Effect of long-term β-blockade on aortic root compliance in patients with Marfan syndrome

作     者：Rios, AS Silber, EN Bavishi, N Varga, P Burton, BK Clark, WA Denes, P 

作者机构：Michael Reese Hosp & Med Ctr Cardiovasc Inst Chicago IL 60616 USA Michael Reese Hosp & Med Ctr Dept Med Genet Chicago IL 60616 USA 

出 版 物：《AMERICAN HEART JOURNAL》 (美国心脏杂志)

年 卷 期：1999年第137卷第6期

页      面：1057-1061页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：肾上腺素能β受体拮抗剂/药理学 肾上腺素能β受体拮抗剂/治疗应用 主动脉/药物作用 主动脉/病理生理学 主动脉瓣/药物作用 主动脉瓣/病理生理学 阿替洛尔/药理学 阿替洛尔/治疗应用 卡方分布 顺应性/药物作用 超声心动描记术/药物作用 心电描记术/药物作用 马凡综合征/药物疗法 马凡综合征/病理生理学 时间因素 血管容量/药物作用 血管容量/生理学 成年人 女(雌)性 人类 男(雄)性 中年人 

摘      要：Background This study was undertaken to assess the effect of long-term beta-blockade on the aortic root stiffness index and distensibility in patients with Marfan syndrome. Methods Aortic root stiffness index and distensibility were calculated according to the formulas of Stefanadis and Hirai, respectively, with 2-dimensional guided M-mode echocardiogram before and after an average of 26 months of atenolol administration. Results Twenty-three asymptomatic patients were studied (11 men and 12 women, aged 31 +/- 14.2 years). The follow-up was 4 +/- 2.2 years. The dose of atenolol was individualized (mean 43.5 +/- 21.6 mg/d). Heart rate decreased from 79 +/- 9 beats/min to 64 +/- 9 beats/min (P =.01), and systolic blood pressure decreased from 124 +/- 13 mm Hg to 114 +/- 2 mm Hg (P =.01). Distensibility increased from 1.85 +/- 0.70 x 10(-6) cm(2)/dynes(-1) to 2.21 +/- 0.76 x 10(-6) cm(2)/dynes(-1) (P =.02), and the stiffness index decreased from 9.68 +/- 3.78 to 8.85 +/- 3.15 (P =.2). Two groups of responses to treatment were identified. Compared with baseline values 15 (65%) patients who responded to treatment had increased distensibility and decreased stiffness index of the aortic root (P =.05). Eight patients (35%) who did not respond to treatment had no significant change. Body weight 91 kg and baseline end-diastolic aortic root diameter 40 mm were significantly associated with no response (P =.05). Two patients in the nonresponding group had echocardiographic progression of aortic insufficiency. Conclusions There was a heterogeneous response in the aortic root elastic properties after long-term treatment with atenolol in asymptomatic patients with Marfan syndrome. Stiffness index and distensibility are more likely to respond when the baseline end-diastolic aortic root diameter is 40 mm.