Department of Cardiology, Beijing Key Laboratory of Hypertension Research, Beijing Chao-Yang Hospital, Capital Medical University, 8# Gong-Ti South Road, Chaoyang District, Beijing, 100020, China.
HTRM Cardiologist Group, BENQ Medical Center, Nanjing Medical University, 181# Zhuyuan Road, Suzhou City, 215000, JiangSu Province, China.
BMC Cardiovasc Disord. 2021 Dec 28;21(1):619. doi: 10.1186/s12872-021-02414-7.
To evaluate the impact of autoantibodies against the M2-muscarinic receptor (anti-M2-R) on the clinical outcomes of patients receiving the standard treatment for peripartum cardiomyopathy (PPCM).
A total of 107 PPCM patients who received standard heart failure (HF) treatment between January 1998 and June 2020 were enrolled in this study. According to anti-M2-R reactivity, they were classified into negative (n = 59) and positive (n = 48) groups, denoted as the anti-M2-R (-) and anti-M2-R (+) groups. Echocardiography, 6-min walk distance, serum digoxin concentration (SDC), and routine laboratory tests were performed regularly for 2 years. The all-cause mortality, cardiovascular mortality, and rehospitalisation rate for HF were compared between the two groups.
A total of 103 patients were included in the final data analysis, with 46 in the anti-M2-R (+) group and 57 in the anti-M2-R (-) group. Heart rate was lower in the anti-M2-R (+) group than in the anti-M2-R (-) group at the baseline (102.7 ± 6.1 bpm vs. 96.0 ± 6.4 bpm, p < 0.001). The initial SDC was higher in the anti-M2-R (+) group than in the anti-M2-R (-) group with the same dosage of digoxin (1.25 ± 0.45 vs. 0.78 ± 0.24 ng/mL, p < 0.001). The dosages of metoprolol and digoxin were higher in the anti-M2-R (-) patients than in the anti-M2-R (+) patients (38.8 ± 4.6 mg b.i.d. vs. 27.8 ± 5.3 mg b.i.d., p < 0.0001, respectively, for metoprolol; 0.12 ± 0.02 mg/day vs. 0.08 ± 0.04 mg/day, p < 0.0001, respectively, for digoxin). Furthermore, there was a greater improvement in cardiac function in the anti-M2-R (-) patients than in the anti-M2-R (+) patients. Multivariate analysis identified negativity for anti-M2-R as the independent predictor for the improvement of cardiac function. Rehospitalisation for HF was lower in the anti-M2-R (-) group, but all-cause mortality and cardiovascular mortality were the same.
There were no differences in all-cause mortality or cardiovascular mortality between the two groups. Rehospitalisation rate for HF decreased in the anti-M2-R (-) group. This difference may be related to the regulation of the autonomic nervous system by anti-M2-R.
评估抗 M2 毒蕈碱受体（anti-M2-R）自身抗体对接受围产期心肌病（PPCM）标准治疗的患者临床结局的影响。
本研究共纳入 1998 年 1 月至 2020 年 6 月期间接受标准心力衰竭（HF）治疗的 107 例 PPCM 患者。根据抗 M2-R 反应性，将其分为阴性（n=59）和阳性（n=48）组，分别记为抗 M2-R（-）和抗 M2-R（+）组。定期进行超声心动图、6 分钟步行距离、血清地高辛浓度（SDC）和常规实验室检查，随访 2 年。比较两组患者的全因死亡率、心血管死亡率和 HF 再住院率。
共有 103 例患者纳入最终数据分析，其中抗 M2-R（+）组 46 例，抗 M2-R（-）组 57 例。抗 M2-R（+）组患者的心率在基线时低于抗 M2-R（-）组（102.7±6.1bpm vs. 96.0±6.4bpm，p<0.001）。抗 M2-R（+）组患者初始 SDC 高于抗 M2-R（-）组患者，且地高辛剂量相同（1.25±0.45 vs. 0.78±0.24ng/mL，p<0.001）。与抗 M2-R（+）组患者相比，抗 M2-R（-）组患者的美托洛尔和地高辛剂量更高（38.8±4.6mg bid vs. 27.8±5.3mg bid，p<0.0001，分别为美托洛尔；0.12±0.02mg/day vs. 0.08±0.04mg/day，p<0.0001，分别为地高辛）。此外，抗 M2-R（-）组患者的心脏功能改善程度大于抗 M2-R（+）组患者。多变量分析表明，抗 M2-R 阴性是心脏功能改善的独立预测因素。抗 M2-R（-）组 HF 再住院率较低，但全因死亡率和心血管死亡率相同。
两组患者的全因死亡率或心血管死亡率无差异。抗 M2-R（-）组 HF 再住院率降低。这种差异可能与抗 M2-R 对自主神经系统的调节有关。
