This Article Full Text Full Text (PDF) CME: Take the course for this article: Circulation: July 3, 2007, Volume 116, Number 1 All Versions of this Article: 116/1/49    most recent CIRCULATIONAHA.106.666016v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Colucci, W. S. Search for Related Content PubMed PubMed Citation Articles by Colucci, W. S. Related Collections Congestive Cardiovascular Pharmacology Related Article

(Circulation. 2007;116:49-56.)
© 2007 American Heart Association, Inc.

Heart Failure

Metoprolol Reverses Left Ventricular Remodeling in Patients With Asymptomatic Systolic Dysfunction

The REversal of VEntricular Remodeling with Toprol-XL (REVERT) Trial

Wilson S. Colucci, MD; Theodore J. Kolias, MD; Kirkwood F. Adams, MD; William F. Armstrong, MD; Jalal K. Ghali, MD; Stephen S. Gottlieb, MD; Barry Greenberg, MD; Michael I. Klibaner, MD, PhD; Marrick L. Kukin, MD; Jennifer E. Sugg, MS, on behalf of the REVERT Study Group^*

From Boston University Medical Center, Boston, Mass (W.S.C.); University of Michigan Medical Center, Ann Arbor (T.J.K., W.F.A.); University of North Carolina School of Medicine, Chapel Hill (K.F.A.); Wayne State University, Detroit, Mich (J.K.G.); University of Maryland Hospital, Baltimore (S.S.G.); University of California at San Diego (B.G.); AstraZeneca LP, Wilmington, Del (M.I.K., J.E.S.); and St Luke’s–Roosevelt Hospitals, Columbia University College of Physicians and Surgeons, New York, NY (M.L.K.).

Correspondence to Wilson S. Colucci, MD, Cardiovascular Medicine, Boston University Medical Center, 88 E Newton St, Boston, MA 02118. E-mail wilson.colucci{at}bmc.org

Received October 5, 2006; accepted April 20, 2007.

Background— There are no randomized, controlled trial data to support the benefit of ß-blockers in patients with asymptomatic left ventricular systolic dysfunction. We investigated whether ß-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— ß-Blocker therapy can ameliorate left ventricular remodeling in asymptomatic patients with left ventricular systolic dysfunction.

Key Words: heart failure • receptors, adrenergic, beta • remodeling • ventricles

Related Article:

Issue Highlights
Circulation 2007 116: 1. [Extract] [Full Text]

This article has been cited by other articles:

				H. Krum Consider {beta} blockers for patients with heart failure BMJ, June 1, 2009; 338(jun01_2): b1728 - b1728. [Full Text]

				U. Landmesser, K. C. Wollert, and H. Drexler Potential novel pharmacological therapies for myocardial remodelling Cardiovasc Res, February 15, 2009; 81(3): 519 - 527. [Abstract] [Full Text] [PDF]

				A. Gourine, S. I. Bondar, K. M. Spyer, and A. V. Gourine Beneficial Effect of the Central Nervous System {beta}-Adrenoceptor Blockade on the Failing Heart Circ. Res., March 28, 2008; 102(6): 633 - 636. [Abstract] [Full Text] [PDF]