Beta-blocker Therapy Research Articles

Are beta-blockers safe and effective after myocardial infarction in patients with COPD?

Clinicians may be hesitant to prescribe beta-blockers in patients with chronic obstructive pulmonary disease (COPD) who have a comorbid compelling cardiovascular indication for beta-blocker therapy. This article summarizes the available data on the safety and efficacy of beta-blockers in patients with COPD and recent myocardial infarction.

Drug utilization, medication adherence and treatment satisfaction amongst glaucoma patients receiving care at secondary health facilities

Abstract Objectives The objective of this study was to assess treatment satisfaction, medication adherence and drug utilization amongst glaucoma patients receiving care at secondary health facilities. Methods A cross-sectional study was conducted amongst glaucoma patients attending eye clinics of General Hospital Ilorin and Civil Service Hospital Ilorin in Kwara State, Nigeria from October 2020 to January 2021. Three hundred and eleven patients were enrolled in the study. Sampling was based on convenience as dictated by the inclusion and exclusion criteria. Ethical permission and informed consent were obtained before data collection. Validated instruments of Morisky Medication Adherence Scale and Treatment Satisfaction Questionnaire for Medication were used during the data collection process. Descriptive and Chi-square analyses were employed. Key findings Amongst the 311 patients studied 184(59.2%) were females with a mean age of 63.79 ± 14.89 years. Timolol eye drop was the drug of choice for monotherapy in (8.7%) of patients. Combination therapy of beta blockers and carbonic anhydrase inhibitors had the highest number (59.5%) of prescriptions. More than half (55.6%) of the patients were adherents. Participants reported being more satisfied with their anti-glaucoma therapy in the domain of global satisfaction (62.89 ± 21.85) followed by medication effectiveness (62.67 ± 20.78) and convenience (60.16 ± 15.79) while medication side effects had the least score (17.17 ± 11.09). There is a statistically significant relationship between patient satisfaction with treatment and medication adherence at P= 0.001. Conclusions Combination therapy was the most frequently utilized anti-glaucoma agent. Most of the patients adhered to their medications and were satisfied with the treatment received.

Effect of beta-blocker therapy on the response to mavacamten in patients with symptomatic obstructive hypertrophic cardiomyopathy.

In the EXPLORER-HCM trial, mavacamten improved exercise capacity and symptoms in patients with obstructive hypertrophic cardiomyopathy (oHCM). Mavacamten effects on the primary endpoint, a composite of peak oxygen consumption (VO2 ) and New York Heart Association (NYHA) class, were greater in patients not receiving background beta-blockers than in those receiving beta-blockers. We sought to determine if the effect of background treatment was consistent across other clinically meaningful parameters. Subgroup analyses by beta-blocker use were performed in patients with oHCM from the EXPLORER-HCM and mavacamten long-term extension (MAVA-LTE) studies. In EXPLORER-HCM, 189 patients (75.3%) were receiving beta-blockers, and 62 (24.7%) were receiving non-dihydropyridine calcium channel blockers or no background HCM medication; 170 patients (90.4%) receiving beta-blockers had chronotropic incompetence. Improvements in peak VO2 at week 30 with mavacamten versus placebo were lower with beta-blockers (mean difference [95% confidence interval (CI)]: 1.04 [0.12, 1.95] ml/kg/min) than without beta-blockers (mean difference [95% CI]: 2.69 [1.29, 4.09] ml/kg/min); improvements in non-heart rate-dependent parameters (VE /VCO2 slope) appeared unaffected by beta-blockers. Improvements in functional capacity parameters at week 30 with mavacamten versus placebo were independent of beta-blockade for post-exercise left ventricular outflow tract gradient (mean difference [95% CI]: -37.9 [-48.0, -27.9] mmHg with beta-blockers; -33.5 [-53.6, -13.3] mmHg without beta-blockers), proportion of patients with reduction of ≥1 NYHA class, Kansas City Cardiomyopathy Questionnaire clinical summary scores and N-terminal pro-B-type natriuretic peptide. Mavacamten benefits were reproduced and maintained in MAVA-LTE regardless of beta-blockade. Mavacamten improved measures of functional capacity, left ventricular outflow tract obstruction, symptom burden and biomarkers in patients with HCM regardless of beta-blocker use. Beta-blocker use was often associated with chronotropic incompetence, affecting peak VO2 and other heart rate-dependent measures, but had minimal impact on heart rate-independent measures.

A nationwide analysis on the interaction between frailty and beta-blocker therapy in hip fracture patients

IntroductionHip fracture patients, who are often frail, continue to be a challenge for healthcare systems with a high postoperative mortality rate. While beta-blocker therapy (BBt) has shown a strong association with reduced postoperative mortality, its effect in frail patients has yet to be determined. This study’s aim is to investigate how frailty, measured using the Orthopedic Hip Frailty Score (OFS), modifies the effect of preadmission beta-blocker therapy on mortality in hip fracture patients.MethodsThis retrospective register-based study included all adult patients in Sweden who suffered a traumatic hip fracture and subsequently underwent surgery between 2008 and 2017. Treatment effect was evaluated using the absolute risk reduction (ARR) in 30-day postoperative mortality when comparing patients with (BBt+) and without (BBt-) ongoing BBt. Inverse probability of treatment weighting (IPTW) was used to reduce potential confounding when examining the treatment effect. Patients were stratified based on their OFS (0, 1, 2, 3, 4 and 5) and the treatment effect was also assessed within each stratum.ResultsA total of 127,305 patients were included, of whom 39% had BBt. When IPTW was performed, there were no residual differences in observed baseline characteristics between the BBt+ and BBt- groups, across all strata. This analysis found that there was a stepwise increase in the ARRs for each additional point on the OFS. Non-frail BBt+ patients (OFS 0) exhibited an ARR of 2.2% [95% confidence interval (CI) 2.0–2.4%, p < 0.001], while the most frail BBt+ patients (OFS 5) had an ARR of 24% [95% CI 18–30%, p < 0.001], compared to BBt- patients within the same stratum.ConclusionBeta-blocker therapy is associated with a reduced risk of 30-day postoperative mortality in frail hip fracture patients, with a greater effect being observed with higher Orthopedic Hip Frailty Scores.

Long-term prognostic impact of beta-blockers in patients with Takotsubo syndrome: Results from the RETAKO Registry

BackgroundNo evidence-based therapy has yet been established for Takotsubo syndrome (TTS). Given the putative harmful effects of catecholamines in patients with TTS, beta-blockers may potentially decrease the intensity of the detrimental cardiac effects in those patients. ObjectiveThe purpose of this study was to assess the impact of beta-blocker therapy on long-term mortality and TTS recurrence. MethodsThe cohort study used the national Spanish Registry on TakoTsubo Syndrome (RETAKO). A total of 970 TTS post-discharge survivors, without pheochromocytoma, left ventricular outflow tract obstruction, sustained ventricular arrhythmias, and significant bradyarrhythmias, between January 1, 2003, and July 31, 2018, were assessed. Cox regression analysis and inverse probability weighting (IPW) propensity score analysis were used to evaluate the association between beta-blocker therapy and survival free of TTS recurrence. ResultsFrom 970 TTS patients, 582 (60.0%) received beta-blockers. During a mean follow-up of 2.5±3.3 years, there were 87 deaths (3.6 per 100 patients/year) and 29 TTS recurrences (1.2 per 100 patient/year). There was no significant difference in follow-up mortality or TTS recurrence in unadjusted and adjusted Cox analysis (hazard ratio [HR] 0.86, 95% confidence interval [CI] 0.59–1.27, and 0.95, 95% CI 0.57–1.13, respectively). After weighting and adjusting by IPW, differences in one-year survival free of TTS recurrence between patients treated and untreated with beta-blockers were not found (average treatment effect −0.01, 95% CI −0.07 to 0.04; p=0.621). ConclusionsIn this observational nationwide study from Spain, there was no significant association between beta-blocker therapy and follow-up survival free of TTS recurrence.

PS-C14-3: HEART RATE RECOVERY IN CORONARY ARTERY DISEASE PATIENTS WITH HYPERTENSION: RELATIONSHIP WITH CLINICAL FEATURES AND LEFT VENTRICULAR REMODELLING

Objective: Heart rate recovery after treadmill exercise testing reflects autonomic dysfunction and is related to higher major adverse cardiac events. Numerous studies suggested the correlation of Heart rate recovery with hypertension and left ventricular remodeling. This study aimed to assess factors related to HRR in coronary artery disease patients who have undergone revascularization and Beta-blocker. Design and method: This cross-sectional study includes CAD patients who came to the outpatient clinic for six to 24 months after hospitalization in Dr. Hasan Sadikin General Hospital from February to August 2021. All patients undergo treadmill tests and transthoracic echocardiography. The treadmill stress test is conducted using Bruce or Modified Bruce Protocol. Transthoracic echocardiography is conducted using GE Vivid 7 ultrasound machine. Heart rate recovery at one minute defines as abnormal if &lt; 18 beats per minute. The t test was used for continuous variables, and the Chi-square or Fisher exact test was used for categorical data. A p-value &lt; 0.05 was considered statistically significant. Results: A total of 63 consecutive coronary artery disease patients with (n = 43, HP) and without (n = 20, NHP) were included in this study. All subjects underwent treadmill exercise testing. Up to 90% of patients have undergone revascularization by percutaneous coronary intervention or coronary artery bypass graft. All patients on Beta-blocker therapy. Peak heart rate (152 ± 29 vs. 132 ± 24, p = 0.010) and Heart rate recovery at one minute (129 ± 18 vs. 118 ± 19, p = 0.025) were significantly higher in the NHP group. Older age and lower peak heart rate were associated with lower heart rate recovery at one minute in the HP group. The previous history, such as diabetes, smoking history, ejection fraction, left wall mass index, and functional capacity, does not correlate with heart rate recovery at one minute in NHP or HP group. Conclusion: The present results demonstrate that heart rate recovery at one minute is affected by older age and peak heart rate. The left ventricular remodelling and other risk factors and their associations in coronary artery disease population who have undergone revascularization and are on beta-blocker medications should be investigated more with larger samples.

Traumatic brain injury and risk of heart failure and coronary heart disease: A nationwide population-based cohort study.

This study examined the long-term risks of heart failure (HF) and coronary heart disease (CHD) following traumatic brain injury (TBI), focusing on gender differences. Data from Taiwan's National Health Insurance Research Database included 29,570 TBI patients and 118,280 matched controls based on propensity scores. The TBI cohort had higher incidences of CHD and HF (9.76 vs. 9.07 per 1000 person-years; 4.40 vs. 3.88 per 1000 person-years). Adjusted analyses showed a significantly higher risk of HF in the TBI group (adjusted hazard ratio = 1.08, 95% CI = 1.01-1.17, P = 0.031). The increased CHD risk in the TBI cohort became insignificant after adjustment. Subgroup analysis by gender revealed higher HF risk in men (aHR = 1.14, 95% CI = 1.03-1.25, P = 0.010) and higher CHD risk in women under 50 (aHR = 1.32, 95% CI = 1.15-1.52, P < 0.001). TBI patients without beta-blocker therapy may be at increased risk of HF. Our results suggest that TBI increases the risk of HF and CHD in this nationwide cohort of Taiwanese citizens. Gender influences the risks differently, with men at higher HF risk and younger women at higher CHD risk. Beta-blockers have a neutral effect on HF and CHD risk.

S-29-2: MEDICAL THERAPY FOR HEART FAILURE WITH PRESERVED EJECTION FRACTION

Hypertension constitutes the major risk factor for heart failure (HF) with preserved ejection fraction (HFpEF); prevalences above 90% have been reported. HFpEF is a prevalent clinical syndrome with increased cardiovascular morbidity and mortality comparable to HFrEF. Long specific guideline-directed medical therapy (GDMT) for HFpEF was hard to establish due to lack of convincing positive outcome data from randomized controlled trials (RCTs) mainly because of major limitations of the available studies. Available evidence has however increased with recent and larger RCTs with statistical power. Besides, control of blood pressure (BP) is widely regarded as central to the prevention and clinical care in HFpEF. Thus, in current guidelines including the 2018 European Society of Cardiology (ESC) and European Society of Hypertension (ESH) Guidelines, blockade of the renin-angiotensin system (RAS) with either angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARBs) provides the backbone of BP lowering therapy in hypertensive patients. Although superiority of RAS blockers has not been clearly shown in dedicated RCTs designed for HFpEF, except for in re-analysis with adjustment for commonly available baseline characteristics or repeat event analysis, we propose that this core drug treatment strategy is applicable for hypertensive patients with HFpEF with the addition of some modifications. The latter apply to the use of spironolactone (MRA) apart from the treatment of resistant hypertension and the use of the angiotensin receptor neprilysin inhibitor (ARNi). In addition, novel agents such as sodium-glucose co-transporter-2 inhibitors (SGLT2-i) and finerenone (non-steroidal MRA) represent promising therapies. Besides, beta-blocker therapy is widely indicated in 60–80% of HFpEF patients due to HT with rapid heart rate (&gt;80 beats/min), rapid atrial fibrillation and/or coronary heart disease. The development of an effective and practical classification of HFpEF phenotypes and GDMT through dedicated high quality RCTs are coming towards firmer conclusions.

PS-BPC07-1: PREEXISTING DIURETIC THERAPY DOES NOT ATTENUATE THE ANTIHYPERTENSIVE EFFECT OF EMPAGLIFLOZIN IN TYPE 2 DIABETIC PATIENTS WITH UNCONTROLLED HYPERTENSION

Objective: The antihypertensive effect of SGLT2 inhibitors has been mostly overlooked, but in patients with type 2 diabetes mellitus (T2DM) and uncontrolled hypertension empagliflozin elicits a powerful systolic blood pressure (SBP) lowering effect, often attributed to diuretic/natriuretic effect and/or weight loss (WL), but other mechanisms are possible. We sought to retrospectively study the impact of the initiation of empagliflozin therapy on SBP in patients living with T2DM and uncontrolled hypertension in a real-world setting, and to assess its relationship with previous diuretic and other classes of antihypertensive therapy, and with weight loss during treatment. Design and Methods: Retrospective analysis of the SBP, weight and antihypertensive medication data in patients with T2DM who initiated empagliflozin therapy while having sitting office SBP &gt; 140 mmHg. Mediation analyses with WL as mediator were performed post-hoc to quantify the relative contribution of WL to SBP reduction. Consent was obtained from all included subjects. Patients who changed their antihypertensive medication simultaneously with empagliflozin initiation were excluded. Results: Data were obtained from 198 patients (59.6% female, age 63.2 ± 8.9 years) from the visit in which empagliflozin (largely 10 mg/day) was started and the following one (3–4 months afterwards). Baseline BMI was 31.7 ± 8.5 Kg/m2. Baseline SBP was 166 ± 17 mmHg. 112 patients had ACEI/ARB, 76 diuretic, 69 calcium antagonist, 32 alpha-blocker and 29 beta-blocker therapy. The SBP reduction was 7.2 ± 5.7 mmHg (p = 0.012, paired t-test). The Figure shows comparisons by number and classes of antihypertensive drugs, with no significant differences for SBP reduction. The WL was 3.2 ± 1.7 kg, and it correlated significantly with the SBP reduction (Pearson's r: 0.22, p = 0.0012). The mediation analyses showed that a SBP reduction of 1.5 ± 0.9 mmHg was mediated by WL while 5.7 ± 4.9 mmHg was WL-independent. Conclusions: Empagliflozin initiation elicited a clinically relevant SBP decrease in patients with T2DM and uncontrolled hypertension. The number and classes of previous antihypertensive effects did not modify the SBP reduction. In particular, previous diuretic treatment does not attenuate it, suggesting that the diuretic effect is not the main driver of SBP reduction with empagliflozin. Also, the contribution of WL seems modest, implying alternative mechanisms for SBP reductions with empagliflozin; improvement of endothelial function and/or arterial stiffness and many others have been suggested.

Beta-Blockers in the Prevention and Treatment of Ischemic Heart Disease: Evidence and Clinical Practice.

Coronary artery disease (CAD) is the most prevalent cardiovascular disease characterized by atherosclerotic plaque buildup that can lead to partial or full obstruction of blood flow in the coronary arteries. Treatment for CAD involves a combination of lifestyle changes, pharmacologic therapy, and modern revascularization procedures. Beta-adrenoceptor antagonists (or beta-blockers) have been widely used for decades as a key therapy for CAD. In this review, prior studies are examined to better understand beta-adrenoceptor antagonist use in patients with acute coronary syndrome, stable coronary heart disease, and in the perioperative setting. The evidence for the benefit of beta-blocker therapy is well established for patients with acute myocardial infarction, but it diminishes as the time from the index cardiac event elapses. The evidence for benefit in the perioperative setting is not strong.

Effect of Prunus Amagdalis (Almonds) on testosterone in Atenolol-induced derangements in the hormonal profile of male Balb-c mice

Background: Infertility is a very common health problem among middle-aged hypertensive individuals on beta-blocker therapy. With advancing research, it is observed that almonds can enhance the fertility index. Aim: To find that how almonds (prunus Amygdalus), cardioselective beta blocker and combined preparation of both these can affect serum testosteronein mice. Methods: This study was done in the Physiology Department, Shifa College of Medicine, Islamabad. Some part of this project was done inNational Institute of Health, Islamabad along with the Centre for Research in Experimental and Applied Medicine (CREAM) Laboratory, Army Medical College, Rawalpindi, and Shifa International Hospital, Islamabad. It was an Animal based experimental study. This study was conducted from December2014 to March 2015. 120 Balb-c mice were selected for our study according to the predefined setcriteria and four groups were made, each group consisting of 30 mice. Group A was the control group, atenolol was given to group B, almonds to group C, and atenolol plus almonds to group D. Serumtestosterone was measured after 3 months. Data was analyzed using SPSS version 17 and mean±standard deviation was determined. For difference, statistical significance was calculated after applying one way ANOVA. The p-value &lt; 0.05 was considered significant. Results: In group A serving as control mean testosterone was found to be 1.58±0.69IU/L. Mean serum testosterone in B-group (Atenolol) was 0.43±0.27 IU/L. In group C (Almonds) it was 3.77±2.64 IU/Lwhich was significantly increased. In group D (almond+Atenolol) serum testosterone level was1.82±1.00 IU/L that is elevated but non-significantly in comparison to the control group. Conclusion: Almonds increase mean testosterone and atenolol lead to adecrease init. It is thus concluded that almondscan revert the changes induced by atenolol. Keywords: Almonds, Testosterone, Atenolol, Hypertension, Infertility.

PREVALENCE AND RISK PREDICTORS OF POST OPERATIVE ATRIAL FIBRILLATION AFTER HEART SURGERY UNDER CPB

The current analysis was designed to assess the prevalence and risk predictors of atrial fibrillation after heart surgery performed under cardiopulmonary bypass (CPB). A descriptive observational study was conducted in the Cardiology Department of Faisalabad Cardiology Hospital, Faisalabad. A total of 150 patients older than 18 years old undergoing CABG and valvular surgery performed by cardiopulmonary bypass were included in the study. The association of POAF and risk factors, including age, LVEF&lt;40%, history of diabetes, myocardialinfarction, beta-blocker therapy, COPD, aortic cross-clamp time, CPB time, inotropic, and ventilation support, was evaluated. The patients with no history of beta blockers showed less risk of developing AF (OR: 0.153); hence the use of beta-blockers is significantly associated with AF. Similarly, patients with LVEF less than 40% and inotropic support for 30 minutes also had less odds of AF (0.174, 0.127); hence these variables are also significantly associated with AF. A history of myocardial infarction increased the risk of AF to 6.27 times. Using a ventilatorfor&gt; 24 hours increased the incidence of AF to 12.28 times. LVEF &lt;40%, inotropic and ventilation support, myocardial infarction, and CPB time preoperatively are strong predictors of POAF after cardiac surgery.

Flecainide in patients with arrhythmic mitral valve syndrome: A case series

Arrhythmic symptoms are prevalent and life-threatening ventricular arrhythmias (VA) are a feared complication in patients with arrhythmic mitral valve syndrome (AMVS) (1). There is no established medical therapy to suppress VA and relieve arrhythmic symptoms in these patients beyond conventional beta-blocker therapy, which is often unsuccessful and not evaluated in randomized controlled trials. Catheter ablation can suppress VA in some patients, but is limited due to the multifocal nature of premature ventricular complexes (PVC), papillary muscle origin, and VA recurrence despite initial successful procedures.

197: CONTINUATION OF AMIODARONE IN CRITICALLY ILL PATIENTS WITH ATRIAL FIBRILLATION

Introduction: Atrial fibrillation (AF) is the most common arrhythmia in critically ill patients in the intensive care (ICU), and leads to longer lengths of stay and an increased mortality. Beta-blockers (BB) are the first-line but are avoided in ICU due to negative inotropic effects in hemodynamically unstable patients. Amiodarone is commonly used to manage AF in ICU due to rate control properties with a minimal decrease in inotropy. Many patients inappropriately continued on amiodarone therapy after transitioning out of ICU, placing patients at increased risk of adverse effects. The purpose of this study was to evaluate the frequency of inappropriate amiodarone continuation after ICU transfer and on discharge. Methods: A retrospective cohort study evaluating patients with AF who were treated with amiodarone infusion between July 1, 2019, and July 1, 2021. Patients were included if they received amiodarone infusion and excluded with a history of ventricular arrhythmias, ICD or pacemaker, and pregnant or lactating mothers. The primary outcome was to assess the proportion of patients discharged on amiodarone. Secondary outcomes included percentage of patients converted to oral once hemodynamically stable, median ICU and hospital length of stay, and percentage of patients converted to BB. Results: A total of 117 patients were evaluated including 79 with chronic AF and 38 with new-onset AF. Amiodarone was continued on discharge in 2 (2.5%) patients in chronic AF group and no patients in new-onset AF group. No patients were converted to oral amiodarone on ICU discharge. Lastly, 28 (35.4%) patients with chronic AF were converted back to BB therapy prior to hospital discharge, while 6 (15.8%) patients were started on BB in new-onset AF group. Conclusions: Although amiodarone was appropriately switched from IV to oral and discontinued in the majority of the patient before ICU or hospital discharge, however, BB therapy was not started or resumed prior to discharge in the majority of patients.

433 A PRO-ARRHYTHMIC DOUBLE HIT

Abstract A 42-year-old man went to the emergency room complaining about dyspnea and palpitations. He reported an episode of atrial fibrillation (AF) with symptoms of dizziness 8 years before. He had a family history of ischemic cardiopathy, his father has suffered from AF since a young age.Acute course: The ECG revealed AF at high ventricular frequency. The echocardiography demonstrated mild reduction of the left ventricular function (EF 45%) with diffuse hypokinesis, and mitral valve prolapse (MVP) with mild mitral regurgitation. The blood tests showed a troponin peak of 750 ng/L (n.v. 0–34 ng/L). The suspect was acute coronary syndrome. Thus, he was treated with dual antiplatet therapy and low doses of beta-blockers, and he underwent coronarography, which demonstrated no significant lesions. So, after a transesophageal echocardiography that excluded thrombosis, and a loading dose of amiodarone, a successful electrical cardioversion was performed. The discharge diagnosis was AF with mild left ventricular disfunction. Three months later: He came back to the emergency room because of suffering some days of progressive epigastric and retrosternal pain radiating to the shoulders. The ECG and the echocardiography were unchanged, the troponin-I values were 79 ng/L-74 ng/L. Therefore, he underwent cardiac magnetic resonance (CMR), which showed normal biventricular dimensions and function (LVEF 64%, LVEDV 80 ml/mq), MVP with mitral annular disjunction (MAD) and curling of the infero-lateral basal wall (Figure A). The native T1, T2 and ECV values were increased, and there was a wide left ventricular subepicardial late gadolinium enhancement (LGE). The conclusion was MVP and active myocarditis. Moreover, he underwent endomyocardial biopsy that revealed focal lymphocytic infiltration, PCRs for common cardiotropic viruses or bacteria were negative. Six months later: The basal ECG was characterized by low QRS voltages in limb leads (Figure B). The CMR revealed a wide left ventricular non-ischemic fibrosis with a ring-like pattern (Figure C). The 24-hours Holter ECG showed premature ventricular beats with a right bundle branch block/superior and inferior axis morphology (Figure D), in keeping with MVP. The next step was the genetic testing that resulted positive for a Filamin-C (FLNC) mutation associated with cardiomyopathy. The final diagnosis was “Hot-phase of Left Ventricular Arrhythmogenic Cardiomyopathy (ACM), MVP and paroxysmal AF”. Discussion: The ACM is a rare hereditary heart muscle disease, and the “hot phase” represents its uncommon clinical presentation. Mutations in FLNC gene could be involved in the pathogenesis of ACM. Moreover, there are few cases in literature about the correlation between FLNC mutations and MVP. FLNC mutation may be a cross-sectional substrate for both these pro-arrhythmic conditions.

185 BETA-BLOCKERS OR CALCIUM CHANNEL BLOCKERS IN HYPERTROPHIC CARDIOMYOPATHY

Abstract Background Guidelines recommend betablockers (BB) as first line therapy in symptomatic patients with hypertrophic cardiomyopathy (HCM). A secondary role in the therapeutic algorithm is assigned to non-dihydropyridine calcium channel blockers (ND-CCB). Since no randomized comparison trials between the two drugs have been made so far, the aim of the present analysis was to evaluate the prognostic impact of BB and ND-CCB in a cohort of patients with HCM, either obstructive or not. Methods From a cohort of 1434 patients with a diagnosis of HCM included in the French register REMY, we retrospectively analysed 601 individuals treated with BB or ND-CCB. Patients taking both BB and ND-CCB or none, patients who already had an implantable cardioverter defibrillator or a pacemaker and who had already undergone a procedure of atrial fibrillation (AF) ablation or of septal reduction therapy were excluded. Results Out of 601 HCM patients, 545 (91%) were treated with BB and 56 (9%) with ND-CCB. At 8-year follow-up no differences were observed as regard the composite endpoint of cardiovascular death, hospitalization for heart failure and hospitalization for AF (133 [24%] vs. 9 [16%] for patients taking BB or ND-CCB respectively, HR 1.84, 95% CI 0.94–3.63). Patients taking ND-CCB were less symptomatic at long-term follow-up but experienced more drug interruptions or changes. Conclusions In a real-world cohort of patients with HCM, ND-CCB therapy was not associated with a higher incidence of adverse events compared to BB therapy.

Beta-blockers in post-acute myocardial infarction patients: Drug prescription patterns from 2018 to Italy's first wave of the COVID-19 pandemic.

Background: Major guidelines recommend the initiation of a beta-blocker therapy after an acute myocardial infarction (AMI). We aimed to map the treatment pathway of beta-blockers for AMI survivors during the first wave of COVID-19 pandemic in Italy and to investigate predictors for treatment non-initiation. Methods: Healthcare utilization databases of Lombardy Region were investigated. Subjects aged ≥18 years who were hospitalised with AMI in the period February-March-April of 2018, 2019, and 2020 were included, and followed for 30 days from the discharge date, to investigate whether they presented a first prescription of beta-blockers. A multivariate logistic model was performed to evaluate the effect of several covariates on the probability of not receiving a post-AMI beta-blocker therapy. Results: The cohorts comprised 2259, 2383, and 1932 individuals who were hospitalised with AMI in the 3-month period in 2018, 2019, and 2020, respectively. Overall in 2020, about 58-60% of individuals with AMI received a prescription of beta-blockers within 1month after the discharge. A continuous decreasing trend over time was observed. Men were 30% more likely to start the treatment than women, increasing age was associated with significant increasing probability of not receiving a post-infarction beta-blocker therapy, while having received an antihypertensive or lipid-lowering treatment, or having been hospitalized for heart failure prior to the AMI hospitalization reduced the likelihood of not being treated with beta-blockers. Conclusion: The initiation of beta-blocker treatment after AMI remains an under-prescribed practice, that does not seem to have been further affected by the first wave of the COVID-19 pandemic.

Beta-blocker use after thoracic endovascular aortic repair in patients with type B aortic dissection is associated with improved early aortic remodeling.

Beta-blockers (BBs) are first-line anti-impulse therapy for patients presenting with acute type B aortic dissection (TBAD). However, little is understood about their effects after aortic repair. The aim of the present study was to evaluate the role of postoperative BB use on the outcomes of thoracic endovascular aortic repair (TEVAR) in TBAD. The Vascular Quality Initiative database was queried for all patients who had undergone TEVAR for TBAD from 2012 to 2020. Aortic-related reintervention, all-cause mortality, and the effects of TEVAR on false lumen thrombosis of the treated aortic segment were assessed and compared between patients treated with and without BBs postoperatively. Cox proportional hazards models were used to estimate the effect of BB therapy on the outcomes. A total of 1114 patients who had undergone TEVAR for TBAD with a mean follow-up of 18± 12months were identified. The mean age was 61.1± 11.9years, and 791 (71%) were men. Of the 1114 patients, 935 (84%) continued BB therapy at discharge and follow-up. The patients taking BBs were more likely to have had an entry tear originating in zones 1 to 2 (22% vs 13%; P= .022). The prevalence of acute, elective, and symptomatic aortic dissection, prevalence of concurrent aneurysms, number of endografts used, distribution of proximal and distal zones of dissection, and operative times were comparable between the two cohorts. At 18months, significantly more complete false lumen thrombosis (58% vs 47%; log-rank P= .018) was observed for patients taking BBs, and the rates of aortic-related reinterventions (13% vs 9%; log-rank P= .396) and mortality (0.2% vs 0.7%; log-rank P= .401) were similar for patients taking and not taking BBs, respectively. Even after adjusting for clinical and anatomic factors, postoperative BB use was associated with increased complete false lumen thrombosis (hazard ratio, 1.56; 95% confidence interval, 1.10-2.21; P= .012) but did not affect mortality or aortic-related reintervention. A secondary analysis of BB use for those with acute vs chronic TBAD showed a higher rate of complete false lumen thrombosis for patients with chronic TBAD and taking BBs (59% vs 38%; log-rank P= .038). In contrast, no difference was found in the rate of complete false lumen thrombosis for those with acute TBAD between the two cohorts (58% vs 51%; log-rank P= .158). When analyzed separately, postoperative angiotensin-converting enzyme inhibitor use did not affect the rates of complete false lumen thrombosis, mortality, and aortic-related reintervention. BB use was associated with promotion of complete false lumen thrombosis for patients who had undergone TEVAR for TBAD. In addition to its role in the acute setting, anti-impulse control with BBs appears to confer favorable aortic remodeling and might improve patient outcomes after TEVAR, especially for those with chronic TBAD.

Long-Term Ambulatory Intravenous Milrinone Therapy in Advanced Heart Failure.

The role of intravenous (IV) inotropes in the treatment of ambulatory patients with advanced heart failure (HF) remains controversial. This was a retrospective study of patients with advanced HF. Patients on home IV milrinone, who remained on it for at least 3 months, were included. We compared the data from 3 months before starting IV milrinone to 3 months after initiating therapy. A subset of patients who remained on milrinone for 6months or longer was analysed separately. A total of 90 patients remained on continuous IV milrinone for 3 months, and 55 patients were treated for 6months or longer. In both groups, improvements in cardiac index (1.86-2.25, p<0.001 and 1.9-2.38, p<0.0001), New York Heart Association (NYHA) class (3.32-2.76, p<0.0001 and 3.25-2.72, p=0.001), and liver function were noted. In the 6-month group, there was also a decrease in mean hospitalised days per patient (9.40 vs 4.12, p<0.001) and an improved tolerance of beta blocker therapy (83.3% vs 98.1%, p=0.006). Long-term IV use of milrinone is associated with improvement in haemodynamics, functional class, tolerance of medical therapy, and decrease in hospitalised days.

Autonomous Aldosterone Secretion in Patients with Adrenal Incidentaloma.

In recent years, research has emphasized the significance of mild clinical and biochemical presentations of primary aldosteronism (PA) that do not meet current diagnostic criteria of the syndrome. In this study, we assessed the prevalence of autonomous aldosterone (Ald) secretion (AAS), defined as a positive (&gt;1.2 ng/dL/mIU/L) Ald-to-renin ratio (ADRR) combined with unsuppressed Ald (&gt;4 ng/dL), and its associations with blood pressure (BP), cardiac function, and common carotid artery (CCA) intima-media thickness (IMT) in patients with incidentally discovered adrenal adenomas (AI), who were either normo- or hypertensive but had no other cardiovascular disease. Among 332 AI patients hospitalized between November 2018 and December 2019, 63 study participants were recruited (26 normo- and 37 hypertensive), who underwent hormonal examinations, 24 h ambulatory BP measurement, transthoracic echocardiography, and CCA IMT assessment without altering chronic medications. AAS was found in approximately 25% of subjects (seven normo- and nine hypertensive); urinary aldosterone excretion (UAldE) exceeded 10 ug/day in none of the subjects. The left ventricular mass index correlated positively with UAldE in non-diabetic patients (n = 50), and negatively with renin in those without beta blocker therapy (n = 38). The study shows that a pragmatic approach to hormonal assessment (no chronic therapy modification) may reveal patients with AAS. Screening for this subclinical PA presentation is probably more effective with a permissive ADRR than UAldE in such a setting.