Beta 3 Agonist Treatment in Heart Failure

Inclusion criteria

• Stable heart failure NYHA class II-III on ischemic or non-ischemic basis
• Left ventricular ejection fraction (LVEF) < 40%
• Stable sinus rhythm (SR)
• On optimised evidence-based pharmacological HF treatment stable > 4 weeks with no current plan for changing HF therapy. The therapy must include a beta-blocker.
• No change in diuretics < 4 weeks
• >18 years

Exclusion criteria

• Unstable cardiac condition
• Acute myocardial infarction (AMI) or revascularisation < 3 month ago
• Atrial fibrillation (for technical reasons in relation to imaging and HR reporting)
• Uncorrected significant primary obstructive valve disease
• Planned major surgery including cardiac revascularisation
• Hemodynamically significant obstructive cardiomyopathy
• Stroke with significant neurological deficit
• Acute myocarditis or constrictive pericarditis
• Symptomatic bradycardia or > 1. degree AV-block unless the patient has a pacemaker
• Clinically significant hepatic (transaminases or bilirubin x 3 above upper reference level) or renal (GFR< 50 ml/min/1,73 m2) diseases
• Heart failure due to uncorrected thyroid disease
• Cardiac mechanical support
• < 6 months after CRT
• Uncontrolled hypotension (defined as symptomatic systolic blood pressure < 90 mmHg) - or hypertension (defined as systolic at 180 mmHg or above and/or diastolic blood pressure at 110 mmHg or below)
• Body mass index (BMI) > 35
• Unable to give informed consent
• Reduced compliance
• All women of child bearing potential will be required to use adequate contraception
• Pregnant or lactating women
• Treatment with a tricyclic antidepressant or CYP2D6 substrates other than beta-blockers or treatment with digoxin.