Early changes in longitudinal performance predict future improvement in global left ventricular function during long term beta adrenergic blockade.

• Contraction of longitudinal and subendocardial myocardial muscle fibres is reflected in descent of the atrioventricular (AV) plane. The aim was therefore to determine whether beta blocker treatment with prolongation of diastole might result in improved function as reflected by AV plane movements in patients with chronic heart failure.Double blind, randomised, placebo controlled and open intervention study.University hospital.Patients with congestive heart failure: placebo controlled (n = 26) and an open protocol (n = 15).12 months of metoprolol treatment.Short axis and long axis echocardiography, invasive haemodynamics, radionuclide angiography.Recovery of systolic and diastolic function during metoprolol treatment was reflected by early changes in mean (SD) AV plane amplitude, from 5.3 (2.0)% to 7.1 (3.2)% and 7.8 (3. 1)% (at 3 and 12 months, respectively; p < 0.05). In a multivariate analysis, only the change in AV plane amplitude by three months was independently associated with improvement in pulmonary capillary wedge pressure by six months (r = 0.80, p = 0.017). Change in AV plane amplitude by three months was also a better predictor of improvement in ejection fraction by 12 months (r = 0.78, p < 0.001) than changes in radionuclide ejection fraction by three months (r = 0.34, p = 0.049).Improvement in longitudinal contraction was closely associated with a decrease in left ventricular filling pressure during metoprolol treatment. This association was stronger than changes in short axis performance or radionuclide ejection fraction, emphasising the importance of AV plane motion for left ventricular filling and systolic performance in patients with heart failure.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kardiologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)

Nyckelord

Adrenergic beta-Antagonists

therapeutic use

Adult

Aged

Analysis of Variance

Cardiomyopathy

Dilated

drug therapy

physiopathology

Diastole

drug effects

Double-Blind Method

Female

Follow-Up Studies

Heart Rate

drug effects

Humans

Male

Metoprolol

therapeutic use

Middle Aged

Prospective Studies

Sympatholytics

therapeutic use

Systole

drug effects

Ventricular Function

Left

drug effects

Publikations- och innehållstyp

ref (ämneskategori)

art (ämneskategori)