Perioperative beta-blockade and late cardiac outcomes: A complementary hypothesis

Yeager, Mark P.; Fillinger, Mary P.; Hettleman, Bruce; Hartman, Gregg S.

doi:10.1053/j.jvca.2004.09.006

Cited by 36 publications

(24 citation statements)

References 49 publications

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“…5,6 In addition, it might be hypothesized that ␤-blockers improve outcome after major noncardiac surgery by its anti-inflammatory effect. 16 It also has been demonstrated that elevated heart rates are associated with an increased risk of vulnerable coronary plaque disruption and that ␤-blockers could reduce the risk of disruption. 17 We defined absolute heart rate change by the cumulative difference between the mean heart rate before, during, and after surgery.…”

Section: Discussionmentioning

confidence: 99%

High-Dose β-Blockers and Tight Heart Rate Control Reduce Myocardial Ischemia and Troponin T Release in Vascular Surgery Patients

et al. 2006

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Background-Adverse perioperative cardiac events occur frequently despite the use of beta (␤)-blockers. We examined whether higher doses of ␤-blockers and tight heart rate control were associated with reduced perioperative myocardial ischemia and troponin T release and improved long-term outcome. Methods and Results-In an observational cohort study, 272 vascular surgery patients were preoperatively screened for cardiac risk factors and ␤-blocker dose. Beta-blocker dose was converted to a percentage of maximum recommended therapeutic dose. Heart rate and ischemic episodes were recorded by continuous 12-lead electrocardiography, starting 1 day before to 2 days after surgery. Serial troponin T levels were measured after surgery. All-cause mortality was noted during follow-up. Higher heart rates during electrocardiographic monitoring (per 10-bpm increase) were significantly associated with an increased incidence of myocardial ischemia (HR, 2.49; 95% CI, 1.79 to 3.48), troponin T release (HR, 1.53; 95% CI, 1.16 to 2.03), and long-term mortality (HR, 1.42; 95% CI, 1.14 to 1.76). Conclusion-This study showed that higher doses of ␤-blockers and tight heart rate control are associated with reduced perioperative myocardial ischemia and troponin T release and improved long-term outcome in vascular surgery patients.

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Section: Discussionmentioning

confidence: 99%

High-Dose β-Blockers and Tight Heart Rate Control Reduce Myocardial Ischemia and Troponin T Release in Vascular Surgery Patients

et al. 2006

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“…Proposed mechanisms by which ␤-blockers exert intraoperative cardioprotective effects are: 1) heart rate control with subsequent prolongation of coronary diastolic filling time; and 2) antiarrhythmic properties reducing the risk for tachycardia (17). In addition, ␤-blockers are known to reduce systolic pressure and ventricular contractile force (17,19).…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the anti-inflammatory properties of ␤-blockers are thought to stabilize coronary plaques (17,19). Recently, it is suggested that left ventricular dysfunction is highly present in the vascular surgery population (20).…”

Section: Association Of Time Between Timing Of ␤-Blocker Initiation mentioning

confidence: 99%

“…For the long-term, ␤-blockers reduce mechanical stress imposed on coronary plaques preventing plaque rupture (16). Patients receiving ␤-blockers tend to have lower plasma concentrations of C-reactive protein (CRP) than those not receiving ␤-blockers, and the anti-inflammatory properties of ␤-blockers are thought to stabilize coronary plaques (17)(18)(19). In addition, ␤-blockers are known to lessen adverse cardiac remodelling in patients with impaired left ventricular function, which is highly prevalent in the vascular surgery population, by inhibiting the sympathetic nervous system and hormone activation (A-type and B-type natriuretic peptides and norepinephrine) (20 -22).…”

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confidence: 99%

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Timing of Pre-Operative Beta-Blocker Treatment in Vascular Surgery Patients

Flu

Kuijk

Chonchol

et al. 2010

Journal of the American College of Cardiology

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Our results indicate that β-blocker treatment initiated >1 week before surgery is associated with lower pre-operative heart rate and improved outcome, compared with treatment initiated <1 week pre-operatively. No reduction of median hs-CRP levels was observed in patients receiving β-blocker treatment >1 week compared with patients in whom treatment was initiated between 0 and 1 week before surgery.

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“…Aus diesen Überlegungen erklärt sich zu mindest teilweise der potenzielle Nutzen einer Herzfrequenzsenkung in der peri operativen Phase beim kardialen Risiko patienten. Eine βRezeptorenBlockade bewirkt [47,53] …”

Section: Grundlagenunclassified

Perioperative β-Rezeptoren-Blockade

et al. 2010

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Results from recent studies have questioned the application of beta-receptor blockers for reduction of morbidity and mortality during the perioperative period. This holds true especially for patients with no or only low cardiac risk. Although beta-receptor blockade was a form of standard therapy at the end of the 1990s, data today show no clear evidence for such a therapy not even in patients at risk for cardiac events. At least in patients with low risk the initiation of beta-receptor blockade during the perioperative period might lead to side-effects, thereby increasing morbidity and mortality.

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Perioperative beta-blockade and late cardiac outcomes: A complementary hypothesis

Cited by 36 publications

References 49 publications

High-Dose β-Blockers and Tight Heart Rate Control Reduce Myocardial Ischemia and Troponin T Release in Vascular Surgery Patients

High-Dose β-Blockers and Tight Heart Rate Control Reduce Myocardial Ischemia and Troponin T Release in Vascular Surgery Patients

Timing of Pre-Operative Beta-Blocker Treatment in Vascular Surgery Patients

Perioperative β-Rezeptoren-Blockade

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