Document Detail

Dose-dependent prognostic effect of carvedilol in patients with chronic heart failure--special reference to transcardiac [corrected] gradient of norepinephrine.
MedLine Citation:
PMID:  19838002     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The effect of the dose of carvedilol on cardiac sympathetic nerve activity (CSA) and mortality remain uncertain in patients with chronic heart failure (CHF).
METHODS AND RESULTS: To compare the dose of carvedilol and the transcardiac gradient of norepinephrine (NE), a biomarker of CSA, and prognosis in patients with CHF, hemodynamic parameters and plasma levels of NE, N-terminal brain natriuretic peptide (NT-proBNP) in the aortic root and coronary sinus were measured in 107 patients with systolic CHF who received carvedilol. Patients were divided into 2 groups [group I: low dose (<10 mg/day, n=41) and group II: high dose (>or=10 mg/day, n=66)]. There was no difference between the 2 groups for the hemodynamic parameters. The dose of carvedilol did not correlate with plasma NE, but was significantly correlated with the transcardiac increase in NE. During a median follow-up of 4.3 years, 13 patients died of cardiac disease. In the Cox stepwise multivariate analyses, a high level of transcardiac increase in NE (P<0.001), high level of plasma log NT-proBNP (P=0.004) and low dose of carvedilol (P=0.012) were significant independent predictors.
CONCLUSION: The carvedilol dose is important for the management of CSA and prognosis in patients with systolic CHF.
Keizo Nishiyama; Takayoshi Tsutamoto; Masayuki Yamaji; Chiho Kawahara; Takashi Yamamoto; Masanori Fujii; Minoru Horie
Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2009-10-17
Journal Detail:
Title:  Circulation journal : official journal of the Japanese Circulation Society     Volume:  73     ISSN:  1347-4820     ISO Abbreviation:  Circ. J.     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2009-11-26     Completed Date:  2010-01-28     Revised Date:  2013-05-28    
Medline Journal Info:
Nlm Unique ID:  101137683     Medline TA:  Circ J     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  2270-5     Citation Subset:  IM    
Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan.
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MeSH Terms
Adrenergic beta-Antagonists / administration & dosage*,  adverse effects
Aged, 80 and over
Biological Markers / blood
Carbazoles / administration & dosage*,  adverse effects
Chi-Square Distribution
Chronic Disease
Dose-Response Relationship, Drug
Heart Failure / drug therapy*,  metabolism,  mortality,  physiopathology
Kaplan-Meier Estimate
Middle Aged
Natriuretic Peptide, Brain / blood
Norepinephrine / blood*
Peptide Fragments / blood
Propanolamines / administration & dosage*,  adverse effects
Proportional Hazards Models
Risk Assessment
Risk Factors
Sympathetic Nervous System / drug effects*,  metabolism,  physiopathology
Time Factors
Treatment Outcome
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Biological Markers; 0/Carbazoles; 0/Peptide Fragments; 0/Propanolamines; 0/pro-brain natriuretic peptide (1-76); 0K47UL67F2/carvedilol; 114471-18-0/Natriuretic Peptide, Brain; 51-41-2/Norepinephrine
Erratum In:
Circ J. 2010 Feb;74(2):385

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