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European Heart Journal 1999 20(8):575-583; doi:10.1053/euhj.1998.1315
Copyright © 1999 by the European Society of Cardiology.
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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.

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