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.
Objective The purpose of the current research was to analyze the relevant risk factors for short-term death in patients with chronic obstructive pulmonary disease (COPD) and heart failure (HF), and to build a predictive nomogram. Methods We conducted a retrospective analysis of clinical data from 1 323 COPD and HF comorbidity patients who were admitted to the Affiliated Hospital of Southwest Medical University from January 2018 to January 2022. Samples were divided into survival and death groups based on whether they died during the follow-up. General data and tested index of both groups were analyzed, and the discrepant index was analyzed by single factor and multiple factor Logistic regression analysis. R software was applied to create the nomogram by visualizing the results of the regression analysis. The accuracy of the results was verified by C index, calibration curve, and ROC curve. Results The results from the multiple factor Logistic regression analysis indicated that age (OR=1.085, 95%CI 1.048 to 1.125), duration of smoking (OR=1.247, 95%CI 1.114 to 1.400), duration of COPD (OR=1.078, 95%CI 1.042 to 1.116), comorbidity with respiratory failure (OR=5.564, 95%CI 3.372 to 9.329), level of NT-proBNP (OR=1.000, 95%CI 1.000 to 1.000), level of PCT (OR=1.153, 95%CI 1.083 to 1.237), and level of D-dimer (OR=1.205, 95%CI 1.099 to 1.336) were risk factors for short-term death of COPD and HF comorbidity patients. The level of ALB (OR=0.892, 95%CI 0.843 to 0.942) was a protective factor that was used to build the predictive nomogram with the C index of 0.874, the square under the working characteristics curve of the samples of 0.874, the specify of 82.5%, and the sensitivity of 75.0%. The calibration curve indicated good predictive ability of the model. Conclusion The nomogram diagram built by the current research indicated good predictability of short-term death in COPD and HF comorbidity patients.
Heart failure affects quality of life and life expectancy of tens of millions of individuals. There are no available economic and effective treatments for end-stage heart failure. Hydrogels are novel tissue engineering materials, which have the potential to ameliorate myocardium remodeling, increase cardiac output, improve quality of life and prolong life span by implantation into myocardium. The preclinical experiments and clinical trials have greatly explored the function of hydrogels in heart failure. In this review, we summarized the approaches of implantation, mechanism and clinical outcomes of the hydrogels.
ObjectiveTo investigate the role of mindfulness-based stress reduction in improving anxiety and depression in elderly patients with chronic heart failure.MethodsFrom August 2016 to August 2018, a total of 196 elderly patients with chronic heart failure were randomly divided into the treatment group and the control group, with 98 cases in each group. The control group received routine care. The treatment group received routine care plus mindfulness-based stress reduction in two 60-minute sessions a week for 8 weeks. The level of serum N-terminal pro-brain natriuretic peptide (NT-proBNP) was detected by electrochemiluminescence immunoassay, and left ventricular ejection fraction (LVEF) was measured by echocardiography before intervention and at week 8 of intervention; the effective rate was calculated. Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), and General Well-Being scale (GWB) were used to assess the degree of anxiety, depression, and well-being of patients before intervention and at week 8 of intervention.ResultsThe serum NT-proBNP levels at week 8 of intervention in the two groups were lower than those before intervention, and the LVEFs were higher than those before intervention (P<0.05). The treatment group showed significant changes when compared with the control group (P<0.05). The effective rate of the treatment group was higher than that of the control group (89.80% vs. 69.39%, P<0.05). Before intervention, the SAS scores in the treatment group and the control group were 56.61±8.25 and 55.98±6.32, respectively, the SDS scores were 59.98±7.21 and 58.86±6.17, respectively, and the GWB scores were 53.19±12.38 and 54.06±10.93, respectively; at week 8 of intervention, the SAS scores in the treatment group and the control group were 40.56±8.17 and 46.25±5.43, respectively, the SDS scores were 42.85±5.77 and 48.34±8.01, respectively, and the GWB scores were 76.17±9.63 and 68.58±13.30, respectively. At week 8 of intervention, the SAS and SDS scores of the two groups were both lower than those before intervention, and the GWB scores were higher than those before intervention (P<0.05). The treatment group showed significant changes when compared with the control group (P<0.05).ConclusionMindfulness-based stress reduction can improve the anxiety and depression of elderly patients with chronic heart failure, improve their well-being and promote the recovery of heart function.
ObjectiveTo systematically review the efficacy of Tai Chi on patients with heart failure.MethodsDatabases including CNKI, VIP, WanFang Data, Web of Science, PubMed, EMbase and The Cochrane Library (Issue 8, 2016) were searched from inception to August, 2016 to collect randomized controlled trials (RCTs) of Tai Chi for heart failure patients. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then meta-analysis was performed using RevMan 5.3 software.ResultsA total of 10 RCTs involving 689 patients were included. The results of meta-analysis showed that, compared with the control group, the heart failure patients in Tai Chi group had better score of minnesotaliving with heart failure questionnaire (MLHFQ) (MD=–9.37, 95%CI –13.09 to –5.65, P<0.000 01), longer six minute walk test (6MWT) (MD=40.37, 95%CI 9.48 to 71.27, P=0.01), higher left ventricular ejectionfractions (LVEF) (MD=7.89, 95%CI 3.01 to 12.77, P=0.002) and lower level of BNP (brain natriuretic peptide) (MD=–10.75, 95%CI –13.20 to –8.30, P<0.000 01); however, as to the maximal oxygen consumption (VO2max) (MD=0.29, 95%CI –1.223 to 1.81, P=0.71), systolic pressure (SBP) (MD=–2.81, 95%CI –8.52 to 2.90, P=0.33) and diastolic pressure (DBP) (MD=0.37, 95%CI –3.73 to 4.48, P=0.86), there were no significant differences between both groups.ConclusionThe current evidence shows that Tai Chi is feasible for patients with heart failure as it has positive effects on life quality, physiological functions. Due to the limited quality and quantity of included studies, the above conclusion should be validated by more high quality studies.
ObjectivesTo systematically assess the efficacy and safety of nitrates for patients with chronic heart failure. MethodWe searched PubMed, EMbase, Web of Science, The Cochrane Library (Issue 1, 2016), CBM, CNKI, VIP, and WanFang Data to collect randomized controlled trials (RCTs) and cross-over studies about nitrates in the treatment of heart failure from inception to January 4th 2016. Two reviewers independently screened literature, extracted data and evaluated the risk of bias of included studies. Then, meta-analysis was performed by RevMan 5.3 software. ResultsTen trials were included involving 414 patients (195 patients in the nitrates group and 219 patients in the control group). The results of meta-analysis showed that, compared with the control group, the nitrates group could reduce arterial blood pressure (MD=-1.91, 95%CI -3.66 to -0.16, P=0.03), pulmonary wedge pressure vessels (PCWP) (MD=-2.00, 95%CI -3.84 to -0.15, P=0.03), increase cardiac index (CI) (MD=0.25, 95%CI 0.09 to 0.42, P=0.003), treadmill exercise time (MD=70.14, 95%CI 55.22 to 85.05, P < 0.000 01); but easily emerge side effects (OR=5.21, 95%CI 2.60 to 10.41, P < 0.000 01). ConclusionCurrent evidence indicates that nitrates treatment could improve the hemodynamic effect, enhance cardiac output and increase exercise tolerance in patients with heart failure.
To investigate the biomechanical effects of direct ventricular assistance and explore the optimal loading mode, this study established a left ventricular model of heart failure patients based on the finite element method. It proposed a loading mode that maintains peak pressure compression, and compared it with the traditional sinusoidal loading mode from both hemodynamic and biomechanical perspectives. The results showed that both modes significantly improved hemodynamic parameters, with ejection fraction increased from a baseline of 29.33% to 37.32% and 37.77%, respectively, while peak pressure, stroke volume, and stroke work parameters also increased. Additionally, both modes showed improvements in stress concentration and excessive fiber strain. Moreover, considering the phase error of the assist device's working cycle, the proposed assist mode in this study was less affected. Therefore, this research may provide theoretical support for the design and optimization of direct ventricular assist devices.
Objective To assess the efficiency and safety of pulsatile catheter (PUCA) pump support during acute ischemic heart failure in sheep. Methods After heart failure model was induced successfully in 10 sheep, PUCA pump was inserted through aorta and the aortic valve orifice with its tip located in the left ventricle. It was then activated to support the hemodynamics for 3 hours. Hemodynamic parameters were monitored and recorded before thoracotomy, heart failure, and every 60 min after the support. Platelet and plasma free hemoglobin were tested during the experiment. Thrombosis in kidney, membrane-pump, and catheter were examined at the end of study. Results PUCA pump support was successful in 7 sheep for 3 hours and failed in 3 due to technical problems. During support with the PUCA pump, mean arterial pressure(MAP), systolic blood pressure (SBP) and diastolic blood pressure(DBP) increased gradually and close to the baseline at the end of experiment. No significant change in platelet and plasma free hemoglobin were found during the whole period of the PUCA pump support. No thrombosis was found as well by means of examining kidney, membrane-pump and catheter. Conclusions PUCA pump can successfully maintain the hemodynamics in a sheep acute heart failure model associated with few blood destruction and thrombosis. It is thus suitable for clinical application to heart failure patients for the maintenance of hemodynamics.