Acute haemodynamic effects of ibopamine in patients with severe congestive heart failure.

Ten patients with congestive heart failure (CHF), in III and IV NYHA Class, were treated orally with a single dose of ibopamine ranging from 1.2-3.3 mg/kg, and were studied using the Swan-Ganz catheter and thermodilution technique. Cardiac index (CI) and stroke volume index (SVI) were increased, and mean pulmonary pressure (PAP), systemic vascular resistances (SVR) were lowered. Ibopamine increased CI (+33%) and SVI (+26%), and decreased PAP (-17%) and SVR (-24%). All changes were statistically significant. The maximum haemodynamic effect occurred 180 min after ibopamine administration. Blood pressure and heart rate were unaffected. Tolerability was good. This study shows that ibopamine when orally administered to human subjects improves cardiac performance and further investigations on its use as a therapeutic agent in the long term treatment of CHF are recommended.     

The hemodynamic effects of ibopamine, a dopamine congener, in patients with congestive heart failure

Ten patients with congestive heart failure underwent noninvasive and invasive hemodynamic testing before and sequentially after the administration of ibopamine to determine the cardiovascular effects of this oral dopamine congener. Single doses of 200, 400 and 600 mg were administered to all patients and 5 repeated doses of 200 or 400 mg were studied in 8. Hemodynamic effects occurred as early as 30 minutes and lasted up to 4 hours after dosing. In general, ibopamine elicited statistically significant dose-related increases in cardiac output and reductions in the derived resistance of the systemic and pulmonary circulations. A biphasic response in central and peripheral pressures was observed; up to 1 hour after administration, ibopamine elevated mean right and left atrial pressures and pulmonary and systemic arterial pressures with a significant reduction of these measurements beyond 1 hour. It did not alter heart rate. Repeated doses qualitatively affected hemodynamics similar to the initial dose and did not appear to be accompanied by short-term tolerance. While oral ibopamine elicits some favorable hemodynamic effects in humans with cardiac failure, the biphasic hemodynamic response is generally undesirable in the majority of these patients.     

Effects of rhein on renal arachidonic acid metabolism and renal function in patients with congestive heart failure

Summary In a randomized double-blind cross-over study the effects of rhein (administered as diacetylrhein 50 mg b.d. for 5 days) and placebo on renal arachidonic acid metabolism and renal function have been compared in 12 elderly patients (mean age 75.2 years) with congestive heart failure, whose renal function was known to be dependent on the integrity of the renal prostaglandin system.Rhein like placebo, did not induce any change in the urinary excretion of prostaglandin (PG) E₂, 6-keto-PGF₁ and thromboxane (TX) B₂, nor did it affect creatinine clearance, blood urea, urine output, natriuresis, body weight, plasma renin activity or plasma aldosterone concentration. Separate analysis of the results obtained in the 5 patients receiving diuretic treatment did not show any significant effect of rhein as compared with placebo on the parameters investigated. Serum TXB₂ concentration during whole blood clotting, as an index of platelet arachidonic acid metabolism, also showed no significant difference when DAR and placebo were compared.It is concluded that in patients with congestive heart failure rhein does not inhibit renal or platelet eicosanoid metabolism, nor does it modify renal function, sodium excretion or the renal response to diuretics.     

The dopamine congener, ibopamine, in congestive heart failure

The hemodynamic effects of the dopamine congener, ibopamine, were investigated in nine patients with chronic congestive heart failure. A placebo-controlled design was utilized. Placebo and ibopamine in doses of 100, 200, and 300 mg were given orally as a single dose to each patient on 4 successive days. Dopamine at 1, 2, 4, and 6 micrograms/kg/min intravenously, was used as an internal standard. Ibopamine did not significantly change heart rate, systemic and pulmonary arterial pressures, pulmonary capillary wedge pressure, or mean right atrial pressure. Significant decreases of systemic arterial resistance (19%) and total pulmonary arterial resistance (21%), and significant increases of cardiac index (20%) and stroke volume index (16%) were elicited by ibopamine at doses of 200 and 300 mg. Peak effects occurred at 1 to 2 h with a duration of action of less than 4 h. The 2 changes were comparable with those obtained by dopamine 2-4 micrograms/kg/min. Except for mild changes at 30 min postdosing, the inotropic indices of the systolic time intervals were not altered significantly by ibopamine. Ibopamine elicits significant hemodynamic effects in patients with chronic congestive heart failure; in large part, these effects appear to be mediated through vasodilatory properties rather than direct positive inotropy.     

Hemodynamic effects of ibopamine in patients with idiopathic congestive cardiomyopathy

We administered 150 mg of ibopamine orally to 10 patients suffering from idiopathic congestive cardiomyopathy. Hemodynamic function was evaluated by right heart catheterization and by measurement of cardiac output with the thermodilution technique. Ibopamine caused no significant change in heart rate or mean arterial pressure. Cardiac index, stroke volume index, and left ventricular work index all increased significantly by about 30%. Mean pulmonary arterial pressure decreased by about 30%, and systemic vascular resistance decreased by about 20%. The effects peaked at about 3 h and lasted 5-7 h. No side effects were noted. These findings with invasive techniques confirm those of others using noninvasive techniques, and suggest that ibopamine may be useful in the treatment of congestive heart failure.     

Acute effects of ibopamine hydrochloride on hemodynamics, plasma catecholamine levels, renin activity, aldosterone, metabolism and blood gas in patients with severe congestive heart failure

Acute effects of 200 mg of orally given 4-[2-(methylamino)ethyl]-o-phenylene diisobutyrate hydrochloride (ibopamine hydrochloride) which is a new diisobutyric ester of N-methyldopamine, on hemodynamics and metabolism were evaluated in 11 patients with severe heart failure (New York Heart Association class IV). Significant effects occurred within 30 min and persisted for 6 h after dosing. Peak effects were observed at 2 h. At peak effects, cardiac index increased from 2.53 to 3.07 l/min/m2 (+20%, p less than 0.01), stroke volume index from 35 to 41 ml/beat/m2 (+18%, p less than 0.05), stroke work index from 35 to 44 g X m/beat/m2 (+26%, p less than 0.05), epinephrine from 0.05 to 0.15 ng/ml (+200%, p less than 0.05), urine volume from 50 to 81 ml/h (+61%, p less than 0.05), pulmonary capillary wedge pressure decreased from 23 to 18 mmHg (-24%, p less than 0.001), mean pulmonary arterial pressure from 33 to 27 mmHg (-19%, p less than 0.001), right atrial pressure from 10 to 7 mmHg (-27%, p less than 0.001), systemic vascular resistance from 1735 to 1546 dyne X s X cm-5 (-11%, p less than 0.1), pulmonary vascular resistance from 204 to 168 dyne X s X cm-5 (-25%, p less than 0.05), arterio-venous oxygen difference from 6.09 to 5.36 ml/dl (-12%, p less than 0.05), norepinephrine from 0.45 to 0.34 ng/ml (-24%, p less than 0.1), renin activity 1.80 to 1.26 ng/ml/h (-30%, p less than 0.05), respectively, whereas there were no significant changes in blood gases, heart rate, blood pressure, double product, aldosterone, urine Na+, K+ or lactate/pyruvate.(ABSTRACT TRUNCATED AT 250 WORDS)     

The effect of diltiazem hydrochloride upon sodium diuresis and renal function in chronic congestive heart failure

d-3-Acetoxy-cis-2,3-dihydro-5-]2-(dimethylamino)ethyl]-2-(p-methoxyphenyl)-1,5-benzothiazepin-4(5H)-one hydrochloride (diltiazem HCl) was orally administered to 9 patients with chronic congestive heart failure (Class IIb to III, NYHA) to examine whether the drug induces sodium retention and aggravates congestive heart failure. Renal hemodynamics and urinary electrolytes excretion were measured for 3 h after the medication in 6 out of 9 patients. Four of the rest of patients had received chronic administration of the drug for about 2 weeks. There was a significant increase in urinary sodium excretion without noticeable change in renal hemodynamics after diltiazem administration, demonstrating the presence of its direct inhibitory action on renal tubules. The increase in urinary sodium excretion was more marked in patients with heart failure than in those without. This difference in the response to diltiazem may be due to the functional constriction of renal cortical vessels in heart failure. This constriction may be related to renin-angiotensin system which diltiazem was reported to antagonize. The chronic administration of the drug did not induce sodium retention and edema. There was no deterioration of symptoms due to congestive heart failure such as dyspnea and body weight increase. It may be concluded that diltiazem does not aggravate congestive heart failure through its diuretic action and probably its systemic vasodilating action.     

碘佛醇、碘克沙醇和碘普罗胺对充血性心力衰竭患者肾功能的影响

目的:观察碘佛醇、碘克沙醇和碘普罗胺对充血性心力衰竭患者肾功能的影响。方法:选取2017年3—12月入住首都医科大学宣武医院行强化CT的充血性心力衰竭患者198例,随机分为碘佛醇组64例、碘克沙醇组65例与碘普罗胺组69例。所有入组患者均在行强化CT检查前及检查后第5、10天查血肌酐(serum creatinine, SCr)、尿素氮(blood urea nitrogen, BUN)及尿微量白蛋白与肌酐比值(urinary albumin/creatinine ratio,mAlb/Cr),计算肾小球滤过率(estimated glomerular filtration rate, eGFR),比较3组肾功能指标变化及造影剂肾病(contrast-induced nephropathy,CIN)发生率。结果:强化CT检查5d后3组患者SCr、BUN及mAlb/Cr均较检查前升高(P<0.05),eGFR较检查前降低(P <0. 05)。检查10 d后碘佛醇组mAlb/Cr与eGFR、碘普罗胺组mAlb/Cr仍未恢复至检查前水平(P<0.05);强化CT检查5d后碘克沙醇组SCr、mAlb/Cr明显低于碘佛醇组(P<0.05), eGRF明显高于碘佛醇组(P<0.05);碘普罗胺组eGFR明显高于碘佛醇组(P<0.05)。碘佛醇组CIN发生率明显高于碘克沙醇组(P<0.05),但与碘普罗胺组CIN发生率无明显统计学差异(P>0.05)。结论:在充血性心力衰竭患者中选择等渗造影剂(如碘克沙醇)可以减低CIN发生率,造影剂黏度对CIN影响较小。     

川芎嗪对充血性心力衰竭病人的急性血液动力学效应

观察川芎嗪对充血性心力衰竭病人的急性血液动力学效应。于给药 0 ,0 .5 ,1 ,1 .5 ,2 ,3,4 ,5 ,6h经7FSan- Ganz导管 (从右股静脉插至右肺动脉 )测肺毛细血管楔嵌压 ( Pcwp) ,平均肺动脉压 ( m PAP) ,平均右心房压 ( m RAP)、心排血指数 ( CI)及血压 ( BP)。结果表明川芎嗪可降低 m PAP,Pcwp,提高 CI,对 BP,m RAP无显著影响     

卡维地洛对充血性心力衰竭患者心功能和QT离散度的影响

目的了解卡维地洛对充血性心力衰竭患者的心功能和QT离散度的作用.方法64例临床诊断为心力衰竭的患者在常规治疗的基础上加用卡维地洛.记录治疗前和治疗后1月、2月及6月超声心动图和12导联心电图.超声心动图分析心脏射血分数,心电图分析心率、QT离散度.结果治疗后6个月射血分数增加和心率的下降均差异有显著性(P＜0.05),QT离散度具有显著性差异(P＜0.05).结论卡维地洛能显著改善心衰患者的心功能,并能有效地减小QT离散度.     

卡维地洛对慢性心衰合并肾功能不全患者肾功能的影响

目的:评价卡维地洛对慢性心衰(CHF)合并慢性肾功能不全(CRF)患者肾功能的影响。方法:入选27例CHF合并CRF患者,在充分抗心力衰竭治疗的基础上,加用卡维地洛,观察不同阶段左室射血分数(LVEF)和肾功能的变化。结果:卡维地洛治疗后,LVEF在治疗3个月后开始升高,12个月后显著高于基线水平(p<0.01)。治疗后1个月,血肌酐(Scr)升高(p<0.05),3个月时回落到基线水平以下(p<0.05),12个月时仍低于基线水平(p<0.05);治疗后1个月,内生肌酐清除率(Ccr)先轻度下降(p<0.05),3个月时回升高于基线水平(p<0.01),12个月时仍显著高于基线水平(p<0.01)。卡维地洛对尿微量白蛋白和24h尿蛋白定量影响不大(p>0.05)。结论:第三代β-受体阻滞剂卡维地洛,可改善慢性心衰合并慢性肾功能不全患者的心功能,早期引起肾功能的轻度降低,随后肾功能显著改善。     

Acute effect of ibopamine and isosorbide mononitrate on blood volume distribution in congestive heart failure

In order to compare ibopamine (IBO), a dopamine congener, with isosorbide mononitrate (ISMN) and to study their interaction in effects on the capacitance vasculature in congestive heart failure (CHF), a prospective, randomized, placebo-controlled, double-blind clinical trial was performed in 32 patients with New York Heart Association class II–IV CHF, randomly assigned to receive single oral doses of placebo, 200 mg IBO, 20 mg ISMN, or both IBO and ISMN. After labelling of red cells with ^99mTc, changes in regional radioactivity, indicative of changes in blood volume, were recorded using a -camera before and at 30, 60 and 120 min after drug administration.At 30 and 60 min, arterial systolic and pulse pressures were higher with IBO than with ISMN and placebo (for pulse pressure by mean 13.7 mm Hg, 95% confidence interval 4.5–23.0 mm Hg, at 30 min), probably reflecting an IBO-induced rise in stroke volume at unchanged heart rate and mean arterial pressure. IBO did not change regional radioactivity except for a transient increase of 4.4% (0.5–7.6%) in the thorax at 30 min. This was attenuated by concomitant ISMN treatment since, starting at 30 min, the drug increased radioactivity in the legs, compared with patients not receiving the drug, by 8.0% (95% confidence interval 0.2–15.8%), leading to a fall in thoracic and left ventricular radioactivity at 30 min of 3.4% (0.3–7.0%) and 6.4% (0.8–11.9%), respectively, and a fall of 5.5% (0.5–10.5%) in hepatic radioactivity at 60 min.In CHF, arterial vasodilating IBO lacks a peripheral venodilating effect and even transiently increases thoracic blood volume, caused probably by a transient rise in left ventricular afterload. This is attenuated by ISMN, which acutely unloads the left ventricle, thorax and liver by venodilation in extremities.     

美托洛尔对42例慢性充血性心衰患者心功能和运动耐量的影响

目的 探讨美托洛尔对慢性充血性心衰患者的心功能和运动耐量的影响.方法 慢性充血性心衰患者42例,分为缺血性心肌病和扩张型心肌病两组,在常规抗心衰治疗基础上,加用小剂量美托洛尔,治疗前后监测左室射血分数,舒张早期与晚期充盈峰速度及二者比率,心功能分级和运动耐量变化.结果 扩张型心肌病组各项指标改善优于缺血性心肌病组.结论 美托洛尔能抑制慢性充血性心衰患者过度兴奋的交感神经,减少其对心肌的不良作用,提高心功能和运动耐量,对以β_1受体下调为主的扩张型心肌病更为适用.     

充血性心力衰竭患者免疫功能的研究

目的：了解充血性心力衰竭患者的免疫功能状态,是否存在的免疫异常及其与病因,病程和心功能的关系,方法：检测４５例心衰患者外周血Ｔ淋巴细胞亚群,淋巴细胞转化率,可溶性白细胞介素Ⅱ受体ｓＩＬ－２Ｒ及免疫球蛋白和补体Ｃ３的变化。结果：与对照组比较,心衰时ＣＤ＾＋４,ＣＤ＾＋４／ＣＤ＾＋８比值,淋巴细胞转化率明显降低（Ｐ〈０．０５）,ｓＩＬ－２Ｒ水平升高（Ｐ〈０．０５）;重度心衰者ＩｇＧ,ＩｇＭ和补体Ｃ３水     

曲美他嗪对慢性心力衰竭患者心功能及心率变异性的影响

目的探讨曲美他嗪对慢性心力衰竭(CHF)患者心功能及心率变异性(HRV)的影响。方法将60例CHF患者随机分为治疗组和对照组,每组30例,对照组给予常规治疗,治疗组在常规治疗的基础上加用曲美他嗪治疗6个月,观察两组患者治疗前后NYHA分级、左心室舒张末期内径(LVEDd)、左心室射血分数(LVEF)、N末端原脑利钠肽(NT-pro-BNP)及6min步行距离(6-MWD)的变化,采用12导联同步HOLTER检测系统检查,测定HRV时域指标(SDNN、SDANNindex、rMSDD、PNN50)。结果 6个月后,治疗组患者的心功能明显改善,LVEDd及NT-pro-BNP与对照组相比明显降低,LVEF及6-MWD与对照组相比明显增加,HRV参数明显好转。结论曲美他嗪可以改善CHF患者的心功能及HRV。     

灯盏花素注射液对重症心力衰竭患者心功能及运动耐量的影响

目的 观察灯盏花素注射液对重症心力衰竭(心衰)患者心功能和运动耐量的影响.方法 将69例心衰患者,心功能(NYHA)分级为Ⅲ～Ⅳ级,随机分为两组:治疗组46例,在心衰常规治疗基础上给予灯盏花素注射液50 mg/d,共14 d.对照组23例予心衰常规治疗.观察心衰患者治疗前后超声心动图和6 min步行试验(6 MWT)的变化.结果 ①治疗组和对照组治疗后临床疗效显效率分别为63.0%和34.8%,差异有统计学意义(P＜0.05);②治疗后治疗组患者左心室射血分数显著升高(P＜0.05),左心室舒张末期内径显著降低(P＜0.05);③两组治疗后6 MWT距离均有所改善,但治疗组治疗后与治疗前比较差异有统计学意义(P＜0.05);④治疗组治疗前后6 MWT距离的升高水平与左心室射血分数增加呈正相关(r=0.72,P＜0.05),而与左心室舒张末期内径缩小呈正相关(r=-0.81,P＜0.05).结论 灯盏花素注射液能明显改善重症心衰患者心功能和运动耐量;6 MWT可作为评价灯盏花素注射液治疗慢性心衰患者疗效评估指标.     

Pharmacokinetics of hydrochlorothiazide in patients with congestive heart failure.

1. Hydrochlorothiazide (HCT, 50-75 mg) was administered orally to seven patients with cardiac failure. 2. Plasma levels and urinary concentration of HCT were determined by GLC. 3. The gastrointestinal uptake of the diuretic in three patients was reduced to approximately half that seen in healthy controls. 4. Plasma halflife of HCT was correlated with endogenous creatinine clearance. 5. Pharmacokinetics of HCT are considerably changed in cardiac failure.     

Intermittent dobutamine hydrochloride infusions in outpatients with chronic congestive heart failure

Patients with severe chronic congestive heart failure were treated with intermittent dobutamine hydrochloride infusions administered on an outpatient basis with a portable infusion device. Eleven patients (eight women and three men), ages 28-71 years, were given initial dobutamine hydrochloride infusions at a rate of 1-2 micrograms/kg/min, and the dose was gradually increased to a maximum dose of 15 micrograms/kg/min. Patients were considered dobutamine responders if their cardiac output increased by at least 30% and pulmonary-capillary wedge pressure did not rise. After a sustained hemodynamic response was demonstrated, the infusion was discontinued to assess the patients' symptoms during drug-free intervals. The patients were instructed and trained in proper catheter care after a venous-access catheter was surgically implanted. Patients were also shown how to use the ambulatory infusion pump. The patients were treated with long-term intermittent dobutamine hydrochloride infusions for 3-24 months. All patients adjusted easily to the routine of catheter and pump care and drug administration. The mean dose of dobutamine hydrochloride resulting in the maximum improvement in cardiac index was 9.4 micrograms/kg/min. All patients observed an improvement in their symptoms of congestive heart failure during the drug infusions and the intervals between the infusions. There was a mean reduction of 1.2 in New York Heart Association functional class. There were 18 congestive heart failure-related hospital readmissions among the 11 patients during 108 cumulative months of long-term dobutamine therapy. The intermittent administration of dobutamine hydrochloride via a portable infusion system appears to have improved the functional capacity of the 11 patients studied. This may be a viable treatment alternative for selected ambulatory patients with severe heart failure who demonstrate hemodynamic improvement with dobutamine.