Atrial fibrillation(AF) is a common arrhythmia with important therapeutic and prognostic implications. An attempt to restore sinus rhythm is considered in most patients with AF. The aim of this study was to assess the...Atrial fibrillation(AF) is a common arrhythmia with important therapeutic and prognostic implications. An attempt to restore sinus rhythm is considered in most patients with AF. The aim of this study was to assess the value of echocardiographic examination and plasma atrial natriuretic peptide(ANP) evaluation in predicting the outcome of cardioversion and maintenance of sinus rhythm in patients with persistent AF. Methods: Eighty-one consecutive patients, aged 62±9 years, with AF of duration 4.7 months were subjected to an echocardiography examination and ANP assessment before cardioversion. The patients were predominantly hypertensive men with moderately enlarged left atrium and ejection fraction of left ventricle of about 50%. All patients were in controlled AF and had normalized blood pressure. In order to predict the outcome of cardioversion, and maintenance of sinus rhythm over a 1 month period, a multivariate logistic regression method was performed using the following variables: left atrial and left ventricular dimensions, left ventricular ejection fraction and plasma ANP levels. Results: Sixty-nine out of the 81 patients were successfully converted to sinus rhythm. At 1 month 57 patients remained in sinus rhythm. There were no statistical differences between sinus rhythm and AF group in baseline ANP levels(59.4 vs 64.2 pg/ml, consecutively), clinical and echocardiographic characteristics. In logistic regression analysis neither baseline echocardiographic variable nor ANP level, predicts successful cardioversion over a 1-month period of observation. Conclusion: Echocardiographic data and ANP level should not be included as an important variable when considering patients for cardioversion.展开更多
The hemodynamic consequences of atrial fibrillation (AF) may lead to impairme nt of the left ventricular function and a reduction in exercise capacity. Studie s on mechanical and neurohormonal remodelling in patients ...The hemodynamic consequences of atrial fibrillation (AF) may lead to impairme nt of the left ventricular function and a reduction in exercise capacity. Studie s on mechanical and neurohormonal remodelling in patients with AF are becoming i ncreasingly important. The results could possibly enhance treatment strategies o f these patients. The aim of this study was to assess changes in exercise capaci ty, echocardiographic findings and plasma atrial natriuretic peptide(ANP) concen trations in patients with non rheumatic persistent AF, before and 30 days after successful cardioversion. Methods: We attempted cardioversion in 42 consecutive patients, aged 58±8 years, with persistent non valvular AF of duration 7.1±7 .1 months. They underwent echocardiography examination and submaximal exercise t esting 24 h before and 30 days after cardioversion. Exercise capacity was determ ined during symptom limited exercise testing, according to a modified Bruce pro tocol with peak VO2 analysis. Plasma samples of ANP were obtained at rest: befor e, the day after, and 30 days after cardioversion therapy, and were prepared by refrigerated centrifugation and stored until radioimmunoassay. The control study group, without AF, comprised of 11 subjects. Results: Cardioversion was success ful in 35 patients. However, in six of the 35 patients, AF reappeared within 1 m onth. There were no statistical differences before cardioversion in exercise tol erance and ejection fraction of left ventricle between the group with successful cardioversion and the group with unsuccessful cardioversion or with recurrence of AF. On the 30th day after cardioversion we recorded a significant increase in exercise tolerance: duration of exercise 13.7±3.2 versus 9.5±3.4 min, (P< 0.0 5); peak oxygen consumption 32.2±3.6 versus 19.85±3.5 ml/min per kg, (P< 0.05) ; and ejection fraction of left ventricle 58.6±9.4 versus 52.7±10.2%(P< 0.05) ; in the sinus rhythm group. There was no significant improvement observed in th e AF group. The mean baseline ANP level was 58.5±15.7 pg/ml in the study group and 34.3±10.2 pg/ml in the control group (P< 0.01). The successful therapy redu ced significantly the pretreatment mean plasma ANP concentration from 58.5±15.7 to 31.4±15.0 pg/ml, (P< 0.01); the day after cardioversion, in the group of 35 patients. It remained stable for the next 30 days(36.9±15.2 pg/ml) in the grou p of 29 patients who remained in sinus rhythm, and increased to 53.4±16.4 pg/ml in the group of six patients who had recurrence of AF. Plasma ANP did not chang e in the group of seven patients with unsuccessful cardioversion. Conclusions: T he restoration of sinus rhythm in patients with persistent AF was associated wit h a significant improvement in cardiac performance and exercise tolerance 1 mont h after cardioversion. Such improvement was not observed in the group with unsuc cessful cardioversion or with AF recurrence. The plasma ANP concentration in pat ients with AF was significantly reduced after successful cardioversion and remai ned stable for a period of 30 days.展开更多
Background: The objective of this study was to compare the efficacy and tolerability of molsidomine prolonged-release 16 mg once-a-day(o.a.d.) with 8 mg twice-a-day(b.i.d.) and placebo in patients with stable angina p...Background: The objective of this study was to compare the efficacy and tolerability of molsidomine prolonged-release 16 mg once-a-day(o.a.d.) with 8 mg twice-a-day(b.i.d.) and placebo in patients with stable angina pectoris. Methods: After a run-in placebo period of 7 days, the two formulations were compared acutely and then chronically(2 weeks) using cycloergometric tests and a randomized, multicenter, double-blind, double-dummy, crossover design in 533 patients. The quality of life was assessed using the frequency of anginal crises and nitrate sublingual tablets consumption. Results: Both formulations significantly improved exercise test parameters compared with placebo, being it after acute drug intake or after a 2-week treatment period and independently of spontaneous diurnal variation in exercise tolerance. Noninferiority of molsidomine 16 mg compared with 8 mg was demonstrated with a statistically significant superiority of the 16-mg formulation from 14 to 24 h postintake. Both treatments reduced incidence of anginal attacks and use of sublingual isosorbide dinitrate tablets. Tolerability of active drugs was satisfactory, the incidence of drug-related headache being not significantly different from placebo. Only hypotension was significantly more frequent with molsidomine 16 mg than with placebo, pretrial diastolic blood pressure being significantly lower in these patients than in those who did not develop hypotension during the study. Conclusions: Both molsidomine formulations were effective in controlling patients’angina, did not induce any habituation and were well tolerated. However, the once-daily 16-mg formulation tended to provide better 24-h protection against myocardial ischemia than the 8-mg b.i.d. formulation.展开更多
文摘Atrial fibrillation(AF) is a common arrhythmia with important therapeutic and prognostic implications. An attempt to restore sinus rhythm is considered in most patients with AF. The aim of this study was to assess the value of echocardiographic examination and plasma atrial natriuretic peptide(ANP) evaluation in predicting the outcome of cardioversion and maintenance of sinus rhythm in patients with persistent AF. Methods: Eighty-one consecutive patients, aged 62±9 years, with AF of duration 4.7 months were subjected to an echocardiography examination and ANP assessment before cardioversion. The patients were predominantly hypertensive men with moderately enlarged left atrium and ejection fraction of left ventricle of about 50%. All patients were in controlled AF and had normalized blood pressure. In order to predict the outcome of cardioversion, and maintenance of sinus rhythm over a 1 month period, a multivariate logistic regression method was performed using the following variables: left atrial and left ventricular dimensions, left ventricular ejection fraction and plasma ANP levels. Results: Sixty-nine out of the 81 patients were successfully converted to sinus rhythm. At 1 month 57 patients remained in sinus rhythm. There were no statistical differences between sinus rhythm and AF group in baseline ANP levels(59.4 vs 64.2 pg/ml, consecutively), clinical and echocardiographic characteristics. In logistic regression analysis neither baseline echocardiographic variable nor ANP level, predicts successful cardioversion over a 1-month period of observation. Conclusion: Echocardiographic data and ANP level should not be included as an important variable when considering patients for cardioversion.
文摘The hemodynamic consequences of atrial fibrillation (AF) may lead to impairme nt of the left ventricular function and a reduction in exercise capacity. Studie s on mechanical and neurohormonal remodelling in patients with AF are becoming i ncreasingly important. The results could possibly enhance treatment strategies o f these patients. The aim of this study was to assess changes in exercise capaci ty, echocardiographic findings and plasma atrial natriuretic peptide(ANP) concen trations in patients with non rheumatic persistent AF, before and 30 days after successful cardioversion. Methods: We attempted cardioversion in 42 consecutive patients, aged 58±8 years, with persistent non valvular AF of duration 7.1±7 .1 months. They underwent echocardiography examination and submaximal exercise t esting 24 h before and 30 days after cardioversion. Exercise capacity was determ ined during symptom limited exercise testing, according to a modified Bruce pro tocol with peak VO2 analysis. Plasma samples of ANP were obtained at rest: befor e, the day after, and 30 days after cardioversion therapy, and were prepared by refrigerated centrifugation and stored until radioimmunoassay. The control study group, without AF, comprised of 11 subjects. Results: Cardioversion was success ful in 35 patients. However, in six of the 35 patients, AF reappeared within 1 m onth. There were no statistical differences before cardioversion in exercise tol erance and ejection fraction of left ventricle between the group with successful cardioversion and the group with unsuccessful cardioversion or with recurrence of AF. On the 30th day after cardioversion we recorded a significant increase in exercise tolerance: duration of exercise 13.7±3.2 versus 9.5±3.4 min, (P< 0.0 5); peak oxygen consumption 32.2±3.6 versus 19.85±3.5 ml/min per kg, (P< 0.05) ; and ejection fraction of left ventricle 58.6±9.4 versus 52.7±10.2%(P< 0.05) ; in the sinus rhythm group. There was no significant improvement observed in th e AF group. The mean baseline ANP level was 58.5±15.7 pg/ml in the study group and 34.3±10.2 pg/ml in the control group (P< 0.01). The successful therapy redu ced significantly the pretreatment mean plasma ANP concentration from 58.5±15.7 to 31.4±15.0 pg/ml, (P< 0.01); the day after cardioversion, in the group of 35 patients. It remained stable for the next 30 days(36.9±15.2 pg/ml) in the grou p of 29 patients who remained in sinus rhythm, and increased to 53.4±16.4 pg/ml in the group of six patients who had recurrence of AF. Plasma ANP did not chang e in the group of seven patients with unsuccessful cardioversion. Conclusions: T he restoration of sinus rhythm in patients with persistent AF was associated wit h a significant improvement in cardiac performance and exercise tolerance 1 mont h after cardioversion. Such improvement was not observed in the group with unsuc cessful cardioversion or with AF recurrence. The plasma ANP concentration in pat ients with AF was significantly reduced after successful cardioversion and remai ned stable for a period of 30 days.
文摘Background: The objective of this study was to compare the efficacy and tolerability of molsidomine prolonged-release 16 mg once-a-day(o.a.d.) with 8 mg twice-a-day(b.i.d.) and placebo in patients with stable angina pectoris. Methods: After a run-in placebo period of 7 days, the two formulations were compared acutely and then chronically(2 weeks) using cycloergometric tests and a randomized, multicenter, double-blind, double-dummy, crossover design in 533 patients. The quality of life was assessed using the frequency of anginal crises and nitrate sublingual tablets consumption. Results: Both formulations significantly improved exercise test parameters compared with placebo, being it after acute drug intake or after a 2-week treatment period and independently of spontaneous diurnal variation in exercise tolerance. Noninferiority of molsidomine 16 mg compared with 8 mg was demonstrated with a statistically significant superiority of the 16-mg formulation from 14 to 24 h postintake. Both treatments reduced incidence of anginal attacks and use of sublingual isosorbide dinitrate tablets. Tolerability of active drugs was satisfactory, the incidence of drug-related headache being not significantly different from placebo. Only hypotension was significantly more frequent with molsidomine 16 mg than with placebo, pretrial diastolic blood pressure being significantly lower in these patients than in those who did not develop hypotension during the study. Conclusions: Both molsidomine formulations were effective in controlling patients’angina, did not induce any habituation and were well tolerated. However, the once-daily 16-mg formulation tended to provide better 24-h protection against myocardial ischemia than the 8-mg b.i.d. formulation.
