Bisoprolol in idiopathic pulmonary arterial hypertension: an explorative study

被引:91
作者
van Campen, Jasmijn S. J. A. [1 ]
de Boer, Karin [2 ]
van de Veerdonk, Marielle C. [1 ,2 ]
van der Bruggen, Cathelijne E. E. [1 ]
Allaart, Cor P. [2 ]
Raijmakers, Pieter G. [3 ]
Heymans, Martijn W. [4 ]
Marcus, J. Tim [5 ]
Harms, Hendrik J. [1 ,3 ]
Handoko, M. Louis [2 ]
de Man, Frances S. [1 ,6 ]
Noordegraaf, Anton Vonk [1 ]
Bogaard, Harm-Jan [1 ,6 ]
机构
[1] Vrije Univ Amsterdam Med Ctr, Inst Cardiovasc Res, Dept Pulm Med, Amsterdam, Netherlands
[2] Vrije Univ Amsterdam Med Ctr, Inst Cardiovasc Res, Dept Cardiol, Amsterdam, Netherlands
[3] Vrije Univ Amsterdam Med Ctr, Dept Nucl Med & PET Res, Amsterdam, Netherlands
[4] Vrije Univ Amsterdam Med Ctr, Dept Epidemiol, Amsterdam, Netherlands
[5] Vrije Univ Amsterdam Med Ctr, Dept Phys & Med Technol, Amsterdam, Netherlands
[6] Vrije Univ Amsterdam Med Ctr, Inst Cardiovasc Res, Dept Physiol, Amsterdam, Netherlands
关键词
POSITRON-EMISSION-TOMOGRAPHY; SYMPATHETIC-NERVOUS-SYSTEM; HEART-RATE-VARIABILITY; BETA-BLOCKER THERAPY; VENTRICULAR DYSFUNCTION; DOUBLE-BLIND; FAILURE; OUTCOMES; REGISTRY; METABOLISM;
D O I
10.1183/13993003.00090-2016
中图分类号
R56 [呼吸系及胸部疾病];
学科分类号
100201 [内科学];
摘要
While beta-blockers are considered contraindicated in pulmonary arterial hypertension (PAH), the prognostic significance of sympathetic nervous system over-activity suggests a potential benefit of beta-blocker therapy. The aim of this randomised, placebo-controlled, crossover, single centre study was to determine the effects of bisoprolol on right ventricular ejection fraction (RVEF) in idiopathic PAH (iPAH) patients. Additional efficacy and safety parameters were explored. Patients with optimally treated, stable iPAH (New York Heart Association functional class II/III) were randomised to placebo or bisoprolol. Imaging and functional measurements were performed at baseline, crossover and end of study. 18 iPAH patients were included, because inclusion faltered before enrolment of the targeted 25 patients. 17 patients completed 6 months of bisoprolol, 15 tolerated bisoprolol, one patient required intravenous diuretics. Bisoprolol was associated with a lower heart rate (17 beats per minute, p= 0.0001) but RVEF remained unchanged. A drop in cardiac index (0.5 L center dot min(-1) center dot m(-2), p= 0.015) was observed, along with a trend towards a decreased 6-min walking distance (6MWD). Although careful up-titration of bisoprolol was tolerated by most patients and resulted in a decreased heart rate, no benefit of bisoprolol in iPAH was demonstrated. Decreases in cardiac index and 6MWD suggest a deteriorated cardiac function. The results do not favour the use of bisoprolol in iPAH patients.
引用
收藏
页码:787 / 796
页数:10
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