ABSTRACT
OBJECTIVE:To evaluate clinical effect and safety of tolvalptan in the treatment of diuretic-resistant heart failure. METHODS:The clinical data of 21 inpatients with diuretic-resistant heart failure in cardiology department of the First Affiliated Hospital of Chongqing Medical University during Jan. 2014-Aug. 2016 were analyzed retrospectively.The heart failure improvement of 21 patients was not obvious after the treatment of a large dose of loop diuretics(furosemide and/or torasemide),and then the treatment was changed into tovalptan. Among them,19 patients were treated with Tovalptan tablets 7.5 mg orally,qd,and 2 pa-tients were treated with Tovalptan tablets 15 mg orally,qd,continuously until the patients discharged. The cardiac function,ede-ma,outcome and body weight,blood pressure,blood sodium,blood creatinine and blood NT-proBNP levels,the change of urine volume per unit time were compared among 21 patients before and after treatment. The occurrence of ADR was observed. RE-SULTS:After treatment,cardiac function of 21 patients were improved significantly,edema and systolic blood pressure were de-creased significantly while blood sodium and urine volume per unit time were increased significantly,with statistical significance (P<0.05).There was no statistical significance in body weight,diastolic blood pressure,blood creatinine or blood NT-proBNP lev-els before and after treatment(P>0.05).Among 21 patients,one patient suffered from dry mouth;systolic blood pressure of 3 pa-tients decreased by 20 mmHg or above,compared to basic value;diastolic blood pressure of 4 patients decreased by 10 mmHg or above,compared to basic value. CONCLUSIONS:For diuretic-resistant patients,tolvaptan can increase urine volume,improve cardiac function and correct hyponatremia,besides it also lowers the systolic blood pressure.
ABSTRACT
OBJECTIVE:To evaluate clinical effect and safety of tolvalptan in the treatment of diuretic-resistant heart failure. METHODS:The clinical data of 21 inpatients with diuretic-resistant heart failure in cardiology department of the First Affiliated Hospital of Chongqing Medical University during Jan. 2014-Aug. 2016 were analyzed retrospectively.The heart failure improvement of 21 patients was not obvious after the treatment of a large dose of loop diuretics(furosemide and/or torasemide),and then the treatment was changed into tovalptan. Among them,19 patients were treated with Tovalptan tablets 7.5 mg orally,qd,and 2 pa-tients were treated with Tovalptan tablets 15 mg orally,qd,continuously until the patients discharged. The cardiac function,ede-ma,outcome and body weight,blood pressure,blood sodium,blood creatinine and blood NT-proBNP levels,the change of urine volume per unit time were compared among 21 patients before and after treatment. The occurrence of ADR was observed. RE-SULTS:After treatment,cardiac function of 21 patients were improved significantly,edema and systolic blood pressure were de-creased significantly while blood sodium and urine volume per unit time were increased significantly,with statistical significance (P<0.05).There was no statistical significance in body weight,diastolic blood pressure,blood creatinine or blood NT-proBNP lev-els before and after treatment(P>0.05).Among 21 patients,one patient suffered from dry mouth;systolic blood pressure of 3 pa-tients decreased by 20 mmHg or above,compared to basic value;diastolic blood pressure of 4 patients decreased by 10 mmHg or above,compared to basic value. CONCLUSIONS:For diuretic-resistant patients,tolvaptan can increase urine volume,improve cardiac function and correct hyponatremia,besides it also lowers the systolic blood pressure.
ABSTRACT
Objective To compare the effect of carvedilol and motoprolol on high altitude chronic congestive heart failure (CHF). Methods Ninety patients with high altitude chronic CHF were divided into three groups randomly:Twenty patients in the regular treatment group treated with angiotensin-converting enzyme inhibitor (ACEI) ,diuretics and digoxin; motoprolol (50 mg twice daily) was given in the motoprolol group( 34cases) additional to regular treatment; carvedilol (25 mg twice daily) was given in the carvedilol group(36cases ) additional to regular treatment. All the patients were followed up for six months and measured the changes of cardiac function by echocardiography. Results Left ventricular end-diastolic dimension (LVEDD) was ( 57. 3 ± 6. 5 ) mm and (57.2 ± 6. 9) mm in the carvedilol group and the motoprolol group respectively, and left ventricular end-systolic dimension (LVESD) was (46. 6 ± 7.0) mm and (44. 0 ± 6. 9 ) mm in the carvedilol group and the motoprolol group respectively, which were all significantly smaller than that in the regular treatment group ([64.7 ±9. 1]mm and [53.4 ±9.8]mm for LVEDD and LVESD,respectively) (Ps ＜0.05). Left ventricular ejection fraction (LVEF) in the carvedilol group and the motoprolol group ( [47.5 ± 8. 1] % and [52. 9 ±8.5] % ,respectively) was higher than that in regular treatment group( [42. 8 ±9. 2]% ) (Ps ＜0. 05).The improvement of LVEF in the carvedilol group was better than that in the motoprolol group (P ＜ 0. 05 ). One case died in the motoprolol group and no death in the carvedilol group,4 cases died in the regular treatment group,the mortality in the motoprolol group and the carvedilol group was significantly lower than that in the regular treatment group. Conclusion Carvedilol and motoprolol significantly improved cardiac function in high latitude CHF patients,and the effect of Carvedilol is slightly better than that of motoprolol.
ABSTRACT
European Society of Cardiology guidelines on diagnosis and treatment of heart failure are among the mostly authorized international directing documents,applied widely in clinical practice,epidemiological researches and randomized clinical trials.The guidelines published in 2008 combined chronic and acute hear failure and made significant modifications in the definition,classification,diagnosis,pharmacological and non-pharmacological treatment of heart failure.Simplification of the recommendations and enhancement of the guidelines implication are also point of focusing.This article represents a brief review of the new guidelines,together with comparison with the previous edition and analysis of recommendations based on local clinical practice,to enhance the standardized management of heart failure in China. Abstract:Summ ary:European Soc iety of Card iology gu idelines on d iagnosis and treatm ent of heart failure are among the mostly au-thorized international d irecting docum ents,app lied w idely in c lin ical practice,ep idem iological researches and random ized c lin ical trials.The gu idelines pub lished in 2008 comb ined chron ic and acute hear failure and m ade sign ificant mod ifica-tions in the defin ition,c lassification,d iagnosis,pharm acological and non-pharm acological treatm ent of heart failure.S imp li-fication of the recomm endations and enhancem ent of the gu idelines imp lication are also point of focusing.Th is artic le re-presents a brief review of the new gu idelines,togetherw ith comparison w ith the previous ed ition and analysis of recomm en-dations based on local c lin ical practice,to enhance the standard ized m anagem ent of heart failure in Ch ina.