|编译服务：||心血管疾病防治||编译者：||张燕舞||编译时间：||May 22, 2018||浏 览 量：||4|
β受体阻滞剂治疗减少射血分数降低（HFrEF）的心力衰竭患者的症状和死亡率，但β受体阻滞剂治疗对保留射血分数（HFpEF）的心力衰竭患者的疗效尚不确定。 一项单独的患者级荟萃分析评估了β受体阻滞剂对窦性心律患者心衰的疗效。 β受体阻滞剂治疗可降低HFrEF患者的死亡率和心血管死亡率，但HFpEF患者的小部分患者没有获益，尽管置信区间很大。 如果没有其他适应症，我们建议不要使用HFpEF的β受体阻滞剂。
Aims Recent guidelines recommend that patients with heart failure and left ventricular ejection fraction (LVEF) 40-49% should be managed similar to LVEF ≥ 50%. We investigated the effect of beta-blockers according to LVEF in double-blind, randomized, placebo-controlled trials.
Methods and results Individual patient data meta-analysis of 11 trials, stratified by baseline LVEF and heart rhythm (Clinicaltrials.gov: NCT0083244; PROSPERO: CRD42014010012). Primary outcomes were all-cause mortality and cardiovascular death over 1.3 years median follow-up, with an intention-to-treat analysis. For 14 262 patients in sinus rhythm, median LVEF was 27% (interquartile range 21-33%), including 575 patients with LVEF 40-49% and 244 ≥ 50%. Beta-blockers reduced all-cause and cardiovascular mortality compared to placebo in sinus rhythm, an effect that was consistent across LVEF strata, except forthose in the small subgroup with LVEF ≥ 50%. For LVEF 40-49%, death occurred in 21/292 [7.2%]randomized to beta-blockers compared to 35/283 [12.4%]with placebo; adjusted hazard ratio (HR) 0.59 [95% confidence interval (CI) 0.34-1.03]. Cardiovascular death occurred in 13/292 [4.5%]with beta-blockers and 26/283 [9.2%]with placebo; adjusted HR 0.48 (95% CI 0.24-0.97). Over a median of 1.0 years following randomization (n = 4601), LVEF increased with beta-blockers in all groups in sinus rhythm except LVEF ≥50%. For patients in atrial fibrillation at baseline (n = 3050), beta-blockers increased LVEF when < 50% at baseline, but did not improve prognosis.
Conclusion Beta-blockers improve LVEF and prognosis for patients with heart failure in sinus rhythm with a reduced LVEF. The data are most robust for LVEF < 40%, but similar benefit was observed in the subgroup of patients with LVEF 40-49%.