β抑制剂与扩张性心肌病和中等范围喷射分数患者的逆重塑有关
Nobuyuki Enzan1, Shouji Matsushima1, Tomomi Ide1
1Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Japan.
概括
β抑制剂有效诱导左心室反向重塑 (LVRR) 在心力衰竭患者中等射出分数 (HFmrEF). 这种益处在心率较高或心房动的患者中尤其明显.
科学领域:
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
- 临床医学 临床医学
背景情况:
- 已知β阻塞剂在心力衰竭中促进左心室逆转型改造 (LVRR) 以减少喷射率 (HFrEF) 的心力衰竭.
- 贝塔抑制剂在诱导中等射出分数 (HFmrEF) 的心力衰竭中LVRR的疗效仍然不太清楚.
研究的目的:
- 调查β-阻断剂是否可以在被诊断为HFmrEF的患者中诱导LVRR.
- 分析β-阻断剂治疗对该患者群体LVEF改善的影响.
主要方法:
- 对日本扩张性心肌病 (DCM) 患者的国家数据库 (2003-2014) 的分析.
- 包括40%至50%左右的左心室喷射分数 (LVEF) 患者,不包括没有两年随访心声图的患者.
- 倾向性得分匹配被用来创建可比较的β阻断剂使用者和非使用者群体,LVRR被定义为2年后≥10%的LVEF改善.
主要成果:
- 在3064名患者中,有602对匹配. 使用β-阻断剂与显著更高的LVRR率 (24.3%与17.8%,或1.48,P=0.006) 相关.
- 亚组分析显示,心率≥75次/小时 (OR2.61) 和心房动 (OR2.30) 的患者从β抑制剂中获得了更大的益处.
- 对心率 (P=0.002) 和心房动 (P=0.046) 观察到显著的相互作用,表明不同的治疗效应.
结论:
- β抑制剂在DCM和HFmrEF患者中有效诱导LVRR.
- 在HFmrEF中β抑制剂对LVRR的积极影响在心率较高和心房动的患者中更为明显.
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