A randomized controlled phase IIb trial of beta(1)-receptor blockade for chronic degenerative mitral regurgitation.
A randomized controlled phase IIb trial of beta(1)-receptor blockade for chronic degenerative mitral regurgitation.
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DOI：
10.1016/j.jacc.2012.04.029
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发表时间：
2012-08-28
影响因子：
24
通讯作者：
Dell'Italia, Louis J.
中科院分区：
文献类型：
--
作者：
Ahmed, Mustafa I.;Aban, Inmaculada;Lloyd, Steven G.;Gupta, Himanshu;Howard, George;Inusah, Seidu;Peri, Kalyani;Robinson, Jessica;Smith, Patty;McGiffin, David C.;Schiros, Chun G.;Denney, Thomas, Jr.;Dell'Italia, Louis J.
评价长期应用β1-肾上腺素能受体阻滞剂(β1-AR受体阻滞剂)对慢性单纯退行性二尖瓣反流(MR)患者左室重构和功能的影响。孤立的MR目前还没有被证实的治疗方法来减轻左室重构或保留收缩功能。38名无症状的中到重度孤立MR受试者随机接受安慰剂或β1-AR阻滞剂(Toprol-XL)治疗，为期两年。在基线和每隔6个月进行磁共振成像(MRI)和组织标记及三维(3D)分析，为期两年。对主要结果的终点变量进行进展率分析：LV舒张末容量/体表面积(EDV/BSA)、LV射血分数(EF)、LVED质量/EDV比率、LVE3D半径/壁厚(r/wt)、LV收缩末期容量(ESV)/BSA、LV纵向应变率和LV舒张期早期充盈率。两组的基线LV MRI或人口统计学变量没有差异。在意向处理分析中，未经治疗的患者对左心室射血分数(P=0.006)和左室舒张早期充盈率(P=0.001)有显著的治疗效果，随着时间的推移，这两项指标逐渐下降，经敏感性分析后仍具有显著意义。对LVED或LVES容量、LVED质量/LVEDV、LVED 3d r/wt、LV纵向应变率均无显著影响。在两年多的时间里，6名服用安慰剂的患者和2名接受β1-AR阻滞组的患者需要接受二尖瓣手术(p=0.23)。β1-AR阻滞剂在两年的随访中改善了孤立MR患者的左心功能，并为具有临床结果的大规模临床试验提供了动力。
Evaluate the effect of long-term β1-aderergic receptor blockade (β1-AR blockade) on LV remodeling and function in patients with chronic, isolated degenerative mitral regurgitation (MR). Isolated MR currently has no proven therapy that attenuates LV remodeling or preserves systolic function. 38 asymptomatic subjects with moderate to severe, isolated MR were randomized to either placebo or β1-AR blockade (Toprol-XL) for two years. Magnetic resonance imaging (MRI) with tissue tagging and 3 dimensional (3D) analysis was performed at baseline and at six month intervals for two years. Rate of progression analysis was performed for end-point variables for primary outcomes: LV end-diastolic volume/body surface area (EDV/BSA), LV ejection fraction (EF), LVED mass/EDV ratio, LVED 3D radius/wall thickness (r/wt); LV end-systolic volume (ESV)/BSA, LV longitudinal strain rate, and LV early diastolic filling rate. Baseline LV MRI or demographic variables did not differ between the two groups. Significant treatment effects were found on LVEF (p=0.006) and LV early diastolic filling rate (p=0.001), which decreased over time in untreated patients on an intention to treat analysis, and remained significant following sensitivity analysis. There were no significant treatment effects found on LVED or LVES volumes, LVED mass/LVEDV or LVED 3D r/wt, or LV longitudinal strain rate. Over two years, six patients in placebo and two patients in β1-AR blockade group required mitral valve surgery (p = 0.23). β1-AR blockade improves LV function over a two-year follow-up in isolated MR and provides the impetus for a large scale clinical trial with clinical outcomes.
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影响因子：
37.8
作者：
Stewart, Ralph A. H.;Raffel, Owen C.;Cowan, Brett R.
通讯作者：
Cowan, Brett R.
影响因子：
4.8
作者：
Mehta, RH;Supiano, MA;Starling, MR
通讯作者：
Starling, MR
影响因子：
15.9
作者：
TSUTSUI, H;SPINALE, FG;CARABELLO, BA
通讯作者：
CARABELLO, BA
影响因子：
37.8
作者：
Schiros CG;Dell'Italia LJ;Gladden JD;Clark D 3rd;Aban I;Gupta H;Lloyd SG;McGiffin DC;Perry G;Denney TS Jr;Ahmed MI
通讯作者：
Ahmed MI
DOI：
10.1152/ajpheart.1997.273.2.h961
发表时间：
1997-08-01
影响因子：
4.8
作者：
DellItalia, LJ;Balcells, E;Oparil, S
通讯作者：
Oparil, S