The Effect of Carvedilol on B-Type Natriuretic Peptide and Cardiac Function in Patients with Heart Failure and Persistent Atrial Fibrillation

Abstract

Objectives: We sought to determine the relationship between changes in natriuretic peptides and symptoms as a consequence of introducing beta-blocker therapy, in patients with chronic heart failure (CHF) and persistent atrial fibrillation (AF). Methods: In a randomised, double-blind, placebo-controlled study involving 47 patients with CHF and persistent AF (mean age 68 years and 62% men), we analysed the individual change (Δ) in B-type natriuretic peptide (BNP) level to the introduction of carvedilol (titrated to a target dose of 25 mg twice daily, group A) or placebo (group B) in addition to background treatment with digoxin. Symptoms score, 6-min walk distance, New York Heart Association (NYHA) class, left ventricular ejection fraction (LVEF), heart rate (24-hour ECG) and BNP were measured at baseline and at 4 months. Results: LVEF (Δ median +5 vs. +0.4, p = 0.048), symptoms score (Δ median -4 vs. 0, p = 0.04), NYHA class (Δ median -33% vs. +3% in NYHA class 3-4, p = 0.046) and heart rate [Δ median 24-hour ventricular rate (VR) -19 vs. -2, p < 0.0001] improved with combination therapy of digoxin and carvedilol compared to digoxin alone, but BNP (Δ median +28 vs. -6 , p = 0.11) trended in the opposite direction. There was no relationship between the degree of symptomatic improvement or VR control and BNP response. Conclusion: After the introduction of carvedilol, clinical outcome appears unrelated to BNP changes in patients with CHF and AF. Changes in BNP cannot be used as a marker of clinical response in terms of symptoms or cardiac function in this setting.

Clinical and Echocardiographic Predictors of Arrhythmias Detected With 24-Hour Holter Electrocardiography Among Hypertensive Heart Failure Patients in Nigeria

“…A larger proportion of our HHF patients may have had reduced EF possibly because of late presentation and advanced disease at the time of presentation. Khand et al 46 reported that dual therapy with carvedilol and digoxin among patients with AF and chronic HF resulted in improved NYHA class and median ventricular rate among other factors as compared with use of digoxin alone. This may imply that a more aggressive approach toward treating AF among HF patients may bring about reduction in ventricular rate, improvement in NYHA class, and possibly a better outcome among HF patients.…”

Digoxin: The good and the bad

“…In a large prospective registry of AF patients in the United States, there was no increase in mortality or hospitalisation in patients using digoxin, with or without HF (55). A single RCT of 47 patients has examined digoxin and beta-blockers in patients with HFrEF and persistent AF (56). Double-blinded withdrawal of digoxin led to a decline in LVEF and increase in BNP, although the size of the trial limits further conclusions.…”

ST2 silencing aggravates ventricular remodeling and chronic heart failure in rats by mediating the IL‐33/ST2 axis

“…Due to an unstable TATAAT sequence and faster mRNA transcription, BNP can be instantaneously synthesized; hence, BNP can directly reflect heart chamber function and the severity of heart chamber dysfunction (Khand et al, 2015). NO also exhibits cytotoxicity and acts as an inflammatory mediator.…”