Abstract 1883: Long Term Echocardiographic and Clinical Outcome in Congestive Heart Failure Patients With “Normalized” Left Ventricular Ejection Fraction After Beta-Blocker Therapy
Background: Previous studies have demonstrated a significant improvement in left ventricular ejection fraction (LVEF) after beta-blocker therapy (BB) in patients (pts) with stable congestive heart failure, with some pts having a LVEF “normalization” (LVEF > 45%).
Hypothesis: Long term outcome of this sub-group of pts with LVEF “normalization” after BB is not known.
Results: We studied 174 pts, defined as good responders to BB (LVEF ≤ 45% before the introduction of BB and LVEF > 45% at least 3 months after maximal tolerated doses of BB have been reached). All the pts were stable with maximal tolerated doses of renin system inhibitors before the initiation of BB. Mean age was 52±13 years, there were 43 women (25%), 47 pts had ischemic cardiomyopathy (27%), most of the pts were in NYHA class I (42, 24%) or class II (121, 69%), 134 received beta1 selective BB, of whom 96 bisoprolol at a mean dose of 8.6±3 mg/d; 40 received carvedilol at a mean dose of 54±26 mg/d. With BB, LVEF improved from 31.4±8.8% to 52±6.8% (p<0.0001). After a median duration of 2 years, LVEF was 49.3±9.3%; 36 pts (21%) had a LVEF ≤ 45% (LVEF: 36±5.2%) while remaining pts had a LVEF > 45% (53±6.6%). There were no clinical or echocardiographic predictors of subsequent LVEF deterioration. After a median duration of 3.6 years (after LVEF “normalization”), there were 8 cardiovascular deaths, of whom 6 were in the subgroup of pts with a LVEF ≤ 45% (16% vs 1%, p<0.0001).
In conclusion, 21% of pts with LVEF “normalization” after BB had a subsequent LVEF deterioration and these pts had a poor outcome. An echocardiographic survey is mandatory in pts with LVEF “normalization” after BB in order to detect pts with a subsequent LVEF deterioration.