Beneficial effects of beta-blockers on left ventricular function and cellular energy reserve in patients with heart failure.
Beta-blockers have been shown to improve left ventricular (LV) function in patients with heart failure. The aim of this study is to non-invasively assess, by means of in vivo 31P-magnetic resonance spectroscopy (31P-MRS), the effects of beta-blockers on LV cardiac phosphocreatine and adenosine triphosphate (PCr/ATP) ratio in patients with heart failure. Ten heart failure patients on full medical therapy were beta-blocked by either carvedilol or bisoprolol. Before and after 3 months of treatment, exercise testing, 2D echocardiography, MRS, New York Heart Association (NYHA) class, ejection fraction (EF), maximal rate-pressure product and exercise metabolic equivalent system (METS) were evaluated. Relative concentrations of PCr and ATP were determined by cardiac 31P-MRS. After beta-blockade, NYHA class decreased (from 2.2 ± 0.54 to 1.9 ± 0.52, P = 0.05), whereas EF (from 33 ± 7 to 44 ± 6%, P = 0.0009) and METS (from 6.74 ± 2.12 to 8.03 ± 2.39, P = 0.01) increased. Accordingly, the mean cardiac PCr/ATP ratio increased by 33% (from 1.48 ± 0.22 to 1.81 ± 0.48, P = 0.03). Beta-blockade-induced symptomatic and functional improvement in patients with heart failure is associated to increased PCr/ATP ratio, indicating preservation of myocardial high-energy phosphate levels.
Clinical Cardiology - Heart Failure Clinic, Istituto Scientifico-Università Vita/Salute San Raffaele, Via Olgettina 60, 20132 Milano, Italy. spoladore.roberto@hsr.it
Roberto
R
Spoladore
Gabriele
G
Fragasso
Gianluca
G
Perseghin
Francesco
F
De Cobelli
Antonio
A
Esposito
Francesco
F
Maranta
Giliola
G
Calori
Massimo
M
Locatelli
Guido
G
Lattuada
Paola
P
Scifo
Alessandro
A
Del Maschio
Alberto
A
Margonato
D000255:Adenosine Triphosphate / Q000378:metabolism; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D017298:Bisoprolol / Q000627:therapeutic use; D002227:Carbazoles / Q000627:therapeutic use; D000077261:Carvedilol; D004452:Echocardiography / Q000379:methods; D004734:Energy Metabolism; D005260:Female; D006321:Heart / Q000187:drug effects*; D006333:Heart Failure / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D006801:Humans; D009682:Magnetic Resonance Spectroscopy / Q000379:methods; D008297:Male; D011412:Propanolamines / Q000627:therapeutic use; D016277:Ventricular Function, Left / Q000187:drug effects*
D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; D000255:Adenosine Triphosphate; D017298:Bisoprolol