Use of a high thoracic epidural analgesia for treatment of end-stage congestive heart failure secondary to coronary artery disease

Shuang, Wu; Fu, Song; Liu, Fengqi; Qu, Renhai; Wang, Lanfeng; Li, Zhu-qin; Wang, Xu

doi:10.1016/j.ijcard.2007.07.150

Cited by 11 publications

(13 citation statements)

References 11 publications

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“…We proved that HTSB improved myocardial remodelling and dysfunction in HF. These results are consistent with previous research [14,15]. Due to the unique effects of sympathetic blockade, HTSB induced vasodilation and reduced heart rate in patients with HF to reduce cardiac workload.…”

Section: Discussionsupporting

confidence: 93%

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Effect of High Thoracic Sympathetic Nerve Block on Serum Collagen Biomarkers in Patients with Chronic Heart Failure

Sun

Liu²,

Qu³

2016

Cardiology

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Objectives: The impact of high thoracic sympathetic block (HTSB) on myocardial fibrosis in chronic heart failure (HF) is unclear. Myocardial collagen synthesis can be assessed by measuring circulating biomarkers. Weobserved the effect of HTSB on serum collagen biomarkers in HF. Methods: Forty-four patients were randomized to a control and a HTSB group. They received routine medications. Repeated epidural injections were given to the HTSB group for 4 weeks. Echocardiography and measurements of serum carboxy-terminal propeptide of procollagen type I (PICP) and amino-terminal propeptide of procollagen type III (PIIINP) were performed at baseline and 4 weeks later. Results: There were significant reductions in left atrial diameter, left ventricular (LV) diameter and volume, LV weight index (LVWI) and serum PICP and PIIINP levels in the HTSB group (p < 0.05). The changes in LV end-systolic volume and ejection fraction (LVEF) were greater in the HTSB group than in the control group (p < 0.05). In the HTSB group, the decreases in PICP and PIIINP were correlated with the decrease in LVWI (PICP: r = 0.695, p = 0.000; PIIINP: r = 0.642, p = 0.001), and the decrease in PICP was negatively associated with the rise in LVEF (r = -0.813, p = 0.000). Conclusion: HTSB reduces myocardial fibrosis in HF, which may accompany the improvement of LV hypertrophy anddysfunction.

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Section: Discussionsupporting

confidence: 93%

“…Long-term HTSB therapy can continuously reduce sympathetic drive in the heart and peripheral vessels in the upper chest in HF patients. Hence, HTSB has been used to treat patients with chronic HF [14,15]. However, the impact of HTSB therapy on myocardial fibrosis in HF is unclear.…”

Section: Introductionmentioning

confidence: 99%

Effect of High Thoracic Sympathetic Nerve Block on Serum Collagen Biomarkers in Patients with Chronic Heart Failure

Sun

Liu²,

Qu³

2016

Cardiology

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“…Kock et al have reported that TEA can improve the left ventricular function during stress-induced myocardial ischemia in patients with coronary artery disease [12]. In addition, we have previously reported a beneficial outcome by one patient treated with TEA [1]. Based on these preliminary results, this study was designed to demonstrate the therapeutic efficacy and safety of the TEA treatment in a clinical trial setting.…”

Section: Introductionmentioning

confidence: 95%

“…Although the use of cardiotonic drugs, diuretics, β-blockers, and angiotensin-converting-enzyme inhibitors (ACEI) can improve the cardiac function in patients with heart failure [1-3], the morbidity and mortality of heart failure continues to remain high [4,5]. Therefore, it is necessary to search for new treatments for heart failure.…”

Section: Introductionmentioning

confidence: 99%

Effects of thoracic epidural analgesia on plasma cAMP and cGMP levels in patients with heart failure

Liu

2013

J Cardiothorac Surg

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Background and aimThe progression of heart failure is affected by several factors, including chronic stimulation of the β-adrenoceptor. This clinical study was designed to measure the effects of thoracic epidural analgesia (TEA) on the plasma levels of norepinephrine (NE), cAMP, and cGMP in patients with heart failure and assess the clinical implication of TEA.MethodsForty patients with heart failure were randomly assigned to TEA (TEA plus standard care) and control groups (standard care). The plasma concentrations of cAMP, cGMP, brain natriuretic peptide (BNP), and NE were measured using ELISA before treatment, the second and fourth weeks of treatment.ResultsThe plasma concentrations of cAMP, cGMP, BNP, and NE in the TEA group were significantly reduced by the fourth week compared to their initial concentrations (P < 0.01, for all parameters) and the control group (P < 0.05, P < 0.05, P < 0.01, and P < 0.05, respectively). The values for left ventricular end diastolic diameter (LVEDD), ejection fraction (EF), and fractional shortening (FS) in the TEA group improved significantly compared to their initial values and the control group. However, the changes in levels for these indices in the control group were no statistical significant compared to the initial levels.ConclusionsTEA can effectively decrease the plasma concentrations of cAMP and cGMP and improve cardiac function in patients with heart failure. The decreased levels of NE and cAMP occurred before the improvement in cardiac function, indicating that the abnormal epidural signal transduction can be corrected in patients with heart failure.

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“…Thoracic epidural anesthesia (TEA) is an effective anesthetic method, which has been widely used in cardiac surgery for its cardiac protective effect . TEA has many benefits, including improving hemodynamic stability, reducing myocardial oxygen consumption, abolishing the catecholamine response, and altering coronary blood flow . In recent years, growing consensus, driven by both clinical and laboratory studies, has demonstrated that TEA could decrease heart rate, systemic vascular resistance, and the size of myocardial infarction, improving cardiac function, and increasing endocardial‐to‐epicardial blood flow in the heart.…”

Section: Introductionmentioning

confidence: 99%

Effects of Thoracic Epidural Anesthesia on Cardiac Function and Myocardial Cell Apoptosis in Isoproterenol‐Induced Chronic Heart Failure Rats

Tao¹,

Qin

Wang

et al. 2014

J Interven Cardiology

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Use of a high thoracic epidural analgesia for treatment of end-stage congestive heart failure secondary to coronary artery disease

Cited by 11 publications

References 11 publications

Effect of High Thoracic Sympathetic Nerve Block on Serum Collagen Biomarkers in Patients with Chronic Heart Failure

Effect of High Thoracic Sympathetic Nerve Block on Serum Collagen Biomarkers in Patients with Chronic Heart Failure

Effects of thoracic epidural analgesia on plasma cAMP and cGMP levels in patients with heart failure

Effects of Thoracic Epidural Anesthesia on Cardiac Function and Myocardial Cell Apoptosis in Isoproterenol‐Induced Chronic Heart Failure Rats

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