TY - JOUR
T1 - Different ventricular remodelling and autonomic modulation after long-term beta-blocker treatment in hypertensive, ischaemic and idiopathic dilated cardiomyopathy
AU - Malfatto, Gabriella
AU - Branzi, Giovanna
AU - Ciambellotti, Francesca
AU - Valli, Paola
AU - Bizzi, Caterina
AU - Facchini, Mario
PY - 2007/10
Y1 - 2007/10
N2 - OBJECTIVE: In this retrospective analysis, we investigated the influence of aetiology on autonomic modulation and reverse ventricular remodelling induced by β-blockade in heart failure. METHODS: Twenty-three heart failure patients without comorbidities (mean age 61 ± 4 years, New York Heart Association class 3.1 ± 0.1, treated with angiotensin-converting enzyme inhibitors and diuretics) were divided into three groups according to aetiology: hypertensive (group 1, n = 7), ischaemic (group 2, n = 6), and idiopathic (group 3, n = 10). Before and after 6 months of carvedilol (53 ± 10 mg/day), patients underwent cardiopulmonary test, echocardiography and autonomic evaluation with spectral analysis of RR variability (10 min of rest plus 10 min of standing: the low frequency/high frequency ratio between low and high frequency components of each spectrum was the index of sympathovagal balance). RESULTS: Carvedilol improved New York Heart Association class and exercise performance. In group 1, ejection fraction and left ventricular end-diastolic volume normalised, and interventricular septum thickness increased. No remodelling occurred in group 2. In group 3, interventricular septum thickness was unchanged, ejection fraction and left ventricular end-diastolic volume improved. Also autonomic modulation differed. At baseline, adrenergic activation was observed either at rest or during standing. After carvedilol treatment, group 1 did not show any change in the low frequency/high frequency ratio in both conditions, whereas groups 2 and 3 showed reduced adrenergic activation at rest and normal response to standing. CONCLUSIONS: Despite favourable ventricular remodelling, the poor autonomic modulation observed with β-blockade indicates a persistent central adrenergic activation in hypertensive heart failure patients.
AB - OBJECTIVE: In this retrospective analysis, we investigated the influence of aetiology on autonomic modulation and reverse ventricular remodelling induced by β-blockade in heart failure. METHODS: Twenty-three heart failure patients without comorbidities (mean age 61 ± 4 years, New York Heart Association class 3.1 ± 0.1, treated with angiotensin-converting enzyme inhibitors and diuretics) were divided into three groups according to aetiology: hypertensive (group 1, n = 7), ischaemic (group 2, n = 6), and idiopathic (group 3, n = 10). Before and after 6 months of carvedilol (53 ± 10 mg/day), patients underwent cardiopulmonary test, echocardiography and autonomic evaluation with spectral analysis of RR variability (10 min of rest plus 10 min of standing: the low frequency/high frequency ratio between low and high frequency components of each spectrum was the index of sympathovagal balance). RESULTS: Carvedilol improved New York Heart Association class and exercise performance. In group 1, ejection fraction and left ventricular end-diastolic volume normalised, and interventricular septum thickness increased. No remodelling occurred in group 2. In group 3, interventricular septum thickness was unchanged, ejection fraction and left ventricular end-diastolic volume improved. Also autonomic modulation differed. At baseline, adrenergic activation was observed either at rest or during standing. After carvedilol treatment, group 1 did not show any change in the low frequency/high frequency ratio in both conditions, whereas groups 2 and 3 showed reduced adrenergic activation at rest and normal response to standing. CONCLUSIONS: Despite favourable ventricular remodelling, the poor autonomic modulation observed with β-blockade indicates a persistent central adrenergic activation in hypertensive heart failure patients.
KW - β-blockers
KW - Autonomic modulation
KW - Heart failure
KW - Hypertension
KW - Ventricular remodelling
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U2 - 10.2459/JCM.0b013e328011708b
DO - 10.2459/JCM.0b013e328011708b
M3 - Article
C2 - 17885524
AN - SCOPUS:34748857980
VL - 8
SP - 840
EP - 845
JO - Journal of Cardiovascular Medicine
JF - Journal of Cardiovascular Medicine
SN - 1558-2027
IS - 10
ER -