane Handbook （version 5.1.0） and the modified Jadad Scale were used to evaluate the quality of the included RCTs. RevMan 5.3 and Stata 12.0 were used for meta-analysis. Results Fourteen RCTs were included，involving 932 patients. Meta-analysis revealed that compared with western medicine treatment alone，WLR with western medicine treatment could further increase the 24-hour urine collection〔MD=499.41，95%CI（287.26，711.55），P<0.000 01〕，improve the LVEF〔MD=5.25，95%CI（3.28，7.22），P<0.000 01〕，clinical symptom response rate〔RR=1.26，95%CI（1.16，1.37），P<0.000 01〕，cardiac function improvement rate〔RR=1.25，95%CI（1.14，1.38），P<0.000 01〕，and serum potassium level〔MD=0.19，95%CI（0.14，0.24），P<0.000 01〕，as well as further decrease the NT-proBNP〔MD=-594.14，95%CI（-796.95，-391.33），P<0.000 01〕. Subgroup analysis found that WLR with western medicine treatment showed greater effects on improving LVEF no matter the sample size was greater or less than 80〔MD=2.04，95%CI（0.64，3.44），P=0.004；MD=6.61，95%CI（5.17，8.04），P<0.000 01〕. Conclusion WLR with western medicine treatment may have better clinical efficacy in patients with heart failure with diuretic resistance with good safety.However，more high-quality clinical studies are still needed to verify this conclusion.
Recent Evidence on Angiotensin Receptor-neprilsin Inhibitor in Heart Failure with Preserved Ejection Fraction
GAO Man，BAI Wenlou，CHENG Siyao，QI Xiaoyong
Chinese General Practice 2021, 24 (23): 2967-2971. DOI: 10.12114/j.issn.1007-9572.2021.00.587
Abstract
Heart failure is the end stage of most cardiac diseases with high morbidity and mortality. Heart failure with preserved ejection fraction（HFpEF），as a clinical focus，accounts for about 50% of all cases of heart failure，and is associated with increased incidence of hospitalization due to low rate of diagnosis and multiple comorbidities. Angiotensin receptor-neprilsin inhibitor（ARNI） has been proved to significantly decrease the rates of death and readmission，and is widely used as the recommended drugs of class Ⅰ in heart failure with reduced ejection fraction（HFrEF）. However，the mechanism of action of ARNI in HFpEF is still unclear. Thus we summarized the latest clinical evidence on its mechanism of action in HFpEF. This article reviews the mechanism of the effect of ARNI in HFpEF and the latest clinical evidence for it，expounds the advantages of ARNI in improving heart and kidney function and reversing ventricular remodeling in patients with HFpEF，in order to provide new treatment ideas for HFpEF.
Predictive Value of Glycogen Protein 125 Combined with Brain-Derived Neurotrophic Factor for Acute Heart Failure in Elderly Patients with Acute Myocardial Infarction
WANG Yating，YAO Jie，GUAN Shihe，CHENG Cheng
Chinese General Practice 2021, 24 (23): 2962-2966. DOI: 10.12114/j.issn.1007-9572.2021.00.594
Abstract
Background Acute myocardial infarction （AMI） is currently an important clinical cause of sudden cardiac death in patients. The occurrence of AMI in general patients can easily lead to myocardial damage，which can lead to acute heart failure （AHF）. Early diagnosis of AHF in AMI patients has positive significance for improving the prognosis of patients and reducing the risk of death. At present，the main clinical diagnosis of AHF is based on brain natriuretic peptide （BNP），but there are many related factors which can affect BNP，and when BNP reaches a diagnostically meaningful value，AHF has occurred in the patient，which may seriously affect the prognosis and survival of the patient. Therefore，a more accurate diagnosis method is needed to predict the occurrence of AHF in the early stage of AMI. Objective To explore the diagnostic value of glycogen protein 125 （CA-125） combined with brain-derived neurotrophic factor （BDNF） in predicting the occurrence of AHF in elderly patients with AMI. Methods 144 patients with AMI admitted to the Department of Cardiology of The Second Affiliated Hospital of Anhui Medical University from September 2017 to March 2020 were enrolled. The clinical data of all patients were collected at the time of admission and their fasting venous blood was drawn after admission to measure serum CA-125 and BDNF levels by an automatic immunoassay analyzer. The enrolled patients were divided into heart failure group （42 cases） and control group （102 cases） according to whether AHF occurred within 1 week after coronary reperfusion therapy. The clinical data of the two groups were compared，and the multivariate logistic regression was used to analyze the independent risk factors that affect the occurrence of AHF in AMI patients. Receiver operating characteristic （ROC） curve was drawn to analyze the predictive value of CA-125 combined with BDNF for AHF in elderly patients with AMI. Results The patients in the heart failure group had higher cardiac troponin （cTnI）. BNP，CA-125，BDNF，and higher number of diseased branches than the control group （P<0.05）. Multivariate Logistic regression analysis showed that elevated levels of BNP 〔OR=1.015，95%CI （1.003，1.026）〕，CA-125 〔OR=23.228，95%CI （4.095，131.748）〕and BDNF 〔OR=1.455，95%CI （1.148，1.845）〕 were independent risk factors for AHF in AMI patients （P<0.05）. The ROC curve shows that the area under the ROC curve of CA-125 combined with BDNF in prediction of AHF in AMI patients is higher than that of CA-125 and BDNF alone （P<0.05），with a diagnostic sensitivity of 78.57% and a specificity of 89.22%. Conclusion Monitoring serum CA-125 and BDNF levels can effectively predict the risk of AHF in elderly patients with AMI.
Prognostic Value of Geriatric Nutritional Risk Index in Patients with Chronic Heart Failure
LI Wenjing1，2，LI Shuren2*，SUN Mingchao3，SHEN Zexue4，LUO Fei3，HAO Xiao2，XUN Liying2
Chinese General Practice 2021, 24 (23): 2955-2961. DOI: 10.12114/j.issn.1007-9572.2021.00.541
Abstract
Background Currently，there are few studies on objective nutritional assessment tools in patients with heart failure，and there is no recognized nutritional assessment method for such patients. Objective To evaluate the prognostic value of geriatric nutritional risk index（GNRI） in hospitalized patients with chronic heart failure. Methods A total of 293 chronic heart failure inpatients were selected from Heart Center，Hebei General Hospital between January and December 2017.Clinical data（including general demographics，admission heart rate and blood pressure，NYHA class，laboratory indices，and echocardiographic indices） collected through consulting electronic medical records were compared between patients divided by GNRI〔GNRI group 1（100 cases with GNRI≤98，having a risk of malnutrition），and GNRI group 2（193 cases with GNRI>98，and normal nutrition）〕. All cases were followed up by telephone till 2019-04-25. All-cause mortality was used as the endpoint. ROC analysis was conducted to estimate the predictive value of GNRI，BMI and serum albumin for death in chronic health failure. The Kaplan-Meier curve was plotted to estimate the survival in two GNRI groups. The Cox proportional-hazards model was adopted to examine the association of GNRI with the risk of death in chronic heart failure. Results The median follow-up time was 509（253）days. For predicting death in chronic heart failure，GNRI〔AUC=0.702，95%CI（0.633，0.772） with the optimal cut-off value of 97.87〕 had higher accuracy than serum albumin 〔AUC=0.657，95%CI（0.586，0.728） with the optimal cut-off value of 35.65 g/L〕，and BMI〔AUC=0.645，95%CI（0.572，0.718） with the optimal cut-off value of 22.88 kg/m2〕. Kaplan-Meier survival analysis found that GNRI group 2 had a statistically higher survival rate than GNRI group 1（P<0.001）. Univariate Cox regression analysis of factors showing statistically intergroup differences and potential factors associated with death revealed that age 〔HR=1.048，95%CI（1.026，1.071）〕，GNRI level〔HR=3.283，95%CI（2.085，5.171）〕，history of diabetes 〔HR=1.955，95%CI（1.245，3.071）〕，history of old cerebral infarction 〔HR=1.779，95%CI（1.131，2.800）〕，use of ACEI/ARB〔HR=0.470，95%CI（0.300，0.763）〕，hospital stay 〔HR=1.036，95%CI（1.018，1.054）〕，diastolic blood pressure 〔HR=0.984，95%CI（0.969，0.999）〕，NYHA class 〔HR=1.546，95%CI（1.066，2.240）〕，serum hemoglobin 〔HR=0.987，95%CI（0.979，0.995）〕，serum creatinine〔HR=1.003，95%CI（1.001，1.005）〕，and glomerular filtration rate 〔HR=0.985，95%CI（0.975，0.995）〕 were associated with death in chronic heart failure（P<0.05）. Multivariate Cox regression analysis of the above-mentioned factors showed that age 〔HR=1.030，95%CI（1.006，1.054）〕，GNRI level 〔HR=2.821，95%CI（1.727，4.616）〕，and diabetes history 〔HR=2.031，95%CI（1.261，3.273）〕 were associated with the risk of death in chronic heart failure（P<0.05）. Conclusion Malnutrition may be a risk factor for poor prognosis in hospitalized patients with chronic heart failure. The prognostic value of nutritional status assessed by GNRI may be higher than that of serum albumin or BMI，which will help to predict the prognosis of such patients.
Correlation between Ambulatory Arterial Stiffness Index and Severity of Heart Failure with Preserved Ejection Fraction in Patients with Hypertension
ZHU Mingna，ZHANG Lihua，JIANG Youxu，MA Xiaoying，XIONG Haiyan，LI Yuan，ZHU Lina，HUANG Xin
Chinese General Practice 2021, 24 (20): 2568-2572. DOI: 10.12114/j.issn.1007-9572.2021.00.429
Abstract
Background The major pathophysiological mechanism of heart failure with preserved ejection fraction（HFpEF）refers to ventricular diastolic dysfunction caused by ventricular remodeling.Ambulatory arterial stiffness index（AASI）refers to a common clinical indicator，which is closely related to both arteriosclerosis and left ventricular remodeling.But less researches on AASI and HFpEF has appeared yet.Objective To examine the changes of AASI in patients with hypertension and HFpEF，and explore the correlation of AASI with cardiac functional and ventricular structural indices.Methods 210 patients with hypertension〔including 112 with HFpEF（63 with NYHA class Ⅱ-Ⅲ and 49 with NYHA class Ⅲ-Ⅳ）and 98 without〕 who were admitted into the Cardiovascular Department，the Second Affiliated Hospital of Zhengzhou University from 2018 to 2019 were enrolled.Gender，age，admission systolic and diastolic blood pressures，and heart rate and medication history（use of ACEIs/ARBs，calcium channel blockers，digoxin，mineralocorticoid receptor antagonists，diuretic），serum indices〔serum creatinine（Scr），serum urea nitrogen（SUN），alanine aminotransferase，aspartate aminotransferase，total cholesterol，triglyceride，high- and low-density lipoprotein〕in the fasting venous blood sample taken after admission，and NT-proBNP and cardiac functional and structural indices，such as echocardiography measured left ventricular ejection fraction（LVEF），left ventricular end-diastolic diameter（LVDd），interventricular septal thickness，left ventricular posterior wall thickness，left atrial diameter，and calculated left ventricular mass，left ventricular mass index（LVMI）and AASI were recorded.Pearson correlation analysis was used to explore the correlation of AASI with cardiac function and ventricular structure indices.Results Hypertensive patients with HFpEF had greater average age，higher average levels of Scr，SUN，NT-proBNP，LVMI，LVDd and AASI，as well as higher rate of using diuretics，but had lower average level of LVEF compared with those without（P<0.05）.Hypertensive patients with HFpEF of NYHA class Ⅰ-Ⅱ had lower average levels of NT-proBNP，LVDd，LVMI and AASI，and higher average level of LVEF than those of NYHA class Ⅲ-Ⅳ（P<0.05）.AASI was positively correlated with NT-proBNP（r=0.434，P<0.001），LVDd（r=0.470，P<0.001）and LVMI（r=0.417，P<0.001），and negatively correlated with LVEF（r=-0.410，P<0.001）in patients with HFpEF and hypertension.Conclusion The AASI was higher，and was related to the changes of cardiac function and the degree of ventricular remodeling in hypertension patients with HFpEF，which may be caused by HFpEF.
Influencing Factors of Treatment Outcome of Chronic Heart Failure in Primary Hospitals
REN Lixia，JIA Xu，WANG Zhihao，ZHANG Wei，ZHONG Ming，MA Xiao
Chinese General Practice 2021, 24 (14): 1769-1775. DOI: 10.12114/j.issn.1007-9572.2021.00.474
Abstract
Background The treatment outcome of chronic heart failure during hospitalization is affected by many factors.Previous research mostly focused on the provincial hospital，but rarely focused on primary hospital.Objective To explore the influencing factors of the treatment outcome of chronic heart failure（CHF）treated in primary hospitals.Methods 339 inpatients diagnosed with CHF of gradeⅡ-Ⅳby New York Heart Association（NYHA）classification in Zaozhuang Central District People's Hospital during June 2012 to July 2018 were selected as the research objects.They were divided into improvement group（n=320）and deterioration group（n=19）according to treatment outcome.The data of gender，age，admission factors，medical history，diagnosis，imaging examination，cardiac ultrasound，biochemical examination，medication，treatment outcome was collected，and the differences between the two groups was compared by unconditional Logistic regression analysis，to explore the influencing factors of the treatment outcome.The patients were divided into ≤100 mm Hg group（41 cases），100 mm Hg < systolic pressure < 130 mm Hg group（132 cases），≥130 mm Hg group（166 cases） according to the systolic blood pressure at admission and the clinical treatment outcomes in the 3 groups were compared.Results The proportion of pulmonary infection，left ventricular end-diastolic diameter，pulmonary artery systolic blood pressure，transglutaminase，urea nitrogen，NT-proBNP，and the application rate of dobutamine in the worsening group were higher than the improvement group.The high-density lipoprotein cholesterol，prealbumin，blood sodium，blood chloride，application rate of β-blockers and statins were lower than the improvement group（P<0.05）.The results of unconditional Logistic regression analysis showed that systolic blood pressure〔OR=0.977，95%CI（0.972，0.981），P<0.001〕，pulmonary infection〔OR=4.799，95%CI（1.156，19.919），P=0.031〕，aspartate aminotransferase〔OR=1.003，95%CI（1.000，1.006），P=0.039〕，albumin 〔OR=0.910，95%CI（0.891，0.928），P<0.001〕，application rate of β-blockers 〔OR=0.202，95%CI（0.046，0.898），P=0.036〕，application rate of spironolactone〔OR=0.125，95%CI（0.066，0.235），P<0.001〕，application rate of statins 〔OR=0.307，95%CI（0.121，0.779），P=0.013〕，application rate of dobutamine 〔OR=9.173，95%CI（1.351，62.272），P=0.023〕 are the influencing factors of treatment outcome of CHF patients（P< 0.05）.In the ≤100 mm Hg group，7 cases（17.1%）deteriorated，34 cases improved（82.9%）；in the 100 mm Hg < systolic pressure <130 mm Hg group，5 cases（3.8%）deteriorated，127 cases improved（96.2%）；in the ≥130 mm Hg group，7 cases deteriorated（4.2%），159 cases（95.8%）improved.Comparison among the three groups，the differences of improvement rates of CHF patients were statistically significant（χ2=8.369，P=0.015）；the proportion of deterioration in the ≤100 mm Hg group was higher than the 100 mm Hg < systolic pressure <130 mm Hg group（χ2=6.619，P=0.010）and the ≥130 mm Hg group（χ2=6.700，P=0.010）.Conclusions The treatment outcome of CHF in primary hospitals can be affected by many factors.Pulmonary infection，systolic blood pressure ≤100 mm Hg at admission，low albumin protein，impaired liver function，and application of dobutamine are risk factors for treatment outcome of CHF，and the use of β-blockers，spironolactone and statins are protective factors.
Effects of Euthyroid Sick Syndrome on the Long-term Prognosis of Patients with Chronic Heart Failure
SHI Genling，FANG Hui，DAI Xixi，GAO Mingxi，SU Gong
Chinese General Practice 2021, 24 (12): 1476-1481. DOI: 10.12114/j.issn.1007-9572.2021.00.120
Abstract
Background Abnormal metabolism of thyroid hormones is involved in the pathological processes of chronic heart failure （CHF）.However，there are few studies on the long-term prognosis of CHF patients with euthyroid sick syndrome （ESS） in China.Objective To study the effects of ESS on long-term prognosis of CHF patients.Methods This study included 304 CHF patients，who were hospitalized in Department of Cardiology，Wusong Hospital of Zhongshan Hospital，Fudan University from January 2017 to June 2019.The general information and laboratory indicators were compared between those with T3 level<1.01 nmol/L and/or FT3 level<3.28 nmol/L（ESS group） and those with T3 level of 1.01-2.48 nmol/L and FT3 level of 3.28-6.47 nmol/L（normal thyroid function group）.Post-discharge follow-up was conducted until June 2020 with all-cause death （including death due to heart failure and non-cardiac death）as the primary endpoint，and readmission due to heart failure as the secondary endpoint.Thyroid hormones 〔T3，FT3，thyroxine （T4），free T4 （FT4），and thyroid stimulating hormone （TSH）〕，B-type natriuretic peptide （BNP），and left ventricular ejection fraction （LVEF）of the survivors were compared with those of the deceased due to all causes，the deceased due to heart failure，and the deceased due to noncardiac causes.The readmission rate due to heart failure，heart failure mortality rate，and all-cause mortality rate between the ESS and normal thyroid function groups were compared，and Kaplan-Meier survival curves were plotted.Cox regression analysis was used to identify the factors associated with heart failure death and all-cause death.Results There were 164 patients in the ESS group and 140 patients in the normal thyroid function group.The distribution of NYHA class showed significant difference between the two groups （P<0.05）.The mean levels of T3，FT3，FT4，TSH，albumin，and hemoglobin，and LVEF were lower，and mean levels of BNP，C-reactive protein，and creatinine were higher in the ESS group （P<0.05）.In a median follow-up period of 25.7 （interquartile range 14.2） months，there were 46 all-cause deaths （32 due to heart failure，and 14 due to noncardiac causes） and 258 survivors（115 were readmitted at least once for heart failure）.The survivors showed higher mean levels of T3，FT3 and LVEF and lower mean level of BNP compared with the deceased due to all causes，or the deceased due to heart failure （P<0.05）.Those with ESS had higher heart failure readmission rate，heart failure mortality rate，and all-cause mortality rate than those with normal thyroid function（P<0.05）.Kaplan-Meier survival analysis showed that the heart failure mortality rate and all-cause mortality rate of the ESS group were higher than those in the normal thyroid function group （P<0.016）.Cox regression analysis showed that age 〔HR=1.056，95%CI（1.009，1.105）〕，FT3 〔HR=0.564，95%CI（0.325，0.976）〕，hemoglobin 〔HR=0.955，95%CI（0.932，0.980）〕，and LVEF〔HR=0.980，95%CI（0.961，1.000）〕 were associated with heart failure death in CHF patients （P<0.05），and age 〔HR=1.055，95%CI（1.019，1.093）〕，hemoglobin〔HR=0.964，95%CI（0.944，0.984）〕，and LVEF 〔HR=0.979，95%CI（0.963，0.994）〕 were associated with all-cause death （P<0.05）.Conclusion CHF patients with ESS had poor renal and liver function.Their heart-failure mortality rate and all-cause mortality rate were higher，and their prognosis was poorer than those of CHF patients without ESS.T3 and FT3 levels reflected the severity and prognosis of CHF patients.
Frailty Prevalence and Associated Factors in Elderly Heart Failure Patients with Preserved Ejection Fraction
YANG Qiqi，SUN Ying，XING Yunli，ZHANG Yanyang，LUO Zhi，WANG Yubo
Chinese General Practice 2021, 24 (11): 1354-1358. DOI: 10.12114/j.issn.1007-9572.2021.00.411
Abstract
Background Chronic heart failure is associated with high prevalence of frailty in older adult patients，which may increase the rate of hospitalization and mortality.Early recognition and intervention of frailty may improve the prognosis of elderly.However，relevant evidence is limited.Objective To investigate the prevalence and associated factors of frailty in elderly patients with preserved ejection fraction（HFpEF）.Methods A total of 95 patients with stable chronic HFpEF（≥65 years old） who hospitalized in Department of Geriatrics，Beijing Friendship Hospital，Capital Medical University from April 2017 to May 2019 due to various causes were selected，and divided into two groups：non-frailty（healthy and pre-frail）（n=64，<3 points） and frailty（n=31，≥3 points） by the Fried Frailty Phenotype.Demographic information（age，gender，height，weight，BMI，smoking history（defined as consuming cigarettes more than 20 a year），comorbidity prevalence（hypertension，diabetes，coronary heart disease，chronic obstructive pulmonary disease，chronic kidney disease，stroke，peripheral vascular disease），and polypharmacy（defined as the use of at least five medications），laboratory test results（white blood cell count，hemoglobin，platelet count，alanine aminotransferase，creatinine，glycosylated hemoglobin，fasting blood glucose，total cholesterol，triacylglycerol，high-sensitivity C-reactive protein，serum iron，albumin，prealbumin），and echocardiographic indicators（left ventricular ejection fraction，left atrial diameter，left ventricular end diastolic dimension，right ventricular diameter，and E/A ratio） were collected.Activities of Daily Living（ADL） scale and the Instrumental Activities of Daily Living（IADL） scale were used to assess the activities of daily living.The Nutritional Risk Screening（NRS2002） scale was used to assess the nutritional risk.Charlson Comorbidity Index was used to assess the comorbidity risk.Multivariate Logistic regression analysis was used to explore the influencing factors of frailty.Results Compared to non-frail group，the frail group had a greater mean age，higher rate of polypharmacy and higher mean score of Charlson Comorbidity Index（P<0.05）.Moreover，The frail group had lower mean ADL，IADL and albumin levels as well as greater mean left atrial diameter（P<0.05）.Multivariate Logistic regression analysis revealed that older age and polypharmacy were associated with frailty （P<0.05）.Conclusion The prevalence of frailty was 32.6% among elderly patients with HFpEF，which was associated with older age and polypharmacy.
Novel Advances in Heart Failure with Mid-range Ejection Fraction
SHI Fang'e，ZHU Jihong
Chinese General Practice 2021, 24 (5): 526-532. DOI: 10.12114/j.issn.1007-9572.2021.00.005
Abstract
Heart failure is the final stage of the development of heart disease.Previous studies classified heart failure into two types based on left ventricular ejection fraction：heart failure with preserved ejection fraction（HFpEF）and heart failure with reduced ejection fraction（HFrEF）.But according to the 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure，heart failure is categorized into HFpEF，HFrEF and heart failure with mid-range ejection fraction（HFmrEF）based on the LVEF.The comparison of epidemiology，clinical characteristics，pathophysiology，treatment and prognosis among the patients with HFrEF，HFmrEF and HFpEF suggests that HFmrEF may be an intermediate phenotype between HFrEF and HFpEF.There are still many diagnosis and treatment strategies for HFmrEF that need to be further explored，such as finding active anti-myocardial ischemia therapies and examining the protective value of ambulatory monitoring of ejection fraction for cardiomyocytes，clinical value of screening for cardiovascular and non-cardiovascular comorbidities in understanding the pathophysiological characteristics of HFmrEF，the diagnostic value of cardiac MRI for pathophysiological changes of HFmrEF，and values of cFGF23 and NPY levels in risk and clinical outcome prediction of HFmrEF.The exploration and research of more relevant information will contribute to improving clinicians' understanding of the pathogenesis and characteristics of HFmrEF to develop effective diagnosis and treatment strategies.
Heart Failure with Preserved Ejection Fraction：Diagnosis and Treatment Strategies
LIU Wei，WEI Ran
Chinese General Practice 2021, 24 (3): 253-258. DOI: 10.12114/j.issn.1007-9572.2020.00.603
Abstract
HFpEF accounts for about 50% of heart failure cases.With the aging of population，its incidence and mortality tend to increase year by year.On the basis of recent developments and recommendations from definitive guidelines/ consensuses regarding HFpEF，we introduced and analyzed the diagnostic procedures and treatment strategies for HFpEF，aiming to provide assistance and guidance to Chinese primary care physicians.However，we believe that there are still many problems and challenges in this field：the pathogenesis of HFpEF is still unclear，there is a lack of effective treatment methods，and a large number of clinical trials have shown negative results，and so on.Further clinical studies are needed to provide evidence for HFpEF treatment and reducing the incidence and mortality of related cardiovascular events.