© 2003 European Society of Cardiology
Increased exercise ejection fraction and reversed remodeling after long-term treatment with metoprolol in congestive heart failure: a randomized, stratified, double-blind, placebo-controlled trial in mild to moderate heart failure due to ischemic or idiopathic dilated cardiomyopathy
a Wallenberg Laboratory and Department of Cardiology, Sahlgrenska University Hospital Göteborg SE-413 45, Sweden
b Klinik und Poliklinik für Innere Medizin III, Universität des Saarlandes Homburg/Saar, Germany
c Department of Medicine II, Johannes Gutenberg-University Mainz, Germany
d Städt Krankenhaus München-Bogenhausen, I Med. Abteilg/Kardiol Ambulanz Munich, Germany
e Private Cardiologist Marienplatz 1 Munich, Germany
f Charité Campus Berlin-Buch Franz Volhard Klinik Humboldt University Berlin, Germany
g Department of Cardiology, Dr-Horst-Schmidt-Kliniken GmbH Wiesbaden, Germany
h Department of Medicine, University of Munich, Starnberg Hospital Germany
i R&D AstraZeneca Mölndahl, Sweden
* Corresponding author. Tel.: +46-31-3423014; fax: +46-31-823762. E-mail address: Waagstein{at}wlab.gu.se
 |
Abstract |
|---|
Background: the effects of long-term administration of β-blockers on left ventricular (LV) function during exercise in patients with ischemic heart disease (IHD) and idiopathic dilated cardiomyopathy (DCM) are controversial.
Patients and methods: patients with stable congestive heart failure (CHF) (New York heart association [NYHA] class II and III) and ejection fraction (EF) 
0.40 were randomized to metoprolol, 50 mg t.i.d. or placebo for 6 months. Patients were divided into two groups: ischemic heart disease (IHD) and idiopathic dilated cardiomyopathy (DCM). The mean EF was 0.29 in both groups and 92% were taking angiotensin-converting enzyme (ACE) inhibitors. In the IHD group, 84% had suffered a myocardial infarction (MI) and 64% had undergone revascularization at least 6 months before the study. LV volumes were measured by equilibrium radionuclide angiography. Mitral regurgitation was assessed by Doppler echocardiography. All values are changes for metoprolol subtracted by changes for placebo.
Results: metoprolol improved LV function markedly both at rest and during sub-maximal exercise in both groups. The mean increase in EF was 0.069 at rest (P<0.001) and 0.078 during submaximal exercise (P<0.001). LV end-diastolic volume decreased by 22 ml at rest (P=0.006) and by 15 ml during exercise (P=0.006). LV end-systolic volume decreased by 23 ml both at rest (P=0.001) and during exercise (P=0.004). Exercise time increased by 39 s (P=0.08). In the metoprolol group, mitral regurgitation decreased (P=0.0026) and only one patient developed atrial fibrillation vs. eight in the placebo group (P=0.01).
Conclusion: metoprolol improves EF both at rest and during submaximal exercise and prevents LV dilatation in mild to moderate CHF due to IHD or DCM.
Key Words: Drugs • Heart failure • Exercise • Cardiomyopathy • Ischemia
Received February 13, 2003; Revised April 2, 2003; Accepted June 16, 2003
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  G. Casaclang-Verzosa, B. J. Gersh, and T. S.M. Tsang Structural and functional remodeling of the left atrium: clinical and therapeutic implications for atrial fibrillation. J. Am. Coll. Cardiol., January 1, 2008; 51(1): 1 - 11. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Enriquez-Sarano, V. T. Nkomo, and H. Michelena Principles and Practice of Echocardiography in Cardiac Surgery Card. Surg. Adult, January 1, 2008; 3(2008): 315 - 348. [Full Text]
|
|
|
|
 |
|
 L. Fauchier, B. Pierre, A. de Labriolle, and D. Babuty Comparison of the beneficial effect of beta-blockers on mortality in patients with ischaemic or non-ischaemic systolic heart failure: A meta-analysis of randomised controlled trials Eur J Heart Fail, November 1, 2007; 9(11): 1136 - 1139. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. G. Svealv, M. S. Tang, F. Waagstein, and B. Andersson Pronounced improvement in systolic and diastolic ventricular long axis function after treatment with metoprolol Eur J Heart Fail, June 1, 2007; 9(6-7): 678 - 683. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. J. Hauptman and H. N. Sabbah Reversal of ventricular remodeling: Important to establish and difficult to define Eur J Heart Fail, April 1, 2007; 9(4): 325 - 328. [Full Text] [PDF]
|
|
|
|
 |
|
 I. A. Nasr, A. Bouzamondo, J.-S. Hulot, O. Dubourg, J.-Y. Le Heuzey, and P. Lechat Prevention of atrial fibrillation onset by beta-blocker treatment in heart failure: a meta-analysis Eur. Heart J., February 8, 2007; (2007) ehl484v1. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Silke Beta-blockade in CHF: pathophysiological considerations Eur. Heart J. Suppl., June 1, 2006; 8(suppl_C): C13 - C18. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. V. Salukhe, M. Y. Henein, and R. Sutton Ischemic Mitral Regurgitation and Its Related Risk After Myocardial Infarction Circulation, January 25, 2005; 111(3): 254 - 256. [Full Text] [PDF]
|
|