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 3months 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.