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- Andersson, Bert, 1952, et al.
(författare)
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Improved exercise hemodynamic status in dilated cardiomyopathy after beta-adrenergic blockade treatment.
- 1994
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Ingår i: Journal of the American College of Cardiology. - 0735-1097. ; 23:6, s. 1397-404
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Tidskriftsartikel (refereegranskat)abstract
- This study was performed to investigate exercise hemodynamic status in a double-blind, placebo-controlled trial and was a substudy in the Metoprolol in Dilated Cardiomyopathy Trial.Previous open studies have shown beneficial effects on exercise hemodynamic status after beta-adrenergic blocking agent therapy in patients with congestive heart failure.The study included 41 patients with idiopathic dilated cardiomyopathy with ejection fraction < 0.40 (metoprolol, 20 patients; placebo, 21 patients) whose hemodynamic status was investigated at rest and during supine submaximal exercise, at baseline and after 6 and 12 months of treatment. Myocardial metabolism was evaluated in a subset of 19 patients.Metoprolol-treated patients responded favorably, as expressed by improved exercise cardiac index ([mean +/- SD] placebo 4.8 +/- 1.6 to 4.7 +/- 1.8 liters/min per m2, metoprolol 4.3 +/- 1.1 to 5.4 +/- 1.9 liters/min per m2, p = 0.0001) and stroke work index (placebo 44 +/- 20 to 41 +/- 27 g.m/m2, metoprolol 35 +/- 16 to 58 +/- 28 g.m/m2, p < 0.0001). Exercise systolic arterial pressure increased (placebo 161 +/- 25 to 151 +/- 23 mm Hg, metoprolol 155 +/- 29 to 165 +/- 37 mm Hg, p = 0.0003) as well as exercise oxygen consumption index (placebo 463 +/- 194 to 474 +/- 232 ml/min per m2, metoprolol 406 +/- 272 to 507 +/- 298 ml/min per m2, p = 0.045). There was a significant increase in exercise duration in the metoprolol group (63 +/- 38 s) compared with the placebo group (-24 +/- 42 s) (p = 0.01). Net myocardial lactate extraction increased in the metoprolol group, suggesting less myocardial ischemia (placebo 17 +/- 22 to 9.5 +/- 6.4 mmol/min, metoprolol -32 +/- 100 to 42 +/- 45 mmol/min, p = 0.03). Peripheral levels of norepinephrine tended to decrease at rest and during exercise, whereas myocardial net spillover was unchanged.Metoprolol improved hemodynamic status in patients with dilated cardiomyopathy at rest and had a more pronounced effect during exercise. These positive effects were achieved along with improved or stable myocardial metabolic data.
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- Andersson, Bert, 1952, et al.
(författare)
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Recovery from left ventricular asynergy in ischemic cardiomyopathy following long-term beta blockade treatment.
- 1994
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Ingår i: Cardiology. - : S. Karger AG. - 0008-6312 .- 1421-9751. ; 85:1, s. 14-22
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Tidskriftsartikel (refereegranskat)abstract
- It has been suggested that long-term beta blockade treatment in congestive heart failure might be less effective in patients with ischemic cardiomyopathy as compared with patients having idiopathic dilated cardiomyopathy. This study was performed to evaluate the effect of long-term adrenergic beta blockade treatment on regional myocardial function in patients with ischemic cardiomyopathy. The regional wall motion (RWM) was evaluated in 12 patients with ischemic cardiomyopathy before and after long-term open treatment with metoprolol. On average, the patients were treated over 11 months (range 6-36 months). The regional left ventricular function was assessed using two-dimensional echocardiographic recordings by two independent blinded observers. The RWM score was evaluated in 16 segments of the left ventricle on a scale from 0 (hypercontractility) to 5 (dyskinesia). Following treatment, there was an improvement in general ventricular function (ejection fraction 0.24-0.31; p = 0.01) as well as in RWM (86 improved segments, 48 deteriorated, 49 unchanged; p < 0.002). Ventricular segments with poor contractility (RWM score > or = 3.5) tended to improve (53 improved segments, 16 deteriorated, 13 unchanged; p < 0.0001), whereas less severely impaired segments (RWM score < 3.5) did not improve (33 improved segments, 32 deteriorated, 36 unchanged; NS). It is suggested that poorly contracting myocardial segments might improve following beta blockade treatment, while an effect on less impaired segments might be lacking. An improvement in overall myocardial function would then be harder to detect.
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- Feng, Q P, et al.
(författare)
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Cardiac neuropeptide Y and noradrenaline balance in patients with congestive heart failure.
- 1994
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Ingår i: British heart journal. - 0007-0769. ; 71:3, s. 261-7
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Tidskriftsartikel (refereegranskat)abstract
- To measure plasma concentrations of noradrenaline and neuropeptide Y-like immunoreactivity in relation to cardiac function in patients with congestive heart failure.Retrospective analysis of plasma noradrenaline concentrations and neuropeptide Y-like immunoreactivity in the arterial and coronary circulations, in patients with a high or low ejection fraction (31.3% (1.3%) or 17.7% (1.1%) respectively) and in healthy volunteers.Cardiology department of a university hospital.41 patients with congestive heart failure with various aetiologies. Ten healthy volunteers served as a reference group.Concentrations of noradrenaline measured by high performance liquid chromatography and of neuropeptide Y-like immunoreactivity measured by radioimmunoassay. Cardiac index, pulmonary capillary wedge pressure, pulmonary vascular resistance, and systemic vascular resistance were derived by catheterisation of the right heart. Ejection fraction was measured by radionuclide angiography, cineangiography, or M mode echocardiography.There were pronounced and significant increases in circulating arterial concentrations of neuropeptide Y-like immunoreactivity and noradrenaline in both the high and low ejection fraction groups compared with the healthy subjects. In the patients myocardial release of neuropeptide Y-like immunoreactivity tended to be greater compared with normal subjects, but not significantly so. While normal subjects showed myocardial noradrenaline uptake, patients with congestive heart failure showed significant and progressive myocardial noradrenaline release. Arterial as well as coronary sinus concentrations of neuropeptide Y-like immunoreactivity correlated significantly with plasma noradrenaline concentrations from the respective sites. Plasma noradrenaline concentrations in the artery and coronary sinus were negatively correlated with ejection fraction and cardiac index; no such relations were found for concentrations of neuropeptide Y-like immunoreactivity.Both circulating concentrations of neuropeptide Y-like immunoreactivity and noradrenaline are significantly increased in moderate to severe forms of congestive heart failure. Plasma concentrations of neuropeptide Y-like immunoreactivity correlated with plasma noradrenaline concentrations, but plasma noradrenaline concentrations alone correlated with ejection fraction and cardiac index. Thus plasma noradrenaline concentration seems to be a more sensitive index of cardiac dysfunction than the concentration of neuropeptide Y-like immunoreactivity in congestive heart failure.
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