Dissociation between exercise hemodynamics and exercise capacity in patients with chronic heart failure and marked increase in election fraction after treatment with beta-adrenergic receptor antagonists

Previous studies have demonstrated that long-term treatment with beta-adrenergic antagonists does not increase exercise capacity in patients with heart failure (HF), despite improvements in hemodynamics at rest and left ventricular ejection fraction (LVEF) at rest.(1) Long-term beta-adrenergic receptor antagonist therapy in subjects with systolic dysfunction increases EF by an average of 8 absolute percentages.(2) Subgroups of patients with chronic HF and severe systolic dysfunction have experienced ventricular recovery after long-term therapy with beta-adrenergic receptor antagonists, with much higher than average increases in EF.(3) This study population provides an opportunity to assess the longterm effect of improved systolic function on exercise capacity in subjects with HE The present report compares the hemodynamic response to maximal exercise in patients with marked increases in EF after treatment with beta-adrenergic receptor antagonists with patients with persistent, severe LV systolic dysfunction after long-term therapy with beta-adrenergic receptor antagonists.