Beta-blockade in heart failure: adding SENIORS to the mix.
Beta-blockade in heart failure: adding SENIORS to the mix.
复制标题
心力衰竭中的β受体阻滞剂：将老年人加入其中。
DOI：
10.1093/eurheartj/ehi693
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发表时间：
2006
影响因子：
39.3
通讯作者：
Freeman,GregoryL
中科院分区：
文献类型：
--
作者：
Lindsey,MerryL;Freeman,GregoryL
2005年初，一项关于奈比洛尔干预对老年心力衰竭患者结局和再住院影响的研究——老年人试验结果发表。共有2128名70岁以上的患者随机接受奈比洛尔或安慰剂治疗，平均随访时间为21个月。奈比volol是第三代高选择性b1肾上腺素能受体抑制剂，具有通过一氧化氮释放介导的血管舒张特性。用该药治疗可降低全因死亡率和心血管住院率（P < 0.04）。尽管先前使用b受体阻滞剂（比索洛尔、卡维地洛或metroprolol）的研究显示心力衰竭的相对死亡风险降低，但他们招募的是年轻患者（不包括老年患者）。80岁)，并专注于低左心室射血分数（LVEF）的患者。因此，这些研究可能不能代表在一般人群中看到的患者，这些患者可能年龄较大，并且具有较高的保留收缩功能的患病率。通过证明b-阻断在老年心力衰竭患者中的发病率和死亡率益处，无论LVEF是否低，老年人试验扩大了我们对这种治疗的理解。Ghio等人4对最初的2128例患者中的104例进行了超声心动图亚研究，报告了奈比洛尔对LVEF分层患者的左室结构和功能的影响，以35%为切入点。在这个亚组中，59%的患者有LVEF。35%，比整体研究（35%）的比例高得多。在低LVEF组，奈比洛尔导致左室收缩期终容积减少和LVEF改善，这些变化表明了反向重构。在左室收缩功能保留组，纳比洛尔不改变左室大小和功能。作者得出结论，奈比洛尔可减小左室大小并改善LVEF 35%的LVEF，但这一机制并不能解释主要为舒张功能不全患者的发病率和死亡率的改善。
In early 2005, results of the SENIORS trial, a Study of the Effects of Nebivolol Intervention on Outcomes and Rehospitalization in Seniors with Heart Failure was published. 1, 2 A total of 2128 patients over the age of 70 were randomized to receive either nebivolol or placebo for a mean follow-up time of 21 months. Nebivolol is a third generation highly selective b1-adrenergic receptor inhibitor with vasodilator properties mediated through nitric oxide release. Treatment with this agent decreased all-cause mortality or cardiovascular hospitalization (P ¼ 0.04). Although previous studies using b-blockers (bisoprolol, carvedilol, or metroprolol) demonstrated a decreased relative risk of death in heart failure, 3 they enrolled younger patients (excluding patients. 80 years of age) and focused on those with low left ventricular ejection fraction (LVEF). Thus, these studies may not be representative of patients seen in the general population, who may be older and have a higher prevalence of preserved systolic function. By demonstrating the morbidity and mortality benefits of b-blockade in elderly patients with heart failure, regardless of whether the LVEF was low, the SENIORS trial expands our understanding of this therapy.Ghio et al. 4 present results of an echocardiographic substudy performed on 104 of the original 2128 patients, reporting the impact of nebivolol on LV structure and function in patients stratified on the basis of LVEF, using 35% as a cut-point. In this subgroup, 59% of the patients had LVEF. 35%, a considerably higher percentage than that was present in the overall study (35%). In the low LVEF group, nebivolol led to a decrease in LV end-systolic volume and an improved LVEF, changes indicative of reverse remodelling. In the group with preserved LV systolic function, nebivolol did not alter the LV size or function. The authors conclude that nebivolol reduces LV size and improves LVEF in patients with LVEF 35% but this mechanism does not explain the improved morbidity and mortality in those patients with primarily diastolic dysfunction.