β-Blockers are effective in congestive heart failure patients with atrial fibrillation

Meng, F.; Yoshikawa, Tsutomu; Baba, Akira; Moritani, Kazunori; Suzuki, Masahiro; Satoh, Tsuyoshi; Yokozuka, Hitoshi; Murayama, Akira; Ogawa, Satoshi

doi:10.1054/s1071-9164(03)00127-1

Cited by 27 publications

(15 citation statements)

References 21 publications

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“…[10][11][12][13] Several studies have compared metoprolol with carvedilol for treating patients with mild to moderate CHF, [14][15][16][17] and some have shown that carvedilol is more efficacious than metoprolol in improving LVEF and hemodynamic parameters. 15,17 The recently published large-scale Carvedilol or Metoprolol European Trial (COMET) demonstrated that carvedilol reduces total mortality to a greater extent than metoprolol.…”

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confidence: 99%

Comparison of the Effects of Carvedilol and Metoprolol on Exercise Ventilatory Efficiency in Patients With Congestive Heart Failure

Kataoka

Satoh

Yoshikawa

et al. 2008

Circ J

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he slope of the relationship between ventilation and carbon dioxide production (V • E/V • CO2 slope) is obtained during symptom-limited cardiopulmonary exercise testing, by plotting ventilation (V • E) vs carbon dioxide production (V • CO2). The increase in the V • E/V • CO2 slope reflects reduced ventilatory efficiency of gas exchange, which is associated with increased physiological dead space, as well as a decrease in the partial arterial pressure of carbon dioxide (PaCO2) regulatory set point. 1,2 The V• E/V • CO2 slope is probably the best indicator of decreased pulmonary blood flow and is elevated in most patients with congestive heart failure (CHF). 3,4 Besides the classical risk factors such as left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) class IV symptoms and neurohormonal markers, peak oxygen consumption (V • O2) was found to predict survival in patients with CHF. 5,6 Recently, the V• E/V • CO2 slope was shown to be a better prognostic indicator than peak V• O2, [7][8][9] suggesting that improvement in the slope could be used as an indicator of prolonged survival of patients with CHF.Large clinical trials have established that -blockers improve left ventricular function and the survival of patients with CHF. [10][11][12][13] Several studies have compared metoprolol with carvedilol for treating patients with mild to moderate CHF, [14][15][16][17] and some have shown that carvedilol is more efficacious than metoprolol in improving LVEF and hemodynamic parameters. 15,17 The recently published large-scale Carvedilol or Metoprolol European Trial (COMET) demonstrated that carvedilol reduces total mortality to a greater extent than metoprolol. 18 However, the relationship between the institution of -blocker therapy and the V • E/V • CO2 slope in patients with CHF isstill unknown.Thus, the purposes of this study were (1) to investigate whether administration of -blockers can improve the V • E/V • CO2 slope, and (2) to compare the influence of 2 -blockers, carvedilol and metoprolol, on the V• E/V • CO2 slope in patients with CHF. Methods Study PopulationA total of 58 patients initially participated, but 1 patient was withdrawn because of sudden death. Therefore, a total of 57 patients with NYHA II-III CHF were examined. The etiology was dilated cardiomyopathy, ischemic, and valvular J 2008; 72: 358 -363 (Received March 16, 2007; revised manuscript received October 30, 2007; accepted November 9, 2007 Background The slope of the relationship between ventilation and carbon dioxide production (V • E/V • CO2 slope), obtained during symptom-limited ramp exercise testing, reflects exercise ventilatory efficiency. Importantly, the V Circ• E/V • CO2 slope is related to prognosis in patients with congestive heart failure (CHF). The aim of the present study was to determine the relationship between the institution of -blockers, carvedilol or metoprolol, and the V• E/V • CO2 slope during exercise in patients with CHF. Methods and ResultsFifty-seven patients with New York Heart Association...

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confidence: 99%

Comparison of the Effects of Carvedilol and Metoprolol on Exercise Ventilatory Efficiency in Patients With Congestive Heart Failure

Kataoka

Satoh

Yoshikawa

et al. 2008

Circ J

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“…Patients with LV dysfunction and persistent AF should be treated with beta blockers and ACE inhibitors and/or angiotensin II receptor antagonists, because these agents help control the heart rate, improve ventricular function, and prolong survival. [305][306][307][308] Coronary artery disease. In stable patients with CAD, beta blockers may be considered first, although their use is supported by only 2 studies 309,310 and data on efficacy for maintenance of sinus rhythm in patients with persistent AF after cardioversion are not convincing.…”

Section: Selection Of Antiarrhythmic Agents In Patients With Cardimentioning

confidence: 99%

ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation—Executive Summary

Fuster¹,

Rydén²,

Cannom³

et al. 2006

Circulation

264

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“…Previous analysis of this HF population was hampered by the lack of a control population as well as the potential confounding effect of alteration of vasodilating drugs or diuretics during up-titration with beta-blockers [21,25]. …”

Section: Discussionmentioning

confidence: 99%

“…In the context of CHF patients with persistent AF, there is limited evidence and, more specifically, no randomised, control group trial data on how B-type natriuretic peptide (BNP) responds to the introduction of beta-blockers in a population of stable HF patients. One post hoc study suggested a more marked reduction of BNP in CHF patients with AF as opposed to sinus rhythm [25]. Amelioration of adverse remodelling of the heart, attenuation of neuro-humoral activation together with improved ventricular rate (VR) control are potential mechanisms by which beta-blockers reduce natriuretic peptides in patients with CHF and persistent AF [26].…”

Section: Introductionmentioning

confidence: 99%

The Effect of Carvedilol on B-Type Natriuretic Peptide and Cardiac Function in Patients with Heart Failure and Persistent Atrial Fibrillation

Khand¹,

Chew²,

Douglas³

et al. 2015

Cardiology

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Objectives: We sought to determine the relationship between changes in natriuretic peptides and symptoms as a consequence of introducing beta-blocker therapy, in patients with chronic heart failure (CHF) and persistent atrial fibrillation (AF). Methods: In a randomised, double-blind, placebo-controlled study involving 47 patients with CHF and persistent AF (mean age 68 years and 62% men), we analysed the individual change (Δ) in B-type natriuretic peptide (BNP) level to the introduction of carvedilol (titrated to a target dose of 25 mg twice daily, group A) or placebo (group B) in addition to background treatment with digoxin. Symptoms score, 6-min walk distance, New York Heart Association (NYHA) class, left ventricular ejection fraction (LVEF), heart rate (24-hour ECG) and BNP were measured at baseline and at 4 months. Results: LVEF (Δ median +5 vs. +0.4, p = 0.048), symptoms score (Δ median -4 vs. 0, p = 0.04), NYHA class (Δ median -33% vs. +3% in NYHA class 3-4, p = 0.046) and heart rate [Δ median 24-hour ventricular rate (VR) -19 vs. -2, p < 0.0001] improved with combination therapy of digoxin and carvedilol compared to digoxin alone, but BNP (Δ median +28 vs. -6 , p = 0.11) trended in the opposite direction. There was no relationship between the degree of symptomatic improvement or VR control and BNP response. Conclusion: After the introduction of carvedilol, clinical outcome appears unrelated to BNP changes in patients with CHF and AF. Changes in BNP cannot be used as a marker of clinical response in terms of symptoms or cardiac function in this setting.

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β-Blockers are effective in congestive heart failure patients with atrial fibrillation

Cited by 27 publications

References 21 publications

Comparison of the Effects of Carvedilol and Metoprolol on Exercise Ventilatory Efficiency in Patients With Congestive Heart Failure

Comparison of the Effects of Carvedilol and Metoprolol on Exercise Ventilatory Efficiency in Patients With Congestive Heart Failure

ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation—Executive Summary

The Effect of Carvedilol on B-Type Natriuretic Peptide and Cardiac Function in Patients with Heart Failure and Persistent Atrial Fibrillation

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