Carvedilol Improves Left Atrial and Left Ventricular Function and Reserve in Dilated Cardiomyopathy After 1 Year of Treatment

Paraskevaidis, Ioannis; Farmakis, Dimitrios; Parissis, John; Dodouras, Thomas; Filippatos, Gerasimos; Tsiapras, Dimitrios; Kremastinos, Dimitrios Th.

doi:10.1016/j.cardfail.2006.10.011

Cited by 6 publications

(3 citation statements)

References 29 publications

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“…Previous studies have shown that the improvement in LV diastolic function is concomitant with [16,17,26] and is followed by [15,18,19] the increase in EF. This study demonstrated that long-term ␤-blocker therapy improves LV diastolic function even without an increase in EF, which is partly compatible with the previous study of Paraskevaidis et al [27].…”

Section: Change In Mitral E-wave Velocity (Cm/s)supporting

confidence: 93%

Long-term β-blocker therapy improves diastolic function even without the therapeutic effect on systolic function in patients with reduced ejection fraction

Tamaki

Sakata

Mano

et al. 2010

Journal of Cardiology

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The beneficial effects of beta-blocker therapy on the clinical outcomes of heart failure with reduced ejection fraction (HFREF) are attributed to the improvement in ejection fraction (EF) and left ventricular (LV) reverse remodeling. Previous studies only reported the beta-blocker therapy-induced improvement of diastolic function accompanied by the increase in EF in HFREF patients. This retrospective study aimed to elucidate whether beta-blocker therapy improves diastolic function even without an increase in EF. Out of the consecutive 11,830 echocardiographic reports, HFREF patients without an increase in EF following long-term beta-blocker therapy comprised the study subjects (n=19). During the mean follow-up of 17 months, beta-blocker therapy significantly decreased peak mitral E-wave velocity (70±25-50±18 cm/s, p<0.01) and ratio of peak mitral E- to A-wave velocities (E/A ratio) (1.4±0.8-0.9±0.4, p<0.05), prolonged deceleration time of the mitral E-wave velocity (DcT) (167±54-206±61 ms, p<0.05), and improved New York Heart Association functional class (2.3±0.7-1.8±0.4, p<0.01) without changes in LV volume. Because DcT and E/A ratio are well known to correlate with LV filling pressures in patients with reduced EF, our results indicate a reduction in LV filling pressures without changes in LV volume, suggesting a reduction in LV stiffness. Thus, long-term beta-blocker therapy is likely to improve diastolic function even without a concomitant increase in EF in HFREF patients, which may be also responsible for the beta-blocker-induced improvement of their symptoms of heart failure.

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Section: Change In Mitral E-wave Velocity (Cm/s)supporting

confidence: 93%

Long-term β-blocker therapy improves diastolic function even without the therapeutic effect on systolic function in patients with reduced ejection fraction

Tamaki

Sakata

Mano

et al. 2010

Journal of Cardiology

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“…In fact, in NYHA Class II-III patients with nonischemic dilated cardiomyopathy, carvedilol therapy has been associated with improved left ventricular and left atrial functions. 26 Furthermore, long-term treatment with the drug increases coronary flow reserve in patients with idiopathic dilated cardiomyopathy, suggesting a favorable effect on cardiac function. 12 Improved cardiac function with carvedilol is less consistently observed in patients with ischemic heart disease.…”

Section: Discussionmentioning

confidence: 99%

Enalapril and Losartan Are More Effective Than Carvedilol in Preventing Dilated Cardiomyopathy in the Syrian Cardiomyopathic Hamster

Crespo

Cruz

Altieri

et al. 2008

J Cardiovasc Pharmacol Ther

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To assess the role of the renin-angiotensin (RAS) and adrenergic systems in the development and progression of dilated cardiomyopathy in the Syrian cardiomyopathic hamster (SCH), echocardiographic parameters were evaluated in 6-month-old animals after 5 months of treatment with enalapril (25 mg/kg/day) plus losartan (10 mg/kg/day), or with carvedilol (1 mg/kg/day). Cardiac output indexes (COI) increased by 53% after RAS blockade and by 20% after beta-blockade in SCH. Moreover, LVEDV and LVESV decreased 30% and 62%, respectively (P < .05) during RAS blockade, whereas ejection fraction (EF) increased by 48%. By contrast, carvedilol reduced LVESV by only 28% (P < .05) and increased EF by only 15% (P < .05). These results suggest that RAS activation plays a critical role in the development of cardiac dysfunction in SCH and that suppression of RAS may be more effective than beta-blockade in retarding the development of cardiomyopathy in SCH. Owing to timing (pre-heart failure stage) and to the single dose protocol, the implications of this study for human subjects remain to be clarified.

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“…ATRIAL SIZE AND function has long been recognized as an important element of cardiovascular function with prognostic implications for cardiovascular death, heart failure, atrial fibrillation, stroke, or myocardial infarction (1–8). Medical treatment has been demonstrated to reduce atrial size and to improve atrial function (9).…”

mentioning

confidence: 99%

Reference values for atrial size and function in children and young adults by cardiac MR: A study of the german competence network congenital heart defects

Sarikouch

Koerperich

Boethig

et al. 2011

Magnetic Resonance Imaging

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Purpose: To provide reference data for atrial size and function during childhood and adolescence by cardiac MR (CMR). Materials and Methods:We prospectively examined 115 healthy children and adolescents (mean age, 12.4 6 4.1 years; range, 4.4-20.3 years) by CMR using a stack of standard two-dimensional steady-state free-precession slices acquisition covering the whole heart in transverse plane. Maximal and minimal volumes of both atria and their respective calculated cyclic volume change (CVC) and emptying fraction (EMF) were determined and reference centile curves were computed (lambda-mu-sigma [LMS]-method).Results: Gender differences were noted for atrial volumes and derived parameters. Maximal right atrial (RA) volume for girls was 53.3 6 11.8 mL/m 2 and 58.1 6 15.7 for boys (P ¼ 0.064), minimal RA volume for girls/boys was 23.2 6 6.2/27.0 6 7.9 mL/m 2 (P ¼ 0.004). Maximal left atrial (LA) volume for girls/boys was 44.2 6 8.7/46.7 6 10.1 mL/m 2 (P ¼ 0.143) and minimal LA volume for girls/boys was 19.2 6 3.9/21.5 6 5.1 mL/m 2 (P ¼ 0.009). For both atria, CVC was higher for boys, but EMF higher for girls. Percentiles of RA/LA volumes showed steeper increase in boys than in girls, who in fact showed a plateau after age 14.Conclusion: Pediatric sex-specific reference centiles are provided to improve clinical interpretation and facilitate future research involving CMR-derived atrial function.

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Carvedilol Improves Left Atrial and Left Ventricular Function and Reserve in Dilated Cardiomyopathy After 1 Year of Treatment

Cited by 6 publications

References 29 publications

Long-term β-blocker therapy improves diastolic function even without the therapeutic effect on systolic function in patients with reduced ejection fraction

Long-term β-blocker therapy improves diastolic function even without the therapeutic effect on systolic function in patients with reduced ejection fraction

Enalapril and Losartan Are More Effective Than Carvedilol in Preventing Dilated Cardiomyopathy in the Syrian Cardiomyopathic Hamster

Reference values for atrial size and function in children and young adults by cardiac MR: A study of the german competence network congenital heart defects

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