Long-term beta-blockade in dilated cardiomyopathy. Effects of short- and long-term metoprolol treatment followed by withdrawal and readministration of metoprolol.
Long-term beta-blockade in dilated cardiomyopathy. Effects of short- and long-term metoprolol treatment followed by withdrawal and readministration of metoprolol.
复制标题
扩张型心肌病的长期β受体阻滞剂。
作者：
F. Waagstein;K. Caidahl;I. Wallentin;C. Bergh;A. Hjalmarson
为了评价β -肾上腺素能阻滞剂（美托洛尔）的短期和长期疗效以及对美托洛尔停药和再给药的反应，对33例扩张型心肌病患者（男25例，女8例，平均年龄47.6 +/- 14.0岁）进行了左、右心导管穿刺、右室活检、二维超声心动图和多普勒超声心动图以及外脉记录的研究。33例患者中有26例存活超过6个月，26例患者中有24例功能等级得到改善（从平均3.3到1.8,p < 0.0001）。这24例患者接受美托洛尔停药，直到无创观察到症状增加和恶化（组1，n = 16），而8例患者在12个月期间没有恶化（组2）。在美托洛尔长期治疗期间，射血分数从0.24增加到0.42 (p < 0.0001)，而左室舒张末期尺寸（从7.3 cm增加到6.4 cm, p < 0.0001）、二尖瓣反流等级（从1.7降至0.4,p < 0.0001）和三尖瓣反流等级（从0.6降至0.05,p < 0.007）下降。肺动脉楔压（从23.8降至10.7 mm Hg， p小于0.0001）、左室舒张末压（从24.1降至13.4 mm Hg， p小于0.002）和收缩血管阻力（从1782降至1499达因/秒/厘米，p小于0.04）均有下降。收缩压（从116增加到132 mmhg， p < 0.003）、心脏指数（从2.17增加到2.58 l/min/m2, p < 0.005）和左室卒中工作指数（从31增加到65 g /m2， p < 0.0001）均有所增加。停用美托洛尔时，心率和左房维数升高（p < 0.0001），射血分数降低（p < 0.0001）。1组16例患者中有12例在停药期存活，再次给予美托洛尔，随后射血分数升高（从0.23增加到0.33,p < 0.002）。与健康对照组相比，患者心室β -肾上腺素能受体数量较低（30.3 +/- 2.9 vs. 97.4 +/- 8.7 fmol/mg蛋白，p < 0.001），但长期美托洛尔治疗可引起中度上调（从30.3 +/- 2.9到49.0 +/- 7.1 fmol/mg蛋白，p < 0.05），这可能有助于对交感刺激的更正常反应。（摘要删节为400字）
To evaluate the short- and long-term effects of beta-adrenergic blockade (metoprolol) as well as the reaction to withdrawal and readministration of metoprolol in severe heart failure, 33 patients (25 men and eight women; mean age, 47.6 +/- 14.0 years) with dilated cardiomyopathy were studied by right and left heart catheterization, right ventricular biopsy, two-dimensional and Doppler echocardiography, and external pulse recordings. Twenty-six of 33 patients survived more than 6 months, and 24 of the 26 patients improved their functional class (from mean 3.3 to 1.8, p less than 0.0001). These 24 patients were subjected to withdrawal of metoprolol until the number of symptoms increased and deterioration occurred as observed noninvasively (group 1, n = 16), whereas the eight patients did not deteriorate during a 12-month period (group 2). During long-term treatment with metoprolol, there was an increase in ejection fraction from 0.24 to 0.42 (p less than 0.0001), whereas there was a decrease in the left ventricular (LV) end-diastolic dimension (from 7.3 to 6.4 cm, p less than 0.0001), in the grade of mitral regurgitation (from 1.7 to 0.4, p less than 0.0001), and in the grade of tricuspid regurgitation (from 0.6 to 0.05, p less than 0.007). There was a decrease in pulmonary wedge pressure (from 23.8 to 10.7 mm Hg, p less than 0.0001), LV end-diastolic pressure (from 24.1 to 13.4 mm Hg, p less than 0.002), and systolic vascular resistance (from 1,782 to 1,499 dynes/sec/cm, p less than 0.04). There was an increase in systolic blood pressure (from 116 to 132 mm Hg, p less than 0.003), cardiac index (from 2.17 to 2.58 l/min/m2, p less than 0.005), and LV stroke work index (from 31 to 65 g.m/m2, p less than 0.0001). During withdrawal of metoprolol, the heart rate and left atrial dimension increased (p less than 0.0001), whereas ejection fraction decreased (p less than 0.0001). The 12 (of 16) patients in group 1 who survived the withdrawal period had metoprolol readministered, and subsequently, ejection fraction increased (from 0.23 to 0.33, p less than 0.002). Patients had a low number of ventricular beta-adrenergic receptors compared with healthy control subjects (30.3 +/- 2.9 vs. 97.4 +/- 8.7 fmol/mg protein, p less than 0.001), but long-term treatment with metoprolol caused a moderate up-regulation (from 30.3 +/- 2.9 to 49.0 +/- 7.1 fmol/mg protein, p less than 0.05), which may facilitate a more normal response to sympathetic stimulation.(ABSTRACT TRUNCATED AT 400 WORDS)
影响因子：
20.1
作者：
BRISTOW, MR;GINSBURG, R;STINSON, EB
通讯作者：
STINSON, EB
影响因子：
158.5
作者：
BRISTOW, MR;GINSBURG, R;STINSON, EB
通讯作者：
STINSON, EB