Left ventricular inotropic reserve and right ventricular function predict increase of left ventricular ejection fraction after beta-blocker therapy in nonischemic cardiomyopathy

Ramahi, Tarik M.; Longo, Marialucia; Cadariu, Arina; Rohlfs, Kate; Carolan, Stella; Engle, Kathryn M.; Samady, Habib; Wackers, Frans J. Th.

doi:10.1016/s0735-1097(00)01162-1

Cited by 39 publications

(33 citation statements)

References 36 publications

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“…The present study could not confirm previous results (6,7) showing that cardiac contractile reserve during dobu- tamine stress is useful for predicting the efficacy of b-blockers in patients with IDC and heart failure. There are several explanations for this discrepancy.…”

Section: Contractile Reserve and Dlvef-carvedilolcontrasting

confidence: 99%

“…These factors might explain the failure of DLVEF-dobutamine to demonstrate a relationship to DLVEF-carvedilol. However, a low-dosage infusion protocol (10-20 mg of dobutamine per kilogram per minute) has been established to evaluate contractile reserve in previous studies (6,7).…”

Section: Study Limitationsmentioning

confidence: 99%

“…b-blockers exert their benefits at least in part by inhibiting sympathetically mediated myocardial damage and necrosis (3,5). Previous studies have reported that cardiac contractile reserve during dobutamine stress predicts the improvement of cardiac function with b-blocker therapy in patients with idiopathic dilated cardiomyopathy (IDC) (6,7). However, it is generally still difficult to predict whether heart failure patients will respond favorably to b-blockers.…”

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confidence: 99%

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Myocardial β-Adrenergic Receptor Density Assessed by ¹¹C-CGP12177 PET Predicts Improvement of Cardiac Function After Carvedilol Treatment in Patients with Idiopathic Dilated Cardiomyopathy

Naya¹,

Tsukamoto²,

Morita³

et al. 2009

J Nucl Med

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We evaluated whether myocardial b-adrenergic receptor (b-AR) density, as determined by 11 C-CGP12177 PET, could predict improvement of cardiac function by b-blocker carvedilol treatment in patients with idiopathic dilated cardiomyopathy (IDC). Methods: Ten patients with IDC (left ventricular ejection fraction [LVEF] , 45%) were studied. Myocardial b-AR density was estimated using 11 C-CGP12177 PET before treatment with carvedilol. Changes of LVEF in response to dobutamine infusion (DLVEF-dobutamine) were also measured by echocardiography. Changes of LVEF (DLVEF-carvedilol) were evaluated after 20 mo of carvedilol treatment. Results: Baseline myocardial b-AR density significantly correlated with DLVEF-carvedilol (r 5 20.88, P , 0.001). In contrast, DLVEF-dobutamine did not correlate with DLVEF-carvedilol (P 5 0.65). Myocardial b-AR density was the significant multivariate independent predictor of DLVEF-carvedilol (b 5 20.88, P , 0.001) among univariate predictors, including functional class (r 5 0.76, P , 0.05), plasma norepinephrine (r 5 0.85, P , 0.01), LVEF (r 5 20.64, P , 0.05), and age as confounding factors. Furthermore, myocardial b-AR density was significantly correlated with plasma norepinephrine (r 5 20.79, P , 0.01) and LVEF (r 5 0.70, P , 0.05). Conclusion: Myocardial b-AR density is more tightly related to improvement of LVEFcarvedilol than is cardiac contractile reserve in patients with IDC. Patients with decreased myocardial b-AR have higher resting adrenergic drive, as reflected by plasma norepinephrine, and may receive greater benefit from being treated by antiadrenergic drugs.

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Section: Contractile Reserve and Dlvef-carvedilolcontrasting

confidence: 99%

Section: Study Limitationsmentioning

confidence: 99%

mentioning

confidence: 99%

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Myocardial β-Adrenergic Receptor Density Assessed by ¹¹C-CGP12177 PET Predicts Improvement of Cardiac Function After Carvedilol Treatment in Patients with Idiopathic Dilated Cardiomyopathy

Naya¹,

Tsukamoto²,

Morita³

et al. 2009

J Nucl Med

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“…Decreased contractile reserve is associated with low response to pharmacological therapy in heart failure. 33,34 We tested the contractile reserve of the right ventricle by perfusion with dobutamine. The contractile reserve of the RV was preserved in the hypertrophic group despite high baseline RV pressures.…”

Section: A C C E P T E Dmentioning

confidence: 99%

Inotropic Effects of Prostacyclins on the Right Ventricle Are Abolished in Isolated Rat Hearts With Right-Ventricular Hypertrophy and Failure

Holmboe

Andersen

Johnsen

et al. 2017

Journal of Cardiovascular Pharmacology

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Background:Prostacyclin mimetics are vasodilatory agents used in the treatment of pulmonary arterial hypertension. The direct effects of prostanoids on right ventricular (RV) function are unknown.We aimed to investigate the direct effects of prostacyclin mimetics on RV function in hearts with and without RV hypertrophy and failure. Methods:Wistar rats were subjected to pulmonary trunk banding to induce compensated RV hypertrophy (n=32) or manifest RV failure (n=32). Rats without banding served as healthy controls (n=30).The hearts were excised and perfused in a Langendorff system and subjected to iloprost, treprostinil, epoprostenol or MRE-269 in increasing concentrations. The effect on RV function was evaluated using a balloon-tipped catheter inserted into the RV. Results:In control hearts iloprost, treprostinil and MRE-269, improved RV function. The effect was, however, absent in hearts with RV hypertrophy and failure. Treprostinil and MRE-269 even impaired RV function in hearts with manifest RV failure.Copyright Ó 2016 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. A C C E P T E D 3 Conclusion:Iloprost, treprostinil and MRE-269 improved RV function in the healthy rat heart. RV hypertrophy abolished the positive inotropic effect and in the failing right ventricle, MRE-269 and treprostinil impaired RV function. This may be related to changes in prostanoid receptor expression and reduced coronary flow reserve in the hypertrophic and failing right ventricle.

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“…␤-Blockers improve the contractility of viable but not contractile myocardial regions in patients with ischemic (hibernating myocardium) and nonischemic etiology. 14 The beneficial effects of chronic ␤-blockade in HF occur despite an initial and transient decrease in contractility. 15 Evidence Supporting the Use of ␤-Blockers in HF…”

Section: Mechanism Of Beneficial ␤-Blocker Effects In Hfmentioning

confidence: 99%

β-Blockers in Chronic Heart Failure

2003

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Left ventricular inotropic reserve and right ventricular function predict increase of left ventricular ejection fraction after beta-blocker therapy in nonischemic cardiomyopathy

Abstract: Patients with nonischemic cardiomyopathy who have higher left ventricular inotropic reserve and normal RVEF derive higher increase in LVEF from beta-blocker therapy.

Cited by 39 publications

References 36 publications

Myocardial β-Adrenergic Receptor Density Assessed by ¹¹C-CGP12177 PET Predicts Improvement of Cardiac Function After Carvedilol Treatment in Patients with Idiopathic Dilated Cardiomyopathy

Myocardial β-Adrenergic Receptor Density Assessed by ¹¹C-CGP12177 PET Predicts Improvement of Cardiac Function After Carvedilol Treatment in Patients with Idiopathic Dilated Cardiomyopathy

Inotropic Effects of Prostacyclins on the Right Ventricle Are Abolished in Isolated Rat Hearts With Right-Ventricular Hypertrophy and Failure

β-Blockers in Chronic Heart Failure

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Left ventricular inotropic reserve and right ventricular function predict increase of left ventricular ejection fraction after beta-blocker therapy in nonischemic cardiomyopathy

Abstract: Patients with nonischemic cardiomyopathy who have higher left ventricular inotropic reserve and normal RVEF derive higher increase in LVEF from beta-blocker therapy.

Cited by 39 publications

References 36 publications

Myocardial β-Adrenergic Receptor Density Assessed by 11C-CGP12177 PET Predicts Improvement of Cardiac Function After Carvedilol Treatment in Patients with Idiopathic Dilated Cardiomyopathy

Myocardial β-Adrenergic Receptor Density Assessed by 11C-CGP12177 PET Predicts Improvement of Cardiac Function After Carvedilol Treatment in Patients with Idiopathic Dilated Cardiomyopathy

Inotropic Effects of Prostacyclins on the Right Ventricle Are Abolished in Isolated Rat Hearts With Right-Ventricular Hypertrophy and Failure

β-Blockers in Chronic Heart Failure

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Myocardial β-Adrenergic Receptor Density Assessed by ¹¹C-CGP12177 PET Predicts Improvement of Cardiac Function After Carvedilol Treatment in Patients with Idiopathic Dilated Cardiomyopathy

Myocardial β-Adrenergic Receptor Density Assessed by ¹¹C-CGP12177 PET Predicts Improvement of Cardiac Function After Carvedilol Treatment in Patients with Idiopathic Dilated Cardiomyopathy