| Mechanisms underlying improvements in ejection fraction with carvedilol in heart failure. | |
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MedLine Citation:
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PMID: 19808339 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Mathew S Maurer; Jonathan D Sackner-Bernstein; Lyna El-Khoury Rumbarger; Madeline Yushak; Donald L King; Daniel Burkhoff |
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Publication Detail:
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Type: Clinical Trial; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't Date: 2009-04-14 |
Journal Detail:
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Title: Circulation. Heart failure Volume: 2 ISSN: 1941-3297 ISO Abbreviation: Circ Heart Fail Publication Date: 2009 May |
Date Detail:
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Created Date: 2009-10-07 Completed Date: 2009-10-27 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101479941 Medline TA: Circ Heart Fail Country: United States |
Other Details:
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Languages: eng Pagination: 189-96 Citation Subset: IM |
Affiliation:
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Division of Cardiology, Columbia Presbyterian Medical Center, New York, NY, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adrenergic beta-Antagonists
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therapeutic use* Aged Arteries / drug effects, physiopathology Blood Pressure / drug effects Carbazoles / therapeutic use* Echocardiography, Three-Dimensional Elasticity Female Heart Failure / drug therapy*, physiopathology, ultrasonography Heart Rate / drug effects* Humans Male Middle Aged Myocardial Contraction / drug effects* Propanolamines / therapeutic use* Severity of Illness Index Sphygmomanometers Stroke Volume / drug effects* Treatment Outcome Vascular Resistance / drug effects Ventricular Function, Left / drug effects* Ventricular Remodeling / drug effects |
| Grant Support | |
ID/Acronym/Agency:
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1 UL1 RR024156-03/RR/NCRR NIH HHS; R01AG027518-01A1/AG/NIA NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Adrenergic beta-Antagonists; 0/Carbazoles; 0/Propanolamines; 72956-09-3/carvedilol |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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