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Acute influence of different beta-blocking agents upon left heart hemodynamics at rest and during exercise in
Insights
Choosing the right beta-blocker is crucial for patients with coronary artery disease. Some beta-blockers can improve or impair cardiac function, impacting left ventricular end-diastolic pressure (LVEDP) during exercise.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Background:
- Coronary artery disease (CAD) affects cardiac function.
- Beta-blockers are commonly used in managing cardiovascular conditions.
- Different beta-blockers possess varying pharmacological properties, potentially influencing hemodynamic responses.
Purpose of the Study:
- To investigate the acute hemodynamic effects of three different beta-blockers in patients with CAD.
- To compare the impact of metoprolol, bunitrolol, and oxprenolol on cardiac function and hemodynamics.
- To determine if beta-blocker choice influences left ventricular function and exercise hemodynamics in compromised hearts.
Main Methods:
- Study included 33 patients with angiographically confirmed coronary artery disease.
- Three beta-blockers were administered intravenously: metoprolol (Group I), bunitrolol (Group II), and oxprenolol (Group III).
- Hemodynamic variables, including left ventricular end-diastolic pressure (LVEDP) and cardiac indexes, were measured at rest and during exercise, before and after drug administration.
Main Results:
- Left ventricular (LV) function improved in 1 patient (metoprolol), 7 (bunitrolol), and 5 (oxprenolol); impaired in 4 (metoprolol) and 1 (oxprenolol).
- Contractility indexes were less affected by bunitrolol and oxprenolol compared to metoprolol.
- During exercise, LVEDP was significantly lower in the bunitrolol group (P < 0.01).
Conclusions:
- The choice of beta-blocker can significantly impact acute hemodynamic changes in patients with coronary artery disease.
- Beta-blockers with intrinsic sympathomimetic activity (ISA) like bunitrolol and oxprenolol showed a trend towards better preservation of LV function.
- Pharmacological intervention with beta-blockers requires careful consideration to avoid further impairment of compromised cardiac function.
Abstract:
The study investigated the acute hemodynamic changes induced in patients with angiographically confirmed coronary artery disease by 3 beta-blockers: metoprolol, cardioselective without intrinsic sympathomimetic activity (ISA), group I, 11 patients; bunitrolol, noncardioselective with ISA, group II, 11 patients; oxprenolol, noncardioselective with ISA, group III, 11 patients. Hemodynamic variables were obtained at rest and during exercise, before and 45 min after 10 mg i.v. of the drug. Changes in LVEDP and cardiac indexes were such as LV function was improved in 1 patient of group I, 7 patients of group II and 5 patients of group III; impaired in 4 patients of group I and in 1 patient of group III; unchanged in the others. Contractility indexes were less influenced by bunitrolol and oxprenolol. During exercise there was a significant difference between groups for LVEDP which was lower in group II (P less than 0.01). The data seem to indicate that the choice of the beta-blocker may be of importance when it is desirable that an already compromised cardiac function be not further impaired by pharmacological intervention.