title: Marked improvement in left ventricular ejection fraction during long-term beta-blockade in patients with chronic heart failure: clinical correlates and prognostic significance.
abstract: BACKGROUND
  Some patients with heart failure (HF) may have a marked improvement in left ventricular ejection fraction (LVEF) after long-term beta-blockade. We compared the clinical characteristics and the prognosis of these patients with those of other patients.
  
  
  METHODS
  One hundred seventy-one patients with chronic HF were assessed before and after 9 to 12 months of maintenance therapy with metoprolol or carvedilol.
  
  
  RESULTS
  Thirty-eight patients (22%) showed an increase in their LVEF >or=15 units (from 20% +/- 8% to 43% +/- 10%). Compared with the other patients (LVEF change from 21% +/- 7% to 26% +/- 9%, P <.0001 for differences between groups), these patients also had a greater decline in the left ventricular end-diastolic volume (from 175 +/- 74 mL/m(2) to 113 +/- 36 mL/m(2)) and in the right atrial, mean pulmonary artery, and pulmonary wedge pressures, with a greater increase in the cardiac index, stroke volume index, stroke work index, and maximal functional capacity. Their long-term prognosis was excellent, with a 2-year cumulative survival rate of 95%, versus 81% for the other patients, and a hospitalization-free survival rate of 73%, versus 50% for the other patients (all P <.05). By means of multivariate analysis, only the nonischemic cause of HF and the mean arterial pressure at baseline were independently associated with an increase of >or=0.15 in LVEF.
  
  
  CONCLUSIONS
  Patients who show a marked improvement in their LVEF after long-term beta-blockade have an excellent prognosis and have a high prevalence of nonischemic HF and a higher blood pressure at baseline.
authors.affiliation: Cattedra di Cardiologia, Università di Brescia, Italy. metramarco@libero.it
authors.forename: Marco
authors.initials: M
authors.lastname: Metra
authors.forename: Savina
authors.initials: S
authors.lastname: Nodari
authors.forename: Giovanni
authors.initials: G
authors.lastname: Parrinello
authors.forename: Raffaele
authors.initials: R
authors.lastname: Giubbini
authors.forename: Carlo
authors.initials: C
authors.lastname: Manca
authors.forename: Livio
authors.initials: L
authors.lastname: Dei Cas
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D002227:Carbazoles / Q000627:therapeutic use*; D002311:Cardiomyopathy, Dilated / Q000188:drug therapy / Q000503:physiopathology; D000077261:Carvedilol; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006334:Heart Function Tests; D006801:Humans; D008297:Male; D008790:Metoprolol / Q000627:therapeutic use*; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011379:Prognosis; D011412:Propanolamines / Q000627:therapeutic use*; D013318:Stroke Volume / Q000187:drug effects* / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000187:drug effects / Q000502:physiology
chemical_list: D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; D008790:Metoprolol