Abstract 1896: Sustained Versus Non-Sustained Improvement in Left Ventricular Systolic Function in Heart Failure Patients on Beta Blocker Therapy
Introduction: Beta-blockers (BB) may improve left ventricular (LV) ejection fraction (EF) in heart failure (HF) due to LV systolic dysfunction. Some pts do not sustain this improvement. Predictors of re-decline have not been well described. We compared characteristics of those who sustained this improvement to those who did not.
Methods: All medical records from the Montefiore Medical Center HF clinic were retrospectively reviewed. Subjects were identified who had an initial LVEF ≤ 40% and subsequently improved their EF by ≥ 10% on BB: carvedilol (C) or metoprolol succinate (M). Subjects were excluded if an event 3 months (mo) prior to or anytime after BB initiation could have influenced EF, if pts were not on maximally tolerated HF therapy or if routine follow-up echocardiography was not available. Subjects were divided into 2 groups. Group R (re-decline) included patients who had a subsequent decrease of ≥ 10% in their EF. Group S (sustained) included all other patients. Baseline means and proportions were compared. Logistic regression was used.
Results: Sixty-three pts met criteria. For groups R (n=12) and S (n=51), mean age (yr) was 53 (±12), 54 (±16); male (%) 50, 59; ischemic (%) 25, 14; C use (%) 33, 65 (p=ns for all groups), respectively. Average mo to improvement in EF for all pts was 21.7 (±2.1). Average mo from improvement to re-decline in EF was 23.2 (±4.8). On comparison of multiple clinical characteristics between groups R and S, only DM (83% vs. 42%, p=0.02) and higher NYHA class at time of improvement in EF (N-I) (p=0.008) differed. C use was associated with a trend toward a decreased rate of re-decline (p=0.058). On multivariate analysis that included DM, BB type and N-I, only DM was associated with increased odds of re-decline (p=0.04). Multivariate analysis of the sub-group of pts with DM (n=31) that included BB type and N-I, C use was associated with decreased odds of re-decline (p=0.05).
Conclusion: Re-decline in EF is not uncommon. In this small retrospective analysis, 19% of subjects experienced a re-decline in EF. DM and increased NYHA class at time of EF improvement are associated with a re-decline in EF. Carvedilol compared to metoprolol succinate use in pts with DM appears to be associated with decreased odds of re-decline in EF. Further study is warranted.