Author + information
- Received May 25, 1994
- Revision received August 8, 1994
- Accepted August 11, 1994
- Published online January 1, 1995.
- Eric J Eichhorn, MD, FACC∗,
- Christian M Heesch, MD,
- Richard C Risser, MS,
- Lucille Marcoux, RN and
- Barbara Hatfield, RN
- ↵∗Address for correspondence: Dr. Eric J. Eichhorn, Director, Cardiac Catheterization Laboratory (IIIA2), University of Texas Southwestern and Dallas Veterans Administration Medical Centers, 4500 South Lancaster, Dallas, Texas 75216.
Objectives. The aim of this study was to determine which patients will have systolic and diastolic improvement after betablockade with metoprolol.
Background. Beta-adrenergic blocking agents improve systolic and diastolic function in patients with heart failure. However, it is unclear which patients will respond best to therapy.
Methods. We retrospectively examined baseline characteristics of 24 patients who underwent double-blind then open-label treatment with metoprolol to determine which characteristic predicted improvement in systolic and diastolic function. Degree of improvement in systolic function (22 patients) was defined by the change in left ventricular ejection fraction after 3 months of therapy. Degree of improvement in diastolic function (15 patients) was defined as the change in left ventricular end-diastolic pressure and change in the slope of the isovolumetric relaxation rate—end-systolic pressure relation.
Results. Both systolic blood pressure at baseline (r = 0.54, p = 0.009) and the maximal positive value of the first derivative of left ventricular pressure with respect to time (peak +dP/dt) at baseline (r = 0.39, p = 0.07) correlated with improvement in ejection fraction after metoprolol treatment. Stepwise logistic regression demonstrated that only peak systolic pressure was an independent predictor of systolic improvement. Baseline heart rate, ventricular volumes, ejection fraction and adrenergic activation, as reflected by coronary sinus norepinephrine, did not predict response. Patients with the most diastolic impairment at baseline had the most favorable diastolic improvement. Those with the lowest myocardial respiratory quotient (most fatty acid utilization) at baseline also had the most marked reduction in left ventricular end-diastolic pressure.
Conclusions. These data suggest that those patients with the highest peak systolic pressure, highest left ventricular end-diastolic pressure and most prolonged isovolumetric relaxation at baseline will respond best to therapy with metoprolol. However, other patients without these characteristics may also benefit.
☆ This study was supported in part by Grant HL-17669 from the National Heart, Lung, and Blood Institute Ischemic Specialized Centers of Research, National Institutes of Health, Bethesda, Maryland.
- Received May 25, 1994.
- Revision received August 8, 1994.
- Accepted August 11, 1994.