Portal de investigación
Effect of ß-Blocker Withdrawal on Functional Capacity in Heart Failure and Preserved Ejection Fraction.
Fecha de publicación:
Fecha Ahead of Print:
Autores de INCLIVA
Participantes ajenos a INCLIVA
- Seller, J
- Dominguez, E
- Ramon, JM
- Valle, A
- Llacer, P
- Bayes-Genis, A
Grupos y Plataformas de I+D+i
Abstract
BACKGROUND: Chronotropic incompetence has shown to be associated with a decrease in exercise capacity in heart failure with preserved ejection fraction (HFpEF), yet ß-blockers are commonly used in HFpEF despite the lack of robust evidence. OBJECTIVES: This study aimed to evaluate the effect of ß-blocker withdrawal on peak oxygen consumption (peak Vo(2)) in patients with HFpEF and chronotropic incompetence. METHODS: This is a multicenter, randomized, investigator-blinded, crossover clinical trial consisting of 2 treatment periods of 2 weeks separated by a washout period of 2 weeks. Patients with stable HFpEF, New York Heart Association functional classes II and III, previous treatment with ß-blockers, and chronotropic incompetence were first randomized to withdrawing from (arm A: n = 26) versus continuing (arm B: n = 26) ß-blocker treatment and were then crossed over to receive the opposite intervention. Changes in peak Vo(2) and percentage of predicted peak Vo(2) (peak Vo(2)%) measured at the end of the trial were the primary outcome measures. To account for the paired-data nature of this crossover trial, linear mixed regression analysis was used. RESULTS: The mean age was 72.6 ± 13.1 years, and most of the patients were women (59.6%) in New York Heart Association functional class II (66.7%). The mean peakVo(2) and peak Vo(2)% were 12.4 ± 2.9 mL/kg/min, and 72.4 ± 17.8%, respectively. No significant baseline differences were found across treatment arms. Peak Vo(2) and peak Vo(2)% increased significantly after ß-blocker withdrawal (14.3 vs 12.2 mL/kg/min [ +2.1 mL/kg/min]; P < 0.001 and 81.1 vs 69.4% [ +11.7%]; P < 0.001, respectively). CONCLUSIONS: ß-blocker withdrawal improved maximal functional capacity in patients with HFpEF and chronotropic incompetence. ß-blocker use in HFpEF deserves profound re-evaluation. (ß-blockers Withdrawal in Patients With HFpEF and Chronotropic Incompetence: Effect on Functional Capacity [PRESERVE-HR]; NCT03871803; 2017-005077-39).
Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.
Datos de la publicación
- ISSN/ISSNe:
- 0735-1097, 1558-3597
- Tipo:
- Article
- Páginas:
- 2042-2056
- PubMed:
- 34794685
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY ELSEVIER SCIENCE INC
Citas Recibidas en Web of Science: 167
Documentos
Filiaciones
Keywords
- HFpEF; chronotropic incompetence; crossover trial; heart rate; peak Vo(2); percentage of predicted peakVo(2); ß-blockers
Financiación
Proyectos y Estudios Clínicos
INCORPORACIÓN DE NUEVAS ÁREAS TEMÁTICAS Y NUEVOS GRUPOS AL CONSORCIO CIBER
Investigador Principal: JUAN SANCHIS FORES
CB16/11/00420 . INSTITUTO SALUD CARLOS III
Retirada del Tratamiento Betabloqueante en Pacientes con Insuficiencia Cardíaca con Función Sistólica Preservada e Incompetencia Cronotrópica. Efecto sobre la Capacidad Funcional.
Investigador Principal: JULIO NUÑEZ VILLOTA
PI17/01426 . INSTITUTO SALUD CARLOS III . 2018
Cita
Palau P,Seller J,Dominguez E,Sastre C,Ramon JM,de la Espriella R,Santas E,Minana G,Bodi V,Sanchis J,Valle A,Chorro FJ,Llacer P,Bayes A,Nunez J. Effect of ß-Blocker Withdrawal on Functional Capacity in Heart Failure and Preserved Ejection Fraction. J. Am. Coll. Cardiol. 2021. 78. (21):p. 2042-2056. IF:27,203. (1).
Effect of ß-Blocker Withdrawal on Functional Capacity in Heart Failure and Preserved Ejection Fraction. Palau P, Seller J, Dominguez E, Sastre C, Ramon JM, de la Espriella R, Santas E et al. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY. 2021 noviembre 23. 78 (21):2042-2056. DOI:10.1016/j.jacc.2021.08.073. PMID:34794685.
