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Prospective crossover comparison of carvedilol and metoprolol in patients with chronic heart failure.
J Am Coll Cardiol. 2001 Oct; 38(4):939-46.JACC

Abstract

OBJECTIVES

This study investigates the effects of a change of beta-adrenergic blocking agent treatment from metoprolol to carvedilol and vice versa in patients with heart failure (HF).

BACKGROUND

Beta-blockers improve ventricular function and prolong survival in patients with HF. It has recently been suggested that carvedilol has more pronounced effects on left ventricular ejection fraction (LVEF) compared with metoprolol. It is uncertain whether a change from one beta-blocker to the other is safe and leads to any change of left ventricular function.

METHODS

Forty-four patients with HF due to ischemic (n = 17) or idiopathic cardiomyopathy (n = 27) that had responded well to long-term treatment with either metoprolol (n = 20) or carvedilol (n = 24) were switched to an equivalent dose of the respective other beta-blocker. Before and six months after crossover of treatment, echocardiography, radionuclide ventriculography and dobutamine stress echocardiography were performed.

RESULTS

Six months after crossover of beta-blocker treatment, LVEF had further improved with both carvedilol and metoprolol (carvedilol: 32 +/- 3% to 36 +/- 4%; metoprolol: 27 +/- 4% to 30 +/- 5%; both p < 0.05 vs. baseline), without interindividual differences. There were no changes in either New York Heart Association functional class or any other hemodynamic parameters at rest. Dobutamine stress echocardiography revealed a more pronounced increase of heart rate after dobutamine infusion in metoprolol- compared with carvedilol-treated patients. After dobutamine infusion, LVEF increased in the carvedilol- but not in the metoprolol-treated group.

CONCLUSIONS

When switching treatment from one beta-blocker to the other, improvement of LVEF in patients with HF is maintained. Despite similar long-term effects on hemodynamics at rest, beta-adrenergic responsiveness is different in both treatments.

Authors+Show Affiliations

Medizinische Klinik und Poliklinik, Innere Medizin III, Universitätskliniken des Saarlandes, Homburg, Germany. maack@med-in.uni-saarland.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo 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

11583862

Citation

Maack, C, et al. "Prospective Crossover Comparison of Carvedilol and Metoprolol in Patients With Chronic Heart Failure." Journal of the American College of Cardiology, vol. 38, no. 4, 2001, pp. 939-46.
Maack C, Elter T, Nickenig G, et al. Prospective crossover comparison of carvedilol and metoprolol in patients with chronic heart failure. J Am Coll Cardiol. 2001;38(4):939-46.
Maack, C., Elter, T., Nickenig, G., LaRosee, K., Crivaro, M., Stäblein, A., Wuttke, H., & Böhm, M. (2001). Prospective crossover comparison of carvedilol and metoprolol in patients with chronic heart failure. Journal of the American College of Cardiology, 38(4), 939-46.
Maack C, et al. Prospective Crossover Comparison of Carvedilol and Metoprolol in Patients With Chronic Heart Failure. J Am Coll Cardiol. 2001;38(4):939-46. PubMed PMID: 11583862.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prospective crossover comparison of carvedilol and metoprolol in patients with chronic heart failure. AU - Maack,C, AU - Elter,T, AU - Nickenig,G, AU - LaRosee,K, AU - Crivaro,M, AU - Stäblein,A, AU - Wuttke,H, AU - Böhm,M, PY - 2001/10/5/pubmed PY - 2001/10/26/medline PY - 2001/10/5/entrez SP - 939 EP - 46 JF - Journal of the American College of Cardiology JO - J Am Coll Cardiol VL - 38 IS - 4 N2 - OBJECTIVES: This study investigates the effects of a change of beta-adrenergic blocking agent treatment from metoprolol to carvedilol and vice versa in patients with heart failure (HF). BACKGROUND: Beta-blockers improve ventricular function and prolong survival in patients with HF. It has recently been suggested that carvedilol has more pronounced effects on left ventricular ejection fraction (LVEF) compared with metoprolol. It is uncertain whether a change from one beta-blocker to the other is safe and leads to any change of left ventricular function. METHODS: Forty-four patients with HF due to ischemic (n = 17) or idiopathic cardiomyopathy (n = 27) that had responded well to long-term treatment with either metoprolol (n = 20) or carvedilol (n = 24) were switched to an equivalent dose of the respective other beta-blocker. Before and six months after crossover of treatment, echocardiography, radionuclide ventriculography and dobutamine stress echocardiography were performed. RESULTS: Six months after crossover of beta-blocker treatment, LVEF had further improved with both carvedilol and metoprolol (carvedilol: 32 +/- 3% to 36 +/- 4%; metoprolol: 27 +/- 4% to 30 +/- 5%; both p < 0.05 vs. baseline), without interindividual differences. There were no changes in either New York Heart Association functional class or any other hemodynamic parameters at rest. Dobutamine stress echocardiography revealed a more pronounced increase of heart rate after dobutamine infusion in metoprolol- compared with carvedilol-treated patients. After dobutamine infusion, LVEF increased in the carvedilol- but not in the metoprolol-treated group. CONCLUSIONS: When switching treatment from one beta-blocker to the other, improvement of LVEF in patients with HF is maintained. Despite similar long-term effects on hemodynamics at rest, beta-adrenergic responsiveness is different in both treatments. SN - 0735-1097 UR - https://www.unboundmedicine.com/medline/citation/11583862/Prospective_crossover_comparison_of_carvedilol_and_metoprolol_in_patients_with_chronic_heart_failure_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(01)01471-1 DB - PRIME DP - Unbound Medicine ER -