LEFT-VENTRICULAR REMODELING WITH CARVEDILOL IN PATIENTS WITH CONGESTIVE-HEART-FAILURE DUE TO ISCHEMIC-HEART-DISEASE

Objectives. The aim of this study, a substudy of the Australia-New Zea land trial of carvedilol in patients with heart failure due to ischemi c heart disease, was to determine the effects of this treatment on lef t ventricular size and function with the use of quantitative two-dimen sional (2D) echocardiography. Background. Beta-adrenergic blocking dru gs have been shown to improve left ventricular ejection fraction in pa tients with heart failure due to either ischemic heart disease or idio pathic dilated cardiomyopathy. However, the effects of such treatment on left ventricular size remain uncertain. Methods. One hundred twenty -three patients from 10 centers in New Zealand and Australia participa ted in the 2D echocardiographic substudy. Echocardiography was perform ed before randomization and was repeated after 6 and 12 months of trea tment. Left ventricular end-diastolic and end-systolic volumes were me asured from apical four- and two-chamber views with the use of a modif ied Simpson's rule method. Results. After 12 months, heart rate was 8 beats/min lower in the carvedilol than in the placebo group, whereas l eft ventricular end diastolic and end-systolic volumes were increased in the placebo group but reduced in the carvedilol group. At 12 months , left ventricular end diastolic volume index was 14 ml/m(2) less in t he carvedilol than in the placebo group (p = 0.0015); left ventricular end-systolic volume index was 15.3 ml/m(2) less (p = 0.0001), and lef t ventricular ejection fraction was 5.8% greater (p = 0.0015). Conclus ions. In patients with heart failure due to ischemic heart disease, ca rvedilol therapy for 12 months reduced left ventricular volumes, incre ased left ventricular ejection fraction and prevented progressive left ventricular dilation. These changes demonstrate a beneficial effect o f carvedilol on left ventricular remodeling in heart failure. The obse rved changes may explain in part the improved clinical outcomes produc ed by treatment with carvedilol. (C)1997 by the American College of Ca rdiology.