Related Experiment Videos
Early changes in longitudinal performance predict future improvement in global left ventricular function during long
B Andersson1, F Waagstein, K Caidahl
1Department of Cardiology, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden. bert.andersson@hjl.gu.se
Insights
Beta blocker treatment improved heart function in heart failure patients, as shown by improved atrioventricular (AV) plane motion. This AV plane movement is a key indicator of improved systolic performance and reduced filling pressures.
Area of Science:
- Cardiology
- Heart Failure Research
- Pharmacological Interventions
Background:
- Atrioventricular (AV) plane descent reflects longitudinal and subendocardial myocardial muscle fiber contraction.
- Chronic heart failure is associated with impaired cardiac function.
Purpose of the Study:
- To investigate if beta-blocker treatment, by prolonging diastole, improves cardiac function in heart failure patients.
- To assess if this improvement is reflected by changes in AV plane movements.
Main Methods:
- A double-blind, randomized, placebo-controlled study with an open intervention arm.
- 12 months of metoprolol treatment in patients with congestive heart failure.
- Echocardiography (short and long axis), invasive hemodynamics, and radionuclide angiography were used.
Main Results:
- Metoprolol treatment led to early improvements in AV plane amplitude (from 5.3% to 7.1% at 3 months, p < 0.05).
- Improved AV plane amplitude at 3 months independently predicted reduced pulmonary capillary wedge pressure at 6 months (r = 0.80, p = 0.017).
- AV plane amplitude change at 3 months was a stronger predictor of ejection fraction improvement at 12 months than radionuclide ejection fraction changes.
Conclusions:
- Improvement in longitudinal contraction, indicated by AV plane motion, is closely linked to reduced left ventricular filling pressure during metoprolol treatment.
- AV plane motion is crucial for assessing left ventricular filling and systolic performance in heart failure patients.
- The observed association highlights the significance of AV plane motion as a functional marker in heart failure management.
Objective:
Contraction of longitudinal and subendocardial myocardial muscle fibres is reflected in descent of the atrioventricular (AV) plane. The aim was therefore to determine whether beta blocker treatment with prolongation of diastole might result in improved function as reflected by AV plane movements in patients with chronic heart failure.
Design:
Double blind, randomised, placebo controlled and open intervention study.
Setting:
University hospital.
Patients:
Patients with congestive heart failure: placebo controlled (n = 26) and an open protocol (n = 15).
Interventions:
12 months of metoprolol treatment.
Main Outcome Measures:
Short axis and long axis echocardiography, invasive haemodynamics, radionuclide angiography.
Results:
Recovery of systolic and diastolic function during metoprolol treatment was reflected by early changes in mean (SD) AV plane amplitude, from 5.3 (2.0)% to 7.1 (3.2)% and 7.8 (3. 1)% (at 3 and 12 months, respectively; p < 0.05). In a multivariate analysis, only the change in AV plane amplitude by three months was independently associated with improvement in pulmonary capillary wedge pressure by six months (r = 0.80, p = 0.017). Change in AV plane amplitude by three months was also a better predictor of improvement in ejection fraction by 12 months (r = 0.78, p < 0.001) than changes in radionuclide ejection fraction by three months (r = 0.34, p = 0.049).
Conclusions:
Improvement in longitudinal contraction was closely associated with a decrease in left ventricular filling pressure during metoprolol treatment. This association was stronger than changes in short axis performance or radionuclide ejection fraction, emphasising the importance of AV plane motion for left ventricular filling and systolic performance in patients with heart failure.