Benefit of betablockers in patients with heart failure and right ventricular dysfunction: insights from the FRESH multicentre study

Background The benefit of betablockers (BB) on mortality in patients with heart failure (HF) has been widely demonstrated. Yet, there are conflicting data regarding the interest of BB in patients with HF and right ventricular (RV) dysfunction. Aims To investigate if BB may be harmfull in patients with HF and RV dysfunction. Methods For this analysis, all patients with HF included in the prospective multicentric FRESH cohort with available data on both RV function and BB intake (regardless of the dose) were included in this analysis. RV dysfunction was defined as tricuspid annular plane systolic excursion (TAPSE) lower than 17 mm and/or peak tricuspid S wave (S wave) < 9.5 cm/s on echocardiography. Severe RV dysfunction was defined as TAPSE < 13 mm and/or Swave < 7 cm/s. The primary endpoint was 1-year all-cause death. Results Overall, n=747 patients with HF (33% de novo) were included in this analysis: median age 67 (56, 77) yo, 73% of men, 62% with HF and reduced ejection fraction (HFrEF), 53% were NYHA I-II and 61% had history of HF hospitalization. The primary endpoint occured in 107/747 (14%) patients. 71% and 33% had RV dysfunction and severe RV dysfunction, respectively. Patients with RV dysfunction were more likely to have a history of atrial fibrillation (p<0.001), prior HF hospitalization (p=0.001), and in NYHA functional class III-IV (p<0.001). The proportion of BB prescription was similar in patients with or without RV dysfunction (80% vs 86%, p=0.06). In patients with RV dysfunction, after adjustment with age, sexe, left ventricular ejection fraction, prior hospitalization for HF, BB prescription remained associated with better survival: HR=0.55, 95%CI[0.38, 0.79], p=0.001). Results were similar in patients with severe RV dysfunction: HR=0.56, 95%CI[0.34-0.94], p=0.03. Among patients with RV dysfunction (or severe RV dysfunction), those without BB had worse survival (Figure). Conclusion Our results suggest that, even in case or severe RV dysfunction, beta-blockers prescription is associated with better survival in patients with heart failure. This reinforces the interest of this therapeutic class, regardless of RV function in patients with HF, when indicated.1-year survival1-year survival