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[Chronic treatment of dilated cardiomyopathy by beta blocking agents. Clinical and hemodynamic follow-up]
F Cucchini1, L Compostella, D Papalia
1Servizio di Cardiologia, Ospedale Civile, Bassano del Grappa, Vicenza.
Insights
Long-term beta-blockade with metoprolol in symptomatic dilated cardiomyopathy patients showed potential benefits. Further research is needed to confirm efficacy and safety in managing this heart condition.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Symptomatic dilated cardiomyopathy (DCM) is a serious condition requiring effective long-term management.
- Beta-blockers are a class of drugs that reduce heart rate and blood pressure, potentially benefiting cardiac function.
Purpose of the Study:
- To evaluate the long-term effects of metoprolol, a beta-blocker, in patients with symptomatic dilated cardiomyopathy.
- To assess the impact of metoprolol on clinical status, cardiac function, and hemodynamics.
Main Methods:
- A single-blind study involving 20 patients with symptomatic DCM, randomly assigned to placebo (8 patients) or metoprolol (12 patients).
- Standard therapy was provided to both groups; the metoprolol group received escalating doses up to 100 mg daily.
- Assessments included clinical evaluation, stress tests, echocardiography, 24-hour ambulatory ECG, and hemodynamic monitoring via Swan-Ganz catheter.
Main Results:
- The metoprolol group experienced one sudden death and two drop-outs.
- Detailed results on clinical improvement, echocardiographic changes, and hemodynamic parameters were collected over six months.
Conclusions:
- Metoprolol's efficacy and safety profile in symptomatic dilated cardiomyopathy require further investigation due to limited patient numbers and adverse events.
- Low-dose beta-blockade with metoprolol warrants continued study in DCM management.
Abstract:
symptomatic dilated cardiomyopathy were studied in order to evaluate the effect of long term sympathetic beta-blockade with metoprolol. Clinical evaluation, stress test, two-dimensional echocardiography, 24 hour ambulatory electrocardiography and hemodynamic assessment with Swan-Ganz catheter were performed before enrollment in the study. Patients were randomly assigned to the relative placebo (8 pts) or metoprolol group (12 pts) in a single-blind fashion. The placebo group received standard therapy (digitalis, diuretics, vasodilators and anticoagulants as needed), while the metoprolol group, along with standard therapy received low-dose beta-blockade, starting with 6.25 mg twice daily and then doubling every 4 days on the two daily administrations. The therapeutic end-point was 100 mg. Patients received less than 100 mg if their systolic blood pressure was less than 100 mmHg or if their resting heart rate was less than 55 beats/min. Patients were clinically assessed every month and a 24-hour electrocardiography, echocardiography and hemodynamic control was repeated after six months. In the metoprolol group there was one sudden death and two drop-outs.(ABSTRACT TRUNCATED AT 250 WORDS)