Abstract
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.
Highlights
Background and aimThe progression of heart failure is affected by several factors, including chronic stimulation of the β-adrenoceptor
Forty patients with heart failure were randomly divided into two groups: (1) the thoracic thoracic epidural analgesia (TEA) group and (2) the control group
The patients were classified according to the New York Heart Association as class IV and class III
Summary
The 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. In the past two decades, extensive investigations have developed several effective approaches for reducing the morbidity and mortality of patients with congestive heart failure 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. The results will be useful for improving the clinical outcome of TEA in patients with heart failure
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