Triska Jeffrey, Tamargo Juan, Bozkurt Biykem, Elkayam Uri, Taylor Addison, Birnbaum Yochai
Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
Department of Pharmacology and Toxicology School of Medicine, Institute Gregorio Marañón, Universidad Complutense, Madrid, Spain.
Cardiovasc Drugs Ther. 2023 Dec;37(6):1205-1223. doi: 10.1007/s10557-022-07334-y. Epub 2022 Mar 31.
The 2021 European Society of Cardiology guidelines on acute and chronic heart failure (HF) recommend that non-dihydropyridine calcium channel blockers (NDCC) should be avoided in patients with HF with reduced ejection fraction. It also emphasizes that beta-blockers only be initiated in clinically stable, euvolemic patients. Despite these recommendations, NDCC and beta-blockers are often still employed in patients with AF with rapid ventricular response and acute decompensated HF. The relative safety and efficacy of these therapies in this setting is unclear.
To address the question of the safety and efficacy of NDCC and beta-blockers for acute rate control in decompensated HF, we provide a perspective on the literature of NDCC and beta-blockers in chronic HF with reduced and preserved ejection fraction and AF, including trials on the management of AF with rapid ventricular response with and without HF.
Robust data demonstrates mortality benefits when beta-blockers are used in patients with chronic HF with reduced ejection fraction. The data that inform the contraindication of NDCC in HF with reduced ejection fraction are outdated and were not primarily designed to address the efficacy and safety of rate control of AF in patients with HF. Several studies indicate that for acute rate control, NDCC and beta-blockers are both efficacious therapies, especially in the setting of tachycardia-induced cardiomyopathy.
Future studies are needed to assess the safety and efficacy of beta-blockers and NDCC in both acute and chronic AF with HF with reduced and preserved ejection fraction.
2021年欧洲心脏病学会关于急性和慢性心力衰竭（HF）的指南建议，射血分数降低的HF患者应避免使用非二氢吡啶类钙通道阻滞剂（NDCC）。该指南还强调，β受体阻滞剂仅应在临床稳定、血容量正常的患者中起始使用。尽管有这些建议，但NDCC和β受体阻滞剂仍经常用于伴有快速心室率的房颤和急性失代偿性HF患者。在这种情况下，这些治疗方法的相对安全性和有效性尚不清楚。
为了解决NDCC和β受体阻滞剂在失代偿性HF中急性控制心率的安全性和有效性问题，我们对NDCC和β受体阻滞剂在射血分数降低和保留的慢性HF及房颤中的文献进行了综述，包括对伴有和不伴有HF的快速心室率房颤管理的试验。
有力的数据表明，在射血分数降低的慢性HF患者中使用β受体阻滞剂可带来死亡率获益。支持在射血分数降低的HF中禁用NDCC的数据已经过时，且这些数据并非主要用于解决HF患者房颤心率控制的有效性和安全性问题。几项研究表明，对于急性心率控制，NDCC和β受体阻滞剂都是有效的治疗方法，尤其是在心动过速性心肌病的情况下。
未来需要开展研究，以评估β受体阻滞剂和NDCC在射血分数降低和保留的伴有HF的急性和慢性房颤中的安全性和有效性。
