Meister S G, Engel T R, Feitosa G S, Helfant R H, Frankl W S
Am Heart J. 1977 Dec;94(6):685-8. doi: 10.1016/s0002-8703(77)80207-x.
Patients with early symptomatic mitral stenosis usually suffer from pulmonary congestion on the basis of left atrial and pulmonary venous hypertension. They are often in sinus rhythm, and cardiac output is usually well maintained. Symptoms occur most often when heart rate, cardiac output, or both are increased. In this study, intravenous propranolol administered to patients with pure mitral stenosis in sinus rhythm resulted in significant reductions in mitral diastolic gradient (-7.1 mm. Hg +/- 1.6 SED), mean pulmonary wedge pressure (--6.9 mm. Hg +/- 1.2) and mean pulmonary artery pressures (--9.0 mm. Hg +/- 1.2). This was due to simultaneous reduction of heart rate (--13.0 beats/minute +/- 2.6 and cardiac output (--0.5 L./minute +/- 0.2). A small associated reduction of left ventricular systolic pressure (--5.1 mm. Hg +/- 2.6) was not accompanied by adverse clinical effects. A potential role for propranolol in medical management of pure mitral stenosis in the presence of sinus rhythm is suggested.
早期有症状的二尖瓣狭窄患者通常在左心房和肺静脉高压的基础上出现肺充血。他们常处于窦性心律，心输出量通常维持良好。症状最常出现在心率、心输出量或两者均增加时。在本研究中，对处于窦性心律的单纯二尖瓣狭窄患者静脉注射普萘洛尔，可使二尖瓣舒张期梯度显著降低（-7.1毫米汞柱±1.6标准误）、平均肺楔压（-6.9毫米汞柱±1.2）和平均肺动脉压（-9.0毫米汞柱±1.2）。这是由于心率同时降低（-13.0次/分钟±2.6）和心输出量降低（-0.5升/分钟±0.2）所致。左心室收缩压有小幅度的相关降低（-5.1毫米汞柱±2.6），但未伴有不良临床影响。提示普萘洛尔在窦性心律存在时对单纯二尖瓣狭窄的药物治疗中可能有作用。
