Provencher Steeve, Herve Philippe, Jais Xavier, Lebrec Didier, Humbert Marc, Simonneau Gerald, Sitbon Olivier
Centre des Maladies Vasculaires Pulmonaires (UPRES EA 2705), Service de Pneumologie, Hôpital Antoine Béclère, Clamart, France.
Gastroenterology. 2006 Jan;130(1):120-6. doi: 10.1053/j.gastro.2005.10.013.
BACKGROUND & AIMS: It has been suggested that beta-blockers might be harmful in pulmonary arterial hypertension. However, no study has evaluated the effect of beta-blockers in these patients. The aim of this study was to investigate the effect of beta-blockers on exercise capacity and pulmonary hemodynamics in patients with portopulmonary hypertension receiving beta-blockers for the prophylaxis of variceal bleeding.
Ten consecutive patients with moderate to severe portopulmonary hypertension (mean pulmonary artery pressure of 52 [10] mm Hg) underwent a 6-minute walk test and a right heart catheterization at baseline and 2 (1) months after beta-blocker withdrawal.
Following beta-blocker withdrawal, 9 of 10 patients increased their 6-minute walked distance with a mean increase in the whole group of 79 (78) meters (P = .01). Cardiac output increased by 28% (P < .01) with no change in mean pulmonary artery pressure, resulting in a 19% decrease in pulmonary vascular resistance (P < .01). Increases in cardiac output were related to a 25% increase in heart rate (P < .01), whereas stroke volume was unchanged (P = .65). The improvements in exercise tolerance were associated with increases in chronotropic response (maximal heart rate minus resting heart rate) from 18 (9) to 34 (12) beats/min (P < .01) during the 6-minute walk test.
In patients with moderate to severe portopulmonary hypertension, beta-blockers are associated with significant worsening in exercise capacity and pulmonary hemodynamics. These deleterious effects support the contraindication of beta-blockers in patients with portopulmonary hypertension.
有研究表明β受体阻滞剂可能对肺动脉高压有害。然而，尚无研究评估β受体阻滞剂对这类患者的影响。本研究旨在探讨β受体阻滞剂对接受β受体阻滞剂预防静脉曲张出血的门肺高压患者运动能力和肺血流动力学的影响。
连续纳入10例中重度门肺高压患者（平均肺动脉压为52[10]mmHg），在基线时及停用β受体阻滞剂2（1）个月后进行6分钟步行试验和右心导管检查。
停用β受体阻滞剂后，10例患者中有9例6分钟步行距离增加，全组平均增加79（78）米（P = 0.01）。心输出量增加28%（P < 0.01），平均肺动脉压无变化，导致肺血管阻力下降19%（P < 0.01）。心输出量增加与心率增加25%有关（P < 0.01），而每搏输出量无变化（P = 0.65）。运动耐量的改善与6分钟步行试验期间变时性反应（最大心率减去静息心率）从18（9）次/分钟增加到34（12）次/分钟有关（P < 0.01）。
在中重度门肺高压患者中，β受体阻滞剂与运动能力和肺血流动力学显著恶化相关。这些有害影响支持门肺高压患者禁用β受体阻滞剂。
