慢性心不全に対するβ遮断療法における心拍数評価とその意義

概要

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The significance of heart rate (HR) monitoring in β-blocker therapy for chronic heart failure is controversial. Therefore, we investigated the relationships between HR and the effects of β-blocker therapy using Holter monitoring. A total of 163 heart failure patients underwent Holter monitoring before and 1 month after carvedilol therapy, and patients' left ventricular ejection fraction (LVEF) and plasma brain natriuretic peptide (BNP) levels were followed. Among mean daily HR, maximum HR, minimum HR, mean waking HR, and mean sleeping HR, the most significant decrease 1 month after carvedilol therapy was observed for mean waking HR. Patients with baseline mean waking HR≥80bpm or who had decreases in HR ≥ 10% after carvedilol had significantly greater improvements in LVEF and plasma BNP levels. Comparison of four groups classified by baseline mean waking HR and reductions in HR after treatment revealed that the group of patients with high baseline HR and greater HR reduction showed greater long-term improvements in LVEF and BNP levels than the other three groups. Furthermore, the group of patients with high HR and lower HR reduction had the poorest outcome. Baselinemean waking HR and post-treatment changes are closely related to the effects and outcomes of β-blocker therapy.