title: Effect of metoprolol on myocardial function and energetics in patients with nonischemic dilated cardiomyopathy: a randomized, double-blind, placebo-controlled study.
abstract: OBJECTIVE
  This study examined the effects of metoprolol on left ventricular performance, efficiency, neurohormonal activation and myocardial respiratory quotient in patients with dilated cardiomyopathy.
  
  
  BACKGROUND
  The mechanism by which beta-adrenergic blockade improves ejection fraction in patients with dilated cardiomyopathy remains an enigma. Thus, we undertook an extensive hemodynamic evaluation of this mechanism. In addition, because animal models have shown that catecholamine exposure may increase relative fatty acid utilization, we hypothesized that antagonism of sympathetic stimulation may result in increased carbohydrate utilization.
  
  
  METHODS
  This was a randomized, double-blind, prospective trial in which 24 men with nonischemic dilated cardiomyopathy underwent cardiac catheterization before and after 3 months of therapy with metoprolol (n = 15) or placebo (n = 9) in addition to standard therapy. Pressure-volume relations were examined using a micromanometer catheter and digital ventriculography.
  
  
  RESULTS
  At baseline, the placebo-treated patients had somewhat more advanced left ventricular dysfunction. Ejection fraction and left ventricular performance improved only in the metoprolol-treated patients. Stroke and minute work increased without an increase in myocardial oxygen consumption, suggesting increased myocardial efficiency. Further increases in ejection fraction were seen between 3 and 6 months in the metoprolol group. The placebo group had a significant increase in ejection fraction only after crossover to metoprolol. A significant relation between the change in coronary sinus norepinephrine and myocardial respiratory quotient was seen, suggesting a possible effect of adrenergic deactivation on substrate utilization.
  
  
  CONCLUSIONS
  These data demonstrate that in patients with cardiomyopathy, metoprolol treatment improves myocardial performance and energetics, and favorably alters substrate utilization. Beta-adrenergic blocking agents, such as metoprolol, are hemodynamically and energetically beneficial in the treatment of myocardial failure.
authors.affiliation: Cardiac Catheterization Laboratory, Dallas Veterans Administration Hospital, Texas.
authors.forename: E J
authors.initials: EJ
authors.lastname: Eichhorn
authors.forename: C M
authors.initials: CM
authors.lastname: Heesch
authors.forename: J H
authors.initials: JH
authors.lastname: Barnett
authors.forename: L G
authors.initials: LG
authors.lastname: Alvarez
authors.forename: S M
authors.initials: SM
authors.lastname: Fass
authors.forename: P A
authors.initials: PA
authors.lastname: Grayburn
authors.forename: B A
authors.initials: BA
authors.lastname: Hatfield
authors.forename: L G
authors.initials: LG
authors.lastname: Marcoux
authors.forename: C R
authors.initials: CR
authors.lastname: Malloy
mesh_terms: D006328:Cardiac Catheterization; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D018592:Cross-Over Studies; D004311:Double-Blind Method; D004734:Energy Metabolism / Q000187:drug effects; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008790:Metoprolol / Q000627:therapeutic use*; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism; D009638:Norepinephrine / Q000378:metabolism; D010101:Oxygen Consumption / Q000187:drug effects; D011446:Prospective Studies; D015635:Radionuclide Ventriculography; D013318:Stroke Volume / Q000187:drug effects; D013997:Time Factors; D016277:Ventricular Function, Left / Q000187:drug effects
chemical_list: D008790:Metoprolol; D009638:Norepinephrine