卡维地洛对系统性右心室患者右心室重构和运动耐量影响的初步研究。
A pilot study on the effects of carvedilol on right ventricular remodelling and exercise tolerance in patients with systemic right ventricle.
机构信息
Pediatric Cardiology and Adult Congenital Unit, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy.
出版信息
Int J Cardiol. 2007 Jan 8;114(2):241-6. doi: 10.1016/j.ijcard.2006.01.048.
BACKGROUND
Patients with atrial repair for transposition of the great arteries and patients with congenitally corrected transposition have a right ventricle (RV) in the systemic position and they may develop RV dysfunction and exercise intolerance with advancing age. No data is available on the effect of carvedilol in patients with dysfunctional systemic RV.
METHODS
We studied with cardiovascular magnetic resonance (CMR), cardiopulmonary exercise testing, and standard 12-leads electrocardiogram, 8 adults (median age 26 years, range 18-31) with chronic stable heart failure and systemic RV dysfunction (6 patients with atrial repair and 2 patients with congenitally corrected transposition). Assessment was done before and after 12 months of carvedilol administration. The initial dose was 3.125 mg twice daily, and the target dose was 25 mg twice a day.
RESULTS
Carvedilol administration was safe and the target dose was achieved in 5/8 (62%) patients. Right ventricular end-diastolic (119 ± 31 vs. 112 ± 28 ml/m², p=0.01) and end-systolic volumes decreased (79 ± 17 vs. 65 ± 14 ml/m², p=0.006), and RV ejection fraction improved (34 ± 6 vs. 42 ± 7%, p=0.004). Left ventricular ejection fraction increased (44 ± 8 vs. 49 ± 9%, p=0.01), suggesting a positive biventricular remodelling. Peak oxygen uptake did not change with carvedilol (26.8 ± 5.3 vs. 27.3 ± 5.7 ml O₂/Kg/min, p=0.58), whereas exercise duration increased (13.4 ± 2.6 vs. 17.3 ± 3.1 min, p=0.008).
CONCLUSIONS
In this small cohort, carvedilol administration was safe and it was associated with positive RV remodelling as well as improved exercise duration.
背景
患有大动脉转位的房间隔修复术患者和矫正性先天性大动脉转位患者的右心室（RV）处于体循环位置，随着年龄的增长，他们可能会出现 RV 功能障碍和运动耐量降低。目前尚无关于卡维地洛在功能性体循环 RV 患者中的作用的数据。
方法
我们通过心血管磁共振（CMR）、心肺运动试验和标准 12 导联心电图研究了 8 名慢性稳定心力衰竭和系统 RV 功能障碍的成年人（中位年龄 26 岁，范围 18-31 岁）。在卡维地洛治疗前和治疗 12 个月后进行评估。初始剂量为每天两次 3.125 毫克，目标剂量为每天两次 25 毫克。
结果
卡维地洛治疗是安全的，5/8（62%）患者达到了目标剂量。右心室舒张末期（119±31 与 112±28 ml/m²，p=0.01）和收缩末期容积减少（79±17 与 65±14 ml/m²，p=0.006），RV 射血分数改善（34±6 与 42±7%，p=0.004）。左心室射血分数增加（44±8 与 49±9%，p=0.01），表明双心室重塑呈阳性。卡维地洛治疗后峰值摄氧量没有变化（26.8±5.3 与 27.3±5.7 ml O₂/Kg/min，p=0.58），而运动时间增加（13.4±2.6 与 17.3±3.1 min，p=0.008）。
结论
在这个小队列中，卡维地洛治疗是安全的，它与 RV 重塑的积极变化以及运动时间的延长有关。
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