Effect of carvedilol on survival and hemodynamics in patients with atrial fibrillation and left ventricular dysfunction: Retrospective analysis of the US Carvedilol Heart Failure Trials Program

Joglar, José A.; Acusta, Andre; Shusterman, Neil H.; Ramaswamy, Karthik; Kowal, Robert C.; Barbera, S; Hamdan, Mohamed H.; Page, Richard L.

doi:10.1067/mhj.2001.117318

Cited by 114 publications

(68 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A retrospective analysis of the US Carvedilol Heart Failure Trial demonstrated that carvedilol therapy improved outcome in patients with concomitant AF and heart failure. 68 A retrospective analysis of COMET demonstrated a survival benefit for carvedilol in patients with AF, similar to the larger trial. 51 In acute AF with rapid ventricular response, the use of digoxin, which has a relatively slow onset of action, is likely to be ineffective.…”

Section: Ventricular Rate Controlmentioning

confidence: 90%

Atrial Fibrillation and Heart Failure

2009

View full text Add to dashboard Cite

Section: Ventricular Rate Controlmentioning

confidence: 90%

Atrial Fibrillation and Heart Failure

2009

View full text Add to dashboard Cite

“…Numerous clinical studies have shown that long-term treatment with ␤-receptor blockers in patients with heart failure significantly improves cardiac function, lessens symptoms of heart failure (29,30), and reduces cardiac and total mortality and morbidity (15,(31)(32)(33). Experimental studies have further demonstrated that carvedilol decreases myocardial fibrosis and heart weight, improves cardiac function, and increases survival in rats with immune-induced dilated cardiomyopathy (46).…”

Section: Discussionmentioning

confidence: 99%

“…These agents not only increase left ventricular systolic function (15,28,30) but also reduce cardiac mortality and morbidity in patients with CHF (7,23,(31)(32)(33). However, the extent of improvements produced by these agents varies, with the greatest improvement in mortality with carvedilol (31).…”

mentioning

confidence: 98%

Importance of antioxidant and antiapoptotic effects of β-receptor blockers in heart failure therapy

Kawai

Qin

Shite

et al. 2004

American Journal of Physiology-Heart and Circulatory Physiology

View full text Add to dashboard Cite

. Importance of antioxidant and antiapoptotic effects of ␤-receptor blockers in heart failure therapy. Am J Physiol Heart Circ Physiol 287: H1003-H1012, 2004. First published April 22, 2004 10.1152/ajpheart.00797.2003.-The present study was carried out to determine whether beneficial effects of carvedilol in congestive heart failure (CHF) are mediated via its ␤-adrenergic blocking, antioxidant, and/or ␣-adrenergic blocking action. Rabbits with heart failure induced by rapid cardiac pacing were randomized to receive subcutaneous carvedilol, metoprolol, propranolol plus doxazosin, or placebo pellets for 8 wk and compared with sham-operated rabbits without pacing. We found rapid cardiac pacing produced clinical heart failure, left ventricular dilation, and decline of left ventricular fractional shortening. This was associated with an increase in left ventricular end-diastolic pressure, decrease in left ventricular first derivative of left ventricular pressure, and myocyte hypertrophy. Tissue oxidative stress measured by GSH/GSSG was increased in the heart with increased oxidation product of mitochondrial DNA, 8-oxo-7,8-dihydro-2Ј-deoxyguanosine, increase of Bax, decrease of Bcl-2, and increase of apoptotic myocytes as measured by anti-single-stranded DNA monoclonal antibody. Administration of carvedilol and metoprolol, which had no effect in sham animals, attenuated cardiac ventricular remodeling, cardiac hypertrophy, oxidative stress, and myocyte apoptosis in CHF. In contrast, propranolol plus doxazosin, which has less antioxidant effects, produced smaller effects on left ventricular function and myocyte apoptosis. In all animals, GSH/GSSG correlated significantly with changes of left ventricular end-diastolic dimension (r ϭ Ϫ0.678, P Ͻ 0.0001), fractional shortening (r ϭ 0.706, P Ͻ 0.0001), and apoptotic myocytes (r ϭ Ϫ0.473, P ϭ 0.0001). Thus our findings suggest antioxidant and antiapoptotic actions of carvedilol and metoprolol are important determinants of clinical beneficial effects of ␤-receptors in the treatment of CHF.carvedilol; metoprolol; oxidative stress; myocytes apoptosis; myocyte hypertrophy.RECENT STUDIES HAVE SHOWN that ␤-adrenergic receptor blockers such as carvedilol, metoprolol, and bisoprolol are efficacious in the treatment of congestive heart failure (CHF) (3). These agents not only increase left ventricular systolic function (15, 28, 30) but also reduce cardiac mortality and morbidity in patients with CHF (7,23,(31)(32)(33). However, the extent of improvements produced by these agents varies, with the greatest improvement in mortality with carvedilol (31). In a direct comparison study published recently (33), carvedilol was shown to produce a greater survival benefit in patients with CHF than metoprolol. Whereas the discrepancies among the studies may relate to the difference in patient populations or degree of ␤-receptor blockade, these ␤-adrenergic blockers may have additional properties that contribute to their different clinical benefits. Unlike metoprolol and bisoprolol, which are sel...

show abstract

“…Carvedilol improves LVEF with a trend toward fewer deaths and HF hospitalizations in patients with concomitant AF and HF and may therefore be the preferred ␤-blocker for patients with both conditions. 33 In addition, recent HF guidelines recommend against the use of calcium channel antagonists in patients with AF and systolic dysfunction. 25 Our approach in hospitalized patients is to initially administer both digoxin and small doses of an intravenous ␤-blocker, usually metoprolol in 2.5-or 5-mg increments, while monitoring for signs of decompensation.…”

Section: Rate Controlmentioning

confidence: 99%