CARDIOVASCULAR MEDICINE

Longitudinal myocardial contraction improves early during titration with metoprolol CR/XL in patients with heart failure

B Andersson, B Grüner Sveälv, M Scharin Täng, R Mobini

Department of Cardiology and Wallenberg Laboratory of Cardiovascular Research, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden

Correspondence to:
Correspondence to:
Dr B Andersson, Department of Cardiology, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden;
bert.andersson{at}hjl.gu.se

Objective: To investigate diastolic and systolic left ventricular recovery during titration with metoprolol CR/XL (controlled release/extended release).

Design: Placebo run in, followed by an open study.

Setting: University hospital.

Patients: 14 patients with chronic heart failure.

Interventions: Metoprolol CR/XL titrated from 12.5 mg once daily to 200 mg once daily.

Main outcome measures: M mode recordings of atrioventricular (AV) plane displacement, Doppler measurement of transmitral flow and pulmonary venous flow, two dimensional ejection fraction, and measurement of venous plasma concentration of noradrenaline. Patients were investigated after 2, 4, 6, and 24 weeks of treatment.

Results: A reduction of heart rate was observed on the first dose (12.5 mg once daily), from a mean (SD) of 74 (11) to 67 (11) beats/min, p < 0.05. This was accompanied by prominent effects on AV plane filling parameters, including an increase in early diastolic filling period from 87 (28) to 105 (33) ms (p < 0.05), and in the lateral AV plane fractional shortening from 8.7 (2.7)% to 10.2 (2.8)% (p < 0.05). An early trend towards improvement in global systolic left ventricular function was also seen, although this was not significant until six weeks. Ejection fraction increased from 33 (7.5)% to 38 (11)% (p < 0.05).

Conclusions: First effects of left ventricular recovery during ß blocker treatment were seen in recordings of longitudinal performance, as expressed by AV plane displacement. Doppler flow dynamics as well as global systolic recovery appeared several weeks later, emphasising the importance of longitudinal performance in evaluating left ventricular function.

Keywords: atrioventricular plane displacement; echocardiography; diastole; adrenergic ß blockers

Abbreviations: AV, atrioventricular; AVP-FS, atrioventricular plane fractional shortening; CR/XL, controlled release/extended release; MDC, metoprolol in dilated cardiomyopathy; MERIT-HF, metoprolol CR/XL randomised intervention trial in congestive heart failure; NYHA, New York Heart Association

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