Danchin Nicolas, Kadri Zena
Department of Cardiology, Hôpital Européen Georges Pompidou, Paris, France.
Adv Cardiol. 2006;43:45-53. doi: 10.1159/000095405.
Heart rate is a major determinant of myocardial oxygen consumption. There is ample evidence of an association between high heart rate and poor outcome in numerous clinical settings. Experimental studies in monkeys have shown a link between increased heart rate and development of atherosclerosis. In the clinical setting, increased heart rate has been found associated with coronary plaque rupture. A causal relationship is further supported by the fact that Beta-blockers have a well-documented efficacy after myocardial infarction, although the other properties of these agents may also participate in their protective effect. Beyond the potential benefits of heart rate lowering in patients with coronary artery disease, medications capable of decreasing heart rate without altering left ventricular function, such as the I(f) current inhibitor ivabradine, might prove particularly helpful in patients with chronic heart failure associated with coronary artery disease, but also in heart failure without systolic dysfunction, or in patients needing inotropic support for acute heart failure.
心率是心肌耗氧量的主要决定因素。大量证据表明，在众多临床情况下，高心率与不良预后之间存在关联。对猴子的实验研究表明，心率增加与动脉粥样硬化的发展之间存在联系。在临床环境中，已发现心率增加与冠状动脉斑块破裂有关。β受体阻滞剂在心肌梗死后具有充分记录的疗效，这一事实进一步支持了因果关系，尽管这些药物的其他特性也可能参与其保护作用。除了降低冠心病患者心率的潜在益处外，能够降低心率而不改变左心室功能的药物，如I(f)电流抑制剂伊伐布雷定，可能对合并冠心病的慢性心力衰竭患者特别有帮助，也适用于无收缩功能障碍的心力衰竭患者，或需要正性肌力支持治疗急性心力衰竭的患者。
