Effect of race on left ventricular ejection fraction decline after initial improvement with beta blockers in patients with non-ischemic cardiomyopathy: a retrospective analysis.
BACKGROUND
Although beta blockers (BBs) are established therapy in heart failure, some patients whose left ventricular ejection fraction (LVEF) initially increases on BB therapy experience a subsequent LVEF decline. This study aimed to evaluate the proportion of patients with non-ischemic cardiomyopathy (NICM) whose LVEF declines while on BB therapy and determine important predictors of LVEF decline.


METHODS
A retrospective analysis of 238 patients receiving a BB (carvedilol, metoprolol succinate, or tartrate), with an ejection fraction of ≤40% and NICM, whose LVEF initially rose ≥5% after 1 year of BB therapy, was conducted. Post-response LVEF decline ≥5% to a final LVEF of ≤35% was evaluated within 4 years of BB initiation.


RESULTS
In our study, we had 52 Caucasians (22%), 78 Hispanics (33%), and 108 African Americans (45%). Overall, 32 patients (13.44 %) had post-response LVEF decline. The nadir LVEF of patients with post-response LVEF decline was 25% (interquartile range 20-27). Compared with others, Hispanics had lower nadir LVEF (22%, p < 0.001). Important predictors of LVEF decline were Hispanic race (odds ratio (OR) 6.094, p < 0.001), New York Heart Association (NYHA) class (OR 2.287, p < 0.05), baseline LVEF (OR 1.075, p < 0.05), and age (OR 0.933, p < 0.001).


CONCLUSIONS
A significant proportion (13.44%) of NICM patients with LVEF increase over 1 year of BB therapy experienced subsequent LVEF decline. Race, NYHA class, baseline LVEF, and age are important predictors of this decline.
Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, USA, ikelesid@gmail.com.
Iosif
I
Kelesidis
Patrick
P
Hourani
Christopher
C
Varughese
Ronald
R
Zolty
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001741:Black or African American; D009202:Cardiomyopathies / Q000188:drug therapy* / Q000208:ethnology* / Q000209:etiology / Q000503:physiopathology; D004305:Dose-Response Relationship, Drug; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D012189:Retrospective Studies; D012737:Sex Factors; D013318:Stroke Volume / Q000187:drug effects*; D013997:Time Factors; D016277:Ventricular Function, Left / Q000187:drug effects*; D044465:White People
D000319:Adrenergic beta-Antagonists