Effects of carvedilol on left ventricular regional wall motion in patientswith heart failure caused by ischemic heart disease

Background: P-Blocker therapy has been shown to improve left ventricular (L V) ejection fraction and reduce LV volumes in patients with heart failure c aused by ischemic heart disease. However, the possible mechanisms of this i mprovement and the effects of such treatment on regional wall motion have n ot been established. In a substudy of the Australia-New Zealand trial of ca rvedilol in patients with heart failure caused by ischemic heart disease, t he effects of treatment on LV regional wall motion were assessed using 2-di mensional echocardiography. Methods and Results: One hundred nineteen patients from 10 centers were inc luded on this substudy. Patients were randomly assigned to treatment with c arvedilol or placebo. Echocardiography was performed before randomization a nd after 6 and 12 months of treatment. LV regional wall motion was assessed using a semiquantitative scoring system. LV wall motion scare index (WMSI) was reduced from 2.40 to 2.29 after 6 and 12 months in the carvedilol grou p and remained unchanged in the placebo group (2-tailed P =.005, carvedilol vs placebo). The percentage of myocardium with normal function also signif icantly improved with carvedilol treatment. Conclusions: Carvedilol improved LV regional WMSI in patients with heart fa ilure caused by ischemic heart disease. These results indicate a mechanism by which P-blocker therapy may benefit patients with heart failure and are consistent with an intrinsic improvement in LV function after treatment wit h carvedilol.