Rate-Adaptive Pacing for Heart Failure With Preserved Ejection Fraction

Kitzman, Dalane W.; Upadhya, Bharathi; Pandey, Ambarish

doi:10.1001/jama.2023.1053

Cited by 3 publications

(4 citation statements)

References 20 publications

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“…We wonder why these participants were at considerable risk of complications. In conclusion, unlike the view expressed in the Editorial accompanying the article, we do not believe the data reported in this study are substantial enough to alter paradigms or change guidelines.…”

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confidence: 96%

Rate-Adaptive Atrial Pacing for Heart Failure With Preserved Ejection Fraction

Olshansky

Hopper

Wilkoff

2023

JAMA

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Role of the Funder/Sponsor: Australian Department of Health and Aged Care had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation or review, but approved the manuscript and the decision to submit the manuscript for publication.Data Sharing Statement: See Supplement 2. Additional Contributions:We acknowledge the participants and staff at the surveillance sites, state and territory health departments, and the contribution of the surveillance tool Vaxtracker.

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confidence: 96%

Rate-Adaptive Atrial Pacing for Heart Failure With Preserved Ejection Fraction

Olshansky

Hopper

Wilkoff

2023

JAMA

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“…For these patients, an increased HR could potentially enhance cardiac output and counterbalance the decrease in stroke volume during exercise. 15…”

Section: Discussionmentioning

confidence: 99%

“…The current findings align with the notion that higher HRs might be particularly beneficial for patients with HFpEF with smaller LV volumes and hyperdynamic systolic function, which are features observed in individuals with lower iLVESV. For these patients, an increased HR could potentially enhance cardiac output and counterbalance the decrease in stroke volume during exercise …”

Section: Discussionmentioning

confidence: 99%

β-Blocker Withdrawal and Functional Capacity Improvement in Patients With Heart Failure With Preserved Ejection Fraction

Palau,

de la Espriella,

Seller

et al. 2024

JAMA Cardiol

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ImportanceIncreasing the patient’s heart rate (HR) has emerged as a therapeutic option in patients with heart failure with preserved ejection fraction (HFpEF). However, the evidence is conflicting, and the profile of patients who benefit most from this strategy remains unclear.ObjectiveTo assess the association of β-blocker treatment withdrawal with changes in the percentage of predicted peak oxygen consumption (VO2) across indexed left ventricular diastolic (iLVEDV) and indexed left ventricular systolic volumes (iLVESV), and left ventricular ejection fraction (LVEF) in patients with HFpEF and chronotropic incompetence.Design, Setting, and ParticipantsThis post hoc analysis was conducted using data from the investigator-blinded multicenter, randomized, and crossover clinical trial, PRESERVE-HR, that took place from October 1, 2018, through December 31, 2020, to investigate the short-term effects (2 weeks) of β-blocker withdrawal on peak oxygen consumption (peak VO2). Patients with stable HFpEF (New York Heart Association functional class II to III) receiving treatment with β-blocker and chronotropic incompetence were included.InterventionParticipants in the PRESERVE-HR trial were randomized to withdraw vs continue with β-blocker treatment. After 2 weeks, they were crossed over to receive the opposite intervention. This crossover randomized clinical trial examined the short-term effect of β-blocker withdrawal on peak VO2.Main Outcomes and MeasuresThe primary outcome was to evaluate the association between β-blocker withdrawal and short-term changes in percentage of peak VO2 across iLVEDV, iLVESV, and LVEF in patients with HFpEF and chronotropic incompetence treated with β-blocker.ResultsA total of 52 patients (mean age, 73 [SD, 13] years; 60% female) were randomized. The mean resting HR, peak HR, peak VO2, and percentage of peak VO2 were 65 (SD, 9) beats per minute (bpm), 97 (SD, 15) bpm, 12.4 (SD, 2.9) mL/kg per minute, and 72.4% (SD, 17.7%), respectively. The medians (minimum-maximum) of iLVEDV, iLVESV, and LVEF were 44 mL/m2 (IQR, 19-82), 15 mL/m2 (IQR, 7-32), and 64% (IQR, 52%-78%), respectively. After stopping β-blocker treatment, the median increase in peak HR was plus 30 bpm (95% CI, 25-35; P &lt; .001). β-Blocker cessation was differentially associated with change of percentage of peak VO2 across the continuum of iLVESV (P for interaction = .02), indicating a greater benefit in those with lower iLVESV.Conclusions and RelevanceIn this study, results showed that in patients with HFpEF and chronotropic incompetence receiving treatment with β-blocker, lower iLVESV may identify those with a greater short-term improvement in maximal functional capacity after stopping β-blocker treatment. Further studies are warranted for further investigation.Trial RegistrationClinicalTrials.gov (NCT03871803)

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“…To the Editor Based on lack of efficacy of rate-adaptive atrial pacing on exercise tolerance in patients with HFpEF and chronotropic incompetence, the authors of the RAPID-HF trial and the accompanying Editorial concluded that rate-adaptive atrial pacing should not be used to treat these patients. Although a significant improvement in V̇ o 2 has been demonstrated with increasing peak heart rate by β-blocker withdrawal, a previous simulation study already indicated that increasing peak heart rate is accompanied by a compensatory decrease in stroke volume, arteriovenous oxygen difference (C[a − v]O 2 ), or both, resulting in only a small increase in peak V̇ o 2 .…”

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confidence: 99%