Metoprolol reverses left ventricular remodeling in patients with asymptomatic systolic dysfunction - The Reversal of ventricular remodeling with Toprol-XL (REVERT) trial

Background - There are no randomized, controlled trial data to support the benefit of beta-blockers in patients with asymptomatic left ventricular systolic dysfunction. We investigated whether beta-blocker therapy ameliorates left ventricular remodeling in asymptomatic patients with left ventricular systolic dysfunction. Method and Results - Patients with left ventricular ejection fraction < 40%, mild left ventricular dilation, and no symptoms of heart failure ( New York Heart Association class I) were randomly assigned to receive extended-release metoprolol succinate ( Toprol-XL, AstraZeneca) 200 mg or 50 mg or placebo for 12 months. Echocardiographic assessments of left ventricular end-systolic volume, end-diastolic volume, mass, and ejection fraction were performed at baseline and at 6 and 12 months. The 149 patients randomized to the 3 treatment groups ( 200 mg, n = 48; 50 mg, n = 48; and placebo, n = 53) were similar with regard to all baseline characteristics including age ( mean, 66 years), gender (74% male), plasma brain natriuretic peptide ( 79 pg/mL), left ventricular end-diastolic volume index ( 110 mL/m(2)), and left ventricular ejection fraction (27%). At 12 months in the 200-mg group, there was a 14 +/- 3 mL/m2 decrease ( least square mean +/- SE) in end-systolic volume index and a 6 +/- 1% increase in left ventricular ejection fraction ( P < 0.05 versus baseline and placebo for both). The decrease in end-diastolic volume index ( 14 +/- 3) was different from baseline ( P < 0.05) but not with placebo. In the 50-mg group, end-systolic and end-diastolic volume indexes decreased relative to baseline but were not different from what was seen with placebo, whereas ejection fraction increased by 4 +/- 1% ( P < 0.05 versus baseline and placebo). Conclusion - beta-Blocker therapy can ameliorate left ventricular remodeling in asymptomatic patients with left ventricular systolic dysfunction.