Effect of selective and nonselective beta-blockers on resting energy production rate and total body substrate utilization in chronic heart failure.
BACKGROUND
In chronic heart failure (CHF) beta-blockers reduce myocardial oxygen consumption and improve myocardial efficiency by shifting myocardial substrate utilization from increased free fatty acid oxidation to increased glucose oxidation. The effect of selective and nonselective beta-blockers on total body resting energy production rate (EPR) and substrate utilization is not known.


METHODS
Twenty-six noncachectic patients with moderately severe heart failure (New York Heart Association class II or III, left ventricular ejection fraction < 0.40) were treated with carvedilol (37.5 +/- 13.5 mg/12 h) or bisoprolol (5.4 +/- 3.0 mg/d) for 6 months. Indirect calorimetry was performed before and after 6 months of treatment.


RESULTS
Resting EPR was decreased in carvedilol (5.021 +/- 0.803 to 4.552 +/- 0.615 kJ/min, P <.001) and bisoprolol group (5.230 +/- 0.828 to 4.978 +/- 0.640 kJ/min, P <.05; nonsignificant difference between groups). Lipid oxidation rate decreased in carvedilol and remained unchanged in bisoprolol group (2.4 +/- 1.4 to 1.5 +/- 0.9 mg m(2)/kg min versus 2.7 +/- 1.1 to 2.5 +/- 1.1 mg m(2)/kg min, P <.05). Glucose oxidation rate was increased only in carvedilol (2.6 +/- 1.4 to 4.4 +/- 1.6 mg m(2)/kg min, P <.05), but did not change in bisoprolol group.


CONCLUSIONS
Both selective and nonselective beta-blockers reduce total body resting EPR in noncachectic CHF patients. Carvedilol compared to bisoprolol shifts total body substrate utilization from lipid to glucose oxidation.
Podbregar
Matej
M
Department for Intensive Internal Medicine, General Hospital Celje, Slovenia.
Voga
Gorazd
G
D000273:Adipose Tissue / Q000187:drug effects; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D001481:Basal Metabolism / Q000187:drug effects*; D017298:Bisoprolol / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D001835:Body Weight / Q000187:drug effects; D002227:Carbazoles / Q000627:therapeutic use; D000077261:Carvedilol; D002908:Chronic Disease; D004837:Epinephrine / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood; D010349:Patient Compliance; D011412:Propanolamines / Q000627:therapeutic use; D012720:Severity of Illness Index; D013223:Statistics as Topic; D013318:Stroke Volume / Q000187:drug effects; D016896:Treatment Outcome; D014527:Uric Acid / Q000097:blood; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology
D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; D014527:Uric Acid; D009638:Norepinephrine; D017298:Bisoprolol; D004837:Epinephrine