Gerson Myron C, Craft Laura L, McGuire Nancy, Suresh Damodhar P, Abraham William T, Wagoner Lynne E
Division of Cardiology, Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio 45267, USA.
J Nucl Cardiol. 2002 Nov-Dec;9(6):608-15. doi: 10.1067/mnc.2002.127717.
Carvedilol treatment reduces the mortality rate in patients with congestive heart failure. It is not known whether carvedilol treatment is effective in heart failure patients with substantial cardiac sympathetic nerve dysfunction. The goal of this study was to determine the effect of chronic carvedilol treatment in patients with cardiac sympathetic nerve dysfunction of varying severity.
In 22 congestive heart failure patients with idiopathic cardiomyopathy, sympathetic nerve function was assessed before and after 7.2 +/- 2.7 months of carvedilol treatment with the use of iodine 123 metaiodobenzylguanidine (MIBG) imaging, radionuclide ventriculography, and transmyocardial norepinephrine sampling. Patients with relatively advanced impairment of cardiac sympathetic nerve function, as manifested by a baseline I-123 MIBG ratio lower than 1.40, had a statistically significant improvement in I-123 heart-mediastinum ratio with carvedilol treatment, from 1.26 +/- 0.12 to 1.39 +/- 0.20 (P =.004). Of 10 patients with a baseline I-123 MIBG ratio lower than 1.40, 9 had an increase in the heart-mediastinum ratio with carvedilol treatment. Left ventricular ejection fraction increased from 25.4% +/- 7.8% to 37.3% +/- 14.7% (P <.001), with no difference between patients with relatively advanced versus relatively preserved cardiac sympathetic nerve function.
Most patients with congestive heart failure show a favorable response in left ventricular function to carvedilol treatment, regardless of the baseline level of cardiac sympathetic nervous system function, as assessed by neuronal imaging with I-123 MIBG. Patients with relatively advanced impairment of baseline I-123 MIBG uptake are most likely to show evidence of improved cardiac sympathetic nervous system function in response to carvedilol therapy.
卡维地洛治疗可降低充血性心力衰竭患者的死亡率。目前尚不清楚卡维地洛治疗对伴有严重心脏交感神经功能障碍的心力衰竭患者是否有效。本研究的目的是确定长期卡维地洛治疗对不同严重程度心脏交感神经功能障碍患者的影响。
对22例特发性心肌病所致充血性心力衰竭患者，在接受卡维地洛治疗7.2±2.7个月前后，采用碘123间碘苄胍（MIBG）显像、放射性核素心室造影和经心肌去甲肾上腺素采样评估交感神经功能。心脏交感神经功能相对严重受损的患者，表现为基线I-123 MIBG比值低于1.40，卡维地洛治疗后I-123心/纵隔比值有统计学意义的改善，从1.26±0.12升至1.39±0.20（P = 0.004）。10例基线I-123 MIBG比值低于1.40的患者中，9例卡维地洛治疗后心/纵隔比值升高。左心室射血分数从25.4%±7.8%升至37.3%±14.7%（P<0.001），心脏交感神经功能相对严重受损与相对保留的患者之间无差异。
大多数充血性心力衰竭患者，无论通过I-123 MIBG神经元显像评估的心脏交感神经系统功能基线水平如何，左心室功能对卡维地洛治疗均有良好反应。基线I-123 MIBG摄取相对严重受损的患者，最有可能显示出对卡维地洛治疗有心脏交感神经系统功能改善的证据。
