Related Experiment Video

Updated: Jul 27, 2026

Testing the Efficacy of Pharmacological Agents in a Pericardial Target Delivery Model in the Swine
10:05

Testing the Efficacy of Pharmacological Agents in a Pericardial Target Delivery Model in the Swine

Published on: July 7, 2016

Prospective crossover comparison of carvedilol and metoprolol in patients with chronic heart failure

C Maack1, T Elter, G Nickenig

  • 1Medizinische Klinik und Poliklinik, Innere Medizin III, Universitätskliniken des Saarlandes, Homburg, Germany. maack@med-in.uni-saarland.de

Journal of the American College of Cardiology
|October 5, 2001
PubMed

Insights

Switching heart failure patients between carvedilol and metoprolol maintains left ventricular ejection fraction (LVEF) improvement. Both beta-blockers show similar long-term effects, but carvedilol enhances LVEF response during stress tests.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Beta-blockers are crucial for heart failure (HF) management, improving ventricular function and survival.
  • Carvedilol may offer superior left ventricular ejection fraction (LVEF) benefits over metoprolol in HF patients.
  • The safety and impact of switching between these beta-blockers on cardiac function remain unclear.

Purpose of the Study:

  • To evaluate the effects of switching beta-adrenergic blocking agents from metoprolol to carvedilol and vice versa in heart failure patients.
  • To determine if changing beta-blocker treatment impacts left ventricular function and hemodynamics.
  • To compare the safety and efficacy of metoprolol versus carvedilol in HF patients.

Main Methods:

  • Forty-four heart failure patients, previously treated with metoprolol or carvedilol, were switched to an equivalent dose of the alternative drug.
  • Echocardiography, radionuclide ventriculography, and dobutamine stress echocardiography were performed before and six months after treatment crossover.
  • Patients had HF due to ischemic or idiopathic cardiomyopathy and had shown a positive response to initial beta-blocker therapy.

Main Results:

  • Left ventricular ejection fraction (LVEF) improved significantly in both groups after six months of crossover treatment (carvedilol: 32% to 36%; metoprolol: 27% to 30%).
  • No significant changes were observed in New York Heart Association functional class or resting hemodynamic parameters.
  • Dobutamine stress echocardiography indicated a greater heart rate increase with metoprolol and a rise in LVEF only in the carvedilol group post-infusion.

Conclusions:

  • Switching between metoprolol and carvedilol in heart failure patients effectively maintains or improves LVEF.
  • While long-term resting hemodynamics are comparable, carvedilol demonstrates a superior effect on LVEF during dobutamine stress compared to metoprolol.
  • Beta-adrenergic responsiveness differs between metoprolol and carvedilol treatments, suggesting distinct physiological impacts beyond resting state parameters.
Abstract

More Related Videos

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing12:45

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing

Published on: December 11, 2017

Cutoff Value of Phase Angle by Bioelectrical Impedance Analysis at Admission as a Prognostic Factor in Patients with Acute Heart Failure05:16

Cutoff Value of Phase Angle by Bioelectrical Impedance Analysis at Admission as a Prognostic Factor in Patients with Acute Heart Failure

Published on: June 10, 2025

Related Concept Videos

Crossover Experiments01:16

Crossover Experiments

Crossover experiments, also called the repeated-measurements design, is a study design in which all experimental units are exposed to all treatments in different periods. Crossover experiments are generally used in psychology, the pharmaceutical industry, agriculture, and medicine.
Crossover designs are performed even with smaller sample sizes since the samples can act as their controls. These are better than simple randomized trials since patients are exposed to all the treatments.
Adrenergic Antagonists: ɑ and β-Receptor Blockers01:31

Adrenergic Antagonists: ɑ and β-Receptor Blockers

Third-generation β-blockers, such as labetalol and carvedilol, represent a significant advancement in managing cardiovascular conditions. Unlike conventional β-blockers, which can induce peripheral vasoconstriction, third-generation drugs block α1 adrenoceptors. This promotes vasodilation through several mechanisms, such as increased nitric oxide production, inhibition of calcium ion entry, opening of potassium ion channels, and antioxidant action. Labetalol, for instance, is clinically...
Heart Failure Drugs: Inotropic Agents01:26

Heart Failure Drugs: Inotropic Agents

Positive inotropic agents are commonly used as the first line of treatment for heart failure. One such agent is digoxin, derived from the genus Digitalis, which has been known for centuries but effectively utilized since 1785. However, these cardiac glycosides can have potentially toxic effects due to their mechanism of action, which involves inhibiting Na+/K+-ATPase and increasing contractility. Digoxin is absorbed orally and distributed in various tissues, including the CNS. It has a long...
Heart Failure Drugs: Inhibitors of Renin-Angiotensin System01:26

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System

The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
Heart Failure Drugs: β-Blockers01:22

Heart Failure Drugs: β-Blockers

β-adrenergic antagonists, commonly known as β-blockers, block the effects of sympathetic neurotransmitters such as noradrenaline (NA) and adrenaline (ADR). They have several beneficial effects in heart failure treatment. They reduce heart rate, the force of contraction, and cardiac muscle relaxation. They also slow the atrial-ventricular conduction rate and raise the threshold for arrhythmias. The concentration of β-blockers determines their effects on bronchodilation, vasodilation, and...
Heart Failure V: Medical Management01:30

Heart Failure V: Medical Management

Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...