Cardiovascular effects of prenalterol on rest and exercise haemodynamics in patients with chronic congestive cardiac failure

?The cardiovascular effects of the cardioselective beta, agonist prenalterol have been studied in nine patients with severe chronic congestive cardiac failure and in six patients with left ventricular dysfunction resulting from previous myocardial infarction. In the patients with cardiac failure intravenous prenalterol in a dosage of 1.5 microgram/kg bodyweight increased the cardiac index from 1.8 +/- 0.1 to 21.+/- 0.1 1/min per m2 and the left ventricular ejection fraction from 22 +/- 3 to 28 +/- 3%. There was a modest but significant increase in heart rate from 76 +/- 3 to 87 +/- 4 beats/min. Systemic vascular resistance fell from 2285 +/- 51 to 2041 +/- 534 dynes s-1 cm-5. On exercise, the left ventricular filling pressure fell from 33 +/- 6 to 26 +/- 3 and both cardiac index and stroke index increased by 13% and 16%, respectively. There was no significant change in heart rate or systemic blood pressure. In the patients with left ventricular dysfunction, coronary sinus blood flow increased from 107 +/- 11 to 133 +/- 12 ml/min but the increase in myocardial oxygen consumption was small and not significant (11.6 +/- 1.2 and 14.5 +/- 1.9 ml/min). In all patients there was no evidence that prenalterol was arrhythmogenic.     

Dose-related haemodynamic effects of nicardipine during rest and exercise and variable anti-anginal effects in patients with chronic stable angina

The effects of increasing doses ofi.v. nicardipine (2.5, 5.0and 7.5 or 10.0 mg) on blood pressure, heart rate and exerciseperformance were studied in 12 patients with chronic effortangina. Plasma nicardipine concentrations correlated closelywith the infused doses (r=0.90). Resting haemodynamic changesafter nicardipine included a dose-related fall in systolic (5%,13%, 15%) anddiastolic (0%, 6%, 8%) blood pressure and a risein heart rate (10%, 19%, 30%). Rate-pressure product was slightlyincreased after the highest dose (10%). During exercise, maximalsystolic blood pressure decreased (3%, 9%, 9%) and heart rateincreased (2%, 4%, 9%) but the rate-pressure product remainedunchanged. Exercise tolerance improved in 10 patients as indicated by prolongedexercise duration in all, delayed appearance of ST-segment depressionin 6, decreased maximal ST-segment depression in 5, and abolished(N = 3) or diminished (N=4) anginal pain at the end of exerciseafter optimal nicardipine dose. Five of the 10 patients obtainedmaximum benefit after the highest dose. The other five patientsimproved after 2.5 or 5.0 mg but deteriorated (N=4) or had nofurther benefit when the dose was increased (N= 1). One patientdeteriorated even after the lowest dose, whereas one patientneither improved nor deteriorated after any dose. The patientswho deteriorated after low or high doses tended to be more severelydiseased than those who tolerated the maximal dose well. Theresults stress the importance of individual dose titration ofnicardipine to ensure maximum benefit in patients with chroniceffort angina.     

Cardiovascular effects of prenalterol on rest and exercise haemodynamics in patients with chronic congestive cardiac failure.

?The cardiovascular effects of the cardioselective beta, agonist prenalterol have been studied in nine patients with severe chronic congestive cardiac failure and in six patients with left ventricular dysfunction resulting from previous myocardial infarction. In the patients with cardiac failure intravenous prenalterol in a dosage of 1.5 microgram/kg bodyweight increased the cardiac index from 1.8 +/- 0.1 to 21.+/- 0.1 1/min per m2 and the left ventricular ejection fraction from 22 +/- 3 to 28 +/- 3%. There was a modest but significant increase in heart rate from 76 +/- 3 to 87 +/- 4 beats/min. Systemic vascular resistance fell from 2285 +/- 51 to 2041 +/- 534 dynes s-1 cm-5. On exercise, the left ventricular filling pressure fell from 33 +/- 6 to 26 +/- 3 and both cardiac index and stroke index increased by 13% and 16%, respectively. There was no significant change in heart rate or systemic blood pressure. In the patients with left ventricular dysfunction, coronary sinus blood flow increased from 107 +/- 11 to 133 +/- 12 ml/min but the increase in myocardial oxygen consumption was small and not significant (11.6 +/- 1.2 and 14.5 +/- 1.9 ml/min). In all patients there was no evidence that prenalterol was arrhythmogenic.     

心肺一体化心脏康复在高龄老年慢性心力衰竭患者中的临床疗效研究

摘要】目的：研究心肺一体化心脏康复在高龄老年（年龄≥75岁）慢性心力衰竭患者中的临床疗效。方法：选取2018年9月～2019年7月在我院治疗,符合入选标准和排除标准的125例高龄老年慢性心力衰竭患者,随机分为对照组64例和研究组61例,均签署知情同意书。研究组在充分的内科治疗基础上,给予个体化的心肺一体化心脏康复训练,运动评估采用无创血流动力学监测下的6分钟步行试验。比较对照组和研究组急性心力衰竭发生情况,比较研究组心肺一体化心脏康复训练前和训练3个月后的6分钟步行试验的步行距离和峰值每搏输出量、峰值每分输出量和总外周血管阻力,以及生活质量量表SF-36的评分。结果：个体化的心肺一体化心脏康复训练能够显著提高患者的6分钟步行实验的步行距离、峰值每搏输出量和每分输出量、降低总外周血管阻力（P均＜0.05）;能够显著提高SF-36的评分。结论：个体化心肺一体化心脏康复训练能够提高患者的运动能力和运动心功能,提升患者生活质量,有良好的临床效果。可为我国开展高龄老年心脏康复提供借鉴和参考。 关键词：高龄老年人,心脏康复,慢性心力衰竭     

Electromechanical effects of cardiac resynchronization therapy during rest and stress in patients with heart failure

BACKGROUND: Haemodynamic and functional effects of cardiac resynchronization therapy (CRT) have been studied mostly at rest. CRT effects on left ventricular (LV) dyssynchrony and function during stress have not been evaluated in detail. AIMS: We studied the electromechanical effects of CRT at rest and during Dobutamine stress echocardiography (DSE), during active and withheld CRT. METHODS: Twenty-one responders to CRT (62+/-12 yr) were assessed by walking test, quality of life, and BNP with active CRT ("on") and 2 weeks after pacing withdrawal ("off"). DSE (10 microg/kg/min) was performed both at "on" and "off" to evaluate dyssynchrony parameters, systolic and diastolic function. RESULTS: At rest, CRT withdrawal was associated with an increased interventricular mechanical delay (IVMD, from 21+/-18 ms to 49+/-24 ms, p<0.001) and impaired intraventricular synchrony. There was a significant decrease in LV systolic function and LV filling time. Dobutamine infusion had no impact on inter- and intraventricular synchrony. During stress, there was an improvement in LV performance both at "on" and "off". However, LV dp/dt, aortic VTI, cardiac output, mean systolic peak velocities and LV filling time during dobutamine stress were significantly greater with CRT "on". CONCLUSION: In long-term responders, CRT improves LV performance both at rest and during dobutamine stress. This is attributable to an improvement in LV synchrony, which is maintained during stress.     

Aldosterone antagonists: a new treatment option for patients with post-myocardial infarction heart failure

Heart failure (HF) in association with acute myocardial infarction is an emerging clinical problem. The benefits of aldosterone blockade have now been extended, with the selective aldosterone antagonist eplerenone demonstrating reduced mortality compared to placebo, in patients with post-myocardial infarction HF. The evidence supporting this agent will be briefly reviewed, followed by a discussion on the clinical implications of aldosterone antagonists in this clinical setting.     

Regulatory peptides in the plasma of patients with chronic cardiac failure at rest and during exercise.

The levels of several regulatory peptides were measured in peripheral plasma samples from individuals with chronic cardiac failure (CCF) and matched controls in both the resting state and during a short period of maximal exercise. Basal levels of noradrenaline (NA; 705 +/- 114 vs 195 +/- 54 ng.l-1; mean +/- SEM; P < 0.05), plasma renin activity (PRA; 12.9 +/- 2.9 vs 2.1 +/- 0.3 ng AI ml-1.h-1; P < 0.05) and aldosterone (ALDO; 325 +/- 49 vs 87 +/- 8 ng.l-1; P < 0.05) were all raised in the patients with CCF, and increased further with exercise. Basal circulating levels of atrial natriuretic peptide (ANP) were also significantly higher in the CCF group compared to controls (136 +/- 35 vs 27 +/- 5 ng.l-1; P < 0.01), but the response to exercise was attenuated, so that at peak exercise, no significant difference was observed. Basal circulating levels of gastrin-releasing peptide (GRP) (29 +/- 4 vs 40 +/- 4 ng.l-1; P < 0.05) and secretin (13 +/- 1 vs 32 +/- 4 ng.l-1; P < 0.05) were significantly lower in the CCF group when compared to controls and there was no significant change in the levels of either peptide with exercise. Levels of neurokinin A (NKA), neuropeptide Y (NPY) and neurotensin (NT) were somewhat higher in patients, but the differences were not significant, and there were no changes during exercise. There were also no significant differences in the levels of vasoactive intestinal peptide (VIP), glucose-dependent insulinotropic polypeptide (GIP), insulin or glucagon in either experimental group both before and during exercise. We have therefore identified different circulating levels of certain regulatory peptides in patients with CCF, but the significance of these remains unclear.     

Effect of nicardipine on rest and exercise hemodynamics in chronic congestive heart failure

The hemodynamic response to vasodilation induced by the new calcium channel antagonist nicardipine was studied in 10 patients with severe, chronic congestive heart failure. Rest and exercise hemodynamics were evaluated in the baseline state and after 1 week of oral nicardipine therapy (30 mg 3 times daily). In addition, respiratory gas exchange and arteriovenous oxygen difference were measured to assess changes in oxygen utilization. The responses of the sympathetic nervous system were evaluated by measuring plasma norepinephrine concentrations at rest and during maximal exercise. At rest, nicardipine administration was associated with significant reductions in mean systemic arterial pressure, systemic vascular resistance, pulmonary artery wedge pressure and pulmonary arterial pressure, and significant increases in cardiac index and stroke volume index. These effects were maintained during exercise. In contrast to findings with other calcium channel antagonists, no negative inotropic effect of nicardipine was identified. Nicardipine administration was associated with reduction of arteriovenous oxygen difference. Nicardipine had no effect on plasma norepinephrine concentrations, suggesting absence of reflex sympathetic nervous activation. Thus, nicardipine-mediated vasodilation leads to significant improvements in both rest and exercise cardiac performance.     

Renal impairment and heart failure with preserved ejection fraction early post-myocardial infarction

AIM: To study if impaired renal function is associated with increased risk of peri-infarct heart failure (HF) in patients with preserved ejection fraction (EF).METHODS: Patients with occluded infarct-related arteries (IRAs) between 1 to 28 d after myocardial infarction (MI) were grouped into chronic kidney disease (CKD) stages based on estimated glomerular filtration rate (eGFR). Rates of early post-MI HF were compared among eGFR groups. Logistic regression was used to explore independent predictors of HF.RESULTS: Reduced eGFR was present in 71.1% of 2160 patients, with significant renal impairment (eGFR < 60 mL/min every 1.73 m²) in 14.8%. The prevalence of HF was higher with worsening renal function: 15.5%, 17.8% and 29.4% in patients with CKD stages 1, 2 and 3 or 4, respectively (P < 0.0001), despite a small absolute difference in mean EF across eGFR groups: 48.2 ± 10.0, 47.9 ± 11.3 and 46.2 ± 12.1, respectively (P = 0.02). The prevalence of HF was again higher with worsening renal function among patients with preserved EF: 10.1%, 13.6% and 23.6% (P < 0.0001), but this relationship was not significant among patients with depressed EF: 27.1%, 26.2% and 37.9% (P = 0.071). Moreover, eGFR was an independent correlate of HF in patients with preserved EF (P = 0.003) but not in patients with depressed EF (P = 0.181).CONCLUSION: A significant proportion of post-MI patients with occluded IRAs have impaired renal function. Impaired renal function was associated with an increased rate of early post-MI HF, the association being strongest in patients with preserved EF. These findings have implications for management of peri-infarct HF.     

心脏彩超应用于心肌梗死后慢性心衰心脏同步性检测中的临床作用

目的：探讨心脏彩超应用于心肌梗死后慢性心衰心脏同步性检测中的临床作用。方法：2013年1月到2015年6月选择在我院进行诊治的心肌梗死患者92例,根据随机数字表法分为治疗组与对照组各46例,对照组给予介入手术治疗,治疗组在对照组治疗的基础上给予心脏再同步化治疗。结果：所有患者都介入治疗成功,介入后14d治疗组与对照组的LVESVI与LVEDVI值都明显都低于介入前(P<0.05),同时比较研究两组的LVESVI与LVEDVI值发现介入后14d治疗组值显著偏低 (P<0.05)。介入后14d治疗组与对照组的Trs-Avg-12值显著降低(P<0.05),并且对介入后14d治疗组进行观察,发现其Trs-Avg-12值比对照组显著要低(P<0.05);两组介入前后的Trs-Avg-6b组内与组间对比差异都无统计学意义(P>0.05)。所有患者介入后随访调查6个月,治疗组的慢性心力衰竭、再次心肌梗死、恶性心律失常和靶病变血管重建等主要心脏不良事件明显少于对照组(P<0.05)。结论：心肌梗死后慢性心衰心脏彩超显示多存在心室收缩不同步情况,心脏再同步化治疗辅助介入治疗能有效改善心功能,改善患者的心室收缩不同步情况,减少慢性心力衰竭等主要心脏不良事件的发生。     

Comparison of acute haemodynamic effects of nifedipine and isosorbide dinitrate in patients with heart failure following acute myocardial infarction

The acute haemodynamic effects of nifedipine (10 mg sublingually) and isosorbide dinitrate (5 mg sublingually) were compared in 13 patients with heart failure due to acute myocardial infarction. Nifedipine induced a significant reduction in systolic (from 122 ± 5 to 107 ± 3 mm Hg: mean ± SEM; P < 0.002) and diastolic blood pressure (from 85 ± 3 to 75 ± 2 mm Hg; P < 0.01). Heart rate did not change significantly, nor did mean right atrial pressure. The mean pulmonary arterial pressure was lowered from 31 ± 2 to 27 ± 2 mm Hg (P < 0.005). The left ventricular filling pressure decreased from 24 ± 1 to 19 ± 1 mm Hg (P < 0.0001). A significant increase in cardiac index (from 2.33 ± 0.13 to 2.69 ± 0.15 l/min per m²; P < 0.001) and in stroke volume index (from 24 ± 2 to 28 ± 2 ml/beats per m²; P < 0.005) was registered. Systemic vascular resistance fell from 1742 ± 145 to 1308 ± 85 dynes/sec per cm⁻⁵ (P < 0.00005). After isosorbide dinitrate was administered a significant reduction in mean right atrial pressure (from 9.5 ± 1.6 to 5.1 ± 1.2 mm Hg; P < 0.0001), in mean pulmonary arterial pressure (from 32 ± 1 to 23 ± 1 mm Hg; P < 0.00001) and in left ventricular filling pressure (from 23 ± 1 to 16 ± 1 mm Hg; P < 0.0001) was seen. No significant change in systolic and diastolic blood pressure, heart rate, cardiac index, stroke volume index and systemic vascular resistance was registered. No side-effects were seen after nifedipine and isosorbide dinitrate were administered.     

Effects of diuretic treatment on cardiac and circulating RAS in chronic heart failure post-myocardial infarction in rats

BACKGROUND: Cardiac angiotensin converting enzyme (ACE) is activated by an increase in wall stress and is involved in remodeling processes. Heart failure is often treated with ACE inhibitors and diuretics although diuretic treatment could activate the renin-angiotensin system (RAS). AIMS: To examine the effects of diuretic treatment on cardiac and circulating RAS in post-infarction chronic heart failure. METHODS: Myocardial infarction was produced by coronary artery ligation in spontaneously hypertensive rats. The rats were randomly assigned to receive either ramipril (1 mg/kg/day), furosemide (4 mg/kg/day), or combination therapy for 6 weeks, commencing 2 weeks after infarction. RESULTS: All three treatment protocols equivalently attenuated reactive hypertrophy of the right ventricle and ventricular septum and improved left ventricular systolic function. Both cardiac ACE mRNA and activity were significantly increased in untreated rats. This increase was attenuated by both ramipril and furosemide and further depressed by the combination. The increase in activity was completely inhibited by either agent alone. Plasma renin activity was upregulated by ramipril or ramipril plus furosemide but not influenced by infarction or furosemide alone. CONCLUSIONS: Furosemide and ramipril significantly reduced cardiac ACE and remodeling. Diuretics work favorably and do not interfere with the effects of ACE inhibitors. Possibly, a reduction in wall stress due to decreased volume overload accounts for the effects of diuretics on cardiac ACE in the treatment of post-infarction remodeling in hypertensive hearts. These data suggest a new mechanism for the frequently observed beneficial effect of diuretics in heart failure.     

心脏再同步化治疗慢性心衰的临床观察

目的观察心脏再同步化治疗(CRT)慢性心力衰竭(CHF)患者的临床疗效。方法选择2008年1月至2009年8月行CRT的患者32例,其中12例植入再同步心脏转复除颤器(CRT-D)。32例中30例为窦性心律,2例为房颤心律。随访21.5±6.2个月,观察患者NYHA心功能分级、QRS波时限、左室射血分数(LVEF)、左室舒张末内径(LVEDD)、6分钟步行距离(6MWD)、因心功不全住院时间等。结果 32例植入CRT(D)患者中,有24例临床症状明显改善,心功分级降低,LVEF和6MWD增加,QRS波时限、LVEDD减少,因心功不全住院时间明显减少约24.5%(p<0.05)。8例患者心功能没有明显改善,但因心功不全住院时间减少约8.3%(p<0.05)。4例患者记录到室性心律失常事件(12.5%),2例室速经抗心动过速起搏(ATP)有效转复,2例患者因室颤而放电,均成功转复,CRT-D均能有效识别和转复。结论 CRT可明显改善CHF患者的心功能,提高生活质量,缓解临床症状,植入CRT-D可有效预防心源性猝死(SCD)。     

The use of an exponential protocol for bicycle and treadmill exercise testing in patients with chronic cardiac failure.

We have studied a standardized exercise protocol suitable for use with a treadmill or bicycle (STEEP protocol) and compared it with a modified Bruce treadmill protocol in a group of patients with chronic cardiac failure. The STEEP protocol has been previously validated in normal subjects. Exercise time (6.79 +/- 2.42 vs 5.34 +/- 1.95 min, P < 0.05) and peak VO2 (16.66 +/- 4.09 vs 15.01 +/- 3.72 ml.min-1.kg-1, P < 0.05) were greater with the STEEP treadmill compared with the bicycle protocol, but VO2 was very similar at equal exercise stages in both modalities. Heart rate and respiratory exchange ratio tended to be greater during bicycle exercise at equal stages. Exercise time was greater with the modified Bruce protocol (9.00 +/- 3.02 min, P < 0.05) than with either STEEP protocol, but peak VO2 (17.13 +/- 4.52 ml.min-1.kg-1) was similar to that obtained with the STEEP treadmill test. We conclude that the STEEP protocol may be used to test patients with chronic cardiac failure, and that exercise times relate well in both treadmill and bicycle. The protocol should prove useful in studies involving a wide range of exercise capacities or both bicycle and treadmill exercise.     

Neurohumoral and hemodynamic effects of ibopamine in a rat model of chronic myocardial infarction and heart failure

Summary There is increasing evidence that both neurohumoral and hemodynamic factors play a role in disease progression in chronic heart failure (CHF). To examine the influence of the oral dopamine agonist ibopamine on these factors, we studied 20 rats with chronic myocardial infarction and CHF, and compared them with 20 normal rats. After 6 weeks, rats were randomly divided between control treatment (50%) or ibopamine (50%) for 3 weeks. At the end of the study, plasma and tissue neurohumoral parameters, as well as hemodynamics, were determined. In infarcted rats, the elevated plasma norepinephrine (PNE) levels were reduced by ibopamine (251±19 vs. 138±32 pg/ml; p<0.05). Other plasma neurohormones measured (epinephrine, renin, aldosterone, and angiotensin converting enzyme [ACE]) were not significantly increased in rats with myocardial infarction and were not affected by ibopamine. Cardiac (tissue) ACE was increased in infarcted rats (12.1±1.9 U/l/min) and was significantly lowered by ibopamine (9.6±1.0 U/l/min; p<0.05); renal ACE was unaffected. Blood pressure and heart rate were similar in the two groups and were not influenced by ibopamine treatment. In conclusion, in chronic myocardial infarction and CHF in rats, ibopamine reduces the elevated levels of PNE and cardiac ACE. Further research will be needed to determine whether this effect may lead to a favorable influence on disease progression in CHF.     

Acute and chronic effects of nicardipine on systolic and diastolic left ventricular performance in patients with heart failure: a pilot study

Nicardipine is a new calcium ion antagonist with vasodilating properties which has been shown to be effective in the treatment of hypertension and angina. We have studied its effect on systolic and diastolic left ventricular function in patients with mild to moderate degrees of congestive heart failure. Ten male patients with New York Heart Association Class II and III heart failure underwent acute treatment with an intravenous infusion of nicardipine (10 mg over 10 minutes). A nuclear probe was used to monitor left ventricular ejection fraction, peak filling rate, and relative cardiac output. Blood pressure and heart rate were also measured. The blood pressure (mean +/- SD) fell from 133 +/- 26/86 +/- 11 mmHg to 103 +/- 22/69 +/- 13; the heart rate rose from 67 +/- 9 beats/min to 85 +/- 10; left ventricular ejection fraction from 31 +/- 7 to 38 +/- 6%; relative cardiac output from 24 +/- 9 to 41 +/- 11; peak filling rate from 1.18 +/- 0.4 end-diastolic volume per second to 1.82 +/- 0.4 (p less than 0.001 in all cases) at the end of infusion. After 4 weeks of chronic treatment in eight patients (20 mg to be taken three times daily (tds) in one and 40 mg tds in 7), the blood pressure and heart rate had returned to baseline values but the improvements in left ventricular ejection fraction, relative cardiac output, and peak filling rate were sustained; this was associated with functional improvement in all 8 patients.(ABSTRACT TRUNCATED AT 250 WORDS)     

Haemodynamic effects of diltiazem at rest and during exercise in patients with previous myocardial infarction

A single blind study between placebo and diltiazem (25 mg i.v.single dose) was carried out on 20 male patients with previousmyocardial infarction and without exertional ischaemia. Patients, 50 ±6.1 (mean±SD) years of age, underwenta right heart catheterization with Seldinger's percutaneousapproach and brachial or radial artery percutaneous catheterization. Haemodynamic variables were recorded in the supine positionafter catheterization in baseline conditions at rest, aftera warming-up period of 6 min, before and after a first and secondexercise test with stepwise increments of 25 W per 3 min. Before the second exercise test, either placebo or diltiazem(25 mg) was injected intravenously in 3 min. In comparison with placebo, diltiazern significantly reducedresting blood pressure (P<0.001) and systemic vascular resistance(P<0001) and increased cardiac index (P<0.01); duringexercise it also reduced the mean pulmonary arterial pressure(P<005), pulmonary wedge pressure (P<0.05), total pulmonaryresistance (P<0.02), and increased the stroke volume (P<005). The present study demonstrated that intravenous diltiazem didnot induce a significant rise in cardiac index but reduced theafterload and slightly reduced the preload. Diltiazem also reducedmyocardial oxygen consumption and decreased blood pressure,mean right atrial pressure and slightly decreased the heartrate.     

The impact of exercise training for chronic heart failure patients with cardiac resynchronization therapy: A systematic review and meta-analysis

Background and objective:Systematically review the current published literature on the impact of exercise training (ET) in chronic heart failure (CHF) patients who were conducted cardiac resynchronization therapy (CRT).Methods:PubMed, EMBASE, and the Cochrane Library of Controlled Trails databases were searched for trials comparing the additional effects of ET in CHF patients after CRT implantation with no exercise or usual care control up until 2020.03.07. We independently screened the literature, extracted data, employed the tool for the assEssment of Study qualiTy and reporting in EXercise (TESTEX) to evaluate study quality and risk of bias, and performed meta-analysis with Revman 5.3 software.Results:Eight trials were identified for qualitative analysis and 7 randomized controlled trails (RCTs) included 235 participants (120 ET; 115 controls) for quantitative analysis. The results showed that the maximal workload (mean difference [MD] 26.32 W, 95% CI 19.41–33.23; P < .00001, I² = 0%) and the exercise duration (MD 68.95 seconds, 95% CI 15.41–122.48; P = .01, I² = 76%) had significant improvement in the ET group versus control. Subgroup analysis showed that compared with control, the change in peak oxygen uptake (VO₂) (MD 3.05 ml/kg/minute, 95% CI 2.53–3.56; P < .00001, I² = 0%), left ventricular ejection fraction (LVEF) (MD 4.97%, 95% CI 1.44–8.49; P = .006, I² = 59%), and health related quality of life (HRQoL) (the change in Minnesota living with heart failure questionnaire [MLHFQ]: MD −19.96, 95% CI −21.57 to −18.34; P < .00001, I² = 0%) were significantly improved in the light to moderate intensity training (non-HIT) group, while there seemed no statistical difference of above endpoints in the high intensity training (HIT) group.Conclusion:During the short term (up to 6 months), non-HIT could improve exercise capacity, cardiac function, and HRQoL in CHF patients with CRT. However, due to the small number of participants, a high-quality large-sample multicenter trial is demanded.     

卡维地洛和培哚普利对急性心肌梗死后心功能改善的影响

目的 :观测卡维地洛和培哚普利对急性心肌梗死后心功能的影响。方法 :急性心梗后心功能不全住院患者 6 2例。随机分成 2组先分别给予卡维地洛及培哚普利治疗 3月 ,然后再联合治疗 3月后复查超声心动图测定左室功能。结果 :1单用卡维地洛或培哚普利均可显著降低左室收缩末期容积 （L VESV ） ,左室射血分数 （L VEF）明显增加 ,左室充盈早期血流传播速度 （L VFPS）明显加快。2两药联用后 L VESV,L VEF及 L VFPS较单用药组有显著性变化。结论 :卡维地洛和培哚普利可明显改善急性心梗后心功能不全患者左心功能