Skip Navigation

European Heart Journal 1999 20(8):575-583; doi:10.1053/euhj.1998.1315
Copyright © 1999 by the European Society of Cardiology.
This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (14)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Andersson, B.
Right arrow Articles by Waagstein, F.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Andersson, B.
Right arrow Articles by Waagstein, F.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

Heart rate dependency of cardiac performance in heart failure patients treated with metoprolol

B. Anderssona,f1, StrömbladS.-O. a, M. Lomskyb and F. Waagsteina

a The Wallenberg Laboratory for Cardiovascular Research, Department of Cardiology, Göteborg, Sweden
b Department of Clinical Physiology, Sahlgrenska University Hospital, Göteborg, Sweden

revised September 2, 1998; accepted September 9, 1998

Abstract

Aims

To investigate whether a low heart rate is necessary to maintain improvement in myocardial function after long-term treatment with a beta-blocker in patients with heart failure.

Methods and Results

Forty-eight patients with congestive heart failure were investigated: 30 patients with dilated cardiomyopathy participating in a placebo-controlled trial (15 on placebo, 15 on metoprolol), and 18 patients treated by metoprolol in an open protocol. Investigations of spontaneous heart rate and of matched paced heart rates were performed at baseline and after 3, 6 and 12 months of follow-up by radionuclide angiography. There were significant signs of improvement in systolic indices of the spontaneous heart rate in the metoprolol-treated group (peak ejection rate: 0·98 to 1·32 end-diastolic volume.s–1,P=0·015) as compared to placebo (1·14 to 1·19 end-diastolic volume.s–1, not significant). Similar effects were observed during the matched paced heart rate (peak ejection rate: metoprolol 0·91 to 1·38 end-diastolic volume.s–1,P=0·037; placebo 1·22 to 1·12 end-diastolic volume.s–1, not significant). No effects were observed in the early peak filling rate. Left ventricular volumes decreased during metoprolol treatment, both for the spontaneous heart rate and during matched pacing.

Conclusions

These data imply that beta-blocker treatment improves the force–frequency relationship of myocardial performance. A lower heart rate is not necessary to maintain cardiac function on a short-term basis, once myocardial recovery has occurred.

Key Words: Dilated cardiomyopathy, heart rate, pacing, adrenergic beta-blocker, diastolic function, force–frequency

f1 Correspondence: Dr Bert Andersson, Department of Cardiology, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden.

References

  1. Kjekshus J. Heart rate reduction—a mechanism of benefit? Eur Heart J. 1987;8:115–122
  2. Colucci WS, Ribeiro JP, Rocco MB. Impaired chronotropic response to exercise in patients with congestive heart failure. Circulation. 1989;80:314–323[Abstract/Free Full Text]
  3. Sugiura T, Iwasaka T, Hasegawa T, Takahashi N, Matsutani M, Inada M. Effect of propranolol on diastolic time during exercise. J Cardiovasc Pharmacol. 1990;15:371–376[Web of Science][Medline]
  4. Boudoulas H, Rittgers SE, Lewis RP, Leier CV, Weissler AM. Changes in diastolic time with various pharmacologic agents. Circulation. 1979;60:164–169[Abstract/Free Full Text]
  5. Schang SJ, Pepine CJ. Effects of propranolol on coronary hemodynamic and metabolic responses to tachycardia stress in patients with and without coronary disease. Cathet Cardiovasc Diagn. 1977;3:47–57[Web of Science][Medline]
  6. Buck JD, Hardman HF, Warltier DC, Gross GJ. Changes in ischemic blood flow distribution and dynamic severity of a coronary stenosis induced by beta blockade in the canine heart. Circulation. 1981;64:708–715[Abstract/Free Full Text]
  7. Andersson B, Lomsky M, Waagstein F. The link between acute haemodynamic adrenergic beta-blockade and long-term effects in patients with heart failure. Eur Heart J. 1993;14:1375–1385[Abstract/Free Full Text]
  8. Andersson B, Hamm C, Persson S. Improved exercise hemodynamic status in dilated cardiomyopathy after beta-adrenergic blockade treatment. J Am Coll Cardiol. 1994;23:1397–1404[Abstract]
  9. Eichhorn EJ, Heesch CM, Barnett JH. Effect of metoprolol on myocardial function and energetics in patients with nonischemic dilated cardiomyopathy: a randomized, double-blind, placebo-controlled study. J Am Coll Cardiol. 1994;24:1310–1320[Abstract]
  10. Mulieri LA, Hasenfuss G, Leavitt B, Allen PD, Alpert NR. Altered myocardial force-frequency relation in human heart failure. Circulation. 1992;85:1743–1750[Abstract/Free Full Text]
  11. Hasenfuss G, Holubarsch C, Hermann H-P, Astheimer K, Pieske B, Just H. Influence of the force-frequency relationship on haemodynamics and left ventricular function in patients with non-failing hearts and in patients with dilated cardiomyopathy. Eur Heart J. 1994;15:164–170[Abstract/Free Full Text]
  12. Andersson B, Caidahl K, Di Lenarda A. Changes in early and late diastolic filling patterns induced by long-term adrenergic beta-blockade in patients with idiopathic dilated cardiomyopathy. Circulation. 1996;94:673–682[Abstract/Free Full Text]
  13. Waagstein F, Bristow MR, Swedberg K. Beneficial effects of metoprolol in idiopathic dilated cardiomyopathy. Lancet. 1993;342:1441–1446[CrossRef][Web of Science][Medline]
  14. Massardo T, Gal RA, Grenier RP, Schmidt DH, Port SC. Left ventricular volume calculation using a count-based ratio method applied to multigated radionuclide angiography. J Nucl Med. 1990;31:450–456[Abstract/Free Full Text]
  15. Nickel O, Schad N, Andrews EJ, Fleming JW, Mello M. Scintigraphic measurement of left-ventricular volumes from the count-density distribution. J Nucl Med. 1982;23:404–410[Abstract/Free Full Text]
  16. Quaife RA, Gilbert EM, Christian PE. Effects of carvedilol on systolic and diastolic left ventricular performance in idiopathic dilated cardiomyopathy or ischemic cardiomyopathy. Am J Cardiol. 1996;78:779–784[CrossRef][Web of Science][Medline]
  17. Lavine SJ, Krishnaswami V, Shreiner DP, Amidi M. Left ventricular diastolic filling in patients with left ventricular dysfunction. Int J Cardiol. 1985;8:423–436[CrossRef][Web of Science][Medline]
  18. Ohno M, Cheng C-P, Little WC. Mechanism of altered patterns of left ventricular filling during the development of congestive heart failure. Circulation. 1994;89:2241–2250[Abstract/Free Full Text]
  19. Morgan JP, Erny RE, Allen PD, Grossman W, Gwathmey JK. Abnormal intracellular calcium handling, a major cause of systolic and diastolic dysfunction in ventricular myocardium from patients with heart failure. Circulation. 1990;81:III-21–III-23
  20. Gwathmey JK, Slawsky MT, Hajjar RJ, Briggs GM, Morgan JP. Role of intracellular calcium handling in force-interval relationships of human ventricular myocardium. J Clin Invest. 1990;85:1599–1613[Web of Science][Medline]
  21. Glass MG, Reiss I, Cory R, O’Brien PJ, Gwathmey JK. Reversal of the negative treppe with ß-blockers: role of sarcoplasmic reticulum function and myocardial energetics. Circulation. 1993;88:I-526
  22. Buckley NM, Penefsky ZJ, Litwak RS. Comparative force-frequency relationships in human and other mammalian ventricular myocardium. Pflugers Arch. 1972;332:259–270[CrossRef][Web of Science][Medline]
  23. Feldman MD, Alderman JD, Aroesty JM. Depression of systolic and diastolic myocardial reserve during atrial pacing tachycardia in patients with dilated cardiomyopathy. J Clin Invest. 1988;82:1661–1669[Web of Science][Medline]
  24. Heilbrunn SM, Shah P, Bristow Mr, Valantine HA, Ginsburg R, Fowler MB. Increased ß-receptor density and improved hemodynamic response to catecholamine stimulation during long-term metoprolol therapy in heart failure from dilated cardiomyopathy. Circulation. 1989;79:483–490[Abstract/Free Full Text]
  25. Ryu KH, Tanaka N, Dalton N. Force-frequency relations in the failing rabbit heart and responses to adren-ergic stimulation. Cardiac Failure. 1997;3:27–39
  26. Waagstein F, Caidahl K, Wallentin I, Bergh C-H, Hjalmarson . Long-term ß-blockade in dilated cardiomyopathy. Effects of short-and long-term metoprolol treatment followed by withdrawal and readministration of metoprolol. Circulation. 1989;80:551–563[Abstract/Free Full Text]
  27. Böhm M, Deutsch HJ, Hartmann D, Rosee KL, Stablein A. Improvement of postreceptor events by metoprolol treatment in patients with chronic heart failure. J Am Coll Cardiol. 1997;30:992–996[Abstract]
  28. Andersson B, Blomström-Lundqvist C, Hedner T, Waagstein F. Exercise hemodynamics and myocardial metabolism during long-term beta-adrenergic blockade in severe heart failure. J Am Coll Cardiol. 1991;18:1059–1066[Abstract]
  29. Lancet. 1997;349:375–380[CrossRef][Web of Science][Medline]
  30. Packer M, Bristow MR, Cohn JN. The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. N Engl J Med. 1996;334:1349–1355[Abstract/Free Full Text]
  31. Waagstein F. Metoprolol in addition to ACE-inhibitors causes regression of left ventricular dilatation and increase exercise ejection fraction in ischemic cardiomyopathy. J Am Coll Cardiol. 1997;29:206A[CrossRef]

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 J Clin PharmacolHome page
L. M. Prisant
Nebivolol: Pharmacologic Profile of an Ultraselective, Vasodilatory {beta}1-Blocker
J. Clin. Pharmacol., February 1, 2008; 48(2): 225 - 239.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
R. H. Ritchie, C. J. Zeitz, R. D. Wuttke, J. T.Y. Hii, and J. D. Horowitz
Attenuation of the Negative Inotropic Effects of Metoprolol at Short Cycle Lengths in Humans: Comparison With Sotalol and Verapamil
J. Am. Coll. Cardiol., September 19, 2006; 48(6): 1234 - 1241.
[Abstract] [Full Text] [PDF]

Home page
 Eur J Heart FailHome page
I. P. Clements
Combined systolic and diastolic dysfunction in the presence of preserved left ventricular ejection fraction
Eur J Heart Fail, June 1, 2005; 7(4): 490 - 497.
[Abstract] [Full Text] [PDF]

Home page
 HeartHome page
B Andersson, B Gruner Svealv, M Scharin Tang, and R Mobini
Longitudinal myocardial contraction improves early during titration with metoprolol CR/XL in patients with heart failure
Heart, January 1, 2002; 87(1): 23 - 28.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
Recommendations for exercise training in chronic heart failure patients
Eur. Heart J., January 2, 2001; 22(2): 125 - 135.
[PDF]

Home page
 HeartHome page
B Andersson, F Waagstein, K Caidahl, I Eurenius, M S. Täng, and R Wikh
Early changes in longitudinal performance predict future improvement in global left ventricular function during long term beta adrenergic blockade
Heart, December 1, 2000; 84(6): 599 - 605.
[Abstract] [Full Text]

This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (14)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Andersson, B.
Right arrow Articles by Waagstein, F.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Andersson, B.
Right arrow Articles by Waagstein, F.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?