Effect of beta-Blocker Bisoprolol on Function of Hibernating Myocardium in Patients With Chronic Heart Failure of Ischemic Etiology

AIM: To elucidate effect of beta-blocker bisoprolol on hibernating myocardium in patients with congestive heart failure (CHF) of ischaemic etiology without concomitant use of angiotensin converting enzyme inhibitors. MATERIAL AND METHODS: Men (n=21, mean age 51,1+/-2,3 years) with NYHA class II-III congestive heart failure were divided into 2 groups according to results of dobutamine stress-echocardiography: with (group I, n=11), and without (group II, n=10) hibernating myocardium. All patients received bisoprolol (mean daily dose 8.9+/-0.5 mg) for 6 months. RESULTS: In both groups treatment was associated with NYHA class lowering (36.7%, p=0.002, in group 1, and 33.5%, p=0.02, in group II), significant increase of tolerance to physical exercise, improvement of quality of life. Left ventricular ejection fraction significantly increased (+10.5%, p=0.008) in patients with hibernating myocardium and practically did not change in group II (+4,8%, p=0,08). Meanwhile number of normokinetic zones increased by 94,4% in group I (p=0.008) and by 37,5% (p=0,02) in group II. This was associated with reduction of wall motion score index by 10.6%, p=0,009, and 8.2%, p=0,009, respectively. CONCLUSION: These results evidence for efficacy of treatment of patients with heart failure and hibernating myocardium with beta-blocker bisoprolol. In patients with heart failure of ischemic etiology bisoprolol facilitates transition of a part of myocardium from hypokinetic to normokinetic state.     

Bisoprolol dose-response relationship in patients with congestive heart failure: a subgroup analysis in the cardiac insufficiency bisoprolol study(CIBIS II).

AIMS: Whether all patients with congestive heart failure (CHF) need to reach the target dose of beta-blocker to obtain a benefit in terms of survival remains uncertain. METHODS AND RESULTS: We classified by tertile the 2647 patients enrolled in CIBIS II according to the last tolerated dose: low dose (LD: 1.25, 2.5 or 3.75mg/day, n=434), moderate dose (MD: 5 or 7.5mg/day, n=328) and high dose (HD: 10mg/day, n=565) of bisoprolol or placebo (LD=234, MD=278 and HD=808). In both groups, patients tolerating only low doses were significantly older with more severe New York Heart Association (NYHA) functional class and higher frequency of co-morbidities. Treatment withdrawal was associated with a significant increase of mortality in the bisoprolol group (relative hazard (RH)=2.13, 95% confidence interval (CI)=1.43-3.17, p=0.0002). After adjustment, all-cause mortality was significantly reduced in the bisoprolol group compared to placebo regardless of the dose level considered: LD (RH=0.66, 95% CI=0.48-0.92), MD (RH=0.33, 95% CI=0.21-0.51) or HD (RH=0.59, 95% CI=0.40-0.89). CONCLUSIONS: Bisoprolol reduces mortality in CHF patients at all tolerated dose levels and its withdrawal increases the risk of mortality. Efforts should be made to maintain bisoprolol therapy based on the individual patient's tolerability.     

Temocapril prevents transition to diastolic heart failure in rats even if initiated after appearance of LV hypertrophy and diastolic dysfunction

OBJECTIVE: Congestive heart failure with left ventricular (LV) diastolic dysfunction and preserved systolic function, i.e. diastolic heart failure (DHF), is often observed in hypertensive patients. Although angiotensin converting enzyme (ACE) inhibitors are widely used as antihypertensive therapy, there is a continued controversy about long-term effect of ACE inhibition on diastolic function. The current study was designed to elucidate a therapeutic effect of ACE inhibitor, temocapril, administration initiated after LV hypertrophy (LVH) and diastolic dysfunction are evident. METHODS: Dahl salt sensitive rats fed on 8% NaCl diet from 7 weeks (hypertensive DHF model) were studied at 13 weeks (n=6) or at 19 weeks following chronic administration of a subdepressor dose of temocapril (0.2 mg/kg/day, TEM(+), n=6) or placebo (TEM(-), n=7) from 13 weeks. RESULTS: Compensatory LVH was associated with prolonged time constant of LV relaxation (Tau) at 13 weeks. In TEM(-), progression of LVH and fibrosis and elevation of LV end diastolic pressure were observed at 19 weeks. Administration of temocapril from 13 weeks prevented the further progression of LVH and fibrosis, attenuated increases in myocardial stiffness constant and Tau, and prevented the development of DHF. These effects were accompanied with the attenuation of decreases in sarcoplasmic reticulum calcium(2+)-ATPase 2a and phosphorylated phospholamban and of hypertrophic signalings' upregulation. CONCLUSIONS: This study demonstrated that chronic administration of temocapril exerts a therapeutic effect on diastolic dysfunction and prevents the transition to DHF even if initiated after appearance of LVH and diastolic dysfunction.     

Rationale, design, and organization of the Diastolic Heart Failure Assessment Study in Tohoku District (DIAST).

BACKGROUND: High mortality and a high readmission rate characterize diastolic heart failure (DHF), but evidence-based therapeutic strategies have not been established for DHF. METHODS: The aim of a multicenter, randomized open trial (the Diastolic Heart Failure Assessment Study in Tohoku District, DIAST) is to evaluate the safety and prognostic efficacy of the multiple action non-selective beta-blocker carvedilol in 160 patients with DHF (left-ventricular ejection fraction > or =50%). The target dose of carvedilol is 10 mg twice a day and the mean follow-up is estimated to be 2 years. The primary endpoints are to evaluate (1) all-cause mortality or hospitalization, (2) cardiovascular mortality or hospitalization and (3) worsening heart failure. The secondary endpoints are to assess (1) cardiovascular events, (2) the individual components of the above combined endpoints, (3) the duration of hospitalization, (4) the functional class and exercise capacity and (5) the safety and tolerability. All patients' data are processed using an original registration system on an internet homepage. Several substudies to assess neurohumoral factors, heart rate variability, oxidative stress and sleep apnea will clarify the pathophysiology of DHF. CONCLUSIONS: The DIAST will contribute to establish therapeutic guidelines for DHF.     

Effect of bisoprolol on perioperative complications in chronic heart failure after surgery (Cardiac Insufficiency Bisoprolol Study II (CIBIS II))

In patients with coronary artery disease undergoing noncardiac surgery, beta-blockers decrease perioperative mortality and nonfatal myocardial infarction. It is presently unknown whether beta-blockers reduce perioperative risk in patients with chronic heart failure. Thus, data of the CIBIS II study were analyzed regarding the effect of bisoprolol on perioperative outcome in patients with moderate to severe heart failure. A total of 2647 patients with heart failure in New York Heart Association (NYHA) class III-IV and left ventricular ejection fraction < or =35% were randomized to bisoprolol or placebo in a double-blind randomized study. Of these patients, 165 underwent surgery (bisoprolol, n = 87; placebo, n = 78). In patients undergoing surgery, mortality was not different between the placebo- and bisoprolol-treated group (7.7% vs 5.8%, p = 0.76). Neither postoperative hospital admission (placebo, 24.4%; bisoprolol, 34.5%, p = 0.17) nor time to postoperative hospital admission (placebo, < or =30 days, n = 2; 31-180 days, n=11; >180 days, n = 6; bisoprolol, n = 9/ 10/11; p = 0.14) were reduced by bisoprolol. Compared to coronary artery disease, perioperative beta-blockade has little effect in patients with chronic heart failure. Therefore, a controlled randomized trial with perioperative beta-blocker treatment in heart failure patients is warranted to further test this hypothesis.     

ACE inhibitor and angiotensin II type 1 receptor blocker differently regulate ventricular fibrosis in hypertensive diastolic heart failure

BACKGROUND: Promoted myocardial stiffening has a crucial role in the transition to overt diastolic heart failure (DHF) in hypertensive hearts and is attributed to progressive ventricular fibrosis. Previous studies revealed the effects of an angiotensin II type 1 receptor blocker (ARB) and an angiotensin-converting enzyme inhibitor (ACEI) on the synthesis and degradation of collagens in the other phenotype of heart failure, systolic heart failure, which has a different pathophysiology; however, little is known about their effects in DHF. OBJECTIVE: To investigate effects of an ACEI and an ARB on the regulatory system of ventricular fibrosis in hypertensive DHF. DESIGN AND METHODS: Dahl salt-sensitive rats fed a diet containing 8% NaCl from age 7 weeks (DHF model) were divided into three groups: six untreated rats, six rats treated with a subdepressor dose of an ARB, candesartan cilexetil (1 mg/kg per day), from age 8 weeks, and six rats treated with a subdepress or dose of an ACEI, temocapril hydrochloride (0.2 mg/kg per day), from age 8 weeks. Six Dahl salt-sensitive rats fed on normal chow served as controls. Data were collected when animals were aged 20 weeks. RESULTS: The administration of an ARB or an ACEI inhibited ventricular fibrosis to the same degree. The ACEI decreased the level of type I collagen mRNA, but the decrease was less than that induced by the ARB. The difference in collagen synthesis was probably cancelled out by that in degradation: both in-vitro and in-situ zymography showed that gelatinase activity was greater in the rats treated with the ACEI than in those treated with the ARB. CONCLUSIONS: An ARB and an ACEI inhibited ventricular fibrosis through different mechanisms in hypertensive DHF.     

Therapeutic effects of angiotensin II type 1 receptor blocker at an advanced stage of hypertensive diastolic heart failure

OBJECTIVE: Angiotensin II type 1 receptor blocker (ARB) is increasingly prescribed for the treatment of systolic heart failure with a growing body of clinical evidence. The roles of ARB, however, remain to be clarified in the treatment of diastolic heart failure (DHF), particularly at its advanced stage. This experimental study investigated the effects of ARB administered at an advanced stage of hypertensive DHF. METHODS: Dahl salt-sensitive rats fed an 8% NaCl diet from age 7 weeks represent overt DHF at age 20 weeks, as noted in previous studies (hypertensive DHF model). The DHF model rats were randomly divided into two groups at age 17 weeks when left ventricular diastolic dysfunction, hypertrophy, fibrosis, macrophage infiltration and reactive oxygen species generation were already augmented; six rats treated for 3 weeks with a subdepressor dose of ARB (olmesartan 0.6 mg/kg per day), and six untreated rats. RESULTS: The 3-week administration of ARB significantly decreased the left ventricular end-diastolic pressure in association with attenuation of left ventricular hypertrophy, fibrosis and diastolic dysfunction. Macrophage infiltration was attenuated with decreased gene expression of transforming growth factor-beta1 and monocyte chemoattractant protein-1 in the left ventricular myocardium of the ARB-treated rats. The production of reactive oxygen species also decreased with NADPH oxidase activity. CONCLUSIONS: ARB provides beneficial effects in hypertensive DHF independent of its antihypertensive effects even if initiated at an advanced stage. The beneficial effects are at least partly attributed to the attenuation of inflammatory changes and oxidative stress through the suppression of cytokine and chemokine production and of NADPH oxidase activity.     

比索洛尔对抗β1-肾上腺素能受体自身抗体阳性心衰大鼠心功能的影响

目的 探讨比索洛尔对抗β1-肾上腺素能受体（β1-AR）自身抗体阳性心衰大鼠心功能的影响。方法 采用缩窄腹主动脉的方法,建立慢性心力衰竭的大鼠模型。将心衰组大鼠（90只最终入组65只）随机分为心衰治疗组（40只）和心衰非治疗组（25只）。心衰治疗组接受比索洛尔4周的治疗。心衰非治疗组接受同剂量的蒸馏水同样时间的治疗。应用ELISA法检测大鼠血清β1-AR自身抗体的阳性率和滴度;应用BL-420E生物机能实验系统于治疗前及治疗后4周检测心功能。结果 ①治疗组组内抗β1-AR自身抗体阳性者较阴性者左室舒张末压低,左室变化的最大速率升高,但无统计学意义;非治疗组组内抗β1-AR自身抗体阳性者较阴性大鼠的心功能进一步恶化,左室舒张末压明显升高（P<0.01）,左室变化的最大速率下降（P<0.05）。②治疗组中抗β1-AR自身抗体阳性者与非治疗组中抗β1-AR自身抗体阳性者比较,前者较后者左室舒张末压明显下降（P<0.01）;左室变化的最大速率均显著升高（P<0.05）。结论 比索洛尔治疗后,心衰大鼠抗β1-AR自身抗体阳性者的心功能较非治疗组中抗β1-AR自身抗体阳性者的心功能明显改善。同为治疗组的抗β1-AR自身抗体阳性者的心功能较阴性者的左室舒张末压低,左室变化的最大速率升高。     

Haemodynamic and clinical effects of ularitide in decompensated heart failure.

AIMS: Ularitide is a synthetic form of urodilatin, a natriuretic peptide produced in the kidney with vasodilating, natriuretic, and diuretic effects, that offers promise for the management of decompensated heart failure (DHF). We assessed the efficacy and safety of ularitide in treating patients with DHF. METHODS AND RESULTS: In this Phase II randomized, double-blind, placebo-controlled trial, 221 DHF patients received either placebo (n=53) or ularitide at 7.5 ng/kg/min (n=60), 15 ng/kg/min (n=53), or 30 ng/kg/min (n=55) as a 24-h continuous infusion. At 6 h, ularitide demonstrated a significant decrease in pulmonary capillary wedge pressure (P=0.052, P=0.000004, P=0.000002, respectively) and improved dyspnoea score in the 7.5, 15, and 30 ng/kg/min ularitide group (P=0.0026, P=0.0026, P=0.0013, respectively). Ularitide reduced systemic vascular resistance and increased cardiac index for the 15 and 30 ng/kg/min groups (P=0.017, P=0.00002, respectively). Systolic blood pressure (BP) decreased dose dependency. Heart rate and serum creatinine were unchanged through day 3. Most frequently reported drug-related adverse events through day 3 in all ularitide groups were dose-dependent BP decrease and hypotension. CONCLUSION: Ularitide lowered cardiac filling pressures and improved dyspnoea without apparent early deleterious effects on renal function in DHF patients. These results suggest that ularitide may play a role in the management of DHF.     

Long-term administration of amlodipine prevents decompensation to diastolic heart failure in hypertensive rats.

OBJECTIVES; We assessed the effects of long-term amlodipine administration in a diastolic heart failure (DHF) rat model with preserved systolic function as well as the relationship between changes in left ventricular (LV) myocardial stiffening and alterations in extracellular matrix. BACKGROUND: Although the effect of long-term administration of amlodipine has been shown to be disappointing in patients with systolic failure, the effect is unknown in those with DHF. METHODS: Dahl salt-sensitive rats fed a high-salt diet for seven weeks were divided into three groups: eight untreated rats (DHF group), eight rats given high-dose amlodipine (10 mg/kg/day; HDA group) and seven rats given low-dose amlodipine (1 mg/kg/day; LDA group). RESULTS: High-dose administration of amlodipine decreased systolic blood pressure and controlled excessive hypertrophy, without a decrease in the collagen content, and prevented the elevation of LV end-diastolic pressure at 19 weeks. Low-dose administration of amlodipine with subdeppressive effects did not control either hypertrophy or fibrosis; however, it prevented myocardial stiffening and, hence, the elevation of LV end-diastolic pressure. The ratio of type I to type III collagen messenger ribonucleic acid levels was significantly lower in both the HDA and LDA groups than in the DHF group. CONCLUSIONS: Long-term administration of amlodipine prevented the transition to DHF both at the depressor and subdepressor doses. Amlodipine did not decrease the collagen content, but attenuated myocardial stiffness, with inhibition of the phenotype shift from type III to type I collagen. Thus, amlodipine may exert beneficial effects through amelioration of collagen remodeling in the treatment of DHF.     

比索洛尔对快速右室起搏犬心室重塑的影响

１９条犬随机分为心脏起搏组（Ｐ，ｎ＝７），起搏加比索洛尔干预组（ＰＢ，ｎ＝６）和对照组（Ｃ，ｎ＝６）。Ｐ与ＰＢ组动物均以２５０次／分钟频率持续右室起搏４周。起搏后Ｐ组动物均出现心力衰竭表现。组织病理学显示心肌细胞浊肿，质膜水肿，肌节排列紊乱，部分肌丝溶解、断裂。ＰＢ组起搏后肺楔压升高和心排量降低幅度以及心肌病理改变程度均显著轻于Ｐ组。以上表明，比索洛尔可以减轻这一心肌病模型的心肌损害程度。     

Effect of bisoprolol on QT dispersion in patients with congestive heart failure--the etiology-dependent response

AIMS: To evaluate the effect of beta1-selective blocker bisoprolol on the QT and QTc dispersion in patients with chronic heart failure and to compare the responses to bisoprolol in patients with different etiologies. METHODS AND RESULTS: Eighty-one patients with heart failure secondary to ischemic heart disease (n=47) or idiopathic dilated cardiomyopathy (n=34) were stratified by etiology and then randomly assigned to the bisoprolol and control group (no tablet) on top of the conventional treatment. QT dispersion was calculated by subtracting the shortest QT from the longest QT, in absolute value (Qtmax-Qtmin). It was also corrected with Bazett's formula (QTc dispersion). After 6 weeks of treatment, QT and QTc dispersion were significantly decreased in the bisoprolol group (QT dispersion: 66.5+/-13.4 ms vs. 49.1+/-16.8 ms for ischemic heart disease (P<0.01); 67.5+/-12.4 ms vs. 59.4+/-14.4 ms for dilated cardiomyopathy (P<0.05); QTc dispersion: 78.3+/-15.2 ms vs. 53.3+/-18.1 ms for ischemic heart disease (P<0.01); 79.1+/-14.2 ms vs. 69.0+/-17.9 ms for dilated cardiomyopathy (P<0.05)), but there was no significant decrease of QT and QTc dispersion in the control group. Linear regression analysis showed that patients with ischemic heart disease tend to have lower 6-week QT dispersion than patients with dilated cardiomyopathy (coefficient beta=-0.283, P=0.009) after controlling for their baseline values in the bisoprolol group. CONCLUSION: These findings suggested that bisoprolol reduces QT and QTc dispersion in patients with chronic heart failure, but the etiology of heart failure affects the response of patients to bisoprolol.     

Rationale and design of a randomized trial to assess the effects of beta-blocker in diastolic heart failure; Japanese Diastolic Heart Failure Study (J-DHF)

BACKGROUND: Heart failure consists of two phenotypes: systolic heart failure and diastolic heart failure (DHF). A growing body of evidence demonstrated benefits of beta-blocker, angiotensin-converting enzyme inhibitor, and angiotensin II receptor blocker in systolic heart failure; however, evidence leading to therapeutic strategy of DHF is lacking. METHODS AND RESULTS: The Japanese Diastolic Heart Failure Study (J-DHF) is a multicenter, prospective, randomized trial designed to assess effects of beta-blocker in patients with DHF. A total of 800 patients (400 patients in each group) will be enrolled. The primary outcome is a composite of cardiovascular death and unplanned admission to hospital for congestive heart failure. Other outcomes include all-cause mortality, worsening of the symptoms of heart failure, or a need for modification of the treatment for heart failure. Serial assessment of echocardiographic and neurohumoral parameters and cost analysis of the treatment regimen will be conducted. The follow-up period is a minimum of 2 years. CONCLUSION: This study will provide important evidences for the treatment of DHF.     

Effects of bisoprolol treatment for chronic heart failure initiated and followed up by primary care physicians

Primary care physicians prescribe beta-blockers for chronic heart failure infrequently. The aims of the study were to assess the effects of beta-blocker treatment in out-clinic patients with regard to NYHA class and frequency of adverse events. Beta-blocker treatment was initiated and followed up by primary care physicians. METHODS: Chronic heart failure patients already treated with ACE-inhibitors and diuretics were included. The 24-week follow-up consisted of a titration phase followed by a maintenance phase. The patients received the beta-blocker bisoprolol with an initial dose of 1.25 mg and a maximal dose of 10 mg. RESULTS: NYHA class II, III and IV had 174, 146, and one patient, respectively. Treatment duration lasted 189+/-73 days with a maximal bisoprolol dose of 7.2+/-3.2 mg. Sixty-one percent of the patients tolerated at least 7.5 mg bisoprolol. The NYHA class improved from 2.4+/-0.5 at baseline to 1.8+/-0.6 at week 24 (P<0.001). At final assessment, 74% of the patients showed an improvement. The number of permanent treatment withdrawals was 57 (17%). Death occurred in six patients and hospitalisation in 38 patients. CONCLUSIONS: Bisoprolol treatment in patients with chronic heart failure was effectively and safely carried out by primary care physicians.     

The effects of Gingko biloba, vitamin E and melatonin on bacterial translocation in thioacetamide-induced fulminant hepatic failure in rats

BACKGROUND AND STUDY AIMS: Bacterial translocation (BT) has been implicated in the development of infectious complications in many serious clinical conditions such as fulminant hepatic failure (FHF). We aimed to investigate the effects of Gingko biloba (GB), vitamin E (Vit E) and melatonin on intestinal oxidative damage and BT in thioacetamide (TAA)-induced FHF in rats. MATERIALS AND METHODS: A total of 42 rats were divided into five groups. Group 1 (n = 8) was the control group. Group 2 (n = 10) was the TAA group, in which rats received 350 mg/kg TAA daily by the intraperitoneal (ip) route for 3 days. Oral 100 mg/kg GB per day was administered to group 3 (n = 8), oral 200 mg/kg Vit E per day to group 4 (n = 8) and ip 3 mg/kg melatonin per day to group 5 (n = 8) 48 h prior to the first TAA injection and was continued for 5 consecutive days. RESULTS: When compared with the control group, serious hepatic and intestinal oxidative damage, increased Escherichia coli counts in ileal aspirates and high BT frequencies were observed in the TAA group (all p < 0.0001). Only GB treatment attenuated hepatic oxidative damage (p < 0.0001). There was no difference in intestinal oxidative damage, E. coli counts in ileal aspirates and BT frequency between TAA and the other antioxidant treatment groups (p > 0.05). CONCLUSION: Our results suggest that intestinal oxidative damage plays a major role in the development of BT by disrupting the barrier function of intestinal mucosa.     

曲美他嗪对病毒性心肌炎小鼠的保护作用及其机制

目的:观察曲美他嗪对M株柯萨奇病毒B3(CVB3m)感染的病毒性心肌炎小鼠的保护作用并探讨其可能作用机制。方法:以CVB3m诱导的病毒性心肌炎Balb/c小鼠模型为研究对象。201只清洁级近交系4～6周龄雄性Balb/c小鼠随机分成5组。正常对照小鼠20只(正常组);病毒性心肌炎小鼠55只(心肌炎组);喂养曲美他嗪10 mg/(kg.d)的正常小鼠20只(药物对照组);喂养曲美他嗪10 mg/(kg.d)的病毒性心肌炎小鼠53只(低剂量治疗组);喂养曲美他嗪20 mg/(kg.d)的病毒性心肌炎小鼠53只(高剂量治疗组)。观察各组血清中肌钙蛋白I(cTnI)水平、血清中超氧化物歧化酶(SOD)、丙二醛(MDA)含量的变化以及心肌组织中Fas mRNA表达水平的变化。结果:小鼠感染CVB3m后第7天及第14天,与正常组及药物对照组比较,心肌炎组、低剂量治疗组和高剂量治疗组血清cTnI水平、MDA含量显著升高,SOD含量显著降低,Fas mRNA的表达显著增加,差异有统计学意义(P<0.05)。小鼠感染CVB3m后第7天,与心肌炎组比较,低剂量治疗组和高剂量治疗组血清cTnI水平显著降低,MDA含量显著降低,差异有统计学意义(P<0.05),与心肌炎组及低剂量组比较,高剂量治疗组SOD含量显著升高,Fas mRNA的表达显著减少,差异有统计学意义(P<0.05)。感染CVB3m后第14天,与心肌炎组比较,低剂量治疗组和高剂量治疗组血清cTnI水平、MDA含量显著降低,SOD含量显著升高,Fas mRNA的表达显著减少,差异有统计学意义(P<0.05),与低剂量治疗组比较,高剂量治疗组上述指标变化更明显,差异有统计学意义(P<0.05)。结论:曲美他嗪能够减少病毒性心肌炎中心肌细胞的损害。其机制可能与其抗氧化作用以及通过下调Fas mRNA水平抑制心肌细胞凋亡有关。     

硫化氢对大鼠压力负荷性心力衰竭发展过程中氧化应激的影响

目的腹主动脉缩窄大鼠心力衰竭(心衰)模型通过腹腔给予硫化氢(H_2S)供体硫氢化钠(NaHS),观察压力负荷性心衰形成过程中H_2S对氧化应激状态的影响。方法 SD大鼠63只,随机分为对照组、心衰组、NaHS组,每组21只。各组均在第4、8、12周时,各取7只大鼠取血及心脏进行检测。结果心衰组4、8、12周血清H_2S含量、心肌H_2S合酶活性均较对照组明显降低,NaHS组4、8、12周血清H_2S含量较心衰组明显升高,心肌H_2S合酶活性较心衰组略有增高,但仍低于对照组。与对照组比较,心衰组4、8、12周血清MDA含量明显升高,超氧化物歧化酶(SOD)活性明显降低;与心衰组比较,NaHS组SOD活性上升,MDA含量下降,其中MDA含量在8、12周时下降明显,但仍明显高于对照组;SOD在12周时明显增高,但仍明显低于对照组。与心衰组比较,NaHS组4、8、12周血清氧化型低密度脂蛋白含量明显降低,但8、12周时仍明显高于对照组。结论外源性给予H_2S供体NaHS能改善压力负荷引起的心衰大鼠体内和心肌内的氧化应激状态,可能是H_2S心脏保护作用机制之一。     

The effects of endothelin-A receptor blockade during the progression of pacing-induced congestive heart failure

Objectives. We sought to identify the effects of endothelin (ET) subtype-A (ET_A)) receptor blockade during the development of congestive heart failure (CHF) on left ventricle (LV) function and contractility.Background. Congested heart failure causes increased plasma levels of ET and ET_Areceptor activation.Methods. Yorkshire pigs were assigned to four groups: 1) CHF: 240 beats/min for 3 weeks; n = 7; 2) CHF/ET_A-High Dose: paced for 2 weeks then ET_Areceptor blockade (BMS 193884, 50 mg/kg, b.i.d.) for the last week of pacing; n = 6; 3) CHF/ET_A-Low Dose: pacing for 2 weeks then ET_Areceptor blockade (BMS 193884, 12.5 mg/kg, b.i.d.) for the last week, n = 6; and 4) Control: n = 8.Results. Left ventricle fractional shortening decreased with CHF compared with control (12 ± 1 vs. 39 ± 1%, p < 0.05) and increased in the CHF/ET_AHigh and Low Dose groups (23 ± 3 and 25 ± 1%, p < 0.05). The LV peak wall stress and wall force increased approximately twofold with CHF and remained increased with ET_Areceptor blockade. With CHF, systemic vascular resistance increased by 120%, was normalized in the CHF/ET_AHigh Dose group, and fell by 43% from CHF values in the Low Dose group (p < 0.05). Plasma catecholamines increased fourfold in the CHF group and were reduced by 48% in both CHF/ET_Ablockade groups. The LV myocyte velocity of shortening was reduced with CHF (32 ± 3 vs. 54 ± 3 μm/s, p < 0.05), was higher in the CHF/ET_AHigh Dose group (39 ± 1 μm/s, p < 0.05), and was similar to CHF values in the Low Dose group.Conclusions. ET_Areceptor activation may contribute to the progression of LV dysfunction with CHF.     

A Cost-Minimization of Heart Failure Therapy with Bisoprolol in the French Setting: An Analysis from CIBIS Trial Data

Beta-blocker–induced benefit in heart failure is under intense evaluation. Several large-scale mortality trials are currently being performed, with CIBIS II evaluating bisoprolol. The economic impact of beta-blocker therapy in heart failure has not been previously determined. The present study is a cost-effectiveness evaluation of bisoprolol treatment based on CIBIS I data. It considers direct costs, that is, the bisoprolol medication cost and the cost of hospitalization related to heart failure and its complications. Hospitalization costs were calculated from the French system of classification (PMSI), which provides costs according to homogeneous groups of patients (GHM). The cost difference between bisoprolol and placebo in the entire CIBIS population and the trial duration result from an increase in cost caused by bisoprolol treatment (+ 2018 Frs/patient) and a decrease in cost related to reduced hospitalization (6349 Frs/patient). A total savings per patient of about 4330 Frs was produced by bisoprolol. Cost reduction is still more pronounced in patients not having a history of myocardial infarction. We conclude that heart failure therapy with bisoprolol lowers medical healthcare costs, mainly due to the reduced rate of hospital admissions for heart failure.     

辛伐他汀对非缺血性心力衰竭大鼠血红素氧合酶-1表达和心室重构的影响

目的 观察辛伐他汀对盐酸多柔比星(商品名:阿霉素)制备的非缺血性心力衰竭模型大鼠血红素氧合酶-1(HO-1)表达与心窒重构的影响. 方法 Wistar大鼠正常组18只.阿霉素腹腔注射2.5 mg·kg-1·d-1,每周3次,累积剂量15 mg/kg,分为模型组20只,他汀干预组19只(2周后给予辛伐他汀20 mg·kg-1·d-1灌胃,共4周).另选9只大鼠,于上述大鼠干预3周购进,经1周适应环境后,给予上述方法阿霉素腹腔注射,为2周组.分别进行血流动力学检查,测定心肌HO-1的mRNA表达、羟脯氨酸含量与病理分析. 结果 6周时模型组与他汀干预组的左心室收缩最人速率(+LVdp/dtmax)与舒张的最大速率(-LVdp/dtmax)均明显下降,其中+LVdp/dtmax两组分别下降28.2%与11.9%,-LVdp/dtmax两组分别下降33.0%与27.9%(F分别为4.899、3.80均为P<0.01);他汀干预组的±LVdp/dtmax较模型组分别高22.6%和7.5%,差异有统计学意义(F=2.461,P<0.05).2周时大鼠心肌羟脯氨酸含量即开始升高,分别为[(485.0±52.9)g/kg和(364.0±41.6)g/kg,F=0.441,P<0.01];6周时,模型组心肌羟脯氨酸含量继续升高为(572.9±75.4)g/kg,F=0.654,P<0.05;而他汀下预组心肌羟脯氨酸含量与2周组[(475.9±86.5)g/kg]比较,差异无统计学意义.6周时模型组大鼠心肌HO-1表达较正常组增高,分别为0.6217±0.1229与0.2475±0.1053,F=0.128,P<0.01;辛伐他汀干预使HO-1的表达进一步升高,分别为0.7860±0.1133和0.6217±0.1229,F=3.622,P<0.05. 结论心力衰竭大鼠心肌HO-1表达增高,辛伐他汀可进一步卜调衰竭心肌HO-1的表达,从而减轻心肌损伤与心力衰竭的程度.