1
|
Efficacy and Safety of Yangyin Shuxin Decoction-a Chinese Herbal Medicine Formula For Heart Failure with Preserved Ejection Fraction: A Randomized Controlled Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:1486366. [PMID: 36588595 PMCID: PMC9800172 DOI: 10.1155/2022/1486366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 07/04/2022] [Indexed: 01/04/2023]
Abstract
Background Heart failure with preserved ejection fraction (HFpEF) is a large subtype of heart failure (HF) characterized by exercise intolerance and reduced quality of life. Studies have shown that traditional Chinese medicine (TCM) combined with conventional Western medicine has a good effect on improving exercise tolerance and quality of life in patients with HFpEF, but the overall quality of evidence is low. This study aimed to determine the safety and efficacy of Yangyin Shuxin (YYSX) decoction in the treatment of HFpEF. Methods A prospective, single-blind, single-center, randomized controlled clinical study was conducted. 64 patients with HFpEF were randomly assigned to receive oral YYSX decoction (150 ml, twice a day) combined with conventional Western treatment or conventional Western treatment alone at a ratio of 1 : 1. The course of treatment was 2 weeks, and the follow-up was 3 months. The primary outcome was peak oxygen uptake (peak VO2) measured by the cardiopulmonary exercise test (CPET). Furthermore, the safety of YYSX decoction was assessed. Results 63 patients (31 in the YYSX group and 32 in the control group) were included in the full analysis set. The peak VO2 of the YYSX group was significantly higher than that of the control group (12.04 ± 3.41 vs. 11.02 ± 3.33, P = 0.013) after 2 weeks. The maximum voluntary ventilation (MVV) was significantly higher in the YYSX group compared with the control group (P < 0.05). The YYSX group had a higher EQ-visual analogue scale (EQ-VAS) score (71.13 ± 13.95 vs. 70.94 ± 13.70, P < 0.05) and a lower TCM Four-Dimensional Diagnostic Information Scale (TCMFDIS) score (49.74 ± 24.73 vs. 64.16 ± 27.15, P < 0.05) than the control group. There was no statistical difference between two groups (P = 0.160), although 51.61% of patients in the YYSX group showed a decrease in brain natriuretic peptide (BNP) levels of at least 30%, compared with 37.50% of patients in the control group. No serious adverse events were reported in either group, but systolic and diastolic blood pressure decreased and serum sodium levels increased slightly in the control group. Conclusion The YYSX decoction combined with conventional Western treatment was superior to the conventional Western treatment alone in improving exercise tolerance, quality of life, and cardiopulmonary function of patients with HFpEF. YYSX decoction is safe and may prevent a drop in blood pressure and sodium retention. Trial Registration. Chinese Clinical Trial Registry (www.chictr.org/cn/, No. ChiCTR-IOR-17014206).
Collapse
|
2
|
Coats AJS, Forman DE, Haykowsky M, Kitzman DW, McNeil A, Campbell TS, Arena R. Physical function and exercise training in older patients with heart failure. Nat Rev Cardiol 2017; 14:550-559. [PMID: 28518178 PMCID: PMC7245611 DOI: 10.1038/nrcardio.2017.70] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Heart failure (HF) is a common end point for numerous cardiovascular conditions, including coronary artery disease, valvular disease, and hypertension. HF predominantly affects older individuals (aged ≥70 years), particularly those living in developed countries. The pathophysiological sequelae of HF progression have a substantial negative effect on physical function. Diminished physical function in older patients with HF, which is the result of combined disease-related and age-related effects, has important implications on health. A large body of research spanning several decades has demonstrated the safety and efficacy of regular physical activity in improving outcomes among the HF population, regardless of age, sex, or ethnicity. However, patients with HF, especially those who are older, are less likely to engage in regular exercise training compared with the general population. To improve initiation of regular exercise training and subsequent long-term compliance, there is a need to rethink the dialogue between clinicians and patients. This Review discusses the need to improve physical function and exercise habits in patients with HF, focusing on the older population.
Collapse
Affiliation(s)
- Andrew J Stewart Coats
- Monash University, Clayton Campus, Melbourne, Victoria 3800, Australia
- University of Warwick, Kirby Corner Road, Coventry CV4 8UW, UK
| | - Daniel E Forman
- Section of Geriatric Cardiology, University of Pittsburgh Medical Center, VA Pittsburgh Healthcare System, 259 Mt Nebo Pointe Drive, Pittsburgh, Pennsylvania 15213, USA
| | - Mark Haykowsky
- College of Nursing and Health Innovation, University of Texas at Arlington, 411 South Nedderman Drive, Arlington, Texas 76019, USA
| | - Dalane W Kitzman
- Cardiovascular Medicine Section, Department of Internal Medicine, Wake Forest School of Medicine, 1 Medical Center Boulevard, Winston-Salem, North Carolina 27157, USA
| | - Amy McNeil
- Department of Physical Therapy, Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois at Chicago, 1919 West Taylor Street, Chicago, Illinois 60612, USA
| | - Tavis S Campbell
- Department of Psychology, University of Calgary, 2500 University Drive North West, Calgary, Alberta T2N 1N4, Canada
| | - Ross Arena
- Department of Physical Therapy, Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois at Chicago, 1919 West Taylor Street, Chicago, Illinois 60612, USA
| |
Collapse
|
3
|
Malfatto G, Caravita S, Giglio A, Rossi J, Perego GB, Facchini M, Parati G. Pulmonary congestion at rest and abnormal ventilation during exercise in chronic systolic heart failure. J Am Heart Assoc 2015; 4:jah3947. [PMID: 25944875 PMCID: PMC4599404 DOI: 10.1161/jaha.114.001678] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In patients with chronic heart failure, abnormal ventilation at cardiopulmonary testing (expressed by minute ventilation-to-carbon dioxide production, or VE/VCO2 slope, and resting end-tidal CO2 pressure) may derive either from abnormal autonomic or chemoreflex regulation or from lung dysfunction induced by pulmonary congestion. The latter hypothesis is supported by measurement of pulmonary capillary wedge pressure, which cannot be obtained routinely but may be estimated noninvasively by measuring transthoracic conductance (thoracic fluid content 1/kΩ) with impedance cardiography. METHODS AND RESULTS Preliminarily, in 9 patients undergoing invasive hemodynamics during cardiopulmonary testing, we demonstrated a significant relationship between VE/VCO2 slope and resting end-tidal CO2 pressure with baseline and peak pulmonary capillary wedge pressure. Later, noninvasive hemodynamic evaluation by impedance cardiography was performed before cardiopulmonary testing in 190 patients with chronic systolic heart failure and normal lung function (aged 67±3 years, 71% with ischemia, ejection fraction 32±7%, 69% with implantable cardioverter-defibrillator or cardiac resynchronization therapy). In this group, we determined the relationship between abnormal ventilation (VE/VCO2 slope and resting end-tidal CO2 pressure) and transthoracic conductance. In the whole population, thoracic fluid content values were significantly related to VE/VCO2 slope (R=0.63, P<0.0001) and to resting end-tidal CO2 pressure (R=-0.44, P<0.001). CONCLUSIONS In patients with chronic heart failure, abnormal ventilation during exercise may be related in part to pulmonary congestion, as detected by resting baseline impedance cardiography.
Collapse
Affiliation(s)
- Gabriella Malfatto
- Divisione di Cardiologia, Ospedale San Luca, Istituto Auxologico Italiano IRCCS, Milano, Italy (G.M., S.C., A.G., J.R., G.B.P., M.F., G.P.)
| | - Sergio Caravita
- Divisione di Cardiologia, Ospedale San Luca, Istituto Auxologico Italiano IRCCS, Milano, Italy (G.M., S.C., A.G., J.R., G.B.P., M.F., G.P.) Dipartimento di Medicina Clinica, Prevenzione e Biotecnologie Sanitarie, Università di Milano-Bicocca, Milano, Italy (S.C., G.P.)
| | - Alessia Giglio
- Divisione di Cardiologia, Ospedale San Luca, Istituto Auxologico Italiano IRCCS, Milano, Italy (G.M., S.C., A.G., J.R., G.B.P., M.F., G.P.)
| | - Jessica Rossi
- Divisione di Cardiologia, Ospedale San Luca, Istituto Auxologico Italiano IRCCS, Milano, Italy (G.M., S.C., A.G., J.R., G.B.P., M.F., G.P.)
| | - Giovanni B Perego
- Divisione di Cardiologia, Ospedale San Luca, Istituto Auxologico Italiano IRCCS, Milano, Italy (G.M., S.C., A.G., J.R., G.B.P., M.F., G.P.)
| | - Mario Facchini
- Divisione di Cardiologia, Ospedale San Luca, Istituto Auxologico Italiano IRCCS, Milano, Italy (G.M., S.C., A.G., J.R., G.B.P., M.F., G.P.)
| | - Gianfranco Parati
- Divisione di Cardiologia, Ospedale San Luca, Istituto Auxologico Italiano IRCCS, Milano, Italy (G.M., S.C., A.G., J.R., G.B.P., M.F., G.P.) Dipartimento di Medicina Clinica, Prevenzione e Biotecnologie Sanitarie, Università di Milano-Bicocca, Milano, Italy (S.C., G.P.)
| |
Collapse
|