Lechat P, Hulot J S, Escolano S, Mallet A, Leizorovicz A, Werhlen-Grandjean M, Pochmalicki G, Dargie H
Pharmacology Department, Pitié Salpêtrière Hospital, Paris, France.
Circulation. 2001 Mar 13;103(10):1428-33. doi: 10.1161/01.cir.103.10.1428.
beta-Blockade-induced benefit in heart failure (HF) could be related to baseline heart rate and treatment-induced heart rate reduction, but no such relationships have been demonstrated.
In CIBIS II, we studied the relationships between baseline heart rate (BHR), heart rate changes at 2 months (HRC), nature of cardiac rhythm (sinus rhythm or atrial fibrillation), and outcomes (mortality and hospitalization for HF). Multivariate analysis of CIBIS II showed that in addition to beta-blocker treatment, BHR and HRC were both significantly related to survival and hospitalization for worsening HF, the lowest BHR and the greatest HRC being associated with best survival and reduction of hospital admissions. No interaction between the 3 variables was observed, meaning that on one hand, HRC-related improvement in survival was similar at all levels of BHR, and on the other hand, bisoprolol-induced benefit over placebo for survival was observed to a similar extent at any level of both BHR and HRC. Bisoprolol reduced mortality in patients with sinus rhythm (relative risk 0.58, P:<0.001) but not in patients with atrial fibrillation (relative risk 1.16, P:=NS). A similar result was observed for cardiovascular mortality and hospitalization for HF worsening.
BHR and HRC are significantly related to prognosis in heart failure. beta-Blockade with bisoprolol further improves survival at any level of BHR and HRC and to a similar extent. The benefit of bisoprolol is questionable, however, in patients with atrial fibrillation.
β受体阻滞剂在心力衰竭（HF）中产生的益处可能与基线心率及治疗引起的心率降低有关，但尚未证实存在此类关系。
在心脏 insufficiency bisoprolol study II（CIBIS II）研究中，我们探究了基线心率（BHR）、2个月时的心率变化（HRC）、心律性质（窦性心律或心房颤动）与预后（死亡率及因HF住院）之间的关系。CIBIS II的多变量分析表明，除β受体阻滞剂治疗外，BHR和HRC均与生存及HF恶化导致的住院显著相关，最低的BHR和最大的HRC与最佳生存及减少住院率相关。未观察到这3个变量之间存在相互作用，这意味着一方面，在所有BHR水平上，与HRC相关的生存改善相似；另一方面，在BHR和HRC的任何水平上，比索洛尔相对于安慰剂在生存方面产生的益处程度相似。比索洛尔降低了窦性心律患者的死亡率（相对风险0.58，P<0.001），但未降低心房颤动患者的死亡率（相对风险1.16，P=无统计学意义）。在心血管死亡率及HF恶化导致的住院方面也观察到了类似结果。
BHR和HRC与心力衰竭的预后显著相关。在任何BHR和HRC水平上，使用比索洛尔进行β受体阻滞均可进一步改善生存，且程度相似。然而，比索洛尔对心房颤动患者的益处存在疑问。
