Abstract 2986: The Effect of Beta-Blocker Therapy on Left Ventricular Function in Heart Transplant Recipients With Allograft Dysfunction
Purpose: Left ventricular systolic dysfunction may represent a devastating complication in cardiac transplant recipients. Although beta blockers represent a cornerstone of medical manegement in heart failure, their use has not gained wide acceptance in the treatment of cardiac transplant recipients, the foremost reason being the concern over the haemodynamic consequences of beta-blockade in a denervated heart. The aim of this study was to evaluate a possible beneficial role of beta blockers in heart transplant recipients with graft failure.
Methods and Materials: We enrolled 35 consecutive adult heart transplant recipients who presented with graft failure, defined as depressed left ventricular ejection fraction (LVEF) and NYHA 2–3 heart failure symptoms in the absence of rejection or infection. Patients were randomised in two goups: Study group (N_22) was started on low dose carvedilol and the Controls (N_13) continued to recieve conventional therapy without beta blockade. At baseline and again after 3 months, echocardiography was performed in both groups and LVEF was measured using the Simpson method.
Results: Overall, graft dysfunction was diagnosed at 2_1.5 years after transplantation. At this time the two groups did not differ in gender, age, weight, height, kidney or liver function tests, medical therapy, or history of rejection or infection episodes. However, the study group was found to have significantly lower LVEF than Controls (34.32_7.05% vs. 40.46_4,34%, P_0.007). After 3 months, LVEF improved significantly in the Study group (from 34.32_7.05% to 43.21_9.22%, P_0.001), but not in the Controls (from 40.46_4.34% to 39.08_7.61%, P_0.58). This resulted in comparable LVEF in the Study group and the Controls at the end of the study (43.21_9.22% vs. 39.08_7.61%, P_0.2).
Conclusions: Despite the small sample size, our study demonstrates that therapy with beta blocking agents may be of benefit in heart transplant recipients with graft failure.