Horiuchi Yu, Tanimoto Shuzou, Aoki Jiro, Nakajima Hiroyoshi, Hara Kazuhiro, Tanabe Kengo
Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan.
Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan.
Int J Cardiol. 2016 Oct 15;221:765-9. doi: 10.1016/j.ijcard.2016.07.123. Epub 2016 Jul 9.
The effects of β-blockers on left ventricular (LV) remodeling have been established in patients with reduced ejection fraction (EF) after acute myocardial infarction (AMI). In AMI patients with preserved EF, additional effects of β-blockers on reperfusion therapy and current medical treatment have not been elucidated.
Patients with preserved EF (≥40%), who underwent percutaneous coronary intervention (PCI) for AMI and obtained complete coronary revascularization were enrolled retrospectively. These were divided into groups treated with or without β-blockers at discharge. Echocardiography was performed on admission and 8months after PCI to observe LVEF, LV end diastolic volume index (LVEDVI), LV end systolic volume index (LVESVI), LV end diastolic diameter (LVDd), and LV end systolic diameter (LVDs).
A total of 114 patients were enrolled; 81 were treated with β-blockers (β-blocker group) and 33 were treated without β-blockers (non-β-blocker group). All patients were prescribed antiplatelets and 96% took either an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker. At follow-up, EF improved in both groups (2.6% in the β-blocker group and 4.6% in the non-β-blocker group). In the β-blocker group, neither LVEDVI nor LVESVI decreased. However, both LVEDVI (-4.3ml/m(2)) and LVESVI (-4.1ml/m(2)) improved in the non-β-blocker group. There were significant increases in LVDd (2.1mm) and LVDs (2.2mm) in the β-blocker group, whereas these parameters did not significantly change in the non-β-blocker group.
Effects of β-blockers on LV remodeling were uncertain in AMI patients with preserved EF, who obtained complete coronary revascularization and received optimal medical treatment.
β受体阻滞剂对急性心肌梗死（AMI）后射血分数（EF）降低患者左心室（LV）重构的影响已得到证实。在EF保留的AMI患者中，β受体阻滞剂对再灌注治疗和当前药物治疗的额外影响尚未阐明。
回顾性纳入EF保留（≥40%）、因AMI接受经皮冠状动脉介入治疗（PCI）并实现完全冠状动脉血运重建的患者。这些患者出院时被分为接受或未接受β受体阻滞剂治疗的组。在入院时和PCI后8个月进行超声心动图检查，以观察左心室射血分数（LVEF）、左心室舒张末期容积指数（LVEDVI）、左心室收缩末期容积指数（LVESVI）、左心室舒张末期直径（LVDd）和左心室收缩末期直径（LVDs）。
共纳入114例患者；81例接受β受体阻滞剂治疗（β受体阻滞剂组），33例未接受β受体阻滞剂治疗（非β受体阻滞剂组）。所有患者均接受抗血小板治疗，96%服用血管紧张素转换酶抑制剂或血管紧张素II受体阻滞剂。随访时，两组的EF均有所改善（β受体阻滞剂组为2.6%，非β受体阻滞剂组为4.6%）。在β受体阻滞剂组中，LVEDVI和LVESVI均未降低。然而，非β受体阻滞剂组的LVEDVI（-4.3ml/m²）和LVESVI（-4.1ml/m²）均有所改善。β受体阻滞剂组的LVDd（2.1mm）和LVDs（2.2mm）显著增加，而非β受体阻滞剂组的这些参数无显著变化。
在实现完全冠状动脉血运重建并接受最佳药物治疗的EF保留的AMI患者中，β受体阻滞剂对LV重构的影响尚不确定。
