Addition of a β1-Blocker to Milrinone Treatment Improves Cardiac Function in Patients with Acute Heart Failure and Rapid Atrial Fibrillation
Addition of a β1-Blocker to Milrinone Treatment Improves Cardiac Function in Patients with Acute Heart Failure and Rapid Atrial Fibrillation
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DOI：
10.1159/000499400
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发表时间：
2019-01-01
期刊：
影响因子：
1.9
通讯作者：
Yano, Masafumi
中科院分区：
文献类型：
--
作者：
Kobayashi, Shigeki;Myoren, Takeki;Yano, Masafumi
背景：心动过速损害急性失代偿性心力衰竭（ADHF）患者的心脏功能。我们研究了兰地洛尔（一种超短效β 1选择性阻滞剂）联合米力农优化心率（HR）是否能改善ADHF和快速房颤（AF）患者的心功能。方法和结果：我们入组了9例ADHF患者（纽约心脏协会分级IV级; HR，138 +/- 18 bpm;左心室射血分数，28 +/- 8%;心脏指数，2.1 +/- 0.3 L/min（-1）/m（-2）;肺毛细血管楔压[PCWP]，24 +/- 3 mm Hg），使用标准治疗（包括利尿剂、血管扩张剂和米力农）不能降低HR。兰地洛尔（1.5-6.0 μ g/kg（-1）/min（-1），静脉注射）加入米力农治疗，以研究其对血流动力学的影响。加入兰地洛尔（1.5 μ g/kg（-1）/min（-1））可显著降低HR 11%，而不改变收缩压（BP），并导致PCWP显著降低和每搏输出量指数（SVI）显著增加，表明HR降低可恢复不完全的LV舒张。兰地洛尔剂量超过3.0 μ g/kg（-1）/min（-1）时，血压、CI和SVI降低。结论：添加剂量为
Background: Tachycardia worsens cardiac performance in acute decompensated heart failure (ADHF). We investigated whether heart rate (HR) optimization by landiolol, an ultra-short-acting beta 1-selective blocker, in combination with milrinone improved cardiac function in patients with ADHF and rapid atrial fibrillation (AF). Methods and Results: We enrolled9 ADHF patients (New York Heart Association classification IV; HR, 138 +/- 18 bpm; left ventricular [LV] ejection fraction, 28 +/- 8%; cardiac index [CI], 2.1 +/- 0.3 L/min(-1)/m(-2); pulmonary capillary wedge pressure [PCWP], 24 +/- 3 mm Hg), whose HRs could not be reduced using standard treatments, including diuretics, vasodilators, and milrinone. Landiolol (1.5-6.0 mu g/kg(-1)/min(-1), intravenous) was added to milrinone treatment to study its effect on hemodynamics. The addition of landiolol (1.5 mu g/kg(-1)/min(-1)) significantly reduced HR by 11% without changing systolic blood pressure (BP) and resulted in a significant decrease in PCWP and a significant increase in stroke volume index (SVI), suggesting that HR reduction restores incomplete LV relaxation. Administration of more than 3.0 mu g/kg(-1)/min(-1) of landiolol decreased BP, CI, and SVI. Conclusion: The addition of landiolol at doses of