LONG-TERM SURVIVAL EFFECT OF METOPROLOL IN DILATED CARDIOMYOPATHY

Objective-To evaluate the additive effect of metoprolol treatment on l ong term incidence of fatal and non-fatal cardiac events in idiopathic dilated cardiomyopathy. Design-586 patients with idiopathic dilated c ardiomyopathy were prospectively enrolled in a multicentre registry an d followed up for a mean (SD) of 52 (32) months. Metoprolol, carefully titrated to the maximum tolerated dose, was added to conventional hea rt failure treatment in 175 patients. Results-Survival and transplant- free survival at seven years were significantly higher in the 175 meto prolol treated patients than in the remaining 411 on standard treatmen t (81% v 60%, p < 0.001, and 69% v 49%, p < 0.001, respectively). By m ultivariate analysis, metoprolol independently predicted survival and transplant-free survival (relative risk reduction values for all cause mortality and combined mortality or transplantation 51% (95% confiden ce interval 21% to 69%), p = 0.002, and 34% (5% to 53%), p = 0.01, res pectively). New York Heart Association class, left ventricular end dia stolic diameter, and pulmonary wedge pressure were also predictive. Se ven year survival (80% v 62%, p= 0.004) and transplant-free survival ( 68% v 51%, p = 0.005) were significantly higher in 127 metoprolol trea ted cases than in 127 controls selected from the entire control cohort and appropriately matched. Metoprolol was associated with a 30% reduc tion in all cause mortality (7% to 48%, p = 0.015) and a 26% reduction in mortality or transplantation (7% to 41%, p = 0.009). Conclusions-T he addition of metoprolol to standard heart failure treatment, includi ng angiotensin converting enzyme inhibitors, was effective in the long term, reducing both all cause mortality and transplantation in patien ts with idiopathic dilated cardiomyopathy.