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Background: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) are risk factors for venous thromboembolism (VTE). Enoxaparin and unfractionated heparin (UFH) help prevent hospital-associated VTE, but few studies have compared them in COPD or HF. Objectives: To compare effectiveness, safety, and costs of enoxaparin vs UFH thromboprophylaxis in medical inpatients with COPD or HF. Methods: This retrospective cohort study included adults with COPD or HF from the Premier PINC AI Healthcare Database. Included patients received prophylactic-dose enoxaparin or UFH during a >6-day index hospitalization (the first visit/admission that met selection criteria during the study period) between January 1, 2010, and September 30, 2016. Multivariable regression models assessed independent associations between exposures and outcomes. Hospital costs were adjusted to 2017 US dollars. Patients were followed 90 days postdischarge (readmission period). Results: In the COPD cohort, 114 174 (69%) patients received enoxaparin and 51 011 (31%) received UFH. Among patients with COPD, enoxaparin recipients had 21%, 37%, and 10% lower odds of VTE, major bleeding, and in-hospital mortality during index admission, and 17% and 50% lower odds of major bleeding and heparin-induced thrombocytopenia (HIT) during the readmission period, compared with UFH recipients (all P

This systematic review explores the relationship between the gut microbiota metabolite trimethylamine N-oxide (TMAO) and heart failure (HF), given the significant impact of TMAO on cardiovascular health. A systematic search and meta-analysis of peerreviewed studies published from 2013 to 2024 were conducted, focusing on adult patients with heart failure and healthy controls. The review found that elevated levels of TMAO are associated with atherosclerosis, endothelial dysfunction, and increased cardiovascular disease risk, all of which can exacerbate heart failure. The analysis also highlights that high TMAO levels are linked to reduced left ventricular ejection fraction (LVEF) and glomerular filtration rate (GFR), further supporting TMAO's role as a biomarker in heart failure assessment. The findings suggest that interventions targeting gut microbiota to reduce TMAO could potentially benefit patients with heart failure, although further research is needed to evaluate the effectiveness of such approaches. [ABSTRACT FROM AUTHOR]

Background: Metabolic disorders and overweight or obesity are highly prevalent and intricately linked in patients with chronic heart failure (CHF). However, it remains unclear whether there is an interactive effect between these conditions and the prognosis of heart failure, and whether such an interaction is influenced by stratification based on age and sex. Methods: A total of 4,955 patients with CHF were enrolled in this study. Metabolic status was assessed according to the presence or absence of metabolic syndrome (MetS). BMI categories included normal weight and overweight or obesity (BMI < 24, ≥ 24 kg/m²). Patients were divided into four phenotypes according to their metabolic status and BMI: metabolically healthy with normal weight (MHNW), metabolically unhealthy with normal weight (MUNW), metabolically healthy with overweight or obesity (MHO), and metabolically unhealthy with overweight or obesity (MUO). The incidence of primary outcomes, including all-cause and cardiovascular (CV) death, was recorded. Results: During a mean follow-up of 3.14 years, a total of 1,388 (28.0%) all-cause deaths and 815 (16.4%) CV deaths were documented. Compared to patients with the MHNW phenotype, those with the MUNW (adjusted hazard ratio [aHR], 1.66; 95% confidence interval [CI], 1.38-2.00) or MUO (aHR, 1.42 [95% CI, 1.24-1.63]) phenotypes had a greater risk of all-cause death, and those with the MHO phenotype (aHR, 0.61 [95% CI, 0.51-0.72]) had a lower risk of all-cause death. Moreover, the above phenomenon existed mainly among males and elderly females (aged ≥ 60 years). In nonelderly females (aged < 60 years), the detrimental effects of MetS were lower (aHR, 1.05 [95% CI, 0.63-1.75] among MUNW group and aHR, 0.52 [95% CI, 0.34-0.80] among MUO group), whereas the protective effects of having overweight or obesity persisted irrespective of metabolic status (aHR, 0.43 [95% CI, 0.26-0.69] among MHO group and aHR, 0.52 [95% CI, 0.34-0.80] among MUO group). Similar results were obtained in the Cox proportional risk analysis of the metabolic overweight/obesity phenotypes and CV death. Conclusions: In male and elderly female patients with CHF, the detrimental effects of MetS outweighed the protective benefits of having overweight or obesity. Conversely, in nonelderly females, the protective effects of having overweight or obesity were significantly greater than the adverse impacts of MetS. [ABSTRACT FROM AUTHOR]

Cardiac remodeling is a shared pathological change in most cardiovascular diseases. Encompassing both adaptive physiological responses and decompensated pathological changes. Anatomically, atrial remodeling is primarily caused by atrial fibrillation, whereas ventricular remodeling is typically induced by myocardial infarction, hypertension, or cardiomyopathy. Mitochondria, the powerhouse of cardiomyocytes, collaborate with other organelles such as the endoplasmic reticulum to control a variety of pathophysiological processes such as calcium signaling, lipid transfer, mitochondrial dynamics, biogenesis, and mitophagy. This mechanism is proven to be essential for cardiac remodeling. Post-translational modifications can regulate intracellular signaling pathways, gene expression, and cellular stress responses in cardiac cells by modulating protein function, stability, and interactions, consequently shaping the myocardial response to injury and stress. These modifications, in particular phosphorylation, acetylation, and ubiquitination, are essential for the regulation of the complex molecular pathways that underlie cardiac remodeling. This review provides a comprehensive overview of the crosstalk between the endoplasmic reticulum and mitochondria during cardiac remodeling, focusing on the regulatory effects of various post-translational modifications on these interactions. [ABSTRACT FROM AUTHOR]

Background and Purpose Experimental Approach Key Results Conclusion and Implications Opioid analgesics can alleviate ischaemia/reperfusion (I/R) injury in chronic heart failure. However, the underlying mechanisms and targets remain unknown. Here, we investigate if caveolin‐3 (Cav3) interacts with μ opioid receptors and if Cav3–μ receptor interactions play a role in morphine‐induced cardioprotection in failing hearts.Cav3 and μ receptor proteins in human and rat heart tissue were determined by western blot, immunofluorescence and co‐immunoprecipitation. Methyl‐β‐cyclodextrin (MβCD), a destroyer of caveolae, and AAV‐Cav3 shRNA were used to reduce Cav3 expression in failing rat hearts. CTOP, a specific μ antagonist, was administrated before morphine preconditioning in perfused failing heart models of myocardial I/R injury.Levels of Cav3 and μ receptor proteins were significantly higher in human and rat myocardial tissues with heart failure than in control tissues. Cav3 and μ receptor expression levels were positively correlated with disease severity. The signal of the cardiac Cav3 protein was colocalized with μ receptor in both the human and rat heart sections. Disruption of caveolae in the failing heart by either MβCD or AAV‐Cav3 shRNA significantly inhibits morphine‐induced phosphorylation of ERK1/2 and cardioprotection. Administration of CTOP substantially reduced Cav3 expression and morphine‐induced cardioprotective effect in heart failure.Our data suggest that up‐regulation of the Cav3/μ receptor complex is critical for morphine protection of the failing heart against I/R injury by regulating the ERK1/2 pathway. The activated Cav3/μ receptor complex is an understudied therapeutic target for opioid treatment of heart failure and ischaemic insult. [ABSTRACT FROM AUTHOR]

Intolerance to exercise is a symptom associated with chronic heart failure (CHF) resulting in SM waste and weakness in humans. The effect of CHF on skeletal muscle (SM) arose from experimental evidence in rat models to explain the underlying mechanism. We investigated SM mechanical and metabolic properties in sham rats and with coronary ligation-induced CHF. After twelve weeks of CHF, rats were catheterized to measure right auricular pressure, SM mechanical properties, SERCA-ATPase activity and plasma membrane Ca2+-ATPase (PMCA) hydrolytic activity in isolated sarcoplasmic reticulum (SR) and transverse tubule (TT membrane), respectively, in the sham and CHF. The right auricular pressure and plasma nitrite concentration in CHF increased two-fold with respect to the sham. Pleural effusion and ascites were detected in CHF, confirming CHF. SERCA activity was conserved in CHF. In TT membranes from CHF, the glucose transporter GLUT4 increased seven-fold, and the PMCA hydrolytic activity increased five-fold, but in isolated muscle, the mechanical properties were unaffected. The absence of a deleterious effect of coronary ligation-induced CHF in the rat model on SM could be explained by the increased activity of PMCA and increased presence of GLUT-4 on the TT membrane, which may be involved in the mechanical outcome of the EDL. [ABSTRACT FROM AUTHOR]

Background: Currently, most elderly chronic heart failure (CHF) patients go home for rehabilitation after certain treatment in hospitals. However, the results of their rehabilitation at home are not satisfactory. According to studies, dyadic treatments can increase the efficiency of home rehabilitation, enhance both partners' quality of life, lessen the caregiver's load of care, and alleviate the strain of medical resources. Thus, the aim of our research is to design a study protocol that included elderly CHF patients and their informal caregivers as an intervention unit and to explore the impact of the protocol on their health and physical outcomes. Methods: This is a prospective randomized controlled trial conducted in a triple-A hospital. In total, 80 elderly CHF patients and informal caregivers (80 dyads) will be recruited with informed consent. Based on the randomized numbers, they are divided into a control group (40 dyads) and an intervention group (40 dyads), subjects in the control group will receive usual care, and subjects in the intervention group will receive a home-based disease management program based on the Theory of Dyadic Illness Management on the basis of the control group. The duration of the intervention is 3 months, and the follow-up is 6 months. Data is collected at enrolment, 3 months after the intervention, and 3 months after the end of the intervention. The primary outcome is patients' quality of life and readmission. Secondary outcomes include patients' self-management behaviors, anxiety, and depression and caregivers' quality of life and care burden. Discussion: This study focuses on whether this home-based disease management program can improve the quality of life of elderly patients with CHF, reduce the readmission rate, enhance their self-management capacity, reduce negative emotions, and reduce the burden of informal caregivers. It can provide a new perspective on home management and cardiac rehabilitation of heart failure disease in the elderly, as well as alleviate problems such as the burden of healthcare resources. Trial registration: Chinese Clinical Trials Registry ChiCRT2300068026. Registered on 3 February 2023, manuscript Version: 1.0, https://www.chictr.org.cn/. [ABSTRACT FROM AUTHOR]

Expansion of CD4+CD28null T‐lymphocytes is common in chronic heart failure (CHF) patients. Its ability to produce high levels of proinflammatory cytokines is probably the key role of these cells in CHF. IL‐10 is a candidate for limiting CD4+CD28null T‐lymphocyte responses, whereas tumour necrosis factor (TNF) is the cytokine most closely involved in the loss of CD28 expression. Serum levels of TNF and IL‐10 were measured in 65 CHF patients (mean age, 65.2 ± 13.84 years). Patients with an IL‐10/TNF ratio ≥1 had significantly lower levels of CD4+CD28null T‐lymphocytes than those with a ratio <1. In vitro, IL‐10 reduced the frequency of proliferative CD4+CD28null T‐lymphocytes stimulated with anti‐CD3. Pre‐treatment with IL‐10 before anti‐CD3 stimulation was required for the cytokine to inhibit TNF production by CD4+CD28null T‐lymphocytes. In addition to the previously described effect of IL‐10 on HLA‐DR and ICAM‐1 expression, LFA‐3 protein and mRNA levels were reduced in the presence of the cytokine in monocytes. IL‐10 inhibition on CD4+CD28null T‐lymphocytes may be mediated by a reduction in HLA class II and LFA‐3 expression because blocking interactions with these costimulators has similar effects to those of IL‐10 treatment. Moreover, costimulation through CD2/LFA‐3 interaction is enough to induce proliferation and cytokine production in CD4+CD28null T‐lymphocytes. [ABSTRACT FROM AUTHOR]

• Identifying which patients with coronary artery disease (CAD) and acute heart failure (HF) or left ventricular systolic dysfunction will benefit from revascularization is challenging owing to population heterogeneity. • We propose a treatment algorithm that categorizes patients with CAD and HF/left ventricular systolic dysfunction into 2 frameworks: those exhibiting CAD-predominant symptoms (acute myocardial infarction, refractory angina, or positive stress test) vs those with HF-predominant symptoms (dyspnea, orthopnea, peripheral edema without angina or positive stress test). • Randomized controlled trials and observational data indicate that revascularization benefits patients with CAD-predominant symptoms, but does not confer symptomatic or mortality benefit in those with HF-predominant symptoms. Patients with heart failure (HF) and underlying coronary artery disease (CAD) have a substantially higher risk of mortality compared with those with HF from other causes. However, identifying individuals with HF for whom revascularization is likely to improve prognosis is a complex clinical decision. Revascularization is likely beneficial for patients with CAD-predominant symptoms, such as those with acute myocardial infarction or stable ischemic heart disease with refractory angina. However, for patients with HF-predominant symptoms, characterized by dyspnea without acute myocardial infarction or refractory angina, the benefits of revascularization are less clear. This state-of-the-art review summarizes the outcomes, clinical trials, and therapeutic approaches for patients with both CAD and HF, and proposes a therapeutic algorithm to guide the diagnosis and comprehensive workup of these complex patients. [Display omitted] [ABSTRACT FROM AUTHOR]

In this study, we investigated the potential therapeutic mechanism of ginsenoside Rg1 (GRg1) in chronic heart failure (CHF), focusing on its regulation of ERK1/2 protein phosphorylation. H9c2 cardiomyocytes and SD rats were divided into the control group, CHF (ADR) group, and CHF+ginsenoside Rg1 group using an isolated cardiomyocyte model and an in vivo CHF rat model induced by adriamycin (ADR). Cell viability, proliferation, apoptosis, and the expression of relevant proteins were measured to assess the effects of GRg1. The results showed that treatment with GRg1 increased cell activity and proliferation, while significantly reducing levels of inflammatory and apoptotic factors compared to the CHF (ADR) group. Moreover, the CHF+ginsenoside Rg1 group exhibited higher levels of Bcl-2 mRNA and protein expression, as well as lower levels of Caspase3 and Bax mRNA and protein expression, compared to the CHF (ADR) group. Notably, the CHF+ginsenoside Rg1 group displayed decreased serum NT-proBNP levels and heart weight/body weight (HW/BW) index. Furthermore, the electrocardiogram of rats in the CHF+ginsenoside Rg1 group resembled that of rats in the control group. Overall, our findings suggested that GRg1 alleviated CHF by inhibiting ERK1/2 protein phosphorylation, thereby inhibiting apoptosis, enhancing cell activity and proliferation, and reducing cardiac inflammatory responses. [ABSTRACT FROM AUTHOR]

Objectives: To date, there is a lack of consensus on the timely implementation of palliative care (PC) in patients with chronic heart failure (HF). We aimed to investigate the impact of primary PC intervention on chronic HF patients with different classes of cardiac function, and to determine a proper time point for the implementation of primary PC intervention. Methods: A consecutive series of 180 chronic HF patients with the New York Heart Association (NYHA) Cardiac function ranging from I to III were enrolled in this study. Patients with the same cardiac function class, they were randomized and equally assigned to the usual care (UC) group or to the PC intervention group. At the end of 24-week treatment, quality-of-life (QoL) measurements were evaluated. Left ventricular ejection fraction and N-terminal pro-B-type natriuretic peptide were measured for each group at baseline and the final follow-up, respectively. Results: Through the 6-month follow-up, patients randomized to the PC intervention group presented significantly better QoL and cardiac function as compared with patients randomized to the UC group alone. Subgroup analysis showed that for patients with NYHA class II or III, significantly improved cardiac function and QoL were observed in the PC intervention group as compared with the control group. As for patients with class I, no significant difference was found between the 2 groups. Conclusions: Palliative program can effectively improve the QoL and cardiac function of patients with chronic HF. Moreover, we provided evidence on timely referral of patients to PC intervention, which could be beneficial for patients with NYHA class II. [ABSTRACT FROM AUTHOR]

Background: The Duke Activity Status Index (DASI) questionnaire has been the focus of numerous investigations - its discriminative and prognostic capacity has been continuously explored, supporting its use in the clinical setting, specifically during rehabilitation in patients with chronic heart failure (CHF).However, studies exploring optimal DASI questionnaire threshold scores are limited. Objective: To investigate optimal DASI questionnaire thresholds values in predicting mortality in a CHF cohort and assess mortality rates based on the DASI questionnaire using a thresholds values obtained. Methodology: This is a prospective cohort study with a 36-month follow-up in patients with CHF. All patients completed a clinical assessment, followed by DASI questionnaire, pulmonary function, and echocardiography. The Receiver Operating Characteristic (ROC) curve analysis was used to discriminate the DASI questionnaire score in determining the risk of mortality. For survival analysis, the Kaplan-Meier model was used to explore the impact of ≤/>23 points on mortality occurring during the 36-month follow-up. Results: One hundred and twenty-four patients were included, the majority being elderly men. Kaplan Meier analysis revealed that ≤/> 23 was a strong predictor of CHF mortality over a 36-month follow-up. Conclusion: A score of ≤/>23 presents good discriminatory capacity to predict mortality risk in 36 months in patients with CHF, especially in those with reduced or mildly reduced ejection fraction. Age, ejection fraction, DASI questionnaire score and use of digoxin are risk factors that influence mortality in this population. [ABSTRACT FROM AUTHOR]

Aims: Cognitive impairment (CI) is a common, yet frequently unrecognized co‐morbidity in chronic heart failure (HF). We quantified trajectories of cognitive performance, brain volume, and related clinical outcome over a time course of 6 years. Methods and results: The Cognition.Matters‐HF cohort study recruited patients with stable HF of any aetiology and severity. Beyond cardiological assessment, the workup included cognitive testing and brain magnetic resonance imaging (MRI). Of 148 recruited patients, 70% exhibited CI at baseline. During the median follow‐up time of 69 months (quartiles: 68, 70), indicators of HF severity remained essentially unaltered. CI was also stable, with the exception of intensity of attention, where age‐adjusted t‐scores decreased from 42 (38, 46) to 38 (34, 44; P < 0.001). Complete sets of four serial brain MRI scans were available in 47 patients (32% of total sample). Total brain volume shrank by 0.4% per year, from 1103 (1060, 1143) cm3 to 1078 (1027, 1117) cm3, which was within limits observed in non‐diseased ageing individuals. During follow‐up, 29 study participants (20%) died, and 26 (18%) were at least once hospitalized due to worsening HF. The presence of CI was not associated with overall (P = 0.290) or hospitalization‐free (P = 0.450) survival. Conclusions: In patients with stable HF patients receiving guideline‐directed pharmacologic treatment and regular medical care, the presence of CI did not affect overall and hospitalization‐free 6‐year survival. The loss of brain parenchyma observed in patients with stable HF did not exceed that of normal ageing. [ABSTRACT FROM AUTHOR]

Aims: Technological advances and the current shortage of donor organs have contributed to an increase in the number of left ventricular assist device (LVAD) implantations in patients with end‐stage heart failure. Demographic change and medical progress might raise the number of these patients, resulting in a further increase in the number of LVAD implantations. The aim of this study was to evaluate the long‐term costs of LVAD therapy and identify diagnoses resulting in expensive stays. Methods and results: In this retrospective analysis of prospectively collected data, all patients after implantation of a second‐ or third‐generation LVAD by 31 March 2022 were included. In addition to demographic and survival data, revenues and case mix points were determined for each patient. Of the 163 patients included, 75.5% were male. The mean age at LVAD implantation was 52 ± 14 years. The mean survival was 1458 ± 127 days. During follow‐up, the total inpatient treatment time per patient was 70 ± 87 days. The average duration of outpatient treatment was 55.1%, based on the total duration of support. The average revenue per patient for the implant stay was $193 192.35 ± $111 801.29, for inpatient readmissions $52 068.96 ± $116 630.00, and for outpatient care $53 195.94 ± $62 363.53. Conclusions: LVAD implantation in patients with end‐stage heart failure leads to improved survival but a significant increase in treatment costs. Further multi‐centre studies are necessary in order to be able to assess the effects of long‐term LVAD treatment on the healthcare system. [ABSTRACT FROM AUTHOR]

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Objective To systematically evaluate the effects of breathing exercises on cardiopulmonary function, exercise endurance and quality of life in patients with chronic heart failure (CHF). Methods Computerized searches of CNKl, Wanfang, VIP, PubMed, EBSCO, Embase, Web of Science, The Cochrane Library, SinoMed, and other databases were conducted to retrieve information on the effects of cardiopulmonary function, exercise tolerance, and quality of life in patients with CHF from inception to December 2023 in a series of randomized controlled trials (RCT). Two researchers independently performed literature screening, data extraction and quality evaluation. Finally, meta-analysis was performed using RevMan 5. 4 software. Pulmonary function indexes included peak oxygen uptake (PeakVO2) and carbon dioxide ventilation equivalent slope (VE/VCO2 slope). Cardiac function indexes included left ventricular ejection fraction (LVEF) and brain natriuretic peptide precursor (NT-proBNP). PeakVO2 and six min walking test (6MWT) were used to evaluate exercise tolerance. Minnesota heart failure quality of life scale (MLHFQ) was used to evaluate quality of life. Results A total of 13 RCTs literature involving 900 patients were included. Compaired with control group, the descriptive results showed that breathing exercises of obviouse group significantly enhanced PeakVO2 [standardized mean deviation (SMD) =0. 47, 95% confidence internal (95%CI) 0.03-0.91, P=0. 04], VE/VCO2 [mean difference (MD) =-3. 20, 95%CI-4.49--1.19, P＜0.001], improved NT-proBNP (MD=-134. 25, 95%CI-141.95--126. 56, P＜0.001), LVEF (SMD=0.53, 95%CI 0. 16-0. 90, P=0.005), 6MWT (MD=77.71, 95%CI 69.50-85.92, P＜0.001), MLHFQ (MD=-7.68, 95%CI-8.99--6.37, P＜0. 001). Conclusion Breathing exercises can significantly increase lung function and exercise tolerance in patients with CHF, and improve cardiac function and quality of life of them to a certain extent. [ABSTRACT FROM AUTHOR]

Chronic heart failure (CHF) is one of the most common diseases with a prevalence of 1–2% in adults, disproportionately affecting the elderly. Despite consistent drug therapy, physical activity (PA) is an integral part of current guidelines. Yet adherence to regular PA and exercise interventions is poor and potential predictors and barriers to PA remain elusive. We examined the effects of a telemonitoring-based exercise intervention in 699 CHF patients in a prospective, randomized-controlled (1:1), multicenter trial. The study was registered in the German Clinical Trials Register under DRKS00019022 on 28.05.2020. For both, the exercise and control group, self-reported PA (MET*h/week) increased and sedentary behavior declined during the 12-month intervention period. In the exercise group, daily step count as analyzed via activity trackers remained stable (pre: 6459 [4016] steps/day, post: 6532 [3858] steps/day; p = 0.621). The average number of completed exercise instruction videos provided via an online application was 1.50 [1.44] videos/week at the beginning and gradually decreased to 1.00 [1.50] videos/week; p < 0.001). Multivariate regression model revealed that exercise-related PA (MET*h/week) and exercise capacity (Wmax) at baseline, CHF severity, atrial fibrillation and age predicted changes in self-reported exercise-related PA (R2 = 0.396). Furthermore, the BMI and the average number of completed videos per week at baseline were associated with the change in completed videos over the course of the study (R2 = 0.251). Our results show the influence of certain baseline characteristics as barriers and predictors of PA progression. Therefore, exercise programs should pay attention to patients' individual conditions to set achievable goals, and eventually affect the adherence and sustainability of exercise-focused interventions. [ABSTRACT FROM AUTHOR]

Heart rate recovery, a widely used indicator in clinical evaluation of the autonomic nervous system, refers to the difference between maximum heart rate during exercise and the heart rate after 1 or a few minutes of cessation. It possesses advantages of being noninvasive and repeatable. Currently, heart rate recovery is extensively applied in cardiovascular diseases for evaluating disease severity, prognosis, risk of cardiovascular events, and mortality. This article primarily discusses the application value and current research progress of heart rate recovery in cardiovascular diseases. [ABSTRACT FROM AUTHOR]

Background/Objectives: Chronic heart failure (CHF) is characterized by complex pathophysiology, leading to increased hospitalizations and mortality. Inflammatory biomarkers such as the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) provide valuable diagnostic insights. Methods: This study evaluates the prognostic relationship between NLR, PLR, and, in a specific subcohort, N-terminal pro B-type natriuretic peptide (NT-proBNP), alongside length of stay (LOS) and 90-day readmission rates in CHF patients, irrespective of heart failure phenotype. A retrospective analysis of 427 CHF admissions (males = 57.84%) was conducted. Results: The mean age of the entire population was 68.48 ± 11.53 years. The average LOS was 8.33 ± 5.26 days, with a readmission rate of 73 visits (17.09%) for 56 patients. The NLR (3.79 ± 3.32) showed a low but positive correlation with the LOS (r = 0.222, p < 0.001). Conversely, the PLR (144.84 ± 83.08) did not demonstrate a significant association with the LOS. The NLR presented a low negative correlation for days until the next admission (r = −0.023, p = 0.048). In a prespecified subanalysis of 323 admissions, the NT-proBNP exhibited a low positive Pearson correlation with the NLR (r = 0.241, p < 0.001) and PLR (r = 0.151, p = 0.006). Conclusions: The impact of the NLR across heart failure phenotypes may suggest the role of systemic inflammation in understanding and managing CHF. [ABSTRACT FROM AUTHOR]

Background: Cardiac lipid metabolism reprogramming is recognized as a critical pathological factor in the progression of chronic heart failure (CHF). The therapeutic potential of digilanid C and electroacupuncture stimulation (ES) in enhancing lipid metabolism and cardiac function has been established. However, the optimal synergistic regulatory strategies of these interventions on cardiac lipid metabolism have yet to be elucidated. Methods: This study aimed to comprehensively evaluate the impact of a digilanid C-ES combination on cardiac steatosis remodeling in CHF. Assessments were conducted across various dimensions, including myocardial oxygen consumption, mitochondrial function, and lipid metabolism. Additionally, we sought to uncover the underlying neuromolecular mechanisms. Results: Our findings, at both molecular and morphological levels, indicated that the synergistic application of digilanid C and ES significantly inhibited myocardial fibrosis and steatosis. This combination therapy facilitated the repair of cardiac neuro-vascular uncoupling and induced a reprogramming of lipid metabolism. Notably, the digilanid C-ES combination ameliorated cardiomyocyte apoptosis and enhanced mitochondrial biogenesis in CHF, leading to a restructured energy supply pattern. Cardiac immunofluorescence analyses revealed the aggregation of cardiac glial cells (CGCs) at sites of abnormal neurovascular coupling, a response to cardiac lipid degeneration. This was accompanied by a marked reduction in the abnormally elevated expression of interleukin 6 (IL-6) and glutamatergic signaling, which correlated with the severity of cardiac steatosis and the aberrant activation of CGCs. The combined therapy was found to activate the Janus kinase 1 (JAK1)/signal transducer and activator of transcription 3 (STAT3) pathway, effectively attenuated lipid accumulation and overrecruitment of CGCs and deprivation of glutamatergic nerves. Conclusion: These findings underscore the potential of digilanid C and ES combination therapy as a novel approach to modulate the complex interplay between neurovascular dynamics and metabolic dysregulation in CHF. [ABSTRACT FROM AUTHOR]

Introduction: A comprehensive assessment of congestion, including circulating biomarkers, is recommended in patients with acute heart failure. The circulating biomarkers natriuretic peptides (NPs) and carbohydrate antigen-125 (CA125) could be useful for congestion assessment in ambulatory chronic heart failure (CHF), but there is only limited information about their applicability in this context. Therefore, this study aimed to examine the association of plasma CA125 and NP levels with clinical and ultrasound congestion parameters in CHF. Methods: This is a cross-sectional substudy of the Cardioren Spanish Registry, which enrolled 1,107 patients with CHF from 13 tertiary hospitals in Spain between October 2021 and February 2022. Through ambulatory visits, we performed a comprehensive assessment of congestion-related parameters, including clinical variables (orthopnea, peripheral edema, and jugular engorgement, represented by the composite congestion score [CCS]), echocardiography variables (lung B-lines and inferior vena cava [IVC] diameter), and circulating biomarkers (CA125 and NPs). The association of the NP and CA125 levels with the clinical and echocardiographic congestion parameters was examined by multiple linear and logistic regression analyses. Results: This substudy included 802 patients for whom all the biomarker parameters were available {median age, 74 (interquartile range [IQR], 63–81) years; 65% male}. The proportion of patients with left ventricular ejection fraction ≥50% and estimated glomerular filtration rate <60 was 34% and 58%, respectively. The median CCS was 0 (IQR: 0–1), with 45% of the sample exhibiting a median CCS of ≥1. The jugular engorgement, peripheral edema, and orthopnea rates were 32%, 21%, and 21%, respectively. A total of 35% of patients who underwent ultrasound examination showed lung B-lines, and the median IVC diameter was 16 mm. The median CA125 and NTproBNP levels were 14 U/mL (IQR: 9–28) and 1,382 pg/mL (IQR: 563–3,219), respectively. Multivariate analysis showed that higher CA125 levels were independently associated with higher odds of peripheral edema (p = 0.023) and lung B-lines (p < 0.001). Further, NTproBNP was positively associated with jugular engorgement (p < 0.001), orthopnea (p = 0.034), and enlarged IVC diameter (p = 0.031). Conclusions: Clinical signs of congestion are frequent in CHF. In the ambulatory setting, NTproBNP was associated with parameters linked to intravascular congestion such as orthopnea, jugular engorgement, and IVC diameter, whereas CA125 was associated with extravascular volume overload parameters (peripheral edema and lung B-lines). [ABSTRACT FROM AUTHOR]

Background: Malnutrition is common in older patients with chronic heart failure (HF) and often accompanies a deterioration of their condition. The Controlling Nutritional Status (CONUT) score is used as an objective indicator to evaluate nutritional status, but relevant research in this area is limited. This study aimed to report the prevalence, clinical correlates, and outcomes of malnutrition in elder patients hospitalized with chronic HF. Methods: A retrospective analysis was conducted on 165 eligible patients admitted to the Department of Cardiology at Huadong Hospital from January 2021 to December 2022. Patients were categorized based on their CONUT score into three groups: normal nutrition status, mild risk of malnutrition, and moderate to severe risk of malnutrition. The study examined the nutritional status of this population and its relationship with clinical outcomes. Results: Findings revealed that malnutrition affected 82% of the older patients, with 28% experiencing moderate to severe risk. Poor nutritional scores were significantly associated with prolonged hospital stay, increased in-hospital mortality and all-cause mortality during readmissions within one year (P < 0.05). The multivariable analysis indicated that moderate to severe malnutrition (CONUT score of 5–12) was significantly associated with a heightened risk of prolonged hospitalization (aOR: 9.17, 95%CI: 2.02–41.7). Conclusions: Malnutrition, as determined by the CONUT score, is a common issue among HF patients. Utilizing the CONUT score upon admission can effectively predict the potential for prolonged hospital stays. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To probe into the mechanism of Shenmai injection (SMI) on improving ventricular remodeling in rats with chronic heart failure (CHF). METHODS: According to random number table method, 40 rats were divided into sham surgery group (0. 9% sodium chloride injection, intramuscular injection), model group (0. 9% sodium chloride injection, intramuscular injection), positive control group ( valsartan 10 mg/ kg, intramuscular injection) and SMI group (Shenmai injection 0. 38 mL/ kg, intramuscular injection), with 10 rats in each group. Except for sham surgery group, another groups were established CHF model by ligation of left anterior descending coronary artery. After establishment of the model, the related drugs were administered once a day for 28 d. Echocardiography was applied to observe the changes of left ventricular and evaluate situation of cardiac function based on hemodynamics. Enzyme-linked immunosorbent assay ( ELISA) were performed to measure serum levels of N-terminal pro-brain natriuretic peptide ( NT-proBNP ), transforming growth factor-β1 (TGF-β1), matrix metalloproteinases 9 (MMP-9) and connective tissue growth factor (CTGF). Morphological changes of myocardium were observed by hematoxylin-eosin (HE) staining and MASSON staining. Expression levels of TGF-β1, Smad2, Smad3 and Smad7 were detected through quantification reverse transcription polymerase chain reaction. RESULTS: Compared with the sham group, the left ventricular ejection fraction (LVEF), left ventricular short-axis shortening rate (LVFS), left ventricular posterior wall thickness (LVPWs), aortic flow peak velocity (AV Peak Velocity), left ventricular pressure (LVP), left ventricular systolic pressure (LVSP), +dp/ dtmax and -dp/ dtmin in the model group decreased significantly; and left ventricular volume (LV vols), left ventricular end-systolic diameter (LVIDs), left ventricular end diastolic pressure (LVEDP) increased significantly; the serum levels of NT-proBNP, TGF-β1, MMP-9 and CTGF decreased significantly; the mRNA expression of TGF-β1, Smad2, and Smad3 increased significantly, the mRNA expression of Smad7 decreased significantly, with statistically significant differences ( P < 0. 01). The morphological analysis showed that there was little cardiomyocyte remained in myocardium with structural disorder and serious degree of fibrosis. Compared with the model group, SMI can significantly increase the levels of LVEF, LVFS and LVPWs in the heart of rats with CHF, reduce LV vols and LVIDs, improve hemodynamics, and reduce the levels of NT-proBNP, TGF-β1, MMP-9 and CTGF, down-regulate the mRNA expression of TGF-β1, Smad2 and Smad3 and up-regulate the mRNA expression of Smad7, with statistically significant differences (P <0. 01). SMI can inhibit myocardial cell necrosis and alleviate myocardial fibrosis. CONCLUSIONS: SMI could inhibit ventricular remodeling and achieve anti-CHF effects by participating into enhancing cardiac function, improving hemodynamics, alleviating myocardial injury, reducing the degree of fibrosis and regulating TGF-β/Smads signaling pathway. [ABSTRACT FROM AUTHOR]

Background: : Family coping, as an essential part of family management of patients with chronic heart failure (CHF), is an important component of CHF interventions, affecting the health of patients, family members, and the whole family. It is necessary to understand the current situation of family coping in patients with CHF to facilitate the development of family interventions for patients with CHF. This study aims to develop and validate a tool for assessing the family coping scale for patients with CHF. Methods: The semi-structured interviews, expert consensus meetings, expert consultations, and item analysis were used to develop the initial scale. We employed classical test theory and exploratory factor analysis to scrutinize and refine the items in the scale. To validate the scale, we used confirmatory factor analysis to assess structural validity. We assessed internal consistency, and split-half reliability to ensure the scale's robustness and accuracy. Results: The FCS-CHF consisted of 24 items, including six dimensions: strategies for better management of CHF, psychological coping, substantial support by family members, emergency coping, overall heart failure awareness, and patients' health behavior. The results of confirmatory factor analysis showed that the scale fitted the data with well construct validity. The results of the confirmatory factor analysis for the overall goodness of fit indices for the fitted model were found to be acceptable for the scale. The scale demonstrates good reliability and validity, meeting the requirements of psychometrics. Conclusions: The FCS-CHF developed in this study is considered reliable and valid, which can measure family coping in patients with CHF and provide a basis for developing family coping enhancement strategies. [ABSTRACT FROM AUTHOR]

Background Hip fractures in older people result in increased mortality. Objective We developed and validated an accurate and simple prognostic scoring system for hip fractures that can be used preoperatively. Design Retrospective study. Setting Multicenter. Participants Patients aged ≥65 years with hip fractures who underwent surgery between 2011 and 2021 were enrolled. Methods The significant factors were determined with logistic regression analysis, and a scoring system was developed. The patients were classified into three groups, and a log-rank test was performed to evaluate 1-year survival rates. The model was internally and externally validated using the 5-fold cross-validation and data from another hospital, respectively. Results We included 1026 patients. The analysis revealed eight significant prognostic factors: sex, body mass index, history of chronic heart failure and malignancy, activities of daily living (ADLs) before injury, hemoglobin and the prognostic nutritional index (PNI) at injury, and the American Society of Anesthesiologists Physical Status. The area under the receiver operating characteristic curve (AUC) after internal validation was 0.853. The external validation data consisted of 110 patients. The AUC of the model for the validation data was 0.905, showing outstanding discrimination. Sensitivity and specificity were 88.7% vs. 100% and 93.3% vs. 95.2% for the development and validation data, respectively. Conclusions We developed and validated an accurate and simple prognostic scoring system for hip fractures using only preoperative factors. Our findings highlight PNI as an important predictor of prognosis in hip fracture patients. [ABSTRACT FROM AUTHOR]

Background/Aim: The study aims to describe the role of diabetes in patients with heart failure. Methods: In all, 1052 chronic heart failure patients were included in the FARmacology and NeuroHumoral Activation (FAR NHL) multicenter prospective registry. They had ejection fraction below 50% and were on stable medication for at least 1 month. Results: More than one‐third (38.9%) of the patients had diabetes mellitus (DM). Diabetic patients (N = 409) were older (median 67 vs. 64, p < 0.001), had higher body mass index (BMI) (30 vs. 28 kg/m2, p < 0.001), much more frequently had ischemic heart disease (71 vs. 47%, p < 0.001), hypertension (80 vs. 67%, p < 0.001), dyslipidemia (89 vs. 69%, p < 0.001), worse renal function (estimated glomerular filtration rate [eGFR] median 63 vs. 73 mL/min/1.73 m2, p < 0.001), and higher N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) (median 681 vs. 463 pg/mL, p = 0.003). All‐cause death, left ventricle assist device implantation, and orthotopic heart transplantation were set as the combined primary end point, which was present in 15.5% (163 patients) within the 2‐year follow‐up. In the 2‐year follow‐up, 81.0% of patients with diabetes survived without a primary end point, while 85.4% of the patients without diabetes survived, the difference being on the verge of statistical significance (p = 0.089). DM is a statistically significant predictor of NT‐proBNP value in univariate analysis, but it is not an independent predictor in a multivariate analysis. When the NT‐proBNP level was high, the presence of DM did not influence the prognosis. Conclusion: The combination of diabetes and NT‐proBNP levels may better stratify the prognosis of patients with chronic heart failure. [ABSTRACT FROM AUTHOR]

Objective: To investigate the relationship between serum apelin (Apelin), cluster of differentiation 40 ligand (CD40L), galectin-3 (Gal-3) and ventricular arrhythmia after cardiac resynchronization therapy (CRT) in patients with chronic heart failure (CHF) and its predictive value. Methods: 235 CHF patients who underwent CRT at Taigang General Hospital Affiliated to Shanxi Medical University and Cardiovascular Hospital Affiliated to Shanxi Medical University from January 2018 to October 2022 were selected as the CHF group. In addition, 150 healthy individuals who underwent physical examinations at the two hospitals during the same period were selected as the control group. The serum Apelin, CD40L and Gal-3 levels of all subjects were detected and compared. CHF patients were followed up for 1 year after CRT, and patients were divided into ventricular arrhythmia group (48 cases) and non-ventricular arrhythmia group (187 cases) according to whether ventricular arrhythmia occurred. The influencing factors of ventricular arrhythmia after CRT in CHF patients were analyzed by multivariate Logistic regression. The value of serum Apelin, CD40L and Gal-3 in predicting the occurrence of ventricular arrhythmias after CRT in CHF patients were analyzed by receiver operating characteristic (ROC) curve. Results: Compared with control group, the serum Apelin level in CHF group was decreased, and the levels of CD40L and Gal-3 were increased (P<0.05). After 1 year of follow-up, the incidence of ventricular arrhythmia after CRT in 235 CHF patients was 20.43%. Increased Apelin was protective factors for ventricular arrhythmias after CRT in CHF patients, and the New York Heart Association (NYHA) cardiac function classification IV and CD40L, Gal-3 increased were risk factors (P<0.05). The area under the curve (AUC) of combined serum Apelin, CD40L and Gal-3 in predicting the occurrence of ventricular arrhythmia after CRT in CHF patients was 0.911, which was greater than 0.770, 0.754 and 0.760 predicted by serum Apelin, CD40L and Gal-3 alone. Conclusion: The decrease of serum Apelin level and the increase of CD40L and Gal-3 levels in CHF patients are relate to the occurrence of ventricular arrhythmia after CRT, the combine detection of serum Apelin, CD40L and Gal-3 levels has a high predictive value for the occurrence of ventricular arrhythmia after CRT in CHF patients. [ABSTRACT FROM AUTHOR]

Natriuretic peptides (NP) play an essential role in heart failure (HF) regulation, and their measurement has improved diagnostic and prognostic accuracy. Clinical symptoms and objective measurements, such as NP levels, should be included in the HF definition to render it more reliable and consistent among observers, hospitals, and healthcare systems. BNP and NT-proBNP are reasonable surrogates for cardiac disease, and their measurement is critical to early diagnosis and risk stratification of HF patients. NPs should be measured in all patients presenting with dyspnea or other symptoms suggestive of HF to facilitate early diagnosis and risk stratification. Both BNP and NT-proBNP are currently used for guided HF management and display comparable diagnostic and prognostic accuracy. Standardized cutoffs for each NP assay are essential for data comparison. The value of NP testing is recognized at various levels, including patient empowerment and education, analytical and operational issues, clinical HF management, and cost-effectiveness. [ABSTRACT FROM AUTHOR]

The present study aimed to explore the association between the neutrophil-to-lymphocyte ratio (NLR) and prognosis of critically ill chronic heart failure patients. The records of 5298 patients who met the inclusion criteria were extracted from the Medical Information Mart for Intensive Care IV database. The primary outcome was 30-days all-cause mortality and the secondary outcome was 90-days all-cause mortality. Multivariable logistic regression analysis was performed to examine the relationship between NLR and 30-days mortality. Subgroup analysis was carried out to identify whether the association between NLR and 30-days mortality differed across various subgroups. For 30-days mortality, after adjusting for multiple confounders, the odds ratio (OR) (95% confidence interval [CI]) for the second (NLR 4.0–8.4) and the third (NLR ≥8.4) tertiles were 1.52 (1.13–2.03) and 2.53 (1.92–3.34), respectively, compared with the first tertile (NLR <4.0). As for 90-days mortality, the OR for the second (NLR 4.0–8.4) was 1.34 (1.07–1.67) and 2.23 (1.81–2.76) for the third (NLR ≥8.4) tertiles compared with the reference (NLR<4.0). The interactions between the sepsis subgroup and 30-days mortality were significant. Our study concluded that the NLR was an independent predictor of 30- and 90-days mortality for critically ill patients with chronic heart failure. [ABSTRACT FROM AUTHOR]

• Our study not only considers the positive contribution of filial culture to the caregiver's role but also enriches the application of the Caregiver Empowerment Model. • Filial values should be taken into account when preparing adult-children of chronically ill patients for caregiving roles. • Healthcare providers should pay attention to the cultural aspect of filial values and implement effective measures to help caregivers adapt to their roles, addressing the increased demand for family caregivers in the context of global ageing and the high prevalence of chronic diseases. To explore the relationship between filial values (responsibility, reciprocity, and obligation) and caregiving preparedness in adult child carers of patients with chronic heart failure (CHF). A total of 339 adult child caregivers of CHF patients were recruited from six hospitals in China. Self-report questionnaires were used to measure caregivers' filial values and their caregiving preparedness. Descriptive analysis, Spearman's correlation analysis, and hierarchical regression analysis were performed. The study adhered to the STROBE guidelines. Filial values were positively correlated with caregiving preparedness. Hierarchical regression analysis revealed a positive relationship between the combined variables of care and respect with caregiver preparedness, jointly explaining 7.9 % of the variance. Filial values promote caregiver preparedness, broadening the applicability of the Caregiver Empowerment Model. [ABSTRACT FROM AUTHOR]

• This systematic review summarised non-pharmacological interventions for the reduction of thirst in patients with chronic heart failure or hemodialysis. • Results show that non-pharmacological interventions could be helpful to reduce thirst in this patient population but the quality of the studies was moderate to low. • Further research of the development and evaluation of complex interventions could be a useful step to better address patients' individual needs and situations. Thirst is a frequent and burdening symptom in many patients, especially in patients with chronic heart failure (CHF) and/or receiving hemodialysis (HD). As drug therapies are not feasible, non-pharmacological strategies are needed to reduce thirst and thirst-related burden. To identify non-pharmacological interventions aiming to reduce thirst in patients with CHF and/ or HD, to describe intervention components, and to evaluate the effectiveness of these interventions. In February 2024, we completed a systematic search in MEDLINE via PubMed, Livivo, CINAHL, Cochrane Library and Web of Science. Two reviewers independently screened titles, abstracts, and full texts, performed critical appraisal and data extraction. We checked risk of bias with the checklists of the Joanna Briggs Institute and the Cochrane Risk of Bias tool and calculated meta-analyses for sufficiently homogeneous studies using fixed-effects models. We included 15 intervention studies applying non-pharmacological interventions including chewing gum (n = 8), low-sodium diet (n = 2), acupressure (n = 1), frozen strawberries (n = 1), fluid timetables (n = 1), ice cubes and mouthwash (n = 1), and a psychological intervention (n = 1). Sample sizes varied between 11 and 88 participants. Eleven intervention studies showed a reduction of thirst as intervention effect. Meta-analyses for chewing gum showed no significant effect on thirst using a visual analogue scale (IV: -2,32 [-10.37,5.73]; p = 0.57) or the dialysis thirst inventory (IV: -0.26 [- 1.83, 1.30]; p = 0.74). Quality of studies was moderate to low. Results indicate that various non-pharmacological interventions could be helpful to reduce thirst in patients with CHF or HD, but important uncertainty remains. [ABSTRACT FROM AUTHOR]

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Beta-blockers are first-line drugs in the treatment of chronic heart failure (CHF). However, there is no consensus on the specific effects of the beta-blockers of the I-III generation on energy metabolism in CHF. The aim of this study is to conduct a study of beta-blockers of different generations on myocardial energy metabolism in experimental CHF. CHF was modeled in white outbred rats by administering doxorubicin. The study drugs were administered intragastrically—new drug Hypertril (1-(β-phenylethyl)-4-amino-1,2,4-triazolium bromide)-3.5 mg/kg, Metoprolol—15 mg/kg, Nebivolol −10 mg/kg, Carvedilol 50 mg/kg, and Bisoprolol, 10 mg/kg. In the myocardium, the main indices of energy metabolism were determined—ATP, ADP, AMP, malate, lactate, pyruvate, succinate dehydrogenase (SDH) activity, and NAD-dependent malate dehydrogenase (NAD-MDH) activity. Traditional second-generation beta-blockers (Metoprolol and Bisoprolol) did not affect the studied indices of energy metabolism, and third-generation beta-blockers with additional properties—Carvedilol and, especially, Nebivalol and Hypertril—improved myocardial energy metabolism. The obtained results will help to expand our understanding of the effect of beta-blockers of various generations used to treat cardiovascular diseases on energy metabolism, and are also an experimental justification for the practical choice of these drugs in the complex therapy of CHF. [ABSTRACT FROM AUTHOR]

BACKGROUND: Chronic cardiac failure belongs to the most threatening and delayed manifestations of cardiotoxicity in oncology patients receiving the treatment with antitumor medicines. As of today, only two groups of drugs were proven to have significant cardioprotective effects in these categories of patients: angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and beta-adrenergic blockers. Recently, the first data were published on the successful use of sodium-glucose cotransporter type 2 inhibitors in patients with chronic cardiac failure, receiving anthracycline therapy. AIM: optimization of cardioprotective therapy in the treatment of chronic cardiac failure in oncology patients receiving cardiotoxic chemotherapy. METHODS: A prospective observational open-label research was carried out with an enrollment of 116 oncology patients with verified chronic cardiac failure, which were receiving cardiotoxic chemotherapy, of which 60 patients of the control group were receiving double cardioprotective therapy (angiotensin-converting enzyme inhibitors/angiotensin receptor blockers) and the 56 patients of the test group were receiving similar therapy with an addition of Dapagliflozin at a dosage of 10 mg once daily in the morning. The controls of the results were conducted in 6 months by means of laboratory and instrumental examinations, as well as by using additional methods of controlling the results. RESULTS: The groups compared did not differ by the combined primary clinical endpoint (the rate of hospitalizations due to cardio-vascular reasons, the refusal to undergo chemotherapy for the reason of chronic cardiac failure progression and the safety of using the drug products: the presence of urinary tract infections and sepsis), but they differed by the surrogate clinical endpoints that included the dynamic trend of the levels of the groups compared did not differ by the combined primary clinical endpoint (the rate of hospitalizations due to cardio-vascular reasons, the refusal to undergo chemotherapy for the reason of chronic cardiac failure progression and the safety of using the drug products: the presence of urinary tract infections and sepsis), but they differed by the surrogate clinical endpoints that included the dynamic trend of the levels of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and the global longitudinal strain (GLS) of the left ventricle, determined within the timeframes established for the research — before the initiation of chemotherapy and in 6 months. The patients that have passed all the control tests (n=47), after the end of the 6 months period, underwent a comparison of the levels of troponin Т, left ventricle ejection fraction (LVEF), NT-proBNP and GLS. It was found that the dynamic changes of troponin T levels in both groups did not significantly differ (p=0,260), as well as the LVEF indicator (p=0.340), while the NT-proBNP level was significantly decreasing in the test group — by 7.8% comparing to the control group (p=0.006). Comparable data were obtained for the GLS (the decrease in the test group by 6.5% in relative values) comparing to the control group (p=0.008). In 22/47 (46,8%) patients, chronic cardiac failure was diagnosed before the initiation of chemotherapy, in 25/47 (53,2%), chronic cardiac failure was developing during the antitumor medication therapy. In both groups, a total of 17 (16%) fatal outcomes were registered, none of which was caused by the cardiac failure. CONCLUSION: We suppose that the decrease in the levels of the cardiac failure marker and the less intensive impairment of the left ventricle longitudinal strain with a background of adding sodium-glucose cotransporter type 2 inhibitors to baseline therapy for chronic cardiac failure in oncology patients receiving cardiotoxic chemotherapy, reflects their cardioprotective potential. Thus, the sodium-glucose cotransporter type 2 inhibitor Dapagliflozin slows down the progression of chronic cardiac failure in oncology patients receiving cardiotoxic chemotherapy.

Chronic heart failure (CHF) is a common complication of many cardiovascular diseases. It is important to study the clinical and functional features of CHF to clarify the further prognosis of this disease due to the unfavorable course and high mortality rate. Diagnosis and treatment of CHF is an issue for doctors of various specialties, in particular when it comes to geriatric patients with multiple concomitant diseases. Various physiological and morphological transformations in the aging population contribute to heart failure. The most common type of HF in older people is HF with preserved ejection fraction. Atypical clinical symptoms of CHF are much more common in elderly people than in young people. The prevalence of HF with age is associated with a longer period of influence of damaging factors on the heart, such as arterial hypertension, metabolic stress or ischemia-related damage. Due to the unfavorable course and high mortality rate, it is important to study the clinical and functional characteristics of CHF to clarify its prognosis. However, the data available on this issue vary significantly; the mechanisms, issues of diagnosis and treatment of patients with heart failure in different age groups have not been sufficiently studied, which determined the purpose of this study ‒ to investigate the features of the clinical and functional characteristics of CHF depending on age. Material and methods. The study included 90 male and female patients with diagnosed CHF stages I-IIB, NYHA functional class I-IV, aged 40–86 years, who underwent echocardiography, general and biochemical blood tests. The patients were divided into two groups: group 1 – patients of working age (women 16–54 years old and men 16–59 years old, n = 20), group 2 – patients older than working age (women 55 years and older, men 60 years and older, n = 70). Results and its discussion. According to the data obtained, the average age of all surveyed was 68.1 ± 9.8 years. The second stage of CHF prevailed in both the first and second groups of the studied categories of participants. Atypical symptoms prevailed, which creates difficulties in its diagnosis and treatment. The frequency of CHF decompensation in patients over working age, as well as the concentration of natriuretic peptide, is higher compared to the group of CHF patients of working age, which is probably due to the presence of comorbid pathology and cognitive deficit. The data obtained can be used to develop an approach to stratify the risk of CHF.

Dilated cardiomyopathy (DCM) is a leading cause of heart failure, sudden cardiac death, and heart transplantation in young patients. The causes of DCM are varied and include genetic factors and metabolic, infectious, toxic and others factors. Today it is known that germline mutations in more than 98 genes can be associated with the occurrence of DCM. However, the penetrance of these genes often depends on a combination of factors, including modifiable ones, i.e. those that change under the influence of the environment. About 20–25% of genetically determined forms of DCM are due to mutations in the titin gene (TTN). Titin is the largest protein in the body, which is an important component of the sarcomer. Although titin is the largest protein in the human body, its role in the physiology of heart and disease is not yet fully understood. However, a mutation in the TTN gene may later represent a potential therapeutic target for genetic and acquired cardiomyopathy. Thus, the analysis of clinical cases of cardiomyopathy in patients with identified mutations in the TTN gene is of great scientific interest. The article presents a clinical case of manifestation of DCM in patient with a revealed pathogenic variant of mutation in the gene TTN and reverse left ventricular remodeling of the against the background of optimal therapy of heart failure in a subsequent outpatient observation.

Aim. To analyze the experience of Chazov National Medical Research Center of Cardiology in patient selection for left ventricular assist device (LVAD) implantation. Materials and methods. 901 patients, whose documents were sent to Chazov National Medical Research Center of Cardiology from regional medical and prophylactic institutions, were screened as selection for LVAD implantation. Firstly, all patients underwent transthoracic echocardiography performed according to the extended protocol with a comprehensive assessment of the left and right ventricle size and function. Patients who underwent the screening procedure underwent further examination including both laboratory and instrumental diagnostic methods. In addition, the polyclinic database of patients diagnosed with chronic heart failure (CHF) and dilated cardiomyopathy was also analyzed. Results. Among 901 screened patients 7.9% were suitable candidates for LVAD implantation and only 23 (2.6%) patients underwent surgery. Among those not eligible for surgery: 208 (29%) patients were not on optimal medical therapy, 15% of patients had indications for other surgical treatment of CHF, 12% of patients had severe right ventricular failure, 9.8% had severe comorbidities, 6.8% of patients refused surgery. Conclusions. The main problems of selection for LVAD implantation were: low awareness of doctors about the introduction of new treatment methods, poor quality of transthoracic echocardiography, a large percentage of patients not receiving basic therapy for CHF, untimely referral of patients for other types of surgical treatment.

The aim of this guideline is to assist physicians in the management of patients with cardiovascular pathology and obstructive sleep-disordered breathing. The article consists data on diagnostic tactics for patients with possible sleep-breathing disorders, describes the basic principles of obstructive sleep apnea treatment, and substantiates the clinical significance of obstructive sleep apnea therapy initiating in the management of patients with cardiovascular diseases.

Introduction. Modern clinical guidelines for heart failure consider a comprehensive approach to treatment using implantation of various devices (cardiac resynchronisation therapy CRT, implantation of cardioverter-defibrillator (ICD), installation of pacemakers (ECS) as well as correction of valve defects. For example, for treatment of severe mitral valve insufficiency the technique of clipping its flaps using MitraClip system is used. Objective. To evaluate the effect of mitral valve intervention with the help of MitraClip on the course of chronic heart failure (CHF) in patients with implanted devices. Materials and Methods. 73 patients with mitral regurgitation of 3-4 degree, heart failure of II-IV NYHA functional class who underwent implantation of MitraClip system on mitral valve flaps were included in the study. The dynamics of EchoCG parameters, exercise tolerance, diuretic therapy and brain natriuretic pro-peptide level was evaluated during six months. The comparison of the results of follow-up of the group of patients who had previously been fitted with ECS, ICD, CRT (group A) with the data of patients without implanted devices (group B) was carried out. Results. Clinical improvement of the course of CCN occurred after 6 months in both observation groups. The mean functional class (FC) of CHF decreased in group A from 2.67 ± 0.8 to 1.81 ± 0.7 (p

Objectives. To evaluate the informativeness of the N-terminal brain-promoting natriuretic peptide (NT-proBNP) for the diagnosis of chronic heart failure (CHF), depending on the presence of senile asthenia syndrome (SSA) in patients with arterial hypertension (AH) 80 years and older.Materials and Methods. 320 patients with hypertension, depending on the presence of CHF and SSA, were divided into groups: group 1A — patients with hypertension, SSA and CHF (n=84), group 1B — patients with hypertension, SSA without CHF (n=77), group 2A — patients with hypertension, CHF without SSA (n=84), group 2B — patients with hypertension without CHF and without SSA (n=75). The CSA was identified by the questionnaire “Age is not a hindrance”. The level of NT-proBNP was determined in blood serum by enzyme immunoassay. ROC analysis was used to determine the threshold value of markers.Results. In patients with hypertension and SSA without CHF, the concentration of NT-proBNP in the blood is 2.3 times higher (p=0.003) compared with patients with hypertension without SSA and without CHF, which indicates the effect of SSA on the level of NT-proBNP. In patients with hypertension and CHF without SSA, the level of NT-proBNP is 4.3 times higher compared with patients with hypertension without SSA and without CHF (p

Luwei Xiang,1,&ast; Jing Wang,1,&ast; Wen Li,1,2 Hongfang Ye1,2 1School of Nursing, Nanjing University of Chinese Medicine, Nanjing, 210023, People’s Republic of China; 2Nursing Department, Nanjing Drum Tower Hospital, Nanjing, 210008, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Hongfang Ye, School of Nursing, Nanjing University of Chinese Medicine, Nanjing, 210023, People’s Republic of China, Email 13915969627@163.comPurpose: To explore the status quo and influencing factors of personal mastery in Chinese patients with chronic heart failure, based on the analysis of patient characteristics.Methods: The sample of the study comprised 249 chronic heart failure patients who visited a university hospital in China. We collected the data using general demographic Information, personal mastery scale, the Simple Coping Style Questionnaire and Minnesota Living With Heart Failure Quality of Life Questionnaire (MLHFQ). SPSS26.0 was used to describe the survey results statistically, and univariate analysis, Pearson correlation analysis and multiple linear regression were used to analyze the influencing factors of personal sense of control.Results: Chronic heart failure patients’ total personal mastery scores were (20.63± 4.486), which is in the medium level. Multiple linear regression analysis shows that Age group (β=− 1.627, p=0.036), NYHA functional classification (β=− 1.563, P< 0.001), Positive coping style (β= 0.088, P=0.004) and MLHFQ (β= − 0.121 P< 0.001) significantly influenced patients’ personal mastery (P< 0.001).Conclusion: Our study suggests that the personal mastery of patients with chronic heart failure is at a moderate level in China. Additionally, age group, NYHA functional classification, Positive coping style and MLHFQ emerged as significant influencing factors. Clinical staff should dynamically observe the changes in the level of personal mastery of patients with chronic heart failure, pay more attention to the elderly and patients with poor heart function according to the influencing factors, and encourage active responses to improve the level of personal mastery of patients with heart failure.Keywords: chronic heart failure, the personal mastery, positive coping style, negative coping style, quality of life

Abstract Background Currently, most elderly chronic heart failure (CHF) patients go home for rehabilitation after certain treatment in hospitals. However, the results of their rehabilitation at home are not satisfactory. According to studies, dyadic treatments can increase the efficiency of home rehabilitation, enhance both partners' quality of life, lessen the caregiver's load of care, and alleviate the strain of medical resources. Thus, the aim of our research is to design a study protocol that included elderly CHF patients and their informal caregivers as an intervention unit and to explore the impact of the protocol on their health and physical outcomes. Methods This is a prospective randomized controlled trial conducted in a triple-A hospital. In total, 80 elderly CHF patients and informal caregivers (80 dyads) will be recruited with informed consent. Based on the randomized numbers, they are divided into a control group (40 dyads) and an intervention group (40 dyads), subjects in the control group will receive usual care, and subjects in the intervention group will receive a home-based disease management program based on the Theory of Dyadic Illness Management on the basis of the control group. The duration of the intervention is 3 months, and the follow-up is 6 months. Data is collected at enrolment, 3 months after the intervention, and 3 months after the end of the intervention. The primary outcome is patients’ quality of life and readmission. Secondary outcomes include patients’ self-management behaviors, anxiety, and depression and caregivers’ quality of life and care burden. Discussion This study focuses on whether this home-based disease management program can improve the quality of life of elderly patients with CHF, reduce the readmission rate, enhance their self-management capacity, reduce negative emotions, and reduce the burden of informal caregivers. It can provide a new perspective on home management and cardiac rehabilitation of heart failure disease in the elderly, as well as alleviate problems such as the burden of healthcare resources. Trial registration Chinese Clinical Trials Registry ChiCRT2300068026. Registered on 3 February 2023, manuscript Version: 1.0, https://www.chictr.org.cn/ .

Abstract Background The Duke Activity Status Index (DASI) questionnaire has been the focus of numerous investigations - its discriminative and prognostic capacity has been continuously explored, supporting its use in the clinical setting, specifically during rehabilitation in patients with chronic heart failure (CHF).However, studies exploring optimal DASI questionnaire threshold scores are limited. Objective To investigate optimal DASI questionnaire thresholds values in predicting mortality in a CHF cohort and assess mortality rates based on the DASI questionnaire using a thresholds values obtained. Methodology This is a prospective cohort study with a 36-month follow-up in patients with CHF. All patients completed a clinical assessment, followed by DASI questionnaire, pulmonary function, and echocardiography. The Receiver Operating Characteristic (ROC) curve analysis was used to discriminate the DASI questionnaire score in determining the risk of mortality. For survival analysis, the Kaplan-Meier model was used to explore the impact of ≤/>23 points on mortality occurring during the 36-month follow-up. Results One hundred and twenty-four patients were included, the majority being elderly men. Kaplan Meier analysis revealed that ≤/> 23 was a strong predictor of CHF mortality over a 36-month follow-up. Conclusion A score of ≤/>23 presents good discriminatory capacity to predict mortality risk in 36 months in patients with CHF, especially in those with reduced or mildly reduced ejection fraction. Age, ejection fraction, DASI questionnaire score and use of digoxin are risk factors that influence mortality in this population.

Abstract Aims Cognitive impairment (CI) is a common, yet frequently unrecognized co‐morbidity in chronic heart failure (HF). We quantified trajectories of cognitive performance, brain volume, and related clinical outcome over a time course of 6 years. Methods and results The Cognition.Matters‐HF cohort study recruited patients with stable HF of any aetiology and severity. Beyond cardiological assessment, the workup included cognitive testing and brain magnetic resonance imaging (MRI). Of 148 recruited patients, 70% exhibited CI at baseline. During the median follow‐up time of 69 months (quartiles: 68, 70), indicators of HF severity remained essentially unaltered. CI was also stable, with the exception of intensity of attention, where age‐adjusted t‐scores decreased from 42 (38, 46) to 38 (34, 44; P

Abstract Aims Technological advances and the current shortage of donor organs have contributed to an increase in the number of left ventricular assist device (LVAD) implantations in patients with end‐stage heart failure. Demographic change and medical progress might raise the number of these patients, resulting in a further increase in the number of LVAD implantations. The aim of this study was to evaluate the long‐term costs of LVAD therapy and identify diagnoses resulting in expensive stays. Methods and results In this retrospective analysis of prospectively collected data, all patients after implantation of a second‐ or third‐generation LVAD by 31 March 2022 were included. In addition to demographic and survival data, revenues and case mix points were determined for each patient. Of the 163 patients included, 75.5% were male. The mean age at LVAD implantation was 52 ± 14 years. The mean survival was 1458 ± 127 days. During follow‐up, the total inpatient treatment time per patient was 70 ± 87 days. The average duration of outpatient treatment was 55.1%, based on the total duration of support. The average revenue per patient for the implant stay was $193 192.35 ± $111 801.29, for inpatient readmissions $52 068.96 ± $116 630.00, and for outpatient care $53 195.94 ± $62 363.53. Conclusions LVAD implantation in patients with end‐stage heart failure leads to improved survival but a significant increase in treatment costs. Further multi‐centre studies are necessary in order to be able to assess the effects of long‐term LVAD treatment on the healthcare system.

Aim – to identify predictors of the risk of adverse events over a three-year period in patients with chronic heart failure (CHF). Material and methods. A retrospective study was conducted on 278 people diagnosed with CHF in patients with coronary heart disease (CHD). A sample of data was made, survival assessment, Charson comorbidity index was calculated. Statistical data processing was carried out using Excel and XLSTAT programs with linear regression calculations. Results. A statistically significant direct relationship between three-year survival was identified with the following indicators: age over 66 years, stage IIB-III CHF, Echo-CG data (low LVEF, left ventricular diameter, systolic pressure in the pulmonary artery (SPAP), the presence of hypertension (HBP) and atrial fibrillation (AF), Charlson comorbidity index of more than 5 points, glomerular filtration rate (GFR) less than 60 ml/min, complete blood count (CBC) data - a decrease in hemoglobin level below 131 g/l and an increase in ESR level above 14 mm/h. Surgical interventions such as coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) were associated with better patient survival. Conclusion. In order to ensure qualified monitoring of patients with CHF and ensure continuity of management of these patients, it seems relevant to create a specialized office for the management of patients with CHF.

Aim. To evaluate the clinical and economic effectiveness of dapagliflozin in patients with chronic heart failure (CHF) with reduced left ventricular ejection fraction (HFrEF) in the Russian Federation in various subgroups of standard therapy for CHF. Materials and methods. A clinical and economic analysis of the use of the drug dapagliflozin in addition to standard therapy was carried out in comparison with standard therapy in various subgroups of standard therapy for HFrEF using a modeling method. Cost calculations were carried out in a mathematical model adapted to the healthcare conditions of the Russian Federation by using Russian cost indicators and characteristics of the patient population. Results. The present study demonstrates that the addition of dapagliflozin is beneficial in terms of clinical and cost-effectiveness, regardless of the initial regimen (angiotensin receptor-neprilysin inhibitors [ARNI] or angiotensin-converting enzyme inhibitors [ACEi]/angiotensin II receptor blockers [ARB]) of standard drug therapy for HFrEF and in all cases leads to an increase in life expectancy, a decrease in the number of hospitalizations and emergency visits due to CHF, as well as cardiovascular mortality. The obtained values of added value per additional year of life in all cases are significantly lower than the willingness-to-pay threshold, which indicates the clinical and economic effectiveness of the strategy of prescribing dapagliflozin as part of standard therapy for patients with HFrEF. In the case of adding dapagliflozin the values of the additional cost of an added year of life in the 3 considered standard therapy options (ARNI or ACEi/ARB, only ACEi/ARB and only ARNI) were 291,256, 279,571 and 338,374 rubles respectively. Thus, the scenario of using dapagliflozin with standard therapy, which included only ACEi/ARB, is characterized by the lowest additional cost and has the best clinical and economic characteristics. At the same time the scenario of use with standard therapy, which included only ARNI, is characterized by the highest value of the additional value of the added year of life.

BACKGROUND: Chronic heart failure is one of the key problems of the Russian domestic healthcare system. E-health can be used to improve medical care quality and reduce the of hospitalizations and mortality. AIM: To examine the effect of telemedicine monitoring on mortality, frequency of hospitalizations, and clinical and functional states of patients with chronic heart failure. MATERIALS AND METHODS: A prospective, controlled, randomized study was conducted in the Central City Hospital No. 20 in Ekaterinburg (Russia), covering the period from December 2020 to December 2022. Patients with a confirmed diagnosis of chronic heart failure were randomized using the envelope method into three groups: group 1, a telephone control group (n=58); group 2, a remote control group using a Russian medical platform Medsenger (n=52); and group 3, the standard control group (n=103). All patients were examined, including NT-proBNP measurement and echocardiography on the first day of the study and at 3, 6, and 12 months. The occurrence of primary and secondary outcomes was evaluated at these reference points. Stata14 and jamovi software were used for statistical processing. RESULTS: The study involved 213 participants, and all three groups were comparable in terms of basic demographic and clinical characteristics. The advantage of remote control (groups 1 and 2) over face-to-face observation in reducing cardiovascular mortality was observed after 3 (odds ratio 2.73, 95% confidence interval 1.1–7.39; p=0.042) and 12 (odds ratio 2.1, 95% confidence interval 1.1–3.7; p=0.027) months and that in reducing the occurrence of the combined primary endpoint (odds ratio 2.1, 95% confidence interval 1.1–5.6; p=0.015) after 12 months. The use of the Medsenger platform also demonstrated an advantage over face-to-face observation in the development of the combined secondary endpoint (odds ratio 1.39, 95% confidence interval 0.19–0.81; p=0.011) after 3 months and over telephone control by a nurse after 12 months in reducing cardiovascular mortality (odds ratio 0.177, 95% confidence interval 0.06–0.487; p=0.021) and development of the combined secondary endpoint (odds ratio 0.427, 95% confidence interval 0.189–0.964; p=0.041). When using the Medsenger platform, the ejection fraction increased from 47% initially to 55% after 12 months (p=0.004). The NT-proBNP level decreased from 817 to 582 pg/mL (p 0.001) after 3 months and then to 233 pg/mL after 12 months (p 0.001). CONCLUSION: Remote monitoring protocols can be a good alternative to the traditional face-to-face monitoring of patients with chronic heart failure, which may improve clinical and functional health indicators.

Abstract Chronic heart failure (CHF) is one of the most common diseases with a prevalence of 1–2% in adults, disproportionately affecting the elderly. Despite consistent drug therapy, physical activity (PA) is an integral part of current guidelines. Yet adherence to regular PA and exercise interventions is poor and potential predictors and barriers to PA remain elusive. We examined the effects of a telemonitoring-based exercise intervention in 699 CHF patients in a prospective, randomized-controlled (1:1), multicenter trial. The study was registered in the German Clinical Trials Register under DRKS00019022 on 28.05.2020. For both, the exercise and control group, self-reported PA (MET*h/week) increased and sedentary behavior declined during the 12-month intervention period. In the exercise group, daily step count as analyzed via activity trackers remained stable (pre: 6459 [4016] steps/day, post: 6532 [3858] steps/day; p = 0.621). The average number of completed exercise instruction videos provided via an online application was 1.50 [1.44] videos/week at the beginning and gradually decreased to 1.00 [1.50] videos/week; p

Myxomatous Mitral Valve Disease (MMVD) is a degenerative condition of the mitral valve where it weakens and causes regurgitation, eventually leading to cardiac remodeling. Jason, a seven-year-old male Shih Tzu weighing 7.5 kg, was presented with a persistent cough and exercise intolerance lasting over a month. A physical examination revealed a Grade II/VI heart murmur. Radiography and echocardiography were performed as part of the laboratory examinations. Radiography demonstrated cardiac remodeling, with a VHS of 10.3 viscerocranial, an intercostal space of 3, and a VLAS of 2.3. Echocardiography unveiled left atrial enlargement, mitral valve regurgitation, and a reduction in heart function. The dog was treated with Pimobendan (Cardisure® 10mg, Dechra, England) as an inodilatator at 0.25mg, Enalapril Maleate 0.5mg/kg (Tenace® 5mg, Combiphar, Indonesia), and furosemide (Farsix® 40mg, Fahrenheit, Indonesia) at 2 mg/kg via oral route twice a day over the course of seven days. Thereafter, the dose was reduced to 1.5 mg/kg PO twice a day for seven days, and eventually once a day for the remainder of the seven days. Following the three-week treatment, there was a significant reduction in the frequency and intensity of coughing.