Henrik Wiggers

Metoprolol Reduces Hemodynamic and Metabolic Overload in Asymptomatic Aortic Valve Stenosis Patients: A Randomized Trial

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Metoprolol Reduces Hemodynamic and Metabolic Overload in Asymptomatic Aortic Valve Stenosis Patients : A Randomized Trial. / Hansson, Nils Henrik; Sörensen, Jens; Harms, Hendrik Johannes; Kim, Won Yong; Nielsen, Roni; Tolbod, Lars Poulsen; Frøkiær, Jørgen; Bouchelouche, Kirsten; Dodt, Karen Kaae; Sihm, Inger; Poulsen, Steen Hvitfeldt; Wiggers, Henrik.

In: Circulation. Cardiovascular Imaging (Online), Vol. 10, No. 10, 2017.

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@article{a243902725df4095917a13c746d63dba,
title = "Metoprolol Reduces Hemodynamic and Metabolic Overload in Asymptomatic Aortic Valve Stenosis Patients: A Randomized Trial",
abstract = "BACKGROUND: Currently, no pharmacological treatment can modify the natural history of aortic valve stenosis (AS). This underlines the critical need to explore novel treatment strategies, which could postpone or prevent the need for aortic valve replacement in patients with asymptomatic AS. The objectives of this study were to investigate whether metoprolol reduce the hemodynamic and metabolic burden imposed by AS.METHODS AND RESULTS: In a double-blinded design, 40 patients with moderate-severe asymptomatic AS (aortic valve area, 0.5±0.1 cm(2)/m(2); peak gradient, 53±19 mm Hg) were randomized to placebo or metoprolol treatment for 22 weeks. Patients were evaluated by echocardiography, cardiovascular magnetic resonance, and (11)C-acetate positron emission tomography. Compared with placebo, metoprolol (100±53 mg/d) decreased heart rate; mean difference (95{\%} confidence interval) -8 minute(-)(1) (-13, -3; P=0.003) and increased ejection time 26 ms (2, 50; P=0.03). Furthermore, metoprolol reduced aortic valve peak -7 mm Hg (-13, 0; P=0.05) and mean -4 mm Hg (-7, -1; P=0.03) gradients, without affecting stroke volume 3 mL/m(2) (-2, 8; P=0.16). Valvuloarterial impedance (ie, global afterload) and myocardial oxygen consumption were reduced by -11{\%} and -12{\%} (P=0.03 and 0.01), respectively; and decreased heart rate correlated with lower valvuloarterial impedance, myocardial oxygen consumption, and improved myocardial efficiency defined as stroke work/myocardial oxygen consumption (r=0.63-0.65; all P<0.01). There were 2 adverse cardiovascular events in the metoprolol group and none in the placebo group.CONCLUSIONS: In patients with asymptomatic AS, metoprolol increases systolic ejection time and reduces aortic valve gradients, global afterload, and myocardial oxygen requirements. Thus, metoprolol displays favorable hemodynamic and metabolic effects and could improve outcome in patients with asymptomatic AS.CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02076711.",
keywords = "Adrenergic beta-1 Receptor Antagonists, Aged, Aortic Valve, Aortic Valve Stenosis, Asymptomatic Diseases, Denmark, Double-Blind Method, Echocardiography, Doppler, Energy Metabolism, Female, Hemodynamics, Humans, Magnetic Resonance Imaging, Cine, Male, Metoprolol, Middle Aged, Oxygen Consumption, Positron-Emission Tomography, Time Factors, Treatment Outcome, Journal Article, Randomized Controlled Trial",
author = "Hansson, {Nils Henrik} and Jens S{\"o}rensen and Harms, {Hendrik Johannes} and Kim, {Won Yong} and Roni Nielsen and Tolbod, {Lars Poulsen} and J{\o}rgen Fr{\o}ki{\ae}r and Kirsten Bouchelouche and Dodt, {Karen Kaae} and Inger Sihm and Poulsen, {Steen Hvitfeldt} and Henrik Wiggers",
note = "{\circledC} 2017 American Heart Association, Inc.",
year = "2017",
doi = "10.1161/CIRCIMAGING.117.006557",
language = "English",
volume = "10",
journal = "Circulation. Cardiovascular Imaging (Online)",
issn = "1942-0080",
publisher = "Lippincott Williams & Wilkins",
number = "10",

}

RIS

TY - JOUR

T1 - Metoprolol Reduces Hemodynamic and Metabolic Overload in Asymptomatic Aortic Valve Stenosis Patients

T2 - A Randomized Trial

AU - Hansson, Nils Henrik

AU - Sörensen, Jens

AU - Harms, Hendrik Johannes

AU - Kim, Won Yong

AU - Nielsen, Roni

AU - Tolbod, Lars Poulsen

AU - Frøkiær, Jørgen

AU - Bouchelouche, Kirsten

AU - Dodt, Karen Kaae

AU - Sihm, Inger

AU - Poulsen, Steen Hvitfeldt

AU - Wiggers, Henrik

N1 - © 2017 American Heart Association, Inc.

PY - 2017

Y1 - 2017

N2 - BACKGROUND: Currently, no pharmacological treatment can modify the natural history of aortic valve stenosis (AS). This underlines the critical need to explore novel treatment strategies, which could postpone or prevent the need for aortic valve replacement in patients with asymptomatic AS. The objectives of this study were to investigate whether metoprolol reduce the hemodynamic and metabolic burden imposed by AS.METHODS AND RESULTS: In a double-blinded design, 40 patients with moderate-severe asymptomatic AS (aortic valve area, 0.5±0.1 cm(2)/m(2); peak gradient, 53±19 mm Hg) were randomized to placebo or metoprolol treatment for 22 weeks. Patients were evaluated by echocardiography, cardiovascular magnetic resonance, and (11)C-acetate positron emission tomography. Compared with placebo, metoprolol (100±53 mg/d) decreased heart rate; mean difference (95% confidence interval) -8 minute(-)(1) (-13, -3; P=0.003) and increased ejection time 26 ms (2, 50; P=0.03). Furthermore, metoprolol reduced aortic valve peak -7 mm Hg (-13, 0; P=0.05) and mean -4 mm Hg (-7, -1; P=0.03) gradients, without affecting stroke volume 3 mL/m(2) (-2, 8; P=0.16). Valvuloarterial impedance (ie, global afterload) and myocardial oxygen consumption were reduced by -11% and -12% (P=0.03 and 0.01), respectively; and decreased heart rate correlated with lower valvuloarterial impedance, myocardial oxygen consumption, and improved myocardial efficiency defined as stroke work/myocardial oxygen consumption (r=0.63-0.65; all P<0.01). There were 2 adverse cardiovascular events in the metoprolol group and none in the placebo group.CONCLUSIONS: In patients with asymptomatic AS, metoprolol increases systolic ejection time and reduces aortic valve gradients, global afterload, and myocardial oxygen requirements. Thus, metoprolol displays favorable hemodynamic and metabolic effects and could improve outcome in patients with asymptomatic AS.CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02076711.

AB - BACKGROUND: Currently, no pharmacological treatment can modify the natural history of aortic valve stenosis (AS). This underlines the critical need to explore novel treatment strategies, which could postpone or prevent the need for aortic valve replacement in patients with asymptomatic AS. The objectives of this study were to investigate whether metoprolol reduce the hemodynamic and metabolic burden imposed by AS.METHODS AND RESULTS: In a double-blinded design, 40 patients with moderate-severe asymptomatic AS (aortic valve area, 0.5±0.1 cm(2)/m(2); peak gradient, 53±19 mm Hg) were randomized to placebo or metoprolol treatment for 22 weeks. Patients were evaluated by echocardiography, cardiovascular magnetic resonance, and (11)C-acetate positron emission tomography. Compared with placebo, metoprolol (100±53 mg/d) decreased heart rate; mean difference (95% confidence interval) -8 minute(-)(1) (-13, -3; P=0.003) and increased ejection time 26 ms (2, 50; P=0.03). Furthermore, metoprolol reduced aortic valve peak -7 mm Hg (-13, 0; P=0.05) and mean -4 mm Hg (-7, -1; P=0.03) gradients, without affecting stroke volume 3 mL/m(2) (-2, 8; P=0.16). Valvuloarterial impedance (ie, global afterload) and myocardial oxygen consumption were reduced by -11% and -12% (P=0.03 and 0.01), respectively; and decreased heart rate correlated with lower valvuloarterial impedance, myocardial oxygen consumption, and improved myocardial efficiency defined as stroke work/myocardial oxygen consumption (r=0.63-0.65; all P<0.01). There were 2 adverse cardiovascular events in the metoprolol group and none in the placebo group.CONCLUSIONS: In patients with asymptomatic AS, metoprolol increases systolic ejection time and reduces aortic valve gradients, global afterload, and myocardial oxygen requirements. Thus, metoprolol displays favorable hemodynamic and metabolic effects and could improve outcome in patients with asymptomatic AS.CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02076711.

KW - Adrenergic beta-1 Receptor Antagonists

KW - Aged

KW - Aortic Valve

KW - Aortic Valve Stenosis

KW - Asymptomatic Diseases

KW - Denmark

KW - Double-Blind Method

KW - Echocardiography, Doppler

KW - Energy Metabolism

KW - Female

KW - Hemodynamics

KW - Humans

KW - Magnetic Resonance Imaging, Cine

KW - Male

KW - Metoprolol

KW - Middle Aged

KW - Oxygen Consumption

KW - Positron-Emission Tomography

KW - Time Factors

KW - Treatment Outcome

KW - Journal Article

KW - Randomized Controlled Trial

U2 - 10.1161/CIRCIMAGING.117.006557

DO - 10.1161/CIRCIMAGING.117.006557

M3 - Journal article

VL - 10

JO - Circulation. Cardiovascular Imaging (Online)

JF - Circulation. Cardiovascular Imaging (Online)

SN - 1942-0080

IS - 10

ER -