MedStar Research Institute, Baltimore, Maryland, USA.
Am J Cardiol. 2010 Jan 15;105(2):229-34. doi: 10.1016/j.amjcard.2009.09.008.
Beta blockers are empirically used in many patients with heart failure (HF) and preserved ejection fraction (HFpEF) because they allow more time for diastolic filling and because they improve outcomes in patients with systolic HF. However, recent data suggest that impaired chronotropic and vasodilator responses to exercise, which can worsen with beta blockade, may play a key role in the pathophysiology of HFpEF. We prospectively examined the association between beta-blocker therapy after hospitalization for decompensated HF and HF rehospitalization at 6 months in 66 consecutive patients with HFpEF (71 +/- 13 years old, 68% women, 42% Black). Subjects were stratified based on receiving (BB+; 15 men, 28 women) or not receiving (BB-) beta-blockers at hospital discharge. In men, HF rehospitalization occurred less frequently in the BB+ than in the BB- group, albeit nonsignificantly (20% vs 50%, p = 0.29). In women, HF rehospitalization occurred more frequently in the BB+ than in the BB- group (75% vs 18%, p <0.001). In univariate analyses, discharge beta-blocker was associated with HF rehospitalization in women (odds ratio [OR] 14.00, 95% confidence interval [CI] 3.09 to 63.51, p = 0.001), but not in men (OR 0.25, 95% CI 0.03 to 1.92, p = 0.18). In a forward logistic regression model that offered all univariate predictors of HF rehospitalization, discharge beta blocker remained an independent predictor of HF rehospitalization in women (OR 11.06, 95% CI 1.98 to 61.67, p = 0.006). In conclusion, this small observational study suggests that beta-blocker therapy may be associated with a higher risk of HF rehospitalization in women with HFpEF. The risks and benefits of beta-blocker therapy in patients with HFpEF should be evaluated in randomized, controlled trials.
β受体阻滞剂在许多心力衰竭(HF)和射血分数保留的心力衰竭(HFpEF)患者中被经验性使用,因为它们可以为舒张期充盈提供更多时间,并且可以改善收缩性 HF 患者的结局。然而,最近的数据表明,运动时的变时性和血管扩张反应受损,随着β受体阻滞剂的使用而恶化,可能在 HFpEF 的病理生理学中发挥关键作用。我们前瞻性地研究了 66 例连续 HFpEF 患者(71 ± 13 岁,68%为女性,42%为黑人)住院治疗失代偿性 HF 后接受β受体阻滞剂治疗与 6 个月时 HF 再住院之间的关系。根据出院时是否接受(BB+;15 名男性,28 名女性)或不接受(BB-)β受体阻滞剂治疗,将患者分层。在男性中,BB+组的 HF 再住院率低于 BB-组,但无统计学意义(20% vs 50%,p = 0.29)。在女性中,BB+组的 HF 再住院率高于 BB-组(75% vs 18%,p <0.001)。在单变量分析中,出院时使用β受体阻滞剂与女性的 HF 再住院相关(优势比[OR] 14.00,95%置信区间[CI] 3.09 至 63.51,p = 0.001),但与男性无关(OR 0.25,95%CI 0.03 至 1.92,p = 0.18)。在提供 HF 再住院所有单变量预测因素的向前逻辑回归模型中,出院时使用β受体阻滞剂仍然是女性 HF 再住院的独立预测因素(OR 11.06,95%CI 1.98 至 61.67,p = 0.006)。总之,这项小型观察性研究表明,β受体阻滞剂治疗可能与 HFpEF 女性 HF 再住院风险增加相关。HFpEF 患者β受体阻滞剂治疗的风险和益处应在随机对照试验中进行评估。