PMID- 11079666
OWN - NLM
STAT- MEDLINE
DCOM- 20010102
LR  - 20190708
IS  - 0735-1097 (Print)
IS  - 0735-1097 (Linking)
VI  - 36
IP  - 5
DP  - 2000 Nov 1
TI  - Nonselective beta-adrenergic blocking agent, carvedilol, improves arterial 
      baroflex gain and heart rate variability in patients with stable chronic heart 
      failure.
PG  - 1612-8
AB  - OBJECTIVES: The purpose of this study was to investigate in a case-controlled 
      study whether carvedilol increased baroreflex sensitivity and heart rate 
      variability (HRV). BACKGROUND: In chronic heart failure (CHF), beta-adrenergic 
      blockade improves symptoms and ventricular function and may favorably affect 
      prognosis. Although beta-blockade therapy is supposed to decrease myocardial 
      adrenergic activity, data on restoration of autonomic balance to the heart and, 
      particularly, on vagal reflexes are limited. METHODS: Nineteen consecutive 
      patients with moderate, stable CHF (age 54 +/- 7 years, New York Heart 
      Association [NYHA] class II to III, left ventricular ejection fraction [LVEF] 24 
      +/- 6%), treated with optimized conventional medical therapy, received carvedilol 
      treatment. Controls with CHF were selected from our database on the basis of the 
      following matching criteria: age +/- 3 years, same NYHA class, LVEF +/- 3%, 
      pulmonary wedge pressure +/- 3 mm Hg, peak volume of oxygen +/- 3 ml/kg/min, same 
      therapy. All patients underwent analysis of baroreflex sensitivity (phenylephrine 
      method) and of HRV (24-h Holter recording) at baseline and after six months. 
      RESULTS: Beta-blockade therapy was associated with a significant improvement in 
      symptoms (NYHA class 2.1 +/- 0.4 vs. 1.8 +/- 0.5, p < 0.01), systolic and 
      diastolic function (LVEF 23 +/- 7 vs. 28 +/- 9%, p < 0.01; pulmonary wedge 
      pressure 17 +/- 8 vs. 14 +/- 7 mm Hg, p < 0.05) and mitral regurgitation area 
      (7.0 +/- 5.1 vs. 3.6 +/- 3.0 cm2, p < 0.01). No significant differences were 
      observed in either clinical or hemodynamic indexes in control patients. 
      Phenylephrine method increased significantly after carvedilol (from 3.7 +/- 3.4 
      to 7.1 +/- 4.9 ms/mm Hg, p < 0.01) as well as RR interval (from 791 +/- 113 to 
      894 +/- 110 ms, p < 0.001), 24-h standard deviation of normal RR interval and 
      root mean square of successive differences (from 56 +/- 17 to 80 +/- 28 ms and 
      from 12 +/- 7 to 18 +/- 9 ms, all p < 0.05), while all parameters remained 
      unmodified in controls. During a mean follow-up of 19 +/- 8 months a reduced 
      number of cardiac events (death plus heart transplantation, 58% vs. 31%) occurred 
      in those patients receiving beta-blockade. CONCLUSIONS: Besides the well-known 
      effects on ventricular function, treatment with carvedilol in CHF restores both 
      autonomic balance and the ability to increase reflex vagal activity. This 
      protective mechanism may contribute to the beneficial effect of beta-blockade 
      treatment on prognosis in CHF.
FAU - Mortara, A
AU  - Mortara A
AD  - Department of Cardiology, Centro Medico di Montescano, S. Maugeri Foundation, 
      IRCCS, Pavia, Italy. amortara@fsm.it
FAU - La Rovere, M T
AU  - La Rovere MT
FAU - Pinna, G D
AU  - Pinna GD
FAU - Maestri, R
AU  - Maestri R
FAU - Capomolla, S
AU  - Capomolla S
FAU - Cobelli, F
AU  - Cobelli F
LA  - eng
PT  - Clinical Trial
PT  - Controlled Clinical Trial
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
RN  - 0 (Adrenergic beta-Antagonists)
RN  - 0 (Carbazoles)
RN  - 0 (Propanolamines)
RN  - 0K47UL67F2 (Carvedilol)
SB  - IM
MH  - Adrenergic beta-Antagonists/*therapeutic use
MH  - Baroreflex/*drug effects
MH  - Carbazoles/*therapeutic use
MH  - Carvedilol
MH  - Case-Control Studies
MH  - Chronic Disease
MH  - Heart Failure/*drug therapy/*physiopathology
MH  - Heart Rate/*drug effects
MH  - Humans
MH  - Middle Aged
MH  - Propanolamines/*therapeutic use
EDAT- 2000/11/18 11:00
MHDA- 2001/02/28 10:01
CRDT- 2000/11/18 11:00
PHST- 2000/11/18 11:00 [pubmed]
PHST- 2001/02/28 10:01 [medline]
PHST- 2000/11/18 11:00 [entrez]
AID - S0735-1097(00)00900-1 [pii]
AID - 10.1016/s0735-1097(00)00900-1 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2000 Nov 1;36(5):1612-8. doi: 10.1016/s0735-1097(00)00900-1.