Binkley P F, Lewe R, Lima J, Unverferth D V, Leier C V
Division of Cardiology, Ohio State University, Columbus 43210.
J Lab Clin Med. 1988 Apr;111(4):393-8.
Beta-blockade has been reported to have beneficial hemodynamic effects in chronic congestive heart failure that may be related to alterations in the abnormal neurohumoral profile characteristic of this population. To determine the relationship of the neurohumoral profile to the hemodynamic response to beta-blockade in patients with chronic congestive heart failure, neurohumoral and hemodynamic variables were measured in 10 subjects having congestive cardiomyopathy at baseline and after administration of the beta-blocker pindolol. Baseline stroke index was noted to have an inverse curvilinear relation with plasma norepinephrine (r = -0.69) and renin (r = -0.71) concentration. Pulmonary vascular resistance demonstrated a direct logarithmic relation with plasma norepinephrine concentration (r = 0.68). Increases in norepinephrine, dopamine, and epinephrine concentrations after dosing were noted, with the most marked increase in norepinephrine concentration being coincident with a significant decline in stroke volume index. Two patients not tolerating beta-blockade were characterized by having baseline norepinephrine concentrations 3 SD higher than those of the remaining patients, more marked increases in epinephrine concentration after dosing, and the most profoundly decompensated heart failure at baseline, as defined by the relationship between neurohumoral and hemodynamic variables. These observations suggest that increases in catecholamines after dosing reflect a compensatory response to the adverse hemodynamic-inotropic effects of beta-blockade in congestive heart failure. The neurohumoral profile and the relationship of neuroendocrine to hemodynamic parameters may be useful in delineating patients at risk for adverse hemodynamic effects of beta-blockade.
据报道，β受体阻滞剂在慢性充血性心力衰竭中具有有益的血流动力学效应，这可能与该人群特征性异常神经体液状况的改变有关。为了确定神经体液状况与慢性充血性心力衰竭患者对β受体阻滞剂的血流动力学反应之间的关系，对10例充血性心肌病患者在基线时以及给予β受体阻滞剂吲哚洛尔后测量了神经体液和血流动力学变量。基线时的心搏量指数与血浆去甲肾上腺素（r = -0.69）和肾素（r = -0.71）浓度呈反向曲线关系。肺血管阻力与血浆去甲肾上腺素浓度呈直接对数关系（r = 0.68）。给药后去甲肾上腺素、多巴胺和肾上腺素浓度升高，去甲肾上腺素浓度升高最为显著，同时心搏量指数显著下降。两名不耐受β受体阻滞剂的患者的特征是，其基线去甲肾上腺素浓度比其余患者高3个标准差，给药后肾上腺素浓度升高更为明显，且根据神经体液和血流动力学变量之间的关系，基线时心力衰竭失代偿最为严重。这些观察结果表明，给药后儿茶酚胺升高反映了对充血性心力衰竭中β受体阻滞剂不良血流动力学-变力作用的代偿反应。神经体液状况以及神经内分泌与血流动力学参数之间的关系可能有助于确定有β受体阻滞剂不良血流动力学效应风险的患者。
