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Entlastung des insuffizienten Herzens. β-Blocker bei idiopathischer und ischämischer Kardiomyopathie

  • F. Waagstein

Zusammenfassung

β-Blocker, die bis vor kurzem bei der Behandlung von Patienten mit eingeschränkter Myokardfunktion als kontraindiziert galten, finden heute dank einer Reihe von Studien, in denen ihre Wirkung auf die Myokardfunktion und Morbidität nachgewiesen wurde, allgemeine Akzeptanz [1]. β-Blocker wurden anfangs — vor mehr als 20 Jahren — bei Patienten mit idiopathischer dilatativer Kardiomyopathie angewendet [2]. Die theoretische Grundlage für das Verständnis der Mechanismen, die der günstigen Wirkung zugrunde liegen, war 1975 jedoc:h noch nicht vorhanden. Das Konzept ungünstiger kardialer Wirkungen einer neuroendokrinen Aktivierung bei Stauungsherzinsuffizienz hat heute einer breiteren Akzeptanz von β-Blockern bei der Behandlung der Herzinsuffizienz den Weg geebnet [3,4]. Darüber hinaus wurde bisher für alle in langfristigen Überlebensstudien untersuchten positiv inotropen Medikamente eine Erhöhung der Mortalität nachgewiesen; eine Ausnahme besteht für Digoxin, das eine neutrale Wirkung auf die Überlebenszeit zeigte.

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Literatur

  1. 1.
    Doughty RN, MacMahon S, Sharpe N (1994) ß-blockers in heart failure: Promising or proved? J Am Coll Cardiol 23: 814–821.PubMedCrossRefGoogle Scholar
  2. 2.
    Waagstein F, Hjalmarson Å, Varnauskas E, Wallentin I (1975) Effect of chronic beta-adrenergic receptor blockade in congestive cardiomyopathy. Br. Heart J 37: 1022–1036.PubMedCrossRefGoogle Scholar
  3. 3.
    Packer M (1988) Neurohormonal interactions and adaptations in congestive heart failure. Circulation 77: 721–730.PubMedCrossRefGoogle Scholar
  4. 4.
    Benedict CR, Shelton B, Johnstone DE et al. for the SOLVD Investigators (1996) Prognostic significance of plasma norepinephrine in patients with asymptomatic left ventricular dysfunc-tion. Circulation 94: 690–697.PubMedGoogle Scholar
  5. 5.
    Tomita M, Spinale FG, Crawford FA, Zile MR (1991) Changes in left ventricular volume, mass and function during the development of supraventricular tachycardia-induced cardiomyo-pathy. Circulation 83: 635–644.PubMedGoogle Scholar
  6. 6.
    Spinale FG, Tanaka R, Crawford FA, Zile MR (1992) Changes in myocardial blood flow during development of and recovery from tachycardia-induced cardiomyopathy. Circulation 85: 717–729.PubMedGoogle Scholar
  7. 7.
    Mulieri LA, Hasenfuss G, Leavitt B, Allen PD, Alpert NR (1992) Altered myocardial force fre-quency relation in human heart failure. Circulation 85: 1743–1750.PubMedGoogle Scholar
  8. 8.
    Mulieri LA, Leavitt B, Hasenfuss G, Allen PD, Alpert NR (1992) Contraction frequency depen-dence of twitch and diastolic tension in human dilated cardiomyopathy (tension-frequency relation in cardiomyopathy). Basic Res Cardiol 87, Suppl I: 199–212.PubMedGoogle Scholar
  9. 9.
    Cohn JN, Levine TB, Olivari MT et al. (1984) Plasma norepinephrine as a guide to prognosis in patients with chronic congestive heart failure. N Engl. J Med 311: 819–823.PubMedCrossRefGoogle Scholar
  10. 10.
    Swedberg K, Eneroth P, Kjekshus J, Wilhelmsen L for the CONSENSUS Trial Study Group (1990) Hormones regulating cardiovascular function in patients with servere congestive heart failure and their relation to mortality. Circulation 82: 1730–1736.CrossRefGoogle Scholar
  11. 11.
    Massie B (1988) Is neurohormonal activation deleterious for the long-term outcome of patients with congestive heart failure? J Am Coll Cardiol 12: 547–558.PubMedCrossRefGoogle Scholar
  12. 12.
    Chidsey CA, Braunwald E, Morrow AG (1965) Catecholamine excretion and cardiac stores of norepinephrine in congestive heart failure. Am J Med 39: 442–451.PubMedCrossRefGoogle Scholar
  13. 13.
    Seferovic PM, Stepanovic S, Vasiljevic V et al. (1994) Dilated cardiomyopathy: Correlation between myocardial catecholamines, hemodynamics and long term survival. J Am Coll Car-diol 23: 148A.Google Scholar
  14. 14.
    Sievers R, Parmley WW, James T, Wikman-Coffelt J (1983) Energy levels at systole vs. diastole in normal hamster hearts vs. myopathic hamster hearts. Circ Res 53: 759–766.PubMedGoogle Scholar
  15. 15.
    Shida S, Nakaya H, Matsumoto S. Kanno M (1994) ß1 adrenoceptor medicated decrease in pHi in quiescent ventricular myocardium. Cardiovasc Res 28: 112–118.PubMedCrossRefGoogle Scholar
  16. 16.
    Neubauer S, Krahe T, Schindler R et al. (1992) ß1 magnetic resonance spectroscopy in dilated cardiomyopathy and coronary artery disease. Altered cardiac high-energy phosphate metabolism in heart failure. Circulation 86: 1810–1818.Google Scholar
  17. 17.
    Mak IT, Weglicki WB (1990) Comparative antioxidant activities of propranolol, nifedipine, verapamil, and diltiazem against sarcolemmal membrane lipid peroxidation. Circ Res 66: 1449–1452.PubMedGoogle Scholar
  18. 18.
    Glass MG, Fuleihan F, Liao R et al. (1993) Differences in cardioprotective efficacy of adrenergic receptor antagonists and Ca2+ channel antagonists in an animal model of dilated cardiomyopathy. Circ Res 73: 1077–1089.PubMedGoogle Scholar
  19. 19.
    Limas CJ, Goldenberg IF, Limas C (1990) Influence of anti-beta-receptor antibodies on cardiac adenylate cyclase in patients with idiopathic dilated cardiomyopathy. Am Heart J 119: 1322–1328.PubMedCrossRefGoogle Scholar
  20. 20.
    Magnusson Y, Marullo S, Hoyer S et al. (1990) Mapping of a functional autoimmune epitope on the ß1-adrenergic receptor in patients idiopathic dilated cardiomyopathy. J Clin Invest 86: 1658–1663.PubMedCrossRefGoogle Scholar
  21. 21.
    Magnusson Y, Wallukat G, Waagstein F, Hjalmarson A, Hoebeke J (1994) Autoimmunity in idiopathic dilated cardiomyopathy - Characterization of antibodies against ß1-adrenoceptor with positive chronotropic effect. Circulation 89: 2760–2767.PubMedGoogle Scholar
  22. 22.
    Bristow MR, Ginsburg R, Minobe W et al. (1982) Decreased catecholamine sensitivity and ß- adrenergic receptor density in failing human hearts. N Engl J Med 307: 205–211.PubMedCrossRefGoogle Scholar
  23. 23.
    Asseman P, McFadden E, Bauchart JJ, Loubeyre C, Thery C (1994) Why do ß-blockers help in idiopathic dilated cardiomyopathy-frequency mismatch? Lancet 344: 803–804.PubMedCrossRefGoogle Scholar
  24. 24.
    Liu C-P, Ting C-T, Lawrence W, Maughan L, Chang M-S, Kass DA (1993) Diminished contractile response to increased heart rate in intact human left ventricular hypertrophy. Systolic versus diastolic determinants. Circulation 88: 1893–1906.Google Scholar
  25. 25.
    Packer M, Carver JR, Rodeheffer et al. (1991) Effect of oral milrinone on mortality in severe chronic heart failure. N Engl J Med 325: 1468–1475.PubMedCrossRefGoogle Scholar
  26. 26.
    Schwartz A, Lindenmayer GE, Harigaya S (1968) Respiratory control and calcium transport in heart mitochondria from the cardiomyopathic Syrian hamster. Trans NY Acad Sci 30, Suppl II: 951.Google Scholar
  27. 27.
    Andersson B, Hedner T, Blomstrom-Lundquist C, Waagstein F (1991) Exercise hemodynamics and myocardial metabolism during long-term ß-adrenergic blockade in severe heart failure. J Am Coll Cardiol 18: 1059–1066.PubMedCrossRefGoogle Scholar
  28. 28.
    Eichhorn EJ, Heesch CM, Barnett JH et al. (1994) Effect of metoprolol on function and energetics in patients with nonischemic dilated cardiomyopathy: A randomized, double-blind, placebo-controlled study. J Am Coll Card 24: 1310–1320.CrossRefGoogle Scholar
  29. 29.
    Maisel AS (1994) Beneficial effects of metoprolol treatment in congestive heart failure. Reversal of sympathetic-induced alterations of immunologic function. Circulation 90: 1774–1780.Google Scholar
  30. 30.
    Tsutsui H, Spinale FG, Nagatsu M et al. (1994) Effects of chronic ß-adrenergic blockade on the left ventricular and cardiocyte abnormalities of chronic canine mitral regurgitation. J Clin Invest 93: 2639–2648.PubMedCrossRefGoogle Scholar
  31. 31.
    Staley NA, Noren GR, Einzig S, Rublein TG (1984) Effect of early propranolol treatment in an animal model of congestive cardiomyopathy: I. Mortality and Ca + transport in sarcoplasmic reticulum. Cardiovasc Res 18: 371–376.PubMedCrossRefGoogle Scholar
  32. 32.
    Magnusson Y, Hoebeke J, Waagstein F, Hjalmarson A, and the MDC Trial Study Group (1994) Predictive role of prautoantibodies in patients with idiopathic dilated cardiomyopathy treated with metoprolol. Circulation 90: 1–543.Google Scholar
  33. 33.
    Heilbrunn SM, Shah P, Bristow MR, Valantine HA, Ginsburg R, Fowler MB (1989) Increased ß-receptor density and improved hemodynamic response to catecholamine stimulation during long-term metoprolol therapy in heart failure from dilated cardiomyopathy. Circulation 79: 483–490.PubMedCrossRefGoogle Scholar
  34. 34.
    Waagstein F, Caidahl K, Wallentin I, Bergh C-H, Hjalmarson A (1989) Long-term ß-blockade in congestive cardiomyopathy. Effects of acute and chronic metoprolol treatment followed by withdrawal and readministration of metoprolol. Circulation 80: 551–563.Google Scholar
  35. 35.
    Beau SL, Tolley TK, Saffitz JE (1993) Heterogeneous transmural distribution of ß-adrenergic receptor subtypes in failing human hearts. Circulation 88: 2501–2509.PubMedGoogle Scholar
  36. 36.
    Waagstein F (1995) Adrenergic ß-blocking agents in congestive heart failure due to idiopathic dilated cardiomyopathy. Eur Heart J 16, Suppl 0: 128–132.PubMedGoogle Scholar
  37. 37.
    Waagstein F, Bristow MR, Swedberg K et al. for the Metoprolol in Dilated Cardiomyopathy (MDC) Trial Study Group (1993) Beneficial effects of metoprolol in idiopathic dilated cardiomyopathy. Lancet 342: 1441–1446.CrossRefGoogle Scholar
  38. 38.
    Australia-New Zealand Heart Failure Research Collaborative Group (1995) Effects of carve-dilol, a vasodilator-ß-blocker, in patients with congestive heart failure due to ischemic heart disease. Circulation 92: 212–218.Google Scholar
  39. 39.
    CIBIS Investigators and Committees (1994) A randomized trial of ß-blockade in heart failure: The Cardiac Insufficiency Bisoprolol Study (CIBIS). CIBIS Investigators and Committees. Circulation 90: 1765–1773.Google Scholar
  40. 40.
    Wiklund I, Waagstein F, Swedberg K, Hjalmarson A (1996) Quality of life on treatment with metoprolol in dilated cardiomyopathy: Results from the MDC Trial. Cardiovasc Drugs Ther 10: 361–368.PubMedGoogle Scholar
  41. 41.
    Ikram H, Chan W, Bennet SI, Bones PJ (1979) Hemodynamic effects of acute ß-adrenergic receptor blockade in congestive cardiomyopathy. Br Heart J 42: 311–315.PubMedCrossRefGoogle Scholar
  42. 42.
    Gilbert EM, Anderson JL, Deitchman D et al. (1990) Longterm ß-blocker vasodilator therapy improves cardiac function in idiopathic dilated cardiomyopathy: A double blind, randomized study of bucindolol versus placebo. Am J Med 88: 223–229.PubMedCrossRefGoogle Scholar
  43. 43.
    DasGupta P, Broadhurst P, Lahiri A (1991) The effects of intravenous carvedilol, a new mul-tiple action vasodilatory ß-blocker, in congestive heart failure. J Cardiovasc Pharmacol 18, Suppl 4: S12–S16.PubMedGoogle Scholar
  44. 44.
    Swedberg K, Hjalmarson A, Waagstein F, Wallentin I (1980) Beneficial effects of long-term ß-blockade in congestive cardiomyopathy. Br Heart J 44: 117–133.PubMedCrossRefGoogle Scholar
  45. 45.
    Andersson B, Lomsky M, Waagstein F (1993) The link between acute haemodynamic adrener-gic ß-blockade and long-term effects in patients with heart failure. A study on diastolic func-tion, heart rate and myocardial metabolism following intravenous metoprolol. Eur Heart J 14: 1375–1385.PubMedCrossRefGoogle Scholar
  46. 46.
    Krum H, Schwartz B, Sackner-Bernstein J et al. (1993) Double-blind, placebo-controlled study of the long-term efficacy of carvedilol in patients with severe heart failure treated with con-verting-enzyme inhibitors. J Am Coll Cardiol 21, Suppl A: 114 A.Google Scholar
  47. 47.
    Wisenbaugh T, Katz I, Davis J et al. (1993) Long-term (3-month) effects of a new ß-blocker (nebivolol) on cardiac performance in patients with dilated cardiomyopathy. J Am Coll Cardiol 21: 1094–1100.PubMedCrossRefGoogle Scholar
  48. 48.
    Kukin ML, Kalman J, Mannino M, Freudenberger R, Buchholz C, Ocampo O (1996) Combined alpha-beta blockade (doxazosin plus metoprolol) compared with ß-blockade alone in chronic congestive heart failure. Am J Cardiol 77: 486–491.PubMedCrossRefGoogle Scholar
  49. 49.
    Anderson JL, Lutz JR, Gilbert EM, Sorenson SG, Yanowitz FG, Menlove RL, Bartholomew M (1985) A randomized trial of low-dose ß-blockade therapy for idiopathic dilated cardiomyo-pathy. Am J Cardiol 55: 471–475.PubMedCrossRefGoogle Scholar
  50. 50.
    Engelmeier RS, O’Connell JB, Walsh R et al. (1985) A randomised trial of low-dose ß-blockade therapy for idiopathic dilated cardiomyopathy. Am J Cardiol 55: 471.CrossRefGoogle Scholar
  51. 51.
    Leung W-H, Lau C-P, Wong C-K, Cheng C-H, Tai Y-T, Lim S-P (1990) Improvement in exer-cise performance and hemodynamics by labetalol in patients with dilated cardiomyopathy. Am Heart J 119: 884–890.PubMedCrossRefGoogle Scholar
  52. 52.
    Pollock SG, Lystash J, Tedesco C, Craddock G, Smucker ML (1990) Usefulness of bucindolol in congestive heart failure. Am J Cardiol 66: 603–607.PubMedCrossRefGoogle Scholar
  53. 53.
    Bristow MR, O’Connell JB, Gilbert EM et al. for the Bucindolol Investigators (1994) Dose- response of chronic ß-blocker treatment in heart failure from either idiopathic dilated or ischemic cardiomyopathy. Circulation 89: 1632–1642.PubMedGoogle Scholar
  54. 54.
    Woodley SL, Gilbert EM, Anderson JL et al. (1991) ß-blockade with bucindolol in heart failure caused by ischemic versus idiopathic dilated cardiomyopathy. Circulation 84: 2426–2441.PubMedGoogle Scholar
  55. 55.
    Fisher ML, Gottlieb SS, Plotnick GD, Greenberg NL, Patten RD, Bennett SK, Hamilton BP (1994) Beneficial effects of metoprolol in heart failure associated with coronary artery disease: A randomized trial. J Am Coll Cardiol 23: 943–950.PubMedCrossRefGoogle Scholar
  56. 56.
    Lindelow B, Andersson B, Waagstein F, Bergh C-H (1995) Prognosis of alternative therapies in heart failure patients not accepted for heart transplantation. J Heart Lung Transplant 14: 1204–1211.PubMedGoogle Scholar
  57. 57.
    Olsen SL, Blank D, Taylor DO, Gilbert EM, Mealey PC, O’Connell JB, Renlund DG (1993) Should patients with idiopathic dilated cardiomyopathy fail ß-blocker therapy prior to cardiac transplantation? Circulation 88: 1–93.Google Scholar
  58. 58.
    Kalman J, Buchholz C, Steinmetz M et al. (1993) ß-blockade as a bridge to cardia transplant. Circulation 88: 1–93.Google Scholar
  59. 59.
    Lichstein E, Hager WD, Gregory JJ, Fleiss JL, Rolnitzky LM, Bigger JT for the Multicenter Dil-tiazem Post-Infarction Research Group (1990) Relation between ß-adrenergic blocker use, various correlates of left ventricular function and the chance of developing congestive heart failure. J Am Coll Cardiol 16: 1327–1332.CrossRefGoogle Scholar
  60. 60.
    Chadda K, Goldstein S, Byington R, Curb JD (1986) Effect of propranolol after acute myocardial infarction in patients with congestive heart failure. Circulation 73: 503–510.PubMedCrossRefGoogle Scholar
  61. 61.
    Olsson G, Rehnqvist N (1986) Effect of metoprolol in postinfarction patients with increased heart size. Eur Heart J 7: 468–474.PubMedGoogle Scholar
  62. 62.
    Packer M, Bristow MR, Cohn JN, Colucci WS, Fowler MB, Gilbert EM, Shusterman NH for the US Carvedilol Heart Failure Study Group (1996) The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. N Engl J Med 334: 1349–1355.CrossRefGoogle Scholar
  63. 63.
    Waagstein F, Swedberg K, Hjalmarson A for the MDC Trial Study Group (1996) Improvement afater metoprolol in idiopathic dilated cardiomyopathy is predicted by baseline systolic blood pressure and change in heart rate. J Am Coll Cardiol 17, Suppl A: 170A.CrossRefGoogle Scholar
  64. 64.
    Bennett SK, Fisher ML, Krichten CM, Greenberg NL, Gottlieb SS (1994) Benefit of ß-blockers in patients with ischemic cardiomyopathy does not correlate with change in heart rate. Circulation 90: 1–544.Google Scholar
  65. 65.
    Koide M, Nagatsu M, Tagawa H, DeFreyte G, Carabello BA (1994) Contribution of heart rate to the ameliorative effects of ß-blocker on contractile function in experimental chronic mitral regurgitation. Circulation 90: 1–542.Google Scholar
  66. 66.
    Lechat P, Boissel JP, Nemoz C, Jaillon P on behalf of the CIBIS Investigators (1944) Survival and prognostic factors in heart failure during the CIBIS Trial. Circulation 90: 1–380.Google Scholar
  67. 67.
    Akanuma M, Ohsuzu F, Katsushika S, Handa S, Yoshikawa T, Kawamura Y (1993) Early blood pressure response was predictive of long term beneficial effects of ß-blocker-therapy in dilated cardiomyopahty (DCM). Circulation 88: 1–346.Google Scholar
  68. 68.
    Yamada T, Fukunami M, Ohmori M et al. (1993) Which subgroup of patients with dilated car-diomyopathy would benefit from long-term ß-blocker therapy? Histologic viewpoint. J Am Coll Cardiol 21: 628–633.PubMedCrossRefGoogle Scholar
  69. 69.
    Eichhorn EJ, Heesch CM, Hatfield B, Marcoux L, Malloy CR (1993) Relation of substrate uti-lization to end-diastolic pressure in patients with dilated cardiomyopathy. Circulation 88: 1–346.Google Scholar
  70. 70.
    Eichhorn EJ, Bedotto JB, Malloy CR et al. (1990) Effect of ß-adrenergic blockade on myocardial function and energetics in congestive heart failure. Improvements in hemodynamic, con-tractile, and diastolic performance with bucindolol. Circulation 82: 473–483.PubMedCrossRefGoogle Scholar
  71. 71.
    Andersson B, Caidahl K, Lenarda A di et al. (1996) Changes in early and late diastolic filling patern induced by long-term adrenergic ß-blockade in patients with idiopathic dilated cardio-myopathy. Circulation 94: 673–682.PubMedGoogle Scholar
  72. 72.
    Sato H, Hori M, Ozaki H et al. (1993) Exercise-induced upward shift of diastolic left ventricular pressure-volume relation in patients with dilated cardiomyopathy. Effects of ß-adreno- ceptor blockade. Circulation 88 (part 1): 2215–2223.PubMedGoogle Scholar
  73. 73.
    Kim MH, Starling MR (1994) Effects of ß-blockade on left ventricular diastolic function in patients with dilated congestive cardiomyopathy. Circulation 90: 1–543.Google Scholar
  74. 74.
    Shimoyama H, Rosman H, Kono T, Alam M, Sabbah HN (1994) Metoprolol improves left atrial contribution to LV filling in dogs with moderate heart failure. Circulation 90: 1–544.Google Scholar
  75. 75.
    Yamamoto T, Furutani Y, Katayama K, Harada M, Ichioka T, Fujii T, Matsuzaki M (1994) A case of dilated cardiomyopathy in which the effect of ß-blocker therapy was clearly demon-strated by 123-I-MIBG scintigraphy. Respir Circ 42/10: 989–993.Google Scholar
  76. 76.
    Andersson B, Hamm C, Persson S, Wikstrom G, Sinagra G, Hjalmarson A, Waagstein F (1994) Improved exercise hemodynamics status in dilated cardiomyopathy after ß-adrenergic blockade treatment. J Am Coll Cardiol 23: 1397–1404.PubMedCrossRefGoogle Scholar
  77. 77.
    Gilbert EM, Olsen SL, Renlund DG, Bristow MR (1993) ß-adrenergic receptor regulation and left ventricular function in idiopathic dilated cardiomyopathy. Am J Cardiol 71: 23C–29C.PubMedCrossRefGoogle Scholar
  78. 78.
    Paolisso G, Gambardella A, Marrazzo G, Verza M, Teasuro P, Varricchio M, D’Onofrio F (1992) Metabolic and cardiovascular benefits deriving from ß-adrenergic blockade in chronic congestive heart failure. Am Heart J 123r 103–110.PubMedCrossRefGoogle Scholar
  79. 79.
    Moe GW, Rouleau JL, Proulx G, Arnold M, Sestier F on behalf of the Canadian PROFILE investigators (1994) Increased mortality with flosequinan in patients with failure is accompa-nied by increased plasma norepinephrine. Circulation 90: 1–380.Google Scholar
  80. 80.
    Rahman MA, Hara K, Senn BM, Daly PA, Wigle ED, Floras JS (1993) Reduction in muscle sympathetic nerve activity after chronic ß-blockade for dilated cardiomyopathy. Circulation.88: 1–415.Google Scholar
  81. 81.
    Domanski MJ, Eichhorn EJ (1994) ß-blockade in congestive heart failure - the need for a definitive study (Editorial). Am J Cardiol 73: 597–599.PubMedCrossRefGoogle Scholar

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  • F. Waagstein

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