Karl Swedberg  瑞典哥德堡大学

    <International Circulation>: Heart rate lowering has been a very important strategy in the management of heart failure.  What are the mechanisms of the benefit of heart rate lowering in the management of heart failure?

  《国际循环》：降低心率已成为心力衰竭治疗中的一个非常重要的策略，在心力衰竭的管理中，降低心率获益的机制是什么？ 
    Prof.Swedberg:  We don’t really know， but probably it is that there is an energy production savings where energy production is limited， potentially with various enzymes involved.  For instance， when heart rate goes up these patients cannot produce enough ATP and then result in going into heart failure.  Reduction in heart rate tilts these hearts into another situation and improves systolic function.  We have also speculated that it is the neural-hormonal bombardment directly on the myocardium but that is just speculation.  We know there is an intense sympathetic drive for sure and that is why we have thought that beta-blockers work.  Now that we have seen the results with a pure sinus node inhibitor， with no anti-adrenergic effect， that it also improves outcomes， I am much more uncertain the action of neural-hormonal antagonists may have.  Mechanistically that is where we are thinking now， saving beats will save energy.

    Prof.Swedberg:我们真的还不知道，但可能是因为在能量产生有限之处存在能量产生的节约，可能有各种酶的参与。例如，当心率升高时，这些患者不能产生足够的ATP，于是导致进入心力衰竭状态。心率的降低使这些心脏进入另一种状态，并改善心脏收缩功能。我们还推测，是因为直接对心肌的神经激素轰击，但这仅仅是猜测。我们知道肯定存在强烈的交感驱动，这就是为何我们一直认为β受体阻滞剂起作用的原因。现在，我们已经看到无抗肾上腺素作用的单纯窦房结抑制剂的结果，它也改善了预后，对神经激素拮抗剂可能有的作用我更不确定。从机制上来看，这正是目前我们所在思考的内容，减少心跳将节约能量。