PMID- 11077226
OWN - NLM
STAT- MEDLINE
DCOM- 20010111
LR  - 20190921
IS  - 1053-2498 (Print)
IS  - 1053-2498 (Linking)
VI  - 19
IP  - 11
DP  - 2000 Nov
TI  - Experience with beta-blocker therapy in patients with advanced heart failure 
      evaluated for HTx.
PG  - 1081-8
AB  - BACKGROUND: The aim of this study was to review our experience with beta-blocker 
      therapy on top of high-dose angiotensin-converting enzyme inhibitors (ACE-I) in 
      patients with advanced heart failure evaluated for heart transplantation, and to 
      question the value of intended heart transplantation for patients receiving this 
      therapy. METHODS: Three hundred eighteen patients (New York Heart Association 
      (NYHA) function class III 34%, class IV 66%, average left ventricular ejection 
      fraction (LVEF) 16%, and average cardiac index 2.2 l/min per m(2) at time of 
      referral) were treated with digitalis, loop diuretics, maximally uptitrated 
      ACE-I, beta-blockers (if tolerated), and intravenous support (if needed). After 3 
      months, patients were retrospectively stratified into those receiving 
      beta-blockers plus ACE-I (Group A, n = 126), ACE-I (Group B, n = 135), and ACE-I 
      plus intravenous support (Group C, n = 57). Endpoint 1 of the study was combined 
      urgent heart transplantation, mechanical assist device implantation, and 
      pretransplant death during a follow-up of 12 to 48 (mean 19 +/- 11) months. 
      Endpoint 2 was posttransplant mortality up to 48 (mean 14 +/- 8) months. RESULTS: 
      In the pretransplantation period the survival rate was 58% and the mortality rate 
      was 20%. Between Groups A and B there was a significant difference in mortality 
      (9% vs 27%, p = 0.001) due to a lower sudden-death rate in Group A (6% vs 17%, p 
      < 0.01). While between Groups A and C all event rates of Endpoint 1 differed 
      significantly, between Group C and Group B total mortality (30% vs 27%) was 
      similar. However, in Group C urgent heart transplantation (HTx) was more often 
      performed than in Group B (54% vs 11%, p < 0.0001). Seventy of 318 patients (22%) 
      underwent heart transplantation (16% urgent, 6% elective). Posttransplant 
      actuarial survival of the entire transplanted cohort (n = 70, 12 deaths) was 
      significantly lower (log rank p < 0.01) than event-free survival in Group A (n = 
      126, 18 events), significantly higher (log rank p < 0. 0001) than event-free 
      survival in Group C (n = 57, 34 events), and similar to that in Group B (n = 135, 
      52 events). CONCLUSION: This experience suggests that it may be particularly 
      useful to add a beta-blocker to ACE-I therapy in patients referred for heart 
      transplantation. In patients who tolerate this treatment, heart transplantation 
      does not seem to provide additional survival benefit in the short term (2 years).
FAU - Berger, R
AU  - Berger R
AD  - Department of Cardiology and Ludwig Boltzman Institute of Cardiovascular 
      Research, University of Vienna, Vienna, Austria. RBerger@gmx.at
FAU - Strecker, K
AU  - Strecker K
FAU - Hulsmann, M
AU  - Hulsmann M
FAU - Frey, B
AU  - Frey B
FAU - Pacher, R
AU  - Pacher R
FAU - Stanek, B
AU  - Stanek B
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - J Heart Lung Transplant
JT  - The Journal of heart and lung transplantation : the official publication of the 
      International Society for Heart Transplantation
JID - 9102703
RN  - 0 (Adrenergic beta-Antagonists)
RN  - 0 (Angiotensin-Converting Enzyme Inhibitors)
RN  - 0 (Carbazoles)
RN  - 0 (Propanolamines)
RN  - 0K47UL67F2 (Carvedilol)
RN  - 50VV3VW0TI (Atenolol)
RN  - 69PN84IO1A (Enalapril)
SB  - IM
MH  - Actuarial Analysis
MH  - Adrenergic beta-Antagonists/*administration & dosage/adverse effects
MH  - Angiotensin-Converting Enzyme Inhibitors/*administration & dosage/adverse effects
MH  - Atenolol/administration & dosage/adverse effects
MH  - Carbazoles/administration & dosage/adverse effects
MH  - Carvedilol
MH  - Dose-Response Relationship, Drug
MH  - Drug Administration Schedule
MH  - Drug Therapy, Combination
MH  - Enalapril/administration & dosage/adverse effects
MH  - Follow-Up Studies
MH  - Heart Failure/*drug therapy/mortality
MH  - *Heart Transplantation
MH  - Humans
MH  - Propanolamines/administration & dosage/adverse effects
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Survival Rate
EDAT- 2000/11/15 11:00
MHDA- 2001/02/28 10:01
CRDT- 2000/11/15 11:00
PHST- 2000/11/15 11:00 [pubmed]
PHST- 2001/02/28 10:01 [medline]
PHST- 2000/11/15 11:00 [entrez]
AID - S1053-2498(00)00201-1 [pii]
AID - 10.1016/s1053-2498(00)00201-1 [doi]
PST - ppublish
SO  - J Heart Lung Transplant. 2000 Nov;19(11):1081-8. doi: 
      10.1016/s1053-2498(00)00201-1.