Palazzuoli A, Bruni F, Puccetti L, Pastorelli M, Angori P, Pasqui A L, Auteri A
Institute of Internal Medicine, University of Siena, Siena, Italy.
Eur J Heart Fail. 2002 Dec;4(6):765-70. doi: 10.1016/s1388-9842(02)00114-9.
Recent studies have shown that carvedilol therapy in patients with heart failure improves clinical outcome and survival, however, the effects of such treatment on left cardiac morphology and function in elderly patients with severe heart failure has not been widely studied.
The purpose of this study was to establish the effect of carvedilol at short- and long-term on left ventricular size and performance with mono- and two-dimensional echocardiography, in subjects with dilated cardiomyopathy, NYHA III functional class, low LV ejection fraction (EF < 35%) and mean age of > 70 years.
We studied 48 patients, previously randomized to treatment with either carvedilol or placebo, and we performed echocardiographic evaluation at the start, and after 3 and 12 months. Left ventricular diameters, LV mass and fractional shortening were calculated by Deveraux formula; left ventricular volumes and ejection fraction were measured by area-length formula; pulmonary pressure was calculated by tricuspid reflow.
After 3 months, only LV end-diastolic diameter was lower in the carvedilol group compared to the placebo group. Nevertheless, after 12 months, patients on carvedilol treatment showed a LV geometric and functional improvement compared to placebo. We found significant differences in: diastolic (P < 0.01) and systolic diameters (P < 0.001); on LV mass (P < 0.002); on LV systolic volume (P < 0.03); and on LV ejection fraction (P<0.01). Pulmonary pressure was also reduced in beta-blocker subjects (P < 0.001).
Carvedilol therapy for 12 months reduced LV diameters and volumes. Thus, improving cardiac remodeling and LV systolic function in elderly patients with severe heart failure. Several months of therapy are required for these favorable effects to occur, as these changes do not occur in the short term.
近期研究表明，卡维地洛治疗心力衰竭患者可改善临床结局和生存率，然而，这种治疗对老年重症心力衰竭患者左心形态和功能的影响尚未得到广泛研究。
本研究的目的是通过一维和二维超声心动图，确定卡维地洛在短期和长期对扩张型心肌病、纽约心脏病协会（NYHA）III级功能分级、低左心室射血分数（EF<35%）且平均年龄>70岁的受试者左心室大小和功能的影响。
我们研究了48例先前随机接受卡维地洛或安慰剂治疗的患者，并在开始时以及3个月和12个月后进行了超声心动图评估。左心室直径、左心室质量和缩短分数通过德弗罗公式计算；左心室容积和射血分数通过面积-长度公式测量；肺动脉压通过三尖瓣反流计算。
3个月后，与安慰剂组相比，卡维地洛组仅左心室舒张末期直径较低。然而，12个月后，与安慰剂相比，接受卡维地洛治疗的患者左心室几何形态和功能有所改善。我们发现以下方面存在显著差异：舒张期（P<0.01）和收缩期直径（P<0.001）；左心室质量（P<0.002）；左心室收缩容积（P<0.03）；以及左心室射血分数（P<0.01）。β受体阻滞剂治疗的患者肺动脉压也降低（P<0.001）。
卡维地洛治疗12个月可减小左心室直径和容积。因此，可改善老年重症心力衰竭患者的心脏重塑和左心室收缩功能。这些有益效果需要数月治疗才能出现，因为这些变化不会在短期内发生。
