Enzan Nobuyuki, Matsushima Shouji, Ide Tomomi, Tohyama Takeshi, Funakoshi Kouta, Higo Taiki, Tsutsui Hiroyuki
Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Japan.
Center for Clinical and Translational Research, Kyushu University Hospital, Japan.
Am Heart J Plus. 2021 Oct 7;11:100053. doi: 10.1016/j.ahjo.2021.100053. eCollection 2021 Nov.
Beta-blockers have been shown to induce left ventricular reverse remodeling (LVRR) in heart failure with reduced ejection fraction. This study aimed to determine whether beta-blockers could induce LVRR in patients with heart failure with mid-range ejection fraction (HFmrEF).
We analyzed the national database from clinical personal records of dilated cardiomyopathy (DCM) maintained by Japanese Ministry of Health, Labour and Welfare, between 2003 and 2014. Patients with left ventricular ejection fraction (LVEF) of ≥40% and < 50% were included. Patients who did not have echocardiography at 2 years of follow-up were excluded. Eligible patients were divided into two groups according to the use of beta-blockers. Patient characteristics of two groups were adjusted by propensity score matching. The primary outcome was LVRR at 2 years of follow-up, defined as an improvement in LVEF ≥10%.
Out of 3064 patients, propensity score matching yielded 602 pairs. The mean age was 59.3 years and 896 patients (74.4%) were male. The primary outcome was observed more frequently in beta-blocker group (24.3% vs. 17.8%; Odds ratio [OR], 1.48; 95% confidence interval [CI], 1.12-1.96; = 0.006). Subgroup analysis demonstrated that patients with heart rate ≥ 75 bpm (≥ 75 bpm; OR, 2.61; 95% CI, 1.66-4.11: < 75 bpm; OR, 1.03; 95% CI, 0.72-1.48; P for interaction = 0.002) and atrial fibrillation (AF) (AF; OR, 2.30; 95% CI, 1.37-3.86: No AF; OR 1.23; 95% CI, 0.88-1.72; P for interaction = 0.046) were benefited by beta-blockers.
Beta-blockers could induce LVRR in patients with DCM and HFmrEF.
β受体阻滞剂已被证明可在射血分数降低的心力衰竭患者中诱导左心室逆向重构（LVRR）。本研究旨在确定β受体阻滞剂是否能在射血分数中等范围的心力衰竭（HFmrEF）患者中诱导LVRR。
我们分析了日本厚生劳动省维护的2003年至2014年扩张型心肌病（DCM）临床个人记录的国家数据库。纳入左心室射血分数（LVEF）≥40%且<50%的患者。排除随访2年时未进行超声心动图检查的患者。根据β受体阻滞剂的使用情况将符合条件的患者分为两组。通过倾向评分匹配调整两组患者的特征。主要结局是随访2年时的LVRR，定义为LVEF改善≥10%。
在3064例患者中，倾向评分匹配产生了602对。平均年龄为59.3岁，896例患者（74.4%）为男性。β受体阻滞剂组更频繁地观察到主要结局（24.3%对17.8%；优势比[OR]，1.48；95%置信区间[CI]，1.12 - 1.96；P = 0.006）。亚组分析表明，心率≥75次/分的患者（≥75次/分；OR，2.61；95%CI，1.66 - 4.11：<75次/分；OR，1.03；95%CI，0.72 - 1.48；交互作用P = 0.002）和心房颤动（AF）患者（AF；OR，2.30；95%CI，1.37 - 3.86：无AF；OR 1.23；95%CI，0.88 - 1.72；交互作用P = 0.046）从β受体阻滞剂中获益。
β受体阻滞剂可在DCM和HFmrEF患者中诱导LVRR。
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