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Long-term effects of carvedilol in idiopathic dilated cardiomyopathy with persistent left ventricular dysfunction

A Di Lenarda1, G Sabbadini, L Salvatore

  • 1Department of Cardiology, Ospedale Maggiore, Trieste, Italy. dilenar@uts.univ.trieste.it

Journal of the American College of Cardiology
|June 11, 1999
PubMed

Insights

In dilated cardiomyopathy (DCM) patients unresponsive to metoprolol, carvedilol improved left ventricular (LV) function and reduced arrhythmias. However, carvedilol negatively impacted exercise capacity, indicating a complex risk-benefit profile for these heart failure patients.

Area of Science:

  • Cardiology
  • Pharmacology
  • Heart Failure Research

Background:

  • Metoprolol benefits most heart failure patients, but some show limited improvement.
  • A subset of patients with heart failure remains symptomatic despite metoprolol treatment.

Purpose of the Study:

  • To evaluate the efficacy of carvedilol in patients with dilated cardiomyopathy (DCM) who are poor responders to metoprolol.
  • To assess carvedilol's impact on left ventricular (LV) function and exercise tolerance in treatment-resistant DCM.

Main Methods:

  • A 12-month, open-label, parallel trial involving 30 DCM patients with persistent LV dysfunction and reduced exercise tolerance.
  • Patients were randomized to continue metoprolol or switch to carvedilol, with dosages tailored to tolerance.

Main Results:

  • Carvedilol treatment led to decreased LV dimensions and improved LV ejection fraction compared to metoprolol.
  • A significant reduction in ventricular arrhythmias was observed in the carvedilol group.
  • No improvement in symptoms or quality of life was noted; peak oxygen consumption decreased with carvedilol.

Conclusions:

  • Carvedilol shows potential benefits for LV systolic function, remodeling, and arrhythmias in metoprolol-refractory DCM patients.
  • The negative impact on exercise capacity necessitates careful consideration of carvedilol's use in this patient population.
Abstract

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