PMID- 17919380
OWN - NLM
STAT- MEDLINE
DCOM- 20081031
LR  - 20161124
IS  - 0376-2491 (Print)
IS  - 0376-2491 (Linking)
VI  - 87
IP  - 25
DP  - 2007 Jul 3
TI  - [Clinical observation of high thoracic epidural anesthesia therapy for patients 
      with congestive heart failure secondary to ischemic cardiomyopathy].
PG  - 1752-4
AB  - OBJECTIVE: To investigate the effects of high thoracic epidural anesthesia (HTEA) 
      on chronic heart failure (CHF) and its safety. METHODS: 117 patients with 
      ischemic cardiomyopathy (ICM) of NYHA class II - IV and with the LVEF < or = 45%, 
      90 males and 27 females, aged 45 - 81, were Randomly divided into 2 groups: 
      control group (n = 54, treated with the routine medication) and HTEA group (n = 
      63, administrated epidurally with 0.5% lidocaine 3 - 5 ml every two hours from 9 
      a.m. to 11 p.m. everyday via an epidural catheter for one month in addition to 
      the routine treatment). Echocardiography was performed before and after the 
      treatment to examine the cardiac structure and left ventricular systolic 
      function. The plasma brain natriuretic peptide (BNP) was examined before and 
      after the treatment. RESULTS: The clinical symptoms and signs of the HTEA group 
      were improved markedly. The total effective rate was 95.2% in the HTEA group, 
      significantly higher than in the control group (85.2%, P < 0.05). 
      Echocardiographic parameters showed that the diameters of ventricles and atrium 
      decreased by 3 - 5 mm in the HTEA group. The left ventricular end diastolic 
      volume (LVEDV) of the HTEA group reduced from (337 +/- 132) ml before treatment 
      to 274 ml +/- 109 ml after treatment, and the left ventricular end systolic 
      volume (LVESV) of the HTEA group reduced from (215 +/- 99) ml before treatment to 
      (147 +/- 73) ml after treatment (both P < or = 0.001). The regurgitation area of 
      mitral valve of the HTEA group reduced from (6.6 +/- 3.7) cm(2) before treatment 
      to (4.3 +/- 2.7) cm(2) after treatment, and the regurgitation area of tricuspid 
      valve of the HTEA group reduced from (5.4 +/- 3.2) cm(2) before treatment to (3.3 
      +/- 2.3) cm(2) after treatment (both P < 0.01). No changes were observed in the 
      E/A ratio in both groups. The BNP level fell from (678 +/- 521) ng/L to (237 +/- 
      225) ng/L in the HTEA group (P < or = 0.05). In the HTEA group, one patient died 
      because of deterioration of cardiac function. HTEA was well tolerated and caused 
      lower incidence of adverse events. CONCLUSIONS: HTEA obviously improves the heart 
      function of the patients with CHS secondary to ICM. Consequently, HTEA is 
      effective and safe in CHF patients with favorable tolerance.
FAU - Wu, Shuang
AU  - Wu S
AD  - Department of Cardiology, First Clinical College of Harbin Medical University, 
      Harbin 150001, China.
FAU - Fu, Shi-ying
AU  - Fu SY
FAU - Liu, Feng-qi
AU  - Liu FQ
FAU - Wang, Lan-feng
AU  - Wang LF
FAU - Qu, Ren-hai
AU  - Qu RH
LA  - chi
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - China
TA  - Zhonghua Yi Xue Za Zhi
JT  - Zhonghua yi xue za zhi
JID - 7511141
RN  - 114471-18-0 (Natriuretic Peptide, Brain)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - *Anesthesia, Epidural
MH  - Echocardiography
MH  - Female
MH  - Heart Failure/diagnostic imaging/etiology/*therapy
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Ischemia/complications/diagnostic imaging/*therapy
MH  - Natriuretic Peptide, Brain/blood
MH  - Thorax
MH  - Treatment Outcome
EDAT- 2007/10/09 09:00
MHDA- 2008/11/01 09:00
CRDT- 2007/10/09 09:00
PHST- 2007/10/09 09:00 [pubmed]
PHST- 2008/11/01 09:00 [medline]
PHST- 2007/10/09 09:00 [entrez]
PST - ppublish
SO  - Zhonghua Yi Xue Za Zhi. 2007 Jul 3;87(25):1752-4.