Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-18T11:37:03.724Z Has data issue: false hasContentIssue false
  • English
  • Français

Interest of β-blockers in patients with right ventricular systemic dysfunction

Published online by Cambridge University Press:  02 June 2010

Rachid Bouallal ,
François Godart ,
Charles Francart ,
Adélaïde Richard ,
Claude Foucher-Hossein  and
Christophe Lions
Rachid Bouallal
Affiliation:
Department of Paediatric Cardiology and Congenital Heart Disease, Cardiology Hospital, University of Lille 2, Lille cedex, France
François Godart*
Affiliation:
Department of Paediatric Cardiology and Congenital Heart Disease, Cardiology Hospital, University of Lille 2, Lille cedex, France
Charles Francart
Affiliation:
Department of Paediatric Cardiology and Congenital Heart Disease, Cardiology Hospital, University of Lille 2, Lille cedex, France
Adélaïde Richard
Affiliation:
Department of Paediatric Cardiology and Congenital Heart Disease, Cardiology Hospital, University of Lille 2, Lille cedex, France
Claude Foucher-Hossein
Affiliation:
Department of Nuclear Medicine, Cardiology Hospital, University of Lille 2, Lille cedex, France
Christophe Lions
Affiliation:
Department of Radiology, Cardiology Hospital, University of Lille 2, Lille cedex, France
*
Correspondence to: F. Godart, MD, PhD, Department of Paediatric Cardiology and Congenital Heart Disease, Service des Maladies Cardiovasculaires Infantiles et Congénitales, Hôpital Cardiologique, CHRU de Lille, University of Lille 2, Bd du Professeur Jules Leclercq, 59037 Lille cedex, France. Tel: +33 32044 5369; Fax: +33 320445456; E-mail: francois.godart@chru-lille.fr
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

β-blockers improve the prognosis of patients with cardiac failure due to left ventricular systolic dysfunction. The aim of this study was to assess the efficacy of β-blockers in patients with dysfunctional systemic right ventricle.

Methods

Fourteen patients with systemic right ventricle following a Mustard or a Senning operation for the transposition of the great arteries, or congenitally corrected transposition were included in the study. All had a decreased systemic right ventricular ejection fraction despite having standard cardiac failure therapy. Quality of life, New York Heart Association class, aerobic capacity, and systemic right ventricular function were assessed before treatment with β-blockers and at the end of the follow-up period, mean of 12.8 months with a range from 3 to 36 months.

Results

Change in New York Heart Association class was significant (p = 0.016). Quality of life improved significantly throughout the study from a median grade 2 with a range from 1 to 3 to a median grade 1 with a range from 1 to 2 (p = 0.008). Systemic right ventricular ejection fraction assessed by radionuclide ventriculography improved significantly from a median of 41% (range: 29–53%) to 49% (range: 29–62%; p = 0.031). However, the change in thee ejection fraction assessed by magnetic resonance imaging was not significant from a median of 29% (range: 12–47%) to 32% (range: 22–63%; p = 0.063).

Conclusion

In patients with cardiac failure due to systemic right ventricular dysfunction, β-blockers improve New York Heart Association class, quality of life, and systemic right ventricular ejection fraction assessed by radionuclide ventriculography.

Keywords

Cardiac failuretranspositioncongenitally corrected transposition
Type
Original Articles
Information
Cardiology in the Young , Volume 20 , Issue 6 , December 2010 , pp. 615 - 619
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Connelly, MS, Liu, PP, Williams, WG, Webb, GD, Robertson, P, McLaughlin, PR. Congenitally corrected transposition of the great arteries in the adult: functional status and complications. J Am Coll Cardiol 1996; 27: 1238–1243.CrossRefGoogle ScholarPubMed
2. Graham, TP, Bernard, YD, Mellen, BG, et al. Long-term outcome in congenitally corrected transposition of the great arteries: a multi-institutional study. J Am Coll Cardiol 2000; 36: 255–261.Google Scholar
3. Dos, L, Teruel, L, Ferreira, IJ, et al. Late outcome of Senning and Mustard procedures for correction of transposition of the great arteries. Heart 2005; 91: 652–656.CrossRefGoogle ScholarPubMed
4. Turina, MI, Siebenmann, R, Von Segesser, L, Schönbeck, M, Senning, A. Late functional deterioration after atrial correction for transposition of the great arteries. Circulation 1989; 80: 162–167.Google Scholar
5. Rickli, H, Steiner, S, Müller, K, Hess, OM. Betablockers in heart failure: carvedilol safety assessment (CASA 2-trial). Eur J Heart Fail 2004; 6: 761–768.CrossRefGoogle ScholarPubMed
6. Macdonald, PS, Keogh, AM, Aboyoun, CL, Lund, M, Amor, R, McCaffrey, DJ. Tolerability and efficacy of carvedilol in patients with New York Heart Association class IV heart failure. J Am Coll Cardiol 1999; 33: 924–931.CrossRefGoogle ScholarPubMed
7. Arnold, RH, Kotlyar, E, Hayward, C, Keogh, AM, Macdonald, PS. Relation between heart rate, heart rhythm, and reverse left ventricular remodelling in response to carvedilol in patients with chronic heart failure: a single centre, observational study. Heart 2003; 89: 293–298.CrossRefGoogle ScholarPubMed
8. Flannery, G, Gehrig-Mills, R, Billah, B, Krum, H. Analysis of randomized controlled trials on the effect of magnitude of heart rate reduction on clinical outcomes in patients with systolic chronic heart failure receiving beta-blockers. Am J Cardiol 2008; 102: 506–507.Google Scholar
9. Thackray, SD, Ghosh, JM, Wright, GA, et al. The effect of altering heart rate on ventricular function in patients with heart failure treated with beta-blockers. Am Heart J 2006; 152: 713.e9–713.e13.Google Scholar
10. Ramahi, TM, Longo, MD, Cadariu, AR, et al. Left ventricular inotropic reserve and right ventricular function predict increase of left ventricular ejection fraction after beta-blocker therapy in non ischemic cardiomyopathy. J Am Coll Cardiol 2001; 37: 818–824.CrossRefGoogle Scholar
11.The Cardiac insufficiency bisoprolol study II (CIBIS-II Investigators and Committees): a randomised trial. Lancet 1999; 353: 9–13.CrossRefGoogle Scholar
12. Nasr, IA, Bouzamondo, A, Hulot, JS, Dubourg, O, Le Heuzey, JY, Lechat, P. Prevention of atrial fibrillation onset by beta-blocker treatment in heart failure: a meta-analysis. Eur Heart J 2007; 28: 457–462.CrossRefGoogle ScholarPubMed
13. Packer, M, Bristow, MR, Cohn, JN, et al. The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. US carvedilol heart failure study group. N Engl J Med 1996; 334: 1349–1355.CrossRefGoogle ScholarPubMed
14.Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL randomised intervention trial in congestive heart failure (MERIT-HF Investigators and Committees). Lancet 1999; 353: 2001–2007.CrossRefGoogle Scholar
15. Van der Zedde, J, Oosterhof, T, Tulevski, II, Vliegen, HW, Mulder, BJ. Comparison of segmental and global systemic ventricular function at rest and during dobutamine stress between patients with transposition and congenitally corrected transposition. Cardiol Young 2005; 15: 148–153.Google Scholar
16. Espinola-Zavaleta, N, Alexanderson, E, Attié, F, et al. Right ventricular function and ventricular perfusion defects in adults with congenitally corrected transposition: correlation of echocardiography and nuclear medicine. Cardiol Young 2004; 14: 174–181.CrossRefGoogle ScholarPubMed
17. Tulevski, II, Zijta, FM, Smeijers, AS, Dodge-Khatami, A, van der Wall, EE, Mulder, BJ. Regional and global right ventricular dysfunction in asymptomatic or minimally symptomatic patients with congenitally corrected transposition. Cardiol Young 2004; 14: 168–173.CrossRefGoogle ScholarPubMed
18. Lubiszewska, B, Gosiewska, E, Hoffman, P, et al. Myocardial perfusion and function of the systemic right ventricle in patients after atrial switch procedure for complete transposition: long-term follow-up. J Am Coll Cardiol 2000; 36: 1365–1370.CrossRefGoogle ScholarPubMed
19. Trojnarska, O. Heart failure in the adult patient with congenital heart disease. Cardiol J 2007; 14: 127–136.Google ScholarPubMed
20. Doughan, AR, McConnell, ME, Book, WM. Effect of beta blockers (carvedilol or metoprolol XL) in patients with transposition of great arteries and dysfunction of the systemic right ventricle. Am J Cardiol 2007; 99: 704–706.CrossRefGoogle ScholarPubMed
21. Giardini, A, Lovato, L, Donti, A, et al. A pilot study on the effects of carvedilol on right ventricular remodelling and exercise tolerance in patients with systemic right ventricle. Int J Cardiol 2006; 114: 241–246.Google Scholar
22. Winter, MM, Bouma, BJ, van Dijk, AP, et al. Relation of physical activity, cardiac function, exercise capacity and quality of life in patients with a systemic right ventricle. Am J Cardiol 2008; 102: 1258–1262.Google Scholar