Effects of metoprolol CR in patients with ischemic and dilated cardiomyopathy - The randomized evaluation of strategies for left ventricular dysfunction pilot study

Article

关键词: BETA-ADRENERGIC-BLOCKADE;    CONGESTIVE-HEART-FAILURE;    CARVEDILOL;    MORTALITY;    PLASMA;    INHIBITORS;    BLOCKERS;    TRIALS;   

DOI  :  10.1161/01.CIR.101.4.378

来源: SCIE

【 摘 要 】

Background-Metoprolol provides clinical benefits in patients with congestive heart failure (CHF). in this study, we investigated the effects of controlled-release metoprolol (metoprolol CR) on clinical status, on left ventricular (LV) volumes and function, and on neurohumoral activation in a large number of patients with CHF of mixed causes. Methods and Results-Four hundred twenty-six patients with symptomatic CHF were randomized to receive metoprolol CR or placebo for 24 weeks. Metoprolol CR did not affect 6-minute walk distance, New York Heart Association functional class, or quality of life. However, there was a significant improvement in measures of LV function with an attenuation in the increase in LV end-diastolic (+23 +/- 65 mL [placebo] versus +6 +/- 61 mL, P = 0.01) and LV end-systolic (+19 +/- 55 mL [placebo] versus -2 +/- 51 mL, P < 0.001) volumes after 24 weeks of therapy. LV ejection fraction was unchanged (-0.05% or -0.005) in the placebo group but increased by 2.4% in the metoprolol CR-treated patients (P = 0.001). Patients receiving metoprolol CR had a greater decrease in angiotensin II (P = 0.036) and renin (P = 0.032) levels bur an increase in N-terminal atrial natriuretic peptide and brain natriuretic peptide levels (P < 0.01). There were fewer deaths in the group receiving beta-blockers (3.4% versus 8.1%), and there was a similar number of patients experiencing the composite outcomes of death or any hospitalization. Conclusions-When added to ACE inhibitors, angiotensin II receptor antagonists, or both, the use of metoprolol CR improves ventricular function, reduces activation of the renin-angiotensin systems, and results in fewer deaths.

【 授权许可】

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