Predictors of systolic and diastolic improvement in patients with dilated cardiomyopathy treated with metoprolol.
OBJECTIVE
The aim of this study was to determine which patients will have systolic and diastolic improvement after beta-blockade with metoprolol.


BACKGROUND
Beta-adrenergic blocking agents improve systolic and diastolic function in patients with heart failure. However, it is unclear which patients will respond best to therapy.


METHODS
We retrospectively examined baseline characteristics of 24 patients who underwent double-blind then open-label treatment with metoprolol to determine which characteristic predicted improvement in systolic and diastolic function. Degree of improvement in systolic function (22 patients) was defined by the change in left ventricular ejection fraction after 3 months of therapy. Degree of improvement in diastolic function (15 patients) was defined as the change in left ventricular end-diastolic pressure and change in the slope of the isovolumetric relaxation rate-end-systolic pressure relation.


RESULTS
Both systolic blood pressure at baseline (r = 0.54, p = 0.009) and the maximal positive value of the first derivative of left ventricular pressure with respect to time (peak +dP/dt) at baseline (r = 0.39, p = 0.07) correlated with improvement in ejection fraction after metoprolol treatment. Stepwise logistic regression demonstrated that only peak systolic pressure was an independent predictor of systolic improvement. Baseline heart rate, ventricular volumes, ejection fraction and adrenergic activation, as reflected by coronary sinus norepinephrine, did not predict response. Patients with the most diastolic impairment at baseline had the most favorable diastolic improvement. Those with the lowest myocardial respiratory quotient (most fatty acid utilization) at baseline also had the most marked reduction in left ventricular end-diastolic pressure.


CONCLUSIONS
These data suggest that those patients with the highest peak systolic pressure, highest left ventricular end-diastolic pressure and most prolonged isovolumetric relaxation at baseline will respond best to therapy with metoprolol. However, other patients without these characteristics may also benefit.
Eichhorn
E J
EJ
Cardiac Catheterization Laboratory, Dallas Veterans Administration Hospital, Texas 75216.
Heesch
C M
CM
Risser
R C
RC
Marcoux
L
L
Hatfield
B
B
D000328:Adult; D000368:Aged; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology*; D003971:Diastole / Q000187:drug effects; D004311:Double-Blind Method; D006321:Heart / Q000000981:diagnostic imaging / Q000503:physiopathology; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008790:Metoprolol / Q000627:therapeutic use*; D008875:Middle Aged; D009200:Myocardial Contraction / Q000187:drug effects*; D011379:Prognosis; D011446:Prospective Studies; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D013599:Systole / Q000187:drug effects
D008790:Metoprolol