Metoprolol Succinate in Cardiac Remodeling Related to Cirrhosis

Study Overview
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Brief Summary
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Cirrhotic cardiomyopathy is defined as a chronic cardiac dysfunction in patients with cirrhosis. It is suspected that this specific cardiac dysfunction contributes to the onset of complications in liver disease. The purpose of this prospective, randomized trial is to determine whether metoprolol succinate can revert cardiac dysfunction secondary to cirrhosis (cirrhotic cardiomyopathy), and prevent complications (renal dysfunction, mortality). A total of 100 patients with cirrhotic cardiomyopathy will be randomized (Group R) to receive metoprolol succinate or placebo; other 25 patients without cirrhotic cardiomyopathy (Group F) will only be followed up without medication. All patients will be evaluated in the beginning and again after six months. The assessment protocol includes clinical evaluation, electrocardiogram, echocardiogram, laboratory analysis and life quality questionaire. The end points will be cardiac remodeling, electrophysiologic changes, sympathetic activity, laboratory issue changes, renal function, quality of life, and mortality.

Detailed Description
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Cirrhotic cardiomyopathy (CMC) is defined as a chronic cardiac dysfunction in patients with cirrhosis. Moreover, it is characterized by an abnormal and blunted response to pathological or pharmacological stress in the absence of any other associated cardiac disease. The diagnostic criteria are: baseline increased cardiac output, attenuated myocardial contractile response to stress, diastolic dysfunction, and electrophysiological repolarization abnormalities. It is suspected that cardiac dysfunction in cirrhosis contribute to the onset of complications in liver disease. We will investigate the effect of metoprolol succinate in the reversal of cardiac dysfunction and prevention of complications of cirrhosis in patients with cirrhotic cardiomyopathy. Furthermore, we want to study the influence of presence of CMC in the evolution of cirrhotic patients. The study will be prospective, randomized, double-blind, and placebo-controlled. The sample consists of 125 patients aged between 18 and 60 years old diagnosed with severe liver cirrhosis (Child B or C or MELD score above 10) with cirrhotic cardiomyopathy or not. Of these, 100 patients with cirrhotic cardiomyopathy will be randomized into two groups: group R1 (metoprolol succinate) and group R2 (placebo). Group F will consist of cirrhotic patients without cardiomyopathy and will not receive medication. Patients will be evaluated by clinical examination, resting electrocardiogram, 24-hour Holter, stress echocardiography and laboratory (brain natriuretic peptide (BNP), catecholamines, plasma renin activity, and troponin) at inclusion and after six months. The end points are: 1) Reversal of cardiac dysfunction in patients with cirrhotic cardiomyopathy, 2) Development of hepatorenal syndrome, 3) Reversal of the electrophysiologic abnormalities, 4)Changes in laboratory tests, and 5) Mortality.

Official Title
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Effect of Metoprolol Succinate in Cardiac Remodeling Related to Nonalcoholic Cirrhosis. Randomized Study.

Conditions
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Cirrhosis, Cirrhotic Cardiomyopathy, Cardiac Remodeling

Intervention / Treatment
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* Drug: Metoprolol succinate
* Drug: placebo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: more than 18 years old. must have signed the written informed consent. nonalcoholic cirrhosis. Exclusion Criteria: Betablockers intolerance; Diagnosis of other cardiomyopathy Chronicle renal disease (Creatinine > 2.5) Heavy alcohol intake history Presence of other disease with possible cardiac implication (infiltrative or storage disease)

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Metoprolol succinate<br>Metoprolol succinate | Drug: Metoprolol succinate<br> <br> * Other names: Selozok;|
| Placebo Comparator: Placebo<br>Placebo | Drug: placebo<br> <br> |
| No Intervention: Follow up<br>Group without cirrhotic cardiomyopathy, only follow up without randomization. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Improvement of systolic function | Systolic functional reserve is measured by aortic velocity time integral in echocardiographic at rest and stress with dobutamine. | six months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Improvement in left ventricular diastolic function |  | six months | 
| Renal function |  | From randomization until six months | 
| Serum level of BNP, catecholamines, plasmatic renin activity |  | Six months | 
| Mortality |  | From randomization until six months of follow up | 
| Quality of life |  | Six months | 
| Electrophysiologic modifications | QT prolongation R-R variability | Six months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Cirrhosis, cirrhotic cardiomyopathy, cardiac remodeling, cardiomyopathy, metoprolol succinate, betablockers