|Title:||Chronic B-Blocker Therapy Improves Autonomic Nervous Regulation in Advanced Congestive Heart Failure – a Longitudinal Heart Rate Variability Study
|Issue Date:||1999||Journal Volume:||v.137||Start page/Pages:||658-665||Source:||THE AMERICAN HEART JOURNAL||Abstract:||
Background: β-blocker therapy is believed to modulate the detrimental effect of overcompensating neurohormonal activation in chronic heart failure. However, clinical doubts remain, particularly the physiologic sympathovagal balance. Methods: To respond to clinical concern about worsening autonomic nervous perturbation in β-blocker therapy of advanced congestive heart failure, 15 consecutive patients were longitudinally studied to elucidate the evolution of cardiac function versus 24-hour heart rate variability (HRV) before and after 1, 3, and 6 to 9 months of atenolol-combined therapy. Results: Two patients died prematurely within 1 month. All 13 surviving patients showed improvement in New York Heart Association functional class, with decrease in left ventricular end- systolic and end- diastolic dimensions and increase in fraction shortening and ejection fraction by echocardiography after at least 3 months of atenolol use. The retarded therapeutic effect was accompanied by a general rise of total, very low, low-, and high-frequency components (9.0±0.5, 8 .8±0.5, 6.2±0.6, and 6.1±0.5 vs 10.9±0.3, 10.7±0.4, 8.6±0.6, and 7.8 ±0.3; all P <0.02) of daily HRV. This implied recovery of parasympathetic and baroreceptor function. Return of sympahtovagal interaction was further supported by the suppression of Cheyne-Stokes type HRV as detected by Wigner- Ville distribution. Conclusions: Long-term β-blocker therapy for advanced congestive heart failure upwardly regulates the autonomic nervous interaction in synchrony with the evolution of cardiac function performance.
|Appears in Collections:||醫學系|
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