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(Circulation. 1995;92:212-218.)
© 1995 American Heart Association, Inc.
Articles |
Effects of Carvedilol, a Vasodilator–ß-Blocker, in Patients With Congestive Heart Failure Due to Ischemic Heart Disease
From the Australia–New Zealand Heart Failure Research Collaborative Group, Auckland, New Zealand. Members are listed in the "Appendix."
Correspondence to ANZ Heart Failure Trials Office, Clinical Trials Research Unit, Department of Medicine, Auckland Hospital, Private Bag 92024, Auckland, New Zealand. E-mail macmahon@ctru.auckland.ac.nz.
Background ß-Blocker therapy has been shown to increase ejection fraction in patients with heart failure of idiopathic etiology. However, in patients with heart failure of ischemic etiology, the effects of this treatment on left ventricular function remain uncertain, as do the effects on exercise performance and symptoms.
Methods and Results This study investigated the effects of
carvedilol, a ß-blocker with 
1-blocking properties, on
left ventricular size and function, maximal and submaximal
exercise performance, and symptoms in 415 patients with stable
heart failure of ischemic etiology (ejection fraction <45%).
After a 2- to 3-week run-in phase on open-label low-dose carvedilol,
patients were randomized to continued treatment with carvedilol (up to
25 mg BID) or to matching placebo. After 6 months, left
ventricular ejection fraction measured by radionuclide
ventriculography had increased by 5.2% (2P<.0001) in the
carvedilol group compared with the placebo group, and left
ventricular end-systolic and end-diastolic
dimensions measured by two-dimensionally guided M-mode
echocardiography had decreased by 2.6 mm
(2P=.0005) and 1.3 mm (2P=.05), respectively.
There were no significant changes in either treadmill exercise duration
or 6-minute walk distance between carvedilol and placebo groups (both
2P>.1); in the carvedilol group, exercise
performance was therefore maintained with a 23% lower
rate-pressure product. Symptoms assessed by the New York Heart
Association (NYHA) scale and the Specific Activity Scale (SAS) were
unchanged in two thirds of patients in both groups, but there was a
small excess of patients whose symptoms worsened and a deficit of
patients whose symptoms improved among those assigned carvedilol (NYHA,
2P=.05; SAS, 2P=.02).
Conclusions In patients with heart failure of ischemic etiology, 6-month treatment with carvedilol improved left ventricular function and maintained exercise performance at a lower rate-pressure product, but symptoms assessed by functional class were slightly worsened. A larger-scale trial is now required to determine whether this treatment will reduce serious morbidity and mortality from heart failure.
Key Words: heart failure • ischemic heart disease • beta adrenergic blockade
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