What question did this study set out to answer?

To determine whether the acute adverse hemodynamic effects of beta-blocker therapy persist during chronic treatment in patients with congestive heart failure.

November 1, 1997HeartOpen Access

β Blockade in congestive heart failure: persistent adverse haemodynamic effects during chronic treatment with subsequent doses

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Why the study?

Does metoprolol readministration cause persistent acute adverse haemodynamic effects in patients with congestive heart failure on chronic treatment?

Population

26 patients with moderate to severe congestive heart failure and background treatment with digoxin…

Comparison

Metoprolol 6.25 mg orally twice daily initially… vs Intra-patient comparison.

Design

Cohort

Follow-up

3 months

Authors

MKMarrick KukinBoston University JKJill KalmanHeart Failure / Cardiomyopathy MMMichael M. ManninoIcahn School of Medicine at Mount Sinai

Discussion

Member takes

Implication

Acute hemodynamic worsening with metoprolol readministration persists after 3 months in heart failure; leaves open effects on long-term outcomes and optimal dosing.

Key Points

To determine whether the acute adverse hemodynamic effects of beta-blocker therapy persist during chronic treatment in patients with congestive heart failure.
Conducted a sequential hemodynamic evaluation in 26 patients with moderate to severe heart failure (NYHA grade II–IV, left ventricular ejection fraction < 25%) receiving background standard medical therapy.
Initiated oral metoprolol at 6.25 mg twice daily and titrated to 50 mg twice daily, evaluating right heart hemodynamics at baseline and after 3 months both before (trough) and after drug readministration.
Chronic 3-month treatment improved overall functional capacity, decreasing heart rate, pulmonary capillary wedge pressure, and systemic vascular resistance while increasing cardiac index and stroke work index.
Readministration of metoprolol after 3 months acutely reduced cardiac index from 2.8 (SD 0.46) to 2.3 (0.38) L/min/m² (p << 0.001) and stroke work index from 31.4 (11.1) to 26.6 (10.0) g·m/m² (p < 0.001).
Readministration at 3 months also acutely increased systemic vascular resistance from 943 (192) to 1160 (219) dyn·s·cm⁻⁵ (p << 0.001).

Structured PICO

Does metoprolol readministration cause persistent acute adverse haemodynamic effects in patients with congestive heart failure on chronic treatment?

Population

26 patients with moderate to severe congestive heart failure (New York Heart Association grade II to IV) and background treatment with digoxin, diuretics, and angiotensin converting enzyme inhibitors, and with a left ventricular ejection fraction < 25%.

Intervention

Metoprolol 6.25 mg orally twice daily initially, gradually increased to a target of 50 mg twice daily, administered for 3 months.

Comparator

Intra-patient comparison (baseline measurements and trough measurements before drug readministration at 3 months).

Outcome

Haemodynamic changes (cardiac index, stroke work index, systemic vascular resistance) upon readministration of full dose metoprolol after 3 months of chronic treatment.surrogate

Despite the long-term benefits of beta-blockade in heart failure, each subsequent dose continues to produce acute, transient adverse haemodynamic effects.

Cite This Study

Kukin et al. (1997) studied this question.

synapsesocial.com/papers/6a8a83956fc170cbc2fbf61e https://doi.org/10.1136/hrt.78.5.444

Topics

HFrEF treatment Heart failure Heart failure hospitalization

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Implication

Acute hemodynamic worsening with metoprolol readministration persists after 3 months in heart failure; leaves open effects on long-term outcomes and optimal dosing.

β Blockade in congestive heart failure: persistent adverse haemodynamic effects during chronic treatment with subsequent doses

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

β Blockade in congestive heart failure: persistent adverse haemodynamic effects during chronic treatment with subsequent doses

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Topics

Also Consider