最大耐受剂量比索洛尔降低心率对左心室逆重构的影响。
Impact of Heart Rate Reduction with Maximal Tolerable Dose of Bisoprolol on Left Ventricular Reverse Remodeling.
机构信息
Division of Cardiology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea.
Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea.
出版信息
J Korean Med Sci. 2018 May 11;33(25):e171. doi: 10.3346/jkms.2018.33.e171. eCollection 2018 Jun 18.
BACKGROUND
We aimed to evaluate effect of heart rate (HR) reduction on left ventricular reverse remodeling (LVRR) in Korean patients with heart failure with reduced ejection fraction (HFrEF).
METHODS
Ambulatory patients with HFrEF, who had paired echocardiograms, N-terminal prohormone brain natriuretic peptide (NT-proBNP), and global assessment score (GAS) at baseline and 6-month (n = 157), were followed up on preset treatment schedule with bisoprolol.
RESULTS
The LVRR occurred in 49 patients (32%) at 6-month. In multivariable analysis, independent predictors associated with LVRR were use of anti-aldosterone agent (odds ratio [OR], 4.18; 95% confidence interval [CI], 1.80-9.71), young age (OR, 0.96; 95% CI, 0.92-0.99), high baseline HR (OR, 3.76; 95% CI, 1.40-10.10), and favorable baseline GAS (OR, 1.73; 95% CI, 1.06-2.81). Beneficial effect of bisoprolol, in terms of LVRR, NT-proBNP, and GAS, was remarkable in the high HR group (baseline HR ≥ 75 beats per minute [bpm]), which showed a large HR reduction.
CONCLUSION
High baseline HR (≥ 75 bpm) showed an association with LVRR and improvement of NT-proBNP and GAS in patients with HFrEF. This seems to be due to a large HR reduction after treatments with bisoprolol. Trial registry at www.ClinicalTrials.gov, NCT00749034.
背景
本研究旨在评估心率（HR）降低对射血分数降低的心力衰竭（HFrEF）韩国患者左心室逆重构（LVRR）的影响。
方法
对基线和 6 个月时具有配对超声心动图、N 末端脑利钠肽前体（NT-proBNP）和整体评估评分（GAS）的 HFrEF 门诊患者，根据预设的比索洛尔治疗方案进行随访。
结果
在 6 个月时，49 例（32%）患者发生 LVRR。多变量分析显示，与 LVRR 相关的独立预测因素为使用抗醛固酮药物（比值比 [OR]，4.18；95%置信区间 [CI]，1.80-9.71）、年龄较轻（OR，0.96；95% CI，0.92-0.99）、基线 HR 较高（OR，3.76；95% CI，1.40-10.10）和基线 GAS 较好（OR，1.73；95% CI，1.06-2.81）。在 HR 较高（基线 HR≥75 次/分）的患者中，比索洛尔在 LVRR、NT-proBNP 和 GAS 方面的获益效果显著，且该组患者的 HR 降幅较大。
结论
基线 HR（≥75 次/分）与 HFrEF 患者的 LVRR 以及 NT-proBNP 和 GAS 的改善相关，这可能归因于比索洛尔治疗后 HR 的大幅降低。试验注册于 www.ClinicalTrials.gov，NCT00749034。
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