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Effect of vasoactive therapy on heart rate variability in patients with acutely decompensated congestive heart failure

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AMERICAN JOURNAL OF CARDIOLOGY 1999年第4期84卷 476-+页

作者： Burger, AJ Aronson, D Beth Israel Deaconess Med Ctr Noninvas Cardiol Lab Div Cardiol Boston MA 02215 USA

Congestive heart failure (CHF) is characterized by generalized thought to contribute to progressive circulatory failure and influence survival.(1,2) Among the major manifestations of neuroendocrine activation are profound abnormalities in autonomic control, characterized by sympathetic overactivity(2) and parasympathetic withdrawal.(3) Analysis of heart rate variability (HRV) has been used to study autonomic function in patients with CHF, and provides independent information on the risk of death in ambulatory patients.(4-6) Moreover, HRV analysis has been used to document the beneficial modulating effect of agents such as angiotensin-converting enzyme inhibitors and beta blockers(7) on autonomic balance. Previous studies on the effect of pharmacologic therapy on HRV parameters have been performed in stable patients with chronic CHF, documenting an improvement within weeks to months. The present study examines baseline HRV parameters of patients with acutely decompensated CHF requiring hospitalization and evaluates the acute effects of medical therapy on HRV parameters.

关键词：急性病自主神经系统/药物作用自主神经系统/病理生理学强心药/治疗应用昼夜节律心电描记术便携式/药物作用随访研究心率/药物作用治疗结果血管舒张药/治疗应用女(雌)性人类男(雄)性中年人

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Cytoprotection in acute myocardial infarction

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INTERNATIONAL JOURNAL OF CARDIOLOGY 1999年第1期72卷 1-2页

作者： Doehner, W Univ London Imperial Coll Sci Technol & Med Sch Med Natl Heart & Lung Inst London SW3 6LY England

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Tailored therapy using dobutamine and nitroglycerin in advanced heart failure

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AMERICAN JOURNAL OF CARDIOLOGY 1999年第8期84卷 941-+页

作者： Drazner, MH Solomon, MA Thompson, B Yancy, CW Univ Texas SW Med Ctr Div Cardiol Dallas TX 75235 USA St Paul Med Ctr Dallas TX USA

In 29 patients with advanced heart failure, therapy tailored to hemodynamic goals was attempted using an initial infusion of dobutamine and nitroglycerin (the latter in those with pulmonary hypertension) followed by escalating doses of oral vasodilators. In the 23 patients who were weaned from inodilator therapy, significant improvements in hemodynamic parameters and a low 90-day hospital readmission rate were documented.

关键词：血管紧张素转换酶抑制药/投药和剂量强心药/投药和剂量强心药/治疗应用多巴酚丁胺/投药和剂量多巴酚丁胺/治疗应用高血压肺性/药物疗法高血压肺性/病因学输注静脉内输注胃肠外异山梨酯硝酸/投药和剂量硝酸甘油/投药和剂量硝酸甘油/治疗应用回顾性研究治疗结果血管舒张药/投药和剂量血管舒张药/治疗应用成年人老年人女(雌)性人类男(雄)性中年人

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Metabolic treatment of myocardial ischaemia

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EUROPEAN HEART JOURNAL 1999年第16期20卷 1144-1145页

作者： Ferrari, R

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A new era in the treatment of erectile dysfunction

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AMERICAN JOURNAL OF CARDIOLOGY 1999年第5B期84卷 18N-23N页

作者： Padma-Nathan, H Male Clin Beverly Hills CA 90212 USA

The recent introduction of sildenafil has revolutionized the treatment of erectile dysfunction (ED). The availability of sildenafil, the first effective oral agent for ED, has also expanded the field of sexual healthcare to include general and primary care practitioners and other nonurology specialists. A new process-of-care algorithm has been developed to facilitate the evaluation and treatment of ED in these nonurology settings. Sildenafil has been demonstrated to be safe and effective in randomized, double-blind, placebo-controlled trials involving >3,000 men ages 19-87 years. Sildenafil is effective across a broad range of etiologies including diabetes. For patients in whom first-line treatment with sildenafil fails or ceases to be effective, second-line interventions with intracavernosal self-injection therapy or transurethral alprostadil may be indicated. In addition to sildenafil, other oral agents such as oral phentolamine and sublingual apomorphine are now in clinical trials. Drugs under development include second-generation phosphodiesterase type 5 (PDE5) inhibitors, endothelin antagonists, and agents that offer specific molecular targeting. Clinical studies are also being planned to examine the efficacy of combination oral drug regimens for ED. (C) 1999 by Excerpta Medica, Inc.

关键词：投药口服算法前列地尔/投药和剂量前列地尔/治疗应用双盲法注射阴茎磷酸二酯酶抑制剂/投药和剂量磷酸二酯酶抑制剂/治疗应用哌嗪类/投药和剂量哌嗪类/治疗应用安慰剂性行为血管舒张药/投药和剂量血管舒张药/治疗应用成年人老年人老年人 80以上人类男(雄)性中年人

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Cardiovascular effects of sildenafil citrate and recommendations for its use

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AMERICAN JOURNAL OF CARDIOLOGY 1999年第5B期84卷 11N-17N页

作者： Kloner, RA Zusman, RM Hosp Good Samaritan Inst Heart Los Angeles CA 90017 USA Univ So Calif Los Angeles CA USA Harvard Univ Sch Med Boston MA USA Massachusetts Gen Hosp Div Hypertens & Vasc Med Boston MA 02114 USA

Siidenafil citrate is the first orally active therapy proved to be effective and safe treatment for erectile dysfunction (ED), Because men with cardiovascular disease are at increased risk of developing ED, and because ED and cardiovascular disease share important risk factors, attention has focused recently on the use of sildenafil in these men. When used in combination with nitroglycerin and other nitric oxide (NO) donors, sildenafil may potentiate major drops in blood pressure, Use of nitrate antianginal agents are an absolute contraindication to sildenafil use. In normotensive men and in men receiving antihypertensive medications evaluated in Phase II/III clinical trials, sildenafil use at the recommended doses (25-100 mg 1 hour before sexual intercourse and no more than once daily) was associated with modest, transient reductions in blood pressure and negligible effects on heart rate. In a more recent study, sildenafil was well tolerated in patients receiving antihypertensive medications and was not associated with major decreases in blood pressure. From the time of its approval in the United States in March 1998 through mid-November 1998, with approximately 6 million prescriptions written, 130 deaths were reported by the US Food and Drug Administration (FDA). Seventy-seven of the men who died had documented cardiovascular events. Sixteen men took or were administered nitroglycerin or an organic nitrate;3 others had nitroglycerin in their possession. Physician prescribing guidelines issued by the American College of Cardiology/American Heart Association (ACC/AHA) recommend caution when prescribing sildenafil to men with certain cardiovascular conditions, liver or kidney disease, and to those taking medications that may prolong sildenafil's half-life (e.g., erythromycin or cimetidine), Those with known or suspected coronary artery disease may benefit from an exercise test to determine whether resumption of sexual activity with use of sildenafil is likely to be a

关键词：医师诊疗模式哌嗪类/投药和剂量哌嗪类/禁忌证哌嗪类/治疗应用危险因素美国美国食品和药物管理局血管舒张药/治疗应用

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Measurement of troponin T to detect cardioprotective effect of trimetazidine during coronary artery bypass grafting

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ANNALS OF THORACIC SURGERY 1999年第6期68卷 2173-2176页

作者： Tünerir, B Çolak, Ö Alatas, Ö Besogul, Y Kural, T Aslan, R Osmangazi Univ Sch Med Dept Cardiovasc & Thorac Surg Eskisehir Turkey Osmangazi Univ Sch Med Dept Biochem Eskisehir Turkey Res Hosp Eskisehir Turkey

Background. The aim of the present study was to evaluate potential myocardial protection by trimetazidine by measurement of the cardiac marker protein troponin T (TnT) during coronary bypass operations. Methods. We conducted a double-blind, placebo-controlled study on 30 randomized patients who had aorta-coronary artery bypass operations. The TMZ group was composed of 15 patients and the placebo group of 15 patients in New York Heart Association class III or IV. Pretreatment was started 3 weeks preoperatively with trimetazidine (60 mg orally per day) or the placebo. In the trimetazidine TMZ group, there were 2 women and 13 men with a mean age of 57.1 +/- 2.2 years and mean cross-clamp time of 44 +/- 1.8 minutes. In the placebo group, there were 5 women and 10 men with a mean age of 58.4 +/- 1.2 years and a mean cross-clamp time of 42 +/- 2.4 minutes. Serial blood samples were collected before and after the operation, and serum concentrations of cardiac TnT were measured. Results. The preoperative serum concentration of TnT was 0 to 0.39 ng/mL in all patients. The mean TnT levels were measured 5 minutes after completion of cardiopulmonary bypass (1.5 +/- 0.3 ng/mL) and 12 (1.4 +/- 0.1 ng/mL), 24 (0.9 +/- 0.1 ng/mL), and 48 hours postoperatively (0.1 +/- 0.1 ng/mL) in the trimetazidine group. Troponin T levels in the placebo group measured at the same time periods were 4.4 +/- 0.4, 4.8 +/- 0.7, 2.8 +/- 0.4, and 0.7 +/- 0.1 ng/mL. In the trimetazidine group, TnT levels were significantly less than those of the placebo group (p < 0.001). The levels of TnT were tested by creatine kinase-MB levels of both groups. Mean cardiac index was evaluated in all patients preoperatively and postoperatively. There was no significant difference in perioperative hemodynamics (blood pressure and cardiac index) between groups. Conclusions. These results obtained by measurement of cardiac TnT suggested that pretreatment with trimetazidine reduces ischemic-reperfusion damage during coronar

关键词：心肺转流术冠状动脉分流术双盲法心肌再灌注损伤/病理生理学心肌再灌注损伤/预防和控制曲美他嗪/治疗应用肌钙蛋白T/血液血管舒张药/治疗应用女(雌)性人类男(雄)性中年人

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Minoxidil and male-pattern alopecia: a potential role for a local regulator of sebum secretion with vasoconstrictive effects?

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MEDICAL HYPOTHESES 1999年第5期53卷 402-406页

作者： Kurbel, S Kurbel, B Zanic-Matanic, D Osijek Clin Hosp Dept Physiol Osijek Croatia Univ Zagreb Univ Hosp Rebro Dept Anaesthesiol Surg Clin Zagreb Croatia

Regulation of the hair cycle takes place at the pilo-sebaceous unit with the sebaceous gland as a sex hormone-dependent part Although minoxidil stimulates proliferation of follicular cells and activation of prostaglandin endoperoxide synthase-l, it was suggested that other mechanisms, such as an increase in the local blood flow, might mediate the drug effect on hair growth. If that is the case, it is possible that minoxidil counteracts some vasoconstrictive mediator of male-pattern alopecia. This hypothetical vasoconstrictive media for X would have to meet some criteria: (I) vasoconstriction both in the general circulation and in the hair-growing skin;(II) local vasoconstrictive activity in the hair growing skin should be related to the circulating testosterone level;(III) only an increase in the local mediator X activity causes male-pattern alopecia, since hypertensive patients are not balder than expected. The sebaceous gland is a possible place of the mediator X secretion since it is a sex-hormone-dependent part of the pilo-sebaceous unit. ET-1 might be a suitable candidate for the media for X, since male hormones raise ET-1 plasma levels and female hormones lower them. The speculation presented here is that ET-1, beside vasoconstriction in the general circulation, might also regulate the sebum secretion, by triggering contractions of the myoepithelial cells. This hypothetical mechanism would normally remain confined to the sebaceous gland. During puberty, sex hormones stimulate growth of sebaceous glands in both sexes. In women hypertrophied sebaceous glands under estrogen control would not increase its ET-1 content, while in men, testosterone would increase ET-1 secretion that might affect the neighboring arterioles. Induced vasoconstriction might reduce the hair growth and promote hair loss. If ET-I plays the described role, then an ET-1 antagonist, i.e. bosentane, should also have some hair-growing properties. (C) 1999 Harcourt Publishers Ltd.

关键词：秃发/血液秃发/药物疗法内皮缩血管肽1/药理学雌激素类/血液米诺地尔/药理学米诺地尔/治疗应用模型理论皮脂/分泌睾酮/血液血管收缩/药物作用血管舒张药/药理学血管舒张药/治疗应用人类男(雄)性

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Transitory left ventricular outflow tract obstruction after mitral valve reconstruction

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DEUTSCHE MEDIZINISCHE WOCHENSCHRIFT 1999年第38期124卷 1095-1098页

作者： Hauber, J Rein, JG Sigel, H Klin Eichert Med Klin 1 D-73006 Goppingen Germany SANA Herzchirurg Klin Stuttgart Germany

History and admission findings:a few days after uneventful surgical reconstruction of the mitral valve a 43-year-old man was found to have a systolic murmur due to prolapse of the posterior leaflet, suggesting renewed mitral regurgitation. Investigations: Echocardiography revealed haemodynamically significant left ventricular outflow tract obstruction (LVOT) with a left ventricle to aorta systolic gradient of 83 mm Hg. In addition there was moderately severe mitral regurgitation as well as a pericardial effusion but no signs of tamponade. Treatment and course: The obstruction was at first treated with verapamil, later with sotalol. The pericardial effusion was interpreted as part of a postcardiotomy syndrome. The effusion regressed under steroid administration, and the LVOT and mitral regurgitation also decreased. A provocation test five months postoperatively no longer brought about an outflow gradient. The good results were still present 12 months postoperatively. Conclusion: The described, rarely seen form of LVOT was probably caused by a combination of a very large anterior mitral leaflet, postoperative pericardial effusion and pharmacological effects. If the obstruction first occurs postoperatively, appropriate medication may improve the cardiac status and reoperation may be avoided. Echocardiography is an important method of diagnosis and serial monitoring.

关键词：肾上腺素能β受体拮抗剂/治疗应用超声心动描记术随访研究二尖瓣/外科学二尖瓣闭锁不全/病因学二尖瓣脱垂/诊断二尖瓣脱垂/病因学心包积液/诊断心包积液/药物疗法心包积液/病因学索他洛尔/治疗应用时间因素血管舒张药/治疗应用室性流出道阻塞/诊断室性流出道阻塞/药物疗法室性流出道阻塞/病因学维拉帕米/治疗应用成年人人类男(雄)性

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Pretreatment with a potassium-channel opener before prolonged cardiac storage: An evaluation in an experimental brain death model

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ANNALS OF THORACIC SURGERY 1999年第6期67卷 1623-1629页

作者： Kirsch, M Bertrand, S Garnier, JP Fernandez, C Baufreton, C Astier, A Loisance, D Ctr Rech Chirurg Henri Mondor Fac Med F-94010 Creteil France Hop St Louis Dept Biochem Paris France

Background. Pretreatment with a potassium-channel opener has been shown to improve functional recovery after long-term cardioplegic arrest. We evaluated whether pretreatment with the potassium-channel opener cromakalim is beneficial in a more clinically relevant experimental model of brain death in the rabbit. Methods. Four groups of rabbits were studied in a 2 x 2 factorial experiment (n = 8 per group). Rabbits were subjected to a sham operation or 90 minutes of brain death induced by inflating a subdurally placed balloon. Thirty minutes before heart explantation, rabbits received either no pretreatment or an intravenous injection of cromakalim, 30 mu g/kg. Hearts then received 5 hours' hypothermic storage in St. Thomas' Hospital solution and were assessed on a buffer-perfused isolated heart preparation. Hemodynamic recovery, coronary now, and creatine kinase release were determined after 60 minutes of reperfusion. Results. Systolic function and diastolic function were significantly altered in hearts explanted from brain-dead rabbits compared with hearts from rabbits having a sham operation. Cromakalim pretreatment had no significant effect on poststorage systolic or diastolic function of hearts explanted from brain-dead or sham-operation rabbits. Further, cromakalim pretreatment did not affect coronary flow or overall creatine kinase release during reperfusion. Conclusions. In vivo pretreatment of brain-dead rabbits or anesthetized rabbits with an intravenous injection of cromakalim had no significant effect on functional recovery of or enzymatic release from explanted hearts after 5 hours' hypothermic storage and 60 minutes' reperfusion. These findings underscore the importance of clinically relevant experimental models. (C) 1999 by The Society of Thoracic Surgeons.

关键词：脑死亡/代谢冠状动脉循环肌酸激酶/代谢色满卡林/治疗应用疾病模型动物肾上腺素/血液评价研究缺血预处理心肌/方法去甲肾上腺素/血液器官保存器官保存液血管舒张药/治疗应用动物兔

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