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Early changes in longitudinal performance predict future improvement in global left ventricular function during long term β adrenergic blockade


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 β blocker treatment with prolongation of diastole might result in improved function as reflected by AV plane movements in patients with chronic heart failure.

DESIGN Double blind, randomised, placebo controlled and open intervention study.

SETTING University hospital.

PATIENTS Patients with congestive heart failure: placebo controlled (n = 26) and an open protocol (n = 15).

INTERVENTIONS 12 months of metoprolol treatment.

MAIN OUTCOME MEASURES Short axis and long axis echocardiography, invasive haemodynamics, radionuclide angiography.

RESULTS Recovery 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).

CONCLUSIONS Improvement 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.

  • diastolic function
  • metoprolol
  • dilated cardiomyopathy
  • echocardiography

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