Effect of carvedilol on diastolic function in patients with diastolic heart failure and preserved systolic function. Results of the Swedish Doppler‐echocardiographic study (SWEDIC)

European Journal of Heart Failure - Tập 6 Số 4 - Trang 453-461 - 2004
Anders Bergström1, Bert Andersson2, Magnus Edner3, Eva Nylander1, Hans Persson3, Ulf Dahlström1
1Department of Cardiology and Physiology University Hospital Linköping SE‐58185 Linköping Sweden
2Department of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden
3Section of Cardiology, Division of Internal Medicine Karolinska Institutet, Danderyd Hospital Stockholm Sweden

Tóm tắt

AbstractAim:The purpose of this study was to investigate the effects of carvedilol on diastolic function (DF) in heart failure patients with preserved left ventricular (LV) systolic function and abnormal DF.Patients and Methods:We randomised 113 patients with diastolic heart failure (DHF) (symptomatic, with normal systolic LV function and abnormal DF) into a double blind multi‐centre study. The patients received either carvedilol or matching placebo in addition to conventional treatment. After uptitration, treatment was continued for 6 months. Two‐dimensional and Doppler echocardiography were used for quantification of LV function at baseline and at follow‐up. Four different DF variables were evaluated by Doppler echocardiography: mitral flow E:A ratio, deceleration time (DT), isovolumic relaxation time (IVRT) and the ratio of systolic/diastolic pulmonary venous flow velocity (pv‐S/D). Primary endpoint was change in the integrated quantitative assessment of all four variables during the study.Results:Ninety‐seven patients completed the study. A mitral flow pattern reflecting a relaxation abnormality was recorded in 95 patients. There was no effect on the primary endpoint, although a trend towards a better effect in carvedilol treated patients was noticed in patients with heart rates above 71 beats per minute. At the end of the study, there was a statistically significant improvement in E:A ratio in patients treated with carvedilol (0.72 to 0.83) vs. placebo (0.71 to 0.76), P<0.05.Conclusions:Treatment with carvedilol resulted in a significant improvement in E:A ratio in patients with heart failure due to a LV relaxation abnormality. E:A ratio was found to be the most useful variable to identify diastolic dysfunction in this patient population. This effect was observed particularly in patients with higher heart rates at baseline.

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Tài liệu tham khảo

10.1016/0002-9343(93)90361-R

Tecce M.A, 1999, Heart failure: clinical implications of systolic and diastolic dysfunction, Geriatrics, 54, 24

10.1016/S0735-1097(99)00118-7

10.1161/01.CIR.98.21.2282

Clarkson P, 1994, Left ventricular diastolic dysfunction, Q J Med, 87, 143

10.1053/euhj.1998.1057

Weber K.T, 1987, Collagen In The Hypertrophied Pressure‐Overloaded Myocardium, Circulation, 75, 40

10.1016/0735-1097(94)90185-6

10.1016/S1388-9842(00)00068-4

10.1023/A:1013745705318

10.1016/0002-9149(89)90022-2

10.1001/archinte.1991.00400110056011

10.1161/01.CIR.77.3.607

Banerjee P, 1994, Emerging facets of diastolic heart failure, JAPI, 42, 789

10.1093/oxfordjournals.eurheartj.a060942

10.1016/S0894-7317(14)80174-0

10.1016/0002-8703(93)91061-I

10.1136/heart.87.1.23

10.1161/01.CIR.103.20.2441

10.1161/01.CIR.58.6.1072

10.1016/S0735-1097(96)82180-2

Pozzoli M, 1995, Reproducibility of Doppler indices of left ventricular systolic and diastolic function in patients with severe chronic heart failure, Eur Heart J, 16, 194, 10.1093/oxfordjournals.eurheartj.a060885

10.1016/0002-9149(90)90937-V

10.1007/BF00192352

10.1016/S0002-8703(00)90036-X

10.1016/0002-9149(92)91199-E

10.1093/eurheartj/16.1.94

10.1016/S1053-2498(01)00776-8

10.1016/S1388-9842(02)00023-5

10.1016/S1388-9842(00)00075-1

10.1161/01.CIR.94.4.673

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European Journal of Heart Failure

Tập 6 Số 4

453-461

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