Spremembe presnove v mirovanju pri zdravljenju kroničnega srčnega popuščanja z zaviralci adrenergičnih receptorjev beta [doktorska disertacija] = Effects of [beta] blockers on resting energy production rate and total body substrate oxidation rate in chronic heart failure
Podbregar, Matej
BACKGROUND. In chronic heart failure (CHF) beta-blockers reduce myocardial oxygen consumption and improve myocardial efficiency by shifting myocardial substrate utilization from increased free fatty ...acid oxidation to increased glucose oxidation. The effect of selective and non-selective beta-blockers on total body resting energy production rate (EPR) and substrate utilization is not known. METHODS. Twenty-six non-cachectic patients with moderately severe heart failure (NYHA class II or III, left ventricular ejection fraction < 0.40) were included. They we treated for 6 months: 13 patients with carvedilol(37.5 13.5 mg/12h) and 13 patients with bisoprolol (5.4 3.0 mg/d). Indirect calorimetry for measuring EPR and substrate utilization was performedbefore and after 6 months of treatment. RESULTS. Resting EPR was decreased in carvedilol (5.021 0.803 to 4.552 0.615 kJ/min, p<0.001) and bisoprolol group (5.230 0.828 to 4.978 0.640 kJ/min, p<0.05; non significant difference between groups). Lipid oxidation rate decreased in carvedilol and remained unchanged in bisoprolol group (2.4 1.4 to 1.5 0.9 mg m2/kg min vs. 2.7 1.1 to 2.5 1.1 mg m2/kg min, p<0.05). Glucose oxidation rate was increasedonly in carvedilol (2.6 1.4 to 4.4 1.6 mg m2/kg min, p<0.05), but didnot change in bisoprolol group. Heart rate was correlated with EPR (r=0.53,p<0.001) CONCLUSIONS. Both selective and non-selective beta-blockers reduce total body resting EPR in non-cachectic CHF patients. Carvedilol compared to bisoprolol shifts total body substrate utilization from lipid to glucose oxidation. Monitoring heart rate can be useful for estimation of resting EPR in CHF patients.
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Založništvo in izdelava - Ljubljana : [M. Podbregar], 2003
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