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Relation between beta-adrenergic blocker use, various correlates of left ventricular function and the chance of
E Lichstein1, W D Hager, J J Gregory
1Division of Cardiology, Maimonides Medical Center, Brooklyn, New York 11219.
Insights
Beta-blocker use was less common in patients with poor left ventricular function after myocardial infarction. Patients not taking beta-blockers had a higher risk of developing congestive heart failure.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Post-myocardial infarction (MI) patients are at risk for left ventricular dysfunction and congestive heart failure (CHF).
- Beta-adrenergic blockers are a cornerstone therapy for post-MI patients, but their utilization in relation to ventricular function is not fully elucidated.
Purpose of the Study:
- To investigate the association between beta-blocker use and indicators of left ventricular function in post-MI patients.
- To determine if beta-blocker therapy influences the risk of developing CHF in this population.
Main Methods:
- Analysis of the placebo group from the Multicenter Diltiazem Post-Infarction Trial.
- Inclusion of 1,084 patients with ejection fraction (EF) data.
- Assessment of correlates of left ventricular function: EF, pulmonary rales, pulmonary congestion on chest X-ray, and S3 gallop.
Main Results:
- Beta-blocker use was lower in patients with EF < 30%, rales, S3 gallop, and pulmonary congestion.
- Patients with diminished left ventricular function had a higher incidence of CHF.
- Patients not receiving beta-blockers had an increased risk of developing CHF for each level of left ventricular function.
Conclusions:
- Beta-blocker therapy is underutilized in post-MI patients with objective signs of left ventricular dysfunction.
- Beta-blocker use is associated with a reduced risk of developing congestive heart failure, independent of left ventricular function severity.
Abstract:
This study examined the relations among beta-adrenergic blocker use, various correlates of left ventricular function and the chance of developing congestive heart failure in patients after myocardial infarction. The study was performed with the placebo group of the Multicenter Diltiazem Post-Infarction Trial. Ejection fraction data were available in 1,084 patients; of these, 557 were receiving a beta-blocker and 527 were not. In addition to ejection fraction, other correlates of left ventricular function included the presence or absence of pulmonary rales, chest X-ray film evidence of pulmonary congestion and the presence of an S3 gallop. Beta-blocker use was less frequent in patients with an ejection fraction less than 30%, rales, an S3 gallop and pulmonary congestion on chest X-ray film. Twenty-one percent of patients with an ejection fraction less than 30%, 42% of patients with rales, 28% of patients with an S3 gallop and 28% of patients with pulmonary congestion were receiving beta-blocker therapy. For every correlate of left ventricular function, the chance of developing congestive heart failure was greater in patients with diminished left ventricular function than in those without. For each level of left ventricular function, the chance of developing congestive heart failure requiring treatment was greater in patients not taking a beta-blocker.(ABSTRACT TRUNCATED AT 250 WORDS)