Negative chronotropic effect of beta-blockade therapy reduces myocardial oxygen expenditure for nonmechanical work

被引:35
作者
Yamakawa, H [1 ]
Takeuchi, M [1 ]
Takaoka, H [1 ]
Hata, K [1 ]
Mori, M [1 ]
Yokoyama, M [1 ]
机构
[1] KOBE UNIV,SCH MED,DEPT INTERNAL MED 1,CHUO KU,KOBE 650,JAPAN
关键词
heart failure; beta-adrenergic receptor blockade; heart rate; energetics;
D O I
10.1161/01.CIR.94.3.340
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background The negative chronotropic effect of beta-blocking agents is likely to provide hemodynamic and energetic advantages. However, the negative chronotropic effect on cardiac energetics observed on the initiation of beta-blockade therapy has not been fully elucidated. Methods and Results In 18 patients with hearth failure, left ventricular pressure and volume, external work (EW), myocardial oxygen consumption per beat (total Vo(2)), mechanical efficiency (EW/total Vo(2)), and Vo(2) for nonmechanical work (total Vo(2) - 2 EW) were measured with the use of conductance catheter and Webster catheter at the following three states under control conditions and after beta-blockade (0.15 +/- 0.07 mg/kg propranolol IV) with and without atrial pacing to keep the heart rate at control levels. Heart rate decreased after atrial pacing was stopped. EW decreased during beta-blockade with pacing and returned to the control level after pacing was stopped. Total Vo(2) did not change during beta-blockade with or without pacing, whereas Vo(2) for nonmechanical work increased with pacing and returned to the control level after pacing was stopped, As a result, mechanical efficiency decreased during beta-blockade with pacing and returned to the control level alter pacing was stopped. Conclusions The negative chronotropic effect of a beta-blocking agent may offset the mechanoenergetical deterioration resulting from its negative inotropic effect through a reduction in oxygen expenditure for nonmechanical work. These findings suggest that the negative chronotropic effect is an important aspect of beta-blockade therapy.
引用
收藏
页码:340 / 345
页数:6
相关论文
共 38 条
  • [1] IMPROVED EXERCISE HEMODYNAMIC STATUS IN DILATED CARDIOMYOPATHY AFTER BETA-ADRENERGIC-BLOCKADE TREATMENT
    ANDERSSON, B
    HAMM, C
    PERSSON, S
    WIKSTROM, G
    SINAGRA, G
    HJALMARSON, A
    WAAGSTEIN, F
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1994, 23 (06) : 1397 - 1404
  • [2] THE LINK BETWEEN ACUTE HEMODYNAMIC ADRENERGIC BETA-BLOCKADE AND LONG-TERM EFFECTS IN PATIENTS WITH HEART-FAILURE - A STUDY ON DIASTOLIC FUNCTION, HEART-RATE AND MYOCARDIAL-METABOLISM FOLLOWING INTRAVENOUS METOPROLOL
    ANDERSSON, B
    LOMSKY, M
    WAAGSTEIN, F
    [J]. EUROPEAN HEART JOURNAL, 1993, 14 (10) : 1375 - 1385
  • [3] [Anonymous], 1994, CIRCULATION, V90, P1765
  • [4] SIMULTANEOUS CONDUCTANCE CATHETER AND DIMENSION ASSESSMENT OF LEFT-VENTRICLE VOLUME IN THE INTACT ANIMAL
    APPLEGATE, RJ
    CHENG, CP
    LITTLE, WC
    [J]. CIRCULATION, 1990, 81 (02) : 638 - 648
  • [5] SIMULTANEOUS MEASUREMENT OF CORONARY VENOUS-BLOOD FLOW AND OXYGEN-SATURATION DURING TRANSIENT ALTERATIONS IN MYOCARDIAL OXYGEN-SUPPLY AND DEMAND
    BAIM, DS
    ROTHMAN, MT
    HARRISON, DC
    [J]. AMERICAN JOURNAL OF CARDIOLOGY, 1982, 49 (04) : 743 - 752
  • [6] BRISTOW MR, 1989, HEART FAILURE, V5, P77
  • [7] ACCURACY OF VOLUME MEASUREMENT BY CONDUCTANCE CATHETER IN ISOLATED, EJECTING CANINE HEARTS
    BURKHOFF, D
    VANDERVELDE, E
    KASS, D
    BAAN, J
    MAUGHAN, WL
    SAGAWA, K
    [J]. CIRCULATION, 1985, 72 (02) : 440 - 447
  • [8] PLASMA NOREPINEPHRINE AS A GUIDE TO PROGNOSIS IN PATIENTS WITH CHRONIC CONGESTIVE HEART-FAILURE
    COHN, JN
    LEVINE, TB
    OLIVARI, MT
    GARBERG, V
    LURA, D
    FRANCIS, GS
    SIMON, AB
    RECTOR, T
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 1984, 311 (13) : 819 - 823
  • [9] CRUICKSHANK JM, 1987, LANCET, V1, P585
  • [10] EFFECT OF BETA-ADRENERGIC-BLOCKADE ON MYOCARDIAL-FUNCTION AND ENERGETICS IN CONGESTIVE HEART-FAILURE - IMPROVEMENTS IN HEMODYNAMIC, CONTRACTILE, AND DIASTOLIC PERFORMANCE WITH BUCINDOLOL
    EICHHORN, EJ
    BEDOTTO, JB
    MALLOY, CR
    HATFIELD, BA
    DEITCHMAN, D
    BROWN, M
    WILLARD, JE
    GRAYBURN, PA
    [J]. CIRCULATION, 1990, 82 (02) : 473 - 483