Metoprolol improves left ventricular longitudinal function at rest and during exercise in obstructive hypertrophic cardiomyopathy
Episode description
Metoprolol improves left ventricular longitudinal function at rest and during exercise in obstructive hypertrophic cardiomyopathy
The following study aimed to characterize left ventricular (LV) systolic function by segmental and global longitudinal strain echocardiography and to investigate changes in relation to exercise, and the effect of standard treatment with beta-blockers. What we already know is that hypertrophic cardiomyopathy (HCM) patients with outflow obstruction often experience symptoms of heart failure upon exertion.
A total of 29 with obstructive HCM and New York Heart Association (NYHA) class ≥ II symptoms were enrolled in a double-blind, placebo-controlled, randomized crossover trial. These patients received metoprolol 150 mg or placebo for two consecutive two-week periods in random order. Echocardiographic assessment with speckle-tracking derived longitudinal strain (LS) was performed at rest and during peak exercise at the end of each treatment period. Segmental LS was calculated as the mean of the six apical, mid, and basal segments.
Coming to the results, treatment with metoprolol improves the LS of the apical segment and mid-segment. The segmental improvement with metoprolol treatment was reflected in an increase in global longitudinal strain for LV function (LV GLS).Peak exercise was associated with a reduction in LV GLS, yet the improvement in LV GLS with metoprolol treatment was consistent upon exercise.
To conclude, systolic performance assessed by LV GLS showed impaired values at rest and during exercise, with severely depressed values of the mid and basal segments. Treatment with metoprolol improved segmental strain and LV GLS upon exercise, indicating a beneficial effect of beta-blocker therapy on LV systolic function.
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