PMID- 7600653
OWN - NLM
STAT- MEDLINE
DCOM- 19950810
LR  - 20181130
IS  - 0009-7322 (Print)
IS  - 0009-7322 (Linking)
VI  - 92
IP  - 2
DP  - 1995 Jul 15
TI  - Effects of carvedilol, a vasodilator-beta-blocker, in patients with congestive 
      heart failure due to ischemic heart disease. Australia-New Zealand Heart Failure 
      Research Collaborative Group.
PG  - 212-8
AB  - BACKGROUND: beta-Blocker therapy has been shown to increase ejection fraction in 
      patients with heart failure of idiopathic etiology. However, in patients with 
      heart failure of ischemic etiology, the effects of this treatment on left 
      ventricular function remain uncertain, as do the effects on exercise performance 
      and symptoms. METHODS AND RESULTS: This study investigated the effects of 
      carvedilol, a beta-blocker with alpha 1-blocking properties, on left ventricular 
      size and function, maximal and submaximal exercise performance, and symptoms in 
      415 patients with stable heart failure of ischemic etiology (ejection fraction < 
      45%). After a 2- to 3-week run-in phase on open-label low-dose carvedilol, 
      patients were randomized to continued treatment with carvedilol (up to 25 mg BID) 
      or to matching placebo. After 6 months, left ventricular ejection fraction 
      measured by radionuclide ventriculography had increased by 5.2% (2P < .0001) in 
      the carvedilol group compared with the placebo group, and left ventricular 
      end-systolic and end-diastolic dimensions measured by two-dimensionally guided 
      M-mode echocardiography had decreased by 2.6 mm (2P = .0005) and 1.3 mm (2P = 
      .05), respectively. There were no significant changes in either treadmill 
      exercise duration or 6-minute walk distance between carvedilol and placebo groups 
      (both 2P > .1); in the carvedilol group, exercise performance was therefore 
      maintained with a 23% lower rate-pressure product. Symptoms assessed by the New 
      York Heart Association (NYHA) scale and the Specific Activity Scale (SAS) were 
      unchanged in two thirds of patients in both groups, but there was a small excess 
      of patients whose symptoms worsened and a deficit of patients whose symptoms 
      improved among those assigned carvedilol (NYHA, 2P = .05; SAS, 2P = .02). 
      CONCLUSIONS: In patients with heart failure of ischemic etiology, 6-month 
      treatment with carvedilol improved left ventricular function and maintained 
      exercise performance at a lower rate-pressure product, but symptoms assessed by 
      functional class were slightly worsened. A larger-scale trial is now required to 
      determine whether this treatment will reduce serious morbidity and mortality from 
      heart failure.
LA  - eng
PT  - Clinical Trial
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Circulation
JT  - Circulation
JID - 0147763
RN  - 0 (Adrenergic beta-Antagonists)
RN  - 0 (Carbazoles)
RN  - 0 (Propanolamines)
RN  - 0K47UL67F2 (Carvedilol)
SB  - IM
MH  - Adrenergic beta-Antagonists/*therapeutic use
MH  - Aged
MH  - Carbazoles/*therapeutic use
MH  - Carvedilol
MH  - Double-Blind Method
MH  - Echocardiography
MH  - Exercise Test
MH  - Exercise Tolerance/drug effects
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Failure/diagnosis/*drug therapy/etiology
MH  - Hemodynamics/drug effects
MH  - Humans
MH  - Male
MH  - Myocardial Ischemia/*complications
MH  - Propanolamines/*therapeutic use
MH  - Radionuclide Ventriculography
MH  - Stroke Volume/drug effects
MH  - Time Factors
MH  - Ventricular Function, Left/drug effects
EDAT- 1995/07/15 00:00
MHDA- 1995/07/15 00:01
CRDT- 1995/07/15 00:00
PHST- 1995/07/15 00:00 [pubmed]
PHST- 1995/07/15 00:01 [medline]
PHST- 1995/07/15 00:00 [entrez]
PST - ppublish
SO  - Circulation. 1995 Jul 15;92(2):212-8.