Anemia Is Associated With Blunted Response to β-Blocker Therapy Using Carvedilol　― Insights From Japanese Chronic Heart Failure (J-CHF) Study ―

Differential Response to Heart Rate Reduction by Carvedilol in Heart Failure and Reduced Ejection Fraction Between Sinus Rhythm and Atrial Fibrillation ― Insight From J-CHF Study ―

“…In the present study the main findings were as follows: (1) greater HR reduction by carvedilol was associated with more favorable LV reverse remodeling in SR but not in AF; (2) ∆HR was an independent predictor for ∆LVEF in SR but not in AF; (3) greater HR reduction by carvedilol HR, although the older age and higher prevalence of anemia in the lower HR group might have affected those findings (data not shown). 17 Multiple regression analysis was performed to determine the independent predictors of ∆LVEF over 56 weeks. In SR, ∆HR was an independent predictor for ∆LVEF whereas achieved dose of carvedilol was not ( Table 2).…”

“…13,14 The Japanese Chronic Heart Failure (J-CHF) study was a prospective randomized study to determine the optimal dose of carvedilol by comparing the efficacy and safety of 3 different doses of carvedilol, and the best predictors of effective outcomes in Japanese patients with HFrEF. [15][16][17] In this substudy, we investigated whether the benefit of HR reduction by carvedilol differs between HFrEF patients with sinus rhythm (SR) and those with AF in terms of left ventricular (LV) reverse remodeling and subsequent I n patients with heart failure and reduced ejection fraction (HFrEF), a higher resting heart rate (HR) is associated with higher morbidity and mortality. [1][2][3] Beta-blockers have been recommended for all patients with HFrEF to reduce morbidity and mortality unless contraindicated.…”

Anaemia and iron deficiency in chronic heart failure patients

“…По мнению Y. Nagatomo с соавт. [73], негативное влияние карведилола на уровень Hb у больных ХСН с анемией обусловлено непрямым подавлением парасимпатической активности, что отражается усилением нарушенной перфузии органов гемопоэза. Следует отметить, что СН, связанная с анемией, может приводить к стойко-му ремоделированию ЛЖ, резистентному к терапии карведилолом.…”

Impact of Anemia on Left Ventricular Reverse Remodeling in Response to Carvedilol

“…The authors assumed that anemia induces a hyper-hemodynamic state and increases work load through increased heart rate and stroke volume, leading to higher sympathetic nervous activity, which can contribute to the attenuation of reverse remodeling. 9 This study suggests that a blunted response A nemia is frequently observed in patients with heart failure (HF) and is associated with high mortality rates (Figure). Although the mechanisms by which anemia worsens the prognosis of HF patients are yet unclear, it has been recently reported that anemia correlates with high cardiac index and low systemic vascular resistance index in congestive HF patients.…”

“…to carvedilol in LV reverse remodeling may be one of the causes of adverse prognosis in HFrEF patients with anemia ( Figure). 9 It has been reported that iodine-123 meta-iodobenzylguanidine imaging 10 and β1 adrenergic receptor polymorphism 11 are useful for predicting LV reverse remodeling. Although the present study adds novel insights regarding anemia as a simple predictor of poor responders to carvedilol in LV reverse remodeling, 9 there are some limitations to this study.…”