Time course of improvement in left ventricular function, mass and geometry in patients with congestive heart failure treated with beta-adrenergic blockade

Echocardiography Laboratory, Dallas Veterans Administration Hospital, Texas.

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.

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				C.H. Davies and Y. Bashir Beta-blockers for heart failure-time to think the unthinkable? QJM, November 1, 1999; 92(11): 673 - 678. [Full Text] [PDF]

				D. L. Mann Mechanisms and Models in Heart Failure : A Combinatorial Approach Circulation, August 31, 1999; 100(9): 999 - 1008. [Full Text] [PDF]

				A. Di Lenarda, G. Sabbadini, L. Salvatore, G. Sinagra, L. Mestroni, B. Pinamonti, D. Gregori, F. Ciani, A. Muzzi, S. Klugmann, et al. Long-term effects of carvedilol in idiopathic dilated cardiomyopathy with persistent left ventricular dysfunction despite chronic metoprolol J. Am. Coll. Cardiol., June 1, 1999; 33(7): 1926 - 1934. [Abstract] [Full Text] [PDF]

				J. K. Gwathmey, C. S. Kim, R. J. Hajjar, F. Khan, T. G. DiSalvo, A. Matsumori, and M. R. Bristow Cellular and molecular remodeling in a heart failure model treated with the beta -blocker carteolol Am J Physiol Heart Circ Physiol, May 1, 1999; 276(5): H1678 - H1690. [Abstract] [Full Text] [PDF]

				D. V. Exner, D. L. Dries, M. A. Waclawiw, B. Shelton, and M. J. Domanski Beta-adrenergic blocking agent use and mortality in patients with asymptomatic and symptomatic left ventricular systolic dysfunction: a post hoc analysis of the studies of left ventricular dysfunction J. Am. Coll. Cardiol., March 15, 1999; 33(4): 916 - 923. [Abstract] [Full Text] [PDF]

				H Kakuchi, T Sasaki, Y Ishida, K Komamura, and K Miyatake Clinical usefulness of 123I meta-iodobenzylguanidine imaging in predicting the effectiveness of beta  blockers for patients with idiopathic dilated cardiomyopathy before and soon after treatment Heart, February 1, 1999; 81(2): 148 - 152. [Abstract] [Full Text]

				D. L. Mann and J. T. Willerson Left Ventricular Assist Devices and the Failing Heart : A Bridge to Recovery, a Permanent Assist Device, or a Bridge Too Far? Circulation, December 1, 1998; 98(22): 2367 - 2369. [Full Text] [PDF]

				A. M. Katz Regression of Left Ventricular Hypertrophy : New Hope for Dying Hearts Circulation, August 18, 1998; 98(7): 623 - 624. [Full Text] [PDF]

				M. Gheorghiade and R. O. Bonow Chronic Heart Failure in the United States : A Manifestation of Coronary Artery Disease Circulation, January 27, 1998; 97(3): 282 - 289. [Full Text] [PDF]

				J E Sanderson, S K W Chan, C M Yu, L Y C Yeung, W M Chan, K Raymond, K W Chan, and K S Woo beta Blockers in heart failure: a comparison of a vasodilating beta  blocker with metoprolol Heart, January 1, 1998; 79(1): 86 - 92. [Abstract] [Full Text] [PDF]

				W. V. Dorffel, S. B. Felix, G. Wallukat, S. Brehme, K. Bestvater, T. Hofmann, F. X. Kleber, G. Baumann, and P. Reinke Short-term Hemodynamic Effects of Immunoadsorption in Dilated Cardiomyopathy Circulation, April 15, 1997; 95(8): 1994 - 1997. [Abstract] [Full Text]

				W. S. Colucci, M. Packer, M. R. Bristow, E. M. Gilbert, J. N. Cohn, M. B. Fowler, S. K. Krueger, R. Hershberger, B. F. Uretsky, J. A. Bowers, et al. Carvedilol Inhibits Clinical Progression in Patients With Mild Symptoms of Heart Failure Circulation, December 1, 1996; 94(11): 2800 - 2806. [Abstract] [Full Text]

				E. M. Gilbert, W. T. Abraham, S. Olsen, B. Hattler, M. White, P. Mealy, P. Larrabee, and M. R. Bristow Comparative Hemodynamic, Left Ventricular Functional, and Antiadrenergic Effects of Chronic Treatment With Metoprolol Versus Carvedilol in the Failing Heart Circulation, December 1, 1996; 94(11): 2817 - 2825. [Abstract] [Full Text]

				E. J. Eichhorn and M. R. Bristow Medical Therapy Can Improve the Biological Properties of the Chronically Failing Heart: A New Era in the Treatment of Heart Failure Circulation, November 1, 1996; 94(9): 2285 - 2296. [Abstract] [Full Text]