Abstract 1895: Protective Effects of Carvedilol against Anthracycline induced Cardiomyopathy
Introduction: Despite its broad effectiveness, Anthracycline (ANT) therapy is associated with ANT-induced cardiomyopathy (CMP). There are several hypotheses to explain mechanism of ANT-induced cardiotoxicity but free-radical formation is generally accepted as main mechanism. Carvedilol blocks beta1, beta2 and alfa-adrenoceptors, and has potent antioxidant and antiapoptotic properties. Recent animal studies and experimental observations showed that carvedilol prevented development of CMP due to chemotherapeutics. However there is no placebo controlled clinical trial concerning prophylactic carvedilol use in preventing ANT-induced CMP. Hypothesis: We assessed the hypothesis that carvedilol prevents ANT-induced CMP in patients receiving chemotherapy for malignity.
Methods: Patients in whom ANT therapy was planned were randomized to administration of carvedilol or placebo. We enrolled 25 patients in both carvedilol and control group. In carvedilol group, 12.5 mg once daily oral carvedilol was given during six months. The patients were evaluated with echocardiography before and after chemotherapy. Left ventricle ejection fraction (EF), systolic and diastolic diameters were calculated.
Results: At end of 6 months of follow up, one patient in carvedilol group and four in control were died. Control EF was below 50% in one subject of carvedilol group and five in controls. The mean EF of carvedilol group was similar at baseline and control echocardiography (respectively 70.5 vs. 69.7 p=0.3) but the mean EF at control echocardiograph was significantly lower in control group (68.9 vs. 52.3 p<0.001). There was not significant change in both systolic and diastolic diameters of left ventricle in carvedilol group (Systolic: 31.4±5.4 vs. 32.2±6.6 p=0.7, diastolic: 47.6±5.6 vs. 47.4±3.7 p=0.8). However, both systolic and diastolic diameters were significantly increased compared to basal measures in control group (Systolic: 30.3±5.2 vs. 38.0±5.3 p= 0.0001, diastolic: 45.6±5.0 vs. 50.9±5.6 p= 0.008).
Conclusions: Preventing ANT-induced CMP is an important clinic problem. In our study, we demonstrated that prophylactic use of carvedilol in patients receiving ANT might protect left ventricle functions.