Kasama Shu, Toyama Takuji, Hatori Takashi, Sumino Hiroyuki, Kumakura Hisao, Takayama Yoshiaki, Ichikawa Shuichi, Suzuki Tadashi, Kurabayashi Masahiko
Department of Cardiovascular Medicine, Gunma University School of Medicine, 3-39-15, Showa-machi, Maebashi, Gunma 371-0034, Japan.
Eur Heart J. 2007 Apr;28(8):989-95. doi: 10.1093/eurheartj/ehm048. Epub 2007 Apr 4.
It has been reported that carvedilol improves cardiac sympathetic nerve activity (CSNA) in patients with dilated cardiomyopathy (DCM). However, the influence of carvedilol on cardiac (123)I-meta-iodobenzylguanidine (MIBG) scintigraphic findings and left ventricular (LV) remodelling has not been determined in DCM patients.
In 30 patients with DCM and 10 normal controls, the delayed heart/mediastinum count (H/M) ratio, delayed total defect score (TDS), and washout rate (WR) were determined by (123)I-MIBG scintigraphy. In addition, the left ventricular end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), and LV ejection fraction (LVEF) were calculated by echocardiography. In the DCM patients, the regional defect score index (RDSI), regional washout rate index (RWRI), and wall motion score index (WMSI) were also determined to evaluate regional adrenergic dysfunction and wall motion. Examinations were repeated in all DCM patients after standard treatment containing carvedilol at a dose of 10-20 mg/day (mean dose: 16 +/- 4 mg/day) for a mean of 12 +/- 1 months. Both the (123)I-MIBG scintigraphic and echocardiographic parameters were significantly worse in the DCM patients than the normal control subjects. After treatment, all of these parameters improved significantly in the DCM patients. There was a significant correlation between the changes of (123)I-MIBG findings and changes of the LVEDV and LVESV after treatment. Moreover, there was a significant correlation between changes of the WMSI and those of the RDSI or RWRI in DCM patients.
Both (123)I-MIBG scintigraphic parameters and echocardiographic parameters were improved in the DCM patients. There was a significant correlation between the changes of (123)I-MIBG scintigraphic and echocardiographic findings after treatment. These findings implicate that long-term, including carvedilol, therapy can improve both CSNA and LV remodelling in patients with DCM.
据报道，卡维地洛可改善扩张型心肌病（DCM）患者的心脏交感神经活动（CSNA）。然而，卡维地洛对DCM患者心脏（123）I-间碘苄胍（MIBG）闪烁显像结果及左心室（LV）重构的影响尚未确定。
对30例DCM患者和10例正常对照者，采用（123）I-MIBG闪烁显像测定延迟心脏/纵隔计数（H/M）比值、延迟总缺损评分（TDS）和洗脱率（WR）。此外，通过超声心动图计算左心室舒张末期容积（LVEDV）、左心室收缩末期容积（LVESV）和左心室射血分数（LVEF）。在DCM患者中，还测定了区域缺损评分指数（RDSI）、区域洗脱率指数（RWRI）和壁运动评分指数（WMSI），以评估区域肾上腺素能功能障碍和壁运动情况。所有DCM患者在接受剂量为10 - 20 mg/天（平均剂量：16±4 mg/天）的含卡维地洛标准治疗平均12±1个月后重复进行检查。DCM患者的（123）I-MIBG闪烁显像和超声心动图参数均显著差于正常对照者。治疗后，DCM患者的所有这些参数均显著改善。治疗后（123）I-MIBG显像结果的变化与LVEDV和LVESV的变化之间存在显著相关性。此外，DCM患者中WMSI的变化与RDSI或RWRI的变化之间存在显著相关性。
DCM患者的（123）I-MIBG闪烁显像参数和超声心动图参数均得到改善。治疗后（123）I-MIBG闪烁显像和超声心动图结果的变化之间存在显著相关性。这些发现提示，长期使用包括卡维地洛在内的治疗可改善DCM患者的CSNA和LV重构。
