Department of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
Int J Cardiol. 2012 Nov 29;161(3):160-5. doi: 10.1016/j.ijcard.2012.06.004. Epub 2012 Jun 21.
It has been suggested that patients with chronic HF and atrial fibrillation (AF) may respond differently to beta-blockers than those in sinus rhythm (SR).
In this predefined analysis of the CIBIS-ELD trial, a total of 876 chronic HF patients (164 patients with AF) were randomized to bisoprolol or carvedilol. During the 12-week-treatment phase, beta-blockers were doubled fortnightly up to the target dose or maximally tolerated dose, which was maintained for 4 weeks.
Patients with AF had lower left ventricular ejection fraction (LVEF), exercise capacity, self-rated health, quality of life (QoL) scores for both SF36 physical and psychosocial component, and higher NYHA class than those in SR. Beta-blocker titration was associated with clinical improvement in both AF and SR patients: LVEF, 6-minute walk distance, physical and psychosocial components of QoL scores, self-rated health and NYHA class (p<0.05, for all). The extent of improvement did not differ between patients with AF and in SR and did not differ between bisoprolol and carvedilol. Heart rate (HR) at baseline was higher in the AF group, and remained higher until the end of the trial. Patients with higher baseline HR had larger reductions in HR, regardless of rhythm. AF patients more frequently reached target beta-blocker dose compared to those in SR (p<0.005).
Elderly patients with chronic HF and AF derive comparable clinical benefits from beta-blocker titration as those in SR. Patients with AF tolerate higher beta-blocker doses than those in SR, which appears to be related to higher baseline HR.
据报道，患有慢性心力衰竭（HF）合并心房颤动（AF）的患者对β受体阻滞剂的反应可能与窦性心律（SR）患者不同。
在 CIBIS-ELD 试验的这项预设分析中，共有 876 例慢性 HF 患者（164 例合并 AF）被随机分为比索洛尔或卡维地洛组。在 12 周的治疗阶段，每两周将β受体阻滞剂加倍，直至达到目标剂量或最大耐受剂量，然后维持 4 周。
与 SR 患者相比，AF 患者的左心室射血分数（LVEF）、运动能力、自我报告的健康状况、SF36 生理和心理社会成分的生活质量（QoL）评分以及 NYHA 心功能分级均较低。β受体阻滞剂滴定与 AF 和 SR 患者的临床改善相关：LVEF、6 分钟步行距离、QoL 评分的生理和心理社会成分、自我报告的健康状况和 NYHA 心功能分级（p<0.05，均）。AF 和 SR 患者的改善程度没有差异，比索洛尔和卡维地洛之间也没有差异。AF 组患者的基础心率（HR）较高，并且一直持续到试验结束。无论节律如何，基础 HR 较高的患者 HR 降低幅度更大。与 SR 患者相比，AF 患者更频繁地达到目标β受体阻滞剂剂量（p<0.005）。
老年慢性 HF 合并 AF 患者从β受体阻滞剂滴定中获得的临床获益与 SR 患者相当。与 SR 患者相比，AF 患者能够耐受更高剂量的β受体阻滞剂，这似乎与较高的基础 HR 有关。
