Beta-blockade in the management of systolic dysfunction

Heart failure is a clinical syndrome that results from systolic or diastolic cardiac dysfunction. Management of systolic heart failure has traditionally focused on the hemodynamic derangements associated with this disorder. In this conceptual framework, beta-adrenergic antagonists (BAAS) were thought to be contraindicated, because acute negative effects on cardiac performance result when the failing heart is deprived of adrenergic support. Current evidence supports the view that chronic activation of the adrenergic nervous system is maladaptive and partly responsible for the progression of myocardial dysfunction. In fact, the efficacy of BAAS in the management of people with heart failure caused by systolic dysfunction has been convincingly demonstrated in a number of randomized clinical trials (RCTs). Although there is reason to believe that this therapeutic avenue holds promise for veterinary patients, evidence of clinical efficacy is currently lacking. This review addresses the pathophysiologic basis for the use of BAAS in heart failure and the potential role of BAAS in veterinary patients with systolic dysfunction.