PMID- 25660493
OWN - NLM
STAT- MEDLINE
DCOM- 20151123
LR  - 20220311
IS  - 1421-9751 (Electronic)
IS  - 0008-6312 (Linking)
VI  - 130
IP  - 3
DP  - 2015
TI  - The effect of carvedilol on B-type natriuretic peptide and cardiac function in 
      patients with heart failure and persistent atrial fibrillation.
PG  - 153-8
LID - 10.1159/000368746 [doi]
AB  - OBJECTIVES: We sought to determine the relationship between changes in 
      natriuretic peptides and symptoms as a consequence of introducing beta-blocker 
      therapy, in patients with chronic heart failure (CHF) and persistent atrial 
      fibrillation (AF). METHODS: In a randomised, double-blind, placebo-controlled 
      study involving 47 patients with CHF and persistent AF (mean age 68 years and 62% 
      men), we analysed the individual change (Delta) in B-type natriuretic peptide (BNP) 
      level to the introduction of carvedilol (titrated to a target dose of 25 mg twice 
      daily, group A) or placebo (group B) in addition to background treatment with 
      digoxin. Symptoms score, 6-min walk distance, New York Heart Association (NYHA) 
      class, left ventricular ejection fraction (LVEF), heart rate (24-hour ECG) and 
      BNP were measured at baseline and at 4 months. RESULTS: LVEF (Delta median +5 vs. 
      +0.4, p = 0.048), symptoms score (Delta median -4 vs. 0, p = 0.04), NYHA class (Delta 
      median -33% vs. +3% in NYHA class 3-4, p = 0.046) and heart rate [Delta median 
      24-hour ventricular rate (VR) -19 vs. -2, p < 0.0001] improved with combination 
      therapy of digoxin and carvedilol compared to digoxin alone, but BNP (Delta median 
      +28 vs. -6 , p = 0.11) trended in the opposite direction. There was no 
      relationship between the degree of symptomatic improvement or VR control and BNP 
      response. CONCLUSION: After the introduction of carvedilol, clinical outcome 
      appears unrelated to BNP changes in patients with CHF and AF. Changes in BNP 
      cannot be used as a marker of clinical response in terms of symptoms or cardiac 
      function in this setting.
CI  - (c) 2015 S. Karger AG, Basel.
FAU - Khand, Aleem U
AU  - Khand AU
AD  - University Hospital Aintree NHS Trust, Liverpool, UK.
FAU - Chew, Pei G
AU  - Chew PG
FAU - Douglas, Homeyra
AU  - Douglas H
FAU - Jones, Julia
AU  - Jones J
FAU - Jan, Aftab
AU  - Jan A
FAU - Cleland, J G F
AU  - Cleland JG
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
DEP - 20150131
PL  - Switzerland
TA  - Cardiology
JT  - Cardiology
JID - 1266406
RN  - 0 (Adrenergic beta-Antagonists)
RN  - 0 (Biomarkers)
RN  - 0 (Carbazoles)
RN  - 0 (Propanolamines)
RN  - 0K47UL67F2 (Carvedilol)
RN  - 114471-18-0 (Natriuretic Peptide, Brain)
RN  - 73K4184T59 (Digoxin)
SB  - IM
MH  - Adrenergic beta-Antagonists/*therapeutic use
MH  - Aged
MH  - Atrial Fibrillation/*drug therapy
MH  - Biomarkers/metabolism
MH  - Carbazoles/*therapeutic use
MH  - Carvedilol
MH  - Case-Control Studies
MH  - Digoxin/*therapeutic use
MH  - Double-Blind Method
MH  - Female
MH  - Heart Failure/*drug therapy
MH  - Heart Rate
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Natriuretic Peptide, Brain/*metabolism
MH  - Propanolamines/*therapeutic use
MH  - Treatment Outcome
MH  - Ventricular Function, Left
EDAT- 2015/02/11 06:00
MHDA- 2015/12/15 06:00
CRDT- 2015/02/10 06:00
PHST- 2014/04/24 00:00 [received]
PHST- 2014/09/29 00:00 [accepted]
PHST- 2015/02/10 06:00 [entrez]
PHST- 2015/02/11 06:00 [pubmed]
PHST- 2015/12/15 06:00 [medline]
AID - 000368746 [pii]
AID - 10.1159/000368746 [doi]
PST - ppublish
SO  - Cardiology. 2015;130(3):153-8. doi: 10.1159/000368746. Epub 2015 Jan 31.