接受卡维地洛治疗的患者的限制性左心室充盈模式及其对收缩性心力衰竭临床病程的影响。

Restrictive left ventricular filling pattern and its effect on the clinical course of systolic heart failure in patients receiving carvedilol.

作者信息

Nessler Jadwiga, Nessler Bohdan, Kitliński Mariusz, Stepniewski Marek, Piwowarska Wiesława

机构信息

Department of Coronary Disease, Institute of Cardiology, Kraków, Poland.

出版信息

Cardiol J. 2008;15(4):329-37.

PMID:18698541

Abstract

BACKGROUND

To analyze differences in brain natriuretic peptide (BNP) levels depending on mitral flow pattern (MFP) and to assess the effects of carvedilol on changes in MFP, left ventricular function and exercise capacity.

METHODS AND RESULTS

The study population consisted of 73 patients with symptomatic heart failure in NYHA classes II and III and LVEF < 40% without prior beta-blockade. In all patients at baseline, before carvedilol, and then at 3 and 12 months after initiation of treatment, the following parameters were assessed: HR(s), serum BNP, echocardiographic parameters, and exercise capacity with gas monitoring during cardiopulmonary stress test. Before carvedilol there was a positive correlation between BNP and E/A (r = 0.17; p = 0.05). BNP was significantly higher in patients with restrictive MFP (rMFP) as compared with nonrestrictive MFP (nrMFP) (541.5 +/- 206.7 vs. 412.6 +/- 207.2; p = 0.009), and lower VO(2peak) in rMFP as compared with nrMFP (12.5 +/- 3.7 vs. 16.5 +/- 4.7; p = 0.001). After initiation of carvedilol, the patients with rMFP had reduced E/A (2.9 vs. 1.4; p = 0.003), and rMFP was changed to nrMFP in 60.8% of patients. Respective BNP concentrations were 342.16 +/- 284.31 vs. 326.40 +/- 264.6; NS. In patients with rMFP VO(2peak) , %N increased significantly from 42.4 +/- 10.2 to 52.4 +/- 14.4; p = 0.012.

CONCLUSIONS

In patients with systolic congestive heart failure, the presence of rMFP is related to higher BNP levels and reduced VO(2peak). Chronic treatment with carvedilol replaces rMFP with nrMFP and improves exercise capacity in some patients.

摘要

背景

分析根据二尖瓣血流模式（MFP）不同脑钠肽（BNP）水平的差异，并评估卡维地洛对MFP变化、左心室功能和运动能力的影响。

方法与结果

研究人群包括73例纽约心脏病协会（NYHA）心功能II级和III级、左心室射血分数（LVEF）<40%且未接受过β受体阻滞剂治疗的有症状心力衰竭患者。在所有患者基线时、服用卡维地洛前以及治疗开始后3个月和12个月时，评估以下参数：心率（HR）、血清BNP、超声心动图参数以及心肺应激试验期间通过气体监测的运动能力。服用卡维地洛前，BNP与E/A呈正相关（r = 0.17；p = 0.05）。与非限制性MFP（nrMFP）患者相比，限制性MFP（rMFP）患者的BNP显著更高（541.5±206.7 vs. 412.6±207.2；p = 0.009），且rMFP患者的峰值摄氧量（VO₂peak）低于nrMFP患者（12.5±3.7 vs. 16.5±4.7；p = 0.001）。服用卡维地洛后，rMFP患者的E/A降低（2.9 vs. 1.4；p = 0.003），60.8%的患者rMFP转变为nrMFP。相应的BNP浓度分别为342.16±284.31 vs. 326.40±264.6；无显著差异（NS）。rMFP患者的VO₂peak、%N从42.4±10.2显著增加至52.4±14.4；p = 0.012。