Drug treatment of heart failure caused by dilated cardiomyopathy: Effect on clinical status, left ventricular systolic function and remodeling

Aim of the study. To assess effects of enalapril and metoprolol on clinical status, left ventricular remodeling and systolic function in patients with heart failure due to dilated cardiomyopathy. Study structure. Randomized, open, controlled, duration - 6 months. Patients. Seventy one patients with dilated cardiomyopathy (mean age 47 years). Treatment groups. Standard treatment (glycosides, diuretics, peripheral vasodilators) - 23 patients; standard therapy plus enalapril (10-20 mg/day) - 24 patients; standard therapy plus metoprolol (slow titration from 10 to a maximum 100 mg/day) - 24 patients. Criteria of evaluation. NYHA functional class, 6-minute walk test, quality of life according to Minnesota Living with Heart Failure (MLHF) questionnaire, echocardiographical parameters of left ventricular remodeling and systolic function. Results. Standard therapy did not change clinical status or left ventricular systolic function, while some parameters of remodeling deteriorated. Enalapril and metoprolol improved quality of life and left ventricular systolic function, and affected favorably left ventricular remodeling. Metoprolol compared with enalapril produced more pronounced decreases of heart rate and indexes of sphericity of left ventricular cavity. Conclusion. Metoprolol compared with enalapril produced greater influence on left ventricular remodeling but effects of both drugs on clinical status of patients with dilated cardiomyopathy during 6 months of therapy were similar.