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Carvedilol improves left ventricular function and symptoms in chronic heart failure: a double-blind randomized study
S L Olsen1, E M Gilbert, D G Renlund
1Division of Cardiology, University of Utah Health Sciences Center, Salt Lake City 84132, USA.
Insights
Carvedilol significantly improved cardiac function and reduced heart failure symptoms in patients with cardiomyopathy. This beta-blocker therapy offers a promising treatment option for heart failure management.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Carvedilol is a beta-adrenergic blocking agent with vasodilator properties.
- The efficacy of carvedilol in heart failure is not well-established.
Purpose of the Study:
- To assess the safety and efficacy of carvedilol in patients with heart failure.
- To evaluate carvedilol's effects on cardiac function and symptoms in idiopathic or ischemic cardiomyopathy.
Main Methods:
- Sixty patients with heart failure (NYHA classes II-IV) and LVEF ≤ 0.35 were enrolled.
- Patients were randomized to carvedilol (n=36) or placebo (n=24) after initial tolerance.
- Medication was titrated over 1 month and continued for 3 months.
Main Results:
- Carvedilol significantly reduced heart rate and pulmonary pressures, increasing stroke volume and left ventricular stroke work.
- Left ventricular ejection fraction increased by 52% in the carvedilol group (0.21 to 0.32, p < 0.0001).
- Carvedilol therapy led to a significant reduction in heart failure symptoms (p < 0.05).
Conclusions:
- Long-term carvedilol therapy improves resting cardiac function in heart failure patients.
- Carvedilol effectively lessens heart failure symptoms, demonstrating its therapeutic benefit.
Objectives:
This study assessed the safety and efficacy of carvedilol in patients with heart failure caused by idiopathic or ischemic cardiomyopathy.
Background:
Carvedilol is a mildly beta 1-selective beta-adrenergic blocking agent with vasodilator properties. Beta-blockade may be beneficial in patients with heart failure, but the effects of carvedilol are not known.
Methods:
Sixty patients with heart failure (New York Heart Association functional classes II to IV) and left ventricular ejection fraction < or = 0.35 were enrolled in the study. All patients tolerated challenge with carvedilol, 3.125 mg twice a day, and were randomized to receive carvedilol (n = 36) versus placebo (n = 24). Study medication was titrated over 1 month from 6.25 to 25 mg twice a day (< 75 kg) or 50 mg twice a day (> 75 kg) and continued for 3 months. One placebo-treated and two carvedilol-treated patients did not complete the study.
Results:
Carvedilol therapy resulted in a significant reduction in heart rate and mean pulmonary artery and pulmonary capillary wedge pressures and a significant increase in stroke volume and left ventricular stroke work. Left ventricular ejection fraction increased 52% in the carvedilol group (from 0.21 to 0.32, p < 0.0001 vs. placebo group). Carvedilol-treated patients also reported a significant lessening of heart failure symptoms (p < 0.05 vs. placebo group). Submaximal exercise duration tended to increase with carvedilol therapy (from 688 +/- 31 s to 871 +/- 32 s), but this change was not significantly different from that with placebo therapy by between-group analysis. Peak oxygen consumption during maximal exercise did not change.
Conclusions:
Long-term carvedilol therapy improves rest cardiac function and lessens symptoms in patients with heart failure.