This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Yamakawa, H. Articles by Yokoyama, M. Search for Related Content PubMed PubMed Citation Articles by Yamakawa, H. Articles by Yokoyama, M.

(Circulation. 1996;94:340-345.)
© 1996 American Heart Association, Inc.

Articles

Negative Chronotropic Effect of ß-Blockade Therapy Reduces Myocardial Oxygen Expenditure for Nonmechanical Work

Hideyuki Yamakawa, MD; Motoshi Takeuchi, MD; Hideyuki Takaoka, MD; Katsuya Hata, MD; Masuki Mori, MD; Mitsuhiro Yokoyama, MD

the First Department of Internal Medicine, Kobe University School of Medicine, Kobe, Japan.

Correspondence to Motoshi Takeuchi, MD, First Department of Internal Medicine, Kobe University School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650, Japan.

Background The negative chronotropic effect of ß-blocking agents is likely to provide hemodynamic and energetic advantages. However, the negative chronotropic effect on cardiac energetics observed on the initiation of ß-blockade therapy has not been fully elucidated.

Methods and Results In 18 patients with heart failure, left ventricular pressure and volume, external work (EW), myocardial oxygen consumption per beat (total O₂), mechanical efficiency (EW/total O₂), and O₂ for nonmechanical work (total O₂-2·EW) were measured with the use of conductance catheter and Webster catheter at the following three states: under control conditions and after ß-blockade (0.15±0.07 mg/kg propranolol IV) with and without atrial pacing to keep the heart rate at control levels. Heart rate decreased after atrial pacing was stopped. EW decreased during ß-blockade with pacing and returned to the control level after pacing was stopped. Total O₂ did not change during ß-blockade with or without pacing, whereas O₂ for nonmechanical work increased with pacing and returned to the control level after pacing was stopped. As a result, mechanical efficiency decreased during ß-blockade with pacing and returned to the control level after pacing was stopped.

Conclusions The negative chronotropic effect of a ß-blocking agent may offset the mechanoenergetical deterioration resulting from its negative inotropic effect through a reduction in oxygen expenditure for nonmechanical work. These findings suggest that the negative chronotropic effect is an important aspect of ß-blockade therapy.

Key Words: heart failure • ß-adrenergic receptor blockade • heart rate • energetics

This article has been cited by other articles:

				D. Logeart, J.-P. Gueffet, F. Rouzet, F. Pousset, C. Chavelas, A. C. Solal, and G. Jondeau Heart rate per se impacts cardiac function in patients with systolic heart failure and pacing: a pilot study Eur J Heart Fail, January 1, 2009; 11(1): 53 - 57. [Abstract] [Full Text] [PDF]

				R. A.H. Stewart, O. C. Raffel, A. J. Kerr, R. Gabriel, I. Zeng, A. A. Young, and B. R. Cowan Pilot Study to Assess the Influence of {beta}-Blockade on Mitral Regurgitant Volume and Left Ventricular Work in Degenerative Mitral Valve Disease Circulation, September 2, 2008; 118(10): 1041 - 1046. [Abstract] [Full Text] [PDF]

				R. Ferrari, C. Ceconi, and G. Guardigli Pathophysiological role of heart rate: from ischaemia to left ventricular dysfunction Eur. Heart J. Suppl., August 1, 2008; 10(suppl_F): F7 - F10. [Abstract] [Full Text] [PDF]

				V. Ciobotaru, M. Heimburger, L. Louedec, C. Heymes, R. Ventura-Clapier, P. Bedossa, B. Escoubet, J.-B. Michel, J.-J. Mercadier, and D. Logeart Effect of Long-Term Heart Rate Reduction by If Current Inhibition on Pressure Overload-Induced Heart Failure in Rats J. Pharmacol. Exp. Ther., January 1, 2008; 324(1): 43 - 49. [Abstract] [Full Text] [PDF]

				K. Fox, J. S. Borer, A. J. Camm, N. Danchin, R. Ferrari, J. L. Lopez Sendon, P. G. Steg, J.-C. Tardif, L. Tavazzi, M. Tendera, et al. Resting Heart Rate in Cardiovascular Disease J. Am. Coll. Cardiol., August 28, 2007; 50(9): 823 - 830. [Abstract] [Full Text] [PDF]

				H. Yamada, K. A. Mowrey, Z. B. Popovic, W. J. Kowalewski, D. O. Martin, J. D. Thomas, and D. W. Wallick Coupled pacing improves cardiac efficiency during acute atrial fibrillation with or without cardiac dysfunction Am J Physiol Heart Circ Physiol, November 1, 2004; 287(5): H2016 - H2022. [Abstract] [Full Text] [PDF]

				D. Mansfield, D. M. Kaye, H. Brunner La Rocca, P. Solin, M. D. Esler, and M. T. Naughton Raised Sympathetic Nerve Activity in Heart Failure and Central Sleep Apnea Is Due to Heart Failure Severity Circulation, March 18, 2003; 107(10): 1396 - 1400. [Abstract] [Full Text] [PDF]

				D. M. Kaye, L. Johnston, G. Vaddadi, H. Brunner-LaRocca, G. L. Jennings, and M. D. Esler Mechanisms of Carvedilol Action in Human Congestive Heart Failure Hypertension, May 1, 2001; 37(5): 1216 - 1221. [Abstract] [Full Text] [PDF]

				T Laperche, D Logeart, A Cohen-Solal, and R Gourgon Potential interests of heart rate lowering drugs Heart, April 1, 1999; 81(4): 336 - 341. [Full Text]

				J E Sanderson, S K W Chan, C M Yu, L Y C Yeung, W M Chan, K Raymond, K W Chan, and K S Woo beta Blockers in heart failure: a comparison of a vasodilating beta  blocker with metoprolol Heart, January 1, 1998; 79(1): 86 - 92. [Abstract] [Full Text] [PDF]