Key result
Treatment with controlled release metoprolol for 6 months had no significant effect on left ventricular end diastolic volume compared to placebo (difference 8 mL; 95% CI -8 to 25; p=0.32).
Why the study?
Does metoprolol CR/XL reduce left ventricular end diastolic volume in asymptomatic patients with moderate or severe chronic aortic regurgitation?
RCT (n=75)
Double-blind
Randomized
Does metoprolol CR/XL reduce left ventricular end diastolic volume in asymptomatic patients with moderate or severe chronic aortic regurgitation?
In asymptomatic patients with moderate to severe chronic aortic regurgitation, 6 months of treatment with metoprolol CR/XL did not significantly reduce left ventricular volumes compared to placebo.
No support for metoprolol to limit LV remodeling in asymptomatic AR; challenges beta-blocker hypothesis and warrants outcome trials.
OBJECTIVE: Chronic aortic regurgitation (AR) creates a volume load on the left ventricle, which induces adaptive responses. With time, excessive left ventricular (LV) dilatation may precipitate heart failure. β-adrenergic receptor antagonists (β-blockers) are beneficial in patients with heart failure, but their effect in AR is unclear. This trial was designed to evaluate the effect of controlled release metoprolol on LV remodelling in patients with AR. METHODS: In this double blind trial, 75 asymptomatic patients aged 44±14 years, 89% males, fulfilling at least two echocardiographic criteria for moderate or severe chronic AR, were randomised to receive metoprolol CR/XL up-titrated to 200 mg/day, or matching placebo. The primary endpoint was LV end diastolic volume, measured by MRI after 6 months of treatment. RESULTS: After 6 months, the difference in the baseline-adjusted LV end diastolic volume between patients allocated to metoprolol and those allocated to placebo was 8 (95% CI -8 to 25) mL (p=0.32). The adjusted LV ejection fraction was 2.7 (95% CI 0.1 to 5.3) percentage points higher in the metoprolol group than in the placebo group (p=0.04). The exercise capacity and peak oxygen consumption did not differ between treatment arms. Serum concentrations of N-terminal pro-B-type natriuretic peptide were 138 (95% CI 71 to 205) pg/mL higher in the metoprolol group (p<0.001). There were no serious adverse events in either treatment arm. CONCLUSIONS: Treatment with metoprolol of adults with chronic, moderate to severe AR had no effect on LV volumes. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Identifier: NCT01157572-results.
No takes yet. Share an insight, caveat, or question.
Broch et al. (2015) conducted an RCT in Chronic aortic regurgitation (n=75). Metoprolol CR/XL vs. Placebo was evaluated on Left ventricular end diastolic volume measured by MRI (Difference 8 mL, 95% CI -8 to 25, p=0.32). Treatment with controlled release metoprolol for 6 months had no significant effect on left ventricular end diastolic volume compared to placebo (difference 8 mL; 95% CI -8 to 25; p=0.32).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: