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Carvedilol therapy is associated with a sustained decline in brain natriuretic peptide levels in patients with congestive heart failure.
Am Heart J. 2005 Mar; 149(3):541-7.AH

Abstract

BACKGROUND

Beta-blocker therapy improves symptoms, left ventricular ejection fraction (LVEF), and survival in patients with congestive heart failure, but chronic effects on neurohormones have not been extensively investigated. Therefore, we examined the neurohumoral effects of carvedilol.

METHODS

Fifty-five patients with New York Heart Association (NYHA) classes II-III congestive heart failure and LVEF < or =35% entered the study with intention to assess LVEF, NYHA class, plasma brain natriuretic peptide (BNP), N-terminal atrial natriuretic peptide (NANP), big-endothelin, endothelin-1, norepinephrine, and angiotensin II at baseline and at 6 and 12 months after initiation of carvedilol.

RESULTS

Forty-six patients completed 12 months of follow-up. Left ventricular ejection fraction improved from 26% +/- 8% at baseline to 39% +/- 14% at 12 months. New York Heart Association class improved from 2.3 +/- 0.4 at baseline to 1.8 +/- 0.7 at 12 months. Brain natriuretic peptide fell from 453 +/- 784 to 208 +/- 393 pg/mL at 6 months and 223 +/- 334 pg/mL at 12 months (P = .01 vs baseline). N-terminal atrial natriuretic peptide did not change between baseline and 6 months but fell at 12 months (2117 +/- 1678, 2015 +/- 1532, and 1438 +/- 1442 pg/mL, respectively, P = .001 between baseline and 12 months). Angiotensin II was lower at 6 and 12 months than at baseline (12.6 +/- 10, 7.8 +/- 5.5 pg/mL, P < 0.001, and 11.3 +/- 17.1 pg/mL, P = .02, respectively). Left ventricular ejection fraction at 12 months correlated inversely with BNP level at 12 months (r = -0.55, P = .001).

CONCLUSIONS

Carvedilol therapy is associated with a sustained decline in BNP and NANP levels. Serial BNP levels can provide some guidance regarding probability of LVEF improvement, but the relationship is not strong enough for BNP levels to supplant measurement of LVEF.

Authors+Show Affiliations

Division of Cardiovascular Diseases and Internal Medicine, Cardiorenal Research Laboratories, Mayo Clinic and Mayo Foundation, Rochester, Minn 55905, USA. frantz.robert@mayo.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo 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
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15864245

Citation

Frantz, Robert P., et al. "Carvedilol Therapy Is Associated With a Sustained Decline in Brain Natriuretic Peptide Levels in Patients With Congestive Heart Failure." American Heart Journal, vol. 149, no. 3, 2005, pp. 541-7.
Frantz RP, Olson LJ, Grill D, et al. Carvedilol therapy is associated with a sustained decline in brain natriuretic peptide levels in patients with congestive heart failure. Am Heart J. 2005;149(3):541-7.
Frantz, R. P., Olson, L. J., Grill, D., Moualla, S. K., Nelson, S. M., Nobrega, T. P., Hanna, R. D., Backes, R. J., Mookadam, F., Heublein, D., Bailey, K. R., & Burnett, J. C. (2005). Carvedilol therapy is associated with a sustained decline in brain natriuretic peptide levels in patients with congestive heart failure. American Heart Journal, 149(3), 541-7.
Frantz RP, et al. Carvedilol Therapy Is Associated With a Sustained Decline in Brain Natriuretic Peptide Levels in Patients With Congestive Heart Failure. Am Heart J. 2005;149(3):541-7. PubMed PMID: 15864245.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Carvedilol therapy is associated with a sustained decline in brain natriuretic peptide levels in patients with congestive heart failure. AU - Frantz,Robert P, AU - Olson,Lyle J, AU - Grill,Diane, AU - Moualla,Soundos K, AU - Nelson,Susan M, AU - Nobrega,Thomas P, AU - Hanna,Richard D, AU - Backes,Richard J, AU - Mookadam,Farouk, AU - Heublein,Denise, AU - Bailey,Kent R, AU - Burnett,John C, PY - 2005/5/3/pubmed PY - 2005/11/1/medline PY - 2005/5/3/entrez SP - 541 EP - 7 JF - American heart journal JO - Am Heart J VL - 149 IS - 3 N2 - BACKGROUND: Beta-blocker therapy improves symptoms, left ventricular ejection fraction (LVEF), and survival in patients with congestive heart failure, but chronic effects on neurohormones have not been extensively investigated. Therefore, we examined the neurohumoral effects of carvedilol. METHODS: Fifty-five patients with New York Heart Association (NYHA) classes II-III congestive heart failure and LVEF < or =35% entered the study with intention to assess LVEF, NYHA class, plasma brain natriuretic peptide (BNP), N-terminal atrial natriuretic peptide (NANP), big-endothelin, endothelin-1, norepinephrine, and angiotensin II at baseline and at 6 and 12 months after initiation of carvedilol. RESULTS: Forty-six patients completed 12 months of follow-up. Left ventricular ejection fraction improved from 26% +/- 8% at baseline to 39% +/- 14% at 12 months. New York Heart Association class improved from 2.3 +/- 0.4 at baseline to 1.8 +/- 0.7 at 12 months. Brain natriuretic peptide fell from 453 +/- 784 to 208 +/- 393 pg/mL at 6 months and 223 +/- 334 pg/mL at 12 months (P = .01 vs baseline). N-terminal atrial natriuretic peptide did not change between baseline and 6 months but fell at 12 months (2117 +/- 1678, 2015 +/- 1532, and 1438 +/- 1442 pg/mL, respectively, P = .001 between baseline and 12 months). Angiotensin II was lower at 6 and 12 months than at baseline (12.6 +/- 10, 7.8 +/- 5.5 pg/mL, P < 0.001, and 11.3 +/- 17.1 pg/mL, P = .02, respectively). Left ventricular ejection fraction at 12 months correlated inversely with BNP level at 12 months (r = -0.55, P = .001). CONCLUSIONS: Carvedilol therapy is associated with a sustained decline in BNP and NANP levels. Serial BNP levels can provide some guidance regarding probability of LVEF improvement, but the relationship is not strong enough for BNP levels to supplant measurement of LVEF. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/15864245/Carvedilol_therapy_is_associated_with_a_sustained_decline_in_brain_natriuretic_peptide_levels_in_patients_with_congestive_heart_failure_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002870304005940 DB - PRIME DP - Unbound Medicine ER -