Heart failure (HF) is a symptoms caused by various diseases. As the myocardial contractility and/or diastolic weakening, the cardiac output decreased, when it can not satisfy the needs of the body, a series of symptoms and signs occurs. HF is an end-stage performance of heart disease, and is also a major factor of mortality. The morbidity of heart failure increased as peoples enter the aging. Despite the continuous improvement of drug treatment,the morbidity and mortality of HF remains high. At present, nondrug treatment of heart failure get more and more attention to clinicians. Surgical methods gets more innovation.Medical intervention has been introducted new auxiliary facilities, and genetics and stem cell technology bring new hope to it’s treatment. This article reviews the HF surgery, nterventional treatment and its related gene and cell therapy and research recently.
Heart failure is a progressive disease with high readmission rate and long treatment duration, which impose a heavy financial burden on patients and their families. The resulting financial toxicity can also affect the health outcomes of patients. This article provides an in-depth analysis of the concept, evaluation tools, research status, hazards, influencing factors, and coping strategies of financial toxicity in patients with heart failure. Suggestions are put forward for the development of evaluation tools and the improvement of coping strategies for financial toxicity, aiming to provide a reference for the development of more scientific and effective systematic intervention strategies.
ObjectiveTo systematically review the efficacy and safety of Xinmailong injection in the treatment of different types of heart failure with ejection fraction.MethodsCNKI, WanFang Data, VIP, CBM, PubMed, EMbase and The Cochrane Library databases were electronically searched to collect randomized controlled trials (RCTs) of Xinmailong injection in the treatment of different types of heart failure with ejection fraction from inception to August 5th, 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software.ResultsA total of 25 RCTs involving 2 467 patients were included. The results of meta-analysis showed that Xinmailong injection combined with conventional therapy was superior to conventional therapy alone on NYHA classification efficiency (HFrEF: RR=1.32, 95%CI 1.04 to 1.69, P=0.02), comprehensive clinical efficacy (HFrEF: RR=1.24, 95%CI 1.15 to 1.34, P<0.000 01; HFpEF: RR=1.22, 95%CI 1.15 to 1.30, P<0.000 01), score of life quality (HFrEF: MD=−7.08, 95%CI −9.34 to −4.82, P<0.000 01), left ventricular ejection fraction (HFrEF: MD=4.99, 95%CI 3.18 to 6.80, P<0.000 01; HFpEF: MD=5.10, 95% CI 0.62 to 9.58, P=0.03), the level of B-type natriuretic peptide (HFrEF: SMD=−0.96, 95%CI −1.36 to −0.56, P<0.000 01; HFpEF: SMD=−1.83, 95%CI−2.35 to −1.31, P<0.000 01), the level of N-terminal pro-B natriuretic peptide (HFrEF: SMD=−2.98, 95%CI −4.45 to −1.51, P<0.000 1), and 6-minute walking distance (HFrEF: MD=52.56, 95%CI 34.22 to 70.90, P<0.000 01). There was no significant difference in drug-related adverse reactions between two groups.ConclusionsCurrent evidence shows that Xinmailong injection combined with conventional therapy have good efficacy and safety in the treatment of heart failure with different ejection fractions. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
As the eventual end of the cardiovascular disease, heart failure is aggravated or results in cachexia when the patient is under malnutrition or exposes to certain risk factors of diet mode during the long disease duration. Researches reveal that the diet has effects on patho-physiology, energy metabolism, inflammation and oxidative stress of heart failure. This article conducts a literature review on the association between diet and heart failure.
ObjectiveTo establish a mouse model of pressure overload-induced heart failure via suprasternal notch approach. MethodsMale mice were separated into a sham group and an experiment group. Through suprasternal notch approach, the aortic arch port between the origin of the right innominate and left common carotid arteries was partially clipped with tantalum clip, which had a remaining opening of 0.35 mm or 0.25 mm in diameter to cause progres-sively increased afterload. Echocardiography was performed 10 weeks after aortic arch clipped or sham surgery to deter-mine left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular posterior wall end-diastolic thickness (LVPWD), ejection fraction (EF) and fractional shortening (FS). After hemodynamic recordings were completed, mouse body weight (BW) and heart weight (HW) were measured for obtaining HW/BW ratio (mg/g). After heart function examination, mice blood sample was collected for evaluation of serum N-terminal pro-brain natriuretic peptide (NT-proBNP). At the end, part of left ventricular free wall was excised, and hematoxylin and eosin stain was made for histopathological examination. ResultsThe HW/BW, LVEDD and serum NT-proBNP significantly increased in the experiment group compared with those in the sham group (P < 0.01, respectively). The LVPWD, EF and FS significantly decreased compared with the sham group (P < 0.01, respectively). Histopathological examination showed malalignment and rupture of cardiac muscle fibers, hypertrophy and degeneration of myocardial cells, part of which had local or patchy necrosis in left ventricule postoperatively 10 weeks. ConclusionThe model of pressure overload-induced heart failure in mice established through suprasternal approach is simple, minimally invasive and reliable.
Objective To evaluate the diagnostic value of N terminal pro-brain natriuretic peptide (NT-proBNP) for heart failure (HF) and the relationship between NT-proBNP and HF. Methods Applying electrochemiluminescence immunoassay on Elecsys 2 010 quantitatively detects NT-proBNP in HF patients with varing heart damage. Results ① Using 155 pg/ml as the cutoff for diagnosis of HF, the sensitivity and specificity are both 80 %, positive likelihood ratio (PLR) is more than 4.0; when NT-proBNP is more than 350 pg/ml, PLR is more than 14. ② NT-proBNP significantly increases in HF patients，and has significant difference compared with disease control group, Plt;0.05. In dilated cardiomyopathy (DCMP) and acute myocardial infarction (AMI) NT-proBNP is the highest, in coronary heart disease (CHD) and hypertension it’s the smallest. With rising NYHA classes, NT-proBNP increases exponentially. The correlation between NT-proBNP and heart function is good, rs=0.859 (Plt;0.01). Conclusions NT-proBNP for diagnosing HF has a high sensitivity and specificity and can effectively evaluate heart function. With worsening of heart damage, NT-proBNP shows exponential or linear increase.
Objective To summarize the clinical experiences of venoarterial extracorporeal membrane oxygenation (ECMO) which provides temporary cardiopulmonary assist for critical patients, and preliminary analysis of the cause of failure. Methods From February 2005 to October 2008, 58 adult patients (male 42, female 16) undergoing cardiogenic shock required temporary ECMO support. Age was 44.8±17.6 years, and support duration of ECMO was 131.9±104.7 hours. There were 24 patients (41.4%) with coronary heart disease, 11 patients (19.0%) with cardiomyopathy, 10 patients (17.2%) with cardiac valve disease,and 9 patients (15.5%) with congenital heart disease. Results 22 patients died in hospital. 11 patients (50%) died of multisystem organ failure, 5 patients (22.7%) died of refractory heart failure despite the ECMO support. Another patients died of bleeding and severe pulmonary hypertension etc. The percentage for patients need cardiac resuscitation before ECMO support and patients with acute renal failure treated by continuous renal replacement therapy (CRRT) under ECMO support were obviously higher in dead patients than those in survivor patients (45.5% vs.19.4%, 40.9% vs. 5.6%; P=0.043，0.001). All of the discharged patients were reassessed, mean followup time were 15.6 months. Three patients died of refractory heart failure， 1 patient died of neurologic complications. The other 32 survivors were in good condition with cardiac symptom of New York Heart Association class Ⅰ or Ⅱ. Conclusion ECMO offers effective cardiopulmonary support in adults. Early intervention and control of complications could improve our results with increasing experience. Combining using CRRT during the ECMO support is associated with significantly higher mortality rate. Suffered cardiac arrest prior to ECMO also influences the survival.
Objective To explore the clinical effects of emergency transcatheter aortic replacement (TAVR) on the treatment of patients with acute refractory heart failure or cardiogenic shock secondary to severe aortic stenosis during hospitalization. Methods The study selected 44 patients from 8 heart valve centers from January 2018 to January 2021. All patients received emergency TAVR treatment. The patients’ baseline clinical data, cardiac ultrasound indicators, and postoperative hospital stay were collected. Paired t-test and McNemar test were used to compare and analyze the preoperative and postoperative cardiac ultrasound indexes, moderate to severe aortic stenosis, and cardiac function. Results The average age of the patients was (72.0±7.9) years. Valve displacement occurred in one patient during the operation, and the surgical success rate was 97.7%. Four cases died during hospitalization, and the mortality rate was 9.1%. The median length of hospital stay was 11.5 d. The postoperative aortic valve area was significantly higher than that before surgery [(0.5±0.2) vs. (3.8±1.6) mm2, P<0.05], the mean transvalvular pressure of the aortic valve was significantly lower than that before operation [(64.0±24.9) vs. (11.3±4.6) mm Hg (1 mm Hg=0.133 kPa), P<0.05], the peak aortic flow velocity was significantly lower than that before operation [(4.5±0.7) vs. (1.9±0.7) m/s, P<0.05], the left ventricular end diastolic inner diameter was lower than that before operation [(59.0±7.2) vs. (56.1±7.3) mm, P<0.05], the left ventricular ejection fraction increased significantly compared with that before operation [(30.1±10.4)% vs. (40.9±11.0)%, P<0.05], and the cardiac function improved significantly compared with that before operation (P<0.05). During the operation, 2 cases (4.5%) underwent valve-in-valve implantation, 11 cases (25.0%) underwent percutaneous coronary intervention during the same period. During the postoperative hospital stay, 1 case (2.3%) developed stroke, 3 cases (6.8%) experienced severe bleeding, 5 cases (11.4%) had severe vascular complications, 2 cases (4.5%) experienced acute myocardial infarction, 30 cases (68.2%) had small or trace paravalvular regurgitation, 3 cases (6.8%) received permanent pacemaker implantation, and 5 cases (11.4%) developed acute kidney injury. Conclustion Emergency TAVR is an effective and feasible treatment plan for patients with acute refractory heart failure or cardiogenic shock secondary to severe aortic stenosis.
Sodium-glucose cotransporter (SGLT) -2 inhibitors is a new type of oral sugar-lowering drug. Instead of relying on insulin, it lowers blood sugar by inhibiting the reabsorption of near-curvy tube glucose, which is drained from the urine. SGLT-2 inhibitors not only have a sugar-lowering effect, but also benefit significantly in cardiovascular disease, and this drug has the advantages of permeable diuretic, reducing capacity load, and improving ventricular remodeling. SGLT-2 inhibitors can improve the diastolic function of patients with heart failure with preserved ejection fraction (HFpEF) and reduce the risk of adverse cardiovascular events. SGLT-2 inhibitors can benefit patients with HFpEF. Therefore, this article will discuss the progress of SGLT-2 inhibitors in HFpEF.
Abstract： Among all kinds of heart diseases, heart failure is the leading cause of death. In recent years, the treatment of terminal heart failure has increasingly become a great challenge to cardiovascular clinical physicians. The limitations of routine medical therapy and surgical interventions, and the shortage of donor hearts have led to the rapid development of mechanical circulation support devices. As the joint research and development of electric machine, mechanical engineering, fluid mechanics, materials science, medical science and some other related subjects, exploring a new type of longterm implantable blood pump has become a hot issue. Axial flow blood pump has the advantages of simple structure, light weight, high flow and efficiency, easy implantation and removal, and at the same time, it does not need to install artificial valves, which can greatly reduce the risk of thrombosis. Compared with the centrifugal pump, axial flow blood pump is smaller and causes much less damage to the blood. At present, axial flow blood pump research has become a focus in cardiac surgery and biomedical engineering field. This article is going to review the operation principles and characteristics of axial flow blood pump, and some key technical issues of current axial flow blood pump research.