Beta-adrenergic blockade in dilated cardiomyopathy, ischemic cardiomyopathy, and other secondary cardiomyopathies
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Beta-blockers were initially given to patients with chronic heart failure due to ischemic heart disease and resting tachycardia. The prompt effect on severe backward heart failure was directly associated with an immediate fall in heart rate. This observation led to long-term administration to patients with idiopathic dilated cardiomyopathy and, later, to patients with ischemic cardiomyopathy and secondary cardiomyopathies as well.
Due to marked down-regulation of beta receptors, patients with heart failure are extremely sensitive to beta blockade. A test dose of metoprolol 5 mg b.i.d. for 2 days is recommended to select patients for longterm beta-blockade, followed by careful titration with increment in dose over 6 weeks.
One important effect of beta-blockade in the early phase of treatment is a reduction in the myocardial energy demand early after the onset of long-term treatment. After 1 month of treatment with beta-blockers, marked improvement of diastolic function is observed. This effect might be attributed to inhibition of calcium overload. After 3 months of treatment, an increase in ejection fraction can be observed, which might be attributed to upregulation of beta receptors. The withdrawal of long-term treatment was followed by a deterioration of heart function in 61% of patients and improvement was seen after reinstitution of beta-blockade. There was an increase in cardiac index and stroke work index at rest as well as during supine exercise. A marked fall in left ventricular filling pressure at rest and unchanged filling pressure during supine exercise was noted, while exercise capacity increased by 25%.
A similar pattern was seen in patients with ischemic cardiomyopathies and other secondary cardiomyophaties. However, the increase in ejection fraction in the ischemic cardiomyopathy group was lower (0.06) compared to the groups with dilated cardiomyopathy and other secondary cardiomyopathies (0.18).
Key wordsBeta-adrenergic blockade Dilated cardiomyopathy Ischemic cardiomyopathy Secondary cardiomyopathies Hemodynamics
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- 2.Åblad B, Abrahamsson T, Björkman J-A, Bjurö T, Ek L, Sjöquist P-O (1985) Effects of metoprolol on ischemic myocardial regional function and oxygen supply/demand ratio in the dog. In: Hugenholtz PG, Goldman BS (eds) Unstable angina, current concepts and management, Schattauer, Stuttgart, pp 159–170Google Scholar
- 6.Ikram H, Fitzpatrick D (1981) Double-blind trial of chronic oral beta-blockade in congestive cardiomyopathy. Lancet II:490Google Scholar
- 7.Currie PJ, Kelly MJ, McKenzie A, Harper RW, Lim YL, Federman J, Anderson ST, Pitt A (1984) Oral beta-adrenergic blockade with metoprolol in chronic severe dilated cardiomyopathy. J Am Coll Cardiol 3:203Google Scholar
- 10.Andersson B, Lundqvist Blomström C, Waagstein F (1988) Exercise hemodynamics and myocardial metabolism in severe heart failure during chronic beta-blockade treatment (abstract). Circulation 78 (Suppl II):II-575Google Scholar
- 11.Tveter KJ, Bianco RW, Mahoney JR, Foker JE (1988) Ribose enhanced recovery of diastolic function after global myocardial ischemia (abstract) Circulation 78 (Suppl II): II-1055Google Scholar
- 13.Andersson B, Lomsky M, Waagstein F (1989) Acute and chronic effects of beta blockade on diastolic and systolic function in severe heart failure (abstract) Cardiovasc Drugs Ther (Suppl 2):574Google Scholar
- 14a.Hori M (1989) The role of adrenergic activity in chronic heart failure and the rationale for beta-blocker therapy. Second conference of the role of adrenergic receptors in chronic congestive heart failure. 18 October 1989, Kyoto, JapanGoogle Scholar
- 14b.Hori M, Kuretsune Y, Sato H, Kagiga T, Kitabatake A, Kamada T (1991) Detrimental effects of beta-adrenergic stimulation on beta-adrenoreceptors and microtubules in the heart. Heart Vess Suppl 6, 11–16Google Scholar
- 16a.O'Connell JB (1989) Clinical assessment of beta-adrenergic blockade in dilated cardiomyopathy. Second conference of the role of adrenergic receptors in chronic congestive heart failure. 18 October, 1989, Kyoto, JapanGoogle Scholar
- 16b.Gilbert EM, O'Connell JB, Bristow MR (1991) Therapy of idiopathic dilated cardiomyopathy with chronic β-adrenergic blockade. Heart Vess Suppl 6, 29–39Google Scholar
- 18.Andersson B, Waagstein F (1989) Improved exercise hemodynamics and myocardial energy utilisation in heart failure during beta blockade treatment (abstract). Cardiovasc Drugs Ther (Suppl 2):573Google Scholar
- 20.Waagstein F, Blomström Lundquist C, Anderson B, Hjalmarson Å (1987) Long-term effects of metoprolol in severe heart failure due to ischemic cardiomyopathy, primary valve disease and diabetes (abstract). Circulation 76 (Suppl IV):IV-358Google Scholar
- 21.Waagstein F (1990) Beta-blockade in dilated cardiomyopathy. In: Baroldi G, Camerini F, Goodwin JF (eds) Advances in cardiomyopathies. Springer, Berlin Heidelberg, pp 442–453Google Scholar
- 22.Heilbrunn SM, Shah P, Valentine HA, Mullin AV, Ginsburg R, Schroeder JS, Bristow MR, Fowler MB (1986) Increased beta-receptor density and improved hemodynamic response to catecholamine stimulation during metoprolol therapy (abstract). Circulation 74 (Suppl II):II-1310Google Scholar
- 23.Hjalmarson Å, Waagstein F (1990) Use of beta-blockers in the treatment of dilated cardiomyopathy. In: Allen PD, Gwathmey J, Briggs M (eds) Inotropic drugs: Basic research and clinical practice.Google Scholar