IRCCS SDN, Naples, Italy.
Centro Cardiologico Monzino, IRCCS, Milan, Italy.
Eur J Heart Fail. 2017 Jul;19(7):904-914. doi: 10.1002/ejhf.775. Epub 2017 Feb 24.
The use of β-blockers represents a milestone in the treatment of heart failure with reduced ejection fraction (HFrEF). Few studies have compared β-blockers in HFrEF, and there is little data on the effects of different doses. The present study aimed to investigate in a large database of HFrEF patients (MECKI score database) the association of β-blocker treatment with a composite outcome of cardiovascular death, urgent heart transplantation or left ventricular assist device implantation, addressing the role of β-selectivity and dosage regimens.
In 5242 HFrEF patients, we investigated the role of: (i) β-blocker treatment vs. non-β-blocker treatment, (ii) β1-/β2-receptor-blockers vs. β1-selective blockers, and (iii) daily β-blocker dose. Patients were followed for 3.58 years, and 1101 events (18.3%) were observed; 4435 patients (86.8%) were on β-blockers, while 807 (13.2%) were not. At 5 years, β-blocker-patients showed a better outcome than non-β-blocker-subjects [hazard ratio (HR) 0.48, P < 0.0001], while also considering potential confounders. A comparable prognosis was observed at 5 years in the β1-/β2-receptor-blocker (n = 2219) vs. β1-selective group (n = 2216) (HR 0.95, P = ns). A better prognosis was observed in high-dose (>2 5 mg carvedilol equivalent daily dose, n = 1005) patients than in both medium dose (12.5-25 mg, n = 1431) and low dose (<12.5 mg, n = 1960) (HR 1.97, P < 0.001; HR 1.95, P = 0.001, respectively), with no differences between the last two groups (HR 0.84, P = ns).
In a large population of chronic HFrEF patients, β-blockers were associated with a more favourable prognosis without any difference between β1- and β2-receptor-blockers vs. β1-selective blockers. A better outcome was observed in subjects receiving a high daily dose.
β受体阻滞剂的应用是射血分数降低的心力衰竭（HFrEF）治疗的一个里程碑。很少有研究比较 HFrEF 中的β受体阻滞剂，而且关于不同剂量的效果的数据也很少。本研究旨在通过 MECKI 评分数据库中的大量 HFrEF 患者数据库，调查β受体阻滞剂治疗与心血管死亡、紧急心脏移植或左心室辅助装置植入的复合结局之间的关联，并探讨β受体选择性和剂量方案的作用。
在 5242 例 HFrEF 患者中，我们研究了以下因素的作用：（i）β受体阻滞剂治疗与非β受体阻滞剂治疗，（ii）β1/β2 受体阻滞剂与β1 选择性阻滞剂，以及（iii）每日β受体阻滞剂剂量。患者随访 3.58 年，观察到 1101 例事件（18.3%）；4435 例患者（86.8%）接受β受体阻滞剂治疗，807 例（13.2%）未接受β受体阻滞剂治疗。在 5 年内，β受体阻滞剂组的患者预后优于非β受体阻滞剂组[风险比（HR）0.48，P<0.0001]，即使考虑到潜在的混杂因素也是如此。在β1/β2 受体阻滞剂（n=2219）与β1 选择性组（n=2216）中，5 年内观察到相似的预后（HR 0.95，P=ns）。与中剂量（12.5-25mg，n=1431）和低剂量（<12.5mg，n=1960）相比，高剂量（>25mg 卡维地洛等效日剂量，n=1005）患者的预后更好（HR 1.97，P<0.001；HR 1.95，P=0.001），后两组之间无差异（HR 0.84，P=ns）。
在一大群慢性 HFrEF 患者中，β受体阻滞剂与更有利的预后相关，β1 受体和β2 受体阻滞剂与β1 选择性阻滞剂之间没有差异。接受高日剂量的患者预后更好。
