Background Hyperventilation and consequent reduction of ventilation (VE) efficiency are frequently observed during exercise in heart failure (HF) patients, resulting in an increased slope of VE/carbon dioxide (VE/VCO(2)) relationship. The latter is an independent predictor of HF prognosis. beta-Blockers improve the prognosis of HF patients. We evaluated the effect on the efficiency of VE of a beta(1)-beta(2) unselective (carvedilol) versus a beta(1) selective (bisoprolol) beta-blocker. Methods We analyzed consecutive maximal cardiopulmonary exercise tests performed on 572 clinically stable HF patients (New York Heart Association class I-III, left ventricle ejection fraction <= 50%) categorized in 3 groups: 81 were not treated with beta-blocker, 304 were treated with carvedilol, and 187 were treated with bisoprolol. Clinical conditions were similar. Results The VE/VCO(2) slope was lower in carvedilol-compared with bisoprolol-treated patients (29.7 +/- 0.4 vs 31.6 +/- 0.5, P=.023, peak oxygen consumption adjusted) and with patients not receiving beta-blockers (31.6 +/- 0.7, P=.036). Maximum end-tidal CO(2) pressure during the isocapnic buffering period was higher in patients treated with carvedilol (39.0 +/- 0.3 mm Hg) than with bisoprolol (37.2 +/- 0.4 mm Hg, P<.001) and in patients not receiving beta-blockers (37.2 +/- 0.5 mm Hg, P=.001). Conclusions Reduction of hyperventilation, with improvement of VE efficiency during exercise (reduction of VE/VCO(2) slope and increase of maximum end-tidal CO(2) pressure), is specific to carvedilol (beta(1)-beta(2) unselective blocker) and not to bisoprolol (beta(1)-selective blocker). (Am Heart J 2010; 159: 1067-73.)
Effects of beta-blockers on ventilation efficiency in heart failure / P., Agostoni; A., Apostolo; G., Cattadori; E., Salvioni; G., Berna; L., Antonioli; C., Vignati; M., Schina; Sciomer, Susanna; M., Bussotti; P., Palermo; C., Fiorentini; M., Contini. - In: AMERICAN HEART JOURNAL. - ISSN 0002-8703. - STAMPA. - 159:6(2010), pp. 1067-1073. [10.1016/j.ahj.2010.03.034]
Effects of beta-blockers on ventilation efficiency in heart failure
SCIOMER, Susanna;
2010
Abstract
Background Hyperventilation and consequent reduction of ventilation (VE) efficiency are frequently observed during exercise in heart failure (HF) patients, resulting in an increased slope of VE/carbon dioxide (VE/VCO(2)) relationship. The latter is an independent predictor of HF prognosis. beta-Blockers improve the prognosis of HF patients. We evaluated the effect on the efficiency of VE of a beta(1)-beta(2) unselective (carvedilol) versus a beta(1) selective (bisoprolol) beta-blocker. Methods We analyzed consecutive maximal cardiopulmonary exercise tests performed on 572 clinically stable HF patients (New York Heart Association class I-III, left ventricle ejection fraction <= 50%) categorized in 3 groups: 81 were not treated with beta-blocker, 304 were treated with carvedilol, and 187 were treated with bisoprolol. Clinical conditions were similar. Results The VE/VCO(2) slope was lower in carvedilol-compared with bisoprolol-treated patients (29.7 +/- 0.4 vs 31.6 +/- 0.5, P=.023, peak oxygen consumption adjusted) and with patients not receiving beta-blockers (31.6 +/- 0.7, P=.036). Maximum end-tidal CO(2) pressure during the isocapnic buffering period was higher in patients treated with carvedilol (39.0 +/- 0.3 mm Hg) than with bisoprolol (37.2 +/- 0.4 mm Hg, P<.001) and in patients not receiving beta-blockers (37.2 +/- 0.5 mm Hg, P=.001). Conclusions Reduction of hyperventilation, with improvement of VE efficiency during exercise (reduction of VE/VCO(2) slope and increase of maximum end-tidal CO(2) pressure), is specific to carvedilol (beta(1)-beta(2) unselective blocker) and not to bisoprolol (beta(1)-selective blocker). (Am Heart J 2010; 159: 1067-73.)I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
