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

Pierantonio Laveneziana, Piergiuseppe Agostoni, Andrea Mignatti, Saima Mushtaq, Paolo Colombo, Daniel Sims, Nir Uriel, Ulrich P. Jorde

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Background: This 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 Results: Seventeen 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. Conclusion: Acute 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.

Original languageEnglish (US)
Pages (from-to)548-555
Number of pages8
JournalJournal of Cardiac Failure
Issue number7
StatePublished - Jul 2010
Externally publishedYes


  • chronic heart failure
  • exercise capacity
  • ventilatory efficiency
  • β-blocker

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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