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European Heart Journal 1996 17(5):741-749;
Copyright © 1996 by the European Society of Cardiology.
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© The European Society of Cardiology

Heart failure

Effects of beta receptor antagonists on left ventricular function in patients with clinical evidence of heart failure after myocardial infarction. A double-blind comparison of metoprolol and xamoterol Echocardiographic results from the Metoprolol and Xamoterol Infarction Study (MEXIS)

H. Persson, S. V. Eriksson and L. Erhardt*

From Section of Cardiology, Division of Internal Medicine, Karolinska Institutet Danderyd Hospital, Sweden
*present address: Department of cardiology, Malmoe University Hospital, University of Lund Sweden

Received 31 August 1995; accepted 20 September 1995.

Correspondence: Hans Persson, MD, Section of Cardiology, Division of Internal Medicine, Danderyd Hospital, S-l82 88 Danderyd, Sweden

Abstract

Two hundred and ten patients with clinical evidence of heart failure, developing after an acute myocardial infarction, were randomized to treatment with the ß1 antagonist metoprolol 50–100mg b.i.d. (n=106) or the ß1 partial agonist xamoterol 100–200 mg bid. (n=104). Left ventricular systolic and diastolic function were assessed with echocardiography and transmitral Doppler cardiography before and after 3 and 12 months of double-blind treatment. E-point septal separation and per cent left ventricular fractional shortening were used as indices of systolic function. The ratio between peak early and late mitral diastolic flow (E/A ratio) and isovolumic relaxation time were used as indices of diastolic function.

In the xamoterol group, there was a deterioration in E-point septal separation (P<0·05). A difference between the treatment groups was present both at 3 months (E-point septal separation 11·4 vs 13·0 mm, P<0·0l, fractional short ening 271 vs 252%, P<005) and 12 months (E-point septal separation Ill vs 13·2 mm, P<0·05 fractional shortening 26·9 vs 25·0%, P<0·05). E/A ratio increased in the metoprolol group (P<0·05) but not in the xamoterol group. At 3 months there was a significant difference (0·85 vs 0·67, P<0·005 between the groups but not at 12 months.

In comparison with the ß1-receptor antagonist metoprolol, the ß1 partial agonist xamoterol impaired left ventricular systolic function in patients with clinical evidence of heart failure after an acute myocardial infarction.

Key Words: Myocardial infarction • left ventricle • heart failure • beta receptor blocking agents • echocardiography • Doppler


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