Administration Of Beta-blockers Research Articles

Effect of Beta-blocker Treatment on V˙O2peak in Patients with Heart Failure.

In addition to prolonged life and reduced hospitalization rates, it is currently unclear whether beta-blocker (BB) treatment modulates peak oxygen consumption (V˙O2peak), a hallmark of exercise capacity, in patients with heart failure (HF). The main aim of this study is to determine the effect of BB treatment on V˙O2peak in HF patients. We conducted a systematic search of MEDLINE, Scopus, and Web of Science since their inceptions until March 2017 for randomized controlled trials (RCT) assessing the effect of BB treatment on V˙O2peak in chronic HF patients. A meta-analysis was performed to ascertain the standardized mean difference (SMD) between the effects of BB and placebo treatment on V˙O2peak. Secondary outcomes included peak exercise performance and New York Health Association functional class. Subgroup and meta-regression analyses assessed potential moderating factors. Fourteen RCT met the inclusion criteria (overall n = 616). Interventions comprised BB (n = 324) or placebo (n = 292) administration lasting 3 to 24 months. Concomitant reported medication did not differ between HF patients assigned to BB and placebo groups. After data pooling, V˙O2peak was preserved with BB compared with placebo treatment (SMD, -0.04; 95% confidence interval (CI), -0.20 to 0.12; P = 0.61); heterogeneity among studies was not detected (I = 0%, P = 0.88). Peak exercise performance was not altered (SMD, 0.02; 95% CI, -0.16 to 0.20; P = 0.85), whereas New York Health Association functional class was reduced with BB compared with placebo (SMD, -0.54; 95% CI, -0.90 to -0.18; P = 0.003). According to evidence from RCT, prolonged BB (B1-selective or nonselective) treatment does not affect V˙O2peak but improves functional status in HF patients.

Association of Beta-Blockers with Survival on Patients Presenting with ACS Treated with PCI: A Propensity Score Analysis from the BleeMACS Registry

The aim was to evaluate prognostic value of beta-blocker (BB) administration in acute coronary syndromes (ACS) patients in the percutaneous coronary intervention (PCI) era. The BleeMACS project is a multicenter, observational, retrospective registry enrolling patients with ACS worldwide in 15 hospitals. Patients discharged with BB therapy were compared to those discharged without a BB before and after propensity score with matching. The primary endpoint was all-cause mortality at 1year. Secondary endpoints included in-hospital reinfarction, in-hospital heart failure, 1-year myocardial infarction, 1-year bleeding and 1-year composite of death and recurrent myocardial infarction. After matching, 2935 patients for each group were enrolled. The primary endpoint of 1-year death was significantly lower in the group on BB therapy (4.5 vs 7%, p < 0.05), while only a trend was noted for recurrent acute myocardial infarction (4.5 vs 4.9%, p = 0.54). These results were consistent for patients older than 80years of age, for ST-elevation myocardial infarction (STEMI) patients, and for those discharged with complete versus incomplete revascularization, but not for non-STEMI/unstable angina patients. BB therapy was related to 1-year lower risk of all-cause mortality, independently from completeness of revascularization, admission diagnosis, age and ejection fraction. Randomized controlled trials for patients treated with PCI for ACS should be performed.

Impact of Medication Adherence on Mortality and Cardiovascular Morbidity: Protocol for a Population-Based Cohort Study.

BackgroundCardiovascular disease (CVD) is a group of disorders of the heart and blood vessels, such as coronary heart disease (CHD), cerebrovascular disease, and peripheral artery disease. CVD is the leading threat to global health, whether measured by mortality, morbidity, or economic cost. Long-term administration of aspirin, statins, beta-blockers, and angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers improves survival in patients with stablished coronary heart disease. Nevertheless, adherence to prescribed medication is poor for long-term drug treatment.ObjectiveWe aim to assess the relationship between adherences to the four pharmacological groups recommended for secondary prevention and the clinical outcomes of cardiovascular morbidity and mortality in patients with established CHD according to the level of adherence to these drugs in a population of incident cases of acute coronary syndrome (ACS).MethodsPopulation-based cohort study of patients with a first episode of ACS during 2006-2015 in the Information System for Research in Primary Care (SIDIAP) database. We will estimate adherence to these drugs. The primary endpoint is a composite of all-cause mortality, ACS, and ischaemic stroke. Bivariate analyses will be performed estimating odds ratios for categorical variables and mean differences for continuous variables. Hazard ratios for adherences will be calculated for outcome events using Cox proportional hazard regression models, and proportionality of hazards assumption will be tested.ResultsWe expect to estimate adherence to all four study treatments, the incidence of MACE, and to analyze if this incidence is associated with the level of drug adherence.ConclusionsWe expect to find that adherent patients have a lower risk of the primary endpoints compared with nonadherent patients.Trial RegistrationThis study protocol was classified as EPA-OD by the AEMPS (IJG-EST-2017-01-2017-01, 07/04/2017) and registered in the EU PAS register (EUPAS19017, 09/05/2017).

Beta-blockers for prevention and treatment of retinopathy of prematurity in preterm infants.

Retinopathy of prematurity (ROP) is a vision-threatening disease of preterm neonates. The use of beta-adrenergic blocking agents (beta-blockers), which modulate the vasoproliferative retinal process, may reduce the progression of ROP or even reverse established ROP. To determine the effect of beta-blockers on short-term structural outcomes, long-term functional outcomes, and the need for additional treatment, when used either as prophylaxis in preterm infants without ROP, stage 1 ROP (zone I), or stage 2 ROP (zone II) without plus disease or as treatment in preterm infants with at least prethreshold ROP. We searched the Cochrane Neonatal Review Group Specialized Register; CENTRAL (in the Cochrane Library Issue 7, 2017); Embase (January 1974 to 7 August 2017); PubMed (January 1966 to 7 August 2017); and CINAHL (January 1982 to 7 August 2017). We checked references and cross-references and handsearched abstracts from the proceedings of the Pediatric Academic Societies Meetings. We considered for inclusion randomised or quasi-randomised clinical trials that used beta-blockers for prevention or treatment of ROP in preterm neonates of less than 37 weeks' gestational age. We used the standard methods of Cochrane and the Cochrane Neonatal Review Group. We used the GRADE approach to assess the quality of evidence. We included three randomised trials (N = 366) in this review. Two of these studies were at high risk of bias. All studies reported on prevention of ROP and compared oral propranolol with placebo or no treatment. We found no trials assessing beta-blockers in infants with established stage 2 or higher ROP with plus disease.In one trial, study medication was started after one week of life, i.e. prior to the first ROP screening. The other two trials included preterm infants if they had stage 2 or lower ROP without plus disease. Based on the GRADE assessment, we considered evidence to be of low quality for the following outcomes: rescue treatment with anti-VEGF or laser therapy; and arterial hypotension or bradycardia requiring inotropic support. Evidence was of moderate quality for the following outcomes: progression to stage 2 with plus disease; progression to stage 3 ROP; and progression to stage 4 or 5 ROP.Meta-analysis of three trials (N = 366) suggested beneficial effects of oral beta-blockers on the risk of requiring anti-VEGF agents (typical risk ratio (RR) 0.32, 95% confidence interval (CI) 0.12 to 0.86; I² = 0%; typical risk difference (RD) -0.06, 95% CI -0.10 to -0.01; I² = 75%; number needed to treat for an additional beneficial outcome (NNTB) 18, 95% CI 14 to 84) and laser therapy (typical RR 0.54, 95% CI 0.32 to 0.89; typical RD -0.09, 95% CI -0.16 to -0.02; I² = 31%; NNTB 12, 95% CI 8 to 47). Meta-analysis of two trials (N = 161) demonstrated a beneficial effect of oral beta-blockers on progression to stage 3 ROP (typical RR 0.60, 95% CI 0.37 to 0.96; I² = 0%; typical RD -0.15, 95% CI -0.28 to -0.02; I² = 73%; NNTB 7, 95% CI 5 to 67). There was no significant effect of oral beta-blockers on progression to stage 2 ROP with plus disease or to stage 4 or 5 ROP. Although meta-analysis did not indicate a significant effect of beta-blockers on arterial hypotension or bradycardia, propranolol dosage in one study was reduced by 50% in infants of less than 26 weeks' gestational age due to severe hypotension, bradycardia, and apnoea in several participants. Analyses did not indicate significant effects of beta-blockers on complications of prematurity or mortality. None of the trials reported on long-term visual impairment. Limited evidence of low-to-moderate quality suggests that prophylactic administration of oral beta-blockers might reduce progression towards stage 3 ROP and decrease the need for anti-VEGF agents or laser therapy. The clinical relevance of those findings is unclear as no data on long-term visual impairment were reported. Adverse events attributed to oral propranolol at a dose of 2 mg/kg/d raise concerns regarding systemic administration of this drug for prevention of ROP at the given dose. There is insufficient evidence to determine the efficacy and safety of beta-blockers for prevention of ROP due to high risk of bias in two included trials and the lack of long-term functional outcomes. We would encourage researchers to conduct large, well-designed trials to confirm or refute the role of beta-blockers for prevention and treatment of ROP in preterm infants. Trials should report on long-term visual impairment. Researchers should consider dose-finding studies of systemic beta-blockers and topical administration of beta-blockers, in order to optimise drug delivery and minimise adverse events.

The Time Point-Specific Effect of Beta-Adrenergic Blockade in Attenuating High Fat Diet-Induced Obesity and Bone Loss.

We aimed to clarify the key factor determining the effect of beta blocker attenuating high fat diet- induced obesity and bone loss. Six-week-old C57BL/6 male mice were assigned to groups reflecting different relative onset of obesity and beta blocker administration, different diet (control vs. high fat), and treatment (vehicle vs. beta blocker: propranolol). Mice in Group 1 were fed a control diet (CON) or high fat diet (HIGH) with vehicle or propranolol for 12weeks. Mice in Group 2 were fed a CON or HIGH without pharmaceutical treatment for the first 12weeks, followed by another 12weeks of treatment with vehicle or propranolol. Mice in Group 3 were fed a CON without pharmaceutical treatment for the first 12weeks, followed by stratification into diet-based subgroups and another 12weeks of treatment with vehicle or propranolol. Propranolol attenuated the HIGH-induced increase in body weight/fat mass in Group 1 mice and in Group 3 mice, but not in Group 2 mice. Propranolol mitigated HIGH-induced reduction in femoral trabecular bone mineral density and bone architecture deterioration in Group 1 mice but not in Group 2 mice. HIGH feeding in Group 3 did not compromise skeletal integrity. Taken together, propranolol attenuates HIGH-induced body weight increases while weight gain is in progress but not once obesity has already been established. HIGH feeding during the growth period results in compromised bone mass/architecture; which can be attenuated by propranolol administration during the growth period, but not by propranolol administration after obesity has already been established.

Beta blockers in critically ill patients with traumatic brain injury: Results from a multicenter, prospective, observational American Association for the Surgery of Trauma study.

Beta blockers, a class of medications that inhibit endogenous catecholamines interaction with beta adrenergic receptors, are often administered to patients hospitalized after traumatic brain injury (TBI). We tested the hypothesis that beta blocker use after TBI is associated with lower mortality, and secondarily compared propranolol to other beta blockers. The American Association for the Surgery of Trauma Clinical Trial Group conducted a multi-institutional, prospective, observational trial in which adult TBI patients who required intensive care unit admission were compared based on beta blocker administration. From January 2015 to January 2017, 2,252 patients were analyzed from 15 trauma centers in the United States and Canada with 49.7% receiving beta blockers. Most patients (56.3%) received the first beta blocker dose by hospital day 1. Those patients who received beta blockers were older (56.7 years vs. 48.6 years, p < 0.001) and had higher head Abbreviated Injury Scale scores (3.6 vs. 3.4, p < 0.001). Similarities were noted when comparing sex, admission hypotension, mean Injury Severity Score, and mean Glasgow Coma Scale. Unadjusted mortality was lower for patients receiving beta blockers (13.8% vs. 17.7%, p = 0.013). Multivariable regression determined that beta blockers were associated with lower mortality (adjusted odds ratio, 0.35; p < 0.001), and propranolol was superior to other beta blockers (adjusted odds ratio, 0.51, p = 0.010). A Cox-regression model using a time-dependent variable demonstrated a survival benefit for patients receiving beta blockers (adjusted hazard ratio, 0.42, p < 0.001) and propranolol was superior to other beta blockers (adjusted hazard ratio, 0.50, p = 0.003). Administration of beta blockers after TBI was associated with improved survival, before and after adjusting for the more severe injuries observed in the treatment cohort. This study provides a robust evaluation of the effects of beta blockers on TBI outcomes that supports the initiation of a multi-institutional randomized control trial. Therapeutic/care management, level III.

Disturbances in melatonin secretion and the efficacy of replacement therapy in sleep disorders

The review presents data on the dependence of endogenous melatonin synthesis on the time of day, age, pineal gland size, lighting conditions, administration of beta-blockers and a number of other medications. The results of studies on parasecretion and efficacy of exogenous melatonin use in sleep-wake cycle disturbances, insomnia, neurodegeneration, diabetes mellitus and oncological diseases are discussed.

Use of Beta-Blockers on Maintenance Dialysis Patients and Ischemic Cerebral and Cardiovascular Deaths: An Examination Using Propensity Score.

Beta-blockers are frequently used in dialysis patients because of their cardioprotective properties. However, the effect of beta-blockers on reducing dialysis mortality has not been sufficiently examined to date. Thus, we sought to examine the effects on cardiovascular prognosis of beta-blockers using our outpatient dialysis database. From 389 dialysis patients registered in our database, subjects taking beta-blockers were extracted and matched with patients not taking beta-blockers using propensity scores based on 39 variables. Cardiovascular mortality, mortality of heart failure/sudden cardiac death, and mortality of ischemic cerebral and cardiovascular death were estimated using Kaplan-Meier method, and a log-rank test was used to analyze the difference between these survival curves for significance. A total of 216 patients, 108 matched pairs, were extracted from the whole cohort. There was no difference in background factors between the two groups. During mean observation periods of 4.4 years, 76 patients died, including 51 cases of cardiovascular death. Cardiovascular deaths included 30 heart failure/sudden deaths and 13 ischemic cerebral and cardiovascular deaths. For both cardiovascular and heart failure/sudden death, the survival curves did not indicate a significant difference between the 2 groups. On the contrary, in case of ischemic cerebral and cardiovascular deaths, 11 patients died in the beta-blocker group, with a significantly poor prognosis observed in the survival curve (p = 0.0132). Through the use of beta-blockers, a significant increase in ischemic cerebral and cardiovascular deaths was observed. The administration of beta-blockers to dialysis patients was found to worsen the cardiovascular prognosis, so sufficient examination will be needed in the future.

Round-the-clock performance of coronary CT angiography for suspected acute coronary syndrome: Results from the BEACON trial

ObjectiveTo assess the image quality of coronary CT angiography (CCTA) for suspected acute coronary syndrome (ACS) outside office hours.MethodsPatients with symptoms suggestive of an ACS underwent CCTA at the emergency department 24 hours, 7 days a week. A total of 118 patients, of whom 89 (75 %) presented during office hours (weekdays between 07:00 and 17:00) and 29 (25 %) outside office hours (weekdays between 17:00 and 07:00, weekends and holidays) underwent CCTA. Image quality was evaluated per coronary segment by two experienced readers and graded on an ordinal scale ranging from 1 to 3.ResultsThere were no significant differences in acquisition parameters, beta-blocker administration or heart rate between patients presenting during office hours and outside office hours. The median quality score per patient was 30.5 [interquartile range 26.0–33.5] for patients presenting during office hours in comparison to 27.5 [19.75–32.0] for patients presenting outside office hours (p=0.043). The number of non-evaluable segments was lower for patients presenting during office hours (0 [0–1.0] vs. 1.0 [0–4.0], p=0.009).ConclusionImage quality of CCTA outside office hours in the diagnosis of suspected ACS is diminished.Key Points• Quality scores were higher for coronary-CTA during office hours.• There were no differences in acquisition parameters.• There was a non-significant trend towards higher heart rates outside office hours.• Coronary-CTA on the ED requires state-of-the-art scanner technology and sufficiently trained staff.• Coronary-CTA on the ED needs preparation time and optimisation of the procedure.

Beta-blockers, and real clinical practice in Russia: the gap between the understanding of the doses of beta-blockers and subsequent prognosis in patients with cardiovascular disease

Presents an analysis of the reception beta-blockers in three epidemiological studies sections of the EPOKhA. Respondents in each slice (2002, 2007, 2017) were stratified into 5 subgroups: only suffering from hypertension - AH (subgroup AH), patients with stable angina pectoris, but in history and clinically has no evidence of acute myocardial infarction (AMI) and chronic heart failure (subgroup of coronary heart disease); after myocardial infarction, but do not have clinical manifestations of chronic heart failure (subgroup myocardial infarction); patients with acute myocardial infarction formed for any reason, but with no previous history of AMI (subgroup chronic heart failure), and patients with clinical manifestations of chronic heart failure after suffering AMI in anamnesis (subgroup myocardial infarction + chronic heart failure). During 15 years in the Russian Federation the frequency of administration of beta-blockers increased from 20% in the section of cardiovascular pathology to 30%. The most sensitive to the use of beta-blockers were patients with a history of AMI and chronic heart failure. Prolonged beta-blockers have been used at the population level only in 2007, but the frequency with any cardiovascular pathology does not exceed the 50% threshold, and the achievement of goals (control heart rate) does not exceed 10% of the level at any pathology. This dependence is associated with low-dose beta-blockers. In any case, the dose of beta-blockers did not exceed 50% of recommended that can be a separate cause of cardiovascular mortality at the population level in Russia.

Effect of prophylactic betablocker or ACE inhibitor on cardiac dysfunction & heart failure during anthracycline chemotherapy ± trastuzumab

BackgroundAdministration of anthracycline chemotherapy ± trastuzumab is associated with cardiac dysfunction. We sought to identify whether prophylactic administration of angiotensin converting enzyme (ACE) inhibitor or beta-blocker attenuates subsequent left ventricular dysfunction and heart failure. MethodsElectronic databases were searched for studies examining the effect of beta-blockers or ACE inhibitors on left ventricular ejection fraction (LVEF) and heart failure in patients receiving anthracycline chemotherapy ± trastuzumab. The end-point was change in LVEF or development of heart failure. ResultsEight studies (1048 patients) were identified. There was no difference in the change in LVEF (weighted mean difference (MWD) – 4.74 (95% confidence interval (CI): −12.6 to 3.1), p = 0.24) or risk of new heart failure diagnosis (Odds ratio (OR) 0.24 (95% CI: 0.03–1.73), p = 0.16) between patients receiving ACE inhibitor or control. Betablocker use was associated with a significant smaller drop in LVEF compared to control (MWD -3.28 (95% CI: −6.1 to −0.51), p = 0.02) but not in patients who received anthracycline chemotherapy alone (MWD – 3.05 (95% CI -7.22 to 1.12), p = 0.15). There was a significant reduction in new heart failure diagnosis in those receiving beta-blocker compared to those not (OR 0.33 (95% CI: 0.14–0.80), p = 0.01). ConclusionsProphylactic ACE inhibitor does not attenuate development of LV dysfunction or heart failure in patients receiving anthracycline chemotherapy ± trastuzumab. Beta-blocker attenuated reduction in LVEF and new heart failure diagnosis. However, the effect in patients only receiving anthracycline is less certain. Studies examining the effect on mortality are required.

Feasibility of a randomized controlled pilot study using propranolol to decrease beta-adrenergic signaling in hematopoietic stem cell transplant recipients

Randomized controlled trials (RCTs) incorporating basic science psychoneuroimmunology (PNI) mechanisms into translatable clinical findings are critical to implementing PNI discoveries into standard medical practice. Biobehavioral pathways involving stress-induced beta-adrenergic signaling are implicated in tumor progression, with beta-blockers demonstrating efficacy in diminishing these effects in animals. We conducted a proof-of-concept RCT pilot study evaluating the feasibility of prophylactic beta-blocker administration with propranolol (peak dose 80 mg/day) to individuals undergoing a rigorous cancer treatment – autologous hematopoietic cell transplantation - for multiple myeloma. Twenty-two patients have been enrolled (target accrual = 25). 199 individuals completed screening between July 2015 and January 2017; 16 patients declined study participation and 28 enrolled in other oncology treatment trials. Of the remaining 155 patients, 132 were ineligible. The most common reason for ineligibility was current beta- blocker usage (44; 22% of total screened). Of the 23 eligible patients who did not decline or enroll in another trial, 22 were successfully enrolled in the propranolol trial (96%). One of the 11 patients in the treatment arm was unable to complete the propranolol course due to hypotension; > 90% of treatment arm patients were compliant with all 5 weeks of propranolol administration. In sum, adjunctive PNI pharmacologically-based cancer trials may compete for enrollment with primary oncology treatment trials, though enrollment is feasible and cancer patients undergoing rigorous antineoplastic treatment tolerate and are compliant with concurrent beta-blocker therapy.

Risk Factors of On-Pump Conversion during Off-Pump Coronary Artery Bypass Graft.

BackgroundOff-pump coronary artery bypass grafting (OPCABG) procedures can avoid the complications of an on-pump bypass. However, some cases unexpectedly require conversion to cardiopulmonary bypass during OPCABG. The risk factors associated with a sudden need for cardiopulmonary bypass were analyzed.MethodsThis retrospective study included 283 subjects scheduled for OPCABG from 2001 to 2010. These were divided into an OPCABG group and an on-pump conversion group. Preoperative, operative, and postoperative variables were compared between the 2 groups.ResultsOf the 283 patients scheduled for OPCABG, 47 (16%) were switched to on-pump coronary artery bypass grafting (CABG). The mortality of the both the OPCABG and on-pump conversion groups was not significantly different. The major risk factors for conversion to on-pump CABG were congestive heart failure (CHF) (odds ratio [OR], 3.5; p=0.029), ejection fraction (EF) <35% (OR, 4.4; p=0.012), and preoperative beta-blocker (BB) administration (OR, 0.3; p=0.007). The use of intraoperative (p=0.007) and postoperative (p=0.021) inotropics was significantly higher in the conversion group. The amount of postoperative drainage (p<0.001) and transfusion (p<0.001) also was significantly higher in the conversion group. There were no significant differences in stroke or cardiovascular complications between the groups over the course of short-term and long-term follow-up.ConclusionPatients who undergo OPCABG and have CHF or a lower EF (<35%) are more likely to undergo on-pump conversion, while preoperative BB administration could help prevent conversions from OPCABG to on-pump CABG.

O17-5 - Intravenous Administration of Beta Blocker and Amiodarone Was Helpful for VA-ECMO Withdrawal in a Patient with Severe Heart Failure

Case: 42 y.o. male. Chief Complaint: Dyspnea. Present History: Mitral valve replacement and myectomy was performed for familial hypertrophic obstructive cardiomyopathy. AF had been chronic for over than 10 years. He admitted to our hospital because of rapid atrial fibrillation and acute exacerbation of chronic heart failure. Clinical Course: On admission day 6, fever and following respiratory failure resulted in sudden cardiopulmonary arrest. CPR was immediately started, however, asystole continued. Venoarterial extracorporeal membrane oxygenation(VA-ECMO) and intra-aortic balloon pumping(IABP) was initiated to regain systemic circulation. On admission day 13, right heart catheter showed meanPAP of 29 mmHg, meanPCWP of 26 mmHg and cardiac index of 1.14L/min/m2 which showed the patients still in severe heart failure. The indication of heart transplantation was thought to be inadequate because of poor family support. We started administration of intra-venous beta blocker and amiodarone because poorly controlled heart rate(130–150 beat/min) was believed to be a key for overcoming the situation. According to heart rate reduction, cardiac index gradually improved, which resulted in VA-ECMO withdrawal on admission day 22. On day 25, IABP was also removed and on Day 27 extubated. Discussion: We experienced a case that intravenous administration of beta blocker and amiodarone was helpful for VA-ECMO withdrawal in a patient with severe heart failure. Intravenous Beta blocker and amiodarone can be safely introduced in the patients with critical severe heart failure.

O54-2 - Super High Dose Beta-blocker Administration for the Patients with Dilated Cardiomyopathy

First case is a 25-year-old female with dilated cardiomyopathy. Left ventricular end-diastolic diameter (LVEDD) was 74 mm and ejection fraction (EF) was 29%. Carvedilol was already uptitrated to 20 mg twice daily. Right heart catheterization (RHC) revealed very low cardiac output (C.O. 2.82 l/min), cardiac index (C.I. 1.47 l/min/m2), stroke volume (SV 29 ml) and rapid heart rate (HR 96/min) despite maximum dosage of carvedilol in Japan. Carvedilol was uptitrated to 50 mg twice daily and additional 10 mg bisoprolol twice daily was started under administration of low-dose dobutamine. After complete uptitration of beta blockers and termination of dobutamine, RHC showed elevated C.O. (4.25 l/min), C.I. (2.25 l/min/m2), SV (52 ml) and decreased HR (82/min). After the initiation of super high dose beta-blocker therapy, she has no heart failure rehospitalization. Second case was 35-year-old male. He has a history of myocarditis following influenza viral infection 7 years before. LVEDD was 79 mm and EF was 21%. Carvedilol was 5 mg twice daily. To reduce HR (93/min at rest), carvedilol was uptitrated to 50 mg twice daily and additional bisoprolol 10 mg twice daily was introduced. LVEDD improved to 69 mm and EF increased to 27% after six months. Beta-blocker is a key drug for heart failure therapy. We should make every effort to maximize the dose of beta blocker as much as possible.

Beta Blocker Administration During Emergency Department Evaluation for Acute Coronary Syndrome Is Associated With Lower Posttraumatic Stress Symptoms 1‐Month Later

We examined whether beta blocker administration in the emergency department (ED) during evaluation for suspected acute coronary syndrome (ACS) was associated with posttraumatic stress disorder (PTSD) symptoms 1-month later. Participants (N = 350) were enrolled in the Reactions to Acute Care and Hospitalization (REACH) study, an ongoing observational cohort study of ED predictors of medical and psychological outcomes after evaluation for suspected ACS. Beta blockade during evaluation in the ED was extracted from medical records, and PTSD symptoms in response to the experience of suspected ACS were assessed 1-month later via telephone. Beta blockade in the ED was associated with lower PTSD symptoms 1-month later, b = -2.80, β = -.09, p = .045, after adjustment for demographics, preexisting psychological and medical covariates, and participants' distress during ED evaluation. Despite small effects, findings suggest that beta blockade during ED evaluation for suspected ACS-a time period relevant to fear consolidation of the memory of this potentially life-threatening event-may have protective effects for later psychological health.

A prospective national survey of coronary CT angiography radiation doses in the United Kingdom

BackgroundLittle real-world radiation dose data exist for the majority of cardiovascular CT. Some data have been published for coronary CT angiography (coronary CTA) specifically, but they invariably arise from high-volume centres with access to the most recent technology. ObjectiveThe aim of this study was to document real-world radiation doses for coronary CTA in the United Kingdom, and to establish their relationship to clinical protocol selection, acquisition heart rate, and scanner technology. MethodsA dose survey questionnaire was distributed to members of the British Society of Cardiovascular Imaging and other UK cardiac CT units. All participating centres collected data for consecutive coronary CTA cases over one month. The survey captured information about the exam conducted, patient demographics, pre-scan details such as beta-blocker administration, acquisition heart rate and scan technique, and post-scan dose indicators – series volumetric CT dose index (CTDIvol), series dose-length product (DLP), and exam DLP. ResultsFifty centres provided data on a total of 1341 coronary CTA exams. Twenty-nine centres (58%) performed at least 20 coronary CTA scans in the collection period. The median BMI, acquisition heart rate and exam DLP were 28 kg/m2, 60 bpm and 209 mGycm respectively. The corresponding effective dose was estimated as 5.9 mSv using a conversion factor of 0.028 mSv/mGycm. There was no statistically significant difference in radiation dose between low and high-volume centres. Median exam DLP increased with the acquisition heart rate due to the selection of wider temporal windows. The highest exam DLPs were obtained on the older scanner technology. ConclusionThis study provides baseline data for benchmarking practice, optimizing radiation dose and improving service quality locally.

Long-term effects of beta-blocker use on lung function in Japanese patients with chronic obstructive pulmonary disease.

BackgroundSome recent studies have suggested that beta-blocker use in patients with chronic obstructive pulmonary disease (COPD) is associated with a reduction in the frequency of acute exacerbations. However, the long-term effects of beta-blocker use on lung function of COPD patients have hardly been evaluated.Patients and methodsWe retrospectively reviewed 31 Japanese COPD patients taking beta-blockers for >1 year and 72 patients not taking them. The association between beta-blocker use and the annual change in forced expiratory volume in 1 second (FEV1) was assessed.ResultsAt baseline, patient demographic characteristics were as follows: 97 males (mean age 67.0±8.2 years); 32 current smokers; and Global Initiative for Chronic Obstructive Lung disease (GOLD) stages I: n=26, II: n=52, III: n=19, and IV: n=6. Patients taking beta-blockers exhibited a significantly lower forced vital capacity (FVC), FEV1, and %FVC, and a more advanced GOLD stage. The mean duration of beta-blocker administration was 2.8±1.7 years. There were no differences in the annual change in FEV1 between patients who did and did not use beta-blockers (−7.6±93.5 mL/year vs −4.7±118.9 mL/year, P=0.671). After controlling for relevant confounders in multivariate analyses, it was found that beta-blocker use was not significantly associated with the annual decline in FEV1 (β=−0.019; 95% confidence interval: −0.073 to 0.036; P=0.503).ConclusionLong-term beta-blocker use in Japanese COPD patients might not affect the FEV1, one of the most important parameters of lung function in COPD patients.

An Analysis of Beta-Blocker Administration Pre-and Post-Traumatic Brain Injury with Subanalyses for Head Injury Severity and Myocardial Injury

A growing body of literature indicates that beta-blocker administration after traumatic brain injury (TBI) is cerebroprotective, limiting secondary injury; however, the effects of preinjury beta blocker status remain poorly understood. We sought to characterize the effects of pre- and postinjury beta-blocker administration on mortality with subanalyses accounting for head injury severity and myocardial injury. In a Level II trauma center, all admissions of patients ≥18 years with a head Abbreviated Injury Scale Score ≥2, Glasgow Coma Scale ≤13 from May 2011 to May 2013 were queried. Demographic, injury-specific, and outcome variables were analyzed using univariate analyses. Subsequent multivariate analyses were conducted to determine adjusted odds of mortality for beta-blocker usage controlling for age, Injury Severity Score, head Abbreviated Injury Scale, arrival Glasgow Coma Scale, ventilator use, and intensive care unit stay. A total of 214 trauma admissions met inclusion criteria: 112 patients had neither pre- nor postinjury beta-blocker usage, 46 patients had preinjury beta-blocker usage, and 94 patients had postinjury beta-blocker usage. Both unadjusted and adjusted odds ratios of preinjury beta-blocker were insignificant with respect to mortality. However, postinjury in-hospital administration of beta blockers was found to significantly in the decrease of mortality in both univariate (P = 0.002) and multivariate analyses (P = 0.001). Our data indicate that beta-blocker administration post-TBI in hospital reduces odds of mortality; however, preinjury beta-blocker usage does not. Additionally, myocardial injury is a useful indicator for beta-blocker administration post-TBI. Further research into which beta blockers confer the best benefits as well as the optimal period of beta-blocker administration post-TBI is recommended.

Эффективность антиаритмических средств при стимуляции симпатической нервной системы

Проблема ослабления действия антиаритмических препаратов в условиях активации симпатической нервной системы стала предметом внимания многих исследователей. Такая ситуация часто встречается при ишемии и инфаркте миокарда, а также у пациентов, имеющих устойчивую желудочковую аритмию. Кроме того, симпатическая гиперактивность является характерной чертой сердечно-сосудистых заболеваний, в том числе, сердечной недостаточности. Стимуляция β-адренорецепторов может значительно модулировать электрофизиологические эффекты антиаритмических препаратов. Существуют значительные различия в способности антиаритмических средств сохранять свою эффективность на фоне симпатической стимуляции. Дополнительное введение β-адреноблокаторов пациентам с желудочковой тахикардией, а также с сердечной недостаточностью, кардиомиопатией, перенесшим инфаркт миокарда, демонстрирует высокую эффективность при таких состояниях и заслуживает дальнейшего исследования. Поиск антиаритмических препаратов, действие которых не ослабевает при симпатической стимуляции, сохраняет актуальность в настоящее время.