2019年β受体阻滞剂在慢性心衰中的作用(英文)-课件.ppt

The Kaplan-Meier plot of death from any cause in the MERIT-HF trial showed that the benefit provided by metoprolol XL is seen very early, at approximately 3 months after initiation of treatment, and increases over time. There was a statistically significant decrease in total mortality in the metoprolol XL group compared with placebo. Relative risk reduction was 34%. Description:COPERNICUS = Carvedilol Prospective Randomized Cumulative Survival Trial; US-CARVEDILOL = U.S. Carvedilol heart failure study; CIBIS-II = Cardiac Insufficiency Bisoprolol Study II; MERIT-HF = Metoprolol CR/XL Randomized Intervention Trial in Chronic Heart Failure; CAPRICORN = Carvedilol Post-Infarct Survival Control in LV dysfunction Trial A Funnel Diagram Showing Use of Beta-Blocker Therapy in Patients with a History of Myocardial Infarction, Asymptomatic Left Ventricular Dysfunction, or Stable Heart Failure. For asymptomatic left ventricular dysfunction without coronary artery disease, beta-blockers are not currently recommended, but ongoing trials are deemed likely to show benefit. LVEF denotes left ventricular ejection fraction, and ACE angiotensin-converting enzyme. 2021/2/7 * MERIT-HF CIBIS-II 2021/2/7 * 2021/2/7 * Randomized (No run-in phase) COMET Study Design 3029 patients with stable heart failure, New York Heart Association Class II-IV, receiving standard treatment including ACE inhibitors Time to 1020 deaths Estimated to be 4 to 6 years Screening Titration to maximum tolerated or target dose (Start: carvedilol 3.125 mg bid, metoprolol tartrate 5 mg bid) Assessments every four months during maintenance phase (n?1500) Metoprolol 50 mg bid (n?1500) Carvedilol 25 mg bid Poole-Wilson PA et al. Eur J Heart Fail 2002;4:321-329. 2021/2/7 * Heart rate (beats.min-1) Metoprolol Carvedilol Time (years) 70 75 80 0 1 2 3 4 5 65 85 ** ** * COMET: Change of heart rate * p0.05, ** p0.01 Error bars represent 1 standard error 2021/2/7 * Time (years) Blood pressure (mm Hg) 70 80 90 100 11