Document Detail


Effects of beta-adrenergic blocking therapy on left ventricular diastolic relaxation properties in patients with dilated cardiomyopathy.
MedLine Citation:
PMID:  10449695     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The hemodynamic mechanism for the improvement in left ventricle (LV) end-diastolic pressure in cardiomyopathy patients treated with beta-adrenergic blocking agents is controversial. We hypothesized that the salutary effect of this kind of therapy on LV end-diastolic pressure would be indicative of an improvement in late, passive diastolic relaxation properties. METHODS AND RESULTS: We studied 14 cardiomyopathy patients in normal sinus rhythm with no arteriographic evidence of coronary artery disease and an LV ejection fraction of </=40% by radionuclide angiography both before and after 6 months of metoprolol therapy with simultaneous micromanometry and biplane cineventriculography. Four comparable patients who were not treated with metoprolol were studied in a similar fashion and served as control subjects. In those receiving metoprolol, LV end-diastolic pressure decreased (P=0.001). The isovolumic relaxation index, tau(ln), shortened (P=0.03). In a similar fashion, the LV chamber stiffness constant, kappa, decreased (P=0.02), LV volume elastance improved (P=0.04), and the myocardial stiffness constant, kappa(e), decreased (P=0.02). A multiple regression analysis revealed that the decrease in LV end-diastolic pressure was indicative of significant improvements in tau(ln) and kappa(e) with the relationship: LV end-diastolic pressure=-4.73+0.27 tau(ln)+0.54 kappa(e) (r=0.81, P<0.0001). These LV diastolic relaxation properties did not change or worsened in the control cardiomyopathy patients. CONCLUSIONS: We conclude that the decrease in LV end-diastolic pressure in cardiomyopathy patients treated with metoprolol is an indicator of improvement in LV diastolic properties resulting from more complete myocardial relaxation.
Authors:
M H Kim; W H Devlin; S K Das; J Petrusha; D Montgomery; M R Starling
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Circulation     Volume:  100     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  1999 Aug 
Date Detail:
Created Date:  1999-09-02     Completed Date:  1999-09-02     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  729-35     Citation Subset:  AIM; IM    
Affiliation:
University of Michigan and Veterans Affairs Medical Centers, Ann Arbor, MI 48105, USA.
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MeSH Terms
Descriptor/Qualifier:
Adrenergic beta-Antagonists / pharmacology,  therapeutic use*
Cardiomyopathy, Dilated / drug therapy*,  physiopathology
Diastole / drug effects*
Female
Heart Rate / drug effects
Humans
Male
Metoprolol / pharmacology,  therapeutic use*
Middle Aged
Muscle Relaxation / drug effects
Myocardial Contraction / drug effects
Stroke Volume / drug effects
Ventricular Function, Left / drug effects*
Grant Support
ID/Acronym/Agency:
R01-HL-36450/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 37350-58-6/Metoprolol

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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