Messias Leandro Rocha, Ferreira Aryanne Guimarães, Miranda Sandra Marina Ribeiro de, Teixeira José Antônio Caldas, Azevedo Jader Cunha de, Messias Ana Carolina Nader Vasconcelos, Maróstica Elisabeth, Mesquita Claudio Tinoco
Universidade Federal Fluminense, Rio de Janeiro, RJ, Brazil.
Hospital Federal dos Servidores do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
Arq Bras Cardiol. 2016 May;106(5):358-66. doi: 10.5935/abc.20160046. Epub 2016 Apr 15.
More than 50% of the patients with heart failure have normal ejection fraction (HFNEF). Iodine-123 metaiodobenzylguanidine (123I-MIBG) scintigraphy and cardiopulmonary exercise test (CPET) are prognostic markers in HFNEF. Nebivolol is a beta-blocker with vasodilating properties.
To evaluate the impact of nebivolol therapy on CPET and123I-MIBG scintigraphic parameters in patients with HFNEF.
Twenty-five patients underwent 123I-MIBG scintigraphy to determine the washout rate and early and late heart-to-mediastinum ratios. During the CPET, we analyzed the systolic blood pressure (SBP) response, heart rate (HR) during effort and recovery (HRR), and oxygen uptake (VO2). After the initial evaluation, we divided our cohort into control and intervention groups. We then started nebivolol and repeated the tests after 3 months.
After treatment, the intervention group showed improvement in rest SBP (149 mmHg [143.5-171 mmHg] versus 135 mmHg [125-151 mmHg, p = 0.016]), rest HR (78 bpm [65.5-84 bpm] versus 64.5 bpm [57.5-75.5 bpm, p = 0.028]), peak SBP (235 mmHg [216.5-249 mmHg] versus 198 mmHg [191-220.5 mmHg], p = 0.001), peak HR (124.5 bpm [115-142 bpm] versus 115 bpm [103.7-124 bpm], p= 0.043), HRR on the 1st minute (6.5 bpm [4.75-12.75 bpm] versus 14.5 bpm [6.7-22 bpm], p = 0.025) and HRR on the 2nd minute (15.5 bpm [13-21.75 bpm] versus 23.5 bpm [16-31.7 bpm], p = 0.005), but no change in peak VO2 and 123I-MIBG scintigraphic parameters.
Despite a better control in SBP, HR during rest and exercise, and improvement in HRR, nebivolol failed to show a positive effect on peak VO2 and 123I-MIBG scintigraphic parameters. The lack of effect on adrenergic activity may be the cause of the lack of effect on functional capacity.
超过50%的心力衰竭患者射血分数正常（HFNEF）。碘-123间碘苄胍（123I-MIBG）闪烁扫描和心肺运动试验（CPET）是HFNEF的预后标志物。奈必洛尔是一种具有血管舒张特性的β受体阻滞剂。
评估奈必洛尔治疗对HFNEF患者CPET和123I-MIBG闪烁扫描参数的影响。
25例患者接受123I-MIBG闪烁扫描以确定洗脱率以及早期和晚期心纵隔比。在CPET期间，我们分析了收缩压（SBP）反应、运动及恢复期间的心率（HR）（HRR）和摄氧量（VO2）。初始评估后，我们将研究队列分为对照组和干预组。然后开始使用奈必洛尔，并在3个月后重复测试。
治疗后，干预组静息SBP有所改善（149 mmHg[143.5 - 171 mmHg]对135 mmHg[125 - 151 mmHg，p = 0.016]），静息HR（78次/分[65.5 - 84次/分]对64.5次/分[57.5 - 75.5次/分，p = 0.028]），峰值SBP（235 mmHg[216.5 - 249 mmHg]对198 mmHg[191 - 220.5 mmHg]，p = 0.001），峰值HR（124.5次/分[115 - 142次/分]对115次/分[103.7 - 124次/分]，p = 0.043），第1分钟的HRR（6.5次/分[4.75 - 12.75次/分]对14.5次/分[6.7 - 22次/分]，p = 0.025）和第2分钟的HRR（15.5次/分[13 - 21.75次/分]对23.5次/分[16 - 31.7次/分]，p = 0.005），但峰值VO2和123I-MIBG闪烁扫描参数无变化。
尽管在控制SBP、静息和运动时的HR方面有更好的效果，且HRR有所改善，但奈必洛尔未能对峰值VO2和123I-MIBG闪烁扫描参数显示出积极影响。对肾上腺素能活性缺乏作用可能是对功能能力缺乏作用的原因。
