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


METHODS
Double blind, randomised, placebo controlled and open intervention study.


METHODS
University hospital.


METHODS
Patients with congestive heart failure: placebo controlled (n = 26) and an open protocol (n = 15).


METHODS
12 months of metoprolol treatment.


METHODS
Short axis and long axis echocardiography, invasive haemodynamics, radionuclide angiography.


RESULTS
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).


CONCLUSIONS
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.
Andersson
B
B
Department of Cardiology, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden. bert.andersson@hjl.gu.se
Waagstein
F
F
Caidahl
K
K
Eurenius
I
I
Täng
M S
MS
Wikh
R
R
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002311:Cardiomyopathy, Dilated / Q000188:drug therapy* / Q000503:physiopathology*; D003971:Diastole / Q000187:drug effects; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008790:Metoprolol / Q000627:therapeutic use*; D008875:Middle Aged; D011446:Prospective Studies; D013565:Sympatholytics / Q000627:therapeutic use; D013599:Systole / Q000187:drug effects; D016277:Ventricular Function, Left / Q000187:drug effects*
D000319:Adrenergic beta-Antagonists; D013565:Sympatholytics; D008790:Metoprolol