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Bundgaard H, Axelsson Raja A, Iversen K, Valeur N, Tønder N, Schou M, Christensen AH, Bruun NE, Søholm H, Ghanizada M, Fry NAS, Hamilton EJ, Boesgaard S, Møller MB, Wolsk E, Rossing K, Køber L, Rasmussen HH, Vissing CR. Hemodynamic Effects of Cyclic Guanosine Monophosphate-Dependent Signaling Through β3 Adrenoceptor Stimulation in Patients With Advanced Heart Failure: A Randomized Invasive Clinical Trial. Circ Heart Fail 2022; 15:e009120. [PMID: 35758031 DOI: 10.1161/circheartfailure.121.009120] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND β3-AR (β3-adrenergic receptor) stimulation improved systolic function in a sheep model of systolic heart failure (heart failure with reduced ejection fraction [HFrEF]). Exploratory findings in patients with New York Heart Association functional class II HFrEF treated with the β3-AR-agonist mirabegron supported this observation. Here, we measured the hemodynamic response to mirabegron in patients with severe HFrEF. METHODS In this randomized, double-blind, placebo-controlled trial we assigned patients with New York Heart Association functional class III-IV HFrEF, left ventricular ejection fraction <35% and increased NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels to receive mirabegron (300 mg daily) or placebo orally for a week, as add on to recommended HF therapy. Invasive hemodynamic measurements during rest and submaximal exercise at baseline, 3 hours after first study dose and repeated after 1 week's treatment were obtained. Predefined parameters for analyses were changes in cardiac- and stroke volume index, pulmonary and systemic vascular resistance, heart rate, and blood pressure. RESULTS We randomized 22 patients (age 66±11 years, 18 men, 16, New York Heart Association functional class III), left ventricular ejection fraction 20±7%, median NT-proBNP 1953 ng/L. No significant changes were seen after 3 hours, but after 1 week, there was a significantly larger increase in cardiac index in the mirabegron group compared with the placebo group (mean difference, 0.41 [CI, 0.07-0.75] L/min/BSA; P=0.039). Pulmonary vascular resistance decreased significantly more in the mirabegron group compared with the placebo group (-1.6 [CI, -0.4 to -2.8] Wood units; P=0.02). No significant differences were seen during exercise. There were no differences in changes in heart rate, systemic vascular resistance, blood pressure, or renal function between groups. Mirabegron was well-tolerated. CONCLUSIONS Oral treatment with the β3-AR-agonist mirabegron for 1 week increased cardiac index and decreased pulmonary vascular resistance in patients with moderate to severe HFrEF. Mirabegron may be useful in patients with worsening or terminal HF. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: 2016-002367-34.
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Affiliation(s)
- Henning Bundgaard
- Department of Cardiology, Rigshospitalet (H.B., A.A.R., A.H.C., H.S., M.G., S.B., M.B.M, E.W., K.R., L.K., C.R.V.), Copenhagen University Hospital, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark (H.B., A.A.R., K.I., N.V., N.T., M.S., A.H.C., N.E.B., H.S., M.G., S.B., M.B.M., E.W., K.R., L.K., H.H.R., C.R.V.)
| | - Anna Axelsson Raja
- Department of Cardiology, Rigshospitalet (H.B., A.A.R., A.H.C., H.S., M.G., S.B., M.B.M, E.W., K.R., L.K., C.R.V.), Copenhagen University Hospital, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark (H.B., A.A.R., K.I., N.V., N.T., M.S., A.H.C., N.E.B., H.S., M.G., S.B., M.B.M., E.W., K.R., L.K., H.H.R., C.R.V.)
| | - Kasper Iversen
- Department of Cardiology, Herlev-Gentofte Hospital (K.I., M.S., A.H.C., E.W.), Copenhagen University Hospital, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark (H.B., A.A.R., K.I., N.V., N.T., M.S., A.H.C., N.E.B., H.S., M.G., S.B., M.B.M., E.W., K.R., L.K., H.H.R., C.R.V.)
| | - Nana Valeur
- Department of Cardiology, Bispebjerg Hospital (N.V.), Copenhagen University Hospital, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark (H.B., A.A.R., K.I., N.V., N.T., M.S., A.H.C., N.E.B., H.S., M.G., S.B., M.B.M., E.W., K.R., L.K., H.H.R., C.R.V.)
| | - Niels Tønder
- Department of Cardiology, North Zealand Hospital (N.T.), Copenhagen University Hospital, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark (H.B., A.A.R., K.I., N.V., N.T., M.S., A.H.C., N.E.B., H.S., M.G., S.B., M.B.M., E.W., K.R., L.K., H.H.R., C.R.V.)
| | - Morten Schou
- Department of Cardiology, Herlev-Gentofte Hospital (K.I., M.S., A.H.C., E.W.), Copenhagen University Hospital, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark (H.B., A.A.R., K.I., N.V., N.T., M.S., A.H.C., N.E.B., H.S., M.G., S.B., M.B.M., E.W., K.R., L.K., H.H.R., C.R.V.)
| | - Alex Hørby Christensen
- Department of Cardiology, Rigshospitalet (H.B., A.A.R., A.H.C., H.S., M.G., S.B., M.B.M, E.W., K.R., L.K., C.R.V.), Copenhagen University Hospital, Denmark.,Department of Cardiology, Herlev-Gentofte Hospital (K.I., M.S., A.H.C., E.W.), Copenhagen University Hospital, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark (H.B., A.A.R., K.I., N.V., N.T., M.S., A.H.C., N.E.B., H.S., M.G., S.B., M.B.M., E.W., K.R., L.K., H.H.R., C.R.V.)
| | - Niels Eske Bruun
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (N.E.B., H.S.).,Department of Clinical Medicine, University of Copenhagen, Denmark (H.B., A.A.R., K.I., N.V., N.T., M.S., A.H.C., N.E.B., H.S., M.G., S.B., M.B.M., E.W., K.R., L.K., H.H.R., C.R.V.)
| | - Helle Søholm
- Department of Cardiology, Rigshospitalet (H.B., A.A.R., A.H.C., H.S., M.G., S.B., M.B.M, E.W., K.R., L.K., C.R.V.), Copenhagen University Hospital, Denmark.,Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (N.E.B., H.S.).,Department of Clinical Medicine, University of Copenhagen, Denmark (H.B., A.A.R., K.I., N.V., N.T., M.S., A.H.C., N.E.B., H.S., M.G., S.B., M.B.M., E.W., K.R., L.K., H.H.R., C.R.V.)
| | - Muzhda Ghanizada
- Department of Cardiology, Rigshospitalet (H.B., A.A.R., A.H.C., H.S., M.G., S.B., M.B.M, E.W., K.R., L.K., C.R.V.), Copenhagen University Hospital, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark (H.B., A.A.R., K.I., N.V., N.T., M.S., A.H.C., N.E.B., H.S., M.G., S.B., M.B.M., E.W., K.R., L.K., H.H.R., C.R.V.)
| | - Natasha A S Fry
- Department of Cardiology, Royal North Shore Hospital, and University of Sydney, Australia (N.A.S.F., E.J.H., H.H.R.)
| | - Elisha J Hamilton
- Department of Cardiology, Royal North Shore Hospital, and University of Sydney, Australia (N.A.S.F., E.J.H., H.H.R.)
| | - Søren Boesgaard
- Department of Cardiology, Rigshospitalet (H.B., A.A.R., A.H.C., H.S., M.G., S.B., M.B.M, E.W., K.R., L.K., C.R.V.), Copenhagen University Hospital, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark (H.B., A.A.R., K.I., N.V., N.T., M.S., A.H.C., N.E.B., H.S., M.G., S.B., M.B.M., E.W., K.R., L.K., H.H.R., C.R.V.)
| | - Mathias B Møller
- Department of Cardiology, Rigshospitalet (H.B., A.A.R., A.H.C., H.S., M.G., S.B., M.B.M, E.W., K.R., L.K., C.R.V.), Copenhagen University Hospital, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark (H.B., A.A.R., K.I., N.V., N.T., M.S., A.H.C., N.E.B., H.S., M.G., S.B., M.B.M., E.W., K.R., L.K., H.H.R., C.R.V.)
| | - Emil Wolsk
- Department of Cardiology, Rigshospitalet (H.B., A.A.R., A.H.C., H.S., M.G., S.B., M.B.M, E.W., K.R., L.K., C.R.V.), Copenhagen University Hospital, Denmark.,Department of Cardiology, Herlev-Gentofte Hospital (K.I., M.S., A.H.C., E.W.), Copenhagen University Hospital, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark (H.B., A.A.R., K.I., N.V., N.T., M.S., A.H.C., N.E.B., H.S., M.G., S.B., M.B.M., E.W., K.R., L.K., H.H.R., C.R.V.)
| | - Kasper Rossing
- Department of Cardiology, Rigshospitalet (H.B., A.A.R., A.H.C., H.S., M.G., S.B., M.B.M, E.W., K.R., L.K., C.R.V.), Copenhagen University Hospital, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark (H.B., A.A.R., K.I., N.V., N.T., M.S., A.H.C., N.E.B., H.S., M.G., S.B., M.B.M., E.W., K.R., L.K., H.H.R., C.R.V.)
| | - Lars Køber
- Department of Cardiology, Rigshospitalet (H.B., A.A.R., A.H.C., H.S., M.G., S.B., M.B.M, E.W., K.R., L.K., C.R.V.), Copenhagen University Hospital, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark (H.B., A.A.R., K.I., N.V., N.T., M.S., A.H.C., N.E.B., H.S., M.G., S.B., M.B.M., E.W., K.R., L.K., H.H.R., C.R.V.)
| | - Helge H Rasmussen
- Department of Cardiology, Royal North Shore Hospital, and University of Sydney, Australia (N.A.S.F., E.J.H., H.H.R.).,Department of Clinical Medicine, University of Copenhagen, Denmark (H.B., A.A.R., K.I., N.V., N.T., M.S., A.H.C., N.E.B., H.S., M.G., S.B., M.B.M., E.W., K.R., L.K., H.H.R., C.R.V.)
| | - Christoffer Rasmus Vissing
- Department of Cardiology, Rigshospitalet (H.B., A.A.R., A.H.C., H.S., M.G., S.B., M.B.M, E.W., K.R., L.K., C.R.V.), Copenhagen University Hospital, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark (H.B., A.A.R., K.I., N.V., N.T., M.S., A.H.C., N.E.B., H.S., M.G., S.B., M.B.M., E.W., K.R., L.K., H.H.R., C.R.V.)
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