Right ventricular ejection fraction and beta-blocker effect in heart failure with reduced ejection fraction: Beta-blocker and outcomes in HFrEF by RVEF

Lam, P. H. et al. (2022) Right ventricular ejection fraction and beta-blocker effect in heart failure with reduced ejection fraction: Beta-blocker and outcomes in HFrEF by RVEF. Journal of Cardiac Failure, 28(1), pp. 65-70. (doi: 10.1016/j.cardfail.2021.07.026) (PMID:34419597)

Abstract

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. Methods: 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 RVEF <35% (n=1012) and ≥35% (n=996). We estimated hazard ratio (HR) and 95% confidence interval (CI) within each RVEF subgroup and formally tested for interactions between bucindolol and RVEF. Results: 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 RVEF ≥35% (HR, 0.70; 95% CI, 0.55–0.89), but not in those with RVEF <35% (HR, 1.02; 95% CI, 0.83–1.24; p for interaction, 0.022). Similar variations were observed for cardiovascular mortality (p for interaction, 0.009) and sudden cardiac death (p for interaction, 0.018), but not for pump failure death (p for interaction, 0.371) or HF hospitalization (p for interaction, 0.251). Conclusions: The effect of bucindolol on mortality in patients with HFrEF was modified by baseline RVEF. If these hypothesis-generating findings can be replicated using approved beta-blockers in contemporary patients with HFrEF, then RVEF may help risk-stratify patients with HFrEF for optimization of beta-blocker therapy.

• Item Type: Articles
• Additional Information: Dr. Ali Ahmed was in part supported by the National Institutes of Health through grants (R01-HL085561, R01-HL085561-S and R01-HL097047) from the National Heart, Lung, and Blood Institute. Dr. Brandon George was in part sponsored by the National Institutes of Health through a grant (T32-HL079888) from the National Heart, Lung, and Blood Institute.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Cleland, Professor John
• Authors: Lam, P. H., Keramida, K., Filippatos, G. S., Gupta, N., Faselis, C., Deedwania, P., George, B., Iskandrian, A., Cleland, J. G.F., Choudhary, G., Wu, W.-C., Morgan, C. J., Fonarow, G. C., and Ahmed, A.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
• Journal Name: Journal of Cardiac Failure
• Publisher: Elsevier
• ISSN: 1071-9164
• ISSN (Online): 1532-8414
• Published Online: 19 August 2021
• Copyright Holders: Copyright © 2021 Elsevier
• First Published: First published in Journal of Cardiac Failure 28(1): 65-70
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher