Carvedilol improves left ventricular function in heart failure patients with idiopathic dilated cardiomyopathy and a wide range of sympathetic nervous system function as measured by iodine 123 metaiodobenzylguanidine |
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Authors: | Myron C Gerson Laura L Craft Nancy McGuire Damodhar P Suresh William T Abraham Lynne E Wagoner |
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Institution: | (1) Division of Cardiology, Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio;(2) E. L. Saenger Radioisotope Laboratory, Department of Radiology, University of Cincinnati Medical Center, Cincinnati, Ohio;(3) Division of Cardiology, University of Cincinnati, PO Box 670542, 45267-0542 Cincinnati, OH |
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Abstract: | Background Carvedilol treatment reduces the mortality rate in patients with congestive heart failure. It is not known whether carvedilol
treatment is effective in heart failure patients with substantial cardiac sympathetic nerve dysfunction. The goal of this
study was to determine the effect of chronic carvedilol treatment in patients with cardiac sympathetic nerve dysfunction of
varying severity.
Methods and Results In 22 congestive heart failure patients with idiopathic cardiomyopathy, sympathetic nerve function was assessed before and
after 7.2 ± 2.7 months of carvedilol treatment with the use of iodine 123 metaiodobenzylguanidine (MIBG) imaging, radionuclide
ventriculography, and transmyocardial norepinephrine sampling. Patients with relatively advanced impairment of cardiac sympathetic
nerve function, as manifested by a baseline I-123 MIBG ratio lower than 1.40, had a statistically significant improvement
in I-123 heartmediastinum ratio with carvedilol treatment, from 1.26 ± 0.12 to 1.39 ± 0.20 (P = .004). Of 10 patients with a baseline I-123 MIBG ratio lower than 1.40, 9 had an increase in the heart-mediastinum ratio
with carvedilol treatment. Left ventricular ejection fraction increased from 25.4% ± 7.8% to 37.3% ± 14.7% (P <.001), with no difference between patients with relatively advanced versus relatively preserved cardiac sympathetic nerve
function.
Conclusions Most patients with congestive heart failure show a favorable response in left ventricular function to carvedilol treatment,
regardless of the baseline level of cardiac sympathetic nervous system function, as assessed by neuronal imaging with I-123
MIBG. Patients with relatively advanced impairment of baseline I-123 MIBG uptake are most likely to show evidence of improved
cardiac sympathetic nervous system function in response to carvedilol therapy.(J Nucl Cardiol 2002;9:608-15.)
Sponsored in part by the American Heart Association-Ohio Valley Affiliate (SW-97-12-S), the National Institutes of Health
(SCOR No. 93-07-26-01), and the John R. Strauss Fund for Research and Education in Cardiac Imaging. |
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Keywords: | Carvedilol heart failure idiopathic dilated cardiomyopathy iodine 123 metaiodobenzylguanidine |
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