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Value of carvedilol in congestive heart failure secondary to coronary artery disease
P Das Gupta1, P Broadhurst, E B Raftery
1Department of Cardiology, Northwick Park Hospital, Harrow, Middlesex, United Kingdom.
Insights
Carvedilol, a beta blocker with vasodilating properties, improved exercise capacity and heart function in patients with chronic heart failure. This study shows carvedilol
Area of Science:
- Cardiology
- Pharmacology
Background:
- Beta-blocking agents are of interest for congestive heart failure (CHF) but limited by negative inotropic effects.
- Vasodilating beta blockers may overcome these limitations.
Purpose of the Study:
- To evaluate the effects of carvedilol, a beta-blocking agent with vasodilating properties, in patients with chronic CHF secondary to ischemic heart disease.
Main Methods:
- 17 patients with chronic CHF and ejection fraction <= 45% received carvedilol (12.5-50.0 mg BID) for 8 weeks.
- Evaluated using exercise testing, radionuclide ventriculography, and cardiac catheterization before and after treatment.
Main Results:
- 11 of 12 completers showed symptomatic and hemodynamic improvement.
- Exercise time increased (4.3 to 7.1 min, p<0.0001).
- Left ventricular ejection fraction improved (27% to 31%, p<0.02), pulmonary artery wedge pressure decreased (19 to 12 mm Hg, p<0.001), and systemic vascular resistance fell (1752 to 1497 dynes/s/cm-5/m2, p<0.02).
Conclusions:
- Carvedilol demonstrated beneficial effects in patients with chronic CHF.
- Hemodynamic improvements were attributed to vasodilation, reduced myocardial oxygen demand, and decreased sympathetic overactivity.
- Carvedilol may be beneficial for chronic CHF patients with coronary artery disease.
Abstract:
Despite considerable interest in the use of beta-blocking agents in congestive heart failure (CHF), their clinical application is limited because of their negative inotropic effects. Beta blockers with vasodilating properties may have the advantage of overcoming this, however. Carvedilol, a beta-blocking agent with vasodilating properties, was evaluated in 17 patients with chronic CHF secondary to ischemic heart disease with a resting left ventricular ejection fraction less than or equal to 45%, who were being maintained on diuretics. Exercise testing, radionuclide ventriculography, and right-sided cardiac catheterization were performed and intraarterial blood pressure measured before and after 8 weeks of carvedilol therapy in a dosage of 12.5 to 50.0 mg twice a day. Twelve patients completed the study and 5 withdrew. Symptomatic and hemodynamic improvement was demonstrated in 11 of the 12 patients. Heart rate and intraarterial blood pressure were both reduced by chronic therapy. Mean +/- standard deviation exercise time improved from 4.3 +/- 1.6 to 7.1 +/- 2.7 minutes (p less than 0.0001), as did resting left ventricular ejection fraction, from 27 +/- 9 to 31 +/- 11% (p less than 0.02). Pulmonary arterial wedge pressure fell from 19 +/- 7 mm Hg to 12 +/- 5 mm Hg (p less than 0.001) and total systemic vascular resistance from 1,752 +/- 403 to 1,497 +/- 310 dynes/s/cm-5/m2 (p less than 0.02). Stroke volume index improved also, from 31 +/- 6 ml to 40 +/- 6 ml (p less than 0.0005). These hemodynamic changes were mediated partly by vasodilation, diminished myocardial oxygen demand and reduction of sympathetic overactivity in the failing heart. These data suggest that carvedilol may have beneficial effects in patients with chronic CHF secondary to coronary artery disease.