Adjunctive effects of exercise training in heart failure patients receiving maximum pharmacologic therapy

The purpose of this pilot study was to test the adjunctive effects of a 12-week exercise training intervention vs. standard pharmacologic therapy on quality of life, functional status, and mood in heart failure patients. A randomized, two-group repeated measures design was used to test outcomes at baseline and 12 weeks in 23 subjects (ejection fraction 相似文献   

Novel possibilities of antithrombotic therapy in patients with chronic heart failure

Modern approaches to prevention of venous thromboembolic complications in patients with chronic heart failure are analyzed in this review which contains results of large studies of low molecular weight heparins. In MEDENOX trial the use of enoxaparin in medical patients was associated with 63% reduction of risk of thrombosis. The authors own experience showed that 2 weeks of therapy with enoxaparin in patients with chronic stage IIB-III heart failure caused significant lowering of soluble fibrin-monomer complexes, fibrinogen, and index of turbo-dynamic potential. These changes evidenced for decreased intravascular blood coagulation. Thus enoxaparin can be effectively used for prevention of thrombosis and thromboembolism in patients with chronic heart failure. Novel antithrombotic agents fondaparinux, idraparinux, ximelagatran, recombinant thrombomodulin are perspective medications for prevention of venous thromboses and embolism in medical patients.     

Overview of emerging pharmacologic agents for acute heart failure syndromes

BACKGROUND: Several therapies commonly used for the treatment of acute heart failure syndromes (AHFS) present some well-known limitations and have been associated with an early increase in the risk of death. There is, therefore, an unmet need for new pharmacologic agents for the early management of AHFS that may improve both short- and long-term outcomes. AIM: To review the recent evidence on emerging pharmacologic therapies in AHFS. METHODS: A systematic search of peer-reviewed publications was performed on MEDLINE, EMBASE and Clinical Trials.gov from January 1990 to August 2007. The results of unpublished or ongoing trials were obtained from presentations at national and international meetings and pharmaceutical industry releases. Bibliographies from these references were also reviewed, as were additional articles identified by content experts. RESULTS: Cumulative data from large studies and randomised trials suggest that therapies with innovative mechanisms of action may safely and effectively reduce pulmonary congestion or improve cardiac performance in AHFS patients. CONCLUSION: Some investigational agents for the management of AHFS are able to improve haemodynamics and/or clinical status. In spite of these promising findings, no new agent has demonstrated a clear benefit in terms of long-term clinical outcomes compared to placebo or conventional therapies.     

Atrial fibrillation in patients with heart failure: pharmacologic options

Atrial fibrillation is a common arrhythmia in patients with heart failure. The presence of atrial fibrillation deteriorates cardiac function and increases the risk of thromboembolic events. The management of patients with atrial fibrillation in association with heart failure should consist of ventricular rate control, prevention of thromboembolic events, and conversion to normal sinus rhythm. Traditionally, digoxin has been widely used in patients with heart failure and atrial fibrillation; however, it does very little to restore sinus rhythm and requires the addition of another rate-limiting agent to control ventricular rate. The likelihood of successful cardioversion is dependent on the duration of heart failure and the degree of neurohormonal activation. The initiation of antiarrhythmic drug therapy in patients with heart failure should be guided by safety issues as well as consideration of potential benefits vs. risks associated with therapy. Amiodarone has been evaluated in numerous clinical trials and appears to be safe and effective when used in low dosage. Treatment with dofetilide is another option. Comparative studies with oral dofetilide vs. amiodarone are needed to evaluate their efficacy in restoration and maintenance of sinus rhythm in patients with heart failure. Such trials will clearly define the role of dofetilide in the treatment of atrial fibrillation. Routine prophylactic use of antiarrhythmic drug therapy for chronic atrial fibrillation in the setting of heart failure is not recommended due to a low efficacy rate and high proarrhythmic risk. Anticoagulation with warfarin and rate control remain the standard therapy. (c)2001 by CHF, Inc.     

Role of beta-blockers in the pharmacologic treatment of congestive heart failure

Beta-blockers are generally considered contra-indicated in heart failure. Some authors have claimed that in dilated cardiomyopathy and in pos myocardial infarction patients with heart failure beta-blockers can improve symptoms and survival. These trials and their conclusions are revised and the rationals of pathologic physiology of heart failure for this treatment are discussed.     

Beta-adrenergic blockade 2002: a pharmacologic odyssey in chronic heart failure

The treatment for heart failure has evolved considerably during the past two decades. Initially focused on hemodynamic derangement, diuretics and vasodilator agents were employed for symptomatic management. Beta blocking agents, with intrinsic negative inotropic activity, were considered specifically contraindicated. Neurohormonal activation subsequently became recognized and validated as a self-perpetuating influence on chronic heart failure and progressive adverse ventricular remodeling. Antagonism of the renin-angiotensin-aldosterone axis produced significant survival benefits in chronic heart failure populations. Concomitant intense sympathetic nervous system activation remained an additional therapeutic target. Pathophysiologic insights revealed a biologically plausible framework for the use of beta blocking agents in heart failure. This review summarizes the major clinical trials of beta blockers in heart failure populations with systolic left ventricular dysfunction. These trials support the integration of beta blockade as a critical component of standard therapy for chronic heart failure. Ongoing trials and unresolved issues are also discussed.     

The effect of pharmacologic therapy of hyperthyroidism on automatic heart conduction

Investigations of the heart automatism were carried out in 10 patients with hyperthyreoidism before thiamazol therapy and after restoration of the euthyroid status. A control group was comprised of 34 healthy subjects. In order to determine the electrophysiologic parameters the transoesophageal atrium extrastimulus technique and the over-driving stimulation were applied. Restoration of the euthyroid status was accompanied by a significant prolongation of the atrial refraction, the border interval, the border conductivity and the sinus rhythm recurrence time. In a half of the patients were atrioventricular and intraventricular conductibility disturbances observed. The authors conclude, that in the early period of the euthyroid status restoration after thiamazole therapy there still exists a risk of cardiologic complications.     

Gene therapy for heart failure

Congestive heart failure accounts for half a million deaths per year in the United States. Despite its place among the leading causes of morbidity, pharmacological and mechanic remedies have only been able to slow the progression of the disease. Today's science has yet to provide a cure, and there are few therapeutic modalities available for patients with advanced heart failure. There is a critical need to explore new therapeutic approaches in heart failure, and gene therapy has emerged as a viable alternative. Recent advances in understanding of the molecular basis of myocardial dysfunction, together with the evolution of increasingly efficient gene transfer technology, have placed heart failure within reach of gene-based therapy. The recent successful and safe completion of a phase 2 trial targeting the sarcoplasmic reticulum calcium ATPase pump (SERCA2a), along with the start of more recent phase 1 trials, opens a new era for gene therapy for the treatment of heart failure.     

心力衰竭的再同步治疗

虽然药物治疗心力衰竭取得了很大的进展,但仍有许多严重的心力衰竭患者疗效不佳,而心脏移植又受到供体的限制.因此,如何提高严重心力衰竭患者的生存率,拓展其治疗途径是目前的研究热点.通过起搏器改善心脏机械运动的协调性即再同步治疗(CRT)心力衰竭已被越来越多的人们所认识和接受.本文就CRT的基础、机制、相关临床实验、适应证、临床思考和存在的问题作一简述.     

Gene therapy in heart failure

With increasing knowledge of basic molecular mechanisms governing the development of heart failure (HF), the possibility of specifically targeting key pathological players is evolving. Technology allowing for efficient in vivo transduction of myocardial tissue with long-term expression of a transgene enables translation of basic mechanistic knowledge into potential gene therapy approaches. Gene therapy in HF is in its infancy clinically with the predominant amount of experience being from animal models. Nevertheless, this challenging and promising field is gaining momentum as recent preclinical studies in larger animals have been carried out and, importantly, there are 2 newly initiated phase I clinical trials for HF gene therapy. To put it simply, 2 parameters are needed for achieving success with HF gene therapy: (1) clearly identified detrimental/beneficial molecular targets; and (2) the means to manipulate these targets at a molecular level in a sufficient number of cardiac cells. However, several obstacles do exist on our way to efficient and safe gene transfer to human myocardium. Some of these obstacles are discussed in this review; however, it primarily focuses on the molecular target systems that have been subjected to intense investigation over the last decade in an attempt to make gene therapy for human HF a reality.     

心力衰竭的基因治疗

心力衰竭的治疗面临新方法的严峻挑战。当前随着载体技术、心脏基因转运技术的发展、完善 ,更为重要的是随着心力衰竭发病分子机制认识的日趋深入 ,使得基因介入治疗心力衰竭成为可能。本文综述了动物模型中有关心脏基因转运技术的最新研究进展 ,并分析了基因介入治疗心力衰竭的作用靶点 ,如 Ca2 +调控 ,β肾上腺素能信号和凋亡等 ,其中 Ca2 +调控增加肌浆网的 Ca2 +转运在动物心力衰竭模型和活体病理心肌细胞中的研究展示了良好的应用前景。然而 ,在以上基础研究和临床实际应用之间架起桥梁还是一项十分艰巨的任务。随着心力衰竭发病机制的进一步阐明 ,人们对心力衰竭基因治疗的前景仍需持谨慎乐观态度。     

老年慢性心力衰竭住院患者药物治疗情况分析

目的 了解老年心衰患者药物干预的实际情况,为临床规范化治疗提供资料和依据.方法 入选天津医科大学第二医院1973年7月至2007年7月、天津市第一中心医院1983年1月至2002年12月年龄60～98岁的心力衰竭住院患者,回顾性调查年龄、性别、病因、心功能、药用等,根据年代分为1973～1979、1980～1989、1990～1999、2000～2007年共4组,建立数据库并应用SPSS13.0软件分析.结果 入选4704例次,占同期成人心力衰竭患者(6602例次)的71.3%,男2430例次(51.7%),女2274例次(48.3%),平均年龄(71.3±7.1)岁,80～98岁的患者占12.8%(4704/6602).1973～1979、1980～1989年组前3位病因分别为肺心病、冠心病和风湿性心脏病(风心病),1990～1999、2000～2007年组的前3位病因则分别为冠心病、肺心病和风心病.心力衰竭治疗药物在4组的应用差异有统计学意义(均P<0.05),血管紧张素转换酶抑制(ACEI)+β受体阻滞剂2种药物合用、ACEI+β受体阻滞剂+醛固酮拮抗剂3药物合用也呈逐年代增加.各种药物及联合应用最多的病因分别为冠心病、风心病、肺心病及扩张型心肌病.随心功能级别的增加,利尿剂、洋地黄制剂、醛固酮拮抗剂、ACEI+β受体阻滞剂+醛固酮拮抗剂3药合用、利尿剂+洋地黄制剂+ACEI+β受体阻滞剂4药合用的应用比例增加;β受体阻滞剂以心功能美国纽约心脏病协会(NYHA)心功能分级Ⅱ级和Ⅲ级的患者应用多;ACEI在NYHA心功能分级Ⅲ级的患者应用多;血管紧张素Ⅱ受体拮抗剂(ARB)以NYHAⅢ级和Ⅳ级患者居多.结论 天津市部分医院老年心力衰竭住院患者的治疗药物以利尿剂、硝酸酯制剂和洋地黄制剂等为主;ACEI、β受体阻滞剂、ARB、醛固酮拮抗剂等药物的应用逐年代增加迅速.