Document Detail

Mechanisms underlying improvements in ejection fraction with carvedilol in heart failure.
MedLine Citation:
PMID:  19808339     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Reductions in heart rate (HR) with beta-blocker therapy have been associated with improvements in ejection fraction (EF). However, the relative contributions of HR reduction, positive inotropism, afterload reduction, and reverse remodeling to improvements in EF are unknown.
METHODS AND RESULTS: Twenty-nine patients (63+/-12 years old) with New York Heart Association class II-III heart failure underwent serial measurements of left ventricular volumes using 3-dimensional echocardiography and blood pressures by sphygmomanometry at baseline, 2 weeks, 2, 6, and 12 months after initiation of carvedilol. From these parameters, left ventricular contractility (indexed by the end-systolic pressure-volume ratio), total peripheral resistance, and effective arterial elastance (E(a)) were derived. Overall, EF increased by 7-percentage points after 6 months of therapy (from 25+/-9 to 32+/-9, P<0.0001). This change was due to an increase in stroke volume (P<0.001) with no significant change in end-diastolic volume (P=0.15). The EF change correlated with increased contractility, decreased HR and decreased total peripheral resistance (P<0.003 in each case). In those patients whose EF increased at least 5 points, approximately 60% of the increase was due to HR reduction, approximately 30% was due to increased contractility, and <20% was due to the decrease in total peripheral resistance.
CONCLUSIONS: Decreased HR, improved chamber contractility and afterload reduction each contributed significantly to improved EF with carvedilol.
Mathew S Maurer; Jonathan D Sackner-Bernstein; Lyna El-Khoury Rumbarger; Madeline Yushak; Donald L King; Daniel Burkhoff
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2009-04-14
Journal Detail:
Title:  Circulation. Heart failure     Volume:  2     ISSN:  1941-3297     ISO Abbreviation:  Circ Heart Fail     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-10-07     Completed Date:  2009-10-27     Revised Date:  2013-05-28    
Medline Journal Info:
Nlm Unique ID:  101479941     Medline TA:  Circ Heart Fail     Country:  United States    
Other Details:
Languages:  eng     Pagination:  189-96     Citation Subset:  IM    
Division of Cardiology, Columbia Presbyterian Medical Center, New York, NY, USA.
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MeSH Terms
Adrenergic beta-Antagonists / therapeutic use*
Arteries / drug effects,  physiopathology
Blood Pressure / drug effects
Carbazoles / therapeutic use*
Echocardiography, Three-Dimensional
Heart Failure / drug therapy*,  physiopathology,  ultrasonography
Heart Rate / drug effects*
Middle Aged
Myocardial Contraction / drug effects*
Propanolamines / therapeutic use*
Severity of Illness Index
Stroke Volume / drug effects*
Treatment Outcome
Vascular Resistance / drug effects
Ventricular Function, Left / drug effects*
Ventricular Remodeling / drug effects
Grant Support
1 UL1 RR024156-03/RR/NCRR NIH HHS; R01AG027518-01A1/AG/NIA NIH HHS
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Carbazoles; 0/Propanolamines; 0K47UL67F2/carvedilol

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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