Ejection Fraction Improvement by β-Blocker Treatment in Patients with Heart Failure: An Analysis of Studies Published in the Literature

Abstract

Because ejection fraction (EF) is one of the most important predictors of survival in patients with left ventricular (LV) dysfunction and because Packer showed a large reduction in mortality figures with carvedilol, in contrast to former studies with bisoprolol and metoprolol, we investigated if this difference in survival may be related to a difference in improvement of LV function by different beta-blockers. We searched the MEDLINE database and all reference lists of articles obtained through the search for the relation between beta-blocker treatment and improvement in EF. Forty-one studies met the criteria and we added two of our own studies. Four hundred and fifty-eight patients were treated with metoprolol with a mean follow-up of 9.5 months and a mean increase in EF of 7.4 EF units. One thousand thirty patients were treated with carvedilol with a mean follow up of 7 months and a mean increase in EF of 5.7 EF units. One hundred ninety-nine patients were treated with bucindolol with a mean follow-up of 4 months and a mean increase in EF of 4.6 EF units. Several small studies with nebivolol, atenolol, and propranolol were also studied and, when combined, the mean increase in EF was 8.6 EF units. When patients with idiopathic and ischemic cardiomyopathies were compared, the average increase in EF units was 8.5 vs. 6.0, respectively. The use of beta-blocker treatment in heart failure patients, irrespective of the etiology, improved LV function in almost all studies and it appears that the differences among beta-blockers and among etiologies is small and probably insignificant. However, there is a difference in survival rate when the various beta-blockers are compared, suggesting that mechanisms other than improvement of LV function by beta-blockers are responsible for the difference in survival.

Wearable Cardioverter-Defibrillator Therapy for the Prevention of Sudden Cardiac Death

“…For example, partial or complete recovery of LVEF has been observed in more than half of patients at 3 months after AMI after institution of heart failure therapies or revascularization. [15][16][17][18][19][20] Guideline-directed medical therapy with β-blockade and renin-angiotensin-aldosterone system antagonism during the early period after diagnosis of nonischemic cardiomyopathy may result in improved ventricular function and decreased future risk of SCD; 50% of patients with newly diagnosed nonischemic cardiomyopathy will demonstrate a 10% improvement in LVEF with the initiation of medical therapy. 21,22 Although the rationale and reasons for postponing ICD implantation are sensible, the current evidence base is incomplete.…”

Predictors of Stable Outcome in Treating Chronic Heart Failure Patients With Carvedilol

“…This finding is compatible with previous studies showing that ejection fraction can be improved by β-blocker treatment in chronic heart failure. 20,21) The possible mechanism of this difference between favorable and unfavorable outcomes may be a different degree of improvement of left ventricular function by the carvedilol used in different left ventricular reserves.…”

Comparative Left Ventricular Functional and Neurohumoral Effects of Chronic Treatment With Carvedilol Versus Metoprolol in Patients With Dilated Cardiomyopathy

“…[10][11][12][13] It remains to be elucidated why -blockers improve cardiac function. Not only 2 and blocking and vasodilatory properties, but carvedilol also has many ancillary effects for cardiac protection, such as potent inhibition of cardiac sympathetic activity 5,6 and antioxidant effects.…”