卡维地洛对阿霉素心肌病兔心脏结构及电稳定性的影响

目的探讨卡维地洛对阿霉素心肌病兔心脏结构及电稳定性的影响。方法 40只日本长耳白兔随机分为空白对照组、空白模型组、倍他乐克组和卡维地洛组,每组10只。采用耳缘静脉注射阿霉素(1mg/kg,每周2次,共16次)建立阿霉素心肌病模型。3周后倍他乐克组和卡维地洛组分别给予倍他乐克(5 mg.kg-1.d-1)和卡维地洛(5 mg.kg-1.d-1)灌胃,空白对照组和空白模型组每日以等容量生理盐水灌胃,给药2个月后制备兔左室楔形心肌块的灌注模型,同步记录心内、外膜动作电位及跨室壁心电图、跨室壁离散度(TDR),并记录快频率程序刺激下触发活动和室性心律失常的发生率。结果空白对照组、空白模型组、倍他乐克组和卡维地洛组触发活动发生率分别为0/10、10/10、9/10和4/10,室性心律失常发生率分别为0/10、9/10、7/10和2/10。与空白对照组比较,阿霉素组触发活动和室性心律失常的发生率明显增加;与空白模型组比较,倍他乐克组无显著性差异,而卡维地洛组触发活动和室性心律失常的发生率明显降低(P均<0.05)。结论卡维地洛能改善阿霉素心肌病引起的心脏结构改变,并有效抑制室性心律失常的诱发。     

卡维地洛对慢性心力衰竭患者室性心律失常和心率变异性影响

目的 探讨卡维地洛对慢性心力衰竭患者室性心律失常和心率变异性的影响。方法 97例慢性心力衰竭患者按随机分配原则，分为治疗组49例和对照组48例，治疗组在常规治疗的基础上加用卡维地洛，初始剂量2．5mg，每Et两次，每2周增加一次剂量，直至20mg一次或最大耐受量为止。用动态心电图分析治疗前后心率、室性心律失常和心率变异性变化，并用超声心动图测定患者治疗前后的心功能。结果 治疗组用卡维地洛治疗6个月后，心率下降、室性心律失常减少、心率变异性参数改善（P〈0．01）；心功能改善亦非常显著（P〈0．01）。结论 卡维地洛治疗慢性心力衰竭患者，可降低室性心律失常的发生，改善心率变异性和心功能。     

卡维地洛对正常大鼠氧化应激的影响

目的研究β受体阻滞剂卡维地洛对正常大鼠氧化应激的抑制能力。方法采用分光光度法测定大鼠血清及肝组织中SOD、GSH-Px、CAT活性和MDA含量的变化,研究卡维地洛对正常大鼠氧化应激的影响。结果卡维地洛能够使正常大鼠的血液中GSH-Px、CAT活性显著升高,肝脏组织中SOD活性显著升高,MDA含量明显降低。结论卡维地洛能够抑制正常大鼠的氧化应激。     

卡维地洛对家兔心肌梗死慢性期梗死周边区交感神经重构和电重构的影响

目的 研究卡维地洛对家兔心肌梗死慢性期梗死周边区交感神经重构和电重构的影响。方法 40只家兔随机分为两组：（1）心肌梗死组结扎冠状动脉前降支；（2）卡维地洛组结扎前降支并卡维地洛5mg·kg^-1·d^-1灌胃。8周后测量梗死周边区跨室壁复极离散度（TDR）、刺激交感神经时TDR、刺激交感神经引起TDR的变化（ATDR）及心室颤动（室颤）阈值，免疫组化法研究梗死周边区心肌中生长相关蛋白43（GAP43）和酪氨酸羟化酶（TH）阳性纤维的分布和密度。结果 心肌梗死组梗死周边区心室肌神经分布紊乱，GAP43和TH染色阳性。卡维地洛组梗死周边区神经纤维密度较心肌梗死组显著降低（P〈0．01），其基础状态梗死周边区TDR、交感神经刺激时TDR和ATDR均较心肌梗死组显著降低（P〈0．01），室颤阈值明显提高（P〈0．01）。结论 卡维地洛可有效调整心肌梗死后神经重构，稳定电重构。     

卡维地洛治疗扩张型心肌病复杂型室性心律失常的疗效评价

目的 :探讨卡维地洛治疗扩张型心肌病复杂型非持续性室性心律失常的临床疗效。方法 :将 10 4例缺血性或特发性扩张型心肌病复杂型心律失常患者随机分成两组 :卡维地洛组 5 4例 ,对照组 5 0例 ,两组均常规强心、利尿及血管紧张素转换酶抑制剂类药物治疗 ,仅卡维地洛组加用卡维地洛口服治疗 ;疗程 6月。采用 2 4 h动态心电图和多普勒超声心动图 ,观测治疗前后的 HR、室性早搏 （PVC）、非持续性室性心动过速 （NSVT）、左心室射血分数（L VEF）。结果 :经卡维地洛治疗 1月后 ,卡维地洛组较对照组抗心律失常作用增加明显 ,有显著性差异 （P<0 .0 5 ） ;3月后 ,卡维地洛组较对照组 L VEF明显增加 （P<0 .0 5 ） ,抗心律失常作用在卡维地洛组进一步增加 ,而 HR、血压无明显变化 （P>0 .0 5 ）。结论 :在传统抗心衰药物治疗的基础上长期加用卡维地洛 ,对治疗扩张型心肌病复杂型室性心律失常具有明显疗效     

不同剂量卡维地洛对心衰大鼠心肌氧化应激和细胞凋亡的影响

目的 :探讨不同剂量卡维地洛 （CAR）对心肌梗死后大鼠心肌细胞凋亡的影响及 CAR治疗充血性心力衰竭（CHF）的作用机制。方法 :将雄性 Waistar大鼠前降支结扎 ,于术后 1周开始分别给予大剂量 CAR（HCAR组 ,6 0mg· kg- 1· d- 1 ）和小剂量 CAR（L CAR组 ,6 m g· kg- 1· d- 1 ）干预 7周 ,观察不同剂量 CAR对大鼠血流动力学参数、心肌细胞凋亡、心肌丙二醛 （MDA）含量和总抗氧化能力 （TAOC）的影响。结果 :CAR可改善心功能指标 ,降低心肌细胞凋亡指数及 MDA浓度 ,上调 TAOC水平 ,其中对心肌细胞凋亡指数 （HCAR组为 4 .6 %± 1.1% ,L CAR组为 8.0 %± 2 .0 % ）、TAOC（HCAR组为 1.92± 0 .2 0 U· mg- 1 ,L CAR组为 1.5 9± 0 .12 U· mg- 1 ）的影响以HCAR组明显。结论 :CAR可有效地减少心肌梗死后心肌细胞凋亡 ,防止 CHF的发生、发展 ,效果以大剂量明显 ,这可能与其维护心肌抗氧化防御系统有关     

卡维地洛对慢性压力超负荷兔左心室跨壁复极离散度的影响

目的探讨卡维地洛长期干预对慢性压力超负荷兔左心室跨壁复极离散度的影响。方法慢性压力超负荷兔模型随机分为结扎组和卡维地洛干预组（CVD组）；分别记录两组左心室心肌内、外膜动作电位并同步记录跨壁心电图，比较两组动作电位时限（APD90）、跨心室壁复极离散度（TDR）、室性心律失常发生率、超声心动图指标和左心室质量与体重比值。结果（1）CVD组左心室射血分数高于结扎组（P〈0．05），左心室质量与体重比值低于结扎组（P〈0．01），差异均有统计学意义。（2）CVD组左心室内、外膜APD90、TDR、QT间期、心律失常发生率较结扎组降低（P〈0．05）。结论卡维地洛长期干预能有效改善肥厚左心室结构和收缩功能；能显著降低动作电位时限、跨壁复极离散度和室性心律失常发生率，改善肥厚左心室结构重构和电重构。     

卡维地洛对家兔心肌梗死边缘区Cx43的影响及与室性心律失常的关系

目的卡维地洛是一种新型的抗心律失常药物,对β1、β2、α1受体都有阻滞作用,而Cx43是心室肌心电传导的基础,本组观察卡维地洛对心肌梗死边缘区Cx43分布的影响及与室性心律失常的关系。方法家兔随机分为梗死组、卡维地洛组、假手术组,每组12只。梗死组和卡维地洛组开胸结扎冠状动脉左前降支,假手术组不结扎。所有家兔普通饲料喂养,卡维地洛组另给予卡维地洛5 mg·kg-1·d-1。12周后观察:(1)动态心电图记录自发性室性心律失常的情况;(2)快速心室连续电刺激诱发的室性心律失常;(3)共聚焦激光显微镜观察梗死边缘区Cx43的分布。结果(1)动态心电图记录显示梗死组和卡维地洛组的偶发和频发室性早搏(室早)明显多于假手术组。与梗死组对比,卡维地洛组发生频发室早和室性心动过速(室速)的家兔数显著降低(分别为2 vs 6,P<0．05;3 vs 6,P< 0．05);(2)心肌梗死组比卡维地洛组更易被连续心室电刺激诱发室速(7 vs 3,P<0．01),而假手术组仅有1只家兔被诱发出室速;(3)共聚焦激光显微镜下观察梗死组的Cx43相对密度显著低于卡维地洛组,分别为0．32％±0．11％,0．16％±0．06％,P<0．05。结论卡维地洛可以减少心肌梗死后自发的和诱发的室性心律失常,这可能与卡维地洛引起Cx43的再分布有关。     

卡维地洛对充血性心力衰竭患者左室功能的影响

目的探讨卡维地洛治疗充血性心力衰竭患者对其左室功能的影响。方法将我院2004年12月～2005年5月收住院治疗的138例充血性心力衰竭患者随机分成卡维地洛组与对照组，卡维地洛组在住院24h内给予口服卡维地洛25mg／d治疗，对照组给常规给予强心、利尿、扩血管治疗。结果在治疗4周后卡维地洛组对心力衰竭患者的左室收缩与舒张功能的改善明显优于对照组（P〈0．05）。结论在充血性心力衰竭患者的治疗中给予卡维地洛治疗，可以明显改善心力衰竭患者的左室功能，提高对充血性心力衰竭患者的治疗效果。     

慢性心力衰竭患者氧化应激与细胞因子的变化及卡维地洛的影响

目的　观察慢性心力衰竭患者 (CHF)氧化应激与细胞因子的变化及卡维地洛对其影响。方法　选择 6 7例CHF患者 ,随机分为对照组 (33例 )及卡维地洛组 (34例 ) ,后者在常规治疗基础上合用卡维地洛 5～ 2 0mg/d ,疗程12w。心脏多普勒超声测定左室射血分数 (LVEF)、左室收缩末期容量指数 (LVESVI) ,并测血浆丙二醛 (MDA)、血清超氧化物歧化酶 (SOD)、肿瘤坏死因子 -α(TNF -α)、白细胞介素- 6 (IL - 6 )及基质金属蛋白酶 - 9(MMP - 9)。结果　随着NYHA心功能分级增加 ,CHF患者MDA、TNF -α、IL - 6及MMP - 9显著增高 ,SOD显著降低 (P <0 0 1)。卡维地洛使血浆MDA、TNF -α、IL - 6及MMP - 9明显降低 (P <0 0 1) ,SOD、LVEF增加、LVESVI降低 (P <0 0 5 ) ,LVEF增加与MDA、TNF -α、IL - 6及MMP - 9降低负相关 (γ =- 0 4 0 ,- 0 36 ,- 0 38,- 0 4 3,P <0 0 5 ) ,与SOD增加正相关 (γ =0 38;P <0 0 5 )。结论　卡维地洛改善CHF患者心功能 ,可能与降低氧化应激与细胞因子水平有关。     

培哚普利联合卡维地洛对老年充血性心力衰竭患者心功能及炎性指标的影响

目的 探讨培哚普利联合卡维地洛治疗老年充血性心力衰竭患者的临床效果.方法 将2016年5月至2018年5月中国人民解放军联勤保障部队第九八一部队收治的97例老年充血性心力衰竭患者随机分成2组,联合组(培哚普利联合卡维地洛)49例和对照组(卡维地洛)48例.比较2组患者治疗前后的临床疗效;比较2组患者治疗前后左心室射血分...     

Impact of concurrent amiodarone treatment on the tolerability and efficacy of carvedilol in patients with chronic heart failure

OBJECTIVE—To assess the safety and efficacy of carvedilol when administered to heart failure patients already receiving amiodarone.
DESIGN—Retrospective analysis of the clinical outcome of 230 patients treated with carvedilol for chronic heart failure, stratified according to whether they were already receiving amiodarone (amiodarone group, 80 patients) or not (non-amiodarone group, 130 patients) at baseline.
SETTING—Heart failure clinic at a university affiliated public teaching hospital.
MAIN OUTCOME MEASURES—Incidence of adverse events; changes in functional status and echocardiographic dimensions at three months.
RESULTS—Adverse reactions to carvedilol occurred in 33 (41%) of the amiodarone group and 43 (29%) of the non-amiodarone group (p = 0.049). Carvedilol was discontinued in 21 (26%) of the amiodarone group and 37 (25%) of the non-amiodarone group (NS). The clinical outcome at three months did not differ significantly between the two groups; 31 (39%) of the amiodarone group improved their New York Heart Association status, 28 (35%) were unchanged, and 21 (26%) deteriorated compared with 67 (45%), 51 (34%), and 32 (21%), respectively, for the non-amiodarone group (NS). Both groups had highly significant decreases in heart rate and left ventricular end systolic dimension, and a significant increase in left ventricular ejection fraction after three months of carvedilol treatment, with no significant differences between the groups.
CONCLUSIONS—The beneficial effects of carvedilol on left ventricular remodelling, systolic function, and symptomatic status are not affected by concurrent treatment with amiodarone. Adverse reactions necessitating cessation of carvedilol are no more frequent in patients receiving amiodarone.


Keywords: carvedilol; amiodarone; heart failure     

Doxorubicin-induced cardiomyopathy treated with carvedilol

Even today, heart failure due to doxorubicin-induced dilated cardiomyopathy seems to have a poor prognosis, as it is often irreversible and relatively unresponsive to standard medical treatment. This paper describes the first case of a patient complaining of severe symptoms of congestive heart failure due to doxorubicin-induced dilated cardiomyopathy unresponsive to standard medical treatment (digoxin, diuretics, and angiotensin-converting enzyme inhibitor), who showed complete clinical recovery and significant improvement of left ventricular dysfunction after carvedilol treatment. It also illustrates the possibility that carvedilol may be a first-choice drug for the treatment of this disease.     

Beneficial effect of carvedilol on heart rate response to exercise in digitalised patients with heart failure in atrial fibrillation due to idiopathic dilated cardiomyopathy

Fourteen digitalised patients diagnosed with heart failure (NYHA Functional class II) with idiopathic dilated cardiomyopathy in chronic established atrial fibrillation were administered carvedilol in addition to their anti-heart failure medications in an attempt to improve their heart rate control. Fourteen matched patients who did not receive carvedilol acted as control subjects. Patients treated with carvedilol showed significantly reduced resting heart rates (10-36%), maximal heart rates on exercise (5-20%) and an increased exercise time (2-30%) on treadmill stress tests (all P=0.001). Ventricular ectopic activity was also diminished. This was associated with symptomatic improvement in effort intolerance and palpitations. NYHA functional class, left ventricular dimensions and ejection fractions did not improve during the study period of 3 months. Thus, addition of carvedilol to digoxin had a beneficial effect on exercise tolerance in patients with idiopathic dilated cardiomyopathy in atrial fibrillation by virtue of an improved heart rate control both at rest and on exercise. Carvedilol was well tolerated despite impaired myocardial function.     

卡维地洛对不伴有心力衰竭的扩张型心肌病患者冠状动脉血流储备的影响

目的:利用无创经胸负荷超声心动图评价不伴有心力衰竭的扩张型心肌病(DCM)患者冠状动脉血流储备(CFR)以及卡维地洛治疗对其影响。方法:入选不伴有心力衰竭的DCM患者40例,正常对照组30例。DCM患者在常规药物治疗基础上,加用卡维地洛至目标剂量或最大耐受剂量,治疗前后行常规超声及负荷超声检测,并评价CFR。结果:①治疗前,DCM组较正常对照组左房内径、左室舒张末期内径明显增加,左室射血分数(LVEF)、二尖瓣舒张早期和晚期峰值血流速度比值减低(P0.05);治疗1个月后各项指标与治疗前差异无统计学意义,而6个月后左房内径、左室舒张末期内径和LVEF有所改善,但与正常对照组仍有差异。②治疗前DCM组较正常对照组舒张期最大峰值血流速度(hCFV)和CFR降低(P0.05)[hCFV:(63.72±5.81)∶(81.65±8.47)cm/s,P0.05;CFR:2.57±0.31∶3.20±0.29,P0.05];治疗1个月、6个月后hCFV和CFR均较治疗前升高(P0.05),1个月后DCM组与正常对照组比较hCFV和CFR仍减低[hCFV:(70.75±6.08)∶(81.65±8.47)cm/s,P0.05;CFR:2.81±0.30∶3.20±0.29,P0.05],6个月后与正常对照组之间各指标差异无统计学意义[hCFV:(78.93±6.88)∶(81.65±8.47)cm/s,P0.05;CFR:3.13±0.36∶3.20±0.29,P0.05]。结论:不伴有心力衰竭的DCM者hCFV和CFR减低,经卡维地洛治疗1个月和6个月后均可有效改善;负荷超声检测CFR可以早期评价卡维地洛治疗效果。     

The effects of chronic carvedilol therapy on QT dispersion in patients with congestive heart failure.

BACKGROUND: Carvedilol therapy reduces mortality from sudden cardiac death and progressive pump failure in congestive heart failure (CHF). However, the effect(s) of carvedilol on ventricular repolarization characteristics is unclear. AIM: The aim of the study was to investigate the effects of chronic carvedilol therapy on ventricular repolarization characteristics as assessed by QT dispersion (QTd) in patients with CHF. METHOD: Nineteen patients (age 53+/-12 years; 16 male, three female) with CHF (eight ischemic, 11 non-ischemic dilated cardiomyopathy) were prospectively included in the study. Carvedilol was administered in addition to standard therapy for CHF at a dose of 3.125 mg bid and uptitrated biweekly to the maximum tolerated dose. From standard 12-lead electrocardiograms the maximum and minimum QT intervals (QTmax, QTmin), QTd, corrected QT intervals (QTcmax, QTcmin) and corrected QTd (QTcd) values were calculated at baseline, after the 2nd and the 16th month of carvedilol therapy. RESULTS: A significant reduction was noted in the QTd and QTcd values with carvedilol therapy after the 16th month (QTd: 81+/-22 ms vs. 40+/-4.3 ms P<0.001; QTcd: 91+/-25 ms vs. 51+/-7 ms P<0.001), but not after the 2nd month (P>0.05). The resting heart rate was also significantly reduced after a 16-month course of carvedilol therapy (78+/-13 bpm vs. 66+/-15 bpm, P<0.05). Carvedilol therapy did not alter QTmax and QTcmax intervals (P>0.05), however, QT min and QTcmin significantly increased with carvedilol at the 16th month (P<0.001 and P<0.01, respectively). CONCLUSION: Long-term carvedilol therapy was associated with a reduction in QTd, an effect that might contribute to the favorable effects of carvedilol in reducing sudden cardiac death in CHF.     

老年男性慢性心力衰竭患者血浆睾酮与心室重构和氧化应激的关系

目的通过对老年男性慢性心力衰竭(CHF)患者血浆总睾酮、超氧化物歧化酶(SOD)、丙二醛水平及左心室质量指数(LVMI)、左心室舒张未内径(LVIDD)的观察,探讨男性CHF患者血浆睾酮水平与心脏重构及氧化应激的相互关系。方法选择男性CHF患者(CHF组)50例,另选年龄相匹配的男性患者(对照组)40例.检测血浆睾酮、丙二醛和SOD水平,应用超声心动图测量LVMI、LVIDD,进行对比和直线相关分析。结果与对照组比较,CHF组睾酮、SOD水平明显降低(P<0.01).丙二醛、LVIDD、LVMI明显增加(P<0.01);CHF组睾酮水平与LVMI、LVIDD、丙二醛呈负相关(r=-0.732、r=-0.629、r=-0.623,P<0.01);与SOD水平呈正相关(r=0.743,P<0.01);SOD水平与LVMI、LVIDD呈负相关(r=-0.621、r=-0.594,P<0.01)。结论男性CHF患者睾酮下降可致心室重构加剧及机体氧化应激水平提高。同时机体抗氧化物质的减少对心室重构有重要促进作用。     

卡维地洛与美托洛尔治疗缺血性心脏病心力衰竭的疗效观察

目的:观察卡维地洛和美托洛尔对缺血性心脏病心力衰竭患者的临床疗效。方法:缺血性心脏病心力衰竭患者80例,左室射血分数（LVEF）≤0.45,心功能（NYHA）ⅡⅣ级,常规治疗基础上随机分为卡维地洛组和美托洛尔组,治疗3月后,观察两种药物对心功能及运动耐量的影响。应用心脏彩色超声仪测定心功能基线值及3月后的变化。用6 m in步行距离测定运动耐量的改善程度。结果:经过3月的治疗,卡维地洛组与美托洛尔组心率、血压、运动耐量改善程度及心功能均有明显改善,且卡维地洛组6 m in步行试验结果,收缩压、舒张压变化及左室收缩末容积（LVESV）、左室舒张末容积（LVEDV）、LVEF改善程度明显优于美托洛尔组（P<0.01）。结论:在常规治疗基础上卡维地洛、美托洛尔对缺血性心脏病的治疗均有显著效果,前者在改善运动耐量、LVEDV、LVESV及心室射血方面更优。