Cardiovascular effects of fluoxetine in depressed patients with heart disease.
Cardiovascular effects of fluoxetine in depressed patients with heart disease.
复制标题
氟西汀对患有心脏病的抑郁症患者的心血管作用。
DOI：
10.1176/ajp.155.5.660
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发表时间：
1998
期刊：
影响因子：
--
通讯作者：
BiggerJr,JT
中科院分区：
文献类型：
--
作者：
Roose,SP;Glassman,AH;Attia,E;Woodring,S;Giardina,EG;BiggerJr,JT
目的探讨氟西汀对合并心脏病的抑郁症患者心血管功能的影响。方法对27例伴有充血性心力衰竭、传导疾病和/或室性心律失常的抑郁症患者(女性占26%，平均年龄73岁)进行为期7周的开放用药试验。主要观察指标为24小时心电记录测量的心率和节律、放射性核素血管造影术测定的射血分数、心脏传导间期和血压。基线值与氟西汀治疗2周和7周时的值进行比较。在60名可比较的患者中，也检测了基线和三环类抗抑郁药去甲替林治疗3周后这些心血管指标的值。结果洛西汀导致心率显著降低6%，仰卧位收缩压增加2%，射血分数增加7%。对心脏传导、室性心律失常或立位血压没有影响。总体而言，4%的氟西汀患者对心血管有不良影响。相反，去甲替林治疗可显著增加心率和直立性低血压，20%的去甲替林治疗患者有心血管不良反应。结论在患有心脏病的抑郁症患者中，氟西汀治疗与三环类抗抑郁药的心血管反应或明显的心脏不良事件无关。然而，从这项仅对27名患者进行了7周监测的研究中，可以得出关于氟西汀的心血管效应和安全性的有限结论。
OBJECTIVEThe purpose of this study was to determine the cardiovascular effects of fluoxetine in depressed patients with cardiac disease.METHODTwenty-seven depressed patients (26% of whom were female and whose average age was 73 years) who had congestive heart failure, conduction disease, and/or ventricular arrhythmia were studied in an open medication trial of fluoxetine, up to 60 mg/day, for 7 weeks. The main outcome measures were heart rate and rhythm measured by 24-hour ECG recordings, ejection fraction determined by radionuclide angiography, cardiac conduction intervals, and blood pressure. Baseline values were compared with those at weeks 2 and 7 of fluoxetine treatment. In 60 comparable patients, values of these same cardiovascular measures at baseline and after 3 weeks of treatment with a tricyclic antidepressant, nortriptyline, were also examined.RESULTSFluoxetine induced a statistically significant 6% decrease in heart rate, a 2% increase in supine systolic pressure, and a 7% increase in ejection fraction. There was no effect on cardiac conduction, ventricular arrhythmia, or orthostatic blood pressure. Overall, 4% of the fluoxetine patients had an adverse cardiovascular effect. In contrast, nortriptyline treatment caused a significant increase in heart rate and orthostatic hypotension, and 20% of the nortriptyline-treated patients had an adverse cardiovascular effect.CONCLUSIONSIn depressed patients with heart disease, fluoxetine treatment was not associated with the cardiovascular effects documented for the tricyclic antidepressants or with significant adverse cardiac events. However, limited conclusions about fluoxetine's cardiovascular effects and safety can be drawn from this study of only 27 patients monitored for 7 weeks.