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Metoprolol Reverses Left Ventricular Remodeling in Patients With Asymptomatic Systolic Dysfunction The REversal of VEntricular Remodeling with Toprol-XL (REVERT) Trial

Metoprolol Reverses Left Ventricular Remodeling in Patients With Asymptomatic Systolic Dysfunction The REversal of VEntricular Remodeling with Toprol-

Metoprolol Reverses Left Ventricular Remodeling in Patients With Asymptomatic Systolic Dysfunction The REversal of VEntricular Remodeling with Toprol-XL (REVERT) Trial   (Citations: 11)
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Background—There are no randomized, controlled trial data to support the benefit of -blockers in patients with asymptomatic left ventricular systolic dysfunction. We investigated whether -blocker therapy ameliorates left ventricular remodeling in asymptomatic patients with left ventricular systolic dysfunction. Method and Results—Patients with left ventricular ejection fraction 40%, mild left ventricular dilation, and no symptoms of heart failure (New York Heart Association class I) were randomly assigned to receive extended-release metoprolol succinate (Toprol-XL, AstraZeneca) 200 mg or 50 mg or placebo for 12 months. Echocardiographic assessments of left ventricular end-systolic volume, end-diastolic volume, mass, and ejection fraction were performed at baseline and at 6 and 12 months. The 149 patients randomized to the 3 treatment groups (200 mg, n48; 50 mg, n48; and placebo, n53) were similar with regard to all baseline characteristics including age (mean, 66 years), gender (74% male), plasma brain natriuretic peptide (79 pg/mL), left ventricular end-diastolic volume index (110 mL/m2), and left ventricular ejection fraction (27%). At 12 months in the 200-mg group, there was a 143 mL/m2 decrease (least square meanSE) in end-systolic volume index and a 61% increase in left ventricular ejection fraction (P0.05 versus baseline and placebo for both). The decrease in end-diastolic volume index (143) was different from that seen at baseline (P0.05) but not with placebo. In the 50-mg group, end-systolic and end-diastolic volume indexes decreased relative to baseline but were not different from what was seen with placebo, whereas ejection fraction increased by 41% (P0.05 versus baseline and placebo). Conclusion—-Blocker therapy can ameliorate left ventricular remodeling in asymptomatic patients with left ventricular systolic dysfunction. (Circulation. 2007;116:49-56.)
Published in 2011.
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