Efficacy of Different Beta-Blockers in the Treatment of Long QT Syndrome
Efficacy of Different Beta-Blockers in the Treatment of Long QT Syndrome
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DOI：
10.1016/j.jacc.2014.05.068
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发表时间：
2014-09-30
影响因子：
24
通讯作者：
Moss, Arthur J.
中科院分区：
文献类型：
--
作者：
Abu-Zeitone, Abeer;Peterson, Derick R.;Moss, Arthur J.
在LQTS中，β受体阻滞剂治疗可有效降低心脏事件（晕厥、心脏骤停中止、心源性猝死）的风险。本研究的目的是比较不同β-受体阻滞剂在长QT综合征（LQTS）和LQT 1和LQT 2基因型阳性患者中的疗效。方法本研究包括来自纽约罗切斯特LQTS登记处的1，530例患者，这些患者被处方了常见的β-受体阻滞剂（阿替洛尔、美托洛尔、普萘洛尔或纳多洛尔）。结果阿替洛尔、美托洛尔、普萘洛尔和纳多洛尔与停用β受体阻滞剂相比，首次心脏事件的危险比和95%可信区间（CI）分别为0.71（0.50至1.01）、0.70（0.43至1.15）、0.65（0.46至0.90）和0.51（0.35至0.74）。在LQT 1中，4种β受体阻滞剂的首次心脏事件风险降低相似，但在LQT 2中，纳多洛尔提供了唯一显著的风险降低（风险比：0.40 [0.16至0.98]）。在服用β-受体阻滞剂期间发生过心脏事件的患者中，不同药物对复发事件的疗效不同（p = 0.004），而普萘洛尔与其他β受体阻滞剂相比效果最差。结论虽然4种β受体阻滞剂在降低LQTS患者首次心脏事件风险方面同样有效，但其疗效因基因型而异;纳多洛尔是唯一与LQT 2患者风险显著降低相关的β受体阻滞剂。在β受体阻滞剂治疗期间发生心脏事件的患者发生后续心脏事件的风险较高，普萘洛尔是该高危人群中效果最差的药物。(C)2014年由美国心脏病学会基金会。
BACKGROUND In LQTS, beta-blocker therapy is effective in reducing the risk of cardiac events (syncope, aborted cardiac arrest, sudden cardiac death). Limited studies have compared the efficacy of different beta-blockers.OBJECTIVES The goal of this study was to compare the efficacy of different beta-blockers in long QT syndrome (LQTS) and in genotype-positive patients with LQT1 and LQT2.METHODS The study included 1,530 patients from the Rochester, New York-based LQTS Registry who were prescribed common beta-blockers (atenolol, metoprolol, propranolol, or nadolol). Time-dependent Cox regression analyses were used to compare the efficacy of different beta-blockers with the risk of cardiac events in LQTS.RESULTS Relative to being off beta-blockers, the hazard ratios and 95% confidence intervals (CIs) for first cardiac events for atenolol, metoprolol, propranolol, and nadolol were 0.71 (0.50 to 1.01), 0.70 (0.43 to 1.15) 0.65 (0.46 to 0.90), and 0.51 (0.35 to 0.74), respectively. In LQT1, the risk reduction for first cardiac events was similar among the 4 beta-blockers, but in LQT2, nadolol provided the only significant risk reduction (hazard ratio: 0.40 [0.16 to 0.98]). Among patients who had a prior cardiac event while taking beta-blockers, efficacy for recurrent events differed by drug (p = 0.004), and propranolol was the least effective compared with the other beta-blockers.CONCLUSIONS Although the 4 beta-blockers are equally effective in reducing the risk of a first cardiac event in LQTS, their efficacy differed by genotype; nadolol was the only beta-blocker associated with a significant risk reduction in patients with LQT2. Patients experiencing cardiac events during beta-blocker therapy are at high risk for subsequent cardiac events, and propranolol is the least effective drug in this high-risk group. (C) 2014 by the American College of Cardiology Foundation.