title: Acute and short-term hemodynamic effects of metoprolol in Eisenmenger syndrome: a preliminary observational study.
abstract: BACKGROUND
  Progressive heart failure and sudden cardiac death are the common causes of death in Eisenmenger syndrome. β-Bockers may be useful in Eisenmenger syndrome, but the safety and efficacy are not proven. The objective of the study was to evaluate the hemodynamic effects and safety of metoprolol in Eisenmenger syndrome.
  
  
  METHODS
  Fifteen patients of Eisenmenger syndrome with a mean age of 22.6 (±8.9) years were studied. Hemodynamic parameters were measured at baseline, after 15 mg of intravenous metoprolol and 6 weeks after oral metoprolol (25 mg/d for 2 weeks and 50 mg/d for 4 weeks).
  
  
  RESULTS
  Intravenous metoprolol was well tolerated, although there was a significant decrease in pulmonary and systemic blood flows. The calculated pulmonary vascular resistance index (23.3 ± 8.6 to 27.4 ± 10.6 Wood U, P = .005) and systemic vascular resistance index (34.9 ± 9.9 to 41.9 ± 13.5 Wood U, P = .005) increased significantly. After 6 weeks of oral metoprolol, the pulmonary artery mean pressure declined significantly (79.9 ± 12.9 to 73.4 ± 14.0 mm Hg, P = .04), which was associated with a slight decrease in mean aortic pressures as compared with baseline. The 6-minutes walk distance increased (401.2 ± 99.9 to 462.5 ± 81.7 m, P = .005).
  
  
  CONCLUSIONS
  Preliminary observations suggest that metoprolol is safe and well tolerated in selected patients with Eisenmenger syndrome. Acute hemodynamic worsening recovers in the short term, and the exercise capacity improves in most patients. Larger studies are warranted.
authors.affiliation: Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India. ramakgmc@rediffmail.com
authors.forename: Sivasubramanian
authors.initials: S
authors.lastname: Ramakrishnan
authors.forename: Chirayu
authors.initials: C
authors.lastname: Vyas
authors.forename: Shyam S
authors.initials: SS
authors.lastname: Kothari
authors.forename: Balram
authors.initials: B
authors.lastname: Bhargava
authors.forename: Bharat Bhooshan
authors.initials: BB
authors.lastname: Kukreti
authors.forename: Mani
authors.initials: M
authors.lastname: Kalaivani
authors.forename: Rajnish
authors.initials: R
authors.lastname: Juneja
authors.forename: Sandeep
authors.initials: S
authors.lastname: Seth
authors.forename: Anita
authors.initials: A
authors.lastname: Saxena
authors.forename: Vinay K
authors.initials: VK
authors.lastname: Bahl
mesh_terms: D000293:Adolescent; D058671:Adrenergic beta-1 Receptor Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D004305:Dose-Response Relationship, Drug; D004541:Eisenmenger Complex / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008790:Metoprolol / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D058671:Adrenergic beta-1 Receptor Antagonists; D008790:Metoprolol