Pascal de Groote1, Marie Fertin2, Anju Duva Pentiah2, Céline Goéminne2, Nicolas Lamblin2, Christophe Bauters2. 1. From the Service de Cardiologie, Pôle Cardio-Vasculaire et Pulmonaire (P.d.G., M.F., A.D.P., C.G., N.L., C.B.) and Service des Explorations Fonctionnelles Cardio-vasculaires, Pôle Imagerie et Explorations Fonctionnelles (A.D.P.), Centre Hospitalier Régional et Universitaire de Lille, France; Inserm U744, Institut Pasteur de Lille, France (P.d.G., M.F., N.L., C.B.); and Faculté de Médecine de Lille, Université de Lille, France (N.L., C.B.). pascal.degroote@chru-lille.fr. 2. From the Service de Cardiologie, Pôle Cardio-Vasculaire et Pulmonaire (P.d.G., M.F., A.D.P., C.G., N.L., C.B.) and Service des Explorations Fonctionnelles Cardio-vasculaires, Pôle Imagerie et Explorations Fonctionnelles (A.D.P.), Centre Hospitalier Régional et Universitaire de Lille, France; Inserm U744, Institut Pasteur de Lille, France (P.d.G., M.F., N.L., C.B.); and Faculté de Médecine de Lille, Université de Lille, France (N.L., C.B.).
Abstract
BACKGROUND: Some patients with left ventricular systolic dysfunction (LVSD) have a dramatic improvement in left ventricular ejection fraction (LVEF) after β-blockade. No study has analyzed the long-term echocardiographic and clinical follow-up of this subgroup of patients. METHODS AND RESULTS: We included in this analysis 174 consecutive patients with LVSD who had an LVEF≥45% after β-blockade. We performed a long-term echocardiographic follow-up (median 7.7 [4-9.9] years) and clinical follow-up (median 9.2 [7.2-10.8] years). LVEF improved from 33±8% to 54±6% after β-blockade (P<0.0001). At the last echocardiographic evaluation, 26% of the patients had an LVEF<45% (mean±SD: 34±6%), whereas 74% still had an LVEF≥45% (mean±SD: 54±6%). Independent predictors of LVEF deterioration were a low LVEF, a high left ventricular end-diastolic diameter and a low heart rate after β-blockade, and the presence of a complete left bundle-branch block. In the overall study population, survival rates were 90% at 5 years and 75% at 10 years. Cardiovascular death rate was 9%, noncardiovascular death rate was 11%, and unknown death rate was 3%. Patients with subsequent LVEF deterioration had a higher cardiovascular mortality compared with patients with sustained recovered LVEF (22% versus 4%). CONCLUSIONS: The long-term survival of patients with LVSD and with near-normal LVEF after β-blockade is good. However, a quarter of these patients may experience a subsequent degradation of LVEF. These patients are at higher risk of cardiovascular mortality.
BACKGROUND: Some patients with left ventricular systolic dysfunction (LVSD) have a dramatic improvement in left ventricular ejection fraction (LVEF) after β-blockade. No study has analyzed the long-term echocardiographic and clinical follow-up of this subgroup of patients. METHODS AND RESULTS: We included in this analysis 174 consecutive patients with LVSD who had an LVEF≥45% after β-blockade. We performed a long-term echocardiographic follow-up (median 7.7 [4-9.9] years) and clinical follow-up (median 9.2 [7.2-10.8] years). LVEF improved from 33±8% to 54±6% after β-blockade (P<0.0001). At the last echocardiographic evaluation, 26% of the patients had an LVEF<45% (mean±SD: 34±6%), whereas 74% still had an LVEF≥45% (mean±SD: 54±6%). Independent predictors of LVEF deterioration were a low LVEF, a high left ventricular end-diastolic diameter and a low heart rate after β-blockade, and the presence of a complete left bundle-branch block. In the overall study population, survival rates were 90% at 5 years and 75% at 10 years. Cardiovascular death rate was 9%, noncardiovascular death rate was 11%, and unknown death rate was 3%. Patients with subsequent LVEF deterioration had a higher cardiovascular mortality compared with patients with sustained recovered LVEF (22% versus 4%). CONCLUSIONS: The long-term survival of patients with LVSD and with near-normal LVEF after β-blockade is good. However, a quarter of these patients may experience a subsequent degradation of LVEF. These patients are at higher risk of cardiovascular mortality.
Authors: Wilson Nadruz; Erin West; Mário Santos; Hicham Skali; John D Groarke; Daniel E Forman; Amil M Shah Journal: Circ Heart Fail Date: 2016-04 Impact factor: 8.790
Authors: Marco V Perez; Aleksandra Pavlovic; Ching Shang; Matthew T Wheeler; Clint L Miller; Jing Liu; Frederick E Dewey; Stephen Pan; Porama K Thanaporn; Devin Absher; Jeffrey Brandimarto; Heidi Salisbury; Khin Chan; Rupak Mukherjee; Roda P Konadhode; Richard M Myers; Daniel Sedehi; Thomas E Scammell; Thomas Quertermous; Thomas Cappola; Euan A Ashley Journal: J Am Coll Cardiol Date: 2015-12-08 Impact factor: 24.094