Hemodynamic predictors of early intolerance and long-term effects of propranolol in dilated cardiomyopathy.
BACKGROUND
Fifty-six patients with dilated cardiomyopathy (DCM) (aged 14-68 years) and background therapy of angiotensin-converting enzyme inhibitors, diuretics, and digoxin were given an initial challenge of propranolol in gradually increasing doses. These patients were studied noninvasively and hemodynamically and subjected to right ventricle biopsy.


RESULTS
Forty-four patients tolerated propranolol and received the drug for 6 months; 12 patients deteriorated after starting the drug with worsening of congestive heart failure and/or hypotension. The patients who did not tolerate propranolol had higher left ventricular end-diastolic dimension (73 +/- 8 vs 66 +/- 8 mm, P < .05), and severe mitral regurgitation was more common. Hemodynamically these patients had higher heart rate, right ventricular end-diastolic pressure, mean pulmonary artery pressure, mean pulmonary artery wedge pressure, and left ventricular end-diastolic pressure (102 +/- 16 vs 89 +/- 12 beats/min, 15 +/- 7 vs 9 +/- 4, 39 +/- 16 vs 31 +/- 12, 28 +/- 8 vs 21 +/- 8, 28 +/- 8 vs 22 +/- 8 mmHg, respectively, P < .01). These patients had a significantly lower cardiac index (1.9 +/- 0.6 vs 2.5 +/- 0.6 L/min/m2, P < .01). Forty patients completed 6 months follow-up evaluation and were further subjected to repeat noninvasive and hemodynamic study. There was a significant improvement in New York Heart Association class, cardiothoracic ratio, and left ventricular end-diastolic dimension (68% vs 62%, 66 +/- 8 vs 62 +/- 7 mm, respectively, P < .01), while the ejection fraction (EF) rose from 23 to 35% (P < .001). Hemodynamically, there was a significant decrease in heart rate, right ventricular end-diastolic pressure, mean pulmonary artery pressure, mean pulmonary artery wedge pressure, and left ventricular end-diastolic pressure (91 +/- 14 vs 71 +/- 5 beats/min, 9 +/- 4 vs 5 +/- 3, 32 +/- 11 vs 22 +/- 7, 25 +/- 9 vs 17 +/- 8, 21 +/- 7 vs 14 +/- 4 mmHg, P < .05). The cardiac index rose from 2.3 +/- 0.6 to 3.2 +/- 0.7 L/min/m2 (P < .01).


CONCLUSIONS
Propranolol in dilated cardiomyopathy is associated with significant intolerance. Those who tolerate propranolol seem to have long-term beneficial effects. This study is limited as it is uncontrolled and nonrandomized.
Talwar
K K
KK
Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
Bhargava
B
B
Upasani
P T
PT
Verma
S
S
Kamlakar
T
T
Chopra
P
P
D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D002311:Cardiomyopathy, Dilated / Q000188:drug therapy* / Q000503:physiopathology; D016009:Chi-Square Distribution; D004334:Drug Administration Schedule; D005069:Evaluation Studies as Topic; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011433:Propranolol / Q000009:adverse effects* / Q000627:therapeutic use; D012016:Reference Values; D013997:Time Factors; D016278:Ventricular Function, Right / Q000187:drug effects*
D000319:Adrenergic beta-Antagonists; D011433:Propranolol