Author + information
- Received September 19, 1994
- Revision received November 29, 1994
- Accepted December 8, 1994
- Published online April 1, 1995.
- Shelley A. Hall, MDa,b,
- Carlos G. Cigarroa, MDa,b,
- Lucille Marcoux, RNa,b,
- Richard C. Risser, MSa,b,
- Paul A. Grayburn, MD, FACCa,b and
- Eric J. Eichhorn, MD, FACCa,b,*
- ↵*Address for correspondence: Dr. Eric J. Eichhorn, Cardiac Catheterization Laboratory (IIIA2), University of Texas Southwestern and Dallas Veterans Administration Medical Centers, 4500 South Lancaster, Dallas, Texas 75216.
Objectives. We examined the time course of ventricular functional improvement in patients with dilated cardiomyopathy who received beta-blockade and the long-term effects of beta-blockade on ventricular mass and geometry in these patients.
Background. Previous studies have shown that beta-adrenergic blocking agents when administered long term improve ventricular function in patients with heart failure. However, the time course of improvement in ventricular function and the long-term effects of beta-blockade on ventricular mass and geometry are not known.
Methods. Twenty-six men with dilated cardiomyopathy underwent serial echocardiography on days 0 and 1 and months 1 and 3 of either metoprolol (n = 16) or standard therapy (n = 10). At 3 months all patients on standard therapy were crossed over to metoprolol, and late echocardiograms were obtained after 18 ± 5 (mean ± SD) months of metoprolol therapy. All echocardiograms were read in blinded manner.
Results. Patients treated with metoprolol had an initial decline (day 1 vs. day 0) in ventricular function (increase in end-systolic volume and decrease in ejection fraction). Ventricular function improved between months 1 and 3 (p = 0.013, metoprolol vs. standard therapy). Left ventricular mass regressed at 18 months (333 ± 85 to 275 ± 53 g, p = 0.011) but not at 3 months. Left ventricular shape became less spherical and assumed a more normal elliptical shape by 18 months (major/minor axis ratio 1.5 ± 0.2 to 1.7 ± 0.2, p = 0.0001).
Conclusions. Patients with heart failure treated with metoprolol do not demonstrate an improvement in systolic performance until after 1 month of therapy and may have a mild reduction in function initially. Long-term therapy with metoprolol results in a reversal of maladaptive remodeling with reduction in left ventricular volumes, regression of left ventricular mass and improved ventricular geometry by 18 months.
- Received September 19, 1994.
- Revision received November 29, 1994.
- Accepted December 8, 1994.
- North American Society of Pacing and Electrophysiology; American College of Cardiology; American Heart Association, Inc.; and European Society of Cardiology.