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The increasing worldwide prevalence of heart failure is associated with numerous hospital admissions and mortality rates. The high thoracic epidural blockade (TEB) is a safe and effective treatment method in the treatment of chronic heart failure (CHF). This study evaluated its short-term effect on the rate of rehospitalization and mortality, and provided the basis for clinical promotion.
CHF patients with NYHA class III or IV and left ventricular ejection fraction (EF) ≤40% were treated by TEB for 4 weeks and followed up for 3 months. Echocardiography and N-terminal-pro-brain-natriuretic-peptide (NT-proBNP) were performed before and after treatment to examine cardiac structure and left ventricular systolic function.
82 patients were treated with TEB, and cardiac function were attenuated dramatically. 81.7 percent of patients restored cardiac function of II grade, and the total effective rate was 94.0%. Compared with those those befored treatment, the left atrial diameter (49.8±8.4mm vs 46.7±7.9mm, P<0.001)and left ventricular diastolic diameter (69.9±8.9mm vs 67.3±9.4mm,P<0.001) were significantly decreased, EF (27%±7.5% vs 35%±9.1%,P<0.001) and short axis shortening (12.5%±4.0% vs 16.9%±4.9%,P<0.001) were remarkably increased, and NT-proBNP (5 344.8±6 380.4pg/ml vs 2 097.9±2 424.6pg/ml, P<0.001)was decreased by 60.5%. Only one patient had a sudden cardiac death at discharge. There were no death and two readmission(2.5%) for heart failure in first month. There were 1 death(1.2%) and 10 HF-related rehospitalizions (12.2%) in 3 months.
TEB therapy can reverse cardiac remodeling, diminish the cardiac chambers, improve the myocardial contractility, and reduce the short-term mortality and rehospitalization rate. The high thoracic epidural blockade therapy in chronic heart failure is effective and safety and to be worth spreading and further research.