Meijboom Lilian J, Westerhof Berend E, Nollen Gijs J, Spaan Jos A E, de Mol Bas A J M, Jacobs Michael J H M, Mulder Barbara J M
Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
Eur J Cardiothorac Surg. 2004 Nov;26(5):901-6. doi: 10.1016/j.ejcts.2004.07.010.
Beta-blocking therapy is the standard therapy in non-operated Marfan patients, however its efficacy after entire aortic replacement is unknown. The aim of this study was to describe the influence of (nearly) entire aortic replacement and beta-blocking therapy on blood pressure and wave reflections in Marfan patients.
Four Marfan patients (mean age 31+/-3 years) and 8 age matched control subjects were studied. Blood pressure and wave reflections (reflection coefficient and augmentation index) were studied by means of magnetic resonance imaging, continuous non-invasive blood pressure measurements and applanation tonometry. Patients were studied with atenolol, labetalol and without beta-blocking therapy.
In Marfan patients, aortic systolic pressure (129+/-13 vs 114+/-10 mmHg), pulse pressure (58+/-13 vs 40+/-5 mmHg), wave speed (11+/-3 vs 4+/-0.4 m s(-1)) and reflection coefficient (65+/-22 vs 41+/-5%) were significantly increased compared to controls. There was no difference in aortic pressure between various medications in Marfan patients (atenolol 129/76 mmHg, labetalol 121/75 mmHg and without beta-blocking therapy 129/71 mmHg). Higher reflection coefficients were seen in patients with atenolol compared to discontinued medication (73+/-18 vs 65+/-22%), and also the augmentation index was higher with atenolol compared to labetalol and discontinued medication (24+/-22 vs 17+/-17 vs 22+/-22%, respectively).
Our results describe increased pulse pressure, systolic pressure, wave speed and wave reflections in four Marfan patients after entire aortic replacement. The use of atenolol or labetalol did not decrease aortic pressure and with atenolol increased wave reflections were observed. Therefore, the beneficial effect of atenolol in these patients is doubtful.
β受体阻滞剂疗法是非手术治疗马凡综合征患者的标准疗法，然而其在全主动脉置换术后的疗效尚不清楚。本研究的目的是描述（近乎）全主动脉置换和β受体阻滞剂疗法对马凡综合征患者血压和波反射的影响。
对4例马凡综合征患者（平均年龄31±3岁）和8例年龄匹配的对照者进行研究。通过磁共振成像、连续无创血压测量和压平式眼压测量研究血压和波反射（反射系数和增强指数）。对患者分别在服用阿替洛尔、拉贝洛尔以及未接受β受体阻滞剂治疗的情况下进行研究。
与对照组相比，马凡综合征患者的主动脉收缩压（129±13 vs 114±10 mmHg）、脉压（58±13 vs 40±5 mmHg）、波速（11±3 vs 4±0.4 m s⁻¹）和反射系数（65±22 vs 41±5%）显著升高。马凡综合征患者使用不同药物后的主动脉压力无差异（阿替洛尔129/76 mmHg，拉贝洛尔121/75 mmHg，未接受β受体阻滞剂治疗129/71 mmHg）。与停药相比，服用阿替洛尔的患者反射系数更高（73±18 vs 65±22%），与拉贝洛尔和停药相比，服用阿替洛尔时的增强指数也更高（分别为24±22 vs 17±17 vs 22±22%）。
我们的结果表明，4例马凡综合征患者在全主动脉置换术后脉压、收缩压、波速和波反射增加。使用阿替洛尔或拉贝洛尔并未降低主动脉压力，且观察到使用阿替洛尔时波反射增加。因此，阿替洛尔对这些患者的有益作用值得怀疑。
