美托洛爾 Metoprolol β1阻斷劑對於二尖瓣膜脫垂且具交感過盛之病患可有效提高HRV

Effect of metoprolol on heart rate variability in symptomatic patients with mitral valve prolapse.

Am J Cardiol.  2007; 99(11):1568-70 (ISSN: 0002-9149)

Taçoy G; Balcio?lu AS; Arslan U; Durako?lugil E; Erdem G; Ozdemir M; Cengel A
Department of Cardiology, Gazi University School of Medicine, Ankara, Turkey. gtacoy@gmail.com

Metoprolol is widely used to eliminate symptoms in patients with mitral valve prolapse (MVP), a condition associated with enhanced sympathetic tone. In this study, effects of metoprolol on heart rate variability (HRV) indices were investigated in symptomatic patients with MVP. Thirty-nine symptomatic patients with MVP (26 women, mean age 26 +/- 7 years) and 16 age- and gender-matched controls were studied. After a baseline 24-hour Holter evaluation in all subjects, patients with MVP were started on metoprolol succinate therapy at a dose of 25 to 100 mg/d, and Holter analysis was repeated at the end of 3 months of metoprolol therapy. At the basal evaluation, all time-domain HRV indices with the exception of proportion of adjacent RR intervals differing by >50 ms in the 24-hour recording were significantly lower in patients with MVP than controls (SD of all normal-to-normal [NN] intervals, p = 0.013; SD of average NN intervals calculated during 5-minute periods of the entire recording, p = 0.03; triangular index, p = 0.025; and square root of mean squared differences in successive NN intervals, p = 0.026). After metoprolol treatment, all HRV indices significantly improved compared with baseline (SD of all NN intervals, p = 0.028; SD of average NN intervals calculated during 5-minute periods of the entire recording, p = 0.043; triangular index, p = 0.004; square root of the mean squared differences in successive NN intervals, p = 0.021; and proportion of adjacent RR intervals differing by >50 ms in the 24-hour recording, p = 0.014), and HRV indices after metoprolol treatment were similar to those of the control group (p >0.05). In conclusion, metoprolol significantly improved impaired HRV parameters in symptomatic patients with MVP.