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Effects of carvedilol on left ventricular remodeling and systolic function in elderly patients with heart failure
A Palazzuoli1, F Bruni, L Puccetti
1Institute of Internal Medicine, University of Siena, Siena, Italy. palazzuoli2@unisi.it
Insights
Carvedilol therapy significantly improved cardiac remodeling and left ventricular function in elderly patients with severe heart failure after 12 months. Short-term treatment showed minimal effects, highlighting the need for sustained carvedilol use.
Area of Science:
- Cardiology
- Pharmacology
- Geriatrics
Background:
- Carvedilol improves outcomes in heart failure.
- Effects on elderly patients with severe heart failure are understudied.
Purpose of the Study:
- Evaluate carvedilol's short- and long-term effects on left ventricular (LV) size and function.
- Focus on elderly patients (>70 years) with dilated cardiomyopathy, NYHA III, and low ejection fraction (<35%).
Main Methods:
- 48 patients randomized to carvedilol or placebo.
- Echocardiography at baseline, 3, and 12 months.
- Assessed LV diameters, mass, fractional shortening, volumes, ejection fraction, and pulmonary pressure.
Main Results:
- After 12 months, carvedilol significantly reduced LV diameters, LV mass, and LV volumes.
- Significant improvement in LV ejection fraction and reduced pulmonary pressure observed.
- Short-term (3 months) effects were less pronounced.
Conclusions:
- 12-month carvedilol therapy improves cardiac remodeling and LV systolic function in elderly severe heart failure patients.
- Favorable effects require several months of sustained treatment.
- Carvedilol is effective for long-term management in this population.
Background:
Recent studies have shown that carvedilol therapy in patients with heart failure improves clinical outcome and survival, however, the effects of such treatment on left cardiac morphology and function in elderly patients with severe heart failure has not been widely studied.
Aim:
The purpose of this study was to establish the effect of carvedilol at short- and long-term on left ventricular size and performance with mono- and two-dimensional echocardiography, in subjects with dilated cardiomyopathy, NYHA III functional class, low LV ejection fraction (EF < 35%) and mean age of > 70 years.
Methods:
We studied 48 patients, previously randomized to treatment with either carvedilol or placebo, and we performed echocardiographic evaluation at the start, and after 3 and 12 months. Left ventricular diameters, LV mass and fractional shortening were calculated by Deveraux formula; left ventricular volumes and ejection fraction were measured by area-length formula; pulmonary pressure was calculated by tricuspid reflow.
Results:
After 3 months, only LV end-diastolic diameter was lower in the carvedilol group compared to the placebo group. Nevertheless, after 12 months, patients on carvedilol treatment showed a LV geometric and functional improvement compared to placebo. We found significant differences in: diastolic (P < 0.01) and systolic diameters (P < 0.001); on LV mass (P < 0.002); on LV systolic volume (P < 0.03); and on LV ejection fraction (P<0.01). Pulmonary pressure was also reduced in beta-blocker subjects (P < 0.001).
Conclusions:
Carvedilol therapy for 12 months reduced LV diameters and volumes. Thus, improving cardiac remodeling and LV systolic function in elderly patients with severe heart failure. Several months of therapy are required for these favorable effects to occur, as these changes do not occur in the short term.