Circulation, Vol 88, 1610-1619, Copyright © 1993 by American Heart Association
HL Haber, CL Simek, LW Gimple, JD Bergin, K Subbiah, AR Jayaweera, ER Powers and MD Feldman
BACKGROUND. Despite its negative inotropic effects, the initiation of
beta-adrenergic blockade is tolerated by patients with congestive heart
failure (CHF). Accordingly, we examined the acute hemodynamic effects of
beta-adrenergic blockade on systolic and diastolic left ventricular (LV)
function and ventriculo-arterial coupling. In addition, isolated myocardium
from patients with CHF shows selective beta 1-receptor downregulation,
implying a greater role for the beta 2-receptor in maintaining in vivo LV
contractility. As a secondary aim, we hypothesized that nonselective
beta-adrenergic blockade would have greater negative inotropic effect than
beta 1-blockade in patients with CHF. METHODS AND RESULTS. Patients with
clinical CHF (n = 24) and control patients without CHF (n = 24) were given
either the nonselective beta-blocker propranolol or the beta 1-selective
blocker metoprolol. LV pressure-volume relations were obtained before and
after the administration of intravenous beta-blocker, and measures of LV
systolic and diastolic function were examined. Patients with CHF had a
deterioration in LV systolic function with a fall in LV systolic pressure
(139 +/- 6 to 125 +/- 6 mm Hg), cardiac index (2.56 +/- 0.11 to 2.20 +/-
0.11 mL.min-1 x M-1), dP/dtmax (1173 +/- 63 to 897 +/- 50 mm Hg/s), and
end-systolic elastance (0.88 +/- 0.10 to 0.64 +/- 0.10 mm Hg/mL), P <
.05 for all. Although there was deterioration of active LV relaxation
(isovolumetric relaxation 63 +/- 2 to 73 +/- 3 milliseconds, peak filling
rate 543 +/- 33 to 464 +/- 28 mL/s, P < .05 for both), there was no
change in passive LV diastolic function (pulmonary capillary wedge, 24 +/-
2 to 24 +/- 1 mm Hg; chamber stiffness, 0.0154 +/- 0.0005 to 0.0163 +/-
0.0005 mL-1, P = NS for both), and a decrease in afterload (arterial
elastance 3.85 +/- 0.31 to 3.38 +/- 0.24 mm Hg/mL, P < .05). Control
patients had no change in these parameters other than a prolongation of
isovolumetric relaxation (48 +/- 1 to 55 +/- 2 milliseconds, P < .05).
The effects of propranolol (n = 12) versus metoprolol (n = 12) on these
parameters in patients with CHF were similar. CONCLUSIONS. These data do
not support a greater in vivo physiological role of the myocardial beta
2-receptor in CHF. The preservation of passive diastolic function and
ventriculo-arterial coupling provide possible explanations of why
beta-adrenergic blockade is tolerated by patients with CHF.
ARTICLES
Why do patients with congestive heart failure tolerate the initiation of beta-blocker therapy?
Department of Internal Medicine, University of Virginia Health Sciences Center, Charlottesville 22908.
This article has been cited by other articles:
 |
|
 |
|
  J. C. Fang Angiotensin-Converting Enzyme Inhibitors or {beta}-Blockers in Heart Failure: Does It Matter Who Goes First? Circulation, October 18, 2005; 112(16): 2380 - 2382. [Full Text] [PDF]
|
|
|
|
 |
|
 S. Sakthivel, N. L. Finley, P. R. Rosevear, J. N. Lorenz, J. Gulick, S. Kim, P. VanBuren, L. A. Martin, and J. Robbins In Vivo and in Vitro Analysis of Cardiac Troponin I Phosphorylation J. Biol. Chem., January 7, 2005; 280(1): 703 - 714. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Ahmed Myocardial beta-1 adrenoceptor down-regulation in aging and heart failure: implications for beta-blocker use in older adults with heart failure Eur J Heart Fail, December 1, 2003; 5(6): 709 - 715. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Merlet, L. Hittinger, J. L. Dubois-Rande, and A. Castaigne Myocardial Adrenergic Dysinnervation in Dilated Cardiomyopathy: Cornerstone or Epiphenomenon? J. Nucl. Med., April 1, 2002; 43(4): 536 - 539. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Zaugg, M. C. Schaub, T. Pasch, and D. R. Spahn Modulation of {beta}-adrenergic receptor subtype activities in perioperative medicine: mechanisms and sites of action Br. J. Anaesth., January 1, 2002; 88(1): 101 - 123. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B Andersson, B Gruner Svealv, M Scharin Tang, and R Mobini Longitudinal myocardial contraction improves early during titration with metoprolol CR/XL in patients with heart failure Heart, January 1, 2002; 87(1): 23 - 28. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Maack, T. Elter, G. Nickenig, K. LaRosee, M. Crivaro, A. Stablein, H. Wuttke, and M. Bohm Prospective crossover comparison of carvedilol and metoprolol in patients with chronic heart failure J. Am. Coll. Cardiol., October 1, 2001; 38(4): 939 - 946. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Dash, V. J. Kadambi, A. G. Schmidt, N. M. Tepe, D. Biniakiewicz, M. J. Gerst, A. M. Canning, W. T. Abraham, B. D. Hoit, S. B. Liggett, et al. Interactions Between Phospholamban and {{beta}}-Adrenergic Drive May Lead to Cardiomyopathy and Early Mortality Circulation, February 13, 2001; 103(6): 889 - 896. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. R. Bristow {beta}-Adrenergic Receptor Blockade in Chronic Heart Failure Circulation, February 8, 2000; 101(5): 558 - 569. [Full Text] [PDF]
|
|
|
|
|
|
E. R. Azevedo, G. E. Newton, and J. D. Parker Cardiac and systemic sympathetic activity in response to clonidine in human heart failure J. Am. Coll. Cardiol., January 1, 1999; 33(1): 186 - 191. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. R. Bristow, E. M. Gilbert, W. T. Abraham, K. F. Adams, M. B. Fowler, R. E. Hershberger, S. H. Kubo, K. A. Narahara, H. Ingersoll, S. Krueger, et al. Carvedilol Produces Dose-Related Improvements in Left Ventricular Function and Survival in Subjects With Chronic Heart Failure Circulation, December 1, 1996; 94(11): 2807 - 2816. [Abstract] [Full Text]
|
|
|
|
|
|
E. J. Eichhorn and M. R. Bristow Medical Therapy Can Improve the Biological Properties of the Chronically Failing Heart: A New Era in the Treatment of Heart Failure Circulation, November 1, 1996; 94(9): 2285 - 2296. [Abstract] [Full Text]
|
|
|
|
|
|
B. Andersson, K. Caidahl, A. di Lenarda, S. E. Warren, F. Goss, A. Waldenstrom, S. Persson, I. Wallentin, A. Hjalmarson, and F. Waagstein Changes in Early and Late Diastolic Filling Patterns Induced by Long-term Adrenergic ß-Blockade in Patients With Idiopathic Dilated Cardiomyopathy Circulation, August 15, 1996; 94(4): 673 - 682. [Abstract] [Full Text]
|
|
|
|
|
|
C. Holubarsch, T. Ruf, D. J. Goldstein, R. C. Ashton, W. Nickl, B. Pieske, K. Pioch, J. Ludemann, S. Wiesner, G. Hasenfuss, et al. Existence of the Frank-Starling Mechanism in the Failing Human Heart: Investigations on the Organ, Tissue, and Sarcomere Levels Circulation, August 15, 1996; 94(4): 683 - 689. [Abstract] [Full Text]
|
|
|
|
|
|
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]
|
|