title: Effects of metoprolol tartrate therapy in patients with heart failure.
abstract: OBJECTIVE
  To study the effects of metoprolol tartrate therapy in patients with heart failure.
  
  
  METHODS
  Fifty patients (36 males) aged 52+/-14.8 yrs, with functional class II to IV heart failure (HF) and left ventricular ejection fraction (LVFE) < 45%, assessed by radionuclide ventriculography, were evaluated in a retrospective study. Metoprolol tartrate was added to the usual therapy, with a starting dose of 12.5 mg, which was increased weekly to a maximum of 200 mg/day, according to patients tolerance. Clinical evaluation, electrocardiogram, Doppler echocardiogram, 24-h Holter monitoring and radionuclide ventriculography were carried out in the pre-treatment phase and repeated three and six months after the start of therapy.
  
  
  RESULTS
  At the end of six months, there was functional class (NYHA) improvement with a reduction from 3.04+/-0.11 to 1.66+/-0.06(p<0.001). Ejection fraction increased from 29.84+1.61% to 38.56+/-1.95% (p< 0.001). The left ventricular diastolic diameter showed a reduction from 67.70+/-1.31 mm to 63.96+/-1.29 mm (p<0.001), and the left ventricular systolic diameter showed a reduction from 54.80+/-1.67 mm to 48.58+/-1.38 (p<0.001). There was no alteration in noradrenaline levels during the six-month follow-up period (p>0.05). Cardiac frequency decreased from 78.84+/-1.68 to 67.48+/-1.86 b.p.m. (p<0.001).
  
  
  CONCLUSIONS
  The adding of metoprolol tartrate to the usual heart failure therapy is followed by an increase of ejection fraction, functional class improvement, and decrease of ventricular diameters and cardiac frequency. These results suggest anti-remodeling effects in patients with HF who utilize metoprolol tartrate in addition to the usual therapy.
authors.affiliation: Universidade Federal do Maranhão e Instituto do Coração do Hospital das Clínicas, FMUSP, São Luiz, MA, São Paulo, Brazil. jafneto@cardiol.br
authors.forename: José Albuquerque
authors.initials: JA
authors.lastname: de Figueiredo Neto
authors.forename: Charles
authors.initials: C
authors.lastname: Mady
authors.forename: César
authors.initials: C
authors.lastname: Grupi
mesh_terms: D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D002303:Cardiac Output, Low / Q000188:drug therapy* / Q000209:etiology; D002311:Cardiomyopathy, Dilated / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008790:Metoprolol / Q000627:therapeutic use*; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D008790:Metoprolol