美托洛尔对肥厚性梗阻性心肌病患者酒精间隔消融术后的影响。
Effect of metoprolol in hypertrophic obstructive cardiomyopathy patients after alcohol septal ablation.
作者信息
Hnátová Hana, Fulínová Klára, Řiháková Barbora, Bonaventura Jiří, Veselka Josef
机构信息
Department of Cardiology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic.
出版信息
Int J Cardiol Heart Vasc. 2023 Dec 2;49:101317. doi: 10.1016/j.ijcha.2023.101317. eCollection 2023 Dec.
BACKGROUND
The use of beta-blockers in hypertrophic obstructive cardiomyopathy (HOCM) patients after alcohol septal ablation (ASA) lacks data support. We aimed to evaluate the effect of metoprolol on exercise capacity, hemodynamic and laboratory parameters, and quality of life in HOCM patients after ASA.
METHODS
This was a prospective randomized single-center open-label crossover trial in 21 HOCM patients after ASA. Patients received metoprolol and no beta-blocker for two periods of three months. The endpoints were: peak oxygen uptake (pVO), maximal left ventricular outflow tract (LVOT) pressure gradient at peak exercise, a ratio of mitral peak velocity of the early filling (E) to early diastolic mitral annular velocity (e') (E/e') at rest, Kansas City Cardiomyopathy Questionnaire (KCCQ) overall summary score, and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) plasmatic concentration.
RESULTS
No significant association was found between the treatment and any of the endpoints in the assessed patients: 1) pVO (19.5 ± 5.3 ml/kg/min vs. 19.4 ± 4.1 ml/kg/min, = 0.90), 2) exercise-induced pressure gradient in LVOT 32 ± 37 mmHg vs. 32 ± 30 mmHg, = 0.84, 3) E/e' ratio at rest (11 ± 4 vs. 10 ± 4, = 0.23), 4) KCCQ overall summary score (78 ± 11 vs. 77 te ± 15, = 0.56), 5) NT-proBNP (215 pg/ml [121-333] vs. 153 pg/ml [102-228], = 0.19).
CONCLUSIONS
In HOCM patients after successful ASA, metoprolol treatment did not improve exercise capacity, hemodynamic and laboratory parameters, or quality of life.
背景
酒精性室间隔消融术（ASA）后肥厚型梗阻性心肌病（HOCM）患者使用β受体阻滞剂缺乏数据支持。我们旨在评估美托洛尔对ASA后HOCM患者运动能力、血流动力学和实验室参数以及生活质量的影响。
方法
这是一项针对21例ASA后HOCM患者的前瞻性随机单中心开放标签交叉试验。患者在两个为期三个月的时间段内分别接受美托洛尔治疗和不使用β受体阻滞剂。终点指标包括：峰值摄氧量（pVO）、运动峰值时最大左心室流出道（LVOT）压力梯度、静息时二尖瓣早期充盈峰值速度（E）与二尖瓣环舒张早期速度（e'）之比（E/e'）、堪萨斯城心肌病问卷（KCCQ）总体总结评分以及脑钠肽前体N末端（NT-proBNP）血浆浓度。
结果
在评估的患者中，治疗与任何终点指标之间均未发现显著关联：1）pVO（19.5±5.3 ml/kg/min对19.4±4.1 ml/kg/min，P = 0.90），2）运动诱发的LVOT压力梯度（32±37 mmHg对32±30 mmHg，P = 0.84），3）静息时E/e'比值（11±4对10±4，P = 0.23），4）KCCQ总体总结评分（78±11对77±15，P = 0.56），5）NT-proBNP（215 pg/ml [121 - 333]对153 pg/ml [102 - 228]，P = 0.19）。
结论
在成功进行ASA后的HOCM患者中，美托洛尔治疗并未改善运动能力、血流动力学和实验室参数或生活质量。
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