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Ejection fraction (EF) has been used in phenotype analyses and to make treatment decisions regarding heart failure (HF). Thus, EF has become a fundamental part of daily clinical practice.This study aims to investigate the characteristics, predictors, and outcomes associated with EF changes in patients with different types of severe HF.A total of 626 severe HF patients with New York Heart Association (NYHA) class III-IV were enrolled in this study. The patients were classified into three groups according to EF changes, namely, increased EF (EF-I), defined as an EF increase ≥10%, decreased EF (EF-D), defined as an EF decrease ≥10%, and stable EF (EF-S), defined as an EF change10%. A p-value lower than 0.05 was considered significant.Out of 377 severe HF patients, 23.3% presented EF-I, 59.5% presented EF-S, and 17.2% presented EF-D. The results further showed 68.2% of heart failure with reduced ejection fraction (HFrEF) in the EF-I group and 64.6% of heart failure with preserved ejection fraction (HFpEF) in the EF-D group. The predictors of EF-I included younger age, absence of diabetes, and lower left ventricular ejection fraction (LVEF). The predictors of EF-D were absence of atrial fibrillation, lower uric acid level, and higher LVEF. Within a median follow-up of 40 months, 44.8% of patients suffered from all-cause death.In severe HF, HFrEF presented the highest percentage in the EF-I group, and HFpEF was most common in the EF-D group.A fração de ejeção (FE) tem sido utilizada em análises fenotípicas e na tomada de decisões sobre o tratamento de insuficiência cardíaca (IC). Assim, a FE tornou-se parte fundamental da prática clínica diária.Este estudo tem como objetivo investigar características, preditores e desfechos associados a alterações da FE em pacientes com diferentes tipos de IC grave.Foram incluídos neste estudo 626 pacientes com IC grave e classe III–IV da New York Heart Association (NYHA). Os pacientes foram classificados em três grupos de acordo com as alterações da FE, ou seja, FE aumentada (FE-A), definida como aumento da FE ≥10%, FE diminuída (FE-D), definida como diminuição da FE ≥10%, e FE estável (FE-E), definida como alteração da FE10%. Valores p inferiores a 0,05 foram considerados significativos.Dos 377 pacientes com IC grave, 23,3% apresentaram FE-A, 59,5% apresentaram FE-E e 17,2% apresentaram FE-D. Os resultados mostraram ainda 68,2% de insuficiência cardíaca com fração de ejeção reduzida (ICFEr) no grupo FE-A e 64,6% de insuficiência cardíaca com fração de ejeção preservada (ICFEp) no grupo FE-D. Os preditores de FE-A identificados foram faixa etária mais jovem, ausência de diabetes e fração de ejeção do ventrículo esquerdo (FEVE) menor. Já os preditores de FE-D encontrados foram ausência de fibrilação atrial, baixos níveis de ácido úrico e maior FEVE. Em um seguimento mediano de 40 meses, 44,8% dos pacientes foram vítimas de morte por todas as causas.Na IC grave, a ICFEr apresentou maior percentual no grupo FE-A e a ICFEp foi mais comum no grupo FE-D.

Background Data on stroke risk factor profiles and atrial fibrillation (AF) for the Chinese population are sparse. This study identified risk factors for stroke among native Chinese with nonrheumatic AF. Methods In this retrospective investigation, patients diagnosed with nonrheumatic AF were identified from 18 hospitals in representative areas of the country, from January 2000 to April 2002, based on the medical records. All parameters relevant to AF were compared between AF patients with stroke and those without. The independent risk factors for stroke were assessed with a logistic regression analysis. Results Patients numbering 3,425 with AF were included, among whom 827 subjects were discharged on account of stroke. The prevalence of stroke in nonrheumatic AF patients was 24.15%. AF patients with stroke were significantly older than controls (73.31 ± 9.18 versus 68.22 ± 12.29 y, p < 0.001) and more likely to have a history of hypertension (71.0 versus 51.6%, p < 0.001) and diabetes (17.9 versus 11.1%, p = 0.001). Both, systolic and diastolic blood pressure, are significantly higher in patients with stroke. Of all the parameters of echocardiography, there was strong evidence that left atrial (LA) thrombi significantly increased risk of stroke. Patients with persistent AF were more likely to have stroke than paroxysmal AF patients, while lone AF is less in patients with stroke than in those without. The rate of anticoagulation treatment is only 9.27%, but there were no significant differences between the 2 groups. In multivariate analysis, age ≥ 75 y (odds ratio [OR] 1.76; 95% confidence interval [CI] 1.08-2.98), history of hypertension (OR 1.52; 95% CI 1.28-1.80), diabetes (OR 1.39; 95% CI 1.11-1.76), high systolic blood pressure (OR 1.71; 95% CI 1.21-2.28), LA thrombi (OR 2.77; 95% CI 1.25-6.13) were independent predictors for stroke. Conclusions The prevalence of stroke in hospitalized nonrheumatic AF patients was high. The population-specific risk factors for stroke were age ≥ 75 y, diabetes, history of hypertension, high systolic blood pressure and LA thrombi by transesophageal echocardiography (TEE). These merit further evaluation. Copyright © 2009 Wiley Periodicals, Inc.

To explore the in-hospital mortality and its determinants for very eldly (80+ years of age) patients with acute myocardial infarction (AMI).A retrospective cohort method was used. The 499 study subjects were very eldly patients with newly diagnosed AMI consecutively admitted into our department between January 1, 2002 and February 22, 2010.Ninety-seven out of 499 patients died during hospitalization period, with total in-hospital mortality of 19.4%. Multivariable logistic regression analysis showed the independent determinants for mortality of very elderly AMI patients were cardiac Killip grades, complete A-V block, renal dysfunction, stent implant, and the type of AMI.The independent determinants for mortality of elderly AMI patients are as following, cardiac Killip grade, complete A-V block, renal dysfunction, stent implant, and the type of MAI. Urgent PCI is safe and effective for some very elderly with AMI, which could improve their survival rate within hospitalization period.

To know the current prevalence of atrial fibrillation (AF) in China and contribute to further Chinese studies on AF in future.We chose 14 natural populations from 14 different provinces across China. Using international standardized methods, we performed an epidemical study which was mainly on AF.The crude rate of prevalence of AF in China is 0.77%, which would be 0.61% after being standardized. Also, it is increasing with aging. The prevalence is higher in men than in women (0.9% vs 0.7%, P = 0.013). Among all the AF cases, valvular, nonvalvular, and lone AF were 12.9%, 65.2%, and 21.9% respectively. Ischemic stroke was the most frequent type seen among AF cases and the stroke rate among cases with AF was significantly higher than that without (12.1% vs 2.1%, P0.01).The prevalence of AF in China, whether classified by age, gender or cause, is similar to the results from other countries, especially North America and Europe. The incidence of stroke among AF cases is rather high in China. However, patients with AF would not like to take the necessary medicine. Therefore it is advisable to enforce the control of AF. We will continue to do the follow-up in these populations.

The aim of this study is to identify the risk factors in Chinese with nonvalvular atrial fibrillation and stroke, using case-control methodology.A total of 4 511 adult patients diagnosed with atrial fibrillation were identified from 18 hospitals over a 2-year period. There were 1 086 patients with rheumatic valvular atrial fibrillation and 3 425 patients with nonvalvular atrial fibrillation. Among the nonvalvular atrial fibrillation patients, 827 had ischemic stroke. The data of the patients having nonvalvular atrial fibrillation with stroke was compared with those having nonvalvular atrial fibrillation without stroke (n = 2 598). The effect of each variable on stroke was assessed with a logistic regression analysis.The studied cases with stroke and controls without stroke were similar in terms of percentage with sex, a past history of congestive heart failure, myocardial infarction, and mean left atrial size. Cases were significantly older than controls (73.3 +/- 9.2 vs. 68.2 +/- 12.3, P0.001) and more likely to have a history of hypertension (71.0% versus 51.6%, P0.001) and diabetes (17.9% vs. 11.1%, P = 0.001). There is strong evidence that left atrial (LA) thrombi make AF patients highly risky for stroke. In multivariate analysis, ageor = 75 (OR 1.76; 95% CI 1.08 approximately 2.98), history of hypertension (OR 1.52; 95% CI 1.28 approximately 1.80), diabetes (OR 1.39; 95% CI 1.11 approximately 1.76), high systolic blood pressure (OR 1.71; 95% CI 1.21 approximately 2.28), LA thrombi (OR 2.77; 95% CI 1.25 approximately 6.13) were independently associated with stroke. The lack of the association between left ventricular dysfunction and stroke is due to the relatively incorrect diagnosis of heart failure in the context of atrial fibrillation.Our analysis suggests that old age, hypertension, diabetes, high systolic blood pressure and LA thrombi detected with echocardiography are independent risk factors, which should be considered when decision of long-term anticoagulation therapy to prevent stroke with nonvalvular atrial fibrillation is to be made.