Beta-blocker treatment of idiopathic and ischemic dilated cardiomyopathy in patients with ejection fractions ≤20%

Abstract

It has been 17 years since Waagstein et al 1 first reported that contrary to prevailing opinion, β-adrenergic blockers actually improve left ventricular function in dilated cardiomyopathy. Many subsequent studies also challenge the presumed necessity for adrenergic support by showing that β blockers improve left ventricular function. 2–4 Other studies have even suggested that rather than being helpful to the failing heart, chronic adrenergic stimulation produces cardiac toxicity. 5,6 Perhaps because few studies have been randomized and blinded, 7,10 and none have been large, the use of β blockers as therapy for impaired left ventricular function has been slow to win adherents. This article reports our observations in 53 consecutive patients with ischemic or idiopathic dilated cardiomyopathy whose left ventricular ejection fractions were ≤ 20%.