Administration of cardioselective beta-adrenoblockers in patients with arterial hypertension and/or ischemic heart disease associated with bronchoobstructive syndrome

AIM: To assess efficacy and safety of selective beta-adrenoblockers (BAB) metoprolol succinate and nebivolol in patients with arterial hypertension (AH) and/or IHD associated with bronchoobstructive syndrome (BOS). MATERIAL AND METHODS: Fifty patients suffering from AH and/or IHD associated with BOS in chronic obstructive pulmonary disease (COPD) and/or bronchial asthma (BA) of any severity in remission received BAB. Safety of BAB was evaluated by dynamics of respiratory symptoms and bronchial patency. An antihypertensive effect of BAB was assessed by the data of 24-h monitoring of BP, an antianginal one--by dynamics of clinical symptoms, amount of nitrates taken and exercise tolerance (6-min walk). The results of Holter ECG monitoring and an antiarrhythmic effect of BAB were also studied. RESULTS; Metoprolol succinate and nebivolol did not deteriorate bronchial patency (baseline FEV1--81.08 +/- 22.57%, at the end of the study--84.58 +/- 23.72% and 71.12 +/- 19.95, 73.19 +/- 21.70, respectively) in COPD and/or BA. Both drugs showed high antihypertensive efficacy as monotherapy and in combined therapy. Anginal attacks severity and frequency reduced significantly. The need in nitrosorbide fell noticeably, exercise tolerance increased significantly. Metoprolol succinate and nebivolol have a good anti-arrythmic effect. CONCLUSION: Metoprolol succinate and nebivolol are safe in patients with bronchoobstructive syndrome and AH and/or IHD in the presence of cardiovascular indications; these drugs can be used in patients with severe COPD and BA as well as their exacerbations unrelated to administration of beta-adrenoblocker.     

Hemodynamic effects of vasodilators on pulmonary hypertension in decompensated chronic obstructive pulmonary disease

Vasodilators have been reported to improve the hemodynamic status of some patients with pulmonary hypertension secondary to chronic obstructive pulmonary disease (COPD). We investigated the effects of sodium nitroprusside (50 micrograms/min) and hydralazine (25 mg) on pulmonary hemodynamics in 12 patients during acute exacerbation of COPD. Apart from its known systemic effects, nitroprusside decreased significantly mean pulmonary artery pressure (MPAP) from 36 +/- 10 to 31 +/- 12 mm Hg (p less than .04), decreased slightly pulmonary vascular resistance, and did not change cardiac index. Except for a slight but significant increase in MPAP from 35 +/- 5 to 38 +/- 5 mm Hg (p less than .002), hydralazine produced no significant hemodynamic changes. These results suggest that vasodilator therapy with sodium nitroprusside and hydralazine for pulmonary hypertension secondary to acute COPD is probably not helpful.     

高原地区肺心病患者血清碱性成纤维细胞生长因子水平与肺动脉压的关系

目的探讨血清碱性成纤维细胞生长因子(bFGF)在低氧性肺动脉高压发病中的作用。方法采用双抗体夹心酶联免疫吸附法(ELISA)检测高原地区(海拔2260~3300m)38例慢性肺源性心脏病(肺心病)急性加重期患者、30例慢性阻塞性肺疾病(COPD)缓解期患者和30例当地健康人血清bFGF含量,并使用彩色多普勒超声心动仪测定肺动脉血流频谱,计算平均肺动脉压(MPAP),使用血气分析仪测定动脉血氧分压(PaO2)。结果肺心病组血清bFGF(87.54±12.15)ng/L、MPAP(45.86±5.63)mmHg(1mmHg=0.133kPa)显著高于COPD组分别为(55.72±9.08)ng/L和(22.95±2.56)mmHg,P均<0.01,COPD组显著高于健康对照组分别为(49.83±8.78)ng/L和(20.34±2.23)mmHg,P均<0.05;肺心病组PaO2(38.79±4.56)mmHg显著低于COPD组(58.22±6.18)mmHg,P<0.01,COPD组则显著低于健康对照组(66.57±5.48)mmHg,P<0.01。肺心病组和COPD组血清bFGF水平与MPAP均呈显著正相关(r肺心病=0.788,rCOPD=0.674,P均<0.01),与PaO2均呈显著负相关(r肺心病=-0.735,rCOPD=-0.587,P均<0.01)。结论慢性肺心病患者血清bFGF水平明显升高,可能与其慢性低氧性肺动脉高压形成有一定关系。     

Early diagnosis of ischemic heart disease in patients with chronic obstructive pulmonary diseases]

AIM: To study incidence rate, course features, principles of diagnosis and therapy of ischemic heart disease (IHD) in patients with chronic obstructive pulmonary diseases (COPD). MATERIALS AND METHODS: Standard clinical examinations, ECG, chest x-ray, echo-CG, 24-h Holter monitoring, coronarography were performed in 60 patients over 40 years of age with bronchial asthma or chronic obstructive bronchitis. Autopsy data were analyzed for 20 patients who died of COPD. RESULTS: IHD was diagnosed in 53.3% of the examinees. 70% of the patients treated with preductal (trimetasidine) benefited from the treatment: they had less frequent episodes of painless myocardial ischemia. Autopsy material has shown that COPD patients frequently suffer of aortic and coronary atherosclerosis. CONCLUSION: IHD diagnosis in COPD patients is rather difficult as there are no well-defined correlations between clinical picture of IHD and data of device investigations, IHD is painless more frequently than in general population (in 84.4% of patients in this study). Preductal is a drug of choice for treatment of IHD in COPD patients.     

Chronic obstructive lung diseases in patients with ischemic heart disease: a 15-year study]

AIM: To characterize acquired chronic obstructive pulmonary diseases (COPD) in patients with ischemic heart disease (IHD). MATERIAL AND METHODS: Monitoring of external respiration function (ERF) was performed for 15 years in 1552 IHD patients on combined drug treatment. RESULTS: The 15-year follow-up has revealed that IHD patients treated with beta-blockers develop pathological changes in respiration pattern manifesting primarily with dyspnea, obstructive and mixed ventilatory disorders, syndrome of early expiratory obstruction in affected small airways due to subnormal lung elasticity, defective diffuse function, signs of terminal respiratory failure. CONCLUSION: IHD patients taking drugs need monitoring of ERF. Optimal treatment consists in early diagnosis of IHD and COPD, adequate combined therapy with beta-blockers and bronchodilating drugs.     

Long-acting m-cholinolytic thiotropium bromide (spiriva) in therapy of patients with chronic obstructive pulmonary disease (stage 3)

AIM: To elicit efficacy of a 3-month treatment with new inhaled cholinolytic drug spiriva in patients with chronic obstructive pulmonary disease (COPD) of stage 3. MATERIAL AND METHODS: Clinical symptoms (a total score of symptoms), external respiration function (ERF), pressure in the pulmonary artery were examined in 28 patients with COPD (stage 3). RESULTS: Long-acting thiotropium bromide relieved symptoms (the score decreased from 7.8 +/- 0.4 to 5.6 +/- 0.5), respiratory capacity rose from 68.8 +/- 2.4% to 75.9 +/- 2.5%, forced expiratory volume per 1 s increased from 41.9 +/- 2.6% to 46.6 +/- 3.2%, mean pressure in the pulmonary artery lowered from 29.0 +/- 0.8 to 25.1 +/- 1.2 mm Hg. CONCLUSION: Regular therapy with long-acting thiotropium bromide in patients with COPD stage 3 reduces clinical symptoms: dyspnea, mean pressure in the pulmonary artery. It also improves bronchial permeability.     

Effectiveness of end-tidal carbon dioxide tension for monitoring thrombolytic therapy in acute pulmonary embolism

OBJECTIVE: In acute massive pulmonary embolism with hemodynamic instability, monitoring of pulmonary artery pressure can be used to assess the efficacy of thrombolytic therapy. As a noninvasive alternative to pulmonary artery catheterization, we investigated the efficacy of continuous monitoring of end-tidal CO2 tension. DESIGN: In 12 patients with massive pulmonary embolism who required mechanical ventilation, mean pulmonary arterial pressure (MPAP) and end-tidal carbon dioxide tension (ETCO2) were registered continuously during thrombolytic therapy. PaCO2, cardiac index as estimated by thermodilution catheter and respiratory ratio of arterial oxygen tension and inhaled oxygen concentration (PaO2/FIO2) were determined every 60 mins. MEASUREMENTS AND MAIN RESULTS: Before thrombolysis, MPAP (34.5+/-9.8 mm Hg) and the difference between PaCO2 and ETCO2 (10.1+/-4.7 mm Hg) were markedly increased compared with normal values. Continuously monitored MPAP was related to ETCO2 for both all patients (r2 = .42; p < .001) and individually (mean r2 = .92; range, .79-.98; p < .001). In ten survivors, the mean cardiac index and PaO2/FIO2 increased during therapy from 1.7+/-0.4 to 2.8+/-0.6 L/min x m2 and 125+/-27 to 285+/-50 mm Hg (p < .01, respectively). In these patients, the difference between PaCO2 and ETCO2 decreased from 9.8+/-4.5 to 2.8+/-0.9 mm Hg (p < .001). Recurrent embolism was detected in two patients by sudden reduction of ETCO2. CONCLUSIONS: Analysis of ETCO2 allows monitoring of the efficacy of thrombolysis and may reflect recurrent embolism. Thus, on the basis of this small study, analysis of ETCO2 appears to be useful for noninvasive monitoring in mechanically ventilated patients with massive pulmonary embolism.     

Hemodynamic and gas exchange responses to inhalation of nitric oxide in patients with the acute respiratory distress syndrome and in hypoxemic patients with chronic obstructive pulmonary disease

Objective: Inhalation of nitric oxide (NO) can improve oxygenation and decrease mean pulmonary artery pressure (MPAP) in patients with the acute respiratory distress syndrome (ARDS). It is not known whether inhaled NO exerts a similar effect in hypoxemic patients with chronic obstructive pulmonary disease (COPD). Design: Prospective clinical study. Setting: General intensive care unit in Sabadell, Spain. Patients: Nine mechanically ventilated COPD patients (mean age 72±2 years; forced expiratory volume in 1 s 0.91±0.11 l) and nine ARDS patients (mean age 57±6 years; mean lung injury score 2.8±0.1) Measurements and results: We measured hemodynamic and gas exchange parameters before NO inhalation (basal 1), during inhalation of 10 ppm NO (NO-10), and 20 min after NO was discontinued (in basal 2) in the ARDS group. In the COPD group, these parameters were measured before NO inhalation (basal 1), during different doses of inhaled NO (10, 20, and 30 ppm), and 20 min after NO was discontinued (basal 2). A positive response to NO was defined as a 20% increment in basal arterial partial pressure of oxygen (PaO₂). MPAP and pulmonary vascular resistance (PVR) decreased significantly, while other hemodynamic parameters remained unchanged after NO-10 in both groups. Basal oxygenation was higher in the COPD group (PaO₂/FIO₂ (fractional inspired oxygen) 190±18 mmHg) than in the ARDS group (PaO₂/FIO₂ 98±12 mmHg), (p<0.01). After NO-10, PaO₂/FIO₂ increased (to 141±17 mmHg, p<0.01) and Qva/Qt decreased (39±3 to 34±3%, p<0.01) in the ARDS group. There were no changes in PaO₂/FIO₂ and Qva/Qt when the NO concentration was increased to 30 ppm in the COPD group. In both groups, a correlation was found between basal MPAP and basal PVR, and between the NO-induced decrease in MPAP and in PVR. The NO-induced increase in PaO₂/FIO₂ was not correlated with basal PaO₂/FIO₂. In the ARDS group, six of the nine patients (66%) responded to NO and in the COPD group, two of nine (22%) (p=0.05). Conclusions: NO inhalation had similar effects on hemodynamics but not on gas exchange in ARDS and COPD patients, and this response probably depends on the underlying disease. Received: 19 December 1995 Accepted: 28 September 1996     

比索洛尔对病情稳定的COPD致肺源性心脏病患者心率变异性的影响

目的：探讨高心血管选择性β受体阻断药比索洛尔对病情稳定的COPD致肺源性心脏病患者心率变异性（ HRV）的影响。方法选择2011年1月至2012年7月治疗稳定的COPD致肺源性心脏病患者36例。患者在规范的COPD、肺源性心脏病及其合并症治疗基础上,加用比索乐尔2.5 mg,随访4周,研究前后所有患者均行动态心电图及FEV1检查。结果与研究前比较,研究结束时,患者HRV明显改善,差异有统计学意义（ P＜0.05）;患者治疗前后FEV1比较,差异无统计学意义（ P＞0.05）。结论比索洛尔能改善病情稳定的COPD致肺源性心脏病患者HRV。     

比索洛尔对冠心病合并慢性阻塞性肺疾病患者BODE指数的影响

目的评价比索洛尔对冠心病合并慢性阻塞性肺疾病（COPD）患者BODE指数的影响。方法42例冠心病合并稳定期轻、中度COPD患者,给予比索洛尔口服,起始剂量1．25mg／d,逐步增加至5mg／d。治疗开始前及治疗60d后,分别检测BODE指数（BODEindex）的四个相关参数,即第1秒用力呼气容积占预计值百分比（（FEVI％pred）、功能性呼吸困难量表评分（MMRC）、6min步行距离（6MWD）、体重指数（BMI）,并计算BODE指数。结果治疗前后BODE指数及其四个相关参数分别为：FEV1％pred（68．05±7．32VS．67．38±7.13）;6MWD（322．834-65．72Vs．320．43±62．34）;MMRC（2．13±0．57VS．2．18±0．65）;BMI（20．58±3．52VS．20．26±3．07）;BODEindex（3．51±1．97vs．3．54±2．01）。（均为P〉0．05）。结论比索洛尔对冠心病合并稳定期轻、中度COPD患者的BODE指数无明显影响。     

Combination of thiotropium bromide with almitrine and pulmonary rehabilitation in the treatment of patients with chronic obstructive pulmonary disease

AIM: To elucidate efficacy of a combination almitrine+thiotropium bromide (TB)+pulmonary rehabilitation (PR) in chronic obstructive pulmonary disease (COPD) of stage II-III complicated with chronic respiratory failure (CRF). MATERIAL AND METHODS: Efficacy of therapy was compared in two groups of patients: group 1 (n = 22) received TB in a dose 18 mcg/day for one year, almitrine in a dose 10 mg/kg/day for 3 months, an 8 week course of PR, group 2 (n = 17) received TB and PR. The treatment efficacy was determined by spirometric parameters of external respiration function, blood gases, dyspnea indices, exercise tolerance assessed by 6-min walk test, quality of life (St. George Hospital Respiratory Questionnaire). RESULTS: Group 1 patients walked longer distance after a course of PR and 1 year later (by 90.5 +/- 25.4 and 44.5 +/- 10.2 m, respectively, p < 0.05), had reduced desaturation measured by pulsoxym-etry at the end of 6-min walk test, increased PaO2 in baseline under 70 mmHg (by 5.8 +/- 1.2 mmHg, p > 0.05), decreased exacerbation rate per 1 patient a year (by 25%). CONCLUSION: Combination treatment with TB, almitrine and PR is indicated for COPD patients with moderate hypoxemia.     

Effects of low-dose dopamine on ventilation in patients with chronic obstructive pulmonary disease

BACKGROUND: Dopamine plays an important role in the regulation of respiration and low-dose dopamine infusion is associated with a decreased respiratory drive response to hypoxia in animals and humans. The effects of dopamine on ventilation in patients with chronic obstructive pulmonary disease (COPD) is unknown. We tested the hypothesis that dopamine inhibits ventilation in patients with COPD. MATERIALS AND METHODS: In a double-blinded, cross-over, placebo-controlled, randomized study we studied nine patients with decompensated COPD, ventilated in the pressure support mode in the intensive care unit (ICU) and five ambulatory patients with stable COPD. All patients received 5 micro g kg(-1) min(-1) of dopamine or an equivalent volume of 5% glucose solution. RESULTS: In the mechanically ventilated COPD patients, there was no difference in the effects of dopamine compared with placebo on blood pressure, heart rate, minute ventilation (-0.5 +/- 1.1 vs. -0.2 +/- 0.9 L min(-1), P = 0.46, respectively), respiratory rate (-0.4 +/- 2.7 vs. -0.3 +/- 2.1 min(-1), P = 0.96), PaO(2) (-5 +/- 4 vs. -5 +/- 10 mmHg, P = 0.90, respectively), or PaCO(2) (-0.7 +/- 1.4 vs. -1.0 +/- 3.4 mmHg, P = 0.83, respectively). In spontaneously breathing stable patients, dopamine increased systolic blood pressure (P = 0.02) but did not influence other haemodynamic and respiratory variables. CONCLUSION: Although low-dose dopamine has been shown to depress ventilation in a variety of conditions, it does not compromise ventilation in COPD patients either breathing spontaneously or when weaned using pressure support ventilation.     

Mononitrates in therapy of ischemic heart disease polycythemia vera

Effectiveness of Mono Mac was assessed in patients with ischemic heart disease (IHD) and concomitant polycythemia vera (PV). 24-h ECG-monitoring, stress-echoCG were performed in 28 patients aged 35-79 years with painless myocardial ischemia (group 1) and painful form (group 2). Mean dose of Mono Mac was 56.4 mg/day. Clinical response was achieved. Positive changes were observed in decreased number of anginal attacks and nitroglycerin tablets, ST wave depression, number of ischemic episodes, improvement of hemodynamics. It is concluded that Mono Mac has a marked clinical effect in IHD patients having associated polycythemia vera.     

Clinicopathogenetic features of coronary heart disease combined with chronic obstructive pulmonary diseases and efficiency of therapy with trimetazidin

Based on retrospective analysis of 2446 in-patient cards, autopsy protocols, outpatient medical documentation, prevalence and features of clinical manifestation of cardiorespiratory pathology (CRP): coronary heart disease (CHD) combined with chronic obstructive pulmonary disease (COPD)--1 stage of study, and also (after randomization and forming of main and control groups), efficiency of myocardial cytoprotector trimetazidin (TMZ) at its long-term use (1 year) in combined therapy (2 stage of study): 135 CHD patients (stable exertional angina functional class II-III: 92 and 43 persons respectively) with COPD of medium severe (111 persons) and severe course (24 persons), were studied. It is shown that CRP is prevailed in elder age groups (after 45 years) and noticed in 56.7% CHD patients. More sevenre course with great risk of myocardial infarction with Q wave (twice, p < 0.001), prolongation of painless ischemia (62.4+/-11.5 min/day vs. 22.8+/-11.1 min/day), inclination to complicated rhythm disturbances (38 vs. 21.9, p < 0.05) and earlier clinical manifestations of heart failure (4.3+/-0.6 years earlier, p < 0.001) is typical for CHD with COPD vs. patients without pulmonary pathology. In one year after beginning of treatment with TMZ (35 mg) number of weekly pain attacks was decreased in patients of 1st group vs. 2nd group (at the average -50.8% -29.3% vs. +12.5% +16.6% respectively); significant (p < 0.05) decrease in duration of painless myocardial ischemia was registered. Decrease in number of supraventricular and ventricular extrasystoles (42.7+/-1.48 vs. 20.5+/-1.07 cases in a day, a < 0.0001), significant (p < 0.05) increase in ejection fraction and decrease in left ventricle end-diastolic volume (12.2+/-0.4% E 12.2+/-0.3% respectively), in dimensions of left (10.9+/-0.03%) and right (8.8+/-0.9%) atrium, in risk of development of acute coronary syndrome were noticed in the patients of main group received TMZ. Thus, long-term (not less then 1 year) use of TMZ (35 mg) in combined treatment assists to normalization of cardiovascular indices, decreases cardiovascular complication occurrence, improves disease prognosis and do not has negative side-effects.     

Pumpan in the treatment of ischemic heart disease associated with arterial hypertension]

AIM: To study effectiveness of natural combined medicine pumpan in patients with ischemic heart disease (IHD) including cases with concomitant arterial hypertension (AH). MATERIAL AND METHODS: 35 patients with different forms of IHD (myocardial infarction, stable and unstable angina pectoris of functional class III-IV) received conventional treatment combined with pumpan given for 7-11 weeks. Changes in clinical condition, biochemical blood indices, ECG, echo-CG, 24-h arterial pressure monitoring data were investigated. RESULTS: The addition of pumpan to the standard therapy reduced frequency of anginal attacks, improved intracardiac hemodynamics, psychic and adaptive indices. CONCLUSION: Pumpan is a good adjuvant to conventional treatment of various IHD forms including combination of IHD with AH. Pumpan enables reduction in the required doses of beta-blockers, ACE inhibitors, nitrates, sedatives. It also provides hypocoagulatory and hypocholesterolemic effect.     

Levels of anti-inflammatory cytokines interleukin-2, interleukin-8, and soluble interleukin-2 receptor in blood of patients with various forms of ischemic heart disease

AIM: To quantify interleukin-8 (IL-8), interleukin-2 (IL-2) and soluble receptor of IL-2 (sIL-2r) in blood serum of patients with various forms of ischemic heart disease (IHD). MATERIAL AND METHODS: Levels of IL-8, IL-2 and sIL-2r were measured with enzyme immunoassay (EIA) in the serum of 75 patients with IHD: angina of effort (group 1), progressive angina (group 2) and acute myocardial infarction (group 3). The EIAs were performed at admission and 2 weeks later. RESULTS: Baseline levels of IL-2 in group 1 and 2 patients were close (9.1 +/- 1.6 and 10.1 +/- 3.8 pg/ml) being significantly lower in group 3 (0.81 +/- 0.57 pg/ml, p < 0.01). 14 days of therapy did not change the values noticeably. IL-8 level was the highest in group 1 (94.2 +/- 27.6, 20.03 +/- 7.4, 22.47 +/- 4.8 pg/ml, respectively). sIL-2r in the three groups did not vary greatly (73.95 +/- 12.23, 89.46 +/- 18.17, 89.2 +/- 14.17 pg/ml, respectively). SIL-2r levels rose in 2 weeks in group 3 (to 147.67 +/- 18.17 pg/ml). CONCLUSION: It is confirmed that IL-2, IL-8 and sIL-2r take part in pathogenesis of IHD. IL-2 and IL-8 levels are persistently high in anginal patients while in patients with acute myocardial infarction they are low. Low concentrations of IL-2 in the latter may be attributed to high levels of its soluble receptor.     

Change in P wave height during progressive exercise in patients with chronic obstructive pulmonary disease

We examined changes in P wave height in lead II of electrocardiogram during progressive exercise in patients with chronic obstructive pulmonary disease (COPD), and obtained the slope (delta P/delta VO2, %/ml/min) of the regression line calculated from the relationship between percent change of P wave height and oxygen consumption (VO2). Four COPD patients, who had a decrease over 5 mmHg in arterial oxygen tension (PaO2) at maximal exercise (group A), had significantly greater slope (0.45 +/- 0.14%/ml/min, mean +/- S.E.) than in five COPD patients (group B, 0.14 +/- 0.05), who did not have a decrease over 5 mmHg in PaO2 at maximal exercise. The increase in P wave height during exercise was inhibited by oxygen inhalation at the given VO2 in group A. These findings suggest that increase in P wave height during exercise in COPD patients may be correlated with hypoxemia during exercise.     

Right ventricular response to high-dose almitrine infusion in patients with severe hypoxemia related to acute respiratory distress syndrome

OBJECTIVE: To evaluate the effects of high-dose almitrine infusion on gas exchange and right ventricular function in patients with severe hypoxemia related to acute respiratory distress syndrome (ARDS). DESIGN: Prospective study. SETTING: Medicosurgical intensive care department (ten beds). PATIENTS: Nine patients with ARDS and severe hypoxemia (PaO2/FIO2 ratio, <150 torr [20 kPa]). INTERVENTION: High-dose almitrine infusion (16 microg/kg/min for 30 mins). MEASUREMENTS AND MAIN RESULTS: Gas exchange and hemodynamic parameters were recorded before and after almitrine infusion. Right ventricular function was evaluated by using a fast response thermistor pulmonary artery catheter that allowed measurement of right ventricular ejection fraction and calculation of right ventricular end-diastolic and end-systolic volumes. Almitrine did not significantly alter arterial oxygenation and intrapulmonary shunt. Almitrine increased mean pulmonary arterial pressure (MPAP) from 31 +/- 4 to 33 +/- 4 mm Hg (p < .05), pulmonary vascular resistance index from 353 +/- 63 to 397 +/- 100 dyne x sec/ cm5 x m2 (p < .05), and right ventricular end-systolic volume index from 71 +/- 22 to 77 +/- 21 mL/m2 (p < .05); almitrine decreased right ventricular ejection fraction from 36% +/- 7% to 34% +/- 8% (p < .05). Stroke volume index and cardiac index did not change. The almitrine-induced changes in right ventricular ejection fraction were closely correlated with the baseline MPAP (r2 = .71, p < .01). CONCLUSION: In patients with severe hypoxemia related to ARDS, high-dose almitrine infusion did not improve arterial oxygenation and impaired the loading conditions of the right ventricle. The decrease in right ventricular ejection fraction induced by almitrine was correlated with the baseline MPAP. Thus, high-dose almitrine infusion may be harmful in ARDS patients with severe hypoxemia and pulmonary hypertension.     

Oxidative stress in patients with COPD and pulmonary hypertension

OBJECTIVE: Oxidative stress plays an important role in the pathogenesis of chronic obstructive pulmonary disease (COPD). Oxidant/antioxidant imbalance has also been reported in various forms of pulmonary hypertension. The present study aimed to assess systemic oxidative stress, as reflected by serum malondialdehyde (MDA) concentrations and activities of antioxidant enzymes in erythrocytes [glutathione peroxidase (GPX), superoxide dismutase (SOD) and catalase (CAT)] in patients with and without pulmonary hypertension secondary to COPD. PATIENTS AND METHODS: Seventy-five patients (58 male) with COPD (mean age 65.1 +/- 1.2 years; mean smoking history 35.6 +/- 3.8 pack-years) were studied. Twenty-one healthy non-smokers served as a control group. Pulmonary function was evaluated with body plethysmography; mean and systolic pulmonary artery pressures (Ppa) were assessed with Doppler echocardiography. Serum concentrations of MDA and activities of GPX, SOD and CAT in washed red blood cells were measured using spectrophotometry. RESULTS: Pulmonary hypertension was present in 28 patients with COPD (systolic Ppa: 46.4 +/- 2.3 mmHg; mean Ppa: 26.0 +/- 1.9 mmHg) and absent in 47 (systolic Ppa: 22.9 +/- 0.8 mmHg; mean Ppa: 13.4 +/- 0.6 mmHg). Compared with the healthy control group, all the patients (with or without pulmonary hypertension) had higher serum MDA concentrations (1.5 +/- 0.1 versus 2.3 +/- 0.1 versus 2.3 +/- 0.1 nmol/mL, ANOVA, P < 0.001) and lower erythrocyte GPX activity (51.3 +/- 3.2 versus 42.2 +/- 2.0 versus 41.3 +/- 2.5 U/g Hb, P = 0.029), whereas SOD (1121.1 +/- 29.0 versus 1032.6 +/- 21.8 versus 1032.7 +/- 36.2 U/g Hb, P = 0.063) and CAT activities (4.9 +/- 0.2 versus 4.6 +/- 0.1 versus 4.7 +/- 0.2 U/g Hb; P= 0.454) were similar. No differences were observed in serum MDA concentrations or activities of GPX, SOD and CAT in erythrocytes between COPD patients with and without pulmonary hypertension. CONCLUSION: The study demonstrates the presence of oxidative/antioxidative imbalance in the systemic circulation in patients with COPD: compared with healthy subjects, COPD patients had higher serum MDA concentrations and lower GPX activity in erythrocytes. The magnitudes of the increase in MDA and reduction in GPX activity were similar in COPD patients with pulmonary hypertension and in those with normal pulmonary artery pressures.     

比索洛尔对高血压病患者左室收缩与舒张功能的影响

目的　观察比索洛尔的降压效果及其对高血压病患者左心功能的影响。方法　对 3 6例初诊轻、中度高血压病患者进行 4周的比索洛尔治疗 ,应用超声心动图观察左室收缩及舒张功能的变化。结果　比索洛尔治疗前后诊室收缩压和舒张压的下降幅度分别为 16.2 3mmHg和 7.65mmHg ;降低血压的同时心房收缩期充盈峰值流速及其与舒张早期充盈峰值流速之比值明显降低 (P <0 .0 5及P <0 .0 1)。结论　比索洛尔在有效降压的同时能够显著改善高血压病患者的左室舒张功能。