Review:Cell therapy in congestive heart failure

Congestive heart failure （CHF） has emerged as a major worldwide epidemic and its main causes seem to be the aging of the population and the survival of patients with post-myocardial infarction. Cardiomyocyte dropout （necrosis and apoptosis） plays a critical role in the progress of CHF; thus treatment of CHF by exogenous cell implantation will be a promising medical approach. In the acute phase of cardiac damage cardiac stem cells （CSCs） within the heart divide symmetrically and/or asymmetrically in response to the change of heart homeostasis, and at the same time homing of bone marrow stem cells （BMCs） to injured area is thought to occur, which not only reconstitutes CSC population to normal levels but also repairs the heart by differentiation into cardiac tissue. So far, basic studies by using potential sources such as BMCs and CSCs to treat animat CHF have shown improved ventricular remodelling and heart function. Recently, however, a few of randomized, double-blind, placebo-controlled clinical trials demonstrated mixed results in heart failure with BMC therapy during acute myocardial infarction.

The Thinking on TCM Differential Treatment of Congestive Heart Failure

Congestive heart failure(CHF),the manifestationat the late stage of cardiovascular diseases,is a commonand critical illness.Traditional Chinese medicine showsa good therapeutic effectiveness in treatment of CHF,especially for latent heart failure,refractory heart failureand digitalis poisoning.The thinking on treatment ofCHF by traditional Chinese medicine on the basis ofclinical practice is described below.

Current and Future Therapeutic Agents in the Man-agement of Heart Failure

Congestive heart failure is a disease in which initially compensatory changes in cardiac , vascular, and renal functions become detrimental over time. The changes are mediated by a large number of neurohormones and cytokines. Counter-regulatory hormones also play a role, but are generally insufficient to offset the adverse effects of the neurohormones or progression of the disease. Symptoms of heart failure occurs in the 'presence of systolic dysfunction, usually documented by a decrease in ejection fraction, or can present with impaired diastolic function occasionally labeled as heart failure with preserved systolic function of the left ventricle. Heart failure and its treatment represent a medical problem of significant importance because of the high mortality associated with it despite the current therapy , which has substantial evidence of reduction in mortality and morbidity. Prevention or slowing of the progressive deterioration in function of the heart and other organs involved through utilizing new agents that affect more or different neurohormonal pathways may be beneficial and forms the focus of heart failure research and drug development. However , the multiplicity of hormonal effects mandate the use of complex therapy in the management of congestive heart failure(CHF). The new agents in addition to the conventional therapy used in the management of heart failure are; Human B-type nalriuretic peptide (in the treatment of decompensated CHF) , endothelin receptor antagonists, calcium sensitizers, neutral endopeptidase (NEP) and vasopeptidase inhibitors, vasopressin antagonists and cytokine inhibitors.

Complications of cardiac resynchronization therapy in patients with congestive heart failure

Background Previous clinical studies have suggested that patients with congestive heart failure and intraventricular conduction delay could benefit from cardiac resynchronization therapy （CRT）. Implantation of left ventricular lead is a complex procedure with some potential for complications. This study was conducted to analyse the complications of CRT in patients with congestive heart failure.Methods Totally 117 patients, 86 males and 31 females, mean age of 53 years, with congestive heart failure and intraventricular conduction delaywere enrolled in this study. Venography was performed on all patients. Different types of coronary sinus leads were used to pace the left ventricle.Results Left ventricular lead was attempted to implant through coronary sinus for all the 117 patients and was successfully implanted in 111 patients. The success rate was 94.9%. Main complications rate was 6.8%, including coronary sinus dissection in 4 patients, phrenic nerve stimulation required lead repositioning in 2 patients and lead dislodgement in 2 patients.Conclusions It is feasible and safe to pace left ventricle through coronary sinus. However, there are some procedural complications.

COMBINED THERAPY OF CAPTOPRIL AND SPIRONOLACTONE FOR REFRACTORY CONGESTIVE HEART FAILURE

It is traditionally considered that angiotensin-converting enzyme inhibitor(ACEI) and spironolactone could not be used simultaneously because of the assumed risk of hyperkalemia.

Efficacy of adaptive servoventilation in patients with congestive heart failure and Cheyne-Stokes respiration

Background Congestive heart failure （CHF） is associated with Cheyne-Stokes respiration （CSR）, which may hasten CHF. Adaptive servoventilation （ASV） is a novel method of ventilatory support designed for removal of CSF in CHF patients. This study compares the efficacy of ASV in patients with CHF and CSR with the efficacy of oxygen therapy. Methods Fourteen patients with CHF and CSR were recruited. During sleep, nasal oxygen therapy and ASV treatment were each performed for two weeks. Comparison before and after each treatment was made for the following items： a） parameters of sleep respiration, sleep structure and quality; b） left ventricle ejection fraction （LVEF） and 6-minute walk distance. Results Compared with the baseline levels of apnoea hypopnoea index of 34.5±6.1 before treatment, the apnoea hypopnoea index significantly decreased following oxygen therapy to 27.8±8.2, P〈0.05 and further reduced following ASV treatment to 6.5 ±0.8, P〈0.01. The minimal pulse oxygen saturation markedly increased following oxygen therapy from a baseline of （84.3±2.6）% to （88.6±3.7）%, P〈0.05 and further increased following ASV treatment （92.1 ±4.9）%, P〈0.01. Stages Ⅰ ＋Ⅱ sleep as percentage of total sleep time decreased from （81.9±7.1）% to （78.4±6.7）% following oxygen therapy and further to （72.4±5.0）% following ASV treatment. Stages Ⅲ＋Ⅳ sleep as percentage of total sleep time decreased from （8.4±5.5）% to （6.0±3.0）% following oxygen therapy and but increased to （11.9 ± 5.4）% following ASV treatment. The arousal index of 30.4 ±8.1 before treatment significantly decreased following oxygen therapy to 25.6±5.7, P〈0.05 and further declined following ASV treatment to 18.2±6.1, P〈0.01. No significant difference was shown in above percentages between day 14 of oxygen therapy and before treatment （P 〉 0.05）. LVEF was significantly higher on day 14 of ASV treatment （37.2 ±4.1）% than on day 14 of oxygen therapy （33.2 ± 5.1）% and before treatment （30.2±4.6）% （all P〈0.05）. Six-minute walk distance was the shortest before treatment （226±28） m, longer on day 14 of oxygen therapy （289±26） m, and the longest on day 14 of ASV treatment （341 ±27） m （all P 〈 0.01）. Conclusion ASV treatment is of better efficacy and greater clinical significance in improvement of CHF by eliminating CSR than oxygen therapy.

Left univentricular pacing for cardiac resynchronization therapy using rate-adaptive atrioventricular delay

Objective To evaluate left univentricular （LUV） pacing for cardiac resynchronization therapy （CRT） using a rate-adaptive atrioven- tricular delay （RAAVD） algorithm to track physiological atrioventricular delay （AVD）. Methods A total of 72 patients with congestive heart failure （CHF） were randomized to RAAVD LUV pacing versus standard biventricular （BiV） pacing in a 1 ： 1 ratio. Echocardiography was used to optimize AVD for both groups. The effects of sequential BiV pacing and LUV pacing with optimized A-V （right atrio-LV） delay using an RAAVD algorithm were compared. The standard deviation （SD） of the S/R ratio in lead VI at five heart rate （HR） segments （Rs/R-SD5）, defined as the ＂tracking index,＂ was used to evaluate the accuracy of the RAAVD algorithm for tracking physiological AVD. Results TheQRS complex duration （132 ± 9.8 vs. 138± 10ms, P 〈 0.05）, the time required for optimization （21 ±5 vs. 50±8min, P〈 0.001）, the mitral regurgitant area （1.9 ± 1.1 vs. 2.5 ± 1.3 em2, P 〈 0.05）, the interventricular mechanical delay time （60.7 ± 13.3 ms vs. 68.3 ± 14.2 ms, P 〈 0.05）, and the average annual cost （13,200 ± 1000 vs. 21,600 ± 2000 RMB, P 〈 0.001） in the RAAVD LUV pacing group were significantly less than those in the standard BiV pacing group. The aortic valve velocity-time integral in the RAAVD LUV pacing group was greater than that in the standard BiV pacing group （22.7 ± 2.2 vs. 21.4 ± 2.1 cm, P 〈 0.05）. The Rs/R-SD5 was 4.08 ± 1.91 in the RAAVD LUV pacing group, and was significantly negatively correlated with improved left ventricular ejection fraction （LVEF） （ALVEF, Pearson＇s r = -0.427, P = 0.009）, and positively correlated with New York Heart Association class （Spearman＇s r - 0.348, P 0.037）. Conclusions RAAVD LUV pacing is as effective as standard BiV pacing, can be more physiological than standard BiV pacing, and can de- crease the average annual cost of CRT.

充血性心力衰竭中医证治概述

充血性心力衰竭(CHF),又称慢性心力衰竭,是现今世界心血管领域的一大重要疾病,其发病率和病死率长期以来居高不下。近年来,中医在心力衰竭的临床治疗及科研方面均取得了较大进展。随着整个社会对中医关注度的提高,坚持中医的传承与创新越来越重要。此文概述了CHF的中医病名来源、病因病机沿革、中医证型与证候要素研究、基本治法方药总结,以期为现今中医对心力衰竭的临床治疗及科学研究提供理论参考和思路启迪。

Cardiac resynchronization therapy in acute pulmonary edema: A case report

We are reporting a case of 71-year old lady with a dual chamber demand pacemaker,who developed acute pulmonary edema due to an acute left ventricular(LV)dysfunction and worsening in mitral valve regurgitation after atrioventricular nodal ablation for uncontrolled atrial fibrillation.This was attributed to right ventricular apical pacing leading to LV dyssynchronization.Patient dramatically improved within 12-24 h after upgrading her single chamber pacemaker to biventricular pacing.Our case demonstrates that biventricular pacing can be an effective modality of treatment of acute congestive heart failure.In particular,it can be used when it is secondary to LV dysfunction and severe mitral regurgitation attributed to significant dyssynchrony created by right ventricular pacing in patients with atrioventricular nodal ablation for chronic atrial fibrillation.

健心颗粒治疗慢性心力衰竭65例临床观察

目的:探讨健心颗粒治疗慢性心力衰竭(CHF)的临床疗效。方法:将128例气虚(阳虚)血瘀、水饮内停证CHF患者随机分为治疗组65例和对照组63例,治疗组在对照组常规治疗基础上加服健心颗粒,连续治疗8周,比较两组临床症状、中医证候疗效及心功能、血浆脑钠肽(BNP)水平改善情况。结果:两组临床症状、中医证候、心功能均有明显改善,且BNP水平均下降;治疗组疗效明显优于对照组。结论:在常规西医治疗基础上加服健心颗粒,可以进一步改善患者的临床症状、心功能及生活质量,安全有效且未出现不良反应。

养心康对心肌肥大型心力衰竭大鼠血浆ET、CGRP含量的影响

【目的】探讨心肌肥大型心力衰竭大鼠血浆内皮素(ＥＴ)和降钙素基因相关肽(ＣＧＲＰ)水平的变化及养心康(由人参。麦冬、毛冬青等组成)的作用机理。【方法】大鼠皮下注射异丙肾上腺素共１３ｄ以制备心肌肥大型心力衰竭模型,采用放射免疫分析法观察各组动物血浆ＥＴ、ＣＧＲＰ水平的变化。【结果】模型组大鼠血浆ＥＴ含量比正常对照组显著升高(Ｐ＜０．０１),ＣＧＲＰ含量则比正常对照组显著降低(Ｐ＜０．０１),而养心豪能降低ＥＴ(Ｐ＜０．０１和升高ＣＧＲＰ含量(Ｐ＜０．０１),其大剂量组的疗效接近地高辛。【结论】ＥＴ、ＣＧＲＰ是参与心力衰竭发病的重要体液因素,二者之间的失衡是心力衰竭发生、发展的重要原因。而养心康的作用机理与纠正失衡的ＥＴ/ＣＧＲＰ比值有关。

强心方对超容量负荷型心衰模型兔的治疗作用

【目的】观察强心方对超容量负荷型心衰模型兔的治疗作用。【方法】新西兰雄性兔20只,随机分为4组:模型组、强心方组(中药组,2.6 g/kg)、西药组(20μg/kg地高辛+1 mg/kg速尿片)、中西药组(2.6 g/kg强心方+20μg/kg地高辛+1 mg/kg速尿片);复制超容量负荷型心衰模型,造模后6 h各给药组分别按设计剂量灌胃给药,连续7 d;采用四道生理仪记录并计算心率(HR)、主动脉收缩压(SBP)、主动脉舒张压(DBP)、左心室收缩压(LVSP)、左心室舒张压(LVPP)、左室内压最大上升速率(+dp/dtmax)、左室内压最大下降速率(-dp/dtmax),左室内压最大变化速率(±dp/dtmax)的值,并采血检测血清超氧化物歧化酶(SOD)和丙二醛(MDA)的含量。【结果】造模后各组体质量无显著性差异,给药1周后西药组体质量显著下降(P<0.05);造模后各组心率下降(与造模前比较,P<0.05或P<0.01),给药1周后各给药组心率与模型组比较无显著性差异;给药1周后各给药组对SBP、DBP、LVDP值无明显影响,中西药组可使LVSP值升高(P<0.01);给药后各组+dp/dtmax、-dp/dtmax、±dp/dtmax值均升高(与模型组比较,P<0.05或P<0.01);模型组血清SOD水平降低,MDA水平升高(均P<0.01),各给药组均可升高SOD水平,降低MDA水平(P<0.05或P<0.01)。【结论】强心方对超容量负荷型心衰模型兔具有一定的治疗作用,与强心、利尿西药合用可减轻其副作用。

加用中药坎离煎对慢性心力衰竭患者活动耐量、生活质量及心衰加重次数的影响

目的:观察加用中药坎离煎对慢性心力衰竭(CHF)患者活动耐量、生活质量和CHF加重次数等的影响。方法:选择CHF心肾阳虚证患者60例,按2∶1随机分为坎离煎组39例和对照组21例。两组患者均以西药规范治疗,坎离煎组加用坎离煎,疗程24周。分别于治疗前、治疗后4、8、12、24周时观察6分钟步行试验(6MWT)、CHF生活质量评分(LHFQ评分)、NYHA分级、中医证候积分、利尿剂和地高辛停减率,并统计1年中因CHF急性加重住院的次数。结果:中医证候疗效、6MWT、LHFQ评分、中医证候积分及NYHA分级方面,坎离煎组均优于对照组;血流动力学指标短轴缩短率、E峰/A峰(E/A)变化两组间差异无显著性;治疗后坎离煎组左室射血分数显著提高,对照组变化不明显;加用坎离煎治疗后,减少了利尿剂和地高辛的用量。结论:在西药治疗基础上加用中药坎离煎能显著提高CHF患者的生活质量和运动耐量,改善心功能,减少利尿剂、地高辛的使用,减少CHF急性加重的住院次数。

低钠血症在慢性心力衰竭患者中30年发生率的变化及原因探讨

目的:分析低钠血症在慢性心力衰竭(心衰)患者中30年发生率的变化,并探讨其原因。方法:收集心脏科1980年1月—2007年8月心衰住院病例,按年代分3组,比较3个年代心衰患者低钠血症发生率的变化及心衰病因、药物治疗的改变。结果:入选2465例,低钠血症在3个年代的发生率分别为28.9%、28.2%和22.5%,呈逐年代降低趋势(χ2=11.374,P<0.01)。风心病、扩心病、肺心病和冠心病患者并发低钠血症的比例分别为33.2%、36.8%、35.7%和22.7%,前三者均高于冠心病(χ2分别为17.817、12.828和12.636,均P<0.01)。风心病、扩心病在心衰病因中的比例呈逐年代减少趋势,冠心病则呈增加趋势(χ2=110.063,P<0.01);应用β受体阻滞剂、血管紧张素转化酶抑制剂(ACEI)或血管紧张素Ⅱ受体阻滞剂(ARB)的患者发生低钠血症的风险较未用者为低(分别为17.6%vs27.4%,χ2=23.247;19.9%vs34.3%,χ2=62.454,均P<0.01),而随着年代增加,ARB、β受体阻滞剂的应用逐渐增加(均P<0.01)。结论:低钠血症在心衰患者中发生率逐年代降低,可能与病种变迁及药物治疗的变化有关。

慢性充血性心力衰竭合并抑郁障碍患者的临床研究

目的:探讨抑郁障碍在慢性充血性心力衰竭(CHF)患者中的患病率及对预后的影响,观察抗抑郁药物盐酸氟西汀(商品名百忧解)对CHF患者的作用。方法:按照Zung抑郁自评量表评分,以≥50分和<50分为标准将患者分为抑郁障碍组和无抑郁障碍组;再将抑郁障碍组患者随机分为百忧解组和安慰剂组,同时选择健康查体者30人作为对照组,比较CHF组与对照组抑郁评分的差别;出院时对CHF患者重新评分,比较各组抑郁评分的变化,观察百忧解的不良反应;3个月时随访入组的CHF患者,分析各组CHF患者死亡率、再入院率的差异。结果:CHF组抑郁障碍的发生率高于对照组(P<0.01);抑郁障碍组患者的住院时间长于无抑郁障碍组(P<0.01);出院时百忧解组评分比安慰剂组显著降低(P<0.01);安慰剂组患者3个月的死亡率、再入院率高于无抑郁障碍组(P<0.001)及百忧解组(P<0.05);百忧解组患者在服药期间无不良反应。结论:抑郁障碍在心力衰竭患者中的患病率高达35.8%,是心衰患者预后不良的重要危险因子;百忧解治疗心力衰竭患者的抑郁症状疗效好,安全性高。

鹿角方逆转充血性心力衰竭大鼠心肌纤维化的机理研究

【目的】观察鹿角方 (由鹿角、补骨脂、淫羊藿、山萸肉、女贞子、沉香等中药组成 )逆转压力负荷增加造成的充血性心力衰竭大鼠心肌纤维化的作用及其机理。【方法】 36只雄性Wistar大鼠随机分为假手术组、模型组、鹿角方组。建立腹主动脉狭窄所致充血性心力衰竭大鼠模型 ,观察左室质量指数 (LVMI) ,采用免疫组织化学染色方法观察心肌Ⅰ、Ⅲ型胶原的改变 ,采用RT PCR方法观察心肌Ⅰ型和Ⅲ型胶原mRNA的表达 ,并采用放射免疫分析方法检测血浆和心肌血管紧张素Ⅱ (AngⅡ )、血浆心钠素 (ANF)、血清醛固酮 (ALD)水平。【结果】模型组LVMI明显高于假手术组 (P <0 0 0 1) ,鹿角方组与模型组比明显下降 (P <0 0 1)。模型组Ⅰ型胶原和Ⅲ型胶原较假手术组显著升高 (P <0 0 1) ,鹿角方组较模型组明显下降 (P <0 0 1)。模型组Ⅰ型和Ⅲ型胶原mRNA的表达较假手术组显著升高 (P <0 0 5 ) ,鹿角方组较模型组显著下降(P <0 0 5 )。模型组血浆AngⅡ和左室心肌AngⅡ水平较假手术组显著升高 (P <0 0 0 1) ,鹿角方能明显降低血浆AngⅡ和左室心肌AngⅡ水平 (P <0 0 1或P <0 0 0 1)。模型组血浆ANF明显高于假手术组 (P <0 0 1) ,而鹿角方组血浆ANF较模型组明显下降 (P <0 0 1)。

大剂量螺内酯与糖皮质激素联合治疗重症慢性心力衰竭的临床观察

目的 探讨顽固性慢性充血性心力衰竭（CHF）时，在常规治疗的基础上加用大剂量螺内酯与泼尼松，观察对水、Na^＋、K^＋代谢及心功能的影响。方法 54例严重CHF患者（心功能Ⅲ～Ⅳ级，D期），随机分为对照组（27侧）与研究组（27例），对照组采用常规治疗（包括螺内酯20mg／d），研究组在常规治疗基础上，螺内酯60mg／d，泼尼松40mg／d连续应用30天。分析治疗后两组患者的一般临床情况、左室射血分数（EF）、血清Na^＋、K^＋、肌酐及24小时尿量、尿Na^＋、尿K^＋的变化。结果 两组患者在治疗后尿量及EF显著增加，但研究组患者用药后尿量较对照组增加更明显，研究组长血清Na^＋7天及30天均高于对照组，7天Na^＋（138．03±3．97）mmol vs（134．48±5.18）mmol／L，30天Na^＋（137．17±3．57）mmol／LVS（134．00±4．46）mmol／L（均P〈O．05）；血清K^＋7天及30天亦均高于对照组，7天K^＋（4．07±0．42）mmol／L vs（3．73±0．33）mmol／L，30天K^＋（4．18±0．49）mmol／L vs（3．79±0．44）mmol／L（均P〈0．05）；而治疗后研究组血清肌酐7天及30天低于对照组，差异有统计学意义，7天K^＋（92．93±28．65）mmol／Lvs（123．19±30．79）mmol／L，30天K^＋（90．07±30．32）mmol／L vs（115．00±40．61）mmol／L（均P〈0．05），尿Na^＋高于对照组（P〈0．05）。结论 常规治疗的基础上，适量应用糖皮质激素及大剂量螺内酯可使重症CHF患者在保持K^＋、Na^＋平衡及有效血容量的基础上能更明显地减轻过重的水负荷，改善心功能。

生脉胶囊治疗慢性心衰双盲随机对照试验中盲法的实施

[目的]以生脉胶囊治疗慢性心衰双盲随机对照试验为例,探讨盲法实施过程和盲法测试的意义。[方法]盲法实施参照GCP(good clinical practices)规范,盲法测试分别由10名测试者独立对安慰剂的外观、气味等做出评测,再由22名测试者模拟试验实际情况独立判断使用药物为何种。[结果]安慰剂在外观方面基本与生脉胶囊一致,但其气味、味道和口感则明显有别,当两者放在一起时容易辨别。但模拟试验情况的测试表明,试验实际实施中可能不易区分服用药物为何种。[结论]该安慰剂的制作技术有待进一步完善。双盲法的实施过程中,应强化实施过程的标准操作规范,由相对独立人员完成随机化、盲法编码和药物包装等过程,并应制定适宜的数据管理方法,以保证盲法实施的成功。

心肌组织速度成像对心脏再同步化治疗术后短期疗效的评价

目的应用常规超声心动图和心肌组织速度成像技术对心脏同步化治疗(CRT)的短期疗效进行评价。方法对18例心衰患者于三腔起搏器置人术前和术后1个月,应用Philips IE33分别测量左心室舒张末、收缩末的直径(LVDD、LVDS)、双平面Simpson's法测量左心室容积和射血分数(LVEF);心肌组织速度成像采集3个标准心尖切面图像,应用Q- lab分析软件测量左室基底部和中部12个节段收缩达峰时间的标准差(Ts-SD-12)及各节段心肌射血期峰值速度(Sm)、左室收缩后收缩(PSS)的峰值速度。结果心脏同步化治疗后,左室收缩同步性改善,Ts-SD-12减低,从(48.4±17.87)ms下降到(35.16±19.4)ms(P<0.05),左心室内径、容积缩小,收缩功能也有明显改善(P<0.05),各节段Sm明显提高(P<0.01)、PSS的峰值速度减低(P<0.05)。结论心肌组织速度成像技术是目前评价心肌再同步化治疗的有效手段。

步行运动训练对慢性充血性心力衰竭患者心脏的康复

目的:观察在药物治疗基础上步行运动训练对慢性心力衰竭(CHF)患者心功能康复的效果,探寻合理的运动方式。方法:621例Ⅱ～Ⅲ级慢性心功能不全的患者在药物治疗基础上随机分为3组:A组(212例):按设定的运动处方进行康复训练;B组(203例):鼓励患者多做运动,但无运动处方;C组(206例):不改变原有生活方式,不限制日常活动。经过6个月的随访,对比各组的血压、静息心率、6min步行距离、心脏超声检查的左室射血分数(LVEF)和左室舒末内径(LVEDd)等的变化。结果:运动训练前3组间一般情况、血压、静息心率、6min步行距离和左室功能无明显差异,6个月后各组死亡情况没有显著差别;A组总再次住院例次和心血管疾病再次住院比率明显低于B、C组(P均<0.05);A组与运动训练前及B、C组比较静息心率明显下降,6min步行距离和LVEF显著增加(P<0.01);3组血压和LVEDd无明显变化。结论:按运动处方进行步行训练方式对于心力衰竭患者的心脏功能康复是有效,并安全的。