In this study of patients with symptomatic heartfailure, metoprolol CR/XL improved survival, reduced the need for hospitalizations due to worsening heart failure, improved NYHA functional class, and had beneficial effects on patient well-being.

No abstract

The early perfusion status of the infarct-related artery is an independent predictor of short-term survival. However, only complete early reperfusion is associated with a reduced in-hospital mortality rate whereas patients with partial perfusion (TIMI grade 2) have a short-term prognosis similar to that of patients with persistently occluded infarct vessels. Therefore, when used as a surrogate end point for mortality, only TIMI grade 3 perfusion of the infarct vessel should be interpreted as a treatment success of thrombolysis in acute myocardial infarction.

Summary: In II normals and 43 patients with coronary artery disease left ventricular (LV) diastolic pressure-volume (P-V) curves were obtained from biplane ventriculograms and simultaneous high fidelity pressure measurements.During exercise ventriculography 20 patients had angina pectoris (group B), and 16 patients were asymptomatic (group A). At rest there were no akinetic segments in 28 patients (group C), and an akinetic segment was found in 15 (group D). With different total work loads (951 ± 134 and 2100±245 kpm in groups B and A), LV minimal and enddiastolic pressures and corresponding ventricular volumes increased to a similar extent in patients with and without angina during exercise ventriculography. With comparable work loads (1,296±221 and I ,494± 195 kpm in groups C and D) the mean increase in diastolic pressure and volume was larger in group D, which corresponded to the more depressed LV resting function.Shifts in the diastolic P-V relationship with exercise were quantitated from the constants a and b of the linear log P-V relationship. In the control group, a and b did not change significantly, but in all CAD groups a significant decrease in a and a significant increase in b were observed during exercise. These changes were more pronounced in groups Band D, but were statistically significant in group A, too.While no patient with angina had an unchanged diastolic P-V relationship, as many as 12 patients had significant P-V shifts in the absence of angina. Eight of these were expected to develop myocardial ischemia with exercise as judged from their coronary artery stenosis and ventriculograms. A similar correlation was found for the diastolic P-V alterations and the exercise ECG. Fourteen patients without any ST-segment change during exercise showed significant P-V shifts, while no patient with signs of ischemia in the ECG had an unchanged P-V curve.We conclude that LV diastolic function is more sensitive to myocardial ischemia than both angina pectoris and the exercise ECG. An inappropriate increase in LV filling pressure with exercise probably reflects myocardial ischemia even in the absence of angina pectoris and ST-segment depression in the ECG.

In 10 controls and 43 patients with coronary artery disease (CAD) left ventricular (LV) diastolic pressure-volume (P-V) curves were obtained from biplane ventriculograms and simultaneous high fidelity pressure measurement at rest and during bicycle exercise. During exercise ventriculography 20 patients had angina pectoris, and 16 patients were asymptomatic. At rest there were no akinetic segments in 28 patients, and at least one akinetic segment was found in 15 patients. Shifts in the diastolic P-V relationship with exercise were quantitated from the constants a and b of the linear log P-V relationship. In the control group a and b did not change significantly, but in all CAD groups a significant decrease in a and a significant increase in b were observed during exercise. While no patient with angina had an unchanged diastolic P-V relationship, as many as 12 patients had significant P-V shifts in the absence of angina. A similar correlation was found for the diastolic P-V alterations and the exercise ECG. Fourteen patients without any ST-segment change during exercise showed significant P-V shifts, while no patient with signs of ischaemia in the ECG had an unchanged P-V curve. In another 20 patients with CAD the relative contribution of the Frank-Starling mechanism, diastolic compliance and the pericardium to the filling pressure rise during exercise was analyzed. Left ventricular and right atrial pressures--as an index of pericardial pressure--were measured simultaneously during rest and exercise ventriculogram. This was done when filling pressures exceeded 30 mmHg or when angina pectoris occurred.(ABSTRACT TRUNCATED AT 250 WORDS)