title: Long-term beta-blocker therapy improves diastolic function even without the therapeutic effect on systolic function in patients with reduced ejection fraction.
abstract: The beneficial effects of beta-blocker therapy on the clinical outcomes of heart failure with reduced ejection fraction (HFREF) are attributed to the improvement in ejection fraction (EF) and left ventricular (LV) reverse remodeling. Previous studies only reported the beta-blocker therapy-induced improvement of diastolic function accompanied by the increase in EF in HFREF patients. This retrospective study aimed to elucidate whether beta-blocker therapy improves diastolic function even without an increase in EF. Out of the consecutive 11,830 echocardiographic reports, HFREF patients without an increase in EF following long-term beta-blocker therapy comprised the study subjects (n=19). During the mean follow-up of 17 months, beta-blocker therapy significantly decreased peak mitral E-wave velocity (70±25-50±18 cm/s, p<0.01) and ratio of peak mitral E- to A-wave velocities (E/A ratio) (1.4±0.8-0.9±0.4, p<0.05), prolonged deceleration time of the mitral E-wave velocity (DcT) (167±54-206±61 ms, p<0.05), and improved New York Heart Association functional class (2.3±0.7-1.8±0.4, p<0.01) without changes in LV volume. Because DcT and E/A ratio are well known to correlate with LV filling pressures in patients with reduced EF, our results indicate a reduction in LV filling pressures without changes in LV volume, suggesting a reduction in LV stiffness. Thus, long-term beta-blocker therapy is likely to improve diastolic function even without a concomitant increase in EF in HFREF patients, which may be also responsible for the beta-blocker-induced improvement of their symptoms of heart failure.
authors.affiliation: Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita 565-0871, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Tamaki
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Sakata
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Mano
authors.forename: Tomohito
authors.initials: T
authors.lastname: Ohtani
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Takeda
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kamimura
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Omori
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Yamamoto
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D003971:Diastole / Q000187:drug effects*; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006352:Heart Ventricles; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013318:Stroke Volume; D013599:Systole / Q000187:drug effects
chemical_list: D000319:Adrenergic beta-Antagonists