beta-Blocker therapy for cirrhotic cardiomyopathy: a randomized-controlled trial

Autor(es):Mostrar menos -

Silvestre, Odilson M. ^[1] ; Farias, Alberto Q. ^[2] ; Ramos, Danusa S. ^[2] ; Furtado, Meive S. ^[3] ; Rodrigues, Ana C. ^[3] ; Ximenes, Rafael O. ^[2] ; de Campos Mazo, Daniel F. ^[2] ; Yoshimura Zitelli, Patricia M. ^[2] ; Diniz, Marcio A. ^[2] ; Andrade, Jose L. ^[3] ; Strunz, Celia ^[1] ; Friedmann, Antonio A. ^[2] ; Lee, Samuel S. ^[4] ; Carrilho, Flair J. ^[2] ; D'Albuquerque, Luiz A. C. ^[2] ; Bacal, Fernando ^[1]

Afiliação do(s) autor(es)

^[1] Univ Sao Paulo, Sch Med, Heart Inst InCor, Sao Paulo - Brazil

^[2] Univ Sao Paulo, Sch Med, Div Gastroenterol & Hepatol, Dept Gastroenterol, Sao Paulo - Brazil

^[3] Univ Sao Paulo, Sch Med, Dept Radiol, Sao Paulo - Brazil

^[4] Univ Calgary, Liver Unit, Calgary, AB - Canada

• Tipo de documento: Artigo Científico
• Fonte: EUROPEAN JOURNAL OF GASTROENTEROLOGY & HEPATOLOGY; v. 30, n. 8, p. 930-937, AUG 2018.
• Citações Web of Science: 3

Resumo

Background Cirrhotic cardiomyopathy is characterized by an attenuated contractile response to stress. Long-term exposure of beta-adrenergic receptors to persistently high levels of catecholamines has been implicated in its pathogenesis. We hypothesized that beta-blockade with metoprolol could reverse the changes in heart function and morphology in cirrhotic cardiomyopathy. Patients and methods In this prospective randomized trial, we included 78 patients aged between 18 and 60 years with abnormal cardiac output response under dobutamine stress echocardiography, without primary cardiac disease or a history of alcohol intake. Patients were assigned randomly to receive metoprolol or placebo for 6 months. The primary endpoint was the improvement in cardiac output response to stress, measured by an increase in the left ventricle stroke volume more than 30%. Results Three (7.3%) patients in the metoprolol group and nine (24.3%) patients in the placebo group showed improved stroke volume (P=0.057). Diastolic dysfunction was found in two (4.8%) patients before and in five (15.6%) patients after therapy in the metoprolol group, and in 10 (27%) patients before and nine (31%) patients after therapy in the placebo group (P=0.67). After treatment, no echocardiography parameter of morphology was significantly different between metoprolol or placebo groups. No significant differences were observed in noradrenaline, plasma renin activity, and troponin levels between groups. Cirrhosis-related clinical events, including hospitalizations and mortality, were not significantly different between the two groups. Six months of therapy with beta-blocker did not ameliorate heart function and morphology in patients with cirrhotic cardiomyopathy. Copyright (C) 2018 Wolters Kluwer Health, Inc. All rights reserved. (AU)

• Processo FAPESP: 10/12223-6 - Efeito do metoprolol na reversão da disfunção cardíaca nos cirróticos não-alcoólicos: estudo randomizado
• Beneficiário: Fernando Bacal
• Modalidade de apoio: Auxílio à Pesquisa - Regular