An overview of chronic heart failure

Improving Nutritional Status in Chronic Heart Failure Patients: Effectiveness of a Transtheoretical Model-Based Stepwise Nutritional Management Program

Objective

To explore the nutritional status of chronic heart failure (CHF) patients and evaluate the effect of a transtheoretical model-based stepwise nutritional management program on nutritional improvement.

Methods

This study conducted a retrospective analysis of 100 chronic heart failure (CHF) patients admitted to our hospital from March 2023 to May 2024. After applying inclusion and exclusion criteria, the patients were divided into an observation group and a control group. The observation group received a stepwise nutritional management program based on the transtheoretical model (TTM), while the control group received routine care. Nutritional improvement and clinical effects were compared between the two groups.

Results

Among the 100 CHF patients, 27% had good nutritional status, 42% were at nutritional risk, and 31% had malnutrition. No significant differences in baseline data were found between the two groups (P > 0.05). After the intervention, the observation group showed significantly lower B-type natriuretic peptide (BNP) levels and higher left ventricular ejection fraction (LVEF) levels compared to the control group (P < 0.05). Psychological scores (Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS)) in the observation group were also significantly lower than those in the control group (P < 0.05). Additionally, serum total cholesterol (TC) and triglycerides (TG) levels were lower in the observation group (P < 0.05), and levels of prealbumin, transferrin, hemoglobin, and albumin were higher (P < 0.05). The Minnesota Living with Heart Failure Questionnaire (MLHFQ) scores in the observation group were significantly lower than in the control group (P < 0.05).

Conclusion

The nutritional status of CHF patients is generally poor, and the transtheoretical model-based stepwise nutritional management program can effectively improve their nutritional status, enhance cardiac function, improve quality of life, and alleviate psychological burden. This intervention is promising for clinical practice.

The effect of high-fiber diet based on gut microbiota in patients with chronic heart failure

This research explored the effect of a high-fiber diet based on gut microbiota on patients with chronic heart failure (HF). Patients with chronic HF, who had undergone a dietary survey indicating a daily dietary fiber intake of less than 15 g/day, were divided into the control and study groups (n = 50). In addition to conventional heart failure treatment, the study group received dietary guidance, while the control group did not receive any dietary guidance and maintained their usual low-fiber dietary habits. After 1 yr intervention, the daily dietary fiber intake, abundance of gut microbiota, plasma trimethylamine N-oxide (TMAO), albumin (ALB), prealbumin (PA), transferrin (TF), C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), interleukin-8 (IL-8), left ventricular ejection fraction (LVEF), left ventricular end-diastolic index (LVEDVI), and left ventricular end-systolic volume index (LVESVI), Barthel index (BI), and 6 min walking distance (6 MWD) were compared. After the intervention, in both groups, the daily dietary fiber intake increased and the abundance of Firmicutes, Proteobacteria, Actinobacteria, and Fusobacteria decreased and that of Bacteroides increased; the plasma TMAO decreased; serum ALB, PA, and TF levels increased; serum CRP, TNF-α, IL-6, and IL-8 levels decreased, and the change was greater in the study group; LVEF elevated, LVEDVI and LVESVI reduced, and the differences between both groups were not significant; BI and 6 MWD elevated, and the study group was higher than the control group. High-fiber diet positively regulates the composition of gut microbiota, nutritional status, and microinflammatory level in patients with chronic HF, thereby improving patients' quality of life.NEW & NOTEWORTHY Traditional heart failure (HF) treatment primarily focuses on medications and surgery, whereas this study explores the improvement effects of a diet high in dietary fiber on patients with chronic HF from the perspective of gut microbiota, providing a new perspective for HF treatment.

Blood Circulating LncRNAs: SNHG5 and ZFAS1 as Biomarkers Reflecting Cachexia Incidence in Chronic Heart Failure Patients

BACKGROUND

Systemic inflammation plays a crucial role in the development and progression of chronic heart failure (CHF) across all phenotypes. The continuous release of proinflammatory cytokines causes muscle atrophy and adipocyte breakdown, ultimately resulting in cachexia. Long noncoding RNAs (lncRNAs) are emerging as potential biomarkers associated with cachexia, as they indirectly regulate muscle and fat tissue metabolism.

OBJECTIVES

This study aimed to identify inflammatory-related, plasma-circulating lncRNAs characteristic of cachexia in patients with CHF. The secondary objective was to assess the clinical utility of these selected lncRNAs as diagnostic and predictive markers for cachexia.

METHODS

Blood plasma samples were collected from 157 newly diagnosed patients with CHF (91 males and 66 females; mean age: 72 ± 13 y) for lncRNA extraction. Molecular testing, using RT2 lncRNA qRT-PCR Array Human Cell Development, Differentiation, and Inflammatory Panel was performed in 2 phases: the discovery phase (screening of 148 lncRNAs in 8 patients) and validation phase (validation of the identified lncRNAs in 157 patients).

RESULTS

Five lncRNAs were found to be differentially expressed in the discovery phase. In the validation phase, 2 of these 5 lncRNAs-SNHG5 and ZFAS1-showed significant expression differences between cachectic and noncachectic patients in the entire study group (both P < 0.001). The combined downregulation of ZFAS1 and upregulation of SNHG5 was identified as an unfavorable lncRNA signature primarily associated with poor nutritional status in females (low fat-free mass, fat-free mass index, and body mass index), abnormal laboratory results (hypoalbuminemia and high concentrations of inflammatory markers), and an increased incidence of cachexia in patients with CHF. When this lncRNA signature was combined with serum C-reactive protein and albumin concentrations, it effectively differentiated between cachectic and noncachectic patients (area under the curve = 1.0). The presence of this unfavorable signature was associated with a 9-fold increased likelihood (odds ratio = 9.2) of cachexia in the study cohort.

CONCLUSIONS

The identified lncRNA signature demonstrates potential clinical value for distinguishing and predicting cachexia in patients with CHF.

A Meta-Analysis on the Efficacy of Noninvasive Positive Pressure Ventilation Combined With Pressure Support Ventilation in Treating Chronic Heart Failure

OBJECTIVE

To evaluate the clinical efficacy and safety of noninvasive positive pressure ventilation combined with pressure support ventilation (NPPV-PSV) in the treatment of chronic heart failure (CHF) through a meta-analysis.

METHODS

A systematic search was conducted using PubMed, Embase, Web of Science, Cochrane Library, CNKI and Wanfang databases to find randomized controlled trials and cohort studies on NPPV-PSV treatment for CHF. The period of search was set from inception until 2024. Eligible studies were included in a systematic review and meta-analysis.

RESULTS

A total of 8 studies with 568 patients were included in this meta-analysis. The meta-analysis revealed that compared with conventional treatment, NPPV-PSV treatment had significant advantages in several aspects: clinical efficacy rate (total effect Z = 5.10, OR = 3.12, 95% confidence interval (CI) [2.01, 4.83], p = 0.000), heart rate (HR) (total effect Z = 16.26, MD = -10.50, 95% CI [-11.76, -9.23], p = 0.000), respiratory rate (RR) (total effect Z = 16.50, MD = -6.44, 95% CI [-7.20, -5.67], p = 0.000) and oxygen saturation (total effect Z = 12.40, MD = 0.09, 95% CI [0.08, 0.11], p = 0.000).

CONCLUSION

Noninvasive positive pressure ventilation combined with PSV treatment significantly improves clinical symptoms, reduces HR and RR and increases oxygen saturation in patients with CHF, showing superior effects compared with conventional treatment.

Correlation between Neutrophil-to-Lymphocyte Ratio, Platelets-to-Lymphocyte Ratio, C-Reactive Protein-to-Albumin Ratio and Clinical Picture of Elderly Chronic Heart Failure Patients

BACKGROUND

Neutrophil-to-lymphocyte ratio (NLR), platelets-to-lymphocyte ratio (PLR) and C-reactive protein-to-albumin ratio (CAR) are believed to be potential inflammatory markers that are closely related to the prognosis and course of cardiovascular diseases. The main goal of this study was the evaluation of NLR, PLR and CAR as factors reflecting the clinical picture and the prognosis of elderly chronic heart failure (CHF) patients.

METHODS

In 150 elderly patients with newly diagnosed CHF, the NLR, PLR and CAR were correlated with cardiac, laboratory and nutritional parameters.

RESULTS

Systemic inflammatory ratios were correlated with selected patient's parameters. CAR was associated with an unfavorable clinical picture of CHF-a reduced EF (p = 0.007), an elevated PASP (p = 0.014), an increased LVESD in both males and females (p = 0.032 and 0.024, respectively) and a decreased TAPSE (p = 0.023). CAR allowed us to distinguish between NYHA I-III and NYHA IV classes with AUC of 0.830. By analyzing the five-year mortality rate in patients with different CAR values, the greater death rate was recorded for patients with high CAR values-one-year death rate (40.3% vs. 17.2%) and five-year death rate (80% vs. 58.3%) (p = 0.002). Both NLR and PLR correlated only with selected parameters.

CONCLUSION

An analysis of inflammatory markers, mainly CAR, allows the management of CHF, because its value can reflect the cardiac and nutritional status of patients with a prognostic value. NLR and PLR can serve as supplementary examinations for CAR evaluation.