Effect of beta-Blocker Withdrawal on Functional Capacity in Heart Failure and Preserved Ejection Fraction
Por:
Palau P, Seller J, Domínguez E, Sastre C, Ramón JM, de La Espriella R, Santas E, Miñana G, Bodí V, Sanchis J, Valle A, Chorro FJ, Llácer P, Bayés-Genís A and Núñez J
Publicada:
23 nov 2021
Ahead of Print:
1 nov 2021
Categoría:
Cardiology and cardiovascular medicine
Resumen:
BACKGROUND Chronotropic incompetence has shown to be associated with a decrease in exercise capacity in heart failure with preserved ejection fraction (HFpEF), yet beta-blockers are commonly used in HFpEF despite the lack of robust evidence.
OBJECTIVES This study aimed to evaluate the effect of beta-blocker withdrawal on peak oxygen consumption (peak V-O2) in patients with HFpEF and chronotropic incompetence.
METHODS This is a multicenter, randomized, investigator-blinded, crossover clinical trial consisting of 2 treatment periods of 2 weeks separated by a washout period of 2 weeks. Patients with stable HFpEF, New York Heart Association functional classes II and III, previous treatment with beta-blockers, and chronotropic incompetence were first randomized to withdrawing from (arm A: n = 26) versus continuing (arm B: n = 26) beta-blocker treatment and were then crossed over to receive the opposite intervention. Changes in peak V-O2 and percentage of predicted peak V-O2 (peak V-O2%) measured at the end of the trial were the primary outcome measures. To account for the paired-data nature of this crossover trial, linear mixed regression analysis was used.
RESULTS The mean age was 72.6 +/- 13.1 years, and most of the patients were women (59.6%) in New York Heart Association functional class II (66.7%). The mean peakV(O2) and peak V-O2% were 12.4 +/- 2.9 mL/kg/min, and 72.4 +/- 17.8%, respectively. No significant baseline differences were found across treatment arms. Peak V-O2 and peak V-O2% increased significantly after beta-blocker withdrawal (14.3 vs 12.2 mL/kg/min [Delta +2.1 mL/kg/min]; P < 0.001 and 81.1 vs 69.4% [Delta +11.7%]; P < 0.001, respectively).
CONCLUSIONS beta-blocker withdrawal improved maximal functional capacity in patients with HFpEF and chronotropic incompetence. beta-blocker use in HFpEF deserves profound re-evaluation. (beta-blockers Withdrawal in Patients With HFpEF and Chronotropic Incompetence: Effect on Functional Capacity [PRESERVE-HR]; (C) 2021 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.
Filiaciones:
Palau P:
Cardiology Department, Hospital Clínico Universitario, Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain
Seller J:
Cardiology Department, Hospital de Denia, Alicante, Spain
:
Fisabio, Universitat Jaume I, Castellón, Spain
Sastre C:
Cardiology Department, Hospital Clínico Universitario, Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain
Ramón JM:
Cardiology Department, Hospital Clínico Universitario, Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain
de La Espriella R:
Cardiology Department, Hospital Clínico Universitario, Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain
Santas E:
Cardiology Department, Hospital Clínico Universitario, Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain
Miñana G:
Cardiology Department, Hospital Clínico Universitario, Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain
Centro de Investigación Biomédica en Red Enfermedades Cardiovascular, Madrid, Spain
Bodí V:
Cardiology Department, Hospital Clínico Universitario, Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain
Centro de Investigación Biomédica en Red Enfermedades Cardiovascular, Madrid, Spain
Sanchis J:
Cardiology Department, Hospital Clínico Universitario, Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain
Centro de Investigación Biomédica en Red Enfermedades Cardiovascular, Madrid, Spain
Valle A:
Cardiology Department, Hospital de Denia, Alicante, Spain
Chorro FJ:
Cardiology Department, Hospital Clínico Universitario, Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain
Centro de Investigación Biomédica en Red Enfermedades Cardiovascular, Madrid, Spain
Llácer P:
Centro de Investigación Biomédica en Red Enfermedades Cardiovascular, Madrid, Spain
Internal Medicine Department, Hospital Ramón y Cajal, Madrid, Spain
Bayés-Genís A:
Centro de Investigación Biomédica en Red Enfermedades Cardiovascular, Madrid, Spain
Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
Núñez J:
Cardiology Department, Hospital Clínico Universitario, Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain
Centro de Investigación Biomédica en Red Enfermedades Cardiovascular, Madrid, Spain
hybrid, Green Published
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