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Impact of beta blockers therapy on right ventricular function in heart failure patients with reduced ejection fraction a prospective evaluation

Session Poster Session 3

Speaker Remi Galves

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure: Pharmacotherapy
  • Session type : Poster Session

Authors : R Galves (Saint Etienne,FR), R Pierrard (Saint Etienne,FR), K Isaaz (Saint Etienne,FR), A Da Costa (Saint Etienne,FR)

Authors:
R Galves1 , R Pierrard1 , K Isaaz1 , A Da Costa1 , 1CHU Saint Etienne Hopital Nord, Cardiology - Saint Etienne - France ,

Citation:

Background.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-Blocker Therapy are well described, its effects on rigth ventricular (RV) function have not been prospectively well studied. Objective. The aim of this prospective study was to: (1) evaluate if ß-Blocker Therapy impacts RV remodellingbased on echo parameters; (2) sought the echo predictive 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% or less; 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) improvement in LVEF =5% were considered significant ß-Blocker therapy responders. Results. Forty patients completing the study were characterized by age: 70±10 years; gender: 10 women; cardiomyopathy aetiology: idiopathic in 24 and ischaemic in 16; NYHA Class: II in 22 and III in 10; LVEF: 32±5%; NTProBNP: 2665±2400pg/ml.The final population comprised 32 pts (79%), given that 8 pts (21%) were excluded: 2 did not tolerate ß-Blocker therapy, 1 was lost of follow-up, 5 did not pursue the protocol. Under ß-Blocker therapy, several echo parameters significantly improved: LVEF from 31.7±9to 40.5±9 (p<0.0001); LV end-diastolic volume (EDV) from 154±54 to 143±45 ml (p=0.06); LV end-systolic volume (ESV) from 107±49 to 88±37 ml (p=0.0006); LV ES from 46±11to 64±13 ml (p=0.008); LV end-diastolic diameter (EDD) (57±9 to 54±6 mm; p=0.04); LV end-systolic diameter (ESD) (48±10 to 44±7 mm; p=0.007); right ventricular systolic pressure (RV SP) from 39±10 to 32±8 (p=0.0001). Significant modifications were observed in terms of RV echo parameters: right ventricular size decreased (30±4 vs. 27±5; p=0.03) and right ventricular systolic function improved significantly based on the tricuspid annular plane systolic excursion (TAPSE) (16.5±4 vs. 19±4 mm; .0006); DTI-derived tricuspid lateral annular systolic velocity wave (S’)(10±2 vs. 11.3±3 cm/s; p=0.03); RIMP (Tei index) (0.5±.1 vs. 0.46±.1; p=0.04) (Table II). RV 2D FAC (fractional area change) was not significantly different despite a clear improvement tendency (35±6 vs. 37±4 %; p=0.1). No significant modifications were observed concerning LV diastolic parameters. 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 HFrEFpatients, ß-Blocker therapy significantly improves significantly LV and RV systolic remodelling. Accordingly, ß-Blocker therapy could be used as soon as possible in HFrEF patients associated with right ventricular dysfunction in order to limit RV remodelling.

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