辛伐他汀治疗扩张型心肌病

目的探讨他汀类药物对非缺血性心力衰竭的治疗作用.方法将36例特发性扩张型心肌病患者随机分为辛伐他汀组(n=17)和安慰剂组(n=19).在常规治疗的基础上,辛伐他汀组加用辛伐他汀,起始剂量为5mg/d,4周后增至10mg/d.结果治疗12后周,辛伐他汀组较安慰剂组血浆总胆固醇和低密度脂蛋白水平降低,心功能改善,左室射血分数提高,为(38.59±3.47)%对(34.11±3.16)%,P＜0.01.血浆肿瘤坏死因子-α(TNF-α)和白介素(IL)-6水平在辛伐他汀组显著降低(P＜0.01).结论辛伐他汀可以显著改善扩张型心肌病心衰患者的心功能和血管内皮功能,提示他汀类药物可用于治疗非缺血性心力衰竭.     

卡维地洛治疗扩张型心肌病严重心力衰竭

目的探讨卡维地洛在扩张型心肌病合并心力衰竭治疗中的应用。方法扩张型心肌病慢性心力衰竭58例,随机分为对照组及治疗组,对照组29例行常规强心、利尿、扩血管治疗,治疗组29例在常规治疗基础上加用卡维地洛,治疗12个月,观察心功能改善、病死率、心力衰竭恶化住院率。结果两组心功能均明显改善,左心室收缩末期容量、左心室舒张末内径、舒张末室间隔厚度、左心室后壁厚度明显缩小,左心室射血分数增大。对照组和卡维地洛组在治疗的改善情况1个月分别为11/29和11/29;6个月为15/29和17/29,12个月为18/29和24/29。结论在常规心力衰竭治疗基础上加用卡维地洛可明显改善扩张型心肌病合并心力衰竭患者的心功能,减少病死及心力衰竭恶化住院病例。     

扩张型心肌病的治疗

扩张型心肌病的治疗包括:①控制充血性心力衰竭(CHF);②防治严重心律失常;③防治血栓栓塞;④对某些继发性者进行病因治疗。 一、 CHF的治疗 扩张型心肌病一旦发生CHF,说明病情已发展到严重阶段。     

扩张型心肌病治疗现状

扩张型心肌病治疗现状解放军总医院心内科宋小武综述杨兴生审校扩张型心肌病亦称充血型心肌病，其特点为心脏扩大而心肌收缩力减弱。临床表现为充血性心衰的症状与体征。本病的发病率呈上升趋势。美国每年有１～２万新病例被诊断为本病［１，２］。本病预后不佳，５０％病...     

美托洛尔治疗扩张型心肌病的临床观察

目的观察口服美托洛尔(倍他乐克)治疗扩张型心肌病(DCM)的临床疗效。方法将62例DCM病人随机治疗组(32例)与对照组(30例),对照组给予利尿剂、血管紧张素转换酶抑制剂、洋地黄等常规治疗,治疗组在常规治疗的基础上加服美托洛尔治疗。结果两组治疗后左室射血分数、每搏输出量显著提高(P<0.05),收缩末期内径明显降低(P<0.05),QT离散度(QTd)明显缩短(P<0.05),但治疗组优于对照组(P<0.05)。结论在常规治疗的基础上加服美托洛尔治疗DCM心力衰竭疗效良好,优于常规治疗。     

卡维地洛治疗扩张型心肌病心力衰竭的疗效

扩张型心肌病（DCM）主要特征是单侧或双侧心脏扩大，心肌收缩功能减退，常发生心力衰竭（HF）。本文旨在探讨新一代β受体阻滞剂卡维地洛对DCM并发HF的临床疗效。     

米力农治疗扩张型心肌病心力衰竭的疗效观察

目的观察米力农注射液静脉滴注治疗扩张型心肌病心力衰竭的疗效。方法回顾性分析50例扩张型心肌病心力衰竭的治疗,其中治疗组25例,用米力农注射液静脉滴注强心治疗,配合利尿、扩血管药物治疗;对照组25例,予洋地黄类药物强心治疗,配合利尿、扩血管药物治疗。结果治疗组总有效率88%,对照组总有效率60%,χ2=5.093,P<0.05。结论米力农是磷酸二酯酶抑制剂,治疗扩张型心肌病心力衰竭疗效显著,是一种较好的强心药物。     

参麦注射液治疗扩张型心肌病心力衰竭疗效观察

目的观察参麦注射液治疗扩张型心肌病心力衰竭的疗效。方法选择扩张型心肌病心力衰竭患者80例,分为对照组和治疗组。对照组给予常规药物治疗,治疗组在常规药物治疗基础上加用参麦注射液。结果两组治疗后较治疗前临床症状以及心脏彩超各参数(射血分数、左室内径)以及6min步行试验均有改善。治疗后两组相比差别有统计学意义(P<0.05)。结论参麦注射液可有效治疗扩张型心肌病心力衰竭,安全性较高,无明显不良反应。     

扩张型心肌病治疗进展

近年来扩张型心肌病的治疗有了长足发展。药物治疗方面第三代 β受体阻滞剂的出现显著降低心血管病病死率。非药物方面基因治疗是新近研究的热点 ,免疫吸附疗法、起搏器治疗、心肌成形术、左室减容术、左室辅助装置及心脏移植都取得不同程度进展。     

倍他乐克治疗扩张型心肌病心力衰竭的临床观察

扩张型心肌病是一种原因不明的心肌疾病 ,以左心室或双心室扩张并伴收缩功能受损为特征 ,常表现为进行性心力衰竭 ,心律失常 ,血栓栓塞 ,猝死 ,预后差。我们 5年来应用倍他乐克( Betaloc)治疗扩张型心肌病 ( DCM)心力衰竭 32例 ,取得较为满意疗效 ,现报道如下 :1　资料与方法1 .1　观察对象 :选择我院 1 995年 1月至 2 0 0 0年2月住院扩张型心肌病患者 (排除低血压 ,窦性心动过缓 ,房室传导阻滞 ,合并支气管哮喘及不能忍受 β受体阻滞剂治疗者。) 5 0例 ,心功能按NYHA (纽约心脏病协会 )分级为 — 级并射血分数 ( LVEF) <0 .4。年龄 …     

扩张型心肌病左心腔大小及其临床意义

目的探讨扩张型心肌病(DCM)的临床特征、左心腔增大程度及其临床意义。方法回顾性分析1994年1月～1999年1月连续收住入院的DCM患者102例。结果102例中,心功能Ⅲ～Ⅳ级者76例,Ⅲ级以下者26例。伴发各种心律失常者93例(91．2％)中,室上性心律失常34例,室性心律失常70例,缓慢心律失常42例。左室舒张末期内径(LVED)平均为(69．4±8．3)mm,伴中、重度二尖瓣反流者(69例)LVED较其他者大(P<0．01)。心功能Ⅲ～Ⅳ级者较其他患者的LVED大、射血分数(FF)低(均P<0．01)。19例伴持续性心房颤动(房颤)者较无房颤者的左心房内径、LVED大,心功能分级较差(均P<0．05)。老年患者占1／4,其病情演进时间[(16±6)个月]较年轻患者短[(30±5)个月](P<0．05)。住院死亡4例,1例死于心力衰竭,3例猝死。另有3例猝死获救。结论DCM患者确诊时大多已呈中、重度心力衰竭,其心功能分级及复杂心律失常的发生、发展均与左室、左房内径大小有关。     

Initial white blood cell count is an independent risk factor for survival in patients with dilated cardiomyopathy

Background

The impact of white blood cell count (WBCc) on the outcome of patients with non-ischemic left ventricular (LV) dysfunction is unknown. In the present study we investigated the influence of WBCc on mortality and cardiac inflammation in patients with reduced LV systolic function in the absence of ischemic or valvular etiology.

Methods and results

We included 381 patients with reduced left ventricular (LV) ejection fraction (LVEF ≤ 45%) quantified by two-dimensional echocardiography. Coronary artery disease and valvular diseases were excluded by angiography and echo, respectively, in all patients. WBCc was quantified routinely upon first hospital admission. In 291 patients, endomyocardial biopsies from the right ventricle were performed upon first hospital admission for assessment of cardiac inflammation. Follow-up was up to 5.5 years (median 2.93 [1.7;4.0]). Information on vital status of patients was obtained from official resident data files. WBCc > 11 Gpt/l was associated with significantly increased mortality in patients with severe LV dilation (end-diastolic diameter (LVEDD) > 70 mm quantified by echocardiography) in comparison to patients showing WBCc ≤ 11 Gpt/l (41.7% vs 13.6%, p = 0.02). Multivariable Cox regression analysis showed that WBCc predicts mortality independently of other cardiovascular risk factors and LVEF (hazard ratio 1.14; p = 0.04). Doses of heart failure medication did not differ significantly in patients with LVEDD > 70 mm and WBCc > 11 Gpt/l when compared to LVEDD > 70 mm and WBCc ≤ 11 Gpt/l (percent of maximum doses: ß-blockers p = 0.51, ACE inhibitors p = 0.56, AT1 antagonists p = 0.77, aldosterone antagonists p = 0.35). WBCc including its subpopulations (monocytes, lymphocytes and granulocytes) did not show a significant correlation with cardiac amounts of CD3⁺-lymphocytes (r = 0.02, p = 0.78) or CD68⁺-macrophages (r = 1.0, p = 0.09) (n = 291).

Conclusion

WBCc at first hospital admission predicts long term-mortality in patients with dilated cardiomyopathy independently of cardiovascular risk factors.     

氯沙坦对扩张型心肌病心力衰竭患者纤溶参数的影响

目的：了解扩张型心肌病心力衰竭患者纤溶参数的变化，及氯沙坦对纤溶参数的影响。方法：测定40名健康者和60例扩张型心肌病心衰患者血浆纤溶酶原激活物（tPA)活性，纤溶酶原激活物抑制物－1（PAI－1）活性以及血管紧张素Ⅱ（AngⅡ）含量，将扩张型心肌病患者随机分成常规治疗组和氯沙坦组。治疗14天后复查tPA、PAI-1、AngⅡ。结果：L与正常对照组相比，扩张型心肌病心衰患者tPA活性下降、PAI－1活性升高、AngⅡ含量上升（P＜0．01）。治疗14天后，常规治疗组tPA与PAI－1的活性和AngⅡ含量无显著变化（P＞0．05）；氯沙坦组tPA活性上升、PAI－1活性下降（P＜0．01），AngⅡ含量降低（P＜0．05）。结论：扩张型心肌病心力衰竭患者纤溶参数明显异常，氯沙坦能改善纤溶参数活性。     

快速性心律失常对扩张型心肌病患者预后的影响

目的　探讨快速性心律失常 ( TCA)对扩张型心肌病 ( DCM)患者预后的影响。方法　对 4 2例 DCM伴 TCA患者 ,住院期间是否发生死亡 ,分为死亡组与存活组 ,分析两组临床特征及心电图。结果　死亡组室性心动过速 ( VT)发作频率快、阵数高、多形性 VT的发生率高 ( P <0 .0 5～ 0 .0 0 1) ;死亡组左心室射血分数 ( L VEF)明显低于存活组 ( P <0 .0 0 1)。结论　 DCM伴 VT,具有发作频率快、阵数高、多形性 VT的特点 ,是 DCM患者猝死的危险因素     

CT引导下胸交感神经阻滞治疗扩张型心肌病心力衰竭的临床价值

目的:探讨CT引导下胸交感神经阻滞治疗扩张型心肌病心力衰竭的临床价值。方法:选择2010年1月至2015年6月收治的扩张型心肌病心力衰竭患者80例,对照组(n=40)采用常规治疗,观察组(n=40)在对照组基础上联合使用CT引导下胸交感神经阻滞,比较两组治疗前后血浆肾上腺素(E)、去甲肾上腺素(NE)和脑钠肽(BNP)水平,治疗后24 h心率变异时域指标和治疗前后心功能相关指标。结果:治疗后两组BNP、E及NE水平均低于治疗前(P均0.05),且治疗后观察组BNP、E及NE水平均低于对照组(P均0.05);治疗后观察组全部正常窦性心搏间期标准差(SDNN)、24 h内每5 min节段平均正常窦性心动周期标准差(SDANN)和全程相邻心搏间期之差均方根值(RMSSD)均长于对照组(P均0.05),特定时间段相邻心搏间期50 ms心搏数所占百分比(PNN50)大于对照组(P0.05);治疗后两组左室内径、左室射血分数和心胸比较治疗前均明显改善(P均0.05),且治疗后观察组左室内径、左室射血分数和心胸比较对照组明显改善(P均0.05)。结论:对扩张型心肌病并发心力衰竭患者,CT引导下胸交感神经阻滞治疗能显著降低交感神经兴奋性,降低儿茶酚胺类激素水平,改善心脏功能。     

卡维地洛治疗扩张型心肌病心力衰竭疗效观察

目的　评价第三代 β受体阻滞剂卡维地洛治疗扩张型心肌病 (DCM)心力衰竭的临床疗效。方法　 6 2例 DCM心力衰竭患者在接受常规治疗 (洋地黄、利尿剂、血管紧张素转换酶抑制剂 )病情稳定后 ,随机分为卡维地洛组和美多心安组。均从小剂量 (卡维地洛组 ,2 .5 m g bid;美多心安组 ,6 .2 5 m g bid)缓慢递增。检测治疗前后 DCM患者左心室功能和结构的变化以及血液中内皮素 - 1(ET- 1)、心钠素 (ANP)和血管紧张素 (Ang )的改变。结果　治疗 6个月后 ,两组心脏功能分级均明显改善 ,左心室射血分数 (L VEF)、短轴缩短率 (FS)、左心室射血前期与射血时间比(PEP/ L VET)、舒张早期峰值血流速度 (PFVE)、舒张早期峰值血流速度与舒张晚期峰值血流速度比 (PFVE/ PF-VA)均明显增加 ,卡维地洛组较美多心安组 L VEF增加更为明显。两组左心房内径 (L AD)、左心室收缩末期内径(L VSD)、左心室舒张末期内径 (L VDD)明显减小 ,卡维地洛组 L VSD减小较美多心安组更明显。治疗后血浆中ET- 1、ANP和 Ang 均明显降低。结论　卡维地洛和美多心安都能够改善 DCM心力衰竭患者左心室收缩和舒张功能 ,逆转左心室重构 ,卡维地洛较美多心安疗效更佳。     

Metabolic manipulation in dilated cardiomyopathy: Assessing the role of trimetazidine

ObjectivesTo study the role of metabolic modulator (trimetazidine: TMZ) in dilated cardiomyopathy (DCM). Optimizing altered substrate metabolism in heart failure (HF) with metabolic modulators allows more efficacious energy production from glucose than from free fatty acids.Methods100 patients of DCM (47.7 years, NYHA class 2.17, LVEF 27.3%) were randomized to TMZ (20 mg tid, n = 50) vs conventional therapy (n = 50). Functional status, BNP and various echocardiographic parameters were assessed at 3–6 months.ResultsAt 3 months, TMZ group had significantly improved NYHA class (2.25 vs 1.85), 6 min walk test (349.7 vs 402 m), LVD-36 score (25.5 vs 21) and BNP (744.7 vs 248.3 pg/ml), all p 0.001. Significant improvement was also seen in LV end-systolic (LVESV, 87.1 ± 27.5 vs 78.5 ± 24.9 ml/m², p 0.001), LV end-diastolic volumes (LVEDV, 117.6 ± 29.3 vs 110.9 ± 27.4 ml/m², p 0.001), LVEF (27 vs 30.9%, p 0.001) and LV wall stress (90.2 ± 18.9 vs 71.1 ± 13.2 dyn/cm², p 0.0001). The % change in LVESV, LVEDV, LVEF and LV wall stress was −9.5%, −5.4%, +8.4% and −21.8%. Other echo parameters also improved after 3 months of TMZ (E/A ratio 1.9 vs 1.2, p = 0.001, E/A VTI 2.7 vs 1.6, p = 0.001, myocardial performance index, MPI 0.8 vs 0.7, p = 0.0001), Tissue Doppler parameters (E/E′ septal (19.7 vs 12.5, p = 0.001) and E/E′ lateral (13.3 vs 9.4, p = 0.0001)). Patients in control group had no change in NYHA class, LVD-36 scores, LV volumes or LVEF at 3 months although BNP and LV wall stress reduced to a slight extent. Patients on TMZ had further improvement in NYHA class, walk test, BNP levels and echocardiographic parameters at 6 months.ConclusionsMetabolic modulators (TMZ) may help in improving LV function in DCM. In this study, benefit was noted by 3 months with further improvement at 6 months.     

扩张型心肌病的治疗进展

扩张型心肌病(DCM)的基本治疗包括抗心力衰竭、心律失常及预防血栓栓塞等并发症。β-受体阻滞剂、血管紧张素转换酶抑制剂与血管紧张素受体拮抗剂及醛固酮受体拮抗剂可降低DCM心力衰竭的死亡率。胺碘酮对室性心律失常的治疗是安全有效的,埋藏式心脏复律除颤器(ICD)则可减少猝死,但ICD是否可在DCM的一级预防中应用尚存争议。心脏再同步治疗为部分心力衰竭患者提供了新的治疗方法。外科治疗主要适用于难以治疗的、晚期的DCM心力衰竭患者。他汀类药物及已酮可可碱、免疫球蛋白的使用可短期改善DCM患者的心功能。     

Circulating microRNAs levels in Chinese heart failure patients caused by dilated cardiomyopathy

BackgroundPrevious studies demonstrated dysregulated expression of microRNAs (miRNAs) in the myocardium of patients with dilated cardiomyopathy (DCM). This study investigated levels of miRNAs in the circulation of DCM patients, and the value of miRNAs as biomarkers for DCM.Methods and materialsIn 45 DCM patients and 39 age- and sex-matched controls, circulating miR-423-5p, miR-126, miR-361-5p, miR-155, and miR-146a concentrations were measured and correlated to cardiac functional parameters, including left ventricular ejection fraction (LVEF) and N-terminal pro-brain natriuretic peptide (NT-proBNP).ResultsPlasma levels of miR-126 and miR-361-5P did not differ between the DCM and control groups (p = 0.331 and p = 0.784, respectively). Plasma levels of the immunity-associated miRNAs, miR-146a and miR-155, did not differ between the DCM and control groups (p = 0.437 and p = 0.702, respectively). Levels of circulating miR-423-5p were significantly greater in the DCM group (p = 0.003). Further, there was a positive correlation between plasma levels of miR-423-5p and NT-proBNP (r = 0.430, p = 0.003). MiR-423-5p distinguished DCM cases from controls with an area under the curve (AUC) receiver operating characteristic (ROC) curve of 0.674 (95% CI, 0.555–0.793).ConclusionsPatients with DCM have elevated plasma miR-423-5p levels. The plasma concentration of miR-423-5p was positively correlated with the level of NT-proBNP. Circulating levels of miR-423-5p could be served as a diagnostic biomarker for heart failure caused by DCM. Plasma levels of immunity-associated miR-146a, -155, and -126 were not significantly different between DCM and control groups.