Eichhorn E J, Heesch C M, Risser R C, Marcoux L, Hatfield B
Cardiac Catheterization Laboratory, Dallas Veterans Administration Hospital, Texas 75216.
J Am Coll Cardiol. 1995 Jan;25(1):154-62. doi: 10.1016/0735-1097(94)00340-v.
The aim of this study was to determine which patients will have systolic and diastolic improvement after beta-blockade with metoprolol.
Beta-adrenergic blocking agents improve systolic and diastolic function in patients with heart failure. However, it is unclear which patients will respond best to therapy.
We retrospectively examined baseline characteristics of 24 patients who underwent double-blind then open-label treatment with metoprolol to determine which characteristic predicted improvement in systolic and diastolic function. Degree of improvement in systolic function (22 patients) was defined by the change in left ventricular ejection fraction after 3 months of therapy. Degree of improvement in diastolic function (15 patients) was defined as the change in left ventricular end-diastolic pressure and change in the slope of the isovolumetric relaxation rate-end-systolic pressure relation.
Both systolic blood pressure at baseline (r = 0.54, p = 0.009) and the maximal positive value of the first derivative of left ventricular pressure with respect to time (peak +dP/dt) at baseline (r = 0.39, p = 0.07) correlated with improvement in ejection fraction after metoprolol treatment. Stepwise logistic regression demonstrated that only peak systolic pressure was an independent predictor of systolic improvement. Baseline heart rate, ventricular volumes, ejection fraction and adrenergic activation, as reflected by coronary sinus norepinephrine, did not predict response. Patients with the most diastolic impairment at baseline had the most favorable diastolic improvement. Those with the lowest myocardial respiratory quotient (most fatty acid utilization) at baseline also had the most marked reduction in left ventricular end-diastolic pressure.
These data suggest that those patients with the highest peak systolic pressure, highest left ventricular end-diastolic pressure and most prolonged isovolumetric relaxation at baseline will respond best to therapy with metoprolol. However, other patients without these characteristics may also benefit.
本研究旨在确定哪些患者在接受美托洛尔β受体阻滞剂治疗后收缩压和舒张压会有所改善。
β肾上腺素能阻滞剂可改善心力衰竭患者的收缩和舒张功能。然而，尚不清楚哪些患者对治疗反应最佳。
我们回顾性研究了24例接受美托洛尔双盲然后开放标签治疗的患者的基线特征，以确定哪些特征可预测收缩和舒张功能的改善。收缩功能的改善程度（22例患者）通过治疗3个月后左心室射血分数的变化来定义。舒张功能的改善程度（15例患者）定义为左心室舒张末期压力的变化以及等容舒张期速率-收缩末期压力关系斜率的变化。
基线收缩压（r = 0.54，p = 0.009）和基线时左心室压力相对于时间的一阶导数的最大正值（峰值 +dP/dt）（r = 0.39，p = 0.07）均与美托洛尔治疗后射血分数的改善相关。逐步逻辑回归表明，只有收缩压峰值是收缩功能改善的独立预测因子。基线心率、心室容积、射血分数以及冠状窦去甲肾上腺素反映的肾上腺素能激活情况均不能预测反应。基线时舒张功能损害最严重的患者舒张功能改善最明显。基线时心肌呼吸商最低（脂肪酸利用率最高）的患者左心室舒张末期压力降低也最显著。
这些数据表明，基线时收缩压峰值最高、左心室舒张末期压力最高且等容舒张期最长的患者对美托洛尔治疗反应最佳。然而，其他没有这些特征的患者也可能受益。
