Nagatomo Yuji, Yoshikawa Tsutomu, Okamoto Hiroshi, Kitabatake Akira, Hori Masatsugu
Department of Cardiology, National Defense Medical College Tokorozawa Japan.
Sakakibara Heart Institute Fuchu Japan.
Circ Rep. 2020 Mar 4;2(3):143-151. doi: 10.1253/circrep.CR-20-0008.
Heart rate (HR) reduction by β-blocker might not benefit patients with heart failure and reduced ejection fraction (HFrEF) with atrial fibrillation (AF). The J-CHF study was a prospective randomized multicenter trial that assigned 360 HFrEF patients to a 2.5 mg/5 mg/20 mg target dose of carvedilol. Carvedilol was uptitrated over 8 weeks and then the dose was fixed. Of 321 patients available for analysis, AF was identified in 65 (20%). Using the median absolute change in HR at 32 weeks (∆HR), the subjects were further divided into group A (∆HR >-6 beats/min) and B (∆HR ≤-6 beats/min). Both in sinus rhythm (SR) and AF, baseline characteristics and achieved carvedilol dose were similar between groups A and B. In SR, the time-dependent change in left ventricular EF (LVEF) and LV end-diastolic dimension (LVEDD) over 56 weeks was more favorable in B compared with A (∆LVEF, P=0.036; ∆LVEDD, P=0.047), and ∆HR was independently associated with ∆LVEF (P=0.040). Group B had a lower rate of the primary endpoint, defined as a composite of death and hospitalization due to cardiovascular causes including acute decompensated HF at 3 years (P=0.002). ∆HR was an independent predictor of the primary endpoint (P=0.01), but this was not observed in AF. Response to the carvedilol HR reduction might differ in HFrEF between SR and AF.
β受体阻滞剂降低心率可能对伴有心房颤动（AF）的射血分数降低的心力衰竭（HFrEF）患者并无益处。J-CHF研究是一项前瞻性随机多中心试验，将360例HFrEF患者分配至2.5mg/5mg/20mg的卡维地洛目标剂量组。卡维地洛在8周内逐渐滴定，然后固定剂量。在可供分析的321例患者中，65例（20%）被确诊为AF。根据32周时心率的中位数绝对变化（∆HR），受试者被进一步分为A组（∆HR＞-6次/分钟）和B组（∆HR≤-6次/分钟）。在窦性心律（SR）和AF中，A组和B组的基线特征及所达到的卡维地洛剂量相似。在SR中，与A组相比，B组在56周内左心室射血分数（LVEF）和左心室舒张末期内径（LVEDD）的时间依赖性变化更有利（∆LVEF，P=0.036；∆LVEDD，P=0.047），且∆HR与∆LVEF独立相关（P=0.040）。B组的主要终点发生率较低，主要终点定义为3年内因心血管原因导致的死亡和住院的复合终点，包括急性失代偿性心力衰竭（P=0.002）。∆HR是主要终点的独立预测因素（P=0.01），但在AF中未观察到这一现象。SR和AF的HFrEF患者对卡维地洛降低心率的反应可能不同。
