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Right Ventricular Ejection Fraction and Beta-Blocker Effect in Heart Failure With Reduced Ejection Fraction.

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Citation: Journal of Cardiac Failure. 28(1):65-70, 2022 01.PMID: 34419597Institution: MedStar Heart & Vascular Institute | MedStar Washington Hospital CenterDepartment: Cardiac Imaging FellowshipForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Heart Failure | Adrenergic beta-Antagonists/tu [Therapeutic Use] | Hospitalization | Humans | Stroke Volume | Ventricular Function, RightYear: 2022 ISSN:

1071-9164

Name of journal: Journal of cardiac failureAbstract: BACKGROUND: A low right ventricular ejection fraction (RVEF) is a marker of poor outcomes in patients with heart failure with reduced ejection fraction (HFrEF). Beta-blockers improve outcomes in HFrEF, but whether this effect is modified by RVEF is unknown.CONCLUSIONS: The effect of bucindolol on mortality in patients with HFrEF was modified by the baseline RVEF. If these hypothesis-generating findings can be replicated using approved beta-blockers in contemporary patients with HFrEF, then RVEF may help to risk stratify patients with HFrEF for optimization of beta-blocker therapy. Copyright (c) 2021 Elsevier Inc. All rights reserved.METHODS AND RESULTS: Of the 2798 patients in Beta-Blocker Evaluation of Survival Trial (BEST), 2008 had data on baseline RVEF (mean 35%, median 34%). Patients were categorized into an RVEF of less than 35% (n=1012) and an RVEF of 35% or greater (n=996). We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) within each RVEF subgroup and formally tested for interactions between bucindolol and RVEF. The effect of bucindolol on all-cause mortality in 2008 patients with baseline RVEF (HR 0.88, 95% CI 0.75-1.02) is consistent with that in 2798 patients in the main trial (HR 0.90, 95% CI 0.78-1.02). Bucindolol use was associated with a lower risk of all-cause mortality in patients with an RVEF of 35% or greater (HR 0.70, 95% CI 0.55-0.89), but not in those with an RVEF of less than 35% (HR 1.02, 95% CI 0.83-1.24, P for interaction=.022). Similar variations were observed for cardiovascular mortality (P for interaction=.009) and sudden cardiac death (P for interaction=.018), but not for pump failure death (P for interaction=.371) or HF hospitalization (P for interaction=.251).All authors: Ahmed A, Choudhary G, Cleland JG, Deedwania P, Faselis C, Filippatos GS, Fonarow GC, George B, Gupta N, Iskandrian A, Keramida K, Lam PH, Morgan CJ, Wu WCOriginally published: Journal of Cardiac Failure. 2021 Aug 19Fiscal year: FY2022Digital Object Identifier:

https://dx.doi.org/10.1016/j.cardfail.2021.07.026

Date added to catalog: 2021-11-01

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Title notes ( 4 )

Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	34419597	Available		34419597

BACKGROUND: A low right ventricular ejection fraction (RVEF) is a marker of poor outcomes in patients with heart failure with reduced ejection fraction (HFrEF). Beta-blockers improve outcomes in HFrEF, but whether this effect is modified by RVEF is unknown.

CONCLUSIONS: The effect of bucindolol on mortality in patients with HFrEF was modified by the baseline RVEF. If these hypothesis-generating findings can be replicated using approved beta-blockers in contemporary patients with HFrEF, then RVEF may help to risk stratify patients with HFrEF for optimization of beta-blocker therapy. Copyright (c) 2021 Elsevier Inc. All rights reserved.

METHODS AND RESULTS: Of the 2798 patients in Beta-Blocker Evaluation of Survival Trial (BEST), 2008 had data on baseline RVEF (mean 35%, median 34%). Patients were categorized into an RVEF of less than 35% (n=1012) and an RVEF of 35% or greater (n=996). We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) within each RVEF subgroup and formally tested for interactions between bucindolol and RVEF. The effect of bucindolol on all-cause mortality in 2008 patients with baseline RVEF (HR 0.88, 95% CI 0.75-1.02) is consistent with that in 2798 patients in the main trial (HR 0.90, 95% CI 0.78-1.02). Bucindolol use was associated with a lower risk of all-cause mortality in patients with an RVEF of 35% or greater (HR 0.70, 95% CI 0.55-0.89), but not in those with an RVEF of less than 35% (HR 1.02, 95% CI 0.83-1.24, P for interaction=.022). Similar variations were observed for cardiovascular mortality (P for interaction=.009) and sudden cardiac death (P for interaction=.018), but not for pump failure death (P for interaction=.371) or HF hospitalization (P for interaction=.251).

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