Can the Use of ?-Adrenergic Blockers for Treatment of HFpEF Worsen Diastolic Dysfunction? - A Review Based on Concept of MyBP-C

Muhammad Nabeel Dookhun, Pooja Doseiah, Yunshan Cao, Ji-Nan Zhang, Xin-Zheng Lu


Heart failure can be classified based on ejection fraction as reduced Heart Failure Reduced Ejection Fraction (HFrEF), moderate Heart Failure Moderate Ejection Fraction (HFmEF) and preserved Heart Failure Preserved Ejection Fraction (HFpEF). Indeed, use of beta-blockers in Heart Failure (HF) reduces mortality and morbidity. However, the controversial effect of the use of beta-blockers in HFpEF is of great concern. HFpEF is associated with a high mortality and hospitalization rate probably due to lack of evidence-based treatment. Hence a proper understanding behind the pathophysiologic mechanism of HFpEF is important. Recently Myosin Binding Protein C (MyBP-C), a cardiac-specific protein, has been shown to be involved in various cardiac pathologic conditions. Phosphorylation of MyBP-C is crucial for normal systolic and diastolic heart function. A failing heart is associated with hypophosphorylation of MyBP-C. Use of beta-blockers in HFpEF would prevent ?-Adrenergic stimulation of MyBP-C by Protein Kinase A (PKA) and can worsen diastolic dysfunction in HFpEF.


HFpEF; heart failure; beta-blocker; MyBP-C.

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