Beta-blockers are associated with reverse remodeling in patients with dilated cardiomyopathy and mid-range ejection fraction

Background:Beta-blockers have been shown to induce left ventricular reverse remodeling (LVRR) in heart failure with reduced ejection fraction. This study aimed to determine whether beta-blockers could induce LVRR in patients with heart failure with mid-range ejection fraction (HFmrEF). Methods:We analyzed the national database from clinical personal records of dilated cardiomyopathy (DCM) maintained by Japanese Ministry of Health, Labour and Welfare, between 2003 and 2014. Patients with left ventricular ejection fraction (LVEF) of ≥40% and < 50% were included. Patients who did not have echocardiography at 2 years of follow-up were excluded. Eligible patients were divided into two groups according to the use of beta-blockers. Patient characteristics of two groups were adjusted by propensity score matching. The primary outcome was LVRR at 2 years of follow-up, defined as an improvement in LVEF ≥10%. Results:Out of 3064 patients, propensity score matching yielded 602 pairs. The mean age was 59.3 years and 896 patients (74.4%) were male. The primary outcome was observed more frequently in beta-blocker group (24.3% vs. 17.8%; Odds ratio [OR], 1.48; 95% confidence interval [CI], 1.12-1.96; P = 0.006). Subgroup analysis demonstrated that patients with heart rate ≥ 75 bpm (≥ 75 bpm; OR, 2.61; 95% CI, 1.66-4.11: < 75 bpm; OR, 1.03; 95% CI, 0.72-1.48; P for interaction = 0.002) and atrial fibrillation (AF) (AF; OR, 2.30; 95% CI, 1.37-3.86: No AF; OR 1.23; 95% CI, 0.88-1.72; P for interaction = 0.046) were benefited by beta-blockers. Conclusions:Beta-blockers could induce LVRR in patients with DCM and HFmrEF.