Betablockers reduce oxygen pulse increase and performance in heart failure patients with preserved ejection fraction. (1st January 2023)

• Record Type: Journal Article
• Authors: Wernhart, Simon; Papathanasiou, Maria; Mahabadi, Amir Abbas; Rassaf, Tienush; Luedike, Peter
• Is Part Of: International journal of cardiology. Volume 370(2023)
• Page Start: 309
• Page End: 318
• Publication Date: 2023-01-01
• Subjects: beta blocker -- HFpEF -- Exercise performance -- CPET; CPET Cardiopulmonary Exercise Testing -- EOV Exercise oscillatory ventilation -- EqO2 at VT1 O2 at the first ventilatory threshold -- HFA-PEFF score Heart Failure Association-Pretest Assessment- Echocardiographic and Natriuretic Peptide Score, Functional Testing in Case of Uncertainty, Final Aetiology -- H2FPEF score Heavy, Hypertensive, Atrial Fibrillation, Pulmonary Hypertension, Elder, Filling Pressure -- O2 pulsemax O2 pulse at peak exercise related to body weight -- ΔO2 pulse Difference between resting and maximal O2pulse -- OUES Oxygen uptake efficiency slope -- RER Respiratory exchange ratio -- VO2peak peak oxygen consumption; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2022.10.009
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Beta blockers (BB) reduce chronotropic response and exercise capacity in heart failure with preserved ejection fraction (HFpEF). To analyze the influence of BB on exercise performance and O 2 pulse increase as a surrogate for stroke volume in HFpEF. Methods: We retrospectively analyzed the influence of BB intake (yes: n = 48/no: n = 51) on peak oxygen uptake (VO 2peak), oxygen uptake efficiency slope (OUES), and increase of O 2 pulse in HFpEF patients undergoing cardiopulmonary exercise testing (CPET). Associations of outcome variables and risk category of the algorithm of the Heart Failure Association of the European Society of Cardiology (HFA-PEFF score) were calculated. Results: Patients on BB showed lower VO 2peak ( p = .003) and OUES ( p = .002), with a dominant effect in the high-risk ( p = .020; 0.002), but not in the low risk-group ( p = .434; p = .499). In the intermediate group BB showed a trend towards lower VO 2peak ( p = .078) and lower values for OUES ( p = .020). Patients on BB also demonstrated a lower increase of O 2 pulse during exercise ( p = .002), without differences between HFA-PEFF risk groups (low: p = .322, intermediate: p = .269, high: p = .313). Conclusions: BB reduce exercise capacity and O 2 pulse increase in HFpEF patients. Direct quantification of O 2 pulse increase may help to improve the discrimination of HFpEF patients. Graphical abstract: Unlabelled Image Highlights: BB intake is associated with reduced exercise capacity in HFpEF patients. BB intake reduces O2 pulse increase as a surrogate for blunted stroke volume. BB should be avoided in selected HFpEF patients. Cardiopulmonary exercise testing contributes to characterize HFpEF phenotype