Immunosuppression and beta-blockade in heart failure

Abstract

Two potential treatments, immunosuppression for myocarditis and beta-adrenergic blockade for heart failure, have been advocated. However, definitive conclusions await the result of ongoing large, multicenter, randomized clinical trials. There is circumstantial evidence that myocarditis may be a common precursor of dilated cardiomyopathy. Animal studies of myocarditis suggest that critically timed immunosuppression may be an effective therapy. Although promising, clinical studies to date are small and mostly uncontrolled. Clinical studies have demonstrated that beta-blockers are generally well tolerated in heart failure, and long-term treatment may result in improved symptomatic and functional status. These effects may be due to antagonism of direct and indirect effects of chronic reflex sympathetic stimulation on the cardiovascular system, including down-regulation of the myocardial beta-adrenergic receptor. However, prolongation of survival has not been documented by any studies. Initiation of beta-blockade requires careful patient selection and titration with small initial doses of metoprolol.