{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,21]],"date-time":"2025-09-21T13:45:34Z","timestamp":1758462334220,"version":"3.44.0"},"reference-count":21,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Heart"],"accepted":{"date-parts":[[1998,6,26]]},"published-print":{"date-parts":[[1998,12,1]]},"abstract":"<jats:p>A 52 year old man with severe chronic left ventricular failure (New York Heart Association class IV) was considered unsuitable for cardiac transplantation because of high and irreversible pulmonary vascular resistance (PVR). In an attempt to produce symptomatic improvement, metoprolol was cautiously introduced, initially at 6.25\u2009mg twice daily. This was slowly increased to 50\u2009mg twice daily over a two month period and continued thereafter. After four months of treatment the patient\u2019s symptoms had improved dramatically. His exercise tolerance had increased and diuretic requirements reduced to frusemide 160\u2009mg\/day only. Assessment of right heart pressures was repeated and, other than a drop in resting heart rate, there was little change in his pulmonary artery pressure or PVR. His right heart pressures were reassessed showing a pronounced reduction in pulmonary artery pressure and a significant reduction in PVR, which fell further with inhaled oxygen and sublingual nitrates. He was then accepted onto the active waiting list for cardiac transplantation. A possible mechanism of action was investigated by assessing responses to \u03b2 agonists during treatment. Not only was there pronounced improvement in PVR but it was also demonstrated that \u03b2 receptor subtype crossregulation may have contributed to the mechanism of benefit.<\/jats:p>","DOI":"10.1136\/hrt.80.6.620","type":"journal-article","created":{"date-parts":[[2014,10,22]],"date-time":"2014-10-22T15:31:45Z","timestamp":1413991905000},"page":"620-622","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Reversal of severe pulmonary hypertension with \u03b2 blockade in a patient with end stage left ventricular failure"],"prefix":"10.1136","volume":"80","author":[{"given":"J G","family":"Crilley","sequence":"first","affiliation":[{"name":"aDepartment of Cardiology, Cardiothoracic Division, South Cleveland Hospital, Marton Road, Middlesbrough TS4 3BW, UK, \n\nbRegional Cardiothoracic Centre, Freeman Hospital, Freeman Road, Newcastle upon Tyne NE7 7DN, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J H","family":"Dark","sequence":"additional","affiliation":[{"name":"aDepartment of Cardiology, Cardiothoracic Division, South Cleveland Hospital, Marton Road, Middlesbrough TS4 3BW, UK, \n\nbRegional Cardiothoracic Centre, Freeman Hospital, Freeman Road, Newcastle upon Tyne NE7 7DN, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J A","family":"Hall","sequence":"additional","affiliation":[{"name":"aDepartment of Cardiology, Cardiothoracic Division, South Cleveland Hospital, Marton Road, Middlesbrough TS4 3BW, UK, \n\nbRegional Cardiothoracic Centre, Freeman Hospital, Freeman Road, Newcastle upon Tyne NE7 7DN, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1998,12,1]]},"reference":[{"key":"2025092100320572000_80.6.620.1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.56.3.468"},{"key":"2025092100320572000_80.6.620.2","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1002\/clc.4960130708","article-title":"Acute haemodynamic and arrythmogenic effects of high-dose intravenous salbutamol in patients with chronic left ventricular dysfunction.","volume":"13","author":"Rotstein","year":"1990","journal-title":"Clinical 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catecholamine sensitivity and beta-adrenergic density in failing human hearts.","volume":"305","author":"Bristow","year":"1982","journal-title":"N Engl J Med"},{"key":"2025092100320572000_80.6.620.12","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1172\/JCI113423","article-title":"Intracoronary infusion of dobutamine to patients with and without severe congestive cardiac failure.","volume":"81","author":"Colucci","year":"1988","journal-title":"J Clin Invest"},{"key":"2025092100320572000_80.6.620.13","first-page":"117A","article-title":"Is \u03b21 receptor down-regulation in the failing human heart the result of cardiac-derived noradrenaline [abstract].","volume":"11","author":"Sandoval","year":"1988","journal-title":"J Am Coll Cardiol"},{"key":"2025092100320572000_80.6.620.14","first-page":"IV-307","article-title":"\u03b21 and \u03b22 receptor down-regulation associated with \u03b2 agonist administration in the failing human heart [abstract].","volume":"76","author":"Rassmussen","year":"1987","journal-title":"Circulation"},{"key":"2025092100320572000_80.6.620.15","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1016\/S0026-895X(25)11117-6","article-title":"\u03b21- and \u03b22-adrenergic receptor-mediated adenylate cyclase stimulation in non-failing and failing human ventricular myocardium.","volume":"35","author":"Bristow","year":"1989","journal-title":"Mol Pharmacol"},{"key":"2025092100320572000_80.6.620.16","doi-asserted-by":"publisher","DOI":"10.1111\/j.1476-5381.1992.tb14276.x"},{"key":"2025092100320572000_80.6.620.17","doi-asserted-by":"publisher","DOI":"10.1161\/01.RES.66.6.1610"},{"key":"2025092100320572000_80.6.620.18","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1161\/01.RES.69.4.959","article-title":"In vivo demonstration of cardiac \u03b22-adrenoreceptor sensitisation by \u03b21-antagonist treatment.","volume":"69","author":"Hall","year":"1991","journal-title":"Circ 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