European Heart Journal Advance Access originally published online on April 5, 2007
European Heart Journal 2007 28(9):1170-1171; doi:10.1093/eurheartj/ehm053
Beta-blockers in asymptomatic dilated cardiomyopathy: to b-block or not to b-block?
Department of Cardiology
Heart Failure Unit
Athens University Hospital Attikon
Rimini 1 Street, Athens 12461, Greece
Department of Cardiology
Heart Failure Unit
Athens University Hospital Attikon
Rimini 1 Street, Athens 12461, Greece
E-mail address: geros{at}otenet.gr
We read with interest the comparison between the different Guidelines on chronic heart failure (CHF).1 In the article, the discrepancies and possible explanations are discussed. However, an important disagreement between the experts, which is likely to affect patient's management is not reported.1 In the Guidelines of the ACC/AHA, beta-blockers are recommended for all patients without a history of MI who have a reduced left ventricular ejection fraction (LVEF) with no HF symptoms (Level of recommendation I, Level of Evidence C).2 Moreover, beta-blockers are recommended for all stable patients with current or prior symptoms of HF and reduced LVEF. (Level of recommendation I, Level of Evidence A).2 In the Guidelines of the HFSA the combination of a beta-blocker and an ACE-inhibitor is recommended as routine therapy for asymptomatic patients with an LVEF <40%. (Post-MI: Strength of Evidence B; non-post-MI: Strength of Evidence C).3 According to the ESC Guidelines, beta-blockers should be considered for the treatment of all patients (in NYHA class II–IV) (Class of recommendation I, Level of Evidence A).4 However, in patients with LV systolic dysfunction, without symptomatic heart failure beta-blockade is recommended only after an acute myocardial infarction to reduce mortality (Class of recommendation I, Level of Evidence B), but not in patients with dilated cardiomyopathy.4 Although controlled clinical trials are lacking in the use of beta-blockers in patients with a low EF and no symptoms,5,6 it would be important for the clinician to know that expert consensus is not different in Europe and North America. In conclusion, the authors are right that ‘the greatest remaining question is why we need four guidelines, including three from North America’.7
References
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[Abstract/Free Full Text] - Hunt SA. American College of Cardiology; American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/ACC/AHA American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). J Am Coll Cardiol (2005) 46:e1–e82. (Erratum in: J Am Coll Cardiol 2006;47:1503–1505).
[Free Full Text] - Heart Failure Society Of America. Executive summary: HFSA 2006 Comprehensive Heart Failure Practice Guideline. J Card Fail (2006) 12:10–38.[CrossRef][Web of Science][Medline]
- Swedberg K, Cleland J, Dargie H, Drexler H, Follath F, Komajda M, Tavazzi L, Smiseth OA, Gavazzi A, Haverich A, Hoes A, Jaarsma T, Korewicki J, Levy S, Linde C, Lopez-Sendon JL, Nieminen MS, Pierard L, Remme WJ. Task Froce for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology. Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005): The Task Force for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology. Eur Heart J (2005) 26:1115–1140.
[Free Full Text] - Vantrimpont P, Rouleau JL, Wun CC, Ciampi A, Klein M, Sussex B, Arnold JM, Moye L, Pfeffer M, for the SAVE Investigators. Additive beneficial effects of beta-blockers to angiotensin-converting enzyme inhibitors in the Survival and Ventricular Enlargement (SAVE) Study. J Am Coll Cardiol (1997) 29:229–236.[Abstract]
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[Abstract/Free Full Text] - Arnold JM, Liu P, Demers C, Dorian P, Giannetti N, Haddad H, Heckman GA, Howlett JG, Ignaszewski A, Johnstone DE, Jong P, McKelvie RS, Moe GW, Parker JD, Rao V, Ross HJ, Sequeira EJ, Svendsen AM, Teo K, Tsuyuki RT, White M. Canadian Cardiovascular Society. Canadian Cardiovascular Society consensus conference recommendations on heart failure 2006: diagnosis and management. Can J Cardiol (2006) 22:23–45.[Web of Science][Medline]
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