Schleman K A, Lindenfeld J A, Lowes B D, Bristow M R, Ferguson D, Wolfel E E, Abraham W T, Zisman L S
University of Colorado Health Sciences Center, Denver, Colorado, USA.
J Card Fail. 2001 Mar;7(1):4-12. doi: 10.1054/jcaf.2001.22491.
Carvedilol has been shown to decrease the progression of heart failure and improve left ventricular function and survival in patients with a left ventricular ejection fraction (LVEF) less than 35%. However, not all patients respond uniformly to this therapy. We proposed to identify variables that could, potentially, be used to predict response to carvedilol therapy as measured by the change in LVEF after treatment (Delta LVEF), and to identify pretreatment variables associated with hospitalization for heart failure after carvedilol therapy.
A retrospective analysis of 98 patients treated with open-label carvedilol for a mean period of 16 months was performed by using bivariate and step-wise multivariate analyses. Bivariate analysis showed a positive correlation of Delta LVEF with heart rate at baseline (P =.001). There was a negative correlation of Delta LVEF with baseline LVEF (P <.01), diabetes mellitus (P =.04), and ischemic cardiomyopathy (P =.0002). Multivariate analysis showed a positive correlation of Delta LVEF with heart rate at baseline (P =.01) and a negative correlation with initial LVEF (P =.02) and ischemic cardiomyopathy (P =.006). Variables associated with hospitalization after initiation of carvedilol therapy were New York Heart Association (NYHA) classification (P =.001), lower extremity edema (P =.001), presence of an S3 (P =.02), hyponatremia (P =.02), elevated blood urea nitrogen (BUN) (P =.002), atrial fibrillation (P =.001), diabetes mellitus (P =.02), and obstructive sleep apnea (P =.009).
Heart failure patients with the lowest LVEF or the highest heart rate at baseline had the greatest gain in LVEF after treatment with carvedilol. Patients with ischemic cardiomyopathy derived less benefit. Patients with clinical evidence of decompensated heart failure were at greater risk for hospitalization after initiation of carvedilol therapy.
已证实卡维地洛可降低心力衰竭的进展，并改善左心室射血分数（LVEF）低于35%的患者的左心室功能和生存率。然而，并非所有患者对这种治疗的反应都一致。我们旨在确定一些变量，这些变量可能用于预测卡维地洛治疗的反应，以治疗后LVEF的变化（ΔLVEF）来衡量，并确定与卡维地洛治疗后因心力衰竭住院相关的治疗前变量。
采用双变量和逐步多变量分析对98例接受开放标签卡维地洛治疗平均16个月的患者进行回顾性分析。双变量分析显示ΔLVEF与基线心率呈正相关（P = 0.001）。ΔLVEF与基线LVEF（P < 0.01）、糖尿病（P = 0.04）和缺血性心肌病（P = 0.0002）呈负相关。多变量分析显示ΔLVEF与基线心率呈正相关（P = 0.01），与初始LVEF（P = 0.02）和缺血性心肌病（P = 0.006）呈负相关。与开始卡维地洛治疗后住院相关的变量有纽约心脏协会（NYHA）分级（P = 0.001）、下肢水肿（P = 0.001）、S3的存在（P = 0.02）、低钠血症（P = 0.02）、血尿素氮（BUN）升高（P = 0.002）、心房颤动（P = 0.001）、糖尿病（P = 0.02）和阻塞性睡眠呼吸暂停（P = 0.009）。
基线时LVEF最低或心率最高的心力衰竭患者在接受卡维地洛治疗后LVEF的增加最大。缺血性心肌病患者获益较少。有失代偿性心力衰竭临床证据的患者在开始卡维地洛治疗后住院风险更高。
