Effects of short- and long-term carvedilol administration on rest and exercise hemodynamic variables, exercise capacity and clinical conditions in patients with idiopathic dilated cardiomyopathy

Metra, Marco; Nardi, Matilde; Giubbini, Raffaele; Dei, Livio

doi:10.1016/0735-1097(94)90174-0

Cited by 296 publications

(153 citation statements)

References 49 publications

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“…5 Its effective clinical dose is about 0.1 to 0.2 g/mL, and the calculated cardiac concentration of carvedilol in the present study is Ϸ1 g/mL. In dogs, carvedilol at 1 and 4 g/mL decreased blood pressure by 9% and 32%, respectively (data not shown), suggesting that the concentration of 1 g/mL of carvedilol in canine heats was comparable to a clinical dose of carvedilol.…”

Section: Clinical Relevance and Limitationsmentioning

confidence: 76%

“…3,4 Carvedilol decreases vascular resistance 3 and improves the pathophysiology of chronic heart failure. 5 This drug dilates both systemic and coronary vessels, 6 which is not a typical characteristic of ␤-blockers. Although this vasodilatory action may contribute to the beneficial effects of carvedilol in ischemic or nonischemic heart failure, 5 it may not be the primary mechanism of cardioprotection, because vasodilators are not always effective at protecting the heart.…”

mentioning

confidence: 99%

“…5 This drug dilates both systemic and coronary vessels, 6 which is not a typical characteristic of ␤-blockers. Although this vasodilatory action may contribute to the beneficial effects of carvedilol in ischemic or nonischemic heart failure, 5 it may not be the primary mechanism of cardioprotection, because vasodilators are not always effective at protecting the heart. 7 Interestingly, carvedilol can also reduce oxidative stress, 8 which causes cellular damage through inactivation of membrane enzymes, pumps, and proteins, such as Na ϩ /K ϩ -ATPase, 9 Ca 2ϩ channels, 10 and ecto-5Ј-nucleotidase.…”

mentioning

confidence: 99%

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β-Adrenoceptor Blocker Carvedilol Provides Cardioprotection via an Adenosine-Dependent Mechanism in Ischemic Canine Hearts

et al. 2004

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Background-Carvedilol is a ␤-adrenoceptor blocker with a vasodilatory action that is more effective for the treatment of congestive heart failure than other ␤-blockers. Recently, carvedilol has been reported to reduce oxidative stress, which may consequently reduce the deactivation of adenosine-producing enzymes and increase cardiac adenosine levels. Therefore, carvedilol may also have a protective effect on ischemia and reperfusion injury, because adenosine mediates cardioprotection in ischemic hearts. Methods and Results-In anesthetized dogs, the left anterior descending coronary artery was occluded for 90 minutes, followed by reperfusion for 6 hours. Carvedilol reduced the infarct size (15.0Ϯ2.8% versus 40.9Ϯ4.2% in controls), and this effect was completely reversed by the nonselective adenosine receptor antagonist 8-sulfophenyltheophylline (45.2Ϯ5.4%) or by an inhibitor of ecto-5Ј-nucleotidase (44.4Ϯ3.6%). There were no differences of either area at risk or collateral flow among the various groups. When the coronary perfusion pressure was reduced in other dogs so that coronary blood flow was decreased to 50% of the nonischemic level, carvedilol increased coronary blood flow (49.4Ϯ5.6 to 73.5Ϯ7.5 mL · 100 g Ϫ1 · min

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Section: Clinical Relevance and Limitationsmentioning

confidence: 76%

mentioning

confidence: 99%

mentioning

confidence: 99%

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β-Adrenoceptor Blocker Carvedilol Provides Cardioprotection via an Adenosine-Dependent Mechanism in Ischemic Canine Hearts

et al. 2004

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“…Some investigators report a reduction in systemic vascular resistance with chronic treatment, 19,20 but this has not been a consistent finding. 21 Recently, Kubo and colleagues 22 reported that 4 months of treatment with carvedilol did not blunt the hemodynamic response to handgrip exercise, which possibly suggests that the peripheral ␣ 1 -adrenoceptor blocking property of carvedilol is not functionally important during long-term treatment.…”

Section: Vittorio Et Al ␤-Blockers and Ang II Vascular Reactivity In mentioning

confidence: 99%

Vasopressor Response to Angiotensin II Infusion in Patients With Chronic Heart Failure Receiving β-Blockers

et al. 2003

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Background-A synergistic interaction between the angiotensin II (Ang II) type 1 receptor and ␣ 1 -adrenergic receptors has been described. We hypothesized that the nonselective ␤-antagonist carvedilol, through its ␣ 1 -adrenergic blocking properties, may modulate vascular reactivity to Ang II in patients with chronic heart failure (CHF). Accordingly, we compared the vasopressor response to infused Ang II in patients treated with carvedilol and metoprolol, a selective ␤-antagonist. Methods and Results-All subjects were treated with carvedilol or metoprolol for at least 3 months. ACE inhibitor therapy was standardized to enalapril 40 mg/d or the maximally tolerated dose. Exogenous Ang II was administered as sequential intravenous bolus injections (2.5 to 30 ng/kg) titrated to a rise in radial artery systolic pressure of Ն20 mm Hg.

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“…3) Carvedilol offers significant benefits in improving the symptoms of heart failure and improves NYHA functional class (Fig. 4).36, 39,54,63 There are also improvements in global assessment scores, improvements in symptom scores, and no effect shown on the Minnesota Living With Heart Failure Q~estionnaire.~~. 39.…”

Section: Effects Of Carvedilol On Ejection Fractionmentioning

confidence: 99%

Carvedilol in the failing heart

Lombardi

Gilbert

2001

Clinical Cardiology

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Summary:Patients with chronic heart failure due to left ventricular systolic dysfunction of ischemic or nonischemic etiology have shown improvement in morbidity and mortality with carvedilol therapy. In patients with symptomatic (New York Heart Association class 11-IV) heart failure, carvedilol improves left ventricularejection fraction and clinical status, and slows disease progression, reducing the combined risk of mortality and hospitalization. Despite the overwhelming evidence for their benefit, there continues to be a large treatment gap between those who would derive benefit and those who actually receive the drug. In this article, the pharmacology, clinical trial evidence, and the potential differences between carvedilol and other beta blockers are discussed. Carvedilol provides powerful therapy in the treatment of chronic heart failure caused by a variety of etiologies and in a wide array of clinical settings.

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Effects of short- and long-term carvedilol administration on rest and exercise hemodynamic variables, exercise capacity and clinical conditions in patients with idiopathic dilated cardiomyopathy

Cited by 296 publications

References 49 publications

β-Adrenoceptor Blocker Carvedilol Provides Cardioprotection via an Adenosine-Dependent Mechanism in Ischemic Canine Hearts

β-Adrenoceptor Blocker Carvedilol Provides Cardioprotection via an Adenosine-Dependent Mechanism in Ischemic Canine Hearts

Vasopressor Response to Angiotensin II Infusion in Patients With Chronic Heart Failure Receiving β-Blockers

Carvedilol in the failing heart

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