Frankenstein Lutz, Zugck Christian, Schellberg Dieter, Nelles Manfred, Froehlich Hanna, Katus Hugo, Remppis Andrew
Department of Cardiology, Angiology, Pulmology, University of Heidelberg, 69120 Heidelberg, Germany.
Eur J Heart Fail. 2009 Feb;11(2):178-84. doi: 10.1093/eurjhf/hfn028.
Like aldosterone escape to ACE-inhibitors, adrenergic escape (AE) to beta-blockers appears conceivable in chronic heart failure (CHF), as generalized systemic neurohumoral activation has been described as the pathophysiological basis of this syndrome. The aim of this study was to examine the prevalence and prognostic value of AE with respect to different beta-blocker agents and doses.
This was a prospective, observational study of 415 patients with systolic CHF receiving chronic stable beta-blocker therapy. AE was defined by norepinephrine levels above the upper limit of normal. Irrespective of the individual beta-blocker agents used and the dose equivalent taken, the prevalence of AE was 31-39%. Norepinephrine levels neither correlated with heart rate (r=0.02; 95% CI: -0.08-0.11; P=0.74) nor were they related to underlying rhythm (P=0.09) or the individual beta-blocker agent used (P=0.87). The presence of AE was a strong and independent indicator of mortality (adjusted HR: 1.915; 95% CI: 1.387-2.645; chi2: 15.60).
We verified the presence of AE in CHF patients on chronic stable beta-blocker therapy, irrespective of the individual beta-blocker agent and the dose equivalent. As AE might indicate therapeutic failure, the determination of AE could help to identify those patients with CHF that might benefit from more aggressive treatment modalities. Heart rate, however, is not a surrogate for adrenergic escape.
如同醛固酮对血管紧张素转换酶抑制剂产生逃逸现象一样，在慢性心力衰竭（CHF）中，肾上腺素能逃逸（AE）对β受体阻滞剂出现似乎是可以想象的，因为全身性神经体液激活已被描述为该综合征的病理生理基础。本研究的目的是探讨不同β受体阻滞剂药物和剂量的AE患病率及其预后价值。
这是一项对415例接受慢性稳定β受体阻滞剂治疗的收缩性CHF患者进行的前瞻性观察研究。AE定义为去甲肾上腺素水平高于正常上限。无论使用何种个体β受体阻滞剂药物和等效剂量，AE的患病率为31% - 39%。去甲肾上腺素水平既与心率无关（r = 0.02；95% CI：-0.08 - 0.11；P = 0.74），也与基础心律（P = 0.09）或所使用的个体β受体阻滞剂药物无关（P = 0.87）。AE的存在是死亡率的一个强有力的独立指标（校正后的HR：1.915；95% CI：1.387 - 2.645；χ2：15.60）。
我们证实了在接受慢性稳定β受体阻滞剂治疗的CHF患者中存在AE，无论个体β受体阻滞剂药物和等效剂量如何。由于AE可能表明治疗失败，AE的测定有助于识别那些可能从更积极治疗方式中获益的CHF患者。然而，心率并不是肾上腺素能逃逸的替代指标。
