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Eur Heart J:LVEF降低的窦性心律心衰患者,β-受体阻滞剂能改善结局吗?

2018-01-26 王淳 环球医学

2018年1月,发表在《Eur Heart J》的一项由英国、意大利、荷兰、挪威等国科学家进行的meta分析,考察了β-受体阻滞剂用于射血分数降低、中程和正常的心衰的作用。

2018年1月,发表在《Eur Heart J》的一项由英国、意大利、荷兰、挪威等国科学家进行的meta分析,考察了β-受体阻滞剂用于射血分数降低、中程和正常的心衰的作用。

目前指南推荐左室射血分数(LVEF)40-49%的心衰患者应该同LVEF≥50%一样被管理。研究旨在考察双盲、随机、安慰剂-对照试验中根据LVEF的β-受体阻滞剂作用。

11项试验的个体患者数据进行meta分析,根据基线LVEF和心律进行分层(Clinicaltrials.gov:NCT0083244;PROSPERO:CRD42014010012)。主要结局是意向治疗分析下在中位随访期为1.3年的全因死亡率和心血管死亡率。对于14262名窦性心律患者,中位LVEF是27%(四分位间距21~33%),包括575名LVEF 40~49%的患者和244名≥50%的患者。β-受体阻滞剂同安慰剂组相比能降低窦性心律的全因死亡率和心血管死亡率,除LVEF≥50%的小型亚组外,其他LVEF分层的作用是一致的。对于LVEF40-49%,β-受体阻滞剂组21/292名患者(7.2%)死亡,而安慰剂组35/283名患者(12.4%)死亡;β-受体阻滞剂组13/292名患者(4.5%)发生心血管死亡,安慰剂组26/283名患者(9.2%);调整后HR 0.48(95%置信区间[CI],0.24~0.97)。随机分配(n=4601)后中位时间1.0年后,除LVEF≥50%外,窦性心律所有组中β-受体阻滞剂会增加LVEF。对于基线时房颤的患者(n=3050),当基线时<50%时β-受体阻滞剂会增加LVEF,但不会改善预后。

结果显示,β-受体阻滞剂能改善LVEF降低的窦性心律心衰患者的LVEF和预后。LVEF<40%的数据是最有力的,但与LVEF40-49%的患者亚组具有相同益处。

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    2018-10-01 zhyy88
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    2018-01-28 zhaojie88
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    2018-01-28 slcumt

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