Long-term ambulatory therapy with prazosin versus placebo for chronic heart failure: relation between clinical response and left ventricular function at rest and during exercise.
Long-term ambulatory therapy with prazosin versus placebo for chronic heart failure: relation between clinical response and left ventricular function at rest and during exercise.
复制标题
哌唑嗪与安慰剂长期门诊治疗慢性心力衰竭：临床反应与静息和运动时左心室功能之间的关系。
DOI：
10.1016/0002-9149(83)90415-0
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发表时间：
1983
期刊：
影响因子：
--
通讯作者：
Cobb,FR
中科院分区：
文献类型：
--
作者：
Higginbotham,MB;Morris,KG;Bramlet,DA;Coleman,RE;Cobb,FR
在一项为期6个月、双盲、安慰剂对照的研究中，评估了口服哌唑嗪（PZ）（15 - 20 mg/天）对纽约心脏协会心功能III级患者的症状、运动能力和左心室（LV）功能的影响。射血分数（EF）测定在休息时和直立自行车运动期间的平衡放射性核素血管造影;舒张末期容积，每搏输出量和心输出量来自相应的计数测量。虽然哌唑嗪组和安慰剂组的临床反应之间没有统计学显著差异，但定性差异表明哌唑嗪的临床反应。在接受PZ治疗的9例患者中，5例改善至功能II级，2例无症状; 2例无应答者在停用PZ时恶化至功能IV级。接受安慰剂治疗的9例患者中有4例改善至功能II级，2例恶化至IV级。哌唑嗪组的运动时间有增加的趋势（6个月时从541 ± 204秒增加到630 ±100秒），安慰剂组的运动时间有减少的趋势（6个月时从539 ± 141秒减少到435 ±148秒），但两种变化都不显著。哌唑嗪可使静息时平均血压持续降低约10 mm Hg，运动时降低幅度在数量上相似但不显著。哌唑嗪组在静息和运动时放射性核素EF增加，LV舒张末期计数显著降低，但安慰剂组无此现象。由于EF和舒张末期计数的变化相似，因此卒中计数和计数输出不变。因此，长期口服PZ治疗导致大多数功能III级患者的血压和LV功能持续变化，但这些变化并没有统一转化为临床改善或运动耐量增加。哌唑嗪似乎不增加心力衰竭患者运动时的心输出量。
The effects of oral prazosin (PZ), 15 to 20 mg/day, on symptoms, exercise performance and left ventricular (LV) function were assessed in a 6-month, double-blind, placebo-controlled study of patients in New York Heart Association functional class III. Ejection fraction (EF) was measured at rest and during upright bicycle exercise by equilibrium radionuclide angiography; end-diastolic volume, stroke volume and cardiac output were derived from corresponding count measurements. Although there was no statistically significant difference between clinical responses in the prazosin and placebo groups, qualitative differences suggested a clinical response to prazosin. Of the 9 patients who received PZ, 5 improved to functional class II and 2 became asymptomatic; the 2 nonresponders deteriorated to functional class IV when PZ was stopped. Four of 9 patients who received placebo improved to functional class II and 2 deteriorated to class IV. Exercise time tended to increase in the prazosin group (from 541 ± 204 to 630 ±100 seconds at 6 months) and decrease in the placebo group (from 539 ± 141 to 435 ±148 seconds at 6 months), but neither change was significant. Prazosin effected a sustained decrease in mean blood pressure of approximately 10 mm Hg at rest, and a quantitatively similar but insignificant decrease during exercise. Radionuclide EF increased and LV end-diastolic counts decreased significantly at rest and during exercise in the prazosin group, but not in the placebo group. Because changes in EF and end-diastolic counts were similar, stroke counts and count output were unchanged. Thus, long-term oral PZ therapy caused sustained changes in blood pressure and LV function in most patients in functional class III, but these changes were not uniformly translated into clinical improvement or increased exercise tolerance. Prazosin does not appear to increase cardiac output during exercise in patients with heart failure.