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Right Ventricular Ejection Fraction and Beta-Blocker Effect in Heart Failure With Reduced Ejection Fraction
Phillip H Lam1, Kalliopi Keramida2, Gerasimos S Filippatos2
1Department of Medicine, Veterans Affairs Medical Center, Washington, DC; Department of Cardiology, MedStar Washington Hospital Center, Washington, DC; Department of Medicine, Georgetown University, Washington, DC.
Journal of Cardiac Failure
|August 22, 2021
Summary
Beta-blockers benefit heart failure patients, but effectiveness varies by right ventricular ejection fraction (RVEF). Bucindolol improved survival in HFrEF patients with higher RVEF, suggesting RVEF can guide therapy.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Low right ventricular ejection fraction (RVEF) indicates poor prognosis in heart failure with reduced ejection fraction (HFrEF).
- Beta-blockers are standard HFrEF treatment, but their efficacy relative to RVEF is not well-established.
Purpose of the Study:
- To investigate if baseline RVEF modifies the effect of bucindolol on mortality in patients with HFrEF.
- To determine if RVEF can be used to stratify HFrEF patients for beta-blocker therapy.
Main Methods:
- Analysis of 2008 patients from the Beta-Blocker Evaluation of Survival Trial (BEST) with baseline RVEF data.
- Patients were stratified into RVEF < 35% and RVEF ≥ 35% groups.
- Hazard ratios and interaction tests were used to assess bucindolol's effect across RVEF subgroups.
Main Results:
- Bucindolol's overall effect on mortality was consistent with the main trial.
- Bucindolol significantly reduced all-cause mortality in patients with RVEF ≥ 35% (HR 0.70) but not in those with RVEF < 35% (HR 1.02).
- Significant interactions were observed for cardiovascular mortality and sudden cardiac death, but not pump failure death or HF hospitalization.
Conclusions:
- Baseline RVEF significantly modifies the effect of bucindolol on mortality in HFrEF.
- RVEF may serve as a biomarker for risk stratification and optimizing beta-blocker therapy in HFrEF.
- Further research with contemporary beta-blockers is warranted to confirm these findings.
Keywords:
Heart failure with reduced ejection fraction (HFrEF)all-cause mortalitybeta-blockersbucindololright ventricular ejection fraction (RVEF)More Related Videos
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