CLINICAL STUDY: HEART FAILURE
Impact of beta-blocker treatment on the prognostic value of currently used risk predictors in congestive heart failure
Christian Zugck, MD*,
Armin Haunstetter, MD*,
Carsten Krüger, MD*,
Robert Kell, MD*,
Dieter Schellberg, MS*,
Wolfgang Kübler, MD, FRCP* and
Markus Haass, MD*,*
* Department of Cardiology, University of Heidelberg, Heidelberg, Germany
Manuscript received August 13, 2001;
revised manuscript received February 20, 2002,
accepted February 25, 2002.
* Reprint requests and correspondence: Dr. Markus Haass, Department of Cardiology, University of Heidelberg, Bergheimerstrasse 58, D-69115 Heidelberg, Germany. markus_haass{at}med.uni-heidelberg.de
OBJECTIVES: This prospective study tested the impact of beta-blocker treatment on currently used risk predictors in congestive heart failure (CHF).
BACKGROUND: Given the survival benefit obtained by beta-blockade, risk stratification by factors established in the "prebeta-blocker era" may be questioned.
METHODS: The study included 408 patients who had CHF with left ventricular ejection fraction (LVEF) <45%, all treated with an angiotensin-converting enzyme inhibitor or angiotensin type 1 receptor antagonist, who were classified into those receiving a beta-blocker (n = 165) and those who were not (n = 243). In all patients, LVEF, peak oxygen consumption (peakVO2), plasma norepinephrine (NE) and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were determined.
RESULTS: Although the New York Heart Association functional class (2.2 ± 0.7 vs. 2.3 ± 0.7), peakVO2 (14.4 ± 5.2 ml/min per kg vs. 14.4 ± 5.5 ml/min per kg) and NT-proBNP (337 ± 360 pmol/l vs. 434 ± 538 pmol/l) were similar in the groups with and without beta-blocker treatment, the group with beta-blocker treatment had a lower heart rate (68 ± 30 beats/min vs. 76 ± 30 beats/min), lower NE (1.7 ± 1.2 nmol/l vs. 2.5 ± 2.2 nmol/l) and higher LVEF (24 ± 10% vs. 21 ± 9%; all p < 0.05). Within one year, 34% of patients without beta-blocker treatment, but only 16% of those with beta-blocker treatment (p < 0.001), reached the combined end point, defined as hospital admission due to worsening CHF and/or cardiac death. A beneficial effect of beta-blocker treatment was most obvious in the advanced stages of CHF, because the end-point rates were markedly lower (all p < 0.05) in the group with beta-blocker treatment versus the group without it, as characterized by peakVO2 <10 ml/min per kg (26% vs. 64%), LVEF 20% (25% vs. 45%), NE >2.24 nmol/l (18% vs. 40%) and NT-proBNP >364 pmol/l (27% vs. 45%), although patients with beta-blocker treatment received only 37 ± 21% of the maximal recommended beta-blocker dosages.
CONCLUSIONS: The prognostic value of variables used for risk stratification of patients with CHF is markedly influenced by beta-blocker treatment. Therefore, in the beta-blocker era, a re-evaluation of the selection criteria for heart transplantation is warranted.
|
Abbreviations and Acronyms
| | ACE | | angiotensin-converting enzyme | | AT1 | | angiotensin type 1 receptor | | CHF | | congestive heart failure | | LVEF | | left ventricular ejection fraction | | NE | | norepinephrine | | NT-proBNP | | N-terminal pro-brain natriuretic peptide | | NYHA | | New York Heart Association | | PeakVO2 | | peak oxygen consumption |
|
This article has been cited by other articles:

|
 |

|
 |
 
U. Corra, A. Mezzani, A. Giordano, E. Bosimini, and P. Giannuzzi
Exercise haemodynamic variables rather than ventilatory efficiency indexes contribute to risk assessment in chronic heart failure patients treated with carvedilol
Eur. Heart J.,
April 30, 2009;
(2009)
ehp138v1.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
N. M. Albert
Improving Medication Adherence in Chronic Cardiovascular Disease
Crit. Care Nurse,
October 1, 2008;
28(5):
54 - 64.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
M. Rosenberg, C. Zugck, M. Nelles, C. Juenger, D. Frank, A. Remppis, E. Giannitsis, H. A. Katus, and N. Frey
Osteopontin, a New Prognostic Biomarker in Patients With Chronic Heart Failure
Circ Heart Fail,
May 1, 2008;
1(1):
43 - 49.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
L. Ingle
Prognostic value and diagnostic potential of cardiopulmonary exercise testing in patients with chronic heart failure
Eur J Heart Fail,
February 1, 2008;
10(2):
112 - 118.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
P. E. F. Daubeney, A. W. Nugent, P. Chondros, J. B. Carlin, S. D. Colan, M. Cheung, A. M. Davis, C.W. Chow, R. G. Weintraub, and on behalf of the National Australian Childhood Car
Clinical Features and Outcomes of Childhood Dilated Cardiomyopathy: Results From a National Population-Based Study
Circulation,
December 12, 2006;
114(24):
2671 - 2678.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
R. V. Milani, C. J. Lavie, M. R. Mehra, and H. O. Ventura
Understanding the Basics of Cardiopulmonary Exercise Testing
Mayo Clin. Proc.,
December 1, 2006;
81(12):
1603 - 1611.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
A. Passantino, R. Lagioia, F. Mastropasqua, and D. Scrutinio
Short-Term Change in Distance Walked in 6 Min Is an Indicator of Outcome in Patients With Chronic Heart Failure in Clinical Practice
J. Am. Coll. Cardiol.,
July 4, 2006;
48(1):
99 - 105.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
M. E. Davis, A. M. Richards, M. G. Nicholls, T. G. Yandle, C. M. Frampton, and R. W. Troughton
Introduction of Metoprolol Increases Plasma B-Type Cardiac Natriuretic Peptides in Mild, Stable Heart Failure
Circulation,
February 21, 2006;
113(7):
977 - 985.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
A. Cohen-Solal, F. Rouzet, A. Berdeaux, D. Le Guludec, E. Abergel, A. Syrota, and P. Merlet
Effects of Carvedilol on Myocardial Sympathetic Innervation in Patients with Chronic Heart Failure
J. Nucl. Med.,
November 1, 2005;
46(11):
1796 - 1803.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J. O. O'Neill, J. B. Young, C. E. Pothier, and M. S. Lauer
Peak Oxygen Consumption as a Predictor of Death in Patients With Heart Failure Receiving {beta}-Blockers
Circulation,
May 10, 2005;
111(18):
2313 - 2318.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J. A Doust, E. Pietrzak, A. Dobson, and P. Glasziou
How well does B-type natriuretic peptide predict death and cardiac events in patients with heart failure: systematic review
BMJ,
March 19, 2005;
330(7492):
625.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
R. Schnabel, H. J. Rupprecht, K. J. Lackner, E. Lubos, C. Bickel, J. Meyer, T. Munzel, F. Cambien, L. Tiret, S. Blankenberg, et al.
Analysis of N-terminal-pro-brain natriuretic peptide and C-reactive protein for risk stratification in stable and unstable coronary artery disease: results from the AtheroGene study
Eur. Heart J.,
February 1, 2005;
26(3):
241 - 249.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
U. Corra, A. Mezzani, E. Bosimini, and P. Giannuzzi
Cardiopulmonary Exercise Testing and Prognosis in Chronic Heart Failure*: A Prognosticating Algorithm for the Individual Patient
Chest,
September 1, 2004;
126(3):
942 - 950.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
R. V. Milani, C. J. Lavie, and M. R. Mehra
Cardiopulmonary Exercise Testing: How Do We Differentiate the Cause of Dyspnea?
Circulation,
July 27, 2004;
110(4):
e27 - e31.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
P. Tandon, F. A. McAlister, R. T. Tsuyuki, M. Hervas-Malo, R. Dupuit, J. Ezekowitz, B. Cujec, and P. W. Armstrong
The Use of {beta}-Blockers in a Tertiary Care Heart Failure Clinic: Dosing, Tolerance, and Outcomes
Arch Intern Med,
April 12, 2004;
164(7):
769 - 774.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J. Butler, G. Khadim, K. M. Paul, S. F. Davis, M. W. Kronenberg, D. B. Chomsky, R. N. Pierson III, and J. R. Wilson
Selection of patients for heart transplantationin the current era of heart failure therapy
J. Am. Coll. Cardiol.,
March 3, 2004;
43(5):
787 - 793.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
S. de Denus, C. Pharand, and D. R. Williamson
Brain Natriuretic Peptide in the Management of Heart Failure: The Versatile Neurohormone
Chest,
February 1, 2004;
125(2):
652 - 668.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
M.R Cowie, P Jourdain, A Maisel, U Dahlstrom, F Follath, R Isnard, A Luchner, T McDonagh, J Mair, M Nieminen, et al.
Clinical applications of B-type natriuretic peptide (BNP) testing
Eur. Heart J.,
October 1, 2003;
24(19):
1710 - 1718.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
R.S. Gardner, F. Ozalp, A.J. Murday, S.D. Robb, and T.A. McDonagh
N-terminal pro-brain natriuretic peptide: A new gold standard in predicting mortality in patients with advanced heart failure
Eur. Heart J.,
October 1, 2003;
24(19):
1735 - 1743.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
H. Rickli, W. Kiowski, M. Brehm, D. Weilenmann, C. Schalcher, A. Bernheim, E. Oechslin, and H. P. Brunner-La Rocca
Combining low-intensity and maximal exercise test results improves prognostic prediction in chronic heart failure
J. Am. Coll. Cardiol.,
July 2, 2003;
42(1):
116 - 122.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
V. Bittner
Exercise testing in heart failure: Maximal, submaximal, or both?
J. Am. Coll. Cardiol.,
July 2, 2003;
42(1):
123 - 125.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
M. T. La Rovere, G. D. Pinna, R. Maestri, A. Mortara, S. Capomolla, O. Febo, R. Ferrari, M. Franchini, M. Gnemmi, C. Opasich, et al.
Short-Term Heart Rate Variability Strongly Predicts Sudden Cardiac Death in Chronic Heart Failure Patients
Circulation,
February 4, 2003;
107(4):
565 - 570.
[Abstract]
[Full Text]
[PDF]
|
 |
|
|