Effect of β-adrenergic blockade on myocardial function and energetics in congestive heart failure

Improvements in hemodynamic, contractile, and diastolic performance with bucindolol

Eric J. Eichhorn, John B. Bedotto, Craig R. Malloy, Barbara A. Hatfield, David Deitchman, Marilyn Brown, John E. Willard, Paul A. Grayburn

Research output: Contribution to journalArticle

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Abstract

The hemodynamic effects of β-adrenergic blockade with bucindolol, a nonselective β-antagonist with mild vasodilatory properties, were studied in patients with congestive heart failure. Fifteen patients (New York Heart Association class I-IV) underwent cardiac catheterization before and after 3 months of oral therapy with bucindolol. The left ventricular ejection fraction increased from 0.23±0.12 to 0.29±0.14 (p=0.007), and end-systolic elastance, a relatively load-independent determinant of contractility, increased from 0.60±0.40 to 1.11±0.45 mm Hg/ml (p=0.0049). Both left ventricular stroke work index (34±13 to 47±19 g-m/m2, p=0.0059) and minute work (5.5±2.2 to 7.0±2.6 kg-m/min, p=0.0096) increased despite reductions in left ventricular end-diastolic pressure (19±8 to 15±5 mm Hg, p=0.021). There was an upward shift in the peak +dP/dtmax-end-diastolic volume relation (p=0.0005). These data demonstrate improvements in myocardial contractility after β-adrenergic blockade with bucindolol. At a matched paced heart rate of 98±15 min-1, the time constant of left ventricular isovolumic relaxation was significantly reduced by bucindolol therapy (92±17 versus 73±11 msec, p=0.0013), and the relation of the time constant to end-systolic pressure was shifted downward (p=0.014) with therapy. The slope of the logarithm left ventricular end-diastolic pressure-end-diastolic volume relation was unchanged (p=0.51) after bucindolol. These data suggest that chronic β-adrenergic blockade with bucindolol improves diastolic relaxation but does not alter myocardial chamber stiffness. Myocardial oxygen extraction, consumption, and efficiency were unchanged despite improvement in contractile function and mechanical work. Thus, in patients with congestive heart failure, chronic β-adrenergic blockade with bucindolol significantly improves myocardial contractility and minute work, yet it does not do so at the expense of myocardial oxygen consumption. Additionally, bucindolol improves myocardial relaxation but does not affect chamber stiffness.

Original languageEnglish (US)
Pages (from-to)473-483
Number of pages11
JournalCirculation
Volume82
Issue number2
StatePublished - Aug 1990

Fingerprint

Adrenergic Agents
Heart Failure
Hemodynamics
Blood Pressure
Oxygen Consumption
bucindolol
Cardiac Catheterization
Stroke Volume
Therapeutics
Heart Rate
Stroke

Keywords

  • β-adrenergic blockade
  • Bucindolol
  • Congestive heart failure
  • Hemodynamics
  • Systolic elastance

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Effect of β-adrenergic blockade on myocardial function and energetics in congestive heart failure : Improvements in hemodynamic, contractile, and diastolic performance with bucindolol. / Eichhorn, Eric J.; Bedotto, John B.; Malloy, Craig R.; Hatfield, Barbara A.; Deitchman, David; Brown, Marilyn; Willard, John E.; Grayburn, Paul A.

In: Circulation, Vol. 82, No. 2, 08.1990, p. 473-483.

Research output: Contribution to journalArticle

Eichhorn, Eric J. ; Bedotto, John B. ; Malloy, Craig R. ; Hatfield, Barbara A. ; Deitchman, David ; Brown, Marilyn ; Willard, John E. ; Grayburn, Paul A. / Effect of β-adrenergic blockade on myocardial function and energetics in congestive heart failure : Improvements in hemodynamic, contractile, and diastolic performance with bucindolol. In: Circulation. 1990 ; Vol. 82, No. 2. pp. 473-483.
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