Department of Geriatric, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, China (mainland).
Department of Cardiology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, China (mainland).
Med Sci Monit. 2018 Jun 4;24:3744-3751. doi: 10.12659/MSM.906893.
BACKGROUND At present, a constant progress in pathophysiology understanding and treatment of the chronic heart failure (CHF) is arising. Meanwhile, hyperhomocysteinemia (HHcy) has been linked to impaired left ventricular function and clinical class in patients with CHF. Atorvastatin therapy can reduce the incidence of sudden cardiac death in patients with advanced CHF. Folic acid could enhance endothelial function in vascular disease states. The present study aims to investigate the effect of atorvastatin and folic acid combined on the cardiac function and ventricular remodeling in CHF patients with HHcy. MATERIAL AND METHODS Elderly CHF patients with HHcy were divided into four groups: routine, routine + atorvastatin, routine + folic acid, and routine + atorvastatin + folic acid groups. Serum homocysteine (Hcy) level was detected using enzymatic cycling methods, and N-terminal pro brain natriuretic peptide (NT-proBNP) level by ELISA. The cardiac function indexes and left ventricular early diastolic peak flow velocity/atrial systolic peak flow velocity (E/A) ratio were evaluated. The six-minute walk test was performed to measure the six-minute walk distance (6MWD). RESULTS 6MWD increased, the serum Hcy and NT-proBNP levels decreased, and cardiac function was improved compared with before treatment, which was the most significant in the routine + atorvastatin + folic acid group, followed by the routine + atorvastatin group, then the routine + folic acid group, and lastly, the routine group. CONCLUSIONS The results indicated that the combination of atorvastatin and folic acid improved the cardiac function and inhibited ventricular remodeling of elderly CHF patients with HHcy.
目前，慢性心力衰竭（CHF）的病理生理学理解和治疗不断取得进展。同时，高同型半胱氨酸血症（HHcy）与 CHF 患者左心室功能和临床分级受损有关。阿托伐他汀治疗可降低晚期 CHF 患者心脏性猝死的发生率。叶酸可增强血管疾病状态下的内皮功能。本研究旨在探讨阿托伐他汀和叶酸联合治疗对 HHcy 的 CHF 患者心功能和心室重构的影响。
将老年 HHcy 的 CHF 患者分为四组：常规组、常规+阿托伐他汀组、常规+叶酸组和常规+阿托伐他汀+叶酸组。采用酶循环法检测血清同型半胱氨酸（Hcy）水平，ELISA 法检测 N 末端脑利钠肽前体（NT-proBNP）水平。评估心功能指标和左心室早期舒张峰值流速/心房收缩峰值流速（E/A）比值。进行 6 分钟步行试验以测量 6 分钟步行距离（6MWD）。
与治疗前相比，6MWD 增加，血清 Hcy 和 NT-proBNP 水平降低，心功能得到改善，其中常规+阿托伐他汀+叶酸组改善最明显，常规+阿托伐他汀组次之，常规+叶酸组次之，常规组最差。
结果表明，阿托伐他汀和叶酸联合使用可改善老年 HHcy 的 CHF 患者的心功能并抑制心室重构。
