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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.
Circulation. 2007 Jul 03; 116(1):49-56.Circ

Abstract

BACKGROUND

There are no randomized, controlled trial data to support the benefit of beta-blockers in patients with asymptomatic left ventricular systolic dysfunction. We investigated whether beta-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, n=48; 50 mg, n=48; and placebo, n=53) 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 14+/-3 mL/m2 decrease (least square mean+/-SE) in end-systolic volume index and a 6+/-1% increase in left ventricular ejection fraction (P<0.05 versus baseline and placebo for both). The decrease in end-diastolic volume index (14+/-3) was different from that seen at baseline (P<0.05) 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 4+/-1% (P<0.05 versus baseline and placebo).

CONCLUSION

Beta-blocker therapy can ameliorate left ventricular remodeling in asymptomatic patients with left ventricular systolic dysfunction.

Authors+Show Affiliations

Cardiovascular Medicine, Boston University Medical Center, 88 E Newton St, Boston, MA 02118, USA. wilson.colucci@bmc.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17576868

Citation

Colucci, Wilson S., et al. "Metoprolol Reverses Left Ventricular Remodeling in Patients With Asymptomatic Systolic Dysfunction: the REversal of VEntricular Remodeling With Toprol-XL (REVERT) Trial." Circulation, vol. 116, no. 1, 2007, pp. 49-56.
Colucci WS, Kolias TJ, Adams KF, et al. Metoprolol reverses left ventricular remodeling in patients with asymptomatic systolic dysfunction: the REversal of VEntricular Remodeling with Toprol-XL (REVERT) trial. Circulation. 2007;116(1):49-56.
Colucci, W. S., Kolias, T. J., Adams, K. F., Armstrong, W. F., Ghali, J. K., Gottlieb, S. S., Greenberg, B., Klibaner, M. I., Kukin, M. L., & Sugg, J. E. (2007). Metoprolol reverses left ventricular remodeling in patients with asymptomatic systolic dysfunction: the REversal of VEntricular Remodeling with Toprol-XL (REVERT) trial. Circulation, 116(1), 49-56.
Colucci WS, et al. Metoprolol Reverses Left Ventricular Remodeling in Patients With Asymptomatic Systolic Dysfunction: the REversal of VEntricular Remodeling With Toprol-XL (REVERT) Trial. Circulation. 2007 Jul 3;116(1):49-56. PubMed PMID: 17576868.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Metoprolol reverses left ventricular remodeling in patients with asymptomatic systolic dysfunction: the REversal of VEntricular Remodeling with Toprol-XL (REVERT) trial. AU - Colucci,Wilson S, AU - Kolias,Theodore J, AU - Adams,Kirkwood F, AU - Armstrong,William F, AU - Ghali,Jalal K, AU - Gottlieb,Stephen S, AU - Greenberg,Barry, AU - Klibaner,Michael I, AU - Kukin,Marrick L, AU - Sugg,Jennifer E, AU - ,, Y1 - 2007/06/18/ PY - 2007/6/20/pubmed PY - 2007/7/21/medline PY - 2007/6/20/entrez SP - 49 EP - 56 JF - Circulation JO - Circulation VL - 116 IS - 1 N2 - BACKGROUND: There are no randomized, controlled trial data to support the benefit of beta-blockers in patients with asymptomatic left ventricular systolic dysfunction. We investigated whether beta-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, n=48; 50 mg, n=48; and placebo, n=53) 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 14+/-3 mL/m2 decrease (least square mean+/-SE) in end-systolic volume index and a 6+/-1% increase in left ventricular ejection fraction (P<0.05 versus baseline and placebo for both). The decrease in end-diastolic volume index (14+/-3) was different from that seen at baseline (P<0.05) 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 4+/-1% (P<0.05 versus baseline and placebo). CONCLUSION: Beta-blocker therapy can ameliorate left ventricular remodeling in asymptomatic patients with left ventricular systolic dysfunction. SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/17576868/Metoprolol_reverses_left_ventricular_remodeling_in_patients_with_asymptomatic_systolic_dysfunction:_the_REversal_of_VEntricular_Remodeling_with_Toprol_XL__REVERT__trial_ L2 - http://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.106.666016?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -