A Comparison of the Effects of β-Blockers With and Without Intrinsic Sympathomimetic Activity on Hemodynamics and Left Ventricular Function at Rest and During Exercise in Patients with Coronary Artery Disease

Choong, C.; Roubin, Gary S.; Harris, Phillip; Tokuyasu, Yoshiki; Shen, Wei-Feng; Bautovich, George J.; Kelly, David T.

doi:10.1097/00005344-198605000-00001

Cited by 9 publications

(3 citation statements)

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“…6 However, in acute heart failure, use of beta-blockers is contraindicated owing to its adverse effects on systemic hemodynamics. 1,5 Taken together, the degree of reduction in MVO 2 obtained in this study is reasonable considering that it is achieved without sacrificing the normal hemodynamic condition.…”

Section: Comparison With Beta-blockade Alonesupporting

confidence: 74%

“…(2)(3)(4)(5)(6)(7)(8) and fixed values of AP, CO, and P LA (Table 1), we numerically simulated the individual relations of HR with E es , SW, PVA, BVO 2 , LV mechanical efficiency (ME) and MVO 2 (Fig. 1).…”

Section: Theoretical Analysismentioning

confidence: 99%

“…6,26 However, in the failing heart, reduction of HR alone may decrease CO, and compromise hemodynamics. 5, 13 We previously demonstrated that AP, CO, and P LA are determined by a mechanical equilibrium of the functional slope of Starling's curve (S L ) for the left ventricle (LV), systemic vascular resistance (R), and stressed blood volume (V). [30][31][32] Conversely, S L , R, and V can be calculated from AP, CO, and P LA , indicating that a set of AP, CO, and P LA values uniquely corresponds to a set of S L , R, and V values.…”

Section: Introductionmentioning

confidence: 99%

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Computationally Managed Bradycardia Improved Cardiac Energetics While Restoring Normal Hemodynamics in Heart Failure

Uemura¹,

Sunagawa

Sugimachi³

2008

Ann Biomed Eng

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In acute heart failure, systemic arterial pressure (AP), cardiac output (CO), and left atrial pressure (P (LA)) have to be controlled within acceptable ranges. Under this condition, cardiac energetic efficiency should also be improved. Theoretically, if heart rate (HR) is reduced while AP, CO, and P (LA) are maintained by preserving the functional slope of left ventricular (LV) Starling's curve (S (L)) with precisely increased LV end-systolic elastance (E (es)), it is possible to improve cardiac energetic efficiency and reduce LV oxygen consumption per minute (MVO (2)). We investigated whether this hemodynamics can be accomplished in acute heart failure using an automated hemodynamic regulator that we developed previously. In seven anesthetized dogs with acute heart failure (CO < 70 mL min(-1) kg(-1), P (LA) > 15 mmHg), the regulator simultaneously controlled S (L) with dobutamine, systemic vascular resistance with nitroprusside and stressed blood volume with dextran or furosemide, thereby controlling AP, CO, and P (LA). Normal hemodynamics were restored and maintained (CO; 88 +/- 3 mL min(-1) kg(-1), P (LA); 10.9 +/- 0.4 mmHg), even when zatebradine significantly reduced HR (-27 +/- 3%). Following HR reduction, E (es) increased (+34 +/- 14%), LV mechanical efficiency (stroke work/oxygen consumption) increased (+22 +/- 6%), and MVO (2) decreased (-17 +/- 4%) significantly. In conclusion, in a canine acute heart failure model, computationally managed bradycardia improved cardiac energetic efficiency while restoring normal hemodynamic conditions.

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Section: Comparison With Beta-blockade Alonesupporting

confidence: 74%

Section: Theoretical Analysismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Computationally Managed Bradycardia Improved Cardiac Energetics While Restoring Normal Hemodynamics in Heart Failure

Uemura¹,

Sunagawa

Sugimachi³

2008

Ann Biomed Eng

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Hemodynamic Effects of Esmolol, an Ultrashort‐acting Beta Blocker

Askenazi¹,

MacCosbe²,

Hoff³

et al. 1987

The Journal of Clinical Pharma

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The hemodynamic effects of esmolol were evaluated in 12 male patients at rest (mean age, 51 +/- 10 years) undergoing routine cardiac catheterization. Hemodynamic measurements were obtained during baseline (prior to esmolol), at steady state (during an intravenous infusion of esmolol 300 micrograms/kg/min), and at 30 minutes after stopping esmolol (postinfusion). Esmolol produced hemodynamic effects similar to the effects of other beta blockers. Significant reductions in rate-pressure product (mean decrease, 15%), cardiac index (mean decrease, 17%), stroke volume index (mean decrease, 13%), left ventricular stroke work index (mean decrease, 20%), and left ventricular ejection fraction (mean decrease, 18%) were observed. In contrast to other beta blockers, all hemodynamic effects of esmolol had returned to baseline values within 30 minutes after the infusion stopped. One patient exhibited hypotension during the esmolol infusion; this episode resolved without sequelae after discontinuation of esmolol. In summary, the effects of esmolol at rest on hemodynamic parameters and left ventricular function are similar to other beta-adrenergic blocking agents. Due to its ultrashort half-life, esmolol can be administered safely in critically ill patients whose disease status makes treatment with currently available beta blockers risky.

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Hemodynamic Effects of Flestolol, a Titratable Short‐Acting Intravenous Beta‐Adrenergic Receptor Blocker

Strom

Josephson

Frishman

et al. 1988

The Journal of Clinical Pharma

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The hemodynamic effects of flestolol were evaluated in 30 patients undergoing routine cardiac catheterization. Hemodynamic measurements were obtained during baseline (prior to flestolol), at steady state during IV flestolol infusion (1, 5, and 10 micrograms/kg/min) and at 20 to 30 minutes after discontinuation (postinfusion). Flestolol-induced hemodynamic changes were similar to those induced by other beta blockers without intrinsic sympathomimetic activity. Significant dose-dependent reduction in heart rate, rate pressure product, and increase in peripheral vascular resistance were seen. Flestolol produced clinically insignificant decrease in myocardial contractility as shown by slight decrease in LVdp/dt, CI, and LVEF. Hemodynamic data from patients with paced heart rate, further confirms a direct mild cardiac depressant effect of flestolol, a finding common to other beta blockers. Consistent with the short elimination half-life of flestolol (t1/2 = 6.5 minutes), most of the hemodynamic changes rapidly returned to preinfusion level within 20 to 30 minutes following its discontinuation. Thus flestolol, with its unique pharmacokinetic profile and titrability, may be beneficial in the treatment of critically ill patients.

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A Comparison of the Effects of β-Blockers With and Without Intrinsic Sympathomimetic Activity on Hemodynamics and Left Ventricular Function at Rest and During Exercise in Patients with Coronary Artery Disease

Cited by 9 publications

References 0 publications

Computationally Managed Bradycardia Improved Cardiac Energetics While Restoring Normal Hemodynamics in Heart Failure

Computationally Managed Bradycardia Improved Cardiac Energetics While Restoring Normal Hemodynamics in Heart Failure

Hemodynamic Effects of Esmolol, an Ultrashort‐acting Beta Blocker

Hemodynamic Effects of Flestolol, a Titratable Short‐Acting Intravenous Beta‐Adrenergic Receptor Blocker

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