Document Detail


Experience with beta-blocker therapy in patients with advanced heart failure evaluated for HTx.
MedLine Citation:
PMID:  11077226     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The aim of this study was to review our experience with beta-blocker therapy on top of high-dose angiotensin-converting enzyme inhibitors (ACE-I) in patients with advanced heart failure evaluated for heart transplantation, and to question the value of intended heart transplantation for patients receiving this therapy.
METHODS: Three hundred eighteen patients (New York Heart Association (NYHA) function class III 34%, class IV 66%, average left ventricular ejection fraction (LVEF) 16%, and average cardiac index 2.2 l/min per m(2) at time of referral) were treated with digitalis, loop diuretics, maximally uptitrated ACE-I, beta-blockers (if tolerated), and intravenous support (if needed). After 3 months, patients were retrospectively stratified into those receiving beta-blockers plus ACE-I (Group A, n = 126), ACE-I (Group B, n = 135), and ACE-I plus intravenous support (Group C, n = 57). Endpoint 1 of the study was combined urgent heart transplantation, mechanical assist device implantation, and pretransplant death during a follow-up of 12 to 48 (mean 19 +/- 11) months. Endpoint 2 was posttransplant mortality up to 48 (mean 14 +/- 8) months.
RESULTS: In the pretransplantation period the survival rate was 58% and the mortality rate was 20%. Between Groups A and B there was a significant difference in mortality (9% vs 27%, p = 0.001) due to a lower sudden-death rate in Group A (6% vs 17%, p < 0.01). While between Groups A and C all event rates of Endpoint 1 differed significantly, between Group C and Group B total mortality (30% vs 27%) was similar. However, in Group C urgent heart transplantation (HTx) was more often performed than in Group B (54% vs 11%, p < 0.0001). Seventy of 318 patients (22%) underwent heart transplantation (16% urgent, 6% elective). Posttransplant actuarial survival of the entire transplanted cohort (n = 70, 12 deaths) was significantly lower (log rank p < 0.01) than event-free survival in Group A (n = 126, 18 events), significantly higher (log rank p < 0. 0001) than event-free survival in Group C (n = 57, 34 events), and similar to that in Group B (n = 135, 52 events).
CONCLUSION: This experience suggests that it may be particularly useful to add a beta-blocker to ACE-I therapy in patients referred for heart transplantation. In patients who tolerate this treatment, heart transplantation does not seem to provide additional survival benefit in the short term (2 years).
Authors:
R Berger; K Strecker; M Hülsmann; B Frey; R Pacher; B Stanek
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation     Volume:  19     ISSN:  1053-2498     ISO Abbreviation:  J. Heart Lung Transplant.     Publication Date:  2000 Nov 
Date Detail:
Created Date:  2001-01-11     Completed Date:  2001-01-11     Revised Date:  2013-05-28    
Medline Journal Info:
Nlm Unique ID:  9102703     Medline TA:  J Heart Lung Transplant     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1081-8     Citation Subset:  IM    
Affiliation:
Department of Cardiology and Ludwig Boltzman Institute of Cardiovascular Research, University of Vienna, Vienna, Austria. RBerger@gmx.at
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MeSH Terms
Descriptor/Qualifier:
Actuarial Analysis
Adrenergic beta-Antagonists / administration & dosage*,  adverse effects
Angiotensin-Converting Enzyme Inhibitors / administration & dosage*,  adverse effects
Atenolol / administration & dosage,  adverse effects
Carbazoles / administration & dosage,  adverse effects
Dose-Response Relationship, Drug
Drug Administration Schedule
Drug Therapy, Combination
Enalapril / administration & dosage,  adverse effects
Follow-Up Studies
Heart Failure / drug therapy*,  mortality
Heart Transplantation*
Humans
Propanolamines / administration & dosage,  adverse effects
Retrospective Studies
Risk Assessment
Survival Rate
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Angiotensin-Converting Enzyme Inhibitors; 0/Carbazoles; 0/Propanolamines; 0K47UL67F2/carvedilol; 29122-68-7/Atenolol; 75847-73-3/Enalapril

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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