Objective To evaluate the efficacy and safety of trimetazidine (TMZ) for chronic congestive heart failure. Methods We searched The Cochrane Library (Issue 3, 2006), MEDLINE (1990-2006), EMBASE (1990-2004), and the Chinese Biomedicine Database (1990- 2006 ) for parallel group randomized controlled trials (RCTs) and cross-over design trials comparing TMZ and placebo or open controls for patients with heart failure.We used The Cochrane Collaboration’s RevMan 4.2 software for data analyses. Results Four RCTs and two cross-over design trials were included. Meta-analyses showed that: compared with the control group, TMZ may improve the NYHA cardiac functional grade (RR 0.85, 95%CI 0.76 to 0.95), increase the total exercise time (WMD 51.40 seconds, 95%CI 15.56 to 87.25), the maximal metabolic equivalents (WMD 0.82, 95%CI 0.28 to 1.37), and the ejection fraction (WMD 7.29%, 95%CI 6.28 to 8.31), but may decrease the left ventricular end-diastolic volume (WMD –12.19 ml, 95%CI –15.29 to –9.09), the left ventricular end-diastolic diameter (WMD –6.05 mm, 95%CI –7.10 to –4.99), the left ventricular end-systolic volume (WMD –16.94 ml, 95%CI –20.34 to –13.55), the left ventricular end-systolic diameter (WMD –5.42 mm, 95%CI –5.98 to –4.86), and the serum brain natriuretic peptide (WMD –239.59 pg/ml, 95%CI –276.53 to –202.65). TMZ may also improve the quality of life (WMD 12.36, 95%CI 5.16 to 19.55). Conclusions TMZ plus standard medical therapy has a beneficial effect on the indices of cardiac function, and may also improve the patient’s quality of life. However, because available RCTs for this systematic review are too small and poor quality, (mainly focusing on the heart failure induced by ischemic heart diseases and merely taking intermediate indices as outcome measures), further high-quality large-scale RCTs with death as the endpoint and which include subgroup analysis of non-ischemic heart failure, are required in order to provide more reliable evidence.
Objective To evaluate the efficacy and safety of angiotensin-converting enzyme inhibitor (ACEI) on the left ventricular texture parameters, blood kinetics parameters, degree of cardiac function and rate of side effects of patients with heart failure when compared to angiotensin receptor blocker (ARB). Methods We searched MEDLINE (1966 to 2004), EMBASE (1989 to 2000), The Cochrane Library (Issue 1, 2004), IPA (1970 to 2004), and Chinese Biomedicine Database (1980 to 2003). The quality of included studies such as randomization, blinding, allocation concealment and loss of follow up was evaluated and meta-analysis was performd by RevMan 4.2 software. Results Eighteen randomized controlled trials (RCTs) were included. The meta-analysis of efficacy didn’t show statistical significance when comparing the pooled effect size of left ventricular end-diastolic diameter (LVEDD), cardiac output (CO), heart rate (HR), degree of cardiac function. The pooled RR rate of side effects was 2.17, 95%CI 1.53 to 3.07, P＜0.000 01. Conclusions No evidence shows significant difference of ACEI group from ARB group in the improvement of cardiac function and left ventricle remodeling. The rate of side effects of ACEI is statistically higher than that of ARB.
【摘要】目的探讨B型脑钠肽(BNP)与慢性充血性心力衰竭预后的关系。方法2008年1月10月收治的慢性充血性心力衰竭患者100例,均符合美国心脏病协会分级标准(NYHA)Ⅲ~Ⅳ级,快速检测BNP,观察心血管事件发生组与未发生组患者血浆BNP浓度差异。结果发生心血管事件患者血浆BNP浓度显著升高,未发生心血管事件患者血浆BNP浓度下降。血浆BNP浓度与心血管事件发生有密切关系结论BNP水平可以指导心力衰竭患者的治疗,并可以预测失代偿期充血性心力衰竭患者的预后。
摘要:目的:探讨胺碘酮治疗充血性心力衰竭(CHF)心房颤动伴快速心室率的临床疗效。方法: 将106例各种原因所致的房颤伴快速心室率的CHF患者按入院顺序随机分为治疗组及对照组。两组抗CHF基础治疗相同,治疗组加用静脉负荷量胺碘酮150 mg后,再以1 000μg/min静脉点滴维持6小时,500 μg/min静滴18小时。同时口服胺碘酮0.2,3次/d,1周;再0.2,2次/d,1周以后以0.2,1次/d 至观察终点,随诊为12个月。 结果: 治疗组53例使用胺碘酮治疗可显著增加抗心律失常有效性,改善左室射血分数,减少心力衰竭再住院率,42例患者转复为室性心律。 结论: 静脉及口服胺碘酮同时应用治疗充血性心力衰竭房颤是有效和安全的。Abstract: Objective: To explore the effect and safety of amiodarone in the treatment of atrial fibrillation with congestive heart failure. Methods:One hundred and six patients of AF with CHF caused by a variety of reasons were randomly divided into treatment group and control group according to hospitalized order.The two groups were treated with the same antiCHF therapy,the treatment group was treated with loaded intravenous amiodarone 150 mg;and then dripped to 1 000 μg/min for 6 hours, dripped to 500 μg/min for 18 hours. United with oral amiodarone by amiodarone tablets with 0.2 g,3 time/day a week,further 0.2 g,2 times/day a week,later 0.2 g,1 times/day to the end.The end of followup time was 12 months. Results:In treatment group,53 cases with amiodarone therapy can significantly increase the effectives of antiarrhythmic, improve the rate and heart failure rehospitalization.42/53 patients reversed to sinus rhythm. Conclusion:The results showed it is effective and safe united with intravenous amiodarone and oral amiodarone in treatment of atrial fibrillation with organic heart disease.
The analysis parameters for the characterization of heart rate variability (HRV) within a very short time (＜1 min) usually exhibit complicate variation patterns over time, which may easily interfere the judgment to the status of the cardiovascular system. In this study, long-term HRV sequence of 41 cases of healthy people (control group) and 25 cases of congestive heart failure (CHF) patients (experimental group) was divided into multiple segments of very short time series. The variation coefficient of the same HRV parameter under multiple segments of very short time series and the testing proportion with statistically significant differences under multiple interclass t-test were calculated. On this account, part of HRV analysis parameters under very short time were discussed to reveal the stability of difference of the cardiovascular system function under different status. Furthermore, with analyzing the receiver operating characteristic (ROC) curve and modeling the artificial neural network (ANN), the classification effects of these parameters between the control group and the experimental group were assessed. The results demonstrated that ① the indices of entropy of degree distribution based on the complex network analysis had a lowest variation coefficient and was sensitive to the pathological status (in 79.75% cases, there has statistically significant differences between the control group and experimental group), which can be served as an auxiliary index for clinical doctor to diagnose for CHF patient; ② after conducting ellipse fitting to Poincare plot, in 98.5% cases, there had statistically significant differences for the ratio of ellipse short-long axis (SDratio) between the control group and the experimental group; when modeling the ANN and solely adopting SDratio, the classification accuracy to the control group and experimental group was 71.87%, which demonstrated that SDratio might be acted as the intelligent diagnosis index for CHF patients; ③ however, more sensitive and robust indices were still needed to find out for the very-short HRV analysis and for the diagnosis of CHF patients as well.
Congestive heart failure is a complication of myocardial infarction threatening human health. Although the pharmacotherapy is effective, it is still a worldwide challenge to thoroughly repair the injured myocardium induced by myocardial infarction. It has been demonstrated that mesenchymal stem cells (MSCs) can repair infarcted myocardium. Much evidence shows that MSCs can generate new myocardial cells in both human and animals' hearts. This review aims at discussing the therapeutic progress of the congestive heart failure treated with MSCs.
In recent years, with the development of ultrasound technology, pulmonary ultrasound is more and more used in the evaluation of patients with heart failure. B-lines are defined as reverberation artifacts starting from the pleural line and extending to the bottom of the screen without disappearing, and moving synchronously with pleural sliding, which are proportional to extravascular lung water in congestive heart failure (CHF). B-lines have the characteristics of no attenuation and synchronous movement with pleural sliding. Pulmonary ultrasound mainly record the numbers and widths of B-lines in the areas when assessing the severity of CHF, which have the characteristics of effectivity, non-invasiveness, instantaneousness, and good repeatability. Currently, there are 4-, 8-, 12-, and 28-subdivision methods for the evaluation of CHF in the pulmonary ultrasound subdivision method. The more subdivisions are, the longer the operation time will be, and the sensitivity and specificity will be different. How to choose a subdivision method is still controversial in clinical practice. Lung ultrasound could be used alone or combined with brain natriuretic peptide, echocardiography, chest X-ray, chest CT scan, etc. in the early diagnosis, assessment of disease severity, evaluation of efficacy, and assessment of prognosis of CHF, with different advantages and disadvantages. This article reviews the application and progress of pulmonary ultrasound in CHF.