Effect of β-Blocker Withdrawal on Functional Capacity in Heart Failure and Preserved Ejection Fraction
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Effect of β-Blocker Withdrawal on Functional Capacity in Heart Failure and Preserved Ejection FractionAutoria
Data de publicació
2021-11-15Editor
Elsevier; American College of CardiologyISSN
0735-1097Cita bibliogràfica
Palau, P., Seller, J., Domínguez, E., Sastre, C., Ramón, J. M., de La Espriella, R., ... & Núñez, J. (2021). Effect of β-blocker withdrawal on functional capacity in heart failure and preserved ejection fraction. Journal of the American College of Cardiology, 78(21), 2042-2056.Tipus de document
info:eu-repo/semantics/articleVersió
info:eu-repo/semantics/publishedVersionParaules clau / Matèries
Resum
BACKGROUND Chronotropic incompetence has shown to be associated with a decrease in exercise capacity in heart
failure with preserved ejection fraction (HFpEF), yet b-blockers are commonly used in HFpEF despite the ... [+]
BACKGROUND Chronotropic incompetence has shown to be associated with a decrease in exercise capacity in heart
failure with preserved ejection fraction (HFpEF), yet b-blockers are commonly used in HFpEF despite the lack of robust
evidence.
OBJECTIVES This study aimed to evaluate the effect of b-blocker withdrawal on peak oxygen consumption (peak VO2)
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 b-blockers, and chronotropic incompetence were first randomized to
withdrawing from (arm A: n ¼ 26) versus continuing (arm B: n ¼ 26) b-blocker treatment and were then crossed over to
receive the opposite intervention. Changes in peak VO2 and percentage of predicted peak VO2 (peak VO2%) 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 peakVO2 and peak VO2% were 12.4 2.9 mL/kg/min, and 72.4 17.8%,
respectively. No significant baseline differences were found across treatment arms. Peak VO2 and peak VO2% increased
significantly after b-blocker withdrawal (14.3 vs 12.2 mL/kg/min [D þ2.1 mL/kg/min]; P < 0.001 and 81.1 vs 69.4%
[D þ11.7%]; P < 0.001, respectively).
CONCLUSIONS b-blocker withdrawal improved maximal functional capacity in patients with HFpEF and chronotropic
incompetence. b-blocker use in HFpEF deserves profound re-evaluation. (b-blockers Withdrawal in Patients With HFpEF
and Chronotropic Incompetence: Effect on Functional Capacity [PRESERVE-HR]; NCT03871803; 2017-005077-39)
(J Am Coll Cardiol 2021;78:2042–2056) © 2021 The Authors. Published by Elsevier on behalf of the American College of
Cardiology Foundation. [-]
Publicat a
JACC VOL. 78, NO. 21, 2021Entitat finançadora
Ministerio de Economía y Competitividad (Spain)
Codi del projecte o subvenció
PI17/01426
Drets d'accés
Copyright © 2021, The Authors. Published by Elsevier on Behalf of The American College of Cardiology
info:eu-repo/semantics/openAccess
info:eu-repo/semantics/openAccess
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