在心力衰竭患者中提取β-阻塞剂和功能能力的改善,使用保存的喷射分数
Patricia Palau1, Rafael de la Espriella1, Julia Seller2
1Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain.
JAMA cardiology
|February 7, 2024
概括
在心力衰竭中停止服用β-阻塞剂,以保留喷射分数 (HFpEF) 的慢性无能症患者可以改善运动能力,特别是在左下心室末缩体积 (LVESV) 患者中. 需要进一步的研究.
科学领域:
- 心脏病学 心脏病学
- 心脏衰竭研究研究
- 临床试验 临床试验
背景情况:
- 增加心率 (HR) 是作为一种治疗心力衰竭的治疗方法,与保存的喷射分数 (HFpEF).
- 证据是相互矛盾的,受益最多的患者子组仍然不清楚.
- 慢性无能 (CI) 在HFpEF中很常见,影响HR对运动的反应.
研究的目的:
- 评估β阻断剂戒断与峰值氧气消耗 (VO2) 变化之间的关联.
- 为了评估这些变化通过索引左心室透静 (iLVEDV),静脉体积 (iLVESV) 和射出分数 (LVEF) 在HFpEF患者CI.
- 为了确定LV体积是否预测β阻断剂撤销的反应.
主要方法:
- 对PRESERVE-HR随机交叉试验的后期分析.
- 包括52名稳定的HFpEF患者 (NYHAII-III类) 接受β-抑制剂的CI.
- 患者接受了为期2周的β阻断剂戒断和延续,并进行交叉治疗.
主要成果:
- 取消β-阻断剂增加了30bpm的HR峰值 (P <.001).
- 停用β抑制剂与iLVESV中峰值VO2百分比的变化有差异性相关 (P相互作用=0.02).
- 在患有较低iLVESV的患者中,观察到VO2峰值的更大改善.
结论:
- 较低的ILVESV可以识别具有CI的HFpEF患者,这些患者从短期的β-阻断剂戒断中获益最多.
- 这一策略可以提高选择患者的最大功能能力.
- 需要进一步的研究来证实这些发现,并探索长期影响.
相关概念视频
01:22Heart Failure Drugs: β-Blockers
340
β-adrenergic antagonists, commonly known as β-blockers, block the effects of sympathetic neurotransmitters such as noradrenaline (NA) and adrenaline (ADR). They have several beneficial effects in heart failure treatment. They reduce heart rate, the force of contraction, and cardiac muscle relaxation. They also slow the atrial-ventricular conduction rate and raise the threshold for arrhythmias. The concentration of β-blockers determines their effects on bronchodilation,...
340
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
431
The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
431
01:22Heart Failure Drugs: Diuretics
381
Heart failure and kidney perfusion are interconnected in a complex way. Reduced renal perfusion and venous congestion are two significant factors that contribute to renal dysfunction in heart failure. The kidneys, primarily responsible for fluid balance in the body, are adversely affected due to compromised cardiac output and increased venous pressure. In response to reduced renal perfusion, the kidneys activate neurohumoral mechanisms to restore balance. However, these mechanisms can be...
381
01:17Pathophysiology of Heart Failure
1.6K
Heart failure (HF) is a progressive syndrome involving ventricles that leads to inadequate cardiac output. It can be classified based on location and output or ejection fraction. Ejection fraction (EF) is an essential measurement in the diagnosis and surveillance of HF. Reduced EF corresponds to systolic heart failure (HFrEF). However, HF with preserved ejection fraction (HFpEF) is becoming increasingly prevalent. Also known as diastolic HF, this form of HF is related to aging. The...
1.6K
01:27Adrenergic Antagonists: Pharmacological Actions of β-Receptor Blockers
803
β-receptor blockers significantly impact the cardiovascular system by counteracting catecholamine-induced sympathetic responses. These medications decrease heart rate, contractility, and cardiac output, potentially leading to cardiac depression, life-threatening bradycardia, and death. Therapeutically, β-blockers function as mild antihypertensives and are utilized in treating angina pectoris and cardiac arrhythmias. However, nonselective β-blockers inhibit β2-receptors in...
803
01:26Heart Failure Drugs: Inotropic Agents
588
Positive inotropic agents are commonly used as the first line of treatment for heart failure. One such agent is digoxin, derived from the genus Digitalis, which has been known for centuries but effectively utilized since 1785. However, these cardiac glycosides can have potentially toxic effects due to their mechanism of action, which involves inhibiting Na+/K+-ATPase and increasing contractility. Digoxin is absorbed orally and distributed in various tissues, including the CNS. It has a long...
588