| To evaluate the hemodynamic effect of beta-blocker in patients with acute decompensated heart failure.BackgroundMultiple studies have shown that beta-blockers reduce mortality in chronic systolic heart failure(SHF).Less data are available on the role of BBs in patients with worsening SHF, specifically whether BBs should be continue or temporarily withdrawn. This retrospective, nonrandomized analysis aim to evaluate the hemodynamic effects of the beta-blockers in patients admitted for worsening systolic heart failure.MethodsThis was a retrospective, single-center, nonrandomized study about the patients between May 2004 and June 2008 in the Heart Failure Care Unit of the Fuwai hospital in Beijing, China. All patients refereed for Swan-Ganz, catheterization had been assessed and investigated by their treating physician and were 18-80 years old with NYHA class III-IV. According to whether had been use beta-blockers orally when received Swan-Ganz catheterization, we have two groups:beta-blocker group and no-beta-blocker group. Analyze the data including hospital mortality, total length of stay, days spend in intensive care unit and hemodynamic parameter. We choose 14 patients who treated with BBs under the monitor of Swan-Ganz catheterization, and analyze all data of hemodynamic parameter. Differences between beta-blocker group and no-beta-blocker group were were evaluated by independent t-test and t'-test. Differences between before and after using beta-blocker were evaluated by paired t-tests.Results(1) Differences between beta-blocker group and no-beta-blocker group:In total of 152 patients (127male,25female),beta-blocker group had 131 patients and no-beta-blocker group had 21 patients, there were no significant difference between two groups on sex, age, NYHA functional class, heart rate, blood pressure, etiology of heart failure, medical history and medications. total length of stay in beta-blockers group was (23.75±26.56) day and total length of stay in no-beta-blocker group was (20.05±18.50) day (P=0.54),days spend in intensive care unit in beta-blockers group was (11.69±16.87) day and days spend in intensive care unit in no-beta-blocker group was (12.62±9.38) day (P=0.716),hospital mortality in beta-blockers group was 2.3%, hospital mortality in no-beta-blocker group was 9.5%(P=0.14). Pulmonary artery systolic pressure(P=0.018), pulmonary artery diastolic pressure (P=0.031),mean pulmonary arterial pressure (P=0.042),pulmonary vascular resistance (P=0.044),central venous pressure (P=0.000) in beta-blockers group was low than in no-beta-blocker group。(2) Differences between before and after using beta-blocker:BBs were to decrease all kinds of pulmonary artery pressure, including pulmonary artery systolic pressure from (49.79±16.29) mmHg to (37.21±15.32) mmHg (P=0.000), pulmonary artery diastolic pressure from (25.5±8.56) mmHg to (16.71±7.45) mmHg (P=0.001),mean pulmonary arterial pressure from(33.57±11.53)mmHg to(23.64±9.83)mmHg(P=0.001).001)and central venous pressure (CVP) from (7.86±5.26) mmHg to (4.36±3.71) mmHg (P=0.025), pulmonary capillary wedge pressure (PCWP) from(21.43±10.19)mmHg to(12.21±9.28) mmHg (P=0.000) while increasing stoke volume index(SVI) from (25.429±9.09) ml/min/m2 to (31.18±7.57) ml/min/m2 (P=0.031), left ventricular stoke work (LVSW) from (43.01±18.42) gm/min to (56.67±14.03)gm/min(P=0.021) and left ventricular stoke work index (LVSWI) from (23.95±9.69) gm/min/m2 to (31.59±7.20) gm/min/m2 (P=0.019).BBs also decreased heart rate (HR)from (88.79±14.05)/min to (81.7±13.12)/min(P=0.033), mean arterial pressure (MAP) from (90.5±14.23) mmHg to(81.93±14.01)mmHg(P=0.032), systolic blood pressure (SBP) from(115.93±16.99) mmHg to (107.43±17.38) mmHg(P=0.036) and systemic vascular resistance(SVR) from (1868.00±715.03) dync s/cm5 to (1402.00±468.19) dync s/cm5 (P=0.004) systemic vascular resistance index (SVRI)from (3340.29±1307.38) dync s/cm5/m2 to (2252.31±908.35) dyncs/cm5/m2 (P=0.015), but cardiac output(CO) (P=0.127) and cardiac index(CI) (P=0.107) did not increase significantly in the fellow-up group.ConclusionsIn patients hospitalized for acute decompensated systolic heart failure, low dose of beta-blockers may not been forbidden. |
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