Heart 1998;79:337-344 ( April )
Long term survival effect of metoprolol in dilated cardiomyopathy
a Department of Cardiology,
Ospedale Maggiore and University, Trieste,
Italy, b Department of Statistics,
University of Trieste, Trieste,
Italy, c Istituto di Fisiologia Clinica CNR Sezione di
Milano, Milan, Italy, d Divisione di Cardiologia, IRCCS Policlinico
San Matteo, Pavia, Italy
Correspondence to: Dr R De Maria, Istituto Fisiologia Clinica CNR, Sezione di Milano, Dipartimento di Cardiologia De Gasperis, Piazza Ospedale Maggiore 3, 201162 Milano, Italy. email: ifcnigmi{at}tin.it
Accepted for publication 3 November 1997
Objective
To evaluate the additive effect of
metoprolol treatment on long term incidence of fatal and non-fatal
cardiac events in idiopathic dilated cardiomyopathy.
Design586 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.
ResultsSurvival 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).
ConclusionsThe 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.
blockade;
dilated cardiomyopathy;
heart
failure
© 1998 by Heart
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