Cardiovascular medicine
Early changes in longitudinal performance predict future
improvement in global left ventricular function during long term 
adrenergic blockade
B Anderssona, F Waagsteina, K Caidahlb, I Eureniusa, M Scharin Tänga, R Wikhc
a Department of
Cardiology, Sahlgrenska University Hospital, S-413 45 Göteborg,
Sweden, b Department of
Physiology, Sahlgrenska University Hospital, c MEDNET, Sahlgrenska University Hospital
Correspondence to: Dr Andersson bert.andersson{at}hjl.gu.se
Accepted 5 September
2000
OBJECTIVE
Contraction of longitudinal
and subendocardial myocardial muscle fibres is reflected in descent of
the atrioventricular (AV) plane. The aim was therefore to determine
whether 
blocker treatment with prolongation of diastole might
result in improved function as reflected by AV plane movements in
patients with chronic heart failure.
DESIGNDouble blind, randomised,
placebo controlled and open intervention study.
SETTINGUniversity hospital.
PATIENTSPatients with congestive
heart failure: placebo controlled (n = 26) and an open protocol
(n = 15).
INTERVENTIONS12 months of metoprolol treatment.
MAIN OUTCOME MEASURESShort axis and
long axis echocardiography, invasive haemodynamics, radionuclide angiography.
RESULTSRecovery of systolic and
diastolic function during metoprolol treatment was reflected by early
changes in mean (SD) AV plane amplitude, from 5.3 (2.0)% to
7.1 (3.2)% and 7.8 (3.1)% (at 3 and 12 months, respectively;
p < 0.05). In a multivariate analysis, only the change in AV plane
amplitude by three months was independently associated with improvement
in pulmonary capillary wedge pressure by six months
(r = 0.80, p = 0.017). Change in AV plane
amplitude by three months was also a better predictor of improvement in ejection fraction by 12 months (r = 0.78,
p < 0.001) than changes in radionuclide ejection fraction by three
months (r = 0.34, p = 0.049).
CONCLUSIONSImprovement in
longitudinal contraction was closely associated with a decrease in left
ventricular filling pressure during metoprolol treatment. This
association was stronger than changes in short axis performance or
radionuclide ejection fraction, emphasising the importance of AV plane
motion for left ventricular filling and systolic performance in
patients with heart failure.
Keywords: diastolic function; metoprolol; dilated cardiomyopathy; echocardiography
© 2000 by Heart
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