Acute hemodynamic effects of beta-blockers in patients with severe congestive heart failure: Comparison of celiprolol and esmolol

The present study was designed to investigate, in patients with severe hear t failure, the dose-dependent acute hemodynamic effects of celiprolol versu s those of esmolol. Celiprolol is a beta (1)-receptor blocker with vasodila ting properties, whereas esmolol is an ultra-short-acting beta (1)-blocker. Included were 14 patients with decompensated chronic heart failure (NYHA c lass IV) due to coronary heart disease (n = 8) or to dilated cardiomyopathy (n = 6). Each patient received both celiprolol and esmolol in random fashi on. The beta -blockers were administered in four dose tiers, with an increa se in dosage every 15 min. Hemodynamic measurements were obtained with a Sw an-Ganz thermodilution catheter. Administration of celiprolol (5, 10, 20, a nd 50 mug/kg) took place intravenously. After intravenous administration of a loading dose of 500 mug/kg, we continuously infused esmolol at increasin g doses, which were individually titrated for each patient. Mean infusion r ates of esmolol were as follows: 40, 75, 140, and 230 mu mol/kg per minute. Celiprolol and esmolol induced a comparable dose-dependent decrease in hea rt rate to a minimum of -10% below baseline. Esmolol caused a significant d ose-dependent decrease (-25% below baseline at the highest dose level) in c ardiac index (CI). After administration of celiprolol, CI decreased only tr ansiently (-10% below baseline at the second and third dose level) and did not differ from the baseline at the highest dose level. For treatment of se vere heart failure, initiation of intravenous beta -blocker therapy with lo w doses of a beta (1)-blocker with vasodilating effects may have hemodynami c advantages over conventional beta -blockade.