Effects of high thoracic epidural sympathetic blockade for the treatment of severe chronic heart failure due to dilated cardiomyopathy.

OBJECTIVE

Beta blockers and angiotensin-converting enzyme inhibitors are known to attenuate the remodelling process in chronic heart failure, but the high mortality after heart failure must be resolved. We aimed to evaluate the effects of using high thoracic epidural sympathetic blockade (HTESB) as an adjunctive treatment to conventional therapy on the regression of left ventricular remodelling in chronic heart failure due to dilated cardiomyopathy.

METHODS

We studied 40 patients with severe chronic heart failure due to dilated cardiomyopathy.These patients were randomly divided into two groups with equal size, and treated either by conventional therapy or HTESB as an adjunctive therapy (HTESB therapy) for 30 days. Echocardiography was performed before and after treatment.

RESULTS

HTESB therapy was found to reduce left ventricular end-diastolic internal dimension by 5.3 mm, left atrial dimension by 7.6 mm, right ventricular dimension by 5.0 mm and right atrial dimension by 10.5 mm (P < 0.01). No discernable changes were observed in patients treated by conventional therapy. Moreover, HTESB therapy produced a greater increase in ejection fraction (11.2% vs. 2.2%) and more significant improvement to NYHA class than conventional therapy (P < 0.05).

CONCLUSIONS

These data demonstrate that the use of HTESB as an adjunctive therapy to conventional therapy in severe chronic heart failure due to dilated cardiomyopathy was associated with reduction in cardiac chamber dimension and increase in left ventricular systolic function. These beneficial effects on remodelling may lead to better prognosis.