© 2002 European Society of Cardiology
Neurohumoral prediction of left-ventricular morphologic response to β-blockade with metoprolol in chronic left-ventricular systolic heart failure
a Department of Cardiology and Endocrinology, Copenhagen University Hospital Frederiksberg Frederiksberg, Denmark
b Danish Research Centre of Magnetic Resonance, Copenhagen University Hospital Hvidovre Hvidovre, Denmark
c Department of Medical Physiology, The Panum Institute, University of Copenhagen Copenhagen, Denmark
d Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Rigshospitalet Copenhagen, Denmark
* Corresponding author. Department of Cardiology and Endocrinology, Copenhagen University Hospital Frederiksberg, Nordre Fasanvej 57, DK-2000 Frederiksberg, Denmark. Tel.: +45-3632-2976; fax: +45-3647-0302. E-mail address: bjoerng{at}dadlnet.dk
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Abstract |
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Background: In order to tailor therapy in heart failure, a solution might be to develop sensitive and reliable markers that can predict response in individual patients or monitor effectiveness of therapy.
Aims: To evaluate neurohumoral factors as markers for left-ventricular (LV) antiremodelling from metoprolol treatment in patients with chronic LV systolic heart failure.
Methods: Forty-one subjects randomised to placebo or metoprolol were studied with magnetic resonance imaging and blood samples to measure LV dimensions and ejection fraction, epinephrine, norepinephrine, plasma renin activity, aldosterone, atrial (ANP) and brain natriuretic peptides, arginine–vasopressin and endothelin-1 at baseline, 5 weeks and 6 months after randomisation.
Results: Baseline ANP was identified as sole independent marker for changes in LV end-diastolic (
LVEDVI: r=–0.70, P=0.002), and end-systolic (LVESVI: r=–0.53, P=0.03) volumes during metoprolol treatment. Change in ANP during the study was an independent marker for LVEDVI: r=0.66, P=0.004, and LVESVI: r=0.69, P=0.002 in the entire metoprolol group, but at the individual patient level, results were less clear.
Conclusion: The pre-treatment plasma level of ANP may be a predictor of LV antiremodelling from treatment with metoprolol in patients with chronic heart failure. However, the potential for individual neurohumoral monitoring of the effects on LV dimensions during β-blockade appears limited.
Key Words: Heart failure • Left ventricle • Neurohormones • Beta-blockers • Magnetic resonance imaging • Remodelling
Received July 10, 2001; Revised October 13, 2001; Accepted December 14, 2001
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