Effect of deferiprone or deferoxamine on right ventricular function in thalassemia major patients with myocardial iron overload

Background

Thalassaemia major (TM) patients need regular blood transfusions that lead to accumulation of iron and death from heart failure. Deferiprone has been reported to be superior to deferoxamine for the removal of cardiac iron and improvement in left ventricular (LV) function but little is known of their relative effects on the right ventricle (RV), which is being increasingly recognised as an important prognostic factor in cardiomyopathy. Therefore data from a prospective randomised controlled trial (RCT) comparing these chelators was retrospectively analysed to assess the RV responses to these drugs.

Methods

In the RCT, 61 TM patients were randomised to receive either deferiprone or deferoxamine monotherapy, and CMR scans for T2* and cardiac function were obtained. Data were re-analysed for RV volumes and function at baseline, and after 6 and 12 months of treatment.

Results

From baseline to 12 months, deferiprone reduced RV end systolic volume (ESV) from 37.7 to 34.2 mL (p = 0.008), whilst RV ejection fraction (EF) increased from 69.6 to 72.2% (p = 0.001). This was associated with a 27% increase in T2* (p < 0.001) and 3.1% increase in LVEF (p < 0.001). By contrast, deferoxamine showed no change in RVESV (38.1 to 39.1 mL, p = 0.38), or RVEF (70.0 to 69.9%, p = 0.93) whereas the T2* increased by 13% (p < 0.001), but with no change in LVEF (0.32%; p = 0.66). Analysis of between drugs treatment effects, showed significant improvements favouring deferiprone with a mean effect on RVESV of -1.82 mL (p = 0.014) and 1.16% for RVEF (p = 0.009). Using regression analysis the improvement in RVEF at 12 months was shown to be greater in patients with lower baseline EF values (p < 0.001), with a significant difference in RVEF of 3.5% favouring deferiprone over deferoxamine (p = 0.012).

Conclusion

In this retrospective analysis of a prospective RCT, deferiprone monotherapy was superior to deferoxamine for improvement in RVEF and end-systolic volume. This improvement in the RV volumes and function may contribute to the improved cardiac outcomes seen with deferiprone.     

Erythrocyte transfusion restored heart rate variability in children with thalassemia major

Thalassemia major (TM) is a severe transfusion-dependent anemia. Regular erytrocyte transfusion is required for the treatment of thalassemia patients. However, repeated transfusion may result in impairements in heart function. In this study, we aimed to investigate short-term effects of erythrocyte transfusion on autonomic control of heart in children with thalassemia major. For that purpose heart rate variability (HRV), which is a non-invasive method used to evaluate the effects of the autonomic nervous system on the heart rhythym, was measured before and after erythrocyte transfusion and compared to the healthy controls. Children diagnosed with TM (n = 17) and sex and age matched healthy children (HC, n = 30) were included in the study. HRV values of TM patients were measured 5 min before erythrocyte transfusion (BET, n = 17) and 5 min after erythrocyte transfusion (AET, n = 17). Parameters of time-domain and frequency-domain of HRV were evaluated in all participants. Heart rate (HR) was higher in the BET than AET (P = 0.002) but there was no difference between AET and HC groups (P > 0.05). HRV parameters were lower in BET than AET (P < 0.05) but there were no statistical difference between AET and HC (P> 0.05). The data suggest that, in thalassemia major patients, erythrocyte transfusion restores HR and HRV parameters to the levels observed in healthy controls and, thus, in short-terms, appears to be beneficial for the autonomic control of the heart.     

慢性心力衰竭患者的心率变异性分析

目的探讨慢性心力衰竭患者的心率变异性特点及心功能损害程度与心率变异性的相关性.方法对69例慢性心力衰竭患者和52例健康对照者的心率变异性资料进行对比分析,比较不同程度心功能不全患者的心率变异性差异.结果心力衰竭组正常R-R间期总体标准差、相邻正常R-R间期差值的均方根、相邻正常R-R间期差值〉50 ms的窦性心搏占心搏总数的百分比、总功率、低频功率和高频功率低于健康对照组,低频与高频功率比值高于健康对照组（P〈0.01）.随着心功能受损程度加重,心力衰竭患者的心率变异性进一步减低,其中低频功率较敏感.结论检测心率变异性在心力衰竭患者中的变化可反映自主神经功能受损情况,同时为心力衰竭程度的预测和治疗提供有用的参考指标.     

厄贝沙坦治疗充血性心力衰竭92例临床疗效观察

目的 观察厄贝沙坦治疗充血性心力衰竭（CHF）的疗效和安全性。方法 选择CHF患者92例,随机分为心力衰竭对照组（45例）和治疗组（47例）。两组病人均给予口服地高辛0.125mg,呋塞米20mg,螺内酯20mg／d,倍他乐克12.5～50.0mg。治疗组加用厄贝沙坦,从小剂量开始,渐增至最大耐受量,疗程6～12个月,两组治疗前和治疗3、6个月均使用超声心动图分别测量左心舒张末期内径（LVEDD）、左室收缩末期内径（LVESD）、左室射血分数（LVEF）。应用超声心动图双平面Simpson＇s法测量左室舒张末期容积（LVEDV）、左室收缩末期容积（LVESV）,并观察心功能变化。结果 治疗3个月LVEDV、LVESD、LVEDD、LVESD在对照组和治疗组均较治疗前明显降低（P〈0.01）,LVEF较治疗前明显升高（P〈0.01）,两组间比较差异无显著性。至6月末,两组LVEDV、LVESD、LVEDD、LVESD进一步下降,治疗组较对照组下降更明显（P〈0.01）,LVEF较对照组升高明显（P〈0.01）。结论 联合应用厄贝沙坦治疗充血性心力衰竭,可明显缩小心室,增加射血分数,改善心功能,提高运动耐量,改善左室重构。     

Telemonitoring in patients with heart failure, the TEHAF study: Study protocol of an ongoing prospective randomised trial

Background

As the prevalence of heart failure (HF) rises sharply, the costs related to the care of these patients increases in parallel. Considering the already limited resources and manpower, in the future the demand for care may exceed the supply. Therefore, health care systems are encouraged to develop innovative strategies to deal with the burden of HF to improve the quality of care in order to medical outcomes and patients’ quality of life. For that reason new management systems - such as telemonitoring - have to be explored.

Objectives

This paper outlines the study protocol of a tailor-made telemonitoring program in ambulant patients with HF.

Design and methods

A prospective randomised controlled trial is carried out at 3 hospitals in the South-Limburg area in the Netherlands. Primary outcome measures are hospital admissions and cost-effectiveness. Secondary outcomes are effects on therapy compliance, level of disease specific knowledge and quality of life. Also determinants are studied of most and less benefited patients in the intervention group.

Power calculation

It is estimated that 390 patients have to be included in the study, with 185 in each arm.

Results

Inclusion started in September 2007 with a follow-up time of 12 months. First results are expected at the end of 2010.     

甲状腺功能亢进性心脏病心力衰竭50例治疗探讨

目的分析甲状腺功能亢进性心脏病（甲亢心）心力衰竭的治疗方法。方法甲亢：药物治疗37例（74％）；^131 I治疗11例（22％）．先药物后手术3例（6％）。心力衰竭：38例（76％）应用洋地黄类药物，43例（86％）应用β肾上腺素能受体阻滞剂，42例（84％）应用血管扩张药物，41例（82％）应用利尿刺，17例（34％）应用抗生素。结果甲亢心症状明显好转43例（86％）；死亡7例（14％）。结论甲亢心心力衰竭治疗的关键是治疗甲亢。此类患者对洋地黄类药物的反应欠佳，晚期易致洋地黄中毒；静脉扩血管制剂的疗效亦欠佳，利尿剂及β受体阻滞剂疗效好。     

二维超声斑点追踪预测充血性心力衰竭患者心脏再同步化治疗的急性期反应

目的 观察二维超声斑点追踪(2D-STE)是否可预测充血性心力衰竭患者心脏再同步化治疗(CRT)的急性期反应.方法 24例充血性心力衰竭患者接受CRT治疗,术后7天分别在CRT关闭(OFF)和开启(ON)状态接受超声检查.将2D-STE测量的左心室短轴前间壁和后壁达峰值径向应变的时间差(T_(AS-POST))≥130 ms定义为左心室收缩不同步.将CRT-ON时左心室压力最大上升速率(LVdp/dt)的增长率Δdp/dt%>25%定义为急性反应有效.结果 15例患者(62.50%) CRT有反应,CRT-ON时左心室射血分数和LVdp/dt增大,T_(AS-POST) 缩短.T_(AS-POST) 是预测Δdp/dt%>25%的独立因素,T_(AS-POST)≥130 ms预测CRT急性反应的敏感度和特异度分别为86.24%和70.38%.结论 2D-STE技术能够有助于选择CRT最适病例,并预测其急性期反应.     

全程健康教育在心力衰竭患者中的应用

目的 评价心力衰竭患者实施全程跟踪式健康教育的应用效果。 方法 将118例心力衰竭患者随机分为观察组与对照组。观察组60例,按照护理程序实施全程跟踪式健康教育|对照组58例,进行常规入院时与出院前健康教育。 结果 观察组知识掌握度、满意度、遵医嘱情况等均好于对照组,再入院率和死亡率低于对照组。 结论 对心力衰竭患者实施全程跟踪式健康宣教,能够纠正患者的不良生活习惯,减少心力衰竭患者的再次入院率,提高患者对护理服务满意度。     

心源性心力衰竭患者自我效能水平及其影响因素的调查

目的探讨心源性心力衰竭患者自我效能水平及其影响因素,为制订护理干预措施提供科学依据,从而提高患者的生活质量和整体护理质量。方法采用慢性心力衰竭自我效能量表、特定活动量表和社会支持量表,通过方便抽样法,对100例再人院心源性心力衰竭患者进行问卷调查。以自我效能总分及各因子得分为应变量,以一般资料、特定活动量表和社会支持量表的各项目为自变量进行多元线性逐步回归分析。结果心力衰竭患者自我效能平均得分（25．50±7．53）分,个人年收入、社会支持系统、病程及就医付费方式四个主要因素与心力衰竭患者的自我效能水平有关（t分别为3．061,4．359,6．175,2．072;P〈0．05）。其影响因素主要为住院次数、急性心力衰竭发作频率、支持系统。结论慢性心力衰竭患者的自我效能有待提高,护理人员应注重病程较长及社会支持系统不完善患者的自我效能的提高。     

心力衰竭患者的心率变异分析研究

目的探讨慢性心力衰竭(CHF)患者心率变异性(HRV)的变化,研究了HRV各指标与心功能程度(NYHA分级)、原发病、心衰类型的关系。方法选取CHF患者76例与正常对照组24例进行回顾性分析。结果正常对照组比较,CHF试验组SDNN,SDANN降低,差异有统计学意义。结论CHF患者HRV部分指标变化可作为判定CHF严重程度的参考指标。各项HRV指标变化大小可能与CHF患者的原发病无关,但部分似与心衰类型有关。     

连续性血液滤过在顽固性心力衰竭中的应用

目的探索连续性静脉-静脉血液滤过(CVVH)对顽固性心力衰竭的治疗效果。方法将40例经内科药物保守治疗效果不佳的顽固性心力衰竭患者分为观察组(22例),对照组(18例),观察组予以CVVH治疗,对照组予以保守治疗;观察治疗前后心功能、血液生化、细胞因子浓度以及两组患者28 d死亡率。结果CVVH可明显改善患者的心功能、纠正代谢紊乱,降低炎症细胞因子水平,28 d死亡率由对照组的94.4%降至45.5%(P<0.05)。结论CVVH对顽固性心力衰竭患者是一种迅速而有效的治疗方法,能在短期内缓解临床症状,阻断疾病的恶性循环,为进一步治疗赢得宝贵的时间。     

Effects of a multidisciplinary disease management programme with or without exercise training for heart failure patients: Secondary analysis of a randomized controlled trial

BackgroundHeart failure is a complex syndrome that causes substantial functional impairment and poor outcomes. Although multidisciplinary disease management programmes are effective, the role of additional outpatient-based exercise training and the effects of multidisciplinary disease management programmes for patients with contraindications to exercise training are unclear.ObjectivesTo compare the effects of the multidisciplinary disease management programme with and without exercise training on heart failure-related rehospitalization, disease knowledge, and functional capacity.DesignSecondary analysis of a randomized controlled trial.Participants and SettingData for 212 patients hospitalized for heart failure at a local teaching hospital in Taiwan were analysed.MethodsPatients’ data were assigned to three groups: control (n = 71), multidisciplinary disease management programme without exercise training (n = 70) or multidisciplinary disease management programme with exercise training (n = 71). The multidisciplinary disease management programme included comprehensive assessments, individualized education, optimizing medications, pre-scheduled clinic visits, and encouraging regular physical activity at home. Outpatient-based exercise training was performed only in the multidisciplinary disease management programme with exercise training group. The control and the multidisciplinary disease management programme without exercise training groups were further divided into subgroups with and without contraindications to exercise training. Patients were followed up monthly for heart failure-related rehospitalizations for 1 year. Cox proportional hazard models and Kaplan-Meier analyses were used to identify the significant predictors of heart failure-related rehospitalizations. A generalized estimation equation model was used to analyse the secondary outcomes, including disease knowledge and 6-min walking distance at baseline and 6 and 12 months after discharge.ResultsAt 12 months after discharge, the multidisciplinary disease management programme with and without exercise training groups had significantly lower heart failure-related rehospitalization rates and better disease knowledge compared with the control group (p < 0.01). Only the multidisciplinary disease management programme with exercise training group had a significant improvement in 6-min walking distance (p < 0.05). For patients with contraindications to exercise, the multidisciplinary disease management programme significantly reduced heart failure-related rehospitalization rates at 12 months after discharge (p < 0.05). For those without contraindications, the event-lowering effect was only noted for the multidisciplinary disease management programme with exercise training group (p < 0.05).ConclusionsOutpatient-based exercise training is recommended to be incorporated into multidisciplinary disease management programmes for patients without exercise contraindications to improve disease outcomes and functional capacity. For patients with contraindications to exercise, a multidisciplinary disease management programme is recommended to improve patient outcomes.     

高尿酸血症对慢性心力衰竭患者预后的影响

目的明确高尿酸血症对慢性心力衰竭患者预后的影响。方法收集确诊为慢性心力衰竭住院患者508例,根据血清尿酸水平分成2组:高尿酸组和正常尿酸组,比较两组患者的终点事件发生情况及流行病学特点,终点事件为3年内死亡或再住院。结果男性慢性心力衰竭患者高尿酸组3年终点事件发生率显著高于正常尿酸组(Log rank P<0.05),女性患者无统计学差异,校正其他影响因素后高尿酸血症是男性慢性心力衰竭患者3年终点事件发生率升高的独立危险因素。结论高尿酸血症是男性慢性心力衰竭患者发生不良终点事件的独立危险因素。     

Sleep disordered breathing in older adults with heart failure with preserved ejection fraction

Heart failure in older adults is frequently accompanied by sleep disordered breathing (SDB). Treatment of SDB in persons with heart failure with preserved ejection fraction (HFpEF) is unclear because most data is on heart failure with reduced ejection fraction (HFrEF). The purpose of this paper was to evaluate studies that report on the effects of positive airway pressure on patient outcomes in older adults with HFpEF and comorbid SDB. A search of the literature found six data-based studies (N = 36 to 126). Treatment with positive airway pressure reduced nighttime SDB symptoms and improved daytime functional status in persons with HFPEF and SDB (New York Heart Association Functional Class: effect sizes = ?0.67 to ?1.60). Limitations (i.e. only two studies were randomized controlled trials, small sample sizes, and women were under-represented) suggest that additional evidence is needed to guide treatment of SDB in older adults with HFpEF.     

辛伐他汀在充血性心力衰竭治疗中的疗效观察

目的观察辛伐他汀对充血性心力衰竭（CHF）患者心功能的影响。方法选择住院病例104例（心功能Ⅱ-Ⅳ级），随机分为治疗组（58）例，对照组（46例）。入院当时所有患者给予卡托普利、螺内酯等基础治疗，治疗组加辛伐他汀20mg／d，次日晨化验CK-Mb、TC、LDL-C、CRP。病例稳定后行超声心动图检查。6个月后复查上述指标。结果6个月后二组患者心功能多项指标及血清TC、LDL-C、CRP、左室射血分数（LVEF）及左室流出道最大血流速度（VLvor）改善较对照组有统计学意义（P〈0.05）。亚组分析结果：冠心病心衰治疗组心功能各项指标的改善均优于对照组（P〈0.05），TC、LDL-C、CRP较对照组下降更显著（P〈0.01）。结论CHF患者在全面拮抗神经-内分泌的基础上，加用辛伐他汀可以进一步改善心力功能并降低TC、LDL-C、CRP。冠心病心力衰竭患者受益更大。     

螺内酯对老年充血性心力衰竭患者心率变异性的干预

目的探讨醛固酮受体拮抗剂螺内酯对老年充血性心力衰竭(CHF)患者心率变异性(HRV)的影响。方法比较52例老年CHF患者在螺内酯(20~40 mg/d)治疗前、第4、16周时HRV的时域指标及左室收缩功能的变化。结果螺内酯治疗4周时,左室收缩功能与治疗前相比差异无显著性意义(P>0.05),HRV的时域指标全部正常,R-R间期标准差(SDNN)、每5分钟R-R间期均值标准差(SDANN)及三角指数(TI)均有显著提高(P<0.05);治疗16周时,HRV上述时域指标进一步改善,同时左室收缩功能也有明显改善(P<0.05)。结论螺内酯可改善老年CHF患者的HRV,改善心功能。     

运动康复护理在慢性心力衰竭患者中的应用效果

目的探讨慢性心力衰竭患者运动康复护理的可行性和效果。方法将77例慢性心力衰竭患者采用随机数字表法分研究组和对照组,研究组40例根据病情除了一般常规护理外,进行运动康复护理,对照组37例采取常规护理,两组均进行健康教育和患者自我管理的培训,并将两组进行比较。结果两组试验前一般情况和心功能指标相当,差异无统计学意义（P〉0．05）,两组试验后心功能指标均有进步,但是通过运动康复护理心衰患者的心衰症状和生活质量明显改善,康复护理后心脏射血分数为（50．5±7．2）％,而对照组护理后心脏射血分数为（35．5±5．2）％,康复护理后明显高于对照组,差异具有统计学意义（t=2．45,P〈0．05）,康复护理组和对照组治疗后心率分别为（76．5±6．8）次／min和（88．6±7．3）次／min,心率都有下降,但是康复护理组明显低于对照组,差异具有统计学意义（t=2．14,P〈0．05）。康复护理组和对照组治疗后6min步行距离分别为（451．4±35．5）m和（350．8±31．5）in,较观察前有增加,而康复护理组较对照组明显增加,差异具有统计学意义（t=13．17,P〈0．叭）。结论慢性心功能衰竭患者适时进行运动康复护理可降低慢性心衰患者的心率,提高心脏射血分数,提高6rain步行距离,也就是表明能改善慢性心衰患者心功能和生活质量。     

左西孟旦治疗急性失代偿性心力衰竭患者不良反应的观察和护理

观察45例急性失代偿性心力衰竭患者应用左西孟旦治疗前后的症状和体征,记录左西孟旦治疗过程中的不良反应,包括血压降低、心律失常和头痛。护理要点是加强用药期间的心电监护,尤其是负荷剂量给药时及持续给药初期;监测血钾、肝肾功能及自觉症状变化;根据患者自身状况和反应通知医生,调整剂量和用药时间等。     

慢性心力衰竭患者预后影响因素的调查分析

目的 探讨慢性心力衰竭(CHF)患者的生存状况及死亡相关危险因素.方法 2008年12月至2010年2月,收集北京阜外心血管病医院CHF监护病房住院的108例患者的基线资料,随访患者出院后6个月的生存状况,以生存状况为因变量进行Logistic回归分析.结果 CHF患者出院后6个月内的病死率为18.5％.多因素非条件Logistic回归分析结果显示,下肢水肿、BMI及明尼苏达生活质量得分与心力衰竭死亡相关,调整OR (95％CI)分别为18.566(1.299～265.408)、0.583(0.404～0.841)、1.075(1.017～1.135).结论 CHF患者的短期病死率较高,营养状况差,生活质量下降,预后较差;入院时水肿等症状明显的患者,短期死亡风险增加.     

美托洛尔缓释片治疗慢性心力衰竭患者的疗效观察

目的：观察美托洛尔缓释片治疗慢性心力衰竭（CHF）患者的疗效。方法：对28例CHF患者在常规治疗的基础上,加用美托洛尔缓释片,并与27例常规治疗组患者进行对照比较,观察1年后患者的心功能、再住院率和死亡率。结果：1年后,美托洛尔缓释片组（治疗组）和对照组比较,心功能改善明显（P〈0.05）;再住院率和死亡率降低（P〈0.05）。结论：美托洛尔缓释片可以改善心功能,降低再住院率和死亡率。