ß-Blocker Withdrawal and Functional Capacity Improvement in Patients With Heart Failure With Preserved Ejection Fraction
Por:
Palau, P, de la Espriella, R, Seller, J, Santas, E, Dominguez, E, Bodi, V, Sanchis, J, Núñez, E, Bayés-Genis, A, Bertomeu-González, V, Meyer, M and Núñez, J
Publicada:
1 abr 2024
Ahead of Print:
1 abr 2024
Resumen:
Importance Increasing the patient's heart rate (HR) has emerged as a therapeutic option in patients with heart failure with preserved ejection fraction (HFpEF). However, the evidence is conflicting, and the profile of patients who benefit most from this strategy remains unclear. Objective To assess the association of beta-blocker treatment withdrawal with changes in the percentage of predicted peak oxygen consumption (VO2) across indexed left ventricular diastolic (iLVEDV) and indexed left ventricular systolic volumes (iLVESV), and left ventricular ejection fraction (LVEF) in patients with HFpEF and chronotropic incompetence. Design, Setting, and Participants This post hoc analysis was conducted using data from the investigator-blinded multicenter, randomized, and crossover clinical trial, PRESERVE-HR, that took place from October 1, 2018, through December 31, 2020, to investigate the short-term effects (2 weeks) of beta-blocker withdrawal on peak oxygen consumption (peak VO2). Patients with stable HFpEF (New York Heart Association functional class II to III) receiving treatment with beta-blocker and chronotropic incompetence were included. Intervention Participants in the PRESERVE-HR trial were randomized to withdraw vs continue with beta-blocker treatment. After 2 weeks, they were crossed over to receive the opposite intervention. This crossover randomized clinical trial examined the short-term effect of beta-blocker withdrawal on peak VO2. Main Outcomes and Measures The primary outcome was to evaluate the association between beta-blocker withdrawal and short-term changes in percentage of peak VO2 across iLVEDV, iLVESV, and LVEF in patients with HFpEF and chronotropic incompetence treated with beta-blocker. Results A total of 52 patients (mean age, 73 [SD, 13] years; 60% female) were randomized. The mean resting HR, peak HR, peak VO2, and percentage of peak VO2 were 65 (SD, 9) beats per minute (bpm), 97 (SD, 15) bpm, 12.4 (SD, 2.9) mL/kg per minute, and 72.4% (SD, 17.7%), respectively. The medians (minimum-maximum) of iLVEDV, iLVESV, and LVEF were 44 mL/m2 (IQR, 19-82), 15 mL/m2 (IQR, 7-32), and 64% (IQR, 52%-78%), respectively. After stopping beta-blocker treatment, the median increase in peak HR was plus 30 bpm (95% CI, 25-35; P < .001). beta-Blocker cessation was differentially associated with change of percentage of peak VO2 across the continuum of iLVESV (P for interaction = .02), indicating a greater benefit in those with lower iLVESV. Conclusions and Relevance In this study, results showed that in patients with HFpEF and chronotropic incompetence receiving treatment with beta-blocker, lower iLVESV may identify those with a greater short-term improvement in maximal functional capacity after stopping beta-blocker treatment. Further studies are warranted for further investigation. Trial RegistrationClinicalTrials.gov (NCT03871803)
Filiaciones:
Palau, P:
Univ Valencia, INCLIVA, Hosp Clin Univ, Cardiol Dept, Valencia, Spain
de la Espriella, R:
Univ Valencia, INCLIVA, Hosp Clin Univ, Cardiol Dept, Valencia, Spain
Seller, J:
Hosp Denia, Cardiol Dept, Alicante, Spain
Santas, E:
Univ Valencia, INCLIVA, Hosp Clin Univ, Cardiol Dept, Valencia, Spain
Dominguez, E:
Univ Valencia, INCLIVA, Hosp Clin Univ, Cardiol Dept, Valencia, Spain
Univ Jaume 1, Castellon De La Plana, Spain
Bodi, V:
Univ Valencia, INCLIVA, Hosp Clin Univ, Cardiol Dept, Valencia, Spain
CIBER Cardiovasc, Barcelona, Spain
Sanchis, J:
Univ Valencia, INCLIVA, Hosp Clin Univ, Cardiol Dept, Valencia, Spain
CIBER Cardiovasc, Barcelona, Spain
Núñez, E:
Univ Valencia, INCLIVA, Hosp Clin Univ, Cardiol Dept, Valencia, Spain
:
CIBER Cardiovasc, Barcelona, Spain
Univ Autonoma Barcelona, Hosp Univ Germans Trias I Pujol, Cardiol Dept, Barcelona, Spain
Bertomeu-González, V:
Univ Miguel Hernandez, Hosp Clin Benidorm, Cardiol Dept, Alicante, Spain
Meyer, M:
Univ Minnesota, Lillehei Heart Inst, Dept Med, Coll Med, Minneapolis, MN USA
Núñez, J:
Univ Valencia, INCLIVA, Hosp Clin Univ, Cardiol Dept, Valencia, Spain
CIBER Cardiovasc, Barcelona, Spain
Univ Valencia, Hosp Clin Univ, Serv Cardiol, INCLIVA, Ave Blasco Ibanez 17, Valencia 46010, Spain
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