JAHA:螺内酯在射血分数正常的房颤患者中的疗效

2020-09-10 MedSci原创 MedSci原创

螺内酯治疗不能改善慢性房颤且射血分数正常患者的运动能力、E/e'比值或生活质量。

永久性房颤患者即使接受最佳抗凝治疗,其预后、运动能力和生活质量也较差。近日,血管疾病领域权威杂志JAHA上发表了一篇研究文章,基于机制和观察性数据,研究人员评估了盐皮质激素受体拮抗剂螺内酯是否可以改善射血分数正常的永久性房颤患者的运动能力、E/e'比值和生活质量。

双盲安慰剂对照的IMPRESS-AF(螺内酯改善心室射血分数正常的心衰患者运动耐受性对房颤心肌纤维化的影响)试验(NCT02673463)将250例稳定的永久性房颤和左心室射血分数正常的患者随机分配接受每天25 mg螺内酯或安慰剂治疗。患者随访2年。该研究的主要疗效结局是在2年时心肺运动测试中达到的峰值耗氧量。该研究的次要结局包括6分钟的步行距离、E/e'比值、生活质量和住院情况。

与安慰剂(14.5 [5.1],调整后的治疗效果为-0.28;95%CI为-1.27至0.71)相比,螺丙内酯治疗2年的峰值耗氧量(14.0 mL/min/kg [SD为5.4],P=0.58)没有改善。在所有敏感性分析中,研究结果是一致的。6分钟的步行距离(调整后的治疗效果为−8.47 m;-31.9至14.9;P=0.48)、E/e'比值(调整后的治疗效果为-0.68;-1.52至0.17,P=0.12)或生活质量(生活质量问卷调查表5版EuroQol-5维度P=0.74)。螺内酯组和安慰剂治疗组分别有15%和23%的患者至少住院1次(P=0.15)。螺内酯组估计的肾小球滤过率降低了6 mL/min,而对照组的肾小球滤过率降低了<1个单位(P<0.001)。与安慰剂组相比,螺内酯组的收缩压降低了7.2 mmHg(95%CI为2.2-12.3)(P=0.005)。

由此可见,螺内酯治疗不能改善慢性房颤且射血分数正常患者的运动能力、E/e'比值或生活质量。

原始出处:

Eduard Shantsila.et al.Spironolactone in Atrial Fibrillation With Preserved Cardiac Fraction: The IMPRESS‐AF Trial.J AM HEART ASSOC.2020.https://www.ahajournals.org/doi/full/10.1161/JAHA.119.016239

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    2020-09-15 咻凡

    样本数量呢?

    0

  3. 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    2020-09-12 zhaohui6731
  4. 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  5. 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target=_blank style='color:#2F92EE;'>#慢性房颤#</a>且射血分数正常患者的运动能力、E/e'比值或生活质量。为什么要开展这项研究?螺内酯可能能改善心衰,为什么会治疗<a href='/topic/show?id=737a54248f5' target=_blank style='color:#2F92EE;'>#房颤#</a>??, beContent=null, objectType=article, channel=null, level=null, likeNumber=199, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88884, encryptionId=8369888840d, topicName=螺内酯), TopicDto(id=53525, encryptionId=5a665352557, topicName=慢性房颤), TopicDto(id=54248, encryptionId=737a54248f5, topicName=房颤)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Thu Sep 10 21:24:37 CST 2020, time=2020-09-10, status=1, ipAttribution=)]
    2020-09-11 心介

    房颤,临床上碰到很多哦

    0

  6. 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target=_blank style='color:#2F92EE;'>#慢性房颤#</a>且射血分数正常患者的运动能力、E/e'比值或生活质量。为什么要开展这项研究?螺内酯可能能改善心衰,为什么会治疗<a href='/topic/show?id=737a54248f5' target=_blank style='color:#2F92EE;'>#房颤#</a>??, beContent=null, objectType=article, channel=null, level=null, likeNumber=199, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88884, encryptionId=8369888840d, topicName=螺内酯), TopicDto(id=53525, encryptionId=5a665352557, topicName=慢性房颤), TopicDto(id=54248, encryptionId=737a54248f5, topicName=房颤)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Thu Sep 10 21:24:37 CST 2020, time=2020-09-10, status=1, ipAttribution=)]
    2020-09-11 内科新手

    谢谢梅斯提供这么好的信息,学到很多

    0

  7. 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encodeId=5a9d88434918, content=确实没有明白这个研究的实际意义,螺内酯对于<a href='/topic/show?id=737a54248f5' target=_blank style='color:#2F92EE;'>#房颤#</a>的治疗意义有多大?, beContent=null, objectType=article, channel=null, level=null, likeNumber=143, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54248, encryptionId=737a54248f5, topicName=房颤)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200901/629d1ce7d6f64d17a642c37c90dea72c/202f9333a3ea4b23a9b07ede3364e86b.jpg, createdBy=1a335163906, createdName=Sunny orchard, createdTime=Thu Sep 10 22:07:32 CST 2020, time=2020-09-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=884342, encodeId=ad0288434294, content=学习啦, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200912/b6f9fd0c92f041fb87d7e5df3981cac6/ebaa3e1fcb174de291f5f06daf872739.jpg, createdBy=dab05329240, createdName=148c6860m17暂无昵称, createdTime=Thu Sep 10 22:00:11 CST 2020, time=2020-09-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=884335, encodeId=74f8884335a9, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Thu Sep 10 21:34:52 CST 2020, time=2020-09-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=884328, encodeId=301d88432806, content=<a href='/topic/show?id=8369888840d' target=_blank style='color:#2F92EE;'>#螺内酯#</a>治疗不能改善<a href='/topic/show?id=5a665352557' target=_blank style='color:#2F92EE;'>#慢性房颤#</a>且射血分数正常患者的运动能力、E/e'比值或生活质量。为什么要开展这项研究?螺内酯可能能改善心衰,为什么会治疗<a href='/topic/show?id=737a54248f5' target=_blank style='color:#2F92EE;'>#房颤#</a>??, beContent=null, objectType=article, channel=null, level=null, likeNumber=199, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88884, encryptionId=8369888840d, topicName=螺内酯), TopicDto(id=53525, encryptionId=5a665352557, topicName=慢性房颤), TopicDto(id=54248, encryptionId=737a54248f5, topicName=房颤)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Thu Sep 10 21:24:37 CST 2020, time=2020-09-10, status=1, ipAttribution=)]
    2020-09-10 Sunny orchard

    确实没有明白这个研究的实际意义,螺内酯对于#房颤#的治疗意义有多大?

    0

  8. 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target=_blank style='color:#2F92EE;'>#慢性房颤#</a>且射血分数正常患者的运动能力、E/e'比值或生活质量。为什么要开展这项研究?螺内酯可能能改善心衰,为什么会治疗<a href='/topic/show?id=737a54248f5' target=_blank style='color:#2F92EE;'>#房颤#</a>??, beContent=null, objectType=article, channel=null, level=null, likeNumber=199, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88884, encryptionId=8369888840d, topicName=螺内酯), TopicDto(id=53525, encryptionId=5a665352557, topicName=慢性房颤), TopicDto(id=54248, encryptionId=737a54248f5, topicName=房颤)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Thu Sep 10 21:24:37 CST 2020, time=2020-09-10, status=1, ipAttribution=)]
    2020-09-10 148c6860m17暂无昵称

    学习啦

    0

  9. 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target=_blank style='color:#2F92EE;'>#慢性房颤#</a>且射血分数正常患者的运动能力、E/e'比值或生活质量。为什么要开展这项研究?螺内酯可能能改善心衰,为什么会治疗<a href='/topic/show?id=737a54248f5' target=_blank style='color:#2F92EE;'>#房颤#</a>??, beContent=null, objectType=article, channel=null, level=null, likeNumber=199, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88884, encryptionId=8369888840d, topicName=螺内酯), TopicDto(id=53525, encryptionId=5a665352557, topicName=慢性房颤), TopicDto(id=54248, encryptionId=737a54248f5, topicName=房颤)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Thu Sep 10 21:24:37 CST 2020, time=2020-09-10, status=1, ipAttribution=)]
    2020-09-10 医鸣惊人

    学习

    0

  10. 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encodeId=5a9d88434918, content=确实没有明白这个研究的实际意义,螺内酯对于<a href='/topic/show?id=737a54248f5' target=_blank style='color:#2F92EE;'>#房颤#</a>的治疗意义有多大?, beContent=null, objectType=article, channel=null, level=null, likeNumber=143, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54248, encryptionId=737a54248f5, topicName=房颤)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200901/629d1ce7d6f64d17a642c37c90dea72c/202f9333a3ea4b23a9b07ede3364e86b.jpg, createdBy=1a335163906, createdName=Sunny orchard, createdTime=Thu Sep 10 22:07:32 CST 2020, time=2020-09-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=884342, encodeId=ad0288434294, content=学习啦, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200912/b6f9fd0c92f041fb87d7e5df3981cac6/ebaa3e1fcb174de291f5f06daf872739.jpg, createdBy=dab05329240, createdName=148c6860m17暂无昵称, createdTime=Thu Sep 10 22:00:11 CST 2020, time=2020-09-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=884335, encodeId=74f8884335a9, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Thu Sep 10 21:34:52 CST 2020, time=2020-09-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=884328, encodeId=301d88432806, content=<a href='/topic/show?id=8369888840d' target=_blank style='color:#2F92EE;'>#螺内酯#</a>治疗不能改善<a href='/topic/show?id=5a665352557' target=_blank style='color:#2F92EE;'>#慢性房颤#</a>且射血分数正常患者的运动能力、E/e'比值或生活质量。为什么要开展这项研究?螺内酯可能能改善心衰,为什么会治疗<a href='/topic/show?id=737a54248f5' target=_blank style='color:#2F92EE;'>#房颤#</a>??, beContent=null, objectType=article, channel=null, level=null, likeNumber=199, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88884, encryptionId=8369888840d, topicName=螺内酯), TopicDto(id=53525, encryptionId=5a665352557, topicName=慢性房颤), TopicDto(id=54248, encryptionId=737a54248f5, topicName=房颤)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Thu Sep 10 21:24:37 CST 2020, time=2020-09-10, status=1, ipAttribution=)]
    2020-09-10 lovetcm

    #螺内酯#治疗不能改善#慢性房颤#且射血分数正常患者的运动能力、E/e'比值或生活质量。为什么要开展这项研究?螺内酯可能能改善心衰,为什么会治疗#房颤#??

    0

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