Circulation, Vol 72, 536-546, Copyright © 1985 by American Heart Association
RS Engelmeier, JB O'Connell, R Walsh, N Rad, PJ Scanlon and RM Gunnar
It has been suspected that the increased sympathetic activity seen in
patients with chronic congestive heart failure from dilated cardiomyopathy
may be harmful. We therefore tested the long-term effect of metoprolol on
eight patients in a double-blind, randomized protocol and 12 patients in an
unblinded, crossover protocol who were treated for 12 months (range 10 to
24), and compared them with 16 similar subjects who were treated with
placebo for 10 months (range 6 to 12) in a double-blind, randomized
protocol. Patients were followed by serial clinical assessment, treadmill
testing, radionuclide ventriculography, and echocardiography.
Metoprolol-treated patients had an improvement in mean exercise capacity by
3 mets (p less than .0001) while experiencing a significant improvement in
functional classification (p less than .001) during both the double-blind
and open-label crossover studies and had an improved ejection fraction
during the double-blind study (p less than .02). These improvements were
not seen in matched control subjects receiving placebo. Seven of 20
patients receiving long-term metoprolol therapy had resolution of nearly
all symptoms of heart failure, doubled their exercise capacity, and had
progressive improvement in resting radionuclide left ventricular ejection
fraction (12.6 +/- 3% to 26.9 +/- 6%) and echocardiographic left
ventricular end-diastolic dimension (7.7 +/- 0.5 to 6.5 +/- 0.5 cm). Only
one of 21 patients treated was intolerant of metoprolol. We conclude that
metoprolol can be given safely to a select group of patients with dilated
cardiomyopathy in doses that substantially reduce both resting and exercise
heart rates. Long-term beta-blockade improved functional class and exercise
capacity in 14 of 20 patients while producing an exceptional clinical
response in seven that was accompanied by improved resting parameters of
left ventricular function.
ARTICLES
Improvement in symptoms and exercise tolerance by metoprolol in patients with dilated cardiomyopathy: a double-blind, randomized, placebo-controlled trial
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