Russian Heart Failure Journal 2004year Metoprolol without ACE inhibitors and in combination with enalapril: Comparative study of the effect on ventricular remodeling in patients with chronic heart failure


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2004/

Metoprolol without ACE inhibitors and in combination with enalapril: Comparative study of the effect on ventricular remodeling in patients with chronic heart failure

Poltavskaya M.G., Arefjeva A.B., Churganova L.Yu., Syrkin A.L.

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Urgency: In chronic heart failure (CHF), β-adrenoblockers are superior to angiotensin-converting enzyme inhibitors (ACEI) by the effect on mortality, remodeling and left ventricular (LV) ejection fraction (EF). However current guidelines recommend administration of β-blockers in CHF only as an adjunction to ACEI, which is not always possible. Aim: Comparing the effect of metoprolol succinate as monotherapy and in combination with enalapril on remodeling and left and right ventricular (RV) function in patients with CHF. Material and methods: Fifty-six patients with CHF resulting from ischemic heart disease (IHD) and dilation cardiomyopathy (DCMP) with EF<45% were evaluated. Forty-one patients were assigned to receiving metoprolol succinate in addition to enalapril; 15 patients received metoprolol succinate as monotherapy for 6 months and after that enalapril was added. Effects of the treatment on parameters of ventricular systolic and diastolic function were evaluated by echocardiography (echoCG) and radionuclide ventriculography data 3, 6 and 12 months after inclusion. Results. Metoprolol therapy either with or without ACEI as well as metoprolol added to the enalapril therapy was efficient and safe. The therapy provided enhancement of exercise tolerance, slowed down cardiac remodeling, and increased EF and diastolic filling of both ventricles.

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