The function of left ventricular basal segments is most important for long-term recovery.
Adrenergic beta-blockade is the most potent pharmacological therapy for the improvement of global left ventricular (LV) function in heart failure. A substantial portion of patients responds poorly to beta-blockers, but there is scarce information about LV regional function and recovery. We intended to evaluate the effects of beta-blockade on LV regional function and recovery, contractile reserve (CR) and response to long-term treatment.


METHODS
Twenty-two patients with heart failure were investigated at rest and during dobutamine stress echocardiography (DSE), before and after 6 months of metoprolol treatment. LV function was evaluated by global ejection fraction (EF), and by regional function in basal, mid and apical segments.


RESULTS
Recovery of LV global function (increase in EF >5%) after metoprolol treatment was significantly and best correlated to CR in basal segments of the ventricle (r=0.79, p<0.001), in comparison with function of mid and apical segments. The correlation between global recovery and global CR was r=0.55, p=0.007. In a multivariate logistic regression, including global and regional CR, age, gender, etiology of heart failure, ACE-inhibitor treatment, heart rate, and baseline EF, only basal CR was independently associated with recovery, OR 1.07 [95% CI, 1.01-1.21], p=0.019.


CONCLUSIONS
The strongest association for prediction of LV recovery after metoprolol treatment was found regarding function of basal segments of the ventricle. Patients that responded favourably to beta-blockade had a significantly better CR, and treatment effect, in these segments. This gives further evidence for the importance of myocardial function in basal segments to the contribution of recovery and LV global function.
Scharin Täng
Margareta
M
Department of Molecular and Clinical Medicine/Cardiology, Institute of Medicine, Sahlgrenska Academy at Göteborg University, Sweden.
Waagstein
Finn
F
Andersson
Bert
B
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000704:Analysis of Variance; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008790:Metoprolol / Q000627:therapeutic use*; D008875:Middle Aged; D009200:Myocardial Contraction / Q000187:drug effects; D012372:ROC Curve; D020127:Recovery of Function; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy* / Q000503:physiopathology
D000319:Adrenergic beta-Antagonists; D008790:Metoprolol