Aortic input impedence and neurohormonal activation in patients with mild to moderate chronic congestive heart failure.

OBJECTIVE: The aim was to investigate the interrelation between pulsatile components (assessed by determination of aortic input impedance) and neurohormonal activation in chronic congestive heart failure. METHODS: Aortic input impedance, plasma noradrenaline, renin, atrial natriuretic factor, and arginine vasopressin were measured in 20 patients with mild to moderate chronic congestive heart failure (coronary artery disease n = 12, idiopathic dilated cardiomyopathy n = 8). RESULTS: Cardiac index [2.2(SEM 0.3) litre.min-1.m-2] and left ventricular ejection fraction [38(4)%] were reduced, and pulmonary wedge pressure was increased [21(2) mmHg]. Plasma concentrations of noradrenaline [462(62) pg.ml-1], renin [12(4) ng AI.ml.h-1], atrial natriuretic factor [408(64) pg.ml-1], and--to a slight degree--arginine vasopressin [1.1(0.3) pg.ml-1] were increased. Characteristic impedance Zc [80(6) dyne.s.cm-5) and relative oscillatory aortic input pressure power [10(1)%]--both reflecting the pulsatile components of left ventricular afterload--were within the normal range. There was no significant correlation between these variables and the degree of neurohormonal activation (r values: -0.05 to -0.35). CONCLUSIONS: The data show that in patients with mild to moderate chronic congestive heart failure there is no interrelationship between the degree of neurohormonal activation and pulsatile components of left ventricular afterload. This may indicate that in these stages of heart failure there are no trophic effects of stimulated neurohormonal systems on the physical properties of the great arteries.     

Rebuttal: Percutaneous balloon dilation of severe pulmonary valve stenosis in patients with cyanosis and congestive heart failure

Transcatheter aortic valve implantation for bicuspid aortic valve stenosis (BAVS) is controversial, as its unfavorable anatomy may lead to device dislocation or malfunctioning. If device failure occurs, the bailout intervention can be more complex and technically challenging. We here report a unique case of late migration of a CoreValve (Medtronic, MN) implanted in a patient with BAVS, who was successfully treated with elective valve‐in‐valve implantation using the first valve as a firm scaffold after waiting for it to adhere at the migrated position. This new strategy may represent a useful salvage option for some patients with prosthesis migration. © 2015 Wiley Periodicals, Inc.     

Hemodynamic comparison of intravenous amrinone and dobutamine in patients with chronic congestive heart failure

Amrinone, a new inotropic agent, has been shown to be beneficial in patients with congestive heart failure. However, its hemodynamic effects have not been compared with those of currently useful catecholamines. In this study, the effects of intravenously administered dobutamine and amrinone were compared in eight patients with severe chronic congestive heart failure. Dobutamine was infused until a maximal increase in cardiac index was reached or undesirable effects were produced. This dose was then continued for 8 hours. After a return of hemodynamic values to baseline level, amrinone was infused at a rate of 40 μg/kg per min for 1 hour and then 10 μg/kg per min for 24 hours. Both drugs significantly improved cardiac index while simultaneously decreasing systemic vascular resistance and right atrial and pulmonary wedge pressures (p <0.05). Initially no differences could be found between the drugs. However, with prolonged infusion amrinone produced a sustained improvement whereas dobutamine had a decreased effectiveness. Thus, amrinone is comparable in effect with the optimal dose of dobutamine and would appear to be an extremely promising drug in the acute treatment of severe congestive heart failure.     

Plasma concentration of alpha-hANP and renal responses to alpha-hANP infusion in patients with congestive heart failure and those with chronic renal failure

To study the role of alpha-human atrial natriuretic polypeptide (alpha-hANP) in body fluid regulation, we measured the plasma concentration of alpha-hANP and renal function in 9 patients with congestive heart failure (CHF), 10 with chronic renal failure (CRF) and 8 normotensives (NT) before and during alpha-hANP infusion at 0.025 microgram/kg.min. The plasma concentration of alpha-hANP was significantly higher in the CHFs and CRFs than in the NTs (319, 168 and 72 pg/ml, respectively). Alpha-hANP infusion decreased mean blood pressure in a similar manner in the 3 groups (-5%, p less than 0.01 each). Increases in urinary sodium excretion and glomerular filtration rate during alpha-hANP infusion, however, were greater in the CHFs and CRFs than in the NTs. Furthermore, the higher the preinfusion level of renal vascular resistance (RVR), the greater was the reduction in RVR by alpha-hANP (r = -0.80, p less than 0.001). The metabolic clearance rate (MCR) of alpha-hANP was significantly smaller in the CHFs and CRFs than in the NTs (38, 35 and 67 ml/min.kg, respectively). These results suggest that the renal vasodilatory actions of alpha-hANP seem to be enhanced in patients with increased RVR and that the elevation of the basal plasma concentration of alpha-hANP in CHFs and CRFs may be in part due to the low MCR.     

Bronchial hyperresponsiveness in patients with chronic congestive heart failure

To investigate the relationship between pulmonary congestion and bronchial responsiveness, we measured bronchial responsiveness to acetylcholine in 51 patients with left heart disorders. The measurement of bronchial responsiveness was performed by inhaling doses of acetylcholine chloride (0.08 to 20 mg/ml) and calculating the PC20-FEV1. The median value for PC20-FEV1 was above 20 mg/ml in the subjects without history of congestive heart failure (n = 18), was 5.29 mg/ml in the subjects with clinical evidence of congestive heart failure in the past days (n = 18; p less than 0.01), and was 5.74 mg/ml in the subjects with clinical evidence of congestive heart failure at the time of study (n = 15; p less than 0.01). The hemodynamic variables by cardiac catheterization and the clinical symptoms were not correlated with the grade of bronchial responsiveness. These results suggest that the bronchial responsiveness was increased in most of the patients with chronic congestive heart failure. We concluded that continuous pulmonary congestion may contribute to the pathogenesis of bronchial hyperresponsiveness.     

Severe congestive heart failure in mild pulmonic stenosis due to dysplastic pulmonary valve associated with cardiomyopathy

Congestive heart failure has never been described in patientswith dysplastic stenotic pulmonary valve without associatedshunt lesions. We describe two patients with mild pulmonic stenosisdue to valvular dysplasia associated with cardiomyopathy whodeveloped severe congestive heart failure. Since the small pressuregradients across the pulmonary valve cannot cause this complication,we suggest that it resulted from the associated hypertrophicnon-obstructive cardiomyopathy. The presence of cardiomyopathymay alter the clinical presentation and prognosis of patientswith dysplastic pulmonary valve. In some cases, like our twocases, the cardiomyopathy rather than the valvular lesion shouldbe considered the main disease.     

Echocardiographic abnormalities in chronic alcoholics with and without overt congestive heart failure

To assess the type and prevalence of cardiac abnormalities in heavy drinkers with and without overt congestive heart failure, M mode echocardiography was performed in 11 symptomatic chronic alcoholics with dilated (congestive) cardiomyopathy and in 22 asymptomatic chronic alcoholics. Echocardiographic data in both groups were adjusted for age and body surface area using previously derived regression equations. All 11 symptomatic patients had a significantly decreased left ventricular percent fractional shortening (mean 14 percent, normal range 28 to 44) along with significant increases in left ventricular systolic and diastolic dimensions (mean increases of 105 and 48 percent above normal, respectively), left atrial dimension (mean increase 21 percent) and estimated left ventricular mass (mean increase 105 percent). Among the 22 asymptomatic patients, 15 (68 percent) demonstrated significant increases in at least one of the following echocardiographic variables: left ventricular mass, left ventricular dimensions, septal and left ventricular wall thicknesses, and left atrial dimension. Asymptomatic patients could be classified into two subgroups: (1) those with a left ventricular diastolic dimension less than 10 percent above the normal predicted value and an increased left ventricular wall thickness to radius ratio (mean increase 16 percent above normal) and upper normal percent fractional shortening, and (2) those with a left ventricular diastolic dimension 10 to 24 percent above normal and a slightly subnormal thickness to radius ratio and lower normal percent fractional shortening. Echocardiographic abnormalities in asymptomatic chronic alcoholics did not correlate with the presence or absence of auscultatory abnormalities on physical examination and appear to reflect an earlier stage in the spectrum of alcoholic disease before the development of dilated cardiomyopathy.     

不同心律的慢性充血性心力衰竭患者对美托洛尔的耐受性比较

目的 :比较不同心律状态下的慢性充血性心力衰竭 (CHF)患者对美托洛尔治疗的剂量耐受情况。方法 :对 14 6例CHF患者 [其中窦性心律 (窦律 ) 10 3例、心房颤动 (房颤 )心律 2 8例、起搏器心律 15例 ]在常规心力衰竭 (心衰 )治疗基础上口服美托洛尔 ,逐渐加量至目标剂量。治疗目标分别为 :①心室率下降到 5 0～ 6 5次 /min(不低于 5 0次 /min) ;②稍加剂量心功能下降 1级 ;③收缩压不低于 90mmHg(1mmHg =0 .133kPa) ;④达最大剂量 :2 0 0mg/d。结果 :窦律者美托洛尔平均剂量低于房颤和起搏器心律者 [(72 .7± 36 .1)mg/d∶(10 4 .7±2 8.7)mg/d和 (10 8.7± 2 4 .6 )mg/d ,P <0 .0 1];窦律者达心率目标的平均剂量低于达心衰的目标剂量 ,房颤者心率和心衰的目标剂量相当 ,而 3种不同心律患者达心衰目标剂量无明显差异 (P >0 .0 5 )。结论 :不同心律的CHF患者对美托洛尔的耐受性均较好 ,且房颤和起搏器心律者好于窦律患者     

美托洛尔治疗慢性充血性心力衰竭的疗效观察

目的：观察美托洛尔（倍他乐克）治疗慢性充血性心力衰竭的临床疗效。方法：选择慢性充血性心力衰竭患者72例,在常规治疗后病情基本稳定的基础上,随机分为对照组34例,给予强心甙、利尿剂、血管扩张剂和血管紧张素转换酶抑制剂治疗;美托洛尔组38例,在对照组治疗基础上加用美托洛尔,初始剂量6．25mg,每日2次,每2周递增1次剂量,为上述剂量的2倍,直至最大耐受剂量50mg,每日2次,维持治疗3个月以上。结果：美托洛尔组的心功能改善显效率为44．7％,总有效率为89．4％,高于对照组的26．5%和64．7％,总有效率差异有显著性（P〈0．05）。与治疗前相比,美托洛尔组心率、血压、左心室射血分数、左心室舒张末期内径均有显著改善（P均〈0．05）,疗效优于对照组（P〈0．05）。结论：在常规治疗基础上,加用美托洛尔治疗慢性充血性心力衰竭安全有效。可以显著改善左室重构。     

Plasma urotensin II level in patients with chronic congestive heart failure

Urotensin II (UTII) is recently discovered neurohumoral factor influencing function and structure of the myocardium and remodeling of the vessels, and it may contribute to pathogenesis of chronic congestive heart failure. The aim of the study was estimation of plasma concentration of UTII in patients with chronic congestive heart failure. The investigations were performed on 79 patients (37 women and 42 men) aged 43-87 yr. (mean 69.2 +/- 9.8 yr.) and 15 healthy individuals. In all patients, echocardiographic examination of the left ventricle structure and function was performed and serum concentration of electrolytes and creatinine were measured. Plasma levels of UTII were determined before treatment and after 1 week, 2 and 4 weeks of treatment using RIA Peninsula Lab. Inc. Plasma level of UTII in patients suffering from chronic congestive heart failure was significantly lower than in healthy individuals before the treatment and after achieving compensation of the circulatory system using standard treatment, independently from sex, kind of heart failure (systolic-diastolic or diastolic) or coexistence arterial hypertension or pulmonary hypertension, ischemic heart disease or diabetes and impaired glucose tolerance. Treatment of chronic congestive heart failure resulted in a transient increase in UTII concentration except for patients with diastolic heart failure or diabetes. Only patients without ischemic heart disease have a permanent increase in UTII concentration at the time of the treatment. After achieving compensation of the circulatory system in the patients suffering from systolic-diastolic heart failure, UTII concentration was significantly lower than in the patients suffering from diastolic heart failure, in the patients suffering from ischemic heart disease significantly lower than in patients without ischemic heart disease, in the patients with arterial hypertension significantly higher than in those with normal arterial tension, in group of the patients with pulmonary hypertension lower than in group of the patients without pulmonary hypertension and significantly higher in group of the patients suffering from diabetes or impaired glucose tolerance than in group of the patients without this metabolic disorders.