Effects of carvedilol on left ventricular remodeling and systolic function in elderly patients with heart failure

Background: Recent studies have shown that carvedilol therapy in patients with heart failure improves clinical outcome and survival, however, the effects of such treatment on left cardiac morphology and function in elderly patients with severe heart failure has not been widely studied. Aim: The purpose of this study was to establish the effect of carvedilol at short- and long-term on left ventricular size and performance with mono- and two-dimensional echocardiography, in subjects with, dilated cardiomyopathy, NYHA III functional class, low LV ejection fraction (EF<35%) and mean age of >70 years. Methods: We studied 48 patients, previously randomized to treatment with either carvedilol or placebo, and we performed echocardiographic evaluation at the start, and after 3 and 12 months. Left ventricular diameters, IV mass and fractional shortening were calculated by Deveraux formula; left ventricular volumes and ejection fraction were measured by area-length formula; pulmonary pressure was calculated by tricuspid reflow. Results: After 3 months, only IV end-diastolic diameter was lower in the carvedilol group compared to the placebo group. Nevertheless, after 12 months, patients on carvedilol treatment showed a LV geometric and functional improvement compared to placebo. We found significant differences in: diastolic (P<0.01) and systolic diameters (P<0.001); on LV mass (P<0.002); on LV systolic volume (P<0.03); and on IV ejection fraction (P<0.01). Pulmonary pressure was also reduced in beta-blocker subjects (P<0.001). Conclusions: Carvedilol therapy for 12 months reduced LV diameters and volumes. Thus, improving cardiac remodeling and IV systolic function in elderly patients with severe heart failure. Several months of therapy are required for these favorable effects to occur, as these changes do not occur in the short term. (C) 2002 European Society of Cardiology. Published by Elsevier Science B.V. All rights reserved.