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Special prognostic phenomenon for patients with mid-range Ejection fraction heart failure:a systematic review and meta-analysis

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Chinese Medical Journal 2020年第4期133卷 452-461页

作者： Pan Guo Jian-Feng Dai Chao Feng Shu-Tao Chen Jin-Ping Feng Department of Cardiology Tianjin Chest HospitalTianjin 300222China Graduate School of Medicine Tianjin Medical UniversityTianjin 300070China

Background:Clinical features and outcomes of heart failure(HF)with mid-range Ejection fraction(HFmrEF)remain controversial.Thus,we systematically reviewed literatures of clinical research to assess and analyze characteristics and prognosis of patients with HFmrEF.Methods:PubMed,Embase,and Web of Science were searched for cohort studies up to April 23,2019.Clinical features and multivariate adjusted hazard ratios(HRs)of endpoints of short-term all-cause mortality(SAM),long-term all-cause mortality(LAM),long-term cardiovascular death(LCD)and long-term HF rehospitalization(LHR)among patients with HFmrEF and HF with preserved Ejection fraction(HFpEF),HF with reduced Ejection fraction(HFrEF)were well addressed.The primary outcome was LAM.Results:Totally 19 studies were included in this study with 164,678 patients enrolled.The follow-up time of LAM was 3.6±2.5 years.HRs of LAM,SAM,LCD,LHR indicated that the risks of patients with HFmrEF were higher than HFpEF patients but lower than HFrEF patients,as for LAM,HFmrEF:HFpEF(reference)HR:1.07,95%confidence interval(CI):1.00-1.15(I2=63%,P=0.0005);HFmrEF:HFrEF(reference)HR:0.80,95%CI:0.73-0.88(I2=70%,P<0.0001).However,HFmrEF patients had the lowest rate in LAM(30.94%),SAM(2.73%),LCD(17.45%),LHR(26.36%)compared with the other two groups.Conclusions:This systematic review and meta-analysis compared features and prognosis between patients with HFmrEF and HFpEF,HFrEF by HRs.There appeared a special"separation phenomenon"showing rates of endpoints were inconsistent with their hazards in patients with HFmrEF compared with HFpEF patients.

关键词： Heart failure Ejection fraction Mid-range Prognosis Meta-analysis

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A dynamic Ejection coal burst model for coalmine roadway collapse

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International Journal of Mining Science and Technology 2019年第4期29卷 557-564页

作者： Dazhao Song Xueqiu He Enyuan Wang Zhenlei Li Menghan Wei Hongwei Mu Key Laboratory of the Ministry of Education of China for High-efficient Mining and Safety of Metal Mines University of Science and Technology BeijingBeijing 100083China School of Civil and Resource Engineering University of Science and Technology BeijingBeijing 100083China Zhong-an Academy of Safety Engineering Beijing 100083China School of Safety Engineering China University of Mining and TechnologyXuzhou221116China

In this study,we established a dynamic Ejection coal burst model for a coalmine roadway subject to stress,and held that the stress concentration zone at the roadway side is the direct energy source of this Ejection.The formation and development of such burst undergoes three stages:(1)instability and propagation of the cracks in the stress concentration zone,(2)emerging of a layered energy storage structure in the zone,and(3)Ejection of coal mass or coal burst due to instability.Moreover,we figured out the initial strength of periodic cracks is parallel to the maximal dominant stress direction in the stress concentration zone and derived from the damage strain energy within the finite area of the zone based on the Griffith energy theory.In addition,we analyzed the formation process of the layered energy storage structure in the zone,simplified it as a simply supported restraint sheet,and calculated the minimum critical load and the internally accumulated elastic energy at the instable state.Furthermore,we established a criterion for occurrence of the coal burst based on the variational principle,and analyzed the coal mass Ejection due to instability and coal burst induced by different intensity disturbances.At last,with the stratum conditions of Junde Coalmine as the model prototype,we numerically simulated the load displacement distribution of the stress concentration zone ahead of the working face disturbed by the main roof-fracture-induced dynamic load during the mining process as well as their varying characteristics,and qualitatively verified the above model.

关键词： Coal and rock burst Evolution model Dynamic Ejection Stress concentration Layered energy storage structure

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Oral Chinese Herbal Medicine for Heart Failure with Preserved Ejection Fraction: A Meta-Analysis

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Chinese Journal of Integrative Medicine 2019年第10期25卷 770-777页

作者： MEI Jun XU Hao XU Feng-qin JU Jian-qing Graduate School Beijing University of Chinese Medicine Beijing (100029) China Cardiovascular Diseases Center Xiyuan Hospital China Academy of Chinese Medical Sciences Beijing (100091) China Geriatric Institution Xiyuan Hospital China Academy of Chinese Medical Sciences Beijing (100091) China

Objective: To evaluate the effectiveness and safety of oral Chinese herbal medicine(OCHM) for heart failure with preserved Ejection fraction(HFp EF). Methods: Pub Med, Excerpta Medica Database(EMBASE), Cochrane Library, Chinese Biological Medicine Database(CBM), Wanfang Database, Chongqing VIP Information(VIP) and China National Knowledge Infrastructure(CNKI) were searched for appropriate articles from respective inceptions until June 3, 2018. Randomized controlled trials(RCTs) investigating the effectiveness of OCHM for the patients with HFp EF were eligible. Quality assessment was performed by employing the Cochrane Risk of Bias assessment tool. Papers were independently reviewed by two reviewers and analyzed using Cochrane software Revman 5.3. Dichotomous data were analyzed by relative risk(RR) with a 95% confidence interval(CI), while continuous variables were analyzed by using mean difference(MD) with 95% CI for effect size. Results: A total of 16 RCTs involving 1,320 participants were identified. Fourteen of the trials used conventional Western medicine(CWM) as the control, the control of 1 trial was no treatment, and another was placebo. Three of the trials served Chinese patent medicine(CPM) as interventions, and other OCHM were Chinese medicine decoctions(CMDs). Only limited evidence showed experimental group with OCHM may get better effect on brain natriuretic peptide(BNP: MD –37.29, 95% CI –53.08 to –21.50, P<0.00001) or N terminal pro B type natriuretic peptide(NT-pro BNP: MD –236.04, 95% CI –356.83 to –115.25, P=0.0001), Minnesota Living with Heart Failure questionnaire(MLHFQ, MD –9.94, 95% CI –16.77 to –3.11, P=0.004), but the results had high heterogeneities. With concerns on 12 of 16 trials, the meta-analysis found that the adjuvant therapy of OCHM might be more effective in increasing overall response rate(RR 1.17, 95% CI 1.11 to 1.24, P<0.00001), when compared with CWM alone. Subgroup meta-analysis between CPMs and CMDs showed that the two CPMs may have more therapeutic effect on MLHFQ, but not

关键词： oral Chinese herbal medicine heart failure with preserved Ejection fraction meta-analysis systematic review

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Heart failure with preserved Ejection fraction in the elderly: pathophysiology, diagnostic and therapeutic approach

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Journal of Geriatric Cardiology 2019年第5期16卷 421-428页

作者： Ernesto Ruiz Duque Alexandros Briasoulis Paulino A Alvarez Cardiomyopathy Section Cardiology Division University of Iowa

Heart failure with preserved Ejection fraction(HFpEF)is a clinical syndrome characterized by symptoms and sings of heart failure with elevated left ventricular filling pressures at rest or during exercise.It is the most common type of heart failure in the elderly and its prevalence increases with age and is higher in females at any given age.HFpEF is frequently accompanied of comorbid conditions such as diabetes mellitus,obesity,atrial fibrillation and renal dysfunction.The diagnosis relies in the integration of clinical information,laboratory data and interpretation of cardiac imaging and hemodynamic findings at rest and during exercise.Conditions that have a specific treatment such as coronary artery disease,valvular disease,cardiac amyloidosis and constrictive pericarditis should be considered and evaluated as appropriate.Aggressive management of comorbidities,optimization of blood pressure control and volume status using diuretics as needed are among the current treatment recommendations.There are no specific therapies that have shown to decrease mortality in HFpEF.In symptomatic patients with history of hospital admission for decompensated heart failure,the implantation of a wireless pulmonary artery pressure monitor should be considered.Finally,given the high mortality of this condition,goals of care discussion should be initiated early and involvement of palliative care medicine should be considered.

关键词： Echocardiography Ejection fraction Heart failure Pharmacology The elderly

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Increased index of microcirculatory resistance in older patients with heart failure with preserved Ejection fraction

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Journal of Geriatric Cardiology 2018年第11期15卷 687-694页

作者： Zhuo XU Hui-Ping GU Yang GU Wei SUN Kun YU Xi-Wen ZHANG Xiang-Qing KONG Department of Cardiology the First Affiliated Hospital of Nanjing Medical University Nanjing China Department of Cardiology the Affiliated Huai'an No.1 People's Hospital of Nanjing Medical UniversityHuai'an China

Objective To study the coronary microvascular function in older patients with heart failure with preserved Ejection fraction (HFpEF) using an invasive pressure–temperature sensor guidewire. Methods Patients undergoing echocardiography and cardiac catheterization examinations for exertional dyspnea and a positive stress test were retrospectively enrolled from January 2014 to November 2017, and were allocated into the control group or HFpEF group. The HFpEF group was secondary divided into two groups according to the age of 65 years. Comparing the clinical features and values obtained in examinations between the three groups, multivariate regression analysis was used to analyze the predictors of left ventricle end diastolic pressure (LVEDP). Results There were 87 patients enrolled in this study. The older HFpEF patients (n = 32) were more likely to be female;and had the most comorbidities, such as diabetes mellitus, atrial fibrillation, and chronic kidney dysfunction (CKD) with a low estimated glomerular filtration rate (eGFR), and had a similar hypertensive prevalence as the adult HFpEF group (n = 24), whose mean LVEDP and index of microcirculatory resistance (IMR) were highest in comparison to the adult HFpEF patients and controls (n = 31). The coronary flow reserve (CFR) in the older HFpEF and adult HFpEF groups was similarly reduced. In the regression analysis, the IMR linearly correlated to LVEDP, and was the only independent predictor of LVEDP. Conclusions An increased IMR and reduced CFR were characteristics of microvascular dysfunction in older HFpEF patients. The IMR independently had a positive linear correlation with LVEDP. Microvascular rarefaction might be a subsequent pathological progression in the development of HFpEF.

关键词： Heart failure Ejection fractions Microcirculatory resistance Microvascular dysfunction

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A novel variable topology design for a multi-flexible Ejection mechanism

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Defence Technology（防务技术） 2020年第2期16卷 432-438页

作者： Hao Liu Jun Zhou Zong-lai Mo Shi-wei Zhang School of Astronautics Northwestern Polytechnical UniversityXi'an710072China School of Mechanical Engineering Nanjing University of Science and TechnologyNanjing210094China Luoyang Opto-Electro Technology Development Center 471009China

The airborne missile launch mechanism often subjects to significant deformations induced by the large Ejection force during high-speed actuations in missile Ejection process,leading to a substantial deviation of separation parameters from designed values that threats safety of the carrier.This study proposes a novel variable topology design for launch mechanism,achieved via a Prsmatic-Revolute-Revolute pair(PR-R)motion formed by the structural gap with a specific direction.It enables launch mechanism variability during missile Ejection process and optimizes the Ejection force given by the front and back Ejection arms,and greatly optimizes the separation parameters during missile Ejection.The kinetics simulation analysis is conducted under working conditions of the original Ejection mechanism and the novel mechanism with variable topology design,respectively.The results show that the novel variable topology design is more befitting for the launch process in terms of system safety and controllability,effectively improving the separation posture,restraining the flexible effect of the mechanism,and fulfilling the effectiveness of the design value of multi-rigid body.

关键词： Variable topology Gap dynamics Multi-flexible body Flexible control Ejection mechanism

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Therapeutic interventions for heart failure with preserved Ejection fraction:A summary of current evidence

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World Journal of Cardiology 2014年第2期6卷 67-76页

作者： Muhammad Asrar ul Haq Chiew Wong Vivek Mutha Nagesh Anavekar Kwang Lim Peter Barlis David L Hare Department of Cardiology The Northern Hospital Department of Medicine University of Melbourne Department of Cardiology The Northern HospitalEpping

Heart failure with preserved Ejection fraction(HFPEF)is common and represents a major challenge in cardiovascular medicine.Most of the current treatment of HFPEF is based on morbidity benefits and symptom reduction.Various pharmacological interventions available for heart failure with reduced Ejection fraction have not been supported by clinical studies for HFPEF.Addressing the specific aetiology and aggressive risk factor modification remain the mainstay in the treatment of HFPEF.We present a brief overview of the currently recommended therapeutic options with available evidence.

关键词： Heart failure Diastolic dysfunction Heart failure with preserved Ejection fraction Heart failure with normal Ejection fraction

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Air pollution and heart failure: Relationship with the Ejection fraction

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World Journal of Cardiology 2013年第3期5卷 49-53页

作者： Alberto Dominguez-Rodriguez Javier Abreu-Afonso Sergio Rodríguez Ruben A Juarez-Prera Eduardo Arroyo-Ucar Yenny Gonzalez Pedro Abreu-Gonzalez Pablo Avanzas Department of Cardiology Hospital Universitario de Canarias Universidad Europea de Canarias Facultad de Ciencias de la Salud Instituto Universitario de Tecnologías Biomédicas Department of Applied Physics Universidad de Valencia Center for Atmospheric Research Izaa AEMET-CSIC Department of Physiology Universidad de la Laguna Department of Cardiology Hospital Universitario Central de Asturias

AIM: To study whether the concentrations of particulate matter in ambient air are associated with hospitaladmission due to heart failure in patients with heart failure with preserved Ejection fraction and reduced Ejection fraction. METHODS: We studied 353 consecutive patients admitted into a tertiary care hospital with a diagnosis of heart failure. Patients with Ejection fraction of ≥ 45% were classified as having heart failure with preserved Ejection fraction and those with an Ejection fraction of Ejection fraction. We determined the average concentrations of different sizes of particulate matter (Ejection fraction population was exposed to higher nitrogen dioxide concentrations compared to the heart failure with reduced Ejection fraction population (12.95 ± 8.22 μg/m 3 vs 4.50 ± 2.34 μg/m 3 , P Ejection fraction (odds ratio ranging from (1.403, 95%CI: 1.003-2.007, P = 0.04) to (1.669, 95%CI: 1.043-2.671, P = 0.03). CONCLUSION: This study demonstrates that shortterm nitrogen dioxide exposure is independently associated with admission in the heart failure with preserved Ejection fraction population.

关键词： Air pollution Heart failure Preserved Ejection fraction Reduced Ejection fraction Nitrogen dioxide

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Biomechanical Manifestations of Diastolic and Systolic Function in Rats with Heart Failure with Preserved Ejection Fraction

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医用生物力学 2019年第A1期34卷 77-77页

作者： Zhongjie Yin Wenchang Tan Department of Mechanics and Engineering Science College of EngineeringPeking University

Objective Heart failure(HF)is divided into two types:Heart failure with reduced Ejection fraction(HFrEF)and heart failure with preserved Ejection fraction(HFpEF).The latter always results in diastolic dysfunction,characterized by changes in mechanical properties.The objective of this study is to build a finite element(FE)model of HFpEF and analyze diastolic and systolic function in rats.Methods Ten Dahl salt-sensitive rats were fed either a low-salt(LS)(n=5)or highsalt(HS)(n=5)diet beginning at 7 weeks of age and scanned by ultrasonic machine at 14 weeks of age.A non-linear FE model of the left ventricle(LV)was built from cardiac echo images at end-diastole and passive material properties of the LV were prescribed using Fung’s transversely isotropic constitutive law.Fiber angles of the endocardium and epicardium were prescribed as 53°°and-52°,respectively,with respect to the circumferential direction and varied linearly through the LV wall.The method developed by Krishnamurthywas used to determine the unloaded geometry to estimate the Fung passive material parameters.LV end-diastolic pressure(EDP)was determined from the measured pressure waves and applied to the endocardium at the unloaded geometry to simulate passive filling.Active material properties of the LV were prescribed using Guccione’s time-varying elastance model and maximum isometric tension was scaled to match the measured peak systolic pressure.The finite element model was then coupled to the Windkessel model,whose parameters were adjusted to the measured hemodynamics.Results Measured LVEDPs of LS and HS rats were 4.9±3.4 mmHg and 13.2±5.4 mmHg(P-0.030 8),respectively.End-diastolic Cauchy stress along the fiber direction for LS rats was significantly lower than for HS rats(0.91±0.60 kPa vs 3.00±0.63 kPa,P=0.001 4)and there was a similar trend in end-diastolic Green Strain along the fiber direction(0.058±0.003 vs 0.072±0.010,P=0.012 8,Figure 1b),as well.There was no distinctive difference between end-systolic Cauchy stress along the fiber direction fo

关键词： Biomechanical Manifestations Heart Failure Preserved Ejection Fraction Cauchy

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Anomalous-plasmoid-Ejection-induced secondary magnetic reconnection: modeling solar flares and coronal mass Ejections by laser–plasma experiments

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High Power Laser Science and Engineering 2013年第1期1卷 11-16页

作者： Quanli Dong Dawei Yuan Shoujun Wang Xun Liu Yutong Li Xiaoxuan Lin Huigang Wei Jiayong Zhong Shaoen Jiang Yongkun Ding Bobin Jiang Kai Du Yongjian Tang Mingyang Yu Xiantu He Neng Hua Zhanfeng Qiao Kuixi Huang Ming Chen Jianqiang Zhu Gang Zhao Zhengming Sheng Jie Zhang School of Physics and Optoelectronic Engineering Ludong University Beijing National Laboratory of Condensed Matter Physics Institute of PhysicsChinese Academy of Sciences Key Laboratory of Optical Astronomy National Astronomical ObservatoriesChinese Academy of Sciences Research Center for Laser Fusion China Academy of Engineering Physics Institute for Fusion Theory and Simulation Physics DepartmentZhejiang University Institute for Theoretical Physics I Ruhr University Institute of Applied Physics and Computational Mathematics National Laboratory on High Power Lasers and Physics Key Laboratory for Laser Plasmas (MoE) and Department of Physics Shanghai Jiao Tong University

The driving mechanism of solar flares and coronal mass Ejections is a topic of ongoing debate, apart from the consensus that magnetic reconnection plays a key role during the impulsive process. While present solar research mostly depends on observations and theoretical models, laboratory experiments based on high-energy density facilities provide the third method for quantitatively comparing astrophysical observations and models with data achieved in experimental settings.In this article, we show laboratory modeling of solar flares and coronal mass Ejections by constructing the magnetic reconnection system with two mutually approaching laser-produced plasmas circumfused of self-generated megagauss magnetic fields. Due to the Euler similarity between the laboratory and solar plasma systems, the present experiments demonstrate the morphological reproduction of flares and coronal mass Ejections in solar observations in a scaled sense,and confirm the theory and model predictions about the current-sheet-born anomalous plasmoid as the initial stage of coronal mass Ejections, and the behavior of moving-away plasmoid stretching the primary reconnected field lines into a secondary current sheet conjoined with two bright ridges identified as solar flares.

关键词： laboratory astrophysics magnetic reconnection laser plasma solar flare coronal mass Ejection

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