Predictors of improvement in left ventricular ejection fraction with carvedilol for congestive heart failure

Background. beta-Blocker therapy has been reported to improve survival and left ventricular ejection fraction (LVEF) in the setting of congestive hear t failure (CHF). The magnitude and predictors of improved LVEF are unclear. Methods. A total of 295 patients were enrolled in the study, Inclusion crit eria were LVEF <35% at baseline and symptomatic (New York Heart Association class II to IV) CHF despite treatment with at minimum an angiotensin-conve rting enzyme inhibitor. Carvedilol was initiated at 3.125 mg twice daily an d titrated to a target dose of 25 or 50 mg twice daily, depending on the pa tient's weight. Paired pretreatment baseline and 9 months with treatment fo llow-up quantitative LVEFs (assessed by resting radionuclide ventriculogram s) were obtained in 161 (55 %) of the patients. Results, LVEF improved from 25% +/- 6% at baseline to 36% +/- 12% at follow -up (P < .001). Mean change in LVEF (Delta LVEF) was greater for nonischemi c cardiomyopathy (NICM) (+14.5 +/- 2 LVEF points) than ischemic cardiomyopa thy (Delta LVEF + 7.6 +/- 10 EF points, P = .001). The Delta LVEF was great er than or equal to 21 LVEF points in 30% of the NICM group versus 10% of t he ischemic cardiomyopathy group. Conversely, the Delta LVEF was unchanged to minimally improved (less than or equal to 5 LVEF points) in 21% of the N ICM group versus 52% of the ischemic cardiomyopathy group. Multivariable an alysis identified NICM and recent onset of congestive heart failure as corr elates of improved LVEF, Conclusions, Carvedilol significantly improved LVEF, especially in patients with NICM and those with recent onset of CHF.