Background Renin-angiotensin-aldosterone system has been demonstrated to be associated with both congestive heart failure （CHF） and atrial fibrillation （AF）. This study investigated the effects of spironolactone, ...Background Renin-angiotensin-aldosterone system has been demonstrated to be associated with both congestive heart failure （CHF） and atrial fibrillation （AF）. This study investigated the effects of spironolactone, a kind of aldosterone antagonist, on atrial electrical remodeling and fibrosis in CHF dogs induced by chronic rapid ventricular pacing. Methods Twenty one dogs were randomly divided into sham-operated group, control group, and spironolactone group. In control group and spironolactone group, dogs were ventricular paced at 220 beats per minute for 6 weeks. Additionally, spironolactone at 15 mg.kgl.d1 was given to dogs 1 week before rapid ventricular pacing until pacing stopped. Transthoracic and transoesophageal echocardiographic examinations were performed to detect structural and functional changes of the atrium. Swan2 Ganz floating catheters were used to measure hemadynamics variances. Atrial effective refractory period （AERP）, AERP dispersion （AERPd） conduction velocity （CV） were determined. The inducib atrial fibrosis was quantified with Masson staining. intra- and inter-atrium conduction time （CT） and intra-atrium ity and duration of AF were also measured in all groups. Finally, Results AERP did not change significantly after dogs were ventricular paced for 6 weeks. However, AERPd, intra- and inter-atrium CT increased significantly, and CV decreased apparently, which was negatively correlated to the atrial fibrosis （r=-0.74, P〈0.05）. Simultaneously, left atriums were enlarged and cardiac hemadynamics worsened in pacing dogs. Although spironolactone could not affect cardiac hemadynamics effectively, it can obviously improve left atrial ejection fraction （P〈0.05）. Spironolactone treatment did not alter AERP duration, but this medicine dramatically decreased AERPd （P〈0.05）, shortened intra- and inter-atrium conduction time （P〈0.05）, and increased atrium CV. Moreover, spironolactone decreased the inducibility and duration of AF （P〈0.05）, as well as at展开更多
目的:探讨Rho激酶抑制剂(RKI)联合呋塞米及螺内酯在急性左心衰(ALHF)治疗中的临床应用价值。方法: 2016年4月~2018年2月我院收治的94例ALHF患者被随机均分为利尿剂组(常规治疗基础上接受呋塞米及螺内酯)和三联治疗组(在利尿剂组基础上加...目的:探讨Rho激酶抑制剂(RKI)联合呋塞米及螺内酯在急性左心衰(ALHF)治疗中的临床应用价值。方法: 2016年4月~2018年2月我院收治的94例ALHF患者被随机均分为利尿剂组(常规治疗基础上接受呋塞米及螺内酯)和三联治疗组(在利尿剂组基础上加用RKI—盐酸法舒地尔),两组均连续治疗7d。观察比较两组治疗前后LVESV、LVEDV、LVEF、血清谷草转氨酶(AST)、乳酸脱氢酶(LDH)、肌酸激酶同工酶(CK-MB)水平,临床疗效。结果:三联治疗组治疗总有效率显著高于利尿剂组(95.75%比82.98%), P =0.045。与治疗前比较,治疗后两组LVEF显著升高,LVESV、LVEDV、血清AST、LDH、CK-MB水平均显著降低, P 均=0.001;与利尿剂组比较,三联治疗组治疗后LVEF[(48.27±5.95)%比(55.14±6.74)%]升高更显著,LVESV[(86.29±10.41)ml比(65.96±9.84)ml]、LVEDV [(133.71±13.42)ml比(120.35±11.25)ml]、血清AST[(81.23±10.44)U/L比(57.58±8.42)U/L]、LDH[(184.24±13.51)U/L比(124.65±12.42)U/L]、CK-MB[(187.84±13.45)U/L比(132.54±11.69) U/L]水平降低更显著, P 均=0.001。两组不良反应发生率无显著差异, P 均>0.05。结论: Rho激酶抑制剂联合呋塞米与螺内酯治疗ALHF效果显著,可显著改善心功能、减轻心肌损害,且安全可靠,值得推广。展开更多
文摘Background Renin-angiotensin-aldosterone system has been demonstrated to be associated with both congestive heart failure （CHF） and atrial fibrillation （AF）. This study investigated the effects of spironolactone, a kind of aldosterone antagonist, on atrial electrical remodeling and fibrosis in CHF dogs induced by chronic rapid ventricular pacing. Methods Twenty one dogs were randomly divided into sham-operated group, control group, and spironolactone group. In control group and spironolactone group, dogs were ventricular paced at 220 beats per minute for 6 weeks. Additionally, spironolactone at 15 mg.kgl.d1 was given to dogs 1 week before rapid ventricular pacing until pacing stopped. Transthoracic and transoesophageal echocardiographic examinations were performed to detect structural and functional changes of the atrium. Swan2 Ganz floating catheters were used to measure hemadynamics variances. Atrial effective refractory period （AERP）, AERP dispersion （AERPd） conduction velocity （CV） were determined. The inducib atrial fibrosis was quantified with Masson staining. intra- and inter-atrium conduction time （CT） and intra-atrium ity and duration of AF were also measured in all groups. Finally, Results AERP did not change significantly after dogs were ventricular paced for 6 weeks. However, AERPd, intra- and inter-atrium CT increased significantly, and CV decreased apparently, which was negatively correlated to the atrial fibrosis （r=-0.74, P〈0.05）. Simultaneously, left atriums were enlarged and cardiac hemadynamics worsened in pacing dogs. Although spironolactone could not affect cardiac hemadynamics effectively, it can obviously improve left atrial ejection fraction （P〈0.05）. Spironolactone treatment did not alter AERP duration, but this medicine dramatically decreased AERPd （P〈0.05）, shortened intra- and inter-atrium conduction time （P〈0.05）, and increased atrium CV. Moreover, spironolactone decreased the inducibility and duration of AF （P〈0.05）, as well as at
文摘目的:探讨Rho激酶抑制剂(RKI)联合呋塞米及螺内酯在急性左心衰(ALHF)治疗中的临床应用价值。方法: 2016年4月~2018年2月我院收治的94例ALHF患者被随机均分为利尿剂组(常规治疗基础上接受呋塞米及螺内酯)和三联治疗组(在利尿剂组基础上加用RKI—盐酸法舒地尔),两组均连续治疗7d。观察比较两组治疗前后LVESV、LVEDV、LVEF、血清谷草转氨酶(AST)、乳酸脱氢酶(LDH)、肌酸激酶同工酶(CK-MB)水平,临床疗效。结果:三联治疗组治疗总有效率显著高于利尿剂组(95.75%比82.98%), P =0.045。与治疗前比较,治疗后两组LVEF显著升高,LVESV、LVEDV、血清AST、LDH、CK-MB水平均显著降低, P 均=0.001;与利尿剂组比较,三联治疗组治疗后LVEF[(48.27±5.95)%比(55.14±6.74)%]升高更显著,LVESV[(86.29±10.41)ml比(65.96±9.84)ml]、LVEDV [(133.71±13.42)ml比(120.35±11.25)ml]、血清AST[(81.23±10.44)U/L比(57.58±8.42)U/L]、LDH[(184.24±13.51)U/L比(124.65±12.42)U/L]、CK-MB[(187.84±13.45)U/L比(132.54±11.69) U/L]水平降低更显著, P 均=0.001。两组不良反应发生率无显著差异, P 均>0.05。结论: Rho激酶抑制剂联合呋塞米与螺内酯治疗ALHF效果显著,可显著改善心功能、减轻心肌损害,且安全可靠,值得推广。
