Fowler M B
Cardiology Division, Stanford University Medical Center 94305.
Am J Cardiol. 1993 Mar 25;71(9):45C-53C. doi: 10.1016/0002-9149(93)90086-r.
Early studies of acute beta-blocking drug therapy, such as metoprolol and acebutolol, in patients with idiopathic dilated cardiomyopathy (IDC) and survivors of acute myocardial infarction were interpreted to have detrimental or, at best, neutral effects on cardiac and clinical hemodynamics. Subsequent trials of longer duration with metoprolol versus placebo in patients with IDC demonstrated an "exceptional response" to beta-blocker therapy in some individuals. Hemodynamics and patient demographic characteristics appear not to predict those patients who may or may not benefit. Controlled trials with newer beta-adrenoceptor modulating drugs--such as xamoterol, bucindolol, and carvedilol--have been equivocal in some situations. Xamoterol has been associated with progressive heart failure and increased sudden cardiac deaths, whereas bucindolol improved clinical heart failure symptoms and testing hemodynamic parameters, as did treatment with carvedilol, in patients with ischemic cardiomyopathy. The success of these agents in patients with congestive heart failure may be in their ability to modulate the excessive myocardial stimulation of the beta-adrenergic nervous system while benefitting the dynamics of the peripheral system.
早期针对特发性扩张型心肌病（IDC）患者以及急性心肌梗死幸存者进行的急性β受体阻滞剂药物治疗研究，比如美托洛尔和醋丁洛尔，被解读为对心脏和临床血流动力学有有害影响，或者充其量只有中性影响。随后在IDC患者中开展的美托洛尔与安慰剂对比的长期试验表明，部分个体对β受体阻滞剂治疗有“特殊反应”。血流动力学和患者人口统计学特征似乎无法预测哪些患者可能受益或不受益。使用新型β肾上腺素能调节药物（如扎莫特罗、布新洛尔和卡维地洛）进行的对照试验在某些情况下结果并不明确。扎莫特罗与进行性心力衰竭及心脏性猝死增加有关，而布新洛尔改善了临床心力衰竭症状并检测了血流动力学参数，卡维地洛治疗缺血性心肌病患者时也有同样效果。这些药物在充血性心力衰竭患者中的成功可能在于它们能够调节β肾上腺素能神经系统对心肌的过度刺激，同时使外周系统动力学受益。
