Metoprolol-induced functional benefit in dilated cardiomyopathy is sustained over four years and favorably influences outcome.

Abstract

BACKGROUND:

Beta-blockers improve survival and ventricular function in patients with heart failure. We evaluated the long-term persistence of metoprolol-induced improvement and its impact on prognosis in idiopathic dilated cardiomyopathy.

METHODS:

Two hundred and four of 586 patients enrolled in a registry on the natural history of idiopathic dilated cardiomyopathy survived 4 years without transplantation; 98 of them were on standard heart failure treatment, whereas 106 took metoprolol in addition. We analyzed the effects of treatment using beta-blockers in terms of changes in left ventricular ejection fraction (LVEF), NYHA functional class and left ventricular end-diastolic diameter index (LVEDDI) after 1, 2 and 4 follow-up years in order to elaborate an improvement score that was related to the subsequent outcome over 60 months after the 4-year follow-up visit.

RESULTS:

Greater LVEF increases and NYHA functional class and LVEDDI decreases were observed in patients submitted to metoprolol vs standard treatment at all stages of follow-up. Changes (delta vs baseline) for LVEF (p = 0.02), NYHA functional class (p = 0.0001) and LVEDDI (p = 0.004) were maximal during the first year (10 +/- 11 vs 6 +/- 12 units, -0.72 +/- 0.77 vs -0.23 +/- 0.81, -3.5 +/- 5 vs -1.6 +/- 3.5 mm), persisted at 2 (12 +/- 12 vs 8 +/- 12 units, -0.80 +/- 0.70 vs -0.37 +/- 0.87, -4.2 +/- 5 vs -2.3 +/- 4 mm) but showed a trend to decline at 4 years (11 +/- 12 vs 8 +/- 13 units, -0.54 +/- 0.90 vs -0.24 +/- 0.91, -4.3 +/- 5 vs -2.3 +/- 5 mm) of follow-up. Improvement at 4 years was associated with a better transplant-free survival (81 vs 52%, p = 0.0005, odds ratio 0.36, 95% confidence interval 0.18 to 0.74).

CONCLUSIONS:

In idiopathic dilated cardiomyopathy, the more significant improvement in symptoms and left ventricular function and size, that is observed following treatment using metoprolol, translates into a better outcome. These benefits peak within the first 2 years of start of treatment but may begin to fade thereafter.

• Authors: R De Maria, A Di Lenarda, A Gavazzi, M Porcu, G Sinagra, M Parolini, SPIC (Italian Multicenter Cardiomyopathy Study) Group
• Journal: Italian heart journal : official journal of the Italian Federation of Cardiology (Ital Heart J) Vol. 2 Issue 2 Pg. 130-8 (Feb 2001) ISSN: 1129-471X [Print] Italy
• PMID: 11256541 (Publication Type: Journal Article)

Chemical References

• Adrenergic beta-Antagonists
• Metoprolol

Topics

• Adrenergic beta-Antagonists (therapeutic use)
• Cardiomyopathy, Dilated (drug therapy, mortality, physiopathology)
• Female
• Humans
• Logistic Models
• Male
• Metoprolol (pharmacology, therapeutic use)
• Prognosis
• Survival Analysis
• Treatment Outcome
• Ventricular Function, Left (drug effects)