Huang Jingjing, Zhang Ran, Liu Xuelu, Meng Yong
a Department of Cardiology , The Second Affiliated Hospital of Kunming Medical University , Kunming , China.
Curr Med Res Opin. 2018 Jan;34(1):141-148. doi: 10.1080/03007995.2017.1333954. Epub 2017 Jun 19.
To investigate the impact of neuropsychiatric disorders on the effect of metoprolol on cardiac and motor function in chronic heart failure (CHF) patients.
From February 2013 to April 2016, CHF patients with clinical mental disorders received metoprolol (23.75 or 47.5 mg, once daily, orally) at the Second Affiliated Hospital of Kunming Medical University. Mental status was confirmed by means of the Hospital Anxiety and Depression Scale (HADS) and the Copenhagen Burnout Inventory (CBI) scale. Cardiac function parameters such as systolic blood pressure (SBP), ejection fraction (EF) and cardiac index (CI) as well as motor function including the 6 meter walk test (6MWT) and the Veteran's Specific Activity Questionnaire (VSAQ) were assessed as primary outcomes of the study.
A total of 154 patients (median age, 66.39 years; men, n = 101) were allocated into eight groups based on their mental status. There were no significant differences in heart rate (HR) or SBP control achieved by metoprolol in any groups compared with the control (patients with normal mental status). Furthermore, biphasic ejection fraction (EF) changes were observed in all the groups with a decrease in the first month and increase from the sixth month. However, this increase was significantly lower (p < .001) than the EF achieved with metoprolol treatment in the control group except for the anxiety group. A similar pattern was seen for CI, 6MWT and VSAQ changes in all the groups. Patients in the anxiety group responded similarly to the patients with normal mental status.
Depressive and high burnout symptoms, but not anxiety, lower the improvement of cardiac and motor function by metoprolol treatment in CHF.
探讨神经精神障碍对美托洛尔治疗慢性心力衰竭（CHF）患者心脏和运动功能疗效的影响。
2013年2月至2016年4月，昆明医科大学第二附属医院的CHF合并临床精神障碍患者接受美托洛尔治疗（23.75或47.5mg，每日一次，口服）。采用医院焦虑抑郁量表（HADS）和哥本哈根倦怠量表（CBI）确定精神状态。评估收缩压（SBP）、射血分数（EF）和心脏指数（CI）等心脏功能参数以及包括6米步行试验（6MWT）和退伍军人特定活动问卷（VSAQ）在内的运动功能，作为研究的主要结局指标。
根据精神状态，共154例患者（中位年龄66.39岁；男性101例）被分为八组。与对照组（精神状态正常的患者）相比，美托洛尔在任何组中实现的心率（HR）或SBP控制均无显著差异。此外，所有组均观察到双相射血分数（EF）变化，第一个月下降，第六个月上升。然而，除焦虑组外，该上升幅度显著低于对照组美托洛尔治疗所达到的EF（p<0.001）。所有组的CI、6MWT和VSAQ变化均呈现类似模式。焦虑组患者的反应与精神状态正常的患者相似。
抑郁和高倦怠症状而非焦虑会降低美托洛尔治疗CHF对心脏和运动功能的改善。
