Eichhorn E J, Bedotto J B, Malloy C R, Hatfield B A, Deitchman D, Brown M, Willard J E, Grayburn P A
Cardiac Catheterization Laboratory, Dallas Veterans Administration Hospital, TX.
Circulation. 1990 Aug;82(2):473-83. doi: 10.1161/01.cir.82.2.473.
The hemodynamic effects of beta-adrenergic blockade with bucindolol, a nonselective beta-antagonist with mild vasodilatory properties, were studied in patients with congestive heart failure. Fifteen patients (New York Heart Association class I-IV) underwent cardiac catheterization before and after 3 months of oral therapy with bucindolol. The left ventricular ejection fraction increased from 0.23 +/- 0.12 to 0.29 +/- 0.14 (p = 0.007), and end-systolic elastance, a relatively load-independent determinant of contractility, increased from 0.60 +/- 0.40 to 1.11 +/- 0.45 mm Hg/ml (p = 0.0049). Both left ventricular stroke work index (34 +/- 13 to 47 +/- 19 g-m/m2, p = 0.0059) and minute work (5.5 +/- 2.2 to 7.0 +/- 2.6 kg-m/min, p = 0.0096) increased despite reductions in left ventricular end-diastolic pressure (19 +/- 8 to 15 +/- 5 mm Hg, p = 0.021). There was an upward shift in the peak + dP/dtmax-end-diastolic volume relation (p = 0.0005). These data demonstrate improvements in myocardial contractility after beta-adrenergic blockade with bucindolol. At a matched paced heart rate of 98 +/- 15 min-1, the time constant of left ventricular isovolumic relaxation was significantly reduced by bucindolol therapy (92 +/- 17 versus 73 +/- 11 msec, p = 0.0013), and the relation of the time constant to end-systolic pressure was shifted downward (p = 0.014) with therapy. The slope of the logarithm left ventricular end-diastolic pressure-end-diastolic volume relation was unchanged (p = 0.51) after bucindolol. These data suggest that chronic beta-adrenergic blockade with bucindolol improves diastolic relaxation but does not alter myocardial chamber stiffness. Myocardial oxygen extraction, consumption, and efficiency were unchanged despite improvement in contractile function and mechanical work. Thus, in patients with congestive heart failure, chronic beta-adrenergic blockade with bucindolol significantly improves myocardial contractility and minute work, yet it does not do so at the expense of myocardial oxygen consumption. Additionally, bucindolol improves myocardial relaxation but does not affect chamber stiffness.
在充血性心力衰竭患者中研究了布新洛尔（一种具有轻度血管舒张特性的非选择性β受体拮抗剂）的β肾上腺素能阻滞的血流动力学效应。15例患者（纽约心脏协会心功能分级I - IV级）在接受布新洛尔口服治疗3个月前后接受了心导管检查。左心室射血分数从0.23±0.12增加到0.29±0.14（p = 0.007），收缩末期弹性（一种相对独立于负荷的收缩性决定因素）从0.60±0.40增加到1.11±0.45 mmHg/ml（p = 0.0049）。尽管左心室舒张末期压力降低（从19±8降至15±5 mmHg，p = 0.021），但左心室每搏功指数（从34±13增至47±19 g - m/m2，p = 0.0059）和每分钟功（从5.5±2.2增至7.0±2.6 kg - m/min，p = 0.0096）均增加。+ dP/dtmax - 舒张末期容积关系出现上移（p = 0.0005）。这些数据表明布新洛尔进行β肾上腺素能阻滞后心肌收缩性得到改善。在匹配的起搏心率98±15次/分钟时，布新洛尔治疗使左心室等容舒张时间常数显著缩短（92±17对73±11毫秒，p = 0.0013），且治疗后时间常数与收缩末期压力的关系下移（p = 0.014）。布新洛尔治疗后左心室舒张末期压力 - 舒张末期容积关系的对数斜率未改变（p = 0.51）。这些数据表明布新洛尔进行慢性β肾上腺素能阻滞可改善舒张期松弛，但不改变心肌腔硬度。尽管收缩功能和机械功有所改善，但心肌氧摄取、消耗和效率未改变。因此，在充血性心力衰竭患者中，布新洛尔进行慢性β肾上腺素能阻滞可显著改善心肌收缩性和每分钟功，且不会以增加心肌氧消耗为代价。此外，布新洛尔可改善心肌松弛但不影响腔室硬度。
