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Effects of carvedilol on left ventricular remodelling in chronic stable heart failure: a cardiovascular magnetic
N G Bellenger1, K Rajappan, S L Rahman
1Royal Brompton Hospital, London, UK.
Insights
Carvedilol significantly improves left ventricular volumes and function in patients with chronic stable heart failure. This beta blocker may reduce mortality and morbidity in these patients.
Area of Science:
- Cardiology
- Pharmacology
- Medical Imaging
Background:
- Beta blockers are known to enhance left ventricular function.
- Limited data exists on their impact on cardiac remodeling in heart failure.
- Coronary artery disease is a common cause of heart failure with systolic dysfunction.
Purpose of the Study:
- To assess the effects of carvedilol on left ventricular remodeling.
- Utilized cardiovascular magnetic resonance (CMR) for detailed imaging.
- Focused on patients with chronic stable heart failure and coronary artery disease.
Main Methods:
- Randomized, double-blind, placebo-controlled trial (CHRISTMAS trial).
- 34 patients with chronic stable heart failure underwent CMR at baseline and 6 months.
- Carvedilol treatment was compared against a placebo.
Main Results:
- Carvedilol significantly reduced end-systolic volume index (ESV(I)) and end-diastolic volume index (EDV(I)).
- Significant improvement in ejection fraction observed in the carvedilol group compared to placebo.
- No significant baseline differences between carvedilol and placebo groups.
Conclusions:
- Carvedilol treatment leads to significant improvements in left ventricular volumes and function.
- These improvements may contribute to reduced mortality and morbidity in heart failure patients.
- CMR is a valuable tool for evaluating cardiac remodeling in response to heart failure therapy.
Background:
The ability of beta blockers to improve left ventricular function has been demonstrated, but data on the effects on cardiac remodelling are limited.
Objective:
To investigate, using cardiovascular magnetic resonance (CMR), the effects of carvedilol on left ventricular remodelling in patients with chronic stable heart failure and left ventricular systolic dysfunction caused by coronary artery disease.
Design:
Randomised, double blind, placebo controlled study.
Setting:
Chronic stable heart failure.
Patients And Intervention:
34 patients with chronic stable heart failure and left ventricular systolic function taking part in the CHRISTMAS trial (double blind carvedilol v placebo) underwent CMR before randomisation and after six months of treatment.
Main Outcome Measure:
Left ventricular remodelling at six months.
Results:
The carvedilol and placebo groups were well balanced at baseline, with no significant intergroup differences. Over the study period, there was a significant reduction in end systolic volume index (ESV(I)) and end diastolic volume index (EDV(I)) between the carvedilol and the placebo group (carvedilol -9 v placebo +3 ml/m2, p = 0.0004; carvedilol -8 v placebo 0 ml/m2, p = 0.05). The ejection fraction increased significantly between the groups (carvedilol +3% v placebo -2%, p = 0.003).
Conclusions:
Treatment of chronic stable heart failure with carvedilol results in significant improvement in left ventricular volumes and function. These effects might contribute to the benefits of carvedilol on mortality and morbidity in patients with chronic heart failure.
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