Yamaji Masayuki, Tsutamoto Takayoshi, Tanaka Toshinari, Kawahara Chiho, Nishiyama Keizo, Yamamoto Takashi, Fujii Masanori, Horie Minoru
Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan.
Circ J. 2009 Jun;73(6):1067-73. doi: 10.1253/circj.cj-08-1026. Epub 2009 Apr 14.
Patients with a high plasma adiponectin have a poor prognosis in chronic heart failure (CHF). Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers are reported to increase the plasma adiponectin concentration, but the effect of beta-blockers on plasma adiponectin in patients with CHF remains unknown.
Blood samples were collected at before and 6 months after administration of carvedilol in 44 CHF patients. The hemodynamic parameters, echocardiography, plasma concentrations of brain natriuretic peptide (BNP), norepinephrine and adiponectin were measured. Six months after treatment, there were significantly decreased plasma concentrations of adiponectin (15.8 +/-1.4 to 11.0 +/-1.1 microg/ml, P<0.0001), BNP and norepinephrine and increased left ventricular ejection fraction (LVEF). On stepwise multivariable analyses, a higher plasma adiponectin concentration before treatment (rs=-0.561, P<0.0001) was a significant independent predictor of a greater decrease in adiponectin concentration and the decrease in plasma adiponectin concentration was significantly correlated with the improvement of LVEF (r=-0.561, P<0.0001).
These findings indicate that carvedilol decreases plasma adiponectin concentration and that the decrease in plasma adiponectin is associated with the improvement of LVEF after treatment with carvedilol in CHF patients.
血浆脂联素水平高的慢性心力衰竭(CHF)患者预后较差。据报道,血管紧张素转换酶抑制剂和血管紧张素II受体阻滞剂可提高血浆脂联素浓度,但β受体阻滞剂对CHF患者血浆脂联素的影响尚不清楚。
收集44例CHF患者服用卡维地洛前及服药6个月后的血样。测量血流动力学参数、超声心动图、血浆脑钠肽(BNP)、去甲肾上腺素和脂联素浓度。治疗6个月后,血浆脂联素浓度显著降低(从15.8±1.4降至11.0±1.1μg/ml,P<0.0001),BNP和去甲肾上腺素浓度降低,左心室射血分数(LVEF)升高。在逐步多变量分析中,治疗前较高的血浆脂联素浓度(rs=-0.561,P<0.0001)是脂联素浓度更大降低的显著独立预测因素,血浆脂联素浓度的降低与LVEF的改善显著相关(r=-0.561,P<0.0001)。
这些发现表明,卡维地洛可降低CHF患者血浆脂联素浓度,且血浆脂联素浓度的降低与卡维地洛治疗后LVEF的改善有关。