| Objective:Heart failure(HF) is the epidemic disease in 21 century,and it has become the most common medical diagnosis-related group(DRG).Nowadays, although the treatment of congestive heart failure(CHF) has gotten important progress,but the mobidity and mortality of severe HF is very high and the year-mortality is higher than 50%.As a result,to explore the new approach for improvement of prognosis has been an important value.Recently,it has been confirmed that routine therapy with angiotensin-converting enztme inhibitor(ACEI),diuretics,cardiac glycoside,and β -blocker combined with small dose of spironolactone(mean 26mg/d) improved the progress of severe HF.At last decade,we have gotten a lot of clinical experience in using higher dosage of spironolactone to treat the severe HF patients.This study want to observe the changes of the cardiac function, ventricular remodeling and myocardial fibrosis after spironolactone intervation in larger dosage,and provide the evidence of the safety.Methods:CHF patients with New York Heart Association(NYHA) Ⅲ ~ Ⅳ class,left ventricular ejectionfraction (LVEF)<35%,and left ventricular end-diastolic diameter(LVEDD)>55cm, Serum Potasium<5.0mmol/L,and Serum Creatine<2.0mg/dL were included .All the patients aged 56 to 73 years old, including 42 male, aged 63.5 + 6.6, and 27 female, aged 65.2 ± 4.5years.The following patients were excluded: including acute coronary syndrome, severe malignant arrhythmia,acute infection,cancer,apoplexy,renalfailure,hyperthy roidism,severe hypertension,lung interstitial fibrosis,osteofibrosis,rheumatism and liver cirrhosis.The patients included randomely devided into smaller dosage spironolactone group(<40mg/d)and larger dosage spironolactone group(> 60mg/d).The baseline therapy included hydrochlorothiazide,digitalis,ACE inhibitor andBeta-blocker.The patient should decrease spironolactone dosage or withdraw from the trial if their Serum Potasium>5.0mmol/L and Serum Creatine>2.25mg/dL were persistent.BNP,PIIINP and cardiac function parameter were measured regularly before and 3,6 months after intervation respectively.All the patients must fast over 12 hours before the blood samples were obtained at 7:00-8:00 in the morning,and had laid on bed for 15 minutes at least,4-6ml of the blood samples were taken from median antebrachial vein,waiting congulation under room-temperature,then centrifugating by 1500/minute for 10 minutes,obtained the serum from the blood,the serum samples were kept in -80 °C refrigerator,then waiting for the collecting to measure at the same time.The biochemistry blood samples(4ml)were taken from vein,obtained the serum from the blood and determined in the same day.The cardiac function parameter were measured by SONOLINE type ultrasonic diagnostic apparatus(Seimens company,Germany) using a 2.5MHZ frequency linear arrey transducer including Left Ventricular end-systolic diameter (LVESD), Left Ventricular end-diastolic diameter (LVEDD), Left Ventricular fraction (LVEF), Left Ventricular posterior wall thickness(LVPWT),and Intraventricular Septation thickness(IVST). Body surface area(BSA) was calculated according to their length and weight,and Left Ventricular mass index(LVMI) was calculated according to Devereux Formula: LVMI(g/m2)= (l.04x ((LVEDD+LVPWT +IVST)3 - LVEDD3) -13.6} -f- BSA,at the same time.to caculate Left Ventricular end-shrinkable volume index(LVESVI) and Left Ventricular end-diastolic volume index(LVEDVI).SPSS 10.0 software pack were used for all the data to make statistical-analysis.Initially the homogeneity of variance among all the groups was analyzed.All the measurement data was denoted by mean±standard deviation and students t test was used to establish significance.Chi-square test was used for analysis of categorical data.We took p<0.05 was as statistic significant level.Results :1.There were no significant differences and comparable with eath other in the baseline data, including BNP PIIINP,LVEF,LVMI,LVEDVI,LVESVI and cardiac function... |
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