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Long-term survival effect of metoprolol in dilated cardiomyopathy. The SPIC (Italian Multicentre Cardiomyopathy
A Di Lenarda1, R De Maria, A Gavazzi
1Department of Cardiology, Ospedale Maggiore and University, Trieste, Italy.
Insights
Metoprolol significantly improved survival and reduced cardiac events in idiopathic dilated cardiomyopathy patients. This beta-blocker offers long-term benefits when added to standard heart failure therapy.
Area of Science:
- Cardiology
- Pharmacology
- Heart Failure Research
Background:
- Idiopathic dilated cardiomyopathy (IDCM) is a significant cause of heart failure.
- Long-term management of IDCM aims to reduce mortality and cardiac events.
- The role of beta-blockers, specifically metoprolol, in IDCM requires further long-term evaluation.
Purpose of the Study:
- To assess the additive impact of metoprolol on the long-term incidence of fatal and non-fatal cardiac events in patients with IDCM.
- To determine if metoprolol improves survival and reduces the need for transplantation in this patient population.
Main Methods:
- A multicentre registry prospectively enrolled 586 patients with IDCM, followed for a mean of 52 months.
- Metoprolol was carefully titrated and added to conventional heart failure treatment in 175 patients.
- Comparative analysis was performed between metoprolol-treated patients and those on standard therapy, including matched controls.
Main Results:
- Seven-year survival and transplant-free survival were significantly higher in metoprolol-treated patients (81% vs. 60% and 69% vs. 49%, respectively; P < 0.001).
- Metoprolol independently predicted improved survival and transplant-free survival, with relative risk reductions of 51% and 34%, respectively.
- Metoprolol was associated with a 30% reduction in all-cause mortality and a 26% reduction in mortality or transplantation (P < 0.015 and P < 0.009, respectively).
Conclusions:
- Adding metoprolol to standard heart failure treatment, including ACE inhibitors, is effective for long-term management of IDCM.
- Metoprolol significantly reduces all-cause mortality and the need for cardiac transplantation in patients with IDCM.
- The findings support the use of metoprolol as an essential component of therapy for idiopathic dilated cardiomyopathy.
Objective:
To evaluate the additive effect of metoprolol treatment on long-term incidence of fatal and non-fatal cardiac events in idiopathic dilated cardiomyopathy.
Design:
586 patients with idiopathic dilated cardiomyopathy were prospectively enrolled in a multicentre registry and followed up for a mean (SD) of 52 (32) months. Metoprolol, carefully titrated to the maximum tolerated dose, was added to conventional heart failure treatment in 175 patients.
Results:
Survival and transplant-free survival at seven years were significantly higher in the 175 metoprolol treated patients than in the remaining 411 on standard treatment (81% v 60%, p < 0.001, and 69% v 49%, p < 0.001, respectively). By multivariate analysis, metoprolol independently predicted survival and transplant-free survival (relative risk reduction values for all cause mortality and combined mortality or transplantation 51% (95% confidence interval 21% to 69%), p = 0.002, and 34% (5% to 53%), p = 0.01, respectively). New York Heart Association class, left ventricular end diastolic diameter, and pulmonary wedge pressure were also predictive. Seven year survival (80% v 62%, p = 0.004) and transplant-free survival (68% v 51%, p = 0.005) were significantly higher in 127 metoprolol treated cases than in 127 controls selected from the entire control cohort and appropriately matched. Metoprolol was associated with a 30% reduction in all cause mortality (7% to 48%, p = 0.015) and a 26% reduction in mortality or transplantation (7% to 41%, p = 0.009).
Conclusions:
The addition of metoprolol to standard heart failure treatment, including angiotensin converting enzyme inhibitors, was effective in the long-term, reducing both all cause mortality and transplantation in patients with idiopathic dilated cardiomyopathy.