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Regression of left ventricular remodeling in chronic heart failure: Comparative and combined effects of captopril and carvedilol.
Am Heart J. 2001 Oct; 142(4):704-13.AH

Abstract

BACKGROUND

This study evaluated the independent and combined effects of captopril and carvedilol on left ventricular remodeling in chronic heart failure. Although angiotensin-converting enzyme inhibitors and b-blockers are known 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 failure (48 ischemic, 9 nonischemic) who were randomized in a double-blind fashion to treatment with carvedilol or captopril at maximum doses of 25 mg twice daily for 3 months, followed by 3 months of combined treatment. Serial echocardiography, right heart catheterization, and treadmill exercise testing were performed at baseline, 3 months, and 6 months. After exclusions, 49 patients were evaluated during monotherapy and 48 during combination therapy.

RESULTS

Carvedilol monotherapy produced significant reductions in end-systolic volume, leading to a greater median increase in ejection fraction compared 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 treatment. Adjunctive treatment with carvedilol produced a trend toward a greater increase in ejection fraction (4.3% vs 2.7%, respectively; P not significant) and significantly greater reductions in the wall thickening score index than with captopril (0.25 vs 0.08, respectively; P =.04).

CONCLUSIONS

Although angiotensin-converting enzyme inhibitor therapy did not alter left ventricular volume, treatment with carvedilol was associated with 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.

Authors+Show Affiliations

Department of Cardiovascular Medicine, Northwick Park and St Mark's Hospital National Health Service Trust, and the Institute for Medical Research, Harrow, United Kingdom.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

11579363

Citation

Khattar, R S., et al. "Regression of Left Ventricular Remodeling in Chronic Heart Failure: Comparative and Combined Effects of Captopril and Carvedilol." American Heart Journal, vol. 142, no. 4, 2001, pp. 704-13.
Khattar RS, Senior R, Soman P, et al. Regression of left ventricular remodeling in chronic heart failure: Comparative and combined effects of captopril and carvedilol. Am Heart J. 2001;142(4):704-13.
Khattar, R. S., Senior, R., Soman, P., van der Does, R., & Lahiri, A. (2001). Regression of left ventricular remodeling in chronic heart failure: Comparative and combined effects of captopril and carvedilol. American Heart Journal, 142(4), 704-13.
Khattar RS, et al. Regression of Left Ventricular Remodeling in Chronic Heart Failure: Comparative and Combined Effects of Captopril and Carvedilol. Am Heart J. 2001;142(4):704-13. PubMed PMID: 11579363.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Regression of left ventricular remodeling in chronic heart failure: Comparative and combined effects of captopril and carvedilol. AU - Khattar,R S, AU - Senior,R, AU - Soman,P, AU - van der Does,R, AU - Lahiri,A, PY - 2001/10/2/pubmed PY - 2002/1/5/medline PY - 2001/10/2/entrez SP - 704 EP - 13 JF - American heart journal JO - Am Heart J VL - 142 IS - 4 N2 - BACKGROUND: This study evaluated the independent and combined effects of captopril and carvedilol on left ventricular remodeling in chronic heart failure. Although angiotensin-converting enzyme inhibitors and b-blockers are known 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 failure (48 ischemic, 9 nonischemic) who were randomized in a double-blind fashion to treatment with carvedilol or captopril at maximum doses of 25 mg twice daily for 3 months, followed by 3 months of combined treatment. Serial echocardiography, right heart catheterization, and treadmill exercise testing were performed at baseline, 3 months, and 6 months. After exclusions, 49 patients were evaluated during monotherapy and 48 during combination therapy. RESULTS: Carvedilol monotherapy produced significant reductions in end-systolic volume, leading to a greater median increase in ejection fraction compared 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 treatment. Adjunctive treatment with carvedilol produced a trend toward a greater increase in ejection fraction (4.3% vs 2.7%, respectively; P not significant) and significantly greater reductions in the wall thickening score index than with captopril (0.25 vs 0.08, respectively; P =.04). CONCLUSIONS: Although angiotensin-converting enzyme inhibitor therapy did not alter left ventricular volume, treatment with carvedilol was associated with 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. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/11579363/Regression_of_left_ventricular_remodeling_in_chronic_heart_failure:_Comparative_and_combined_effects_of_captopril_and_carvedilol_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-8703(01)22397-7 DB - PRIME DP - Unbound Medicine ER -