Circulation, Vol 82, 473-483, Copyright © 1990 by American Heart Association
EJ Eichhorn, JB Bedotto, CR Malloy, BA Hatfield, D Deitchman, M Brown, JE Willard and PA Grayburn
The hemodynamic effects of beta-adrenergic blockade with bucindolol, a
nonselective beta-antagonist with mild vasodilatory properties, were
studied in patients with congestive heart failure. Fifteen patients (New
York Heart Association class I-IV) underwent cardiac catheterization before
and after 3 months of oral therapy with bucindolol. The left ventricular
ejection fraction increased from 0.23 +/- 0.12 to 0.29 +/- 0.14 (p =
0.007), and end-systolic elastance, a relatively load-independent
determinant of contractility, increased from 0.60 +/- 0.40 to 1.11 +/- 0.45
mm Hg/ml (p = 0.0049). Both left ventricular stroke work index (34 +/- 13
to 47 +/- 19 g-m/m2, p = 0.0059) and minute work (5.5 +/- 2.2 to 7.0 +/-
2.6 kg-m/min, p = 0.0096) increased despite reductions in left ventricular
end-diastolic pressure (19 +/- 8 to 15 +/- 5 mm Hg, p = 0.021). There was
an upward shift in the peak + dP/dtmax-end-diastolic volume relation (p =
0.0005). These data demonstrate improvements in myocardial contractility
after beta-adrenergic blockade with bucindolol. At a matched paced heart
rate of 98 +/- 15 min-1, the time constant of left ventricular isovolumic
relaxation was significantly reduced by bucindolol therapy (92 +/- 17
versus 73 +/- 11 msec, p = 0.0013), and the relation of the time constant
to end-systolic pressure was shifted downward (p = 0.014) with therapy. The
slope of the logarithm left ventricular end-diastolic
pressure-end-diastolic volume relation was unchanged (p = 0.51) after
bucindolol. These data suggest that chronic beta-adrenergic blockade with
bucindolol improves diastolic relaxation but does not alter myocardial
chamber stiffness. Myocardial oxygen extraction, consumption, and
efficiency were unchanged despite improvement in contractile function and
mechanical work. Thus, in patients with congestive heart failure, chronic
beta-adrenergic blockade with bucindolol significantly improves myocardial
contractility and minute work, yet it does not do so at the expense of
myocardial oxygen consumption. Additionally, bucindolol improves myocardial
relaxation but does not affect chamber stiffness.
ARTICLES
Effect of beta-adrenergic blockade on myocardial function and energetics in congestive heart failure. Improvements in hemodynamic, contractile, and diastolic performance with bucindolol
Cardiac Catheterization Laboratory, Dallas Veterans Administration Hospital, TX.
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|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
H. Yamakawa, M. Takeuchi, H. Takaoka, K. Hata, M. Mori, and M. Yokoyama Negative Chronotropic Effect of ß-Blockade Therapy Reduces Myocardial Oxygen Expenditure for Nonmechanical Work Circulation, August 1, 1996; 94(3): 340 - 345. [Abstract] [Full Text]
|
|
|
|
 |
|
 M. A. Pfeffer and L. W. Stevenson {beta}-Adrenergic Blockers and Survival in Heart Failure N. Engl. J. Med., May 23, 1996; 334(21): 1396 - 1397. [Full Text]
|
|
|
|
 |
|
 J. D. Sackner-Bernstein and D. M. Mancini Rationale for Treatment of Patients With Chronic Heart Failure With Adrenergic Blockade JAMA, November 8, 1995; 274(18): 1462 - 1467. [Abstract] [PDF]
|
|
|
|
|
|
G. W. Dec and V. Fuster Idiopathic Dilated Cardiomyopathy N. Engl. J. Med., December 8, 1994; 331(23): 1564 - 1575. [Full Text]
|
|
|
|
|
|
A. M. Feldman Can We Alter Survival in Patients With Congestive Heart Failure? JAMA, April 8, 1992; 267(14): 1956 - 1961. [Abstract] [PDF]
|
|