ABSTRACT
Alcoholic cardiomyopathy is a kind of specific cardiomyopathy caused by long-term heavy drinking.It stands the final influence of alcoholism on heart.Its symptoms show no difference with other cardiomyopathy.Therefore,early diagnosis of alcoholic cardiomyopathy is very important.Though it has been aware by physicians,there still exist some defects in its pathophysiology,pathogenesis,prognosis and treatment.
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Objective To observe the effect of conventional therapy plus trimetazidine on alcoholic cardiomyopathy (ACM) and plasma brain natriuretic peptide (BNP).Methods Eighty-six cases of ACM patients were divided into control group and observation group by random digits table method with 43 cases each.Control group was treated with conventional therapy,while observation group was added trimetazidine.Course of treatment was 3 months.The left ventricular ejection fraction (LVEF),left ventricular end diastolic diameter (LVEDD),6 min walk distance,plasma BNP before and after treatment and the efficiency in two groups was observed and compared.Results LVEF,LVEDD,6 min walk distance,BNP before treatment in control group were respectively (37.2 ±7.4)％,(57.6 ±7.4) mm,(312.8 ±21.6) m,(846.2 ±63.7)μg/L,and the indicators in observation group were respectively (38.5 ±8.1)％,(57.1 ±6.8) mm,(316.5 ± 23.9) m,(857.6 ± 61.4) μ g/L.All indicators between two groups was no statistically different (P＞0.05).LVEF,LVEDD,6 min walk distance,BNP after treatment in control group were respectively (43.5 ±8.6)％,(54.3 ± 6.4) mm,(511.6 ± 26.7) m,(679.4 ± 51.3) μg/L,and there were significant difference compared with those before treatment (P ＜ 0.05).LVEF,LVEDD,6 min walk distance,BNP after treatment in observation group were respectively (51.6 ± 9.2)％,(51.2 ± 6.3) mm,(579.3 ± 25.1) m,(536.5 ± 50.6)μ g/L,and there were significant difference compared with those before treatment (P ＜ 0.05).There were significant difference in LVEF,LVEDD,6 min walk distance and BNP after treatment between two groups (P ＜ 0.05).The total effective rate in observation group was 90.7％ (39/43),which was significantly higher than that in control group [72.1％ (31/43)] (x2 =4.914,P ＜ 0.05).Conclusion Adding trimetazidine on the basis of conventional therapy can improve the cardiac function and myocardial remodeling of ACM patients and improve clinical efficacy.
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Objective To investigate the mechanism of the effects of heavy alcohol consumption in a short term and the protection of angiotensin Ⅱ receptor blocker (valsartan) on cardiac function in rats. Methods The 42 male Wistar rats aged 20 weeks were randomly divided into 4 groups:control group (group C, n= 10), alcohol group (group A, n=10), low-dose valsartan group (LD group, n= 11) and high-dose valsartan group (HD group, n= 11). They were supplied with same animal feeds, but all of them were administered different dose of alcohol and medicine via intragastric tube: group C was administered water, group A was administered alcohol (6. 4 g/kg), LD group was administered alcohol (6.4 g/kg) and valsartan (15 mg/kg), HD group was administered alcohol (6.4 g/kg) and valsartan (30 mg/kg). And 9 weeks later, the change of cardiac function was observed by echocardiography, the body and heart weight were measured, the hydroxyproline content of rat myocardium was determined by sample alkaline solution. Results After 9 weeks, there were no significant differences among four groups in left ventricular ejection fraction (LVEF), stroke volume (SV) and fraction shortening (FS). But the E peak, Ea/Aa, Ea peak and Aa peak were obviously lower in group A than in groups of C, LD and HD (all P＜0.05), and there were significant differences among C group, LD group and HD group in E peak, Ea/Aa (all P＜0. 05). The HW/BW and hydroxproline (Hyp) contents of myocardium were higher in group A than in groups of C, LD and HD (all P＜0. 01), but there were no statistical significances among group C, LD group and HD group (all P＞0. 05). Conclusions The short term heavy alcohol consumption results in impaired ultrastructure and diastolic function of myocardium in rats, the angiotensin Ⅱ receptor blocker (valsartan) may protect it.
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Objective To observe the preventive and therapeutic effects of L-carnitine on the metabolic disorder and cardiac remodeling in alcoholic cardiomyopathy. Methods Experimental animals were divided into three groups: alcohol-fed group(A), an alcohol/L-carnitine fed group(B) and a control group(C). Free fatty acid(FFA) and earnitine were detected in the blood serum at different time. mRNA and protein expressions of peroxisome proliferator-activated receptors (PPARα and PPARγ), retinoic acid receptor retinoid X receptor alpha (RXRα), earnitine palmitoyl transferase isoform and medium-chain acyl-CoA dehydrogenase (MCAD) were observed with RT-PCR and Western blotting methods. Results (1) When group A and B were compared with group C, FFA was increased and carnitine was decreased;mRNA and protein expressions of PPARα, RXRα, CPT-Ⅰ and MCAD were decreased with the development of alcoholic cardiomyopathy (ACM), being more significantly in group A than group B (P < 0.05). (2) mRNA and protein expressions of PPARγ had no statistical significance between these three groups at the end of 2 and 4 months(P>0.05), but after 6 months, they were increased in group B and decreased in group A (A vs. C,P<0.01;B vs. C,P<0.05). Conclusion Metabolic disorder and cardiac remodeling occur in the development process of ACM; they are partly prevented by L-carnitine through downregulating mRNA and protein expressions of PPARct, RXRα, CPT-Ⅰ, MCAD and PPARγ.
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@# Objective To analyse the diagnosis characteristics of the aged and non-aged patients with dilated cardiomyopathy (DCM).Methods 192 inpatients suspected DCM from 2004 to 2006 were analysed retrospectively, as the groups of the aged (≥60 y) and non-aged (<60 y). Results The percentage of the aged group with idiopathic dilated cardiomyopathy (IDCM) or ischemic cardiomyopathy (ICM) was obviously higher than that of the non-aged group (P<0.01 and P<0.05, respectively). The percentage of the non-aged group with alcoholic cardiomyopathy (ACM) or viral cardiomyopathy (VCM) was higher than that of the aged group(P<0.01). Conclusion There are various diseases similar to DCM should be identified. The causes leading to DCM are different in the aged and non-aged patients.
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Objective To discuss the nursing characteristics in patients with heart failure of alcoholic cardiomyopathy during hospitalization.Methods 16 patients with heart failure of alcoholic cardiomyopathy were studied and experience summarizations were made from four different aspects:normal nursing,life sign monitoring,observation and nursing during medication and psychological nursing.Results After abstinence of alcohol,heart failure treatment,nutrition treatment of cardiac muscle,detailed observation and careful nursing,the heart function of the 16 patients were improved,and the symptom disappeared so that those patients were ready to leave the hospital.Conclusion The key for the treatment in heart failure of alcoholic cardiomyopathy is immediate and thorough abstinence of alcohol,and,if heart failure happens,life sign monitoring,medication observation and psychological nursing are also important.