Effect of Beta-blocker Treatment on VO2peak in Patients with Heart Failure

ABSTRACT Purpose In addition to prolong life and reduce hospitalization rates, it is currently unclear whether beta-blocker (BB) treatment modulates peak oxygen consumption (VO2peak), a hallmark of exercise capacity, in patients with heart failure (HF). The main aim of this study is to determine the effect of BB treatment on VO2peak in HF patients. Methods We conducted a systematic search of MEDLINE, Scopus and Web of Science since their inceptions until March 2017 for randomized controlled trials (RCTs) assessing the effect of BB treatment on VO2peak in chronic HF patients. A meta-analysis was performed to ascertain the standardized mean difference (SMD) between the effect of BB versus placebo treatment on VO2peak. Secondary outcomes included peak exercise performance and New York Health Association (NYHA) functional class. Subgroup and meta-regression analyses assessed potential moderating factors. Results Fourteen RCTs met the inclusion criteria (overall n=616). Interventions comprised BB (n=324) or placebo (n=292) administration lasting 3 to 24 months. Concomitant reported medication did not differ between HF patients assigned to BB and placebo groups. After data pooling, VO2peak was preserved with BB compared with placebo treatment (SMD=-0.04, 95 % CI=-0.20, 0.12; P=0.61); heterogeneity among studies was not detected (I2=0 %, P=0.88). Peak exercise performance was not altered (SMD=0.02, 95 % CI=-0.16, 0.20; P=0.85), whereas NYHA functional class was reduced with BB compared with placebo (SMD=-0.54, 95 % CI=-0.90, -0.18; P=0.003). Conclusion According to evidence from RCTs, prolonged BB (B1-selective or non-selective) treatment do not affect VO2peak yet improves functional status in HF patients. Correspondence: Dr. David Montero, University Heart Center, University Hospital Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland. Tel.: + 41 44 255 33 53, Fax: +41 44 255 48 59. Email: david.monterobarril@usz.ch The results of the present study do not constitute endorsement by ACSM. The authors declare that the results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. DM receives research salary from the Forschungskredit Award, Faculty of Medicine, University of Zurich. The authors have no conflicts of interest to disclose. Accepted for Publication: 27 November 2017 © 2017 American College of Sports Medicine

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