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Effect of β-blockade on regional left ventricular function in patients with dilated cardiomyopathy

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Journal of Nuclear Cardiology Aims and scope

Abstract

It has been reported that β-blockade has beneficial effects on the cardiac function and prognosis of patients with congestive heart failure. However, the mechanism for these effects remained unclear. This study compared the use of an angiotensin-converting enzyme (ACE) inhibitor (enalapril, 2.5 to 5.0 mg/day, or delapril, 15 to 30 mg/day) alone with the effects of β-blockade therapy (metoprolol, 40 to 60 mg/day) coupled with an ACE inhibitor on global and regional left ventricular (LV) function in patients with dilated cardiomyopathy. In 12 patients with dilated cardiomyopathy, the global LV ejection fraction (EF), regional EF (rEF), and regional ejection time (rET) were determined by sector analysis of the radionuclide ventriculogram before and after therapy (duration 14±9 months). The coefficients of variation of rEF and rET were calculated as indexes of the heterogeneity of regional LV systolic wall motion. EF increased significantly from 20%±8% to 30%±8% (p<0.05) in patients who received β-blockade and an ACE inhibitor (n=5). Furthermore, the coefficients of variation of rET decreased from 27%±13% to 16%±7% (p<0.05). In contrast, patients treated with an ACE inhibitor only (n=7) showed no significant improvements in any of these parameters. These results suggest that, compared with an ACE inhibitor alone, β-blockade improves global and regional LV function in dilated cardiomyopathy by synchronizing myocardial contraction.

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References

  1. Waagtein F, Caidahl K, Wallentin I, Bergh CH, Hjalmarson A. Long-term beta-blockade in dilated cardiomyopathy: effects of short- and long-term metoprolol treatment followed by with-drawal and readministration of metoprolol. Circulation 1989; 80:551–63.

    Google Scholar 

  2. Waagstein F, Bristow MR, Swedberg K, et al. Beneficial effects of metoprolol in idiopathic dilated cardiomyopathy. Lancet 1993;342:1441–6.

    Article  PubMed  CAS  Google Scholar 

  3. Swedberg K, Hjalmarson A, Waagstein F, Wallentin I. Prolongation of survival in congestive cardiomyopathy by betareceptor blockade. Lancet 1979;1:1374–6.

    Article  PubMed  CAS  Google Scholar 

  4. Anderson JL, Gilbert EM, O’Connell JB, et al. Long-term (2 year) beneficial effects of beta-adrenergic blockade with bucindolol in patients with idiopathic dilated cardiomyopathy. J Am Coll Cardiol 1991;17:1373–81.

    PubMed  CAS  Google Scholar 

  5. Krum H, Schwarz B, Sackner-Bernstein J, et al. Double-blind, placebo-controlled study of the long-term efficacy of carvedilol in patients with severe heart failure treated with converting-enzyme inhibitor [Abstract]. J Am Coll Cardiol 1993;21:114A.

    Google Scholar 

  6. Braunwald E, Sonnenblick EH, Ross J. Mechanisms of cardiac contraction and relaxation. In: Braunwald E, ed. Heart disease. 4th ed. Philadelphia: WB Saunders, 1992:351–92.

    Google Scholar 

  7. Kleulen TH, Gorlin R, Herman VH. Ventricular patterns and hemodynamics in primary myocardial disease. Circulation 1973;47:299–308.

    Google Scholar 

  8. Ritchie JL, Clark LJ, Reicheubach D. Congestive cardiomyopathy with segmental wall motion abnormalities and a nonuniform pattern of fibrosis. Cathet Cardiovasc Diagn 1979;5:283–7.

    Article  PubMed  CAS  Google Scholar 

  9. Kawai C, Takatsu T. Clinical and experimental studies on cardiomyopathy. N Engl J Med 1975;293:592–7.

    PubMed  CAS  Google Scholar 

  10. Wallis DE, O’Connell JB, Henkin RE, Costanzo-Nordin MR, Scanlon PJ. Segmental wall motion abnormalities in dilated cardiomyopathy: a common finding and good prognostic sign. J Am Coll Cardiol 1984;4:674–9.

    PubMed  CAS  Google Scholar 

  11. Herman MV, Heinle RA, Klein MD, Gorlin R. Localized disorders in myocardial contraction. N Engl J Med 1967;277: 222–32.

    PubMed  CAS  Google Scholar 

  12. Brutsaert DL. Nonuniformity: a physiological modulator of contraction and relaxation of normal heart. J Am Coll Cardiol 1987;9:341–8.

    PubMed  CAS  Google Scholar 

  13. Grines CL, Booth DC, Nisses SE, Gurley JC, Bennett KA, DeMaria AN. Acute effects of parenteral beta-blockade on regional ventricular function of intact and noninfarct zones after reperfusion therapy in humans. J Am Coll Cardiol 1991;17:1382–7.

    PubMed  CAS  Google Scholar 

  14. Vitale DF, Green MV, Bacharach SL, Bonow RO, Findley SL, Jones AE. Assessment of regional left ventricular function by sector analysis: a method for objective evaluation of radionuclide blood pool studies. Am J Cardiol 1983;52:1112–9.

    Article  PubMed  CAS  Google Scholar 

  15. Morozumi T, Ishida Y, Sato H, et al. Analysis of regional LV function using radionuclide ventriculography in patients with dilated cardiomyopathy (in Japanese). Shinzo 1993;21:74–81.

    Google Scholar 

  16. Yamada T, Fukunami M, Ohmori M, et al. Which subpopulation of patients with dilated cardiomyopathy would benefit from long-term beta-blocker therapy?: a histological viewpoint. J Am Coll Cardiol 1993;21:628–33.

    PubMed  CAS  Google Scholar 

  17. Alderman J, Grossman W. Are β-adrenergic blocking drugs useful in the treatment of dilated cardiomyopathy? Circulation 1985;71:854–7.

    PubMed  CAS  Google Scholar 

  18. Waagstein F, Hjalmmarson A, Varnauskas E, Wallentin I. Effect of chronic beta-adrenergic receptor blockade in congestive cardiomyopathy. Br Heart J 1975;37:1022–36.

    Article  PubMed  CAS  Google Scholar 

  19. Packer M. Pathophysiological mechanisms underlying the effects of β-adrenergic agonists and antagonists on functional capacity and survival in chronic heart failure. Circulation 1990;82(suppl):I-77–I-88.

    CAS  Google Scholar 

  20. Lew WYW, Chen Z, Guth B, Covell JW. Mechanisms of augmented segment shortening in nonischemic areas during acute ischemia in angina pectoris. Circ Res 1985;56:351–8.

    PubMed  CAS  Google Scholar 

  21. Yamanishi K, Fujita M, Sasayama S, Nakajima H, Asanoi H, Ohno A. Functional characteristics of nonischemic region during pacing-induced myocardial ischemia in angina pectoris. Am J Cardiol 1988;61:1214–8.

    Article  PubMed  CAS  Google Scholar 

  22. Theroux P, Franklin D, Ross J Jr, Kemper WS. Regional myocardial function during acute coronary artery occlusion and its modification by pharmacologic agents in the dog. Circ Res 1974;35:896–908.

    PubMed  CAS  Google Scholar 

  23. Molaug M, Geiran O, Kiil F. Compensatory cardiac mechanisms evoked by septal ischemia in dogs. Am J Cardiol 1983;51:201–6.

    Article  PubMed  CAS  Google Scholar 

  24. Heindricks GR, Gaig H, Nelleus P, Lausen I, Fishbein MC, Vatner SF. Depression of regional blood flow and wall thickening after brief coronary occlusions. Am J Physiol 1978;234:H653–9.

    Google Scholar 

  25. Rigaud M, Rocha P, Boschat J, Farcot JC, Bardet J, Boundarias JP. Regional left ventricular function assessed by contrast angiography in acute myocardial infarction. Circulation 1979; 60:130–9.

    PubMed  CAS  Google Scholar 

  26. Yamaguchi S, Tsuiki K, Hayasaka M, Yasui S. Segmental wall motion abnormalities in dilated cardiomyopathy: hemodynamic characteristics and comparison with thallium-201 myocardial scintigraphy. Am Heart J 1987;113:1123–8.

    Article  PubMed  CAS  Google Scholar 

  27. Hayashida W, Kumada T, Nohara R, et al. Left ventricular regional wall stress in dilated cardiomyopathy. Circulation 1990;82:2075–83.

    PubMed  CAS  Google Scholar 

  28. Sunnerhagen KS, Bhargava V, Shabetani R. Regional left ventricular wall motion abnormalities in idiopathic dilated cardiomyopathy. Am J Cardiol 1990;65:364–70.

    Article  PubMed  CAS  Google Scholar 

  29. Kurozumi H, Yokota Y, Fukuzaki H. Clinical and histopathologic correlation in patients with dilated cardiomyopathy. Jpn Heart J 1989;30:431–41.

    PubMed  CAS  Google Scholar 

  30. Henninng RJ, Levy MN. Effects of autonomic nerve stimulation, asynchrony, and load on dP/dtmax and on dP/dtmin. Am J Physiol 1991;260:H1290–8.

    Google Scholar 

  31. Bonow RO, Vitale DF, Bacharach SL, Frederick TM, Kent KM, Green MV. Asynchronous left ventricular regional function and impaired global diastolic filling in patients with coronary artery disease: reversal after coronary angioplasty. Circulation 1985;71:297–307.

    PubMed  CAS  Google Scholar 

  32. Nakanishi O, Yokota Y, Fukuzaki H. Comparative study of dilated cardiomyopathy and specific heart muscle disease from pathophysiological aspects. Jpn Circ J 1990;54:1147–57.

    PubMed  CAS  Google Scholar 

  33. Bonow RO, Vitale DF, Bacharach SL, Maron BJ, Green MV. Effects of aging on asynchronous left ventricular regional function and global ventricular filling in normal human subjects. J Am Coll Cardiol 1988;11:50–8.

    Article  PubMed  CAS  Google Scholar 

  34. Perrone-Filardi P, Bacharach SL, Dilsizian V, Bonow RO. Impaired left ventricular filling and regional diastolic asynchrony at rest in coronary artery disease and relation to exercise-induced myocardial ischemia. Am J Cardiol 1991;67: 356–60.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. First Department of Medicine, Osaka University Medical School, Yamada Oka 2-2, 565, Suita Osaka, Japan

    Takakazu Morozumi, Yoshio Ishida, Hideo Kusuoka, Hideyuki Sato, Masatsugu Hori, Takenobu Kamada & Tsunehiko Nishimura

  2. Division of Tracer Kinetics, Biomedical Research Center, Osaka University Medical School, Suita Osaka, Japan

    Takakazu Morozumi, Yoshio Ishida, Hideo Kusuoka, Hideyuki Sato, Masatsugu Hori, Takenobu Kamada & Tsunehiko Nishimura

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  1. Takakazu Morozumi
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  2. Yoshio Ishida
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  5. Masatsugu Hori
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Morozumi, T., Ishida, Y., Kusuoka, H. et al. Effect of β-blockade on regional left ventricular function in patients with dilated cardiomyopathy. J Nucl Cardiol 2, 231–237 (1995). https://doi.org/10.1016/S1071-3581(05)80060-1

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  • DOI: https://doi.org/10.1016/S1071-3581(05)80060-1

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