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Xue Shuren Zhang Xueyu Wang Chong Wang Caixia Between Manchu Liuzhuo Min Xu-Yun Lee is too dry Abstract Objective To observe metoprolol on dilated cardiomyopathy on long-term efficacy and prognosis. Methods 100 patients with dilated cardiomyopathy were confirmed by echocardiography and cardiac X ray confirmed the three films, according to treatment randomly divided into A, B groups, A group of 50 patients given metoprolol 25 ~ 100 mg / d, B serving the same dose group of 50 patients placebo treatment groups based on similarities. Regularly to the clinic follow-up, taking a long-term adherence to 4 years, the average time for medication 494 days, at least 1 year after follow-up echocardiography were to determine the efficacy end point was mortality and clinical heart function. The results of metoprolol to patients with dilated heart rate, heart function improved, echocardiography showed left ventricular end diastolic diameter reed and reduced left atrial diameter, left ventricular ejection fraction increased. 1 year follow-up compared with the control group had no reduction of mortality, but the deterioration of heart function was significantly less than the control group. Long-term follow-up significantly improved survival compared with the control group. Conclusion In patients with dilated cardiomyopathy metoprolol can stick with long-term improvement of cardiac function, improved quality of life and improve prognosis. Key words: cardiac disease, congestive metoprolol Me


toprolol for the selective 1-receptor blockers, for the observation of dilated cardiomyopathy drug efficacy and the impact of its long-term prognosis, this study, metoprolol 50 cases of dilated cardiomyopathy , a separate control group of 50 patients were followed up for 1 to 4 years are summarized below.55 mm, left ventricular ejection fraction (LVEF) * 132 2.4 * 54.7 6.6 * 38.7 3.5 34.1 4.1 * 36.7 3.1 * 91.9 6.7 120 3.8 57.0 4.0 42.5 3.0 35.4 2.8 30.8 2.4 Note: * Compared with before treatment, P90 mm Hg. Therefore, the amount of principal with the treatment of the patient's age, weight, heart rate, blood pressure and it is set. 1,3,6,,48 were followed up during a month. Major record heart rate, blood pressure, cardiac function, quality of life questionnaire and medication compliance. Each case at least 1 year after follow-up echocardiography were evaluated. 3. The clinical therapeutic efficacy: markedly improved cardiac function refers to two, effective means to improve cardiac function in an invalid that no significant improvement in heart function. 1 year follow-up mortality refers to the death. Worsening symptoms of heart failure has been increasing means, such as seat cough, shortness of breath at rest, the lungs sound wet increase shall be repeated continuously hospitalized. 4. Echocardiography indices: left ventricular long axis obtained before and after treatment in the two-dimensional guided M-mode ultrasound measurement chart LVEDD, left ventricular end systolic diameter (LVESDD), left atrial diameter (LADD), frequency of 2.5 MHz probe . Calculated by Teichholz LVEF. 5. Statistical analysis: All the measured data with mean standard deviation, paired t test with a test. From March 1991 ~ March 1998 a total of 105 patients were enrolled in this study, but 5 patients because of persistent low blood pressure, heart failure symptoms worsen, and the reasons for poor compliance and withdrawal from the study, of which 3 cases of group A, B group 2 cases. Formal research program was selected and completed a total of 100 cases, and finally 1 case of treatment in March 1999 over a year. Before treatment the parameters of a good balance between the two groups the difference was not statistically significant. Metoprolol treatment services were added to improve heart function, improved quality of life, heart rate, cardiac ejection fraction and reduce the degree of improvement is better than conventional therapy plus placebo (Table 1). A group of markedly improved heart function in 25 cases (7 cases in which recovery workers), an improvement of heart function effectively in 18 cases, cardiac function deteriorated in 2 cases; and B group markedly improved heart function of 21 patients (to restore workers 3 cases), cardiac function improved in 16 cases of effective heart function deteriorated in 9 patients. Comparing the two groups deteriorated markedly and the number of cases were significantly different. Table 1 shows, A group after treatment, the LVEDD, LADD, LVEF values than before treatment were significantly different (P [1]. There are many studies suggest that, in the heart disease detection of autoantibodies in the diagnosis and treatment guidance, especially 1 receptor autoantibodies may be the long-term over stimulation of myocardial damage caused by one of the reasons, the treatment of cardiomyopathy gradually from simple to correct hemodynamic disorders caused by myocardial injury and move to the expansion of myocardial fibrosis and use of energy barriers [2 ]. blockers can correct abnormal gene expression, improving myocardial energy metabolism [3,4], inhibition of excessive release of catecholamines in the circulatory system, to prevent calcium overload in myocardial cells myocardial damage [5]. upregulated myocardial cells -receptor and to restore their sensitivity to inhibition of excessive activation of the renin - angiotensin - aldosterone system, the peripheral vasodilation, reduce sodium and water retention, reducing the heart before and after the load [6]. The study found that some patients a few days in the metoprolol in the treatment of cardiac dysfunction indeed increased, but insisted that taking more than 1 month before treatment can be restored to the level of 3 to 5 months after the cardiac function improved quality of life increased. This suggests that reduced cardiac function early after administration of the drug's pharmacological effects are negative inotropic effect that the late improvement of cardiac function to play the drug at the cellular level biological effects. Although metoprolol on mortality in this group of patients 1 year did not change significantly, but the results prove that long term use of -blocker metoprolol on dilated cardiomyopathy favorable long-term disease outcome. It allows patients with heart rate, heart function improved quality of life improved significantly. Echocardiography showed a left ventricular end diastolic diameter of left atrial diameter compared with the control group reduced the proportion of the increase, LVEF was significantly increased. The results also suggest that this group of metoprolol in the treatment of dilated cardiomyopathy with heart failure may reduce the amount of digoxin. Digoxin, mainly through the vagus nerve to control the excited heart rate, and sympathetic nerve activity due to rapid heart rate caused by excessive often ineffective. Add services Metoprolol can inhibit sympathetic nerve activity, quickly reduce the heart rate too fast, so that ventricular diastolic filling full and active diastolic function improved. During metoprolol treatment of myocardial disease should not suddenly stop, this group of patients in stable condition after a small number of self-withdrawal rebound to the disease, continue taking 2 weeks to 1 month after the disease was able to stabilize. But the treatment of a highly atrioventricular block, heart rate less than 50 times / min are advised to stop. Fund: funded research project in Shanxi Province Xue Shuren (030001 Taiyuan, Shanxi Province, Department of Cardiology, Cardiovascular Research Institute) Zhang Xueyu (030001 Taiyuan, Shanxi Province, Department of Cardiology, Cardiovascular Research Institute) Wang Chong (030001 Taiyuan, Shanxi Province, Department of Cardiology, Cardiovascular Research Institute) WANG Cai-xia (030001 Taiyuan, Shanxi Province, Department of Cardiology, Cardiovascular Research Institute) Between Manchu (030001 Taiyuan, Shanxi Province, Department of Cardiology, Cardiovascular Research Institute) Liu Zhuomin (030001 Taiyuan, Shanxi Province, Department of Cardiology, Cardiovascular Research Institute) Xu-too (030001 Taiyuan, Shanxi Province, Department of Cardiology, Cardiovascular Research Institute) Lee Yun dry (030001 Taiyuan, Shanxi Province, Department of Cardiology, Cardiovascular Research Institute) 1, Communal C, Singh K, Pimental DR, et al. The -adrenergic pathway mediates norepinephrine stimulated apoptosis in vitro in adult rat cardiac myocytes. Circulation, 1997, 96 (Suppl): 226-23 2, Wagstein F. Adrenergic beta-blocking agents in congestive heart failure due to idiopathic dilated cardiomyopathy. Eur Heart J, 1995, 16 (Suppl): 128-13 3, Tominaga M, Matsumor A, Okada I, et al. -blockers treatment of dilated cardiomyopathy. Circulation, 21-202 4, Hjlamaeson A, Wagstein F. The role of beta-blockers in the treatment of cardiomyopathy. Drugs, 1994, 47 (Suppl): 37c-45c. 5, Magnusson Y, Marullo S, Hoyer S, et al. Mapping of a functional autoimmune epitope on the 1-adrenergic receptor in patients with idiopathic dilated cardiomyopathy. J Clin Invest, 58-166 6, Karl Swed berg. Initial experience with beta-blockers in dilated cardiomyopathy. Am J Cardiol, 1993, 71 (Suppl): 30c-38c. (Article Journal of Cardiology 2000, Vol 28 No. 3)


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