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首页> 外文期刊>Cardiovascular therapeutics >Chronotropic Incompentence and Functional Capacity in Chronic Heart Failure: No Role of β-Blockers and β-Blocker Dose
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Chronotropic Incompentence and Functional Capacity in Chronic Heart Failure: No Role of β-Blockers and β-Blocker Dose

机译：慢性心力衰竭中的慢性营养不良和功能能力：β-受体阻滞剂和β-受体阻滞剂剂量无作用

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Aim: To assess the effect of chronotropic incompetence on functional capacity in chronic heart failure (CHF) patients, as evaluated as NYHA and peak oxygen consumption (pVO 2), focusing on the presence and dose of β-blocker treatment. Methods: Nine hundred and sixty-seven consecutive CHF patients were evaluated, 328 of whom were discarded because they failed to meet the study criteria. Of the 639 analyzed, 90 were not treated with β-blockers whereas the other 549 were. The latter were further subdivided in high (n = 184) and low (n = 365) β-blockers daily dose group in accordance with an arbitrary cut-off of 25 mg for carvedilol and of 5 mg for bisoprolol. Failure to achieve 80% of the percentage of maximum age predicted peak heart rate (%Max PHR) or of HR reserve (%HRR) constituted chronotropic incompetence. Results: No differences were found in NYHA or pVO2 between patients with and without β-blockers and, similarly, between high and low β-blocker dose groups. Twenty and sixty-nine percent of not β-blocked patients showed chronotropic incompetence according to %Max PHR and %HRR, respectively, whereas this prevalence rose to 61% and 84% in those on β-blocker therapy. Patients taking β-blockers without chronotropic incompetence, as inferable from both %Max PHR and %HRR, showed higher NYHA and pVO2 regardless of drug dose, whereas, in not β-blocked patients, only %HRR revealed a difference in functional capacity. At multivariable analysis, HR increase during exercise (ΔHR) was the variable most strongly associated to pVO2 (β: 0.572; SE: 0.008; P 0.0001) and NYHA class (β: -0.499; SE: 0.001; P 0.0001). Conclusions: ΔHR is a powerful predictor of CHF severity regardless of the presence of β-blocker therapy and of β-blocker daily dose.
机译：目的：评估变时性功能不全对慢性心力衰竭（CHF）患者的功能能力的影响（以NYHA和峰值耗氧量（pVO 2）评估），重点在于β受体阻滞剂治疗的存在和剂量。方法：对967例连续性CHF患者进行了评估，其中328例因不符合研究标准而被丢弃。在分析的639种药物中，有90种未使用β受体阻滞剂治疗，而其他549种则没有。后者根据卡维地洛的25 mg和比索洛尔的5 mg的任意临界值进一步分为高（n = 184）和低（n = 365）的β受体阻滞剂日剂量组。未能达到最大年龄预测峰值心率（％Max PHR）或HR储备（％HRR）百分比的80％构成了变时能力。结果：在有和没有β-受体阻滞剂的患者之间，以及在高和低β-受体阻滞剂剂量组之间，NYHA或pVO2均无差异。根据％Max PHR和％HRR，分别有29％和69％的未受β阻滞的患者表现出变时功能不全，而接受β受体阻滞剂治疗的患病率上升至61％和84％。从％Max PHR和％HRR均可以推断出服用无变时性无力的β受体阻滞剂的患者，无论药物剂量如何，其NYHA和pVO2均升高，而在没有β受体阻滞的患者中，仅％HRR的患者表现出功能能力的差异。在多变量分析中，运动中的心率增加（ΔHR）是与pVO2（β：0.572; SE：0.008; P <0.0001）和NYHA类（β：-0.499; SE：0.001; P <0.0001）密切相关的变量。结论：无论是否存在β受体阻滞剂治疗和每日β受体阻滞剂剂量，ΔHR都是CHF严重程度的有力预测指标。

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