Chronic heart failure with preserved ejection fraction after myocardial infarction: are beta-antagonists necessary? A two-year prospective study

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Abstract

BACKGROUND: Advances in the diagnosis and treatment of myocardial infarction have triggered an ≥50% increase in the proportion of patients with preserved left ventricular ejection fraction. The relevance of using adrenergic beta-antagonists in this patient cohort remains a topic of active debate.

AIM: To study the two-year catamnesis of patients suffering from myocardial infarction with chronic heart failure and preserved left ventricular ejection fraction who either received or did not receive adrenergic beta-antagonists.

METHODS: The study encompassed 127 patients with myocardial infarction aged 53 (48; 60) years with preserved left ventricular ejection fraction. On days 4–9 of myocardial infarction and on its 12- and 24-month anniversary, echocardiography with assessment of global longitudinal strain, longitudinal electrocardiogram monitoring, measurement of N-terminal natriuretic hormone peptide concentration, and a 6-minute walk test were performed. The endpoint was chronic heart failure progression over subsequent 2 years.

RESULTS: The adrenergic beta-antagonist group included 98 patients (77%) who received adrenergic beta-antagonist therapy, whereas the remaining 29 patients (23%) who did not receive such therapy due to hypotension and bradycardia made up the no adrenergic beta-antagonist group. In the adrenergic beta-antagonist group, by the second year of the post-infarction period, there was an increase in the indexed values of end-diastolic and end-systolic volumes, a decrease in left ventricular ejection fraction by 3.1% (р = 0.00077) and global longitudinal strain by 2.4% (р = 0.0002); in the other group, these parameters remained flat. In patients of the adrenergic beta-antagonist group, a decrease in chronotropic load on the myocardium and an increase in the circadian index while maintaining its rigid level were recorded; in the no adrenergic beta-antagonist group of patients, an increase in chronotropic load and normalization of the circadian heart rhythm profile were observed as early as by the 12th month of observation. The number of patients with progressive chronic heart failure over 2 years of observation in both groups did not differ: 21% and 24%, respectively (the risk ratio is 0.659; the 95% confidence interval is 0.35–1.243).

CONCLUSION: In today’s context, with the use of reperfusion methods for treating patients with myocardial infarction, it is necessary to conduct large-scale randomized clinical trials studying the effect of adrenergic beta-antagonist therapy on the prognosis in patients with preserved left ventricular ejection fraction. According to the results of this study, no significant differences were found in the frequency of progression of chronic heart failure in groups of patients who had suffered myocardial infarction and preserved left ventricular ejection fraction. In the group of patients who did not receive adrenergic beta-antagonists, more stable myocardial volume and deformation characteristics were observed within 24 months of myocardial infarction.

About the authors

Elena V. Averyanova

Penza State University

Author for correspondence.
Email: averyanova-elena90@bk.ru
ORCID iD: 0000-0001-9925-2096
SPIN-code: 6769-9467

MD, Cand. Sci. (Medicine), Associate Professor

Russian Federation, address: 40 Krasnaya st, Penza, 440026

Angelina A. Chernova

Penza State University

Email: angelinakorneeva170498@gmail.com
ORCID iD: 0009-0002-7957-8034
SPIN-code: 6328-4745

MD

Russian Federation, address: 40 Krasnaya st, Penza, 440026

Olga D. Vershinina

Penza State University

Email: poloz.ol@yandex.ru
ORCID iD: 0000-0002-4127-6607
SPIN-code: 3802-9783

MD

Russian Federation, address: 40 Krasnaya st, Penza, 440026

Valentin E. Oleynikov

Penza State University

Email: v.oleynikof@gmail.com
ORCID iD: 0000-0002-7463-9259
SPIN-code: 9204-2690

MD, Dr. Sci. (Medicine), Professor

Russian Federation, 40 Krasnaya st, Penza, 440026

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2. Fig. 1. Dynamics of echocardiography parameters in the comparison groups: * p <0.05, ** p <0.001 (statistically significant differences between the initial and subsequent values); # p <0.05 (statistically significant intergroup differences). LVEF ― left ventricular ejection fraction; IVRT ― left ventricular isovolumetric relaxation time; iSVO ― end-systolic volume index; iEDV ― end-diastolic volume index; ESD ― end-systolic dimension; GLS ― global longitudinal strain.

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3. Fig. 2. Evaluation of the clinical condition and symptoms of chronic heart failure in the comparison groups: a — patients receiving β-blockers (β-blocker group); b — patients who did not receive β-blockers (no β-blocker group). c — Visual analogue scale; d — Minnesota Multiphasic Personality Inventory; * intragroup differences: p <0.05.

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4. Fig. 3. Dynamics of chronotropic load parameters in comparison groups. * Statistically significant differences between initial and subsequent values (p <0.05). Ta ― percentage of time during which the heart rate is above the threshold; Sa ― normalized area index limited by the threshold level and the heart rate trend.

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