Klein H O, Sareli P, Schamroth C L, Carim Y, Epstein M, Marcus B
Am J Cardiol. 1985 Oct 1;56(10):598-601. doi: 10.1016/0002-9149(85)91018-5.
Exercise capacity is frequently impaired in patients with mitral stenosis (MS) and sinus rhythm (SR). The resulting increased heart rate, which shortens the diastolic filling period, and the increased cardiac output lead to further elevations of left atrial pressure and subsequent pulmonary congestion. The effect of the beta-receptor blocking agent atenolol, 100 mg/day, was assessed in 13 patients with MS and SR. Exercise performance was assessed using a modified multistage Bruce protocol after 2 weeks of placebo and after 2 weeks therapy with atenolol in a single-blind, crossover, placebo-controlled, randomized study. Atenolol resulted in significant decreases in mean heart rates at rest and during exercise (p = 0.0015) and a significant increase in total exercise time (p = 0.0015). Maximal exercise capacity was also significantly improved (p = 0.0015). All patients were both objectively and subjectively improved by atenolol. Thus, beta-blockade with atenolol improves exercise capacity in patients with MS and SR and may be of benefit to most such patients. The improved effort tolerance is attributed to reduction of the exercise-associated sinus tachycardia by beta-blockade, allowing a longer diastolic filling period and better left atrial decompression.
二尖瓣狭窄（MS）且为窦性心律（SR）的患者，其运动能力常受损。由此导致的心率增加会缩短舒张期充盈时间，而心输出量增加会使左心房压力进一步升高，继而引发肺充血。在13例MS且SR的患者中评估了每日100毫克β受体阻滞剂阿替洛尔的疗效。在一项单盲、交叉、安慰剂对照、随机研究中，使用改良的多级布鲁斯方案，在服用安慰剂2周后以及服用阿替洛尔治疗2周后评估运动表现。阿替洛尔使静息和运动时的平均心率显著降低（p = 0.0015），总运动时间显著增加（p = 0.0015）。最大运动能力也显著改善（p = 0.0015）。所有患者在客观和主观上均因阿替洛尔而有所改善。因此，阿替洛尔进行β受体阻滞可改善MS且SR患者的运动能力，可能对大多数此类患者有益。运动耐力的改善归因于β受体阻滞减少了运动相关的窦性心动过速，从而使舒张期充盈时间延长，左心房减压更好。
