PMID- 12827037
OWN - NLM
STAT- MEDLINE
DCOM- 20031121
LR  - 20190724
IS  - 0160-2446 (Print)
IS  - 0160-2446 (Linking)
VI  - 42
IP  - 1
DP  - 2003 Jul
TI  - Long-term treatment with the beta-blocker carvedilol restores autonomic tone and 
      responsiveness in patients with moderate heart failure.
PG  - 125-31
AB  - The authors performed two studies on the effects of carvedilol on autonomic tone 
      and responsiveness in patients with heart failure. In study 1, the autonomic 
      responses of 25 patients (age, 60 years+/-2; New York Heart Association [NYHA] 
      class, 2.6+/-0.5; pVO2, 16.6 mL/Kg/min+/-1.1) treated with angiotensin-converting 
      enzyme inhibitors, diuretics, and carvedilol (38.0 mg/d+/-2.5) were compared to 
      those of 25 patients of similar age, therapy, NYHA class, and pVO2 in whom 
      carvedilol was not yet administered. In study 2, autonomic tone and 
      responsiveness were studied in 20 patients (age, 57 years+/-9; NYHA class, 
      2.5+/-0.2; pVO2, 15.6 mL/Kg/min+/-3.4), before and 6 months after additional 
      carvedilol treatment (40.0 mg/d+/-12.5). Autonomic evaluation was performed with 
      autoregressive power spectral analysis of RR variability during 10 minutes of 
      supine rest (control), breathing 20 times per minute (vagal stimulus), and 
      standing (sympathetic activation). The ratio between low-frequency (LF) and 
      high-frequency (HF) components of the autospectra indicated the sympathovagal 
      interaction. In study 1, spectral analysis in controls showed sympathetic 
      hyperactivity which was blunted in patients receiving carvedilol (LF/HF ratio: 
      10.4+/-1.4 vs. 7.0+/-1.1; P<0.05) who responded to vagal and adrenergic stimuli 
      (LF/HF, -35% with regular breathing and 72% standing). In study 2, left 
      ventricular function, volumes, and exercise performance improved with carvedilol 
      (EF, 31%; EDLV volume, -22%; pVO2, 11%; P<0.05). Sympathetic hyperactivity in 
      control was reduced (LF/HF ratio, 4.9+/-0.8 from 7.9+/-1.3; P<0.05), whereas a 
      response to vagal and adrenergic activation on breathing and standing reemerged 
      (LF/HF ratio, -31% during regular breathing and 88% on standing). Therefore, 
      combined autonomic and hemodynamic effects may determine the favorable effects of 
      beta-blockers in heart failure.
FAU - Malfatto, Gabriella
AU  - Malfatto G
AD  - Division of Cardiology, Istituto Scientifico Ospedale San Luca, Istituto 
      Auxologico Italiano IRCCS, Milano, Italy. malfi@auxologco.it
FAU - Facchini, Mario
AU  - Facchini M
FAU - Branzi, Giovanna
AU  - Branzi G
FAU - Riva, Beatrice
AU  - Riva B
FAU - Sala, Luca
AU  - Sala L
FAU - Perego, Giovanni B
AU  - Perego GB
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PL  - United States
TA  - J Cardiovasc Pharmacol
JT  - Journal of cardiovascular pharmacology
JID - 7902492
RN  - 0 (Adrenergic beta-Antagonists)
RN  - 0 (Carbazoles)
RN  - 0 (Propanolamines)
RN  - 0K47UL67F2 (Carvedilol)
SB  - IM
MH  - Adrenergic beta-Antagonists/administration & dosage/*therapeutic use
MH  - Autonomic Nervous System/drug effects/*physiology
MH  - Carbazoles/administration & dosage/*therapeutic use
MH  - Cardiac Output, Low/*drug therapy/physiopathology
MH  - Carvedilol
MH  - Exercise Tolerance/physiology
MH  - Female
MH  - Heart/*innervation/physiopathology
MH  - Heart Rate/drug effects/physiology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Propanolamines/administration & dosage/*therapeutic use
MH  - Sympathetic Nervous System/drug effects/physiology
MH  - Ventricular Function, Left/drug effects/physiology
EDAT- 2003/06/27 05:00
MHDA- 2003/12/03 05:00
CRDT- 2003/06/27 05:00
PHST- 2003/06/27 05:00 [pubmed]
PHST- 2003/12/03 05:00 [medline]
PHST- 2003/06/27 05:00 [entrez]
AID - 10.1097/00005344-200307000-00019 [doi]
PST - ppublish
SO  - J Cardiovasc Pharmacol. 2003 Jul;42(1):125-31. doi: 
      10.1097/00005344-200307000-00019.