title: Effects of high thoracic epidural sympathetic blockade for the treatment of severe chronic heart failure due to dilated cardiomyopathy.
abstract: 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.
authors.affiliation: Division of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
authors.forename: Weiyan
authors.initials: W
authors.lastname: Guo
authors.forename: Fengqi
authors.initials: F
authors.lastname: Liu
authors.forename: Lu
authors.initials: L
authors.lastname: Fu
authors.forename: Renhai
authors.initials: R
authors.lastname: Qu
authors.forename: Guizhen
authors.initials: G
authors.lastname: Wang
authors.forename: Cuili
authors.initials: C
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D002311:Cardiomyopathy, Dilated / Q000150:complications* / Q000503:physiopathology; D004452:Echocardiography; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007268:Injections, Epidural; D008875:Middle Aged; D012720:Severity of Illness Index; D013318:Stroke Volume; D013563:Sympathectomy, Chemical / Q000379:methods*; D013904:Thoracic Vertebrae; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling; D055815:Young Adult