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Beneficial effects of metoprolol in heart failure associated with coronary artery disease: a randomized trial
M L Fisher1, S S Gottlieb, G D Plotnick
1Department of Medicine, University of Maryland School of Medicine, Baltimore.
Insights
Titrated metoprolol therapy is safe and beneficial for patients with heart failure, coronary artery disease, and low ejection fraction. This beta-blocker treatment reduced hospital admissions and improved heart function and exercise capacity.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Beta-adrenergic antagonists show benefits in idiopathic dilated cardiomyopathy.
- Limited evaluation exists for heart failure patients with coronary artery disease.
Purpose of the Study:
- To determine the safety and clinical impact of titrated metoprolol in heart failure patients with coronary artery disease and low ejection fraction.
Main Methods:
- A 6-month, double-blind, placebo-controlled randomized trial involving 50 patients.
- Assessed heart failure exacerbations, New York Heart Association functional class, ejection fraction, and exercise duration.
- Included a crossover group for further evaluation.
Main Results:
- Metoprolol was safely titrated to a mean maximal dose of 87 mg/day.
- Significantly reduced hospital admissions (4% vs. 32%, p < 0.05).
- Improved functional class (p = 0.02), ejection fraction (p < 0.05), and exercise duration (p < 0.01).
Conclusions:
- Cautious use of titrated metoprolol is safe and beneficial.
- Metoprolol enhances standard heart failure therapy in patients with coronary artery disease.
Objectives:
This clinical trial was performed to determine the safety and clinical impact of titrated metoprolol therapy in patients with heart failure, documented coronary artery disease and a low ejection fraction.
Background:
Despite known cardiodepressant effects, long-term use of beta-adrenergic antagonists appears to be beneficial in patients with idiopathic dilated cardiomyopathy. However, this therapy has not been critically evaluated in patients with heart failure and coronary artery disease.
Methods:
In 50 patients with heart failure, known coronary artery disease and an ejection fraction < or = 0.40, we examined the impact of metoprolol therapy in a 6-month double-blind, placebo-controlled randomized trial, assessing the frequency of heart failure exacerbations and changes in symptoms (New York Heart Association functional class), ejection fraction and exercise duration. Placebo-treated patients who completed 6-month follow-up studies then underwent a trial with metoprolol therapy (crossover group).
Results:
Metoprolol was titrated to a mean maximal dose of 87 mg/day (range 25 to 100) without serious adverse reactions. During double-blind therapy, use of a beta-blocker was associated with a significant reduction in the number of hospital admissions (4% vs. 32%, p < 0.05), overall improved functional class (p = 0.02), increased ejection fraction (4 +/- 7% [mean +/- SD] compared with 0 +/- 6%, p < 0.05) and a greater increase in exercise duration (193 +/- 276 vs. 38 +/- 213 s with placebo, p < 0.01). Crossover outcome paralleled the favorable impact seen during randomized metoprolol therapy.
Conclusions:
Cautious use of titrated metoprolol appears to be safe and beneficial when added to standard heart failure therapy in patients with dilated cardiomyopathy associated with coronary artery disease.