Metoprolol reverses left ventricular remodeling in patients with asymptomatic systolic dysfunction: The REversal of VEntricular Remodeling with Toprol-XL (REVERT) Trial

Wilson S. Colucci, Theodore J. Kolias, Kirkwood F. Adams, William F. Armstrong, Jalal K. Ghali, Stephen S. Gottlieb, Barry Greenberg, Michael I. Klibaner, Marrick L. Kukin, Jennifer E. Sugg

Research output: Contribution to journalArticlepeer-review

135 Scopus citations

Abstract

BACKGROUND - There are no randomized, controlled trial data to support the benefit of β-blockers in patients with asymptomatic left ventricular systolic dysfunction. We investigated whether β-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/m), and left ventricular ejection fraction (27%). At 12 months in the 200-mg group, there was a 14±3 mL/m 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 - β-Blocker therapy can ameliorate left ventricular remodeling in asymptomatic patients with left ventricular systolic dysfunction.

Original languageEnglish
Pages (from-to)49-56
Number of pages8
JournalCirculation
Volume116
Issue number1
DOIs
StatePublished - Jul 2007
Externally publishedYes

Keywords

  • Heart failure
  • Receptors, adrenergic, beta
  • Remodeling
  • Ventricles

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