Doughty R N, Whalley G A, Gamble G, MacMahon S, Sharpe N
Department of Medicine, University of Auckland, New Zealand.
J Am Coll Cardiol. 1997 Apr;29(5):1060-6. doi: 10.1016/s0735-1097(97)00012-0.
The aim of this study, a substudy of the Australia-New Zealand trial of carvedilol in patients with heart failure due to ischemic heart disease, was to determine the effects of this treatment on left ventricular size and function with the use of quantitative two-dimensional (2D) echocardiography.
Beta-adrenergic blocking drugs have been shown to improve left ventricular ejection fraction in patients with heart failure due to either ischemic heart disease or idiopathic dilated cardiomyopathy. However, the effects of such treatment on left ventricular size remain uncertain.
One hundred twenty-three patients from 10 centers in New Zealand and Australia participated in the 2D echocardiographic substudy. Echocardiography was performed before randomization and was repeated after 6 and 12 months of treatment. Left ventricular end-diastolic and end-systolic volumes were measured from apical four- and two-chamber views with the use of a modified Simpson's rule method.
After 12 months, heart rate was 8 beats/min lower in the carvedilol than in the placebo group, whereas left ventricular end-diastolic and end-systolic volumes were increased in the placebo group but reduced in the carvedilol group. At 12 months, left ventricular end-diastolic volume index was 14 ml/m2 less in the carvedilol than in the placebo group (p = 0.0015); left ventricular end-systolic volume index was 15.3 ml/m2 less (p = 0.0001), and left ventricular ejection fraction was 5.8% greater (p = 0.0015).
In patients with heart failure due to ischemic heart disease, carvedilol therapy for 12 months reduced left ventricular volumes, increased left ventricular ejection fraction and prevented progressive left ventricular dilation. These changes demonstrate a beneficial effect of carvedilol on left ventricular remodeling in heart failure. The observed changes may explain in part the improved clinical outcomes produced by treatment with carvedilol.
本研究是澳大利亚 - 新西兰对缺血性心脏病所致心力衰竭患者进行的卡维地洛试验的子研究，旨在通过定量二维（2D）超声心动图确定该治疗对左心室大小和功能的影响。
β - 肾上腺素能阻滞剂已被证明可改善缺血性心脏病或特发性扩张型心肌病所致心力衰竭患者的左心室射血分数。然而，这种治疗对左心室大小的影响仍不确定。
来自新西兰和澳大利亚10个中心的123名患者参与了二维超声心动图子研究。在随机分组前进行超声心动图检查，并在治疗6个月和12个月后重复检查。使用改良的辛普森法则从心尖四腔和两腔视图测量左心室舒张末期和收缩末期容积。
12个月后，卡维地洛组的心率比安慰剂组低8次/分钟，而安慰剂组的左心室舒张末期和收缩末期容积增加，卡维地洛组则减少。在12个月时，卡维地洛组的左心室舒张末期容积指数比安慰剂组少14 ml/m²（p = 0.0015）；左心室收缩末期容积指数少15.3 ml/m²（p = 0.0001），左心室射血分数高5.8%（p = 0.0015）。
在缺血性心脏病所致心力衰竭患者中，卡维地洛治疗12个月可减少左心室容积，增加左心室射血分数，并防止左心室进行性扩张。这些变化表明卡维地洛对心力衰竭患者左心室重构有有益作用。观察到的变化可能部分解释了卡维地洛治疗所产生的改善的临床结局。
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