卡维地洛治疗扩张型心肌病患者心功能及心脏交感神经活性的疗效：与美托洛尔治疗的比较

Efficacy of carvedilol treatment on cardiac function and cardiac sympathetic nerve activity in patients with dilated cardiomyopathy: comparison with metoprolol therapy.

作者信息

Toyama Takuji, Hoshizaki Hiroshi, Seki Ryotaro, Isobe Naoki, Adachi Hitoshi, Naito Shigeto, Oshima Shigeru, Taniguchi Koichi

机构信息

Gunma Prefectural Cardiovascular Center, Maebashi, Japan.

出版信息

J Nucl Med. 2003 Oct;44(10):1604-11.

PMID:14530474

Abstract

UNLABELLED

Carvedilol and metoprolol have been reported to be effective in the treatment of patients with chronic heart failure. However, to our knowledge, there have been no studies comparing the effects of the 2 drugs on cardiac function, including cardiac sympathetic nerve activity.

METHODS

We compared 15 patients with dilated cardiomyopathy (DCM) who were receiving carvedilol (group A) with 15 patients with DCM who were receiving metoprolol (group B). Before and after 1 y of treatment, cardiac (123)I-metaiodobenzylguanidine ((123)I-MIBG) uptake was assessed using the total defect score (TDS) and the heart-to-mediastinum (H/M) activity ratio from the delayed images. The New York Heart Association (NYHA) class and echocardiographic left ventricular ejection fraction (LVEF) also were assessed.

RESULTS

In both groups, the TDS decreased (in group A, from 25 +/- 14 to 16 +/- 14, P < 0.01; in group B, from 27 +/- 9 to 19 +/- 10, P < 0.01), the H/M increased (in group A, from 1.67 +/- 0.31 to 2.01 +/- 0.36, P < 0.01; in group B, from 1.68 +/- 0.21 to 1.93 +/- 0.32, P < 0.01), the LVEF increased (in group A, from 31% +/- 10% to 48% +/- 10%, P < 0.01; in group B, from 28% +/- 9% to 47% +/- 15%, P < 0.01), and the NYHA functional class improved (in group A, from 2.9 +/- 0.3 to 1.7 +/- 0.5, P < 0.01; in group B, from 2.8 +/- 0.6 to 1.7 +/- 0.6, P < 0.01). The change in LVEF was mildly correlated with the change in the TDS in group A (r = 0.41) as well as in group B (r = 0.53). In the patients with a favorable response in the TDS or H/M, the NYHA class improved more than in the patients without a favorable response (P < 0.05).

CONCLUSION

Carvedilol treatment can improve cardiac function, symptoms, and cardiac sympathetic nerve activity in patients with DCM to a similar extent as metoprolol treatment. The improvement of cardiac function and symptoms is related to the improvement of cardiac sympathetic nerve activity.

摘要

未标注

据报道，卡维地洛和美托洛尔在治疗慢性心力衰竭患者方面有效。然而，据我们所知，尚无比较这两种药物对心功能（包括心脏交感神经活动）影响的研究。

方法

我们将15例接受卡维地洛治疗的扩张型心肌病（DCM）患者（A组）与15例接受美托洛尔治疗的DCM患者（B组）进行了比较。在治疗1年前后，使用延迟图像的总缺损评分（TDS）和心/纵隔（H/M）活性比值评估心脏（123）I-间碘苄胍（（123）I-MIBG）摄取。还评估了纽约心脏协会（NYHA）分级和超声心动图左心室射血分数（LVEF）。

结果

两组患者的TDS均降低（A组从25±14降至16±14，P<0.01；B组从27±9降至19±10，P<0.01），H/M升高（A组从1.67±0.31升至2.01±0.36，P<0.01；B组从1.68±0.21升至1.93±0.32，P<0.01），LVEF升高（A组从31%±10%升至48%±10%，P<0.01；B组从28%±9%升至47%±15%，P<0.01），NYHA功能分级改善（A组从2.9±0.3降至1.7±0.5，P<0.01；B组从2.8±0.6降至1.7±0.6，P<0.01）。A组和B组中LVEF的变化与TDS的变化均呈轻度相关（A组r = 0.41；B组r = 0.53）。在TDS或H/M有良好反应的患者中，NYHA分级改善程度大于无良好反应的患者（P<0.05）。