Β-receptor Blockers Research Articles

RNA-seq analysis of human trabecular endothelial cells after treatment with timolol maleate.

Timolol maleate (timolol), a β-receptor blocker, reduces intraocular pressure by decreasing aqueous humor production. Timolol reportedly also protects ganglion cells, decreases aqueous humor outflow facility, and destroys the extracellular matrix in the trabecular meshwork. In this study, we investigated the effects of timolol on cultured human trabecular endothelial cells purchased from ScienCell using next-generation sequencing. Experimental investigation. Total ribonucleic acid (RNA) was extracted after 24 h. More than 100 million RNAs in control and timolol-treated group were sequenced using a next-generation sequencer. The expression of 55,778 RNAs was analyzed. A total of 2,105 genes were significantly upregulated and 2,125 genes were downregulated, after the addition of timolol. VGF nerve growth factor inducible (VGF) (388-fold) had the maximum increase in expression, followed by amphiregulin (333-fold), a member of the epidermal growth factor family. Moreover, the expression of extracellular matrix-degrading enzymes, matrix metalloproteinases (MMPs) 1, 2, 3, 10, 12, and 14, increased. Timolol exerts various effects on human trabecular endothelial cells. The increase in MMP expression may contribute to the decrease in the aqueous humor outflow facility.

Development of Efficient Analytical method for the multicomponent analysis of Pravastatin Sodium and Nebivolol Hydrochloride in Bulk Drug by RP-HPLC

Cardiovascular diseases are managed through multi drug regimens. For better patient compliance and cost effectiveness, desired therapeutic efficacy is achieved through combination of more than two drugs in single dosage form. Nebivolol Hydrochloride is β1 receptor blocker and Pravastatin sodium exhibits its pharmacological action through inhibition of cholesterol synthesis. Both drugs are therapeutically compatible and can be administered in single dose formulation. A review of the literature found that there was no effective strategy for the selected drug combination. As a result, an attempt was made to establish a simple, efficient, sensitive, specific, and rapid method for simultaneously estimating Pravastatin sodium and Nebivolol hydrochloride in bulk drugs using RP-HPLC.Column C-18 (Shim-pack) 250 x 4.6 mm, particle size 5 m, mobile phase acetonitrile and water in the ratio 20:80 at 257 nm were found to be the optimal chromatographic conditions. Pravastatin sodium and Nebivolol hydrochloride had retention times of 2.092 and 3.623 minutes, respectively, with average percentage recovery of 99.38% and 99.54%, respectively.The proposed technique was found to be in accordance with the guidelines of the International Conference on Harmonization (ICH).

Bradykinin B2 receptor blockade and intradialytic hypotension

IntroductionIntradialytic hypotension (IDH) is a common clinical complication and is associated with increased morbidity and mortality in patients undergoing maintenance hemodialysis (MHD). The pathogenesis of IDH has been attributed to the rapid reduction of plasma volume during hemodialysis and the inadequate compensatory mechanisms in response to hypovolemia, such as the lack of vasoconstriction. This may be due to the increased production of vasodilators, such as bradykinin. In this study we test the hypothesis that bradykinin B2 receptor blockade prevents intradialytic hypotension.MethodsWe performed a post-hoc analysis of a double-blind, placebo-controlled, randomized, 2 × 2 crossover clinical trial comparing the continuous infusion of icatibant, a bradykinin B2 receptor blocker, and placebo during hemodialysis. Icatibant or placebo was infused for 30 min before and during hemodialysis in 11 patients on MHD.ResultsSeven of the patients had IDH, defined as a reduction of systolic blood pressure equal to or greater than 20 mmHg during hemodialysis. Stratified analysis, based on the presence of IDH, revealed that icatibant prevented the decrease in blood pressure compared to placebo in patients with IDH [blood pressure at average nadir (2.5 h after hemodialysis): Placebo,114.3 ± 8.9 vs. icatibant, 125.6 ± 9.1 mmHg, mean ± S.E.M]. Icatibant did not affect blood pressure in the group of patients without IDH.ConclusionBradykinin B2 receptor blocker may prevent the occurrence of IDH. Further studies should evaluate the hemodynamic effects of icatibant during hemodialysis and the symptomatology associated with IDH.

Bradykinin-(1–9) mitigates autophagy through upregulating PI3K/Akt in rats with myocardial infarction

The cardioprotective mechanisms of bradykinin-(1–9) in myocardial infarction were unclear. We investigated the effect of bradykinin-(1–9) on cardiac function, fibrosis, and autophagy induced by myocardial infarction and identified the mechanisms involved. To investigate the cardioprotective effect of bradykinin-(1–9), various doses of bradykinin-(1–9), its B2 receptor blocker HOE140, or their combination were administered to rats via subcutaneous osmotic minipump implantation before myocardial infarction. After 2 days, myocardial infarction was induced by ligation of the left anterior descending coronary artery. After 2 weeks, echocardiographic measurements and euthanasia were performed. Bradykinin-(1–9) treatment attenuated left ventricular dysfunction, fibrosis, and autophagy in rats with myocardial infarction, which was partially reversed by HOE140 administration. Moreover, the downregulatory effect of bradykinin-(1–9) on autophagy was partially reversed by combination with the PI3K inhibitor LY294002. Thus, bradykinin-(1–9) inhibits myocardial infarction-induced cardiomyocyte autophagy by upregulating the PI3K/Akt pathway.

Association between visceral adiposity index and heart failure: A cross-sectional study.

Obesity is an important risk factor for heart failure (HF). Visceral adiposity index (VAI) is a simple metric for assessing obesity; however, the association between VAI and risk for HF has not been studied. A cross-sectional study involving 28 764 participants ≥18 years of age from the National Health and Nutrition Examination Survey (NHANES), 2009-2018, in the United States was performed. VAI was calculated using body mass index (BMI), waist circumference (WC), triglycerides (TG), and high-density lipoprotein cholesterol. VAI was analyzed as a continuous and categorical variable to examine its association with HF. Subgroup analysis was also performed. The highest VAI (fourth quartile [Q4]) was found among males, BMI, systolic and diastolic blood pressure, WC, hypertension, diabetes, liver disease, coronary heart disease, smoking, total cholesterol, and TG. More participants in Q4 took β-receptor blockers, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers/angiotensin receptor-neprilysin inhibitor, calcium channel blockers, and antidiabetic and antihyperlipidemic medications. Participants with HF exhibited greater VAI. A per-unit increase in VAI resulted in a 4% increased risk for HF (odds ratio [OR] 1.04 [95% confidence interval (CI) 1.02-1.05]). After multivariable adjustment, compared with the lowest quartile, the OR for Q3 was 1.55 (95% CI 1.24-1.94). Subgroup analysis revealed no significant interactions between VAI and specific subgroups. VAI was independently associated with the risk for HF. As a noninvasive index of visceral adiposity, VAI could be used for a "one shot" assessment of HF risk and may serve as a novel marker.

Perspective of SGLT2i in the Treatment of Abdominal Aortic Aneurysms.

The incidence of abdominal aortic aneurysm (AAA) in the elderly is increasing year by year with high mortality. Current treatment is mainly through surgery or endovascular intervention, which is not sufficient to reduce future risk. Therefore, we still need to find an effective conservative measure as an adjunct therapy or early intervention to prevent AAA progression. Traditional therapeutic agents, such as β-receptor blockers, calcium channel blockers, and statins, have been shown to have limited effects on the growth of AAA. Recently, sodium-glucose cotransport proteins inhibitors (SGLT2is), a new class hypoglycemic drug, have shown outstanding beneficiary effects on cardiovascular diseases by plasma volume reduction, vascular tone regulation, and various unidentified mechanisms. It has been demonstrated that SGLT2i is abundantly expressed in the aorta, and some studies also showed promising results of SGLT2i in treating animal AAA models. This article aims to summarize the recent progress of AAA studies and look forward to the application of SGLT2i in AAA treatment for early intervention or adjunct therapy after surgical repair or stent graft.

Retracted: Exploration on the Effect of Nonselective β-Receptor Blockers (NSBBs) on Hemodynamic Parameters in Complicated Liver Cirrhosis.

[This retracts the article DOI: 10.1155/2022/7922906.].

Influence of β- blockers on the activity of some anti-epileptic drugs on convulsions induced by picrotoxin in mice

Adrenergic β-receptor blockers are widely used in clinic for the management of cardiovascular disease and some other illnesses. However, this group of drugs known to cause central nervous system side effects such as drowsiness, sleep disturbance, hallucination, migraine and tremors. As anti-epileptic drugs exert their action mainly through the inhibition of the central nervous system to decrease the firing and the excitability of neurons. Accordingly, β-blockers might influence the pharmacological activity of anti-epileptic drugs. Aim:The aims of this study is to investigate the influence of β –blockerson the anti-convulsant activity of two anti-epileptic drugs, i.e. phenytoin and phenobarbital. Methods: Three beta blockers with different β-receptor blocking selectivity and degree of solubility (atenolol, metoprolol, and propranolol) were injected intraperitoneally (IP) into mice either alone or in combination with phenytoin or phenobarbital. After 30 min mice were injected with picrotoxin (8mg/kg) to induce convulsions. Convulsion parameters recorded were; the onset of jerks, number of tonic and clonic convulsions, and % mortality. Results: Picrotoxin produced 100% death in all control animals. However, mosttheanimals treated with antiepileptics alone or in combination with β-blockers were protected from death. The effect of phenytoin on the onset of convulsions was significantlyenhanced when it combined with β-blockers. However, in regard to phenobarbital only the increase was noticed with propranolol. Giving phenytoin with β-blockers improves its effect in reducing clonic convulsion, whereas, no change in phenobarbital activity when administered together with β-blockers. Combination of either phenytoin or phenobarbital with β-blockers did not result in any significant change in their ability to reduce tonic convulsions except when phenytoin co-administered with metoprolol a significant decrease was observed. Conclusion: The administration of β-blockers in concomitant with phenytoin and phenobarbital increased their anticonvulsant activity. However, β-blockers alone could have some protective effect against convulsions.

Influence of systolic blood pressure on outcomes in Nigerians with peripartum cardiomyopathy.

The relationship between blood pressure (BP) trajectories and outcomes in patients with peripartum cardiomyopathy (PPCM) is not clear. Aim: The study aimed to assess the clinical features and outcomes (all-cause mortality and unrecovered left ventricular [LV] systolic function) of PPCM patients grouped according to their baseline systolic BP (SBP). PPCM patients presenting to 14 tertiary hospitals in Nigeria were consecutively recruited between June 2017 and March 2018 and then followed up till March 2019. SBP at first presentation was used to categorize the patients into seven groups: <90, 90-99, 100-109, 110-119, 120-129, 130-139, and ≥140 mmHg. Unrecovered LV systolic function was defined as echocardiographic LV ejection fraction (LVEF) below 55% at the last profiling. Two hundred and twenty-seven patients were recruited and followed up for a median of 18 months. Of these, 4.0% had <90 mmHg, 16.3% had 90-99 mmHg, 24.7% had 100-109 mmHg, 24.7% had 110-119 mmHg, 18.5% had 120-129 mmHg, 7.5% had 130-139 mmHg, and 4.4% had ≥140 mmHg of SBP at presentation. The highest frequency of all-cause mortality was recorded among patients with SBP ≤90 mmHg (30.8%) followed by those with 90-99 mmHg (20.5%) (P = 0.076), while unrecovered LV systolic function did not differ significantly between the groups (P = 0.659). In a Cox proportional regression model for all-cause mortality, SBP <90 mmHg had a hazard ratio (HR) of 4.00 (95% confidence interval [CI] 1.49-10.78, P = 0.006), LVEF had an HR of 0.94 (95% CI 0.91-0.98, P = 0.003, B = 0.06%), and use of angiotensin-converting enzyme or angiotensin receptor and/or β-receptor blockers had an HR of 1.71 (95% CI 0.93-3.16, P = 0.085). However, SBP was not associated with LV function recovery. In our cohort of PPCM patients, one-fifth was hypotensive at presentation. SBP <90 mmHg at presentation was associated with a four-fold higher risk of all-cause mortality during a median follow-up of 18 months.

Research advance of the mechanism and treatment of septic cardiomyopathy

Sepsis is a life-threatening organ dysfunction caused by dysregulation of the body's response to infection. It is one of the common and serious complications in clinically critical patients with trauma, burn, shock, infection, etc., with high morbidity and mortality. Although the treatment of sepsis has made great achievements in clinical practice, the mortality of patients with sepsis is still increasing due to its secondary complications. Septic cardiomyopathy (SCM) is one of the major complications that threaten septic patient's life. SCM refers to myocardial dysfunction with the aggravation of the primary disease, which is manifested by biventricular dilatation accompanied by a decrease in left ventricular ejection fraction (LVEF). It is one of the major complications that threaten the life of patients with sepsis. The existing research shows that the mechanism of SCM includes myocardial mitochondrial dysfunction, myocardial cell apoptosis, calcium circulation disorder and its treatment including conventional treatment, β1 receptor blocker treatment and traditional Chinese medicine treatment,etc. This paper reviewed the pathogenesis of SCM and its related, in order to provide references for the rational diagnosis and treatment of SCM.

Enantioseparation of β-receptor blockers and the enantioselective degradation of carvedilol in soil

Enantioseparation of seven β-receptor blockers, including carvedilol, metoprolol, atenolol, sotalol, propafenone, bisoprolol and arotinolol was investigated using HPLC coupled with pre-column derivatization in this work. The derivative conditions of the ratio of the analytes and the derivative reagent, (S)-N-(4-nitrophenoxycarbonyl) phenylalanine methoxyethyl ester, the amount of sodium tetraborate, the reaction temperature and reaction time were optimized. The effects of the types of chromatographic columns, the composition and ratio of the mobile phase and mobile phase additives on enantioseparation were also evaluated in HPLC analysis. The seven pairs of enantiomers showed a good baseline separation on an InfinityLab Poreshell 120 EC-C18 column (150 mm × 4.6 mm, 4 µm) using the mobile phase of methanol and 5 mM ammonium bicarbonate at a flow rate of 1.0 mL/min. In addition, a LC-MS/MS method coupled with QuEChERS extraction for the enantioselective quantitation of carvedilol in soil was developed. The method was fully validated in terms of selectivity, linearity, matrix effect, accuracy, precision, limit of detection and limit of quantification. The linear ranges of carvedilol enantiomers were both 0.5–100 ng/mL and the limits of quantification were 0.5 ng/mL. Extraction recoveries were more than 83.0% with the intra-day and inter-day precision less than 6.8%. The matrix effect values were in the range from 84.5% to 91.3%. The proposed method was successfully applied to determine carvedilol enantiomers in soil and their degradation process was investigated. The degradation of carvedilol enantiomers in soil at natural condition conformed to the first-order degradation kinetics (R2 > 0.9790). The half-lives of carvedilol enantiomers were 17.77 and 16.90 days, respectively and the enantiomer fraction (EF) values of carvedilol enantiomers ranged from 0.488 to 0.523 with time in soil, indicating the degradation behaviors, disposition and biotransformation of carvedilol enantiomers in soil showed no enantioselectivity (P > 0.05).

Nomogram Model Based on Clinical Risk Factors and Heart Rate Variability for Predicting All-Cause Mortality in Stage 5 CKD Patients.

Background: Heart rate variability (HRV), reflecting circadian rhythm of heart rate, is reported to be associated with clinical outcomes in stage 5 chronic kidney disease (CKD5) patients. Whether CKD related factors combined with HRV can improve the predictive ability for their death remains uncertain. Here we evaluated the prognosis value of nomogram model based on HRV and clinical risk factors for all-cause mortality in CKD5 patients. Methods: CKD5 patients were enrolled from multicenter between 2011 and 2019 in China. HRV parameters based on 24-h Holter and clinical risk factors associated with all-cause mortality were analyzed by multivariate Cox regression. The relationships between HRV and all-cause mortality were displayed by restricted cubic spline graphs. The predictive ability of nomogram model based on clinical risk factors and HRV were evaluated for survival rate. Results: CKD5 patients included survival subgroup (n = 155) and all-cause mortality subgroup (n = 45), with the median follow-up time of 48 months. Logarithm of standard deviation of all sinus R-R intervals (lnSDNN) (4.40 ± 0.39 vs. 4.32 ± 0.42; p = 0.007) and logarithm of standard deviation of average NN intervals for each 5 min (lnSDANN) (4.27 ± 0.41 vs. 4.17 ± 0.41; p = 0.008) were significantly higher in survival subgroup than all-cause mortality subgroup. On the basis of multivariate Cox regression analysis, the lnSDNN (HR = 0.35, 95%CI: 0.17–0.73, p = 0.01) and lnSDANN (HR = 0.36, 95% CI: 0.17–0.77, p = 0.01) were associated with all-cause mortality, their relationships were negative linear. Spearman’s correlation analysis showed that lnSDNN and lnSDANN were highly correlated, so we chose lnSDNN, sex, age, BMI, diabetic mellitus (DM), β-receptor blocker, blood glucose, phosphorus and ln intact parathyroid hormone (iPTH) levels to build the nomogram model. The area under the curve (AUC) values based on lnSDNN nomogram model for predicting 3-year and 5-year survival rates were 79.44% and 81.27%, respectively. Conclusion: In CKD5 patients decreased SDNN and SDANN measured by HRV were related with their all-cause mortality, meanwhile, SDNN and SDANN were highly correlated. Nomogram model integrated SDNN and clinical risk factors are promising for evaluating their prognosis.

Exploration on the Effect of Nonselective β-Receptor Blockers (NSBBs) on Hemodynamic Parameters in Complicated Liver Cirrhosis.

Esophageal-gastric variceal bleeding occurs in 5–15% of patients with liver cirrhosis annually, and the mortality rate is as high as 20% within 6 weeks of the first bleed. The more compromised the liver function, the higher the mortality. Effective control of bleeding is pivotal for reducing mortality in patients with liver cirrhosis. To explore the effect of nonselective β-receptor blockers (NSBBs) on hemodynamic parameters in liver cirrhosis complicated with esophageal-gastric variceal bleeding and the association with hepatorenal syndrome (HRS), this retrospective study assessed the clinical data of 248 patients with liver cirrhosis and esophageal-gastric variceal hemorrhage admitted to our hospital for research. 112 patients are treated with somatostatin (control group) and 136 with somatostatin+propranolol (study group). The success rate of hemostasis, changes of hemodynamic parameters before and after treatment, and incidence of HRS are compared between the groups. Logistic regression analysis is used to explore the use of propranolol when HRS occurred. NSBBs combined with somatostatin are more effective than somatostatin alone in the treatment of liver cirrhosis complicated with esophageal-gastric variceal bleeding; NSBBs may be associated with the occurrence of HRS.

A Review of Sarcopenia Pathophysiology, Diagnosis, Treatment and Future Direction.

Sarcopenia is a progressive and generalized loss of skeletal muscle mass and function. The prevalence of sarcopenia was reported to be up to 29% in older persons in the community healthcare setting. Sarcopenia diagnosis is confirmed by the presence of low muscle mass plus low muscle strength or low physical performance. Sarcopenia management options include non-pharmacological and pharmacological approaches. Non-pharmacological approaches include resistance exercise and adequate nutrition. Of the two, resistance exercise is the standard non-pharmacological treatment approach for sarcopenia with significant positive evidence. Some dietary approaches such as adequate intake of protein, vitamin D, antioxidant nutrients, and long-chain polyunsaturated fatty acid have been shown to have positive effects against sarcopenia. Currently, no specific drugs have been approved by the Food and Drug Administration for the treatment of sarcopenia. However, several agents, including growth hormone, anabolic or androgenic steroids, selective androgenic receptor modulators, protein anabolic agents, appetite stimulants, myostatin inhibitors, activating II receptor drugs, β-receptor blockers, angiotensin-converting enzyme inhibitors, and troponin activators, are recommended and have been shown to have variable efficacy. Future research should focus on sarcopenia biological pathway and improved diagnostic approaches such as biomarkers for early detection, development of consistently pre-eminent treatment methods for severe sarcopenia patients, and establishing sensitive measures for predicting sarcopenia treatment response.

Effect of non-selective β-receptor blockers on inflammatory factors and prognosis in advanced chronic liver disease

Effect of non-selective β-receptor blockers on inflammatory factors and prognosis in advanced chronic liver disease

Effect of diltiazem on exercise tolerance in patients with stable coronary artery disease and hypertension.

The present study aimed to investigate the effect of diltiazem on cardiovascular risk and exercise tolerance in patients with stable coronary artery disease and hypertension. From 2016 to 2018, 80 patients with stable coronary artery disease (5 < Gensini score < 20) and hypertension were enrolled into the present study. These patients were randomly divided into two groups: diltiazem group (Dil, 90 mg, bid), and control group (angiotensin-converting enzyme inhibitors (ACEI)/angiotensin II receptor blockers (ARB) for reducing blood pressure and β-receptor blockers for controlling heart rate). Liver and kidney function, heart rate variability (HRV), blood pressure variability (BPV) and bicycle exercise were measured at baseline and after six months. The incidence of cardiovascular events (re-hospitalization due to angina pectoris, acute myocardial infarction, and cardiogenic death) was also assessed. The differences in all indexes at baseline between these two groups were not statistically significant (P > 0.05, respectively). After six months of treatment, both groups of patients had significant improvements in HRV, BPV and exercise tolerance compared that before treatment (p < 0.05). The difference in the decrease in systolic blood pressure, improvement of HRV and BPV, and cardiovascular events between these two groups was not statistically significant (P = 0.588, 0.431, 0.152, 1.000, respectively). But the Dil group was significantly better than the control group in degree of heart rate decline, diastolic blood pressure decline, and improvement of ST segment depression (P < 0.001), and the improvement in exercise tolerance was also better than that of the control group. We found that diltiazem compared with ACEI/ARB and β-receptor blockers can further improve the exercise tolerance of patients with stable coronary artery disease and hypertension.

Contribution of sympathetic activation to antihypertrophic memory after regression of exercise-induced physiological myocardial hypertrophy in mice

To investigate whether anti-hypertrophic memory exists after regression of exercise-induced physiological myocardial hypertrophy (PMH) and explore the contribution of sympathetic activation to hypertrophic memory formation. Seventy-two mice were randomized equally into 6 groups, including sedentary sham-operated group, exercise hypertrophic preconditioning (EHP) + sham operation group, bisoprolol (an adrenergic β1 receptor blocker) + EHP + sham operation group (biso+Exe+Sham group), sedentary group with transverse aortic constriction (TAC) (Sed+TAC group), EHP+ TAC group (Exe+TAC group), and bisoprolol+EHP+TAC group (biso+Exe+TAC group). The mice in the EHP groups were subjected to 3 weeks of swimming training, and in the bisoprolol groups, bisoprolol was administered by gavage once daily from two days before till the end of the training. One week after the training, TAC or sham surgery was performed. Echocardiography and hemodynamic measurements were performed to evaluate cardiac function of the mice, and the myocardial tissues were examined histologically to detect cardiac remodeling. Compared with the sedentary group, the mice receiving 3 weeks of swimming training had significantly increased heart weight to body weight ratio (HW/BW), HW to tibia length ratio (HW/TL), and the cross-sectional area of the cardiomyocytes (P < 0.05). One week after the training, exercise-induced PMH rapidly diminished and both HW/BW and HW/TL recovered the baseline levels. Treatment with bisoprolol obviously prevented the occurrence of PMH. Four weeks after TAC, the left ventricular posterior wall thickness, HW/BW, HW/TL, left ventricular end diastolic pressure and cross-sectional area of cardiomyocytes were all significantly lower (P < 0.05) while the left ejection fraction and maximal change rate of left ventricular pressure were significantly higher (P < 0.05) in Exe + TAC group than in Sed + TAC group. No significant difference was found in these parameters between biso + Exe + TAC group and Sed + TAC group. Anti-hypertrophic memory exists even after the regression of exercise-induced PMH, which may be attributed to the activation of sympathetic nervous system during exercise.

Chinese experts suggestions on the application of esmolol injections in patients with arrhythmia

β-receptor blocker is the cornerstone for the treatment of many cardiovascular diseases. Esmolol, an ultra-short-acting intravenous β-receptor blocker, is characterized with rapid onset of action, a fast metabolism process and convenience in adjusting its effect. It is an important drug in the treatment of acute arrhythmia. By blocking sympathetic excitation, esmolol has other multiple effects, such as negative inotropic action, negative chronotropic action, lowering blood pressure etc. Relative contraindications of its application may occur in clinical practice. Thus, it is of great necessity to master the indications and contraindications for the standard prescriptions and rational administration of the drug.

Circadian rhythms of melatonin, cortisol, and clock gene expression in the hyperacute phase of wake-up stroke: study design and measurement.

Circadian rhythms of melatonin, cortisol, and clock gene expression in the hyperacute phase of wake-up stroke: study design and measurement.

Clinical Characteristics, Treatment, and Outcomes in Patients with Idiopathic Inflammatory Myopathy Concomitant with Heart Failure.

This study sought to evaluate clinical features, treatment patterns, and outcomes of patients with idiopathic inflammatory myopathy (IIM) complicated by heart failure (HF). Thirty-two patients with IIM-HF admitted to the Peking Union Medical College Hospital between January 1999 and January 2018 were retrospectively reviewed, including 14 patients with polymyositis, 11 with dermatomyositis, and 7 with overlap syndrome. Survivors and no-survivors were compared on clinical characteristics and treatment. Although systemic symptoms were variable, all patients presented with elevated troponin I. Rapid atrial arrhythmia was the most frequent arrhythmia. Systolic dysfunction and restrictive diastolic dysfunction were typical presentations in echocardiography. Twenty-nine patients were followed up for a median of 2.8 years (0.1 month to 11 years). We recorded 13 deaths of cardiogenic cause, 1 of serious IIM, and 3 of infective complications. The median survival time from diagnosis of IIM-HF to all-cause mortality was 8.4 months (range from 1 month to 5 years). Both all-cause deaths and cardiogenic deaths were more reported in the methotrexate-alone group than in the combination therapy group (6/7 versus 3/10, P = 0.050; 5/6 versus 2/9, P = 0.041). Combination therapy including methotrexate (HR = 0.188, 95%CI 0.040-0.871, P = 0.033) and taking β-receptor blockers (HR = 0.249, 95%CI 0.086-0.719, P = 0.010) was associated with reduced risk of all-cause deaths. In conclusion, elevated troponin I, atrial arrhythmia, and systolic and restrictive diastolic dysfunction are typical characteristics of IIM-HF. Combined immunosuppression that includes methotrexate and β-receptor blockers seems to be important to improve survival.