Regression of left ventricular remodeling in chronic heart failure: Comparative and combined effects of captopril and carvedilol

Background This study evaluated the independent and combined effects of cap topril and carvedilol on left ventricular remodeling in chronic heart failu re. Although angiotensin-converting enzyme inhibitors and P-blockers are kn own to attenuate the remodeling process in chronic heart failure, a direct comparison of these agents has not been performed. Methods We investigated 57 patients with mild to moderate chronic heart fai lure (48 ischemic, 9 nonischemic) who were randomized in a double-blind fas hion to treatment with carvedilol or captopril at maximum doses of 25 mg tw ice daily for 3 months, followed by 3 months of combined treatment. Serial echocardiography, right heart catheterization, and treadmill exercise testi ng were performed at baseline, 3 months, and 6 months. After exclusions, 49 patients were evaluated during monotherapy and 48 during combination thera py. Results Carvedilol monotherapy produced significant reductions in end-systo lic volume, leading to a greater median increase in ejection fraction compa red with captopril monotherapy (4.7% vs 1.5%, respectively; P < .05). Each drug caused similar reductions in left ventricular mass, chamber sphericity , and pulmonary artery wedge pressure during monotherapy and combined treat ment. Adjunctive treatment with carvedilol produced a trend toward a greate r increase in ejection fraction (4.3% vs 2.7%, respectively; P not signific ant) and significantly greater reductions in the wall thickening score inde x than with captopril (0.25 vs 0.08, respectively; P = .0-4). Conclusions Although angiotensin-converting enzyme inhibitor therapy did no t alter left ventricular volume, treatment with carvedilol was associated w ith reductions in chamber volume; both drugs reduced left ventricular mass and sphericity. These beneficial effects on remodeling may help to explain the relative prognostic benefits of these therapies.