Effects of αβ-Blocker Versus β1-Blocker Treatment on Heart Rate Response During Incremental Cardiopulmonary Exercise in Japanese Male Patients with Subacute Myocardial Infarction
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Patients
2.2. Clinical Characteristics
2.3. Symptom-Limited CPX
2.4. Calculation of the Chronotropic Index
2.5. Statistical Analysis
3. Results
4. Discussion
4.1. Selecting Beta-Blocker Type for Subacute MI Patients
4.2. Differences in HR Response During CPX Among Subacute MI Patients Undergoing αβ-Blocker Versus β1-Blocker Treatment
4.3. Effects of αβ-Blocker Versus β1-Blocker Treatment on HR Response During CPX in Subacute MI Patients After Adjusting for Multiple Factors
4.4. Beta-Blocker Doses
4.5. Clinical Application of Study Findings
4.6. Limitations
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Clinical Characteristics | αβ-Blocker Group (n = 67) | β1-Blocker Group (n = 17) | No-β-Blocker Group (n = 47) | p-Value |
---|---|---|---|---|
Age (years) | 64.98 ± 10.48 | 61.59 ± 8.91 | 61.62 ± 10.83 | 0.184 |
Body mass index (kg/m2) | 23.44 ± 2.78 | 23.58 ± 3.27 | 23.12 ± 3.10 | 0.804 |
MI | 0.621 | |||
Inferior | 23 (37.3) | 7 (41.2) | 24 (51.1) | |
Anterior | 34 (50.8) | 9 (52.9) | 19 (40.4) | |
Lateral | 8 (11.9) | 1 (5.9) | 4 (8.5) | |
Residual coronary artery stenosis | 30 (44.9) | 11 (64.7) | 19 (40.4) | 0.221 |
Medical history | ||||
Prior MI | 4 (5.8) | 2 (11.8) | 4 (8.5) | 0.696 |
Hypertension | 48 (71.6) | 13 (76.5) | 31 (66.0) | 0.673 |
Dyslipidemia | 39 (58.2) | 12 (70.6) | 30 (63.8) | 0.605 |
Chronic kidney disease | 7 (10.5) | 2 (11.8) | 6 (12.8) | 0.929 |
Diabetes mellitus | 19 (28.4) | 4 (23.5) | 19 (40.4) | 0.287 |
Orthopedic disorder | 2 (3.0) | 1 (6.3) | 0 (0) | 0.309 |
Cerebrovascular disease | 1 (1.5) | 0 (0) | 3 (6.4) | 0.241 |
Respiratory disease | 2 (3.0) | 0 (0) | 1 (2.1) | 0.760 |
Hyperuricemia | 7 (10.5) | 3 (17.7) | 8 (17.0) | 0.533 |
Peripheral arterial disease | 1 (1.5) | 1 (5.9) | 1 (2.1) | 0.555 |
Dementia | 0 (0) | 0 (0) | 1 (2.1) | 0.406 |
Heart failure after MI | 6 (9.0) | 1 (5.9) | 5 (10.6) | 0.841 |
Medication | ||||
Diuretic | 9 (13.4) | 2 (11.8) | 4 (8.5) | 0.718 |
Renin-angiotensin system inhibitor | 63 (94.0) | 12 (70.6) | 41 (87.2) | 0.024 |
Calcium antagonist | 12 (17.9) | 1 (5.9) | 3 (6.4) | 0.125 |
Aldosterone antagonist | 5 (7.5) | 3 (17.6) | 2 (4.3) | 0.204 |
Anticlotting drug | 2 (3.0) | 1 (5.9) | 1 (2.1) | 0.742 |
Antiplatelet drug | 67 (100) | 17 (100) | 47 (100) | 1.00 |
αβ-blocker, Carvedilol | 67 (100) | - | - | - |
β1-blocker, Bisoprolol/Atenolol | - | 11 (64.7)/6 (35.3) | - | - |
Beta-blocker dose | ||||
Carvedilol (mg/day) | 5.48 ± 2.99 | - | - | - |
Bisoprolol/Atenolol (mg/day) | - | 2.50 ± 1.40/33.33 ± 12.91 | - | - |
% maximum dose of beta-blocker (%) | 27.41 ± 14.94 | 44.12 ± 24.65 | - | <0.001 |
Max CK-MB (ng/ml) | 306.70 ± 228.05 | 232.01 ± 214.07 | 275.43 ± 225.89 | 0.477 |
Log max CK-MB | 5.40 ± 0.90 | 5.03 ± 1.08 | 5.18 ± 0.10 | 0.262 |
LVEF (%) | 52.91 ± 8.81 | 57.94 ± 13.60 | 54.34 ± 12.28 | 0.230 |
Time between MI and CPX (days) | 32.09 ± 11.50 | 27.76 ± 8.72 | 31.19 ± 12.35 | 0.387 |
Hospitalization before 2006 | 7 (10.4%) | 10 (58.8%) | 40 (85.1%) | <0.001 |
Cardiopulmonary Exercise Testing Data | β-Blocker Group (n = 67) | β1-Blocker Group (n = 17) | No-β-Blocker Group (n = 47) | F-Value | p-Value |
---|---|---|---|---|---|
Average time of exercise (min) | 7.03 ± 1.57 | 7.27 ± 1.63 | 7.53 ± 1.61 | 1.372 | 0.402 |
AT (ml/kg/min) | 15.92 ± 3.24 | 14.72 ± 2.24 | 15.91 ± 2.73 | 1.226 | 0.297 |
Peak VO2 (ml/kg/min) | 23.27 ± 5.32 | 21.47 ± 3.72 | 23.66 ± 4.42 | 1.302 | 0.276 |
RERAT | 0.89 ± 0.05 | 0.89 ± 0.05 | 0.89 ± 0.07 | 0.033 | 0.968 |
RERpeak | 1.20 ± 0.07 | 1.20 ± 0.07 | 1.18 ± 0.06 | 2.086 | 0.128 |
HRrest (bpm) | 71.49 ± 9.86 †† | 66.65 ± 11.14 †† | 79.02 ± 11.39 | 11.147 | <0.001 |
HRAT (bpm) | 105.76 ± 11.19 ‡‡ | 95.47 ± 10.20 †† | 111.19 ± 12.24 § | 11.940 | <0.001 |
HRpeak (bpm) | 138.76 ± 14.59 ‡‡ | 123.77 ± 18.80 †† | 148.38 ± 16.21 §§ | 15.865 | <0.001 |
SBPrest (mmHg) | 127.43 ± 16.14 † | 129.77 ± 18.91 | 119.64 ± 17.23 | 3.734 | 0.027 |
SBPAT (mmHg) | 158.49 ± 21.23 | 151.77 ± 27.66 | 149.30 ± 29.78 | 1.904 | 0.153 |
SBPpeak (mmHg) | 185.93 ± 28.23 | 180.00 ± 29.19 | 183.40 ± 32.46 | 0.295 | 0.745 |
DBPrest (mmHg) | 77.03 ± 12.16 | 84.29 ± 10.73 †† | 74.02 ± 10.39 | 5.099 | 0.007 |
DBPAT (mmHg) | 76.00 ± 17.21 | 80.24 ± 10.13 | 76.81 ± 11.83 | 0.575 | 0.564 |
DBPpeak (mmHg) | 84.51 ± 18.20 | 85.65 ± 15.96 | 82.77 ± 12.83 | 0.2576 | 0.773 |
ΔAT HR (bpm) | 34.27 ± 8.79 ‡ | 28.82 ± 8.10 | 32.17 ± 7.76 | 3.098 | 0.049 |
Δpeak HR (bpm) | 67.27 ± 13.43 ‡ | 57.12 ± 13.97 † | 69.36 ± 16.44 | 4.464 | 0.013 |
ΔAT-peak HR (bpm) | 32.76 ± 9.99 | 28.29 ± 11.46 † | 37.41 ± 12.11 | 4.965 | 0.008 |
MCR-AT | 0.85 ± 0.07 ‡‡ | 0.77 ± 0.07 †† | 0.87 ± 0.07 | 13.122 | <0.001 |
MCR-peak | 0.90 ± 0.08 ‡‡ | 0.78 ± 0.11 †† | 0.94 ± 0.09 § | 19.205 | <0.001 |
Independent Variables | Dependent Variable: MCR-AT | |||
---|---|---|---|---|
B ± SE | β | 95% CI of B | p-Value | |
Inferior infarct * | −0.002 ± 0.012 | −0.025 | −0.025 to 0.021 | 0.865 |
Anterior infarct * | −0.001 ± 0.011 | −0.001 | −0.023 to 0.022 | 0.946 |
Residual coronary artery stenosis | −0.009 ± 0.007 | −0.117 | −0.022 to 0.004 | 0.170 |
Heart failure after MI | −0.007 ± 0.011 | −0.053 | −0.029 to 0.015 | 0.518 |
Diabetes mellitus | 0.001 ± 0.007 | 0.016 | −0.012 to 0.015 | 0.836 |
Renin-angiotensin system inhibitor | −0.004 ± 0.010 | −0.031 | −0.025 to 0.017 | 0.719 |
αβ-blocker treatment ** | −0.008 ± 0.010 | −0.108 | −0.028 to 0.011 | 0.394 |
β1-blocker treatment ** | −0.050 ± 0.011 | −0.432 | −0.071 to −0.028 | <0.001 |
Hospitalization before 2006 | 0.000 ± 0.001 | 0.003 | −0.018 to 0.018 | 0.979 |
Constant | 0.807 ± 0.016 | 0.000 | 0.776 to 0.839 | <0.001 |
Coefficient of determination R2 = 0.187, F = 3.092, p = 0.002 |
Independent Variables | Dependent Variable: MCR-Peak | |||
---|---|---|---|---|
B ± SE | β | 95% CI of B | p-Value | |
Inferior infarct * | −0.002 ± 0.015 | −0.017 | −0.031 to 0.027 | 0.907 |
Anterior infarct * | −0.001 ± 0.001 | −0.007 | −0.029 to 0.028 | 0.962 |
Residual coronary artery stenosis | −0.012 ± 0.008 | −0.114 | −0.028 to 0.005 | 0.166 |
Heart failure after MI | 0.002 ± 0.015 | 0.012 | −0.026 to 0.031 | 0.883 |
Diabetes mellitus | 0.004 ± 0.009 | 0.038 | −0.013 to 0.021 | 0.642 |
Log max CK-MB | 0.018 ± 0.024 | 0.067 | −0.029 to 0.064 | 0.449 |
LVEF | −0.027 ± 0.025 | −0.100 | −0.077 to 0.021 | 0.266 |
Renin-angiotensin system inhibitor | 0.003 ± 0.013 | 0.021 | −0.023 to 0.030 | 0.800 |
αβ-blocker treatment ** | −0.019 ± 0.012 | −0.185 | −0.043 to 0.006 | 0.134 |
β1-blocker treatment ** | −0.071 ± 0.014 | −0.473 | −0.099 to −0.044 | <0.001 |
Hospitalization before 2006 | −0.004 ± 0.012 | −0.043 | −0.019 to 0.027 | 0.706 |
Constant | 0.844 ± 0.020 | 0.000 | 0.840 to 0.884 | <0.001 |
Coefficient of determination R2 = 0.263, F = 3.865, p < 0.001 |
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Nemoto, S.; Kasahara, Y.; Izawa, K.P.; Watanabe, S.; Yoshizawa, K.; Takeichi, N.; Kamiya, K.; Suzuki, N.; Omiya, K.; Matsunaga, A.; et al. Effects of αβ-Blocker Versus β1-Blocker Treatment on Heart Rate Response During Incremental Cardiopulmonary Exercise in Japanese Male Patients with Subacute Myocardial Infarction. Int. J. Environ. Res. Public Health 2019, 16, 2838. https://doi.org/10.3390/ijerph16162838
Nemoto S, Kasahara Y, Izawa KP, Watanabe S, Yoshizawa K, Takeichi N, Kamiya K, Suzuki N, Omiya K, Matsunaga A, et al. Effects of αβ-Blocker Versus β1-Blocker Treatment on Heart Rate Response During Incremental Cardiopulmonary Exercise in Japanese Male Patients with Subacute Myocardial Infarction. International Journal of Environmental Research and Public Health. 2019; 16(16):2838. https://doi.org/10.3390/ijerph16162838
Chicago/Turabian StyleNemoto, Shinji, Yusuke Kasahara, Kazuhiro P. Izawa, Satoshi Watanabe, Kazuya Yoshizawa, Naoya Takeichi, Kentaro Kamiya, Norio Suzuki, Kazuto Omiya, Atsuhiko Matsunaga, and et al. 2019. "Effects of αβ-Blocker Versus β1-Blocker Treatment on Heart Rate Response During Incremental Cardiopulmonary Exercise in Japanese Male Patients with Subacute Myocardial Infarction" International Journal of Environmental Research and Public Health 16, no. 16: 2838. https://doi.org/10.3390/ijerph16162838