TDI技术评价卡维地洛对高血压患者左室舒张功能的影响

目的:应用组织多普勒显像(TDI)技术评价卡维地洛对高血压患者左室舒张功能的影响.方法:对30例高血压给予卡维地洛治疗24周.治疗前、治疗后12周、24周用TDI技术测量左室收缩期二尖瓣环平均舒张早期运动速度(Ea)、舒张晚期运动速度(Aa)及Ea/Aa,并与血流多普勒指标E波速度(E)、A波速度(A)、E/A进行比较,观察降压效果及对左室舒张功能的影响.结果:卡维地洛治疗12周后收缩压(SBP)、舒张压(DBP)、心率(HR)均较治疗前下降(P＜0.05),Ea、Ea/Aa均较治疗前升高(P＜0.05),治疗24周后E、E/A较治疗前升高(P＜0.05),Aa较治疗前降低(P＜0.05),Ea、Ea/Aa有进一步改善的趋势(P＜0.05).结论:TDI技术在评价左室舒张功能方面较二尖瓣血流频谱更敏感;卡维地洛对轻、中度高血压具有良好的降压作用,且能改善患者左室舒张功能.     

卡维地洛治疗慢性充血性心力衰竭40例临床分析

目的评价卡维地洛治疗慢性心力衰竭（CHF）的临床疗效。方法将76例CHF患者随机分为两组，常规治疗组36例，应用洋地黄、利尿剂、血管紧张素转换酶抑制剂、硝酸酯类药物治疗；卡维地洛治疗组40例，在常规治疗病情稳定基础上加用卡维地洛。治疗前后分别行超声心动图检查并对心功能（NYHA）分级、心率、血压进行比较分析。结果经过3个月的治疗，与常规治疗组比较，卡维地洛治疗组心功能、心搏量（SV）和左室射血分数（LVEF）明显改善，左室舒张末期内径（LVEDD）、收缩末期内径（LVESD）显著缩小。结论卡维地洛治疗CHF可显著改善患者心功能。     

卡维地洛治疗慢性心力衰竭疗效观察

目的研究卡维地洛治疗慢性心力衰竭的疗效及其耐受剂量,用药的安全性。方法患者87例心功能分级(NYHA)Ⅱ级15例,Ⅲ级61例,Ⅳ级11例;LVEF<45%。随机分成两组,入选患者病情基本稳定无明显液体潴留,在常规应用血管紧张素转换酶抑制剂、利尿剂、洋地黄基础上,由小剂量开始服用卡维地洛3.125mg,2次/d。可耐受者每2～4周增加剂量,直至患者的最大耐受量。目标剂量为50mg/d。随访时间为6～18个月,以核素心肌显像观察左室功能和容积。结果经过6～18个月的观察和治疗,卡维地洛组临床症状和心功能明显改善,LVEF增加,由(23.31±6.0)%增至(43.53±4.6)%(P=0.0012)。左室收缩末期容积由(146.31±30.32)ml减至(69.56±14.27)ml(P=0.0026)。左室舒张末期容积减少由(189.97±29.9)ml减至(117.92±19.14)ml(P=0.0037)。卡维地洛组有53例(60.9%)耐受目标剂量(50mg/d),用药中无特殊不良反应。最常见的不良反应是头晕,未出现肝、肾功能损害及血脂、血糖、电解质和血象的变化。结论在心力衰竭标准治疗基础上应用卡维地洛,可以提高射血分数,缩小扩大的心室腔,改善心功能,改善心室重塑,用药安全、有效。     

Do beta-blockers prolong survival in heart failure only by inhibiting the beta1-receptor? A perspective on the results of the COMET trial

Experimental and clinical studies indicate that carvedilol exerts multiple antiadrenergic effects in addition to beta(1)-receptor blockade, but the prognostic importance of these actions has long been debated. This controversy has now been substantially advanced by the results of the recently completed Carvedilol Or Metoprolol European Trial (COMET), which showed that carvedilol (25 mg twice daily) reduced mortality by 17% when compared with metoprolol (50 mg twice daily), P=.0017--a result that was consistent with the differences seen across earlier controlled trials with beta-blockers in survivors of an acute myocardial infarction and in patients with chronic heart failure. Questions have been raised about the interpretation of these findings in view of the fact that the trial did not use the dose or formulation of metoprolol that was shown to prolong life in a placebo-controlled trial (ie, Metoprolol CR/XL [Controlled Release] Randomized Intervention Trial in Heart Failure). Pharmacokinetic and pharmacodynamic analyses, however, indicate that the dosing regimen of metoprolol selected for use in the COMET trial produces a magnitude and time course of beta(1)-blockade during a 24-hour period that is similar to the dose of carvedilol targeted for use in the trial. These analyses suggest that the observed difference in the mortality effects of metoprolol and carvedilol is not related to a difference in the magnitude or time course of their beta(1)-blocking effects but instead reflect antiadrenergic effects of carvedilol in addition to beta(1)-blockade.     

卡维地洛治疗慢性充血性心力衰竭78例疗效观察

目的探讨卡维地洛治疗慢性充血性心力衰竭的临床疗效及安全性。方法患者78例,其中男42例,女36例,年龄(56±19)岁。心功能(NYHA)Ⅱ级28例,Ⅲ级44例,Ⅳ级6例。入院患者分为对照组、实验组,对照组均使用强心等抗心衰药物,实验组在对照组的基础上加用卡维地洛(3.125mg,2次/日~25mg,2次/日)治疗3个月观察其疗效。结果实验组有效率94.9%,对照组有效率66.7%,实验组有效率明显高于对照组。结论卡维地洛治疗慢性充血性心力衰竭能明显改善心功能,副作用小。     

国内卡维地洛与拉贝洛尔治疗轻中度高血压随机对照试验的Meta分析

目的 评价卡维地洛与拉贝洛尔治疗轻中度高血压的疗效与安全性的差异。方法 对国内有关卡维地洛与拉贝洛尔治疗轻中度高血压的随机对照研究资料进行全面调研；在严格的质量评价基础上，利用RevMan4．1软件对7项随机对照临床试验的结果进行Meta分析。根据研究间异质性检验结果，采用相应的模型分析：固定效应模型或随机效应模型。结果 （1）卡维地洛与拉贝洛尔治疗轻中度高血压有效率的合并检验分析，综合检验结果为：Z=2．08，P=0．04，合并OR=1．53，95％可信区间为（1．03，2．29）；（2）敏感性分析显示结果可靠性较好，漏斗图分析结果未发现显著偏倚；（3）两组药物治疗前后舒张压差值的比较综合检验结果：Z=3．02，P=0．002，权重均数差（WMD）=1．65（0．58，2．71）；（4）两组药物治疗前后收缩压差值的比较综合检验结果：Z=0．08，P=0．9，WMD=0．29（-6．66，7．24）；（5）两组药物治疗前后心率差值的比较综合检验结果：Z=0．78，P=0．4，WMD=1．62（-2．46，5．69）；（6）两组不良反应发生率的比较综合检验结果：Z=-1．22，P=0．2，合并OR=0．79，95％可信区间为（0．55，1．15）。结论 卡维地洛治疗轻中度高血压的总有效率高于拉贝洛尔，尤其对舒张压的下降幅度更大；目前国内在治疗轻中度高血压的临床试验中，设计仍不够严谨。     

卡维地洛+生脉注射液治疗慢性心力衰竭120例疗效观察

目的:观察卡维地洛+生脉注射液治疗慢性心力衰竭的临床疗效及安全性。方法:120例患者随机分组分为卡维地洛+生脉注射液治疗组(A组)和倍他乐克治疗组(B组)。两者均常规应用洋地黄、利尿剂、血管紧张素转换酶抑制剂、硝酸酯类等药物。A组在常规治疗的基础上加卡维地洛2.5mg,2次/d开始,每2周递增1次,直至最大量20mg,2次/d,稳定剂量维持6个月,并应用生脉注射液40mL加入250mL液体中静滴,每日1次,共2周。B组在常规治疗的基础上加用倍他乐克6.25mg每天2次开始,每2周递增1次,最大量为50mg每天2次,稳定剂量维持6个月。每周测量血压、心率、评定心功能、治疗前后查超声心动图、记录不良反应。结果:卡维地洛+生脉注射液治疗组心功能分级、左室射血分数(LVEF)明显升高,左室舒张末内径(LVEDD)和收缩末期内径(LVESD)明显降低(P<0.01),心率减慢(P<0.01),血压下降(P<0.01),与对照组相比差异有显著性。结论:卡维地洛+生脉注射液治疗慢性心力衰竭能改善心功能,改善左室重塑,安全有效,生脉注射液能提高重度心力衰竭患者对卡维地洛的耐受性。     

卡维地洛与美托洛尔治疗慢性充血性心力衰竭疗效观察

目的:探讨卡维地洛及美托洛尔在治疗慢性充血性心力衰竭(CHF)中的疗效比较.方法:将200例患者随机分为两组,分别给予卡维地洛及美托洛尔治疗.随访3年,观测两组的心功能分级(NYHA-FC),左室射血分数(LVEF)及6分钟步行距离.结果:两组在改善心功能、LVEF及6分钟步行距离,并不存在显著性差异.结论:卡维地洛和美托洛尔在治疗CHF中效果近似.     

Use of <Superscript>123</Superscript>I-MIBG scintigraphy to assess the impact of carvedilol on cardiac adrenergic neuronal function in childhood dilated cardiomyopathy

Iodine-123 metaiodobenzylguanidine (MIBG) cardiac scintigraphy is a useful tool for the assessment of cardiac adrenergic neuronal function, which is impaired in children with idiopathic dilated cardiomyopathy (DCM). In adults with DCM, long-term treatment with carvedilol improves both cardiac adrenergic neuronal function and left ventricular function. The aim of this prospective study was to evaluate the impact of carvedilol on cardiac adrenergic neuronal function using ¹²³I-MIBG scintigraphy and on left ventricular function using equilibrium radionuclide angiography in children with DCM. Seventeen patients (11 female, six male; mean age 39±57 months, range 1–168 months) with DCM and left ventricular dysfunction underwent ¹²³I-MIBG cardiac scintigraphy and equilibrium radionuclide angiography before and after a 6-month period of carvedilol therapy. A static anterior view of the chest was acquired 4 h after intravenous injection of 20–75 MBq of ¹²³I-MIBG. Cardiac neuronal uptake of ¹²³I-MIBG was measured using the heart to mediastinum count ratio (HMR). Radionuclide left ventricular ejection fraction (LVEF) was assessed following a standard protocol. MIBG cardiac uptake and left ventricular function respectively increased by 38% and 65% after 6 months of treatment with carvedilol (HMR=223%±49% vs 162%±26%, P<0.0001, and LVEF=43%±17% vs 26%±11%, P<0.0001). Carvedilol can improve cardiac adrenergic neuronal and left ventricular function in children with dilated cardiomyopathy. Further studies are needed to assess the relationship between improvement in MIBG cardiac uptake and the beneficial effects of carvedilol on morbidity and mortality.     

Carvedilol blockade of rat myocardial alpha1-adrenoceptors

Carvedilol is a combined alpha(1)- and beta-adrenoceptor antagonist. The ability of carvedilol to antagonize functional effects mediated through myocardial alpha(1)-adrenoceptors has never been investigated. We tested the ability of carvedilol to antagonize the inotropic effect mediated by myocardial alpha(1)-adrenoceptors compared to the antagonism of beta-adrenoceptors. Papillary muscles from rat heart left ventricle were mounted in an organ bath and concentration-response experiments for the inotropic effects of separate alpha(1)- and beta-adrenoceptor stimulation were performed in the absence and presence of carvedilol. Carvedilol antagonized myocardial alpha(1)-adrenoceptors with an inhibition constant (K(i)) of 11.0+/-3.0 nmol/l and the functional experiments were supported by radioligand-binding studies. Corresponding functional studies on the response to beta-adrenoceptor stimulation revealed a K(i) of 1.2+/-0.35 nmol/l. Thus, carvedilol antagonizes the myocardial alpha(1)-adrenoceptors with a 9-fold lower potency than the beta-adrenoceptors. Antagonism of myocardial alpha(1)-adrenoceptor evoked effects may contribute to clinical effects of carvedilol.