Di Lenarda A, De Maria R, Gavazzi A, Gregori D, Parolini M, Sinagra G, Salvatore L, Longaro F, Bernobich E, Camerini F
Department of Cardiology, Ospedale Maggiore and University, Trieste, Italy.
Heart. 1998 Apr;79(4):337-44. doi: 10.1136/hrt.79.4.337.
To evaluate the additive effect of metoprolol treatment on long-term incidence of fatal and non-fatal cardiac events in idiopathic dilated cardiomyopathy.
586 patients with idiopathic dilated cardiomyopathy were prospectively enrolled in a multicentre registry and followed up for a mean (SD) of 52 (32) months. Metoprolol, carefully titrated to the maximum tolerated dose, was added to conventional heart failure treatment in 175 patients.
Survival and transplant-free survival at seven years were significantly higher in the 175 metoprolol treated patients than in the remaining 411 on standard treatment (81% v 60%, p < 0.001, and 69% v 49%, p < 0.001, respectively). By multivariate analysis, metoprolol independently predicted survival and transplant-free survival (relative risk reduction values for all cause mortality and combined mortality or transplantation 51% (95% confidence interval 21% to 69%), p = 0.002, and 34% (5% to 53%), p = 0.01, respectively). New York Heart Association class, left ventricular end diastolic diameter, and pulmonary wedge pressure were also predictive. Seven year survival (80% v 62%, p = 0.004) and transplant-free survival (68% v 51%, p = 0.005) were significantly higher in 127 metoprolol treated cases than in 127 controls selected from the entire control cohort and appropriately matched. Metoprolol was associated with a 30% reduction in all cause mortality (7% to 48%, p = 0.015) and a 26% reduction in mortality or transplantation (7% to 41%, p = 0.009).
The addition of metoprolol to standard heart failure treatment, including angiotensin converting enzyme inhibitors, was effective in the long-term, reducing both all cause mortality and transplantation in patients with idiopathic dilated cardiomyopathy.
评估美托洛尔治疗对特发性扩张型心肌病患者致命和非致命性心脏事件长期发生率的附加作用。
586例特发性扩张型心肌病患者前瞻性纳入一个多中心登记处，平均（标准差）随访52（32）个月。175例患者在常规心力衰竭治疗基础上加用美托洛尔，并仔细滴定至最大耐受剂量。
175例接受美托洛尔治疗的患者7年生存率和无移植生存率显著高于其余411例接受标准治疗的患者（分别为81%对60%，p<0.001；69%对49%，p<0.001）。多因素分析显示，美托洛尔可独立预测生存率和无移植生存率（全因死亡率和联合死亡率或移植的相对风险降低值分别为51%（95%置信区间21%至69%），p = 0.002；34%（5%至53%），p = 0.01）。纽约心脏协会心功能分级、左心室舒张末期直径和肺楔压也具有预测性。127例接受美托洛尔治疗的病例的7年生存率（80%对62%，p = 0.004）和无移植生存率（68%对51%，p = 0.005）显著高于从整个对照组中选取并适当匹配的127例对照。美托洛尔使全因死亡率降低30%（7%至48%，p = 0.015），使死亡率或移植率降低26%（7%至41%，p = 0.009）。
在包括血管紧张素转换酶抑制剂在内的标准心力衰竭治疗基础上加用美托洛尔，对特发性扩张型心肌病患者具有长期疗效，可降低全因死亡率和移植率。
