慢性心力衰竭的非药物治疗进展

慢性心力衰竭在常规药物治疗的基础上,非药物治疗可进一步改善病人的预后.心脏再同步化治疗、埋藏式心脏复律除颤器及心脏机械辅助装置等慢性心力衰竭器械治疗发展迅速,基因、干细胞移植及植物神经干预等非药物治疗方法也不断在探索中前进.     

慢性射血分数降低性心力衰竭治疗的研究进展

从病因、药物和非药物3方面对慢性射血分数降低性心力衰竭的治疗进行综述,提出研究新型抗心力衰竭药物及新型器械可用于治疗。     

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慢性心力衰竭是各种心脏病的晚期严重阶段,其发病率及病死率较高.随着研究的不断深入,临床上对慢性心力衰竭的治疗也有了很大的进展.2005年9月,美国心脏病学会和美国心脏学会(ACC/AHA)推出了最新的慢性心力衰竭诊断与治疗指南,该指南全面、客观地评估了现有的心力衰竭治疗方法,包括药物及非药物治疗措施,既涵盖了最新循证医学结果,又包括心力衰竭专家丰富的临床经验,是目前治疗慢性心力衰竭最好的指导性文献.     

慢性心力衰竭心脏再同步化治疗的现状和进展

1慢性心力衰竭治疗现状慢性心力衰竭常常是由不同的病因引起的心脏舒缩功能异常,泵出的血液达不到组织的需求,形成血流动力功能异常和神经体液激活两方面特征的临床综合征。虽然药物治疗心力衰竭仍是目前的主流,但是对于重度心力衰竭患者,病死率还是很高。新的非药物疗法如细胞     

12例严重心力衰竭的冠心病患者的介入治疗

慢性心力衰竭是各种心脏病的严重阶段，导致患者生活质量下降且预后差、病死率高，其中冠心病是慢性心力衰竭的常见病因。虽然心力衰竭的药物治疗取得很大进展，但冠心病严重心力衰竭患者的药物治疗效果仍不理想，本研究初步观察了介入治疗在经药物治疗后症状改善不明显、仍然不能平卧患者中的安全性及有效性。     

慢性心力衰竭器械治疗进展

慢性心力衰竭发病率越来越高,预后差。指南指导的药物治疗使心力衰竭患者预后得到了一定程度改善,但结果仍不理想。近年来,有多种器械用来治疗慢性心力衰竭。心力衰竭器械治疗对一些药物难治性以及终末期心力衰竭患者发挥了重要作用,有助于缓解症状,延长生存时间。本文将重点讨论心脏再同步治疗、心脏收缩力调节器以及机械辅助循环。     

心脏再同步化治疗充血性心力衰竭5例

慢性心力衰竭(CHF)是心内科治疗上的难题,尽管药物治疗取得了突破性的进展,但仍有较高患病率和死亡率.近年来中重度心力衰竭的非药物治疗有了飞速的发展,其中心脏再同步化治疗(CRT)是一种较新的手段,已取得令人鼓舞的效果.     

心力衰竭的进展(16)难治性心力衰竭的治疗原则和措施(续11)

严重的慢性心力衰竭患者,经常规药物积极治疗后,心力衰竭症状和体征无明显改善甚至恶化,称为难治性心力衰竭。难治性心力衰竭的治疗原则是充分利尿、扩血管和强心。在稳定血流动力学基础上加用神经内分泌阻滞剂;对效果仍不理想者应考虑行血流动力学监测和非药物治疗措施,包括机械辅助、心脏移植等。     

慢性心力衰竭的非药物治疗进展

从一般治疗、透析治疗、电生理治疗、外科手术治疗、针灸治疗几方面综述慢性心力衰竭的非药物治疗进展.一般治疗、透析治疗、生理治疗仅是作为辅助手段;外科手术则有着药物不可替代的作用;针灸治疗心力衰竭尚无足够证据支持用于临床.     

倍他乐克治疗慢性充血性心力衰竭100例临床观察

慢性充血性心力衰竭是一个常见临床综合征,预后差,病死率高,需长期药物治疗,目前β受体阻滞剂已成为治疗慢性充血性心力衰竭的基础药物.我院2003年4月-2004年4月收治100例慢性充血性心力衰竭病人,使用倍他乐克治疗取得良好效果,现总结报道如下.     

Atrial fibrillation and congestive heart failure: risk factors, mechanisms, and treatment

Atrial fibrillation (AF) and congestive heart failure (CHF) are commonly encountered together, and either condition predisposes to the other. Risk factors for AF and CHF include age, hypertension, valve disease, and myocardial infarction, as well as a variety of medical conditions and genetic variants. Congestive heart failure and AF share common mechanisms, including myocardial fibrosis and dysregulation of intracellular calcium and neuroendocrine function. Pharmacological treatments including beta-blockers, digoxin, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers can be useful in treating both of these conditions. Antiarrhythmic medications intended to achieve and maintain sinus rhythm may be beneficial in some patients with AF and CHF. Advances in pacemaker and defibrillator therapy, including cardiac resynchronization therapy, may also benefit patients with AF and CHF. Surgical and catheter-based ablation therapy can restore sinus rhythm in patients with AF, with proven benefit in patients with concommitant CHF. Investigational biologic therapy, including cell and gene based therapy, offers promise for the future of reversing the pathophysiological mechanisms that underlie AF and CHF.     

Epidemiology of sudden cardiac death in patients with heart failure

Mortality in congestive heart failure (CHF) usually occurs from either progressive worsening of cardiac pump failure or sudden cardiac death (SCD). Medical interventions that counter neurohormonal changes slow the progression of CHF and also prevent SCD. The benefits of medical therapy on SCD prevention have been variable, depending on the type of medical therapy. This article discusses the incidence, prediction, and prevention of SCD in CHF due to ischemic and nonischemic cardiomyopathy.     

Current status and future expectations for multisite pacing in heart failure

The number of patients with congestive heart failure (CHF) has achieved astonishing proportions. It is a debilitating and usually lethal condition, aside from being responsible for an enormous proportion of health care expenditures. Advances in medical therapy have not been sufficient to significantly improve prognosis, and heart transplantation can only benefit a minority of patients. Biventricular pacing has emerged as a promising form of therapy for patients with severe, medical refractory CHF with ventricular conduction defects. However, there are many technical issues to be solved, and better methods of selecting patients who respond favorably to this form of therapy are yet to be developed. This article reviews the rationale, delivery modes, and available data supporting multisite cardiac pacing as an alternative form of therapy for the failing heart.     

Managing congestive heart failure patient factors in the device era

Device-based care such as implantable cardioverter-defibrillators and cardiac resynchronization therapy extends congestive heart failure (CHF) care into a new era. The purpose of this paper is 2-fold: (1) to review the development of device-based CHF management and the implications from a medical and patient management perspective, and (2) to provide assessment and treatment approaches on how to clinically manage patient outcomes optimally. Quality of life, depression, and anxiety are targeted as concerns for patients with CHF and cardiac resynchronization therapy/implantable cardioverter-defibrillators. Brief clinic-based interview questions and formal assessment tools are reviewed. Furthermore, a cognitive-behavioral paradigm using the "Appropriate Education, Behavioral Support, and Cognitive Coping" (ABC) model is proposed to aid health care professionals in addressing patients' device-specific concerns. Available research suggests the need for future studies assessing the efficacy of cognitive-behavioral treatments in patients with CHF and cardiac resynchronization therapy/implantable cardioverter-defibrillators.     

Therapy insight: congestive heart failure, chronic kidney disease and anemia, the cardio-renal-anemia syndrome

Congestive heart failure (CHF) and chronic kidney disease (CKD) often progress to end stage even with optimum medical therapy. One factor that is common to both conditions is anemia, which is present in about a third of CHF patients. CHF can cause or worsen both anemia and CKD, and CKD can cause or worsen both anemia and CHF. Thus, a vicious circle exists between these three conditions, with each causing or worsening the other. We have called this condition the cardio-renal-anemia syndrome. Anemia in CHF is associated with increased mortality and hospitalization, reduced cardiac function and evidence of more severe CHF and CKD than in nonanemic patients. Intervention studies in anemic CHF patients have shown that optimum medical treatment of CHF and the correction of the associated anemia with subcutaneous erythropoietin and oral iron or intravenous iron sucrose can improve cardiac function, patients' functional status, renal function and quality of life, and reduce the frequency of hospitalization and the dose of diuretics required.     

Telemedical Interventional Monitoring in Heart Failure (TIM-HF), a randomized, controlled intervention trial investigating the impact of telemedicine on mortality in ambulatory patients with heart failure: study design

AIMS: Remote patient management (telemonitoring) may help to detect early signs of cardiac decompensation, allowing optimization of and adherence to treatments in chronic heart failure (CHF). Two meta-analyses have suggested that telemedicine in CHF can reduce mortality by 30-35%. The aim of the TIM-HF study was to investigate the impact of telemedical management on mortality in ambulatory CHF patients. Methods CHF patients [New York Heart Association (NYHA) II/III, left ventricular ejection fraction (LVEF)≤35%] with a history of cardiac decompensation with hospitalization in the past or therapy with intravenous diuretics in the prior 24 months (no decompensation required if LVEF≤25%) were randomized 1:1 to an intervention group of daily remote device monitoring (electrocardiogram, blood pressure, body weight) coupled with medical telephone support or to usual care led by the patients' local physician. In the intervention group, 24/7 physician-led medical support was provided by two central telemedical centres. A clinical event committee blinded to treatment allocation assessed cause of death and reason for hospitalization. The primary endpoint was total mortality. The first secondary endpoint was a composite of cardiovascular mortality or hospitalization due to heart failure. Other secondary endpoints included cardiovascular mortality, all-cause and cause-specific hospitalizations (all time to first event) as well as days lost due to heart failure hospitalization or cardiovascular death (in % of follow-up time), and changes in quality of life and NYHA class. Overall, 710 CHF patients were recruited. The mean follow-up was 21.5±7.2 months, with a minimum of 12 months. Perspective The study will provide important prospective outcome data on the impact of telemedical management in patients with CHF.     

心力衰竭患者标准药物治疗和心脏再同步化治疗结果分析

目的根据心脏再同步化用于心力衰竭(CARE-HF)研究结果 ,结合我国目前国情,探讨心力衰竭患者标准药物治疗和心脏再同步化治疗(CRT)联合有除颤功能的心脏再同步化治疗(CRTD)的长期结果。方法选择1999年12月至2008年4月行CRT、CRTD治疗的患者68例,为CRT/CRTD治疗组。选择同期常规药物治疗心力衰竭患者84例为对照组。所有入选患者,均需根据患者病情需要给予相应的药物治疗。结果 CRT/CRTD组患者生活质量较常规药物治疗组明显改善,但最终存活率差异无统计学意义[76.5%(52/68)比73.8%(62/84),P>0.05]。但CRT/CRTD组中死于充血性心力衰竭的患者显著少于常规药物治疗组[8.8%(6/68)比19.0%(16/84),P<0.05]。结论 CRT不能降低充血性心力衰竭患者的总体病死率,但在严重的充血性心力衰竭患者中,同时具备CRT和埋藏式心脏复律除颤器(ICD)的CRTD治疗可能成为最佳治疗方案。     

Pacemakers and defibrillators for congestive heart failure

Although medical therapy is the primary therapy for patients with heart failure, the use of pacemakers to improve cardiac hemodynamics is under investigation. Despite promising initial results, controlled studies have not verified the benefit of application of VDD or DDD pacing to a nonselected population of severely symptomatic congestive heart failure (CHF) patients to simply shorten their atrioventricular (AV) delay. There is increasing interest in pacing the left side of the heart or simultaneously pacing the right and left ventricles. Early studies suggest that these techniques may produce favorable hemodynamic effects in patients with CHF. Controlled, randomized studies are now underway. Further, it has been shown that sudden cardiac death accounts for 50% of deaths in patients with CHF. The value of an implantable cardioverter defibrillator (ICD) in secondary prevention of sudden cardiac death is well established. The use of ICD for primary prevention of sudden cardiac death in patients with CHF is being actively evaluated. Several large multicenter trials are underway, some combined with biventricular pacing, and should provide useful data in the coming years.     

Surgery Insight: surgical methods to reverse left ventricular remodeling

The management of patients with congestive heart failure (CHF) is challenging and the mortality with medical therapy alone is high. Left ventricular dilatation represents one of the strongest predictors of mortality in CHF, and a variety of surgical interventions have been proposed over the years to reverse ventricular remodeling. The most common surgical methods currently used are myocardial revascularization, left ventricular restoration, mitral valve repair, surgical ablation of atrial fibrillation, and employment of diastolic support and ventricular assist devices. In many patients a combination of these procedures is required to address the multiple pathophysiologic components of CHF. As techniques are refined and more data become available, the results of surgical treatment of heart failure are likely to improve. In addition, advances in innovations such as gene therapy, cell therapy and engineered artificial myocardial tissue will hopefully bring additional benefits to this problematic therapy over the next few years. In this review we discuss the characteristics of the most common surgical techniques for reversing left ventricular remodeling.     

左卡尼汀治疗老年2型糖尿病合并慢性心力衰竭患者的临床观察

目的 观察左卡尼汀治疗老年2型糖尿病合并慢性心力衰竭患者的疗效.方法 选择60例老年糖尿病合并慢性心力衰竭患者,随机分为左卡尼汀组及对照组各30例.两组均行常规抗心力衰竭治疗,左卡尼汀组患者在常规治疗基础上加用左卡尼汀2 g静脉泵入,一日两次,共15天,用药前以及开始用药后15天两组均检测左心室射血分数（LVEF）、左心室短径缩短率（LVFS）、心排出量（CO）、血浆氨基末端脑钠素前体（NT-pro-BNP）等指标,并分别对其治疗前后进行比较.结果 左卡尼汀能够增加心力衰竭患者的心肌收缩力及改善心功能,显著降低血NT-pro-BNP水平（P＜0.05）,两组比较差异有统计学意义（P＜0.05）,均未见明显不良反应,且血糖、三酰甘油（TG）、胆固醇（CHO）较治疗前明显下降.结论 左卡尼汀对治疗2型糖尿病合并慢性心力衰竭疗效较好,且无明显不良反应.