Clinical Observation On The Effect Of Warfarin On Cardiac Function And Prognosis In Patients With Chronic Heart Failure

Objective:To explore the protection of Warfarin for the chronic heart failure through observing the cardiac funetion, the level of NT-proBNP、6mintues walk test(6MWT)、 Minnesota living with heart failure questionnaire (MLHFQ)、left ventricular ejection fraction (LVEF).and major adverse cardiac events (MACE) in patients with chronic heart failure, which provided the basis for more effective, safer use of warfarin.Method:This study enrolled consecutive patients with chronic heart failure and warfarin adaptation from hospitalization or outpatient department in the First Affiliated Hospital of Kunming Medical University on november1,2011to november1,2012. Before entering the group with the patient and family members signed the consent. If agree with warfarin therapy for warfarin group, while in the control group. Atotal of200patients, The Warfarin group have99cases(52male,47female, Age27-85years old, the average age of69.44±10.27), NYHA classification:Ⅱ grade9cases.Ⅲ grade49cases, Ⅳ grade41cases; The control group have101cases (53male,48female, Age28-87years old, the average age of69.18±9.68). NYHA classification:Ⅱ grade10cases,Ⅲ grade52cases, Ⅳ grade39cases. There were no significant differences in gender, age, cardiac function, prevalence of hypertension, prevalence of type2diabetes and smoking rates between two groups. Both groups were given therapy of regulating anti-heart failure therapy. Warfarin group was additionally given with warfarin(target international normalized ratio,2.0-3.0).The following changes of both groups were determined before and after treatment for three months and six months respectively:1、New York Heart Association cardiac function classification;2、6mintues walk test(6MWT),3、Minnesota Living with Heart Failure Questionnaire(MLHFQ),4、Test the heart failure marker:NT-terminal pro-brain natriuretic peptide(NT-proBNP),5、echocardiography parameters:left ventricular end-diastolic dimension (LVEDD)and left ventricular ejection fraction(LVEF),6、During the period of observation of the heart failure readmission, thromboembolic events and bleeding events. Curative effect judgmentheart functional judgment standard:The treatment back of the body function improves above2levels is the signifcant effectively, improves1level is effectively, while the treatment back of the body function does not have the improvement or the aggravation is invalid. All the data were analyzed with SPSS software (version13.0), continuous variables were presented with mean±standard deviation, to test for homogeneity of variance using the Levene test, if the variance is homogeneous, comparisons between groups using two independent samples t test, compared with groups of repeated measurement data analysis of variance for repeated measurement data, categorical variables were presented with percent and compared between groups with the use of Chi-square tests or Fishers exact probability, Rank tests for the numerical variable data of the nonnormal distribution and grade material. P-value of less than0.05was considered to be statistically significant.Results:1、In two groups the level of New York Heart Association cardiac function classification、6mintues walk test(6MWT)、Minnesota Living with Heart Failure Questionnaire(MLHFQ)、Test the heart failure marker(NT-terminal pro-brain natriuretic peptide NT-proBNP)、left ventricular end-diastolic dimension (LVEDD)and left ventricular ejection fraction(LVEF) after treatment were improved.the differences were statistical significance(P<0.05)、We realizde that the vary of New York Heart Association cardiac function classification6mintues walk test(6MWT)、Minnesota Living with Heart Failure Questionnaire(MLHFQ)、Test the heart failure marker(NT-terminal pro-brain natriuretic peptide NT-proBNP)、left ventricular end-diastolic dimension (LVEDD)and left ventricular ejection fraction(LVEF),in the two groups had not statistical difference before treatment(P>0.05) Compared with the control group,the treatment group showed a more improve of New York Heart Association cardiac function classification、6mintues walktest(6MWT)、Minnesota Living with Heart Failure Questionnaire(MLHFQ、Test the heart failure marker(NT-terminal pro-brain natriuretic peptide NT-proBNP)、left ventricular ejection fraction(LVEF) after treatment, the differences were statistical signifieance(P<0.05). but the left ventricular end-diastolic dimension (LVEDD) had not statistical difference after treatment(P>0.05) Compared with the control group.2、Compared with the control group. The warfarin group showed a more improve Of clinical effect.The effieiency rate of two groups had statistical difference:the warfarin group (79.8%)vs controlgroup (67.4%) the differences were statistical signifieance(P<0.05)3、Among all the patients:the warfarin group have10cases died(10.1%), the control group have14cases died(13.9%),(10.1%VS13.9%, P=0.275); the warfarin group have9cases hospital readmission for heart failure (9.1%), the control group have16cases hospital readmission for heart failure (15.8%),(9.1%VS15.8%, P=0.10); the warfarin group have0case of nonfatal myocardial infarction (0%), the control group have1case of nonfatal myocardial infarction (0.9%),(0%VS0.9%, P=0.505); the warfarin group have1case of nonfatal stroke (1.0%), the control group have3cases of nonfatal stroke (3.0%),(1.0%VS3.0%, P=0.318); the warfarin group have1case of major bleeding (1.0%), the control group have0case of major bleeding (0%),(1.0%VS0%, P=0.495); the warfarin group have0case of peripheral thrombosis (0%), the control group have1case of peripheral thrombosis (0.9%),(0%VS0.9%, P=0.505); the warfarin group have0case of pulmonary embolism (0%), the control group have1case of pulmonary embolism (0.9%),(0%VS0.9%, P=0.505), all of these had not statistical difference.4、The warfarin group have2cases of thromboembolic events (2.0%), the control group have10cases Of thromboembolic events (9.9%),(2.0%VS9.9%, P=0.018); the differences were statistical signifieance(P<0.05).Conclusions:1、The cardiac function and the quality of life of all the patients had been improved.But the improvement of patients in the warfarin therapy group was better than that control group.2、Warfarin therapy can decrease thromboembolic events than antiplatelet therapy, the differences were statistical signifieance3、Warfarin therapy can decrease hospital readmission for HF, reduce major adverse cardiac events,but had not statistical difference. 4、To regulate use of Warfarin is safe and effective, not increase bleeding and other adverse events...