Impact of ß-blocker therapy on right ventricular function in heart failure patients with reduced ejection fraction. A prospective evaluation.

ABSTRACT

BACKGROUND: Beta-blocker (ß-blocker) therapy has been shown to improve mortality and reduce hospitalizations in patients with heart failure (HF) with reduced ejection fraction (HFrEF). Although the physiological action mechanisms of ß-blockers are well described, their effects on right ventricular (RV) function have not been prospectively studied. OBJECTIVE: This prospective study aimed to (a) evaluate whether ß-blocker therapy impacts RV remodeling based on echo parameters and (b) determine the predictive echo factors of ß-blocker therapy response. METHODS: From September 2017 to September 2018, HF patients were prospectively enrolled using CIBIS criteria Class II, III, or IV HF; left ventricular ejection fraction (LVEF) of ≤40%; hospitalized for HF within the previous 12 months. Echo evaluation was performed before initiating ß-blocker therapy and 3 months after optimal dose adjustment. Based on previous studies, patients with (absolute) LVEF ≥ 5% improvement were considered significant ß-blocker therapy responders. RESULTS: Overall, 40 patients (pts) completed the study, characterized as follows by age 70 ± 10 years; gender 10 women; cardiomyopathy etiology idiopathic in 24 and ischemic in 16; NYHA Class II in 22 and III in 10; LVEF 32 ± 5%; and NTProBNP 2665 ± 2400 pg/mL. The final population comprised 32 pts (79%), with eight (21%) excluded two because of ß-blocker therapy intolerance, one lost to follow-up, and five withdrew from the study. Under ß-blocker therapy, several echo parameters significantly improved LVEF from 31.7 ± 9 to 40.5 ± 9 (P < .0001); LV end-diastolic volume (EDV) from 154 ± 54 to 143 ± 45 mL (P = .06); LV end-systolic volume (ESV) from 107 ± 49 to 88 ± 37 mL (P = .0006); LV ES from 46 ± 11 to 64 ± 13 mL (P = .008); LV end-diastolic diameter (EDD) from 57 ± 9 to 54 ± 6 mm (P = .04); LV end-systolic diameter (ESD) from 48 ± 10 to 44 ± 7 mm (P = .007); and right ventricular systolic pressure (RV SP) from 39 ± 10 to 32 ± 8 mm Hg (P = .0001). Significant modifications were observed in terms of RV echo parameters right ventricular (RV) size decreased from 30 ± 4 to 27 ± 5 mm (P = .03), while RV systolic function significantly improved based on tricuspid annular plane systolic excursion (TAPSE) (16.5 ± 4 vs. 19 ± 4 mm; 0.0006); DTI-derived tricuspid lateral annular systolic velocity wave (S') (10 ± 2 vs. 11.3 ± 3 cm/s; P = .03); and RIMP (Tei index) (0.5 ± 0.1 vs 0.46 ± 0.1; P = .04). RV 2D fractional area change (%) did not significantly differ despite a clear improvement tendency (35 ± 6 vs. 37 ± 4%; P = .1). No significant modifications were observed concerning LV diastolic parameters. Overall, ß-blocker echo responders (n = 23/32; 72%) exhibited the same left and right echo parameters. No echo variables predicted the ß-blocker response. CONCLUSIONS: In HFrEF pts, ß-blocker therapy significantly improves LV and RV systolic remodeling. Accordingly, ß-blocker therapy could be applied as soon as possible in HFrEF patients with right ventricular dysfunction so as to limit RV remodeling.