Noninvasive Indexes Prediction And Interventions Evaluation Of The Risk Of Death In Chronic Heart Failure Patients

Part I. The Evaluation of risk early warning and assessment of quality of life in patients with chronic heart failureBackground Chronic heart failure (CHF) was the end stage of various heart diseases. With the rise in the incidence of coronary heart disease and the extension of the overall life expectancy in our country, the incidence of CHF and clinic rate also had increased year after year. Then the increased mortality and poor survival quality owing to poor heart function in CHF were got more attention by people. As a representative of the chronic disease management, at the same time of actively treating diseases, the condition assessment and the risk of death warning were also belong to one of important content. In recent years, some new index or scale had appeared constantly, and we were necessary to verify and evaluate them in practice.In CHF evaluation index, after index of traditional, New York heart cardiac function classification, and Left ventricular ejection fraction (LVEF), we had new indexes of Brain natriuretic peptide (BNP) and N-terminal pro Brain natriuretic peptide(NT-proBNP). We assessed Cardiac autonomic nerve function by heart rate turbulence(HRT) and heart rate variability (HRV), and now Deceleration capacity of rate(DC) was promoted. The Acute Physiology and Chronic Health Evaluation (APACHE) had nearly 30 years of history, and been updated to the fourth edition. The latest version was facing the localization because of region and disease category. The Minnesota heart failure survival quality scale (MLHF) had been widely recognized, and there's Chinese version today. The new indexes widly applied will promote our understanding better of CHF, facilitate the management of CHF, reduce the happening of cardiovascular events, speed the recovery of CHF patients, improve the life quality of patients.Objective study index changes of the risk of dying and life quality evaluation of CHF patients in different periodsMethods We included in advance 268 patients of DCHF, and collected their general information,and etiology and history of heart failure. We need finish indexes evaluation of Echocardiography, NT-proBNP, dynamic electrocardiogram, APACHE, and MLHF before 3 days in hospital and within 3 days of discharge from hospital. Patients or family members were arranged to learrn health knowledges of CHF during the stay in hospital, and incorporated into chronic disease management. We need to strengthen the health guidance and follow-up, follow up patients after 1 month and 3 months after discharge from hospital, record the events outside hospital, counted MLHF scores again, at last, compare the above monitoring indexes change before and after.Results We included 219 cases of patients in all,210 cases get better before leaving hospital,4 cases not cured, and 5 cases died, the survey during hospitalization showed the patients had well awareness of their diseases, but, their concepts to health management and medicine adherence were relatively poor, particularly in ? receptor blockers and ACEI (ARB) applications. The proportion of patients visiting on one's own initiative was lower. The Echocardiography results(LVEF?left ventricular end-diastolic diameter, left atrial diameter) were no significant change before and after the patient in the hospital (p>0.05). HRV and DC increased significantly after treatment, and it was statistical significance (p<0.05). Immune index NT-proBNP, APACHE and MLHF were significantly lower after treatment, and they were statistical significance (p<0.05). After accepting Chronic disease mission, the consciousness of health education in patients was Obviously improved, and the adherence and rate of reaching the standard of medication were obviously increased than before. In these patients of CHF, their self health management projects, except for smoking cessation and monitoring of blood sugar, exercise, diet and blood pressure, pulse, weight monitoring were obviously improved than Pre-Admission, and it was statistically significant (p<0.05). There were 3 patients died and 4 patients lost to follow-up during Chronic disease management. Under disease management mode of self-discipline in patients and surperviseandurge of medical workers, the above indicators after discharged 1 month and 3 months were no significant change (p> 0.05), smoking cessation and monitoring of blood sugar had a tendency to rebound.Conclusion When the disease outcome has certain change, monomial index and comprehensive index Predicting DCHF death risk could all change, and each had advantages and disadvantages. Because of the difference in monitoring of convenience and value guidance, the predictive value of death to comprehensive index was higher than monomial index generally. Under Chronic disease management, the self management abilities of patients were obviously improved, and MLHF score decreased obviously.Part II. Early warning value of deceleration capacity of heart rate in the risk of death in patients with decompensated chronic heart failureBackground DCHF was always the key point of clinical research in cardiovascular disease because of high risk of death. The patient's blood flow dynamics and neuroendocrine state occupied a large proportion in the etiology of Cardiovascular events, so further studing the relationship of DCHF and autonomic nervous was imperative. As clinical indicators of autonomic nerve testing, DC, which was brought forward by Georg Schmidt of German on the basis of HRT, undoubtedly brought new hope for us.DC was Confirmed mainly reflecting the function of the vagus nerve. As people had realized that the vagus nerve played a more important role in DCHF, the value of the DC testing was more obvious. As the first index of quantifing the difference' between vagus nerve and sympathetic nerve, how was the relationship between it and cardiovascular events in DCHF patients? and how the relationship between it and cardiac function in patients? and whether or not it was better than HRV commonly used autonomic nervous index? and whether or not it was consistent with the overall mortality risk score APACHE? The questions all need be solved by multicenter, large-scale research, and need everyone's practical application. As China's researchers, the professor named guo ji-hong introduced DC to China, and the DC had fused together with dynamic electrocardiogram, and the professor guo advised that Chinese doctors should make full use of this advantage, positive practice, sum up experience, and contribute to our country for early warning and prevention of sudden cardiac death.Objective To investigate the predictive value of DC in the risk of death in patients with DCHF.Methods Seventy-four patients with DCHF were evaluated by holter monitoring and APACHE before and after treatment. DC and HRV were recorded and analyzed by Holter. Compare the difference of DC, HRV and APACHE score in different heart function classification, Calculate the correlation between DC and HRV?APACHE score, and Compare with the Area Under Curve (AUC) of DC?HRV and APACHE score.Results DC and Time domain index of HRV:totality standard deviation between RR period(SDNN), average standard deviation between RR in 5 minutes period(SDANN), mean square root of difference between adjacent RR(RMSSD), were below normal in DCHF patients before treatment, and each index was increased after treatment, and it was statistically significant before and after treatment (t=5.518, 3.075,2.814,3.109, p<0.05); The APACHE scores were higher than normal before treatment, and decreased significantly after treatment, and it was statistically significant before and after treatment(t=4.072, p< 0.05). Under different heart function classification, the respective comparison of DC, HRV (SDNN, SDANN and RMSSD), and APACHE score were all statistically significant (F=11.33,10.76,11.33,10.76, 10.98, p<0.05). The index at DC and HRV followed heart function down, and the APACHE scores increased along with heart function decline. Positive correlations were observed between DC and the index of HRV(SDNN, SDANN, RMSSD) (r=0.601,0.588,0.457, p< 0.05). Negative and moderate correlation was observed between DC and APACHE (r=-0.639, p<0.05).The warning value of risk of death in DCHF patients:APACHE score> DC> SDANN (AUC=0.905, 0.795,0.905), the warning value of DC was moderate.Conclusion The index at DC and HRV followed heart function down, and the APACHE scores increased along with heart function decline. the correlation between DC and APACHE, comprehensive evaluation index in critical condition, was very good. The correlation between DC and HRV, indicating autonomic nerve disorder, was very. good as well. DC had a higher value as a single index early warning death risk of DCHF.Part ?. Shensong yangxin capsule evaluations to the autonomic nervous function in patients with chronic heart failureBackground CHF patients exist severe autonomic nerve dysfunction, and we used to think that sympathetic nerve function was strengthened at cardiac remodeling, now and we considered that it was mainly the role of the vagus nerve weakening. As the noninvasive indexes evaluating function of autonomic nervous state developped, we have new indicators:DC and deceleration capacity of rate (DRs), Which integrate useful signals through analysising dynamic electrocardiogram, and they can quantitatively reflect vagus nerve function.Clinical study had found that ? blockers can reduce the risk of sudden death of CHF, and its mechanism was mainly that it can inhibit sympathetic nerve to improve autonomic nerve dysfunction. On the one hand, the consequence of pure inhibiting sympathetic nerve may possiblly cause negative inotropic effect, on the other hand it was limited linically because of potential problems drug use time and standard time, therefore, it became our research direction to explore new drugs or means to regulate autonomic nervous function. Traditional Chinese medicine "shensong yangxin capsule" can adjust autonomic nervous function, it had a good curative effect, it had the advantages of multiple targets and two-way regulation, This not only become the advantages of it, even caused concept reflection in the anti-arrhythmic medication treatment field.Due to the less use of shensong yangxin capsule in patients of CHF, and a new evaluation index, we planed to compare shensong yangxin capsule and metoprolol to regulate autonomic nerve dysfunction by DRs in patients of CHF, and find a more effective method to regulate autonomic nerve dysfunction for patients of CHF.Objective Evaluate the regulation effect of Shensongyangxin capsules to autonomic nerve dysfunction in chronic heart failure patients.Methods Randomize into shensongyangxin group (n=53) and metoprolol group (n =46) from 99 diagnosis cases of patients with chronic heart failure clinically confirmed; perform Holter monitoringbefore treatment and after treatment for one month; calculate continuous heart rate deceleration; compare the regulating effect of the two drugs to continuous heart rate deceleration; evaluate these value of its regulating autonomic function and prevention of sudden death. Results each index DRs change, for example DR2, DR4, DR8 is a very close approximation before and after treatment in two groups of patients. The risk of sudden death was significantly reduced after treatment in the two groups of patients.Conclusion The regulating effects to autonomic function of Shensongyangxin Capsule in patients with chronic heart failure are fairly basic with metoprolol tablets; The indication and tolerance of Shensongyangxin Capsule are better than metoprolol tablet.