EFFECTS OF CARVEDILOL ON SYSTOLIC AND DIASTOLIC LEFT-VENTRICULAR PERFORMANCE IN IDIOPATHIC DILATED CARDIOMYOPATHY OR ISCHEMIC CARDIOMYOPATHY

Recent evidence has shown that improvement in left ventricular (LV) sy stolic function in patients with New York Heart Association class II t o III heart failure occurs with beta-adrenergic blocking agents. Howev er the specific effects on LV diastolic function have been subjected t o only limited examination. This study investigated the effects of the combined beta blocker/vasodilator, carvedilol, on systolic and diasto lic LV performance in dilated cardiomyopathy. Thirty-six patients with New York Heart Association II to III heart failure and LV ejection fr action less than or equal to 0.35 were entered into either arm of this placebo-controlled, double-blind 4-month trial. Twenty-one subjects w ere entered into the carvedilol treatment arm and 15 patients were ent ered into the placebo arm in a 3:2 ratio. Carvedilol therapy resulted in a significant improvement in LV ejection fraction, from 0.22 +/- 0. 02 to 0.30 +/- 0.02 when compared with the placebo group (0.19 +/- 0.0 2 to 0.21 +/- 0.02 at baseline and after 4 months of therapy, respecti vely; p = 0.0001). However, no significant change in radionuclide para meters of LV diastolic function, including peak filling rate or time t o peak filling rate, was observed. LV end-diastolic volume index did n ot change with carvedilol therapy, whereas end-diastolic volume index increased in the placebo group, although the difference between groups at 4 months was significant (p = 0.02). In conjunction with these cha nges, end-systolic volume index was smaller at 4 months after carvedil ol treatment compared with that of the placebo group (p = 0.04). Thus, these results demonstrate that in moderate chronic heart failure, sys tolic LV performance improves but diastolic LV function does not impro ve when compared with placebo after treatment with carvedilol.