Neurohumoral prediction of left-ventricular morphologic response to beta-blockade with metoprolol in chronic left-ventricular systolic heart failure.
BACKGROUND
In order to tailor therapy in heart failure, a solution might be to develop sensitive and reliable markers that can predict response in individual patients or monitor effectiveness of therapy.


OBJECTIVE
To evaluate neurohumoral factors as markers for left-ventricular (LV) antiremodelling from metoprolol treatment in patients with chronic LV systolic heart failure.


METHODS
Forty-one subjects randomised to placebo or metoprolol were studied with magnetic resonance imaging and blood samples to measure LV dimensions and ejection fraction, epinephrine, norepinephrine, plasma renin activity, aldosterone, atrial (ANP) and brain natriuretic peptides, arginine-vasopressin and endothelin-1 at baseline, 5 weeks and 6 months after randomisation.


RESULTS
Baseline ANP was identified as sole independent marker for changes in LV end-diastolic (deltaLVEDVI: r=-0.70, P=0.002), and end-systolic (deltaLVESVI: r=-0.53, P=0.03) volumes during metoprolol treatment. Change in ANP during the study was an independent marker for deltaLVEDVI: r=0.66, P=0.004, and deltaLVESVI: r=0.69, P=0.002 in the entire metoprolol group, but at the individual patient level, results were less clear.


CONCLUSIONS
The pre-treatment plasma level of ANP may be a predictor of LV antiremodelling from treatment with metoprolol in patients with chronic heart failure. However, the potential for individual neurohumoral monitoring of the effects on LV dimensions during beta-blockade appears limited.
Groenning
Bjoern A
BA
Department of Cardiology and Endocrinology, Copenhagen University Hospital Frederiksberg, Frederiksberg, Denmark. bjoerng@dadlnet.dk
Nilsson
Jens C
JC
Hildebrandt
Per R
PR
Kjaer
Andreas
A
Fritz-Hansen
Thomas
T
Larsson
Henrik B W
HB
Sondergaard
Lars
L
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001685:Biological Factors / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D002908:Chronic Disease; D003971:Diastole / Q000187:drug effects; D004311:Double-Blind Method; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000188:drug therapy*; D006339:Heart Rate / Q000187:drug effects / Q000502:physiology; D006352:Heart Ventricles / Q000187:drug effects / Q000473:pathology; D006728:Hormones / Q000097:blood; D006801:Humans; D008297:Male; D008790:Metoprolol / Q000627:therapeutic use*; D008875:Middle Aged; D015999:Multivariate Analysis; D018377:Neurotransmitter Agents / Q000097:blood*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012083:Renin / Q000097:blood; D012680:Sensitivity and Specificity; D013318:Stroke Volume / Q000187:drug effects / Q000502:physiology; D013599:Systole / Q000187:drug effects; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000097:blood* / Q000188:drug therapy*; D020257:Ventricular Remodeling / Q000187:drug effects*
D000319:Adrenergic beta-Antagonists; D001685:Biological Factors; D015415:Biomarkers; D006728:Hormones; D018377:Neurotransmitter Agents; D012083:Renin; D008790:Metoprolol