Quaife R A, Gilbert E M, Christian P E, Datz F L, Mealey P C, Volkman K, Olsen S L, Bristow M R
Division of Cardiology, University of Colorado Health Sciences Center, Denver, USA.
Am J Cardiol. 1996 Oct 1;78(7):779-84. doi: 10.1016/s0002-9149(96)00420-1.
Recent evidence has shown that improvement in left ventricular (LV) systolic function in patients with New York Heart Association class II to III heart failure occurs with beta-adrenergic blocking agents. However the specific effects on LV diastolic function have been subjected to only limited examination. This study investigated the effects of the combined beta blocker/vasodilator, carvedilol, on systolic and diastolic LV performance in dilated cardiomyopathy. Thirty-six patients with New York Heart Association II to III heart failure and LV ejection fraction < or = 0.35 were entered into either arm of this placebo-controlled, double-blind 4-month trial. Twenty-one subjects were entered into the carvedilol treatment arm and 15 patients were entered into the placebo arm in a 3:2 ratio. Carvedilol therapy resulted in a significant improvement in LV ejection fraction, from 0.22 +/- 0.02 to 0.30 +/- 0.02 when compared with the placebo group (0.19 +/- 0.02 to 0.21 +/- 0.02 at baseline and after 4 months of therapy, respectively; p = 0.0001). However, no significant change in radionuclide parameters of LV diastolic function, including peak filling rate or time to peak filling rate, was observed. LV end-diastolic volume index did not change with carvedilol therapy, whereas end-diastolic volume index increased in the placebo group, although the difference between groups at 4 months was significant (p = 0.02). In conjunction with these changes, end-systolic volume index was smaller at 4 months after carvedilol treatment compared with that of the placebo group (p = 0.04). Thus, these results demonstrate that in moderate chronic heart failure, systolic LV performance improves but diastolic LV function does not improve when compared with placebo after treatment with carvedilol.
近期证据表明，纽约心脏协会II至III级心力衰竭患者使用β-肾上腺素能阻滞剂后左心室（LV）收缩功能有所改善。然而，其对LV舒张功能的具体影响仅得到有限的研究。本研究调查了β受体阻滞剂/血管扩张剂组合药物卡维地洛对扩张型心肌病患者LV收缩和舒张功能的影响。36例纽约心脏协会II至III级心力衰竭且LV射血分数≤0.35的患者进入了这项为期四个月的安慰剂对照、双盲试验的任一试验组。按照3:2的比例，21名受试者进入卡维地洛治疗组，15名患者进入安慰剂组。与安慰剂组相比，卡维地洛治疗使LV射血分数显著改善，从0.22±0.02提高到0.30±0.02（安慰剂组在基线时和治疗4个月后分别为0.19±0.02和0.2l±0.02；p = 0.0001）。然而，未观察到LV舒张功能的放射性核素参数有显著变化，包括峰值充盈率或达到峰值充盈率的时间。卡维地洛治疗后LV舒张末期容积指数未改变，而安慰剂组舒张末期容积指数增加，尽管两组在4个月时的差异具有统计学意义（p = O.02）。与这些变化相关的是，卡维地洛治疗4个月后的收缩末期容积指数比安慰剂组小（p = 0.04）。因此，这些结果表明，在中度慢性心力衰竭中，与安慰剂相比，卡维地洛治疗后LV收缩功能改善但舒张功能未改善。
