Effect of Acute β-blocker Withholding on Ventilatory Efficiency in Patients With Advanced Chronic Heart Failure

BackgroundThis is the first study to examine the effect of acute (24-hour) β-blocker withholding on ventilatory efficiency in patients with advanced chronic heart failure (CHF) during maximal incremental treadmill cardiopulmonary exercise test.Methods and ResultsSeventeen CHF patients were studied either 3 hours after administration of β-blocker (BBON) or 27 hours after the last β-blocker ingestion (BBOFF). The ventilatory efficiency was measured via the slope of the linear relationship between ventilation (V′E) and carbon dioxide production (V′CO2) (ie, V′E/V′CO2 slope). Measurements were also made at rest, anaerobic threshold (AT), maximal end-tidal pressure for carbon dioxide (PETCO2max), respiratory compensation point (RC), and peak exercise. Compared with BBON, the V′E/V′CO2 slope was significantly increased during BBOFF (30.8 ± 7.4 vs. 29.1 ± 5.4, P = .04). At peak exercise, oxygen uptake (V′O2, 16.0 ± 2.7 vs. 15.6 ± 2.8 mL·kg·min) and V′CO2 (1458 ± 459 vs. 1414 ± 429 mL/min) were not different between the 2 conditions, whereas V′E was higher during BBOFF (49.5 ± 10.7 vs. 46.1 ± 9.6 L/min, P = .04). No differences were noted at AT and RC in V′O2, V′CO2, V′E, V′E/V′O2, and V′E/V′CO2 ratios during the 2 conditions. At PETCO2max, used to noninvasively estimate the CO2 set point, V′E was higher (33.9 ± 7.6 vs. 31.7 ± 7.3 L/min, P = .002) and PETCO2 was lower (37.4 ± 4.8 vs. 38.5 ± 4.0 mm Hg, P = .03), whereas V′CO2 was unchanged (1079 ± 340 vs. 1050 ± 322 mL/min) during BBOFF.ConclusionAcute β-blocker withholding resulted in decreased ventilatory efficiency mostly from an increase of V′CO2-independent regulation of V′E and less likely from a change in ventilation/perfusion mismatching.