Lechat Philippe P
Pharmacology Department, Pitié-Salpêtrière Hospital, Paris, France.
Card Electrophysiol Rev. 2003 Sep;7(3):233-5. doi: 10.1023/B:CEPR.0000012389.01561.27.
Large randomized trials have demonstrated that beta-blocker treatment reduces morbidity and mortality in patients in chronic heart failure. Questions remain about the influence of individual characteristics on the magnitude of the benefit of beta-blockers in patients with heart failure including the influence of heart rate and cardiac rhythm. In the Cardiac Insufficiency Bisoprolol Study II, baseline heart rate and heart rate change over time had prognostic value but treatment with bisoprolol was associated with a benefit at all levels of baseline heart rate and additional benefit related to heart rate slowing was observed. In the subgroup of patients with atrial fibrillation, morbidity and mortality rates were similar in placebo and bisoprolol treated patients. It is possible that patients with atrial fibrillation had a higher level of sympathetic stimulation that would have required higher doses of bisoprolol to achieve a similar level of beta-blockade. Alternatively, the failure to observe improved outcome in the subgroup with atrial fibrillation may have been due to chance. However, because this finding was not observed in other large trials, and because there was no clear explanation, it should not be concluded that patients with chronic heart failure and atrial fibrillation do not benefit from beta-blockade.
大型随机试验表明，β受体阻滞剂治疗可降低慢性心力衰竭患者的发病率和死亡率。关于个体特征对心力衰竭患者使用β受体阻滞剂获益程度的影响，包括心率和心律的影响，仍存在疑问。在心脏不全比索洛尔研究II中，基线心率和心率随时间的变化具有预后价值，但在所有基线心率水平，比索洛尔治疗均带来益处，且观察到与心率减慢相关的额外益处。在心房颤动患者亚组中，安慰剂组和比索洛尔治疗组的发病率和死亡率相似。心房颤动患者可能具有较高水平的交感神经刺激，这可能需要更高剂量的比索洛尔才能达到相似的β受体阻滞水平。或者，在心房颤动亚组中未观察到预后改善可能是由于偶然因素。然而，由于其他大型试验未观察到这一发现，且没有明确的解释，因此不应得出慢性心力衰竭合并心房颤动患者不能从β受体阻滞中获益的结论。
