Effect of the addition of a beta-blocker on left ventricular remodeling and prognosis in patients with dilated cardiomyopathy treated with angiotensin-converting enzyme inhibitor

To examine the effect of the addition of a beta-blocker in the treatment of chronic heart failure due to dilated cardiomyopathy, we compared the change of left ventricular remodeling and the prognosis between patients treated with angiotensin-converting enzyme inhibitors and patients who had beta-blockers added to angiotensin-converting enzyme inhibitors. Fifty-seven patients were treated with an angiotensin-converting enzyme inhibitor in addition to combination therapy with furosemide, spironolactone and digoxin. In 60 patients, a beta-blocker was administered in addition to combination therapy with furosemide, spironolactone, digoxin and an angiotensin-converting enzyme inhibitor. Changes of left ventricular dimensions at end-diastole and end-systole, fractional shortening, cardiac events and death were examined during the follow-up periods. The mean follow-up periods were 4.9 +/- 4.1 years in the angiotensin-converting enzyme inhibitor group and 3.9 +/- 2.5 years in the beta-blocker group, respectively. Baseline hemodynamic characteristics showed no significant differences between the two groups. After the treatment, the heart rate significantly decreased in both groups and the systolic blood pressure increased in the beta-blocker group. Both left ventricular dimensions at end-diastole and end-systole significantly decreased in both groups. Fractional shortening increased from 17.0 +/- 7.6 to 19.8 +/- 8.9% (p = 0.017) in the angiotensin-converting enzyme inhibitor group and from 16.6 +/- 7.2 to 24.7 +/- 8.0% (p0.0001) in the beta-blocker group, respectively. Changes of left ventricular dimensions at end-diastole and at end-systole, and fractional shortening were all greater in the beta-blocker group than in the angiotensin-converting enzyme inhibitor group. The event-free rate and the cumulative survival rate during the follow-up periods were markedly better in the beta-blocker group than in the angiotensin-converting enzyme inhibitor group (p = 0.0019 and p = 0.0099, respectively). These results indicate that the suppression of left ventricular remodeling and the improvement of prognosis in patients with dilated cardiomyopathy are markedly stronger in the beta-blocker group than in the angiotensin-converting enzyme inhibitor group. Thus, beta-blocker should be added to patients with dilated cardiomyopathy treated with an angiotensin-converting enzyme inhibitor.