扩张型心肌病心力衰竭病人卡维地洛治疗前后的冠脉血流储备评价

目的:利用无创腺苷激发经胸超声多普勒显像对卡维地洛治疗的扩张型心肌病心力衰竭病人冠脉血流储备(CFR)进行评价。方法:入选2004年6月至2005年6月因扩张型心肌病引起的慢性心力衰竭病人31例,在常规药物治疗基础上,加用卡维地洛至目标剂量或最大耐受剂量,治疗6mo。在卡维地洛治疗前后进行腺苷激发经胸超声多普勒显像检查,记录冠脉血流速度(CFV)及冠脉血流速度储备(CFVR),以CFVR评价CFR。结果:卡维地洛治疗前心力衰竭病人静息状态CFV与对照组无显著差别(P>0.05),最大冠脉扩张状态时CFV减低(P<0.05),CFVR较对照组明显下降(2.4±s0.3vs 3.2±0.4, P<0.05);治疗6mo后心力衰竭病人静息状态下CFV无明显改变(P>0.05)、最大充血状态时CFV升高(P<0.05),CFVR增加(2.7±0.3 vs 3.2±0.4,P<0.05);治疗后心力衰竭组CFV及CFVR与对照组比较仍有显著差别。结论:非选择性β受体阻滞剂卡维地洛能够改善扩张型心肌病心力衰竭病人的冠脉CFR,这可能也是β受体阻滞剂有效治疗扩张型心肌病的作用机制之一。

Evaluation of coronary flow reserve in patients with heart failure of dilated cardiomyopathy before and after treatment with carvedilol

AIM:To evaluate the coronary flow reserve(CFR)in patients with heart failure of dilated cardiomyopathy(DCM)by coronary flow imaging of transthoracic echocardiography.METHODS:Based on traditional treatments,31 patients with chronic heart failure of DCM were given carvedilol for 6 months.Before and after treatment,the coronary flow velocity(CFV)of left anterior descending (LAD) was measured with transthoracic doppler echocardiography during venous adenosine infusion at rest and hyperemia state and the coronary flow velocity reserve(CFVR)was calculated.CFR was evaluated by CFVR.RESULTS:There were no difference of CFV at rest between patients and controls before and after treatment(P>0.05).Compared with controls,patients with heart failure had lower CFV(P<0.05)at hyperemia state and lower CFVR(2.4±s 0.3 vs 3.2±0.4,P<0.05)before treatment,but had higher CFV(P<0.05)at hyperemia state and higher CFVR(2.7±0.3 vs 3.2±0.4,P<0.05)after treatment.CONCLUSION:As a non-selectiveβ-adrenoceptor agonists,carvedilol can improve CFR of patients with heart failure of DCM,which might be the mechanisms thatβ-adrenoceptor agonists is effective in the treatment of DCM.