Thoracic Epidural Anesthesia Reversed Myocardial Fibrosis in Patients With Heart Failure Caused by Dilated Cardiomyopathy.

OBJECTIVE: To verify that high thoracic epidural anesthesia (TEA) could reverse myocardial fibrosis in heart failure caused by dilated cardiomyopathy (DCM).

DESIGN: Hospitalized patients with DCM and heart failure.

SETTING: Harbin Medical University, Harbin, Heilongjiang, China.

PARTICIPANTS: Eight patients.

INTERVENTIONS: 0.5% lidocaine was administered epidurally at the T4-T5 interspace for 4 weeks.

MEASUREMENTS AND MAIN RESULTS: Eight hospitalized patients with DCM and heart failure were enrolled into the present study. All patients received TEA plus optimal medical therapy (OMT) for 4 weeks. Echocardiograms and cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE) technique were used to evaluate cardiac function and detect myocardial fibrosis before and after treatment. The 6-minute walking distance and the level of N-terminal pro-B-type natriuretic peptide (NT-proBNP) also were measured. The authors used before-after study to verify whether thoracic epidural anesthesia could reverse myocardial fibrosis. The left ventricular end-diastolic diameter was reduced significantly and the left ventricular ejection fraction (LVEF) was increased significantly after a 4-week treatment. Meanwhile, the 6-minute walking distance was increased dramatically. Furthermore, the level of NT-proBNP was reduced significantly after TEA plus OMT treatment. Consistent with echocardiography parameters, the LVEF measured by CMR also was increased markedly. Both total LGE volume and average LGE volume were reduced significantly after 4 weeks of TEA plus OMT treatment.

CONCLUSIONS: TEA plus OMT could reverse myocardial fibrosis and improve cardiac function in patients with heart failure caused by DCM.