PERSISTENCE OF REVERSE LEFT VENTRICULAR REMODELLING IN RESPONSE TO CARVEDILOL IN HEART FAILURE
A.M. Keogh, R.H. Arnold*, J.A. Harland, D.J. McCaffery, P.S. Macdonald.
Heart & Lung Transplant Unit, St Vincent's Hospital, Sydney, New South Wales.
Background: Carvedilol improves systolic function and reduces left ventricular dimensions in patients with dilated cardiomyopathy. The time course of these benefits is yet to be clearly defined.
Methods: 358 patients with NYHA Class I-IV heart failure received open label carvedilol. Serial echocardiographic measurements were obtained at baseline, 3, 12 and 18 or 24 months. Fifty-five patients have been followed for 12 months, 31 of these to 24 months.
Results: Sixty percent of the improvement in the left ventricular ejection fraction occurred within the first three months of treatment. Systolic and diastolic dimensions continue to fall out to 24 months.
|
ECHO |
BASELINE |
3 MONTHS |
12 MONTHS |
18-24 MONTHS |
|
LVEDD |
73±10 |
73±10 |
70±11 |
67±12 |
|
LVESD |
63±11 |
61±11 |
57±13* |
55±13* |
|
FS (%) |
13±6 |
16±6* |
19±14** |
18±6** |
|
EF (%) |
26±9 |
30±8* |
33±10** |
33±10** |
*p<0.05 **p<0.001
Conclusion: Benefits of carvedilol treatment in left ventricular volume reduction persist out to 2 years. There is no definite plateau of ejection fraction or ventricular dimensions and continued improvement may well continue beyond 24 months.
