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      The β-Adrenergic Agonist Albuterol Improves Pulmonary Vascular Reserve in Heart Failure with Preserved Ejection Fraction: A Randomized Controlled Trial

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          Abstract

          Rationale:

          Pulmonary vascular resistance (PVR) fails to decrease appropriately during exercise in patients with heart failure with preserved ejection fraction (HFpEF). Interventions that enhance pulmonary vasodilation might be beneficial in this cohort, but could also worsen left atrial hypertension, exacerbating lung congestion. Intravenous β-agonists reduce PVR, but are not suitable for chronic use.

          Objective:

          We hypothesized that the inhaled β-adrenergic agonist albuterol would improve pulmonary vasodilation during exercise in patients with HFpEF, without increasing left heart filling pressures.

          Methods and Results:

          We performed a randomized, double blind, placebo-controlled trial testing the effects of inhaled albuterol on resting and exercise hemodynamics in subjects with HFpEF using high fidelity micromanometer catheters and expired-gas analysis. The primary end point was PVR during exercise. Subjects with HFpEF (n=30) underwent resting and exercise hemodynamic assessment and were then randomized 1:1 to inhaled, nebulized albuterol or placebo. Rest and exercise hemodynamic testing was then repeated. Albuterol improved the primary endpoint of exercise PVR as compared to placebo (−0.6±0.5 vs +0.1±0.7 Wood units, p=0.003). Albuterol enhanced cardiac output reserve and right ventricular-pulmonary artery coupling, reduced right atrial and pulmonary artery pressures, improved pulmonary artery compliance, and enhanced left ventricular transmural distending pressure (all p<0.01), with no increase in pulmonary capillary hydrostatic pressures.

          Conclusions:

          Albuterol improves pulmonary vascular reserve in patients with HFpEF without worsening left heart congestion. Further study is warranted to evaluate the chronic efficacy of β-agonists in HFpEF as well as other forms of pulmonary hypertension.

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          Author and article information

          Journal
          0047103
          2974
          Circ Res
          Circ. Res.
          Circulation research
          0009-7330
          1524-4571
          30 October 2018
          18 January 2019
          18 January 2020
          : 124
          : 2
          : 306-314
          Affiliations
          The Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN 55906
          Author notes
          Address correspondence to: Dr. Barry A. Borlaug, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, Tel: 507-255-4152, Fax: 507-266-0228, borlaug.barry@ 123456mayo.edu
          Article
          PMC6336508 PMC6336508 6336508 nihpa1511117
          10.1161/CIRCRESAHA.118.313832
          6336508
          30582447
          bf33340f-3aef-4cf8-9243-4f8759a3fa14
          History
          Categories
          Article

          Heart Failure,Hemodynamics,Treatment,Pulmonary vascular disease,beta agonist,treatment,HFpEF,Pulmonary Hypertension,pulmonary hypertension,albuterol,heart failure,Pathophysiology,exercise,hemodynamics

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