Abstract: The ventricle assist device has emerged as an important therapeutic option in the treatment of both acute and chronic heart failure. The blood pumps which are the major components of ventricle assist devices have also progressed to the third generation. The magnetic and/or liquid levitation technologies have been applied into the third generation blood pumps. The impellers which drive blood are levitated in the blood pumps. The third generation blood pumps are mainly composed of the levitation system and the driving system. The development of the third generation blood pumps has three stages: the stage of foreign motor indirectly driving the impeller with the levitation and driving system separated, the stage of motor directly driving the impeller with the levitation and driving system separated, and the stage of levitation system integrated with the driving system. As the impellers do not contact with other structures, the third generation blood pumps possess the advantages of low thrombosis, less hemolysis and high energy efficiency ratio. Currently most of the third generation blood pumps are in the research stage, but a few number of them are used in clinical trials or applying stage. In this article, the history, classification, mechanism and research situation of the third generation blood pumps are reviewed.
ObjectiveTo systematically review the efficacy of Chinese medicine injection (CMI) for treating heart failure (HF).MethodsCNKI, WanFang Data, VIP, The Cochrane Library, PubMed, and EMbase databases were electronically searched from inception to January 2021 to identify randomized controlled trials (RCTs) on CMI for treating HF. Two reviewers independently screened literature, extracted data, and evaluated the risk of bias of included studies. Network meta-analysis was then performed by RevMan 5.2 software and Stata 16.0 software.ResultsA total of 47 studies were included involving 4 902 patients and 5 types of CMIs, including Shenmai, Shenfu, Yiqi Fumai (lyophilized), Shengmai, and Danhong injections. The results of network meta-analysis showed that the efficacy of combined CMIs was superior to conventional Western medicine alone. For the main efficacy, Shenmai, Shengmai, and Shenfu injections had significant advantages in improving the total clinical effectiveness. Shengmai, Shenmai, and Yiqi Fumai (lyophilized) injections were significantly more effective for reducing NT pro-BNP levels than other injections. Shenfu and Shengmai injections were significantly more effective for reducing BNP levels than other injections. Shenmai, Danhong and Shengmai injections were significantly more effective for improving the left ventricular ejection fraction than the other injections. These CMIs showed similar advantages for secondary efficacy indicators as for main efficacy indicators.ConclusionsThe combined 5 types of CMIs for treating HF can improve the clinical efficacy when compared with conventional Western medicine treatment. Shenmai injection, Yiqi Fumai injection (lyophilized), and Shengmai injection, which is part of Sheng Mai San, have clear advantages in terms of the overall curative effect or on individual indices.
Heart failure is a global problem that occurs in 38 million patients worldwide, and the number is dramatically increasing in elderly society. Meanwhile, heart dysfunction is also the most common disease among hospitalized patients more than 65 years, especially in high-income countries. Approximately, one million patients are hospitalized because of heart failure in the world every year. Drug therapy is currently the most popular treatment for heart failure in clinic, however, the effects are limited. Therefore, exploring novel treatment strategies gradually becomes a focus not only in basic but also in clinical research.
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.
Objective To investigate the therapeutic effects of thyroid hormone replacement on critically ill COPD patients with low serum thyroid hormone. Methods Sixty-seven critically ill patients with acute exacerbation of COPD ( AECOPD) , and complicated with respiratory and/ or heart failure and low serum thyroid hormone, admitted from July 2008 to June 2011, were recruited for the study. They were randomly divided into an intervention group ( n = 34) and a control group ( n = 33) . The control group received conventional treatment and the intervention group received conventional treatment plus additional thyroid hormone replacement therapy. Results Compared with the control group, the overall efficacy of the intervention group was not significantly different ( 88. 2% vs. 81. 8% , P gt; 0. 05) , while average effective time was significantly shorter [ ( 9. 6 ±2. 5) d vs. ( 12. 3 ±2. 8) d, P lt; 0. 05] . The post-treatment serum FT3 , FT4 , TT4 , and h-TSH levels were significantly higher in the intervention group than those in the control group, and significantly higher than baseline ( P lt;0. 05) . Conclusions For AECOPD patients complicated with respiratory and/or heart failure and low serum thyroid hormone, thyroid hormone supplement at low dosage will help to improve serumthyroid hormone level, and promote early recovery.
Heart failure is a disease that seriously threatens human health and has become a global public health problem. Diagnostic and prognostic analysis of heart failure based on medical imaging and clinical data can reveal the progression of heart failure and reduce the risk of death of patients, which has important research value. The traditional analysis methods based on statistics and machine learning have some problems, such as insufficient model capability, poor accuracy due to prior dependence, and poor model adaptability. In recent years, with the development of artificial intelligence technology, deep learning has been gradually applied to clinical data analysis in the field of heart failure, showing a new perspective. This paper reviews the main progress, application methods and major achievements of deep learning in heart failure diagnosis, heart failure mortality and heart failure readmission, summarizes the existing problems and presents the prospects of related research to promote the clinical application of deep learning in heart failure clinical research.
Objective To evaluate the effects of enhanced external counterpulsation (EECP) on exercise capacity and quality of life in patients with chronic heart failure. Methods PubMed, The Cochrane Library, EMbase, CNKI, Wanfang Data, VIP and CBM databases from January 1, 2010 to October 1, 2022 were searched by computer for the randomized controlled trial (RCT) about the intervention of EECP in patients with heart failure. Two researchers independently screened literature and extracted data. The meta-analysis was performed by RevMan 5.3. Results Nineteen RCTs were included. After EECP treatment, 6-minute walk distance (MD=57.37, 95%CI 40.89 to 70.85, P<0.001) and left ventricular ejection fraction improved (SMD=0.85, 95%CI 0.55 to 1.14, P<0.001). B-type natriuretic peptide decreased significantly (SMD=?0.67, 95%CI ?1.09 to ?0.25, P=0.002). The left ventricular end diastolic diameter (MD=?7.77, 95%CI ?11.49 to ?4.04, P<0.001), and the left ventricular end systolic diameter were significantly reduced (MD=?8.53, 95%CI ?13.47 to ?3.60, P<0.001). The quality of life of patients was improved (MD=16.34, 95%CI 0.59 to 32.10, P=0.04). Conclusion EECP can improve the exercise ability and the quality of life in patients with heart failure. However, more and larger well-designed RCTs are still needed to verify this conclusion.
Objective To systematically review the efficacy and safety of different SGLT2 inhibitors in the treatment of heart failure. Methods The Cochrane Library, Web of Science, PubMed and EMbase databases were searched for randomized controlled trials on the efficacy and safety of SGLT2 inhibitors in patients with heart failure from inception to July 2, 2021. Two researchers independently screened literature, extracted data and evaluated the risk of bias of the included studies. Network meta-analysis was then performed using Stata 16.0 software. Results A total of 16 randomized controlled trials, including 15 312 patients, involving 5 interventions, namely dapagliflozin, empagliflozin, canagliflozin, sotagliflozin and ertugliflozin were included. Results of network meta-analysis showed that there was no significant difference in the compound outcome of hospitalization for heart failure or cardiovascular death, hospitalization for heart failure, all-cause mortality, risk of cardiovascular mortality and serious adverse reactions among patients with heart failure among 5 different SGLT2 inhibitors (P>0.05). Compared with placebo, both selective and non-selective SGLT2 inhibitors improved the risk of hospitalization for heart failure, hospitalization for heart failure, or compound cardiovascular mortality (P<0.05), while only selective SGLT2 inhibitors improved the risk of cardiovascular mortality, all-cause mortality, and serious adverse events (P<0.05). However, there was no significant difference between them (P>0.05). The area under the cumulative ordering probability curve of selective and non-selective SGLT2 inhibitors ranked first and second, except for the combined outcome of heart failure or cardiovascular death. Conclusion The current evidence indicates that there is no significant difference in the efficacy and safety of the 5 different SGLT2 inhibitors in the treatment of heart failure, and there is no significant difference between selective SGLT2 inhibitors and non-selective SGLT2 inhibitors. Due to the limited quantity and quality of included studies, more high-quality studies are needed to verify the above conclusion.
Objective To systematically review the influence of frailty on the prognosis of non-cardiovascular surgery heart failure (HF) patients and to provide references for its prevention and management. Methods CNKI, VIP, CBM, WanFang Data, PubMed, EMbase, Web of Science, and The Cochrane Library were searched to collect cohort studies on the prognosis of non-cardiovascular surgery HF patients with frailty from inception to November 1st, 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of the included studies. Then, meta-analysis was performed using RevMan 5.3 software and Stata 14.0 software. Results A total of 20 studies involving 11 127 patients were included. The results of meta-analysis showed that frailty increased the risk of all-cause mortality (HR=1.72, 95%CI 1.61 to 1.84, P<0.000 01), hospitalization (HR=2.06, 95%CI 1.26 to 3.37, P=0.004), and combined endpoint (HR=1.59, 95%CI 1.37 to 1.84, P<0.000 01) in non-cardiovascular surgery HF patients. Conclusion Current evidence shows that frailty can increase the risk of all-cause mortality, hospitalization, and combined endpoints in non-cardiovascular surgery HF patients. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
The "2022 AHA/ACC/HFSA guideline for the management of heart failure" replaces the "2013 ACCF/AHA guideline for the management of heart failure" and the "2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure". The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose and manage patients with heart failure. Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to manage patients with heart failure, with the intent to improve quality of care and align with patients’ interests. New recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses. This article summarized and interpreted the new concept of heart failure in 2022 guidelines, especially the new evidence and suggestions related to cardiac surgery.