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作 者:刘颖娴[1] 宋彦君 陈未[1] 林雪[1] 赖晋智[1] 黎婧怡 吴炜[1] LIU Ying-xian;SONG Yan-jun;CHEN Wei;LIN Xue;LAI Jin-zhi;LI Jing-yi;WU Wei(Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences &Peking Union Medical College, Beijing 100730, China)
机构地区:[1]中国医学科学院北京协和医学院北京协和医院心内科,北京100730
出 处:《基础医学与临床》2021年第11期1637-1642,共6页Basic and Clinical Medicine
基 金:国家自然科学基金(82000470)。
摘 要:目的探讨伊伐布雷定对不同病因非缺血性心力衰竭(HF,简称心衰)患者的临床疗效。方法对2018年1月至2020年2月在北京协和医院就诊、左室射血分数(LVEF)小于50%,且服用伊伐布雷定至少3个月的非缺血性心衰患者进行单中心回顾性病例分析。结果38例患者(男性24例)中位年龄31.5(26.0~44.0)岁,分为原发性(n=17)与继发性(n=21)心肌病两组。伊伐布雷定起始剂量为5 mg/d的患者最多(65.8%),3月后耐受剂量为10~15 mg/d的患者比例为57.9%,停药6例。整体患者平均心率从(93.7±13.5)次/min降至(75.9±12.4)次/min,其中继发性心肌病组从(99.0±11.4)次/min降至(78.6±13.8)次/min(P<0.001),血压无显著变化。治疗后,两组的纽约心脏病协会(NYHA)心功能分级、左室舒张末内径及LVEF均显著改善(P<0.05)。中位随访9.5个月,其中死亡4例,均为继发性心肌病患者;心衰再入院13例,其中继发性心肌病组10例,高于原发性心肌病组(47.6%vs 17.6%)(P<0.001);仅有1例患者出现伊伐布雷定相关的心动过缓。结论伊伐布雷定能够安全有效应用于非缺血性心衰患者,减慢心率并改善心功能。尤其适用于系统性疾病伴窦性心动过速的继发性心衰患者。Objective To investigate the efficacy and safety of ivabradine on cardiomyopathy and heart failure(HF)with non-ischemic etiology.Methods A single-center retrospective study was carried out.Patients who admitted to Peking Union Medical College Hospital from January 2018 to February 2020,with non-ischemic heart failure,left ventricular ejection fraction(LVEF)less than 50%,and treatment of ivabradine for at least 3 months were enrolled.Results Thirty-eight patients(24 males),with a median age of 31.5(26.0-44.0)years old,were divided into primary(n=17)and secondary(n=21)cardiomyopathies groups.Ivabradine of 5 mg/d was taken in 65.8%of the patients as the initial dose,and 10-15 mg/d was tolerated in 57.9%of patients after 3 months.Six patients withdrew the ivabradine treatment.The mean value of heart rates decreased from(93.7±13.5)beats/min to(75.9±12.4)beats/min after 3 months in all patients and from(99.0±11.4)beats/min to(78.6±13.8)beats/min in the group with secondary cardiomyopathies(P<0.001,respectively),while no significant changes in blood pressure were observed.NYHA classification,left ventricular end-diastolic diameter and LVEF were signifi-cantly improved in both groups after treatment(P<0.05).After a median follow-up of 9.5 months,4 patients died,all of them were patients with secondary cardiomyopathies;Thirteen patients with heart failure re-admitted to hospital,including 10 with secondary and 3 with primary cardiomyopathies(47.6%vs 17.6%,P<0.001).Only one case of ivabradine-related bradycardia was observed.Conclusions Ivabradine is safe and effective in patients with non-ischemic cardiomyopathy to control heart rates and to improve cardiac functions,especially for heart failure secondary to systemic diseases accompanied by sinus tachycardia.
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