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Effectiveness of long-term beta-blocker therapy for dilated cardiomyopathy—echocardiographical follow-up

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Summary

To evaluate the effectiveness of long-term beta-blocker therapy for dilated cardiomyopathy (DCM), two groups (Group I: 18 patients, Group II: 17 patients) with DCM divided by the order at the entry were followed echocardiographically for 16.9 ± 3.0 months in Group I and 21.4 ± 3.9 months in Group II. Metoprolol (final dose: 60 mg/day) was administered in Group I, but not in Group II (the control), although the conventional treatment for heart failure was continued. The left ventricular end-systolic dimension and ejection fraction assessed by echocardiography improved significantly after 6 months in Group I, but not in Group II, even after 48 months, although there were no significant differences in baseline data between the two groups. The end-diastolic dimension decreased significantly after 12 months in Group I only. It was estimated, using the point count method on a left ventricular endomyocardial biopsy specimen taken at entry, that the improvement (AEF) of the ejection fraction 12 months after metoprolol administration inversely correlated (r = - 0.677, p < 0.01) with percent fibrosis, indicating that the more myocardium remains, the more improvement is expected. These findings suggested a favorable effect of beta blockade in DCM, especially in cases with less fibrosis, showing that the endomyocardial biopsy could be of clinical use in selecting candidates for chronic beta-blocker therapy in DCM.

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References

  1. Thomas JA, Marks BH. Plasma norepinephrine in congestive heart failure.Am J Cardiol 1978;41:233–243.

    Article  PubMed  CAS  Google Scholar 

  2. Cohn JN, Levine TB, Olivari MT, et al. Plasma norepinephrine as a guide to prognosis in patients with chronic congestive heart failure.N Engl J Med 1984;311:819–823.

    PubMed  CAS  Google Scholar 

  3. Fowler MB, Bristow MR. Rationale for beta-adrenergic blocking drugs in cardiomyopathy.Am J Cardiol 1985;55:120D-124D.

    Article  PubMed  CAS  Google Scholar 

  4. Murphree SS, Saffitz JE. Distribution of beta-adrenergic receptors in failing human myocardium. Implications for mechanisms of downregulation.Circulation 1989;79:1214–1225.

    PubMed  CAS  Google Scholar 

  5. Kagiya T, Watanabe Y, Iwakura K, et al. Decrease in cell surface beta2-receptor number of lymphocyte in patients with congestive heart failure (abstr).Jpn J Pharmacol 1987;43(Suppl):256.

    Google Scholar 

  6. Horn EM, Corwin SJ, Steinberg SF, et al. Reduced lymphocyte stimulatory guanine nucleotide regulatory protein and beta-adrenergic receptors in congestive heart failure and reversal with angiotensin converting enzyme inhibitor therapy.Circulation 1988;78:1373–1379.

    PubMed  CAS  Google Scholar 

  7. Heilbrunn SM, Shah P, Bristow MR, et al. Increased betareceptor density and improved hemodynamic response to catecholamine stimulation during long-term metoprolol therapy in heart failure from dilated cardiomyopathy.Circulation 1989;79:483–490.

    PubMed  CAS  Google Scholar 

  8. Hashimura K, Fukunami M, Ohmori M, et al. The role of lymphocyte beta-receptor number and responsiveness in chronic beta-blocker therapy for dilated cardiomyopathy (abstr).Cardiovasc Drugs Ther 1989;3(Suppl 2):590.

    Google Scholar 

  9. Fukunami M, Hoki N, Yamada M, et al. Possible mechanism for the beneficial effect of chronic beta-blockers administration in patients with dilated cardiomyopathy (abstr).Circulation 1987;76(Suppl 4):IV-358.

    Google Scholar 

  10. Hashimura K, Fukunami M, Ohmori M, et al. Effect of beta-blocker withdrawal on beta-receptor-adenylate cyclase coupling in patients with dilated cardiomyopathy (abstr).Circulation 1989;78(Suppl 4):IV-116.

    Google Scholar 

  11. Waagstein F, Hjalmarson A, Varnauskas E, et al. Effect of chronic beta-adrenergic receptor blockade in congestive cardiomyopathy.Br Heart J 1975;37:1022–1036.

    Article  PubMed  CAS  Google Scholar 

  12. Swedberg K, Hjalmarson A, Waagstein F, et al. Prolongation of survival in congestive cardiomyopathy by beta-receptor blockade.Lancet 1979;1:1374–1376.

    Article  PubMed  CAS  Google Scholar 

  13. Swedberg K, Hjalmarson A, Waagstein F, et al. Beneficial effects of long-term beta-blockade in congestive cardiomyopathy.Br Heart J 1980;44:117–133.

    Article  PubMed  CAS  Google Scholar 

  14. Swedberg K, Hjalmarson A, Waagstein F, et al. Adverse effects of beta-blockade withdrawal in patients with congestive cardiomyopathy.Br Heart J 1980;44:134–142.

    Article  PubMed  CAS  Google Scholar 

  15. Ikram H, Fitzpatrick D. Double-blind trial of chronic oral beta-blockade in congestive cardiomyopathy.Lancet 1981; 2:490–492.

    Article  PubMed  CAS  Google Scholar 

  16. Currie PJ, Kelly MJ, McKenzie A, et al. Oral betaadrenergic blockade with metoprolol in chronic severe dilated cardiomyopathy.J Am Coll Cardiol 1984;3:203–209.

    PubMed  CAS  Google Scholar 

  17. The Xamoterol in Severe Heart Failure Study Group. Xamoterol in severe heart failure.Lancet 1990;336:l-6.

    Google Scholar 

  18. The German and Austrian Xamoterol Study Group. Double-blind placebo-controlled comparison of digoxin and xamoterol in chronic heart failure.Lancet 1988;1:489–493.

    Google Scholar 

  19. Leung W-H, Lau C-P, Wong C-K, et al. A double-blind crossover trial of labetalol in patients with idiopathic dilated cardiomyopathy (abstr).Circulation 1989;80(Suppl 2): II-118.

    Google Scholar 

  20. Eichhorn EJ, Bedotto J, Hatfield B, et al. Improvement in contractile performance in patients with congestive failure by chronic beta-blocker therapy with bucindolol (abstr).Circulation 1989;80(Suppl 2):II-117.

    Google Scholar 

  21. Pollock SG, Lystash JC, Tedesco CL, et al. Bucindolol-beta blockade with vasodilation improves congestive heart failure (abstr).Circulation 1989;80(Suppl 2):II-118.

    Google Scholar 

  22. Colucci WS, Alexander W, Williams GH, et al. Decreased lymphocyte beta-adrenergic-receptor density in patients with heart failure and tolerance to the beta-adrenergic agonist pirbuterol.N Engl J Med 1981;305:185–190.

    Article  PubMed  CAS  Google Scholar 

  23. Anderson JL, Lutz JR, Gilbert EM, et al. A randomized trial of low-dose beta-blockade therapy for idiopathic dilated cardiomyopathy.Am J Cardiol 1985;55:471–475.

    Article  PubMed  CAS  Google Scholar 

  24. Engelmeier RS, O’Connell JB, Walsh R, et al. Improvement in symptoms and exercise tolerance by metoprolol in patients with dilated cardiomyopathy: A double-blind, randomized, placebo-controlled trial.Circulation 1985;72:536–546.

    PubMed  CAS  Google Scholar 

  25. Golf S, Hansson V. Effects of beta blocking agents on the density of beta adrenoceptors and adenylate cyclase response in human myocardium: Intrinsic sympathomimetic activity favours receptor up-regulation.Cardiovasc Res 1986;20:637–644.

    Article  PubMed  CAS  Google Scholar 

  26. Majid PA, Niznick J, Nishizaki S, et al. Favourable effects of pindolol in dilated cardiomyopathy.Chest 1986;90:777–779.

    Article  PubMed  CAS  Google Scholar 

  27. Yamada H, Fukunami M, Yamada M, et al. Evidence for beneficial effects of low dose beta-blocker therapy in dilated cardiomyopathy (abstr).Jpn Circ J 1987;51:P-290.

    Google Scholar 

  28. Report of the WHO/ISFC task force on the definition and classification of cardiomyopathies.Br Heart J 1980;44: 672–673.

    Google Scholar 

  29. Feigenbaum H, ed.Echocardiography. Philadelphia: Lea and Febiger, 1981.

    Google Scholar 

  30. Waagstein F, Caidahl K, Wallentin I, et al. Long-term beta-blockade in dilated cardiomyopathy. Effects of short- and long-term metoprolol treatment followed by withdrawal and readministration of metoprolol.Circulation 1989;80:551–563.

    PubMed  CAS  Google Scholar 

  31. Brodde OE, Schuler S, Kretsch R, et al. Regional distribution of beta-adrenoceptors in the human heart: Coexistence of functional beta1 and beta2-adrenoceptors in both atria and ventricles in severe congestive cardiomyopathy.J Cardiovasc Pharmacol 1986;8:1235–1242.

    Article  PubMed  CAS  Google Scholar 

  32. Brodde OE, Daul A, Michel-Reher, et al. Agonist-induced desensitization of beta-adrenoceptor function in humans: Subtype-selective reduction in beta1- and beta2-adrenoceptor-mediated physiological effects by xamoterol or procaterol.Circulation 1990;81:914–921.

    PubMed  CAS  Google Scholar 

  33. Michel MC, Pingsmann A, Beckeringh JJ, et al. Selective regulation of beta1 and beta2-adrenoceptors in the human heart by chronic beta-adrenoceptor antagonist treatment.Br J Pharmacol 1988;94:685–692.

    PubMed  CAS  Google Scholar 

  34. Van der Meiracker AH, Man in’t Veld AJ, Boomsma F, et al. Hemodynamic and beta-adrenergic receptor adaptations during long-term beta-adrenoceptor blockade. Studies with acebutolol, atenolol, pindolol, and propranolol in hypertensive patients.Circulation 1989;80:903–914.

    PubMed  Google Scholar 

  35. Brodde OE, Kretsch R, Ikezono K, et al. Human beta-adrenoceptors: Relation of myocardial and lymphocyte beta-adrenoceptor density.Science 1986;231:1584–1585.

    Article  PubMed  CAS  Google Scholar 

  36. Kagiya T, Hori M, Fukunami M, et al. Role of beta-adrenergic receptors in beta-blocker therapy for chronic heart failure in patients with dilated cardiomyopathy (abstr).Circulation 1987;76:(Suppl 4):IV-308.

    Google Scholar 

  37. Fukunami M, Hashimura K, Ohmori M, et al. Effectiveness of long term beta-blocker therapy for dilated cardiomyopathy (abstr).Cardiovasc Drugs Ther 1989;3(Suppl 2):586.

    Google Scholar 

  38. Marquetant R, Brehm B, Strasser RH, et al. cAMP-independent transregulation of antagonist receptors of the adenyl cyclase system (abstr).Circulation 1989;80(Suppl 2):II-18.

    Google Scholar 

  39. Stevenson LW, Fowler MB. Schroeder JS, et al. Poor survival of patients with idiopathic cardiomyopathy considered too well for transplantation.Am J Med 1988;83:871–876.

    Article  Google Scholar 

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Authors and Affiliations

  1. Division of Cardiology, Osaka Prefectural Hospital, 3-1-56, Mandai-Higashi, Sumiyoshi-ku, 558, Osaka, Japan

    Masatake Fukunami, Kazuhiko Hashimura, Masaharu Ohmori, Toshitaro Ikeda, Kiyoshi Umemoto, Kazuaki Kumagai, Akihiko Sakai, Takahisa Yantada, Nobuhiko Kondoh, Tetsuo Minamino & Noritake Hoki

  2. Division of Pathology, Osaka Prefectural Hospital, Japan

    Tomofumi Nagareda & Kiyoshi Kotoh

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  1. Masatake Fukunami
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  2. Kazuhiko Hashimura
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  3. Masaharu Ohmori
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  4. Toshitaro Ikeda
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  6. Kazuaki Kumagai
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  13. Noritake Hoki
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Fukunami, M., Hashimura, K., Ohmori, M. et al. Effectiveness of long-term beta-blocker therapy for dilated cardiomyopathy—echocardiographical follow-up. Cardiovasc Drug Ther 5, 463–469 (1991). https://doi.org/10.1007/BF03029771

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