de Groote Pascal, Delour Pierre, Mouquet Frédéric, Lamblin Nicolas, Dagorn Joël, Hennebert Olivier, Le Tourneau Thierry, Foucher-Hossein Claude, Verkindère Christine, Bauters Christophe
Service de Cardiologie C, Hôpital Cardiologique, Centre Hospitalier Régional et Universitaire de Lille, Boul Prof J Leclercq, Lille Cedex, France.
Am Heart J. 2007 Sep;154(3):589-95. doi: 10.1016/j.ahj.2007.05.013.
Previous studies, with limited number of patients, have tried to determine the predictors of left ventricular ejection fraction (LVEF) improvement after beta-blockade. No study has demonstrated that LVEF improvement was an independent predictor of cardiac survival.
The aims of the study were to determine in a large group of patients with stable chronic heart failure associated with reduced LVEF the predictors of LVEF improvement (difference in LVEF [deltaLVEF], ie, the value after beta-blockade minus the value before beta-blockade) after beta-blockade and to analyze prognostic impact of deltaLVEF. Three hundred fourteen consecutive patients underwent an echocardiogram, a radionuclide angiogram, and a maximum cardiopulmonary exercise test before and 3 months after maximal tolerated doses of beta-blockers have been reached.
After beta-blockade, LVEF improved from 30% +/- 11% to 40% +/- 13%. In the whole population, independent predictors of deltaLVEF were nonischemic etiology, baseline LVEF (negative correlation), and baseline heart rate (positive correlation). In ischemic patients, independent predictors of deltaLVEF were absence of history of myocardial infarction, baseline heart rate, and baseline LVEF; whereas in nonischemic patients, independent predictors were baseline LVEF and baseline QRS width (negative correlation). After 1082 days of follow-up, there were 53 cardiovascular deaths and 2 urgent transplantations. Left ventricular ejection fraction improvement (defined as an absolute increase in LVEF > 5%) was an independent predictor of cardiac survival. Patients who had an LVEF < or = 45% after beta-blockade with a deltaLVEF < or = 5% represented a high-risk subgroup.
In patients with chronic heart failure, predictors of LVEF improvement after beta-blockade were different according to etiology. Left ventricular ejection fraction improvement was an independent predictor of cardiac survival.
既往研究纳入的患者数量有限，曾试图确定β受体阻滞剂治疗后左心室射血分数（LVEF）改善的预测因素。尚无研究表明LVEF改善是心脏生存的独立预测因素。
本研究旨在确定一大组伴有LVEF降低的稳定慢性心力衰竭患者中，β受体阻滞剂治疗后LVEF改善（LVEF差值[ΔLVEF]，即β受体阻滞剂治疗后的数值减去治疗前的数值）的预测因素，并分析ΔLVEF的预后影响。314例连续患者在达到最大耐受剂量的β受体阻滞剂治疗前及治疗3个月后接受了超声心动图、放射性核素血管造影及最大心肺运动试验。
β受体阻滞剂治疗后，LVEF从30%±11%提高至40%±13%。在总体人群中，ΔLVEF的独立预测因素为非缺血性病因、基线LVEF（负相关）及基线心率（正相关）。在缺血性患者中，ΔLVEF的独立预测因素为无心肌梗死病史、基线心率及基线LVEF；而在非缺血性患者中，独立预测因素为基线LVEF及基线QRS波宽度（负相关）。随访1082天后，发生53例心血管死亡及2例紧急心脏移植。左心室射血分数改善（定义为LVEF绝对增加>5%）是心脏生存的独立预测因素。β受体阻滞剂治疗后LVEF≤45%且ΔLVEF≤5%的患者为高危亚组。
在慢性心力衰竭患者中，β受体阻滞剂治疗后LVEF改善的预测因素因病因不同而异。左心室射血分数改善是心脏生存的独立预测因素。
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