卡维地洛对不伴有心力衰竭的扩张型心肌病患者冠状动脉血流储备的影响

Effect of coronary flow reserve in patients with or without heart failure of dilated cardiomyopathy before and after the treatment of carvedilol

目的:利用无创经胸负荷超声心动图评价不伴有心力衰竭的扩张型心肌病(DCM)患者冠状动脉血流储备(CFR)以及卡维地洛治疗对其影响。方法:入选不伴有心力衰竭的DCM患者40例,正常对照组30例。DCM患者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,治疗前后行常规超声及负荷超声检测,并评价CFR。结果:①治疗前,DCM组较正常对照组左房内径、左室舒张末期内径明显增加,左室射血分数(LVEF)、二尖瓣舒张早期和晚期峰值血流速度比值减低(P<0.05);治疗1个月后各项指标与治疗前差异无统计学意义,而6个月后左房内径、左室舒张末期内径和LVEF有所改善,但与正常对照组仍有差异。②治疗前DCM组较正常对照组舒张期最大峰值血流速度(hCFV)和CFR降低(P<0.05)[hCFV:(63.72±5.81)∶(81.65±8.47)cm/s,P<0.05;CFR:2.57±0.31∶3.20±0.29,P<0.05];治疗1个月、6个月后hCFV和CFR均较治疗前升高(P<0.05),1个月后DCM组与正常对照组比较hCFV和CFR仍减低[hCFV:(70.75±6.08)∶(81.65±8.47)cm/s,P<0.05;CFR:2.81±0.30∶3.20±0.29,P<0.05],6个月后与正常对照组之间各指标差异无统计学意义[hCFV:(78.93±6.88)∶(81.65±8.47)cm/s,P>0.05;CFR:3.13±0.36∶3.20±0.29,P>0.05]。结论:不伴有心力衰竭的DCM者hCFV和CFR减低,经卡维地洛治疗1个月和6个月后均可有效改善;负荷超声检测CFR可以早期评价卡维地洛治疗效果。

Objective：To investigate the changes of coronary flow reserve （CFR） of patients without heart failure of dilated cardiomyopathy （DCM） by non-invasive transthoracic stress echocardiography before and after the treatment of carvedilol.Method：Forty patients without heart failure of DCM were involved. 30 healthy subjects with normal angiography and negative ECG exercise test served as controls. Based on traditional treatments,all patients were given enough carvedilol in 6 months,and echocardiography was checked in the first and sixth month. Doppler measurements of distal left anterior descending were recorded at rest and hyperemia state by adenosine infusion,and CFR was calculated before and after the treatment. Result：①Compared with controls,no HF group had larger LAd and LVDd,lower LVEF and E/A before treatment （P〈0.05）. LAd,LVDd and LVEF of no HF group didn＇t change after 1 month,but improved after 6 months （P〈0.05）. ② Compared with controls,no HF group had lower hCFV and CFR before treatment （hCFV[63.72±5.81] vs [81.65±8.47] cm/s,P〈0.05; CFR 2.57±0.31 vs 3.20±0.29,P〈0.05）. After treatment of carvedilol,hCFV and CFR of these two groups rised after 1 and 6 months. Although hCFV and CFR of no HF groups were still lower than that in control group after 1 month （hCFV [70.75±6.08] vs [81.65±8.47]cm/s,P〈0.05;CFR 2.81±0.30 vs 3.20±0.29,P〈0.05）,there were no difference between no HF group after 6 months of DCM and controls （hCFV [78.93±6.88] vs [81.65±8.47] cm/s,P〉0.05;CFR 3.13±0.36 vs 3.20±0.29,P〉0.05）.Conclusion：Patients without heart failure had lower CFR. As the third generation -β locker,carvedilol could not only reverse ventricular remodelingof DCM,but also improve CFR of these patients after treatment of 1 and 6 months. CFR by stress echocardiography could early evaluate the effect of carvedilol prior to the index of traditional echocardiography.