血管紧张素受体拮抗剂对于心房颤动防治的研究进展

心房颤动（atrial fibrillation,AF）是临床常见的疾病,它严重威胁着人体健康。血管紧张素受体拮抗剂（angiotensin-receptor blockers,ARB）是临床实践中的一类常见药物,对于特定的心血管疾病有着良好的疗效,同时还具有抑制和逆转心房重构的作用。本文就ARB对新发性AF和术后AF的防治效果与机制进行综述。     

醛固酮受体拮抗剂改善急性心肌梗死后左心室重构的研究进展

近年来醛固酮及其受体拮抗剂对急性心肌梗死后左心室重构的影响渐成为国内外学者研究的热点。本文着重阐述了醛固酮在心脏中的合成及摄取、醛固酮诱发心肌纤维化、以及醛固酮及其受体拮抗剂对于急性心肌梗死后左心室重构的影响。     

醛固酮受体拮抗剂的降压治疗进展

醛固酮是肾素-血管紧张素-醛固酮系统的终末环节,在原发性高血压、顽固性高血压中起重要作用.醛固酮受体拮抗剂在高血压治疗方面的作用越来越受到重视.现综述醛固酮在高血压中的病理生理作用,醛固酮受体拮抗剂的分类、降压机制及临床应用进展等.     

醛固酮受体拮抗剂的研究进展

醛固酮由肾上腺皮质球状带分泌,新近研究发现,肾上腺外组织亦可合成醛固酮。醛固酮不仅在维持体内水、电解质平衡方面起重要作用,而且可以促进组织胶原沉积,导致多个器官纤维化和结构重构,在心血管及其他疾病的发生、发展中起到十分重要的作用。本文对醛固酮在各种疾病中的作用及其拮抗剂在临床治疗中的研究进展进行综述。     

血管紧张素Ⅱ受体拮抗剂抗心房颤动的研究进展

心房颤动(Af)是临床上最常见的快速性心律失常之一,有较高的致残率和致死率,是脑卒中最强的独立危险因素,15%的脑卒中事件与Af有关~([1]).因此,恢复窦性心律不仅可改善症状,而且可减少血栓栓塞,降低患者死亡率.临床上,Af多发于高血压、慢性心力衰竭、冠心病及瓣膜病变等基础病变之上,随着人口老龄化进程,Af的发生率不断增高,有关Af的预防,尤其是高危人群Af的预防具有重要的理论和临床意义.     

醛固酮受体拮抗剂在急性心肌梗死中的应用

本文通过近期公布的EPHESUS试验研究,关注醛固酮受体拮抗剂(AB)在心肌梗死中的应用,主要从AB的相关临床试验研究,心肌梗死后神经内分泌系统的激活,AB在心肌梗死后作用机制以及临床遇到的问题做简要综述.     

醛固酮受体拮抗剂在扩张型心肌病中的应用

扩张型心肌病患者神经激素长期过度激活机制对心血管系统产生不良作用,导致预后不佳。患者体内肾素-血管紧张素系统的过度激活导致了醛固酮合成增加,过多产生的醛固酮导致水钠潴留,心肌纤维化。在扩张型心肌病治疗上加用醛固酮受体拮抗剂可改善发病率和死亡率。     

醛固酮对心力衰竭的有害作用与醛固酮(受体)拮抗剂

大量的流行病学资料及临床研究证实 ,慢性心力衰竭患者 ,特别是 6 0岁以上患者的发生病因 ,主要是高血压病和心肌梗死。多年来抗高血压治疗的进展使脑出血发生率下降以及急性心肌梗死复苏抢救成功率高和心肌血运重建术成功率高 ,使这两种常见病、多发病患者的生存率提高、寿命延长。但是 ,某些已经有心肌肥厚的病人 ,在心肌细胞程序死亡到一定程度 ,就会加速心力衰竭的发生。另外 ,有的心肌梗死和 (或 )慢性冠心病心肌缺血患者 ,虽然得到了血运重建 (ＰＴＣＡ或ＣＡＢＧ)的治疗 ,但在已经失去一定数量的存活心肌细胞情况下 ,其剩留心肌细胞…     

醛固酮受体拮抗剂与心力衰竭心源性猝死

减少心源性猝死发生率对减少心血管疾病总死亡率至关重要。醛固酮与心肌炎症、内皮功能障碍和心肌纤维化等有关,可导致心室重构,易产生室性心律失常,引起心源性猝死。临床研究证实,醛固酮受体抑制剂可预防心源性猝死发生。     

醛固酮拮抗剂依普利酮治疗高血压病研究进展

肾素-血管紧张素-醛固酮系统(RAAS)在高血压病病理生理和临床治疗中的作用已经得到了深入的研究.血管紧张素转换酶抑制剂(ACEI)和血管紧张素受体拮抗剂(ARB)均能有效降低血压,保护肾脏,并能降低心力衰竭患者的发病率和病死率.     

血管紧张素Ⅱ受体拮抗剂在心房颤动防治中的研究进展

心房颤动是临床上最常见的心律失常之一,抗心律失常药物因效果不佳且不良反应多,使其在心房颤动的防治中应用有限。血管紧张素Ⅱ通过促进心房纤维化,缩短心房有效不应期,延长房室传导,诱导细胞内Ca^2＋超负荷及炎症反应等,促进心房的电重构及组织重构,从而在心房颤动的发生和维持中起积极作用。越来越多的研究表明血管紧张素Ⅱ受体拮抗剂在心房颤动的防治中具有广泛作用。     

Recent Advances in Drug Therapy for Atrial Fibrillation

Despite the major new insights into our knowledge of the mechanisms underlying initiation and perpetuation of atrial fibrillation (AF) gained in the last decade, the treatment of this common arrhythmia remains unsatisfactory in many patients. Although several new treatment modalities (e.g., internal cardioversion, pulmonary vein ablation, preventive pacing) have been developed, pharmacologic therapy remains the first-line therapy in most patients with AF. As illustrated by recent trials comparing rhythm control and rate control, current antifibrillatory drugs are hampered by a relatively low success rate in maintaining long-term sinus rhythm and the occurrence of proarrhythmic and other adverse events. This article discusses currently available antiarrhythmic drugs for rhythm and rate control, with special emphasis on more recently developed drugs and drugs still under development. Selective blockers of atrial ion channels (I _Kur and I _K.ACh ), multi-ion channel blockers, and selective A ₁ -adenosine receptor antagonists are examples of the newer antiarrhythmic drugs that are expected to be more effective and safer than those currently available. (J Cardiovasc Electrophysiol, Vol. 14, pp. S40-S47, September 2003, Suppl.)     

钙离子通道与老龄心房颤动心房电重构的研究进展

随着心房颤动电生理机制研究的广泛深人,已经认识到离子通道重构在心房颤动的发生和维持过程中起重要作用。L-型钙通道及其基因表达的改变可能是老年人容易发生心房颤动电生理重建的离子和分子基础。现就心脏钙离子通道及年龄与心房颤动的研究进展予以综述。     

The Role of Atrial Electrical Remodeling in the Progression of Focal Atrial Ectopy to Persistent Atrial Fibrillation

Although atrial fibrillation- (AF) induced changes in atrial refractoriness (atrial electrical remodeling) have been demonstrated in a number of different animal models, the clinical significance of this process is unknown. We describe a patient in whom there has been documented progression of atrial ectopy to persistent AF accompanied by evidence of atrial electrical remodeling, with reversal of remodeling following successful ablation of the focal source of AF. A second patient with focal AF, but with a "nonfocal" appearance on the ECG, is also described. These cases illustrate: (1) the possibility that a significant proportion of younger patients with idiopathic persistent AF may well have a focal source as the underlying abnormality; and (2) atrial electrical remodeling reverses following ablation of the underlying source.     

心房有效不应期离散度与心房颤动

心房颤动是临床最常见的心律失常之一,有较高的致残率及致死率,关于心房颤动的机制有较多的学说,目前研究已经证实心房电重构能够促进心房颤动的发生与维持,心房电重构包括心房有效不应期的缩短,心房有效不应期离散度的增加及局部电传导的减慢,现就心房有效不应期离散度与心房颤动的关系及其影响机制做一综述。     

Eplerenone: A Selective Aldosterone Receptor Antagonist (SARA)

Aldosterone, the final product of the renin‐angiotensin‐aldosterone system (RAAS), is a mineralocorticoid hormone that classically acts, via the mineralocorticoid (aldosterone) receptor, on epithelia of the kidneys, colon, and sweat glands to maintain electrolyte homeostasis. Aldosterone has also been shown to act at nonepithelial sites where it can contribute to cardiovascular disease such as hypertension, stroke, malignant nephrosclerosis, cardiac fibrosis, ventricular hypertrophy, and myocardial necrosis. Although angiotensin‐converting enzyme (ACE) inhibitors and angiotensin type 1 (AT₁) receptor antagonists act to suppress the RAAS, these agents do not adequately control plasma aldosterone levels — a phenomenon termed “aldosterone synthesis escape.” Spironolactone, a nonselective aldosterone receptor antagonist, is an effective agent to suppress the actions of aldosterone; its use is, however, associated with progestational and antiandrogenic side effects due to its promiscuous binding to other steroid receptors. For these reasons, eplerenone — the first agent of a new class of drugs known as the selective aldosterone receptor antagonists (SARAs) — is under development. In rodent models, eplerenone provides marked protection against vascular injury in the kidney and heart. In phase II clinical trials, eplerenone demonstrates 24‐h control of blood pressure with once or twice daily dosing, and is safe and well tolerated in patients with heart failure when given with standard of care agents. Pharmacokinetic studies reveal that eplerenone has good bioavailability with low protein binding, good plasma exposure, and is highly metabolized to inactive metabolites and excreted principally in the bile. Eplerenone is well tolerated in acute and chronic safety pharmacology studies. Ongoing phase III trials of eplerenone in the treatment of hypertension and heart failure are underway. These studies will extend our understanding of selective aldosterone receptor antagonism in the treatment of chronic cardiovascular disease.     

心房颤动患者心房纤维化研究进展

心房颤动的发生和维持与心房重构有关。心房纤维化是心房颤动患者心房结构重构最突出的表现,目前被认为是发生心房颤动的结构基础,是心房颤动发生、维持的一个重要因素。现综述心房颤动患者心房纤维化及其发生机制。通过对心房颤动患者心房纤维化结构改变及肾素-血管紧张素系统、转化生长因子、基质金属蛋白酶等在心房纤维化的发生和心房颤动发生、维持中的作用等的全面阐述,,探讨了心房颤动患者心房纤维化的研究进展。防治心房颤动新的策略取决于对心房纤维化机制更好的理解。     

Patients with Persistent Atrial Fibrillation Taking Oral Verapamil Exhibit a Lower Atrial Frequency on the ECG

Background: While there is agreement that verapamil attenuates the AF‐ induced refractory period shortening when given before AF induction, controversy exists regarding its effects when given after the onset of persistent AF. This study aimed to compare atrial fibrillatory frequency obtained from the surface ECG in patients with persistent atrial fibrillation (AF) with oral verapamil treatment to those without this treatment. Methods and Results: Surface ECG recordings were performed in 57 patients (34 male, 23 female, mean age 59 ± 11 years) with persistent AF (> 7 days). The frequency content of the fibrillatory baseline was quantified using digital signal processing (filtering, QRST complex averaging and subtraction. Fourier transformation). In 27 patients with verapamil treatment (120 or 240 mg/day for at least 7 days) mean fibrillatory frequency measured 6.4 ± 0.2 Hz, compared to 7.0 ± 0.4 Hz (P = 0.012) in 30 patients without verapamil. In a subset of 20 randomly selected patients (10 with, 10 without verapamil treatment) a 24‐hour Holter ECG recording was performed and fibrillatory frequency determined at 4 PM, 10 PM, 4 AM, and 10 AM. While there was a significant frequency reduction in the verapamil treated patients at night (P = 0.011), it remained constant over time in the other patients. Conclusion: In patients with persistent AF, fibrillatory frequency assessed by spectral analysis of the surface ECG is lower in patients taking verapamil. A.N.E. 2002;7(2):92–97