Talwar K K, Bhargava B, Upasani P T, Verma S, Kamlakar T, Chopra P
Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
J Card Fail. 1996 Dec;2(4):273-7. doi: 10.1016/s1071-9164(96)80013-3.
Fifty-six patients with dilated cardiomyopathy (DCM) (aged 14-68 years) and background therapy of angiotensin-converting enzyme inhibitors, diuretics, and digoxin were given an initial challenge of propranolol in gradually increasing doses. These patients were studied noninvasively and hemodynamically and subjected to right ventricle biopsy.
Forty-four patients tolerated propranolol and received the drug for 6 months; 12 patients deteriorated after starting the drug with worsening of congestive heart failure and/or hypotension. The patients who did not tolerate propranolol had higher left ventricular end-diastolic dimension (73 +/- 8 vs 66 +/- 8 mm, P < .05), and severe mitral regurgitation was more common. Hemodynamically these patients had higher heart rate, right ventricular end-diastolic pressure, mean pulmonary artery pressure, mean pulmonary artery wedge pressure, and left ventricular end-diastolic pressure (102 +/- 16 vs 89 +/- 12 beats/min, 15 +/- 7 vs 9 +/- 4, 39 +/- 16 vs 31 +/- 12, 28 +/- 8 vs 21 +/- 8, 28 +/- 8 vs 22 +/- 8 mmHg, respectively, P < .01). These patients had a significantly lower cardiac index (1.9 +/- 0.6 vs 2.5 +/- 0.6 L/min/m2, P < .01). Forty patients completed 6 months follow-up evaluation and were further subjected to repeat noninvasive and hemodynamic study. There was a significant improvement in New York Heart Association class, cardiothoracic ratio, and left ventricular end-diastolic dimension (68% vs 62%, 66 +/- 8 vs 62 +/- 7 mm, respectively, P < .01), while the ejection fraction (EF) rose from 23 to 35% (P < .001). Hemodynamically, there was a significant decrease in heart rate, right ventricular end-diastolic pressure, mean pulmonary artery pressure, mean pulmonary artery wedge pressure, and left ventricular end-diastolic pressure (91 +/- 14 vs 71 +/- 5 beats/min, 9 +/- 4 vs 5 +/- 3, 32 +/- 11 vs 22 +/- 7, 25 +/- 9 vs 17 +/- 8, 21 +/- 7 vs 14 +/- 4 mmHg, P < .05). The cardiac index rose from 2.3 +/- 0.6 to 3.2 +/- 0.7 L/min/m2 (P < .01).
Propranolol in dilated cardiomyopathy is associated with significant intolerance. Those who tolerate propranolol seem to have long-term beneficial effects. This study is limited as it is uncontrolled and nonrandomized.
56例扩张型心肌病（DCM）患者（年龄14 - 68岁），接受血管紧张素转换酶抑制剂、利尿剂和地高辛作为背景治疗，给予逐渐增加剂量的普萘洛尔进行初始挑战。对这些患者进行了非侵入性和血流动力学研究，并进行了右心室活检。
44例患者耐受普萘洛尔并接受该药治疗6个月；12例患者在开始用药后病情恶化，出现充血性心力衰竭和/或低血压加重。不耐受普萘洛尔的患者左心室舒张末期内径更大（73±8 vs 66±8 mm，P <.05），重度二尖瓣反流更常见。血流动力学方面，这些患者心率、右心室舒张末期压力、平均肺动脉压、平均肺动脉楔压和左心室舒张末期压力更高（分别为102±16 vs 89±12次/分钟，15±7 vs 9±4，39±16 vs 31±12，28±8 vs 21±8，28±8 vs 22±8 mmHg，P <.01）。这些患者的心指数显著更低（1.9±0.6 vs 2.5±0.6 L/分钟/平方米，P <.01）。40例患者完成了6个月的随访评估，并进一步接受重复的非侵入性和血流动力学研究。纽约心脏协会心功能分级、心胸比和左心室舒张末期内径有显著改善（分别为68% vs 62%，66±8 vs 62±7 mm，P <.01），而射血分数（EF）从23%升至35%（P <.001）。血流动力学方面，心率、右心室舒张末期压力、平均肺动脉压、平均肺动脉楔压和左心室舒张末期压力显著降低（91±14 vs 71±5次/分钟，9±4 vs 5±3，32±11 vs 22±7，25±9 vs 17±8，21±7 vs 14±4 mmHg，P <.05）。心指数从2.3±0.6升至3.2±0.7 L/分钟/平方米（P <.01）。
扩张型心肌病患者使用普萘洛尔存在显著不耐受情况。耐受普萘洛尔的患者似乎有长期有益作用。本研究存在局限性，因为它未设对照且未随机分组。
