西拉普利对充血型心力衰竭的疗效观察

目的：ACE抑制剂已经广泛地用于治疗严重充血性心力衰竭,但是用于治疗轻、中度心力衰竭少见报道。本组观察西拉普利对轻、中度心力衰竭的疗效。方法：68例心力衰竭病人,NYHAⅡ-Ⅲ级,观察治疗前后试验组病人症状、体征和运动试验耐受情况,并同安慰剂组进行对照。结果：试验组运动耐受程度改善27％,而安慰剂组仅为5％（P＜0．001）;试验组心力衰竭和NYHA分级也明显提高,两组血清钾、肌酐和尿酸无显著差异。结论：西拉普利明显改善轻、中度心力衰竭的症状、提高运动耐量,而且耐受良好。     

美托洛尔治疗慢性心力衰竭临床研究

目的观察β受体阻滞剂美托洛尔c慢性心力衰竭(CHF)远期预后的影响.方法选择CHF患者72例随机分为对照组29例和观察组43例,对照组采用综合疗法,观察组在综合治疗的基础上加美托洛尔125～50mg,2/d.在治疗前和观察期二年f分别对心功能(NYHA)2～3级患者作踏车负荷实验,记录患者所能耐受的最大运动功率和运动持续时间.结果二年期间,对照组和观察组因心力衰竭加重再住院率分别为82.76%和25.58%(P＜0.005),病死率分别为31.03%和9.03%(P＜0025);与治疗前相比,观察组心功能(NYHA分级)、最大运动功率、运动持续时间均明显改善(P＜0001),而对照组无明显改善.结论关托洛尔可显著改善慢性心力衰竭患者的远期预后.     

体外反搏与心功能保护——PEECH研究结果解读

体外反搏治疗用于左室功能正常的冠心病心绞痛患者,可以改善患者的心绞痛症状和运动耐量。为探讨体外反搏治疗对收缩性心功能不全患者的疗效,PEECH研究评价了体外反搏在轻-中度心力衰竭患者治疗中的益处。187个轻-中度有症状的心力衰竭患者被随机分配给予体外反搏治疗联合已发表指南所要求的常规药物治疗或单纯常规药物治疗。两个主要观察终点是：6个月随访时,运动时间至少延长60s的病人百分数以及峰值氧耗量至少提高1.25ml/（min.kg）的病人百分数。PEECH研究结果显示,体外反搏治疗可以提高患者的运动耐量、功能状态和生活质量,但是不影响峰值氧耗量。PEECH研究存在一些局限性,比如未能对病人进行设盲,体外反搏治疗的有效性可能归因于安慰剂效应。因此,需要设计更好的临床试验来帮助评价体外反搏用于慢性心力衰竭治疗的整体效应及其作用机制。     

比索洛尔治疗慢性心力衰竭的临床研究

目的观察β受体阻滞剂比索洛尔（博苏）对慢性心力衰竭的治疗效果。方法选择慢性心力衰竭病人80例,随机分为对照组（35例）和观察组（45例）。对照组采取强心、利尿、血管紧张素转换酶抑制剂治疗。观察组在对照组治疗基础上加用博苏1.25mg/d～7.50mg/d,疗程1年。在治疗前和观察期1年时分别对心功能（NYHA）Ⅱ级～Ⅲ级病人做血流动力学变化和临床治疗效果的评价。结果对照组和观察组总有效率分别为88.57%和95.56%。两组心力衰竭病人血流动力学指标均有改善,但治疗组心率明显减慢,病人生活质量显著提高。结论比索洛尔可显著改善慢性心力衰竭病人的远期预后。     

西拉普利与比索洛尔联合治疗慢性心力衰竭的临床观察

目的 观察血管紧张素转换酶抑制剂西拉普利和β-受体阻滞剂比索洛尔联合应用对慢性心力衰竭（CHF）的远期疗效。方法 共选择CHF患者114例，随机分为对照组56例和治疗组58例。对照组采用传统的常规治疗，即利尿、扩血管、强心；治疗组在此基础上加用西拉普利2．5—5mg／d和比索洛尔2．5—7．5mg／d。在治疗前和治疗期满4年时，分别对心功能NYHAⅡ～Ⅲ级的患者做6rain步行试验。结果 在随访观察的4年期间，对照组和治疗组中困心力衰竭加重再住院率分别为：治疗组24．13％，对照组82．14％，P〈0．005；病死率分别为：治疗组8．62％，对照组33．93％，P〈0．0l，与治疗前比较，治疗组在4年后心功能NYHA分级及6mitt步行距离均有明显改善，P〈0．001，而对照组无明显改善，甚至有加重趋势。结论 西拉普利和比索洛尔联合应用治疗CHF，可以显著改善CHF患者的远期预后。     

美托洛尔治疗慢性心力衰竭疗效分析

目的探讨美托洛尔治疗慢性心力衰竭(CHF)的疗效和耐受性.方法各种病因引起的慢性心力衰竭病人62例,在传统方法治疗基础上加用美托洛尔治疗,分别于治疗3周后和6周后观察其疗效和耐受性.结果治疗前与治疗后不同时间比较病人左心室射血分数(LVEF)、心率(HR)均有明显改善.随着治疗时间的延长,NYHA分级心功能提高1级至2级的人数逐渐增多.用药治疗3周后有50%以上的病人心功能开始得到改善,从6.25mg的小剂量开始给药并逐渐增加至每日100 mg～200mg,6周后只有不到l0%的病人不能耐受.结论β1受体阻滞剂美托洛尔治疗CHF,从小剂量开始服用,90%以上的病人可以耐受.     

稳心颗粒治疗慢性心力衰竭合并心房纤颤临床观察

目的 观察稳心颗粒治疗慢性心力衰竭合并心房纤颤的临床疗效.方法 选择42例慢性心力衰竭合并心房纤颤患者,心功能符合纽约心脏病协会(NYHA)分级Ⅱ级～Ⅲ级,左室射血分数(LVEF)≤40％,随机分为两组.两组均口服美托洛尔、苯那普利;试验组口服稳心颗粒,从小剂量开始逐渐增加到最大耐受剂量.治疗随访8周,观察用药前后心率、心律及心功能变化.结果 两组治疗后38例患者心功能有效改善、左室射血分数平均提高10％、心率下降(10～20)/min.结论 稳心颗粒治疗慢性心力衰竭合并心房纤颤的临床治疗效果明显.     

比索洛尔治疗慢性心力衰竭的疗效观察

目的观察比索洛尔治疗慢性心力衰竭的疗效。方法90例慢性心力衰竭病人随机分为治疗组(46例)和对照组(44例)。对照组采用常规抗心力衰竭治疗。治疗组在对照组治疗基础上加用比索洛尔。治疗6个月后观察病人的心率、血压、超声心动图及运动耐量试验。结果治疗组治疗后心率、血压明显下降(P<0.01),临床症状和心功能明显改善,生活质量明显提高。结论比索洛尔治疗慢性心力衰竭较安全有效。     

慢性心力衰竭患者运动康复治疗的疗效观察(英文)

目的:观察运动康复疗法对于慢性心力衰竭(CHF)患者的疗效。方法:慢性心力衰竭患者60例,随机分成常规治疗组(30例)和运动康复组(30例,在常规抗心衰药物的基础上实施运动康复疗法),观察3月后患者的心功能、运动耐量、6 min步行距离和再住院率。结果:与常规治疗组比较,运动康复组心功能改善总有效率明显升高(80.0%比93.3%,P<0.05);临床心功能明显改善[NYHA分级:(1.96±0.89)级比(1.48±0.72)级P<0.05],运动能力[(4.01±0.82)METs比(5.24±1.16))METs]、6 min步行距离[(322.5±23.4)m比(413.6±26.5)m]显著增加(P均<0.01),再住院率明显降低(56.7%比30.0%),P<0.05。结论:运动康复治疗可以改善慢性心力衰竭的心功能,提高运动能力,降低再住院率。     

运动干预对尿毒症合并慢性心力衰竭患者心功能的疗效分析

目的　探讨有计划的运动干预对尿毒症合并慢性心力衰竭患者心功能的影响。方法　对86例尿毒症合并慢性心力衰竭患者，随机分为常规治疗组和运动干预组，两组患者给予等同条件的血液透析和基础治疗，常规治疗组避免任何运动干预，运动干预组另加在家步行（或慢跑）与抗阻力运动相结合的运动干预，观察疗程为10周。结果　常规治疗组NYHA心功能分级Ⅱ级患者所占比例由治疗前46.51%下降到44.19%；运动干预组NYHA心功能分级Ⅱ级患者所占比例由治疗前44.19%提高到69.77%，差异有统计学意义（P<0.05）。常规治疗组左心室射血分数（LVEF）由治疗前41.2%±6.5%提高到41.3%±7.1%；运动干预组LVEF由治疗前41.9%±7.0%提高到42.9%±6.4%，差异无统计学意义（P>0.05）。常规治疗组血清脑利钠肽（BNP）水平由治疗前1120.9±310.6　ng/L升高到1143.9±282.3　ng/L，运动干预组血清BNP水平由1083.3±294.3　ng/L下降到928.8±279.3　ng/L，差异有统计学意义（P<0.05）。结论　运动干预对合并慢性心力衰竭的维持性血液透析患者是安全的；运动干预可改善合并慢性心力衰竭的维持性血液透析患者NYHA心功能分级、血清BNP水平。     

Poor relationship between exercise capacity and spirometric measurements in patients with more symptomatic heart failure

BACKGROUND: The origin of exercise limitation in patients with chronic heart failure (CHF) is multifactorial, and the relative contributions of different abnormalities may vary with severity of heart failure symptoms. The aim of the current study was to determine the extent to which spirometric indices predict peak exercise capacity in patients with differing severity of symptoms. METHODS AND RESULTS: A total of 340 patients with left ventricular systolic dysfunction underwent spirometry, and a ramped, maximal exercise treadmill test with metabolic gas exchange measurements. For comparative purposes, a group of 174 aged-matched controls with no major structural heart disease (MSHD) was also included. In a stepwise linear regression model, forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were independent predictors of peak oxygen uptake (pVO2) in controls (r2= 18-25%; P = .001) and New York Heart Association (NYHA) I-II patients (r2= 16-18%; P = .001). No association between spirometric indices (FEV1/FVC) and pVO2 (r2= 1-2%; P > .05) was found in NYHA III-IV patients. CONCLUSION: In aged-matched controls with no MSHD, spirometric variables (FEV1/FVC) explain 18% to 25% of the variance in pVO2, and 16% to 18% of the variance in patients with NYHA class I-II symptoms. As symptoms worsen, the influence of spirometric variables on peak exercise capacity diminishes, and there is no such relation in the NYHA class III-IV patients.     

Comparison of captopril and ibopamine in mild to moderate heart failure.

OBJECTIVE: To determine the effects of ibopamine 100 mg three times daily compared with captopril 25 mg three times daily on exercise capacity in patients with chronic heart failure. DESIGN: A randomised, double blind, parallel group comparison of the addition of ibopamine versus captopril during a period of 24 weeks. SETTING: 26 outpatient cardiology clinics in seven European countries. PATIENTS: 266 patients, with mild to moderate chronic heart failure (New York Heart Association (NYHA) functional class II, 81% and III, 19%) and evidence of an enlarged left ventricle. Patients received concomitant treatment with diuretics and/or digitalis. MAIN OUTCOME MEASURE: Exercise duration after 24 weeks of treatment, compared with baseline. RESULTS: Mean (SD) ejection fraction was 29 (8)% and the baseline exercise duration in the captopril and ibopamine groups 665 (160) and 675 (174) seconds, respectively. At the end of the study, exercise duration had improved in both groups, by 29 seconds in the ibopamine group (P < 0.01), and by 24 seconds in the captopril group (P < 0.05). There was no difference between groups (P = 0.69, 95% confidence interval -22 to 33). NYHA class, signs and symptoms score, and dyspnoea and fatigue index improved equally in both groups. The total number of adverse events was the same in both treatment groups, but gastrointestinal complaints occurred more often in the ibopamine group. The number of patients with premature withdrawals was no different. CONCLUSIONS: No difference was detected between the effect of captopril and ibopamine on exercise time in patients with mild to moderate heart failure during a treatment period of 24 weeks.     

A large-scale trial of captopril for mild to moderate heart failure in the primary care setting

A large-scale, prospective, 8-week, office-based study was conducted to evaluate the effects of adding captopril to a therapeutic regimen of diuretic and digoxin or diuretic alone in the management of patients with mild to moderate congestive heart failure (CHF). A total of 2218 primary care physicians evaluated 6669 patients over the study period for efficacy parameters, which included changes in a modified New York Heart Association (NYHA) functional classification, symptomatology, and daily activity levels. Overall, 63.8% of evaluated patients improved with regard to functional ability, with 19% improving two or more modified NYHA classes. Symptoms of CHF, including dyspnea on exertion, fatigue, and orthopnea and signs, including rales and peripheral edema, were reduced in 86% of these patients: 41.5% demonstrated mild improvement; 30.0%, moderate improvement; and 14.5%, marked improvement. Three parameters, with which patients reported having difficulty at study entry, were assessed serially to evaluate changes in functional capacity; 78.5% of patients reported an increased walking distance, 72.3% had increased capacity for climbing stairs, and 60.2% had improved capacity for individual recreational activities. Adverse experiences were reported in 18.1% of all patients; 4.9% of patients withdrew from the study because of an adverse effect. Combination therapy with captopril and diuretic for CHF was shown to be safe and effective regardless of patient age (less than 70 years vs. greater than or equal to 70 years), duration of heart failure (less than 1 year vs. greater than 1 year), presence of digoxin treatment, or the dosing schedule employed.(ABSTRACT TRUNCATED AT 250 WORDS)     

Quality of life in chronic heart failure: cilazapril and captopril versus placebo. Cilazapril-Captopril Multicentre Group

OBJECTIVE: To measure quality of life (QOL) in patients with mild to moderate heart failure treated with angiotensin converting enzyme (ACE) inhibitors cilazapril or captopril. DESIGN: Randomised, double blind, placebo controlled, parallel groups trial. SUBJECTS: 367 patients with New York Heart Association (NYHA) heart failure class II (62%), III (36%) or IV (1%). METHODS: Patients were randomised to receive cilazapril 1 mg daily (n = 191) or captopril 25 mg three times daily (n = 90) for 24 weeks, or placebo for 12 weeks followed by cilazapril 1 mg daily for a further 12 weeks (n = 86). If patients had not responded after four weeks cilazapril was increased to 2.5 mg daily and captopril to 50 mg three times daily. QOL was assessed at baseline, 12, and 24 weeks using the sickness impact profile (SIP), the profile of mood states (POMS), the Mahler index of dyspnoea-fatigue, and a health status index (HSI). RESULTS: The physical dimension of the SIP averaged 7 units at baseline and improved after 12 weeks by 2.24 units in the cilazapril group, 2.38 units in the captopril group, and 1.51 units in the placebo group. The difference between drug and placebo was therefore 0.73 units (95% CI -0.86 to 2.32) for cilazapril, and 0.87 units (95% CI -0.96 to 2.70) for captopril, with small non-significant effect sizes (a statistical method for estimating the importance of a treatment related change) of 0.12 and 0.14. Similar results were observed for the total POMS and HSI scores. Although QOL improved more on the ACE inhibitors than on placebo, the effect sizes were not significant (< or = 0.26). CONCLUSIONS: Improvements in QOL in mild to moderate heart failure were small when treated with cilazapril or captopril compared with placebo.     

运动康复改善老年慢性心衰患者心功能和生活质量的研究

目的:观察老年慢性心衰患者运动康复后心功能和生活质量的改变。方法:对60例老年慢性心衰病人在常规药物治疗的基础上,实施运动康复疗法,并与58例非康复组进行对照比较;观察出院时病人6min步行距离、运动耐量、平均住院日和心功能变化,同时测定血浆脑钠肽(BNP)含量,对其生活质量进行评定;观察随访一年时病人的心功能、再住院率和死亡率。结果:出院时康复组运动贮量、生活质量明显提高,NYHA心功能级别显著改善(P<0.05或<0.01),BNP水平和心室重量指数(LVMI)则显著降低(P<0.05);较之对照组除上述指标显著改善(P<0.05~<0.01)外,6min步行距离增加非常显著(P<0.01)平均住院日显著减少(P<0.05);随访一年时康复组病人的心功能、6min步行距离、运动贮量、生活质量、左室射血分数(LVEF)和E/A比值均明显增加,NYHA心功能级别显著改善(P<0.01),左房内径(LAd)、LVMI以及再入院率和死亡率明显低于对照组(P<0.01或P<0.05)。结论:运动康复可以改善心功能,提高运动耐量和生活质量,缩短住院时间,降低再入院率和死亡率;长期运动康复可能有改善心肌的重构的作用。     

比索洛尔和卡维地洛治疗慢性心力衰竭的临床疗效观察

目的研究比索洛尔和卡维地洛治疗慢性心力衰竭的临床疗效及安全性。方法选择125例慢性心力衰竭患者,按心功能分级(NYHA)Ⅱ~Ⅳ级,经超声心动图证实左心室射血分数≤40%,将患者随机分配到比索洛尔组(62例)或卡维地洛组(63例),均治疗30周。每次随访评估心功能,记录主要心脏不良事件。结果两组左心室射血分数明显改善,比索洛尔组提高11%,卡维地洛组提高12%,左心室射血分数改善程度组内比较均有显著性意义(P<0.01)。心力衰竭症状两组均较前改善,心功能分级比索洛尔组和卡维地洛组心功能Ⅲ级治疗后减少至5例(8.1%)和6例(9.5%),两组治疗前后组内比较有显著性意义(P<0.01)。比索洛尔组和卡维地洛组主要心脏不良事件发生率分别为32.3%和34.9%,组间比较无显著性意义(P>0.05)。结论慢性心力衰竭患者应用比索洛尔和卡维地洛一样安全有效,比索洛尔可以达到与卡维地洛靶剂量长期治疗相同的疗效。     

Complementary roles of simple variables, NYHA and N-BNP, in indicating aerobic capacity and severity of heart failure

AIMS: The extent of exercise intolerance in patients with chronic heart failure (CHF) is dependent on and representative of the severity of heart failure. However, few primary care physicians have direct access to facilities for formal exercise testing. We have therefore explored whether information readily obtainable in the community can reliably predict the functional capacity of patients. METHODS AND RESULTS: Ninety-six subjects with a wide range of cardiac function (10 healthy controls and 86 CHF patients with NYHA classes I-IV, LVEF 36.9+/-15.2%) were recruited into the study and had resting plasma N-BNP and cardiopulmonary exercise testing to measure peak oxygen consumption (VO2). Significantly higher N-BNP levels were found in the CHF group (299.3 [704.8] fmol/ml, median [IQR]) compared with the healthy control group (7.2 [51.2] fmol/ml), p<0.0001. There were significant correlations between peak VO2 and N-BNP levels (R=0.64, P<0.001), peak VO2 and NYHA class (R=0.76, P=0.001), but no significant correlation was seen between peak VO2 and LVEF (R=0.0788, P=0.33). Multivariate analysis identified plasma N-BNP (P<0.0001) and NYHA class (P<0.0001) as significant independent predictors of peak VO2. Logistic modelling with NYHA class and log N-BNP to predict peak VO2<20 ml/kg/min showed that the area under the curve of receiver-operating-characteristic (ROC) curve was 0.906 (95% CI 0.844-0.968). A nomogram based on the data has been constructed to allow clinicians to estimate the likelihood of peak VO2 to be <20 ml/kg/min for given values of plasma N-BNP and NYHA class. CONCLUSIONS: By combining information from a simple objective blood test (N-BNP) and a simple scoring of functional status (NYHA), a clinician can deduce the aerobic exercise capacity and indirectly the extent of cardiac dysfunction of patients with CHF.     

老年慢性心衰患者运动康复的效果

目的：探讨老年慢性心衰患者实施运动康复的安全性及效果。方法：83例老年慢性心衰患者被随机分为常规护理组（41例,常规护理）和运动康复组（42例,在常规护理基础上接受运动训练）。疗程均为8周,随访12个月。患者心功能以纽约心脏病协会（NYHA）分级表示,以超声心动图测定左室射血分数（LVEF）和左室舒张末期内径（LVEDd）,同时测定6min步行距离（6MWD）,血浆脑钠肽（BNP）水平,代谢当量（METs）,明尼苏达心力衰竭生活质量量表（MLHFQ）评分表示健康相关生活质量,记录12个月内的再入院率和死亡率。结果：两组治疗8周时LVEF、LVEDd、NYHA分级均显著改善（P均〈0．05）,且与常规护理组相比,运动康复组LVEF[（54．7±6．2）％比（65．4±8．7）％]、LVEDd[（49．6±8．3）mm比（40．2±9．3）mm]、NYHA分级[（2．7±0．8）级比（1．9±0．9）级]改善更显著（P〈0．05）;6MWD[（122．7±9．2）m比（175．6±8．7）m]和METs[（5．8±1．8）比（8．4±2．4）]也明显增加（P〈0．01）,血浆BNP水平[（43．4±9．8）pg／ml比（31．7±8．9）pg／ml]明显降低（P〈0．05）;运动康复组康复训练中未发生严重不良事件。12个月时,运动康复组MLH-FQ评分明显高于常规护理组[（68．9±7．9）分比（45．65=8．2）分,P〈0．053,因心衰再入院率明显低于常规护理组（9．5％比24．4％,P〈0．05）。结论：对老年慢性心衰患者实施运动康复安全有效,可明显改善心功能,增强运动耐力,提高生活质量。     

Exercise skeletal muscle blood flow is related to peripheral microvascular stiffness in idiopathic dilated cardiomyopathy.

Peripheral microvascular function plays an important role in congestive heart failure (CHF). Decreased exercise blood flow and microvascular dysfunction have been described in CHF and both factors are regarded as parameters that might influence exercise capacity in these patients. Whether these factors are related to or can be characterized in clinical severity of CHF has not been elucidated in this population. Skeletal muscle blood flow (SMBF) was measured continuously noninvasively, by means of the local isotope washout technique using (133)Xenon, in musculus tibialis anterior during graded maximal supine bicycle exercise. The distensibility in skeletal muscle was measured in a papaverine-relaxed vascular bed using (99m)Tc-pertechnetate. The investigation included 20 patients with moderate CHF (NYHA II), 11 patients with severe CHF (NYHA III, IV) due to idiopathic dilated cardiomyopathy (IDCM), and 31 age-matched healthy subjects. The maximal SMBF level was significantly lower in severe CHF (3.6 +/- 2.5 (ml x (100 g x min)(-1))) compared with moderate CHF (8.6 +/- 5.1 (ml x (100 g x min)(-1)); P < 0.005) and controls (11.0 +/- 4.1 (ml x (100 g x min)(-1)); P < 0.0001), but similar between moderate CHF and controls. Distensibility in skeletal muscle was decreased in severe CHF (12 +/- 8%) compared with controls (44 +/- 17%; P < 0.0001 vs severe CHF) and decreased with increasing severity of CHF (moderate CHF, 23 +/- 14%; P < 0.0005 vs controls). In CHF patients, a relationship was demonstrated between skeletal muscle distensibility and the maximal SMBF (P < 0.0001; r = 0.70). Moreover, maximal SMBF correlated directly to exercise time (P < 0.005; r = 0.54). Patients with CHF have reduced exercise SMBF, which may be a limiting factor for the reduced maximal exercise capacity. Moreover, microvascular distensibility in skeletal muscle is reduced and correlates to maximal exercise SMBF. Furthermore, maximal SMBF correlates to exercise time. This implies that increased skeletal muscle microvascular stiffness may contribute to the reduced blood flow during exercise and SMBF may partly limit exercise performance in CHF patients due to IDCM.     

Physical training in patients with chronic heart failure of ischemic origin: effect on exercise capacity and left ventricular remodeling.

BACKGROUND: Physical training is a well-known complementary treatment for chronic heart failure (CHF); however, many aspects require further studies. One of them is the impact on remodeling of the left ventricle (LV). The purpose of this study was to evaluate the effect of 6 months of training on LV, exercise capacity and safety issues in patients with ischemic CHF. METHODS: Fifty patients (mean age 60.1+/-9.2 years) with ischemic CHF, New York Heart Association (NYHA) classification class II and III and left ventricular ejection fraction (LVEF) 相似文献