卡维地洛与比索洛尔治疗慢性心力衰竭的疗效比较研究

目的探讨卡维地洛与比索洛尔治疗慢性心力衰竭(CHF)的临床疗效和安全性。方法将广西桂林市中西医结合医院心内科2002年1月至2004年2月因CHF(NYHA心功能Ⅱ~Ⅲ级)收治的83例患者随机分成2组:卡维地洛组(42例)和比索洛尔组(41例)。卡维地洛组口服卡维地洛从小剂量3.125mg每日2次开始,每2周剂量加倍,直至靶剂量25mg每日2次或最大耐受剂量,疗程6个月。比索洛尔组口服1.25mg每日1次,剂量递增同前,直至靶剂量10mg每日1次或最大耐受剂量,疗程6个月。比较两组的心功能改善情况和不良反应。结果用卡维地洛和比索洛尔治疗后超声检查各项心功能指标和NYHA心功能分级均有改善。不良反应发生情况卡维地洛组有1例患者,比索洛尔组有2例患者不能耐受而退出。结论卡维地洛与比索洛尔治疗慢性心力衰竭疗效相似,而且安全性良好。     

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。     

小剂量卡维地洛治疗重度充血性心力衰竭短期临床观察

目的观察小剂量卡维地洛治疗重度充血性心力衰竭(CHF)的临床耐受性和安全性.方法28例重度CHF患者在标准治疗基础上(利尿剂、血管紧张素转换酶抑制剂(ACEI)和洋地黄类制剂等)加用卡维地洛,起始剂量3125mg,2/d,2周后增至625mg,2/d,维持3个月,治疗前后分别对患者心功能(NYHA分级法)、血压、心率、及生化指标进行检测,以评价小剂量卡维地洛治疗重度CHF的耐受性、安全性及疗效.结果应用小剂量卡维地洛治疗3个月后患者心功能较治疗前改善,12例心功能由Ⅲ、Ⅳ级改善为Ⅱ级,心率、左心室舒张末期压下降,不良反应少,对肝肾功能、血糖、血脂、血常规均无影响,耐受性好.结论小剂量卡维地洛治疗重症CHF短期疗效、耐受性及安全性良好.     

卡维地洛治疗慢性心力衰竭的临床疗效观察

目的观察卡维地洛治疗慢性心力衰竭患者的临床疗效。方法将108例心衰患者随即分为两组，常规治疗组：常规应用强心剂、利尿剂、血管扩张剂。治疗组：在常规治疗的基础上加用β-受体阻滞剂，从小剂量开始，12．5mg／次，每日2次，逐渐增至50mg／次，每日2次。测量两组治疗前后6个月超声心动图及运动耐量试验。结果与对照组相比，治疗6个月后超声心动图指标明显改善，运动耐量明显提高。结论卡维地洛能明显减缓慢性心衰患者的进展，能提高心衰患者的运动耐量和生活质量。     

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。     

倍他乐克治疗慢性充血性心力衰竭临床观察

目的观察倍他乐克治疗慢性心力衰竭的耐受性.方法对于病情相对稳定的慢性心力衰竭(心功能NYHAⅡ级、Ⅲ级)病人,在常规治疗基础上加用倍他乐克,从小剂量6.25 mg开始,每日2次,隔2周～4周递增1次剂量,直至靶剂量50 mg,每日2次或最大耐受剂量,治疗6个月.每周监测心功能分级、心率、血压、心电图、血脂及其他不良反应,评判耐受性和安全性.结果40.5%的病人可达到推荐靶剂量,54.8%的病人可耐受25 mg～37.5 mg每日2次的剂量,不良反应较少,安全性较高.结论倍他乐克治疗慢性充血性心力衰竭,耐受性、安全性较好,适宜长期维持治疗使用.     

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。     

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     

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。     

氯沙坦与卡维地洛合用治疗慢性心力衰竭60例临床观察

目的评价氯沙坦与卡维地洛联合治疗慢性心衰的疗效和安全性。方法将120例慢性心衰患者随机分成两组。在常规抗心衰治疗基础上,治疗组口服氯沙坦与卡维地洛,对照组口服卡维地洛,对比两组治疗后的疗效及各项指标的变化。结果治疗组治疗后各指标均明显提高(P<0.05),且总有效率优于对照组(P<0.05)。结论采用氯沙坦与卡维地洛联合治疗慢性心力衰竭安全有效,耐受性好。     

卡维地洛治疗老年心力衰竭患者的耐受性研究

目的评估卡维地洛治疗老年心力衰竭患者的耐受性。方法52例稳定性老年(>70岁)心力衰竭患者接受卡维地洛递增剂量治疗。治疗前后分别对血压、心率,心脏射血分数和纽约心脏病学协会(NYHA)分级进行检测,评判疗效和安全性。结果卡维地洛治疗后,患者收缩压从133.3mmHg降为120.8mmHg,舒张压从78.0mmHg降为70.4mmHg,治疗前后比较,差异均有统计学意义(P<0.01);心率从81.9次/min下降为70.7次/min(P<0.01),射血分数从39.8%上升为43.9%(P<0.05),NYHA分级下降;平均剂量为36.8mg/d,其中55.8%的患者可以耐受卡维地洛50mg/d,除2例退出,96.1%的老年患者心力衰竭可坚持卡维地洛治疗。结论老年心力衰竭患者基本可以耐受卡维地洛治疗。     

国产卡维地洛治疗心力衰竭的临床观察

目的观察国产卡维地洛治疗心力衰竭（CHF）的临床疗效及不良反应。方法将118例住院CHF患者随机分为对照组40例，给予常规治疗。治疗组78例，在常规治疗基础加用国产卡维地洛起始剂量2．5mg／次；2次／d，若耐受，每2周剂量加倍，直至20．0mg／次，2次／d，共8周，观察治疗前、后各组及组间的心功能分级，血压、心率及超声心动图变化。结果两组患者疗效间差异有显著性意义（P〈0．05）；治疗组治疗后2、4、6、8周与治疗前比较血压、心率均有明显改善（P〈0．01）；治疗组除个别患者出现心动过缓外，无一例发生严重低血压及严重房室传导阻滞。结论国产卡维地洛对心力衰竭患者有明显疗效，且副作用少。     

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。     

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。     

Beneficial effect of carvedilol on heart rate response to exercise in digitalised patients with heart failure in atrial fibrillation due to idiopathic dilated cardiomyopathy

Fourteen digitalised patients diagnosed with heart failure (NYHA Functional class II) with idiopathic dilated cardiomyopathy in chronic established atrial fibrillation were administered carvedilol in addition to their anti-heart failure medications in an attempt to improve their heart rate control. Fourteen matched patients who did not receive carvedilol acted as control subjects. Patients treated with carvedilol showed significantly reduced resting heart rates (10-36%), maximal heart rates on exercise (5-20%) and an increased exercise time (2-30%) on treadmill stress tests (all P=0.001). Ventricular ectopic activity was also diminished. This was associated with symptomatic improvement in effort intolerance and palpitations. NYHA functional class, left ventricular dimensions and ejection fractions did not improve during the study period of 3 months. Thus, addition of carvedilol to digoxin had a beneficial effect on exercise tolerance in patients with idiopathic dilated cardiomyopathy in atrial fibrillation by virtue of an improved heart rate control both at rest and on exercise. Carvedilol was well tolerated despite impaired myocardial function.     

Effect of carvedilol on blood levels of cytokines and symptoms of heart failure in patients with postinfarction cardiac dysfunction.

Effect of 6 months treatment with carvedilol (25 mg/day) on blood levels of cytokines (interleukins 1alpha, 2, 6, 8, tumor necrosis factor alpha) and clinical symptoms of heart failure was studied in patients with cardiac dysfunction after myocardial infarction. Patients with NYHA class II heart failure, ejection fraction 50% and moderately lowered tolerance to physical exercise (n=21) initially had enhanced cytokine expression: blood content of interleukin (IL) 2 was 2.8 times, tumor necrosis factor (TNFalpha) 78%, IL-1alpha 60% above normal level. Therapy with carvedilol in this group was associated with decreases of Il-2 (-23.8%), TNFalpha (-16.7%), IL-1alpha (-12.5%) (p<0.05-0.01). This was accompanied by alleviation of clinical symptoms and improved exercise tolerance. Patients with NYHA class III heart failure (n=16) with low left ventricular ejection fraction (30+/-2.7%) and low exercise tolerance had high levels of all studied cytokines. Levels of IL-2, TNFalpha and IL-1alpha were most elevated (3.1, 2.8 and 2 times higher than normal values, respectively). Therapy with carvedilol was associated with improvement of clinical symptoms and exercise tolerance (+35%, p<0.05)), increase of ejection fraction (+15%, p<0.05), decrease of left ventricular end systolic volume (-17.5%, p<0.05), and lowering of blood levels of TNFalpha (-31%), IL-2 (-17.4%), IL-1alpha (-15.6%). However cytokine levels remained substantially elevated compared with normal values. Carvedilol was well tolerated, and did not cause negative metabolic effects or other complications.     

Long-term outcome and tolerability of carvedilol therapy in Japanese patients with chronic heart failure

OBJECTIVES: Randomized controlled clinical studies in western countries have shown that the beta-blockers improve the survival of patients with chronic heart failure and are highly tolerable. The tolerability of beta-blocker therapy and the long-term prognosis for patients with chronic heart failure receiving beta-blockers remain unclear in Japan. In the present study, carvedilol was employed for the treatment of mild to severe chronic heart failure and the long-term prognosis of the patients was monitored to evaluate the tolerability and chronic efficacy of beta-blocker therapy in Japanese patients. METHODS: Three hundred and twenty-seven patients with chronic heart failure [Classes II to IV according to the New York Heart Association (NYHA) classification] were studied. Carvedilol was started at a dose of 1.25 to 5 mg/day and then increased to the final target dose of 20 mg/day, depending on its tolerability in each patient. The patients were monitored with respect to their NYHA classification, daily mean heart rate (evaluated by Holter electrocardiography), changes of the plasma brain natriuretic peptide level, and prognosis. They were followed up for a mean period of 4.4 +/- 1.8 years. RESULTS: Carvedilol was not tolerated by 21 of the 327 patients (6.4%), and was discontinued during the follow-up period in 38 patients (11.6%). The mean maintenance dose for the remaining 268 patients (82.0%), in whom treatment could be continued over the long term, was 14.1 +/- 7.5 mg. The NYHA classification and plasma brain natriuretic peptide level were significantly improved, and the daily mean heart rate was also significantly reduced in the 268 patients. Significant improvement was also observed in patients with severe heart failure (classes III or IV of the NYHA classification). The five-year survival rate of patients continuously treated with carvedilol was 83%, and their outcome was significantly better than that of those who could not tolerate the drug (49%; p < 0.001) or those who discontinued treatment prematurely (68%; p < 0.001). The treated group also had a significantly lower cardiac death rate than the intolerant group or discontinued group. CONCLUSIONS: Carvedilol was well tolerated by Japanese patients with chronic heart failure. Treatment with low-dose carvedilol may improve the symptoms and prognosis of patients with mild to severe chronic heart failure over the long term.     

Tolerability and efficacy of carvedilol in patients with New York Heart Association class IV heart failure

OBJECTIVES: The purpose of this study was to assess the tolerability and efficacy of carvedilol in patients with New York Heart Association (NYHA) functional class IV symptoms. BACKGROUND: Carvedilol, a nonselective beta-adrenergic blocking drug with alpha-adrenergic blocking and antioxidant properties, has been shown to improve left ventricular function and clinical outcome in patients with mild to moderate chronic heart failure. METHODS: We retrospectively analyzed the outcomes of 230 patients with heart failure treated with carvedilol who were stratified according to baseline functional class: 63 patients were NYHA class IV and 167 were NYHA class I, II or III. Carvedilol was commenced at 3.125 mg b.i.d. and titrated to 25 mg b.i.d. as tolerated. Patients with class IV symptoms were older (p = 0.03), had lower left ventricular fractional shortening (p < 0.001), had lower six-min walk distance (p < 0.001) and were receiving more heart failure medications at baseline compared with less symptomatic patients. RESULTS: Nonfatal adverse events while taking carvedilol occurred more frequently in class IV patients (43% vs. 24%, p < 0.0001), and more often resulted in permanent withdrawal of the drug (25% vs. 13%, p < 0.01). Thirty-seven (59%) patients who were NYHA class IV at baseline had improved by one or more functional class at 3 months, 8 (13%) were unchanged and 18 (29%) had deteriorated or died. Among the less symptomatic group, 62 (37%) patients had improved their NYHA status at 3 months, 73 (44%) were unchanged and 32 (19%) had deteriorated or died. The differences in symptomatic outcome at three months between the two groups were statistically significant (p = 0.001, chi-square analysis). Both groups demonstrated similar significant improvements in left ventricular dimensions and systolic function. CONCLUSIONS: Patients with chronic NYHA class IV heart failure are more likely to develop adverse events during initiation and dose titration when compared with less symptomatic patients but are more likely to show symptomatic improvement in the long term. We conclude that carvedilol is a useful adjunctive therapy for patients with NYHA class IV heart failure; however, they require close observation during initiation and titration of the drug.     

卡维地洛对慢性心力衰竭心功能和ANP及BNP的影响

目的观察卡维地洛(达利全)对慢性心力衰竭(CHF)患者心功能和ANP/BNP的影响。方法60例CHF患者,在常规治疗病情基本稳定的基础上,增加服用卡维地洛,从每次3.125mg开始,2次/d,缓慢递增。治疗前后分别进行心率、血压、心功能分期评估和血清ANP/BNP测定。结果与治疗前相比,治疗5个月后,心率明显下降(P<0.01),心功能分级明显改善,血清ANP/BNP明显下降(P<0.01)。66.7%患者服用卡维地洛剂量可达到目标剂量25mg,2次/d;33.3%患者使用中等剂量12.5mg,2次/d,维持治疗。结论长期服用卡维地洛能改善心功能,降低血清ANP和BNP水平。     

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。