| Heart failure(HF) is a group of syndrome that the main clinical manifestations are congestion of pulmonary circulation and(or) systemic circulation, organ and tissue hypoperfusion.The reason is that a variety of cardiac structural or functional diseases lead to ventricular filling and(or) ejection function impaired and cardiac output cannot meet the body tissue metabolism.HF is the end stage performance of cardiovascular disease and the main cause of death. It is a serious threat to human health. With the development of society and the advancement of medical technology, China has gradually entered the aging society and the incidence of heart failure is increasing year by year. There are about 26 million heart failure patients in the whole world currently. The prevalence of HF approaches 1~2%. In the western countries, the prevalence of HF for the adults≥70 years of age was higher than 10%. 74% of HF have at least one complication, resulting in a high rate of rehospitalization and high mortality. The prognosis of advanced HF was worse than some of solid tumors and myocardial infarction. The five-year survival rate was less than 20%. Therefore, the patients with HF were identificated early and given priority treatment and long-term follow-up which were the main measures of reduce the incidence and mortality of heart failure patients.The epidemiological investigation shows that, at present, coronary heart disease(CHD) is the most common cause of HF, and already a large number of studies have shown that homocysteine(Hcy) is the risk factor of atherosclerosis, and which is closely related to the occurrence of CHD. In recent years, some studies showed that the plasma level of Hcy increased can lead to HF, and which is closely related to the severity and prognosis of HF. Some studies have shown that an increased plasma homocysteine level independently predicts risk of the development of CHF in adults without prior myocardial infarction. So we assume that if the plasma Hcy level can be reduced to control the risk factors, it can delay the progression of heart failure and improve heart function in patients with HF. It is unclear whether homocysteine-lowering therapy with folic acid can improve the cardiac structure and function of HF patients.Objective:The aim of the study is by observing the concentration of hyperhomocysteinemia(HHcy) in heart failure patients with coronary heart disease to observe the correlation between level of serum homocysteine and heart failure[including New York Heart Association(NYHA), B type natriuretic peptide concentration(BNP), left ventricular diastolic end diastolic diameter(LVEDD) and left ventricular ejection fraction(LVEF), 6 minutes walk test(6MWT)].Meanwhile the objective is to investigate the effect of a hyperhomocysteinemia(HHcy) therapy by folic acid(FA) supplementation on heart failure patients with coronary heart disease and to observe the correlation between level of serum homocysteine and heart failure.Methods:1 The study subjects: 126 heart failure patients with coronary heart disease who had HHcy(higher than 15μmol/L) in Department of Cardiology of Baoding the First Central Hospital hospitalized from December 2014 to August 2015 were investigated, aged from 38 to 90 years old,including 79 males and 47 females. Diagnosis was made according to the Framingham heart failure diagnostic criteria, the medical history, symptoms, signs, ECG(electrocardiograph), echocardiography and chest X-ray. The heart function of HF patients was classified according to the New York Heart Association classification of cardiac function(NYHA).2 Observation index: Recording the general conditions of patients that included name, gender, age, history of smoking, history of drinking, basic drug therapy etc. Fasting blood levels of Hcy, BNP and left ventricular end diastolic diameter(LVEDD), left ventricular ejection fraction(LVEF), 6-minute walk test(6MWT) were compared between 2 groups at pre- and 3 months post-treatment.3 The group of subject and treatment plan: A total of 126 relevant patients with blood level of Hcy>15 μmol/L were randomly divided into 2 groups: Routine group, the patients received anti-platelet therapy, statins, beta-blockers, diuretics, angiotensin converting enzyme inhibitor(ACEI) or angiotensin II receptor antagonist and FA group, in addition to above mentioned therapies, the patients also received FA 5 mg/day. n=63 in each group and all patients were treated for 3 months.4 Statistical analysis: All statistical analysis was performed by spss 20.0 software. The rate was indicated the count data, and χ2 test was adopted to compare the intergroup difference of the count date. The mean and standard deviation( x ±s) was indicated the measurement data and paired samples t test was adopted to compare the difference of sample own control and two samples t(t’) test was adopted to compare the difference of intergroup difference of the measurement data. Multiple samples were compared using single factor analysis of variance. The Pearson correlation analysis were used to compare the correlation between two variables. P<0.05 for the difference was considered statistically significant.Results:1 The difference had not statistical significance that in many aspects including age, gender, heart function classification, hypertension, diabetes, blood lipid, blood glucose, creatinine lifestyle, basic drug therapy and so on(P>0.05).2 Based on NYHA classification, the patients with cardiac function at II, III, IV had accordingly increased blood levels of Hcy, BNP and LVEDD, while decreased LVEF and 6MWT, all P<0.05.3 Blood levels of Hcy were positively related to BNP(r =0.771, P<0.001) and LVEDD(r =0.487, P<0.001), negatively related to LVEF(r =-0.362, P<0.001) and 6MWT(r =-0.485, P<0.001).4 Before treatment, FA group compared with Routine group showed that there was no significant difference(P>0.05) in the serum Hcy level, plama level of BNP, LVEDD, LVEF and 6MWT.5 With 3 months treatment, FA group and Routine group showed decreased Hcy level as(8.68±1.95) μmol/L vs(5.08±1.19) μmol/L and BNP(1519.33±750.21) pg/ml vs(1202.87±685.00) pg/ml, reduced LVEDD(6.44±1.90) mm vs(4.06±1.83) mm, while elevated LVEF(8.94±2.34) % vs(4.14±2.66) % and 6MWT(138.21±55.79) m vs(78.25±42.69) m, all P<0.05.Conclusion:1 HHcy is a risk factor for heart failure. The serum Hcy increased with increasing New York Heart Association(NYHA) classes of heart failure.It related to the clinical and laboratory indicators of heart failure(BNP, LVEDD, LVEF, 6MWT) and can reflect the severity of heart failure.2 Increased blood level of Hcy is risky for HF occurrence, FA may treat HHcy and further improve the cardiac structure and function in HF patients. |
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