Felodipine improves left ventricular emptying in patients with chronic heart failure: V-HeFT III echocardiographic substudy of multicenter reproducibility and detecting functional change

Background: The echocardiographic substudy of the Vasodilator-Heart Failure Trial III (V-HeFT III) aimed to determine if felodipine treatment in patie nts with heart failure who were taking an angiotensin-converting enzyme inh ibitor had a favorable effect on left ventricular (LV) structure and functi on. Earlier V-HeFT trials showed that hydralazine isosorbide dinitrate impr oved ejection fraction (EF) and survival, whereas enalapril achieved greate r survival with smaller increases in EF. Would the combination of a potent vasodilator and enalapril produce greater improvements in function and surv ival? Methods and Results: Doppler-echocardiographic data were collected from 260 males with heart failure who were randomized to felodipine or a placebo. M ean intrasubject differences between baseline, at 3 months, and at 12 month s were compared. Intersite and intrareader reproducibilities were measured from duplicate recordings and readings. At 3 months, no changes in ultrasou nd variables from baseline occurred in either group. At 12 months, felodipi ne patients achieved greater increases in EF, shortening of LV end-systolic length, and increases in stroke volume index. Reproducibility coefficients of variation were 7.4% (EF), 6.0% (end-diastolic length), and 13.0% (strok e volume index). Conclusions: The echocardiographic substudy showed that felodipine, added t o heart failure therapy, increased EF, shortened end-systolic length, and i ncreased stroke volume index. The changes were small and confirmed that rep roducibility from multiple laboratories can be coordinated into a useful re search tool.