PMID- 10515224
OWN - NLM
STAT- MEDLINE
DCOM- 19991104
LR  - 20191103
IS  - 0902-0063 (Print)
IS  - 0902-0063 (Linking)
VI  - 13
IP  - 5
DP  - 1999 Oct
TI  - Carvedilol improves functional class in patients with severe left ventricular 
      dysfunction referred for heart transplantation.
PG  - 426-31
AB  - PURPOSE: Limited options are available to improve the functional class of 
      patients awaiting cardiac transplantation. We assessed the effect of carvedilol 
      on New York Heart Association (NYHA) class, heart rate (HR), blood pressure (BP), 
      jugular venous pressure (JVP), electrolytes and renal function in patients with 
      markedly decreased left ventricular (LV) function referred for cardiac 
      transplantation assessment. METHODS: Sixty-one patients (age = 52 +/- 12 yr, EF = 
      23 +/- 7%, VO2 max = 16 +/- 5 mL/kg/min) referred to the cardiac transplant 
      clinic were reviewed before and after the addition of carvedilol (starting dose 
      3.125 mg twice daily to target dose of 25 mg twice daily) to usual heart-failure 
      therapy. Over a 1-yr period, at each visit prior to initiation, at baseline 
      initiation visit and at each follow-up visit, NYHA class, BP, HR, JVP, 
      electrolytes, and renal function were obtained. Statistical analysis was 
      performed using random effects regression approach. A multiple logistic 
      regression analysis was performed on 52/61 patients to determine possible 
      associations between NYHA improvement and the following patient characteristics: 
      sex, etiology of cardiomyopathy, initial NYHA class, and dose of carvedilol. 
      RESULTS: Three patients died (2 after stopping carvedilol) and 3 were 
      transplanted. Median follow-up was 100 d. Sixteen patients reached the target 
      dose after a mean of 137 d (2.75 visits). Estimated time-to-target dose is 8 
      months (5.6 visits). BP tended to increase (p = 0.07 for change in trend) with no 
      change in JVP, electrolytes or renal function. HR decreased 6 +/- 3 b.p.m. (p = 
      0.03). Of 14 patients NYHA class I/II at baseline, none were class III/IV at last 
      follow-up visit. Of 47 patients NYHA class III/IV at baseline, 25 were class 
      I/II, and 22 were class III/IV at last follow-up (p < 0.001). Multiple logistic 
      regression analysis did not demonstrate any factor predictive of subsequent NYHA 
      class improvement. CONCLUSIONS: Despite less than target doses in most patients, 
      a favorable effect of carvedilol on functional class in patients with severe 
      congestive heart failure (CHF) referred for transplant was observed. Those with 
      good functional status remained stable and those with poor functional status 
      improved or remained stable. No baseline patient characteristic predicted 
      improvement. The shortage of donor organ requires optimal use of medical regimens 
      which may improve functional class while awaiting transplantation and which may 
      delay the necessity for heart transplantation. Therefore, addition of carvedilol 
      to usual medical therapy may be beneficial even in patients with severe LV 
      dysfunction and poor NYHA classification.
FAU - Pamboukian, S V
AU  - Pamboukian SV
AD  - Department of Medicine, St. Paul's Hospital, Vancouver, British Columbia, Canada.
FAU - Aminbakhsh, A
AU  - Aminbakhsh A
FAU - Thompson, C R
AU  - Thompson CR
FAU - Amin, H
AU  - Amin H
FAU - Mortimer, S
AU  - Mortimer S
FAU - D'yachkova, Y
AU  - D'yachkova Y
FAU - Ignaszweski, A P
AU  - Ignaszweski AP
LA  - eng
PT  - Journal Article
PL  - Denmark
TA  - Clin Transplant
JT  - Clinical transplantation
JID - 8710240
RN  - 0 (Adrenergic beta-Antagonists)
RN  - 0 (Carbazoles)
RN  - 0 (Propanolamines)
RN  - 0K47UL67F2 (Carvedilol)
SB  - IM
MH  - Adrenergic beta-Antagonists/*therapeutic use
MH  - Blood Pressure/drug effects
MH  - Carbazoles/*therapeutic use
MH  - Carvedilol
MH  - Heart Failure/drug therapy/*physiopathology/surgery
MH  - Heart Rate/drug effects
MH  - *Heart Transplantation
MH  - Humans
MH  - Kidney/physiopathology
MH  - Middle Aged
MH  - Propanolamines/*therapeutic use
MH  - Venous Pressure/drug effects
MH  - Ventricular Dysfunction, Left/drug therapy/*physiopathology/surgery
EDAT- 1999/10/09 00:00
MHDA- 1999/10/09 00:01
CRDT- 1999/10/09 00:00
PHST- 1999/10/09 00:00 [pubmed]
PHST- 1999/10/09 00:01 [medline]
PHST- 1999/10/09 00:00 [entrez]
AID - 10.1034/j.1399-0012.1999.130509.x [doi]
PST - ppublish
SO  - Clin Transplant. 1999 Oct;13(5):426-31. doi: 10.1034/j.1399-0012.1999.130509.x.