卡维地洛治疗老年慢性心力衰竭的临床疗效观察

目的：观察卡维地洛治疗老年慢性充血心力衰竭（CHF）的临床疗效及副作用。方法：72例老年CHF患者随机分为卡维地洛组（治疗组）和常规治疗组（对照组），各36例。对照组使用洋地黄、利尿剂、血管紧张素转换酶抑制剂、硝酸酯类等药物治疗。治疗组在常规治疗的基础上加用卡维地洛5mg／d，只要能耐受尽可能递增到10～20mg／d，疗程20周。每周测量血压、心率，评定心功能，治疗前后检查超声心动图。结果：治疗组左室射血分数（LVEF）明显升高（P〈0．001），心功能分级、左室舒张末期内径（LVEDD）、心肌耗氧指数和收缩末期内径（LVESD）明显降低（P〈0．01），心率减慢，血压降低（P〈0．01）．与对照组比较差异有显著性（P〈0．05）。结论：卡维地洛治疗心力衰竭改善心功能，改善左室重塑，安全有效。     

卡维地洛治疗老年心力衰竭的有效性和安全性

目的：探讨卡维地洛治疗老年充血性心力衰竭（CHF）患者的有效性和安全性。方法：60岁以上老年CHF患者86例，在心衰症状已基本缓解，常规治疗基础上加用卡维地洛2．5mg，2次／d，以后根据患者耐受情况在4～6周内渐增到病人能耐受的最大剂量或达到目标剂量20mg，2次／d。维持剂量治疗3个月。观察治疗前及维持剂量治疗3个月后心率、血压、血生化及心功能的变化。结果：治疗后心率、血压均明显下降（P〈0．01），心搏量、心脏指数、心排血量、左室射血分数均明显增加（P〈0．01或P〈0．05），左房内径、左室收缩末期内径、左室舒张末期内径均明显降低（P〈0．01）；而各项生化指标均无明显改变（P〉0．05）。结论：卡维地洛治疗老年心力衰竭可明显改善心功能并且耐受性良好。     

卡维地洛治疗慢性心力衰竭40例疗效观察

目的评估卡维地洛治疗慢性心力衰竭的临床疗效及安全性。方法80例慢性心力衰竭患者随机分为治疗组和对照组各40例。对照组采用慢性心力衰竭的标准治疗;治疗组在此标准治疗的基础上,卡维地洛从小剂量2．5mg／次、2次／d开始,每2周增加1倍剂量,直至最大剂量（靶剂量）25mg,2次／d。治疗前后分别对两组患者行血常规、心电图、心功能、肝肾功能、心脏B超等检查。结果治疗6个月后,治疗组左室收缩末径、左室舒张末径减小,左室射血分数增加,且血压、心率均明显改善,与治疗前比较差异有统计学意义（P〈0．05或〈0．01）;而对照组治疗前后以上指标比较差异无统计学意义。两组治疗后肝肾功能、血常规均无异常改变。结论卡维地洛治疗慢性心力衰竭安全、有效。     

小剂量卡维地洛治疗老年慢性心力衰竭的疗效观察

目的探讨小剂量卡维地洛对老年（≥60岁）慢性心力衰竭（CHF）患者的疗效。方法将90例经常规心衰治疗病情稳定的老年CHF患者随机分为两组。卡维地洛组50例，在原有治疗基础上加服卡维地洛3．125mg，2次／d；持续2周后，无明显不良反应者加量至6．25mg，2次／d，直到6个月。常规治疗组40例作为对照，采用心力衰竭的标准治疗方案。分别检测两组患者治疗前后心率（HR）、左室射血分数（LvEF）和左室后壁（LVP）、室间隔（IVS）厚度。结果与常规治疗组相比，卡维地洛组患者的HR变慢，LVEF增加，LVP和IVS厚度均减少。结论卡维地洛治疗老年CHF6个月后，具有逆转左室重构和改善心功能的有益作用。     

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。     

卡维地洛治疗大心脏伴慢性心功能不全的疗效及安全性

目的:探讨卡维地洛治疗大心脏[左室舒张末期内径(LVEDd)≥65 mm],伴慢性心功能不全(CHF)的疗效及安全性。方法:入选大心脏伴CHF患者23例,在常规治疗≥2周基础上,加用卡维地洛,从3．125 mg,2次／d 开始,每2周递增1次,直至靶剂量25 mg(体重大于85 kg可增加至50 mg),2次／d,或最大耐受剂量,疗程6个月。观察治疗前、后心功能、血压、心率、左室射血分数(LVEF),评价其疗效及安全性。结果:卡维地洛治疗6个月后患者的心功能明显改善,血压、心率降低,LVEF升高(P均<0．05);且不良反应少,安全性好。结论:卡维地洛能安全改善大心脏伴CHF患者的心功能。     

卡维地洛治疗老年慢性心力衰竭患者的临床观察

目的　观察国产卡维地洛治疗老年慢性心力衰竭 (CHF)患者的临床疗效。方法　将 94例CHF患者随机分成两组 ,常规治疗组 (44例 )使用洋地黄、利尿剂、血管紧张素转换酶抑制剂、硝酸酯类等药物治疗 ,卡维地洛治疗组(5 0例 )在常规治疗组的基础上 ,心力衰竭初步控制后加用卡维地洛 5mg ,2次 d ,缓慢逐增至 10mg ,2次 d。评估治疗前后心功能、心率、血压、超声心动图 ,并进行对照。结果　与常规治疗组及治疗前后比较 ,卡维地洛治疗组治疗3个月后心功能分级、左心室射血分数均有明显改善。心率减慢 ,左心室舒张末内径及收缩末内径明显缩小。结论老年CHF患者在常规治疗的基础上加用卡维地洛有较好的临床疗效     

小剂量卡维地洛治疗老年慢性心力衰竭的疗效观察

目的：探讨小剂量卡维地洛对老年（≥60岁）慢性心力衰竭（CHF）患者疗效。方法：将60例经常规心衰治疗病情稳定的老年CHF患者随机分为两组。卡维地洛组30例，在原有治疗基础上加服卡维地洛3．125mg，每日两次；持续2周后，无明显不良反应者加量至6．25mg，每日两次，直到6个月。常规治疗组30例作为对照。分别检测两组患者治疗前后心率（HR）、左室射血分数（LVEF）和左室后壁（LVP）、室间隔（IVS）厚度。结果：与常规治疗组相比，卡维地洛组患者的HR变慢，LVEF增加，LVP和IVS厚度均减少。结论：卡维地洛治疗老年CHF6个月后，具有逆转左室重构和改善心功能的有益作用。     

卡维地洛治疗慢性充血性心力衰竭的临床疗效观察

目的观察卡雏地洛治疗慢性充血性心力衰竭（chronic hear failure，CHF）的临床疗效。方法选择我院68例慢性充血性心力衰竭患者随机分为治疗组、对照组各34例。对照组使用洋地黄、利尿剂、血管紧张素转换酶抑制剂、硝酸酯类等药物治疗，治疗组在常规治疗的基础上，加用卡雏地洛，起始剂量2．5mg／次，1次／d，每周剂量加倍，遥渐增量至10～20mg／d，疗程6个月。每周测量血压、心率、评定心功能，治疗前、后检查超声心动图。结果两组患者临床疗效、病死率间差异均无显著性意义（P〉0．05）。但治疗组左室射血分数（LVEF）、左室舒张末期内径（LVEDD）和收缩末期内径（LVESD）均较对照组明显改善（P〈0．05）。结论卡维地洛治疗慢性充血性心力衰竭能改善心功能，改善左室重塑。     

卡维地洛并氯沙坦治疗慢性充血性心力衰竭的疗效

目的:探讨卡维地洛联合氯沙坦治疗慢性充血性心力衰竭(CHF)的临床疗效。方法:60例CHF患者随机单盲分成治疗组和对照组,治疗组给予氯沙坦50 mg／d,卡维地洛3．125 mg,1次／d,对照组给子氯沙坦及安慰剂治疗。两组基础治疗相同,疗程3个月。观察治疗前后两组患者的血压、心率、每搏量(SV)、心脏指数(CI)、左室射血分数(LVEF)、心输出量(CO)及不良反应。结果:治疗3个月后,治疗组心功能改善的临床显效率63．3％和总有效率96．7％均较对照组(30．0％和66．7％)显著提高(P<0．05)。与治疗前相比,治疗组治疗后血压、心率、LVEF、 SV、CI均有显著改善(P<0．01),与对照组比较差异亦有显著性意义(P<0．01)。结论:卡维地洛联合氯沙坦治疗 CHF可以增强疗效。     

卡维地洛治疗轻中度稳定性慢性心力衰竭耐受性和安全性研究

目的：评估卡维地洛治疗轻中度稳定性慢性心力衰竭的I临床耐受性和安全性。方法：482例符合轻中度慢性心衰标准的患者在常规治疗后，病情基本稳定的基础上加用卡维地洛。卡维地洛从小剂量3．125mg每日两次开始，每两周递增一次，直至靶剂量25mg每天2次或最大耐受剂量。治疗前后分别对心功能(NYHA)分级、心衰评分、血压、心率等体征及实验室(血常规，肝肾功能及心电图等)检查进行检测，评判疗效、耐受性及安全性。结果：用卡维地洛治疗后心功能明显改善，心衰评分下降，提示生活质量改善，同时不良反应少，安全性好。60％的患者可以达到推荐靶剂量。结论：卡维地洛治疗轻中度慢性稳定性心衰耐受性和安全性良好。     

美托洛尔和卡维地洛对慢性心力衰竭的影响

目的比较选择性β1受体阻滞剂美托洛尔和非选择性β受体阻滞剂卡维地洛治疗对慢性心力衰竭(CHF)代谢底物、细胞因子及心脏功能的影响。方法选择CHF患者86例(CHF组)及健康体检者25例(正常对照组)。CHF组患者又随机分为美托洛尔组(43例)和卡维地洛组(43例)。记录两组CHF患者治疗前后心功能分级及不良事件次数及TNF-α、白细胞介素-1β(IL-1β)和白细胞介素-6(IL-6)含量。所有入选者均测定血清游离脂肪酸(FFA)含量。结果美托洛尔组和卡维地洛组患者经过治疗后心功能明显改善(P<0.01),其中卡维地洛组更加明显(P<0.01)。美托洛尔组不良事件40次,卡维地洛组不良事件24次(P<0.01)。血浆TNF-α、IL-1β和IL-6较治疗前显著降低(P<0.05)。卡维地洛组较美托洛尔组TNFα和IL-1β降低更明显(P<0.01,P<0.05)。CHF组患者血清FFA含量同正常对照组比较明显升高(P<0.01)。治疗后卡维地洛组血清FFA较美托洛尔组降低更明显(P<0.01)。结论β受体阻滞剂可以改善CHF患者心功能,降低血浆细胞因子及FFA水平,非选择性的β受体阻滞剂卡维地洛优于选择性的β1受体阻滞剂美托洛尔。     

卡维地洛治疗充血性心力衰竭的临床研究

目的:探讨卡维地洛对充血性心力衰竭(CHF)患者心功能的影响。方法:45例CHF患者被随机分成2组.对照组(B组)用利尿剂、强心甙、硝酸酯类等药进行治疗,治疗组(A组)在B组治疗基础上加用卡维地洛,起始剂量3.125mg,2次/d,每2周加量1倍,至最大剂量25mg,2次/d。结果:治疗16周后,两组的心功能分级均有明显改善.与对照组比较,治疗组LVEF增加更加显著(P<0.05)。结论:卡维地洛对CHF有较好的疗效。     

Effects of carvedilol on oxidative stress and chronotropic response to exercise in patients with chronic heart failure

BACKGROUND: Our previous studies suggest that the increase in heart rate from rest to peak exercise is reduced in patients with chronic heart failure (CHF) and this is associated with increased oxidative stress, as determined by malondialdehyde (MDA) plasma levels. AIM: To investigate the effects of carvedilol on the heart rate response to exercise and oxidative stress in patients with CHF. METHODS AND RESULTS: Thirty stable NYHA classes II-III CHF patients received carvedilol therapy for 6 months, at a mean maintenance dose of 25 mg (range 6.25-50 mg/day). After treatment, the patients showed a significant improvement in their functional NYHA class (p=0.013), increased left ventricular ejection fraction (LVEF) (24+/-1.4% to 31+/-2.3%, p=0.003) and 6-min walk distance (499+/-18 to 534+/-18 m, p=0.03), without changes in the peak VO2. At baseline, norepinephrine (NE) plasma levels increased with exercise (510+/-51 to 2513+/-230 pg/mL, p<0.001), and these levels were not affected by carvedilol. Chronotropic responsiveness index (increase in heart rate divided by the increase in NE from rest to peak exercise) was not changed by carvedilol (0.049+/-0.001 to 0.042+/-0.001, p=0.6). MDA levels of CHF patients decreased after treatment with carvedilol (2.4+/-0.2 to 1.1+/-0.2 microM, p<0.001), without changes in antioxidant enzyme activities. CONCLUSIONS: Carvedilol treatment in patients with CHF results in reduced oxidative stress without restoration of the chronotropic responsiveness index.     

The effects of chronic, sustained-release moxonidine therapy on clinical and neurohumoral status in patients with heart failure

AIMS: Congestive heart failure (CHF) is characterized by elevated plasma norepinephrine (PNE) associated with a poor prognosis. Moxonidine selectively stimulates medullary imidazoline receptors which centrally inhibit sympathetic outflow and potently suppress levels of circulating PNE. This study was designed to evaluate the effects of central sympathetic inhibition on clinical and neurohumoral status in patients with CHF. METHODS AND RESULTS: This study evaluated 25 patients (age=69+/-7 years, 20 males) with symptomatic CHF (NYHA II-III), stabilized on standard therapy. The mean ejection fraction was 28+/-7% at baseline. Patients were titrated in a double-blind fashion to 11 weeks of oral therapy with placebo (n=9) or sustained-release (SR) moxonidine 0.9 mg bid (n=16). Clinical and neurohumoral status were evaluated at baseline, on chronic therapy at the target dose, and during cessation of therapy. All patients completed the trial and reached the target dose. Dry mouth, symptomatic hypotension, and asthenia were more frequent in the moxonidine SR-treated group. PNE was substantially reduced after 6 weeks at the maximum dose (0.9 mg bid) by 50% vs. placebo (P<0. 0005). A reduction in 24-h mean heart rate (P<0.01) was correlated to the reduction in PNE (r=0.70, P<0.05). A 36% increase in the standard deviation of normal-to-normal intervals (SDNN) was observed in the moxonidine SR group vs. a 2% decrease for placebo (P=0.06); for the root mean square of successive differences (rMSSD), there was a 21% increase for moxonidine SR vs. a 19% decrease for placebo (P<0.05). Abrupt cessation of chronic therapy resulted in substantial increases in PNE, blood pressure, and heart rate. CONCLUSIONS: Chronic therapy with a sustained-release formulation of moxonidine in patients with CHF was well tolerated, with substantial and sustained reductions in PNE. The tachyarrhythmias were attenuated, with evidence of improved autonomic tone. Due to the observed effects following moxonidine discontinuation, tapering of therapy is recommended.     

卡维地洛治疗充血性心力衰竭的临床研究

目的观察卡维地洛对充血性心力衰竭(CHF)左心功能的影响。方法患冠心病、原发性高血压、扩张型心肌病的CHF患者共174例随机分为治疗组和对照组各87例,治疗组在强心、利尿、血管紧张素转换酶抑制剂(A-CEI)治疗的基础上,每天给卡维地洛6.25~50mg口服治疗,疗程24周。作治疗前、后NYHA分级、心功能的对照。结果治疗后NYHA分级、心功能均得到改善。结论卡维地洛治疗CHF 24周后,能抑制CHF的恶化,改善心功能,改善生活质量。     

步长稳心颗粒并美托洛尔对慢性心力衰竭伴心房颤动的疗效

目的:探讨步长稳心颗粒联用美托洛尔对慢性心力衰竭(CHF)伴慢性心房颤动(AF)患者的疗效。方法:选择CHF伴慢性AF98例,随机分为治疗组(50例)和对照组(48例)。两组均常规使用地高辛等常规用药,治疗组加用美托洛尔(12.5~50mg/d)及步长稳心颗粒(27g/d)。观察两组1月疗效,并随访半年心脏原因所致再住院率、死亡率。结果:治疗1月后,治疗组患者静息心室率(HR)和运动前、后即刻心室率差值(HD)显著降低,6min步行距离(m),左室射血分数(LVEF)显著增加,心功能NYHA分级,生活质量(QOL)显著改善(P<0.05~<0.01)。对照组的上述参数除HD外亦有显著改善(P<0.05),但HR、HD、6min步行距离改善显著次于治疗组(P<0.05)。随访半年,和对照组相比,治疗组患者因心力衰竭再住院率较低(14.0%∶27.1%,P<0.05),死亡率亦较低(6%∶14.6%,P<0.05);NYHA分级、6min步行距离、LVESV、LVEDV、LVEF、QOL评分明显优于对照组(P<0.05)。结论:对于慢性心力衰竭合并心房颤动患者,在常规治疗的基础上,步长稳心颗粒联用美托洛尔1个月仅HR,HD,6min步行距离改善显著优于对照组,而半年后心功能、生活质量都明显优于对照组。     

A randomized, placebo-controlled trial assessing the effects of rosiglitazone on echocardiographic function and cardiac status in type 2 diabetic patients with New York Heart Association Functional Class I or II Heart Failure.

OBJECTIVES: This study investigated the effects of rosiglitazone (RSG) on left ventricular ejection fraction (LVEF) in subjects with type 2 diabetes (T2DM) and pre-existing chronic heart failure (CHF) (New York Heart Association [NYHA] functional class I to II). BACKGROUND: Fluid retention is an important consideration in the use of thiazolidinediones in T2DM patients because it could exacerbate symptoms or precipitate decompensation in those with previously stable CHF. METHODS: A total of 224 patients with T2DM and NYHA functional class I to II CHF with LVEF < or =45% were randomized to a 52-week treatment with RSG (4 to 8 mg daily, n = 110) or placebo (PLB) (n = 114) in addition to background antidiabetes therapy. Treatment was uptitrated to achieve target fasting plasma glucose <126 mg/dl; CHF medications were adjusted as appropriate. RESULTS: The LVEF was similar in both groups at baseline (RSG 35.3 +/- 6.2%, PLB 35.7 +/- 7.8%) and after 52 weeks of treatment (mean difference 1.49%, p = 0.1). Glycemic control was significantly better in the RSG group (mean difference in hemoglobin A1c -0.65%, p < 0.0001). There were significantly more adjudicated events in the RSG group of new or worsening edema (RSG n = 28 [25.5%]; PLB n = 10 [8.8%]; p = 0.005) and increased CHF medication (RSG n = 36 [32.7%], PLB n = 20 [17.5%]; p = 0.037), but no significant difference between groups for other adjudicated end points. A similar proportion of patients withdrew from each treatment group because of adverse events. CONCLUSIONS: After 52 weeks of treatment, RSG improved glycemic control but did not adversely affect LVEF in patients with T2DM and NYHA functional class I to II CHF. More fluid-related events occurred with RSG, although these generally did not lead to withdrawal from the study.     

Effects of carvedilol on left ventricular diastolic function and chamber volumes in advanced heart failure

AIM: Carvedilol treatment in chronic heart failure (CHF) demonstrated to reduce mortality and rehospitalisation, and improvement of cardiac systolic function with reduction of left ventricular volumes and remodelling. The effects of the drug on left ventricular (LV) filling are less studied. Systolic dysfunction is often associated to diastolic alteration, pseudonormal and restrictive filling pattern are related with poor prognosis. In this study we evaluated diastolic cardiac modifications during carvedilol therapy at early and long term in patients with advanced CHF and pseudonormal or restrictive filling pattern by echo Doppler method. METHODS: We studied 59 patients with severe but stable CHF (40 in class NYHA III and 19 in class NYHA IV) with both systolic and diastolic dysfunction due to idiopathic or ischemic cardiomyopathy. Group I (n=32) received preceding treatment plus carvedilol and Group II (n=27) continued standard therapy with ACE-inhibitors, diuretics, digossin and vasodilators. In all subjects were evaluated LV volumes mass and ejection fraction (EF). Therefore, we studied transmitral filling parameters: Early filling wave (E), atrial filling wave (A), E/A ratio, deceleration time of E (DT) and isovolumetric releasing time (IVRT) by echo Doppler method. RESULTS: After 4 months of therapy carvedilol group showed a significant increase of A wave (p<0.001) DT (p<0.0001) and IVRT (p<0.0001), and significant reduction of E/A ratio (p<0.0005) respect to Group II. Any significant changes were observed for volumes mass and EF. Transmitral Doppler measurements remained unchanged or further ameliorated at 12 months (A p<0.0005; DT p<0.00002; IVRT p<0.000004; E/A p<0.0008), we also observed E wave reduction (p<0.001) in Group I respect to controls. Besides, after 1 year of follow-up we observed a reduction of systolic volume (p<0.001) pulmonary pressure (p<0.0001) and consequent increase of EF (p<0.001) in group treated with beta-blockers. Multivariate analysis demonstrated that Doppler modification were minimally related to heart rate and blood pressure reduction. CONCLUSIONS: Carvedilol treatment improve diastolic function in CHF with severe diastolic impairment driving restrictive or pseudonormal filling pattern towards altered pattern at early time. These changes remained also after 1 year of therapy and appeared to precede increase of systolic function and improvement of emodynamic status.     

中西医结合治疗对慢性心衰患者心功能的影响

目的观察中西医结合治疗对慢性心力衰竭(CHF)患者心功能的影响。方法将60例符合入选标准的CHF患者随机分为治疗组和对照组,各30例。对照组给予西医基础治疗,治疗组在对照组治疗基础上加服通阳活血方,疗程3周。分别于治疗前后记录患者纽约心脏病学会(NYHA)心功能分级及Lee积分情况。结果 NYHA心功能分级疗效,治疗组总有效率为93.33%,对照组总有效率为73.33%,治疗组优于对照组,但差异无统计学意义(P0.05)。Lee氏积分总疗效,治疗组总有效率为93.33%,对照组总有效率为70.00%,治疗组优于对照组(P0.05)。两组治疗前后Lee氏总积分较治疗前均明显下降(P0.01),且治疗组较对照组下降明显(P0.01)。结论中西医结合治疗可以明显改善CHF患者的心功能。