Cardiovascular Disease Progression: A Target for Therapy?

Clinical research aimed at preventing cardiovascular disease has focused on the effect of interventions to reduce risk factors on the incidence of future morbid events. Disease progression, which likely serves as a necessary prerequisite for morbid events, has not served as a target for therapy. The Rasmussen Center at the University of Minnesota has, for the past 18 years, been performing a noninvasive cardiovascular evaluation in individuals with no history of cardiovascular disease. The studies, performed in 1 hour in one room, provide a comprehensive noninvasive assessment of the severity of functional and structural abnormalities in the small arteries, the large arteries and the left ventricle, the target organs for most cardiovascular morbid events. Preliminary follow-up data have revealed a striking relationship between the Disease Score, which represents the sum of the abnormal tests, and the risk of future morbid events. In order to develop strategies to prolong cardiovascular disease-free life expectancy, studies in early stages of disease aimed at slowing disease progression should be encouraged.     

钙增敏剂——Levosimendan在抗心力衰竭治疗中的作用和地位

传统的正性肌力药物———儿茶酚胺类、磷酸二酯酶抑制剂、洋地黄制剂均通过增加细胞内cAMP和Ca2 浓度来提高心肌收缩力。而细胞内钙离子浓度的增加可引起心律失常、增加心肌耗氧。钙增敏剂———Levosimendan是不增加细胞内环磷酸腺和Ca2 的新型抗心力衰竭药物,避免了上述药物的不利作用,并且因为激活ATP敏感型钾通道而有扩血管作用。这些特性使其有望在抗心力衰竭治疗中具有可观前景。     

Relaxin: Review of Biology and Potential Role in Treating Heart Failure

Relaxin is a naturally occurring human peptide initially identified as a reproductive hormone. More recently, relaxin has been shown to play a key role in the maternal hemodynamic and renal adjustments that accommodate pregnancy. An understanding of these physiologic effects has led to the evaluation of relaxin as a pharmacologic agent for the treatment of patients with acute heart failure. Preliminary results have been encouraging. In addition, the other known biologic properties of relaxin, including anti-inflammatory effects, extracellular matrix remodeling effects, and angiogenic and anti-ischemic effects, all may play a role in potential benefits of relaxin therapy. Ongoing, large-scale clinical testing will provide additional insights into the potential role of relaxin in the treatment of heart failure.     

Assessing Guideline-Directed Medication Therapy for Heart Failure in End-Stage Renal Disease

Background

Treatment of heart failure with reduced ejection fraction (HFrEF) requires guideline-directed medication therapy (GDMT) consisting of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker in combination with an indicated beta-blocker. There is concern that end-stage renal disease (ESRD) patients are not being prescribed GDMT. The study aim was to determine whether outcomes differ for patients with HFrEF and ESRD receiving GDMT compared to those not receiving GDMT.

肿瘤坏死因子在心力衰竭过程中的作用

肿瘤坏死因子 -α( TNF-α)是一种细胞因子 ,与其受体结合能产生多种生物效应 ,如免疫刺激、调节机体的抗菌作用、蛋白激酶 C的激活和涉及多种炎症、细胞生长的基因表达的激活[1] 。Levine等[2 ] 在 1990年第一次报道了慢性充血性心力衰竭 ( CHF)患者循环中TNF- α水平升高 ,之后 ,人们对 TNF- α在心力衰竭发病机制中的作用开展了广泛的研究 ,本文对此进行了综述。1　 TNF- α的产生TNF- α主要由激活的单核细胞产生 ,许多不同种类细胞均可产生这种细胞因子 ,包括淋巴细胞 ,中性粒细胞 ,成纤维细胞和平滑肌细胞。在体内 TNF- α…     

Role of Beta-Blocker Therapy in Heart Failure and Atrial Fibrillation

Heart failure is a serious disorder associated with substantial morbidity and mortality. Approximately 15-30% patients with systolic heart failure are in atrial fibrillation and the proportion increases with severity of heart failure. Patients with heart failure and atrial fibrillation have worse outcome than those in sinus rhythm. Beta-blockers, together with angiotensin-converting enzymes inhibitors, are the standard therapy in patients with chronic heart failure. Retrospective studies have suggested that despite the improvement in left ventricular systolic function after treatment with beta-blockers, the exercise capacity and symptoms in those heart failure patients with atrial fibrillation was not improved as much as those in sinus rhythm. Moreover, the use of bisoprolol in the Cardiac Insufficiency Bisoprolol Study II, unlike those in sinus rhythm, failed to produce any survival benefit in patients with poor systolic function and atrial fibrillation. It seems that those patients with heart failure and atrial fibrillation may have different response to beta-blocker therapy. Prospective trials to clarify the impact of beta-blocker therapy and the optimal therapeutic strategy in this high-risk group of patients are warranted.     

Intensity of Guideline-Directed Medical Therapy for Coronary Heart Disease and Ischemic Heart Failure Outcomes

PurposeThe impact of guideline-directed medical therapy for coronary heart disease in those hospitalized with acute heart failure is unknown.MethodsWe studied guideline-directed medical therapies for coronary disease: angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs), beta-adrenoreceptor antagonists, antiplatelet agents or anticoagulants, and statins. Using inverse probability of treatment weighting the propensity score, we examined associations of guideline-directed medical therapy intensity (categorized as low [0-1], high [2-3], or very high [4] number of drugs) with mortality in 1873 patients with angina, troponin elevation, or prior myocardial infarction.ResultsAt discharge, 0-1, 2-3, and 4 medications were prescribed in 467 (25%), 705 (38%), and 701 (37%) patients, respectively. Relative to those prescribed 0-1 drugs (reference), all-cause mortality was lower with 2-3 (hazard ratio [HR] 0.48, 95% confidence interval [CI] 0.28-0.84, P = 0.009) or all 4 drug classes (HR 0.56, 95% CI 0.33-0.96, P = 0.034) over 181-365 days, with similar reductions present from 0-180 days. In those with heart failure with preserved ejection fraction, mortality trended lower with 2-3 drug classes (HR 0.43, 95% CI 0.18-1.02, P = 0.054) and was significantly reduced with 4 drugs (HR 0.32, 95%CI 0.12-0.84, P = 0.021) during 0-180 day follow-up. In heart failure with reduced ejection fraction, all-cause mortality was reduced during both 0-180 and 181-365 days when discharged on 2-3 (HR 0.30 for 181-365 days, 95%CI 0.14-0.64, P = 0.002) or all 4 drug classes (HR 0.43, 95%CI 0.19-0.95, P = 0.038).ConclusionsIncreasing guideline-directed medical therapy intensity for coronary heart disease resulted in lower mortality in patients with acute ischemic heart failure with both preserved and reduced ejection fractions.     

补肾活血法治疗慢性心力衰竭的临床研究

目的观察补肾活血法对慢性心力衰竭的临床疗效。方法将128例慢性心力衰竭患者随机分为治疗组和对照组,各64例。对照组给予常规抗心力衰竭治疗(血管紧张素受体拮抗剂、β受体阻滞剂、血管扩张剂、利尿剂、强心剂等药物),治疗组在对照组治疗基础上加用补肾活血为主的补肾活血汤,疗程4周。观察慢性心力衰竭患者治疗前后中医临床症状、体征、纽约心脏病协会(NYHA)心功能分级,应用彩色多普勒测定左室射血分数(LVEF)、左室舒张末内径(LVEDD),测定血清脑钠肽(BNP)浓度、行6min步行试验(6MWT)。结果治疗组总有效率95.3%,优于对照组的78.1%(P<0.05)。两组治疗后LVEF、LVEDD、BNP、6min步行试验结果均有改善,治疗组优于对照组(P<0.05)。结论补肾活血法对慢性心力衰竭具有确切的疗效,对心功能各项指标均具有明显的改善作用。