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Sympathetic nervous activity is a major determinant of prognosis in heart failure. Recent studies have shown that high thoracic epidural analgesia (HTEA), by downregulating sympathetic activity, improves cardiac function. Heart failure secondary to idiopathic dilated cardiomyopathy (IDCM) has heterogeneous characteristics from that secondary to myocardial infarction, and the clinical outcomes may be different. In this study, we compared the efficacy of HTEA in coronary artery disease (CAD)-induced heart failure with that in IDCM-induced heart failure.
Heart failure patients (n=84) (New York Heart Association (NYHA) class II-IV) were divided into two groups: a CAD group (n=30) and an IDCM group (n=54). Both groups received conventional medical therapy plus HTEA for 4 weeks. Echocardiography, N-terminal pro-brain natriuretic peptide (NT-proBNP) level, 6-minute walk test (6MWT), and NYHA classification were assessed before and after 4 weeks of treatment.
Echocardiography results revealed showed decrease in left ventricular end-diastolic dimension (LVEDd) and increase in left ventricular ejection fraction (LVEF) in both groups post treatment (P<0.05). Both groups showed significant improvement in NYHA classification and the 6-minute walk test (P<0.05). Marked decrease in NT-proBNP levels were found in both groups (P<0.05). Compared with the CAD group, the improvements in NYHA class, 6-minute walk test, and NT-proBNP level were significantly better in the IDCM group (P<0.05).
HTEA improves cardiac function and reverses myocardial remodelling in heart failure patients. It is more effective in IDCM-induced heart failure than in CAD-induced heart failure.