Abstract
Background: The effects of treatment with captopril or metoprolol on heart rate variability (HRV) were investigated in 38 patients (29 men and 9 women) with mild to moderate symptoms of heart failure due to idiopathic dilated cardiomyopathy (DCM).
Hypothesis: The aim of the study was to investigate and compare the effects of the angiotensin‐converting enzyme inhibitor captopril with those of the selective beta‐adrenergic receptor blocker metoprolol on HRV in patients with idiopathic DCM.
Methods: Heart rate variability was analyzed in the time and frequency domains from 18 h of Holter monitoring before randomized treatment was started, after 6 months of therapy, and 1 month after therapy was stopped.
Results: Captopril treatment increased HRV expressed as total power and low‐frequency power in the frequency domain. There was no change in the time domain. In the metoprolol group, there was a pronounced increase in both time‐and frequency‐domain indices of HRV. The increase in total power was partly maintained 1 month after therapy was stopped in both treatment groups.
Conclusion: Treatment with captopril and metoprolol increases HRV in patients with DCM. This effect seems to be maintained for at least 1 month after therapy is stopped. The increase in HRV seems to be more pronounced with metoprolol, and the two different pharmacologic approaches may have additive effects that are of prognostic importance in patients with heart failure.
Keywords: heart rate variability, dilated cardiomyopathy, treatment, beta blocker, angiotensin‐converting enzyme inhibitor
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References
- 1. Pomeranz B, Macaulay RJ, Caudill MA, Kutz I, Adam D, Gordon D, Kilborn KM, Barger AC, Shannon DC, Cohen RJ: Assessment of autonomic function in humans by heart rate spectral analysis. Am J Physiol 1985; 248: H151–153 [DOI] [PubMed] [Google Scholar]
- 2. Kjellgren O, Gomes J: Heart rate variability and baroreflex sensitivity in myocardial infarction. Am Heart J 1993; 125: 204–215 [DOI] [PubMed] [Google Scholar]
- 3. Kleiger R, Miller J, Bigger J, Moss A: Decreased heart rate variability and its association with increased mortality after acute myocardial infarction. Am J Cardiol 1987; 59: 256–262 [DOI] [PubMed] [Google Scholar]
- 4. Pipilis A, Flather M, Ormerod O, Sleight P: Heart rate variability in acute myocardial infarction and its association with infarct size and clinical course. Am J Cardiol 1991; 67: 1137–1139 [DOI] [PubMed] [Google Scholar]
- 5. Farrell TG, Bashir Y, Cripps T, Malik M, Poliniecki J, Bennet ED, Bennett ED, Ward DE, Camm AJ: Risk stratification for arrhythmic events in postinfarction patients based on heart rate variability, ambulatory electrocardiographic variables and the signal‐average electrocardiogram. J Am Coll Cardiol 1991; 18: 687–697 [DOI] [PubMed] [Google Scholar]
- 6. Binder T, Frey B, Porenta G, Heinz G, Wutte M, Kreiner G, Gossinger H, Schmidinger H, Pacher R, Weber H: Prognostic value of heart rate variability in patients awaiting cardiac transplantation. PACE 1993; 15: 2215–2220 [DOI] [PubMed] [Google Scholar]
- 7. Brouwer J, Van Veldhuisen D, Man in't Veld A, Dunselman P, Haaksma J, Lie K: Circadian patterns of heart rate variability in heart failure is progressively disturbed with increasing neurohormonal activation. J Am Coll Cardiol 1994; (suppl A): 392 A
- 8. Yi G, Goldman JH, Keeling PJ, Reardon M, McKenna WJ, Malik M: Heart rate variability in idiopatic dilated cardiomyopathy: Relation to disease severity and prognosis. Heart 1997; 77 (2): 108–114 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9. Ponikowski P, Anker SD, Chua TP, Szelemej R, Piepoli M, Adamopoulos S, Webb‐Peploe K, Harrington D, Banasiak W, Wrabec K, Coats AJ: Depressed heart rate variability as an independent predictor of death in chronic congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. Am J Cardiol 1997; 79 (12): 1645–1650 [DOI] [PubMed] [Google Scholar]
- 10. Kienzle M, Ferguson D, Birkett C, Myers G, Berg W, Mariano D: Clinical, hemodynamic and sympathetic neural correlates of heart rate variability in congestive heart failure. Am J Cardiol 1992; 69: 761–767 [DOI] [PubMed] [Google Scholar]
- 11. The SOLVD Investigators : Effect of enalapril on survival in patients with reduced ejection fraction and congestive heart failure. N Engl J Med 1991; 325: 293–302 [DOI] [PubMed] [Google Scholar]
- 12. Waagstein F, Hjalmarson Å, Varnauskas E, Wallentin I: Effect of chronic beta‐adrenergic receptor blockade in congestive cardiomyopathy. Br Heart J 1975; 37: 1022–1036 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13. Counihan P, Fei L, Bashir Y, Farrell T, Haywood G, McKenna W: Assessment of heart rate variability in hypertrophic cardiomyopathy. Association with clinical and prognostic features. Circulation 1993; 88: 1682–1690 [DOI] [PubMed] [Google Scholar]
- 14. Report of the WHO/ISFC task force on the definition and classification of cardiomyopathies. Br Heart J 1980; 44: 672–673 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15. Jansson K, Karlberg KE, Nylander E, Karlsson E, Nyquist O, Dahlström U: More favourable hemodynamic effects of metoprolol than of captopril in patients with dilated cardiomyopathy. Eur Heart J 1997; 18: 1115–1121 [DOI] [PubMed] [Google Scholar]
- 16. Sahn J, DeMaria A, Kisslo J, Weyman A: Recommendations regarding quantitation in M‐mode echocardiography: Results of a survey of echocardiographic measurements. Circulation 1978; 58: 1072–1083 [DOI] [PubMed] [Google Scholar]
- 17. Henry W, Gardin J, Ware J: Echocardiographic measurements in normal subjects from infancy to old age. Circulation 1980; 62: 1054–1061 [DOI] [PubMed] [Google Scholar]
- 18. Heart Rate Variability. Standard of Measurement, Physiological Interpretation and Clinical Use. The Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation 1996; 93: 1043–1065 [PubMed] [Google Scholar]
- 19. Ericson MO, Lindblad LE: Microcomputer based system for RR‐interval detection and autoregressive spectral analysis of variability in biological signals. Technical report. Royal Institute of Technology, Stockholm: 1991; ISSN 1100–5718, TRIATA AVF;10 [Google Scholar]
- 20. Casolo G, Balli E, Taddei T, Amuhasi J, Gori C: Decreased spontaneous heart rate variability in congestive heart failure. Am J Cardiol 1989; 64: 1162–1167 [DOI] [PubMed] [Google Scholar]
- 21. Flapan A, Nolan J, Neilson J, Ewing D: Effect of captopril on cardiac parasympathetic activity in chronic cardiac failure secondary to coronary artery disease. Am J Cardiol 1992; 69: 532–535 [DOI] [PubMed] [Google Scholar]
- 22. Coumel P, Hermida J, Wennerblom B, Leenhradt A, Maison‐Blanche P, Cauchemez B: Heart rate variability in left ventricular hypertrophy and heart failure, and the effects of beta‐blockade. Eur Heart J 1991; 12: 412–422 [DOI] [PubMed] [Google Scholar]
- 23. Pousset F, Copie X, Lechat P, Jaillon P, Boisell JP, Hetzel M, Fillette F, Remme W, Guize L, Le Heuzey JY: Effects of bisoprolol on heart rate variability in heart failure. Am J Cardiol 1996; 77: 612–617 [DOI] [PubMed] [Google Scholar]
- 24. Waagstein F, Bristow MR, Swedberg K, Camerini F, Fowler MB, Silver MA, Gilbert EM, Johnson MR, Goss FG, Hjalmarson A: Beneficial effects of metoprolol in idiopathic dilated cardiomyopathy. Lancet 1993; 342: 1441–1446 [DOI] [PubMed] [Google Scholar]
- 25. The Consensus Trial Study Group : Effects on mortality in severe congestive heart failure: Results of the Cooperative North Scandinavian Enalapril Survival Study. N Engl J Med 1987; 316: 1429–1435 [DOI] [PubMed] [Google Scholar]
- 26. Osterziel K, Rhorig N, Dietz R, Manthey J, Hech J, Khubler W: Influence of captopril on arterial baroreceptor reflex in patients with heart failure. Eur Heart J 1988; 9: 1137–1145 [DOI] [PubMed] [Google Scholar]
- 27. Cody R, Franklin K, Kluger J, Laragh J: Sympathetic responses and plasma norepinephrine during therapy of chronic congestive heart failure with captopril. Am J Med 1982; 72: 791–797 [DOI] [PubMed] [Google Scholar]
- 28. Zhang Y, Song Y, Zhu J, Hu T, Wan L: Effects of enalapril on heart rate variability in patients with congestive heart failure. Am J Cardiol 1995; 76: 1045–1048 [DOI] [PubMed] [Google Scholar]
- 29. Hagerman I, Berglund M, Ericson M, Sylven C: Vagal influence on deterministic chaos of heart rate in patients after acute myocardial infarction. Ann Noninvas Electrocardiol 1997; 2 (4): 370–377 [Google Scholar]
- 30. Fleiss JL, Bigger JT, Rolnitzky LM: The correlation between heart period variability and the mean period length. Stat Med 1992; 11: 125–129 [DOI] [PubMed] [Google Scholar]
- 31. Panina G, Khot UN, Nunziata E, Cody RJ, Binkley PF: Assessment of autonomic tone over a 24‐hour period in patients with congestive heart failure: Relation between mean heart rate and measures of heart rate variability. Am Heart J 1995; 129: 748–753 [DOI] [PubMed] [Google Scholar]
- 32. Coumel P, Maison‐Blanche P, Catuli D: Heart rate and heart rate variability in normal young adults. J Cardiovasc Electrophysiol 1994; 5: 899–911 [DOI] [PubMed] [Google Scholar]
- 33. Packer M, Bristow MR, Cohn JN, Colucci WS, Fowler MB, Gilbert EM, Shusterman NH: The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. N Engl J Med 1996; 334: 1349–1355 [DOI] [PubMed] [Google Scholar]
- 34. Krum H, Bigger T, Goldsmith R, Packer M: Effect of long‐term digoxin therapy on autonomic function with chronic heart failure. J Am Coll Cardiol 1995; 25: 289–294 [DOI] [PubMed] [Google Scholar]
- 35. Fauchier L, Babuty D, Cosnay P, Autret ML, Fauchier JP: Heart variability in patients with idiopathic dilated cardiomyopathy: Characteristics and prognostic value. J Am Coll Cardiol 1997; 30: 1009–1014 [DOI] [PubMed] [Google Scholar]