Beta-blockade improves right ventricular diastolic function in exercising pulmonary arterial hypertension

Right ventricular (RV) function is a main determinant of outcome in pulmonary arterial hypertension (PAH) [1]. Increased neuro-humoral activation associated with decreased survival in PAH may worsen RV adaptation to increased afterload [2, 3]. There is rationale therefore for the use of β-blockers in PAH especially given their beneficial effect on RV function in experimental PAH models [4, 5]. Small clinical studies in PAH using bisoprolol and carvedilol have demonstrated acceptable patient tolerance, however no change in exercise capacity was seen and concerningly, resting cardiac output (CO) decreased despite unchanged or even mild improvement in RV ejection fraction (EF) [6, 7]. Moreover, in exercising PAH, associated with impaired RV adaptation to high afterload, acute effects of β-blockers on the RV are unstudied. In the present study, we reasoned that the acute administration of β-blockers in PAH patients might improve RV diastolic filling as has been observed in experimental PAH [5] and accordingly contribute to preservation of coupling of RV function to the pulmonary circulation during exercise. Footnotes This manuscript has recently been accepted for publication in the European Respiratory Journal . It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article. Conflict of Interest: Pierre-Régis Burgel reports support for the present work from Vaincre la Mucoviscidose. Pierre-Régis Burgel reports grants from Boehringer Ingelheim, GSK, Vertex; consulting fees and lecture honoraria from Boehringer Ingelheim, GSK, AstraZeneca, Vertex, Chiesi, Pfizer, Novartis, Zambon, Insmed; outside the submitted work. Conflict of Interest: All authors have nothing to disclose.