Beta‐Blocker Use Is Associated With Prevention of Left Ventricular Remodeling in Recovered Dilated Cardiomyopathy

Abstract

Background Withdrawal of optimal medical therapy has been reported to relapse cardiac dysfunction in patients with dilated cardiomyopathy (DCM) whose cardiac function had improved. However, it is unknown whether beta‐blockers can prevent deterioration of cardiac function in those patients. We examined the effect of beta‐blockers on left ventricular ejection fraction (LVEF) in recovered DCM. Methods and Results We analyzed the clinical personal record of DCM, a national database of the Japanese Ministry of Health, Labor and Welfare, between 2003 and 2014. Recovered DCM was defined as a previously documented LVEF <40% and a current LVEF ≥40%. Patients with recovered DCM were divided into 2 groups according to the use of beta‐blockers. A one‐to‐one propensity case‐matched analysis was used. The primary outcome was defined as a decrease in LVEF >10% at 2 years of follow‐up. Of 5370 eligible patients, 4104 received beta‐blockers. Propensity score matching yielded 1087 pairs. Mean age was 61.9 years, and 1619 (74.5%) were men. Mean LVEF was 49.3±8.2%, and median B‐type natriuretic peptide was 46.6 (interquartile range, 18.0–118.1) pg/mL. The primary outcome was observed less frequently in the beta‐blocker group than in the no‐beta‐blocker group (19.6% versus 24.0%; odds ratio [OR], 0.77; 95% CI, 0.63–0.95; P =0.013). Subgroup analysis demonstrated that female patients (women: OR, 0.54; 95% CI, 0.36–0.81; men: OR, 0.88; 95% CI, 0.69–1.12; P for interaction=0.040) were benefited by beta‐blockers. Conclusions Beta‐blocker use could prevent deterioration of left ventricular systolic function in patients with recovered DCM.

Nationwide Temporal Trends in Clinical Characteristics and Treatment of Dilated Cardiomyopathy From 2003 to 2013 in Japan ― A Report From Clinical Personal Records ―

“…17, 18 In addition, the use of β-blockers was associated with the prevention of LV dysfunction in reversed DCM. 16 LV reverse remodeling is a surrogate endpoint in HF clinical trials. 21 Previous national surveys in Japan in 2002 revealed that the prescription rates of β-blockers and ACEi for DCM were 41% and 65%, respectively, 11,12 indicating insufficient OMT for DCM patients.…”

“…In previous studies, we have used the Clinical Personal Records to report on the clinical features of DCM patients and routine practices, as well as the effectiveness of β-blockers and ACEi/ARB on LV reverse remodeling in DCM. [15][16][17][18] This database is the largest and most reliable for investigations into clinical information regarding DCM in Japan. The aim of the present study was to describe temporal trends in the clinical characteristics and medical treatment of DCM in Japan using the nationwide Clinical Personal Records database.…”

Effect of β‐blocker on patients with moderate functional mitral regurgitation undergoing surgical aortic valve replacement

“… 10 Many clinical studies also show that BB could effectively suppress the progression of left ventricular remodelling, 22 , 23 which directly contributes to the improvement of left ventricular function. 17 Sahoo et al . have also reported that the usage of BB is able to improve left ventricular parameters in a group of patients with rheumatic mitral regurgitation.…”

Prognosis after discontinuing renin angiotensin aldosterone system inhibitor for heart failure with restored ejection fraction after acute myocardial infarction

“…Although our data did not include any parameters of cardiac structure or function other than LVEF, these results strongly suggest that recovered LV function alone is not a clinically useful indicator that may advise discontinuation of HF medications, even in post-AMI HFresEF patients 32 . Also, these observations implied the importance of regular surveillance and continuation of GDMT including RAASi in HFresEF patients 35 . Future studies should determine which component of GDMT is more critical to prevent relapse, and also should focus on elucidating the characteristics that distinguish remission from permanent recovery in post-AMI HFresEF patients.…”