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Objective: dilated cardiomyopathy (dilated cardiomyopathy, DCM) is based on the expansion of the left ventricle and right ventricle or dual-chamber cavity characterized, accompanied by systolic dysfunction, with or without heart failure performance cardiomyopathy. The diagnosis of dilated cardiomyopathy need to rule out systemic disease and primary disease of the heart chamber enlargement disease. Higher incidence of DCM, the annual incidence is 36/100 000, to confirm the diagnosis of DCM for 5 to 8/10 million. 14% of middle-aged and elderly patients with DCM in no clinical symptoms of the state. DCM harm is one of the main reasons for heart failure (HF). Since 1975 Waagstein first reported β-blocker treatment of dilated cardiomyopathy complicated by heart failure to obtain satisfactory results, people are beginning to realize that including dilated cardiomyopathy with systolic heart failure (CHF) treatment in addition to conventional applications cardiotonic, diuretics, other than vascular-converting enzyme inhibitors (ACEI), beta-blockers have a good effect. Significant effect nerve - endocrine antagonist therapy for the DCM treatment progress in recent years, especially with high-dose beta-blocker therapy for patients with DCM, and DCM patients reverse ventricular remodeling, and significantly improve the prognosis. However, for DCM patients with bradycardia, it is difficult to make the β blockers application \compliance has significant value. This test these patients were randomly divided into the pacemakers intervention group and the control group, in order to observe the help of a pacemaker, the larger dose (target dose) of beta-blockers on cardiac function. Methods: According to the 1995 WHO diagnostic criteria for dilated cardiomyopathy, in our hospital 2006-1 to 2007-9 Cardiology, dilated cardiomyopathy patients (NYHA Ⅲ ~ Ⅳ grade LVEF lt; 40%) 25 cases, and left ventricular diastolic final inside diameter (LVEDD) gt; to 55mm, cardiothoracic ratio of X-ray examination gt; 0.5. (Equivalent to small doses of beta blockers metoprolol 50mg / d below) and heart rate of less than 60 beats / min or patients accompanied by atrioventricular block after treatment. 14 male, 11 female patients, aged 14 to 75 years old. Except for patients with rheumatic valvular heart disease, congenital heart disease, hypertensive heart disease, the other specific cardiomyopathy and local cardiomyopathy, diabetes, severe liver and kidney dysfunction. Randomly divided into the pacemakers intervention group (13), the control group (12) using a random number table. All patients can tolerate small doses of beta blockers and the routine application cardiotonic, diuretics, angiotensin-converting enzyme inhibitors (ACEI), aldosterone receptor antagonists prior to enrollment. The intervention group received conventional treatment based on the implantation of a permanent pacemaker (physiological AAI or DDD pacing mode); control group still tolerated dose of beta blockers and other conventional treatments, do not use permanent cardiac pacemaker. If no serious adverse reactions, all enrolled patients should not be free to withdraw from the trial. Treatment before treatment and 1, 3, and 6 months, respectively, after the detection of heart function indicators: chest X-ray, echocardiography, 6-minute walk test (6-minute walk test, 6 MWT). Kodak DirectView CR 850 X-ray machine, the anterior chest films after a chest, the patient for the shooting frame upright, chest close to the cassette and two chest try pronation. Shoulders as far as possible flat, the clavicle with a horizontal position. Body the middle of the face of the cassette center. The centerline alignment fourth thoracic. Shooting chest films should pay attention: ① deep breathing after exposure; ② The distance (2m) and a short time (1/20s or less) shooting; ③ chest, anterior, left lateral cardiac blood vessels after anterior shooting left bit position pendulum method is the same, different centerline of the lower of the latter, to be aligned with the sixth thoracic developing better. Cardiothoracic ratio to the heart of the widest transverse diameter of the thorax widest diameter ratio. Produced by the German company Siemens SEQUOIA, S-512 type ultrasonic diagnostic apparatus, the probe frequency 2.5MHz, two-dimensional sampling at the left sternal long axis ventricular end-diastolic M-type mitral chordae level measurement of left ventricular end systolic diameter (LVESD ), left ventricular end-diastolic internal diameter (LVEDD), interventricular septum thickness (IVST), left ventricular posterior wall thickness (LVPWT). Calculation based on height and weight of the body surface area BSA (m2) = [0.0061 × height (cm) 0.0128 x weight (kg)] -0.01529 the Devereux formula for calculation of left ventricular mass index LVMI (g/m2) = {1.04 × ([LVEDD LVPWT IVST) 3-LVEDD3] -13.6} ÷ BSA; tracings apical four-chamber view, two-chamber view endocardium in end-systolic and end-diastolic trajectory, the application of a dual-plane area length method to calculate the left ventricular end-diastolic volume ( LVEDV), left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), these measurements were taken three different cardiac cycles mean value. The volume measured values ??with BSA correction, calculated left ventricular end-diastolic volume index (LVEDVI), left ventricular end-systolic volume index (LVESVI). Ultrasound technology - the parameters are the same for all of the test objects. The 6MWT test methods reference to 1985 the Guyatt the design program: subjects in quiet, walking back and forth within a 30 m long corridor of the ventilation test purpose and method, explained to the patient before the test to patients as quickly as possible to finish the 6 min when you can take a break before and after the test to measure heart rate, blood pressure, respiratory rate, test monitoring ECG, clinical symptoms. Test malignant arrhythmia, angina, severe dyspnea, syncope and other symptoms of immediate termination of the test. Tests appropriate to encourage the middle to allow the time necessary to adjust the pace or rest, once restored to continue to walk can walk on. Recorded at the end of the 6 min walk test researchers sitting in the chair of the promenade end of Hutchison walking distance. Record the movement symptoms such as angina, dyspnea, fatigue, dizziness and fainting. Used statistics, measurement data with data input SPSS11.0 statistical software package as mean ± standard deviation, the groups were compared using the t-test group before and after treatment with a paired t-test, X2 test count data (gender), ranked data (heart function) comparison using the Wilcoxon rank sum test. P lt; 0.05 was considered statistically significant. Results: 1 During the experiment, the intervention group and the control group, there was no death or lost to the cases. 2 before intervention, the two groups between baseline age, sex, cardiothoracic ratio, LVEDD, LVESD, LVEF, LVMI, LVEDVI, LVESVI, heart rate, β-blocker dose, the six-minute walk test and heart function grading no statistically learning differences (P = gt; 0.05), the balance of two sets of data, comparable. 3 3 and 6 months after treatment between the two groups LVEDD, LVESD, LVEF, LVMI, LVEDVI, LVESVI six-minute walk test and cardiothoracic than statistically significant (P value lt; 0.05). 4 the end of treatment, compared with before treatment, the two groups LVEDD, LVESD, LVEF LVMI, LVEDVI LVESVI, and six-minute walk test and cardiothoracic than statistically significant (P value lt; 0.05). Conclusion: In support of the pacemaker, using a target dose of beta blockers, can significantly improve heart function, reverse ventricular remodeling.
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