Predictors of systolic and diastolic improvement in patients with dilated cardiomyopathy treated with metoprolol
Objectives. The aim of this study was to determine which patients will have systolic and diastolic improvement after betablockade with metoprolol. Background. Beta-adrenergic blocking agents improve systolic and diastolic function in patients with heart failure. However, it is unclear which patients...
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| Veröffentlicht in: | Journal of the American College of Cardiology 1995-01, Vol.25 (1), p.154-162 |
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| creator | Eichhorn, Eric J Heesch, Christian M Risser, Richard C Marcoux, Lucille Hatfield, Barbara |
| description | Objectives. The aim of this study was to determine which patients will have systolic and diastolic improvement after betablockade with metoprolol.
Background. Beta-adrenergic blocking agents improve systolic and diastolic function in patients with heart failure. However, it is unclear which patients will respond best to therapy.
Methods. We retrospectively examined baseline characteristics of 24 patients who underwent double-blind then open-label treatment with metoprolol to determine which characteristic predicted improvement in systolic and diastolic function. Degree of improvement in systolic function (22 patients) was defined by the change in left ventricular ejection fraction after 3 months of therapy. Degree of improvement in diastolic function (15 patients) was defined as the change in left ventricular end-diastolic pressure and change in the slope of the isovolumetric relaxation rate—end-systolic pressure relation.
Results. Both systolic blood pressure at baseline (r = 0.54, p = 0.009) and the maximal positive value of the first derivative of left ventricular pressure with respect to time (peak +dP/dt) at baseline (r = 0.39, p = 0.07) correlated with improvement in ejection fraction after metoprolol treatment. Stepwise logistic regression demonstrated that only peak systolic pressure was an independent predictor of systolic improvement. Baseline heart rate, ventricular volumes, ejection fraction and adrenergic activation, as reflected by coronary sinus norepinephrine, did not predict response. Patients with the most diastolic impairment at baseline had the most favorable diastolic improvement. Those with the lowest myocardial respiratory quotient (most fatty acid utilization) at baseline also had the most marked reduction in left ventricular end-diastolic pressure.
Conclusions. These data suggest that those patients with the highest peak systolic pressure, highest left ventricular end-diastolic pressure and most prolonged isovolumetric relaxation at baseline will respond best to therapy with metoprolol. However, other patients without these characteristics may also benefit. |
| doi_str_mv | 10.1016/0735-1097(94)00340-V |
| format | Article |
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Background. Beta-adrenergic blocking agents improve systolic and diastolic function in patients with heart failure. However, it is unclear which patients will respond best to therapy.
Methods. We retrospectively examined baseline characteristics of 24 patients who underwent double-blind then open-label treatment with metoprolol to determine which characteristic predicted improvement in systolic and diastolic function. Degree of improvement in systolic function (22 patients) was defined by the change in left ventricular ejection fraction after 3 months of therapy. Degree of improvement in diastolic function (15 patients) was defined as the change in left ventricular end-diastolic pressure and change in the slope of the isovolumetric relaxation rate—end-systolic pressure relation.
Results. Both systolic blood pressure at baseline (r = 0.54, p = 0.009) and the maximal positive value of the first derivative of left ventricular pressure with respect to time (peak +dP/dt) at baseline (r = 0.39, p = 0.07) correlated with improvement in ejection fraction after metoprolol treatment. Stepwise logistic regression demonstrated that only peak systolic pressure was an independent predictor of systolic improvement. Baseline heart rate, ventricular volumes, ejection fraction and adrenergic activation, as reflected by coronary sinus norepinephrine, did not predict response. Patients with the most diastolic impairment at baseline had the most favorable diastolic improvement. Those with the lowest myocardial respiratory quotient (most fatty acid utilization) at baseline also had the most marked reduction in left ventricular end-diastolic pressure.
Conclusions. These data suggest that those patients with the highest peak systolic pressure, highest left ventricular end-diastolic pressure and most prolonged isovolumetric relaxation at baseline will respond best to therapy with metoprolol. However, other patients without these characteristics may also benefit.</description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/0735-1097(94)00340-V</identifier><identifier>PMID: 7798494</identifier><identifier>CODEN: JACCDI</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Adult ; Aged ; Biological and medical sciences ; Cardiomyopathy, Dilated - diagnostic imaging ; Cardiomyopathy, Dilated - drug therapy ; Cardiomyopathy, Dilated - physiopathology ; Cardiotonic agents ; Cardiovascular system ; Diastole - drug effects ; Double-Blind Method ; Heart - diagnostic imaging ; Heart - physiopathology ; Hemodynamics - drug effects ; Humans ; Male ; Medical sciences ; Metoprolol - therapeutic use ; Middle Aged ; Myocardial Contraction - drug effects ; Pharmacology. Drug treatments ; Prognosis ; Prospective Studies ; Radionuclide Imaging ; Retrospective Studies ; Systole - drug effects</subject><ispartof>Journal of the American College of Cardiology, 1995-01, Vol.25 (1), p.154-162</ispartof><rights>1995</rights><rights>1995 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c466t-9f09e950fd6e26e33d38f14231558f9a83b1a949b2ba470e5416c4403cd3f2213</citedby><cites>FETCH-LOGICAL-c466t-9f09e950fd6e26e33d38f14231558f9a83b1a949b2ba470e5416c4403cd3f2213</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/0735-1097(94)00340-V$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>309,310,314,780,784,789,790,3550,4050,4051,23930,23931,25140,27924,27925,45995</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=3385992$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/7798494$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Eichhorn, Eric J</creatorcontrib><creatorcontrib>Heesch, Christian M</creatorcontrib><creatorcontrib>Risser, Richard C</creatorcontrib><creatorcontrib>Marcoux, Lucille</creatorcontrib><creatorcontrib>Hatfield, Barbara</creatorcontrib><title>Predictors of systolic and diastolic improvement in patients with dilated cardiomyopathy treated with metoprolol</title><title>Journal of the American College of Cardiology</title><addtitle>J Am Coll Cardiol</addtitle><description>Objectives. The aim of this study was to determine which patients will have systolic and diastolic improvement after betablockade with metoprolol.
Background. Beta-adrenergic blocking agents improve systolic and diastolic function in patients with heart failure. However, it is unclear which patients will respond best to therapy.
Methods. We retrospectively examined baseline characteristics of 24 patients who underwent double-blind then open-label treatment with metoprolol to determine which characteristic predicted improvement in systolic and diastolic function. Degree of improvement in systolic function (22 patients) was defined by the change in left ventricular ejection fraction after 3 months of therapy. Degree of improvement in diastolic function (15 patients) was defined as the change in left ventricular end-diastolic pressure and change in the slope of the isovolumetric relaxation rate—end-systolic pressure relation.
Results. Both systolic blood pressure at baseline (r = 0.54, p = 0.009) and the maximal positive value of the first derivative of left ventricular pressure with respect to time (peak +dP/dt) at baseline (r = 0.39, p = 0.07) correlated with improvement in ejection fraction after metoprolol treatment. Stepwise logistic regression demonstrated that only peak systolic pressure was an independent predictor of systolic improvement. Baseline heart rate, ventricular volumes, ejection fraction and adrenergic activation, as reflected by coronary sinus norepinephrine, did not predict response. Patients with the most diastolic impairment at baseline had the most favorable diastolic improvement. Those with the lowest myocardial respiratory quotient (most fatty acid utilization) at baseline also had the most marked reduction in left ventricular end-diastolic pressure.
Conclusions. These data suggest that those patients with the highest peak systolic pressure, highest left ventricular end-diastolic pressure and most prolonged isovolumetric relaxation at baseline will respond best to therapy with metoprolol. However, other patients without these characteristics may also benefit.</description><subject>Adult</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Cardiomyopathy, Dilated - diagnostic imaging</subject><subject>Cardiomyopathy, Dilated - drug therapy</subject><subject>Cardiomyopathy, Dilated - physiopathology</subject><subject>Cardiotonic agents</subject><subject>Cardiovascular system</subject><subject>Diastole - drug effects</subject><subject>Double-Blind Method</subject><subject>Heart - diagnostic imaging</subject><subject>Heart - physiopathology</subject><subject>Hemodynamics - drug effects</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Metoprolol - therapeutic use</subject><subject>Middle Aged</subject><subject>Myocardial Contraction - drug effects</subject><subject>Pharmacology. Drug treatments</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Radionuclide Imaging</subject><subject>Retrospective Studies</subject><subject>Systole - drug effects</subject><issn>0735-1097</issn><issn>1558-3597</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1995</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU9PHCEYh0nTRlfbb9AmHBqjh7EwMDBcTIyp2sTEHlqvhIWXSDMzrMBq9tuX3Z3s0RN_3uf9AQ8IfaXkkhIqfhDJuoYSJc8VvyCEcdI8fUAL2nV9wzolP6LFATlGJzn_I4SInqojdCSl6rniC7T6ncAFW2LKOHqcN7nEIVhsJoddMPMqjKsUX2GEqeAw4ZUpoU4zfgvluWKDKeCwNcmFOG5iLT9vcEmw294xI5RYI4Y4fEafvBkyfJnHU_T39uefm_vm4fHu1831Q2O5EKVRnihQHfFOQCuAMcd6T3nLts_zyvRsSY3iatkuDZcEOk6F5Zww65hvW8pO0dk-tx77soZc9BiyhWEwE8R11lKSXgohK8j3oE0x5wRer1IYTdpoSvRWtN5a1FuLWnG9E62fatu3OX-9HMEdmmaztf59rptszeCTmWzIB4yxvlOqrdjVHoPq4jVA0tlWt7Z-SgJbtIvh_Xv8B0BCm_Y</recordid><startdate>199501</startdate><enddate>199501</enddate><creator>Eichhorn, Eric J</creator><creator>Heesch, Christian M</creator><creator>Risser, Richard C</creator><creator>Marcoux, Lucille</creator><creator>Hatfield, Barbara</creator><general>Elsevier Inc</general><general>Elsevier Science</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>199501</creationdate><title>Predictors of systolic and diastolic improvement in patients with dilated cardiomyopathy treated with metoprolol</title><author>Eichhorn, Eric J ; Heesch, Christian M ; Risser, Richard C ; Marcoux, Lucille ; Hatfield, Barbara</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c466t-9f09e950fd6e26e33d38f14231558f9a83b1a949b2ba470e5416c4403cd3f2213</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1995</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Cardiomyopathy, Dilated - diagnostic imaging</topic><topic>Cardiomyopathy, Dilated - drug therapy</topic><topic>Cardiomyopathy, Dilated - physiopathology</topic><topic>Cardiotonic agents</topic><topic>Cardiovascular system</topic><topic>Diastole - drug effects</topic><topic>Double-Blind Method</topic><topic>Heart - diagnostic imaging</topic><topic>Heart - physiopathology</topic><topic>Hemodynamics - drug effects</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Metoprolol - therapeutic use</topic><topic>Middle Aged</topic><topic>Myocardial Contraction - drug effects</topic><topic>Pharmacology. Drug treatments</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Radionuclide Imaging</topic><topic>Retrospective Studies</topic><topic>Systole - drug effects</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Eichhorn, Eric J</creatorcontrib><creatorcontrib>Heesch, Christian M</creatorcontrib><creatorcontrib>Risser, Richard C</creatorcontrib><creatorcontrib>Marcoux, Lucille</creatorcontrib><creatorcontrib>Hatfield, Barbara</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American College of Cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Eichhorn, Eric J</au><au>Heesch, Christian M</au><au>Risser, Richard C</au><au>Marcoux, Lucille</au><au>Hatfield, Barbara</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predictors of systolic and diastolic improvement in patients with dilated cardiomyopathy treated with metoprolol</atitle><jtitle>Journal of the American College of Cardiology</jtitle><addtitle>J Am Coll Cardiol</addtitle><date>1995-01</date><risdate>1995</risdate><volume>25</volume><issue>1</issue><spage>154</spage><epage>162</epage><pages>154-162</pages><issn>0735-1097</issn><eissn>1558-3597</eissn><coden>JACCDI</coden><abstract>Objectives. The aim of this study was to determine which patients will have systolic and diastolic improvement after betablockade with metoprolol.
Background. Beta-adrenergic blocking agents improve systolic and diastolic function in patients with heart failure. However, it is unclear which patients will respond best to therapy.
Methods. We retrospectively examined baseline characteristics of 24 patients who underwent double-blind then open-label treatment with metoprolol to determine which characteristic predicted improvement in systolic and diastolic function. Degree of improvement in systolic function (22 patients) was defined by the change in left ventricular ejection fraction after 3 months of therapy. Degree of improvement in diastolic function (15 patients) was defined as the change in left ventricular end-diastolic pressure and change in the slope of the isovolumetric relaxation rate—end-systolic pressure relation.
Results. Both systolic blood pressure at baseline (r = 0.54, p = 0.009) and the maximal positive value of the first derivative of left ventricular pressure with respect to time (peak +dP/dt) at baseline (r = 0.39, p = 0.07) correlated with improvement in ejection fraction after metoprolol treatment. Stepwise logistic regression demonstrated that only peak systolic pressure was an independent predictor of systolic improvement. Baseline heart rate, ventricular volumes, ejection fraction and adrenergic activation, as reflected by coronary sinus norepinephrine, did not predict response. Patients with the most diastolic impairment at baseline had the most favorable diastolic improvement. Those with the lowest myocardial respiratory quotient (most fatty acid utilization) at baseline also had the most marked reduction in left ventricular end-diastolic pressure.
Conclusions. These data suggest that those patients with the highest peak systolic pressure, highest left ventricular end-diastolic pressure and most prolonged isovolumetric relaxation at baseline will respond best to therapy with metoprolol. However, other patients without these characteristics may also benefit.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>7798494</pmid><doi>10.1016/0735-1097(94)00340-V</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aged Biological and medical sciences Cardiomyopathy, Dilated - diagnostic imaging Cardiomyopathy, Dilated - drug therapy Cardiomyopathy, Dilated - physiopathology Cardiotonic agents Cardiovascular system Diastole - drug effects Double-Blind Method Heart - diagnostic imaging Heart - physiopathology Hemodynamics - drug effects Humans Male Medical sciences Metoprolol - therapeutic use Middle Aged Myocardial Contraction - drug effects Pharmacology. Drug treatments Prognosis Prospective Studies Radionuclide Imaging Retrospective Studies Systole - drug effects |
| title | Predictors of systolic and diastolic improvement in patients with dilated cardiomyopathy treated with metoprolol |
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