D. Platts*, S. Rudham, DJ. McCaffrey, AM. Keogh and PS. Macdonald.

St. Vincents Hospital, Sydney, NSW, Australia

Background:  Carvedilol (C) reduces left ventricular (LV) dimensions and improves systolic function in patients with systolic heart failure (SHF).  The aim of this study was to determine if reverse LV remodeling (rLVR) in response to C was affected by the degree of left ventricular dilation (LVD) at baseline.

Methods:  LVR was assessed by serial echocardiographs in 124 patients with SHF who received C for at least 12 months.  LV dimensions were analyzed as both continuous and categorical variables.  For the latter, patients were divided into two groups above (n=66) and below (n=58) the mean baseline left ventricular end diastolic dimension (LVEDD) of 73mm.

Results:  Patients with a "large" baseline LVEDD were more likely to be male and to have a lower baseline fractional shortening (FS), but did not differ from those with a "small" baseline LVEDD with respect to the following characteristics: age, diagnosis, duration of heart failure, NYHA class, serum Na+ and creatinine or concomitant drug therapy.  Changes in LV size and function over 12 months in the two groups (expressed as mean ± sd) are summarised in the table:

*p<0.05; **p<0.01; ***p<0.001; ****p<0.0001 vs baseline

Abbreviations:  EDD = end-diastolic dimension, ESD = end‑-systolic dimension, FS = fractional shortening (all LV measurements)

There were significant decreases over time in EDD and ESD and a highly significant increase in FS in both "large" and "small" groups, but no differences between groups.  Furthermore, simple regression revealed no significant relationship between baseline LVEDD and the change in LVEDD, LVESD over 12 months.

Conclusions:  rLVR in response to C occurs independently of the baseline LVD.

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