β受体阻滞剂对心力衰竭患者通气效率的影响。

Effects of beta-blockers on ventilation efficiency in heart failure.

机构信息

Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy.

出版信息

Am Heart J. 2010 Jun;159(6):1067-73. doi: 10.1016/j.ahj.2010.03.034.

DOI:10.1016/j.ahj.2010.03.034

PMID:20569721

Abstract

BACKGROUND

Hyperventilation and consequent reduction of ventilation (VE) efficiency are frequently observed during exercise in heart failure (HF) patients, resulting in an increased slope of VE/carbon dioxide (VE/Vco(2)) relationship. The latter is an independent predictor of HF prognosis. beta-Blockers improve the prognosis of HF patients. We evaluated the effect on the efficiency of VE of a beta(1)-beta(2) unselective (carvedilol) versus a beta(1) selective (bisoprolol) beta-blocker.

METHODS

We analyzed consecutive maximal cardiopulmonary exercise tests performed on 572 clinically stable HF patients (New York Heart Association class I-III, left ventricle ejection fraction < or =50%) categorized in 3 groups: 81 were not treated with beta-blocker, 304 were treated with carvedilol, and 187 were treated with bisoprolol. Clinical conditions were similar.

RESULTS

The VE/Vco(2) slope was lower in carvedilol- compared with bisoprolol-treated patients (29.7 +/- 0.4 vs 31.6 +/- 0.5, P = .023, peak oxygen consumption adjusted) and with patients not receiving beta-blockers (31.6 +/- 0.7, P = .036). Maximum end-tidal CO(2) pressure during the isocapnic buffering period was higher in patients treated with carvedilol (39.0 +/- 0.3 mm Hg) than with bisoprolol (37.2 +/- 0.4 mm Hg, P < .001) and in patients not receiving beta-blockers (37.2 +/- 0.5 mm Hg, P = .001).

CONCLUSIONS

Reduction of hyperventilation, with improvement of VE efficiency during exercise (reduction of VE/Vco(2) slope and increase of maximum end-tidal CO(2) pressure), is specific to carvedilol (beta(1)-beta(2) unselective blocker) and not to bisoprolol (beta(1)-selective blocker).

摘要

背景

在心力衰竭（HF）患者的运动过程中，常观察到过度通气和随之而来的通气（VE）效率降低，导致 VE/二氧化碳（VE/Vco(2)）关系斜率增加。后者是 HF 预后的独立预测因子。β-受体阻滞剂改善 HF 患者的预后。我们评估了β1-β2 非选择性（卡维地洛）与β1 选择性（比索洛尔）β受体阻滞剂对 VE 效率的影响。

方法

我们分析了 572 例临床稳定的 HF 患者连续进行的最大心肺运动测试，这些患者分为 3 组：81 例未接受β受体阻滞剂治疗，304 例接受卡维地洛治疗，187 例接受比索洛尔治疗。临床情况相似。

结果

与比索洛尔治疗的患者（29.7±0.4 比 31.6±0.5，P=0.023，峰值氧耗调整）和未接受β受体阻滞剂治疗的患者（31.6±0.7，P=0.036）相比，卡维地洛治疗的患者 VE/Vco(2)斜率较低。在等碳酸缓冲期，卡维地洛治疗的患者最大呼气末 CO(2)压力较高（39.0±0.3 毫米汞柱），高于比索洛尔（37.2±0.4 毫米汞柱，P<0.001）和未接受β受体阻滞剂治疗的患者（37.2±0.5 毫米汞柱，P=0.001）。