Background Endothelin-receptor blockade provides haemodynamic benefit in expe rimental and clinical heart failure. We aimed to measure the effects of long-te rm endothelin-blockade on left-ventricular (LV) remodelling...Background Endothelin-receptor blockade provides haemodynamic benefit in expe rimental and clinical heart failure. We aimed to measure the effects of long-te rm endothelin-blockade on left-ventricular (LV) remodelling and clinical outco mes in patients with chronic heart failure. Methods 642 patients with chronic he art failure were assigned the oral endothelinA-antagonist darusentan at 10, 25, 50, 100, or 300 mg daily or placebo for 24 weeks in addition to standard therap y in a randomised, doubleblind, placebo-controlled trial. In the 50-300 mg gro ups, darusentan was uptitrated over 6 weeks. Primary endpoint was change in LV e nd-systolic volume (LVESV) at 24 weeks from baseline, measured by MRI. All pati ents for whom assessable MRI scans were available at baseline and follow-up wer e included in the analysis. Findings Darusentan was well tolerated. LVESV could be assessed in 485 (76%) patients with paired MRI data at baseline and 6 months . The change in LVESV was not significantly different from that with placebo at any dose (mean difference from placebo 1.27 mL <<95%CI -9.9 to 12. 4>> with 10 m g dose, -1.84 mL <<-13.0 to 9.3>> with 25 mg, -5.68 mL <<-16.9 to 5.6>> with 50 mg, -4.05 mL <<-15.5 to 7. 4>> with 100 mg, and -4.34 mL <<-15.7 to 7. 0>> with 300 mg). Heart failure worsened in 71 (11.1%) patients, and 30 (4.7%) died dur ing the study with no difference between groups. Interpretation EndothelinA bloc kade with darusentan did not improve cardiac remodelling or clinical symptoms or outcomes in patients with chronic heart failure receiving an angiotensin-conve rting-enzyme inhibitor, βblocker, or aldosterone antagonist. Thus, endothelinA blockade is unlikely to be useful as an add-on treatment in such patients.展开更多
目的研究参附注射液联合布美他尼注射液治疗慢性充血性心力衰竭的临床疗效。方法选取2018年1月—2022年10月无锡市中医医院收治的90例充血性心力衰竭患者,通过随机数字表法将所有患者分为对照组和治疗组,每组各45例。对照组静脉滴注布...目的研究参附注射液联合布美他尼注射液治疗慢性充血性心力衰竭的临床疗效。方法选取2018年1月—2022年10月无锡市中医医院收治的90例充血性心力衰竭患者,通过随机数字表法将所有患者分为对照组和治疗组,每组各45例。对照组静脉滴注布美他尼注射液,2 mg置于250 mL 0.9%氯化钠注射液中稀释,滴注时间30~60 min,1次/d。治疗组在对照组基础上静脉滴注参附注射液,40 mL置于250 mL 5%葡萄糖注射液中稀释,滴注时间30~60 min,1次/d。两组患者均连续治疗10 d。观察两组的临床疗效,比较两组患者呼吸机辅助通气时间、心功能指标和血清脑钠肽(BNP)、N末端B型利尿钠肽原(NT-proBNP)。结果治疗后,治疗组的总有效率95.56%显著高于对照组的总有效率82.22%(P<0.05)。治疗后,治疗组无创呼吸辅助通气时间明显短于对照组,差异有统计学意义(P<0.05)。治疗后,两组左心室收缩末期内径(LVESD)、左心室收缩末期容积(LVESV)均较治疗前显著降低,左心室射血分数(LVEF)较治疗前明显升高(P<0.05),且治疗组LVESD、LVESV低于对照组,LVEF高于对照组,两组比较差异有统计学意义(P<0.05)。治疗后,两组血清BNP、NT-proBNP水平均较治疗前明显降低(P<0.05),且治疗组血清BNP、NT-proBNP水平明显低于对照组,两组比较差异有统计学意义(P<0.05)。结论参附注射液联合布美他尼注射液治疗充血性心力衰竭的疗效确切,可改善患者心功能,降低血清BNP、NT-proBNP水平,安全性良好。展开更多
文摘Background Endothelin-receptor blockade provides haemodynamic benefit in expe rimental and clinical heart failure. We aimed to measure the effects of long-te rm endothelin-blockade on left-ventricular (LV) remodelling and clinical outco mes in patients with chronic heart failure. Methods 642 patients with chronic he art failure were assigned the oral endothelinA-antagonist darusentan at 10, 25, 50, 100, or 300 mg daily or placebo for 24 weeks in addition to standard therap y in a randomised, doubleblind, placebo-controlled trial. In the 50-300 mg gro ups, darusentan was uptitrated over 6 weeks. Primary endpoint was change in LV e nd-systolic volume (LVESV) at 24 weeks from baseline, measured by MRI. All pati ents for whom assessable MRI scans were available at baseline and follow-up wer e included in the analysis. Findings Darusentan was well tolerated. LVESV could be assessed in 485 (76%) patients with paired MRI data at baseline and 6 months . The change in LVESV was not significantly different from that with placebo at any dose (mean difference from placebo 1.27 mL <<95%CI -9.9 to 12. 4>> with 10 m g dose, -1.84 mL <<-13.0 to 9.3>> with 25 mg, -5.68 mL <<-16.9 to 5.6>> with 50 mg, -4.05 mL <<-15.5 to 7. 4>> with 100 mg, and -4.34 mL <<-15.7 to 7. 0>> with 300 mg). Heart failure worsened in 71 (11.1%) patients, and 30 (4.7%) died dur ing the study with no difference between groups. Interpretation EndothelinA bloc kade with darusentan did not improve cardiac remodelling or clinical symptoms or outcomes in patients with chronic heart failure receiving an angiotensin-conve rting-enzyme inhibitor, βblocker, or aldosterone antagonist. Thus, endothelinA blockade is unlikely to be useful as an add-on treatment in such patients.
文摘目的研究参附注射液联合布美他尼注射液治疗慢性充血性心力衰竭的临床疗效。方法选取2018年1月—2022年10月无锡市中医医院收治的90例充血性心力衰竭患者,通过随机数字表法将所有患者分为对照组和治疗组,每组各45例。对照组静脉滴注布美他尼注射液,2 mg置于250 mL 0.9%氯化钠注射液中稀释,滴注时间30~60 min,1次/d。治疗组在对照组基础上静脉滴注参附注射液,40 mL置于250 mL 5%葡萄糖注射液中稀释,滴注时间30~60 min,1次/d。两组患者均连续治疗10 d。观察两组的临床疗效,比较两组患者呼吸机辅助通气时间、心功能指标和血清脑钠肽(BNP)、N末端B型利尿钠肽原(NT-proBNP)。结果治疗后,治疗组的总有效率95.56%显著高于对照组的总有效率82.22%(P<0.05)。治疗后,治疗组无创呼吸辅助通气时间明显短于对照组,差异有统计学意义(P<0.05)。治疗后,两组左心室收缩末期内径(LVESD)、左心室收缩末期容积(LVESV)均较治疗前显著降低,左心室射血分数(LVEF)较治疗前明显升高(P<0.05),且治疗组LVESD、LVESV低于对照组,LVEF高于对照组,两组比较差异有统计学意义(P<0.05)。治疗后,两组血清BNP、NT-proBNP水平均较治疗前明显降低(P<0.05),且治疗组血清BNP、NT-proBNP水平明显低于对照组,两组比较差异有统计学意义(P<0.05)。结论参附注射液联合布美他尼注射液治疗充血性心力衰竭的疗效确切,可改善患者心功能,降低血清BNP、NT-proBNP水平,安全性良好。
