Objective:To evaluate the efficacy and safety of conventional diuretic therapy versus Tolvaptan in elderly chronic heart failure patients combined with mild to moderate renal insufficiency with hyponatremia, in order to provide clinical evidence for the treatment of heart failure in the elderly.Methods:This was a randomized control trial.A total of 88 elderly chronic heart failure patients combined with mild to moderate renal insufficiency with hyponatremia were randomly divided into the control group(n=46)and the experimental group(n=42). Once enrolled both groups stopped taking oral loop diuretics.In addition to routine treatment, the control group was treated with furosemide 40 mg once a day, while the experimental group was treated with Tolvaptan 15 mg once a day.The rate of effectiveness in relieving heart failure, the diuretic effects and improvement in heart and kidney function were monitored, and changes in serum potassium and sodium levels and the incidences of thirst and other adverse events were compared between the two groups.Results:The effectiveness rate on heart failure was higher in the experimental group than in the control group(85.7% or 36/42 vs.65.2% or 30/46, χ2=17.855, P<0.001). After treatment, greater changes in average 24-hour urine volume from baseline(787.4±219.6 ml vs.388.6±179.6 ml, t=322.588, P<0.001), more weight loss(-2.4±2.1 kg vs.-1.7±1.6 kg, t=6.942, P=0.009), smaller changes in N-terminal pro-B-type natriuretic peptide(NT-proBNP)from baseline(-897.6±432.1 ng/L vs.-578.4±476.9 ng/L, t=539.400, P<0.001), greater changes in left ventricular ejection fraction(LVEF)from baseline(6.5±5.6 % vs.1.5±5.7 %, t=3.966, P=0.048), smaller changes in serum creatinine from baseline(-8.6±12.4 μmol/L vs.9.6±11.3 μmol/L, t=87.161, P<0.001), and greater changes in estimated glomerular filtration rate(eGFR)from baseline(1.4±1.8 ml·min -1·1.73m -2vs.-4.1±5.6 ml·min -1·1.73m -2, t=63.856, P<0.001)and in serum sodium from baseline(6.2±2.1 mmol/L vs.1.4±1.9 mmol/L, t=234.065, P<0.001)were observed in the experimental group than in the control group.There was no significant difference in the incidences of thirst, dry mouth and other adverse events between the two groups(16.7% or 7/42 vs.10.9% or 5/46, χ2=0.626, P=0.429). Conclusions:Tolvaptan can effectively improve the clinical symptoms and cardiac function and correct hyponatremia in elderly chronic heart failure patients combined with mild to moderate renal insufficiency, with a good safety profile.

Objective To investigate the association of CYP2C19 gene polymorphism with the efficacy of clopidogrel in patients with acute coronary syndrome(ACS) after percutaneous coronary intervention(PCI).Methods Thromboelastography was performed on 260 elderly ACS patients 3 days after PCI.Patients with the adenosine diphosphate(ADP)-induced platelet aggregation inhibition rate ＜30％ were assigned to the clopidogrel resistance group(CR group,n=78),and those with the ADP-induced platelet aggregation inhibition rate ＞ 30％ were assigned to the non-clopidogrel resistance group (non-CR group,n =152).Baseline data,clinical data,CYP2C19 genotype and phenotype were compared between the two groups.Results After drug treatment,the ADP-induced platelet aggregation inhibition rate was(16.0 ± 8.1) ％ for the CR group and (54.4 ± 17.3) ％ for the non-CR group.Of all 230 patients,36 (15.6 ％)had the slow metabolic genotype,66 (28.7 ％)had the intermediate metabolic genotype and 128 (55.7 ％) had the fast metabolic genotype.The difference was statistically significant between the intermediate or fast metabolic genotype group and the slow metabolic genotype group (All P＜ 0.05).In the non-CR group,the slow,intermediate and fast metabolic genotype cases were 12 (33.3 ％),46 (69.7 ％) and 94 (73.4 ％),respectively;There were no statistically significant differences between these groups(x2 =0.35,P＞0.05).In the CR group,the slow,intermediate and fast metabolic genotype cases were 24 (66.7 ％),20 (30.3 ％) and 34 (26.6％),respectively;There were statistically significant differences between these groups(x2=9.72,P＜ 0.01).Conclusions The incidence of CR in elderly patients with acute coronary syndrome after PCI is closely related to the CYP2C19 gene polymorphism.

Objective To observe the clinical efficacy of ezetimibe combined with atorvastatin calcium on hyperlipidemia,and to evaluate the role of ezetimibe on lipid management in elderly patients with coronary heart disease (CHD) after coronary intervention.Methods A total of 150 elderly CHD patients with hyperlipidemia to undergo coronary intervention in our hospital were selected.Patients were randomly divided into the control group and the experimental group (n=75,each).Patients in control group were treated with atorvastatin,and in the experimental group with ezetimibe plus atorvastatin.The change of blood lipids levels and the incidence of adverse reactions were compared between the two groups 1 month after the treatment.Results The numbers of patients with normal serum levels of total cholesterol (TC),triglycerides (TG),low density lipoprotein (LDLC) were much more in the experimental group than in the control group after treatment [68 cases (90.7％) vs.50 cases (66.7％),62 cases (82.7％) vs.44 cases (58.7％),56 cases (74.7％) vs.38 cases (50.7％),x2 =12.87,10.42,9.23,respectively,all P＜0.01].There was no significant difference in the incidence of adverse reactions between the two groups [5.3％ (4 case) vs.2.7％ (2 cases),x2 =0.17,P ＞ 0.05].Conclusions Compared with atorvastatin calcium treatment,ezetimibe combined with atorvastatin calcium treatment has a better clinical efficacy on hyperlipidemia with no increase of adverse reactions in elderly CHD patients.

Objective To investigate the value of brain natriuretic peptide (BNP) detection in the diagnosis and treatment of heart failure patients with normal ejection fraction.Methods Totally 78 elderly patient were selected in our hospital,with left ventricular ejection fraction (LVEF) ≥45 ％,among which 52 cases of patients were consistent of heart failure criteria (heart failure group),27 cases with normal left ventricular diastolic function as control group.The echocardiographic indices of diastolic function and the change of the concentration of BNP were compared.Results As compared with heart failure group,BNP concentration (108.7 ± 32.2) ng/L vs.(190.3 ± 41.5) ng/L,left ventricular posterior wall thickness (11.3 ± 1.7) mm vs.(13.6 ± 1.4) mm,left ventricular mass index (119.3±10.2)g/m2 vs.(130.7±8.9)g/m2 were elevated in heart failure group (all P＜0.01).Conclusions BNP detection can be used for a diagnosis of heart failure as a simple and easy method.The BNP and ultrasound heart beat graph combination can improve heart failure diagnostic accuracywith normal ejection fraction in elderly patients.

Objective To explore the changes and clinical significance of plasma redox status in patients with acute myocardial infarction,angina pectoris and people with normal coronary artery.Methods According to the clinical manifestation,electrocardiograms and the myocardium markers,68 acute myocardial infarction patients (group A) were involved.68 angina pectoris patients (group B) and 68 normal coronary artery people (group C) were also chosen according to the coronary artery radiographs.Peripheral venous blood of 3 groups were collected.Plasma glutathione (reduced form GSH and oxidized form GSSG) and nicotinamide adenine dinucleotide phosphate (reduced form NADPH and oxidized form NADP+) were detected.The GSH/GSSG and NADPH/NADP+ redox potentials were calculated according to Nernst equation.Results Along with the pathological aggravation of coronary artery (from group C to group A),the levels of GSH [(8.39±1.03)μmol/L,(6.54±0.94) μmol/L,(4.49±0.86) μmol/L,respectively] and GSH/GSSG (14.22±2.14,9.76±1.67,5.76±1.18,respectively) were gradually reduced; the levels of GSSG [(0.59±0.03) μmol/L,(0.67±0.04) μmol/L,(0.78 ± 0.05) μmol/L,respectively] and GSH/GSSG redox potential [(-150.43±3.43) mV,(-141.22±3.12) mV,(-135.21±2.31) mV,respectively] were gradually increased (all P＜ 0.05); the changes of NADPH/NADP+ redox status were similar to GSH/GSSG but milder.Conclusions The imbalance of plasma redox status deviating to oxidation has a relationship with atheromatous plaque formation,plaque rupture and plaque thrombosis in the coronary artery.

Objective To evaluate the efficacy and safety of double-dosage Clopidogrel in elderly patients with Clopidogrel resistance after percutaneous coronary intervention(PCI).Methods The randomized control trials design was used in this study.108 senile ACS patients with Clopidogrel resistance(platelet inhibition rate＜ 30 ％) were randomized into control group(Clopidogrel 75 mg/d,n =54)and experimental group(Clopidogrel 150 mg/d,n=54).Blood platelet inhibition rate of ADP,major adverse cardiovascular events and main side effects were observed before and 7 d,30 d,90 d and 180 d after intervention.Results Compared with control group,the experimental group was associated with significantly increased platelet inhibition rate on 7 d (22.4 ± 4.5) ％ vs.(37.6 ± 4.5)％,30 d(22.6±4.3)％ vs.(38.8±4.7)％,90 d(22.7±4.6)％ vs.(38.5±4.5)％,and 180 d (23.7±4.3)％ vs.(38.9±4.6)％ after treatment(all P＜0.05).Furthermore,the incidence of main adverse cardiovascular events was also significantly lower in the experimental group(3.7％ vs.35.1％,x2 =15.133,P＜0.001).Meanwhile,the incidence of bleeding and dyspnea were higher in experimental group,but there was no significant difference between the two groups.Conclusions Compared with general dosage,double-dosage of Clopidogrel offers better curative effect and good safety in elderly ACS patients with Clopidogrel resistance after PCI.

Objective:To evaluate the therapeutic effects of Tolvaptan on refractory heart failure in patients aged 75 years and older.Methods:This was a randomized controlled trial.A total of 68 patients with refractory heart failure aged 75 years and older were divided into the control group(n=38)and the experimental group(n=30)by randomly generated numbers.Patients in the control group were given levosimendan and recombinant human brain natriuretic peptide intravenously plus routine treatments such as diuresis and electrolyte correction.In the experimental group, 30 patients were given a single dose of 15 mg Tolvaptan per day in addition to what was received by the control group.The effects on heart failure were compared between the two groups 1 week after treatment.Changes in rehospitalization rate, emergency intervention frequency and mortality rate were recorded after a 3-month follow-up.Results:Clinical symptoms of heart failure were alleviated in both the experimental and control groups after treatment.Improvements in 24-h urine volume, body weight and 6-minute walking distance were more significant in the experimental group than in the control group after treatment[(1 470.5±200.6)ml vs.(972.5±201.7)ml, (-6.4±2.1)kg vs.(-2.8±1.9)kg, (189.3±13.7)m vs.(151.3±12.5)m, P<0.05]. Changes in serum sodium levels and improvement of LVEF were greater and reduction of N-terminal B-type brain natriuretic peptide(NT-proBNP)levels was more significant in the experimental group than in the control group after treatment[(5.2±2.1)μmol/L vs.(-1.1±2.4)μmol/L, (10.1±4.1)% vs.(7.0±4.0)%, (-6 670±1 815.7)ng/L vs.(-5 025.3±1 876.7)ng/L, P<0.05]. There was no significant difference in the incidence of adverse reactions between the two groups( P>0.05). The experimental group had shorter hospital stays, while the rehospitalization rate, emergency intervention times and mortality had no significant difference between the two groups during the follow-up period( P>0.05). Conclusions:Addition of Tolvaptan to treatment can increase urine volume, improve cardiac function, correct hyponatremia and shorten the length of hospitalization in refractory heart failure patients aged 75 years and older with good safety and has no significant impact on renal function.

Objective: To investigate the impact of comprehensive geriatric assessment(CGA)on treatment outcomes of chronic heart failure(CHF)complicated with emotional disorders in the elderly. Methods: A total of 216 CHF patients with emotional disorders at Henan Provincial People’s Hospital were recruited from September 2017 to March 2019 and were randomly divided into a CGA group and a control group with 108 cases in each group.The control group was given standard drug treatment and psychological counseling, whereas individualized treatment was given to participants in the CGA group in compliance with CGA guidelines.The clinical effects after intervention for 8 weeks in the two groups were examined, using measures such as Hamilton Depression Rating Scale for Depression(HAMD)-24, Hamilton Anxiety Scale(HAMA)-14, amino-terminal pro-brain natriuretic peptide(NT-proBNP), the 6 minute walk test(6MWT)and left ventricular ejection fraction(LVEF). The changes of cognitive status, nutritional status, fall risk and other indicators in patients were comprehensively assessed and statistically analyzed. Results: Compared with pre-treatment data, 8 weeks of treatment for both the control group and the CGA group resulted in decreased HAMD-24 scores(Control group: 31.78±9.08, 23.69±10.16; CGA group: 32.09±8.98, 15.35±7.91; P<0.05), HAMA-14 scores(Control group: 22.38±7.09, 15.28±6.54; CGA group: 21.99±8.12, 10.48±6.82; P<0.05)and NT-proBNP levels[Control group: (4672±392)ng/L, (3279±282)ng/L; CGA group: (4861±378)ng/L, (2387±215)ng/L; P<0.05], and increased LVEF(%)[Control group(34.5±6.2)%, (39.8±7.5)%; CGA group(35.1±3.9)%, (42.5±6.1)%; P<0.05]and 6MWT scores[Control group(298±79±7.5)m, (358±102)m; CGA group(305±98)m, (402±178)m; P<0.05], with more marked changes in all the measures in the CGA group than in the control group(P<0.05). Conclusions The early application of CGA can improve the condition and prognosis in elderly heart failure patients complicated with emotional disorders.

Objective:To investigate the relationship between serum albumin(SA)levels and left atrial thrombosis(LAT)in elderly patients with nonvalvular atrial fibrillation(NVAF), and to evaluate the clinical value of SA in predicting LAT in elderly NVAF patients.Methods:Clinical data of 180 elderly patients with NVAF undergone transesophageal echocardiography(TEE)in our hospital were retrospectively analyzed.According to whether there was thrombosis in the left atrium, patients were divided into the thrombus group(n=42)and the non-thrombus group(n=138). Logistic regression was used to analyze factors related to left atrial appendage thrombosis in NVAF patients.The receiver operating characteristic(ROC)curve was used to evaluate the value of serum albumin levels in predicting LAT formation in elderly NVAF patients.Results:The duration of AF was longer in the thrombus group than in the non-thrombus group(all P<0.05). C-reactive protein(CRP)levels and platelet(PLT)counts were higher, and SA levels and the international normalization ratio(INR)were lower in the thrombus group than in the non-thrombus group(all P<0.05). The left atrial diameter(LAD)was larger in the thrombus group than in the non-thrombus group( P<0.05). Multiple Logistic regression analysis showed that the duration of AF and CRP levels were independent risk factors for LAT( P<0.05), and SA levels and INR were independent protective factors for LAT( P<0.05). ROC curve results showed that the area under the curve(AUC)of SA in predicting LAT was 0.778(95% CI: 0.711-0.837, P<0.001). Conclusions:Low serum albumin levels are closely related to LAT in NVAF patients and can be regarded as a predictor of LAT.Serum albumin levels should be monitored in clinical practice to reduce the incidence of stroke events in patients with AF.

Objective:To explore the influencing factors of drug application deviation in elderly diabetes mellitus patients during hospital-family transition period.Methods:A total of 278 elderly diabetes mellitus patients in Henan Provincial People's Hospital from March 2019 to March 2021 were selected as the study subjects.All patients were followed up by telephone 1 week after discharge.The drug deviation evaluation tool(MDT)was used to evaluate the drug application deviation in patients during the hospital-family transition period.They were divided into drug application deviation group and non-drug application deviation group.Sociodemographic and disease-related data and medication management data were compared between the two groups.Logistic regression analysis was used to analyze the influencing factors of drug application deviation in elderly patients with diabetes mellitus during hospital-family transition period.Results:Of the 278 elderly patients with diabetes, 162(58.27%)had at least one drug application deviation during hospital-family transition period.The family care index was lower in drug application deviation group than non-drug application deviation group( Z=6.578, P<0.001).As compared with non-drug application deviation group, drug application deviation group had the higher number of drugs at discharge, and had lower scores of Morisky Medication Adherence Scale with Eight-Item(MMAS-8), had lower scores of Summary of Diabetes Self Care Activities(SDSCA)and had lower scores of Self-efficacy for Appropriate Medication Use Scale(SEAMS), with statistically significant differences( Z=10.971, 6.077, t=5.947, 14.105, all P<0.001).Binary Logistic regression analysis and forest map showed that the more number of discharge medication was a risk factor for drug application deviation during hospital-family transition period in elderly patients with diabetes mellitus( OR=4.128, P<0.001); family care index, MMAS-8 score, SDSCA score and SEAMS score were its protective factors( OR=0.343, 0.523, 0.922, 0.568, all P<0.05). Conclusions:The incidence of drug application deviation during hospital-family transition period is higher in elderly patients with diabetes mellitus.The possible protective factors are high scores of family care index, MMAS-8, SDSCA and SEAMS, and the risk factor is large number of drugs ordered by discharged doctors.Therefore, targeted intervention measures can be implemented to reduce the occurrence of drug application deviation during hospital-family transition period.