伊伐布雷定治疗低血压状态射血分数降低的心力衰竭患者的疗效和安全性  

Efficacy and safety of ivabradine in treatment of heart failure patients with reduced ejection fraction under hypotension

作　　者：王丹 李馨 秦宗磊 WANG Dan;LI Xin;QIN Zong-lei(Department of Cardiology,Chongqing Red Cross Hospital,CHONGQING 400020,China)

机构地区：[1]重庆市红十字会医院心血管内科,重庆400020

出　　处：《中国新药与临床杂志》2022年第1期47-51,共5页Chinese Journal of New Drugs and Clinical Remedies

基　　金：重庆市科卫联合项目资助(2020FYYX101)。

摘　　要：目的探讨伊伐布雷定治疗低血压状态射血分数降低的心力衰竭(HFrEF)患者的疗效及安全性。方法采用开放、前瞻性队列研究,纳入126例低血压状态HFrEF患者,根据是否使用伊伐布雷定分为常规治疗组(n=73)和伊伐布雷定组(n=53),共治疗180 d。主要终点为患者因心脏疾病住院或再发心力衰竭等心血管事件的累积发生率,次要终点包括6 min步行试验(6MWT)距离、氨基末端脑钠肽前体(NT-proBNP)水平和心功能改变。采用明尼苏达州心力衰竭生活问卷(MLWHFQ)评估患者生活质量,并记录安全性终点事件。结果治疗180 d后,伊伐布雷定组心血管事件的累积发生率较常规治疗组下降(9%vs.25%,P<0.05)。与治疗前相比,治疗后2组患者6MWT距离和左室射血分数(LVEF)均上升(P<0.05),NT-proBNP水平下降(P<0.01),伊伐布雷定组6MWT距离和LVEF高于常规治疗组,NT-proBNP水平低于常规治疗组(P<0.05)。治疗后常规治疗组和伊伐布雷定组MLWHFQ评分分别为(63.5±8.3)分和(73.6±8.8)分,均较治疗前显著升高(P<0.05),且伊伐布雷定组高于常规治疗组(P<0.05)。2组安全性终点事件发生率无显著差异(P>0.05)。结论伊伐布雷定能够减少低血压状态HFrEF患者心血管终点事件发生率,提高患者心功能,改善生活质量,且安全性较高。AIM To explore the efficacy and safety of ivabradine in the treatment of heart failure patients with reduced ejection fraction(HFrEF)under hypotension.METHODS This was an open-label,prospective cohort study.A total of 126 HFrEF patients under hypotension were divided into conventional treatment group(n=73)and ivabradine group(n=53),according to whether using ivabradine or not for 180 days treatment.The primary end point is the cumulative incidence of cardiovascular events such as the patient’s hospitalization for heart disease or recurrence of heart failure.The secondary endpoint included 6-minute walking test(6MWT)distance,the changes of N-terminal pro-brain natriuretic peptide(NT-proBNP)and the cardiac function.The quality of life was assessed by Minnesota living with heart failure questionnaire(MLWHFQ),and the safety endpoint events were recorded.RESULTS After 180 days of treatment,the cumulative incidence of cardiovascular events in the ivabradine group was lower than that in the conventional treatment group(9%vs.25%,P<0.05).Compared with before treatment,the 6MWT distance and the left ventricular ejection fraction(LVEF)in both groups increased after 180 days of treatment(P<0.05),but the NT-proBNP level decreased(P<0.01).The 6MWT distance and LVEF in the ivabradine group and NT-proBNP was lower than those in the conventional treatment group(P<0.05).After the treatment,MLWHFQ scores of the conventional treatment group and ivabradine group were(63.5±8.3)points and(73.6±8.8)points,respectively,which were significantly higher than those before the treatment(P<0.05),and the ivabradine group was higher than the conventional treatment group(P<0.01).There was no significant difference in the incidence of safety endpoint events between the two groups(P>0.05).CONCLUSION Ivabradine can reduce the cumulative incidence of cardiovascular events in HFrEF patients with hypotension,improve cardiac function and quality of life,and is safe.

关 键 词：伊伐布雷定 心力衰竭 生活质量 低血压 

分 类 号：R972[医药卫生—药品]