Grüner Sveälv Bente, Täng Margareta Scharin, Waagstein Finn, Andersson Bert
Department of Molecular and Clinical Medicine/Cardiology, Wallenberg Laboratory, Sahlgrenska Academy at Göteborg University, SE-413 45 Göteborg, Sweden.
Eur J Heart Fail. 2007 Jun-Jul;9(6-7):678-83. doi: 10.1016/j.ejheart.2007.02.007. Epub 2007 Apr 19.
Although it is well known that left ventricular (LV) function improves after treatment with beta-blockers in heart failure, little attention has been paid to the effects on LV long axis (LAX) function.
To evaluate LV LAX function after treatment with metoprolol, and to assess whether LV LAX contractile reserve could predict future long-term improvement.
Twenty-four heart failure patients were randomised to metoprolol or placebo for 6 months, followed by 6 months of open treatment with metoprolol. Rest and dobutamine stress echocardiography (DSE) was performed before and after each treatment period.
After treatment with metoprolol, LV LAX function improved significantly, systolic velocity from 29+/-8 to 32+/-15 mm/s, p<0.01 (metoprolol) vs. 28+/-7 to 28+/-11 mm/s, ns (placebo); atrioventricular plane fractional shortening (AVP-FS) from 5.4+/-2.1 to 7.4+/-2.7%, p<0.001 (metoprolol) vs. 5.9+/-2.1 to 5.8+/-2.9%, ns (placebo). The improvement in function was maintained during DSE. LV LAX contractile reserve could not predict treatment response; the treatment effect on LV LAX function was significantly greater than the contractile reserve at baseline. The relative improvement in LV LAX function after metoprolol was 38%, compared with a 20% improvement in LV ejection fraction (EF).
A significant improvement in LV LAX function was observed after treatment with metoprolol. AVP-FS and systolic velocities increased significantly, and to a greater extent than LVEF.
虽然众所周知，心力衰竭患者使用β受体阻滞剂治疗后左心室（LV）功能会改善，但对左心室长轴（LAX）功能的影响却很少受到关注。
评估美托洛尔治疗后左心室LAX功能，并评估左心室LAX收缩储备是否能预测未来的长期改善情况。
24例心力衰竭患者被随机分为美托洛尔组或安慰剂组，治疗6个月，随后接受6个月的美托洛尔开放治疗。在每个治疗期前后进行静息和多巴酚丁胺负荷超声心动图（DSE）检查。
美托洛尔治疗后，左心室LAX功能显著改善，收缩速度从29±8增加到32±15mm/s，p<0.01（美托洛尔组），而安慰剂组从28±7增加到28±11mm/s，无显著差异（ns）；房室平面缩短分数（AVP-FS）从5.4±2.1%增加到7.4±2.7%，p<0.001（美托洛尔组），而安慰剂组从5.9±2.1%增加到5.8±2.9%，无显著差异（ns）。功能改善在DSE期间得以维持。左心室LAX收缩储备不能预测治疗反应；美托洛尔对左心室LAX功能的治疗效果显著大于基线时的收缩储备。美托洛尔治疗后左心室LAX功能的相对改善为38%，而左心室射血分数（EF）改善20%。
美托洛尔治疗后观察到左心室LAX功能显著改善。AVP-FS和收缩速度显著增加，且增加幅度大于左心室射血分数。
