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Prevalence and prognostic significance of adrenergic escape during chronic β‐blocker therapy in chronic heart failure
Author(s) -
Frankenstein Lutz,
Zugck Christian,
Schellberg Dieter,
Nelles Manfred,
Froehlich Hanna,
Katus Hugo,
Remppis Andrew
Publication year - 2009
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1093/eurjhf/hfn028
Subject(s) - medicine , heart failure , cardiology , adrenergic , heart rate , beta blocker , observational study , prospective cohort study , pathophysiology , blood pressure , receptor
Aims Like aldosterone escape to ACE‐inhibitors, adrenergic escape (AE) to β‐blockers appears conceivable in chronic heart failure (CHF), as generalized systemic neurohumoral activation has been described as the pathophysiological basis of this syndrome. The aim of this study was to examine the prevalence and prognostic value of AE with respect to different β‐blocker agents and doses. Methods and results This was a prospective, observational study of 415 patients with systolic CHF receiving chronic stable β‐blocker therapy. AE was defined by norepinephrine levels above the upper limit of normal. Irrespective of the individual β‐blocker agents used and the dose equivalent taken, the prevalence of AE was 31–39%. Norepinephrine levels neither correlated with heart rate ( r = 0.02; 95% CI: −0.08–0.11; P = 0.74) nor were they related to underlying rhythm ( P = 0.09) or the individual β‐blocker agent used ( P = 0.87). The presence of AE was a strong and independent indicator of mortality (adjusted HR: 1.915; 95% CI: 1.387–2.645; χ 2 : 15.60). Conclusion We verified the presence of AE in CHF patients on chronic stable β‐blocker therapy, irrespective of the individual β‐blocker agent and the dose equivalent. As AE might indicate therapeutic failure, the determination of AE could help to identify those patients with CHF that might benefit from more aggressive treatment modalities. Heart rate, however, is not a surrogate for adrenergic escape.