Improvement in left ventricular function in response to carvedilol is accompanied by attenuation of neurohumoral activation in patients with dilated cardiomyopathy.

Abstract

BACKGROUND:

We sought to evaluate whether improvement in ejection fraction (EF) with carvedilol therapy is accompanied by improvement in neurohumoral factors.

METHODS AND RESULTS:

Forty-two patients with dilated cardiomyopathy were given carvedilol for 3 to 5 months. Changes in EF, plasma atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), and norepinephrine levels were determined. Iodine-123 metaiodobenzylguanidine (MIBG) images were also obtained before and after carvedilol therapy. Myocardial uptake of MIBG was calculated as the heart to mediastinal activity ratio (H/M). Storage and release of MIBG was calculated as percent myocardial MIBG washout rate (WR). We divided patients into 2 groups: 27 responders whose EF increased by more than 5% and 15 nonresponders whose EF increased by 5% or less. EF of responders increased by 15 +/- 5% and that of nonresponders by 1 +/- 4%. Although MIBG image-derived indexes of nonresponders remained unchanged, the delayed H/M (1.91 +/- 0.34 v 2.24 +/- 0.53, P < .01) and WR (49 +/- 11 v 39 +/- 9%, P < .01) of responders improved, respectively. The plasma ANP (51 +/- 50 v 27 +/- 24 pg/mL, P < .01) and BNP (194 +/- 197 v 49 +/- 62 pg/mL, P < .01) levels of responders decreased. The degree of changes in the plasma BNP level correlated with changes in EF (r = -.698, P < .01).

CONCLUSION:

The improvement in EF with carvedilol therapy was proved to be accompanied by an improvement in neurohumoral factors.

• Authors: M Fujimura, Y Yasumura, Y Ishida, S Nakatani, K Komamura, M Yamagishi, K Miyatake
• Journal: Journal of cardiac failure (J Card Fail) Vol. 6 Issue 1 Pg. 3-10 (Mar 2000) ISSN: 1071-9164 [Print] United States
• PMID: 10746813 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Adrenergic beta-Antagonists
• Biomarkers
• Carbazoles
• Propanolamines
• Radiopharmaceuticals
• Carvedilol
• Natriuretic Peptide, Brain
• 3-Iodobenzylguanidine
• Atrial Natriuretic Factor
• Norepinephrine

Topics

• 3-Iodobenzylguanidine
• Adrenergic beta-Antagonists (therapeutic use)
• Adult
• Aged
• Atrial Natriuretic Factor (blood)
• Biomarkers (blood)
• Carbazoles (therapeutic use)
• Cardiomyopathy, Dilated (blood, drug therapy, physiopathology)
• Carvedilol
• Female
• Heart Ventricles (diagnostic imaging, drug effects, physiopathology)
• Humans
• Male
• Middle Aged
• Natriuretic Peptide, Brain (blood)
• Norepinephrine (blood)
• Propanolamines (therapeutic use)
• Radiopharmaceuticals
• Recovery of Function
• Retrospective Studies
• Stroke Volume (drug effects)
• Tomography, Emission-Computed, Single-Photon
• Treatment Outcome
• Ventricular Function, Left (drug effects, physiology)