Long-term β-blocker therapy improves diastolic function even without the therapeutic effect on systolic function in patients with reduced ejection fraction

Abstract

The beneficial effects of beta-blocker therapy on the clinical outcomes of heart failure with reduced ejection fraction (HFREF) are attributed to the improvement in ejection fraction (EF) and left ventricular (LV) reverse remodeling. Previous studies only reported the beta-blocker therapy-induced improvement of diastolic function accompanied by the increase in EF in HFREF patients. This retrospective study aimed to elucidate whether beta-blocker therapy improves diastolic function even without an increase in EF. Out of the consecutive 11,830 echocardiographic reports, HFREF patients without an increase in EF following long-term beta-blocker therapy comprised the study subjects (n=19). During the mean follow-up of 17 months, beta-blocker therapy significantly decreased peak mitral E-wave velocity (70±25-50±18 cm/s, p<0.01) and ratio of peak mitral E- to A-wave velocities (E/A ratio) (1.4±0.8-0.9±0.4, p<0.05), prolonged deceleration time of the mitral E-wave velocity (DcT) (167±54-206±61 ms, p<0.05), and improved New York Heart Association functional class (2.3±0.7-1.8±0.4, p<0.01) without changes in LV volume. Because DcT and E/A ratio are well known to correlate with LV filling pressures in patients with reduced EF, our results indicate a reduction in LV filling pressures without changes in LV volume, suggesting a reduction in LV stiffness. Thus, long-term beta-blocker therapy is likely to improve diastolic function even without a concomitant increase in EF in HFREF patients, which may be also responsible for the beta-blocker-induced improvement of their symptoms of heart failure.

Comparison of the effects of carvedilol and nebivolol on diastolic functions of the left ventricle in patients with non-ischemic heart failure

“…In our study, mitral E/A ratio was similarly reduced with carvedilol or nebivolol therapy due to reduction of mitral E wave velocity. This finding is in accordance with the results from previous studies [10,[18][19][20]22]. In contrast, Patrianakos et al [9] have reported that mitral E/A ratio was significantly decreased with nebivolol treatment in nonischemic HF patients at 12-month follow-up, but not with carvedilol therapy.…”

“…In HF patients with low EF, carvedilol therapy reduced mitral E velocity, E/A ratio and IVRT while it prolonged DT [18,20,22], as in our study. In contrast, mitral inflow velocities and mitral E/A ratio remained unchanged with carvedilol therapy in HF patients in previous two studies [9,10].…”

“…Beta-blockers can frequently improve LV diastolic function in association with an increase in EF of HF patients [18,19]. However, they can recover diastolic dysfunction even without a concomitant EF elevation *p < 0.05 vs. baseline in each group; P 1 -comparisons of two groups at 3 months; P 2 -comparisons of two groups at 6 months; A -mitral late diastolic velocity; DBP -diastolic blood pressure; HR -heart rate; LAD -left atrial diameter; LVEDD -left ventricular end-diastolic diameter; LVESD -left ventricular end-systolic diameter; LVEF -left ventricular ejection fraction; SBP -systolic blood pressure; other abbreviations are as shown in Table 1 and 2. in such patients [20]. There are several explanations for their favorable effects.…”

“…Carvedilol [7,9,10,18,20,[22][23][24] and nebivolol [8-10, 19, 25, 26] have been reported to have different effects on mitral E wave velocity and E/A ratio in previous studies. In our study, mitral E/A ratio was similarly reduced with carvedilol or nebivolol therapy due to reduction of mitral E wave velocity.…”

Comparison of Beta-Blocker Effectiveness in Heart Failure Patients With Preserved Ejection Fraction Versus Those With Reduced Ejection Fraction

“…Beta blockers (BB) have been shown to decrease death and re-hospitalization of patients with HF and reduced EF, 6,8,9 and have been endorsed in both guidelines and performance measures. 2 Consequently, this class of medications is an appealing, but unproven, choice for treating HF patients with preserved EF.…”