Effect of metoprolol in hypertrophic obstructive cardiomyopathy patients after alcohol septal ablation
Hana Hnátová1, Klára Fulínová1, Barbora Řiháková1
1Department of Cardiology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic.
Insights
Metoprolol did not improve exercise capacity or quality of life in hypertrophic obstructive cardiomyopathy patients after alcohol septal ablation. This study found no significant benefits of beta-blocker treatment in this specific patient group.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Hypertrophic obstructive cardiomyopathy (HOCM) is a condition affecting heart muscle.
- Alcohol septal ablation (ASA) is a procedure used to treat HOCM.
- The role of beta-blockers in HOCM patients post-ASA is not well-established.
Purpose of the Study:
- To investigate the efficacy of metoprolol in HOCM patients following ASA.
- To assess the impact of metoprolol on exercise capacity, hemodynamics, and quality of life.
Main Methods:
- A prospective, randomized, single-center, open-label crossover trial was conducted.
- 21 HOCM patients post-ASA were treated with metoprolol and without beta-blockers for two 3-month periods.
- Endpoints included peak oxygen uptake (pVO2), LVOT pressure gradient, E/e' ratio, KCCQ score, and NT-proBNP levels.
Main Results:
- Metoprolol treatment showed no significant improvement in peak oxygen uptake (pVO2).
- No significant changes were observed in the maximal left ventricular outflow tract (LVOT) pressure gradient or E/e' ratio.
- Quality of life scores (KCCQ) and NT-proBNP levels also did not significantly differ between treatment periods.
Conclusions:
- Metoprolol does not offer significant benefits for exercise capacity in HOCM patients post-ASA.
- Beta-blocker therapy with metoprolol did not improve hemodynamic parameters or quality of life in this cohort.
- Further research may be needed to clarify the role of pharmacotherapy in HOCM management after ASA.
Background:
The use of beta-blockers in hypertrophic obstructive cardiomyopathy (HOCM) patients after alcohol septal ablation (ASA) lacks data support. We aimed to evaluate the effect of metoprolol on exercise capacity, hemodynamic and laboratory parameters, and quality of life in HOCM patients after ASA.
Methods:
This was a prospective randomized single-center open-label crossover trial in 21 HOCM patients after ASA. Patients received metoprolol and no beta-blocker for two periods of three months. The endpoints were: peak oxygen uptake (pVO2), maximal left ventricular outflow tract (LVOT) pressure gradient at peak exercise, a ratio of mitral peak velocity of the early filling (E) to early diastolic mitral annular velocity (e') (E/e') at rest, Kansas City Cardiomyopathy Questionnaire (KCCQ) overall summary score, and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) plasmatic concentration.
Results:
No significant association was found between the treatment and any of the endpoints in the assessed patients: 1) pVO2 (19.5 ± 5.3 ml/kg/min vs. 19.4 ± 4.1 ml/kg/min, p = 0.90), 2) exercise-induced pressure gradient in LVOT 32 ± 37 mmHg vs. 32 ± 30 mmHg, p = 0.84, 3) E/e' ratio at rest (11 ± 4 vs. 10 ± 4, p = 0.23), 4) KCCQ overall summary score (78 ± 11 vs. 77 te ± 15, p = 0.56), 5) NT-proBNP (215 pg/ml [121-333] vs. 153 pg/ml [102-228], p = 0.19).
Conclusions:
In HOCM patients after successful ASA, metoprolol treatment did not improve exercise capacity, hemodynamic and laboratory parameters, or quality of life.
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